May I first say how grateful I am that MRSA has been chosen as the subject for discussion today? I welcome the opportunity to open the debate and thank colleagues for participating in it. It is important for me to put on record our sympathy and condolences to people who have been affected by MRSA. The National Audit Office has reported that about 5,000 people a year are killed in hospitals, a fact that is obviously of major concern to politicians, staff and, of course, patients. It is creating a situation in which constituents throughout the country are now worried about even going into hospital, something that we must take on board and change. We can do that only by improving the problem of MRSA in all acute trusts in the United Kingdom.

The NAO's excellent report deals extensively with MRSA. The point of the debate is not to blame particular staff in any part of the UK. We commend staff who are battling each day against MRSA. By staff, I mean not only clinicians and nurses, but cleaning and catering staff who are trying to improve the way in which they work. We can strengthen that effort by saying continually that cleaners, catering workers and porters are every bit as important as the clinicians and nurses. They all form part of an effective staff team in hospitals, a point that we must reinforce.

Furthermore, when we discuss MRSA, there is always an attempt to make political capital from it, something that we must resist today. The problem of MRSA is not down to a Labour Government or a Conservative Government; it is not about politics. It would be a tremendous mistake for people to play a political game with MRSA. It is far too important for that. The only political point that I want to make is that when sisters, matrons and nursing staff are asked what they feel about MRSA, they say that are unhappy about not having control of cleaning staff. Cleaning is a central and crucial issue in the fight against MRSA.

Surveys carried out by the Royal College of Nursing and other organisations have highlighted the fact that they would like control of cleaning to be in the hands of ward sisters and matrons, so that they can determine the level of cleaning and when, where and how it is carried out in conjunction with the cleaning management and its staff. That is a central point. The problem arises because of contractors. Sisters and matrons have no say in the cleaning of wards by contractors, and that is a major mistake. If hospital staff want more cleaning to be carried out, they are told that it cannot be done because it is not in the contract, so they must accept a level of cleaning that they may consider inadequate and poor. We must discuss that issue. I want to see the removal of contractors from hospitals. I want sisters and matrons to have control of the cleaning staff so that they can determine the level of cleaning in a ward or other parts of a hospital. Such practice would not be going against contractors, but would give control to an in-house cleaning team and the nursing and clinical staff who work with it. It is as simple as that.

I have been following the hon. Gentleman's remarks with great interest. What would he say to the spokesman at the Department of Health who said this week that there was no correlation between the contracting out of cleaning and the incidence of MRSA?

I am not an expert, so I do not know whether there is a correlation. All I am saying is that, even in those hospitals where there have been improvements, nursing staff are deeply unhappy about the fact that they cannot be involved in the issue of cleaning. We will never overcome the problem in the longer term if we do not deal with cleaning because it is central and everything else depends on it. I am only reflecting the survey evidence from nursing staff who feel strongly about the matter.

There may or may not be a direct correlation between the contracting-out of services and the lack of proper cleaning in our hospitals, but does my hon. Friend agree that when services are contracted out we bring in people on extremely low wages and with poor conditions? At the end of the day, one gets what one pays for, as I know from my own practical experience.

My hon. Friend is right, and I thank him for that point.

All I am saying is that in a busy ward or intensive care unit nursing staff may feel that extra cleaning is needed from time to time to try to keep on top of any problems, and I commend them for that. However, it is important that the cleaning staff and others are able directly to respond to that request. The last thing that we want is clinicians and nurses making requests that can be denied because of contract arrangements. That is a major mistake.

I want to put on record my thanks to Stephanie Dancer, a microbiologist in Glasgow, for her advice on MRSA when I was preparing for this debate and, above all, for her dedication to the NHS and its staff. She works enthusiastically, day by day, to try to combat MRSA in every possible way.

I shall try to be brief because a number of hon. Members want to contribute and it can only assist us if more people are involved. I have said before that the historical context is simple: MRSA has been around for a long time. It has existed, and increased, under Conservative and Labour Governments. That is a fact of life and there is no political point to be made. I congratulate the NAO and Sir John Bourn on the first-class report that they produced in July. It deals with the matter in a balanced way and encourages best practice where it exists, but tackles the issue of acute trusts and others who are falling down when dealing with MRSA. As I said at the outset, 5,000 lives a year are involved at a cost, according to the NAO, of £1 billion a year to the NHS.

Some Members of Parliament have gone on record as saying that this is a major political issue and should be a central debate during the general election. They are playing politics, and it would be better if they looked after the general hospital rather than the prospects at the general election. Such comments are untimely and undermine the fight by staff to try to reverse the trend of MRSA in some of our acute trusts.

One point in the NAO report that I support and commend is that on inspection. The situation in the UK is patchy. There have been major improvements in dealing with MRSA, but some parts of the UK seem to have been unable to reverse the increasing trend of MRSA in their hospitals. We need an independent watchdog to keep the pressure on acute trusts from year to year to ensure not only that they are talking about making improvements but that they are actually making physical improvements, producing results and achieving more than just statistics. People must be able to see that there has been an improvement in their trust. I am sure that we all know the story of our own local trusts and what they are doing and not doing.

I want to concentrate on four issues: hand hygiene, antibiotic prescriptions, hospital cleaning and rapid testing for MRSA in hospitals. In recent years, hand hygiene has become critical for staff in acute trusts and other parts of the health service. It is an issue for everyone: clinicians, including consultants, nursing staff, catering staff, and cleaning and portering staff. No one can be exempt from the need for clean hands when dealing with patients and equipment. It is clear that equipment in hospitals, and wards in particular, carries MRSA, and we need to reinforce that point. Good practice exists in some trusts, but others need to up their game: they need to do more and make major improvements. Basic cleanliness can stop the spread of MRSA. It is not a recommendation; it must be a common obligation on staff. No one is exempt from hand cleaning and hand hygiene, and everyone needs to heed that message.

The NHS is doing a lot of work on hand hygiene; for instance, it is introducing alcohol-based gel dispensers, for which I salute it. Those are working very well, and we need to ensure that they are not just a flash in the pan, but a persistent and consistent part of cleanliness in our wards throughout Britain. The position is best summed up by Mr. James Johnson, the chairman of the British Medical Association, who said that is has become

"socially, morally and ethically unacceptable for doctors not to wash their hands before touching each and every patient."

He continues:

"Doctors, nurses and other members of NHS staff who have contact with patients must take ownership and responsibility for their own practice".

His words should become a watchword in every trust in the country.

It is not just medical staff and people from the hospital who come into contact with patients; it is also visitors and relatives. I would be happy if the hon. Gentleman included them in the list of people who need to be careful about hand hygiene.

I thank the hon. Lady for that point. When I was preparing for this debate, a number of MPs came to me and said, "John, it's all very well talking about the staff, but the whole question of patients needs to be addressed, as well." To be fair, the Patients Association is trying to reinforce the message. Whether we like it or not, visitors to hospitals carry MRSA. People go into a ward—I have been in one myself recently—and sit on the bed. There is all sorts of contact that one would think inappropriate in that situation. There is a need not only for discipline among staff, but to ensure that visiting becomes part of the hygiene regime.

The general public feel that if there is a family member or a friend in hospital, it is their duty to go and visit them, perhaps even if they do not feel 100 per cent. fit themselves. They may carry germs and illnesses into the hospital. Does my hon. Friend agree that that is the wrong kind of environment for such a person to go into?

Extended visiting hours also cause a problem. In my local hospital, people can visit some wards from 2 in the afternoon until 8 in the evening. That sounds fine, but in reality it cuts down on the time available to cleaners to do their job properly in the wards.

My hon. Friend makes a valid and important point that trusts need to recognise. Hopefully they will acknowledge it in the regimes that they are establishing in their hospitals.

I am not an expert on antibiotics and their prescription, but there seems to be growing evidence among professionals and microbiologists that we need to do something about those that are being used to fight MRSA. Some of the antibiotics that we have been using for some time are becoming ineffective as strains of MRSA seem to be getting stronger. A review is needed of the antibiotics that have been used and are being used. We need to ensure that the curriculum for undergraduate training includes something about MRSA and the prescribing of antibiotics to fight it. That would give us a major fillip in our effort to defeat MRSA.

Does my hon. Friend agree that there is also a need for even greater public education about antibiotics; that the more a specific antibiotic is used the more likely bacteria are to evolve drug resistance; and that the public need to be educated that antibiotics must be used sparingly if they are to retain their usefulness in circumstances where they can save lives as opposed to merely helping us to recover more quickly from minor ailments?

My hon. Friend makes a valid point. As the professionals say quite readily, the consumption of antibiotics may be driving up the incidence of MRSA in some locations.

Clinicians need specialist training on how best to treat MRSA. If there is best practice in one part of the UK, let us share that knowledge to assist everyone in their approach. We must have a full study of possible new treatments for MRSA. Good creams and lotions have come on to the market, and we must say to the National Institute for Clinical Excellence that we need to fast-track those inventions to ensure that we tackle the problem on all fronts. I hope that that can be done quickly.

It is not only MPs and politicians who worry about antibiotics but specialists, microbiologists and clinicians. Steve Davis, microbiologist and specialist adviser to the Institute of Biomedical Science, has highlighted the problem whereby some antibiotics that have been used in the past are no longer strong enough to defeat MRSA. We must review the entire strategy for recommending and prescribing antibiotics in order to provide not more but better antibiotics, to try to reduce antibiotic use in acute trusts.

Cleaning is a central issue, and we will make no improvements until we deal with it. Evidence from an RCN survey showed that 42 per cent. of the nurses questioned highlighted the use of agency cleaners as a problem, and they also mentioned inadequate cleaning of hospitals. Some 49 per cent. thought that the use of agency cleaners was one cause of the rise of the superbug. We must ensure that we reflect the views of professionals who are on the wards day to day trying to deal with this issue.

I am sure that my hon. Friend remembers the time, when I was part of the NHS, when the cleaning staff were part of a team and they felt part of a team. When they come in from an agency and are viewed merely as a member of the cleaning staff, they do not feel part of that team. They do not feel the same obligation, and sometimes they do not have the proper materials to do the job as well as they could. I found that when the cleaning and portering staff were part of the whole team, they did a better job. Does my hon. Friend agree?

I do; it is important to give staff proper recognition. We all know from our constituencies that if we do not have decent cleaning staff in our schools we face major problems, and it is the same in hospitals. Cleaners need to feel part of the staff, and progress is being made on that , but we must do more so that they feel part of the clinical collective on the ward who are fighting MRSA and helping the patients whom we represent.

This issue is not just about the management of the ward, or the sister and the matron. We must ensure that there are adequate numbers of cleaners, that there is adequate time for cleaning and that there is flexibility in the cleaning team. If a sister, staff nurse or matron thinks that a ward needs a deep clean, she should be able to make that decision along with the clinicians and not be told, "I'm very sorry but that's not in the contract so you can't have it." Health service staff need that flexibility 24 hours a day, seven days a week, 52 weeks a year. There is a serious concern that we get to Friday and think that we can lower our guard on Saturday and Sunday. I am saying the opposite: the standard of cleaning that we have from Monday to Friday is needed over the weekends as well. We need to make sure that we have 365 days a year of best practice in every hospital.

The chief medical officer, Sir Liam Donaldson, said:

"Tackling MRSA is a top priority. There is no room for complacency. The National Audit Office report makes it clear that some parts of the NHS do better than others in controlling infection."

Of course they do; that is the central thrust of my contribution today. The evidence is good in some areas and patchy in others.

This debate is not about pointing the finger; it is about encouraging some hospitals to become more focused and to match the best practice in others. There are brilliant examples of best practice, where people have been totally focused. This debate is about commending staff, saluting their work and helping patients, but it is also about telling others that they need to be more focused and determined in fighting MRSA so that we have good practice throughout the UK.

We need a better system of identifying MRSA. At present, it takes something like 48 hours for most acute trusts to identify it. It may take even longer if someone is admitted late on a Friday and the hospital has no facility to identify the infection over the weekend. We must change that. We need services to be available every day to clinicians, microbiologists and others involved.

We need to consider capital investment in equipment that can do that work for us. The Chancellor has produced billions of pounds for the health service; we all know that, and give it due recognition. The beauty of the polymerase chain reaction equipment, which can cost £40,000 or £50,000, is that it will give a result on MRSA in an hour, and it would be a valuable investment for any location. People may say that that is expensive. I think that the money is there, but trusts need to prioritise spending and see that that would be a good way of working. Perhaps NICE can look at that and make a recommendation. At the end of the day, the quicker we can identify MRSA, the quicker clinical staff can take decisions about the isolation of the person affected and protect high-dependency and high-risk patients.

I ask Members to use this debate to be constructive about what is happening in our hospitals, but at the same time—and without being overly critical—to say that we need more from hospitals that are not doing enough. As I said at the outset, I commend staff. They are doing an excellent job in some locations, but we need others to be more focused so that we can now build on the improvement that has been achieved and defeat MRSA.

I congratulate the hon. Member for Strathkelvin and Bearsden (Mr. Lyons) on instigating the debate and making a knowledgeable and constructive speech, with almost all of which I am in agreement.

MRSA is not just a serious problem today, but a growing one. The incidence of MRSA has grown rapidly in the past 10 years, and some experts believe that if we do not take action it could double during the next five or 10 years. Obviously we hope that that does not occur. MRSA is clearly a serious and central problem, which will reward investment. It is important to remember that the cost of MRSA to hospitals at the moment is very great. That is not just the cost of treatment; it involves bed occupancy and a cost to patients and patient lives.

Although I do not believe that capital investment is the key to the problem, all the evidence is that investment in MRSA control procedures will save money for the NHS. Some hon. Members will have read the article in the British Medical Journal this July which outlined the experiment in Chelmsford where intensive steps were taken to manage MRSA in particular wards. One interesting thing about that experiment, although it is hard to draw generalised conclusions from it, is that a 17 per cent. increase in the throughput of patients was achieved as a consequence of that control.

What is striking is that the incidence of MRSA is very variable, and that is the main theme of my contribution. The incidence varies widely between countries—we know that this country has a very high incidence, possibly the highest—but it also varies between like-for-like hospitals in the NHS. Indeed, it varies within hospitals. In my local trust, the apparently modern facilities in Maidstone have a high incidence of MRSA, and, curiously, the old-fashioned facilities in Tunbridge Wells have a low incidence.

It is also clear that the incidence of MRSA varies between sectors. For instance, BUPA hospitals report that they have a negligible incidence of MRSA. There are particular reasons for that, and it is clear that they have advantages. However, I am making a point not about private versus public, but about the fact that there is wide variability. That is not the result of scientific or biological factors; it is the result of way in which hospitals are managed.

Many of the factors that the hon. Gentleman mentioned are to do with the approach to cleaning, discipline and the standards of hygiene that run through the hospital organisation. At heart, this is a management issue. From the chief executive downwards—through the consultants, the medical director, the modern matrons and sisters and right down to the cleaners—there must be a set of habits and disciplines and a way of working that are continuously enforced, measured and monitored. People must be rewarded for that way of working and made to feel that they are getting ahead of the problem.

That sort of culture must be created if we are to tackle MRSA. It cannot be done by spraying leaflets and propaganda around the place or by putting up posters. I am not against those things, but they simply are not the solution. I am sceptical about the idea of creating a watchdog or MRSA tsar for hospitals. I honestly believe that that misses the point, which is that the way in which hospitals are managed and operated from top to toe is of central importance.

In the early days of the NHS and pre-NHS—before we had antibiotics—hospitals were obsessive about discipline. One reason for that rather old-fashioned approach, with matrons in starched white uniforms and so on, was precisely that one could not treat hospital-acquired infections with antibiotics. Of course, people have forgotten about that time 50 or 60 years ago, and we cannot go back to that era, but there is a lesson to be learned.

So many of the little things that made up those disciplines have vanished. We can all see that if we walk round a ward. The hon. Member for Dumfries (Mr. Brown) mentioned visitor access. On balance, for quality of patient care and comfort, it is an attractive idea that people can visit their relatives at any time of the day or night. However, it is not a practical idea if one wants to regain control of the ward environment. I am not advocating that we go back to strictly limited visitor hours, but sisters, nurses and cleaners clearly say that they need strictly enforced times without visitors so that they can get control of the ward. There must be enough hours when the wards are uncluttered by visitors for the cleaning to be done, for consultants to do their visits, for problems to be cleared up and for patients to be attended to and cleaned.

The sister and nurses on the ward would be able to prepare for visitors' arrival, and visitors absolutely would have to adopt the same disciplines as any doctor or nurse coming on to the ward. There must be hand washing and caution about what they do and do not touch. They must be aware of what they are wearing and their cleanliness when they arrive. Cleanliness must be a total culture. It cannot be something that just one person does. It is not just to do with putting alcohol-based solution around the place. That is a good idea, but it is not enough.

I share the view of the hon. Member for Strathkelvin and Bearsden that if we do not measure the problem, we will not solve it. It is possible to walk into one ward and believe that it is entirely clean, then walk into another ward and think that it is inadequately cleaned, yet find that the latter has a lower rate of MRSA. Cleanliness is not just visual and superficial.

At the moment, far too many of our measures of cleanliness are just that—visual and superficial; for example, the patient environment advisory team inspections, which the Government like to cite as evidence that we have clean hospitals, are basically visual measures and too superficial to measure the incidence of MRSA. That must change because it is clear that those inspections are missing the point. According to the inspections, in 2003 no NHS hospital had a poor cleanliness record, yet we have a continuously rising and internationally high level of MRSA. That cannot be an acceptable measure; it simply shows that we are missing the point and risk reinforcing complacency.

I make the point, which the Minister may want to respond to, that 78.7 per cent. of hospitals were described as having "good" cleanliness records. They do not. That is simply missing the point and it must change. Investment in measuring MRSA incidence and propensity in the wards is required. It means that there must be a more laborious process than simply wandering around and having a look. I recognise that that will be more expensive, but I strongly believe that it will pay off.

I know that we are not meant to be fond of targets in the NHS, but I see no harm in measuring to see whether we are succeeding. That is entirely sensible. For ward sisters to be able to say, "Actually, my ward's done pretty well—last year I had a high level of MRSA and this year a much-reduced one", seems to me entirely reasonable and admirable and a requirement of good ward management.

In that vein, of how to regain control of the ward and how managers can seek to take responsibility, I want to touch on the hon. Gentleman's point about cleaners. I share the view that there is a problem with cleaning contractors in many NHS hospitals. I do not share the view that that cleaners must be employed by the NHS or by those hospitals, but I entirely accept that if cleaning is a subcontracted service, it is more difficult, and requires greater effort, to ensure that cleaners are managed as though they were employees. If sisters are to have control of their ward environment, they must have the capacity to clean.

Cleanliness in wards is not a question of a daily routine that can be prescribed in a contract. It is a function of incidents that happen, responses that must be made when patients arrive, or must be moved, perhaps unexpectedly, and when they have accidents or problems. In hospital life, that happens all the time, so if one is responsible for a ward, having the capacity to clean at one's fingertips is critical. That will only happen if there is sufficient flexibility in the contracts and motivation, good will and a sense of teamwork.

I want to touch on that as well. One of the things that concerns me, not just in the NHS, but in many organisations, is the tendency to regard subcontracted functions as delegated-out functions—in other words to think, "They're no longer things that we own. I'm a ward sister, it is subcontracted and is not mine." With that goes a desire to cut cost, which is understandable, and a reduction in status. I strongly believe that cleaning in hospitals must be regarded as a specialist occupation and that cleaners must be regarded as worthy of as much respect as a hospital consultant or chief executive.

Only when we start treating our people that way, and listening to what they say about the cleaning routine and equipment, will we create an environment in which they feel motivated to deliver a better outcome. Whether or not they work for a contractor, cleaners need to be aware of the problems and to be trained in tackling them. They need to know that they have got measures of performance, and that they are part of the team and welcome to come to work. They may be cleaning the floor, but that is a worthwhile job and they make a decent contribution that the team appreciates. All too often, cleaners do the job only because it is a way of earning a daily crust. That is why things will not work.

The hon. Gentleman remains unconvinced that subcontracting-out is the problem. Does he share my experience, which is that in hospitals, including those with contractors, the cleaner is part of the team? They build up a relationship with the nurses and doctors and know exactly what their responsibilities are. That does not exist under subcontracted-out services, because in reality there is a different cleaner in each ward every day. People do not take ownership of responsibility.

The hon. Gentleman touches on an important point. One of the great problems with cleaners is that it is a low-status job. They are not involved in a team, and there is limited work satisfaction. They do not feel that they are striving towards a goal and achieving things for patients in the way that other people in the hospital are. That means that those who take up the job are often people who have been unable to find employment elsewhere; as soon as they do, they leave. Work satisfaction and morale are extremely low. That is why the system does not work.

I entirely share the view that if cleaners are rotated from ward to ward, they will not derive any satisfaction from their work. However, the issue on which we are touching is whether we can deliver a quality-managed, rewarding role in a subcontracted environment. There are other models—for example, in IT provision and other fields of medicine—in which highly motivated employees operate in a contract framework that allows them to be part of a team. In those models, the contractor is measured not just on whether enough warm bodies turn up every day to clean the floor, but on whether outcomes are delivered, whether there is job satisfaction, and whether the labour turnover is sufficiently low for people to spend enough time in the job learning how to do it.

My hon. Friend the Member for Strathkelvin and Bearsden (Mr. Lyons) said that he did not want the subject to become a political issue, but sometimes we cross the battleline on these matters. He commented on the status of the job and the high turnover. I fully appreciate that there will be different situations as regards cleaning operators in different parts of the country, but there are many dedicated cleaning staff. I can only highlight my own locality, where there are people who have worked in the service for 15, 20 or 25 years, and who are dedicated to doing a job that is seen by some people as very mundane—almost as a case of putting in the time in return for money. There will be turnover, but many members of staff—the vast majority, I think—are genuinely dedicated.

We are in danger of violently agreeing. It is not my intention to be critical of the cleaning staff that we have; quite the contrary. The way forward is to create a workplace environment in which there can be more of the type of staff to which the hon. Gentleman referred: those who are dedicated because they have great satisfaction in coming to work, and because they feel that they are part of the team and are treated as playing a serious, important role in the battle against MRSA. The issue that we are touching on is whether that can be delivered under a subcontracted arrangement. I am not one to take a dogmatic stance on that; it is an open question. All I would say is that it is not impossible, in my experience, to deliver high-quality performance and to involve motivated employees though subcontractors. It is possible, but it can be difficult.

I will move on quickly, because I am aware that I am using a lot of time. It is important to tackle MRSA holistically, right the way through the hospital management system. That includes not just doctors and cleaners, but the nursing environment. One thing that gives me great concern is that sisters no longer feel that they have control of the ward environment, for some of the reasons that we described. They no longer, for instance, control the access for doctors and consultants as they used to; they no longer feel that they have sufficient control of the cleaning environment. They find themselves tied down with far more paperwork and back-office activities and therefore do not have the capacity to play a commanding front-line role for as much of their time as they would like.

When attacking a problem like this in any organisation, it is central to establish the supremacy of the first line manager, who, in the case that we are discussing, would be the sister. The sister must have control of everybody who comes in and out of the ward, and of the disciplines that are applied. That has to be clearly established in the hospital culture.

It is important, too, that we start to think again about the training of some of the nurses. We have moved a lot of nursing training into the classroom and out of the ward environment. There have been steps to try to create a higher status for the nursing profession and for nurses to take up some of the roles previously undertaken by doctors. All those are understandable measures. However, we should never allow the idea that nurses are too important to do the cleaning, which is starting to appear in some parts of NHS hospitals, to become widespread.

At the end of the day, the nurse should be responsible for the whole of patient care, and that includes every aspect of the environment and cleaning. It does not mean that qualified nurses should delegate such activities to unqualified nurses. From anecdotal evidence, it seems that that happens in far too many hospitals today: if cleaning needs to be done or a patient needs cleaning, we look around for an unqualified nurse. Let us remember that we have substantially increased the number of unqualified nurses during the past six or seven years. I think that they make up something like 27 per cent. of the total number, although that figure may have changed.

I urge the Minister to think rapidly about another point touched on by the hon. Member for Strathkelvin and Bearsden: the design of, and access to, washing facilities in hospitals. We are building substantial numbers of new hospitals, and the development of MRSA has important implications for design. One of the reasons why there is not effective hand cleaning today, even in very modern hospitals, is because it is difficult to do. First, the hand-cleaning facilities are out of sight. Secondly, they are 50 or 100 yd away at the other end of the ward. If doctors are moving from patient to patient and visitors come into the ward and there are no visible hand-cleaning facilities, the chances of their missing out on hygiene and hand cleanliness are much greater. It is critical that we should think again about design. If hygiene and hand cleanliness are to be part of the continuous discipline of the ward environment, hand-cleaning, washing and bathroom facilities need to be substantially improved.

The last thing that I want to touch on, although it has not cropped up to date, is bed occupancy levels. If, as we seek to do in the NHS, we run very high bed occupancy levels—for good reasons, for the most part, such as our effort to reduce waiting lists and maintain throughput—the MRSA environment becomes much more difficult to control. Patients are moved from ward to ward to maximise utilisation, and there is a risk of spreading infection as a result. There is not enough time to screen patients as they come into critical wards. When wards ought to be closed down or when extreme cleaning measures ought to be taken, the stress on management to deliver targets—dreaded word—and to accept patients is in conflict with its capacity to take the measures necessary to deal with what appears to be the invisible problem of MRSA, which is unmeasured and lurking behind the scenes.

I do not believe that there need be a direct conflict between bed occupancy levels and the control of MRSA; it is not as simple as saying that occupancy levels should move down from 85 per cent. to 80 per cent. However, I believe that we should again vest control of the ward environment in the sister and in the chief executive of the hospital. It needs to be absolutely clear that the NHS trust, the chief executive, the line management and the sister are responsible for making such clinical judgments. That is why we have to be extremely careful about the type of pressures that we are putting on chief executives and trusts with a target-based performance regime; I have discussed that before with the Secretary of State and others. There is a balance to be struck, and I am not convinced that we have got it right.

Order. I have no control over the time that Members take, but I can say to them that the purpose of these debates is for the Member initiating them to get a full response from the Minister. If hon. Members are brief, I will have time to call them before I start the wind-ups, but if they are not brief we will have to go straight into the wind-ups.

I will be very brief. I want to make two general points followed by a specific one about an issue that has not been raised.

My first point is that, to a certain extent, the problem of MRSA will get worse regardless of what we do about it. The rise of drug and antibiotic-resistant bacteria is an inexorable fact of life. It is a fact that bacteria are incredibly successful at evolving, and the more we use drugs and antibiotics the more they will evolve resistance to them. We have to try to slow down the rate at which that drug and antibiotic resistance occurs. The clinical guidelines on the way that drugs and antibiotics are used are important and should be adhered to, because sensible use of drugs and antibiotics can slow down the development of resistance and extend their useful life. That is the issue that I was trying to raise earlier. It is a matter of everybody adhering to clinical guidelines, but it is also a matter of educating the public to understand that antibiotics can have a very limited life if we use them irresponsibly.

Secondly, I commend the hon. Member for Tunbridge Wells (Mr. Norman) for his remarks about management. In hospitals, a lot of people are collected together who are, by definition, ill. They therefore have limited resistance to infections to which the healthy population would be resistant. That means that hygiene is of prime importance and, to protect patients, there must be clear management structures that maintain a proper hygienic environment within hospitals.

My third point arises out of a specific issue that could affect the hospital in Milton Keynes, and it is that the media must act responsibly. I understand that ITV was planning to broadcast a programme about MRSA on Monday evening in which publicity would be given to MRSA cases in a number of hospitals, including the one in Milton Keynes. The hospital management there drew to ITV's attention the fact that the information on which the programme was based was unfounded: an allegation, for which there was no proof, that there had been a case of MRSA in the Milton Keynes hospital. Moreover, ITV had apparently asked a private firm to go round the hospitals testing their public spaces for the presence of MRSA, and the test that that firm had used was not one of the approved tests; apparently, it cannot distinguish between MRSA and MRSE. Do not ask me to say now, off the top of my head, what the E stands for; suffice it to say that MRSE is a different infection which, although serious, is not as bad as MRSA.

I am pleased that ITV did not go ahead with the programme. I have no idea whether it intends to show it on another date, but I hope that the postponement is evidence that it has acted responsibly, and that when it was drawn to its attention that the information on which its programme was based was inaccurate, it chose to withdraw it. I hope that that is a proper interpretation of its behaviour. If it is, I wish to place on record my appreciation for that part of the media acting responsibly. If my interpretation of ITV's behaviour is wrong, my commendation will be withdrawn. I simply wanted to get that example into the public domain. It shows that the issue is serious and needs to be publicly debated. However, it is incredibly important that the debate is well informed, based on solid facts and does not confuse the public still further.

The Evening Standard was responsible for similar infiltration, in which a journalist posed as a porter and took swabs in my local hospital—the Royal Surrey County. We did not have the opportunity to check the facts before they went into print. I subsequently asked the Health Protection Agency to look into the claims in the Evening Standard that the hospital was rife with MRSA—that it was on every surface. As of this morning—even now—the agency has not received the MRSA isolates to try to reproduce those tests. This case involves a laboratory, Chemsol, which has done a lot of the testing in hospitals that the Evening Standard has highlighted as being riddled with MRSA. We need accuracy in this matter, because people worry when they go into hospital. We want to know where MRSA is—not where it is not. That is an outstanding problem.

I absolutely concur with that. Responsible media reports are very useful, but the media must not confuse the public about an important issue, many aspects of which have been responsibly explored in this debate.

Before I call the hon. Member for Weston-super-Mare (Brian Cotter), I ask him to be brief, because we want to get to the wind-ups.

Thank you, Mr. Deputy Speaker. I also thank the hon. Member for Strathkelvin and Bearsden (Mr. Lyons) for raising what is always said to be an important debate in this Chamber in terms of trying to achieve clarity. People have worries about the matter and the problem must be addressed, so I thank him for his constructive and informed comments.

The hon. Gentleman referred to the National Audit Office and the figure of 5,000 patients a year. It has said since the report that patchy progress has been made since 2000 in tackling this issue. I took part in a debate in January, after it was announced that Weston general hospital had come out as one of the worst in the country for MRSA cases. In fact, there are complications relating to how figures were arrived at—in Weston in particular—but I have a concern about the matter.

We have a new chief executive of the Weston hospital, and in recent times I have been encouraged by how he has tackled the issue. As many of us are, I am encouraged by the way that various initiatives have been taken to do with the cleaning of hands by doctors and nurses. I hope, and am assured, that they are encouraged to clean their hands after every single contact with patients and others; I am assured that that is happening in Weston.

In Weston, I attended the initial meeting of the patients' environment forum, which is bringing medical staff, patients, housekeepers, cleaners—everybody—round a table together. I was glad to see them sitting round the table talking about the problem and trying to make a combined effort. I have referred to the fact that Weston has had some particularly bad statistics. It also has a population whose age is higher than average. Given that, it is imperative that action is taken to improve standards of cleanliness.

It has sometimes been claimed that problems arise from residential and care homes. According to Mark Gritten, the chief executive of Weston hospital, between April 2003 and April 2004, 15 out of 32 cases of MRSA at the hospital involved people who had been admitted with that condition. According to a recent Government report, more than a third of care homes failed to have strict infection control. Although I know that the majority of homes in Weston are of a high standard, what action is the Minister taking—given that the Government identified this as an issue—to try to get care homes cleaned more satisfactorily?

I want to make a point to the Minister on behalf of Weston general hospital and the trust, which I have made before, but which I feel constrained to make again. We have some real statistics that show that my area is underfunded as against other parts of the country to the tune of £10 million. I shall return to that issue; I hope it will be addressed, because it is having an impact in other respects too. Recently, under the new chief executive, the hospital voted an extra £50,000 to be spent on cleaning services, which is good. But if we had more money, we could spend a little more on what needs to be done, as many people have identified, in terms of cleaning and general issues.

To quote a local source from the hospital—the chief executive—we have a problem, because with underfunding, particularly in Weston, it is difficult to

"try to screen known MRSA patients by using single cubicles, but the increase in the number of affected patients, and the general pressure of emergency admissions on the hospital"

is making screening and keeping people to one side very difficult. Perhaps the Minister will reconsider Weston's funding in this respect, because it is having an impact in all sorts of ways.

I welcome the debate but draw my remarks to a conclusion, as we all want to hear what the Minister has to say.

I, too, congratulate the hon. Member for Strathkelvin and Bearsden (Mr. Lyons) on securing this important debate. I associate myself with his remarks about it being a tragedy for patients, their relatives and staff when an MRSA case comes to light and, unfortunately, leads sometimes to the patient's death.

The hon. Gentleman made some good points about how important everyone in the hospital is—not just the medical staff, but the non-medical staff—and the importance of their working together. I shall return to that in a minute. Although there is perhaps no direct link between the observed cleanliness of a ward and the MRSA cases that occur in it, patients' perceptions are important. Patients who believe that they are going to get better seem to do so more often. When a patient goes into a ward that is untidy and dirty, with dust on surfaces and dirt on the floor, it is likely that that will affect their perception of their getting better. It is important, for patients' perceptions apart from anything else, that the ward is demonstrably clean.

We have not dwelt a great deal on statistics, possibly because, as my hon. Friend the Member for Sutton and Cheam (Mr. Burstow) highlighted, one problem is that they are not massively available on this front—the recording has not been as effective as it might have been. We know that the death toll from hospital-acquired infections is about 5,000 a year, but the National Audit Office estimates that there may be as many as an additional 15,000 cases per year where hospital-acquired infections are a contributory cause of death. However, they are not properly recorded, so we do not know.

The NAO estimates the cost of hospital-acquired infections to be £1 billion per year, so anything we can do to reduce that amount means that there is quite a prize to be won, not just in terms of patients getting better more quickly, but in terms of the health service saving the money that it has to spend on those infected patients.

Some 9 per cent. of patients have a hospital-acquired infection, which is a horrendous statistic. I make no party political point on that because it has been the case for a number of years, and it requires investigation. Although it is common to quote that it is less of a problem in other countries, statistically, it is not much different there, and any difference could be accounted for by variations in accounting methods. It is not helpful to bandy about the idea that this is a British disease.

I must correct the hon. Lady. Although rates of hospital-acquired infection are more or less uniform across Europe, the chances of catching MRSA certainly are not. There is a 40 times greater chance of getting MRSA in the UK than in Holland, for example.

I am well aware that, where MRSA is concerned, there are variations within hospitals, across the country and in different countries. We do not know enough about that, or about why there are such variations across different countries, within our country and within wards. However, I was talking about hospital-acquired infections generally, and MRSA is part of that wider spectrum.

The Public Health Laboratory Service said in 1999 that patients stayed in hospital 2.9 times longer if they had a hospital-acquired infection: they stayed an average of 14 days, at a cost of £3,000 per patient. That cost will be higher now. A person with a hospital-acquired infection is seven times more likely to die in hospital than someone without one. Those are important facts and estimates on which we need more information, and more collecting of information.

My hon. Friend the Member for Sutton and Cheam asked some time ago, in a parliamentary question, about MRSA research studies that were then still to report. I shall be interested to obtain any information that the Minister can give us on the studies that should have reported by now. For example, it was reported on 6 October 2003 that the study entitled "Faster Testing for MRSA: Models to Estimate the Cost-effectiveness of Faster Testing of Cases Admitted for Hip and Knee Replacement" would report by November 2004. It would be useful if the Minister gave us an update on some of the information that she gave earlier.

I agree with many of the points made by the hon. Member for Tunbridge Wells (Mr. Norman), but I take exception to his view that cleaning is necessarily a low-status job and I want to dissociate myself and my party—

I just want to clarify that my point was not that cleaning is necessarily a low-status job, but that it should not be. Cleaning is as much a specialist and critical part of the control of the ward environment as any other role there. In fact, I specifically said that we must get to a stage at which we take cleaners and their contribution as seriously as we do that of consultants, nurses and the chief executive of the hospital.

I thank the hon. Gentleman for that clarification. I hope therefore that he will not again use the term "enough warm bodies". That is a somewhat derogatory remark to make about anyone working in the health service.

The hon. Gentleman is absolutely right, though, to say that this problem is a matter for everyone working in the health service, and for patients as well. My hon. Friend the Member for Weston-super-Mare (Brian Cotter) made the point that he was pleased to see at his hospital medical and non-medical staff, patients and visitors all working together via a patients forum to try to reach a solution. He is right about that, and I am pleased to say that my hospital, Stepping Hill, is similarly taking notice of patients forum responses.

I support the points made by the hon. Member for Milton Keynes, South-West (Dr. Starkey), who asked for greater responsibility from the media. Some reporting of MRSA that has taken place will undoubtedly create fear in the minds of quite a few patients and leave them afraid to go to hospital. I have even felt that it is best to stay away if it is possible at times. The prospect of going into hospital when the headlines are screaming MRSA is a concern in the minds of patients who are immune-depressed. Those headlines are often based on faulty science or a woeful lack of information. The matter must be publicly debated, and I support the debates in this House, but scaremongering is not useful.

We need more information about the impact of cleaning methods in hospitals. Since we know that hands are the most important vector of infection and of MRSA in particular, anything that they touch must be clean. We know that dust can carry infection. We have concerns about cleaning contracts, the wages paid to cleaners and the contracts associated with private finance initiative and public private partnership methods of building new hospitals. All those must be looked at—we must ask whether they produce more hand contact with infection. Unfortunately, I think that in some cases they do. I visited a hospital recently where the beds seemed to be very close to each other, and that concerned me greatly, particularly as they were in a renal unit.

The issue of more than 85 per cent. occupancy must be examined as well. Is 85 per cent. the optimum point beyond which we can go no further? It would be useful to know what research has been done on that.

We know that hand washing is the most important activity for cutting cross-infection. In my constituency, bedside-mounted and staff-carried alcohol gel dispensers are being installed at Stepping Hill hospital, which already has a low incidence of infection. That is not a gimmick; it is useful. Views from the patients forum have been sent to the clinicians and a week-long awareness raising campaign is forthcoming.

I do not think that anyone has mentioned that elective surgery patients can be separated from trauma patients. That seems to be producing good results in many hospitals. We need more single rooms in order to isolate people, and that seems to be a deficiency in some hospitals. In the South Manchester University Hospitals NHS Trust, which is also used by my constituents, an integrated care pathway for MRSA has reduced cross-infection. We should examine all good practice to see whether it can be spread throughout the country.

The Royal College of Pathologists is concerned at the lack of training in microbiology in medical schools and training establishments. I would be grateful to the Minister if she addressed that issue.

I congratulate the hon. Member for Strathkelvin and Bearsden (Mr. Lyons) on bringing this debate to Westminster Hall. It is an important issue. Before the party conference recess, we debated the similar issue of hospital-acquired infections during an Opposition-day debate. There is a great deal of commonality between MRSA and hospital-acquired infections; indeed, the one cannot really be considered without the other.

I recall on 8 September when we debated hospital-acquired infections that the Minister was keen to draw attention to the fact that this is a non-partisan issue. We celebrated that during the debate, but the Secretary of State subsequently abandoned the refreshing attempts at consensus and claimed that MRSA rates increased substantially while the Leader of the Opposition was a member of the Cabinet over a decade ago. The Secretary of State neglected to point out that rates of MRSA infection have doubled since 1997. I mention that only to get the partisan part of the debate off my chest. In the spirit of this debate and of Westminster Hall, I will resist the temptation to score points during the rest of my remarks, which I will keep brief given that the Minister has many points to answer.

We must get away from the blame culture—we have touched on that at some length today—but equally we must be clear about what the evidence suggests. In the context of contract cleaning, it is important to state for the record that there is little evidence that there is a correlation between contracting out of cleaning and the incidence of MRSA. There may be some good common-sense reasons—my hon. Friend the Member for Tunbridge Wells (Mr. Norman) touched on some—for supposing that contracted-out cleaning might not be as good as in-house cleaning, but we need at least to acknowledge the evidence that exists. I am afraid that this area, more than any other, is susceptible to political manipulation, and we must avoid that.

I echo the points made by hon. Members about the importance of the cleaning staff. I know that, as a politician, it is always extremely easy to say that kind of thing, but it is genuinely the case. I speak from some experience. My first job as an NHS employee was as a hospital porter some 25 years ago, so I understand the importance of ancillary staff in the national health service. I hope that, as we try to work out how to deal with this problem in the NHS, Ministers will give further thought to how ancillary staff can be made to feel a better part of the hospital team. At the moment, ancillary staff sometimes do not feel that way.

I hope that the Minister will recall a constituent of mine called Mrs. Burton, whose story I raised during the Opposition-day debate on 8 September. Mrs. Burton trained to be a nurse many years ago and unfortunately recently had occasion to be admitted to hospital as a patient. When she came out, she wrote me a very good letter in which she laid out 20 points covering things that she thought might be improved in the NHS, particularly in relation to the management of wards, to address the problem of hospital-acquired infection and MRSA. It was a very considered letter. I did send it to the Minister and I would be grateful if, when she replies, she said when I will receive a reply to those points. We are facing a real problem in the NHS in respect of MRSA and the Minister ought to be grateful for any help that she can get at this juncture. Mrs. Burton's remarks were valuable in that respect.

Although many of the points raised by my constituent might seem not particularly trendy or a little old-fashioned, many of those who are involved in the sector feel that we might need to look at old-fashioned notions of cleanliness and asepsis. I was interested to see an editorial in the British Medical Journal last month that essentially said exactly that. It was authored by a professor of infection control from the Netherlands, a country that has a very low rate of MRSA—although I should say, in response to the remarks by the hon. Member for Cheadle (Mrs. Calton), that it has a hospital-acquired infection rate that pretty well mirrors our own. We need to be a little careful about confusing one with the other.

The professor concerned stated that we must have some

"faith in the strength of common sense."

By that, I think that he meant that sometimes in this area it is difficult to get material that is high up the evidence hierarchy to persuade us to act in one way or another to tackle the range of conditions, but we must apply what appears to be common sense. In that respect, the remarks by my hon. Friend the Member for Tunbridge Wells were particularly valuable. Sometimes, there will not be strong evidence for acting in one way or another and we must apply what appears to be common sense in management terms.

The Leader of the Opposition called MRSA "the British disease". I think that he probably meant that it was an NHS disease, because the instances of MRSA are a lot higher in the NHS. In private hospitals, it is less of a problem, or less of a declared problem—perhaps there is a subtle difference between the two.

Does the hon. Gentleman accept that he is not comparing like with like? NHS hospitals have a much higher percentage of chronically ill patients than private hospitals and one needs to take into account the susceptibility of the patients to the infection as well as the prevalence of the infection.

The hon. Lady is absolutely right. I am not being judgmental; I am just stating a fact. We must compare like with like. It might be useful to compare orthopaedic cases in the private sector and in the NHS. The same applies to other case mixes. We need to learn why that is. Given that throughput in the private sector is comparable with that in the NHS, we cannot blame the fact that the NHS sees more patients. We must learn about the problem wherever we can.

We must also compare large hospitals with small hospitals. It seems that MRSA is far less of a problem in community hospitals than in larger ones. Above all, we must consider why we seem to be doing so badly in resolving the problem of MRSA in this country compared with other European countries.

The National Audit Office said that the cost to the NHS is £1 billion, but the true cost is far higher in terms of patient suffering and problems for staff. It should be no surprise to any of us here that it is a real problem for staff morale. Trust in NHS staff has taken a major hit. We all receive letters about MRSA and the question of trust has arisen in my mailbag. We are at a sorry pass when the Government exhort patients to ask nursing staff if they have washed their hands. I am unhappy about that because washing hands should be part of the culture of the NHS and I welcome measures to introduce basic hygiene into the clinical curricula.

I said on 8 September—it is worth repeating in the context of MRSA—that during my medical training no attention at all was paid to hand washing or hygiene of any sort. It was perhaps dismissed as being not sufficiently academic to be introduced into a medical curriculum. It jolly well is and I hope that the Minister will do everything she can to ensure that hygiene is an integral part of the curriculum for everyone who trains for a post in the NHS.

I shall rattle through the remainder of my speech briefly. There is some unfinished business from 8 September to which the Minister may now be in a position to respond. First, my right hon. Friend the Member for North-West Hampshire (Sir George Young) asked about the rapid review of innovative products and the Minister of State, Department of Health, the right hon. Member for Barrow and Furness (Mr. Hutton), said that his Department was considering six of them. I wrote to clarify which ones and to ask for a progress report, but I have received none. Perhaps the Minister can help me with that.

Secondly, I asked how many times senior nursing staff have been able to exercise the powers that Ministers have apparently given them to withhold payment to contractors and departments that have not cleaned to a satisfactory standard. Again, I have received no answer. Finally, the Government's then recently announced target of a tub of hand cleanser for every bed by April 2005 implied that it was good enough to wait nine months, but I asked whether that could be speeded up. Again, I would be grateful if the Minister gave a progress report on that.

I have said enough. The Minister has many points to respond to and I would be grateful if she did so.

I congratulate my hon. Friend the Member for Strathkelvin and Bearsden (Mr. Lyons) on securing this debate on an important subject and I welcome him back from the summer recess. It is a pleasure to see him looking so well.

Hospital-acquired infections, including MRSA, are a financial burden on the NHS, but, more importantly, as a number of hon. Members have said, they affect patients by causing illness, pain, anxiety, longer stays in hospital and sometimes death. We are therefore facing up to the challenges that they present. Such infections are a problem not only for the NHS, but for health services everywhere, as a number of hon. Members noted. In the United States, Australasia and most European countries, including ours, the percentage of patients who experience a hospital-acquired infection ranges between 4 per cent. and 10 per cent. That proportion is remarkably consistent.

Unfortunately, as a number of hon. Members commented, not all hospital-acquired infections are preventable. Many factors contribute to the problem. As my hon. Friend the Member for Milton Keynes, South-West (Dr. Starkey) said, more susceptible patients, such as those with severe and chronic diseases, are being treated than ever before. At the same time, advances in treatment that improve patient survival rates, such as chemotherapy, can leave patients much more vulnerable to infections. However, although there is no simple solution to this complex and multi-faceted problem, it is generally accepted that up to 30 per cent. of cases of infection could be avoided with the better application of existing knowledge and good practice.

MRSA has become a greater problem in the UK for a number of interrelated reasons, including the simple fact that the strains responsible for most of the infections in the UK are particularly well adapted to spreading between patients. Although the causes of MRSA are many and complex, we believe that the risk of contracting MRSA and other health care-associated infections can be reduced by simple and effective infection-control measures. We know that more needs to be done but, as the NAO report acknowledges, our work has moved infection control up the NHS agenda, so that it is now a top priority.

I shall deal briefly with the political aspects. Like the hon. Member for Westbury (Dr. Murrison), I am delighted about the tone in which this debate and the previous debate in the House have been conducted. The problem will not be solved by party political rhetoric, and I am deeply grateful to hon. Members for generally resisting the political. However, perhaps they will forgive me if in response to the hon. Gentleman's comments, I say simply that if his leader will not listen to the rest of us, he should listen to his hon. Friend the Member for Tunbridge Wells (Mr. Norman) and recognise that we have published data on hospital-acquired infection rates and there is no doubt that the imperative under the Conservative Government to take the cheapest competitive tender did not help the situation in the early days, or that the lack of investment has not helped the health service.

Will the Minister give way?

I have got very little time, but I will give way once to the hon. Gentleman on this point.

I am very grateful to the Minister for giving way. There may be some truth in what she says, but the number of MRSA cases continues to climb; it went up by 4 per cent. last year, which is a significant increase. It is therefore a bit disingenuous of her to blame Conservative regimes for the problem.

I was only making the point that we either have done or are doing a lot of the things that have been suggested and that the genesis of the problem lies much further back in time. In that genesis we see issues such as getting the cheapest cleaning rather than seeking to achieve value for money and maintaining standards.

I was interested in the remarks of my hon. Friend the Member for Milton Keynes, South-West about the responsibility of the media. It is important that all of us, including the media, conduct the debate in the best possible way. Otherwise, as a number of hon. Members said, we will increase patients' anxiety about going into hospital. The hon. Member for Cheadle (Mrs. Calton) pointed out how sad it would be if that were to happen, because the vast majority of patients are far better off receiving their treatment than worrying about infection rates.

Turning to the scale of the problem, our best data on MRSA are drawn from surveillance of bloodstream infections, which have shown a slight, but not dramatic, increase—about 5 per cent.—in the past three years. I have with me a list, extracted from the published data, which shows that infection rates are currently falling in a number of trusts. We want to continue that success and build on it so that every trust is in that category, which is why there is now a target for all trusts to reduce infection rates. That can only help. In addition all the actions suggested in the documents "Winning Ways" and "Towards cleaner hospitals and lower rates of infection" are now being pursued. That will begin to have an impact.

It has been suggested that collecting data from every ward might be advantageous. I counsel against that because of the different patient mixes in wards and the different issues and ward environments. In addition, it might lead to great anxiety on the part of patients in some areas, and perhaps to over-reassurance for staff and patients in others.

I am not going to go through the situations in other countries, because that subject was substantially aired in the previous debate in the House. However, a couple of Members have mentioned the built environment and PFI schemes. I agree with the hon. Member for Tunbridge Wells in that respect—indeed, I agree largely with a lot of what he said. Getting the built environment right is crucial. Since 1997, our guidance on major hospital redevelopments has aimed for a minimum of 50 per cent. of bedrooms to be single bedrooms. As the plans progress, we should be better placed to achieve the same low infection levels as in the best examples abroad, which might partly be due to building structures, although I agree that there are other issues such as where basins and hand cleaning provisions are located. All indications are that investment in buildings will bring about a big change. Single-bedroom provision in the major PFI projects is running at 35 per cent. to 40 per cent.—sometimes even 50 per cent. Change is taking place.

In July, we announced a new year-on-year MRSA reduction target to show the priority that we give the problem. Having a target also ensures that the issue is given priority in the NHS. I must briefly address the question whether targets in some way militate against solving the problem. A number of trusts that have falling rates of MRSA have hit all their targets. There is no straightforward correlation, and I counsel hon. Members against stating any such correlation: the figures show that no such correlation has been proved. Targets have improved access to treatment and shortened waiting times. We are confident that the new target will help in improving infection control.

As Members have said, hand hygiene is very important. In September, we launched the first ever national hand hygiene campaign. I agree that just having a campaign is not sufficient, but we are taking a phased approach. Good preparation is important to the introduction of such measures. The National Patient Safety Agency is driving that forward.

The provision of alcohol rubs has been mentioned. That is being rolled out over the next year, but that is not to say that we are not trying to bring it forward. Some Members have already highlighted the fact that such provision already exists in a number of places; it depends on the circumstances, on what provision there was before, and on how quickly people have been able to institute it. At the end of the day, such provision may not be possible for every single bed. For example, it is not always feasible in children's wards. However, handrubs will be required at all staff-patient contact points and a number of hospitals are driving that forward in the most positive way.

Many hon. Members asked about cleanliness and the role of ward sisters and matrons. We have already said clearly, and I reiterate, that it is important that matrons and ward sisters are in control. They should have sufficient control over cleaning staff to make sure that they are able to maintain and have oversight of the wards. Under the new "Agenda for Change" pay system, the minimum wage in the NHS will be the national minimum wage plus 84p. That will help to make sure that cleaners are paid more than the minimum rate for other cleaning jobs. I agree strongly with hon. Members, particularly my hon. Friends, who made points about the significance of including cleaners in the ward team. Increasingly, all such people will be under the control of matrons and hospital staff, with the flexibility to deal with issues if they arise. Better, renewed contracts will strengthen provision.

Concerns have been voiced about the training of microbiologists. The inspector of microbiology and infection control is discussing the training curriculum with the royal colleges to improve course content on infection control. That is the right avenue to take.

We have made sure that all the right measures are in place to start to tackle the problem. I agree that the problem is one of culture and that it needs to be tackled in the most fundamental way by hospitals, but they have the incentives and resources to do so and are able to give it priority.

This is my first experience of speaking in this excellent adjunct, and of addressing this excellent Minister, and I am grateful on both counts.

I have come largely to talk about a pub. In part, its plight is symbolic of many other such places in the city of Birmingham and my constituency of Erdington, although it is an actual, specific pub. It is what one great American writer might have called a personal pub—not that I personally have ever been in it. It is now an ex-pub, and, several years after its demise, it is causing serious problems. The Minister is not responsible for this pub or, as far as I am aware, for any pubs; he is not that kind of Minister. Nor is he directly responsible for the continued, ugly, dangerous, and pointless existence of the benighted building in question. However, he is responsible for the law and its attendant regulations that have allowed the situation to occur. I shall sketch out the problem that has led me to trouble the Chamber and the Minister today, before going on to the more widely applicable matter of what I would like him to do about it.

On Six Ways island—Britain's first, and one of Birmingham's best known, traffic islands—which might be thought of as the entrance to Erdington's high street, sits the former Queen's Head public house. That is an inauspicious eventuality. It is the burnt-out shell of a former pub, enclosed in a metal sheath to keep children away from the vermin, vagabonds and structural hazards within.

During the several years in which it has lain derelict, the site has twice been the playground of arsonists, who have started very serious fires. That prompts me to wonder when anything has ever been "secured" from idle-handed youngsters by having a fence put around it. A derelict building—fence or no fence—is a lethal challenge to every kid in the neighbourhood. Yet the enforcement order served on the site in 2001 required only that the site be made "secure", which, apparently, means a fence. As I say, I believe—as does everybody else in Erdington—that the only way to "secure" such a site is to knock it down. The travellers who were on the site prior to the order may have moved on, but does that make the site secure? No.

As I understand it, the Housing Act 1985 provides demolition provision for properties that are unfit for residential accommodation, but when does a non-residential property become such an intolerable part of a community that it, too, must be demolished? The Town and Country Planning Act 1990 does not seem to provide a satisfactory answer.

The site is neither secure nor safe; those two terms seem, but ought not, to be the only criteria that can compel demolition. Can it be true that the law provides no avenue for demolition on grounds of commercial regeneration or social aesthetics? If no one will knock down this monstrosity—let us be clear, it will have to be knocked down in the end; it is a filthy, pointless, burnt-out shell—the only questions are how many more than the five years already it will be left standing hideously until they do, and whether the next time it is burned down there will be a gang of kids or rough sleepers inside.

This is a ridiculous situation. The area around the site is having hundreds of thousands of pounds of taxpayers' money spent on regeneration. Graffiti and posters are being removed from the high street, and we have plans to pedestrianise more of that street. There is a new village green. Shoplifting and street crime have been massively cut by new CCTV, and so on. Those projects involve high levels of community participation and partnership with local groups, yet the Erdington town centre partnership reports that new private sector investment is being discouraged by the visual blight that is this long-derelict building. Erdington residents association has described it as

"in appalling condition; an eyesore which people first see when they enter Erdington from Birmingham city centre. It has been derelict for . . . years and the Fire Brigade has described it as dangerous—after all it has been attacked by arsonists twice. Rats have been seen on the site, as has evidence of drug taking. Once it's flattened it will be better for everyone."

I know that the Minister cannot comment on individual cases. This is a matter for the city council. However, it would kind of like to see it knocked down too. In a letter to me this week, the district planning officer said:

"We consider that since tidying-up measures would be sufficient to secure a reasonable appearance, specifying demolition only could well prompt an appeal, indeed a possibly successful appeal, further delaying the aim of achieving a visually-better site. We have decided therefore, and subject to final legal agreement, that a notice specifying tidying-up or demolition is the best way forward—the site owner can choose which suits him, and a delaying appeal will be much less likely. The site will either be tidied, or the buildings demolished, both options to the benefit of the locality. In any event, I will continue to informally encourage demolition at the earliest opportunity."

That is marvellous.

I come to the several issues that the Minister can put right, which we might call the parameters of action provided to local authorities by central Government: laws that are made in this place and guidance that comes from the Government. First, the council says:

"tidying-up measures would be sufficient to secure a reasonable appearance".

That is nonsense. Nobody in Erdington believes it. The only thing that will secure a reasonable appearance for the Queen's Head is knocking it down. Councils do not come to such conclusions autonomously. They have legislation and guidance that tightly prescribes the parameters of their opinions. If their conclusions are wrong, discounting, as I do, the almost inconceivable eventualities of incompetence or ill will on their part, the parameters that they were set must be wrong. That is a matter for the Minister.

It is also wrong if requiring this monstrosity to be demolished

"could well prompt an appeal, indeed a possibly successful appeal".

That is also a matter of planning law and, therefore, for the Minister. Furthermore, it is clear that in cases such as these there is considerable confusion as to what constitutes danger. That is puzzling to me; danger is such a straightforward concept. If one is in a burning building that should have been knocked down years ago and it is falling on one's head, that is clearly dangerous. I know what dangerous means and I hope that the Minister might encourage moves towards redrafting the legislation or the guidance, such that that unfortunate ambiguity is ironed out.

For the district planning officer to believe that requiring straightforward demolition under a section 215 notice of the Town and Country Planning Act 1990 would make a successful appeal more likely is simply not good enough. The council needs better powers to require such buildings, which are inevitably going to be demolished anyway, to be demolished in reasonable time. Indeed, the council should have an obligation so to require, and to do so well before the five years that we have been waiting for somebody to do something about the Queen's Head.

I say nothing of arrogant and irresponsible landlords. I do not ask the Minister to legislate on this occasion for good corporate citizenship. I ask only that he give appropriate powers to local authorities to take control where bad landlords cannot be bothered.

What precisely does Erdington want from the Minister? Flicking through a recent Hansard—as I do—I came across a few words of the hon. Member for New Forest, West (Mr. Swayne) that expressed my feelings perfectly. He said:

"I have not come here to find out what the law is. The courts determine what the law is; lawyers will tell us what the law is. I have come here, and brought the Minister here, to do what only a Minister and a politician can do—discuss not what the law is, but what the law ought to be and, if it ought to be different, what he proposes to do to change it."—[Official Report, Westminster Hall, 15 September 2004; Vol. 424, c. 466WH.]

The hon. Gentleman was talking merely about the defence of the realm and the practice of medicine. They are simple matters compared with my subject today, which is planning. Planning is a legal minefield and not one on which I propose to dance a meretricious minuet with the Minister. I have no interest, and nor do my constituents, in trading subsections, appendices and special provisions.

Locally elected councillors sit on planning committees and the time has now come for those committees to be given proper powers to deal with places that are complete eyesores in our communities. They should be able to hold proper committee meetings on that basis and be able to deal rapidly with such issues.

I am grateful to my excellent next-door neighbour for his timely and wise intervention. We want to bring to the attention of the Minister and his Department a problem that is serious, chronic, potentially lethal, pointless and emblematic of a wider problem throughout the city of Birmingham and, for all I know, other cities. I was about to say similar cities, but obviously there are no cities comparable with Birmingham. I refer to the problem of when big, old pubs on corner plots have outlived their licensed usefulness, are continually being redeveloped and often lie dormant or derelict for—in the case under discussion—far too many years. The council has insufficient power or insufficient statutory obligation to compel demolition in such circumstances as I have outlined. Either way, that is a matter for the Minister, and we in Erdington would like him to sort it out for us.

I congratulate my hon. Friend the Member for Birmingham, Erdington (Mr. Simon) on raising such an important issue. Far be it from me to imply that there is another city like Birmingham—I understand that as a constituency Member of Parliament—although the issue that he raises is how best to deal with something that is of course faced by other authorities too.

From my reading of the reports about the site that my hon. Friend has provided to the Department and the report that was printed in the Birmingham Evening Mail, I can well understand the frustration that is felt by him and the local residents about the eyesore, as he puts it, on their doorstep in the shape of the Queen's Head public house and about the period over which the issue has run.

Let me at the outset point out that the Government are committed to tackling dereliction and to retaining land in productive use. That is a key part of our drive to maintain and improve the quality of the built environment, as much as it is important to have a sustainable development strategy. My hon. Friend will recognise the importance of retaining land and bringing it back into use, as it fits 100 per cent. into the sustainable community strategy that the Government are pursuing, and eases pressure on other possible greenfield sites and the countryside further afield. That is the baseline where we start.

My hon. Friend is right that we do not have direct responsibility for public houses. Our approach to planning is not to interfere day by day with the powers of local, democratically elected planning authorities. It is for them to make the best decisions for their local communities. They are on the ground and are best able to take such action. My hon. Friend is right, however, that we have a responsibility to create a legislative environment in which local planning authorities undertake their planning responsibilities, and I want to cover some of those issues and provisions.

Section 215 of the Town and Country Planning Act 1990 provides a local authority with the ability to require buildings and land to be cleaned up when their condition is adversely affecting the amenity of an area. When the condition of a particular plot of land or a building seems to be having a negative effect on an area, the authority can serve notice requiring the owner to remedy the situation. Such notices are often referred to as untidy site notices or section 215s.

My hon. Friend will recognise—I am not talking about specific sites—that there could be one owner or a collection of owners and, because the sites are in private ownership, a number of issues are immediately raised and further steps have to be taken responsibly by the local authority in using the planning controls at its disposal and the legal system. We must make sure that it is right; that is only fair under the law.

The powers under section 215 have been effectively used to make derelict buildings look occupied while keeping them secure from acts of vandalism, incidents such as those at the Queen's Head to which my hon. Friend referred, and antisocial behaviour. In fact, in several local authorities, an owner required to undertake external works has gone further and redeveloped the site or the building, to bring it back into proper use, rather than just securing it from health and safety and other points of view. We have also given powers to local authorities under section 219: If a landowner does not remedy what is listed in a section 215 order, the local authority can do so by default and recharge the landowner. Those powers have also been used.

I said at the outset that it is not for us to dictate day to day; it is for us to provide the framework. Part of that framework is planning legislation, such as section 215, and part is guidance to local authorities on how that can be used. In the past there has certainly been resistance to using some of the powers available to local authorities because of worry about costs being levied against them. That particularly applies to the default powers. That is why, in 1998, we issued guidance in circular 02/98, which is still relevant, on practical measures that can be taken to tackle dereliction. It contains positive measures to help prevent and tidy up derelict sites and to encourage local planning authorities to use their default powers.

I will come in a moment, as far as I can, to the case of Birmingham and the specific site to which my hon. Friend referred. It is for the local authority to decide whether a section 215 notice under the provisions would be appropriate in a particular case. It would have to take account of local circumstances and would need to consider, for example, the condition of the site, the impact on the surrounding area and the scope of its powers. A section 215 notice can be a stand-alone process or carried out in partnership with other agencies that might be relevant to a particular site or combination of sites. That is alongside proactive measures such as empty homes strategies, developments briefs and public-private funding programmes. Those are all development control tools that can be used by a local authority.

Before the end of the year, we will take that further by issuing a good practice guide on the use of section 215. We have already consulted with stakeholder organisations on the contents, and the final version will be circulated before the end of December to all local planning authorities. We recognise that many local authorities have successfully used 215s to deal with the type of problems to which my hon. Friend refers.

I am conscious that the Minister may go on to say all kinds of things that I do not know about yet, but could he keep in mind that, although I take his points about section 215, we want the pub knocked down? The site is no more likely to be rebuilt or put back together than Stonehenge. It is only a matter of time before the building is demolished. I am concerned by the impression I have formed that the local authority has neither the power nor the statutory obligation to compel demolition rather than tidying up.

I thank my hon. Friend for that intervention. I am bearing in mind what he would like to happen. I know that his endeavours on the issue with Birmingham city council and others have been great. He read out a letter that he received from the planning officer, which indicates that there is some movement towards what he wants. Action is being taken—rightly so—by local government, which best knows the site's potential or where we can go with it. When I say "we", I am talking about the local authority, the local planning authority and the strategic authority, along with the private landowners who hold that patch of land. All those factors have to come together, and, because of variations on any given site, it is difficult for straightforward requirements to be laid down at a national level. I shall explain a bit more as I come now to deal with the Birmingham city council case.

My hon. Friend is aware that a section 215 was issued in September 2002. Birmingham city council took that decision on the public house. Unfortunately, the section 215 was issued on the previous owner of that site. At the time of its being issued, there was a change in ownership. One can immediately see one of the hurdles of dealing with privately owned sites through the system. The local planning authority is preparing a new section 215. I know that my hon. Friend has been heavily involved with it through his work as a constituency MP. It is intended to cover not just the public house but the whole site, which also contains several other former industrial or commercial buildings that are equally derelict. Birmingham city council has taken the decision that it is important to cover the whole site.

My hon. Friend is keen to see in the new 215 a 100 per cent. requirement—no holds barred—for demolition of the building. The information that I received from the council and the letter that he recently received from the planning officer indicate that the authority is considering a provision in the 215 for remedial action or demolition. Clearly, that has come about because of the work of my hon. Friend, local people and organisations such as the Erdington residents association.

There is always a danger that any decision will be challenged through the courts, and I know that my hon. Friend will want to ensure that whatever is put in place now through the system has a lasting effect and is not delayed further by great court cases. Therefore—learning from the best practice of other authorities and using existing powers and guidance provided by the Department on their use—it is sensible that Birmingham city council gets it right and we get a lasting solution for his residents. He is right to say demolition controls are about whether dwellings—houses or flats—are unfit for habitation. I suspect that he knows why legislation was introduced specifically on housing and homes for people: we want to eradicate any instance of someone living in an unfit home. He is right that that is where the Housing Act 1985 leads us.

The use of compulsory purchase orders is also open to local authorities, which enable them compulsorily to purchase a site, but although the Government believe that those are important tools for local authorities as a means of assembling land, we expect CPOs to be used as a last resort, and most local authorities do so. Nevertheless, compulsory purchase is another tool for a local authority to consider using. CPO powers cannot be used in isolation; the local authority must be using other powers—requiring that the land be redeveloped for housing, for example, under the 1985 Act. The land must be acquired for a purpose.

We have sought to make CPO powers easier for local authorities to use. My hon. Friend will no doubt recall the Planning and Compulsory Purchase Act 2004, which contains, in part 8, a series of measures to reform the compulsory purchase system, and they will be brought into effect at the end of this month. For example, the Act amends the power of local authorities, joint planning boards and the national parks authorities, and allows them compulsorily to acquire land if they think that it will

"facilitate the carrying out of development, redevelopment or improvement on or in relation to land which is likely to contribute to the promotion or improvement of the economic, social . . . or environmental"

benefit to

"their area."

I quote that specifically so that it is clear. I reiterate, however, that the Secretary of State would normally expect any statutory procedures intended to remedy derelict or unsightly land, such as section 215s, to be followed through first and foremost and exhausted before CPOs are considered. In addition, the new Act introduces a "well-being" power—well-being for the given area—which helps to make an argument, although we would still expect there to be a clear proposal for the use of the land under a CPO.

My hon. Friend will be aware of the highway improvements that are required under the bus showcase standard. That affects part of the land about which we are talking and is part of the opportunity to secure a sustainable change of use. Again, it is for the local authority, together with landholders and other interested parties, to become involved in finding out how to take forward a given site to make a lasting change that benefits everyone, particularly the residents in the area. I noted that my hon. Friend said that there is a lot going on around the area—CCTV cameras, a new village green and getting money into existing communities through various programmes.

I hope that my hon. Friend recognises that the Government are keen that a remedy for such sites is found as quickly and as fairly as possible, because they are important to the sustainable communities programme, which this Government have been developing and taking forward. I know that through the hard work of my hon. Friend and neighbouring colleagues, they will ensure the best result through Birmingham city council.

I begin with a quote, Mr. McDonald.

Order. That was not even close. My title is Mr. Deputy Speaker, but my name is McWilliam.

Thank you, Mr. Deputy Speaker. The quote is as follows:

"Our visits to Little Haven give us relief from some of the pressures we have to face all the time. It is very difficult to have a normal family life.

Looking after Betty is extremely demanding, but we want to spend as much time with her as we can. She is so precious and we don't know how long she will be with us."

The quote is from one of the families who use Little Haven hospice in my constituency.

I wish to start by thanking Mr. Speaker for kindly selecting the hospice movement as the subject of our discussion. This is a very important debate and I thank sincerely all hon. Members who have taken the trouble to come along to the Chamber this afternoon. I shall focus on the children's hospice movement. I shall be as brief as I can—about 10 to 15 minutes, depending on interventions—because there are so many hon. Members present who are much more eloquent and expert than me in such matters and they deserve to have time to speak.

I wish to thank Andy Smith, chief executive of Little Haven, who has contributed greatly to what I have to say. Indeed, I thank all who are involved in the hospice movement: those concerned with medical matters, domestic matters, management matters, voluntary support and, of course, the fundraisers. I hope that my family never need their help but, if they do, I know that the hospice movement will be there for them.

Funding is one of the key issues in the hospice movement. Children's hospices receive 5 per cent. statutory funding. Little Haven in my constituency receives 1.9 per cent. funding from statutory sources, leaving almost all the funding it needs having to be collected from the voluntary sector. Thankfully, we have a wonderful voluntary support sector locally and excellent campaigning local newspapers whose editors, Martin McNeill and Steve Neale, do all they can. We receive support from local businesses such as BP and the three Conservative clubs in my constituency. The Hadleigh, Canvey Island and Benfleet Conservative clubs raise money for the hospice virtually every year. We receive support from the schools; the whole community mucks in to do what it can to support such a wonderful movement.

The fact is that hospices need 40 per cent. statutory core funding. I wish to refer briefly to the special case of motor neurone disease. We have a wonderful MND association in south Essex with great people. People with MND need palliative care to maximise the time and quality of the time that they have left. Readily available high-quality services can significantly improve people's quality of life, but many people who are diagnosed with MND will, of course, live long, fulfilled and happy lives, giving joy to themselves and those around them. Sadly, however, half those people will die within 14 months, so it is important that palliative care is available early in the process to those who have this particular disease.

Access to palliative care is generally low and varies depending on diagnosis, with priority given to people with cancer. That brings me to Marie Curie Cancer Care. It is a wonderful organisation and I pay tribute to everyone connected with it. Marie Curie provides specialist palliative care for about 24,000 people a year in the United Kingdom. The organisation runs 10 hospices in the UK, but perhaps it is best known for its 2,500 Marie Curie nurses who provide care for people in their homes.

About two thirds of people would prefer to die at home. About a quarter of people would prefer to die in a hospice and fewer than one in 20 would prefer to die in a hospital. However, most people die in hospitals, although this is clearly a matter in which personal choice should rule the day, whenever possible. Marie Curie helps to give that choice, and God bless it for that.

In July 2004, the Health Committee published a report on palliative care whose two key recommendations were on funding and access. Access is patchy at best and works against those in less affluent areas. Both Marie Curie Cancer Care and the Motor Neurone Disease Association believe that access should be available to everyone who needs it regardless of diagnosis or postcode; currently, it is not. I know that the Minister is a very good lady, and that she is listening carefully and will address these points.

Little Haven in Castle Point is one of 35 children's hospice services in the UK. They help children with life-limiting conditions, as well as the families of those children. In the UK, there are 15,000 to 20,000 children with such conditions, most of whom will not live to adulthood. The daily toll of caring for a child with a life-limiting condition needing 24/7 care places a huge emotional, physical and financial strain on the whole family.

The hon. Gentleman refers to the fact that there are 35 children's hospices in the UK—one of which is the Rainbows children's hospice in Loughborough in the constituency of my hon. Friend the Member for Loughborough (Mr. Reed), who is my neighbour. In the points that the hon. Gentleman is about to make, will he press the Minister to take a closer look at what the Government say about funding? They say it is the responsibility of PCTs to negotiate agreements, but the number of PCTs, as well as the fact that children's hospices are so specialist and their catchment area so large, makes that proposition unviable. Does the hon. Gentleman accept that?

I do. The hon. Gentleman is a great campaigner for the hospice movement—he supports his local hospice tremendously well—and he has anticipated my words. I hope he will listen carefully to what I have to say.

The daily toll of caring for children with life-limiting conditions is heavy, as care can be required 24 hours a day, seven days a week, sometimes for many years. That places a huge strain on the family. Life expectancy can vary from just a few months to a number of years, and the health of the child often deteriorates gradually, making them increasingly dependent on the parents and carers. The needs of such children are met in many settings, including the children's hospices, which play a key role, in partnership with other agencies, in helping to meet those complex needs and to support the whole family.

I wonder what images spring to mind when the words "children's hospice" are spoken. Perhaps they are images of unhappiness and despondency—indeed, at times there is great sadness—but children's hospices are focused on enjoying life to the full while it is there, and the children and their families experience much fun and laughter in them. They know that they are not alone. Children's hospices welcome families for a break together in a friendly and homely environment; they allow them time to be a family and to enjoy the life of their child while they can. This is a time when the burden of being the principal carers is lifted.

Children's hospices also help children and families in their own home; that is important. They offer information, practical assistance and advice. They provide a 24-hour telephone support helpline, as well as expert emergency and palliative care and advice, and they frequently make home visits. They also provide end-of-life care and, after the death of a child, bereavement support. That care meets the physical, emotional, social and spiritual needs of individual children and their families.

Children's hospices help in a way that the national health service cannot. They bring together a range of care and advice to support the whole family throughout all the stages of the child's illness, keeping children and families right at the centre of that process. The need for these services is beyond doubt. Another family that use Little Haven said:

"The support we get from the staff at the hospice is incredible, Jono is really well looked after and we meet other families in similar situations we can relate to."

Children's hospices also benefit our local communities, bringing them together with a common goal of helping others in need. A children's hospice can cost anywhere between £3 million and £4 million to build and have £1.5 million annual running costs thereafter. Almost all that money is raised in the local community. That takes unprecedented commitment and dedication.

I congratulate the hon. Gentleman on securing this debate. Last Friday, I was fortunate enough to bring a group of children from the Rainbows hospice to visit No. 10, which emphasises his point about the need for a wider social aspect to this issue.

I assume that the hon. Gentleman will, quite rightly, come on to the financing of children's hospices. My hon. Friend the Member for North-West Leicestershire (David Taylor) has mentioned the PCTs, but will the hon. Gentleman concentrate some of his energies on the role of social services? Social services from across the region often use the services of such hospices, particularly those of the Rainbows hospice. They know that they should pay, but get away with not paying because the fundraising is so good. Will he insist that social services departments pay their way?

I am grateful for the hon. Gentleman's intervention and for all the work that he does in his constituency to help families with children with life-limiting conditions. That is much appreciated. I shall be addressing the Treasury rules that come into play in 2006, which state that any work done in the charitable sector that should have been undertaken by the statutory sector, or that displaces work that the statutory sector would otherwise have to do, should be reimbursed by the statutory sector. The hon. Gentleman has given me the opportunity to make that point, and I thank him for that.

May I say that no Opposition Member raises their constituents' interests as consistently well as the hon. Gentleman? On funding, will he pay attention to the cross-border issues that afflict constituencies such as mine, which sits in the east midlands but naturally looks to Yorkshire, including to the Bluebell Wood children's hospice in Sheffield, for hospice places for our children?

I thank the hon. Gentleman for his kind words. This is one of those debates at which the House excels. A number of people who work very hard for the hospice movement, all of whom care deeply for their constituents and put party politics aside, are making contributions. I will probably use that as my final comment before finishing my speech.

I was talking about the involvement of the whole community in raising funds. Little could get me out of my bed on a cold, wet Sunday morning to run 26 and a quarter miles, but my local hospice movement did, and I was proud to take part. I recommend it to other Members. Almost all the money for children's hospices is raised in the local community, which takes tremendous dedication.

It would have been easy for me to try to score cheap political points on funding, but I will not do that. In fact, I warmly congratulate the Government and thank them for the extra funding that they are putting into the health service; I will not mention the application of such funds at this point. On average, children's hospices receive only 5 per cent. of their funding from statutory sources. I urge the Government to work in partnership with children's hospices, as they do with adult hospices, to develop a mechanism to fund a service that the state would have to provide if children's hospices were not there. That point was raised by the hon. Member for Loughborough (Mr. Reed) a moment ago.

The same principle that applies to adult hospices should apply to children's hospices. Unfortunately, it does not; the same dialogue is not taking place with children's hospices, which is a glaring anomaly. I ask the Minister to address that point today or to write to me about the matter as soon as possible.

The Government should include the children's hospice service in their funding discussions with the adult hospice sector. The national service framework for children and young people could prove to be a powerful agent in helping to achieve the necessary change. Although children's palliative care is a thin slice of the section on disabled children, the NSF offers a key stepping stone towards developing such services. The Government now need to ensure that the PCTs are assessing the need for children's palliative care in their locality and meeting the full cost of providing that care. That should form part of the monitoring of the NSF. I would be grateful if the Minister confirmed that that will be the case and told us how it will be achieved.

The New Opportunities Fund, now the Big Lottery Fund, has helped Little Haven and many other children's hospices. We are all deeply grateful for that, but the money runs out in March 2006. The funding has become an important mainstay of children's hospices in terms of meeting their running costs, and when that disappears in 2006, the funding situation will become very fragile.

The Government have described how children's hospices should negotiate with PCTs for statutory funding; I hope that the Minister will not dwell too long on that, as we have all heard that argument. Because of the absence of any central guidance from the Government to PCTs, the arrangement results in unacceptable uncertainty for the hospices. Children's hospices have to deal with up to 15 PCTs in any one area. That means 15 rounds of negotiations and 15 very variable possible outcomes. That is not good enough, as it consumes valuable hospice resources.

We need the Government to focus on that and to ensure that the process is streamlined and clarified for everyone's sake. Children's hospices are not looking for an easy life; they simply want a fair deal, practical help and support in finding their way through the funding maze, so that they can concentrate on what they were set up to do.

The Minister is a good Minister. I said that before, and I really mean it. She knows that, as a society, we need hospices. I hope she accepts that and will do what she can to support them in terms of funding and access.

A Minister under the Conservative Administration, the right hon. Member for South-West Surrey (Virginia Bottomley), stated:

"The Government's objective is to work towards a position in which the contribution from public funds available to voluntary hospices and similar organisations matches that of voluntary giving."—[Official Report, 15 December 1989; Vol. 163, c. 847W.]

I hope that this Government pick up that objective and run with it. Does the hon. Gentleman agree?

I am delighted with that intervention, because it gives me the opportunity to say that there is no better man in the House when it comes to fighting for the health service and for constituents than my hon. Friend the Member for West Chelmsford (Mr. Burns), who is on the Front Bench. He will explain Conservative policy on the matter.

When thinking about hospice care, it is all too easy to become distracted by age groups, buildings and disease types, but a hospice is not just a building. It is a service for adults and children, providing, for instance, care at home—a total service. There are many important differences between children's and adults' hospices, but they share the same vision of caring for people at their time of greatest need. Help the Hospices and the Association of Children's Hospices have called on the Government to appoint a Minister for palliative care. That Minister's role would be not only to join up policy on palliative care for children and adults, but to co-ordinate a cross-departmental cross-sector strategy to support people coping with death.

We all value our hospices. They are a jewel in the health service crown.

I congratulate the hon. Gentleman, as other hon. Members have, on securing this debate.

The hon. Gentleman referred to cross-departmental responsibilities. Is not one of the key issues for hospices the amount that VAT takes out of their budgets? Is it not time that the Government made all children's and adults' hospices exempt from VAT?

The hon. Lady makes a fair point, and one that I intended to address, although I failed to do so. I am grateful to her. No doubt the Minister will deal with the matter.

We know that hospices are very important. As a hospice user put it:

"We know that while we are at the hospice we are in safe and knowledgeable hands—and so do our families".

Let us work together in Parliament, cross-party, to get this right.

rose—

Order. Many Members are trying to catch my eye. If speeches are brief, I can get everyone in; if they are lengthy, I cannot.

I congratulate the hon. Member for Castle Point (Bob Spink) on securing this debate. He has an excellent record of speaking on behalf of the vulnerable in society, and he did so just a moment ago.

Palliative care has long been the poor relation in terms of publicity and funding in the NHS. As we are now aware, more people will be living longer due to improvements in medicine and a better standard of living; as a result, we are also aware that more people will require palliative care. Therefore, the NHS has taken more responsibility for funding. In the past, hospices were funded totally by voluntary contributions, but with the realisation that the number of people needing palliative care was increasing, the NHS had to accept that responsibility—quite right too. Palliative care services were provided in some hospitals, but the voluntary hospices were still essential to supply the total need. We know that fundraising is essential to the upkeep of the many voluntary hospices.

The management and volunteers at the local Springhill hospice in Rochdale, which serves my constituency—and serves it so well—have come up with ever more innovations to persuade people to part with their money in the worthiest of causes. There is, for example, the annual man and woman of the year luncheon, at which it raises a huge amount of money. I am on one of the committees that organises those events, which are very enjoyable and raise the awareness of the local community. There are concerts, tug-of-wars, sponsored walks and bike rides, auctions, coffee mornings, fairs and other entertainments enjoyed and supported by all in the borough. There is a hospice shop, staffed and run by volunteers, which supplies everything under the sun.

One cannot fault the hard work and commitment that have been put in over the years to keep the hospice movement going as a vibrant, irreplaceable service in the area. I was a member of the local health authority when another member, Margaret Geohagen, started the hospice. It is to her credit that she did so, and she is still its chair.

There is a constant headache of achieving targets each year. Hospices are the victims of their own success. They are now providing specialist palliative care at home and in the hospice; they are providing respite care to give carers a necessary break; they are providing care for families of patients; and, at the same time, they have to deal with the upkeep and refurbishment of the buildings and grounds.

The NHS contributes about a third of the funding of palliative care, as I understand it, in adult hospices run by local charities. The National Institute for Clinical Excellence guidelines suggest that the NHS should commission palliative care services, but that providers may come from the independent sector. The Treasury recommended that all Departments should ensure that the price of contracts reflects the full cost of the service, with a deadline of April 2006. I understand that the Charity Commission states that a charity should not use its resources to supplement what the public bodies should provide, so the NHS should fund the costs of providing palliative services. Hospices should be using their funds to supplement and improve the services funded by the NHS.

I receive letters from my local hospice suggesting that it is not yet receiving the full cost of the service as described by NICE, and there is a bit of uncertainty over its future budgets. Primary care trusts will need to be sure that they are assessing correctly the special palliative care needs in their areas and they must ensure that all such needs are met.

rose—

Order. Before I call the hon. Lady, may I remind Members of the rule about reading? Copious notes are allowed, but reading is not. The hon. Member for Heywood and Middleton (Jim Dobbin) appears to be on the first page of his notes. I did advise that Members should be brief.

Thank you, Mr. Deputy Speaker.

I thank my hon. Friend the Member for Heywood and Middleton for giving way. As the neighbouring constituency MP, my constituents are also served well by Springhill hospice. First, does he agree that there is a role that has not yet been used by the strategic health authority, whereby many hospices serve many PCTs in that the PCTs all—equally and separately—fund what they are meant to fund, rather than putting the weight on one or two PCTs that are fully apprised of the value of the hospice movement?

Secondly, will my hon. Friend add his praise to mine for the hospice movement for the work it does in the palliative care networks? We know the value of the work that the movement does for people in homes and in the hospices, but the problem is the plight of people who have to suffer in hospitals and do not get the same palliative care. The movement has been leading in finding a way to train of lots of nurses in palliative care on the wards.

I accept the points that my hon. Friend is making. She represents a seat in the same borough, so she knows the hospice that I am talking about. I also accept your guidance, Mr. Deputy Speaker. The point that I am coming to is that one Minister needs to be given responsibility for the full provision of palliative care for adults and for children's carers and providers. I want to come to a close, because you have asked us to be brief and more hon. Members want to speak. I pay tribute to the voluntary ethos of the hospice movement and to its dedication to raising funds to keep itself going.

I appreciate all the work that the Government are doing. I ask them to focus a bit more on the financial needs and the financial supports of the hospice movement, particularly the support given to children's hospices throughout the country. There is a dearth of support in that area. That needs to be examined.

I congratulate my hon. Friend the Member for Castle Point (Bob Spink) on securing this debate; I agree with everything he said. I suppose I could sit down immediately, but there are one or two points that I wish to make.

This is not a party political matter; no political party invented hospices. Dame Cicely Saunders has led the movement and I applaud everything she has done. As a member of the Committee that considered the Bill that enabled primary care trusts to come into existence, I say to the Minister that I and many other colleagues made many points about funding at that stage. I hope she will address the issues, specifically funding, as the primary care trusts are expected to deliver practically everything, but that is not quite working as the Minister had told us all.

My hon. Friend the Member for West Chelmsford (Mr. Burns) and I have the privilege of serving on the Health Committee. I am delighted that my hon. Friend the Member for Castle Point mentioned our report on palliative care and I know that the Minister gave evidence to us.

The Committee was briefed by Dr. Keri Thomas that patients had little real choice about how they would spend their last days. We were told that

"though most of the final year of life is spent at home, most patients still die in hospital."

Will the Minister address that in terms of the back-up service? Locally in Southend, we have a wonderful organisation called SPDNS, which is led by John and Rosalind Matty. They have celebrated 25 years of trying to help people die with dignity at home. However, there are other challenges in terms of getting the necessary staff support to give people the opportunity to die at home if they so wish.

As my hon. Friend said, we are served by three wonderful hospices locally: Little Haven, Fair Havens and St. Luke's. When I was first elected to Parliament in 1983, I knew little about the hospice movement, although I knew about St. Joseph's hospice in Hackney. Within a year, I had celebrated my second miracle in my then constituency—the first was to be elected—which was to be given the great honour of laying the foundation stone of St. Luke's hospice.

That came about through a wonderful lady called Trudy Cox, who was a district nurse. She was called to attend a house, thinking that the person concerned was ill. She walked into the bedroom and the mother lay dead in the bed with her children around her. She said that, after that, she was determined that no one should ever die in those circumstances again. She called a meeting and said that she was not going to argue with the Government about funding, but that she would mortgage her house and there would be a hospice. Within a short time, and with no huge benefactors, St. Luke's hospice was built. It does a wonderful job, just as Little Haven and Fair Havens do.

The adult hospices in England and Wales have given all hon. Members the same briefing. Mine is a tiny contribution in terms of what the Minister might respond to, because she will know that that movement wants full cost recovery. It feels strongly that primary care trusts are required to fund sufficient services to meet local need but that they are not delivering on that. It also feels that commissioning sufficient services for its population should happen in reality and the hospices should not be necessarily left to fill all the gaps.

As the hon. Member for Heywood and Middleton (Jim Dobbin) said, Government leadership and strategy are very important. The adult hospice movement wants the Government to ensure that there is one Minister with responsibility for joining up palliative care policy across diagnosis for adults and children, working closely with palliative care providers and patient and carer organisations. It also feels that there should be integration with existing quality programmes and streamlining of statutory inspections. We have only to think of our schools being inspected by Ofsted to know how disruptive such a process can be for all concerned.

All Members of Parliament support their local hospices and wish to be associated with their local hospice movement, but I hope that the Minister will deal specifically with how primary care trusts can address the current funding difficulty.

rose—

Order. I thank the hon. Members who have spoken thus far; they have been exemplary. I call David Taylor.

I do not want to speak.

Sorry, I thought you did. I call Martin Linton.

Thank you, Mr. Deputy Speaker. I am sure that my hon. Friend the Member for North-West Leicestershire (David Taylor) will make some excellent contributions to the debate.

I thank the hon. Member for Castle Point (Bob Spink) for applying for the debate because it gives us a chance to discuss the needs of the hospice movement. He has mentioned the Little Haven children's hospice so often that it must have become the most famous hospice, at least among fellow Members of Parliament. I hope to do the same for the Trinity hospice, which was established in 1891, making it the oldest in the United Kingdom. Its catchment area is the whole of south- west London, which has a population of some 750,000 people.

My constituency is at the centre of that catchment area and, although the hospice itself is a few yards outside my constituency, I have good links with it. Those links have become much firmer since April when, like the hon. Member for Castle Point, I ran the marathon as part of the hospice team to raise money for it. I had two targets: one was related to how quickly I could get to the finish, which I just about met, and the other was to try to raise £1,500 for the hospice. I am glad to say that I achieved that, thanks to the generosity of local people and the fact that, as soon the Trinity hospice was mentioned, so many people said, "I just don't know how I can thank that place enough for what it has done for my family." I was able to say to them, "It's easy, you can sponsor me in the marathon." Many people did so and I was able to raise nearly three times the sponsorship target. It is sobering to discover, however, that my £4,000 will keep the hospice going for less than half a day.

Hospices such as Trinity need to fundraise because they do not get 100 per cent. funding from the national health service. As I understand it, the health service will fund the community service—there is a community team at the hospice with about 280 patients on its books—and the bed service. Trinity has about 30 beds, although it could happily double that number. However, when it comes to core needs, Trinity gets only about 45 per cent. of its funding from the health service. The funding does not in any case include complementary therapies not recognised by the NHS such as massage, heart therapy, relaxation therapy and hypnotherapy, which are excellent forms of palliative care. As a result of those two factors, the Trinity hospice gets about 35 per cent. of its funding from the NHS— £2 million out of £6 million.

Many people have mentioned the need for full funding. Talking to my local hospice, I found that it does not want 100 per cent. funding. There are a few NHS hospices in London that are 100 per cent. funded, although there are very few across the rest of the country. Trinity hospice values its independence and freedom, but like most hospices it wants an increase in the percentage of its costs that are funded through the NHS. It would warm to the suggestion made by my hon. Friend the Member for North-West Leicestershire of a 50–50 split between NHS funding and its own fundraising.

Within that general demand are several specific points that concern the hospice. I shall raise them briefly while I have the Minister's ear, so that she can comment on them. The first is even funding between primary care trusts. The hospice has to negotiate with seven different PCTs, and some are likely to offer a higher percentage than others. It is known that some will be in danger next year of short-changing the hospice because of their financial situation. It is important that such organisations as hospices should have the same rate of funding from all PCTs. If there is anything the Department of Health can do to ensure that those PCTs are able to give them the same funding, that will be helpful.

Another point that the hospice raises is that the voluntary sector has great difficulty matching the pay rises for NHS staff, although it has to do that. I would never argue against those pay rises, which are richly deserved, but they should be taken into account in deciding how much to fund the hospices, which have to try to keep pace with NHS increases.

Another suggestion is to work towards a system of funding per head. At present, the block grant is based on last year's occupancy and on 80 per cent. bed occupancy. Trinity achieves a good 96 per cent. bed occupancy, which means that the funding it gets is underfunding. It would be far better if were Trinity funded on the basis of the bed occupancy it achieves, even if that is not 100 per cent.

The hospice has also told me that it would like three-yearly, not one-yearly, budgets. This Government have tried to follow that principle for many voluntary bodies, Government agencies, local authorities and education authorities. We can understand that hospices have an equal need for predictability and dependability in their funding. One of their aims, which they can achieve only with funding improvements, is to expand their care to illnesses other than cancer. Cancer was the original reason for most hospices coming into existence, and the bulk of the palliative care that they give is for that, but there are many other illnesses for which hospice care would be appropriate.

Hospices suffer, perhaps even more than the health service, from bed blocking. Often, that problem depends on a patient finding a nursing home place. Trinity has had examples of people who no longer need hospice care occupying a hospice bed for more than a year while they try to find a nursing home place.

In central London there is a huge problem with parking, which I as a constituency MP have helped to deal with on behalf of district nurses. People working for the hospice can pay about £500 a year for the privilege of parking in the street outside their hospice. The community team needs to be able to move freely around the boroughs to visit the 280 people on its list.

I pay tribute to the chairman of Trinity hospice for the past 10 years, Patrick Hurst. He has brought about a real revolution in the hospice's ability to deal with the demand for its places, including a new capital build plan and far greater services to the community than Trinity was ever able to deliver before. There has been an increase of about 400 per cent. in the community team, and thus a huge increase in the number of patients with whom the hospice is able to deal.

I make those suggestions in the knowledge that the Department of Health and the Government are already doing an enormous amount to help hospices through the primary care trusts, but this is the direction in which hospices—certainly my local hospice—would like them to move in future.

Finally, Mr. Deputy Speaker, I apologise if I have to leave a little early. My excuse is the only one that would cut any ice with you: I have to see Mr. Speaker.

I know the feeling. I call Sir Teddy Taylor.

We all owe a debt to my hon. Friend the Member for Castle Point (Bob Spink) for raising this issue, as it concerns many of us. We are all aware of his total commitment to Little Haven. The great work that he does for it is well known and is, I am sure, greatly appreciated. I have had a connection with Fair Havens and Little Haven for many years as an honorary office bearer. All of us are well aware of the fantastic work done by hospices. Of course, they depend enormously on voluntary helpers—without voluntary help, it would be difficult for them to continue—and they have to raise a huge amount of money to ensure that the service is maintained.

I wish to put three brief points to the Minister. One thing that worries me enormously—I hope she will confirm whether this is true or untrue—is that, on the basis of figures I have seen, NHS funding of hospices as a percentage of total spending has decreased in recent years. That should worry us all, irrespective of the Government in power. Obviously, this can happen without people noticing. In 1996–97, 35 per cent. of funding was covered by the NHS. In 2001–02, that fell to only 29 per cent., which is a massive reduction. Since then, there has been the £50 million boost for specialist palliative care, which increased the amount to 32 or 33 per cent. However, we should be aware that that percentage of total spending is still less than it was in 1996–97. That should worry us all.

The hospices in the Southend area and in Castle Point are very fortunate to receive enormous contributions from the local communities, but hard work is required to maintain them and, as expenditure is constantly increasing, that is no easy task. My first question is, does the Minister accept that funding has been reduced and that there is a need to increase it?

Secondly, does the Minister accept that funding for children's hospices is tiny compared with the funding available to hospices generally? Only about 5 per cent. of total funding is provided from public funds, which is very low indeed. In the case of Little Haven, the figure is only 1.9 per cent. When we have had problems in the past, Governments have said to us that there are things we can do. For instance, we can request lottery funding, which has been greatly appreciated. A special fund has been set up, but the plain fact is that it will fall out and stop in 2006.

The main guidance has been that we should go to the primary care trusts. A delightful lady runs one for us in Southend, but there are so many PCTs that it really is a bit confusing. Some hospices have to deal with three, four, five or—in the case mentioned by my hon. Friend the Member for Castle Point—15. Trying to get straight guidance from them on how funding should be provided is almost impossible. The Government really need to give clear indications or rules to PCTs as to what funding they should provide for children's hospices. It is no good at all to leave that to discussions. We appreciate that PCTs have a bit of a nightmare, as do all organisations in the health service, in covering all their costs. Therefore, we need a commitment to additional spending and a clear promise that the PCTs will be advised on suitable funding.

Further to the hon. Gentleman's last point, I have a children's hospice in Chorley—Derian House suffers in respect of funding from PCTs. The local PCTs give money, but young children come from as far away as London or Scotland and may make a one-off visit this year, or perhaps in three years, so their PCT never contributes.

The hon. Gentleman is absolutely right that children's hospices have always been the poor relation in funding. Does he agree that we ought to have more funding directly from the Secretary of State, or in another way, if funds cannot be channelled through the PCTs equally?

The hon. Gentleman expresses my feelings exactly. I would much prefer to have straight funding from the Government, due to the confusion in the system with all the PCTs. That would be infinitely better as it would clear up a lot, but, on the other hand, we do not want to interfere with the powers given to PCTs because they are very sensitive.

I agree with the hon. Gentleman. If that proposal were possible, great; if not, PCTs should have some clear guidance on the funding needed.

Does the hon. Gentleman think that the target set by the Government for funding child and adolescent mental health—guidance referring to a non-ring-fenced target of 10 per cent. growth year on year over the next three years—is a good example? That has been met by nearly all PCTs. Would he recommend that formula to the Government?

That is something for the Minister to consider, because it is far too complicated for me. We need straight indications that, because of the reduction that has taken place, there will be an increase and that PCTs will be given clear guidance. The hon. Lady has mentioned something important that the Minister will need to examine, but I am looking for those two straight pieces of guidance.

I hope that when the Government work out such things as the inspections that are taking place, they will bear in mind the burdens on those running a hospice. Some of our schools have different views on inspections: those that get good reports think they are a wonderful idea while those that get bad reports think they are a very unusual system.

For hospices, the real problem is the time taken up by inspections. My understanding—the Minister can tell me if I am wrong—is that we have two organisations undertaking the inspections; they do not attract much notice and they take up a huge amount of time. Quite honestly, when people have the job of running a hospice, particularly when they depend a great deal on voluntary work, having two such inspections is bad. Surely, through the simplification of democracy, we could have one organisation, and only one, to carry out the inspection. If a hospice gets a good report and is clearly well managed, there should be some means whereby a gap between inspections is introduced for it compared with others.

I hope that the Minister appreciates the huge burdens that hospices have to bear and the enormous task of fundraising undertaken by volunteers. I also hope she realises that problems could arise unless something is done. Many people spend a great deal of time and effort on ensuring the continued operation of hospices, but they need additional help.

The Minister will be aware that the only guidance she has had from Members present is that something should be done. I hope she can provide some guidance. All of us present appreciate the special interest taken by my hon. Friend the Member for Castle Point, and we thank him for giving us the opportunity to raise these important issues.

rose—

Order. If Members are brief, I can get one or possibly two more speakers in. Ignore the annunicator; we know what we are talking about.

Thank you, Mr. Deputy Speaker. I am glad that you said that before I rose to speak and I hope that you feel that way at the end.

I will be brief because much has already been said. I probably need only clarify. I am grateful to the hon. Member for Rochford and Southend, East (Sir Teddy Taylor) for homing in on where we can make progress.

I have asked questions and raised this issue particularly in relation to children's hospices. The Rainbows hospice in my constituency is only 10 years old; it was 10 years old last month. It has celebrated great growth in that time, and it continues to want to grow. It is a happy place. The first time I visited, I was rather nervous, thinking that it would be a deeply depressing place, but far from it. I had my photograph taken in the ball pit with some of the children, and we really enjoyed ourselves. I left with mixed emotions of joy and an understanding of what a hospice is really about. The hospice serves many PCTs and has exactly the same problems as those already mentioned.

I want to raise the specific problem that occurs when social services departments use the hospices. The county council passed a motion supporting a campaign run by the local newspaper and me, until I wrote to the council to say, "Congratulations on supporting the campaign to fund the Rainbows hospice. If your social services department were to pay up, it would make some difference." I have still not had a reply to that letter, strangely enough. Perhaps today's debate will trigger the county council to deliver some of the cash. It uses the services; it needs to pay.

The matter comes down to the specific issue about guidelines. Like most Members, I have spoken to my local PCT. I encouraged all the Members I know in the east midlands to do that. The PCT will say, "Yeah, we totally agree. We should be funding children's hospices." It is wonderful, is it not? However, when it comes to the detailed negotiation, the money is not there, or it is not the priority at that time. The Department of Health will say, "It is a priority and the PCT should be funding it", and we get caught in a muddle.

The only way forward is if we establish some guidelines and guidance that, while not exerting extreme pressure, make it clear to PCTs and to social services departments that use those facilities for health matters that we expect them not to pay 100 per cent. but to pay the 40 per cent. that we estimate is used to provide health service care at our hospice. PCTs should just pay their way. That is not a Stalinist diktat from the centre. We need some simple guidelines that make it clear to every PCT in the country that it ought to pay its fair share.

I congratulate everyone at Rainbows on their hard work in raising £1.5 million every year. What a daunting prospect it is to wake up every 1 April knowing that one needs to raise another £1.5 million, but every year they do it. Fortunately, I did not have to do a marathon. They are going to get me to jump out of an aeroplane with a parachute. Suddenly, the marathon sounds a lot more enticing.

rose—

Order.

I thank the hon. Member for Castle Point (Bob Spink) not only for securing the debate but for covering so many of the important points that we came along to make. I will try not to repeat any more than is necessary to make my points.

St. Christopher's hospice opened in my constituency not long after I was elected. There is a history of concern about primary care trust funding for hospices. I hope that, by the time that we go into the next election, we will have resolved the issue. Three and a half years ago, the hon. Member for Putney (Mr. Colman) and I went to see the then Minister in charge of children's care, the Under-Secretary of State, Office of the Deputy Prime Minister, the hon. Member for Pontefract and Castleford (Yvette Cooper). We discussed two issues: the difficulty in securing PCT funding and regionalisation.

After that meeting, we all came away feeling that we needed stronger guidelines—particularly with children's hospices—about regional cover. Otherwise, we end up with fundraising in adjacent areas almost in competition. There is a problem and it needs to be dealt with.

We did not get very far though—nothing much happened on the funding that we hoped for—so, in October 2002, I wrote to the next Minister. By March 2003, another Minister was in place. I was fortunate to secure an Adjournment debate in May 2003 and the Minister made it clear that PCTs should contribute. At that point, I made the history clear—the fact that the chief executive of my local children's hospice had been round the PCTs and not succeeded. However, I was again given the advice that the PCTs should contribute. Since then, the chief executive has been round again and not succeeded. I tell that story to make it clear that people have been trying to resolve the issue for a long time.

I invite the Minister to visit St. Christopher's hospice. We invited the Minister for Children, Young People and Families, the right hon. Member for Barking (Margaret Hodge), and she said that it was not her job. It is important that a Minister visits to look at the brilliant work that is being done by St. Christopher's. I am sure that it is on a par with what is being done across the country.

The important thing is the justice of the issue. We talked about where the Government should play their part. I agree with Members who suggested that we should have a Minister with responsibility for palliative care. We all have huge fundraising efforts. In my area, Standard Life Healthcare, Allianz Cornhill and the cricketer Adam Hollioake do huge amounts of work, as do lots of ordinary people. However, they should not be doing it in the knowledge that the Government are not stepping up to the mark. We are looking not for 100 per cent. funding—hospice care is different from hospital care—but for funding to provide those elements that the national health service would provide if the hospice were not there. That is a matter of justice. I hope that we get it. I would like to go into the next general election knowing that we have got that point nailed once and for all.

I congratulate the hon. Member for Castle Point (Bob Spink) on securing this important debate, and commend the many contributions that have been made in the debate and the points that have been made to the Minister. I want to illuminate and add to some of those points and to ask the Minister some questions to which the debate begs answers.

The need for such services is beyond doubt and, like the hon. Gentleman, I cannot miss the opportunity of expressing my appreciation of the work of the hospice in my constituency. St. Raphael's hospice covers the population in my constituency and that of Merton borough. It has a fantastic team of staff and an extraordinary team of volunteers, who go out of their way to make a difference to the quality of life of patients and families who are struggling to cope with the difficult circumstances that brought them to the hospice. Two hundred and fifty volunteers play a part in that hospice and I take my hat off to them for their efforts.

The local paper, the Sutton Guardian, recently launched a campaign to raise £50,000 to expand the services provided by St. Raphael's hospice. In less than three months, it hit the halfway mark, which indicates how powerfully hospices move local populations, how strongly people feel attached to them and how much people are willing to dip into their own pockets to ensure that their hospice survives, thrives and continues to support people in the local community.

That brings me to the first and key question of funding. Will the Minister tell us something about the road map for realising the Treasury cross-cutting review of the voluntary sector? That review was published in 2002. As we have heard, it said that, when there is a statutory responsibility for a service, even if it is provided within the voluntary sector, there is a requirement for full reimbursement of costs. What is the plan to ensure that that conclusion, which the Treasury reached in 2002, becomes reality by 2006?

Clearly, it is not appropriate in the long run—it is not defensible even now—that hospices rely on charitable and lottery funding to pay for services that would be free if they were provided within the NHS. Trustees have a legal duty not to use charitable money for such purposes and, given what the Treasury has said, there will come a point when the Charity Commission will have to step in to question whether the level of funding is adequate to meet the need.

We have had the figures showing how the level of funding for adult hospice care has fluctuated and fallen compared with the level only a few years ago. If adult hospice care is the Cinderella of services in palliative care, children's hospice care is the poor relation of that Cinderella. To have only 5 per cent. of its funding from the NHS cannot be an adequate or acceptable measure of the support that we as taxpayers should be prepared to put into such an important service.

Many hon. Members have described the lottery of PCTs accepting their responsibility in principle but not picking it up in practice. Where children's hospices seek to work out who they have a relationship in respect of planning and commissioning services and whom to talk to about the new arrangements for payment by results, how will that go forward? Surely, this is an area in which specialist commissioning has a part to play, given that it cannot be right for voluntary organisations to have to play a game of chasing multiple PCTs to find the right person to release resources.

I want to ask my hon. Friend a question on behalf of the Shooting Star Trust, which is just starting to open its doors as a children's hospice in my constituency. Is there a logical basis for the disadvantageous funding of children's hospices, which the hon. Member for Rochford and Southend, East (Sir Teddy Taylor) emphasised? The purpose of hospices is to provide respite care and the cost of looking after children in a hospice is often disproportionately higher. Why are children's hospices discriminated against in this way?

In his question, my hon. Friend has put his finger on the nub of the matter. We are effectively talking about discrimination being perpetuated in the system of funding hospice care. It cannot be right or acceptable that children's hospices that provide core services that social services and the NHS want to use have to rely heavily on flag days and other fundraising devices to cover their costs.

It is vital to remember that we should focus not only on the very important work that palliative and hospice care provides for those with cancer. More than 95 per cent. of the services in hospices are concentrated on that group, but there are more than 300,000 people with degenerative and other diseases who would benefit from palliative care and hospice care. In evidence to the Select Committee report, the British Lung Foundation made representations about coronary obstructive pulmonary disease and people with that condition who would benefit from palliative care. We have heard about motor neurone disease and how people from that group are very fortunate if they can access hospice care. However, many do not, which also applies to those with dementia of one sort or another.

Reference has been made to social care and its role. It is incumbent upon the Government to be a lot clearer about where the line is drawn with regard to who is responsible for funding those services. I am thinking in particular of the issue of continuing NHS care, which was explored during the Select Committee's inquiry, but has not been satisfactorily dealt with through answers from the Government.

Quite recently, I asked a question to find out when the Government will be publishing their review of where strategic health authorities had got to in considering the criteria in respect of continuing care. I received an answer that did not relate at all to the question that I asked, and I hope that the Minister will give us some idea of when we shall see the outcome of that review.

During our inquiry, we were told that people were still in a situation where arbitrary time periods on when funding would be available were set by strategic health authorities. A person could be 11 weeks from death—I do not know how on earth someone comes to that judgment— and then they would get continuing care funding from the NHS. The period may be nine weeks or eight weeks. None of those procedures is lawful or fits within the guidance that the Department issues. How can that be allowed and tolerated and what is being done to change it? Will the Minister tell us today where the Government have got to with their long-awaited review?

This is an important area of public policy. Parliament should be debating it, and the Government should focus their attention on it, whether through a Minister or a national service framework for palliative care—I think that the latter is more likely to pull the threads together than simply having a figurehead. It is right and proper to have this debate. We need to see the funding put in and the services developing. Of those people who could benefit, only 1 per cent. benefit from palliative care in this country. That is an appalling indictment. More people must benefit from such services in future.

I congratulate my hon. Friend the Member for Castle Point (Bob Spink) on giving us the opportunity to have this important debate, which has generated considerable interest, shown not least by the number of hon. Members who wished to take part in it. I was particularly pleased that he secured the debate because he rightly and with justification spoke about the Little Haven children's hospital in his constituency, in the south of Essex. I welcome and recognise what he said about the excellent work that that hospice does because it also serves my constituency, alongside the children's hospice based in Cambridge, which also provides that service.

Along with many other hon. Members who have contributed to the debate, I have an adult hospice in my constituency, Farleigh hospice, which has done a fantastic job during the past 18 to 20 years in looking after adults in need of palliative care. Like all hospices, it works day in, day out, through the tremendous work that the staff do in the hospice, and also through the work of an army of volunteers who help with the running of the hospice and, equally, with fundraising.

We all know from our own experiences in our constituencies how extremely expensive it is to provide palliative care and the extent of the demands on that service. Public-spirited, generous individuals do amazing work day in, day out, coming up with novel ideas for raising money to help to ensure that this fantastic endeavour continues providing a seamless service for some of the most vulnerable members of our local communities.

The extent of the work that is done up and down the country is tremendous. Let me give just a few figures. There are 216 adult hospitals with palliative care units in the country, with 25 for children alone. There are 3,096 beds, with 196 beds on top of that for children. There are 51 beds per 1 million of the population. The average size of a hospice is 15 beds, seven for children. The most common size of a hospice is 10 beds. The estimated number of admissions per year is 59,000. The estimated number of new admissions is 41,000. The mean length of stay is 13 and a half days. The estimated number of deaths in palliative care in hospices is 29,000.

That is a tremendous input into the entire provision of palliative care. Like other hospices, Farleigh hospice has been fundraising over the past few years so that it can move from its existing site. It has secured a site by Broomfield hospital, which is part of the Mid Essex Hospital Services NHS Trust, and it is building a far larger hospice by private donation, having raised a considerable number of millions of pounds with help from other areas. That is the way forward because the demand for palliative care is always going to be increasing.

Therefore, we return to one of the common themes that has run through this whole debate, which is the question of funding. Few if any people within the hospice movement would want to see 100 per cent. funding from central Government. That is not the aim, or the aspiration of the hospice movement. What the people in that movement believe is that they need their efforts—their fundraising efforts, and the time and energy they put into making sure that the palliative care in the hospices is second to none—to be recognised more in financial terms by the Government. That would help to ease some of the pressures that are placed on them to raise what are phenomenal sums of money in order to keep the hospices running. The hon. Member for Battersea (Martin Linton) said that he took part in the London marathon, that he raised £4,000 or £4,500 for his local hospice, and that that was equivalent to about half a day's running of the hospice. That figure puts into perspective the sheer extent of the costs.

Other hon. Members talked about the money that the NHS has made available to the hospice movement over the past six or seven years. I am not going to claim that the Government have cut the funding to the hospice movement, because they have not. However, the Minister will recognise that, as a number of my hon. Friends and others have said, the contribution that the NHS makes to the hospice movement fell between 1996–97 and 2001–02 from about 35 per cent. of the costs of running a hospice to 29 per cent. That proportion has improved somewhat since 2001–02, because the Government made £50 million available for palliative care. Even so, the figure is still somewhere between the top end of 32 per cent. and 33.33 per cent., which is lower than in 1996–97—it was 35 per cent. then.

Part of that problem is simply that health service inflation is considerably higher than the retail prices index, or other methods of managing and assessing inflation. The Government must consider that again, not only for adult services but, as several hon. Members have said, for children's services in particular. For the average funding for children's hospices coming from the NHS to be 5 per cent. is unreasonable, as I am sure the Minister will accept. That is why my party made a manifesto commitment at the 2001 election that the NHS contribution to the hospice movement—both adult and children's hospices—would be 40 per cent. of the running costs if we were returned to government. That remains our pledge for the next election, because we recognise the important role that the hospice movement plays in the provision of palliative care.

I want to consider two other funding matters. The first, which many hon. Members have raised, is the fact that many hospices do not cover just a single constituency, a single PCT or even, in some cases, a single strategic health authority area. In my area, mid-Essex, the Farleigh hospice has to deal with at least five PCTs. It is important that Ministers in the Department of Health look at that again. I am not arguing that they should take away the powers of PCTs, because they were established to devolve powers to the localities, so that local people could take local decisions to meet local health needs and commitments. However, I am arguing for some rationalisation, so that there is more consistency and ease for hospices to deal with PCTs as a group, rather than having to deal with each, one by one.

The second problem, whose resolution would greatly benefit the hospice movement, is that, more often than not, particularly because of the financial pressures on PCTs, it can be late in the day—even early in the next financial year—before they decide what to fund their local hospice with. That causes problems with the provision of service.

The Government, to their credit, have changed the system in other sectors of health provision, so that announcements are made on a three-year rolling programme of future funding, which gives more stability and more opportunity for planning. That is a positive step, and I ask the Minister to examine whether it would be possible and reasonable to bring in such a mechanism for PCTs when they consider funding for hospices. That would give hospices more security and enable more straightforward future planning.

There is a gap in the hospice movement in provision for the age group of 18 to 40-year-olds. There is only one hospice in England that caters for that group, based in Oxford. There is a significant difference between the needs of that age group and those of the more elderly population and children. That was brought home to me by a constituent, Mrs. Whiffen, whose son Jonathan died aged 19 from a degenerative disease. He was looked after in the children's hospice in Cambridge for some years, but when he became 16 or 17, he and his mother felt that he had outgrown the services there. The service had been wonderful for him until then, but now that he had grown older, he felt that it provided more of a children's environment.

Mrs. Whiffen was concerned because, when Jonathan went to an adult hospice, the average age of the patients being cared for there was 72, a considerable jump for a teenager. She feels—there is some justification for this—that more needs to be done to meet the requirements of that age group, rather than placing those young people in hospices where the population is of a more mature age, and where their needs and desires might conflict with those of more mature individuals. She is trying to do something about that in the Chelmsford area by seeking to raise funds to set up a hospice somewhere in mid-Essex to replicate the services provided by the hospice for young adults in Oxford. More must be done in that field.

Will the hon. Gentleman give way?

If the hon. Lady will forgive me, I will not because I have spoken for my time and I do not want to encroach on the Minister's time.

In conclusion, no one in this debate has questioned the dedication, hard work and fantastic achievement of all those involved in the hospice movement and that field of palliative care. We just ask the Minister, who I am sure recognises and accepts many of our arguments, that more be done to meet the financial costs of providing that fantastic care.

I join all other Members in congratulating the hon. Member for Castle Point (Bob Spink) on instigating today's debate. I know that he takes a keen interest in this issue, and it is obvious from the quality of today's contributions that many other Members also take such an interest.

Like other Members, I acknowledge the outstanding work done by all in the hospice movement who care for those in need of specialist palliative care. I entirely endorse the closing remarks of the hon. Member for West Chelmsford (Mr. Burns) on their role. The contribution of the voluntary hospice movement cannot be overestimated, and our partnership with it is very important. I recognise that the voluntary contribution to hospices is a tremendous strength of the movement and a tremendous success, and I recognise the big role that voluntary activity in hospices plays in our lives.

For adult hospices, the partnership that I mentioned has been strengthened nationally through the joint NHS-voluntary sector national partnership group for palliative care, chaired by the national cancer director. That group includes representatives from the local voluntary sector, NHS hospices, Help the Hospices, the Independent Hospice Representative Committee and the National Council for Palliative Care. At a local level, cancer networks have established effective partnerships for service planning and provision, ensuring that local voluntary and statutory sector services work in effective partnership and co-ordination.

On the children's palliative care side, the Department has observer status on the council of the Association for Children with Life-threatening or Terminal Conditions and their Families, and we are in regular contact with the Association of Children's Hospices. We have worked with the council and the association to promote children's palliative care and sponsored projects being taken forward by both organisations. We have also worked with the New Opportunities Fund, which has been mentioned, and which is providing important funding for projects in support of children with life-threatening illnesses.

In passing, I want to address the question of a Minister for palliative care. I am the Minister with responsibility for adult palliative care, and my colleague the Under-Secretary of State for Health, my hon. Friend the Member for South Thanet (Dr. Ladyman), is the Minister who deals with children's hospices. I realise that an argument is being advanced in this debate for putting those roles together. However, my betting is that had we done so, various people would have bobbed up in this debate to make a point about the need to separate children and adults because their needs are very different. I have just heard a version of an argument about why such roles need to be separated, because of the needs of different age groups.

There is no easy way of cutting up this particular cake to find the best possible answer, but what we have is in my view the right approach—considering the needs of children in this area alongside those of all children, who are, broadly speaking, very different from adults. I take the point that we are not yet necessarily meeting the needs of adolescents, nor perhaps of people in their early 20s. I am not quite sure about the age band mentioned by the hon. Member for West Chelmsford, but I fear that my children of around that age would not really identify themselves with people aged 40. I am sure that there are others in a similar position.

The work of the Select Committee on Health has been extremely helpful. The Committee has praised the initiatives to double the palliative care work force and the £50 million extra investment that has already been mentioned, and particularly the funding for black and ethnic community projects and services for children. The Committee and we accept that more needs to be done, and we need to ensure that integrated services are in place to meet the needs of patients who are receiving palliative care, regardless of their diagnoses. We all recognise that a lot of the palliative care is still provided to cancer patients, certainly on the adult side, but less on the children's services side, where there is a greater mix. We need to recognise that there are issues. The question of the integration of services remains a high priority for the Government.

I should like to deal briefly with a couple of points about adult hospices before moving on to children. First, I recognise that some of the points made and concerns expressed about funding relate both to adults' and children's hospices. Those arguments have been advanced in both quarters, although they have been advanced particularly in relation to children's hospices this afternoon. The 2000 NHS cancer plan pledged to increase the funding for specialist cancer care services for adults by 2004, with the £50 million that we have put in. That additional funding is for services in their entirety, and not only for hospices. It helps to tackle inequalities in access to specialists in palliative care and enable the NHS to make a realistic contribution to the costs that hospices incur in providing agreed levels of service. We have met that commitment and ensured that the moneys reach the front-line services. We set up a central budget for three years to do that, which has ensured that the money is protected.

Does the Minister agree that, because the money is being channelled to provide services for cancer patients, it excludes everyone else—the 300,000 people a year who have degenerative diseases, but not cancer, and who would benefit?

The money is for specialist palliative care, and although it comes from that route, there will be flexibilities.

Will the Minister give way?

I would rather make some progress, because hon. Members have raised so many points that I do not have the chance to answer many of them in any case.

Will the Minister answer on funding?

I am coming to that.

Before the additional funding was granted, independent adult hospices received an average of 28 per cent. of their annual costs from the NHS. That percentage has now increased. Although we do not have the final figures for the whole country, preliminary data from monitoring in 2003–04 shows that £24.5 million or 54 per cent of the £45.8 million reported on so far has gone to voluntary sector organisations, and mostly to hospices. Some £8.2 million has supported new developments and £16.3 million has supported existing services. The remainder has supported services in the NHS, or if it has not been spent in-year, it has been protected for future use for palliative care. The £50 million is recurrent in the PCT baselines.

The Minister said that the figure was 28 per cent. and that it rose, but everyone else understands that, as a proportion of the total cost, it was 35 per cent., dropping to 29 per cent. by 2001–02. Why is there a discrepancy in the figures?

The hon. Gentleman will understand that if a huge amount extra is put into in the NHS, as we have been doing, the proportion may drop when one looks at the whole. There is an increase in the funding for hospices coming through the routes about which we are talking, as I said a moment ago.

Will the Minister give way on that point?

No; I have seven minutes in which to deal with a lot of points.

On three-year funding and the short-term issues that all the hospices need to address, the PCTs have received the three-year funding and have already got £50 million extra, specifically for palliative care for the three years between 2005 and 2007–08. There is no reason why they should not make commitments in the longer term, rather than year by year. We recognise that there is a need for more funding, but we have met the commitment in the cancer plan, and PCTs must assess their local priorities. Hon. Members are adopting different attitudes to that issue. On one hand, people are urging us to go down the road of devolving more responsibilities to a local level, as we are rightly doing, and at the same time, whenever there is an issue on which people want to see a change locally, they are coming back to the centre of Government, saying, "You should legislate on these matters and provide central direction."

We believe that payment by results will be important in future and will radically change the arrangements for funding care providers. It will comprise a nationally set tariff for most service activity, including services provided by voluntary or independent sector providers, and it will be built on treatments and activities called health care resource groups. We remain on course to implement payment by results for adult palliative care in the NHS and the voluntary sector by 2008–09. A lot of work is under way at the moment, including that of the national partnership group, which is working to validate the costs incurred by a range of hospices. That work will inform the development of the health care resource groups.

Much of the debate has concentrated on children's hospices. The hon. Member for Castle Point has previously made points about the need to provide a general uplift in funding for children's hospices, and that has been the theme of some of the contributions this afternoon. However, he has made the assumption that a central funding directive would offer a practicable method of achieving that. On previous occasions, it has been suggested that we should base such an uplift in funding on some predetermined linkage to adult hospices or on a pre-set percentage of hospice running costs, rather than allow the level of NHS funding to be determined by NHS servicing arrangements.

Although I entirely share the hon. Gentleman's desire to see the children's hospice movement succeed, I cannot agree with the proposed solutions. Children's palliative care involves a much longer-term provision than adult palliative care, and it is structured around the successful management of serious chronic conditions at home rather than in the hospice. As Members have seen for themselves, such care is about promoting the quality of life associated with domesticity, social interaction, growth, increasing independence and the customary pursuits and developmental achievements of childhood. As a number of Members have commented, it is as much a celebration of life as anything else.

Support measures in the children's home, access to education and social activity are all key to that achievement, and it is important that the PCTs ensure that provision is properly balanced and that there is full availability of home care in their areas. Directions to PCTs to fund hospices by some given percentage could easily unbalance the essential mix of care, and favouring hospice care over home care could diminish the latter. The majority of child and adolescent deaths occur at home; a mistaken comment was made about that earlier. Linking the level of funding for a children's hospice to that of an adult hospice would ignore local perspectives and experience. I am glad that many Members support the extra money going into the NHS, although it is not supported equally by all parties when it comes to overall national funding decisions.

On the role of the national service framework for children and palliative care provision, we of course have a role in securing the right level of hospice services for children. That is why there was a module focused on support for disabled children in the recently launched NSF for children. Copies of the complete set of NSF documents are, or will be, placed in the Library. I shall ensure that the hon. Member for Castle Point in particular receives a copy of the disabled child document, which includes a specific section on palliative care and the support of children with life-threatening illnesses. It clearly identifies that high-quality palliative care services should be available for all the children and young people who need them. That goes a long way towards addressing the points made by Members about the need for a clear central statement of what is being called for. That is in the children's NSF.

That section notes that palliative care services are provided by a network of agencies and that close co-ordination and liaison are essential. It also notes the importance that we attach to recognising the changing needs of young people receiving palliative care as they move on from children's services. It therefore goes some way towards meeting the point made by the hon. Member for West Chelmsford.

We are saying clearly that local authorities, PCTs and NHS trusts must ensure that palliative care services provide high-quality, sensitive support that takes account of the physical, emotional and practical needs of the children or young people and their families, including their siblings; that services maximise choice, independence and creativity to promote their quality of life; that services are delivered where the child and the family want them—in the home, hospital, hospice or any other setting; that services include the prompt availability of equipment to support care; that palliative and terminal care services are regularly reviewed with parents, or carers and patients; that gaps in provision are identified or addressed; and that issues such as short-term breaks are also taken into account. In order to help the PCTs in their strategic development of those services, we aim to—

Order. Time is up. I thank all Members for their co-operation. We managed to hear seven Back-Bench contributions and four interventions from Members who did not contribute. It is thanks to the co-operation that has been given that we have managed it.

I am delighted to have this opportunity to launch this short debate on penalties for driving without entitlement. I am glad to see that the Minister is about to take his place, because I know what an interest he takes in the issue. I should say at the outset that I am grateful for the briefings and advice that I and other hon. Members have received from the Parliamentary Advisory Council for Transport Safety or PACTS. I am also grateful for the interest that the media have taken in the subject, and in particular for the campaign run by the hon. Member for South Dorset (Jim Knight), who presented a ten-minute Bill, of which I was pleased to be a co-sponsor, just before the summer recess. We wish that well.The Sun. Also, I support the campaign by

On 12 October 2003, a year ago yesterday, there was a horrific crash in Hove, which is adjacent to my constituency. My constituent Natalie McCabe, known as Flo, a 21-year-old nursery nurse, and her friend Vicki Browne, aged 19, died in that horrific crash. Becky Fish, the third passenger, lost a leg, and will be maimed for life. The driver was a 21-year-old barman, who was relatively unscathed and later found hiding in a shop doorway. He had no licence. In fact, he had never possessed a licence or passed his test. He had no tax and no insurance for the car. It was estimated that he was driving at 60 mph in a 30 mph zone in the middle of town, and he was almost two times over the alcohol limit. The cruel irony was that he had offered to drive the girls home as he thought that it would be safer.

On 18 March this year, the driver was sentenced to five and a half years' imprisonment on two counts of causing death by dangerous driving, driving without a licence and insurance, and drink-driving. At least he had the decency to plead guilty. He was also banned from driving for five years. I do not know what the significance of that is, given that he had no licence in the first place. Perhaps he will seek to take driving lessons while he is in jail.

In April, the family asked the Solicitor-General whether she would review the case on the basis that too lenient a sentence had been handed out. Unfortunately, the Solicitor-General declined and said that there were no grounds for doing so. The driver will be eligible to get out of prison to go for job interviews next Easter. In January 2006, he will be eligible to apply for early release and by July 2006, if he behaves himself, it is likely that he will be released, despite the seriousness of the crimes. Meanwhile, the McCabe family and the family of Vicki Browne have each lost a daughter, both of whom had everything to live for. The tragedy has overshadowed the families. To add insult to injury, the McCabe family had to pay for the funeral expenses plus VAT. They are to get a headstone on which they will also be charged VAT.

The McCabe family did not take the matter lying down. Despite their obvious grief, they decided to get up and do something about the injustice suffered by the families. They campaigned for a change in the law to include a separate penalty category for drivers without a licence who maim or kill. They contend that that should carry a similar sentence to death by dangerous driving. They also advocate a system whereby drivers are required to display a valid driving licence and insurance documents on the windscreen of their vehicle.

I support that campaign and have given the family every assistance. It culminated yesterday, which marked the first anniversary of Flo's death, with the McCabes—the parents and other members of the family—coming to Westminster to present a petition signed by more than 23,000 people from my constituency and neighbouring areas in Sussex. The petition was presented to my right hon. and learned Friend the Member for Folkestone and Hythe (Mr. Howard) and last night I presented the petition formally on the Floor of the House. The family gathered that amazing number of signatures mainly by standing outside shopping centres every weekend for most of the past year. The McCabe family also e-mailed all Members of Parliament asking them to support early-day motion 1495 on penalties for driving illegally, which I tabled back in July. So far almost 90 hon. Members have signed it, and I hope that more across the political spectrum will add their support to it. Throughout the year, the McCabe family have been campaigning under the slogan "You don't need a licence to kill".

I pay tribute to the courage and dignity of the McCabe family and to the way in which they have responded to such an enormous tragedy. However, they—and I—now want action. This is not just a constituency issue that is relevant to me; it is relevant nationwide. It is an issue that has inspired many debates in this Chamber, as it has several early-day motions and private Member's Bills. I have referred already to the hon. Member for South Dorset.

The extent of the problem is alarming. It has been estimated that 1.25 million people are driving without insurance. It has been assessed that that is 5 per cent. of all drivers. That compares with an estimate of only 1 per cent. of drivers in other northern European countries who are driving without insurance. It is also estimated that about 1.75 million drivers are driving untaxed vehicles, which is 6 per cent. of all drivers. Most worryingly though, it has been calculated that such unentitled drivers are nine times more likely to be involved in accidents and 10 times more likely to have driving convictions. It has been assessed that unlicensed drivers commit about 9.5 per cent. of all recorded motoring offences and that almost two thirds of them do not tell their passengers that they are driving illegally—as was the case with Natalie McCabe and her friends a year ago. It has also been calculated that such irresponsible behaviour adds at least £500 million to the insurance premiums of responsible drivers who are entitled to drive.

Having a road traffic accident is one thing; having a road traffic accident while under the influence of alcohol is bad enough, as it has been estimated that 6 per cent. of all accidents involve drink-driving; but not being entitled to drive and getting behind the wheel of what can be a lethal weapon, as was clearly the case that night a year ago, is completely unacceptable. It is sticking two fingers up at society, the law and responsible citizens, the majority of whom go about their business lawfully and much more safely.

This is a very important debate and I congratulate the hon. Gentleman on securing it. I wish to bring an extra dimension to our discussion and refer to the interaction between military law and civil law. I had the most ghastly experience in my constituency in which a young lady aged only 18 years lost her life in a car driven by a soldier who was serving in Palace barracks in Holywood, County Down. It transpired that that particular soldier had been disqualified months beforehand in Scotland. The Army at Palace barracks had been notified but that gentleman continued to be allowed to drive in Northern Ireland while disqualified—on duty, I understand—and while there were two warrants for his arrest. The interaction between civil and military law must be examined in respect of those who are disqualified drivers and not legally entitled to drive on our roads—on or off duty.

I am very alarmed to hear what the hon. Lady says. I cannot comment on that case, but I am sure that she will be taking it up with the relevant authorities. When there are agencies of government that could avoid such accidents, it is doubly unacceptable that they have happened.

Generally, the United Kingdom has a good safety record. In 2003, 1,169 drivers, 600 car passengers and 774 pedestrians were killed. That sounds a lot. Of course it is far too many, but it compares with a figure of about 40,000 drivers who were killed in the United States. Men are three times more likely than women to die in traffic accidents. However, just over 3.9 per cent. of all fatal or personal injury crashes involved a driver who was subsequently prosecuted for unlicensed driving, while about 14,500 drivers who caused injury or death went untraced. That figure has been increasing. In my constituency in West Sussex, 89 pedestrians were killed or seriously injured, including 23 children, and 41 cyclists died. So, there is a problem in my area and throughout the whole country, but what are the penalties?

Currently, the average fine for driving while not entitled to do so is £150 and occasionally some points. The maximum penalty is £5,000, disqualification and potentially six months in jail, but it is used very rarely. For the risk of a £150 fine, a person can buy what is virtually a disposable car. It is not a bad bet for people to drive recklessly on the basis that they do not really need the car if it is of low value anyway.

There have been some improvements, such as the merging of the DVLA database with the industry-run motor insurance computer database, so that non-insured drivers can be chased automatically. Some years ago in my constituency, PC Jeff Tooley was knocked down in Shoreham while on speed traffic control by a white van driven by somebody who did not stop. It turned out that the driver was over the limit. He was eventually apprehended, but the sentence that he received was later reduced from six years. That sentence could have been higher if he had stolen the policeman's motor car rather than knocked him down and killed him. I am glad to say that the Government have responded to that issue, and I am sure that that was one case that contributed to the weight of opinion that brought about an increase in the penalty for causing death by dangerous driving to 14 years' imprisonment, which we welcome.

There has also been greater use of automatic vehicle number plate recognition and the possibility of powers being given to traffic wardens. We welcome the greater use of technology. However, overall the number of traffic police has sharply declined in recent years and it is not viewed as a priority. There are concerns that too many people are still flouting the law. The Road Traffic (New Drivers) Act 1995 revokes the licence of a new driver who accumulates six penalty points within two years of passing the driving test, but as at April 2004, of the 78,000 drivers who have been disqualified under the 1995 Act, only 37,000—fewer than half—have successfully retested. What has happened to the other 40,000? Have they just given up driving? I very much doubt it. I fear that many of them are driving while not entitled to do so.

There has been some progress on the number of prosecutions. In 2002, there were 24,338 prosecutions for driving, or for causing or permitting another person to drive, other than in accordance with a licence. That was up from 23,482 prosecutions 10 years earlier. However, too many people are still getting away with it. I fear that the Government are not going to review penalties as they stand.

I am glad to see the report from Professor David Greenaway at Nottingham university, which identifies the scale of the problem. He recommends the greater use of technology to catch offenders before they can cause accidents. He also recommends considering the confiscation of cars, which is a policy that my party certainly supports—whether or not the car is owned by the driver. We need separate penalty categories in order to send out a clear message. The McCabes were obviously disappointed that the judge did not even use the tougher penalty from the maximum range allowed to him.

Perhaps we need to be more imaginative in sentencing too. A judge in Texas recently ruled in a fatal road rage crash that the offender must carry a photograph of the mangled wreckage from the horrendous crash that he caused; that he should take medicine that will make him violently ill if he drinks alcohol; that he must drive only vehicles of less than 130 hp; and that he must display a bumper sticker asking other motorists to ring the local probation department if he is driving recklessly. Those are quite extreme alternatives, but they are imaginative and they get to the heart of the problem.

I ask that, as part of the review I know that the Government are carrying out, they consider bringing in a separate category of offence for drivers who cause accidents while not entitled to drive, and who stick two fingers up at the rest of us, who go about our business lawfully. There should be serious penalties attached to that offence along the lines of causing death by dangerous driving.

I support all that my hon. Friend is saying. I suggest that he also ask the Minister to go on reviewing whether there should be extra penalties for drivers involved in a crash who do not stop even though they are pretty sure that someone has been injured. In the case of Callum Oakford, the late brother of Kathryn Proudfoot, in my constituency, the driver may have been driving only carelessly—he was uninsured and without a licence—but he certainly drove away knowing that an injury had been caused.

My hon. Friend makes a very important point, which I was going to finish on. I was aware of the case, which hit the headlines nationally and locally. What made that case all the worse was that not only was the person who caused the accident not entitled to drive and should not have been there in the first place, but they did not stop afterwards despite having known that someone had been knocked down and was seriously injured—he eventually died. If anything could have been done to save the life of that child, it was incumbent on the driver, however bad the accident for which he may have been responsible, to help out. The fact that he just drove on is quite outrageous and another factor that must be taken into account.

None of this will bring back Flo McCabe or Vicki Browne. However, changes along the lines that the family and I are suggesting might go some way to preventing more Flo McCabes or Vicki Brownes from losing their young lives needlessly. A change in the law would be a fitting response to the strength of feeling of those 23,000 people who signed the petition, and it would be a fitting tribute to the courage, determination and bravery shown by the family and parents of the two girls who have worked so hard on the campaign.

I begin by congratulating the hon. Member for East Worthing and Shoreham (Tim Loughton) on securing this debate on penalties for driving without entitlement. As he said, he has tabled early-day motion 1495, which has attracted signatures from hon. Members from all parties. I have learned through this debate, and through others in which I have participated with him, that he has a knack of assiduously taking the concerns and the experience of his constituents and applying them to wider issues of public policy. I congratulate him on the way in which he has done that again today. I welcome the spirit in which he mentioned the work of my hon. Friend the Member for South Dorset (Jim Knight). I am also pleased that the hon. Members for Worthing, West (Peter Bottomley) and for North Down (Lady Hermon) have been able to participate and raise issues of constituency concern to them.

I want to take the opportunity to join the hon. Member for East Worthing and Shoreham in offering my sincere condolences to the families of Natalie McCabe and Victoria Browne. As we have heard, they died so tragically just a year ago yesterday. As the hon. Gentleman explained, the driver of the car in which they were passengers was disqualified from driving; he was uninsured and was over the drink-drive and speed limits. He was sentenced to five and a half years' imprisonment on two counts of causing death by dangerous driving.

I know that the families of the victims felt that the sentence was lenient, and the hon. Gentleman referred to that. They requested that the Crown Prosecution Service consider referring the case to the Attorney-General as an unduly lenient sentence. As we have heard, that did not take place, because the sentence fell within the range of the relevant guideline. Therefore, the case was not sent on to the Court of Appeal.

I know that the hon. Gentleman will appreciate that I cannot comment on an individual case. It is, of course, a matter for magistrates and judges to sentence offenders on the facts of each case and to do so within the maximum limits that are laid down by Parliament. However, it may be helpful if I briefly make reference to the Court of Appeal guideline on causing death by dangerous driving, which was issued on 3 April 2003 and was based on the advice of the sentencing advisory panel after wide consultation. It suggests as a starting point a sentence of six years' imprisonment or more for cases involving the most serious culpability.

Hon. Members and their constituents will take their own view about the appropriateness of that guideline. As the hon. Member for East Worthing and Shoreham accepted, in this particular case account would have been taken of the driver's guilty plea and the sentence was within the maximum limit of 10 years. Although I recognise that no sentence can address the anguish of bereaved families, we have since increased the penalty for causing death by dangerous driving to 14 years. The hon. Gentleman acknowledged that. That is the highest maximum penalty for any type of offence, save the most serious, where the maximum is a life sentence. The higher maximum penalty now available might well have led to a more severe sentence in this dreadful case.

The increase arose from the concerns that were expressed during the road traffic penalties review, which reported in July 2002. It became apparent that there was a good deal of concern about the framework for the more serious bad driving offences and the adequacy of the maximum penalties in dealing with offenders who drive badly and cause death and injury on the roads. As a consequence of the review, the maximum penalty for causing death by dangerous driving was increased and the penalty for causing death by careless driving while under the influence of alcohol or drugs was also increased from 10 to 14 years. Aggravated vehicle taking where a death occurs was increased from five to 14 years' imprisonment. The new maximum penalties for those offences were introduced in the Criminal Justice Act 2003 and applied to all offences that are committed on or after 23 February.

In announcing the increased penalties for the most serious driving offences, my right hon. Friend the Home Secretary underlined our position that dangerous drivers who kill should be properly punished. The devastation that they can cause is immeasurable not only for victims' families but whole communities. Apart from the specific offences for bad driving, manslaughter can be charged in certain cases, for which the penalty is life imprisonment. For that offence the standard of proof is necessarily high in view of the penalty available. In relation to bad driving, manslaughter is not often used, but where it is charged it is mainly used where a person intended to cause harm, for example by deliberately driving into someone.

Under the Criminal Justice Act, we also introduced extended sentences and a sentence of imprisonment for public protection for specified violent offences, which can include the most serious driving offences where the court considers that the offender poses a significant risk of serious harm to the public. The reforms under the 2003 Act are designed to modernise and rebalance the criminal justice system in favour of victims, witnesses and communities.

In the debate on the clauses relating to causing death by bad driving, my right hon. Friend the Home Secretary said:

"It is very important that the voices of victims and their families should be heard. There have been the most terrible occasions on which families have been unable to come to terms with what has happened for the rest of their lives and believe that they have not been listened to and that their voices go unheeded. We need to find ways of addressing that." —[Official Report, 20 May 2003; Vol. 405, c. 876.]

This Adjournment debate is, of course, one such occasion for hearing those public concerns. I want to reassure all hon. Members present that we will take careful note of what has been said today, of the strength of public feeling caused by such tragic cases and of the issues they raise. I join the hon. Member for East Worthing and Shoreham in congratulating the McCabe family on the huge campaign that they have led over the past very sad 12 months and I congratulate the hon. Gentleman on the size of the petition that he presented yesterday to Parliament.

We have ensured that the law provides for the most severe penalties in cases where bad driving has led to a death on the road. For the offence of causing death by dangerous driving, it is necessary to prove that the standard of driving fell far below that of a reasonable and competent driver. If the manner of driving is simply lower than that which is expected, the appropriate charge will be careless driving. It is the behaviour of the driver rather than the consequences that is the deciding factor in determining the appropriate offence to charge.

Where a death has occurred it is especially important that offenders are brought to justice, but as the law stands death does not by itself turn an incident into careless driving or turn careless driving into dangerous driving. Offences such as driving without a licence or insurance are punishable with a fine, penalty points and possible disqualification from driving. The fact that a death has occurred can be taken into account by the court when sentencing, but the court will be limited by the maximum penalty available for those offences. There is no culpability for any consequences resulting from driving with no licence or insurance built into the offence. Those penalties can and do seem insignificant when, as sometimes happens, drivers go on to be involved in a fatal road incident. We fully recognise the anguish and grief of families and friends who lose loved ones in those circumstances.

I had a case in my constituency three years ago in which a 12-year-old boy, Geoffrey Foy, was killed in a road traffic accident involving a driver who had no licence or insurance and who was speeding. The offender received only a fine, which made the tragedy all the harder for the family and, indeed, the wider community to bear.

The Government take a serious view of people who drive without insurance cover. Figures show—the hon. Gentleman highlighted some of them—that antisocial drivers are 10 times more likely to have been convicted of drink-driving, six times more likely to have been convicted of driving an unsafe vehicle and three times more likely to have been convicted of driving without due care and attention. That is why we have announced a tough new approach to target the estimated 1 million motorists on our roads who drive without insurance.

The Department for Transport plans to introduce as soon as possible a provision that will enable the police to seize and, in appropriate cases, destroy a vehicle being driven by someone not fulfilling the requirement to be insured against third-party risk. Such vehicles will be released only on production of insurance documentation and payment of removal and storage charges.

Uninsured drivers add about £30 on average to the annual premium of honest motorists and are more likely to be involved in road traffic accidents, to be non-compliant with other road traffic requirements and obligations, and to be involved in other criminal activity. The hon. Gentleman mentioned the Greenaway report. I am glad that he did so. That piece of work, which was commissioned by the Department for Transport, was published in August and made 20 recommendations. The Government have accepted the majority of the recommendations and are looking at them closely to see how and when it will be possible to implement them. I will be happy to ensure that we write to the hon. Gentleman to keep him up to date on that.

The Government are also increasing police powers to use new technology in order to make detection and enforcement more effective. A powerful new tool—again, the hon. Gentleman mentioned this—is the extended use by the police of automatic number plate recognition, or ANPR. It enables the police easily and immediately to check passing vehicles against entries on the police national computer and other databases. They can then take action as appropriate in respect of drivers who may be of interest for some offence, including that of having no insurance.

To make the use of ANPR even more effective for tackling the offence, the Government have introduced a fixed penalty of £200 as an alternative to prosecution. It is much higher than other fixed penalties and enables the police to enforce the offence on the spot, at the roadside, with an immediate impact on the offender. Of course, the police still retain the discretion to seek a prosecution if they consider that to be the more appropriate course of action, and prosecution is automatic if action is taken in respect of a second or subsequent offence.

The use of ANPR is resulting in much more rigorous enforcement, with more offenders being caught and dealt with. As ANPR usage develops further, motorists will find it increasingly difficult to drive uninsured vehicles without their being detected. Detection will largely be automatic and will no longer require the time and vigilance of individual police officers.

We plan to legislate at an early opportunity to strengthen enforcement still further by improving the information available from ANPR. To assist enforcement, the Government fully supported the Association of British Insurers in the setting up of the motor insurance database, which went live in July 2001. The database makes checking insurance a much simpler and more effective operation by giving police officers immediate access to information about insurance policies at the roadside. Police inquiries to the database are running at about 25,000 a day.

Finally, I want to mention the current review of all bad driving offences that is being led by the Home Office. We must ensure that the criminal law provides a comprehensive and clear framework for addressing bad driving and its all too often appalling consequences. We are aware of the strength of feeling generated by difficult cases such as the one outlined by the hon. Gentleman. The review will be followed by a public consultation exercise, and we shall listen carefully to all responses to the consultation paper on this area of the law. Work is ongoing on the detail of the paper, which will be published as soon as possible. I am sure that the hon. Gentleman and others present today will contribute to that consultation as and when they are able to do so.

I welcome the opportunity to have this debate. I am proud and privileged to represent what is probably—arguably, certainly—the most beautiful constituency in the country. It has six lakes, including Loweswater, Crummock, Buttermere, Bassenthwaite, Derwentwater and Thirlmere, and some of the highest mountains in England, including Skiddaw and the foothills of Helvellyn. Artists and poets, for example Wordsworth, have spent time waxing lyrical about the beauties of the area.

It is not just the lakes. The Solway coast is also spectacularly beautiful. It has fantastic sunsets. One can stand on the coast and look at the Scottish mountains across the firth and turn round and look at the English mountains on the other side. We have one of the few sites where there are red squirrels and the only two breeding ospreys anywhere in England. There is a world heritage site just to the north at Hadrian's wall. The Lake District national park has also applied for world heritage designation. So I hope that hon. Members realise that we are talking about one of the most beautiful places not only in this country, but in the world.

The coastal scenery that I mentioned also includes nationally designated areas of outstanding natural beauty. There are areas of special scientific interest running along the coast. It is that beauty that brings more than 2.5 million visitors a year to that area alone. Those visitors support about 5,000 jobs and bring about £209 million into the local economy. It is a spectacular area and tourism is being developed not only because of the Lake district, but because of the beauty of the coastal strip.

So people are surprised that, at a time when we are trying to develop tourism—there are brand new big brown signs saying, "Welcome to Cumbria" and so on—there are so many planning applications for wind turbines. Many of the sites are close to the national park, and many others are close to, if not part of, areas of outstanding natural beauty. It is not as though we do not have wind turbines already. In a 3 km radius from my hometown, Workington, there are about 36 wind turbines. That is a fair number in a relatively small area. As I said, constituents find it difficult to match the idea of tourism development and economic regeneration with wind turbines sprouting up along the coastline.

Thus far, the only guidance that we have, or seem to have, is planning policy statement 22, published in August 2004. Taken in isolation, that does not provide the clarity that is required. A policy vacuum exists in which local planners are asked to operate without the tools required to do their job properly. I think that the Department acknowledges that. What we are asking for, and what I hope is being developed for publication soon, is a set of guidelines that sits alongside that policy document.

I have other comments on that issue. PPS22 fails to acknowledge the necessity for buffer zones. If we simply acknowledge that the Lake District national park and areas of outstanding natural beauty need to be protected, we could still end up with a ring of wind turbines around the national park. In those terms, that would be okay, because those turbines would not be in the national park. Is anyone going to tell me that, if they were to walk up Sca Fell or Scafell Pike, or climb Great Gable or Red Pike, seeing wind turbines between them and the sea—or, when on the coast, seeing wind turbines between them and the Lake district—would not have a detrimental effect on the area and on its value as a tourist attraction? I think that about 45 per cent. of all jobs in Cumbria involve the tourist industry and up to 15 million tourists come to that part of the world every year.

There has also been no mention from central Government of area-based targets. I am proud that the UK is leading the world on Kyoto, but why do we not break down the treaty targets for renewable energy production into manageable chunks for different geographical areas? Failure to do so may leave areas such as my constituency, which has an obvious abundance of hills and wind, exposed to the actions of a series of power companies, which will say, "This is a nice area. Let's stick up some wind turbines."

We all recognise that we should encourage renewable energy. This country's chief scientific adviser has said that climate change is probably a greater danger to the planet than terrorism. We must heed that warning and ensure that we continue our policy of developing renewable energy. Having placed my support for renewables clearly on the record, however, I want to draw attention to a number of other issues.

If we get this wrong and start to put up wind turbines in inappropriate places—there are planning applications with Allerdale borough council, which covers my area, for turbines in very unsuitable areas—people will be turned against the concept of renewables and wind turbines in particular. In the rush to get turbines going because we must meet certain targets, if we put them in the wrong place, people will say, "They are horrible, hideous and terrible, and we do not want them at any cost." That would cause great damage to the renewable energy debate and we should avoid it.

That turn-off effect would be most profound in the areas that suffer most greatly from environmental degradation caused by badly planned wind turbine development, such as my constituency. The irony is that in my constituency, which has a proud industrial heritage, construction of wind turbines seems a forward-thinking way of carrying forward that industrial heritage, but as yet, we see no benefit to the area.

I have made clear the grave consequences of badly thought-out development, and I want to return to my earlier theme of the guidance that I want from the Government and the Office of the Deputy Prime Minister and how badly planned development can be avoided.

I have already discussed the need for area-based renewable energy targets. I believe that such a system operates successfully in Wales. I argue that that is an example of how devolved government can, first, provide policy solutions better tailored to local needs and, secondly, act as a catalyst for policy improvement elsewhere. I mean quite simply that those in Wales are doing it and it is working for them, so why cannot England have it?

In a situation of this complexity, local feeling is running extremely high. A planning application was turned down by Allerdale planning authority last week or the week before. Hundreds of people turned up at the planning meeting. When the industry is inexperienced and seems at times to be champing at the bit to extend production and the Government are rightly eager to maximise renewable energy production, the policy vacuum needs to be filled as soon as possible. Planning decisions are rightly taken by democratically elected local representatives who are in touch with the needs of the locality, but the parameters of action must be decided centrally, and I hope that that will soon be the case for wind turbines.

Housing is a local level policy area and the local authority develops its own plan for where houses should go and so on. Search areas are another aspect that we should look at. I make that remark because a group of people came to see me which, like all such groups, started by saying, "We are not against renewable energy or wind turbines, but . . . " Basically, those people were talking about planners being given the right, duty and obligation to sit down and decide with the local community where the best sites were. There are brownfield sites, industrial sites and other sites that currently exist where local people may give acceptance. There is no problem with those sites, but it is this attitude of "No, no; we can't have search areas or say where companies should come and place wind turbines" that is the problem. We simply allow companies to put in a planning application, and as I said, a couple of developments have damaged the image of wind turbines in a great stretch of my constituency because they are totally inappropriate.

My other fear relates to the inspectorate. I would like to see a great deal more consistency concerning the inspectors. When two applications were made not too long ago, one inspector said, "This area has high ground, it is an area of natural beauty. We don't want wind turbines there." Another inspector came along to a different site and said, "It is on high ground, and it is an area of natural beauty. The wind turbines will enhance the geography of the area." Hang on—we cannot have both views. Such subjective views create the fear that, regardless of what local councils decide, an inspector will come from London, Bristol or somewhere and say, "We've considered the matter, but the Government want as many wind farms as possible, so one will be allowed." We cannot accept that position.

Just to prove that I am in favour of renewables, I point out that I wish that we could develop more offshore wind turbines. One site is being constructed at the moment a few miles away from the coast of my constituency. It has raised some controversy, but I would pose the following questions to you. This particular site, Robin Rigg, is in Scottish waters, but the electricity will come ashore in my constituency at a small village called Flimby. Whose electricity is it? Is it Scottish or English? Who gets the credit for it: Scotland or us?

Order. I think that I am the wrong Chairman to answer that question.

Those questions are an interesting point when we are considering the matter of targets.

I would like to conclude so that the Minister has ample time to answer. I took part in a Radio Cumbria interview last night on the issue of wind turbines in the area. The gentleman interviewing me started by saying, "Mr. Cunningham, all this is really about is common sense, isn't it?" He is right. It is only about common sense, and if we can have a common-sense approach where we designate areas appropriate for wind turbines, we shall have renewable energy, but be able to protect areas of outstanding natural beauty, areas of special scientific interest and areas that are special as far as wildlife and archaeology are concerned. I hope to hear from the Minister that there will be a common-sense approach and that we shall have that balance, so we can make some progress.

I am grateful to my hon. Friend the Member for Workington (Tony Cunningham) for raising the issue of planning for wind farms in his constituency. I know that it is a matter of considerable interest to his constituents and to people in many parts of the country. He has spoken eloquently this afternoon about the concerns of his constituents and has put his case very powerfully, which is a credit to him in his role as constituency MP.

I would just like to make a point about the area that I am at liberty to cover. We know that wind farms might be located both onshore and offshore, but the planning system deals only with onshore sites. I shall say something later about my hon. Friend's point concerning the offshore site providing electricity that arrives on his shore. The development of wind farms offshore as a technical point is a matter for the Department of Trade and Industry rather than the Office of the Deputy Prime Minister.

I would like to stand back from the detail of the specifics of wind farms in my hon. Friend's constituency and paint a broader picture of the policy background to the debate. I was glad to hear him say at the beginning of his contribution that it is important that we do what we can to reduce carbon dioxide emissions and maintain reliable and competitive energy supplies. The development of renewable energy, plus improvement in energy efficiency and the development of combined heat and power, will make a vital contribution to the aims that we both share.

The energy White Paper "Our energy future—creating a low carbon economy" sets a target to generate 10 per cent. of the country's electricity from renewable energy sources by 2010 and to double that figure to 20 per cent. by 2020. It suggests that more renewable energy will be needed beyond that if we are to meet the aim of cutting carbon dioxide emissions by 60 per cent. by 2050. We have a shared agreement on that ambition because of the importance of climate change and the impact of global warming.

I am pleased that the Minister mentioned energy conservation. A constituent of mine said recently that if every household in my constituency were given energy-saving bulbs, more electricity would be conserved than would be generated by hundreds of wind farms. I am not sure of the science, but I hope that point emphasises that energy conservation is as important as creating more electricity.

I am not able to confirm the details of statistics concerning light bulbs, but it is absolutely right to say that the way we will arrive at a successful, sustainable energy efficiency policy regarding carbon dioxide emissions will be based on a combination of activities, one of which is energy efficiency.

In the Office of the Deputy Prime Minister we have responsibility for the decent homes standard, which is improving the quality of thermal comfort and aiding energy efficiency. I am also the Minister responsible for putting in place building regulations for new build and existing building stock, so we can bear down on building regulations to reduce the carbon output of building. My hon. Friend is right to suggest that there is more than one way to do this, but it is the combination of factors that add up to the ambitious target that I was describing earlier.

On renewable energy in particular—I will deal with wind farms in a moment—as my hon. Friend rightly pointed out, we made it clear in planning policy statement 22, which we published in August, that increased development of renewable energy resources is a vital part of the target achievement if we are to deliver on the commitment on climate change and renewable energy. Positive planning, as well as common sense, which facilitates renewable energy developments, can contribute to all four elements of our renewable energy strategy.

So that we see this in context, I will outline the four elements to the renewable energy strategy. First is social progress, which my hon. Friend has just described. It means contributing to energy needs, ensuring all homes are adequately and affordably heated and providing new sources of energy in remote areas. Secondly, effective environmental protection is achieved by reducing emissions of greenhouse gases and thereby helping to limit the effects of climate change. Third is the prudent use of resources and reducing reliance on diminishing supplies of fossil fuels. Fourthly, economic growth and employment can be delivered through the creation of jobs directly related to specific developments and the development of new technologies. My hon. Friend mentioned that that is one of the benefits of the new technologies, including wind turbines and much else. They are bringing jobs to this country as we invest in the ability of manufacturing to produce new forms of technology.

I also stress that although we are debating wind farms, renewable energy covers other important sources of energy such as water flow, tides, the sun and biomass. Wind energy has a very important contribution to make in meeting the Government's targets, but other renewable energy strategies and technologies have a part to play, too. We believe most strongly that renewable energy developments are capable of being accommodated throughout the country where the technology is viable and where environmental, social and economic impacts can be addressed satisfactorily. The crux is to look at all three of those and see how they work.

As for wind farms, I am sure my hon. Friend will understand that I cannot comment on the merits of any particular proposal for a wind farm which is the subject of planning applications by Allerdale borough council, or anybody else, because of the quasi-judicial role that we in the ODPM play. However, I am aware of his concerns. If an application is rejected by a local planning authority, it is for the applicants to consider whether to exercise right of appeal to the Deputy Prime Minister, which takes me on to the point about inspectors and how that system works.

My hon. Friend raised a particular concern about consistency. Let me emphasise that, in determining appeals, planning inspectors act in a quasi-judicial role. They do so under delegated powers for the Deputy Prime Minister. I believe that the integrity, impartiality and fairness with which each appeal is handled are widely acknowledged, although I have heard my hon. Friend's points loud and clear. I assure him that the planning inspectorate has a well-developed training programme whereby inspectors are kept fully abreast of national policy development. However, it is of course for individual inspectors to weigh all the evidence presented by the parties in respect of any particular appeal before reaching a decision to allow or dismiss that appeal. Importantly, each case must be determined—that is the legal framework—on its individual merits. However, in doing so, inspectors take into account planning guidance.

PPS22 on renewable energy makes it clear that we want to work with regional and local bodies to deliver the Government's objectives around renewable energy. Therefore, regional and local plans should contain policies designed to promote and encourage, rather than to restrict, the development of renewable energy resources. The current published regional planning guidance—we now call it a regional spatial strategy or an RSS because the jargon changes—is the subject of a partial review. I was not sure whether my hon. Friend was aware of that.

The draft revision has been published by the North West regional assembly for public consultation, and it will be debated at an examination in public in November. The Deputy Prime Minister will consider the proposals contained in that draft in the light of the report on that examination in public and other representations he has received, and he will then publish his decision in due course.

Importantly, the published draft proposes targets for the region and for sub-regional areas. It proposes that Cumbria comprises a sub-region and a target for the county, and it also sets targets for other parts of the region. The critical point is that it sets out a number of criteria-based policies against which proposed wind farm developments might be assessed. This is an important part of the process. My hon. Friend's Adjournment debate is timely: the consultation period on the draft review ended in July so it is too late to make representations on that, but it is open to interested parties—which might include himself or others who have been making representations to him—to submit a short written statement to the panel conducting the examination in public by 1 November on any of the issues that it has been asked to address. That list of issues is being publicised this week and it includes a number of questions about policies relating to renewable energy, so there is an opportunity for my hon. Friend and those whom he is seeking to represent to put their case.

My hon. Friend eloquently described the beauty of his consistency. I know it well; I have walked those hills and dales on many occasions. He is lucky, but other MPs might want to challenge his assertion that it is the most beautiful constituency in the country. I would not make that claim for Corby, but other constituencies might want to vie for that title. However, he is right to say that many parts of his constituency are subject to being nationally and internationally designated areas: they include the Solway firth area of natural beauty, the Hadrian's wall military zone world heritage site and the Lake District national park, which is also proposed as a world heritage site.

The Government's advice on the handling of planning applications where the development proposed might affect internationally or nationally designated sites is clearly set out in PPS22. Generally speaking, proposals for renewable energy development need to be considered carefully in such areas of national or international importance for landscape and for nature conservation and wildlife, and they should be granted planning permission only where the criteria set out in PPS22 and other guidance and legislation are met.

My hon. Friend mentioned red squirrels and other forms of wildlife that are almost exclusive to his constituency. In assessing any proposals put to councils that might affect a designated site, local planning authorities should have regard to the more detailed guidance in respect of European nature conservation sites currently set out in planning policy guidance 9 on nature conservation. That provides guidance on how the Government's policies for the conservation of our natural heritage are to be reflected in planning.

For internationally designated sites, planning permission for renewable energy developments likely to have an adverse impact on the site should be granted only once an assessment has shown that the integrity of the site would not be adversely affected. If the development would have an adverse impact, it should be allowed only very exceptionally. Similar considerations apply to nationally designated sites, so the key issue is to seek to ensure that the qualities for which an area has been designated will not be compromised.

The point that I was trying to make—I touched on it when I mentioned buffer zones—is that we can protect the site, but if we put wind turbines all around it, the effect is that the area is blighted, regardless of the fact that the wind turbines are not on it. On PPS22, I think I am accurate in saying that, strictly speaking, the policy protects the green belt around certain areas in a more stringent way than it does areas of outstanding natural beauty. Surely that is wrong.

I was coming specifically to that point. With regard to land adjacent to the boundaries of particular designated sites, I regret to have to tell my hon. Friend that it is our view that local authorities should not seek to introduce buffer zones. We do not want lines on maps showing, for example, that no wind farms would be permitted within 10 km or 20 km, or some other distance, of the boundary of a national park. However, that does not leave things in the situation that he described. Instead of taking the approach that he is promoting, we believe that it is for the local planning authorities to introduce, through their local development plan—this is the critical point in the planning process—appropriate criteria-based policies against which they and prospective developers making planning applications might assess the suitability or otherwise of specific sites.

Around and indeed within nationally designated sites, some areas of land will of course be more sensitive than others to change that might impact on the designated area, so the development plan should provide the tools to help to identify those areas. The local authorities for those areas can address the type of concern that my hon. Friend puts forward through the local development plan and the criteria-based policies within it.

Let me stress that PPS22 sets out firm policies to ensure that our most valued landscapes, such as national parks, and our most environmentally sensitive areas are protected from large-scale renewable energy developments that have detrimental impacts. It has been said, and we must recognise, that some smaller-scale renewable energy developments can be accommodated in such areas without serious environmental detriment to those areas, but again we look to the local planning authorities, through their local development plan, to ensure that the right criteria-based policies are put in place to secure the right results.

I want to mention the companion guide to which my hon. Friend referred. PPS22 moves on from the old PPG system. It is designed to be a short and succinct statement of the Government's policies on renewable energy. It is not a catalogue of policies and guidance. Instead, we are producing in addition a companion guide to PPS22 that will provide more detailed descriptions of different technologies, as well as examples of good practice in development plans and developments. That has been produced through consultation. It will be published in the very near future, and I believe that it will provide the kind of help and support that my hon. Friend sought in his contribution. It will be a valuable tool.

To sum up, we are firmly of the view that the development of renewable energy, including the harnessing of wind energy, has an important part to play in reducing carbon dioxide emissions. We believe it right to support and encourage the development of wind farms, but we must do so in a way that is subject to the environmental, social and economic impacts being addressed satisfactorily. I congratulate my hon. Friend on bringing the issue to the attention of the Chamber today, and I urge him and his colleagues to consider the examination in public of the regional spatial strategy as a further approach that he might take in pursuing his aims.

Question put and agreed to.

Adjourned accordingly at half-past Four o'clock.