I am grateful to Mr. Speaker for granting me this debate on an important issue, not only for me, my constituents and neighbours, but many hon. Members—as can be seen by their attendance in the Chamber this morning. I welcome the Under-Secretary of State for Transport, the hon. Member for Regent's Park and Kensington, North (Ms Buck), to her new ministerial responsibility. I have a feeling that she will know more about aviation in the next few months than she ever dreamed possible. It is not exactly the best portfolio at this time, but I am sure that it will be challenging and a position in which she can make some brave and courageous decisions, which we shall welcome.

I want to start by talking about aviation in the south-east with particular reference to Heathrow. A couple of weeks ago, the master plan—almost a plan of the same cunning variety as that employed by Baldrick in the television series "Blackadder"—was published by the BAA and we now know more about what we suspected was the case. It allows for a third runway and a sixth terminal—a fact that was, interestingly, denied at most levels of discussion. Although I do not know too much about such matters, I believe that anyone with a degree of common sense would understand that a third runway would require a sixth terminal. The runway would not simply be an additional runway; the plans show that what amounts to another airport, of some size, will be deposited on the existing airport, so when people who do not understand the position consider matters and say that a third runway is needed, the fact that the plans show an additional airport is a great worry.

Those of us who are lucky enough to live in what was rural Middlesex in the borough of Hillingdon have lived for many years with the threat and the benefits of Heathrow and it would be unfair of me not to point out that Heathrow has brought jobs and benefits to the local economy. It has also brought disadvantages—not only pollution and congestion, which I shall discuss later, but a polarisation of our economy into one particular industry. Not long ago, just after the 9/11 outrage, various Members of Parliament from the Heathrow area had to ask the Prime Minister to consider helping the aviation industry. Just as in times past some places were devastated when, for example, coal mining was hit suddenly, a whole area could be devastated. One of my economic arguments for not increasing capacity and development at Heathrow is that we do not want all our eggs in one basket.

I return to the master plan. It suggests that, initially, at least 700 homes should be destroyed. I believe that the number will be greater than that, because anyone who knows about pollution levels will realise that many more homes, including many in my constituency in West Drayton, particularly on the Wise Lane estate, will not be habitable because they will fall under the permissible levels of habitation because of the amount of pollution.

I have paid tribute to the Minister before and I do so again now. I have listened to her talking about housing in London in this debating chamber. It does not take a great expert to work out that if at least 700 homes are destroyed, not to mention schools, while we are expecting more jobs to be created—that is the argument that is advanced—there will be an increased need for homes in an area where we already desperately need more affordable housing. Destroying those homes will only create more problems. Most of the people affected frankly do not know what to do, because they will have to move right away from the area. The irony is that the destruction is of nothing but villages; a lot of people would not realise that they are still villages, but they are.

The villages of Sipson, Harlington and Harmondsworth are in the constituency of my good friend the hon. Member for Hayes and Harlington (John McDonnell). He may not be my hon. Friend as far as party politics goes, but on this subject, as on so many others, I would describe him as an hon. Friend, because we fight together to try to ensure that our constituents are not threatened, and their lives are not ruined, by such development. He apologises to you, Mr. Cook, and to me for not being able to take part in today's debate; he would dearly love to, but unfortunately he has a long-standing engagement to open a new educational facility in his constituency. However, he has arranged a meeting with the Minister, who has very kindly agreed to meet representatives, so she will shortly hear another episode in this ongoing saga.

I mentioned the schools because last week we had a protest meeting of the villages to try to galvanise us into deciding what is the best action to take. It took place in one of the schools—in fact, in the school most immediately threatened with closure. As we sit here now, many children are happily going about their normal affairs at school, while there is the threat that their community, and even their school, will soon no longer be in existence. In today's world, that is no longer acceptable. It might have been acceptable in the era of the Stalinist dictatorships in eastern Europe, or in China, where vast Government plans meant the forced moving-out of people. But we are not in that country; we now have more human rights than ever before, and such a proposal is not acceptable.

It is also true to say that this threat goes on over generations. Unfortunately, the decision cannot be taken immediately; it is not like the structure of the Olympic bid, which will allow us to know quite soon whether we have won. This threat will hang around for years and years. There is nothing that we can do, unless the Government take a different view on expansion of aviation in the south-east. People do not know what to do. They cannot move as they cannot sell their houses for an adequate price, and they do not know where their children will be educated. From that point of view, the situation is totally unacceptable.

Many of us believe that the expansion will not be able to take place because of the increased pollution. It is already known that levels of pollution around the airport are unacceptable under EU limits. We are assured from time to time that these things are being considered and will be sorted out, so I would like to say at the start that my constituents, and those of many other hon. Members, will want to be assured, in today's rather cynical world, that the monitoring of those air quality levels will be done in a fair way that reflects what is happening. I am afraid that, over the years, I have seen traffic monitoring done on a Sunday afternoon in summer, and have then been told that not much traffic goes down that road. I am not accusing anyone of anything in particular, but we want to make sure that the monitoring of something as fundamental as the air that we breathe is done appropriately and fairly, and that the people in my constituency understand that. The same goes for noise, and I can see hon. Friends present for whom noise is also a big issue; they may be lucky enough to catch your eye later, Mr. Cook.

I do not know what the situation is at Heathrow, but around Gatwick the cost of air quality monitoring falls on local council tax payers. The cost is more than £100,000 a year to Reigate and Banstead borough council. Does my hon. Friend not think that in that case, as in all others, the polluter should pay?

My hon. Friend, who during the previous Parliament was Chairman of the influential Environmental Audit Committee—hopefully he will be again—is right. It is unfair for my constituents and council tax payers, and those of so many others, to pay to ensure that the monitoring is done appropriately.

Given the self-evident fact that it is the noise of an aircraft on the ground that hits the eardrums of residents, disturbs them and causes stress and lack of sleep, does my hon. Friend think that it might be sensible to recognise the actual noise of an aircraft on the ground, rather than the theoretical noise that it makes in the factories when it is being manufactured?

My hon. Friend is right. I welcome him to this campaign.

I served on the Transport Committee in the previous Parliament. Subsequent information has shown that schoolchildren's education suffers badly as a result of aircraft noise, as opposed to traffic noise. The problem affects a wide area. Unfortunately, residents from many areas, who will be badly affected, do not understand how serious the expansion and the third runway will be for the quality of their lives. It will affect a huge area, which stretches into London and outside London, as reflected by the number of my hon. Friends who are present.

Sometimes we are accused of nimbyism. We do not want this proposal, and most people understand why, but I also do not want it dumped on any other area if it is unacceptable at Heathrow.

I do not think that it is a question of nimbyism; we are saying that the load should be spread more fairly around the country. Is it right that 65 per cent. of the flights go out of the south-east and that we are talking about a model that will encourage people from the north of England to travel down our clogged roads to the south-east to take their cheap holiday flights abroad? Surely, we ought to have a model in which the north of England has its own flights.

I accept that argument. The situation is unfair for the south-east and for those living away from the south-east. I will go on in a short while, although I will not go on for a long while, to point out that we must take great consideration of where aviation is going generally.

I am not here today to say that it would be better to put extra runways at Stansted or Gatwick—far from it. There should be no further expansion of aviation in the south-east until we recognise what we are doing to our atmosphere and environment, and, without getting overdramatic, to our planet.

Climate change, as we know and as the Prime Minister has acknowledged, is the most pressing environmental issue facing our world today. One of the Government's advisers said that it is more threatening than terrorism. We should all recognise that, although climate change is not as immediate, which is one of the problems; we do not see it face to face, although funnily enough increasingly on our television screens we see extremes of climate occurring. We saw the flash floods in the north—in Yorkshire—just this weekend. Although we are sometimes told that we are alarmist, I am becoming increasingly concerned about what we are doing. Most people acknowledge that climate change is happening, but Governments and citizens must take note of what they are doing themselves to cut emissions of carbon dioxide and other greenhouse gases. Aviation is undoubtedly a rapidly growing industry. It is also the fastest-growing source of climate change emissions. We have to tackle that.

I have seen a report that was produced for Friends of the Earth, but it was researched by the Tyndall Centre for Climate Change Research. A lot of hon. Members were at the presentation. We would agree that the evidence is pretty compelling. In 2050, if aviation is allowed to carry on at the present rate, in order to meet the targets that have been set we would not be able to produce any other emissions—none from our homes, and we would not be able to drive.

As the Minister will be aware, there has been talk of road charging, to cut down congestion. Interestingly, yesterday, the rail operating bodies were talking about trying to limit the number of people on trains at certain times of the day. But aviation seems to be allowed to carry on and on regardless. That is not acceptable. I am not going to say that we should suddenly impose such heavy taxes or punishment on people wanting to travel that only the rich can afford to, but we have to curb the growth. We should not be making it any cheaper.

One of the Minister's predecessors, admittedly in an interregnum between ministerial jobs, said words that he might now regret—although I do not think he does, because he is again on the Back Benches. He said that cheap air travel is not a human right. Air travel is not a human right when it not only causes untold misery for thousands of people, but is also destroying our planet.

I say to the Minister, please look at the whole issue. It is time to look at the White Paper again. We cannot go on in this way. Yes, we can destroy 700 homes eventually. Why not? It is only 700 homes, they will go somewhere else. But it will not be the end. Only recently in the Heathrow area, when the fifth terminal went ahead, the people at BAA said, "We do not want a third runway." Months later, they want a third runway. "We do not need a sixth terminal", they said. Now there are plans for a sixth terminal. Where will it end?

Perhaps we should be honest. The borough of Hillingdon should be taken off the map and made into one vast airport. Perhaps that is the answer.

My hon. Friend has made a passionate case on behalf of Hillingdon residents. As a fellow Hillingdon MP, I wholly endorse his position, but will he help me to reconcile one aspect of this debate, which is the Government's apparent support for a third runway at Heathrow? Also, the aspiration of the Ministry of Defence is that RAF Northolt, in my constituency, should become

"A 'core' site for the delivery of military outputs within Greater London,"

and that is supported by the redevelopment of the site. However, my hon. Friend may recall that in 2003, during his time on the Transport Committee, the Government's view was clear. I quote from the answer to his own written parliamentary question:

"We believe that a third runway would preclude flying activity at RAF Northolt."—[Official Report, 3 June 2003; Vol. 406, c. 293W.]

Does this sound like joined-up government?

I thank my hon. Friend. It is true that there are plenty more knock-on effects of a third runway. I do not think that the Government for one minute would want to lose the capacity to fly out of Northolt. After that particular question and a little publicity, the Ministry of Defence was spoken to and there was a slight reining back, but I think that that was the view.

Finally, given the number of people in this country who are increasingly aware of climate change and all the problems being caused, we ask the Government to give the matter consideration. We are a bit suspicious, because an organisation called Future Heathrow, headed by Lord Soley, is very much in favour of development at the airport. It was interesting that the Secretary of State was present at the recent launch. That sends a bad message. As I said during a debate on the Natural Environment and Rural Communities Bill, a degree of even-handedness would be a good idea; that is all that my constituents want from this Government. They want them to take this issue as seriously as it deserves.

rose—

Order. It will be to the benefit of the Chamber if I remind hon. Members that the convention is to start the first of the three winding-up speeches 30 minutes before the debate's conclusion. That means that Back-Bench contributions must be completed by 10.30 at the latest. Hon. Members can see how much time is now left and that Members have risen to speak; I have caught sight of four.

I congratulate the hon. Member for Uxbridge (Mr. Randall) on raising one of the most important issues facing us in the south-east. That issue is a big contributor, both good and bad, to our quality of life.

I am the Member of Parliament for Crawley, and Gatwick airport is wholly within my constituency. However, that is not half the story; airports have an impact not only locally and nationally, but internationally. I firmly believe that, as representatives, we Members have a responsibility to ensure that we consider all such issues and take them into account when we adopt views about airport expansion, ground transport and environmental issues, and I have attempted to do that.

My history with Gatwick airport goes back a long while. I moved to Crawley as a small baby. As a child, I remember listening, in bed just a couple of miles from the airport, to screaming BAC 111 jets taking off at all hours, and I remember how our whole environment was ruined by what was, at the time, disgraceful noise. At that time, the numbers of people who went through the airport were only a fraction of what they are now. That is why I have always maintained an interest not only in our local environment, but in the airport's impact on the wider community of Crawley.

When I joined the local authority, I was placed on the Gatwick airport consultative committee to take a proper look at what was happening at Gatwick. I was looking at expansion, which, of course, has gone on for many years, and I tried to give a reasonable response to it. I remember well, in the late '80s, setting up a noise line for local residents to ring because the appalling Department for Transport line, set up by the Conservative Government of the time, often was not even functioning, so when people telephoned they could not get through to anyone. It was important that people had the right to complain.

I absolutely agree that residents should have better noise monitoring and ability to report noise. In Putney, residents are asked to phone a hotline at the moment, which at 4.30 am when they are woken up by night flights generally just takes messages and is an incredibly frustrating experience for them. Does not the hon. Lady agree that they should be able to talk to a real person and should not have to be relied on to report excessive noise that should be monitored in the first place by the airports?

I ensure that people are able to speak to a real person around Gatwick, although it might not be at 4.30 am. I have taken a particular interest in that matter in my patch. If I have a constituent who is complaining consistently, or has genuine concerns about noise, I take it upon myself to go with them into the airport, where we look together at the noise mapping and the routing of aircraft and decide whether they have a relevant and real concern and address it in that way. If there is a concern, it can go to a noise and track-keeping group at Gatwick that considers those issues. I hope that the hon. Lady finds that helpful.

As I said, my involvement at airports is not new. I have attempted, over the years, not just to take an oppositionist view, because Gatwick airport employs 36,000 people, on and off. It has always been my contention that no matter how we look at expansion and other issues, we have to ask whether 36,000 people living in Crawley and the wider area would have no interest in environmental issues and no concern about the air that they and their families are breathing, just because they happen to be associated with the airport. Of course, that is not the case. In fact, on the many occasions when the local trade unionists have become involved they have been much more in favour of expansion than I. I would want only to see a close parallel runway at Gatwick if ever that were on the table—it is not—and they are keen on expansion because of the jobs. That is the important matter for them. If we disregard the views of people who live, work and achieve their quality of life through tremendous job opportunities in the south-east, we are not having a proper debate.

It is important that we bring people together. In 2002, before any of the White Papers were published, I brought together all the major stakeholders around Gatwick and had an e-consultation and a series of meetings in the town to talk to people. Of course, there were opposing views. Some were fiercely in favour of large-scale expansion at Gatwick and others were absolutely opposed to expansion. We have an active group, called the One's Enough Campaign, which wants to ensure that Gatwick remains a single-runway airport. In many ways I share their views. If we were to sit down as Members of Parliament, stakeholders and objectors in our communities, there would be much to bring us together. We all want to see airports maximised to their best ability; we do not want to see expansion for expansion's sake; and we want to ensure that we are making the best use of the runways that we have. The White Paper is clear that we should ensure that we are maximising the use of our existing airports.

The hon. Lady has said twice that we ought to be maximising the use of our airports. Every Member of Parliament with an airport interest reflects and shares the views that have been expressed in environmental terms about noise, particularly night flying. However, does not she think it a shame that when the Secretary of State introduced the consultation document in the House, he effectively dismissed the regional airports, some of which, like Manston in Kent, are trying to develop and could make a major contribution to alleviating the pressure on the other major airports? The Secretary of State paid no attention to that at all; he dismissed it out of hand.

I thank the hon. Gentleman for his intervention, but I do not believe that the Secretary of State dismissed it. I know of hon. Members who have been campaigning for expansion of airports such as Finningley, and it looks as though their aims and objectives will be achieved.

I understand the difficulty in and around the south-east. We have two world-class airports and, frankly, a printout of the pattern of flights over the south-east looks like knitting to me. It is perfectly obvious that we are constrained, and that there are difficulties to overcome. That does not mean to say, however, that they are insurmountable. They may preclude us from using some of the smaller airports. We have the same debate in and around Gatwick, and I know that hon. Members who represent those areas will know that Redhill aerodrome was making a real play to be one of those regional airports. In fact, that would cause enormous difficulty for the two major players.

Can the hon. Lady confirm that that proposal is widely regarded as utterly farcical?

I certainly confirm that it was utterly farcical. None the less, the application was made, considered and rejected with good reason.

As to how we tackle the environmental issues, it is no good having weasel words about worrying about the environment, and saying, "Of course, all my constituents must be allowed to fly" at the same time. We have to be much more robust in our arguments about facing the benefits of airports.

I take issue with the remarks of the hon. Member for Uxbridge about employment and being what is called a one-horse town. Recently, Sussex Enterprise undertook a survey of the many businesses in and around Gatwick and the south-east. We are extremely fortunate in the range of businesses that we have, particularly in Crawley.

Will the hon. Lady give way?

Would the hon. Gentleman mind if I finished the point?

Order. I am somewhat concerned that some of the contributions and remarks are being addressed away from the Chair. For the occupant of the Chair to be able to see that affairs are conducted within rule and in order, the Chair has to be able to hear what is being said. Therefore, it does not help to have remarks addressed away from the Chair, or sotto voce. So please: to the Chair, through the Chair, at all times.

Thank you, Mr. Cook. I thank the hon. Member for Uxbridge for his intervention, and would like to finish the point that I was attempting to make.

In that survey, it was very clear that companies locate in and around Gatwick because their business is related to Europe or the United States and they need access to air transport. It is obvious that what is needed is an integrated transport system that allows business to thrive. Airports therefore have a positive impact on the business community within a region, not a negative one as was felt before.

I now address some of the other difficult matters that we have to face. Environmental matters, both locally and nationally, are vital to the future of the south-east economy. We know that we are under pressure in the south-east for reasons that we understand: global warming, emissions, pollution, asthma and the ill-health of young children.

Does the hon. Lady accept that, with the projected expansion in air travel—not only in the south-east, but throughout the country—it will be virtually impossible to meet the 2020 and 2050 Kyoto targets for the reduction of emissions in greenhouse gases?

I thank the hon. Gentleman for that intervention. Of course those are matters that we must face. What concerns me is that we can concentrate too much on the air industry. Although it is one of the fastest-growing greenhouse gas promoters, it is still a small percentage of the overall picture. It is fair that we tackle the whole issue, and important that we understand it.

I happen to be in favour of trying to tackle these matters now, and I firmly believe that emissions trading is one of the best ways to move forward and mitigate the effects of air pollution caused by the airline industry.

The hon. Lady says that she believes in tackling the matter now. What is the earliest date that an emissions trading system could be introduced?

That question is probably best directed to the Minister, and I am hopeful that she will be able to answer it, but I have certainly been pressing for that. Fuel duty is another key matter.

The hon. Lady says that we need to deal with aviation as part of the overall climate change issue. Does she not understand that including aviation in the emissions trading scheme, for example, would obliterate the ability of any other industry to emit CO ₂ at all?

That is not a view that I share; nor do I believe that that is the only way that we should tackle these matters. We are, for the first time, talking about duty on aviation fuel. The aviation community and industry stakeholders are now taking seriously the question of how properly to recognise the impact of air travel. Most of us have read recent articles on that and heard the things that are now being said in the European Parliament about fuel duty. The matter has to be tackled globally, of course, but I believe that we in Europe should start to try to persuade other nations that it is the right way forward; we should be able to do that. It is not true to say that there is no fuel duty and that nothing is being done. Almost £1 billion is raised through the air passenger duty, so it would be wrong to say that no duty is in place to try to tackle the matter.

I agree with those Members who think that this is an urgent issue, but we must recognise and protect the positive aspects of our airline industry. We must not allow ourselves to get into a situation where airlines go to airports outside the United Kingdom, because I have a sneaking suspicion that if that were to happen we would all be back in this Chamber bitterly complaining about the loss of jobs in our regions, when what we should be doing is looking after the interests of our constituents—making sure that they are well employed, that they have a decent environment and that they have the quality of life that we want for them.

This matter has been of concern for some time, and many people involved in the industry congratulate the Government on tackling it now, on coming forward with plans, and on ensuring that we have the opportunity to discuss openly the whole issue of expansion. This matter was kicked into the long grass for many years before the Labour Government came to power, and we should accept that we are now making progress and are having a decent debate.

rose—

Order. May I have clarification? Has the hon. Member for Crawley (Laura Moffatt) finished, or is this an intervention?

It is an intervention.

I thank the hon. Lady. Does she agree that last year's White Paper was fundamentally flawed? It proposed to expand Heathrow, to end mixed mode and to put in a third runway, but in its appendix it was admitted that doing so would break not only rules on CO ₂ emissions but those on air quality—NO ₂ emissions—on the ground, and that at the moment there was no prospect of exploring that. The White Paper was incompatible with itself, let alone with any other views that people might have.

The White Paper outlined the fact that there is no clear path forward and there are extremely difficult environmental matters to be overcome at Heathrow. However, that does not mean that we should not discuss those matters and that they should not be addressed honestly and openly in the White Paper.

That environmental issue has left Gatwick airport in a difficult position. As Mark Froud of Sussex Enterprise says, it leaves Gatwick on the subs' bench because those matters need to be settled before Gatwick will even be considered. That is after the 2019 legal agreement, which I stand by wholeheartedly, has expired.

It is good that the Government are ensuring that we consider those matters properly and have an open discussion. That is what I suggest in all the communities. This matter is raised locally, but the debate around Gatwick is not bitter; it is honest, and people are able to talk to each other. Groups invite representatives of those who are very much in favour of airport expansion as well as those who are against. We have an open debate and ensure that all the points raised in favour of and against airport expansion are given a proper hearing. All I ask of this House is that we have an open debate, that we do not become polarised, that we do not end up in a corner saying that there will be no expansion at any cost, and that we look at the bigger picture, as well as at the important matter of our constituents. We should tackle the matter as honestly and openly as we can.

I hope that the House will pay greater attention to my remarks than has happened so far this morning. There are 19 minutes remaining and four Members who want to speak. Members should bear that in mind not only when making their contributions, but when receiving and responding to interventions.

I congratulate my hon. Friend the Member for Uxbridge (Mr. Randall), who has a distinguished track record of serving his constituents and standing up for environmental issues, of which this debate is a classic example.

I shall begin by talking about a matter that affects my constituents in Horley. The Government seem to think that expanding aviation is inherently an economic good and that the economic imperative overrides other concerns. Environmental issues, however, are one of the reasons why people get concerned about airport expansion. As I mentioned earlier, Reigate and Banstead council is monitoring air quality in Horley, in parts of which levels of nitrogen dioxide are above the UK target. The council has modelled forwards and, using a business-as-usual case for the airport, has worked out that in 2010, when the EU limit is introduced, NO 2 levels in those parts of Horley will have exceeded the EU limit in each of the preceding five years. Therefore without any further expansion—with or without a second runway—there is a serious problem. NO 2 affects peoples' health. It creates smog, which is very unpleasant and can lead to painful lung conditions. We are talking about people's health as much as about the wider environmental issues that have been touched on this morning.

We all recognise that there is an economic benefit to aviation, but that must be placed in the context of its environmental impacts. As my hon. Friend the Member for Uxbridge pointed out, aviation is the fastest-growing contributor to climate change gases. In the previous Parliament I was fortunate enough to chair the Environmental Audit Committee, which produced no fewer than four reports on the impact of aviation on the environment. When that Committee gets up and running again, I have no doubt that it will return to the issue, so the Minister may look forward to many happy debates on the subject. I hope that she takes a more conciliatory view than her predecessor, whose attitude was dismissive and, as it turns out, factually incorrect, which is a serious matter.

At the end of the previous Parliament, the Committee said that there had been an irretrievable breakdown between its opinion and that of the Department for Transport and that it would return to the issue in the future. I sincerely hope that when it is up and running again, it does so. Recently—since the Committee published its reports—two significant new reports have been published. The report by the Tyndall Centre for Climate Change Research confirms the proposition that the Committee advanced, which is that if aviation is allowed to continue growing at the excessive rate that characterises its present expansion, there will be no chance of the Government meeting their overall target of reducing CO 2 emissions by 60 per cent. by 2050. The Government and the Department in particular need to understand that and work with that proposition rather than against it.

Almost at the same time as that report was issued, help came from an unlikely source. The South East England regional assembly produced an extremely comprehensive document, put together by Roger Tyms and Partners, about the impact of aviation in the south-east. The document is highly critical of the Government's position. I carry no banners for the South East England regional assembly, but it has made an extremely useful intervention in this case. It points out that the basic proposition behind the White Paper is, in terms of its impact on the south-east, completely incompatible with the Government's stated objectives on sustainable development.

The hon. Member for Crawley (Laura Moffatt) might wish to know that the report deals with the question of jobs. Its view is that jobs can be created through aviation, but that because of labour and land shortages in the south-east, the benefit in terms of employment and wealth creation of piling more aviation capacity into the region is significantly less than it would be if those jobs were created elsewhere in the United Kingdom. Those in the South East England regional assembly—bully for them—have at last come up with a decent idea that I can support wholeheartedly.

The evidence is mounting and the Department for Transport must get to grips with it; it cannot continue to deny the impact of aviation on our quality of life, on the immediate local environment and on the wider global environment. There is a danger that if we go on as we are and if the Government refuse to engage with the issue properly, aviation will come to be seen as a rogue industry irresponsibly trashing the quality of life for future generations—albeit providing some brief, sparkling pleasure in Ibiza in the short term—and the Department will be regarded as a rogue Department within Government. Many Departments are seriously engaged with sustainable development and a huge amount of work is going on through policy and departmental practice to make the way that we govern in this country compatible with the principles of sustainable development, in recognition of the fact that we all live within environmental limits.

The Department for Transport has a blind spot, particularly when it comes to aviation. It seems to have got the message on cars to some extent. The problems of cars are relatively easy to solve because of new technology and new engines—interestingly, in the air quality surveys carried out in my part of the world it is estimated that NO 2 levels will fall outside the airport environment because of improved efficiency in cars, but in the airport area itself they are predicted to rise because of aviation. I ask the Government, the Department and the new Minister to engage seriously with this issue.

It has been mentioned before but it is important to reconsider the White Paper, which I believe to be profoundly flawed. It should be parked and the Government should look again at the evidence. The White Paper was based on certain assumptions: that demand for aviation would grow at 4 per cent. a year until 2030; that the cost of travelling would fall by 1 per cent. a year until 2030; and that the price of oil would be roughly static, at about $25 a barrel. The price of oil is now $50 a barrel. The assumptions behind the White Paper are unrealistic, and it is those assumptions that have led to the Department's position, which is to predict and provide for excessive and environmentally unsustainable growth. Let us revisit those assumptions and scale down the future forecasts of aviation growth.

By all means, let us use emissions trading if it will work. However, I have grave doubts that by 2008, which is when the new emissions trading scheme is likely to be introduced, there will be any hope of getting aviation included in the scheme. There are real difficulties, particularly since France and Germany seem to be profoundly hostile to the idea of trading and favour instead a tax system to deal with and dampen growth.

Let us consider using fiscal measures more bravely than we have before. No one—at least, no one sensible—is talking about halting aviation growth. We are talking about curbing the excessive demand on which the Government's current policies are based. No one will thank us if this generation of politicians adopts policies that are wholly incompatible with the interests of future generations and that contribute to the potentially catastrophic risk of climate change.

Nine and a half minutes remaining; three hon. Members bidding.

By speaking solely—and briefly—about the role of business aviation, I wish to give some hope to my hon. Friends the Members for Uxbridge (Mr. Randall) and for East Surrey (Mr. Ainsworth) and the hon. Member for Crawley (Laura Moffatt).

I represent Farnborough, which was voted Europe's No. 1 business aviation centre by the operators. Farnborough has the opportunity to provide some relief for Gatwick and Heathrow by providing business aviation services. It has authorised limits of 28,000 movements a year, which means that 28,000 movements are taken away from places such as Heathrow and Gatwick, thus spreading the burden. Moreover, it provides an extremely valuable service, because approximately 400 jet and turboprop aircraft are operated in this country—I exclude those that come in from overseas—serving businesses and international business.

I am delighted that when the Conservative party was last in power, my right hon. Friend the Member for North-West Hampshire (Sir George Young), then the Transport Minister, designated Farnborough as the business aviation centre to serve London and the south-east. Unlike Northolt, which my hon. Friend the Member for Ruislip-Northwood (Mr. Hurd) is privileged to have in his constituency, Farnborough has a runway that is capable of providing a sufficient facility to enable a Gulfstream GV to take off and travel non-stop to the west coast of the United States.

I apologise to the Minister for not being able to stay to hear her response to the debate; I have another meeting to attend. I suspect that she will say little about business aviation, but may I flag up just one point? Farnborough needs better facilities and better support from special branch and the immigration services. It is a relief airfield in the sense that it takes business that would otherwise be directed to Heathrow and Gatwick, so it is incumbent on the Government to ensure that they provide the services necessary to sustain the international operations that take place at Farnborough. Farnborough adds enormous value to the United Kingdom; the aerodrome is used by high net worth individuals and by the Heads of State of other countries because it is discreet, secure and close to London. Farnborough has enormous advantages, but it needs better services. I hope that the Minister will be able to write to me to let me know what the Government plan to do about that.

Six and a half minutes are available before I call the Front-Bench speakers. I think that there are two hon. Members bidding.

Thank you very much for calling me, Mr. Deputy Chairman.

Order. I am not a Deputy Chairman—I am either the Chairman, or Mr. Cook. Please will all hon. Members also take note of the fact that I cannot assume that they want to speak unless they indicate that by standing erect?

Thank you very much, Mr. Cook. Stansted airport is right next to several villages in my constituency, including Cold Christmas, Little Hadham and Braughing. For many years those villages have experienced problems with noise from the airport, but I believe it is generally accepted that we should have our airport in the countryside at Stansted. We are, however, against massive expansion of the airport and building a second runway. When the inspector on the original inquiry into Stansted considered how many runways there should be, he made it clear that it would be an environmental catastrophe if there were more than one.

We need to question the whole idea that the focus for cheap holiday flights from Britain should be on the south-east of England. Some 65 per cent. of air traffic goes from the south-east at present and the assumption for the future seems to be that we should try to suck holiday travel passengers down from the midlands and the north by road to fly from airports such as Stansted. That is ridiculous. We must ask ourselves if that assumption is not partly driven by BAA and what it wants to happen. It seems to feel that it is entitled to cross-subsidise from Heathrow to Stansted in order to make use of its dominant market position, even though that means higher costs for passengers and is unfair to other airports, as we have heard in the debate. The time has come to question seriously whether BAA should be able to demand that the south-east bears the burden of all the extra air traffic and to consider whether BAA should retain its monopoly of 93 per cent. of the airports market in this country. We must think about whether it should be broken up.

It is wrong to propose building a second runway at Stansted and not even to consider how to pay for the infrastructure. The roads in my part of the world are clogged and the rail services are so full that people have to stand on the trains, yet the infrastructure is supposed to be able to sustain a huge extra expansion of housing and airports. Frankly, that just does not add up.

Finally, may I ask the Minister a question? Can she point to a single measure that the Government have taken or are considering that will tackle the effect of aviation on global warming?

Three minutes are available.

Thank you, Mr. Cook. I will keep my comments brief. I echo the concerns already expressed by hon. Members on the sustainability of the development of aviation in the south-east. My concern is about Heathrow. Planes come in to land at that airport directly over Putney, and my postbag is full of letters from people who are extremely worried about the proposals in the latest White Paper for a third runway, the potential end of mixed mode, and the ongoing review of night flights with the impact that that will have on noise and the general quality of life in respect of air pollution in my constituency.

At present, there are no noise monitoring sensors in Putney or in Fulham, which is slightly further away from the runway. My first question is, can the Minister investigate whether the Civil Aviation Authority, and therefore BAA, can be compelled to put those sensors in place and to monitor the noise? Secondly, noise mapping feeds into many of the decisions taken on Heathrow and its sustainability, but that is mapping of average noise, which is the equivalent of my travelling to Rotherham to visit my family, getting done for exceeding the speed limit and then being told that it is okay because my average speed was under the limit so I stayed within the law. Can the Minister confirm that she will consider whether noise mapping should monitor peaks and troughs and excessive noise, not just average noise? The letters that fill my postbag complain about excessive noise.

Does my hon. Friend agree that it is one noisy aircraft, at night or during the day, that disturbs people? That certainly seems to be the case in Datchet, Old Windsor, Wraysbury, Poyle and Colnbrook. Does my hon. Friend think that we should consider measures that take into account a single noisy aircraft rather than the general noise quotients, which seem to hide a multitude of sins?

I certainly do agree with my hon. Friend. It is time that we took responsibility for the noise created by individual planes that land at airports. We need to take a fresh look at the economic case for developing Heathrow; I would argue that as well as people flying in close by, my constituents also deliver a fair amount to the London economy.

It is a pleasure to participate in a debate initiated by my friend the hon. Member for Uxbridge (Mr. Randall). I respect his views on flight, whether powered or otherwise.

There is clearly some agreement this morning on some of the Government's proposals, particularly those on making better use of existing resources, airports and runways. Unfortunately, that is where the consensus ends. It is worth reminding Members that the background to this debate, as mentioned in today's Metro and other papers a couple of days ago, is that CO ₂ emissions in the EU rose by 1.5 per cent. in 2002, with Britain one of the worst offenders behind Italy and Finland. The Minister may believe that aviation can take a smaller cut in its emissions because other industries will pick up the slack, but that clearly will not happen. Other industries are already failing to meet their targets for reducing CO ₂ emissions.

As the hon. Member for East Surrey (Mr. Ainsworth) said, perhaps there is a consensus on the Department for Transport's recognition that there is a problem on the roads, which is why it has proposed road pricing. I do not think that the Minister's officials are rogue officials—the hon. Gentleman suggested that the Department might become a rogue Department—but there is a problem with the Government's approach to aviation. The freedom-to-fly approach is almost a free-for-all, and Government documents are peppered with phrases such as "capacity running out", "runways are full", "we need to provide more" and so on. There is not much focus on sustainability; the priority always seems to be providing more capacity.

My hon. Friend will be aware that one major problem in the south-east is the number of short-haul flights. From my constituency in Edinburgh, 75 flights will today take off for the south-east. Does he agree that a high-speed rail link would not only provide a desirable rail substitute but free up slots at airports for international flights, for which there is no alternative mode of transport, without increasing capacity?

I thank my hon. Friend for his helpful intervention. We know that the Secretary of State for Transport has talked about looking at high-speed rail links—although he should do more than just look at them—and providing trains as an alternative to short-haul flights. I question whether the Government's approach is sustainable.

Several hon. Members have referred to the Lancet report. It examined 3,000 children aged nine to 10 in Britain, the Netherlands and Spain and the impact on them of aircraft noise. It found, perhaps not surprisingly, that chronic exposure to aircraft noise impairs children's reading comprehension, that schools close to an airport are not a healthy educational environment, and that there is a link between aircraft noise and stress and a reduced quality of life.

What action have the Government taken since the report was published? Is the Minister satisfied that all the schools in the vicinity of Heathrow, Stansted or Gatwick are sufficiently insulated? Is she satisfied that, if a third runway at Heathrow or a new runway at Stansted is built, schools in the vicinity will be sufficiently protected from the increased noise? Will she commit to a review of noise standards to see whether the Government need to respond to anything in the report?

The industry, rather belatedly, has produced its own sustainable aviation strategy, which the Minister has welcomed. It talks positively about aircraft manufacturers reducing emissions and improving fuel efficiency by 50 per cent. per seat kilometre. Does the Minister believe that the proposals can deliver a sustainable aviation strategy? Can she confirm that the Government's plans already take into account the industry's estimates for emissions reductions and that, therefore, those estimates are not an improvement on the Government's plans for the reduction of emissions?

Another point made by the industry is that airlines will develop solutions for the inclusion of CO 2 emissions in the EU emissions trading scheme. When will that scheme be introduced or when will aviation be incorporated into it? Given that the likely date for introduction will be 2012 or beyond, will interim measures have to be taken? In any case, can the aviation industry adopt a sustainable strategy when someone like the chief executive of Ryanair, Mr. O'Leary, is quoted in the papers today saying that if people are worried about air pollution, they should sell their car? Does the Minister think that that is a sensible approach? If some industry players are not going to contribute to reducing CO 2 emissions, what can the Government do about them?

On the subject of the industry's ability to sharpen up its act and reduce CO ₂ emissions, is the hon. Gentleman aware of what Mike Clasper, the chief executive of BAA, wrote last spring? He said:

"So how does a growing industry which will continue to rely on aviation kerosene cut its emissions? Frankly, we can't."

He went on to say that, although there would be fuel efficiencies, the level of emissions would continue to rise for the next half century or longer.

That is a worrying statement. I am pleased that others in the industry, such as the outgoing chief executive of British Airways, Rod Eddington, have adopted a different approach and suggested that the short-haul flights to which my hon. Friend referred a few seconds ago are entirely inappropriate.

It is clear that the projected increase in emissions is unsustainable. As hon. Members will know, if growth in aviation continues unmanaged, by 2030 the demand for air travel will be slightly less than 500 million journeys a year in the UK, and carbon emissions will quadruple—taking into account the multiplier effect that applies to emissions at high altitude, the increase will be greater still. Demand management is now the name of the game.

Is the hon. Gentleman aware of any measure that the Government have taken or are considering taking to tackle the effects of aviation on global warming?

It is appropriate for the Minister to respond—she has had about 15 minutes to think about it—but I suspect that the response will be rather short.

In terms of demand management, there are solutions that the Government could consider. Could slot auctioning be a solution, provided that safeguards are in place for some flights from more remote areas? Could personal carbon allowances provide a solution? What about the high-speed rail links that have been mentioned?

The aviation White Paper seemed to accept two important planks of Liberal Democrat aviation policy: first, that a "predict and provide" approach is the wrong approach for future requirements; and secondly, the principle that the polluter must pay. The Minister has an opportunity to prove that her Government are not just paying lip service to those principles but are prepared to implement them.

I congratulate my hon. Friend the Member for Uxbridge (Mr. Randall) on securing this debate, timely as it is with the Civil Aviation Bill due to have its Second Reading next week. His constituents already know how extremely hard he works for them. I received the aviation and shipping briefs a few weeks ago and his extraordinary environmental knowledge extends across both sides of my new parliamentary interests. His speech was powerful, and it moved us all.

I remind the House of three simple statements first articulated by my hon. Friend the Member for South Suffolk (Mr. Yeo) in his former shadow Cabinet position. First, he said that before any expansion in runway capacity in the south-east is sanctioned, we will use our best endeavours to ensure that Britain is a full participant in an EU emissions trading regime covering the aviation industry. Secondly, he said that we will ask BAA to review its compensation arrangements with a view to being much more generous to those people whose homes are blighted by airport development. That is of course a simple example of the principle that the polluter, whether by emissions, or in this case by noise as well, should pay. Thirdly, he said that we will oppose the cross-subsidy of airport development costs, which is something that used to be accepted across the political spectrum.

To the three points made by my hon. Friend I should like to add a fourth. We need to address seriously the issue raised by my hon. Friend the Member for North-East Hertfordshire (Mr. Heald) and others about why so much aviation is focused on the south-east and, in particular, on the three big airports controlled by BAA. At this point, I welcome the Minister to her new post, and I look forward to her winding-up speech.

Airlines should be seen as an integral part of the nation's public transport network. They provide transport to every corner of the globe as well as throughout this country. Although we are discussing the less desirable features of airlines, it is important to remember that for people well down the economic scale the growth of low-cost carriers has brought opportunities for tourism beyond the dreams of earlier generations. That growth has also had enormous benefits for business, and more than half the passengers on the new low-cost carriers are business men and women.

Nevertheless, most speakers today, particularly my hon. Friends the Members for Uxbridge and for East Surrey (Mr. Ainsworth), have reminded us just how strongly the environmental features, especially those relating to global warming, are being challenged.

I also attended the worrying presentation by the Tyndall Centre for Climate Change Research. It claims that if aviation continues to grow at its present rate, it could wipe out all savings made by all other sectors of the economy, making it completely impossible for the Government to achieve their CO 2 emissions targets. Indeed, it is a straightforward historical fact that since this Government took office, aviation on its own has been responsible for CO 2 emissions going up rather than down.

Does the hon. Gentleman agree with my earlier point that far from aviation making any savings and being able to access savings made by other areas of industry, the evidence shows that our emissions are going up?

Our emissions are indeed going up, although even the Tyndall study accepted that through efficiency measures there is scope for savings of about 2 per cent. a year. There are a number of other objections to its analysis. It has not taken account of the impact of the growth of fuel prices on demand, which is a market correction of its own. Further, its extraordinary claim that one must multiply by a figure of 2.7 is not borne out by scientific evidence.

I am grateful to my hon. Friend for giving way, but I must say to him that his last point was incorrect. The figure of 2.7 is a Treasury figure that is applied for very good reasons as a multiplier to the climate change impact of aviation.

We do not have time for a long debate, but as one example of a study from the other side, I quote the analysis of the three days after 9/11 when there were no flights in America at all. If one considers temperature movements during that period, it appears that aviation trails have some effect of reflecting sunlight. There are profound disagreements within the scientific community, but there is a general recognition that the impact of aviation in such an area is huge, although it is difficult to quantify.

I do not want to foreshadow the Civil Aviation Bill that will be discussed next week, except to say that we strongly support the view that the polluter must pay. There are issues where we can build on relationships with the industry and I welcome the initiative that was announced a day or two ago that the industry wants to become part of a robust European emissions trading scheme, which would allow it to trade permits with other European airlines. Along with its contribution, we shall be debating other ways in which we can consider the matter on Monday.

As for compensation, we all know that planned airport expansion worries local people and can have a devastating effect on house prices. My hon. Friend the Member for Uxbridge said that that happens many years before the bulldozers move in—if, indeed, they do. Many people find that their houses become unsaleable because of the prospect of development although they live outside those areas that are covered by the existing, narrowly drawn blight compensation schemes. BAA plc is a highly profitable organisation, which enjoys a 93 per cent. virtual monopoly in the south-east. Frankly, it can afford a more generous scheme.

I come now to my third policy point. It used to be accepted by all parties that there should be no cross-subsidy within the near-monopolistic giant that is BAA plc. Yet the Government have committed themselves on a tight timetable to an expansion at Stansted of a second runway, despite the fact that Stansted has failed to attract intercontinental business; 90 per cent. of its flights are carried out by Ryanair and easyJet, both profitable airlines, but the relatively small aeroplanes that they use and a business that pays per passenger obviously only generate a fraction of the business that is generated by wide-bodied jets. No one seriously believes that Stansted could finance such an expansion from its own revenues.

The Government concluded in its White Paper that there was a serious need for additional runway capacity. With Gatwick blocked until 2019, if the Government's demand figures are right, if the present growth of aviation is allowed to continue and if it all happens in the south-east, that could only mean Heathrow. However, those are very big ifs.

It is not only the direct impact on local people that is worrying; there are also transport issues, but time does not allow me to elaborate on such matters. Heathrow airport's new terminal 5, which is almost complete, could generate up to 50,000 car trips each day across London and the south-east. While welcome in other ways, the Crossrail proposal may undermine the existing Heathrow Express service and the imaginative new proposals for a new link to Waterloo. Meanwhile, the train service to Stansted is becoming worse. Two new stops will be introduced soon.

The Government's policy in the White Paper is a mess. It lacks a coherent vision. The Government want to tackle climate change; they want to expand capacity in respect of the most serious polluters. They are willing to allow airport expansion, but chose the wrong site in the wrong place with an inadequate infrastructure and a deteriorating train service. They are egging on the promoters of the Heathrow extra runway on the one hand, but doing remarkably little about pollution control on the other.

The truth is that we need a bold, joined-up vision for aviation in this country. Serious questions need to be asked, such as how much growth is sustainable, how much of it should be in the south-east and how it will fit into the other areas of transport, particularly rail and road services. Such matters needed to be studied in the round. Sadly, the Government's White Paper and current policy do not do that.

I congratulate the hon. Member for Uxbridge (Mr. Randall) on securing the debate and I congratulate other hon. Members on their contributions. The discussion has ranged widely, extending to matters beyond aviation in the south-east, the specific title of the debate. I accept why that has happened; such matters cannot be put in a box, but I hope that hon. Members will forgive me if I cannot deal with each issue that they raised as comprehensively as it would probably warrant in its own right.

The hon. Member for Uxbridge made a number of points, some of which I will try to address in my speech. I recognise his long-standing concern for his constituents, and it is right and proper that he and others, as constituency Members of Parliament, should champion their constituents' interests. He mentioned the fact that my hon. Friend the Member for Hayes and Harlington (John McDonnell) was unable to be here today. He, too, has consistently championed the cause of his constituents and their concerns and he asked me to apologise for his absence.

I thank my hon. Friend the Member for Crawley (Laura Moffatt) in particular for bringing to bear in the debate her very long-standing experience and expertise on behalf of her constituents. I was pleased to hear her reflect a degree of balance that was missing from the other contributions, as I hope to be able to explain. I also very much appreciate the tremendous expertise, built up over a long time, of the hon. Member for East Surrey (Mr. Ainsworth) in his capacity as chair of the Environmental Audit Committee. He raised many important issues, which warrant many other debates and to which I am sure we shall return. The hon. Member for Aldershot (Mr. Howarth) raised specific issues and I will write to him. In the next few minutes I will try to pick up some of the issues that other hon. Members raised.

No one will be surprised that I do not intend in these comments to deviate from the broad thrust of the air transport White Paper, which, 18 months ago, for the first time in decades and possibly ever, set out a strategic framework for the future of the aviation industry in this country and for air transport. It recognised, rightly, that the economic, personal, cultural and social benefits of air travel must be balanced against the undisputed environmental impacts at both local and global level and the needs of the communities that airports serve.

I feel that the economic arguments were peremptorily dismissed by the hon. Member for Uxbridge and others. That is sad, because many Opposition Members represent constituencies that gain directly and indirectly from the economic benefits that aviation has brought to this country. Some 200,000 jobs depend on the industry directly and one third of all UK exports are delivered by air. Aviation is crucial to tourism: 70 per cent. of all visits to the UK in 2003 by overseas residents were made by air. Indeed, 20 per cent. of all international flights in the world in 2003 began or ended in the UK.

We must be careful, in an era of intense international competition, not to jeopardise the prosperity and employment opportunities that accrue to London, the south-east and Britain as a whole as a result of aviation. Simply acting as if we are not operating in an international context is not good enough. We know what is happening at Schiphol, Frankfurt and Charles de Gaulle, to mention just some airports that are only an hour away from us. Not to consider the growth in their role as hub airports is to miss something important in the international context. We must be aware of that for our future prosperity.

The economic benefits include low flight prices, but again they were swiftly dismissed by the hon. Members for North-East Hertfordshire (Mr. Heald) and for Carshalton and Wallington (Tom Brake). My 11-year-old son has travelled far more than I had done by the age of 21. In fact, I did not go abroad until I was 21, and that phenomenon was replicated in my generation among people from lower-income backgrounds. We must be careful not to shut down the personal, cultural and social opportunities for travel that, frankly, everyone in this Room enjoys for themselves.

We were told that Stansted was an airport in the countryside, serving our area. Yes, we all use it; we go on holiday from there. But we are against the strategy of making people from the north of England and the midlands come down to Stansted before they go on their holiday. Why can they not go from their own airport?

Is that a declaration of independence for the south-east? I think colleagues should be told. One of the enormous strengths of the air transport White Paper is the strategic approach to the development of airports in regions across the country. One of my first tasks as a Minister was to go to Bristol airport to welcome the first international flight into Bristol from America. That is part of a deliberate approach to encourage the growth of regional airports for their own economic prosperity, for the benefit of the country and to relieve pressures on London and the south-east. [Interruption.] I just want to finish this point. We need to be wary of opportunism. When the Department launched a debate on road pricing, there were Opposition Members who immediately leapt in to say that it was a war on the motorist. That argument is against a background of a fall in the real costs of motoring—a fall that opens up the possibility of debate on options for roads. To call that war on motorists while saying that the opportunity for cheap flights is almost a moral wrong strikes me as deeply inconsistent.

The White Paper makes it clear—I hope that people recognise this; it was recognised by the hon. Member for Carshalton and Wallington—

Will the Minister give way?

Yes.

I hear what the hon. Lady says about low-cost travel, and I tried to make it clear that there is a need to curb future demand, not deny people the right to travel now. Would she not say that there is something quite odd about a situation in which it costs 10 times more to park a car at Gatwick airport for two weeks than to fly to Marbella and back?

That is partly to do with the marginal cost of tickets. It depends on what tickets someone gets. It is not, strictly speaking, comparing like with like. As the hon. Gentleman is well aware, the point about surface access to airports is very much integral to the debate on pollution that was rightly mentioned by a number of hon. Members. If we are serious about tackling the air pollution problems that we all recognise exist around airports, we must accept that surface access arrangements, discouraging the car and using public transport alternatives are absolutely central to that argument.

The Government's approach is absolutely not to predict and provide. We have taken the overall view of looking forward to a level of aviation that meets pressures on existing airports and future demand but is absolutely at the lower end of the unconstrained level of provision. Our first priority is to make efficient use of existing capacity at existing airports, but as we made clear in the White Paper, that would fall a long way short of a lasting solution. That is why we support two new runways in the south-east: one at Stansted and—provided strict environmental conditions can be met—an additional third short runway at Heathrow.

Time is running out, so I shall quickly focus on Heathrow, as it was central to the argument advanced by the hon. Member for Uxbridge. We have made it absolutely clear in the White Paper that, as a precondition for expansion at Heathrow, three core tests must be met: there must be compliance with air quality standards, in particular on nitrogen dioxide; there should be no further increase in the size of the 57 dB average daytime noise contour; and there must be improvements to public transport across the airport. I shall skip the point about public transport to focus on air quality.

A key requirement of expansion is that we must be confident that EU air quality limits, which will be binding on this country from 2010, will be met. Air quality around Heathrow would not meet European standards for nitrogen dioxide if those limits were applicable today. Work done at the time of the White Paper suggested that they would not be met in 2015 at Heathrow if there were further development. In some cases, the work predicted that many hundreds of thousands of people would be exposed to nitrogen dioxide levels over the limits that will be mandatory from 2010. That is a clear recognition of the scale of the problem and the need to tackle it as a precondition for expansion.

There is a lot that I could say about the monitoring arrangements to be put in place. There is to be peer review and independent scrutiny, on both aircraft emissions and surface transport. I am sure that we shall discuss that when I meet the hon. Member for Uxbridge and others in the near future.

We also recognise the importance of noise limits. The hon. Member for Putney (Justine Greening) asked about monitoring. Noise is currently monitored at airports, and controls are operated with respect to certificated noise in accordance with international practice, but I will look into her specific question about Putney and come back to her on that.

Will the Minister give way?

I have one minute left and, if the hon. Gentleman will forgive me, I just want to make a final point about climate change.

We cannot act unilaterally on emissions. By far the most effective way—and the right way—to proceed on climate change and aviation's contribution is to work in an international context. That is why we are committed to working for an emissions trading scheme with the EU by 2008, or as soon as possible thereafter. There are positive negotiations going on about that, and it will be a centrepiece of the Government's negotiations during their chairmanship of the EU. I hope—but do not necessarily expect—that that will give some reassurance that the Government are approaching the issue strategically and with a clear balance between the economy and the environment.

Order. We must move on to the next topic for our consideration.

For the second time in two weeks I am extremely grateful to Mr. Speaker for the opportunity to stand in this Chamber and defend a vital local service. Two weeks ago the issue was the impact of the Licensing Act 2003 on a range of institutions and organisations, especially village halls. At first sight that was a national issue with local implications, whereas today's debate appears to be a strictly local affair that has implications that go no further than Evesham. However, that assessment would be wrong for three reasons, which is why it is right that the Minister should have the opportunity to explain.

The first reason is shown by the presence of the hon. Members for Worcester (Mr. Foster) and for Wyre Forest (Dr. Taylor). The proposal virtually to halve the size of Evesham community hospital by closing two wards, removing general practitioners from caring for patients in another ward and transferring orthopaedic services to Kidderminster has serious implications for the whole county of Worcestershire and its surrounding areas.

The second reason is that the proposals fly in the face of one of the Government's key national policy objectives for the national health service: local service delivery and accountability. In 2003, "Keeping the NHS local: a new direction of travel" challenged the perceived wisdom that biggest is best, and committed to the delivery of as local a provision of services as possible. It also strengthened the commitment for the NHS to work with and not for local people in developing options for the delivery of services.

In 2000, "The NHS Plan: a plan for investment, a plan for reform" and in 2004, "The NHS Improvement Plan: Putting people at the heart of public services" again committed to a major investment in services closer to home, particularly the management of patients with long-term conditions. South Worcestershire primary care trust is doing the exact opposite. It is reducing local primary care services in order to support the costs of a large acute hospital sector that provides a range of services that could, and should, be provided close to patients' homes and in primary care settings.

The third reason is that the drivers of the outrageous proposals are all national. The cuts being considered by South Worcestershire PCT, of which the proposals for Evesham community hospital are just a part, are its response to national policies imposed on it, often against its will. Its experience is far from unique. The proposals for Evesham were developed not on clinical grounds, but simply because it is the largest part of the PCT's budget over which it has any discretion. This would be the second round of damaging cuts at the hospital in three years and has four equally unacceptable parts.

The first is the proposal to close the enormously successful and essential rehabilitation ward, Bredon ward, which offers a vital service to support the county's acute hospitals and was developed only two years ago with the current PCT. Closing the ward will mean many things: patients being stuck in an acute hospital where the focus is on primary treatment not rehabilitation; increased pressure on an already seriously overstretched acute sector; patients not being able to return near to home for post-operative care and rehabilitation; more travelling for families to see and to support relatives; and less locally co-ordinated discharge planning and so more chance of problems on discharge.

The second part is the closure of the immensely well regarded Willows stroke unit. The letters I have received about that proposal would melt even the stoniest heart. I have many of them here and if time permitted I would quote from them extensively. The stories they tell of hope reborn and of outstanding nursing care show how much the service achieves and how precious it is. The ward is widely recognised as a centre of excellence. It was opened only a few years ago by the late Sir Harry Secombe, and the PCT itself has invested in it significantly. Early discharge of the kind of people treated on the ward would be to betray their best clinical interests. It would lead to huge pressure on families, and would severely compromise treatment and rehabilitation and, crucially, jeopardise successful outcomes.

The closure of those two wards would undermine the viability of the staff grade doctors' role at the hospital. That would probably lead to the closure of the one ward, the William Astley ward, otherwise unaffected by this package. The attempt to keep that role viable probably explains the third proposal, to remove GPs from Izod ward, which would mean a reckless loss of continuity of care from local GPs who know their patients' circumstances and full medical history. The quoted saving for ending the role of GPs seems remarkable, because the current total Izod ward bed-fund payments for all the GPs put together amounts only to little more than a third of the quoted saving, and there would probably be redundancy payments to make as well.

The fourth proposal is the transfer of orthopaedic services to the independent sector treatment centre at Kidderminster. The only reason for that is that the Department of Health has forced the primary care trust into a contract that it, the local GPs and the patients do not want. On a case by case basis, Evesham community hospital is cheaper than the treatment centre. The Kidderminster centre is a 55-mile round trip from Evesham; therefore, the journeys that would have to be made there for an initial consultation, surgery and a single follow-up visit would amount to a combined trip of 165 miles. That assumes that patients have easy access to cars, which many do not. By public transport, the journey is a nightmare, especially from the villages of south Worcestershire.

The PCT must know that the loss of orthopaedics would also lead to physiotherapy and X-ray at Evesham becoming less viable. What makes this proposal truly bizarre is that, under the Government's policies, most local people will choose to be referred to the much closer Cheltenham general hospital, where the cost will be even greater than at Evesham.

In summary, these cuts are as unacceptable to the people of Evesham and the surrounding community as the downgrading of Kidderminster hospital was to the people of Wyre Forest. The hon. Member for Wyre Forest is present, and I am grateful to him for the support he has given us.

I just want to put on the record that the Kidderminster treatment centre was provided, following a Government inquiry, to perform elective surgery to relieve the pressure on the acute hospitals in the county, at Redditch and Worcester. It was not provided to rob other community hospitals of services that are being performed locally and that already take the load off the acute hospitals.

I entirely agree, and I am most grateful for that very helpful clarification. The hon. Gentleman understands the role of community hospitals, and I hope that by the end of the debate the Minister will understand it, too. I feel sure that I will be encouraged in that respect.

There is anger of unprecedented proportions in the vale of Evesham, and I am deeply grateful to two local institutions for their magnificent support for our campaign; the fine local paper, the Evesham Journal, and Evesham Technology, the local computer manufacturer and retailer. They have helped to give focus and expression to that anger.

To understand the depth of that anger, it is necessary to understand the history of Evesham's hospital; or, rather, hospitals, because Evesham used to have two, Briar Close, built in 1879, and Avonside, built in 1930. I understand that there was also a third isolation hospital in the town, but this debate has its origins in the story of Briar Close and Avonside.

In 1986, Worcester and district health authority announced plans to deal with an overspend of £1.8 million by, among other things, transferring services from Briar Close to Avonside, although, to be fair, the plans also included the building of a new theatre. Seventy health workers lost their jobs when Briar Close closed down in 1988 and the land was sold for housing development. Evesham was now down to having one hospital, in which, when it was taken over by the NHS in 1948, there had been 287 beds, many for long-stay elderly care, so it was a significant hospital.

Some extensive ward upgrading took place at Avonside in 1986, but in the same year the maternity unit moved to Worcester, despite widespread public opposition. That loss of service marked the beginning of a tale of the gradual erosion of the hospital, with some bright and encouraging exceptions. In 1990, ward six closed, and Bartholomew ward went the same way in 1998. On a brighter note, a public appeal launched in 1993 led to the establishment of the Macmillan palliative care unit. However, 2003 saw further trauma as another round of cost cutting by the PCT led to a reduction in staffing at the minor injuries unit, and in 2004 the physiotherapy unit suffered reduced staff numbers. We now come to 2005 and the latest cuts, which would reduce the hospital to just 42 beds, including the five Macmillan beds, all of which is designed to contribute to a £4 million cost saving exercise by the PCT.

Over the years, Evesham people have always been told that their hospital was secure, and over those same years it has been slowly chipped away at by an NHS looking to make savings to make good problems elsewhere in the county. Evesham has been the sacrificial lamb once too often, and it must not happen again.

Evesham people felt very closely attached to both hospitals, and they continue to make generous donations to the remaining hospital. All the wards undertake continual fundraising to provide extra facilities. The friends of the hospital receive frequent bequests and numerous donations from clubs, groups, organisations and businesses from Evesham and the surrounding area. Over many years, the friends have supplied equipment; for example, they kitted out a young disabled person's room with a shower and hand basin with equipment specially designed for disabled use. These cuts are the reward for their loyalty.

The hospital must be saved, and the long-promised new hospital must be built. That must happen not just because local people are upset and angry; indeed, it is not just local people who are upset. Evesham provides a service to the whole county, and its wonderful staff are held in deep affection the length and breadth of Worcestershire. I accept that the Minister may not have a detailed grasp of Worcestershire's geography, but it is significant that the Kidderminster Times this week has a letter of protest from Bewdley, and my first telephone call of outrage came from Hartlebury. Evesham must be saved because it provides essential services to the whole county, because closing these wards will endanger patients, and because the proposed cuts will not generate the savings claimed.

I was pleased to get the support of the hon. Member for Wyre Forest, and to receive an early request from the hon. Member for Worcester to intervene in this debate; I happily give way to him now.

I am most grateful to the hon. Member for Mid-Worcestershire (Peter Luff) for giving way. The issue that he raises of the capacity of the health economy in Worcestershire concerns us all. Does he agree that if the Government are seriously considering building new community hospitals, an ideal base for one such building would serve my constituents in Worcester and his on the Droitwich side of his constituency? That would be the ideal place for a new community hospital.

The hon. Gentleman is absolutely right. We need more community beds, and that location would be very suitable for them. We must support an acute hospital under desperate pressure.

Put simply, and perhaps more controversially, the financial pressures on the South Worcestershire primary care trust are the direct result of the enforced implementation of national Government policy. That is why it is right that the Minister should be here. The Government imposed on the NHS well-meaning but expensive commitments—such as the waiting time initiatives and the new GP contract—but did not provide sufficient extra funding to pay for them fully.

They forced acute hospital trusts and primary care trusts to find every creative device to balance the books in the year before an election. Then, incredibly, they ordered those same trusts to achieve balance again in the current financial year. That last instruction, which no trust manager dare ignore, precipitated the crisis for Evesham. The tricks of election year cannot be repeated, but the Government have made the cynical calculation that howls of outrage the year after one election will be forgotten by the next one. However, if those cuts are allowed to proceed, the people of Worcestershire will not forget it. We do not even know what the acute hospital is going to do to find the £20 million it needs to balance its books.

Two specific local problems, imposed on the county by central Government, lie at the heart of our difficulties. First, the Government built a major acute hospital under the PFI that was too small and had a contract that was too inflexible. All the risk is borne by the NHS, and when the Worcestershire Royal hospital operates well beyond the sensible and contractually agreed level of 85 per cent. of capacity—as it has to most of the time; sometimes it operates at more than 100 per cent.—the contractor receives massive penalty payments to compensate for those excessive activity levels.

Secondly, the Government imposed on the county—for reasons rightly set out by the hon. Member for Wyre Forest—an orthopaedic independent sector treatment centre at Kidderminster, where the profit making contractor gets paid the full contractual sum, irrespective of how many procedures are performed there. It is not full; no wonder the PCT is trying to bully Evesham patients into making the impossible journey to Kidderminster.

The Government are imposing high and unavoidable costs on the local NHS to meet contractual obligations to profit-making private sector operators, and that has led directly to cuts in local services. Evesham hospital is being sacrificed to meet the bills of two private sector contractors; that is what makes the story truly remarkable. The only matter for local decision making now in Worcestershire's NHS is which local services should be cut to meet the obligations imposed on it by Whitehall. What makes this matter additionally disturbing is that the South Worcestershire primary care trust appears to be one of the worst funded in England.

In 2003–04, the latest year for which I have figures, the trust was funded at about £100 per head below the English average. Given that there is a population of roughly 250,000, that means we were short-changed by at least £25 million. I am trying to get more up-to-date figures from the Government, but the figures that I have mentioned, taken from an article in Pulse magazine, appear to show that the South Worcestershire primary care trust should not be seeking £4 million in cuts, but be looking for ways to spend an extra £21 million.

As it is, the PCTs have said that saving around £2 million from the cuts at Evesham is unrealistic. Additional costs flowing from the proposals—the costs of longer stays at Cheltenham General and Worcestershire Royal hospitals, of additional nursing and day rehabilitation services and of spending more on hospital care outside the PCT—would further reduce savings.

The campaigners have some positive suggestions to address the financial situation. The merger of the county's three PCTs—South Worcestershire, Wyre Forest and Bromsgrove and Redditch—would cut central costs a bit and significantly improve the efficiency of commissioning. Equitable funding for Worcestershire's NHS would give us enough resources to abandon the cuts, and the redevelopment of Evesham community hospital—a new hospital—could reduce capital and maintenance charges, improve efficiency and expand services, repatriating work to the county and costs back into the PCT.

To sum up, here are some specific points for the Minister. He will not be able to answer them all today, but they are the local points that need to be answered. On orthopaedic services, can the Minister confirm that it is NHS policy to encourage and support patients to choose the hospital from which they receive treatment? What makes the Government confident that they will choose Kidderminster hospital rather than Cheltenham General hospital? As the procedures at Cheltenham will be at full tariff price and therefore more expensive than at Evesham hospital, how would that save money?

On the processes of the primary care trust itself, section 11 of the Health and Social Care Act 2001 requires PCTs to involve patients and the public from the very beginning when developing possible service changes, rather than just consulting them on proposals developed by PCT management. Can the Minister explain how patients and the public have been involved in developing those proposed service cuts?

With respect to the closure of wards, can the Minister confirm that patients who need rehabilitation but who are discharged home from the acute hospitals instead of being transferred to Evesham would receive the same level of therapy and nursing? Can he confirm that the closure of the two wards would not lead to more patients being forced to enter care homes to free up acute hospital beds because they are not fit enough yet to return home? Can he confirm that the ward closures would not shift costs of care to social services or to individuals and their families?

With respect to the proposal to remove GPs from Izod ward, can the Minister explain why the PCT wants to do that at Evesham but not at Malvern, Pershore or Tenbury Wells? Can he confirm how much the reduction in quality of service at Evesham will actually save? Will it be easy to recruit good staff-grade doctors in the future? There are doubts about that.

With respect to the capacity of the county's health service, the acute hospitals are regularly on alert and unable to find beds for people requiring emergency admissions. Worcestershire Royal was on black alert only last Friday night, so how will the loss of 38 more beds from the Worcestershire health economy affect the situation? As the hon. Member for Worcester suggested, should not we be developing new community beds rather than cutting existing ones?

Can Evesham still expect the new hospital that it has been promised for so long and that it so urgently needs to provide a broad range of services similar to that currently provided? Can the Minister assure me that the capital sums raised by any sale of the existing site will not be used to plug one year's deficit, but be reinvested in the health service of south Worcestershire in the shape of that new hospital?

I hope that the Minister understands that he cannot shrug off responsibility for the mess and say it is all about local decision making. It is the decisions of the Government that have created the situation, and I hope that it is the Government who will help get us out of it.

Thank you, Mr. Cook. I think that this is the first time I have served under your chairmanship, and it is a pleasure to do so.

I congratulate the hon. Member for Mid-Worcestershire (Peter Luff) on securing this debate on Evesham community hospital. He has taken a keen interest in health matters in Worcestershire, and I know that his expertise does not extend simply to the borders of his own constituency. During his career, he has had some exposure to health matters in the great city of Worcester, which I am glad to see is also represented in this debate by my hon. Friend the Member for Worcester (Mr. Foster).

I know, too, that the hon. Gentleman has raised the proposals now under discussion by his local primary care trust in a parliamentary question, to which my hon. Friend the Minister of State replied on 9 June. In what was an eloquent dissertation today, he raised a number of detailed issues. I will address as many of those as I can, and I will write to him on those that I am unable to answer satisfactorily.

If the hon. Gentleman will indulge me, I will describe a bit of the backdrop before I turn to address the specifics of the important local issues that he has raised. Perhaps the most prominent feature of that backdrop is the extent to which health care in communities up and down our country, including in places such as Evesham, has changed in the past six or seven years. Massively increased investment has allowed us to hire more staff, build more hospitals, cut waiting times and cut mortality rates, in some cases quite dramatically.

I looked at some of the figures as I prepared for an Adjournment debate on Monday with the hon. Member for Wyre Forest (Dr. Taylor), who also knows a great deal about health care in the area that we are discussing. Some of the figures bear some repetition. Overall, spending is up by a third. Staff numbers are up by 21 per cent., with GP numbers up 13 per cent., consultant numbers up 44 per cent. and nurse numbers up 25 per cent., and 85 new hospitals have already been delivered. That has allowed us to cut in-patient waiting times first to 12 months, then to nine months and now to six months. Indeed, I understand that nobody in the South Worcestershire PCT area is waiting more than nine months for inpatient appointments.

When we look at some of the biggest killers in the country, we can see the results of that investment and improvement. Cancer death rates are down by 12 per cent., and coronary heart disease death rates down by 27 per cent. I was glad when officials told me that that improvement in health outcomes appears to be shared by the residents of Mid-Worcestershire. Indeed, Evesham hospital has benefited from the increased investment. Its budget has increased by more than £1 million, or about 16 or 17 per cent., in the past few years.

The larger question that looms over our debate this morning is where we go from here; where do we go nationally, and where do we go in Mid-Worcestershire? The larger question is, on the basis of the investment and success to date, how can we create an NHS that is truly patient centred; an NHS that we would be happy to use and that we would be happy for our constituents and our own families to use?

The Government's answer is straightforward. First, we believe in more investment, but it must be coupled with a new degree of choice for patients about where and how they would like to be treated. Secondly, we propose national frameworks, or national standards, for how that care is provided. Some of those standards have been described variously as the envy of the world and among the world's leading definitions of health care, but they must be coupled with a new freedom for local health care professionals working with their local communities to decide how best those standards are met. It is that new freedom which is the real author of today's debate.

Here we have a situation where local health care professionals have very properly surveyed the health needs of the local population, and have come to a set of recommendations, or provisional conclusions, about how to invest the resources with which they have been entrusted, and their plans have, as we have heard quite graphically this morning, struck a note of discord.

It is important to understand that the primary care trusts do not want to make these cuts. They are not my enemy. They disagree with what they are having to do; it is not their choice. They have no discretion over the rest of their budget. The only discretion they have concerns small pots of money, as at Evesham community hospital. They are making these cuts not out of choice, but because they have no choice.

I will address that argument as I develop this hypothesis.

The provisional recommendations that the primary care trust has set out are plans that must be drawn up to explain just how the local health economy intends to deliver the standards that people ultimately voted for in the general election a few weeks ago. They are set out according to guidance issued in July 2004 by my Department and snappily entitled "National Standards, Local Action: Health and Social Care Standards and Planning Framework 2005/06—2007/08".

The first point to make, however, is that these are not recommendations or provisional conclusions born of a financial crisis. Far from it. The hon. Gentleman will know this. Revenue allocations are made to primary care trusts on the basis of the relative needs of their populations. It is quite right that, as a country, we invest health resources in areas where there is the greatest health need.

This means that South Worcestershire will receive an allocation of £313.5 million next year, rising to £344 million in 2007–08. There is a cash increase of £57.1 million, 19.9 per cent. over the next two years. I hope the hon. Gentleman will accept that this is a significant increase in resources.

The hon. Gentleman mentioned two points. First he felt that the local primary care trust has been in some way short-changed. The response to that is that we must invest in areas where there is the greatest health need. Secondly, he felt that the cost of new standards was over and above the resources that have been invested. I want to point out that in 2002–03, the primary care trust had a budget of something like £200 million. When we look forward to 2007–8 and we see that the figure is £344 million, I think that an increase of £144 million over a fairly short time is a very significant envelope with which to invest in delivering new standards.

Another pertinent point is that the health professionals of South Worcestershire primary care trust will not and are not making decisions about how to spend this very significant amount of money without intensive engagement with the local community. This is a matter of fact and, I might say, a matter of law. The hon. Gentleman mentioned section 11 of the Health and Social Care Act 2001, which is very important. It placed a new duty, from the beginning of 2003, on NHS trusts, primary care trusts and strategic health authorities to involve and consult patients and the public in service planning and in the development of proposals for changes. As the hon. Gentleman points out, that encompasses ongoing service planning, development of proposals—not just consideration of the final product—and decisions about general service delivery, not just major changes.

Furthermore, the Healthcare Commission will regularly assess patient and public involvement as part of its review of clinical governance. The Act, as the hon. Gentleman pointed out, was reinforced by the approach and principles set out in "Keeping the NHS Local", published on Valentine's day 2003. It provided new guidance on service change that builds on the new arrangements for patient and public involvement. It challenged the view that biggest is best, and explored some innovative ways of keeping high quality and locally accessible services within the important bounds of patient safety.

As the hon. Gentleman might know, one of the core principles of that guidance is to take a whole systems view of the local health economy, encompassing the different contributions of hospitals, primary care settings, intermediate care settings and social care providers.

What does that mean for Evesham hospital? I understand that, as a result of the dialogue around the primary care trust's local delivery plan, three basic proposals were discussed at the primary care trust board meeting on 8 June, and will be part of the debate with local stakeholders prior to the public consultation which will follow. It goes without saying that these proposals are at a very early stage.

As the hon. Gentleman pointed out, I understand that the proposals encompass the possible closure of two wards at Evesham hospital, in the context of the development of community matrons and an increased district nursing service; the reduction of orthopaedic activity at Evesham hospital, with the treatment being undertaken at the new Kidderminster independent sector treatment centre; and changes to the arrangements for medical cover.

I am advised that the PCT has been open in its handling of this matter and I am pleased about that. That is in no small part down to the hon. Gentleman's long-standing engagement with local health care professionals. The PCT is discussing the proposals with a wide range of stakeholders, including staff, patients, the local council, social services and the public. Those discussions are ongoing and I expect the PCT carefully to consider all the representations that it receives.

It might help the House to weigh up what the proposals mean in practice if I explain that Evesham hospital conducted around 32,260 cases last year, spanning minor injuries, day hospital cases, and outpatient, inpatient and day cases. The combined total of discharges on Willows ward and Bredon ward was about 256. Of course, it is not very fair to set one figure against another but were I pressed to do that, I would point out that the total number of discharges from the two wards represents about 1.75 per cent. of total activity in 2004–05.

The hon. Gentleman challenged the idea of chipping away at the service. It is probably fair to consider exactly where the local PCT is talking about investing the money that it is being given. It proposes that there will be £700,000 for new NHS dentistry, £700,000 for new mental health services, £2 million to be directly invested in access to acute services and the move to a maximum 18-week waiting time, £700,000 for community services, including four new community matrons, an intravenous therapy team, a community rehabilitation team, a muscular sclerosis nurse specialist, a Parkinson's disease nurse, community health trainers for the prevention of obesity and three heart failure community nurse specialists. So the proposals that the PCT is weighing up do not relate solely to the issue of closing one ward; there is also the serious issue of what other investments will be made.

The hon. Gentleman mentioned the issue of Kidderminster independent treatment centre. My understanding is that the contract for that independent treatment centre was agreed on the basis of 100 per cent. new orthopaedic activity, as required by the local health community. South Worcestershire PCT was a signatory to the final business case and raised no concerns at that time. That was the basis on which that was put forward.

There are important choices ahead for the local community. I am reliably informed that the intention is to discuss the matter further at the PCT's board meeting on 3 August. Ultimately, decisions about the local configuration of services are not made from Whitehall. I think that there is a degree of consensus about these issues. Among some of the extremely interesting reading that I was ploughing through last week I came across an interesting quote, which thundered

"we will stop trying to run the day-to-day health service from the desks of Whitehall".

That was a quote not from a member of the Government, but from the hon. Member for South Cambridgeshire (Mr. Lansley).

The hon. Member for Mid-Worcestershire made a number of constructive suggestions and I congratulate him on his engagement with local health professionals in structuring some of these proposals, which will be a valuable input to the board meeting on 3 August. However, I underline that the role of Health Ministers and the Department of Health is to secure adequate resources for funding the NHS and to set out the strategic framework for the NHS to work within. My hon. Friend the Member for Worcester mentioned the possibility and indeed the opportunity of provision for greater community capacity in and around Worcester. The Government will undertake an important public consultation on out-of-hospital care later this year. I encourage both my hon. Friend and the hon. Gentleman to be active players in that consultation, because as the future of health care changes, it is important to change the shape and nature of local health care provision.

Our policy structure allows decisions about local NHS services to be taken at a local level. It cannot be right for Health Ministers to stand in Westminster and write a prescription for what health services should look like in every community up and down the country. We have increased the funding for PCTs significantly. We have set the standards. It is now down to local PCTs to decide their local priorities. I look forward to hearing further news from South Worcestershire PCT as these plans are developed together with the local community, as it goes through the consultation procedures that have been set out over the weeks and months ahead.

First, I know that other hon. Members are interested in the debate, which I am pleased to have secured. I know also that my hon. Friends the Members for Norwich, North (Dr. Gibson), for Bristol, North-West (Dr. Naysmith) and for Brighton, Kemptown (Dr. Turner) want to talk about their experiences with the National Institute for Health and Clinical Excellence.

I want to do four things: review the current situation; talk about and give examples of technology and different types of treatments and how they are dealt with; talk about related relationships within the United Kingdom, because NICE has an interesting relationship with the rest of the UK beyond England—there are organisations in Wales and Scotland that do similar work—and say something about how all that affects commissioners and delivery agencies; and assess how such issues affect financial efficiency, the making of changes and the improvement of standards.

Running through the subject is a second aim because two things are involved. One aim is to consider efficiency, process and practice when making changes, but that has to be done for a particular reason, because relative to all that are the human tragedies and journeys. Patients and families are people, so the second aim is to drive up the quality of their care by the efficiency changes, as well as efficiency being gained simply for its own sake.

I have had three Westminster Hall debates on the subject, and you will know from those, Mr. Cook, because you chaired one of them, of my interest in it. I became involved because there was, at that time, a huge incidence of cancer in my constituency and I had been looking at how to improve standards of cancer care. One thing that came to my attention was people's treatment in relation to anaemia and blood. As a consequence of that, I looked at how standards were applied for alternative technologies to blood transfusion, for example. That led me to NICE and the process of rationing in the NHS. Since then, I have asked 50-odd parliamentary questions and have had these debates, in the last of which, in July 2003, the then Under-Secretary of State for Health, Melanie Johnson, said of NICE:

"Central to our modernisation programme is the National Institute for Clinical Excellence, which we established to give clear national guidance on the use of drugs and other treatments. Its work reaches into all aspects of the NHS, from wider judgments on whether a new treatment is both clinically and cost effective, to assessments of what care is best for individual patients."

She went on to say:

"We set up NICE to tackle postcode prescribing and inequality, and it is central to our plans to modernise the NHS and drive up standards."—[Official Report, Westminster Hall, 8 July 2003; Vol. 408, c. 240–41WH.]

I could not demur from that, as that is a laudable set of aims, so why am I back here two years later? It is because of some reports that I heard in the Whitsun period after the general election. In the July 2003 debate, I was told that NICE was to receive extra money and resources to enable it to go from doing two appraisals a year to three, but I now hear that it is to move backwards and go from three appraisals to two.

Of the various reasons for that, the main one seems to be that because the Health Development Agency was assimilated by NICE in April, NICE has had to make a budget cut of £3.5 billion to subsume the new work and combine the two organisations. I am told that that is the reason for the change in the number of yearly appraisals. I do not know whether that is true. I understand that Ministers deny that there is any cut in the budget to NICE, but whatever is happening with the finance, the number of appraisals is to be reduced. A long queue of things, which are of great need to individuals in all our constituencies, were being assessed, but that has now stopped.

When I considered other treatments, such as drug alternatives to blood transfusions, an argument immediately started about how to assess the true and total cost. How do we assess true value in the NHS? I do not say that in an accusatory fashion, but I have observed that it is difficult for the NHS to value things in the way that I see them. For example, I get into discussions that are like a cross between metaphysics and linguistic philosophy. I might say, "Well, surely if you introduce this treatment, this will mean that someone can go home earlier. Therefore you will make an efficiency gain and a bed will be flung free for someone else to use." I am told, "Ah, now hang on a minute: what's a bed day? What's a bed? What's a day?" So no change is made because there is apparently no way of deciding what the real value is or whether efficiency is achieved.

There are organisations and engines that are supposed to help—apparently—the greatest of which, I have been told, is the National Institute for Health and Clinical Excellence. It was supposed to be a mechanism of change that could reconcile some of the problems, square a number of the circles and build a community of understanding of the real value of something. Now, however, I am told that the situation is as I have described it.

The number of appraisals has declined, and although NICE is supposed to help with such things, I was told in an answer to one of my questions that NHS circular 1999/176 says that, in the mean time,

"national health service bodies should continue with local arrangements for the managed introduction of new technologies where guidance from the National Institute for Clinical Excellence"

has not yet been issued. It went on:

"These arrangements should involve an assessment of the available evidence on clinical effectiveness."—[Official Report, House of Commons, 7 Mar 2005; Vol. 431, c. 1568W.]

That all sounds fine, but I am being told, on the one hand, that we need that engine of change and that it exists, but, on the other, that it is being reduced, although that does not matter because there is another process. The truth is that without NICE making a declaration there is no real agreement about money, which takes me back to the original response that I received.

The question is not only whether something is efficient in the sense of being effective as a medical treatment, but whether it is efficient in the sense that we should spend money on it. Without that, whatever the local arrangements, the budgets will not allow certain treatments. That is the power that NICE has because it gives local people the ability to square the circles, and that is the problem. A lack of NICE guidance means that local arrangements cannot really apply, unless there is a magical way of finding money to make things work.

That is the background, and I shall give a few examples to demonstrate why a lack of NICE guidance is so important. Some new medical technologies and treatments are licensed and some are not. Hon. Members will know the argument that runs, "Well, there's this fancy thing that I've found on the internet, but I've been to the doctor and it's not got a licence." We all encounter such problems as constituency MPs, but in the NHS the problem is bigger. There are also licensed technologies and treatments that do not have NICE approval.

In the UK, to reduce both bed blocking, which is a huge inefficiency problem in the NHS, and waiting lists, thereby allowing patients to leave hospital more quickly, there is a set of treatments for wounds. There is a huge problem with MRSA. People have wounds in hospitals for different reasons—they might go in as a trauma case, for instance. However, there is now a technology that, I understand, works on a vacuum system—it is a machine as opposed to a drug—and is put on to the patient in some way. The wound is sealed up and kept treated. Multiple wounds are treated and the person is allowed to go home, rather than staying in an environment where they can get an infection.

If nothing else, the precautionary principle suggests that it would be sensible to fund that technology to improve efficiency in the health service and the quality of care for the patient. I am told that the MRSA rapid review panel—a different body again—looked at the technology and said, "But this is not a new technology. The only new thing about it is that it is portable. We will not, therefore, include it in our assessment of what might be useful in combating MRSA." If NICE cannot appraise it or has not got the time to do so, perhaps another body could. Perhaps that body could license its use—but apparently not.

Wounds can result in all sorts of things, and diabetics are probably most affected in that respect, as a result of ulcers, sores and so on. People in my community are in that situation. There is ill health in a number of forms in the Welsh valleys and similar communities, as a result of diet and the rest of it. People have to go into hospital, sometimes just for simple things such as foot ulcers. Those things can be treated in such a way that people do not have to remain in hospital and are not exposed to infections. Yet, it has not been agreed that this technology is the best process and the best practice. That is not because of the arguments about what is efficient and what is good quality care for patients, but because it does not fit with the budgetary processes.

A diabetic can end up with wounds and the rest of it, and the only treatment may be to amputate. Some of the treatments that are given in such circumstances go back almost to Trafalgar—Nelson would recognise some of this stuff. However, there is no need for these things to come about when there is a new technology that can avoid these problems in hospital and when people can be given better quality care that allows them to stay at home. There are examples of this technology being used. I know of a nurse in Scotland, for example, who has a problem and who is using the machine. She is out of hospital and back at home, so she is not exposed to extra infection. She is also back at work.

Another thing that interests me is that there is a budget for lopping off limbs, but no budget for introducing this machine, which seems barking mad in the 21st century. I do not understand how we can move from one position to the other without engines of change to allow us to do so. NICE is one of those engines of change, and every time I look at it, as a lay person trying to understand the edifices, the interest groups, the old boys' clubs, the reasons why things cannot happen and the budgetary processes, I see ever more clearly why we have arrived at this situation. It is obvious to me as a lay person that we should make the change, but we cannot seem to find a way to agree on that.

As I understand the figures, such a change could save huge amounts of money—billions of pounds. A study estimated recently that pressure ulcers alone account for £2 billion annually. That is 4 per cent. of the NHS budget. I have no difference with the Minister about the declaration of aims. If we look back at my previous debates, it is clear that we have always ended up agreeing about the need to move to European standards. We need to do all these things because we need to improve. I am told that mechanisms will be in place to help us to do that, but I find out daily that they are not. The mechanisms are dysfunctional and deficient, and resources need to be made available, but NICE is now getting fewer resources.

Perhaps all this can be explained away and I can be told that I am a naive shaver who does not understand these things, but I have seen examples and I have mentioned them. I want to know when that technology will be properly assessed. If NICE cannot do the appraisals, when will it be considered? It seems relatively simple to do that, but there is no mechanism. That is completely ridiculous.

The other thing I have discovered is that there are different drug therapies and technical assessments of technologies. I am a lay person, so I simply look at things from a straightforward point of view. The wound technology is not a treatment—it is a machine, not a drug—and such technologies have to follow certain criteria. So there is a problem in getting technologies assessed, but once they are, there is a problem with the criteria—another barrier. Apparently, the assessment has to be done with a blind randomised testing procedure, because the patient is not supposed to know about it, but it is a little difficult not to know about it if a machine is strapped to your body. It might be possible to do that with a drug, but not with a vacuum pump. So once one hurdle is cleared, there is another. All those things are barriers in a process rather than equipment in the tool bag of someone working on the engine of change to ensure the progress that we all apparently want.

I should like the Minister to consider that problem, if nothing else. We need to think about the criteria used for technological and medical processes—in other words, drug or pharmaceutical processes—so that we do not end up with anomalies. Frankly, the criteria seem to be excuses for not making changes and not being able properly to see the value of such technology to society.

I intend to deal with where the Treasury sits on the subject because the nurse who I mentioned earlier is still in work. She is contributing to society. She is not on benefit, does not need a carer and is not drawing the support that she would otherwise need. Her mental health and her quality of care are better. As a consequence, her family is better off. There are costs beyond the simple budgetary processes of the NHS, so it is not entirely an NHS matter. A wider understanding is needed of the value of such technologies, so that they can drive efficiency within the NHS and beyond, to the broader macro-economic benefit of the country. That is my experience of the examples that I recently found out about.

The differences between the various parts of the United Kingdom can be problematic. You, Mr. Cook, will understand that, as we have discussed it before. As a Member for a Welsh constituency, I know that a number of health matters are devolved, and I remember discussing whether we might have devolved arrangements in the north-east. Nevertheless, there is a relationship between different practices. I know that my hon. Friend the Member for Bristol, North-West has a particular view of the matter because he sits on the border between England and Wales, where there are several examples of different practices.

My experience is that NICE informs all decisions across the whole of the United Kingdom. It could be said that they apply in both England and Wales. However, that relationship became a little more disturbed recently because the NHS in Wales decided to put more emphasis on the All Wales Medicines Strategy Group, an equivalent organisation trying to do similar things. In Scotland, the situation might be slightly problematic for the Scottish Medicines Consortium; in the absence of guidance being adopted by the Scottish Parliament, the NICE guidance would apply.

The situation is simple. In England, if NICE makes a decision the funding has to come within three months. However, Wales and Scotland may not adopt NICE decisions in quite the same way, which is why those relationships and what they should achieve have been considered. However, the All Wales Medicines Strategy Group now makes decisions about licensed products in Wales; things happen within three months.

Other considerations are the number of appraisals that NICE can do and the various things that it can look at; indeed, the speed with which things happen is part of the argument. It seems that we have a group in Wales that is able to move more speedily than NICE, which covered the area before and made appraisals within three months. As I understand it, the Scottish medicines consortium takes a similar time, taking three months to evaluate something.

Patients in Wales can now get different types of treatment. NICE was set up for the purpose, among other things, of getting rid of postcode prescribing. That was the political declaration that was made. However, postcode prescribing happens not only in England, or even in parts of Wales or Scotland, but also, it would seem, between different parts of the United Kingdom.

Let us take as an example someone from Wales with rheumatoid arthritis. There is a problem with rheumatoid arthritis in Wales; in January this year agreement was given for a new anti-tumour necrosis factor drug, called Humira, to be used in Wales. The patient might go to a hospital on the border, in Herefordshire. Although a patient from Wales being treated in an English hospital would get the treatment, a patient from England being treated there might not get it because NICE has not come to the same agreement as the Welsh body.

The Welsh organisation can apparently act and assess matters more quickly than the English one. That is positive for me in Wales, I suppose. I could be challenged to say why I am complaining; the Welsh patient is getting the treatment, so what is the problem? However, what I have outlined illustrates the problem that exists across the piece: how do we evaluate and change processes? How do we decide on the best treatment and standard, the way to apply it and the way to follow the money?

I am told that the only thing that we can rely on is NHS circular 1999/176, which tells us, "OK, that doesn't matter, because if NICE has not appraised a treatment, things can still be done locally." I recently encountered an example from Birmingham relevant to that approach. A patient went to Birmingham for cancer treatment. That was fine; the treatment was great and the patient came back. I have a list of 10 drugs from the cancer network in Birmingham, which I can provide to the Minister later. What interested me is that without NICE having agreed standards for the drugs, the default position is that all drugs, including the 10 on the list, will not be prescribed unless and until it is possible to find—what is the phrase?—"a clinical champion".

When I saw that, I thought, "What does that mean?" Presumably it means finding someone with some dosh to pay for the drugs—someone who is able to juggle a budgetary process somewhere to provide the treatment. There is an understanding that the treatment is the best one, but it cannot be given. There is now almost a conspiracy. That is perhaps a bad word to use. There is a coincidence of understanding within the cancer network in Birmingham and among the commissioners, the primary care trusts. That is not my patch. I apologise to Birmingham Members; I just have that example and use it for what it is.

The situation may not be entirely as I understand it. However, it seems to me that the real message is that unless a series of agreements is struck elsewhere through NICE there is a problem, and the only way to cater for the need in question is to take a default position in which no one gets the treatment unless someone somewhere comes up with the money to pay for it and shows us how to juggle the budget.

That brings me to the point that I made earlier. It seems that there is a silo mentality. I do not know why the health economists in the Department of Health cannot find a way through. It seems that there is a budget for that and a budget for this, and there is no quick way to change the arrangements and move money with the patient. Yet that is what the declaration was about. There can be a budget for chopping off arms and legs but not one for the vacuum pumps, so we have amputations instead of pumps. There is a budget for transfusing blood but not one for pushing a drug alternative into someone. No way can be found to make the best decision. The only decision that can be made is the one allowed by the process. That is why I want to make the point about the necessity for process change and my view of the system as dysfunctional.

I am quite happy to share examples of cross-border care with the Minister, but what I have outlined needs to be examined if those default positions are being adopted, and if that is what circular 1999/176 really means. It looks positive, and I am sure that it is positive in intention. It tells people that they can make the best arrangement locally. The truth is that they cannot, because the other processes will not allow them to. The circular can also be used negatively rather than positively, and people can go off and do their own thing. I suspect that it is being used as an excuse not to apply some of the NICE guidance, or to slow things down and find ways of avoiding it.

Perhaps I am being accusatory about things that I should not be, and perhaps I only half understand the problem, but these things warrant investigation and go some way towards illustrating the problems of the laws of motions that apply here. Does the Minister agree?

I return to the point about finance. In all this, there is a desire to improve standards of care. Indeed, the Government have made political declarations about improving standards of care and about spending money. In practice, we are spending huge extra sums, but there is tension as to whether the efficiency changes will come in concert with investment. That is what I am trying to get at. All those political declarations are fine and the actions are good; I simply feel frustrated that the practice on the ground is not delivering results.

The Secretary of State said at the NHS conference this week that it was paramount that best value was delivered and that every pound going into the NHS must deliver it. I agree entirely, but the politics are also important. The politics of the personal are important. Every day, I see individuals who could have a better quality of life but are not getting it. I see people who live in valleys who have difficulties with transport. Even the NHS has difficulties in transporting them from their properties to their places of treatment. If those people were treated differently, they might not need to make half the journeys that they make. They could be liberated by the quality of their care, and what they can do as individuals could change as a result of changes to the system.

Politics more broadly is important. The Government have declared that they will increase national insurance contributions by 1 per cent. to provide all this extra money for the NHS. I applaud that. That is exactly what we should have done, but we were going to get the efficiency gains that went with it. That is what I am questioning, because if we do not increase national insurance contributions and get those gains, the harpies will be on the wire saying, "You won't do it, and you'll have to raise taxation, Gordon." We see them there every day—the City scribblers who write in the press. We must address the problem whether we like it or not. We must have real change and real efficiency, not spurious processes.

I differ from the Government on how to effect that change. I do not believe that the market does it. We must drive the process if we want a real improvement in efficiency. That is how we save the money and improve the quality of care. We do not do that through managerial arrangements elsewhere. To me, that is a false notion. This is the guts of the argument if we are to improve health, deliver better treatments and increase efficiency.

Some of the problems are avoidable. I do not believe that, having put men on the moon in 1969, we cannot do this. Perhaps I am naive, but I take that point of view. A woman who comes to my surgery with foot ulcers because she is diabetic is going through the whole process that I described when she does not need to. It is simply more efficient for the hospital not to see her. We have to find ways around this. How do we do that? I asked that question when I met the Minister, along with a delegation, to discuss another example of the problem. This warrants further examination by Departments working together.

This is the point at which I return to the subject of the Treasury. As you know, Mr. Cook, I served on the Defence Committee during the previous Parliament. In many ways, we had a similar debate. There was a huge overspend on defence budgets, and the Treasury said, "Oh well, we will have resource-cum-budgeting. We will have this, that and the other, and we will sort out all these problems by keeping stocks." Neither the Ministry of Defence nor the Department of Health is Tesco, however. It would be fine if we had a load of tins of beans on a shelf and we wanted to move them quickly and would not be punished for keeping stocks. That is one bit of the argument.

There is, however, something much more fundamental, which relates to process. I want standards such as resource accounting and budgeting—or whatever the other mechanism is—applied across the piece to find the engines of change, one of which I believe is NICE. One could advance a political argument against that, querying whether making a decision about medical efficiency and spending for a bunch of technocrats is a good idea. However, if such a procedure will deliver a change, I do not care about that, because political responsibility will still rest at the top.

Processes must be found to take such action. I hope that the Treasury will take account of the arguments that have been advanced today. Perhaps the Minister can promote a way in which all the Departments responsible for such matters are not subject to blame, but understand the reality of saying, "How do we make two things happen?". That takes me back to the first time that I spoke about such matters in 2002, probably under your chairmanship, Mr. Cook. At the time, I said that two outcomes could be achieved: step change and good, consolidated implemental change in the processes that deliver not only efficiency of spend, but quality of care, with standards being driven up for patients.

Order. For the convenience of hon. Members, I wish to call to mind the fact that we start the first of the three wind-up speeches 30 minutes before conclusion of the debate. We are due to finish the debate at 4 pm, which means that wind-up debates must start in 29 minutes. I ask hon. Members to bear that in mind when making their contributions and also when accepting, and responding to, interventions.

I am delighted to take part in the debate and will be as brief as possible. I congratulate the hon. Member for Merthyr Tydfil and Rhymney (Mr. Havard) on being granted the debate because it is important.

I refer the Chamber to two reports undertaken by the Health Committee in the previous Session, the first of which is the report on the National Institute for Clinical Excellence in 2001–02. The second report concerns the pharmaceutical industry inquiry that the Health Committee has just completed. The first inquiry led NICE to be much more open in its work, to put itself before the World Health Organisation for a review and to be much more open with the bible that all doctors carry, the "British National Formulary", in which NICE recommendations are now summarised, a huge help.

The second relevant report is the fourth report of the Health Committee, undertaken in 2004–05. The Committee inquired into the pharmaceutical industry and the report gives a useful summary of NICE and its work. It defines technology appraisals, clinical guidelines, cancer service guidelines and interventional procedures. It states that NICE publishes about 25 technology appraisals, 12 clinical guidelines and 60 pieces of interventional procedures each year. That is all it can do. I completely support the hon. Member for Merthyr Tydfil and Rhymney (Mr. Havard) and agree that NICE is limited in the amount that it can do. The fact that it is taking on extra work is a bit of a disaster for its future work load.

I wish to concentrate briefly on some current concerns. I am sure that we have all been bombarded with letters about the drugs for dementia. Although NICE reviews cold, scientific evidence, there must be a place for the human element by which to take account of the value to the patient and carer, which, sadly, cannot be measured. Another worry is the inequality of availability of recommended drugs.

The hon. Member for Merthyr Tydfil and Rhymney touched on that; he referred to anti-TNF drugs, which are vital for patients with rheumatoid arthritis. I am delighted to be able to inform the House that NICE has approved them in England. The problem is that some primary care trusts do not have enough money to follow the NICE recommendation. Those drugs are very important. One of my rheumatologists has about 80 patients on them, 75 per cent. of whom have been absolutely transformed; they no longer rely on piles of drugs, and they are mobile again. That sort of drug is crucial.

That point brings me on to the prioritisation of assessments by NICE. Somehow, potential major advances must be fast-tracked so that they become available sooner. Let me give an example from the past to illustrate that. Herceptin is a crucial drug for a relatively small group of patients with breast cancer; in my opinion, it is far more important than drugs for influenza, but I do not think that it was fast-tracked in any way. The anti-TNF drugs are also very important; much more important than the COX-2 inhibitors, which were the drugs that were supposed not to have any side effects for people with rheumatoid arthritis.

This is where there is tremendous conflict with the pharmaceutical industry and the Health Committee report tries to crystallise that. To remain viable, pharmaceutical companies have to make profits and recoup their costs, and there have been press reports recently of the United Kingdom drug industry calling GPs luddites for being slow and a little conservative in introducing new drugs to medical practice. Therefore, there is a conflict, and the Health Committee report makes several recommendations. One of them is

"that consideration be given to limiting those who can prescribe a new drug in the two years following launch. Drug and Therapeutics Committees would be well-placed to implement this."

So, the Health Committee feels that the rapid, explosive liberation of a new drug is, perhaps, not the best thing. I was brought up by a very conservative and very senior physician who was around when rheumatoid arthritis was first treated with cortisone. Patients who took cortisone appeared immediately to be cured by it, and it was only after a few months that it was realised that that was all an illusion and that they were in fact made very much worse.

A later recommendation is also crucial:

"New drugs that might represent significant advances should be fast-tracked through these—

drug and therapeutics—

"committees."

That is because those committees are much more widely spaced than NICE, and they can review and give wise advice, provided that they are all of the same high standard as some of the committees that we saw during our inquiry.

On the way that NICE is used, let me read out another quote from the report:

"The Department of Health asks the Institute to look at particular drugs and devices only where the availability of the drug or device varies across England and Wales or where there is confusion or uncertainty over its value."

Therefore, it does not have to look at all drugs and, hopefully, drug and therapeutics committees in trusts and hospitals can provide a great deal of the input that is needed.

I would like NICE or the Department of Health to address some ridiculous situations. One has arisen, particularly with the non-steroidal anti-inflammatory drugs since the revelation that the new, selective ones, including Vioxx, can lead to cardiac problems. Unbelievably, other NSAIDs have been examined and have also been shown to cause a risk of cardiac problems. Ibuprofen, which has been around for 40 years and has been the mainstay of anti-inflammatory treatment is now found to be not free of cardiac risk. Walking along a road is not free of risk, neither is driving a car, nor is going on the tube, but we do so. We must guard against some purist scientist or safety expert taking away a lifeline of chronic rheumatoid patients like this, rather as Coproxamol has been removed because of the risks of abuse.

I have a final plea. NICE carries out valuable work, but it acts too slowly and covers only a proportion of the drugs available. The Health Committee recommends increased funding for NICE to allow it to evaluate more medicines more quickly. The consequent improvement in prescribing standards should make such investment cost-effective.

Thank you, Mr. Cook. Just watch me go.

I congratulate my hon. Friend the Member for Merthyr Tydfil and Rhymney (Mr. Havard) on securing this debate. I am sure that you are delighted too, Mr. Cook, given your sterling work on laser eye surgery in the previous Parliament, which will continue into this one.

From my point of view, and that of many others, thank goodness we have NICE; it would have been a lot worse without it. Although we are feeling the frustrations all the time, we are getting some decisions out of it and we aim to improve those decisions, both their number and the areas that are investigated. NICE has a huge agenda, comprising medicines, medical devices, diagnostic testing, surgical procedures and health promotion, but most of its time is spent with medicines and medical devices get a little share of its time and energy. However, in the past 18 months NICE's interventional procedures advisory committee has come up with lots of sets of guidance so that it is on the move. Our job is to ensure it gets weaving and gets a faster move on.

The frustrations are not just being mentioned here today, but are out there in the community, with the people who practise medicine and use the devices, and particularly with patient groups, which are well informed about these issues. Hon. Members will know that last week at the NHS Confederation conference the Secretary of State for Health said that there are three big challenges in our time:

"Putting patients first"

—it is important that we are making politics do things—

"transforming the whole service that people receive, and engaging all our staff."

I think that all hon. Members are glad that these will be the priorities.

CancerBACUP, which could be described as the scourge of NICE, has been going for a long time—Relenza was the first campaign that we all got involved in—and is continually pushing on, through Taxotere and other cancer drugs, and supporting many patients. Its latest dossier—"A Dossier of Delay"—says that additional delays are unacceptable and it is calling for NICE to introduce a system of fast-tracking for cancer treatments that have shown significant results.

The dossier illustrates 10 new cancer treatments that CancerBACUP thinks should be made widely available to patients and is trying to encourage those to be looked at. It has been told that it will have to wait for one to two years before some of the drugs are used.

The same is true for medical devices. We know now that there are stents and catheters made of certain alloys that prevent hospital infections. MRSA is not the biggest hospital infection of patients, and catheters are one way in which hospital infections have been reduced. There has been a long delay after the approval of a certain catheter before getting it into service. Lots of things are going on in that area.

Last week I saw a woman—she works for "Newsnight"—who has back pain, which is a formidable problem for many people. There is now a bionic arm that can manipulate the spine much better than the human hand, and it can give great relief. I notice that, in the United States, the Food and Drug Administration approved that hand in no time at all; it got on and did it, and it is bringing great relief to people.

Many other devices are coming through, and one of the biggest is positron emission tomography scanning, which is used to scan the heart. That gives us knowledge about what further treatment should be given, and can be used for brain scans, cancers and so on. That is more readily available in the private than the public sector. I live for the day when everyone gets a PET scan for free in this country. It is expensive, but it gives people the chance to get further treatment, and it prevents many things from happening.

While that is all going on, we are worried about lifestyle illnesses, such as obesity and smoking. Those issues are taking up a lot of time, and prevention is getting much more of a hearing than ever before. I welcome that; because of it, down the line less money perhaps will be needed by the health service for such problems, and so we will have more to make these devices available.

I feel that we have a future ahead of us, but there will be more and more devices, and more pressure for them to be looked at. As I say, NICE has got to get weaving. When nanotechnology sets in across the world and in this country there will be an explosion of new devices in this area. I say to NICE, "Please, carry on the good work, but you will have to increase your resources, your number of people, the number of appraisals you make and so on, so keep the pressure on. Stop sitting back and saying that you are doing a good job but are under pressure; we want more." We need that evidence-based medicine; it is out there and available, and we politicians have to open the door so that it can be introduced.

Thirteen minutes available, and two Members bidding. I call Dr. Naysmith.

I congratulate my hon. Friend the Member for Merthyr Tydfil and Rhymney (Mr. Havard) on calling for this debate, which could hardly be more timely. [Interruption.] I am dropping a big chunk of my speech, you will be glad to see, Mr. Cook.

Like my hon. Friend the Member for Norwich, North (Dr. Gibson), I have been a supporter of NICE since it was set up. If used properly, it offers the opportunity to combine evidence-based medicine with evidence-based politics, something that is not always achieved, even in this House. There is no doubt that NICE has contributed enormously to rational decision making in this country since its inception. There is good reason to believe that many other countries have looked at the NICE methodology and have set about adopting something similar. The occasional controversy has only strengthened the case for continuing with NICE; if its findings were never controversial, it would suggest that all it was doing was bureaucratic rubber-stamping, and I do not believe that that has been the case.

I want to talk a little about myeloma, partly because I am a supporter of the International Myeloma Foundation UK, which this very week celebrates its seventh awareness week. The organisation has campaigned for some time for faster access to the latest treatments for people with myeloma. It is right to speak about the subject in this debate, partly because there is currently controversy about a drug believed to be of importance in fighting this disease.

Myeloma has been under-recognised for years, and only in the past few years have there been dramatic advances, with treatments that promise significantly to improve patients' quality of life, halt progress of the disease and improve chances of survival. A recent example is Velcade, or Bortezomib, which is the first treatment to be licensed for myeloma in over 10 years. The All Wales Medicines Strategy Group recommended the use of this drug in NHS Wales earlier this month, pending ministerial ratification. The treatment has also been made available in Scotland, following approval by the Scottish Medicines Consortium last year. Unfortunately, this treatment is not due to be reviewed by NICE until its 12th wave work programme, and therefore is unlikely to be appraised until 2007 at the earliest. That will be too late for many people who currently have myeloma and could result in a disparity of access between England and its neighbours. Such delays with NICE appraisals send confused messages to cancer networks and primary care trusts, which refuse to fund treatments in the absence of NICE guidelines, as we have heard.

It has recently been reported that all the PCTs in Birmingham are also refusing to fund Velcade, and a number of other important cancer treatments yet to be approved by NICE, on those grounds. In other areas of England, such as the Thames valley, there is a wide disparity of access between those who can get it and those who cannot. Surely that is an unacceptable and unfair situation for patients suffering from rarer cancers in England and demonstrates that change must take place, perhaps in the way in which NICE appraises treatments. Possibly more importantly, there needs to be an increase in the new organisation's capacity, which seems unlikely if its funds are reduced for whatever reason.

We need to put more resources into the new organisation, not less. As was pointed by the hon. Member for Wyre Forest (Dr. Taylor), who is a fellow member of the Health Committee, NICE has been studied twice by that Committee. On both occasions, it recommended increased capacity and increased funding. In 2002, it said:

"This may necessitate an increase in NICE's capacity and/or a change in its organisational structure".

In a more recent report, it said:

"We recommend increased funding of NICE to allow it to evaluate more medicines more quickly. Consequent improvement in prescribing standards should make such investment cost-effective."

I am not too sure about that last statement, but I am sure about the first.

There are nine minutes remaining.

I, too, congratulate my hon. Friend the Member for Merthyr Tydfil and Rhymney (Mr. Havard) on securing this debate. This is an important topic, because it is vital in terms of achieving the aim that we set out when we came into Government in 1997 of ending postcode prescribing, and getting best practice and best treatments made universally available in the health service.

I want to declare a personal interest: I am the beneficiary of an example of medical technology, without which I would not have been able to carry on as an MP. I can think of two other Members who are in the same position. Just over 10 years ago, I was finally diagnosed with osteoarthritis in the hip.

I was refused any treatment by an orthopaedic surgeon, who, when I was eventually seen, said, "Well, you got in my office without a stick. You are not bedridden. You are not dosing yourself up to the eyeballs with painkillers. Go away. Come back and see me in 10 years when you are completely crippled." That was effectively what happened to anyone who was not aged 60-odd and severely crippled.

The situation was making life impossible, and I read about a new treatment that had been developed; metal on metal arthroplasty. It is more popularly known as Birmingham hip resurfacing or the McMinn prosthesis. It is quite different from a total hip replacement. It works marvellously, has a 30-year expected lifetime and is virtually impossible to dislocate, which means that I have taken up fencing again. That was how I damaged my hip in the first place. Anyone who knows about fencing will be aware that the movements involved would immediately dislocate any normal total hip replacement.

I could not get that treatment on the NHS—I am talking about a time before NICE, obviously—and I was very miffed. It went well against my principles to go to private medicine, so I had the operation done by McMinn, who led the team that developed the treatment. When I got into this place and when NICE was formed, I wanted that treatment available on the NHS. I agitated for it to be studied by NICE. Its response was to do a study of total hip replacements and it swept the McMinn prosthesis into that study. That, of course, was a disastrous thing to do. It was like comparing apples and doughnuts; they were so different that there was absolutely no point. It would have been disastrous to have had it in that study so it was finally made the subject of a separate study.

There was then the problem of NICE's methodology for considering technologies, as opposed to drugs. My hon. Friend the Member for Merthyr Tydfil and Rhymney has already referred to it; NICE operates with the mindset appropriate for a double-blind clinical trial. That is fine for drugs, although double-blind clinical trials are done as part of the licensing process. All NICE has to do is agree that a drug is effective and that the trial results are okay, and consider cost-effectiveness; those are the only decisions that it has to make.

However, there are clearly no double-blind clinical trials for technology. NICE set out to study the Birmingham hip by saying, "We shall do it as if it were a clinical trial and compare it with watching and waiting." Setting up a clinical trial on that basis would be totally unethical because patients—even in a double-blind trial, they would know whether they had had an operation— would be offered the choice of having a treatment that would give them their bodies back or having a painful time. Clearly, that would go against all ethics.

However, NICE used that mindset as the basis for its cost-effectiveness calculation. The only things that went into that were the relative costs of the operations—it got that wrong, because the cost was exactly the same as with the total hip replacement—and the benefits. It would be difficult to compare the benefits enjoyed by people getting the Birmingham hip with those enjoyed by people who had had total hip replacements, because the people getting the Birmingham hip would not be having THRs and would be a younger and more active cohort. There is just no comparison.

A sensible, holistic approach to cost-effectiveness would take into account the impact of immobilisation on health. Immobilisation certainly had an impact on me; I put on two or three stones, and have never been able to get them off since, because this place does not leave me with time for the violent exercise I need to keep my weight down. That obviously impacts on blood pressure, cholesterol and the chances of developing coronary artery disease.

Obviously, there is a cost—it may run to many thousands—to the health service as a result of that. In the long run, it is clearly much cheaper not to have to treat a patient for coronary heart disease, and that disease can be avoided by restoring a patient's activity at an earlier stage in life. The cost-effectiveness calculation did not take such things into account. When the provisional assessment came out, it was going to deny the use of the treatment. There was a bit of to-ing and fro-ing. We finally got it, and I am happy to say that now the treatment is approved.

However, NICE anticipated that about 5,000 of the operations would be carried out, and was worried when the number turned out to be 14,000. Any rational person might think, "If that is not an indication of success, I don't know what is." There is a problem with NICE's approach to technology assessment, and it needs to be looked at carefully. Part of the problem is that NICE is underfunded and cannot afford the correct people to do assessments. It tends to farm work out for very low fees to university departments, which will use the most junior postgraduate student around. One gets the results that one pays for, if one is not careful, and that is only one of NICE's problems. Do not get me wrong; I support the principle behind NICE wholeheartedly, but I think that we need to get it absolutely right.

There is also the question of NICE blight; I had it, and many people still do. It relates to drugs. In the case of drugs, the pharmaceutical industry calls NICE the fourth hurdle, and I do not like to hear it described in that way. We need to speed up and systematise all of these assessments, and after that we have to eliminate the seasonal prescribing that occurs when NICE has made a recommendation that should be available but PCTs are running over budget. Those problems have to be ironed out before we can finally get to where we want to be.

We all agree that it has been a worthwhile debate this afternoon, and I congratulate the hon. Member for Merthyr Tydfil and Rhymney (Mr. Havard) on bringing this important subject before us. There is a good deal of support throughout the House for the principle of NICE. It has to be right that such assessments are conducted systematically and free of political interference as far as possible, and that guidance should be made available throughout the health service.

This afternoon we have heard examples of where that process is not working as well as it should, and I want to refer to that aspect this afternoon. We heard the hon. Member for Merthyr Tydfil and Rhymney mention the discrepancies between England and Wales and we heard from the hon. Member for Bristol, North-West (Dr. Naysmith), my constituency neighbour, about treatments available in Scotland.

I want to cite one such example. The chemotherapy Taxotere was licensed in January 2005, a couple of years after the data were first presented. Guidance from NICE in England is not expected until February 2007, but guidance from the Scottish Medicines Consortium is expected this autumn. The important question here is why we are getting a different answer in Scotland and Wales. Some things should be devolved, but some things should not be. It seems crazy to me if there is unnecessary duplication, different bodies doing the same work on different schedules. In a sense, Scotland has every right to decide what its drug priorities are, but that is a different question to that of whether something is a cost-effective treatment or not.

The Government should ensure, perhaps in co-operation with the devolved Assemblies, that we minimise duplication and, for example, where the Scottish Medicines Consortium has looked at something, NICE should be able to piggyback on that, and vice versa, to try to ensure that a treatment agreed to be cost-effective and clinically effective is available as broadly and as quickly as possible.

We heard some of the problems of assessing new technologies, but I want to focus on the assessment of new drug treatments. We heard from the hon. Member for Norwich, North (Dr. Gibson) about the campaign by CancerBACUP and some of the treatments it has mentioned. Herceptin has been very much in the news and CancerBACUP is concerned that it could be 2009 before that treatment is widely available—four years hence—despite the growing body of evidence of its potential effectiveness now.

The merger of NICE and the Health Development Agency raises a fundamental issue of resources. I have tabled questions, as has the hon. Member for Merthyr Tydfil and Rhymney, about the resourcing of NICE. The Government's answer is a bit paradoxical; they do not quite say, "NICE is nothing to do with us", but they do say that it is up to NICE how it spends its money. If NICE has decided that it does not have the money to run three appraisal committees, but only two, and if NICE is saying that it will take an extra four months to assess some cancer drugs, it is not good enough for the Government to wash their hands of the issue and say, "That is not a matter for us, it's up to NICE." The Government need to take responsibility for such matters and if the system is not properly resourced, they need to ensure that it is.

There are a range of drugs where there are delays in the system, and one suggested possible alternative is whether, for example, a treatment that is pretty uncontentious should necessarily take its place at the back of the queue, or whether there should be a fast-track option for treatments that most people can see make a lot of sense. We would also need to work out whether that would reduce, as it were, the greatest good of the greatest number. Trying to weigh up the competing claims of a cancer sufferer of one sort and a cancer sufferer of another is a very difficult business, but if there are treatments that everyone understands would go through pretty quickly, making them wait may not be a good idea.

I would be interested to hear the Minister's comments on running the licensing of new drugs and the NICE appraisal of new drugs much more in tandem, rather than having a sequential process whereby, first of all, the licensing procedure happens and then the appraisal starts. Perhaps a lot of the appraisal could be done at the same time, avoiding duplication of effort, probably much more cost-effectively. I imagine that things of this sort are starting to happen, but I do not sense that it is the norm. I hope that the Minister looks into that.

There are some aspects of what NICE does that are transparent, and that is welcome. One of the things that is not terribly transparent, however, is how the Government determine the work programme for NICE. I hope the Minister will respond positively to the suggestion that there might be better parliamentary scrutiny of what goes on the list in the first place. Once NICE is looking at these different drugs, we will see what is going on. Yet how does something get into their in-tray in the first place? How far does this place scrutinise that process? We do not want politicians deciding which drugs work and which do not but, clearly, as representatives of our local communities, we might well want to have a say in which drugs might be examined first, at least. That is a legitimate area of democratic accountability.

I was interested in the comments of the hon. Member for Wyre Forest (Dr. Taylor) about the issue of the speed of take-up of new treatments once they have gone through the NICE process. Certainly, coming to this cold, my assumption was that once NICE has said that something works and is cost-effective, we want people to get on with it. His suggestion was that perhaps we do not want people to get on with it, and should be a bit cautious. His example of cortisone was from the days well before NICE; had it been through a NICE process, some of the worries about effectiveness would have been dealt with in advance. Perhaps, however, I can discuss that with him outside this Chamber.

The hon. Member for Wyre Forest also mentioned dementia treatments. I hope the Minister can give us an update on that. It is an interesting case study, because it is one where, as politicians, we think NICE gave the wrong answer. We have all heard from local Alzheimer's groups and individuals who are very worried that treatments might not be available. We feel, particularly because of the concerns of carers and people with dementia, as the hon. Gentleman mentioned, that we want them to have the treatment. The Government seem to have responded to that political pressure by, if I can put it charitably, deciding that perhaps NICE was not asked quite as complete a question as it might otherwise have been. My feeling is that if NICE is not being asked complete questions, which it probably is not, we should not just ask them when there is a big fuss, but should do so systematically. I wonder whether the Minister has any views.

NICE is asked to assess drugs. An economist thinking in terms of cost-benefit analysis would say that we need to ensure that it is looking at the really big picture. The hon. Member for Merthyr Tydfil and Rhymney hinted at this; there is a danger that if we are looking at silos—individual budgets here and there, local and national budgets, budgets of different Government Departments—we will not see the big picture. Surely something like NICE can do precisely that. I hope that that will not be just in the case of dementia drugs but, more broadly, that NICE will say that a treatment is cost-effective in the broadest sense, taking into account the whole range of what the public sector spends and, indeed, intangibles. Obviously, there are techniques for trying to put a value on the benefits to carers of the people they are caring for getting proper treatment, and for trying to factor that in.

I do not think anybody is here to criticise the principle of NICE. I think most of us would want to see a better funded NICE, and Ministers not washing their hands of responsibility for it. We would want to see systematic answering of big questions, not just very narrowly-defined ones. We would like to see a lot more transparency in how the work programme of NICE is determined, involving all of us in that process, while accepting their right to be independent, scientific analysers, free of political interference.

I congratulate the hon. Member for Merthyr Tydfil and Rhymney (Mr. Havard) on securing the debate. It is an important debate, and an important organisation. There is cross-party support for NICE. Since 1999, it has served a very good purpose. My party certainly hopes that it will continue to do that, perhaps in an even more positive way. It certainly marries very well with our plans for health care in this country. So we wish it a fair passage, and very much hope that the Minister will take any criticism that we may have in good heart, perhaps as constructive criticism.

There are problems, however. We have touched on excessive delays, which are of greatest concern to our constituents in respect of this particular body. CancerBACUP has done a fantastic job of tabulating in a dossier—certainly not a dodgy dossier—the delays experienced in appraising a large number of cancer drugs. Time does not allow me to go through the whole list, but I am sure that during the past few days hon. Members have received that list in their mailbags. I suggest that they, and the Minister in particular, study it carefully and compare the dates for which treatments were licensed for various cancer types with the expected dates for NICE to publish its guidance. They should then consider what that means in terms of lost opportunities for treatment of many people with cancer.

It falls to us to examine why NICE is not operating as efficiently as it could. Is it due to lack of resources? The Minister said on 8 June that it was not and that NICE was adequately resourced. We must explore other reasons why NICE guidance is not coming on line as rapidly as it ought to, and it behoves us to consider other, similar systems of analysing medication and health care technologies. All we have to do is look north of the border to the Scottish system and the Scottish Medicines Consortium, which was set up at about the same time. It will consider an intervention in three months; NICE is taking 12 months. We must consider why the Scottish system can issue its guidance so much more rapidly. The answer seems to be that the Scottish system produces quick and dirty assessments—if it is not too pejorative to say so—of the technologies and treatments for which there is no huge amount of controversy, and for which there is a general acceptance that they are good and beneficial. The Scottish system has not gone to the huge lengths that NICE has to approve some treatments.

It would be reasonable for the Minister to consider whether, given that there is no vast difference between the appraisals produced by the two systems, we might adopt more closely the Scottish model. At the very least, closer co-operation between the Scottish Medicines Consortium and NICE would be useful. The hon. Member for Northavon (Steve Webb) touched on the point that we appear to have two parallel systems in what is, despite the devolved settlement, essentially the same system. That seems to me, and I think it would seem to most of our constituents, somewhat inefficient. I hope that the Minister will comment on that.

Although NICE is not that old, we see some early signs of ossification. There appears to be no mechanism for re-scheduling or re-prioritising. We must appreciate that medical research moves far more rapidly than NICE is able to consider its guidelines. One particularly good example of that has been anti-Alzheimer's drugs. Research during the past few months has shown that the drugs affect the condition at a bio-chemical level, and that the number of brain cells killed in the process of Alzheimer's disease are reduced as a result of the use of anti-Alzheimer's drugs. However, we see no reflection of that in the determination made by NICE. I wonder if NICE's structure is insufficiently flexible to incorporate research as it comes on stream. The structure seems to be far too retrospective, and it would be interesting to know how it could it so that it is more reactive to research.

I am sure that hon. Members will have received in addition to CancerBACUP's useful contribution to the debate, the Alzheimer's Association's response to NICE guidelines on anti-Alzheimer's drugs. I share the concern expressed today by several hon. Members that the question of cost-benefit analysis—how much it costs and who it benefits—has not been precisely explored by NICE in connection with that range of treatments. In particular, we see precious little reference to the benefits to carers, for example. Most health economists would say that that is a relevant consideration. Over the past few years, Ministers have made great play of their concerns for carers. It is extraordinary that the benefits that undoubtedly accrue to carers from this range of drugs have not been incorporated in the guidance. Given the concerns expressed by carers' organisations, I very much hope that the Minister will comment on the issue.

Concern has been expressed about the lack of transparency in the pre-appraisal and scheduling of NICE assessments, and I am talking here about the work that is given to NICE. Clearly, NICE's considerations are not political, and rightly so. Indeed, that is one of its charms. However, the work that is fed to it clearly is politically influenced, and there is a lack of clarity and transparency at that stage. The Minister might like to comment on how she sees us improving clarity and transparency. Perhaps she can illustrate her point by commenting on the 12th wave of appraisals. When will they be presented to NICE? Perhaps she would like to share with us what that 12th wave might contain. What will be the justification for inclusion in or exclusion from it? Presumably, it is on her desk at the moment.

We have seen a little in the press recently about the part that the so-called citizen's council plays in the NICE process. I think that we all agree—I hope that hon. Members see from my comments about carers that I certainly do—that patients and carers need to be involved fully in NICE appraisals. They have a legitimate voice, which must be heard.

The more excitable elements of the media may have deliberately misunderstood that organisation and they seem to be suggesting that it is engaging in ageism. I am sure that the Minister would join me in condemning any ageism in NICE appraisals, while accepting that certain interventions are beneficial for certain age groups and that that is a legitimate concern for NICE. I hope that she will also condemn the notion that people who are elderly and who have fewer years left to run are therefore less deserving of certain treatments, as the media have suggested in the past few days. I am sure that we would all condemn that Robespierre version of citizen's councils.

Finally, it would be useful to hear the Minister's comments about improving the uptake of NICE guidelines. We have heard mention of the drug Herceptin, and NICE has produced guidelines on its use in metastatic breast cancer. NICE's investigation into whether it might be beneficial for earlier-stage breast cancer is some way down the track. None the less, it issued guidelines on the use of Herceptin for metastatic breast cancer very early on; indeed, it was about three years ago. Yet, cancer networks in some parts of the country are making the drug, shall we say, less than fully available. Surely, that is not acceptable, given that they have now had three years in which to implement the NICE guidelines. It would be interesting to hear how the Minister feels we can improve practice so that NICE guidelines—when they eventually emerge—are fully implemented.

Finally—this really is my final remark—we need some comments on the 1999 health service circular referred to by the hon. Member for Merthyr Tydfil and Rhymney. It appears to have been used to indulge, to a certain extent, in a postcode lottery, particularly in relation to Taxotere. It would be interesting to hear whether the Minister has audited the effectiveness of the guidance that she issued at that time, because it seems not to have been fully implemented.

Mr. Cook, I was right in what I said prior to our debate; my hon. Friend the Member for Merthyr Tydfil and Rhymney (Mr. Havard) is indeed a serial offender in securing these debates. I welcome the opportunity to listen once again to what is clearly a professionally well informed debate. I appreciate that my hon. Friend has a keen interest in health issues, especially those where he feels that guidance from the National Institute for Health and Clinical Excellence would be of benefit. However, as a new Minister, if I had just picked up on the tone of this debate—the gloom, the disaster, the chaos that has been described—I might have been forgiven for running screaming from the Room. A new Minister might be dismayed if what has been described were the case, but, on the contrary, I regard this as a really exciting time to be invited to take on this brief.

I accept that there are concerns about the operation of NICE and the wider picture and I will focus on that, rather than being drawn into some of the individual examples that have been offered. Before I go any further, I welcome the hon. Member for Northavon (Steve Webb)—it is good to see him in his new role; he is following me across Departments—and I also welcome the hon. Member for Westbury (Dr. Murrison) to his position speaking for the Opposition on this subject. I welcome his constructive approach and look forward to debating these issues with him. Both hon. Gentlemen raised an important point, which I want to study further, about devolution and the way in which these processes and procedures are working across the devolved authorities. I am interested in that and wanted to acknowledge it.

A quick question was asked by the hon. Member for Westbury about the 12th wave. That is under consideration and he is quite right; it is on my desk as we speak. I cannot give him an exact timetable, but it will be submitted to NICE very shortly.

I will come on to the concerns that were raised about the transparency of the process and the procedures. There are concerns about how topics are selected for referral to NICE and there is not always universal agreement about the priority of the topics that are referred. However, this area is given careful consideration. The topic selection process involves a wide range of individuals, including representatives of professional and patient groups, the pharmaceutical industry, the NHS, NICE itself and Department of Health officials.

The views of all those groups are taken into account in deciding which topics should be referred to NICE through the wave process. All the parties involved consider the suitability of the potential topics for referral against the published selection criteria, taking into account first the available evidence base, secondly, the likely impact on NHS resources and, thirdly, the relative priority of the topic against strategic issues. Nothing is referred to NICE capriciously, and I know that nobody is suggesting that.

I accept, too, that the topic selection process could be faster and that matter is subject to ongoing review by officials in the Department of Health and by me. We are already looking into ways in which the process could be shortened, whether it could include greater NHS and public health representation and whether it could be more flexible. I am pleased to say that some changes have already been introduced; for example, referring clinical guidelines to NICE earlier in the process. We should see benefits flowing from that.

My hon. Friend the Member for Merthyr Tydfil and Rhymney asked three important questions. He pressed me about the move from three committees to two. I understand that NICE expanded from two to three appraisal committees about two years ago. The expansion was made on the basis of an anticipated significant increase in the number of new technologies that would need appraisal and would be referred by Ministers. However, the expected expansion in referrals of new technologies has not been as significant as NICE thought and the three appraisal committees have not been working at full capacity. I can tell by my hon. Friend's face that he has a degree of scepticism about my reply.

I will turn to the other issue that my hon. Friend raised; his suspicion that there are budgetary reasons for the change. The reason why I gave the answer that I did—about how NICE organises its resources—was not because I wanted to duck responsibility. Let me quickly explain the budgets. Rightly, my right hon. Friend the Secretary of State talked to the NHS Confederation about finances last week. It is important to remember that all this work is going on in the context of a threefold increase in the resources available to the NHS globally by 2008. It is always in that context that I address representations about organisations needing more resources.

The 2005–06 budget for the new National Institute for Health and Clinical Excellence—following the Health Development Agency joining it on 1 April—is £29.9 million. Members might like to know that the previous year's funding for NICE—without the HDA—was approximately £19 million, and that the HDA's budget was about £12.5 million. It does not take much to work out that if those two sums are added together we get a total of £31.5 million. One of the reasons for bringing these two organisations together was to achieve administrative savings that could then be ploughed back into front-line work. That is what has happened.

Sometimes, the reason given for not funding treatments, medicines or devices is lack of resources. That is not exactly an excuse, but it is a way of ducking decisions at strategic health authority level. We will carefully look into that, because I take very seriously the concerns that we might be reintroducing a different kind of postcode variability in treatment. We must examine the effects of what we are doing.

As always in important debates, I have not got enough time to say all that I wish to say. I have spoken about the topic selection process. The hon. Member for Wyre Forest (Dr. Taylor) referred to the World Health Organisation report. I want to quote from another section of that report. The WHO recognised:

"NICE has developed a well-deserved reputation for innovation and methodological developments that represent an important model for technology appraisals internationally".

Its report went on to say that NICE is

"a leading agency in technology assessment",

and it particularly praised "the transparency" and "inclusiveness" of the appraisal process, as well as "the commitment" of NICE and its partner organisations.

The fact that NICE's processes are so thorough raises the question of the effect on the uptake of new medical technologies in the interim period while the publication of NICE's recommendations are awaited. The Department of Health has issued guidance to the NHS advising that health bodies continue with local arrangements for the managed introduction of new technologies. My hon. Friend the Member for Merthyr Tydfil and Rhymney raised this matter.

NICE's procedures may well not always be the most appropriate route to take for the appraisal of some new technologies and treatments. My hon. Friend the Member for Brighton, Kemptown (Dr. Turner) described an experience he had; that might be—I am not suggesting that it definitely is—an example of a treatment that, as he said, could have been dealt with in a better way than it was. He described his experience in detail, and it is precisely that sort of experience that a Minister gets benefit from in these sorts of debates.

A number of Members talked of the improvements that have taken place. That is one of the good effects of NICE. There has not just been one long catalogue of problems and inefficiencies. For instance, there was a 1,000 per cent. increase in the space of 12 months in the use of two drugs for ovarian cancer—I am not even going to attempt to pronounce them, given my last experience—following the publication of NICE technology appraisals. It is not unusual for there to be that sort of increase following the publication of NICE recommendations.

We should go back to the issue of what should happen in the meantime. The Department of Health has made things clear to health authorities—

Order. We must move on to the next debate.

May I first say that I am pleased to see the hon. Member for Mid-Norfolk (Mr. Simpson) in his place? I suggested that he participate in this debate, as most of the Acle straight is in his constituency.

I am glad that we are finally having this Adjournment debate, after being denied that chance following the early Prorogation of the previous Parliament. I first raised the Acle straight in Parliament as long ago as 1998. The focus of today's debate should be simple, as it was then: do we allow environmental concerns and the general presumption against schemes affecting environmentally sensitive sites that are the habitat of important species to stop the implementation of safety measures to prevent any more needless deaths of those who travel on the road? Do we put environmental concerns above the lives of road users?

Having campaigned on the issue for many years, I strongly believe that the safety measures needed to stop the current spate of accidents on the road will have to be significant, involving the redesign of the road. Against that, I am keenly aware of the previous indifference of Governments to that stretch of road over the past 30 years. Polarised local opinion on its dualling and the recent politicisation of the issue has turned what should be a simple decision about safety into the complex situation that we now face.

In 1998 the Government launched a new deal for trunk roads in England that reversed Tory proposals to scrap the scheme and provided an open and accountable approach for considering all proposals about the road. The report emphasised the need for the completion of the dualling of the A11 to Norwich and proposed that the A47 Norwich to Great Yarmouth road-based study should consider solutions to congestion and safety on single carriageway sections of the route, including the Acle straight.

The A47 Norwich to Great Yarmouth road-based study was completed in October 2001. The report recommended minor safety improvements on the road in the short term, at Halvergate junction and at the westbound approach to Acle roundabout, which were completed in 2001. In the long term, the report said that the preferred approach was to widen the existing road, to provide a higher standard single carriageway. That was proposed instead of dualling, because of environmental concerns. Further, providing an offline route was rejected, as it would not have been good value for money. Doing nothing was also rejected, given the road's poor safety record.

Although the Government have accepted that doing nothing is not an option, it was decided that the outcome of the Highways Agency study was inconclusive. The Highways Agency was asked to undertake further work to help inform the decision-making process on the road. That work included a full stage 3 environmental assessment of widening or dualling, and investigations into the buildability of any proposal and, on the economics of the proposals, construction delays to traffic.

The final conclusion of the report came a year later than anticipated, in September 2004, leading to further local frustration. Although I share that frustration, we now have a real chance of a positive conclusion to the unhappy saga, with the submission being considered by the Minister and the further work of the Highways Agency on the Norwich to Great Yarmouth road-based study now complete.

I urge the Minister to come to a decision as soon as possible on a proper course of action for the road. What do I propose that that course of action should be? Following my own research, via the Highways Agency and in response to a letter that I sent to the office of David Jamieson, the then Under-Secretary of State for Transport, on 7 April, I found that if a decision to undertake work to dual the Acle straight were taken now, the earliest date that such work could be undertaken would be 2011. That would be more than five years on from the date when the agency would be commissioned to start the work, and would involve consultations, route announcements, draft orders, environmental statements, a public inquiry, approval and the possibility of legal challenge. Add to that the time that it would take to construct the road and we find that dualling, although the preferred long-term option on safety and economic grounds, is not a solution to the road's well-documented safety problems in the near term.

It is well known locally that combinations of slow-moving cars, lorries and farm traffic on this long, straight stretch of road, with limited ability to pass, present a large safety problem. The long stretches of the road make judgment of distance difficult and accidents and fatalities a horrific and regular occurrence.

Recent accidents include the deaths of a young father of two children, Glenn Fransham, who was just 38, and of Basil Jackson, who was 74, which occurred in shocking circumstances in November and January. Both deaths were due to accidents that were not the fault of the person who died. What makes them even more shocking is that both those drivers might have been alive today had it not been for the water-filled ditches running along the Acle straight. They died because as they left the road their cars wedged upside down in the ditches, leaving them trapped and drowning.

Those incidents are not isolated. In June a driver had a lucky escape from those ditches after his Peugeot overturned into the ditch; he was rescued. Similar accidents on the road have happened in the past, they happen now, and they will happen in the future, resulting in more people losing their lives.

I am sure that my hon. Friend will be aware that many of my constituents use the road regularly because Great Yarmouth, being one of the country's premier holiday resorts and having a great race track, is very popular with the people of South Yorkshire. Does my hon. Friend recall my telling him some months ago that I was involved in an accident on that stretch of road in which I and my brother-in-law had to rescue an elderly couple from their upturned car? It was quite a serious incident and we had to call an ambulance.

Indeed I do remember that story, which shows that accidents there are not new; they happen regularly. The ditches are within 3 ft of the roadside. The Acle straight is probably the narrowest of the UK's A roads; there is no room for manoeuvre. What my hon. Friend has told the House shows that such accidents have been happening for too long. However, what really brings the problem home to everyone is the fact that three accidents have happened in the past seven months in which cars were left upside down in the ditch with people trapped inside. Fortunately, everyone survived the accident that my hon. Friend was involved in; clearly his quick action had something to do with that.

The Government have stated targets to reduce the number of people killed or seriously injured by 50 per cent., compared with the average for 1994–98, by 2010. Indeed, at Question Time today the Prime Minister qualified that. With regard specifically to the Acle straight, the Minister has asked the Highways Agency to give serious consideration to lowering the speed limits from 60 mph to 50 mph and has also asked for the current study of safety on the road, prompted by the two recent fatalities, to include improved incident management and driver information. It is my experience that those measures will do little to prevent such tragedies in the future and to allow the Government to achieve their laudable goal.

It is painfully apparent to Glenn's relatives that something significant must be done immediately to deal with the danger from the dykes, which are filled with water and provide no escape routes. Indeed, all along the narrow verges, with no safety fence protection from the side slopes, the drainage dykes have been a constant danger.

I have also been approached by a constituent who is concerned about the kerbs that have recently been placed on sections of the road by the Highways Agency, and which were designed originally as safety measures. He raised concerns that if hit at speed those kerbs might on occasion lead to cars becoming airborne and flipping into the dykes.

The Highways Agency procedure is to complete safety studies on all fatalities on the trunk road network and it has completed a study on the recent fatalities. In response to my letter of 7 April the Department for Transport stated:

"The key message to emerge is that there is little similarity between these events (which were 5.5 km apart) except that vehicles have ended up in dykes adjacent to the road."

That really brings it home to me that the whole eight-mile stretch of the road, the majority of which is covered by dykes on each side, is a danger because of the dykes.

Although I recognise, as I have said, that some safety measures have been put in place during the last five or so years, especially near the Halvergate junction—I do not dismiss those currently being examined—I am deeply concerned that the Department for Transport has not taken on board the true danger posed by the dykes. The dykes need to be moved far enough from the road to allow for a possible barrier, or even far enough away for any cars involved in an accident to come to a halt on soil. The cost of doing that would make very little difference to the Department's budget, but would prevent further fatalities such as that of Glenn Fransham, whose parents told me when I met them a few weeks ago that they would not want anyone else to lose their loved ones to a fate similar to that of their son.

However, the environmental lobby has strongly contended that the dykes and grassland habitats affected by dualling are protected by national and international designations, and that any attempt to remove or relocate the dykes, or to widen or dual the road, would come up against stiff opposition in the European courts, where the safety and economic case would have to be overridden. In my opinion, that case would certainly be won and would override other considerations.

That conclusion is also reached in a new report prepared for the Highways Agency by consultants Hyder. However, Hyder also recognises that there would be a significant improvement in preventing accidents, as well as economic benefits, if the road were dualled. There are serious questions to be asked about the environmental reports, as stated in the road-based study, as well as in a research paper by a mature student at the university of East Anglia, Karen Young, who is a constituent of mine, entitled, "Is the science of ecology being used as a tool of convenience?" It is the most detailed ecological report about the road that I have ever seen. Rather than go through the report, I forwarded a copy to the Minister's Department, and will be interested in her comments on it, if not today, then in correspondence.

However, I should like to raise in today's debate a section of Karen's report in which she responds to a statement in the A47 report on dualling. It says:

"These impacts comprise direct habitat loss, including loss of biodiversity habitat, habitat fragmentation and habitat damage."

In her appraisal of that statement, Karen says:

"To appraise this quote, there would indeed be habitat loss: 141 hectares for dualling, and 93 hectares for widening, so this statement is true although the phrase 'loss of biodiversity habitat' is not quite grammatically correct and appears to be ambiguous. This leads to a questioning of the knowledge of ecology contained therein. The next phrase is a reference to habitat fragmentation; the use of the term is not required, as habitat fragmentation is the division of the original area into subdivisions of metapopulation and area. In both cases the key word is divided. The Acle straight is already divided; improvements of the road would not result in any further division of the area."

May I at this stage put on record my appreciation and thanks to Karen Young for her important report, and for allowing me to quote from it? The Government have accepted that the Acle straight needs widening, and to do it, dykes will have to be moved anyway, but I would suggest that consideration be given to moving the dykes far enough back to take into account any possibility of future dualling. Widening the road itself will take up to 92 hectares of land, whereas dualling the road would take 140 hectares—just 50 hectares more. Such an increase is not substantial enough to delay the compulsory purchase of the necessary land, with a view to dualling in the long term, but allowing the necessary safety measures to be taken in the interim.

I also want to make it clear that although we must have safety now, we must also have prosperity for Great Yarmouth. Reports considering the socio-economic impact of dualling the Acle straight illustrate the fact that Great Yarmouth inherited a high unemployment rate in 1997, which was compounded by shifts in seasonal employment, a weak skills base, and low earning associated with severe deprivation. While the Government have sustained a campaign of investment into Great Yarmouth to combat that, leading to much lower unemployment levels, record investment in schools, police and the NHS, and the good news of the urban regeneration company for Great Yarmouth and Lowestoft, as well as approval for public funding for Great Yarmouth's outer harbour scheme, those regeneration efforts would be complemented through dualling.

I caution the Minister against any hesitation in tackling the issue once and for all. She has stark questions to answer. How many more people have to die to prove that the dykes are unsafe and should be moved? Steps can be taken to save lives now. We can still have a dualled Acle straight in the future, but we must act—and act now—if we are genuine in our desire to save lives.

I congratulate the hon. Member for Great Yarmouth (Mr. Wright) on introducing the debate and thank him and the Minister for allowing me to make a short speech. As he said, 50 per cent. or more of the Acle straight lies in the eastern part of my constituency of Mid-Norfolk. Indeed, the town of Acle is situated there.

The hon. Member for Great Yarmouth and I entered the House together in 1997. I have always said that the A47 will probably be engraved on my heart, as Calais was on the heart of Mary Tudor, and that the Acle straight will probably be engraved on the hon. Gentleman's heart. I do not want to repeat what he said most powerfully, but I must make an important point. There are strong arguments for dualling other parts of the A47, but we have reached the stage with the Acle straight when doing nothing specifically about the accidents and deaths that he and the hon. Member for Barnsley, East and Mexborough (Jeff Ennis) graphically described is no longer an option. It is bad enough having an accident in the area, but a person can come off the road and drown. I do not believe that many other countries in the world would allow such a state of affairs. If Great Yarmouth and Acle were situated on the outskirts of London, Manchester or Glasgow, the outcry about what was happening would be so great that something would be done about matters immediately.

I agree with the hon. Member for Great Yarmouth. If dualling is in the mid to far distance, something that we must keep aiming for, at the very least remedial work should be carried out to widen the single carriageway. Powerful arguments have certainly been voiced to move the ditches/dykes. Local environmentalists, farmers and the Royal Society for the Protection of Birds—some members of which helped in Karen Young's excellent study—have told me that dykes and ditches in that area have been moved over many hundreds of years. Such matters now have to be a priority. Although we are aware of the wonderful environment in Norfolk in which we are privileged to live, I hope that I am quoting the hon. Gentleman correctly when I say that, at times, the habitats of a few species should not be more important than the lives of individuals.

When a major accident occurs on the A47, Yarmouth is cut off on one side. That has an immediate economic impact on Great Yarmouth and on the lives of many of my constituents. Doing nothing is no longer an option.

I congratulate my hon. Friend the Member for Great Yarmouth (Mr. Wright) on securing the debate and on the thoughtful and measured presentation of his case. I also appreciate the comments made by the hon. Member for Mid-Norfolk (Mr. Simpson). I was pleased to hear my hon. Friend say that the issue has a long history. It is important that that is recognised. In fact, the matter has been under consideration by various Governments for 30 years.

I welcome the opportunity, albeit belatedly as my hon. Friend said, to outline the Government's current thinking on the issue. I know that our words of condolence are not always welcome, but it is important to place on the record our deepest sympathy for the families and friends of those people who have been killed tragically in the incidents that my hon. Friend mentioned. I assure him that both I and the Highways Agency always take such incidents seriously and are committed to improving safety on our network. As my hon. Friend said, the Government have targets to reduce the number of people who are killed or seriously injured in road crashes in Great Britain by 40 per cent. and the number of children killed or seriously injured by 50 per cent. by 2010 compared with the average for 1994–98.

In fact, in 2003 there were 3,508 people killed in road crashes and 33,707 seriously injured. That is halfway to the 40 per cent. target set for 2010. Obviously, every single one of those crashes is a unique incident, and I am sure that for those involved recognition that we are on the way to the target is of very little comfort. None the less, it is important to set such incidents in a statistical context so that we can measure the progress made.

For the record, whenever a fatality occurs on the trunk network, a study is undertaken to see whether there are any quick actions that could be taken to avoid a similar occurrence. For the recent incident outlined by my hon. Friend, that was done. As he recognised, the key message to emerge was that there was little similarity between the events, which happened over 5.5 km apart, except—and it is an important exception—for the fact that the vehicles ended up in dykes adjacent to the road. The agency has embarked on a study to consider the potential for bringing forward measures that could reduce the incidence.

With respect to the particular cases raised by my hon. Friend, I should add that one of the crashes resulted in criminal prosecution. In another, the coroner declared a verdict of accidental death. The incident earlier this month is the result of suspected drink-driving.

As part of the safety study, I have asked the Highways Agency to give serious consideration to lowering the speed limit from 60 to 50 mph. The study should also look into the issues of improved incident management and driver information. That could include the introduction of automatic incident detection and variable message signs to assist with warning motorists and implementing temporary diversion of traffic.

Of course, as always, the agency will work closely with the police and local stakeholders such as the safety camera partnerships in taking forward any recommendations emerging from this study. Without being complacent, the latest published casualty figures for the Acle straight fall below the national rate for all- purpose single carriageway roads of A-road classification, but of course every single incident is one too many, and the casualty figures are only part of the story.

Due to the extensive marshes and broads in the area—my hon. Friends the Members for Great Yarmouth and for Barnsley, East and Mexborough (Jeff Ennis) and the hon. Member for Mid-Norfolk are far more aware than I of the exact geography—there are very few alternative routes to Great Yarmouth. Consequently, when incidents occur on the network, severe congestion builds up almost inevitably. Additionally, there are numerous field accesses directly on to the A47 along the whole of the straight, with few, if any, alternatives available. Use of those accesses contributes to the substandard nature of the route. Overall, the character and nature of the route gives a perception of remoteness and peripherality. The service for road users is affected by occasional hold-ups at junctions and farm access points, and congestion at the A47/A12 Vauxhall roundabout, located to the east of the Acle straight.

My hon. Friend mentions the number of accesses on to farmland. As someone who used that road regularly, and who has lived all his life in the area, I can say that the problem is not road accesses on to the Acle straight; it is more the congestion at the Vauxhall roundabout end and, to a lesser extent, the Acle end. I consider it a red herring, but people suggest that the number of accesses on to the Acle straight are a particular problem. However, it is easy to overcome such problems.

We should take due cognisance of the local knowledge of my hon. Friend and the hon. Member for Mid-Norfolk in the appraisal of what exactly contributes to the problem.

In addition to the problems with the Vauxhall roundabout, there are difficulties in overtaking, as I think both hon. Members would acknowledge, due to the restricted carriageway width and poor perception of vehicle speeds and distances due to the straightness of the road.

Following the previous Government's decision of November 1996 to remove the trunk road programme by stopping a large number of schemes—including two designed to deal with the single carriageway sections between Norwich and Great Yarmouth—we undertook a strategic review of the roads programme. This work culminated in a number of multi-modal and road-based studies, including one to consider solutions to congestion and safety problems along the single sections of the A47 route. The study, known as the Norwich to Great Yarmouth road-based study, was completed in October 2001, and recommended a number of transport schemes, including two highway schemes, to address the problems of the single sections of road—those same sections that were to be covered by schemes that were removed from the programme by the previous Government.

The East of England Local Government Conference's review of the study findings highlighted the importance of the economic regeneration needs of Great Yarmouth and Lowestoft, as has been mentioned, and with one exception—the treatment of the Acle straight— supported those recommendations. The Government accepted the conference's view and endorsed the recommendations, particularly the dualling of the Blofield to North Burlingham section of the A47, which was added to their targeted programme of improvements in July 2002.

With respect to the Acle straight, the conference considered that there was insufficient information on a range of environmental and economic factors on which to make a decision. The Government also endorsed that view and asked the Highways Agency to undertake further work into the environmental implications of widening or dualling the road, issues of buildability and the effects of construction delays on the economics of the proposals. That work has been completed, as my hon. Friend the Member for Great Yarmouth acknowledges, and I have a copy of the findings.

I am aware—I hope that my hon. Friend appreciates this point—that there is a deep polarisation of views on this subject. Although there is always a risk of seeing it as a choice between the risk of accident and environmental considerations, it is none the less important to remember that it is not just a straight choice between the two, but those factors have to be borne in mind, considering the general background of accident risk on that stretch of road.

There is a strongly and widely held local view, which includes the majority of local authority representatives, the local MPs and the business community, that the economy of Great Yarmouth is stifled and unlikely to grow without improvements to the A47 Acle straight. In support of that view, Norfolk county council has presented to me a report on the wider economic benefits of improving that stretch of road.

I am also aware that the environmental groups are strongly opposed to any improvement of the Acle straight. They consider that the unique nature of the broads, and the high risk of potential damage to the ecology of the area resulting from a highway improvement, would outweigh any regeneration efforts that such a scheme might offer.

The hon. Member for South Suffolk (Mr. Yeo) claimed before the general election that the improvements to the Acle straight could be constructed within the lifetime of the next Government, if a choice were made to go ahead on the basis of the time scale that was under consideration earlier this year. I stress that even if a decision to proceed were to be made in the next few months, the earliest possible date that works could be undertaken on the Acle straight is 2011, because any scheme would be subject to statutory procedures and regional prioritisation. We should also bear in mind the difficult environmental conditions and the implementation of any mitigation measures that might extend that date.

There is no doubt that this will be a hard decision and there are strong competing factors. We are alive to the significant environmental concerns and the general policy that there is a strong presumption against schemes that would significantly affect environmentally sensitive sites, or important species or habitats. That must be balanced against the economic benefits that the improvements appear to bring. Consequently, we are considering carefully the Highway Agency's work on this issue.

Will my hon. Friend give a commitment that when the Highways Agency reviews this matter she will ask it to consider my request to move the dykes far enough back from the road to create a safer environment and also to take into account the possibility of dualling the road at some time in future—whether in the medium or long term?

I see no reason why I should not give that commitment, in the sense that it is advisable to consider a range of options, given the environmental concerns advanced against the road-widening option. The more options we can consider, the better it will be.

In summary, this is a difficult decision. Environmental considerations and economic and regeneration elements of the scheme must all be borne in mind—that case has been well put. Of course, it must be on the top of our minds that we must do everything that we can to ensure safety and prevent, wherever possible, any repetition of those sad accidents that have claimed lives. Considering those issues together on the basis of the information that has been put to me, including the contribution that my hon. Friend has made today, I expect to gather that information in the not-too-distant future and hope that we will be able to come forward with a decision.

Thank you, Mr. Cook, for allowing today's debate.

This is a welcome and crucial opportunity to impress on the Minister the importance that many MPs from Devon, Cornwall and Scotland attach to the sleeper services that run through their constituencies. I shall try to be brief because I understand that other people want to speak, and I want to ensure that their views and those of their constituents are aired today.

The debate is timely for the reason that has made me decide to focus primarily on Cornwall's night riviera service—on 1 June invitations to tender and consultations regarding the Greater Western franchise were opened. That was the first indication that the future of Cornwall's sleeper service could be in doubt, and that it could be axed as early as next April.

As the organisation leading the process, the Strategic Rail Authority—which, I understand, transfers to the Department for Transport next week—has asked those submitting bids to outline separately the costs of running the overnight sleeper service between Paddington and Penzance. We are concerned that that may indicate that a decision to cut the service when the new franchise comes into being has already been taken. I understand that formal correspondence emphasises that no such decision has been taken and that the final decision will rest with the Secretary of State, but we are worried by reports in The Times, on 9 June, that a Whitehall source said that the Cornish sleeper service is being targeted first because it is less politically sensitive than the Scottish services. Therefore, I seek your assurance that no decision has been taken, that that is not your approach, that no outcome has been prejudged and that you will acknowledge the strong support—here and in the wider community—for Cornish and Scottish sleeper services.

I hope that you will also justify—

Order. I know that the hon. Lady is new to the House, but she must address all remarks through the Chair, not directly to the Minister.

Having had the chance to collect my thoughts during the Division, I want to make them clear to the Minister. I hope that he will reassure us that the issue has not been prejudged and that the consultation process will be fed into the bidding process. I also hope that he will acknowledge the amount of support for our sleeper services that is being shown in the Chamber today and in our wider communities.

Will the Minister justify the singling out of the sleeper service from among other services in the Greater Western franchise? I am sure that he will correct me if I am wrong, but I understand that part of the rationale behind the franchise was to ensure a balance between high and low-usage services, so that profitable services could be maintained while allowing the less profitable but still important services to be kept and the overall franchise to run at a small profit. I do not see why the sleeper service has been singled out if that is the justification for maintaining some branch lines in the franchise, especially since the cost of running the service is only a tiny fraction of the total cost of the franchise.

Staff who work on the sleeper service communicated to me that sense of being singled out when I travelled on the sleeper to Cornwall last week. They talked in particular about problems with the telesales booking service, which has resulted in many passengers being told that there are no berths available when there are. Although many passengers would still turn up for daytime services and hope to get a seat, most people would not turn up for a sleeper service unless they knew that they would get a berth, because they do not want to sit up all night.

I have had that experience of not being able to get a berth and having to sit up all night on the sleeper service. Does my hon. Friend agree that if the SRA gets away with separating out the sleeper service from the rest of the service, which should be seen as a whole, it will also separate out other non-profit-making elements of the vital service all the way to Penzance, including the service from Plymouth to Penzance, and that this is a retrograde step, which we must fight all the way?

We are not the only people for whom it may be the thin end of the wedge. The sleeper staff are putting together a petition, which many colleagues have already signed. It highlights the level of support from all who use the service, including business people, visitors and even those hon. Members in the Chamber today. I hope that the Minister will take that strength of opinion into account, and that it will be fed into the consultation process.

I hope that my hon. Friend is aware of the strong support that was shown in Scotland for the future of Scottish sleeper services when they were threatened in the 1990s. The Scottish Executive have undertaken to protect the sleeper services to Scotland from now on. Perhaps the Government could learn from that. Is my hon. Friend also aware of the further potential threat to sleeper services that comes from Network Rail? It is important that Network Rail continues to allow passage for sleeper services on the rail lines through England before they reach Scotland without the sort of disruption seen in previous years. I hope that my hon. Friend will press the Minister on that point.

I certainly will; and I shall be raising the matter with Network Rail.

I have been contacted by many business people in my constituency who are concerned that the sleeper service is under threat. One wrote:

"I am a regular user, and if it were to be cut it would have a significant impact on my business as well as affecting the amount of time I spend with my family."

For many business people in Cornwall, work and leisure time is too valuable to be spent travelling on a train for more than an entire working day simply to attend a meeting in London. Without a sleeper service, travelling on the train will not make economic sense, and some may revert to driving or flying. Some may stop developing their businesses further afield, which is a great concern.

My hon. Friend will be aware—I hope that the Minister, too, is aware—that there is also a threat to the Newquay air service. However, if one leaves London in the morning without the overnight sleeper service, the earliest one can arrive in parts of Cornwall is midday. That is so even if one uses the Newquay air service. That would effectively cut us off for business purposes. Certainly Imerys China clay company would not be able to continue employing senior staff in Cornwall who work internationally if those services are lost.

I was hoping to deal with that point later. I was also hoping that the Minister would have conducted a study not only into the direct profitability of the service but into its wider economic benefits. I was sorry to learn from a written answer that I received yesterday that no such assessment has been made. The wider economic benefits and the capacity that needs to be built in Cornwall are vital, and the economic benefits that the sleeper service brings must surely run into many millions of pounds. I ask the Minister to look into the issue during the consultation process so that that information, too, can be fed into the bid.

I entirely agree with the thrust of the hon. Lady's argument. I know that the chamber of commerce in Plymouth would agree entirely that the night sleeper brings business to Plymouth that is vital for the regeneration of the city, and that we must do all that we can to ensure that the service continues.

I thank the hon. Lady for pointing out that it is an issue in Devon as much as in Cornwall.

There is a dearth of hard data. That is due partly to the commercial confidentiality that surrounds the bidding process and to what I said about the need for wider research into the question. However, First Group has provided me with occupancy figures for April. It is an off-peak time, and there were still serious problems with the telephone booking service. It nevertheless shows an occupancy rate in standard class individual sleeper berths to Cornwall of between 80 and 90 per cent. during that month. In the summer months, it is impossible to secure a berth without early booking. Although the aggregated figures for each month of the year may show lower occupancy rates, that could be due to a lower uptake on some Plymouth carriages and also to shared and first-class berths.

At our meeting with the SRA yesterday, it was reported that the existing service was not being run in the most efficient way. However, I hope that the franchise bidders will be urged to consider options to streamline the service—perhaps through different carriage and berthing arrangements or by reconsidering the price structure; for instance, many business men use the service, and there may be potential for greater price flexibility.

I congratulate the hon. Lady on gaining this debate; it was well done. In a parliamentary answer, the Minister said that no assessment had been made of the economic effect of the withdrawal of the sleeper between London and Penzance. That is very odd indeed. Does she agree that the only assessment that the Government seem to be making is how to get more money from the licence operators and how they can reduce the running costs?

That may well be the case. I would like a solution that best fits need, not one that fits financial or political expediency.

Finally, and most importantly, I want to draw attention to the wider transport network in Cornwall, which highlights the strategic importance of the sleeper service. Visitors to the county double our population in the summer months, and most of them enter the county through our road network. It will continue to creak under the strain until the A30 improvements finally take place. Our bus network is woefully inadequate and, as has been said, our airport is under threat and is due to be mothballed in 2007.

For many visitors, the train will be the only public transport alternative to the car. For business men, flights do not provide the range of options and the convenience that mainline train services offer in such a long peninsula. They would lose a huge amount of their working day in travelling if they chose to travel during the day.

Far from increasing our public transport capacity in Cornwall, the Government currently seem to be doing all that they can to remove the public transport options that exist for us. That will threaten our local economy. Things such as objective 1 have been building our economic capacity and we are worried that that will be undermined if the sleeper service goes.

Sleeper services such as the night riviera continue to be held up as objects of public affection. They conjure up romantic notions of being lulled to sleep by the swaying of the carriage and arriving in Cornwall in the morning to see the sun rising over our dramatic coastline. For many visitors it makes the journey down to Cornwall part of their holiday and for that reason alone it should be supported. In addition, it is a crucial service for many of our dynamic businesses that have markets and customers to tend to outside the county. Vital work would simply not be cost-efficient for them to do if it involved many working hours spent on the train.

The existing service may well not be perfect and I am sure that there is considerable scope to improve efficiency, but I urge the Minister to recognise the importance of the service and to do so by guaranteeing its inclusion in the main Greater Western franchise.

I congratulate the hon. Member for Falmouth and Camborne (Julia Goldsworthy) on securing the debate and providing an opportunity for the House to discuss sleeper services. I have also received representations from my hon. Friends the Members for Plymouth, Sutton (Linda Gilroy) and for Plymouth, Devonport (Alison Seabeck), who are present. It is an important debate. I understand that a number of Members have concerns and that shows the importance of the issue to them.

There are currently sleeper services between London Paddington and Penzance and between London Euston and Edinburgh, Glasgow, Aberdeen, Inverness and Fort William. The sleeper service to Cornwall also acts as a Motorail service carrying cars and their occupants on Friday evenings from the middle of June until the middle of September. All those sleeper services are operated at present by mark 3, modern, air-conditioned rolling stock, which is loco-hauled—using diesel ones for the Cornish services and a mixture of electric and diesel ones for the Scottish ones.

The Scottish sleeper services were mentioned by the hon. Member for Inverness, Nairn, Badenoch and Strathspey (Danny Alexander). The services between England and Scotland are part of the ScotRail franchise, which was re-let on 17 October 2004 and will run until October 2011. Under the Railways Act 2005, the Scottish Executive will be wholly responsible for the ScotRail franchise from later this year.

I return to the issue of the sleeper services to Devon and Cornwall. The overnight sleeper runs from London Paddington to Penzance and from Penzance to London Paddington, on Monday to Friday nights and Sunday nights. There are no sleeper services on Saturday night/Sunday morning in either direction. One sleeper car is detached or attached at Plymouth so that passengers to and from Plymouth can remain in their berths later or join the train earlier. The west of England overnight services require a fleet of five locomotives, 20 vehicles and crews for each night of operation.

Specific mention has been made about loadings and about the number of people using the service. By the very nature of the rolling stock, the capacity of the sleeper trains is low. Each sleeper carriage only has 16 berths—12 standard and four first class. The normal configuration is one carriage dedicated to Plymouth, which is separated from the train there, and three for Penzance. It is also possible to be seated for the journey and not pay the £21 to £36 supplement for the sleeper berth, as there is seating accommodation and a lounge buffet carriage. The seating capacity is 86.

Over the past three years, the average occupancy of the sleeping berth has been four to Plymouth and 17 to Penzance. At the summer peak, the Plymouth sleeper carriages carried around seven passengers each way and the Penzance sleeper carriages around 37. Because of the service stopping at Reading and then frequently between Plymouth and Penzance, it is not possible to determine the exact number of seated passengers using the service. However, over the year, the average number of passengers between Paddington and Reading has been 34, and 13 between Plymouth and Penzance. Overall, we estimate that, last year, overnight services carried around 13,000 sleeping-car passengers and 26,000 seated passengers, out of an estimated 5 million overnight visitors in the case of Cornwall.

As to the proposals, which the hon. Member for Falmouth and Camborne discussed before, the Strategic Rail Authority published a consultation document on the Greater Western franchise specification on 2 June. It includes the sleeper services in the base case, so each bidder must be prepared to offer this service. It does, however, ask for a costed option of not providing it, and encourages bidders to propose alternative ways of serving the market for overnight travel between London and the south-west.

The aim is to provide evidence of the cost of providing this service and, if possible, ways of identifying better value for money options. Decisions about the future of this service will be made after the SRA has transferred its responsibility for franchising to the Department for Transport. While I would be reluctant to deprive passengers and potential passengers of a method of transport to and from Cornwall, consideration must also be given to the value for money obtained from any expenditure of Government funds. The Department will evaluate the responses and identify the costs of running the services, together with possible options for meeting the demand in a different way.

Will the Minister agree to a meeting once the consultation period has closed but before the bids have been finalised, to discuss what representations have been made, and how that is going to change the bidding process?

I will be happy to have a meeting with the hon. Lady at that point. We can discuss the timing of that at a later stage. I would not want to pre-empt anything about the process that we are going through at the moment but, before a decision is made, I will certainly agree to have a meeting.

As I have said, the Department will evaluate the responses and identify the costs of running a service, together with possible options for meeting the demand in a different way. This will provide a sound basis for decisions for the eventual service level in the new Greater Western franchise. I stress, however, that no decision has yet been taken.

On services between London and the west country more generally, the Greater Western inter-city routes serve significantly sized communities throughout their length. Accordingly, there is a trade-off between fast services with few stops to more distant places, such as Penzance, Plymouth and Exeter, and the need to serve the intermediate markets within the financial and route capacity constraints of the franchise.

The SRA is proposing in its franchise specification to broadly retain the current level of services and provide Newquay with a new daily train service to and from London Paddington. I think it is worth putting the details of the services on the record. They are as follows: London to Exeter, 19; Exeter to London, 17; London to Paignton, two; Paignton to London, two; London to Plymouth, 14; Plymouth to London, 14; London to Newquay, one; Newquay to London, two; London to Penzance, seven; and Penzance to London, six.

Before the Minister tells us the times of the line, where the trains stop and how long they take, I would like to tell him that the arguments put forward by the hon. Members for Cornwall also apply to a great chunk of Devon. The businesses in Devon are dependent on regular train services. As things are, one cannot get to Plymouth, let alone Totnes—my constituency—until nearly midday. So one's whole day is wasted in travelling. That sleeper is essential unless one has a train leaving at six in the morning in London, which is horribly early. I hope that the Minister will recollect that issue.

I thank the hon. Gentleman for his comments.

Train services between the west country and Bristol will mostly be provided by Virgin trains' cross country services, with an approximate hourly frequency throughout most of the day. It is worth setting out the objectives of the Greater Western franchise. They are to improve the train service performance, matching resources to changing and growing market needs, and to ensure affordability and value for money. That reflects the results of research into passenger key requirements. We are consulting about what the nature of the new Greater Western franchise should be. The formal consultation that has already been referred to runs for eight weeks from 2 June.

Following the receipt and analysis of all the responses to that consultation, it will be possible to make changes, if required, to the specification issued to the bidders for the franchise.

The Minister has not addressed the principled case. This service cannot be salami-sliced into profit-making and non-profit-making, value-for-money and non-value-for-money elements; it can be seen—particularly by customers at the far end of the line, in Penzance in my constituency—only in terms of the full 24-hour service. Does the Minister not agree that the service must be seen as a whole and that there is a fear that if the sleeper service can be disaggregated, the line from Plymouth to Penzance will be disaggregated in future as well?

I understand the hon. Gentleman's point, but this service is unique. It has five locomotives and is different from the service in the rest of the franchise. Although it will be part of the base bid, we think it reasonable to consider the costs and whether there are alternative or better ways of delivering the service. That is why the strategy has been put forward in the franchise.

The Minister will be as aware as we are that there will be confidentiality issues. However, the Department for Transport presumably has some notional idea of the service's levels of costs and subsidy. Can he give us any indication of those and of how much of a view the Department has on their acceptability or otherwise?

I have just double-checked that, and my understanding is that if we stopped the service, there would be a saving of £5 million per annum. I hope that that is useful to the hon. Gentleman.

It is important that the cost-effectiveness of the west of England sleeper service be examined because it is important that all expenditure of Government funds achieves the best value for money.

We were told by First Great Western that the loss would be £1 million. Is that not an irrelevance, given that the Government hope to get a licence fee? Whether the figure is £10 million, £15 million, £20 million or more, there will be only £1 million off for the franchise operator. The Minister has put forward a bit of a red herring.

Well, I can only repeat that, according to the figure that I have been given, the cost saving would be £5 million. I give the hon. Gentleman an assurance that if that should turn out to be different, I would confirm that to him.

A point was made generally about overall transport provision in the south-west.

Given that the western rail passenger committee has now been amalgamated into one for the south-west region and that there are now no representatives with travel experience of the far west of England, how does the Minister plan to take full account of the needs of people there in the franchise consultation process?

Would the hon. Gentleman repeat that? I am not sure that I understood the question.

My question relates to consultation during the franchise process and particularly to the fact that the western passenger committee has been amalgamated into the one for the south-west region. How would the Minister address the concerns of those in the far west of the region?

The new rail passenger committee is in the process of being set up, so the concerns of people in the south-west can then be put forward. The consultation process taking place is another way in which people in the south-west can make sure that their views and concerns are expressed.

The Minister may not be aware that there is no representative from the far west on the new body. Given that we in that region are the most reliant on the service, it seems extraordinary that we should now be excluded from the formal process of passenger representation.

It does not follow that representation will not still be made and that the Rail Passengers Council will not be able to put forward the concerns of rail passengers and people in the south-west. I repeat that the whole consultation process is taking place as we speak.

Just before the last intervention, I began to refer to overall transport provision, which a number of hon. Members have brought up today. It is important that there are good transport links for the west country, as has already been reiterated, but we plan to continue to develop rail services to maximise existing capacity.

On air services, the Under-Secretary of State for Transport, my hon. Friend the Member for Regent's Park and Kensington, North (Ms Buck), is discussing the future of Newquay airport with Cornwall county council later this week. We are clear on its importance to the county's economy and want to work with colleagues in the Ministry of Defence to find the best outcome for Cornwall. There are a number of road improvement schemes under consideration, particularly the A30, the A303/A358 and the A38 at Dobwalls. I am particularly pleased that the Highways Agency has announced that work will begin on the long-awaited improvements to the A30 at Goss Moor in central Cornwall.

In doing all this, we are paying strong regard to the cost-effectiveness and affordability of all modes of transport and we will continue to do so. Regarding the future schemes, we will listen to the region's priorities and take account of its strategies, which are very important for economic growth and housing.

I realise that the Minister's remarks are coming to an end, but can he confirm that at the end of the 12-week period—an eight-week consultation period followed by four weeks of consideration, when I hope that my hon. Friend the Member for Truro and St. Austell (Matthew Taylor) will lead a delegation to meet the Minister—the final decision will be made by the Secretary of State? If a decision is made to remove the sleeper service from Cornwall, or elsewhere, the final decision should be made by the Secretary of State.

That is correct, but I reiterate that we will ensure that we listen to all views and opinions before we come to a decision. I reiterate for the second time that no decision has been taken at this point in time. The consultation process is currently under way, and we want to consider what has been put forward there and other representations that have been made. At the right point in time, I will be happy to receive a delegation to discuss where we go before the decision has been made.

Before the Minister finishes, could I just—

Order. I must point out to the House that when making an intervention it is important that before launching into it, one gets some kind of visual or verbal consent from the receiving Member.

I wanted to get some visual consent from the Minister, and I am most grateful to you, Mr. Cook.

I would like to ask the Minister whether he is going to find a way of consulting the business community, and I include tourist operators in that. Tourist operators are terribly dependent on tourists—that is what they are about—and their businesses require a transport system whereby they can get about easily, travel overnight to Heathrow and so on. The night sleeper provides that service very efficiently. Is the Minister going to consult tourist operators and business men, not just in Cornwall but in Devon, Plymouth and Exeter, on the matter of the sleeper?

I can only reiterate that a consultation process is going on as we speak in which people can put forward their views and concerns. From what I have heard today during the debate, I know that already a number of business people, tour operators and so on have been in contact with local Members of Parliament to make their views known. There is plenty of opportunity for the business and tourist communities in the south-west to make their views known.

I would just like to confirm that the cost per annum was £5 million, as I said before.

Question put and agreed to.

Adjourned accordingly at thirteen minutes past Five o'clock.