For over one and a half centuries—[Interruption.]

Order. Hon. Members should leave the Chamber quietly, and those who are in the Chamber should be quiet as well.

For over one and a half centuries, the annual Gracious Address has been drafted inside Government and agreed by the Cabinet far from the public arena, but I believe that it is right, in the interests of good and open government and public debate, that each year the Prime Minister make a summer statement to the House so that initial thinking, previously private, can be the subject of widespread and informed public debate. Today, in advance of final decisions, the Leader of the House is publishing details of our initial list of proposed legislative measures, inviting debate on them in both Houses this month and making provision for region-by-region deliberation and responses.

To respond to the rising aspirations of the British people we must deliver new and better opportunities in education, employment and the provision of housing and health care, and ensure that in a fast-changing world there is opportunity and security not just for some people, but for all British people. A new educational opportunity Bill will mean that for the first time not just some but all young people will be able to stay in education or training until the age of 18. The new pensions Bill will ensure that, for the first time, not just some but all working people have the right to a workplace pension, with a duty on every employer to contribute towards it.

Putting affordable housing within the reach of not just the few but the many is vital both to meeting individual aspirations and to securing a better future for our country, so for housing and planning in the 2007-08 Session there are three proposed legislative measures. Let me tell the House the scale of the new opportunities for home buying and to rent that we are proposing. In two eras of the last century—the inter-war years and the 1950s onwards—Britain made new house building a national priority. Now, through this decade and right up to 2020, I want us, in environmentally friendly ways, using principally brownfield land and building eco-towns and villages, to meet housing need by building over 250,000 more homes than previously planned. That would be a total by 2020 of 3 million new homes for families across the country. For England, we will raise the annual house building target for 2016 from 200,000 houses a year to 240,000 new homes a year.

We propose a new housing Bill that will support and encourage initiatives on the ground by local authorities and other authorities. We will bring together English Partnerships and the Housing Corporation to create a new homes agency charged with bringing surplus public land into housing use to deliver more social and affordable housing and to support regeneration. This work will include new partnerships with local authorities, health authorities and the private and voluntary sectors to build more housing made affordable by shared equity schemes and more social housing responsive to individual needs.

The planning Bill will implement the Eddington and Barker reports to speed up the development of major infrastructure projects that Britain now needs to facilitate economic and housing growth, and it will speed up planning generally. The planning gain supplement Bill—to ensure that the public benefit from planning gain—is provisional, because if, prior to the pre-Budget report, a better way is identified of ensuring that local communities receive significantly more of the benefit from planning gain, enabling them to invest in necessary infrastructure and transport, and it is demonstrated that it is a better alternative, the Government will be prepared to defer next Session’s legislation.

To move housing supply forward, English Partnerships is negotiating a new deal with the Ministry of Defence to acquire at least six major redundant sites. Similar discussions are being undertaken with the Department for Transport, the Highways Agency and the British Railways Board residuary body, and the Department of Health is undertaking an urgent review of surplus land owned by NHS organisations and trusts. I can announce that in total over 550 sites owned by central Government are now being examined for housing development, with the potential for up to 100,000 new homes. In addition, we estimate that another 60,000 homes can be built on brownfield land currently owned by local authorities. The Minister for Housing will publish further details next week in a Green Paper to this House.

The Chancellor of the Exchequer is announcing today that he will consult on creating a new regime for “covered bonds” to help mortgage lenders to finance more affordable 20 to 25-year fixed-rate mortgages, and he will report by the Budget on how to overcome other barriers that prevent lenders from offering people long-term mortgages, including the case for changes to instruments used by the Debt Management Office.

At the same time as building more affordable homes we must reduce the environmental impact, so we will consult local councils on using the New Towns Acts to enable eco-towns with zero or low-carbon housing to be built, and to ensure that they are built more quickly. I assure the House that we will continue robustly to protect the land designated as green belt.

Alongside this, measures in the Climate Change Bill, which was published in draft on 13 March, will make Britain the first country in the world to introduce a legal framework for reducing carbon emissions by setting targets for carbon emission reductions for each five-year period to 2050. The energy Bill will also provide greater incentives for renewable energy generation. The local transport Bill will support the Government’s strategy to tackle congestion and to improve public transport.

I turn to some of the other proposed Bills in our programme. As we approach the 60th anniversary of the NHS, we will do more to put power in the hands of patients and staff and ensure that every patient gets the best treatment. Alongside the NHS review announced last week, the health and social care Bill will create a stronger health and social care regulator, and there will be a clear remit to ensure improved access, clean and safe services, and high-quality care.

The children in care Bill is an attempt to do more to protect vulnerable children. The child maintenance Bill will do more to prevent children from falling into poverty when parents split up. Behind the unclaimed assets Bill is our determination that money in dormant bank accounts will be used to improve our country’s youth and community facilities. The Human Tissue and Embryos Bill has already been published in draft for discussion.

Measures to support British businesses as they strive to succeed in the new global economy and to break down the barriers holding enterprise back include the enforcement and sanctions Bill, which will keep the burden of regulation on compliant businesses to a minimum while effectively targeting and penalising those deliberately disregarding the law. The employment simplification Bill will deliver simpler and fairer enforcement of the national minimum wage.

Protecting the security and safety of the British people is paramount for every Government. We stand ready to introduce new measures into the Criminal Justice Bill, which will be carried over into the next Session, including measures that come from the review of policing by Sir Ronald Flanagan, which will report later this autumn. We are committed to building a broad consensus on the right balance between protecting our national security and safeguarding the civil liberties of every individual in this country, so the Home Secretary plans to consult on, and we will seek an all-party consensus on, new measures to ensure more successful prosecutions against terrorist suspects and increased penalties for terrorists charged with other criminal offences. We will consult on, and hope to achieve a consensus on, the period of pre-charge detention where, for terrorism alone, exceptional circumstances in my view make it necessary, while ensuring rigorous judicial oversight and parliamentary accountability, that we extend the time. As the House knows, we shall review the use of intercept material in prosecutions.

The full and final programme will be set out in the Queen’s Speech in November. Many of the proposals that I set out to the House last week will also be taken forward in a constitutional reform Bill. Just as with the challenge of securing justice and security for all, the challenge for the Government and the foundation of next Session’s legislative programme is to support all parents with children, not just some; to invest in the educational chances of all young people, not just a few; to offer more people the chance to get on the housing ladder for the first time; to help more people into work; and to give all patients the best health care. In this way, we respond to the rising aspirations of the British people, by ensuring that the opportunities that are today available to only some are available to all. I commend the statement to the House.

I thank the Prime Minister for his statement. I know that it is meant to be some great constitutional innovation, but most of what he announced sounded rather like the Queen’s Speech last year, the year before and the year before that—a long list of Bills, the same priorities and the same failures, and we have heard it all before.

The Prime Minister says that he wants to build more homes, but did he not say that in 1994, 1998, 2005 and 2006? Is it not the case that every year the Government have built less social housing than was built in any year under their predecessor? Was not the announcement about building on MOD land made in May 2006, and again today? He says that he wants 25-year mortgages, but did he not first announce that four years ago? He wants apprenticeships and universal education after 16, but I have checked the record and he told us that in 1996—a year before he even came to office. For 10 years he has plotted and schemed for the top job, but all we have got is a sort of re-release of the 1997 manifesto. The country has moved on, but he simply has not.

Let us deal with whether the Prime Minister is really listening to people’s priorities, which is what he told us on the radio this morning. Some 86 per cent. of people in this country want a referendum on the European treaty, so where is the Bill for a referendum? Does that not show that his promise to listen is a complete and utter sham? [Interruption.]

Order. Hon. Members should please allow the right hon. Gentleman to be heard. He is the Leader of the Opposition and he is entitled to be heard—[Interruption.] Perhaps the hon. Member for City of Durham (Dr. Blackman-Woods) will listen to me and will know what not to do, and that is to start speaking.

Let us take a look at the areas where we agree. As I have said before, we shall work with the Government on anti-terror legislation to make this country safe from terrorists. I am glad that the Prime Minister has agreed to my proposal for the Privy Council committee to consider the use of intercept evidence. He has also taken up our idea of interviews after charge. He has said again today that he is considering our border police proposals. Will he confirm that they could be introduced in the Queen’s Speech this year?

Let us look at other proposals. On housing, the Prime Minister says that it is difficult for people to get their foot on the housing ladder, but who does he think is responsible for that? It was his Government who doubled the council tax, restricted the right to buy and increased stamp duty, including for first-time buyers. Will he confirm that as a result, home ownership in Britain is actually falling for the first time since figures were published? Is that not Labour’s record on housing? As Chancellor, he launched the planning gain supplement in a great blaze of glory, but is he not back-pedalling on it today? As he broke the housing ladder, why should anyone think that he is the right person to mend it?

The Prime Minister promised action on the NHS. Why does he not listen to his own Health Secretary, who has said that there is

“confusion and frustration in the NHS”?

Who has been running the NHS for these past 10 years? The Health Secretary has said:

“Doctors, clinicians and nurses complain that they are fed up with too many top-down instructions”.—[Official Report, 4 July 2007; Vol. 462, c. 961.]

Who has been responsible for the top-down instructions over the past decade? Today, we have an NHS in which nurses are being sacked, accident and emergency units are closing and junior doctors are having to leave the country to look for work. A week ago, the Prime Minister announced a fundamental review of the NHS. Today, he is promising fundamental legislation on the NHS. Either the review is bogus or the legislation has not been thought through, or—knowing this Government—probably both.

Ten years ago, the Government said that education was their priority, yet 10 years later almost half of our 11-year-olds cannot read, write or add up properly. The number of young people not in work, education or training has actually gone up under this Government to over 1 million. The one change that the Prime Minister and his new Secretary of State for Children, Schools and Families are making seems to be going in entirely the wrong direction. Does not the Prime Minister intend to dilute the reform agenda by giving academies less independence? What we need is more freedom for schools, more power for head teachers and more choice for parents. While the previous Prime Minister was beginning to move in the right direction on education, is this one not moving in the wrong direction?

The Prime Minister has talked about the constitution. We proposed, and will support, measures that genuinely strengthen Parliament and decentralise power. However, real change means giving the House of Commons the right to determine its own timetable; real change means a proper bill of rights to replace the Human Rights Act 1998—and, I have to say to the Prime Minister, real change means addressing the West Lothian question. I ask him again: where is the fairness in allowing Scottish MPs the right to vote on hospitals, schools and housing in my constituency, while no MP is allowed to vote on hospitals, schools and health in his constituency?

So much for what was in the draft Queen’s Speech; let us see what was left out. There was nothing in this speech to address Britain’s broken society. Where are the measures to address teenage pregnancy, drug addiction and personal debt? Where are the measures to strengthen families and marriage? Where is the package to tackle the highest rate of family breakdown in Europe? The Prime Minister knows that he cannot tackle social breakdown because he has presided over social breakdown.

The Prime Minister tells us that he wants to be accountable to Parliament, so let us see whether he can ditch the usual pre-prepared rant and answer three questions. First, he says that there will be a pensions Bill. Will it give faster help to the 125,000 people who have been left with no pension under his Government? Secondly, will he announce a moratorium on A and E and maternity unit closures, and an end to the top-down targets that are leading to NHS cuts? Thirdly, will he give the British people a referendum on the European constitution, which they all want? Three straight questions; let us have three straight answers.

Will not people conclude from what they have heard today that all this Prime Minister has to offer is more of the same from a Government who have failed?

The answers to the right hon. Gentleman’s three questions are: first, we will deal with the problems that are facing those who have lost their pensions as a result of their companies collapsing. We have instructed a review of the assets of bankrupt companies and their pension funds, and we believe that we will be able to move the 80 per cent. guarantee that we have given further towards to 90 per cent. We will make an announcement very soon.

On the second issue of A and E, I say to the right hon. Gentleman exactly what I said to him at Prime Minister’s questions: all seven reconfigurations have been referred to the medical committee, which will review them on medical and surgical grounds. I would have thought that he would be gracious enough to support that move. On his third question, on the European referendum, I think that he should listen to some other voices in his own party. The debate within his own party is raging at the moment, with Lord Heseltine saying that, as a result of our achieving our red lines in the negotiations, if we can secure the amending treaty, there is no case for a referendum. Perhaps, in the spirit of consultation, the right hon. Gentleman should consult his own party on these matters.

On housing, we have just raised the level of house building commitment to 240,000 houses a year. We have just released a lot of public sector land, and announced that 500 more sites are being examined with a view to releasing land for housing. At the same time, we are creating the new homes agency to bring together all the agencies that can help. I am disappointed, therefore, that the right hon. Gentleman says that there is nothing in that for the Conservative party. The reason there is nothing in it for the Conservative party in that the shadow housing Minister has said that

“you cannot build your way out of housing problems.”

The leader of the Conservative party has something to answer for, too. He told the Conservative party conference, when he was trying to speak to young people:

“If we are to be the party of aspiration…that means building more houses and flats for young people.”

He then spoke to Age Concern, the pensioners organisation, and said that his policy was

“fewer homes designed for young single people.”

I hope that the Conservative party will find a way to support many of the measures that we propose. There was general agreement in this House about some of the measures in the constitutional reform Bill. I hope that the right hon. Gentleman will support us on the counter-terrorism Bill. Employers and trade unions have agreed on the employment simplification Bill. I believe that there is a growing consensus about what we have to do on human tissues and embryos. I hope that on the unclaimed assets Bill, which will give money to youth services, we will not find a reluctant Conservative party unwilling to support it.

I hesitate to think what a Conservative Queen’s Speech would look like in the present circumstances. “No more grammar schools” was a policy that was publicised one week, but abandoned the next; then there were to be museum charges—publicised one week, abandoned the next; then there was to be VAT on airline flights—publicised one week, abandoned the next; and then, this week, there were to be taxes on alcohol—said on Monday, abandoned by Tuesday. Then, of course, the shadow education Secretary, who led the clause 4 moment on grammar schools, was himself abandoned by the Conservative leader. It is U-turn after U-turn after U-turn in the Conservative party. The Conservative leader may U-turn if he wants; it is clear that the Conservative party is not for turning.

If these proposals represent a genuine attempt by the Government to consult in advance of the Queen’s Speech, they most certainly should be welcomed, but I say to the Prime Minister that we should be concerned about the quality of legislation as much as we are about the quantity. I hope that he feels it appropriate to ensure that there is much more pre-legislative scrutiny during his time in No. 10 Downing street than there has been hitherto. It is worth pointing out that during the past 10 years, there have been 382 Acts of Parliament, including 10 health Acts, 12 education Acts and 29 criminal justice Acts, and more than 3,000 new criminal offences have been created. The mantra might have been, “Education, education, education”, but the reality has been, “Legislation, legislation, legislation.”

I shall deal with some of the points raised in the Prime Minister’s statement. On the issue of education, he said that it is the Government’s intent to raise—[Interruption.]

Order. There is far too much noise in the Chamber.

The Prime Minister has said that the Government intend to raise the school-leaving age to 18 years. How will the curriculum be made relevant to those who find themselves in school between the ages of 16 and 18, who might otherwise have anticipated leaving? What funding will be made available to ensure that that curriculum is worth while and constructive?

On housing, I state right at the outset that local planning gain should be locally located and controlled. I hope that in the consideration the Prime Minister is obviously willing to give to this issue, he will ensure that local authorities can reap the benefit of development within their areas, and determine in consultation with their citizens how that benefit should be supplied.

Since 1997, the number of families on social housing lists has risen by 50 per cent., from approximately 1 million to 1.5 million. That is a measure of the seriousness of the crisis, which is why I welcome the Prime Minister’s attention to the issue. I suggest that we probably need as many as 1 million socially rented houses by 2020. He would help the House if he gave a more detailed breakdown of how the 3 million target will be made up. I hope that he and the whole House are sympathetic to the fact that by 2020, less than 10 per cent. of the total housing stock will be carbon neutral. If we are serious about dealing with climate change, surely more has to be done in relation to housing.

We do not have to go very far in the national health service to meet doctors, nurses and health professionals who are demoralised and confused by constant reorganisation. Any legislation that the Government introduce must surely focus on standards, and not on yet another restructuring.

We will obviously consider with care any proposals that the Government make on terrorism. We, of course, have previously argued for the use of intercept evidence—phone-tap evidence—in court proceedings, and for the notion of questioning suspects after charge, subject to proper judicial protection.

On climate change, to which I already referred, I hope that the Government will look again at annual emission reduction targets. How will we know whether we are making progress unless we have some annual figure on precisely what is happening as a result of Government policies? Should not the aim be a carbon-neutral Britain? The Prime Minister must remember that green taxes fell as a percentage of national income during his period at the Treasury.

On climate change and the environment, will he categorically state today that there will be no open—or, indeed, hidden—public subsidy for the nuclear industry, bearing in mind the fact that we already have a liability of about £70 billion to clean up existing nuclear power stations?

Finally, I hope that the Government will embrace the idea that legislation, once passed, should not simply be allowed to lie on the statute book. It is time that we had a proper system of revision to repeal out-of-date, inept and ineffective legislation. If we are going to be better engaged with the quality of legislation through pre-legislative scrutiny, surely we should be equally conscientious in striking from the statute book provisions that have long since lost their use.

I am grateful for the support that the right hon. and learned Gentleman offers. I hope that it will be forthcoming on the counter-terrorism legislation, and I hope that there will be all-party consensus by the time we finally legislate. I hope, too, that he will be able to support the major measures of our constitutional reform Bill. I understand what he says about the number of Acts that come before this House and the House of Lords, but the House of Commons Library tells me that the number of Acts has, if anything, declined over the past 20 to 30 years. Between 1987 and 1997, there were 40 Government Bills per Session, and now the average is fewer than 35 per Session.

On the right hon. and learned Gentleman’s specific points about the nuclear subsidy, we say in our consultation document that the nuclear industry will have to pay the full share of storage and the total costs of building and running, but that is very much part of the consultation we are having at the moment, and I look forward to hearing his comments, and those of others throughout the country.

On the issue of young people, I assure him that as we raise the education leaving age to 18, the plan is to provide a vocational stream as well as an academic one—both of high status—that will enable young people at 14 to choose a vocational route that could lead to an apprenticeship and, certainly over time, to a career and job. Our investment in education means that we will have more than doubled the amount spent per pupil over the past 10 years.

I am sorry that the right hon. and learned Gentleman is reluctant to support what we have tried to do on the environment. We introduced the climate change levy but did not receive a great deal of support from other parties in the House. We did not have full-hearted support on the fuel duty escalator, even from the right hon. and learned Gentleman’s party, when we tried to take those measures to deal with climate change. I hope that he will recognise that it is very difficult and that it is better to have a five-year target in the Climate Change Bill, given the performance of the economy in any one year. The amount of carbon used, therefore, is dependent on the growth rate of the economy, the weather and a whole series of incidental factors such as the price of oil and commodities. But of course, there is annual reporting.

There is an increase in social housing: there has been a 50 per cent. increase in the past three years in social housing built for rent. I agree with the right hon. and learned Gentleman that if we can find a solution on the planning gain supplement that allows us to achieve far more planning gain to enable us to build more houses and the infrastructure at the same time, we will support that. I hope that people will understand that the country’s attention must be on building more houses, and that that means making difficult decisions nationally as well as locally. We are determined to build as much of that housing as possible on brownfield sites—that is why the percentage of brownfield sites used has increased under this Government and will continue to be high. I hope that over time—despite current evidence—we can get an all-party consensus on the need to build more homes.

I welcome the proposals on affordable housing. Will my right hon. Friend confirm that, unlike the current position in my constituency with the local Lib Dem planning authority, which simply approves plans for luxury apartments for investment purposes, his proposals will deliver housing for families and those in housing need?

My hon. Friend is right. The new housing developments should be for mixed communities and include a high proportion of affordable housing. I hope that all councils will bear in mind the fact that there is an outstanding demand for more housing, especially more affordable housing, in this country.

I welcome in principle the idea of publishing for consultation at this stage a list of Bills that might be included in the Queen’s Speech. Does the Prime Minister agree that if the proposal is to have any practical purpose, as opposed to being just a gesture, it would now be a good idea to refer to the appropriate Committees of the House the question of how much time should properly be allocated to each Bill for debate and scrutiny—and for the Government to contemplate dropping from the programme such Bills as need to be dropped to make sure that we can make a sensible reality of debating and scrutinising Bills without the pressure of totally unrealistic timetables?

I take on board the right hon. and learned Gentleman’s remarks. I know that he chaired the Conservative party’s constitutional committee, which made several recommendations about the management of business in the House. The Liaison Committee will discuss the matter, and I look forward to its comments. Several Bills have already been published in draft, and that practice will increase. There will be a debate in Government time on the draft legislative programme before the summer recess. I hope that there will be a similar debate in the House of Lords. At the same time, it would be good for this country if region by region consultation took place, whereby people in their constituencies and communities could take a view on some of the more controversial measures. Of course the purpose of consultation is listening to what people say, and that means that we must be prepared to make changes as a result.

I warmly welcome the Prime Minister’s statement, which contrasted with the churlish Punch-and-Judy effort from the Leader of the Opposition. I suspect that parliamentarians throughout the House will welcome my right hon. Friend’s comments today. Will he examine the relationship between Parliament and the Executive? Government and Parliament are stronger in partnership than when one dominates the other. In that context, will he ensure that all Bills are introduced in draft, so that the House can discuss them properly? Will he also ensure the fullest pre-legislative scrutiny? If we have that, we will end up with better law and better government.

I am grateful to my hon. Friend, who takes a huge interest in those constitutional matters and has made several very good proposals about how we can improve the workings of the House. Yes, we want more draft Bills for scrutiny before they are given a Second Reading—but it is not always possible to do that, especially in relation to justice and counter-terrorism. However, I hope that the practice can become more widespread, that the House will play a bigger role in examining such matters before legislating, and that over time there will be all-party support for the procedures. My intention is to devolve power from the Executive to Parliament in some vital matters.

Why has it taken so long to develop the housing that was already planned for the Thames Gateway? Was the reason lack of co-ordination between Departments and agencies —or was it the Prime Minister’s own dead hand, as Chancellor, in refusing to finance the necessary infrastructure that Kent county council demanded?

I think that the hon. Gentleman knows that planning permission was given for the Ebbsfleet project only in the past few days. One of the great difficulties is the amount of time taken in the planning process—often for legitimate reasons and to deal with legitimate complaints that people want to make. The new planning Bill will make some provision to speed up planning applications in future. In addition, I hope that local authorities will co-operate and want to work with a strategy that is intended to build more houses—and more environmentally friendly houses—so that, with some of our proposals for eco-towns and eco-villages, we can move beyond the old debate about housing being an alternative to a good environment. Again, I hope that there will be all-party support for that.

May I tell my right hon. Friend that for many people, the subject of climate change feels remote and distant, and that consultation will give people the opportunity to think about climate change in a real way? Will he, as part of the consultations, consider the virtuous circle that could be created, through investment in innovators in microgeneration, such as those in my constituency, so that people can make genuine choices about fuel efficiency in their homes? People can thus make for themselves choices that have an impact on climate change.

My hon. Friend is right to say that microgeneration has an important role to play in future. We set up a new microgeneration fund, which is heavily oversubscribed because of demand for wind turbines, solar power and other means of using energy more efficiently and in a low carbon way. We will extend that in future, but it is one part of the solution to meeting our energy needs in an environmentally friendly way. I hope that my hon. Friend will understand that the debate about nuclear power, as well as that about the future of coal, oil and gas, is important to the supply of energy.

Is the Prime Minister aware that in the century before 1914 there were only 13 criminal justice Bills, and between 1914 and 1997 there were 40, but that since 1997 there have been approximately 64, and we are about to embark on the 65th? May we have a little less legislation and rather better government? May we then perhaps have a reduction in the prison population, adequate capacity for prisons and a reduction in the rate of crime? At the moment, we seem to be getting a lot of bad legislation and a lot of bad crime.

I hesitate to make a partisan point—but I will. The reason why we have had to legislate more on criminal justice is that crime doubled under the Conservative Government, and we had to take action to deal with it. I agree with the hon. and learned Gentleman that we want to consider better alternatives to prison in some cases, but we also need to build prison places. Again, I hope that there will be support from the Conservative party for doing that.

One of the biggest issues that faces my constituency continues to be the number of people on incapacity benefit—nearly one in five people of working age—largely thanks to economic measures that previous Governments took. Nearly 50 per cent. of those people are on incapacity benefit with mental health problems. We are trying to get more people into work, but are we going to ensure that proper mental health services are available, so that instead of popping pills and sitting on benefits, people can be in work and lead a productive life?

My hon. Friend is right; I know that he has taken a big interest in those issues. Getting the numbers of people on incapacity benefit down is one of the Government’s major strategic objectives. The numbers on incapacity benefit have fallen in the past year, despite a big rise over a 20-year period. I accept my hon. Friend’s point that many people could benefit from special help to deal with mental health problems. I hope that, as a result of some improvements in the new deal in particular, we can give people better advice, better support and better counselling, and help them get from benefit into work.

May I tell the Prime Minister that the announcement is a good idea, but there is more than a whiff of déjà vu about the content?

Today, the Plaid Cymru leader in Cardiff will be sworn in as Deputy First Minister. He will, in effect, be acting First Minister during Mr. Rhodri Morgan’s indisposition. Will the Prime Minister confirm that he will commit himself to co-operating fully with that Administration in seeing through the various changes for which the National Assembly calls?

It is pleasing that the Government are reconsidering planning gain supplement. On business, the Prime Minister mentioned regulation of the minimum wage. Will there be something on corporation tax—perhaps export assistance through research and development?

A week ago, together with my hon. Friend the Member for Moray (Angus Robertson)—[Hon. Members: “It’s pronounced ‘Murray’.”] Whatever. Together with the hon. Gentleman sitting beside me, I wrote to the Prime Minister to say that we in Plaid Cymru and in the Scottish National party were fully committed to talks about changes in terrorism legislation. We have received no answer to that letter yet. Will the Prime Minister please confirm that he will include us in those discussions?

I will write to the hon. Gentleman today. On the other issue that he raises, I am sure that the whole House will want to send our best wishes to the First Minister in Wales and wish him a speedy recovery. I will, as I have already said, co-operate with the devolved Administrations in every respect and work with them for the benefit of the whole country. As for the research and development tax credit, we continually examine the matter and I have no doubt that in the run-up to his pre-Budget report and Budget, the Chancellor will be looking into how to improve our ability to service the research and technology companies of this country so that we can become world leaders in a whole range of areas where we deserve to be so, and where support from the Government can be of help. If the hon. Gentleman has any specific proposals, will he put them to the Chancellor?

I thank the Prime Minister for his statement, and I welcome the concept of having a discussion about legislation before the state opening of Parliament. I am particularly pleased with the section on housing, but is my right hon. Friend aware that typically, more than three quarters of the population living in inner London have no possibility whatever of buying their homes in their communities? For them, the only way out of the housing crisis is the construction of social homes, particularly council housing, so will the Prime Minister ensure that legislation promotes that? Will he also give real consideration to the plight of people living in private rented accommodation and the need for real accountability of social landlords such as housing associations, as part of the package for dealing with a very real crisis affecting many people in inner London whose lives are blighted by bad housing?

It is precisely because of what my hon. Friend says that we are publishing our proposals, and the Minister for Housing will present our Green Paper next week. I agree with my hon. Friend about the special problems that people in London face, and I know that the Mayor is planning to publish a housing strategy paper by the end of the month. We will attempt to support him in his efforts to increase the amount of social housing in London. As for the rented sector, we are looking at the Hills report on social housing. We are interested in improving accountability to tenants in the housing system, and we will consider any proposals that my hon. Friend puts forward.

What proportion of the 240,000 new houses to be built every year are accounted for by the move towards smaller households, and what proportion are accounted for by net migration? If the Prime Minister cannot give an accurate reply now, I would be grateful if he would write to me later.

The biggest increase will be in respect of housing for single people, where there is clearly a deficiency at the moment. The hon. Gentleman should view the figures not as an attempt to create more houses out of the same sites, but as an attempt to increase the number of sites available. I said earlier today that we had identified 500 additional public sector sites where the land can be released and housing can be built. I hope that within that development, the amount and proportion of affordable housing will be very high. This is an attempt to release more land in order to get the housing market moving, and to increase the supply in a way that I believe both sides of the House should welcome.

I very much welcome my right hon. Friend’s setting out his plans for consultation in this way. What plans does he have to deal with the unacceptable growth of inequality in our country, particularly in view of the indefensible non-domiciled tax status, and the frankly Babylonian excesses of private equity?

The tax status of private equity is the subject of a review that the Treasury set up in March. It will report in time for the pre-Budget report. I think that my right hon. Friend knows that inequality is an issue in every advanced industrial country, but he should also know that the numbers of children and pensioners taken out of poverty in our country have been very substantial over recent years. We will continue to press forward our programme to get more children out of poverty and to ensure that every pensioner has dignity and security in retirement.

Further to the Prime Minister’s reply to my right hon. and learned Friend the Member for Rushcliffe (Mr. Clarke), when he confirmed that there would be a debate on the legislative programme in Government time later this month, is he aware that at last Thursday’s business questions, the Leader of the House suggested that that debate should coincide with the debate on the summer Adjournment just before the House rises? Does the Prime Minister agree that his statement, and the legislative programme, deserve a better offer than that?

Yes, and when the Leader of the House makes a statement to the House tomorrow, the right hon. Gentleman will find that his points have been taken fully on board. There will be a debate in Government time, outside the Adjournment debates, so that the full text of the draft legislative programme can have a full airing in this House.

I welcome the innovative process that my right hon. Friend described in his statement and I welcome the measures listed in it, particularly the local transport Bill. May I urge him to include, as part of the integrated transport strategy that he proposes, light rail and trams?

I hear what my right hon. Friend says.

I welcome the statement on the draft legislative programme. The Prime Minister mentioned a Bill to deal with deregulation. I urge him to be as bold as possible in reducing the burden on business in that regard—consistent, of course, with the need for proper enforcement, where necessary. On the pensions Bill, I urge the Prime Minister finally to take the opportunity to put an end to the terrible injustice suffered by those who have lost their occupational pensions through no fault of their own. I welcome the Pension Protection Fund and the financial assistance scheme, but will he use the pensions Bill to implement the conclusions of the parliamentary ombudsman in that regard?

I take it that the hon. Gentleman is referring to people who lost their pensions when their companies went bankrupt. If so, we are talking about 120,000 workers, for whom we have guaranteed for the first time an 80 per cent. pension at a cost of something in the order of £8 billion over the next few decades. As I told the leader of the Conservative party, we are looking into further measures to enhance that pension beyond the 80 per cent. by seeing what funds remain in the companies that went bust. We will report back to the House in due course.

As for burdens on business, the hon. Gentleman knows that the new Department for Business, Enterprise and Regulatory Reform will be working on precisely the points that he raised. The first Bill will come forward in due course, and the new Ministers are looking carefully at what they can do to cut burdens on business.

I welcome my right hon. Friend’s statement and the innovative way in which he has introduced consultation on future legislation. I would like to comment particularly on the unclaimed assets Bill. The Prime Minister will be aware of the great concern about antisocial behaviour in all our communities. Parents are becoming increasingly concerned about the lack of facilities to divert young people from involvement in antisocial behaviour in the first place. I welcome my right hon. Friend’s determination to use dormant money to improve youth services, and I would ask for two particular things. First, this money should be additional to the resources that councils currently make available. Secondly, councils should be encouraged to engage with the local community before the money is freed up. It is crucial to engage the local community. I find a lot of good will out there, particularly among parents, many of whom would like to get involved in such activities if only the resources and the capacity were made available.

One of the great causes of the next decade will be to improve youth facilities and amenities in all our communities. As I go around the country, I meet people who rightly say that we must be tough on antisocial behaviour, but people also tell me very clearly that there is little for many young people to do. The law-abiding decent majority of young people need better facilities, and we have to do something about that. That is why the unclaimed assets Bill will provide additional money for youth services and facilities. At the same time, there will be improvements in the method by which the money can be dispensed. As the hon. Gentleman probably knows, in a previous Budget we set up youth budgets for local areas, whereby young people themselves can take decisions about how the money is spent. We will review how that is working and take a decision on the best way forward. I look forward to hearing my hon. Friend’s views on how we can best achieve that.

On what specific grounds does the Prime Minister rule out legislation authorising a referendum on the fundamental constitutional changes in the European reform treaty? That, on an unprecedented mandate, would merge the treaty on economic union with the treaty on European union, collapse the pillars, impose new legal duties on this Parliament that are enforceable by the European Court of Justice, and alter the structural relationship not only between Britain and Europe, but between the Government and Parliament and this country’s electors, which is the basis of all referendums.

The text of the statement issued after the Brussels summit started by saying that the constitutional project—the project to set up a totally new constitution—had been “abandoned”. That was the term used at the Council.

In pursuing the challenge of helping more people into work, will my right hon. Friend encourage and support his Ministers in tackling issues of occupational segregation and the difference in skill levels between men and women, so that we can enhance the skills of the whole population and tackle the gender pay gap? Will he confirm his continued support for the Government’s programme of further child care facilities, children’s centres and the Sure Start programme, which is doing so much to support families and parents?

I am grateful to my hon. Friend, who has led the way in her constituency in pushing forward the children’s centre programme, which, over time, should mean that there are half a dozen children’s centres in each constituency of England; roughly 3,000 or more centres by 2010. We will continue to support children’s centres and provide the money necessary for their expansion. I agree also that we have to do more to break down the barriers of discrimination and inequality that have been a problem for women seeking employment over many years.

If the Prime Minister is to introduce new housing legislation, will he reform the housing revenue accounts subsidy scheme, through which Whitehall takes 29p in every pound paid in rent by Kingston council tenants to spend elsewhere in the country, preventing essential and basic repairs from being made to council homes in my constituency? How can it be fair for his Government to force council tenants on estates in places such as Kingston to pay for council house repairs elsewhere in the country?

There has been a great deal of investment, but I shall look at the very specific examples from the hon. Gentleman’s constituency. Over time there will be reforms of the housing revenue accounts system and how it is dealt with.

When he was in his previous job, I drew my right hon. Friend’s attention to some of the problems faced by carers, and work is still outstanding on that subject. Last Friday, I met Gateshead Alzheimer’s Society and we discussed these and other issues. The society raised with me the Government’s proposals for the use of dormant funds under the unclaimed assets Bill. The society put it to me that as it was likely that those funds belong or belonged to elderly people, it would only be reasonable for some, if not most, to be used to support carers. Is that an argument that my right hon. Friend finds persuasive?

Any argument that comes from my hon. Friend is a persuasive one. We have set up a review into what we can do to help carers more. We are trying to provide more respite care, more training, more help and more support. I will take on board what he says specifically about Alzheimer’s and the particular problems that carers and families face in relation to that. I hope that he will find that he can feed into the review, and that the report, when it is eventually done, will be to his satisfaction.

Will the Prime Minister give to state schools the same freedom to adopt the international GCSE exam that independent schools have? Would not that be a key way of ensuring academic rigour in our exam system and of extending educational opportunity to all children, regardless of their background?

Obviously I will look at that. Proposals have been made over time as to how the baccalaureate could be used in the state sector, and I shall write to the hon. Gentleman on that.

The Prime Minister will be aware that many Members on both sides of the House are alarmed at the prospect of an increase in the time limit for pre-charge detention. We believe that far from making us safer, detaining people for months at a time without trial could exacerbate community tensions. He said that any change would apply to terrorism alone. Will the Bill state that the increase in pre-trial detention applies only to people prosecuted under terrorism legislation?

That is what the debate is about. I hope that in dealing with such an important national security issue as the terrorist threat, the whole House can come together to agree measures that balance the need for security with attention to a matter in which, historically, this House has been most interested—the civil liberties of the people of this country. When we have the discussion, I hope that my hon. Friend will feel able to support our measures, along with Opposition parties.

On 25 July, the Joint Committee that has been looking at the draft Human Tissue and Embryos Bill will report back to Government, as we were charged to do. There are two crucial issues: the regulator and the future of research, particularly into embryos and using animal and human elements. Will the Prime Minister give an assurance that that Bill will be in the Queen’s Speech and that we will get it on to the statute book within his first Session as Prime Minister?

That is the plan—but it is in the hands not just of the Government but of the House. The hon. Gentleman would want us to look at the report that is being written on the Bill and at these two particularly controversial measures, and that is exactly what we will do.

May I warmly welcome the Government’s renewed efforts on affordable housing? Will my right hon. Friend bear in mind the fact that what is affordable in some areas is not affordable in others? In Islington, where a first-time buyer’s flat costs £300,000, owning a flat is not an option; even part-ownership may not be an option. Affordable rented housing is what we need in Islington. Also, I hope that he will not take a moment’s time to listen to any advice from the Liberal Democrats, who in my constituency—

Order. This is a statement. There are other occasions on which the hon. Lady can attack whichever party she wants, even her own.

I am grateful to my hon. Friend, a persistent campaigner who has talked to me on many occasions about the cost of housing in her constituency and the need for more affordable homes. Further to my earlier comments, of the 223,000 households created in this country, the biggest increase has been in single-person households. Of the 240,000 houses that we want to build by 2016, we want more to be family homes. I want that to be clear to the House, and if I was misunderstood, I apologise.

Clearly there is a consensus that we need more affordable housing, but will the Prime Minister expand on the implications on the new raised national target, which presumably means new raised regional targets as well? He may be aware that the current south-east regional target has been reached after a long, difficult and passionate consultation. If he is to tear up the results of that consultation and announce a new top-down central national target, I am afraid that his attempt to present himself as a new listening Prime Minister will be greeted with scepticism in that area.

The country will have this debate. We believe that to provide fairness for families and single people, the amount of housing that we have announced must be built over the next few years. Obviously we have to persuade many decision makers, including local authorities, that that is the right thing to do. But I hope that we can move to a consensus that it is essential to build more homes, and then look at how we can do that in a way that is environmentally friendly. We must also look at how we can make housing more affordable for people who are missing the chance of being on the housing ladder.

I know that the South East England regional assembly is not in favour of an expansion of house building in the region as we are, but it should reconsider the view of its Conservative chairman that there is no evidence that simply building more houses makes it more affordable to buy a home. We must build more houses if we are to make housing more affordable. I am ready to work with the assembly and local councils to do that and, as can be seen, we are ready to release a lot of public sector land to make that possible.

I warmly welcome the Prime Minister’s announcement of the greater priority for housing and his willingness to reconsider the planning gain supplement. Does he recognise that there is a considerable variation in the performance of individual local authorities and that if he can find the mechanisms to raise the performance of the weakest up to those of the best—whether through section 106 or tariff agreements—we will get a substantial increase in the planning gain yield for necessary infrastructure and social investment?

I applaud my right hon. Friend’s work as a Housing Minister and as a campaigner for more affordable housing for his constituents and the rest of this country. The Government are offering a deal: we would be prepared to withdraw the planning gain supplement Bill if we could find a means of extracting more planning gain for local communities as new housing and new infrastructure are built. We await the consultation and the responses of those who can help us to achieve that high level of planning gain.

During the last 10 years of the new Labour Government, only 4,000 council houses were built. In the first 10 years of the Thatcher Government, 400,000 council houses were built. The Prime Minister was silent on the building of council houses. Why is he hostile towards council houses? How many of the 240,000 new homes a year will be council houses?

The first thing the hon. Gentleman should recognise is that the priority after 1997 was to modernise and improve the existing stock. A huge amount of investment, worth billions of pounds, went into improving more than 1 million council housing and social housing tenancies. As a result, many children, pensioners and other people who were living in substandard accommodation are now living in decent accommodation. Therefore, it is wrong of the hon. Gentleman to portray the last 10 years as a period when we failed to renovate stock. [Interruption.] Exactly: we have renovated stock. We now have to build more stock. [Interruption.] The hon. Gentleman is right: he says that we have done well, and I hope that that will be included in Hansard.

I said, “You could have done both.”

Having renovated, we now must build. I hope that we can find a means by which social housing partners, housing associations and local authorities can be involved in that.

I welcome the Prime Minister’s statement, as well as yesterday’s statement by my right hon. Friend the Secretary of State for Children, Schools and Families. I chaired the all-party review on the needs of disabled children, and may I remind the Prime Minister that we strongly recommended that there should be a statutory minimum entitlement to short-term breaks and respite care? On the basis of the evidence we received, if that were to be included in legislation it would have great support from disabled people and their carers and families.

No Member has done more to promote legislation in the interests of disabled persons than my right hon. Friend, and we are grateful to him for being a pioneer in this area. I will look into what he has said. The carers review will report soon, and I hope that he will be able to contribute to its work and that we will be able to make the progress that he wants.

rose—

Order. We must move on. I will keep a note of the names of the Members whom I have not called.

I beg to move,

That leave be given to bring in a Bill to establish a national compulsory proof of age scheme for persons aged between 16 and 21 years in connection with the purchase of alcohol, tobacco, knives, air weapons and other items; and for connected purposes.

Because of the current absence of a national biometric identity card, the Bill is necessary for reasons I shall set out.

Every day in Britain, hard-working shop workers ensure that we can get hold of everything from A to Z—from apples to cuddly zebras—and are involved in millions of transactions, many of which involve age-restricted items such as alcohol, cigarettes, knives and airguns. Conflict does not usually arise over sales of apples or cuddly toys but, sadly, it all too frequently arises over the sale of age-restricted items. Research shows that the refusal to sell age-restricted products is the most common cause of verbal abuse towards shop staff and that it can also provoke physical violence. It is believed that as many as 90 per cent. of shop workers have suffered some form of abuse, and many of them do so daily.

As well as verbal abuse, shop workers are often subjected to physical abuse, ranging from being spat at to violent assault. For example, a shop worker who refused to serve a bottle of beer to someone whom they thought was under age was told that they would be knifed. Other shop workers report being beaten up for refusing to sell alcohol to young lads. Thankfully, according to the most recent figures, incidents of violent abuse against shop workers have declined. That is in part owing to initiatives such as the Union of Shop, Distributive and Allied Workers’ successful “Freedom from Fear” campaign, and USDAW is today celebrating its “respect for shop workers” day. I pay tribute to it for its work in raising the profile of the millions of shop workers who serve us each and every day.

One way of addressing the problem of assault on shop workers is to foster a culture of “No ID, no sale”, so that customers know that if they look under 21, they will need to show proof of age. That would help to defuse tension and reduce opportunities for confrontation when a customer is challenged about their age.

I fear that the problems associated with selling age-restricted products will peak this autumn when the age at which tobacco products can be sold rises from 16 to 18. Many young people who are approaching their 18th birthday will have been buying cigarettes legally for almost two years but will no longer be able to do so. Similar increases in the minimum age for purchase will rightly apply to knives, airguns and crossbows.

I am particularly concerned about the availability of so-called pendant knives. They look like a piece of jewellery, but they contain two blades that fold out. I was horrified to learn that that item can be sold legally as it is not a concealed blade and the blades are not long enough to make it illegal. I fail to understand how such items can be justified, but I look forward to the date when at least no one under 18 can buy one.

The Bill has two key points: it proposes that we have a nationally recognised, Government-controlled proof of age scheme, and that that be compulsory for those aged 16 to 21 who wish to make restricted purchases. Let us be clear about what we are addressing. Tobacco and alcohol are not the only items whose purchase is age-restricted. Other age-restricted products include fireworks, which can cause great misery in the hands of people who misuse them, DVDs, videos and solvents—the problems associated with solvent misuse have been raised with the Prime Minister. Other items include aerosol paints—young people sometimes use them to put their tags on walls—lottery tickets, petrol and crossbows. It is right and proper that such items are sold only to those who are deemed to be of a suitable age.

It would be wrong to claim that there are no voluntary schemes already in place to train and support shop workers in order to help them meet their legal obligations and check the age of customers. Many Members will be aware of the pass scheme, and I pay tribute to all involved in that, including the drinks industry, which plays an active role. The pass scheme is supported by robust audits carried out by trading standards bodies, and only accredited cards may bear the registered hologram. About 2 million such cards are in use, and where they are applied, their use is beneficial. However, as well as the four national card schemes that are accredited by a pass, there are also about 20 local authority entitlement cards, which also provide proof of age, and numerous other non-accredited schemes. More worryingly, there are cards showing false details that can be downloaded and printed from the internet. Furthermore, in some parts of the country it is more usual for young people to use passports or driving licences to prove their age. I understand that it is estimated that about two thirds of those aged 18 and 19 have passports, and that a similar proportion have driving licences. Inevitably, there is a significant overlap between those two groups, so perhaps a quarter of all those aged 18 and 19 do not have some form of official Government proof of age.

Apart from the costs involved, what are the dangers in carrying around such documents? Identity theft dangers are heightened. Passports and other documents can easily be stolen when people are on a night out. Replacing them is both costly and time consuming. It is an administrative burden for the young person, the police and the passport agency.

There is currently a variety of proof of age cards and documents, and, although the pass hologram should be widely recognised, a young person who visits elsewhere in the country—perhaps a person from Stoke-on-Trent visiting a friend in Portsmouth—might find that his proof of age card is not recognised there. A single, national, Government-run scheme would simplify the position on proof of age by removing the myriad schemes. Its establishment would also raise the profile of the single scheme in the minds of customers.

If we were to have compulsion, that would help create the culture we need to foster whereby anyone who looks under the age of 21—I can only wish that that included me—automatically shows their proof of age when purchasing age-restricted items. If showing a proof of age card is compulsory, that should take off the shop worker the pressure of having to ask to see such proof. That in turn should lead to less scope for confrontation and less abuse and assault of our shop workers. Regardless of how well a voluntary scheme might be run, I do not believe that it would stop abuse of shop workers. The scheme must be compulsory.

Although we may no longer be described as a nation of shopkeepers, we should celebrate the work our shop workers do—often at times when the rest of the population is not at work, such as early in the morning, late in the evening, at weekends, and during holidays and bank holidays. Our shop workers deserve the greatest respect, and to be treated properly. My Bill would add to the protection of those hard-working men and women. I commend the Bill to the House.

Question put and agreed to.

Bill ordered to be brought in by Mr. Robert Flello, Mr. Adrian Bailey, Lyn Brown, Mr. David Kidney, Sarah McCarthy-Fry and Lynda Waltho.

Proof of Age Scheme (Purchase of Restricted Goods)

Mr. Robert Flello accordingly presented a Bill to establish a national compulsory proof of age scheme for persons aged between 16 and 21 years in connection with the purchase of alcohol, tobacco, knives, air weapons and other items; and for connected purposes: And the same was read the First time; and ordered to be read a Second time on Friday 19 October, and to be printed [Bill 143].

We now come to the first debate on the Opposition motions. Mr. Speaker has selected the amendment in the name of the Prime Minister.

I beg to move,

That this House notes that stroke is the third most significant cause of death and the leading cause of adult disability; believes that stroke prevention and care have received insufficient attention despite £2.8 billion in direct care costs to the NHS; welcomes the report of the National Audit Office (NAO), Reducing brain damage: faster access to better stroke care, HC 452, and the subsequent Report from the Committee of Public Accounts (PAC), of the same title, HC 911; further welcomes the Government’s publication of a consultation on a national stroke strategy; commends the Stroke Association, the Different Strokes charity and the Royal College of Physicians in raising awareness of stroke and the needs of stroke patients and survivors; calls for the rapid implementation of the NAO and PAC recommendations thereby saving over 10 lives a week, delivering high-quality stroke care and securing value-for-money for NHS resources; is concerned at the continuing deficiencies in stroke care and wide disparities in access to specialist stroke services disclosed in the 2006 National Stroke Audit published in April 2007; and urges the Government to give priority and urgency to the measures needed to deliver improving outcomes for stroke patients.

I am grateful to my colleagues for permitting me to use Opposition time to raise the important issue of stroke. I declare an interest as chair of the all-party parliamentary group on stroke, and I am also grateful to the Secretary of State and his colleagues for their support of the all-party group and for the Government’s amendment. Unfortunately, I cannot prefer their amendment to our motion, because the latter faces up to the reality of international comparisons in stroke care and the wide discrepancies and deficiencies in it across the UK. I wish that we could have had a combined motion, because the purpose of this debate is not to engage in partisan argument, but to raise the priority of stroke care. It has been more than four years since we have had a debate on stroke in this House, including in Westminster Hall, so it is right to do so now.

I wish to pay tribute to some people who have been instrumental in raising the priority of stroke. There are voluntary organisations, including patient representative groups such as the Stroke Association and Different Strokes, and national organisations, such as the Royal College of Physicians, which through the National Sentinel stroke audit has brought forward much vital information about the quality of stroke services and helped to push forward the improvements that have been occurring. I do not want to leave out clinical leaders such as Tony Rudd at St. Thomas’, Peter Rothwell in Oxford and Gary Ford in Newcastle, or the work of the Department of Health in the past 18 months, led by Roger Boyle, the national clinical director, and the team of officials.

Nor should we ignore the role of the National Audit Office. The report that it produced in November 2005 was a remarkable example of the value of the NAO, not only in considering issues of value for money and public expenditure, but in examining how services can be improved in ways that have radically changed attitudes in the Government about what can be achieved in stroke care.

My hon. Friend kindly mentions the NAO report and I am proud of the work that it and the Public Accounts Committee have done in this area. I hope that we can do for stroke what we did for methicillin-resistant Staphylococcus aureus in bringing it to the forefront of the political agenda. I hope that we are now doing that for dementia, as well. Will he comment on our particular view that so many people are left debilitated, and therefore become an increased cost to the NHS, because of the lack of early scans in hospitals?

I am grateful to my hon. Friend for the work of not only the NAO but the Public Accounts Committee, which has followed up on the issue in the same way as it followed up the original inquiry into health care-acquired infections. It revisited that subject and made further important recommendations, which have helped to raise the importance of the issue. He makes an important point: one of the NAO’s recommendations was the need for immediate access to screening.

At the conference organised by the NAO last October, at which my hon. Friend the Member for Gainsborough (Mr. Leigh) spoke, Professor Anthony Rudd outlined the 2006 National Sentinel audit results and explained that across England, Wales and Northern Ireland, 226 hospital sites were offering CT scanning, but only 18 per cent. were able to provide scanning within four hours. On weekdays, the vast majority of trusts were able to do a scan within 48 hours, although 7 per cent. could not. However, at weekends, 35 per cent. were taking longer than 48 hours. So scans for stroke patients are being delayed, even though we know that time lost is brain lost in those circumstances.

At that same conference, Professor Norrving from Lund university in Sweden said that his country had a virtually 100 per cent. delivery rate for CT scans within 24 hours and Professor Bladin from Melbourne, Australia described how all patients at his hospital have immediate access to scanning. Those international comparisons should serve to demonstrate to us what a dramatic difference there is in the quality of stroke care being provided in this country compared with some of the leading examples across the world.

My hon. Friend is rightly concentrating on acute care, but does he agree, given his stated interest in public health, that it is important for the health and welfare of the nation that, wherever possible, we avoid stroke incidents at source? There is still a huge national problem of undiagnosed, undetected and unremediated hypertension. Will he encourage the Department to do everything possible, through GPs and otherwise, to ensure that that is tackled, alongside the acute services to which he rightly draws attention?

I am grateful to my hon. Friend. I was not intending to dwell on that important point, but the evidence, not least from Stroke Association surveys, is that the public have far too limited an awareness of what stroke is. They have become confused about the issue and perhaps just a bare majority understand that a stroke is a brain attack. Even fewer have a clear understanding of what leads to a stroke. In recent examples, such as the Food Standards Agency’s campaign on salt reduction, raising the public awareness of the need to reduce salt intake has been focused on the risk of a heart attack. That is valid, but it was done on the basis that the public did not understand the relationship between salt intake, hypertension and stroke. In fact, in terms of mortality and morbidity, stroke is the greater risk, so we need to work harder on that.

The quality and outcomes framework for general practitioners rightly includes the management of hypertension, but—as my hon. Friend suggests—many people do not yet know their blood pressure and, in cases in which it is appropriate, are not properly monitored or attempting to address the problem through diet and exercise or even medication. We need to make that happen, because reducing the incidence of stroke must be one of our key priorities. The awareness of stroke and how to prevent it should form part of our strategy, and the NAO made that clear.

rose—

Hear, hear.

My hon. Friend draws attention to the need for better care for stroke sufferers. Some 110,000 people suffer from stroke each year, and last December I was among them. I was extremely lucky, because I received excellent care from the specialist stroke unit at St. Mary’s hospital on the Isle of Wight. I owe them so much for that and would like to thank them all publicly for it. Does my hon. Friend agree that other people in other places need care as good and as local as ours is on the island?

I am delighted, on behalf of colleagues on both sides of the House, to welcome back my hon. Friend. I know that he has already been active in his constituency, but we are delighted to have him here. I share entirely his view, and we should not forget the many staff working in stroke care who are delivering excellent care. However, we need to be aware of the lack of stroke physicians and services. As the Sentinel audit recently made clear, we have limited numbers of consultant nurse posts and a quarter of hospitals have no specialist stroke nurses available. Those are essential parts of the process of delivering high-quality stroke care. However, I entirely share my hon. Friend’s view about the need to match what has been achieved on the Isle of Wight.

Does my hon. Friend not agree that one of the most lamentable aspects of the National Sentinel audit to which he refers is the state of affairs prevailing in Wales? Only 45 per cent. of eligible hospitals in Wales have a specialist stroke unit, compared with a figure of 97 per cent. in England. The conclusion reached was that patients in Wales are more likely to die from stroke, and that, if they do survive, they will have higher levels of disability than patients in England or Northern Ireland. Does that not reflect the lamentable state of affairs in Wales and a failure on the part of the Welsh Assembly Government?

I am very grateful to my hon. Friend for making that point. I was about to come to the findings of the 2006 National Sentinel audit of stroke care. The first of its top 10 recommendations is that

“The Welsh Assembly Government, Commissioners, Managers and Clinicians should urgently address the growing divide in quality of stroke care between Wales and the rest of the United Kingdom. The highest priority should be given to the development of specialist stroke services, both in hospital with full provision of stroke units and in the community.”

I am afraid that it felt compelled to say that the very low rate of stroke unit admission in Wales was unacceptable. My hon. Friend, given his responsibilities, will be pressing for precisely that priority to be given in Wales. It is important for us to recognise that today’s debate—from our point of view—is about stroke services in the United Kingdom, not just in England. I hope that the Government hear that message and communicate it to the Welsh Assembly Government. I know that my hon. Friend will do exactly that.

In looking at the Sentinel audit, I do not want to diminish the progress that is being made, in part, precisely because stroke physicians have been pressing for it. For example, there has been an increase in the number of specialist stroke units in hospitals in England—up to 91 per cent. from 79 per cent. in the previous audit—but only 62 per cent. of patients are admitted to a specialist stroke unit. However, that is an increase on previous figures. There has been an increase in the number of neurovascular clinics, which means that transient ischaemic attacks—mini-strokes, as it were—are increasingly followed up in clinics. However, we need to do more. As I said, there are too few stroke physicians and too few specialist stroke nurses, and only 22 per cent. of hospitals have an early supported discharge team.

One central issue in the development of stroke care is acute care—treating stroke as an emergency. Here, I pay tribute to the Stroke Association, which ran a campaign entitled “Stroke is a medical emergency” and uses the FAST protocol—the face, arm, speech test protocol—developed by Gary Ford and his colleagues at Newcastle university. The publishing and dissemination of such developments across the country is a vital part of raising awareness of the fact that stroke is an emergency.

Of course, we must not allow the situation to arise whereby, when stroke symptoms develop, they are identified, an ambulance is called for and it takes the victim to an accident and emergency department, only for time simply to pass and brain function to be lost. We must take urgent action to ensure that that does not happen. I have been involved in the all-party group on stroke, of which I am now chairman, since its inception in early 2003, and we have argued for the taking of such action since early 2004. The protocols and structures required have become increasingly clear; indeed, on visiting other places throughout the world—the NAO visited Australia—one can see precisely how they can be achieved.

The Sentinel audit tells us how far we have come. In Australia, after immediate CT scanning, all those patients for whom thrombolysis is appropriate get access to it. About 10 per cent. of stroke patients get such access. According to the audit, however, in the preceding year 218 patients in this country were thrombolysed, representing 0.2 per cent. of all such patients. That is an enormous disparity. Some 18 per cent. of hospitals in this country still have no specialist acute stroke unit, and only 10 per cent. of hospitalised stroke patients are admitted directly to an acute stroke unit.

Those two elements are central: patients should be admitted directly to a unit capable of undertaking immediate CT scanning; and, where appropriate, they should undergo thrombolysis. In any case, such patients should be admitted directly to specialist stroke units, and should in virtually all cases spend their time in hospital in such a unit. We have known about these issues for some time, but we have by no means made sufficient progress on them. The NAO report was clear on the benefits that could accrue from treating such cases as emergencies.

The point was brought home to me some three or four weeks ago, when I attended the memorial service for Sir Arthur Marshall. After the service, a gentleman named Ivan came up to me and said, “You’re interested in stroke and involved in Westminster’s all-party group on stroke—I’d like to help. I used to work at Marshall Aerospace, and I woke up one night a year or so back and I couldn’t speak, couldn’t feel anything and couldn’t move the left side of my body. I was taken to Addenbrooke’s hospital”—Addenbrooke’s is in my constituency—“and I had a CT scan straight away and I was thrombolysed.” Presumably, he is one of the 218 patients to whom I referred earlier. I looked at him and said, “Well, it’s clearly gone very well.” The extent of his subsequent loss of brain function is that occasionally he has pins and needles in his left hand. Previously, he would probably have had full left-side paralysis. So, dramatic differences have been made, and we need to be aware of the scale of what we can achieve if we take such steps.

My hon. Friend is making a very good point. It is absolutely critical that we get patients scanned as quickly as possible, but in rural areas such as my own in Devon, that is not always possible. Will he join me in congratulating Devon air ambulance on its continuing work? It gets no money from the Government whatever, but it plays an absolutely critical role in getting people from remote areas to the hospitals that can treat them quickly.

I am very happy to share my hon. Friend’s support for the air ambulance service, which also plays a central role in parts of East Anglia. As I drive into Exeter, I always note the shop that the service has there. Perhaps I will stop next time I pass it, in order to support Devon air ambulance. The fundraising for the service provides a dramatic benefit. The health service supports the paramedics and the other medical and clinical aspects of the service, but putting the helicopter in the sky and maintaining it is funded entirely from voluntary support.

The NAO report makes certain things very clear. For example, it estimates that admitting stroke patients to, and treating them in, a stroke unit could save up to 550 lives. It says that transient ischaemic attacks should be followed up rapidly in a clinic, given that there is a 20 per cent. risk of a stroke immediately following a TIA. Such action can forestall and prevent major strokes. For many patients who suffer from artery occlusion, sclerotic artery surgery produces benefits within 14 days. Interestingly, the PAC and the NAO identified that such changes, which would substantially improve outcomes for patients, would not cost the NHS more. If all those measures were implemented, there would be an overall saving to the NHS, not an additional cost. The aim is a change in the design of services, and to get the NHS to respond by prioritising service delivery, which would be better for patients and better for the NHS in value-for-money terms.

Where do we go from here? One purpose of the debate is to raise the profile of the issue of stroke. Another purpose was to try to make sure that the Government publish their consultation on a national stroke strategy before the House rises for the summer, but I am delighted to say that the Secretary of State did that on Monday, which means that we can debate it. Happily, plenty of Opposition Members are present, and a few Labour Members are too, but I hope that more colleagues are listening to the debate, or will read it.

I want to encourage colleagues in all parties to include in their constituency engagements a visit to their local hospitals to talk about the stroke services that are provided. In addition, I hope that hon. Members with a branch of the Stroke Association in their areas will talk to its members—for myself, I am patron of the Stroke and Dysphasia Association in Cambridgeshire. We should all make sure that we have conversations with everyone involved over the next three months, as the consultation on the national stroke strategy ends on 12 October, which means that the scope will be limited when we return after the recess.

I welcome the Government’s publication of the document “A new ambition for stroke”. Clearly, it was a very inclusive process, and many of the people I know to be leaders in the field were engaged in the working groups that led to the document. It is very important that the Government show that priority is now attached to stroke. Unfortunately, a top-down system such as the NHS needs to show top-down priority, so it is important that the Department of Health has published a document.

I do not want to be at all churlish but, although the document published on Monday sets out very well the sort of ambitions that we must have for a stroke service in the future, there were few surprises or novelties on top of what the National Audit Office produced 20 months previously. I am therefore slightly at a loss as to the purpose of having a consultation on a national stroke strategy now, given that the document makes it clear that the Government know what they think the stroke service should be like. As I understood it, the Government’s document was intended to turn the NAO recommendations of 20 months ago into an action plan. It was supposed to show how we should get from here to there, but in many respects the document that has been produced does not achieve that.

As some of my hon. Friends made clear earlier, the availability of CT scanning is absolutely fundamental. Does the national stroke strategy make clear how, for example, diagnostic contracts and the like will be used to ensure that CT scanning is available 24/7? The strategy presents the model of a hub-and-spoke system, as we always knew it would, but its parameters are still too wide. For instance, we need to be clear about the scale of population to be covered by such a system, and the length of time that people will stay in each hyper-acute stroke unit. We also need to be sure that such questions are followed up in individual locations.

A month ago, Manchester started work on producing its local service plan. The document that has been produced there says that patients admitted to a hyper-acute stroke unit should be scanned and given immediate treatment—including thrombolysis, if necessary—and also be given access to the earliest possible rehabilitation. However, what is interesting is that the document suggests that people need spend only 24 hours in such a unit. I have visited many places across the country, and talked to a lot of senior managers. They tend to imagine that creating better acute care for stroke sufferers will involve concentrating stroke units into larger units at specialised hospitals. In contrast, the people in Manchester have not adopted that approach. Instead, they seem to be saying that the hyper-acute phase needs to be concentrated, but that patients should be referred back to their local hospitals 24 or 48 hours later; each such hospital should have a specialist, multi-disciplinary stroke unit, where hospital treatment can be concluded and people discharged early.

That is different from the approach adopted by many in the NHS around the country. Sir Ara Darzi’s report, “Healthcare for London: A Framework for Action”, does not appear fully to have taken on board the thinking in Manchester, as it continues to propose a limited number of specialist stroke units in a limited number of specialist hospitals. That does not have to be the structure at all.

My hon. Friend is making an extremely interesting point. In my area, Chippenham hospital has one of the best stroke rehabilitation units in the country, and it recently won the Sentinel award for the best in England. However, it is not in the same PCT as Swindon’s Great Western hospital, which is where the acute unit is located. A number of patients have been stuck in the acute unit because Wiltshire PCT cannot afford to move them to the rehabilitation unit down the road. Is that example not especially worrying?

I am grateful to my hon. Friend, as he has illustrated very well the point that I hope I was making. His intervention leads me to the related point that a critic of the national stroke strategy would want to make sure that the incentives and levers available are being used to deliver the standard of stroke care that we want to achieve. For some time we have argued that unbundling the tariff—that is, dividing the acute phase from the subsequent rehabilitation phase—is important. The Department of Health has done that, but the structure proposed in Manchester would require dividing the tariff into three phases: the hyper-acute first 48 hours, the subsequent initiation of rehabilitation and support, and then rehabilitation in the community.

The tariff is anything but clear about how it will support and incentivise the process of commissioning. Unfortunately, if it does not reflect the best possible standard of care, it can substantially inhibit the introduction of such care. For example, a manager at Kingston hospital told me that his hospital wanted to be able to provide acute stroke care in the form advised, but that the tariff did not support that. We therefore need to concentrate on the tariff: although I hesitate to talk about something that can be a preoccupation for NHS anoraks, it is very important that we get it right.

The document “A new ambition for stroke” contains many elements that read extremely well and are clearly the right things to do, but one or two criticisms remain. For example, GP protocols for the referral of patients after a transient ischaemic attack were set out first in the national service framework for older people in 2001. They were supposed to be implemented across the country by April 2004, but now they are being repeated in a document published in July 2007. It is not good enough for policy makers to publish documents which reiterate the standards of service that we want to achieve but find that progress is inadequate and that the available levers to ensure that those standards are achieved are not being used.

Obviously, the Secretary of State cannot add very much to a document that he published on Monday, but his foreword says that it is the “first step” to a national strategy. It is not the first step—it is about the 13th, and we need the strategy to be turned, rapidly, into action. I have talked to ambulance service staff across the country, and they know that in a few months they will be delivering emergency patients in acute need to hospitals. That is already happening in some places, but it will be no good if the NHS fails to treat patients as emergencies from that point onwards. The evidence is absolutely clear that such patients must be treated in specialist units, and that subsequent support by multi-disciplinary rehab teams in the community is vital.

Too often, stroke patients tell us that they feel that going out into the community is like falling off the edge of a cliff. They leave a supported service in a hospital context and move to a place where the social services and the NHS services do not join up and the necessary teams do not exist. From the Healthcare Commission’s report, we know that six months after leaving hospital 50 per cent. of patients feel that they are not getting the standard of care they should, and that 12 months afterwards the number has risen to 80 per cent. Half the stroke patients who want to be involved in a local support group are not; 28 per cent. feel that they are not getting help when they need it to deal with mobility problems; 49 per cent. do not receive help with emotional problems when they need it; and 26 per cent. feel they are not given help with speech problems when they need it. It is tragic that large numbers of physiotherapists and speech and language therapists cannot find jobs in those services when they leave college, even though we know there is a specific need for them to provide such therapy for stroke patients. Their participation is needed in community multi-disciplinary teams.

At the risk of borrowing a phrase, the purpose of the debate is to say that a lot has been done, but there is a lot more to do.

Thanks for that.