I sought this debate with deep concern and in the knowledge that the United Kingdom will face an energy crisis unless action is taken soon. Energy is the lifeblood of the nation; it affects our business community, enterprise, domestic heating and, indeed, life itself. The old and the infirm, hospitals, rail travel, schools and everything that moves—the entire economy—can do nothing without energy. It is also a weapon of foreign policy, or can be used as such. The bottom line is that we need a continuous supply of this vital commodity and to maintain relative energy independence from other nations.

The UK desperately needs an energy policy. Despite the length of this summer’s energy White Paper—it runs to 342 pages—it dealt much more with what we need to do than with how to do it. It was largely mute on how investment from UK companies is to be stimulated and encouraged in order to build new power stations and energy infrastructure. It has been 10 years since I secured an Adjournment debate on the future of British coal reserves in the coal industry—this is not a new subject for me—and 15 years since I voted, with only three others, against my own Conservative Government’s pit closure programme and the then much-heralded dash for gas. I firmly believe that many of the economic issues that this nation faces will be guided and determined by our ability and capacity to provide households and businesses with the lowest priced energy possible. I do not resile from my decision to vote against my own Government.

Our over-dependence on expensive gas for the generation of electricity is placing more households in fuel poverty, which is when more than 10 per cent. of household income is spent on energy bills. That over-dependence on gas is also jeopardising the UK’s safety and security of energy supply, because more and more gas is being imported from Russia, the middle east and north Africa. We have seen already the effects of the new politics of energy. When Russia shut off the gas supply to Ukraine early last year, it caused a massive spike in gas prices by interrupting one of the main supplies into Europe. That over-dependence on gas should make us aware of the precarious situation that we need to avert quickly by taking the correct energy decisions now.

I am concerned also about the fact that the EU reform treaty, which the House will debate soon, contains a new energy chapter and essentially the same provisions as those in the original constitutional treaty. It also adds a new element to the policy—the interconnection of energy networks. As was the case under the original constitutional treaty, energy measures cannot affect a member state’s right to determine conditions for the exploitation of energy resources, its choice of energy resources or the structure of its energy supply. However, environmental measures—I am told that we will discuss the planning statement this afternoon—can affect such matters. Although such matters are governed by unanimity, the doctrine of the “occupied field” could severely inhibit the manner in which we can legislate. If the new energy chapter goes in, albeit unanimously, we would remain in a very difficult position should we seek to legislate on our own terms—something that I insist upon, because Parliament has to have sovereignty over its energy policy and legislation.

I thank the hon. Gentleman for his commitment to the coal industry. He mentioned our over-dependence on gas. As he will be aware, we are likely to experience an energy crisis between 2012 and 2015 because of the simultaneous closure of coal and nuclear stations. Some 40 per cent. of our electricity is provided by gas, and during that crisis, and before we bring on new nuclear stations, the Government are likely to accept section 36 applications for many more stations. By the end of 2015, therefore, we might well be even more dependent on gas. Does the hon. Gentleman therefore agree that the Government ought to take the line that a sufficient number of gas stations are now providing electricity and that no more gas stations should be brought on?

I agree with the hon. Gentleman, and that point will become clearer in the light of what I have to say. I pay tribute to his work as the chairman of the all-party group on coalfield communities, of which I have the honour of being vice-chairman. I believe strongly that his work and focus on such questions is of inestimable importance to the national interest.

It is clear now that the irresponsible claim, made in October 1992 as part of the justification for the coal closure announcement, that the country’s gas reserves were sufficient for around 55 years was wrong and misleading. That announcement was led by the then Minister with responsibility for such matters, the now Lord Heseltine. I vigorously opposed him and the then Government, who have a great deal to answer for on this matter. Among other things, they binned the former Energy Select Committee, which should be recalled in order to focus specifically on the questions being discussed today. I accept that energy has been enveloped by another Select Committee; however, we need a special focus on it.

British gas reserves are in decline and we now face increasing gas prices, coupled with increasing oil prices, which is having an upward impact on the price of electricity. We are at risk of putting all our energy eggs in the gas basket.

I am learning a lot from my hon. Friend. In the last year or so, gas prices have fallen because new import infrastructures have come on stream. I have spoken to people in the energy industry, and their outlook for the next three to five years is that there will be relatively low gas prices.

That is because of imports, but we must have regard to the impact of over-dependence on supplies from elsewhere. Part of the problem is the great insecurity and uncertainty over Russia, along with German control of the pipeline system, which was evidenced by the fact that Mr. Schröder’s first act after leaving the chancellorship of Germany was to take up the chairmanship of one of the most important divisions of Gazprom. If that does not tell us something, I do not know what does. We must also consider the insecurity and instability in the middle east. I recognise that my hon. Friend has a constituency interest in this matter and that we should welcome imports. However, that does not mitigate the fact that we are facing increasing gas prices over the medium and long term as well as a lack of supply security.

We must incentivise new clean coal and nuclear build. Only last month it was announced that one quarter of the country’s nuclear power stations are to be shut down because of safety issues. News of the shutdowns led to fears of possible power shortages and made electricity prices on the spot market spike by 17 per cent. As recently as 14 November, the national grid issued a flash warning that there might not be sufficient spare generating capacity to meet any unexpected surge in electricity demand the following day.

The days when Britain could rely on plentiful gas from the North sea are gone. Indeed, in recent years, Britain has fallen back on relying on coal generation of electricity to see it through. I represent a constituency in north Staffordshire, which was one of the jewels in the coal mining crown. Florence, Silverdale and Trentham collieries were big hitters, often beating their annual production targets. As I have already said, I vigorously opposed the closures of Silverdale and Trentham collieries, both of which had substantial reserves. I might add that I also challenged Arthur Scargill when he was doing an enormous amount of damage to our local industry in Staffordshire. I went on a platform, took the microphone away from him and told him to lay off my miners. In other words, I do not just choose my targets—I try to get the balance right across the board.

I was aware then, as I am now, that those pits represented a part of Britain’s future energy security. At the moment, we also have a very interesting situation developing in Kent. All I can say is that I sincerely hope that the planning paper being presented today will give us a real opportunity to make certain that the development of clean coal technology is given a fair opportunity and is not in any way diminished by the planning proposals that we shall hear about later today.

I would like to set out how I believe that coal can and should enjoy a renaissance in the energy sector. I am speaking not out of nostalgia, but in the light of the new technologies that allow us to reduce the fuel’s carbon emissions radically. The fact is that coal generates the cheapest electricity on the grid and allows us to use an indigenous energy asset that Britain enjoys in abundance. Furthermore, if the coal supply is properly calibrated, it would guarantee that in any international crisis, we would not be over-dependent on other countries if that crisis worsened. That idea is absolutely fundamental to my argument; we must not be over-reliant on other countries.

Can my hon. Friend give a sense of what he means by over-dependence? Is he arguing that we should make it the goal of British energy policy to be self-sufficient and energy-independent? I would argue that that is unrealistic. Alternatively, is he saying that we should achieve a better energy balance? If his argument is about achieving a better balance, what proportion of energy imports would constitute over-dependence?

It is almost impossible to arrive at a calculated formula that would give an answer to the latter question. However, I do favour the idea of a proper balance of policies; I am not suggesting that we should just have one policy. As I said earlier, energy is the lifeblood of the nation and we must have a safeguard, so that if we were put in a perilous situation, we would know that we were not in a hazardous position and that we would be able to maintain energy supplies across all the domestic fields that I listed earlier. Therefore, I am arguing for balance—I am not saying that our energy policy should be based exclusively on coal. However, if there were perilous circumstances, we need to know that we could rely on a proper and proportionate amount of coal to guarantee that we were not put in an unduly hazardous situation.

Coal still plays a very important part in electricity generation in Britain. In an average year, it produces more than 35 per cent. of the UK’s base load electricity. As I have already indicated, in recent winters, which have been quite mild, that figure has risen to as much as 50 per cent. Coal has many advantages. It is plentiful, indigenous and can be stockpiled; it is comparatively cheap, flexible and responsive to peaks and troughs in demand; and, unlike gas imports, it is not vulnerable to geopolitical risk. Only nuclear power can match those advantages. However, current coal-fired power stations were considered environmentally unacceptable because of their substantial carbon emissions—until new clean coal technologies emerged. The Government cannot avoid providing development and support for those new technologies if they genuinely wish to create a balanced energy portfolio.

The UK has the opportunity to be at the forefront in developing such technology. I welcome the Anglo-Chinese clean coal agreement, which was announced last week. I also welcome bringing in other kinds of imported opportunities for supply, which can lead to a better energy policy. At the same time, however, if the United Kingdom is to avoid an energy crisis, we must place clean coal at the heart of our future energy policy and stimulate investment in the development of our substantial reserves.

I have a particular interest in the carbon capture and sequestration project that the Government announced recently, because Longannet power station, the second largest coal-fired power station in Europe, is in my constituency. There are, however, a couple of concerns about the project: first, only one successful project has been proposed as part of the competition; and secondly, the Government have not been clear enough about what is required from the competition. Does the hon. Gentleman have any comments to make about that?

Yes, I do, and I have no doubt that the Minister will reply to and deal with that issue. The point is that we have reached a watershed, and the need to accelerate and incentivise clean coal technology is a matter of extreme national importance. It is no good saying, “We have got a balance because we are taking some interest in this”; it is a question of proportionality. There has to be clean coal, and there must be a proper system that takes account of the problem that the hon. Gentleman just mentioned. Having said that, however, I think we need more, not less, emphasis on this issue.

Could it not already be too late in the day to bring forward clean coal technology? The point has already been made powerfully that the crunch will come in the next 10 years, with the retiring of old coal-fired and nuclear power stations. In the absence of commercially viable clean coal technology that can help to bring on a new generation of coal-fired power stations, the industry will in the meantime introduce low-cost, low-risk solutions, meaning yet more gas-fired power stations.

I recognise where my hon. Friend is coming from, but I repeat what I have said already: we must have a proper balance. The emphasis on clean coal technology is disproportionately diminished, and I want this debate to generate some interest in that issue.

Estimates of coal are not made annually in the same way that they are for UK gas and oil reserves, but it is important that the House be made aware of some recent industry estimates. In 2006, the Coal Authority estimated that there were more than 600 million tonnes of coal in established and accessible UK reserves. Importantly, in British Coal’s 1992 annual report, it estimated that 190 billion tonnes of coal lay underneath the UK, of which 45 billion tonnes could be extracted using the then known techniques. Of course, a lot of progress has been made since. British Coal estimated that the pits then open—before the 1992 closures—had 1.1 billion tonnes in classified reserves that could be economically extracted.

To put those estimates in context, total UK coal output between 1853 and 2006 was only 22.7 billion tonnes. That gives us some sense of what is left now—even after the whole industrial revolution and two world wars. Some 22.7 billion tonnes has been used since 1853, and the estimate is that 190 billion tonnes of coal lies underneath the UK now. To make coal-fired power stations more efficient and less polluting, clean coal technology uses equipment such as super-critical boilers that can be retrofitted to Britain’s ongoing coal-fired stations.

However, the most exciting prospect is the so-called carbon capture and storage process, which the hon. Member for Dunfermline and West Fife (Willie Rennie) mentioned. That involves capturing carbon dioxide before it is released into the atmosphere, turning it into a liquid and storing it in old oil or gas fields under the sea. One positive by-product of injecting pressurised gas into such depleted fields could be the further extraction of oil reserves—a process known as enhanced oil recovery. The Treasury would be the obvious winner in such a process.

The main types of carbon capture technology are defined by whether the carbon is removed before or after the coal is burned—pre-combustion and post-combustion. There are pros and cons to both techniques. Post-combustion uses more energy than pre-combustion and the equipment is more considerable, requiring more land to be available at each power station, but pre-combustion is suitable only for new coal-fired power stations.

I was disappointed to note that, as I understand it, the Government have decided to back only post-combustion clean coal technology; no doubt the Minister can confirm that. It is important that incentives and overt Government support also be given to pre-combustion, which will allow us effectively to turn coal into gas and remove 90 per cent. of CO₂ emissions for sequestration. Such clean coal stations, known as integrated gasification combined cycles, represent a near zero-emission coal solution for the UK, which is quite a prize. I firmly believe that there should be more encouragement from the Government for such projects, and I await the Minister’s comments on pre-combustion technologies.

While modernising existing stations is to be welcomed, we should also support brand new designs and therefore new build, which would allow us to use our coal well into the future. New power stations that gasify coal represent the only process that changes one form of energy—coal—into another, more flexible energy: hydrogen gas. As the Minister will know, hydrogen is becoming increasingly important in new technologies such as those possible in air travel and the motor car. Those technologies are important and we need to develop them. The benefits are clear. In addition to providing a clean, reliable and local source of power, the gas does not have to be fired to generate electricity, but can be injected into the gas network and thereby improve our gas supply position—I pay tribute to my hon. Friend the Member for Preseli Pembrokeshire Mr, Crabb) for his interest in gas—and our negotiating position with gas importers. The Minister and his Department must do more to encourage that process and those working to bring it about in the UK. Coal-rich countries such as the United States and Australia are streets ahead in their support for the technology.

Electricity generated from coal offers a number of strategic advantages for Britain. It ensures that sustainable and competitively priced electricity is available to UK customers; it offsets security risks and the costs of importing increasingly expensive gas from the middle east and Russia; and it has proven over many years its ability to meet rises in electricity demand, compared with the less predictable output from renewables. The Government have produced a statement on that in the past week or so. With new clean coal technology installed at new and existing powers stations, it can also help to foster a high-growth, low-carbon economy.

The UK has an installed electricity generating capacity of 77 GW. However, much of it will come off stream in the next decade as older nuclear and coal stations are decommissioned. Unless capacity problems are addressed rapidly, the UK could face an estimated 33 GW electricity generation capacity shortage by 2016. That, in short, represents the energy crisis that I mentioned earlier. EDF Energy argues that that generation gap will be a direct result of paying off older coal and nuclear stations without swiftly replacing them with clean coal and new nuclear stations. As a consequence of such a development, we could become perilously over-dependent on gas.

If, as I strongly believe, clean coal and nuclear power are needed in the balance to fill the fast-approaching energy gap, and consequently reduce emissions while maintaining competitively priced electricity, streamlined planning procedures for such major infrastructure projects are essential. I await the planning reform statement this afternoon and the Planning Bill with much interest and anticipation.

Due to the running down of the domestic coal industry, there are only a handful of deep mines left, producing about 10 million tonnes of coal a year. Coupled with open-cast output, that takes the total output of British-mined coal to a mere 20 million tonnes a year. The market for coal in the United Kingdom, largely for the power stations, is about 60 million tonnes. The huge difference of about 40 million tonnes is taken up by unnecessary and expensive coal imports from countries such as Russia, Poland, Colombia and Australia. For the reasons that I am giving, a disproportionate amount of coal is imported.

As shipping costs soar, there is a consequent impact on the price of coal imports and the electricity that they generate. Imported coal is more expensive than British-mined coal. British coal is also free of the volatility associated with international coal prices and exchange rates. Imported coal puts more pressure on docks and transport infrastructure and contributes substantially to the UK’s balance of payments deficit. Also, the carbon footprint of importing coal is significantly more than that of producing coal locally and transporting it the short distance to local power stations. Port-to-power-station coal flows are significantly longer than the pit-to-power-station merry-go-round rail operations that still operate, but on a much smaller scale than in the past. That places extra pressure on our rail infrastructure. Imported coal is discharged at Immingham, Avonmouth, Clydeport, Medway, Liverpool, Hull and many other ports miles from the power stations that it must reach.

There are some encouraging developments on the mining scene. A healthy coal price has made some new prospects viable. The Hatfield colliery near Doncaster has reopened and plans to become a 2 million tonnes a year pit. Importantly, its owner, Powerfuel, intends to build an IGCC power station alongside the mine. However and as I have said, the Government have decided against supporting pre-combustion clean coal technology. In Wales, the Unity drift mine in the vale of Neath and the Aberpergwm mine have recently started production. They are the first deep mines to be opened there in 30 years and will supply the Aberthaw power station, which is to be retrofitted with clean coal technology. In recent years, Aberthaw has depended heavily on coal imports through Swansea. New mines are also planned in Scotland.

My hon. Friend is being generous in giving way. He should be aware that the Aberthaw project on the retrofitting of clean coal technology is not even a demonstrative project; it is being called a pilot project. It is a small, 1 MW facility to test the infrastructure to see whether it could ever be developed into a commercially viable and usable bit of kit. That returns me to my earlier point that we as a nation should have been moving towards clean coal technology a lot faster. I fear that, even if the Aberthaw project eventually proves viable, it will come too late in the day, by which time more and more gas power stations will have been built to plug the energy gap in the next 10 years that my hon. Friend has so eloquently identified.

I am grateful to my hon. Friend, and that is an extremely good point. We are in a catch-up position, but there is an opportunity to do that. I have optimism and hope that the Government will take these points on board.

Mining experts estimate that it would cost hundreds of millions of pounds to sink a new shaft and commence mining operations at a new site, but the Government must seek to support those who are considering new and expanded mining operations. Given the new clean coal technologies that I have highlighted and the energy capacity crunch that the UK will soon face, I believe firmly that we must maximise our indigenous reserves of coal. On that point, will the Minister address the guidance in minerals policy 3, which is a major hindrance to open-cast miners who wish to exploit the substantial coal reserves that lie close to the surface?

Does the hon. Gentleman accept that a combination of open-cast and deep mining is extremely important for the future? We could have the situation that we have had in Scotland for a number of years. Open-cast can lead to drift mines; that, in turn, means that investment in open-cast can be combined with investment in drift mines, which can take us underground.

I do accept that. Part of the usefulness of this debate is to demonstrate the need for balance in all directions, even within the coal industry. I was about to say that huge coal deposits can be extracted from open-cast mines, but MP3 is the problem. Will the Minister tell me whether mining operations in general will be covered in the Planning Bill? Why is he not prepared to issue a statement of need of at least 20 million tonnes of domestic coal output, as called for by the Government’s own coal forum?

The renewables obligation is the Government’s principal policy instrument to encourage the development of the renewable electricity sector. It is an indirect subsidy system drawing funds from consumer bills and passing them to renewable electricity generators. That currently amounts to £1 billion a year and will have totalled £32 billion by the end of the scheme. In light of the fact that renewable energies such as wind are intermittent and do not provide base load energy, would some of the substantial moneys that go to wind power, which is the major beneficiary, not be better spent on projects such as clean coal? This is a major issue in my constituency, as there are projects for wind turbines near Maer hills and Norton in Hales, which we shall vigorously oppose.

Will the hon. Gentleman give way?

In a moment. The clear benefits of clean coal would be increased reliability of supply and cheaper electricity prices for the consumer. Before I give way to the hon. Gentleman, I should point out that it is well established that the idea of wind farm projects in the midlands area is very counter-productive.

The hon. Gentleman has joined a number of Conservative Back Benchers and councils in opposing wind power, but it has to be a vital part of our future energy mix. On what basis does he oppose wind farms?

Frankly, they just do not work and are over-subsidised. I have not come here to talk exclusively about wind and wind farms, but I can tell the hon. Gentleman that there is a great deal of opposition in my constituency to the non-productive use of such technologies, which are completely useless according to the evidence that we have received. I am talking specifically about the midlands; it is not for me to go into the broader picture in this debate, but I treat the whole issue of wind farms with a great deal of scepticism and I think that they are extremely damaging environmentally.

Clean coal should enjoy financial incentives equal to those enjoyed by the renewable energy sector, and nor should the subsidies that have gone to nuclear power be forgotten. Will the Minister address this specific point in his response?

I should like to give a brief but important example of how over-zealous support for renewables, particularly wind power, has led to increased carbon emissions. Denmark has the most intense concentration of wind generation in Europe. At peak output, its wind farms can account for nearly 64 per cent. of Danish peak power, but that rarely occurs. Last year, Danish carbon emissions rose as the Danish grid fell back on older, coal-fired power stations to plug the energy gap left by underperforming wind farms. Its power stations used 50 per cent. more coal than in 2005 to cover the failings of wind power, and its wind turbines generated a mere 22 per cent. of electricity, down from 29 per cent. in 2005. The increased demand for coal and the fact that it was burned in old, unmodified stations meant that Danish carbon emissions rose by 36 per cent. in 2006. My point is obvious, and I suspect that Danish investment in clean coal is imminent.

Investing in clean coal technology could allow us to enjoy consistent and competitively priced base load supply, with huge reductions in carbon emissions. Overzealous and irresponsible support for renewables, no matter how well-meaning, can and will lead to what is increasingly called “the Danish problem”. There are considerable financial incentives and support for renewable energy sources, but no such moneys exist to assist and promote ongoing indigenous mining projects, which are crucial if we are to retain and develop our coal reserves and have a clean coal generating sector that does not depend only on coal imports.

The recent surge in coal prices has whetted the appetite of indigenous coal producers who wish further to develop reserves. Loan guarantees would rightly provide an alternative to direct subsidy and could reflect the Government’s strategic support in the national interest. The money could be used to access new reserves and to help develop existing reserves. Developing new coal faces underground can take years, and considerable finance is required. A facility for Government loans or loan agreements would resolve that issue and secure access to coal reserves that require large-scale, ongoing investment. Harworth colliery, in Nottinghamshire, has been mothballed because money cannot be found to access the 50 million tonnes of coal that could be mined there and sold to power stations literally on its doorstep in the Trent valley. Will the Minister address the issue of loan agreements as one concept for the financing of mining operations in the national energy interest?

The nature of a loan is that the money is returned to the lender—in this case, when the coal mined as a result of the loan has been sold to the generators. Coal is the world’s most abundant fossil fuel. According to the International Energy Agency, in the light of new clean coal technology the use of coal is set to grow, especially in the developing economies of China and India and in countries such as the United States and Australia. It is therefore imperative that we use this national asset, as so many other countries are doing. In doing so, we can demonstrate how it can be used in a balanced and environmentally responsible way by supporting the concept of clean coal technology with action, not just words.

It is imperative that the Government provide a lead on energy policy. The Minister might disagree, but many in the energy sector and in this House are not aware that a policy with set targets or ambitions to address these critical questions exists. I look forward to his responses to my points.

rose—

Order. The winding-up speeches will start at 10.30 am. I have no power to impose a time limit on speeches, but I would like to call everyone to speak, so I appeal to hon. Members to share the time out.

I congratulate the hon. Member for Stone (Mr. Cash) on securing the debate. He has proven once again that he speaks well on not only Europe; he has given good speeches on energy—on coal today—and on water in Africa in previous debates.

The UK has billions of tonnes of coal, which we might need to use one day. It would be foolish to write off that coal completely and have the dash for gas that has been described. As my hon. Friend the Member for Barnsley, West and Penistone (Mr. Clapham) said in an intervention, we might end up with a span of three years in which we have to go to gas and might therefore build new gas power stations that will not meet our need to reduce carbon dioxide emissions.

I firmly believe that we should all try to reduce our use of oil and gas. They are finite resources, and if we are serious about securing a clean, sustainable supply of energy for future generations, we must act now. I am particularly disappointed by the Government announcement that we will be into the new year before we hear what will happen with the energy Bill and the Government’s policy on it. It was supposed to be dealt with before Christmas, but it seems to be being put back and back. That time could be used to deal with this country’s needs. If we keep putting these matters back, we will certainly end up with a dash for gas.

Does the hon. Gentleman share my disappointment that the Peterhead project has been put back? Does he agree that it offers a tremendous opportunity and that the Government should stop dithering on it, so that it is delivered?

Yes, I am disappointed, but I am also disappointed by many things that are happening in Scotland on energy. Perhaps the hon. Gentleman could influence some of his colleagues north of the border to open their eyes and consider the wider possibilities of energy there and the needs of not only the Scottish people, but people in the UK and, possibly, beyond in places where we could sell that energy.

On having a wider influence in the energy market, does the hon. Gentleman welcome the Scottish Government’s initiative for a super grid in the North sea? That would help to link Norway and Scotland and do exactly what he is promoting—get energy that we produce into the wider market.

I accept what the hon. Gentleman says, but the caveat is that he assumes that the grid will give Scotland access to Norway. If we keep to our present energy policy, Scotland will be taking energy from Norway. That is why we quickly have to make a decision now and go forward.

There are huge opportunities for coal on the international market if we develop clean coal technology and carbon sequestration. It is estimated that the use of coal will rise by 32 per cent. by 2015 and by 59 per cent. by 2030. The International Energy Agency forecasts that coal will retain a quarter share of the world’s energy mix.

When we talk about coal, it is important to consider China. Coal is still the great fuel in China, where it is used in everything from power stations to the samovars for heating water on trains. The answer to China’s fuel needs is to go back to the past. China’s future fuel will still be coal.

Coal has a bad reputation: dirty, dangerous and highly polluting. The prospect of a coal-powered future may fill many with dread. China is already by far the world’s biggest producer and consumer of coal. Its 30,000-odd mines churned out more than 2 billion tonnes of the stuff last year. That is more than a third of all the coal produced in the world. The mines also cost the lives of 6,000 Chinese miners. Coal is the main reason why China is now second only to the US in the output of greenhouse gases and is soon to overtake the US.

Coal’s dirty reputation may be about to change, however. China has given the go-ahead for the construction of several huge new projects to turn dirty coal into clean gas. A company not far from my constituency, Babcock, is one of the leading lights in the technology. I hope that we do not allow another country to get ahead of us by taking the technology in which we were once the experts and cashing in on it in the future. It is important that we as a country get behind coal gasification. We have understood for years that it is one way to make money for this country.

With oil prices now more than $90 a barrel, it has finally become profitable to use coal again, but we have to build multi-billion-dollar plants to be able to use it and to reduce carbon dioxide emissions to the levels that will be acceptable in the future.

I am sure that the hon. Gentleman would agree that it would not be a terribly good idea if we went for gasification and it led to a forest of derricks. In other words, there is a way to draw gas without environmental disruption.

The hon. Gentleman is right, but that technology is still a long way down the road. Unfortunately, our needs are now and not in the future. We should never throw the baby out with the bath water. We must consider everything and exclude nothing.

According to the experts, the new mega-plants will take dirty, sulphur-rich coal and turn it into clean, sulphur-free gases, such as methane, which will be ready to be liquefied and put into the tanks of China’s millions of cars or burned it its power stations.

On energy policy, it is no surprise that I, as the chairman of the all-party group on nuclear energy, support a fully balanced energy policy. I am concerned that we may miss opportunities by delaying decisions to allow the private sector to build nuclear power plants. We may end up depending on gas for the vast majority of our energy sources. If China is on the road to investing in clean coal technology, why are we not? The Chinese have announced £10 billion of investment in renewable energy; therefore, why can we not do so?

Reducing the use of oil and gas is a sensible option. Any further delay will only increase our dependence on foreign gas. The hon. Gentleman identified in great detail the problems in respect of not just energy, but national security.

I hope that the Minister will indicate how the Government view the situation. I believe that China can be an example, not a threat. We must consider why it is investing money in new coal technologies, and why it has entered into a $20 billion agreement with a French company, Areva, to build six new power stations, while we dither and wonder what to do with our energy policy. It is important that we get the matter sorted out quickly.

I congratulate the hon. Member for Stone (Mr. Cash) on securing this important debate. I am still trying to visualise him telling off Heseltine and Scargill at the same time. I remember that during that difficult period one or two lone voices in the Conservative ranks argued for the coal industry in the long term, and I congratulate him on that. He has a long history in respect of the coal industry.

Coal is a big issue. We should be considering what is in front of us and what we need to do to address the big problems that face this nation. I am the chairman of the all-party group on coalfield communities, having taken over from my hon. Friend the Member for Barnsley, West and Penistone (Mr. Clapham). The term that I think of every time that we talk about coal is “dirty coal”. “Clean coal” is often described as a contradiction in terms because coal is seen as dirty, inefficient and heavily polluting.

The environmental group Greenpeace has waged war against the possibility of any new coal-fired power station. Last week, it was already attacking the possibility of our going ahead, and it says that it will climb all over any such planning permission. It has done that before on many occasions and will, I imagine, continue to do so. It points out that the last new such power station was built in 1974, and that coal is the least environmentally friendly way of producing energy. Its website states:

“We don’t need more outdated, inefficient coal fired power plants. We need an energy system that can meet the demands of the 21st century”.

I agree with that, and that is what we are discussing in this debate.

I also agree that if the technology and efficiency of coal had been static since the last power station was built in 1974, we would not be having this debate. When we promote the coal industry, we are promoting not the technology used by previous or even existing plants, but the technology that we hope will be developed in the future. We are talking about the possibilities of new and dynamic technologies through which coal is crushed and washed to remove sulphur, through which it can be burnt in modern, efficient power stations and co-fired with biomass, and through which carbon is captured during production. Conventional coal production could release as much as 0.9 million tonnes of carbon dioxide each year in order to create 500 MW of electricity. That is nearly three times as much as gas—that point was made earlier—which is too much.

If that were the only way to burn coal, yes, coal would be a useless resource. However, with improved efficiency, CO₂ emissions can be reduced from 0.9 million tonnes to just 0.69 million tonnes. Through combined biomass, they can be reduced to 0.6 million tonnes. Through carbon capture and storage, emissions from coal-fired power stations can be reduced by around 90 per cent. to less than 0.1 million tonnes of CO₂, making coal cleaner than other traditional forms of energy production. We are promoting a modern, clean and efficient form of energy production.

There are three considerations when looking at our energy mix. Security of supply is one of the most important considerations for this country. The environmental impact is important, of course, as is the price that we have to pay to develop our strategy. All those issues are interlinked and must carry equal weight. So how does coal stack up against the three criteria? The UK has a large supply of cheap coal, and could be self-sufficient—and therefore secure—in it. We are certainly the envy of many of our European partners, of which only Germany and Poland produce more coal each year than the UK. That will change because Germany is moving toward zero coal production by 2010. That mistake is, I believe, based on the fact that it has agreements with Russia, about which I have great concerns.

One of my gravest concerns during debates and meetings about coal with Lord Heseltine was that at that time, Germany was receiving authorised Commission subsidies of £4 billion a year and we were receiving none, which created a complete imbalance in generation. When privatisation took place, the consequence was to reduce the critical mass to a point at which privatisation was scarcely able to get off the ground properly.

The hon. Gentleman makes a valid point and he covered the issue in detail in his speech. Indeed, I shall omit a substantial amount of my speech because I do not want to cover that ground again; I am also mindful that other Members want to speak.

Security of supply is important. According to the Government’s 2006 energy review, the UK has around 142 million tonnes of coal in identified surface and deep mines, and at present levels there will be 70 million tonnes left in 2020—a point clearly made by the hon. Member for Stone. The UK has 190 billion tonnes of coal, and we are the envy of most European countries. It is incumbent on us to deliver a strategy to develop clean coal technology.

The UK has a large supply of coal that could assist in providing a long-term solution. More importantly, it has a supply big enough to make public and commercial investment viable. So why did the UK become an importer of coal? Why is it still an importer of coal when coal has doubled in price since 2003? The reason is that the UK has one of the most liberalised energy markets in the world, and we take the price today without considering what we will do in future. It is disappointing that we continue to move the energy debate further away. The first and foremost issue for debate is security of supply, before we go into the details of one form of energy versus another. I do not want to go into those details, and I try to avoid the obvious disagreements that may develop regarding wind power, nuclear power and so on. There is room on the table for all processes, and we must remember to consider the next century going forward.

The UK was forced, in my opinion, to import coal, and the hon. Member for Stone referred to the carbon footprint that results from coal being transported to this country. The Government now have an opportunity. The increased price of gas and higher demand from the developing economies of India and China mean that we cannot rely on an everlasting supply of cheap, imported gas.

China, which is building two new coal-fired power stations a day, is probably the best example. It has 30,000 collieries—not 30,000 miners—but there is a price to pay, and what it is doing is completely wrong. There have been 6,000 deaths in the mining industry, which is an indication of how cheaply the Chinese value life. There are far better ways of extracting coal. One colliery has 10,000 miners, which is phenomenal.

By 2030, coal consumption will have increased by 230 per cent. from 2004 levels in China alone. That is the real world, and we must consider clean coal technology. We must not fail to develop it, and to buy into it when it has been developed elsewhere. Our problem is that China and India are the engine houses of the world, and America is beginning to expand its coal industry. They will determine the worldwide price of coal, so it is important for us to have self-determination.

The supply of oil and gas remains volatile, and Russia and Iran hold more than half the world’s gas supply. Oil is concentrated in a few countries, many of which are in the middle east. That leaves the UK vulnerable over the next decade and beyond. We must secure a supply of energy and start to realise that coal is a major part of our energy mix. The question is not, “Does Britain need coal?” The energy market is demanding the use of coal, so the questions is, “Would we be better off producing coal in Britain, rather than paying the market price for it?” Given that coal must be part of our long-term strategy, how can we make it more efficient and environmentally friendly?

In other words, the attraction of coal is supply and price, but environmentalism is an urgent issue. Everyone says that open-cast mining is terrible, but the same people are against windmills and other forward-looking technology. We must look at the bigger picture. If development is necessary, planning issues must be addressed and changes made. That also applies in Scotland, where the Scottish Parliament controls planning issues. If planning approaches in the UK can be relaxed to develop a strategy to secure energy supply, such development must also take place in Scotland.

I was delighted when the Prime Minister announced during his speech to the World Wildlife Fund on 19 November that the Government are launching a competition to build the world’s first commercial carbon capture storage coal project. It is hoped that that will demonstrate the possibility of CO₂ capture, transport and storage. I confess that I was surprised but delighted that he also said:

“We will also consider whether, if we can show that carbon capture and storage is technologically and commercially viable, it should be made mandatory in some form for all new British fossil fuel plants.”

It is becoming clear that coal is again important to the UK energy mix. The increasing price and instability of imported fuels is leading the energy market to turn to coal, and the Government are finally making progress in dealing with coal’s environmental impact. The next stage of the process must be to look at how our coal reserves can be used. The UK has just eight working mines, none of which is in Scotland. If the Government are committed to a new generation of coal stations, working with carbon capture and storage, they will send a clear signal that investment in mining is commercially viable.

I turn to geothermal heating, which has not been referred to. I want to plug the fact that Midlothian is building 5,000 new houses with geothermal water from the Monktonhall workings. With a small investment, we could develop a strategy for the first geothermal heating project in the UK. The Prime Minister said that he wanted five new settlements throughout the UK and to make them environmentally friendly. I suggest that he choose Midlothian as a Scottish example, with its geothermal heating, because that is a good example of history helping the future of coal extraction.

Our country is at a crossroads. When we have the energy debate in the House, Members will have to make probably the most important decision that we will ever have to make, apart from on war. It will affect the survival of our country as a world economic power. I support what the hon. Member for Stone said, and I hope that the debate takes place sooner rather than later.

It gives me pleasure to make a concise contribution to this debate, following the thoughtful contribution from my hon. Friend the Member for Midlothian (Mr. Hamilton). The hon. Member for Stone (Mr. Cash) spoke with typical passion. I am glad to see the Minister in his place, but I am disappointed that he is not supported by a Whip. It will give me no pleasure to write a stern letter to the Chief Whip asking for an explanation.

The hon. Member for Stone said that we still have a share of the market, with 20 million tonnes of indigenous coal. It is interesting to look at what happened over the past year. When the Selby complex closed, coal was about £21 a tonne. That has almost tripled, and on the spot market in Rotterdam it is £100 a tonne. That has had an impact on some of the eight mines that my hon. Friend the Member for Midlothian mentioned. The dominant producer is still UK Coal, and a year ago the question was whether the generators would renegotiate the contracts with UK Coal. Those contracts were set in stone when prices were much lower. It is good news that, partly through the influence of the coal forum, both E.ON and EDF Energy have signed much improved contracts with UK Coal in the past couple of months. Kellingley, the one remaining mine in my constituency, which employs 700 men—it is the second biggest mine in the country—is still waiting for its contract with Drax to be renegotiated. Even so, with the prospect of the Beeston seam coming on stream, UK Coal is recruiting extra staff. There is also the prospect that the mine at Hatfield, which is just down the road, will be reopened shortly, with 300 jobs becoming available.

With that, my time is up, but I want to say just two final things on the point that my hon. Friend the Member for Midlothian made about safety. Surely to goodness, one thing that we in this country can do is export our good safety record. We should be doing more to pass on our expertise not only to China, but to places such as Ukraine, where there was recently a terrible number of deaths. Surely to goodness, the coal forum, and even the Department for International Development, can look at the expertise of the Mines Rescue Service and the safety culture of British mines.

I congratulate the hon. Member for Stone (Mr. Cash) on securing a debate on such an important subject, and it is always a pleasure to follow the hon. Member for Selby (Mr. Grogan), even though he was unfairly constrained by the clock.

Clearly, this is an important issue. I do not agree with everything that the hon. Member for Stone said in his opening remarks, but I do agree about the need to ensure that the UK’s energy supply is safe and secure. However, my emphasis would be rather more on the environmental need for action, particularly in the light of the fourth assessment report by the intergovernmental panel on climate change, which, if anything, shows that the science is becoming more worrying and the need for action more urgent. Fossil fuels meet 90 per cent. of UK energy needs, so we must tackle the contribution that such fuels make to our carbon emissions.

It is tempting to find the solution to energy supply problems in certain fossil fuels, given that oil and gas supplies will be exhausted at some point, while there is an abundance of coal worldwide and a relative abundance of it even in the UK. However, coal is undoubtedly dirty, with 30 per cent. of this country’s CO₂ emissions and hundreds of millions of tonnes of carbon coming from electricity generation.

What should be our response? There are several priorities that we should put before the development of clean coal technologies—I shall return to them—but the first priority must be energy efficiency. There is huge potential for reducing the demand for energy at household level through things such as smart meters. In the housing sector, the Government are now finally going some way towards setting a target of zero carbon emissions for new-build houses. However, they have not so far addressed the urgent need to look at the existing housing stock, even though the majority of the houses that will exist in 2050 have already been built. More therefore needs to be done on that front.

The second strategy must be to promote this country’s renewable energy sector, which is fast expanding, but which is still far too small. It is shameful that we are so far down the European league table when we have such enormous potential. On the large scale, we have onshore wind, which the British Wind Energy Association reckons could supply 6,000 MW by 2010, with 3,500 turbines, or 50 per cent. more than was previously imagined was viable.

Contrary to what the hon. Member for Stone said, the Carbon Trust, whose work I trust, is clear that onshore wind is currently an economically viable technology and a perfectly reliable part of the energy mix, and we should expand it. Let me take this opportunity to congratulate the trust on its new partnership for renewables, under which it is seeking to release public sector land for renewable energy programmes. The project might well support an even greater increase in the use of onshore wind at no cost to local authorities, and that valuable initiative is exactly the kind of thing that we should promote.

May I point out to the hon. Gentleman that the Select Committee on Scottish Affairs took evidence from Scottish Power on this issue two years ago? The company was asked, “Would you be building wind turbines if there was no subsidy,” and it finally had to answer, “No, we would not be developing this strategy if there was no subsidy.” My point, of course, is that we must have subsidies before we can develop such a strategy.

Good point.

It is a good point. The Carbon Trust’s analysis shows that, although many renewable technologies need support initially, they can become viable over time, and onshore wind and geothermal energy are now virtually completely commercially viable.

Offshore wind has even greater potential. The British Wind Energy Association reckons that offshore wind may produce 10,000 MW by 2017, and that could be increased if we exploit the full potential of the ambitious plans to put a gigantic wind farm in the North sea.

We have geothermal energy, and the hon. Member for Midlothian (Mr. Hamilton) suggested Midlothian as place where it might be developed, but there are plenty of others, including relatively hot, dry potential sites in south-west England. There are already commercially viable ground source heat pumps from companies such as Geothermal International. Gloucestershire’s new police headquarters is heated using a commercial ground source heat pump, as is the Chelsea building society’s new call centre in my constituency.

We have solar photovoltaic technology, which has rather been the Cinderella of the renewable energy sector because it is relatively expensive, but it still has great potential in terms of carbon reduction. If the cost issues can be dealt with, solar photovoltaics will have great potential, and such output is increasing by huge percentages each year.

We also have tidal flow technology, wave power, tidal barrages and lagoons. Liverpool bay could contribute 1,500 MW, and the Severn estuary could contribute 4,500 MW. All these things could combine to provide at least 10 per cent. of the UK’s energy capacity.

Providing that we can get over the challenge of ensuring that biofuels are absolutely sustainable by introducing a proper certification system as soon as possible, biofuels and biomass will also certainly have a major role to play.

On the large scale, therefore, we have a burgeoning variety of renewable energy sources. The hon. Member for Stone mentioned what he called the Danish problem: if we rely on one renewable energy source that turns out to be intermittent, we may encourage less energy-efficient, more carbon-inefficient technologies. However, that can be dealt with by having a diversity of supply, and I have discussed the issue with National Grid, which is confident that we can do well if we develop a variety of renewable sources. Household microgeneration and heat generation, as well as combined heat and power and community-based renewable sources, can add to that diversity.

The challenge is to reduce carbon emissions, in the Government’s terms, by 60 per cent. by 2050, although the Liberal Democrats would go even further and aim for 100 per cent. clean-technology generation by 2050. Unfortunately, that will require some transitional technologies, and the question is which ones. Obviously, one option is nuclear, but that is unpopular. According to a Parliamentary Office of Science and Technology survey, three quarters of respondents expressed a preference for renewable over nuclear. I think that nuclear is immoral.

I have heard all this before. Why does it have to be a contest between renewables and nuclear for the Liberal party? Why can we not have a debate in which the needs of the nation come first?

The needs of the nation will last for thousands of years in various forms. One of the most immoral things about nuclear power is that it bequeaths a dangerous legacy to generations so far into the future that we have no idea how they will be able to respond. Nuclear is not a clean technology; nor is it particularly secure, because it depends on an imported fuel—uranium. The first of the new generation of nuclear power stations will also be too late to help with much of the energy gap, because they are unlikely, on the most optimistic scenario, to generate power before 2017.

The transitional technology that I favour is clean coal, with carbon capture and storage. The storage problems are equivalent to those of nuclear, but clean coal has many advantages over nuclear. Gas and coal-fired power stations are more flexible than nuclear power stations, which is an advantage in terms of the reliability and flexibility of supply. Nuclear waste is also far more dangerous than CO₂, which can be injected into oilfields and gas fields. Not only would our supply of energy be more secure, but we would probably have a competitive advantage, in that we have unique expertise in such technology from our experience in the North sea.

The Government have given out mixed signals. I agree with the criticism of the competition approach. It is very regrettable that the Peterhead project—which has been referred to, which could have been on line by 2010, extracting CO₂ from natural gas and pumping it into the Miller oilfield and on which BP has already spent £50 million—effectively had the rug pulled from under it by the Government’s competition initiative. There has been a lot of criticism from Centrica, BP and others about that.

The Government have, however, made positive initiatives too, and I join the hon. Member for Stone in welcoming the near-zero carbon initiative. It is a positive step, but it is a shame in a sense that it will be developed with China, when we could have developed something entirely home grown at Peterhead. Nevertheless, where the Government take their foot off the brake and keep it on the accelerator, they will have our support on carbon capture and storage. The long-term vision is one of avoiding fossil fuels and dangerous waste altogether and of all our energy needs one day being met from renewable sources.

I welcome you to the Chair, Mr. Amess, and congratulate you on your remarkable and impressive impression of a Government Whip. I suspect that they are busy looking for CDs somewhere.

I congratulate my hon. Friend the Member for Stone (Mr. Cash), not just on his speech, but on securing the debate, which is timely. He stressed not only the technical issues, but how energy supply and price and the choices before us affect every one of our constituents. He showed his long-standing interest and the consistency of his beliefs about the matter. I, like other hon. Members, would love to have had 24-hour live television news coverage of his battles with the noble Lord Heseltine and Mr. Scargill. I think that, somewhere along the line during the debate, that has become a single battle, but I suspect that it was a little more complex than that.

My hon. Friend rightly referred to over-reliance on gas, particularly imported gas. As several hon. Members have mentioned, dependency on a single supply, and especially a foreign single supply, is an important issue, and I trust that the Minister will refer to it. My hon. Friend also set out well why clean coal technologies should be given a fair opportunity to develop, and why he believes that both pre-combustion and post-combustion technologies should be encouraged. He highlighted several other issues, particularly the potential importance of today’s announcement about the Government’s planning Bill. I hope that the Minister will be able to explain how the Bill will ease the development of new low-carbon energy opportunities. My hon. Friend concluded with remarks about non-productive wind; it was rather appropriate that the Liberal Democrat spokesman should intervene at that moment.

The hon. Member for Glasgow, North-West (John Robertson) expressed concern about how Ministers have delayed—indeed, dithered—on several issues, particularly the CCS project at Peterhead. I shall discuss that too. He made a useful contribution, particularly on international comparisons and China, with respect to not just technology, but safety issues. He concluded by saying that Ministers need to lead, and he asked why, when other Governments are proactive, ours cannot be. I hope that the Minister will answer that question.

We had an excellent contribution from the hon. Member for Midlothian (Mr. Hamilton), who looked forward to a range of different technologies that could help to develop the low-carbon power that we all need. He spoke authoritatively about the potential of carbon capture and storage, and he made a bid for geothermal power in his constituency. Perhaps I may add, as a born and bred Cornishman, that I trust that opportunities in the duchy will not be overlooked.

Lastly, the hon. Member for Selby (Mr. Grogan) made a short but knowledgeable contribution, particularly on safety, on which perhaps we might have had more discussion. It was a shame that the clock did not permit a longer contribution.

Any sensible energy policy should, as other hon. Members have mentioned, avoid relying exclusively on a single technology or on one source of fuel. Such reliance would expose us to needless risk, not least as the soaring demand for energy outstrips the ability of the oil and gas industries to keep up. What is needed instead is that strategy and policy should balance two strategic objectives: reducing carbon emissions from electricity generation and its supplies and, as the hon. Member for Midlothian stressed, putting security of supply clearly at the heart of any decision on the balance between different fuel sources and technologies. Those twin objectives are the best way to create the environment in which business can plan and invest for the long term. At the heart of the approach is the recognition that no single fuel is the answer. We need different fuels and technologies if we are to make a long-term change.

In May, the Government finally published their latest energy White Paper, setting out the direction in which policy would be developed. It included a range of issues: a possible framework for future nuclear power stations; changes to the renewables obligation; and a new cap-and-trade scheme for large businesses—important, particularly in the context of this debate. It also rather hesitantly set out ideas on such matters as energy efficiency, decentralised energy and smart metering.

Yet in the past two years—some would say in the past 10—there seems to have been little action. There have been plenty of reviews and consultations, and dozens of studies. We have had interdepartmental meetings, briefings and assertions by the previous and present Prime Ministers that we must change and aspire to improve, but we have had little action.

Sadly, time is not on our side. This country faces a looming energy gap, which has been predicted not for a couple of years, but for much of the past decade. Roughly a third of existing generating capacity will shut in the next 20 years. All our nuclear power stations, except Sizewell B, are scheduled for closure, and many older coal-fired power stations may be forced to close under EU regulation.

Will the hon. Gentleman give way?

Briefly—or rather, I will not, because time is against me; I have only three minutes left. We want to make sure that the Minister has his chance.

Meanwhile, as all that closure takes place, our once healthy position as a net exporter of both oil and gas has changed. Three years ago, we became a net importer of gas and last year a net importer of oil—I think that that is the first time in my lifetime that that has happened.

What about coal? We have heard wide variation today—and previously—about the potential reserve of coal in this country. It is measured in capacity and in time. Some say that we have a 200-year potential reserve, and others say it is up to 600 years. However, that will of course depend on two things: the geological and engineering assessments of how much coal can be mined practically and economically, and the rate of production. In the past two years alone, there has been wide variation in production. In 2005, 20 million tonnes were mined; in 2006, 18 million tonnes were mined. In the first six months of this year, the figure was just 8.2 million tonnes, so there is a steady decline, as hon. Members will realise.

The decline in domestic production has ironically occurred at a time of rising imports. Last year, for example, they rose 33 per cent. on the previous year, to 42.7 million tonnes. A large proportion of that—nearly half—comes from one country: Russia. People have different views about the issue, but everyone will recognise that to be so dependent on one source creates enormous danger for the long-term security of this country’s energy.

In this context, the role of carbon capture and storage technology is vital. Here we come to the nub of the debate, on which I hope the Minister will make a full contribution. We have heard about the issues affecting CCS technology. Evidence suggests that that form of technology costs somewhere between $40 and $60 per tonne of CO₂ . However, many references have been made to the expectation that that figure will reduce as the technologies develop. It would be useful if the Minister clarified the Government’s view of that. It is clear that whatever the figures are, the Government need to become far more proactive; that is not only my view, but that of other hon. Members in the Chamber.

For the past three years, Ministers have talked about the potential of CCS, yet for much of that time, little has happened. Indeed, it has taken Ministers so long to get their pilot scheme up and running that the one CCS scheme that was under way—at Peterhead—has been shut down. As I understand it, the Government are now pursuing post-combustion rather than pre-combustion technology for the CCS pilot. Will the Minister tell us the reasoning behind that, and will he tell us what representations the industry has made to him on the matter? Does he agree that the result of the delay could be that the nascent technology will move and be followed up abroad and become successful there?

This has been a timely and worthwhile debate. Not only have we talked about coal and coal technology—important though those things are—but we have put them in the context of the wider energy question. All hon. Members accept that there is a large and growing gap in our generation capacity, and that it is crucial for low-carbon generation to come on stream. Any Government strategy must address the gap, and it must do so by reducing carbon emissions while not exposing us to undue insecurity of supply. For much of the past two years, Ministers have produced paper but not a lot else. I hope that the Minister will today answer the questions asked by my hon. Friend the Member for Stone, and explain finally how the Government intend not to talk, but to act.

May I first of all apologise for my informal approach to the formalities at the beginning of the debate? If it means that I am never appointed a Government Whip, it will have achieved a purpose of sorts.

I congratulate the hon. Member for Stone (Mr. Cash) on securing the debate and, more importantly, on the interesting and thoughtful way in which he introduced the subject. In a way, there have been two debates: one about coal and clean technologies and another about wider energy policy. It is difficult to strike the balance, but I shall seek to reflect on both debates even if most of my remarks focus on coal and clean coal technology. I also acknowledge the important contributions made by other colleagues, not least those of my hon. Friends the Members for Glasgow, North-West (John Robertson), for Midlothian (Mr. Hamilton), and for Selby (Mr. Grogan) who played an important cameo role.

The significance of the issue is evidenced by the fact that we have three interrelated Bills to consider during this Session. The energy Bill itself will be introduced early next year—my hon. Friend the Member for Glasgow, North-West perhaps needs to be a little more patient to hear good news on that measure. The Climate Change Bill will put into statute the Government’s ambitions for emissions reductions, and the Planning Bill, to which the hon. Member for Stone referred. Essentially, that measure will be designed to streamline our planning system so that we do not have huge delays in putting in place infrastructure, including energy infrastructure, that is vital to the nation.

We must tackle two great challenges of the 21st century: first, climate change, on which the Prime Minister made an important speech only last week and, secondly, energy security. We are becoming more familiar with the science and the challenge of global warming, but we need to become more familiar with the related issue of energy security. I take absolutely the point made by the hon. Member for Stone on that. There is a huge global demand for energy, but the geopolitics of energy security become more difficult. We will need to import a great deal of our energy, but we therefore need to strike the best possible balance between the need to import and our need to develop home-grown energy resources. It is a pity that we do not have more time in which to pursue those issues.

The good news, however, is that the two challenges have a shared solution, which is for us to move as quickly as is reasonably possibly towards a successful low-carbon economy. The Government are committed to that, and I have mentioned the Climate Change Bill. We must become better on energy efficiency because, after all, the cheapest and cleanest form of energy is that which we do not use, and which we therefore do not need to generate or import. We need a robust carbon price—I noticed that the hon. Member for Stone did not dwell too long on the European emissions trading scheme—and that is significant. Pollution must carry a cost if we are to incentivise the economy to become low-carbon.

Does the Minister agree that a concrete step to create a more viable carbon price would be the introduction of feed-in tariffs for renewable energy?

That is one methodology and one mechanism. The Government have chosen a different if not entirely dissimilar route—namely, the renewables obligation. We are now reforming that because of its importance. It is significant that the Prime Minister committed the country to the EU’s target of having 20 per cent. of energy come from renewables by 2020 and we are negotiating Britain’s percentage of the reduction.

We have been accused of taking no action, but I will not apologise for the fact that the Government have been thoughtful about the matter and that we have looked at the evidence and, hence, unlike some parties, we are not all over the place on some of the critical issues facing the nation. We have had the energy review, a White Paper, and there will soon be an energy Bill. We gave the go-ahead only recently for the world’s largest off-shore wind farm, the London Array, and last week the go-ahead for the world’s largest biomass power station in Port Talbot. Both those things are significant and go alongside our feasibility study, the details of which we will announce soon, on the Severn barrage. I was also asked to comment on Cornwall. The wave hub project in Cornwall is significant—wave, marine and tidal energy is absolutely vital.

The International Energy Agency world energy outlook predicts that world coal use will rise by 73 per cent. by 2030; much of the growth will be in China. The UK’s remaining coal resources are a valuable national asset that we need to put to the best possible use, provided that the economic and environmental costs are acceptable. I note the honourable opposition of the hon. Member for Stone to the last Conservative Government’s savage and foolhardy assault on Britain’s coal mining industry, and the silence of the hon. Member for Hertford and Stortford (Mr. Prisk), the Opposition spokesman, on the issue. Our coal authority estimated that reserves at existing and potential sites amount to more than 2 billion tonnes. The Government have until recently supported the coal industry financially—there has been more than £200 million in state aid since 2000—but total UK output has continued to fall. Production in 2006 was 20 million tonnes, down 10 per cent. on 2005.

The principal customer for that coal is the electricity generating industry. Coal-fired generation supplies around a third of UK electricity and can rise to more than 50 per cent., often at very short notice, when demand peaks in winter. I am pleased that we have enabled generators and supply companies to get together usefully through the coal forum. My hon. Friend the Member for Selby acknowledged the importance of that. The forum is a useful vehicle and, incidentally, I hope that it will discuss the mines rescue service soon.

The Government are committed to carbon capture and storage. I do not mind the fact that we are the first Government to announce a major demonstration project. It is interesting how the debate has moved on—some are now asking why there should not be two demonstration projects. Such projects are expensive. The science and technology is relatively untried and no-one has put together a whole project featuring carbon capture, transportation and storage.

Will the Minister give way?

Of course not—if the hon. Gentleman looked at the clock, he would see why not.

Internationally, we are in a lead position on carbon capture and storage, which is a good place for Britain to be. If we are to square the circle between using fossil fuels in future, particularly coal, and climate change, carbon capture and storage is absolutely vital, and we are now in a good position. We need adequate regulation and we are working hard with the Norwegians in the North sea on CCS projects. It was no jest to the hon. Member for Stone when I talked about the emissions trading scheme. It is a vitally important European way in which to pay for CCS in future. This has been a significant debate and I again congratulate the hon. Gentleman on securing it, and on the thoughtful way in which he introduced the topic.

Thank you, Mr. Amess for affording so much of your valuable time to Chair this debate. I know how time consuming that task can be, as I have occupied that same seat many hundreds of times in the past as Deputy Speaker in Westminster Hall. Indeed, I will fulfil my next spell of duty in your place tomorrow morning and afternoon.

Mr. Amess, may I ask respectfully that you convey my thanks to Mr. Speaker for granting this debate today? This is the fifth debate that I have initiated in this Chamber; the others took place in the recent past. The first was on police re-organisation and the second, on hospital reconfiguration, was followed by a debate on the problems in prisons and the Prison Service. Very recently, I secured a debate on the Remploy factory closure proposals. I think that I can claim, modestly but with some justification, that in each case I caused the Government to stop and think again and modify their view. I hope and pray for a similar degree of success today.

First, the topic for debate is the National Institute for Health and Clinical Excellence and, at this stage, I put a heavy emphasis on the last two words of its title—clinical excellence—because I hope to return to that, if I live long enough, before resuming my seat.

Secondly, we are debating stents so I suppose that, for the uninitiated, I must start by discussing what a stent is. Many people in this country and in the world have problems with forms of coronary heart disease, a serious and common problem, which is the most common cause of premature death in the United Kingdom: it causes about 105,000 deaths a year. In some 30 per cent. of heart attacks, the patient dies. In the UK, someone has a heart attack every two minutes—some 230,000 people each year—so if we think that, during this 90 minute debate 45 heart attacks will occur somewhere in the country, it might help us focus our attention.

Patients with coronary artery disease have narrowing in the arteries, restricting the blood supply to the heart, and a procedure may be needed to help improve the blood flow. Cardiac surgeons, such as the noble Lord Darzi of Denham, can do a coronary artery bypass graft operation that provides a new route for blood to flow around the narrowing. Cardiologists can do a procedure called percutaneous coronary intervention, or PCI, which is also known as an angioplasty, in which they open up the narrowing by inflating a small balloon in the artery. Both procedures fall under the general description of revascularisation: in other words, easing the flow of blood through our system of veins.

The PCI is often accompanied by a stent, which is a form of scaffolding or mesh, of which there are various designs. The stent is inserted and threaded through the veins, having entered the body through the groin. The cardiologist can position the stent where there is a restriction in the arteries and, with the help of the small balloon, raise the stent open, force back the walls of the vein and then withdraw.

How do I know all this? The cardiologists at the James Cook university hospital on Teesside, having given me an angiogram, determined that there were three restrictions in my left anterior descending artery: one was at 18 per cent. restriction, another was at 53 per cent. and the other one was at 97 per cent. I did not know that and thought I was fine, but the cardiologists decided that something had to be done about it, so having done an angiogram, they did an angioplasty and placed stents in my left anterior descending artery. That procedure was done about three or four years ago and although it has not cured my problems it has eased them enormously. I am ever grateful to Mark de Belder for doing that for me, at the suggestion of Dr. Shyam Sundar. I am also grateful to Jim Hall, who helped Mark de Belder establish the department in the James Cook university hospital, because they worked night and day for more than three years before establishing it and, as a result, probably saved my life and the lives of many others.

Stents come in two forms: one is a bare metal stent—in other words, stark scaffolding—and others are drug-eluting, being coated with drugs. Some bright character worked out something about restenosis. However, I have not explained what restenosis is, so I had better do so. When a stent is put in place, the platelets and flesh in the inside of the vein start to grow around it. Sometimes too much scarring tissue can grow, causing a restriction again: that is called restenosis. Some bright character thought that, if stents were coated with a drug, it might be possible to inhibit a build-up of such scarring tissue. Would you believe that two drugs were discovered? One is called paclitaxel, which was discovered in 1967 in the stem bark of the Pacific yew tree. The other is called sirolimus, also known as rapamycin, which was found in a soil sample from Easter Island—would you believe? The local name for that island is Rapa Nui, so that is why the drug is called rapamycin.

Not only is the amount of restenosis reduced by using stents coated in drugs—drug-eluting stents—but the need for repeat procedures is reduced. A bare metal stent with the build-up, or restenosis, can sometimes need a repeat procedure done on it. It is sometimes difficult to repeat, some months or years later, a procedure that has already been carried out.

The drug-eluting characteristic has the advantage of reducing the need for a repeat procedure. However, it sometimes causes problems and has been known to give rise to a late thrombosis, which is obviated by a drug called clopidogrel, or Plavix. In America, doctors call Plavix the surgeon’s nightmare, because it is an anti-coagulant: but that is why it is used. I was given Plavix for about 15 months. It is taken regularly on a daily basis so as to ensure that the flow of blood is constant through the stented area and does not tend to wait, pause or clot and cause another problem. Plavix can be advantageous in that sense.

I have so many notes that you would not believe it, Mr. Amess. I am getting phone calls from all over the country giving me ever more information on this subject. People are very concerned about this matter.

Clopidogrel, or Plavix, is the standard treatment for the prevention of clots post-angioplasty. Now, however, details of Plasugrel—an improvement on Plavix —have been reported in The New England Journal of Medicine. When used in the same circumstances as Plavix to prevent coronary thrombosis and clot formation, Plasugrel reduced the death rate by 19 per cent., and early reports suggest that it will counteract any problems associated with drug-eluting stents.

Am I making progress? I have described what stents are and what drug-eluting stents are, and I come to the issue of cost. There is some argument about cost, and when we discuss it we should be careful to consider every aspect. It is not just the item itself that has a cost; there is a cost in inserting it, and possibly in having to replace it. There is also the cost of time spent in bed in hospital and of recovery time. If we do not use stents, the only other option is open-heart surgery in the form of a bypass, which involves opening the sternum and putting various bits of tubing around wherever the blockage is. That means increased bed, theatre and recovery time, increased need for theatre crew, and lots of pain. When we address cost, therefore, we should consider not only the accountants’ estimates, because you know as well as I, Mr. Amess, that accountants know the cost of everything and the value of nothing. I am thinking about value, rather than cost, which is why I am emphasising the broader assessment.

We should not neglect that broader assessment, because it might be believed that NICE—that body of esteemed worthies whose task is to concentrate on clinical excellence—would ensure that all their assessments are based on sound knowledge and practice. There is a very strange story to tell in relation to that, however, and I wonder whether I have time to tell it all before 12.30 pm.

Initially, an assessment group was established. It was not a national assessment group, however; it was a group based in Liverpool. I have nothing against Liverpool; I was a great fan of Tommy Handley and Ted Ray. I am not very keen on Jimmy Tarbuck, but I appreciate Steve Gerrard and Michael Owen, so I am not down on Liverpool at all. The assessment group was asked by NICE to consider its views on stents, including drug-eluting stents. It formed an opinion, and published it—openly and publicly—well before the closing date for consultation. Having published its views at that point, it seems it was reluctant to withdraw from the position it had adopted, which in my opinion is rather less well informed than that of other agencies that took a broader view.

The fact that the mesh design of stents was being refined in various different places—not just in this country but elsewhere—was not taken into account; neither were the economies of scale—size would be a misleading word, nor the fact that costs are reducing. The initial conclusion that drug-eluting stents would cost something like £600 more than bare metal stents was totally off the wall, completely wrong, and very badly out of date.

I have to say that the opinions of so many different experts—by which I mean consultants—is testimony to the fact that the earlier sums were wrong, and that the opinions need to be reviewed. NICE is currently making its assessment, but has already issued a statement that it is likely to recommend that drug-eluting stents no longer be used in the national health service. That position is based on the assessments of the Liverpool group, which hardly seems sensible given that those evaluations were based on knowledge that is more than two and half years old. In that period, there have been developments in the forms of stents and in their production and cost of manufacture. It is now generally thought that the cost difference between bare metal stents and drug-eluting stents is something in the region of £320 for a 12-month procedure. If we include in the comparison the fact that the drug-eluting stent causes fewer repeat procedures, the cost saving is even greater.

If we measure the advantages of using stents compared with bypass surgery, there is a colossal saving in theatre time, bed time, healing time and staff time, which holds out the prospect of the Government reaching its 18-week target waiting time, of which they have made so much in the past.

Unfortunately, it seems that there is a bit of an argument between cardiac surgeons and cardiological interventionists. The number of PCIs—stent insertions—used to be the same as the number of open-heart procedures, but there are now three or four insertions for every open-heart operation. Some will immediately say that that is very good, because it reduces waiting lists and improves patient prospects. However, I can understand that if a cardiac surgeon has spent 12 years or so working out how to carve somebody’s sternum into two, open their thoracic cage and get at whatever he finds inside—he would not find much in this place, because not many politicians have a heart—then he will want to protect his professional status and the need for his expertise. Nevertheless, our prime consideration should be the interests of the patients. Even allowing for the vagaries of accountants, we should also consider the cost implications—or rather, the value implications.

I am concerned that NICE’s assessment might well be adversely affected by false logic and misinformed intervention. The fact that we have put our faith in drug-eluting stents in the past is well testified to by Professor Lord Darzi. This morning I spoke to the Secretary of State for Health, although not on this topic. At a certain party conference that I have to say that I did not attend, he said:

“Eight years ago the NHS performed 17,000 angioplasties, a procedure to widen blood vessels for patients suffering from heart problems. Last year the figure was 55,000, a 3-fold increase. This has significantly reduced the length of stay in hospitals for patients who would otherwise have had a much more complicated operation.”

Professor Darzi, in his testimony to the Select Committee on Health, made particular reference to drug-eluting stents, but for the life of me I cannot find the quotation. I apologise for that.

Several studies of drug-eluting stents in routine clinical practice have suggested that those devices may be associated with a reduction in death—the most important of all health outcomes, I would suggest. Studies that confirm that have been conducted in Ontario, Massachusetts, western Denmark, the Carolinas, Pennsylvania, New Jersey, Seoul, Rotterdam—the list goes on. All reported the beneficial impact of drug-eluting stents, but NICE is in danger of announcing that they will no longer be available in the national health service, and all on the basis of NICE’s quite wrong impression that a drug-eluting stent costs £600 more than a bare metal stent when in fact the cost difference is £320—that is not taking into account the repeat procedures on a bare metal stent.

The other aspect of the issue that makes me feel real anger is that I am told that NICE will announce its decision on 31 December and there will be only a 15-day period in which appeals can be made. You, Mr. Amess, are a very sociable fellow and, like me, you will enjoy a party or two with your family and friends during the yuletide period. That includes 31 December, and festivities usually require a recovery period, which sometimes means a visit to a GP. Fifteen days from 31 December means compiling and submitting an appeal by 14 January. It seems less than sensitive to the needs of the community that things should be decided in that way.

I know that other hon. Members want to speak, but before I conclude let me make it plain that I am not making the case for drug-eluting stents as opposed to bare metal stents. The medical profession has the responsibility to look at each individual patient and assess them and their needs, not in isolation but with a clear focus. The medical profession has to decide what the needs are and whether the best approach is drugs only, which could be the case; bypass surgery, which could be the case depending on what is happening in the person’s plumbing; bare metal stents, which might be the most advantageous approach; or drug-eluting stents. Those are the options, but drug-eluting stents cannot be used if they have been taken out of the list. That would be nonsense.

I am not arguing that it should be drug-eluting stents as opposed to bare metal stents, that it should be stents as opposed to open-heart surgery or that it should be anything as opposed to drugs. I seek an undertaking from the Minister that NICE will be asked to concentrate on its job of assessing fully all the information—not just the information that was gathered two and a half years ago but the information that is being collated as we speak—before it comes up with its decision on 31 December. What has hitherto centred on the question what cost drug-eluting stents has, in my view, crystallised into the question what cost clinical excellence? NICE should concentrate on that.

It is a pleasure to serve under your chairmanship, Mr. Amess, especially as I know your interest in this area. I congratulate my hon. Friend the Member for Stockton, North (Frank Cook) not only on securing this important debate, but on putting the case so eloquently. I, too, declare an interest. I am of an age when I may need a drug-eluting stent at any time, unlike my hon. Friend, who has first-hand experience and is living proof of the virtue of this piece of technology. Also, among my other activities, I chair the all-party group on medical technology.

Medical technologies have made many important contributions, particularly in the field of cardiology. They include pacemakers and so on, but the drug-eluting stent is one of the outstanding ones. The normal problem that we find with the adoption of medical technologies by the health service is that it is rather bad at taking them up, for various reasons, which I will not dwell on now. We find that in the UK, compared with our European neighbours and the United States—compared with other medically advanced countries—the use of very helpful, cost-effective medical technologies that have great patient benefits is at a very low level. The galling thing is that, in every case, those technologies have been assessed by NICE and NICE has approved and recommended them, but they still have not been adopted.

The drug-eluting stent was assessed in 2003 by NICE and was recommended, and it has been enthusiastically adopted by cardiologists throughout the land. It is virtually a first choice of treatment. That is entirely consistent with the national service framework for coronary heart disease, which was one of the first NSFs produced by the Government. That was appropriate because coronary heart disease is the country’s biggest killer. It was therefore one of the first NSFs to be developed.

It is still the case that, in that NSF, revascularisation—in other words, angioplasty—as opposed to a bypass is the recommended first line of treatment for coronary artery disease, provided that the patient fulfils the reasonable criteria. In addition, a recent report by Professor Roger Boyle, the national director for heart disease and stroke—the heart tsar, if you like—entitled “Mending hearts and brains—clinical case for change” sets out the case for drug-eluting stents as the appropriate first treatment for a heart attack in appropriate patients. So why is NICE taking the line that it is at this time? Why is it seeking to take out of cardiologists’ toolkit their most treasured and sharpest chisel?

NICE must have a very good case if it is to do that, because with angioplasty we are talking about a procedure that has great advantages. It is much cheaper for the health service than a bypass operation. It is not invasive. The stay in hospital is extremely short and the patient can make a rapid return to normal life. One of the best recent examples is our own much loved Rhodri Morgan, who recently had a coronary event and was given a drug-eluting stent, I am informed. He was back leading the National Assembly of Wales within a few days. That shows the value of that piece of kit and of the procedure.

As my hon. Friend has said, in the last year in which they were counted, 54,000 angioplasties were carried out. The problem with angioplasty and a bare metal stent is restenosis—the reblocking of the vessel. That can occur in 50 per cent. of patients who are given bare metal stents. With the use of drug-eluting stents, that is dramatically reduced by 55 to 60 per cent. The total costs of the procedures are £4,240 for an angioplasty using a bare metal stent and £4,588 for using a drug-eluting stent. The percentage difference is minimal—in the single figures. However, cost-effectiveness should be established by the reduction in the number of repeat procedures alone.

It beggars belief that NICE can come up with a cost-effectiveness calculation that gives the price of £200,000 for a quality year, which is the unit that NICE and other health economists use. I cannot see how NICE has come to that conclusion, given such a small differential between the price of using a drug-eluting stent and a bare metal stent. How does it get that figure? Its information base—derived from the Liverpool assessment group—is clearly completely different from that of all European cardiologists and the rest of the UK.

The implication of NICE’s calculations is profound: if it proceeds with its draft guidance and withdraws its recommendation of the stent, the number of repeat angioplasties will increase by a degree that is difficult to estimate. That will have a cost through the deterioration of patient quality of life as well as a cost to the health service in repeat procedures. The cost will be enormous. The implication is also that others will not be able to be revascularised and will have to have bypass operations, which cost twice as much. The implication of that misguided guidance, if it is followed through, will be an enormous financial cost to the health service, a considerable cost to patients—including some otherwise avoidable deaths—

I am not sure whether the hon. Gentleman means that NICE guidance was poor because its research base was poor, because the process of appraisal was poor or because both were poor.

Both are perceived to be poor in this case. I have observed that in other NICE appraisals in the past. They have come out right in the end, but involved a lot of heartache in the process. We have a narrow patient base that is not representative and a false interpretation in carrying out the calculation.

The consequences are enormous for patients and enormous in cost. The capacity of the NHS will also be threatened, including its capacity to deliver the reduction in waiting times that we are looking for. The implications for the increasing use of beds and for staffing are enormous. NICE’s recommendation is critical.

It is also critical to NICE’s reputation. My hon. Friend the Member for Stockton, North is absolutely right to say that it boils down to NICE meaning clinical excellence. If NICE is to set the standard of clinical excellence, the way in which it does so and the reliability of that standard are critical. I simply ask the Minister—I know that she cannot direct NICE, because we have set it up with a degree of independence—

Can I alert my hon. Friend to the fact that I felt very concerned that Andrew Dillon, the chairman of NICE, publicly expressed the view—at least, it is printed in The Times—that he wishes NICE to become independent of the NHS? What does my hon. Friend think could be the possible consequences of NICE breaking away from the NHS and then assuming an input on the practices and procedures that the NHS adopts?

My hon. Friend has made an important point. Although NICE needs to be independent, in the sense that we do not want it to be dictated to by Government—we do not want the Government to turn to NICE and say, “The cost of the health service budget is getting out of hand. Can you make sure that your recommendations keep it down for us?”—with that independence goes a heavy responsibility. NICE must ensure that its scientific and medical assessments are made to the highest standards so that when it says that x is an example of clinical excellence and should be used, or alternatively that x is sort of okay but is not recommended because it is not worth it, we can rely absolutely on that advice.

NICE does not do its own research. It relies on others. Thereby hangs the weakness. Not all the people whom NICE calls on to carry out assessments for it are of the same excellent standard. In this case, one has to question why the Liverpool group is so much at odds with the entire cardiac community.

I am sorry; I do not want to keep intervening. However, will my hon. Friend consider the fact that the situation may have come about because the group was so keen to publish its initial findings? It would have been much wiser for it to wait and to hear a broader view before crystallising it into a definitive opinion. The group dug itself into a foxhole, but continued to dig further rather than stopping.

My hon. Friend raises an interesting point. I would love to know what peer reviewers of the Liverpool publication had to say, assuming that it was peer reviewed. I do not know whether it was. Any peer reviewer considering a publication that is so much at odds with what everyone else thinks would need to look closely to ensure that the methodology is correct. The Minister has every reason to ask NICE, in the nicest possible way, to reconsider very carefully its methodology and to see whether it is sound. The simple logic dictated by the narrow cost difference between bare metal stents and drug-eluting stents is that its cost-effectiveness figures are impossible. If NICE proceeds with them, I fear that its reputation will be fatally damaged. If the figures are right, however—that is a big if, and I put the odds at about 200:1 against—NICE needs to go to great lengths to justify them, otherwise it will not only do patients, the NHS and the cardiac community a great disservice, but it will undermine its own credibility.

It is a pleasure to serve under your cheerful chairmanship, Mr. Amess. I congratulate the hon. Member for Stockton, North (Frank Cook) on introducing this important debate in an informative and extremely knowledgeable way. I must say that neither drug-eluting stents nor cardiology is a specialist subject of mine, although I recently had my heart checked out during an annual health check. They put the blood pressure tourniquet on me, and all was going well, until the phone went—it was my local paper. My blood pressure shot up immediately, and I had to ask them to do it again.

The efficacy of treatments is not an obvious subject for politicians. It could be regarded as a medical debate between cardiologists and surgeons about whether the use of stents is preferable to keyhole or bypass surgery; whether metal stents work better than drug-coated eluting stents or genetically engineered stents; about when and where they should be used, or about the short and long-term effects of each therapy. The side effects and the psychological, physiological and social effects of each therapy can be discussed, and issues have been raised about whether the research into the effects and powers of various treatments has been adequate.

Ordinarily, this serious debate would be a matter for research journals, such as The Lancet, rather than Westminster Hall, if it were not for the fact that public money is involved. When spending public money, we must ask ourselves which treatments work better and, therefore, whether we are using public money as best we can; we then ask policy makers to form a view. In most circumstances, we are reluctant to give clinicians a completely free hand, because we recognise the pressures on them—for example, from drugs companies. Furthermore, they have vested interests. Contributors to this debate have mapped out the vested interests of surgeons as opposed to cardiologists. We are also reluctant to give patients a completely free choice, because cost and clinical outcomes can be uncertain.

In an age when medical treatment was much of a muchness and much of it unsuccessful, we could be fairly relaxed about value for money. However, things are not so easy in an age when medicines are high-tech, and when there are significant differences in the price of treatments. In a sense, therefore, we need a body such as NICE, whose primary job, as I understand it, is to separate therapies that deliver value for money from those that do not. It does not provide regulation; it does not forbid anything. It provides guidance. It does not outlaw procedures, but suggests which ones offer better value for money. Primary care trusts and other health care providers can then respond accordingly.

I attended a session at which NICE considered a particular drug—not one related to cardiology or heart complaints—and I was quite impressed by the exhaustive nature of the process. Patients suffering from the complaint under investigation were present during the assessment and it was robustly chaired. I am reluctant to venture a counter-opinion to the flow of the general debate today, but without proviso, I can say that NICE does a very workman-like and thorough job. However, demonstrably—this is illustrated in debate after debate—it does not end arguments, as is the case here. That is probably because value-for-money judgments in the medical world differ from those in other contexts.

I serve on the Public Accounts Committee and am familiar with debates about value for money, but by and large, we look at public expenditure and policy. We do not debate whether a policy is good or bad; however daft we consider it to be from the point of view of value of money, its objectives are normally relatively clear. It is fairly simple, therefore, to consider how efficiently a certain policy or programme of expenditure delivers on its objectives.

The objectives of medical therapies, drugs and other treatments are not as clear and are often quite diverse, as seems to be the case with stents. They can fulfil a number of objectives: they can avoid the need for surgery, prolong life and diminish pain. I understand that there are differences in how far different stents diminish the pain from complaints such as angina. They can also complement other therapies such as—most obviously—angioplasty and reduce patient anxiety. Furthermore, we must consider how much they can evade side effects or forestall subsequent treatment.

Different evaluations ride upon how those objectives are weighted. Behind that, there is another debate about how NICE should prioritise legitimate medical objectives, such as pain relief, as opposed to cures and clinical efficacy. There can be uncertainty about such clinical priorities, and disputes about the objective of therapies and medicine, which engineers controversies that have been aired today. That will be true especially if the real time effects are questionable—I am talking about the Liverpool research. There is no infallible pope to help the medical world.

I am the first to agree with the hon. Gentleman’s statement—of course, no assessment is infallible. However, does he agree that in making a more realistic assessment, it would be better to use information from 2007-08, rather than from 2004-05?

I accept that point, except that a number of people have made legitimate criticisms of the processes that NICE uses to do its job. I am arguing that there are weaknesses in the process, but it could be, and has been, argued that it has not made the best fist of the process as it is customarily run.

NICE gives guidance and, presumably, works under a constitution, which it has to establish in advance and through which it conducts its own procedures. There is no evidence that the guidance that NICE works with is less contentious than the guidance that it gives. That creeps into other issues—for example, in connection with Alzheimer’s drugs. With those drugs, what it criticised is not so much what the research is saying but what research NICE allows to be taken into account in the first place.

I do not think that it can be plausibly argued that quality added years, which NICE awards therapies and which are the basis for its recommending them, follow through an irresistible, logical, conclusive process from the research that NICE commands and surveys. It just ain’t that simple.

At the end of the day, no mathematical calculation can simply produce the right or appropriate number. No mathematical calculation can substitute for a degree of human judgment, and no human judgment is completely uncoloured by unstated preferences and values. None the less, despite saying all that, I must acknowledge that NICE aspires to giving a dispassionate verdict and that, if NICE is not perfect, there does not seem to be a better tool currently available.

I think that the hon. Member for Stockton, North has made a very convincing case about why NICE should examine its verdict on stents again, not only because he says that it should, but because he is speaking on behalf of the thousands of patients whose lives depend on NICE getting this judgment call right.

May I begin, Mr. Amess, by saying how pleased I am to see you in the Chair today?

I should like to join other hon. Members in congratulating the hon. Member for Stockton, North (Frank Cook) on securing this important debate and introducing it in such an articulate and informed way. He detailed the medical procedures; he quite rightly highlighted his personal experience, the benefits of which we all heard today in his articulate and passionate introduction, and he was speaking not only on his own behalf but on behalf of the many thousands of people who have benefited from those procedures in the past.

The hon. Gentleman comprehensively set out the issues regarding the different types of stent, including the all-important drug-eluting stents that we are discussing this morning. Importantly, he also highlighted the complexity and disparity of medical opinion regarding the cost-effectiveness of drug-eluting stents, and it is that opinion that NICE must make difficult judgments about. I am sure that he would be the first to acknowledge the difficulty of making those judgments.

We then heard from the hon. Member for Brighton, Kemptown (Dr. Turner), who made an extremely informed contribution to the debate. He set out the international comparison and the international dimensions, which are very important. He also highlighted the importance of restenosis—in other words, the likelihood of recurrence of such problems, which would be made more prevalent by the use of bare metal stents, and the ongoing cost to the NHS of that procedure. He also highlighted his view that both the research base and the analysis on which NICE seems to be making its judgment were flawed.

NICE, in my experience, is extremely thorough in all its investigations. It needs to be acknowledged that NICE is, correctly, an independent body and that it must make very difficult judgments and decisions. However, I think that I am right in saying that those at NICE who are involved in making those decisions will read this debate avidly and will take on board the information from the various comments that have been made.

Before I go on to the specific issues, I just want to set out the context of this debate. The Conservatives are extremely supportive of the NHS, which is why we have promised to match the Government’s spending, as outlined in the comprehensive spending review. We have three specific priorities for the NHS: first, we want it to be patient-centred, based on information; secondly, we want it to be based on outcomes, not on centrally processed and driven targets; and thirdly, we want much greater emphasis to be placed on public health. We want to empower patients to be at the centre of the NHS, and we want the NHS to look outwards and not, as it currently does, upwards.

The Conservatives are also extremely supportive of NICE, and we respect its independence. It is right that decisions about the guidance on which drugs are made available by the NHS should be made by clinicians and other experts, rather than by politicians. We support the Government in establishing NICE. In a moment, I will come to some of our recommendations to improve the procedure of NICE. However, such judgments should be made as freely from political interference as possible; otherwise, the power of lobbying groups will end up dictating which conditions and treatments should receive approval and which should not.

It is right that patients have access to treatments that are judged to be cost-effective and clinically effective for their condition. There should be no reason for variances in national access. However, there are areas in which NICE could be improved and we have made a number of suggestions to that end.

Currently, there are long delays before drugs and treatments are approved by NICE, which has caused significant regional variations in prescribing and legal challenges to those variations. Before the decision by NICE, individual primary care trusts set prescribing criteria. As we all know from our constituencies, those criteria can vary widely, both between primary care trusts and within individual primary care trusts.

Such variation in access to drugs and treatments causes a great deal of uncertainty and angst for patients and their families, and it reinforces concerns about a postcode lottery. It also gives the impression that NICE is hindering clinical guidance and clinical betterment, rather than enabling it, and that impression needs to be changed. That is one of the reasons why the Conservatives have pledged to allow NICE to begin its assessment of new drugs and treatments as the drug licensing process begins, rather than afterwards. That would reduce the period of uncertainty between licensing and the completion of NICE guidelines.

If I may just help the hon. Gentleman, that is already the case; NICE starts its procedures at that point. As yet, he has not raised anything that would lead to a change in procedures. So, before he tries to advance a point that he thinks is new, let me reassure him that that is precisely what NICE does as licences come up to be agreed.

I am intrigued by that intervention from the Minister. If she will bear with me, I will move on to a couple of other points. However, she will also be aware that that is not what happens in practice at the moment. We need to speed up the process of the appraisal of drugs and medical treatments, because there is a lot of uncertainty.

The hon. Gentleman knows that an absolutely crucial part of NICE’s determination process, which my hon. Friend the Member for Stockton, North (Frank Cook) rightly wants clarified today, is the consultation period and then the time for appeal against its initial determination. That is the pressure on the length of time that NICE takes to complete its procedures. Which one of those two things does the hon. Gentleman suggest that NICE should jettison to shorten the exercise?

Both things must be considered, because we need faster clarity both for patients and for the primary care trusts that will ultimately commission the services on their behalf.

In our recently published Bill on NHS autonomy and accountability, we propose a statutory and expanding role for NICE, to give it greater independence and establish it as a statutory body, rather than as a special health authority, as it currently exists. To pick up a point that the hon. Member for Brighton, Kemptown made, we also need to analyse the quality adjusted life years method. We must carefully consider whether the threshold should be adjusted, whether it should take into account wider societal costs, where appropriate, and the complete cost to the national health service of particular treatments and whether NICE should approve them in guidelines. NICE should also play a wider role in producing evidence-based commissioning guidelines on standards of care to encourage best practice and the achievement of outcome objectives.

The hon. Member for Stockton, North quite rightly mentioned that patient groups, including people at high risk of restenosis, such as those with small blood vessels, long narrowings or diabetes, and some clinicians have voiced concerns about the decision potentially to allow treatment with only bare metal stents. Those patients account for about 40 to 55 per cent. of all patients undergoing angioplasty. I shall summarise the arguments that NICE must consider while it fully assesses all the available information to make a decision about potential guidance by the end of the year.

There is an argument that the decision would represent a step backwards in the clinical treatment of heart disease. Unlike most situations in which NICE has denied a treatment for drug-eluting stents, bare metal stents have previously been approved, and there is a suggestion that that decision may change, so I can understand why that issue is causing such angst and concern.

The hon. Member for Brighton, Kemptown was absolutely right that more patients will require repeat procedures if they develop restenosis. Studies have shown that drug-eluting stents reduce the necessity of further intervention by between 60 and 80 per cent., which is a significant amount. Not only could repeat procedures be detrimental to the patient, but they will be more expensive for the NHS to provide in the long run, according to the British Association of Cardiac Patients. The British Cardiovascular Society has calculated that, if NICE recommendations do not change, more than 5,000 patients will require a repeat procedure that they might not have had to undergo if initially given drug-eluting stents. NICE needs to consider that information in full.

Clinicians might also have to refer more patients for open-heart surgery instead of angioplasty, as the risk of restenosis in certain patient sub-groups, such as those with diabetes, is so high—currently, 24.9 per cent. It is obvious that surgery carries more risk to the patient, and it is more expensive in both treatment cost and length of recovery. The combination of more repeat procedures and more surgery could also increase waiting times, as surgeons will have more and longer procedures to undertake. As the hon. Member for Brighton, Kemptown highlighted, drug-eluting stents are widely used elsewhere in the world, and the guidance against their use in the UK could send an unhelpful message to those developing new technologies and treatments.

The British Cardiovascular Society has claimed that the NICE assessment process for drug-eluting stents was flawed in three further ways. I am not saying that I agree, but these points need to be considered when decisions are made. First, the process was based too much on a local audit from a single intervention facility. Secondly, the figures that NICE uses to calculate cost-effectiveness are inflated compared with the true costs that hospitals actually pay, making the stents appear less cost-effective than they truly are. Thirdly, the BCS is concerned that patients with complex conditions who are turned down for surgery may well have no treatment at all, as bare metal stents might not be appropriate in their individual cases. That needs to be considered carefully.

The decision must ultimately be for NICE to take. It is right that, as an independent body with specific clinical expertise, it considers such complex and difficult matters. It is not for politicians of any party, without the necessary expertise, to have a definitive influence. Decisions about clinical effectiveness and cost-effectiveness should be decided by NICE. However, we urge it to ensure that its assessment process is rigorous, fair and takes into account potential costs to the national health service, as well as the quality of life of the individuals involved. We want Britain to have the best health service in the world, with outcomes equal to or better than those of other European countries. For that to be achieved, we must offer the most innovative and effective treatments and ensure the best possible outcomes for patients and their families.

I begin by thanking my hon. Friend the Member for Stockton, North (Frank Cook) for raising this important issue and, as others have said, for his detailed consideration of how best we can improve clinical care for people with heart disease. His personal reflections on the care that he has received from cardiac specialists provide a powerful backdrop to the debate. If I may say so, he stands as an impressive testimony to the great strides forward in modern medicine that the NHS has made in recent years. I pay tribute to him for the energetic role that he plays in the House on a wide range of matters and for his commitment to improving care for other people affected by heart disease.

The Government, too, are committed to developing a world-class service for heart disease that prevents ill health, saves lives through better treatment and improves the quality of life of people living with heart disease—all the main points that my hon. Friend touched on. We have already made great progress: deaths have fallen, long waits are a thing of the past and we have invested in more staff and modern facilities to deliver state-of-the-art treatments. The pace of medical progress means that we are continually offered new opportunities to treat more people in different ways with an ever-broadening array of drugs and devices.

Of course, it right that we must regularly review treatments used in the NHS to ensure that they are both clinically effective and cost-effective. As my hon. Friend is aware, NICE has yet to conclude its review of earlier guidance on using drug-eluting stents in the treatment of narrowed heart arteries. It issued a consultation document last summer, and its appraisal committee met earlier this month to consider the responses submitted. Clearly, it would not be appropriate for me to go into the detailed discussions about the possible content of NICE’s recommendations while guidance is still being developed. All the Members who spoke touched on the importance of the independence and thoroughness of NICE’s procedures. I hope that I can reassure my hon. Friend the Member for Stockton, North that robust mechanisms are in place for the consideration of the concerns that he raised.

I say to my hon. Friend that the advice given to me was that we were expecting NICE to publish its final guidance next March. I have not been provided with the date when the next series of documents will be available following the appraisal committee’s discussions. If he will bear with me, I will look further into the date of 31 December that he mentioned. Perhaps I can write to him on that, as I do not have the details before me.

On the robust measures being adopted to remedy any complaints that people may have, a point that has been made persistently in the debate is the rather narrow research base on which NICE is working. What will be the robust mechanism to address that? Will a peer review be presented to convince sceptics that the Liverpool research should be relied upon?

If the hon. Gentleman will bear with me, I wish to touch in the same sequence as my hon. Friend the Member for Stockton, North did on what treatments should be available, their price and the collection of evidence. I shall come in a moment to the point that a number of Members have made about the Liverpool data.

It is precisely because of the complexities of modern treatment and the opportunities offered that we need to ensure equity, clinical effectiveness, as my hon. Friend repeatedly said, and value for money for patients. Those were the reasons for the establishment of NICE as an independent body. It should take into account all the factors that he suggested in coming to conclusions and making recommendations.

Before we had NICE, guidance was issued by numerous bodies at national, regional and local levels, which had different ways of appraising evidence and developing recommendations. The status and implications of that guidance procedure were not clear, which led to confusion for clinicians who, as my hon. Friend said, rightly want to know what care they should be expected to give, and for patients, who want to know what care they should expect to receive. They want the evidence, advice and guidance on that to be coherent, so that we do not have variations in practice emerging across the country, as my hon. Friend said. NICE therefore has to have robust, evidence-based guidance, which we expect clinicians to take fully into account. NICE has modernised the way in which decisions are made in the NHS, bringing greater certainty, clarity and confidence. It spreads good practice, helps to protect patients from outdated or unproven treatments and is internationally recognised for its excellence.

In October 2003, NICE published a technology appraisal of the use of stents in operations for heart diseases. As my hon. Friend so eloquently explained, stents are tiny mesh scaffolding devices that are used to hold open damaged arteries. There are two main types: the older, bare metal stents; and the more recently developed drug-eluting stents, which—I shall not attempt to improve on my hon. Friend’s excellent description—are coated with drugs to reduce the likelihood of the artery later becoming inflamed or obstructed.

In its 2003 guidance, NICE stated that the decision on which type of stent should be used should depend on the person’s syndrome and the size and shape of the narrowed part of the artery. It recommended the use of drug-eluting stents for arteries of small diameter or with longer narrowed areas. As with that 2003 appraisal, NICE returns to and routinely reviews its earlier guidance, as it is now doing. It has to publish an appraisal consultation document, which it did last July. I absolutely agree with my hon. Friend that the focus should be on therapeutic outcomes and what needs to be developed.

Between 2003 and now, stent technology has developed rapidly and many new products have come on to the market. There has been some comment on price, and I must point out that in that period, unusually, the list price for drug-eluting stents has increased. It is now in a price range of about £650 to £1,500, whereas the cost of bare metal stents has fallen. My hon. Friend rightly touched on the question of those costs and more complex relationships, to which I shall return. First, I want to make it clear that the draft recommendations do not constitute NICE’s guidance to the NHS. All recommendations are preliminary and may change after it has considered the full range of consultation responses that it has received.

I am encouraged by the Minister’s assurances, but I think that she should check the basis for the statements that she has made in the past two minutes. I have done up-to-the-minute research on this issue and I know for a fact that the unit cost of drug- eluting stents has been falling progressively in the past 18 months. It is somewhat incorrect to say that they cost the amounts that the Minister has just presented to the House. I entreat her to get her team to check the basis on which she has made those remarks.

I have done precisely that. If my hon. Friend looks at the NICE “Ischaemic heart disease—coronary artery stents (review): appraisal consultation document”, under paragraph 3, “The Technologies”, he will see the collection of data on price.

The key consideration for NICE when making its determination on this issue is the cost-effectiveness of drug-eluting stents compared with bare metal stents, and it is undertaking work on that. When making a recommendation, it has to be confident that it is using a price that is stable, transparent and available to any NHS purchaser of that drug or device. That is why it relies on the manufacturer’s list price as the most effective and reliable guide to the cost of devices, and that is precisely the way in which we would expect it to determine reliable prices.

Surely the most realistic estimate of cost is not the price of individual stents but the cost of the whole procedure. If NICE’s cost-effectiveness calculations were based on the cost of the whole procedure, taking into account the high occurrence of restenosis and repeat procedures with bare metal stents, the outcomes would be very different, because the percentage differential between the two forms of angioplasty with two different forms of stents is only in single figures—about 5 per pent.

That is precisely the work that NICE undertakes. We all want transparency and reliability in the NHS on the cost of drugs and devices. The calculations that my hon. Friend has just described—comparing the clinical effectiveness and price of bare metal and drug-eluting stents, as well as the benefits—is precisely the work that NICE is undertaking. I know that many representations have been made on this during the consultation period, and I do not want to stray into speculation because of independence considerations. The issue is this: if we cannot rely on the list price that manufacturers say they are charging, how do we get a reliable, transparent price that enables NICE to make complex assessments on clinical need and effectiveness?

I make these remarks with the utmost respect to you, Sir John, but I am afraid that we are in danger of succumbing to the accountant’s mentality of looking at the cost of everything, rather than the value. The case that I am making is not about whether drug- eluting or bare metal stents, bypass or drugs should be used. They are all part of the panoply of techniques that a cardiologist and cardiac surgeon can use. Which one is used on which patient is entirely a medical decision to be made by professional people who are fully trained and experienced. My case is that there is a danger, as my hon. Friend the Member for Brighton, Kemptown (Dr. Turner) said, of NICE removing from the toolbox the drug-eluting stent tool when, in fact, it is eminently sensible to use it in certain cases. If it is not there, a patient who is badly in need of the technique may be penalised. That is the whole purpose of the debate—it is not to say which technique is best here or best there. That is for the consultant to decide.

I do not think that my hon. Friend and I disagree on the point about what constitutes appropriate treatment, but the debate is about the assessment that NICE is undertaking of the clinical effectiveness of the bare metal stent as compared with the drug-eluting stent. The work that NICE does involves a complex collection of information and research, using what is referred to as a QALY—a quality adjusted life year—to consider precisely the point that my hon. Friend rightly raises: whether, for the extra cost, there are extra benefits that make one treatment more clinically effective. The question is not whether treatments are available.

I have listened carefully to my hon. Friend’s points, and I know that NICE will consider this debate alongside its other considerations. At present, the recommendations are preliminary and they may change after NICE has considered the full range of consultation responses. The advice currently in place is from 2003.

I assure my hon. Friend that the Department of Health—alongside professional organisations such as the British Cardiovascular Intervention Society, representatives from industry and patient organisations—has contributed its views to the consultation exercise. NICE’s appraisal committee is reflecting on the responses. As I said, it would not be appropriate for me to try to pre-empt what it may conclude, as it is independent, but I want to reassure Members about the Liverpool assessment group’s view on costings. The Department has asked for the economic model to be reviewed because of concerns about the use of the Liverpool data. NICE is taking that information into account in its consideration of all the responses to the consultation, which I am informed it will publish on its website. Therefore, I reassure my hon. Friend that the specific points about the Liverpool assessment group have been taken up. Let me be clear: until NICE concludes its review, its early guidance remains in place. It is entirely appropriate for clinicians to follow the 2003 guidance.

Ensuring the most up-to-date, evidence-based, high-quality clinical care for people with heart disease is of course pivotal to the work of implementing the national service framework for coronary and heart disease. Since the publication of that framework in March 2000, the hard work and commitment of NHS staff in tackling heart disease has meant that some 178,000 lives have been saved. We have already met our 2010 target to reduce mortality from cardiovascular disease by 40 per cent. in people aged under 75; in fact, it was met five years early. Since 2005, no one has had to wait more than three months for heart surgery, and 68 per cent. of people who suffer a heart attack are treated with clot-busting drugs within 60 minutes of calling for help.

Of course, there is more to do. As my noble Friend Lord Darzi of Denham outlined in his interim report, “Our NHS, our future”, we have been running a feasibility study to look at expanding the use of stenting, or primary angioplasty, as the main treatment for heart attack right across England. That vision is set out in more detail in “Mending hearts and brains”, the December 2006 report by the national clinical director for heart disease and stroke, Professor Roger Boyle, who was referred to earlier.

I absolutely assure my hon. Friend and others who have taken part in this debate that the treatment of heart disease continues to be a high priority for this Government. The great strides that have been made since the publication of the national service framework should be built on. I hope that I have been able to stress—without straying outside my specific responsibilities and inadvertently into the independence of NICE—the value of having a completely independent body to review a complex and ever-changing evidence base and to take proper and due consideration of all of the evidence and views expressed on the subject.

I again thank my hon. Friend and the other contributors to this thoughtful and reflective debate on these incredibly important issues. NICE should and will consider their comments carefully.

It is a great pleasure to have this opportunity to initiate a debate about post office closures in the London borough of Sutton. The issue is of great concern to many of my constituents and those of my hon. Friend the Member for Carshalton and Wallington (Tom Brake), who hopes to catch your eye, Sir John, and who has the agreement of the Minister to contribute to the debate.

This debate is a continuation of one that started in the chamber of Sutton council just last week when the local authority debated its concerns about the network change programme that is about to be unleashed on the residents of Sutton. On behalf of the local authority, I pass on to the Minister its serious concerns about the methodology and adequacy of the envisaged consultation, and its desire to sustain and support a proper network of sub-post offices in the London borough of Sutton and to engage seriously with the team that is conducting the consultation.

I come here with three pleas. The Minister will not be surprised to hear that the first is a plea to abandon the plans that are unfolding around the country, and to seize the opportunity to launch a rethink about future ways of securing the network. However, if that plea falls on stony ground, I have two others to which I hope the Minister will give further consideration. The first is that there needs to be more time for the consultation regarding the network change programme if it is to be meaningful and if the public are to have any confidence in it.

My final plea concerns the need for greater flexibility in the decision-making process. I come to this debate with experience of the network reinvention programme of two or three years ago, which saw six post offices close in my area. Many of my constituents believe—I share their belief—that the consultation exercise was little more than a sham. It started with the suggestion that substantial sums of money would be offered to sub-postmasters who opted to close, and they signed contracts, which effectively tied their hands to a decision by Post Office Ltd. Those financial incentives made the consultation exercise unfair, and the consequence was unplanned gaps in the network.

My constituency witnessed the closure of Belmont village post office, which left a lot of my constituents many miles away—bus journeys away—from the nearest post office. Lack of common sense behind the proposals led to, for example, the closure of the Cheam village post office. Again, that post office was well used not just by local residents but by local businesses, which must also now go further afield to bank their cash.

The intention was that the network reinvention programme would be a strategic process to stabilise the network, but how long was it supposed to stabilise it for? Here we are again, with more proposals on the way. The network change programme threatens every local sub-post office in the land. We understand that in Sutton the proposals are being rushed out on 19 February next year for six weeks’ consultation, which brings me to my first substantive point. The six-week consultation period is just not enough to do justice to the proposals that we are likely to face. It is a breach of the Cabinet Office’s rules, which say that the written consultation period should be a minimum of 12 weeks. I know that it is not a Government consultation, but it flows directly from Government policy and should therefore follow Cabinet Office guidelines.

Six weeks is not enough for customers, and it is not enough for my constituents. It is certainly not enough for local authorities and other local organisations to engage meaningfully, to criticise, to scrutinise and to examine the justification for the proposals. Indeed, I agree with the report of the Select Committee on Trade and Industry, which will be debated later this week, that it was hard to understand why an extra six weeks could not be justified, given that, despite the argument that that would create further uncertainty for sub-postmasters, they have been living with uncertainty since 1999 at the very least. Slightly more time for consultation would help to ensure that if the closures go ahead, the outcome will be more durable and will not result in our returning to the matter in two or three years to seek another set of closures to stabilise the network again.

My second point concerns flexibility. Predetermining the number of closures—2,500 on this occasion, of which 1,250 are in urban and suburban areas—turns the consultation exercise into little more than a data validation or checking exercise. There must be more flexibility on the number of post office closures, so that the consultation is seen to be meaningful and genuine in affecting the outcomes and totality of closures. My constituents want to be reassured that the methodology for selecting post offices for closure is fair and well grounded in evidence. There should be transparency, even if that only helps to validate the data on which the decisions are made. We also need to be sure that when the Post Office says that 90 per cent. of the population will live within a mile of a post office and 99 per cent. within three miles, that is not just an exercise of drawing circles on maps, and that real weight is given to local knowledge, transport infrastructure, the way in which major roads and railway lines disrupt access, and commercial and regeneration factors. If those matters are not included in the decision making, I fear that we may have a network that looks perfect on paper but is not fit for purpose on the ground.

The Government must make a clear decision about what they are doing to support the post office network. Departments have made a number of decisions that continue to destabilise the network. For example, the decision of the Department for Work and Pensions not to renew the Post Office card account contract beyond 2010 means that £1 billion of post office network revenue will be lost. Local post offices are a vital lifeline. They contribute to the vitality of the local economy, and their closure causes difficulties and hardship. Research by Help the Aged found that between 2001 and 2005, the proportion of elderly people who use post offices once a week went up, which is an example of more people wanting to use post offices. If their local branch closed, 88 per cent. of older people would have to make special travel arrangements. The fear is that this further round of closures will not stabilise the network, but will simply leave it in an even more vulnerable condition.

It remains unclear what happens when an unplanned closure takes place. If the programme goes through and we have a new, lean, mean network, and if branches start to close, how will the gaps be plugged, and what guarantees are there that those gaps will be plugged? Instead of managing the decline of the network, why do the Government not take steps to improve the competitiveness and diversification of services? Why not unlock some of the value of the Royal Mail to reinvest in the network, and to bring new capital into the business?

My constituents have seen the number of post offices fall from 16 in 1999 to seven today. The local postal network is already full of holes, and more closures will result in even more holes. We were told that the network reinvention programme was the answer, but we are debating the matter again today. Clearly, it was not the solution for stabilising the network. We are now told that the network change programme is the answer, but will it be? If there must be more closures, I hope that the Minister will say today that there will be more time for consultation so that there can be meaningful dialogue with local people and their representatives, and that there will be more flexibility regarding the outcomes. If that is not possible, my constituents will rightly draw the conclusion that in February next year they will be faced with yet another sham consultation and yet another piece of evidence that the Government are content to preside over the decline of our postal network.

I thank my hon. Friend the Member for Sutton and Cheam (Mr. Burstow) for allowing me to speak in this important debate about the future of post offices in Sutton. No one can be in any doubt about the importance of post offices. People understand that, and often refer to the fact that, they are the lifeblood of rural communities. Indeed, they are often the lifeblood of urban and suburban communities. Just last week, I was in the queue at my local post office—I try to give it as much custom as possible—and the person behind me tapped me on the shoulder and said, “You won’t let them close it, will you?”. That view is no doubt supported by the 600 or so people who have signed a petition in the past few weeks about the future of local post offices.

Post offices provide a lifeline for people, and the postmasters who run them often bend over backwards to provide additional services not only to help their customers, but to ensure the longer-term survival of their businesses. For example, they may provide free cash machines in places where they were not previously available.

As my hon. Friend said, it is extremely disappointing that the proposals for yet another round of closures are coming so soon after the closures that came with the network reinvention programme, which has an Orwellian ring to it. That saw the closure of post offices in Westmead road, Stanley Park road, Stafford road, Plough lane, and Banstead road in my constituency, to name but a few. When such closures take place, consideration should be given to the impact on remaining post offices, because the queues at post offices that are still open are dramatic. That must be factored in when these matters are looked at.

I want now to focus on the Government’s responsibility for post offices. A few years ago, I sought to raise the related issue of the way in which postcodes are allocated, because there is an ongoing problem in Beddington, in my constituency, whereby people are being allocated Croydon postcodes, which means that they must pay higher insurance premiums, for instance. However, I was not allowed to initiate a debate about that in Parliament because the Government have no control over the issue. The issue before us would appear to be very similar, because the Government say that they have no responsibility for post offices or for Royal Mail, although that flies in the face of what everyone in the country believes.

I asked a parliamentary question about the issue on 8 November and received a response on 13 November. I asked the Secretary of State for Business, Enterprise and Regulatory Reform what assessment had been made of the effects of post office closures on local communities in London. The response that I received said that the Government had no responsibility whatever in that respect and that it was for Post Office Ltd to take account of the impact of such closures. It concerns me greatly that the Government do not consider that they have any role in assessing the effects of proposed post office closures, when a range of people—from business people through to very vulnerable groups—depend heavily on post offices.

The Government cannot simply wash their hands of this issue; they are not an independent observer who can sit and watch as 2,500 post offices are closed throughout the country over the next few years. If they were willing, they could will the means in the way that my hon. Friend set out: they could introduce imaginative proposals to secure the future of many post offices, and perhaps the opening of new post offices in places where there is increased demand. I want the Minister to give us some indication that the Government are not simply watching events from afar, but are willing actively to engage in the process and particularly to assess the impact of post office closures, rather than leaving that to Royal Mail.

I congratulate the hon. Member for Sutton and Cheam (Mr. Burstow) on securing the debate and the hon. Member for Carshalton and Wallington (Tom Brake) on the points that he raised. This is an important issue, and I cannot pretend that any process involving the closure of post offices will be popular or that it will not give rise to significant concern in local communities, so I appreciate the concerns that both Members have raised on behalf of their constituents. However, I want to take some time to show that, faced with declining customer numbers, increasing losses in the network and lifestyle changes that have affected how people access services and information, the Government and Post Office Ltd had to take the difficult decision that they did.

The background to this issue is the consultation document that the Government issued last December, which set out our initial view. That was followed by the Secretary of State’s announcement in May this year. In brief, he announced that there would be up to 2,500 post office closures and that sub-postmasters leaving the network as part of the programme would be compensated for their service to the community. I am not quite sure whether that is what the hon. Member for Sutton and Cheam meant when he talked about financial arrangements, but it is right and proper that sub-postmasters leaving the network be compensated for their efforts, and that is part of the programme.

Just for the record, I was referring to the network reinvention programme under which people were offered money as a financial incentive to leave the network, not to people being paid compensation when they were nominated to leave the network, which is what is now being proposed.

I thank the hon. Gentleman for clarifying that he is happier with the present arrangements than with the previous ones.

The Secretary of State also announced that there would be 500 new outreach services alongside the closures, and that there would be new access criteria to ensure reasonable access to post office services. The Government’s role and Government support have been mentioned. As part of the present programme, the Government, on behalf of the taxpayer, will invest £1.7 billion in the network until 2011, including an annual subsidy of £150 million to keep open branches that would otherwise not be sustained.

The Minister has rightly said that the Government are investing in the post office network. If they are doing so, however, why do they not believe, according to the parliamentary answer that I received, that they have any role in assessing the impact of post office closures?

The Government set the financial framework but we do not make decisions about individual post offices, as I am sure that the hon. Gentleman understands—that is a matter for Post Office Ltd.

If the Post Office operated on a purely commercial basis with no external subsidy of the kind that we have allocated, it is estimated that up to four times more branches could be under threat than under the current programme. However, the Government do not take the view that this is purely a commercial service, which is why we have committed such a large public subsidy to the Post Office and why we are working with it to secure a more stable network for the future. That was recognised by George Thomson, the general secretary of the National Federation of SubPostmasters, who recently said that

“although regrettable we believe that these closures are necessary to ensure the remaining post offices are able to thrive in the future.”

Let me set out some of the current challenges faced by the post office network. Post Office Ltd has been losing money for some years now, and those losses ran at about £3.5 million a week last year. Four million fewer people visit post offices every week, compared with just two years ago. Eight hundred post offices have fewer than 16 customers a week, and each transaction in those offices costs the taxpayer about £17 in public subsidy. Some 1,600 offices have fewer than 20 customers a day, and the subsidy per transaction in those offices is about £8. In urban areas, 1,000 sub-post offices are competing for business with at least six other post offices within a mile of them, and at a time when the overall number of customers has been falling.

The Post Office is also being challenged by lifestyle change. Eight out of 10 pensioners have their pension paid into a bank account, and the figure is nine out of 10 among new retirees. Last year, half a million people a month renewed their car tax online, but a million people a month have done so this year, with almost half of them doing so outside the normal office hours of nine to five. Other changes, such as direct debit and competition from those offering bill payment services, for example, also have an impact.

Reference has been made to Government decisions on these fronts, but the Government have a duty to respond to trends in the way that people expect their money to be paid to them. There is also the legitimate issue of the public purse. It costs 1p to pay a benefit or pension into a bank account, but 80p to do so through the Post Office card account and £1.80 a time to do so using a girocheque. Do we really believe that any Government will reverse the trend toward putting services online so that people can access them 24 hours a day, and go back to girocheques that cost £1.80 a time, with the increased risk of fraud that that would entail?

I was asked about the future of the Post Office card account. There will be a successor product but the Government cannot legally just allocate it to the Post Office, which is why it is out to tender. The Post Office is bidding and we believe that it is in a strong position, but there must be a tendering process involving the competition that is out there, whether the hon. Gentlemen like it or not.

The challenge to the Post Office is real because of lifestyle changes and competition. Of course, not everyone is online and not everyone is gaining access to services, paying bills and receiving money in that way, but millions are, which inevitably affects the way that people access Post Office services. The trends that I have described will not go away; they will probably intensify. I do not believe that the future for the Post Office can involve a call to turn back the clock. Instead, it will be a question of giving people new reasons to use it, and of providing services that make it a local provider of choice.

I still think that the Post Office will have great strengths. Even after the closure programme, the network will be bigger than that of all the banks put together, and about three times bigger than that of all five of the biggest supermarket chains put together. It will still have an unparalleled reach into every corner of the UK. The Post Office has been rising to the challenge of innovation and the development of new products. It is now the biggest provider of foreign exchange in the country; it is a major provider of car insurance; it has launched a new broadband service in partnership with British Telecom; it is introducing 4,000 free-to-use cash machines; and it has recently, and perhaps topically, announced a new, secure Christmas pre-payment scheme, aimed at Christmas 2008, which will be in full operation next year. That is the road that the Post Office must travel—providing new services and new reasons to go to it, all based on a trusted brand.

At the same time as the closures are happening, Post Office Ltd will open about 500 new outreach services in outlets such as community centres, retail outlets and mobile post offices, all of which could help to mitigate the consequences of the planned closures in some areas.

I thank the Minister for giving way on the subject of the consequences of closures. I hope that he will respond to my question about the extent to which he expects account to be taken of the impact of closures on neighbouring post offices, and particularly on queues.

Postwatch, the consumer body, is closely involved in the preparation of the plans. Several factors are taken into account, and I shall come to the way in which the process of network change is working. Let me answer some of the questions about that, and about timing and the six-week consultation period.

It is true that representations were made to the Government about making the six-week consultation period 12 weeks or longer; that view was taken in the report by the Select Committee on Trade and Industry, and by others. We had a decision to take. The process is already taking 18 months, and we felt that to increase the consultation period significantly would increase uncertainty in the network. We had to take a decision that would give the right balance, and we think that a six-week period achieves that. The six weeks are for public consultation, but before that stage the area plans seek input from Postwatch, local authorities and sub-postmasters. It is then that the six-week consultation process begins.

I want to be clear about what the process involves. It is essentially about how, not whether, the plan is implemented. That was made clear to Members in the letter that they received from the Post Office in July, setting out the closure process. It stated:

“As you will understand, the consultation in respect of the Local Area Plan will not concern the principle of the need for change of the Network, nor its broad extent and distribution...Rather consultation will be seeking representations on the most effective way in which Government policy—as set out in the Response Documents—can be best implemented in the particular Area in question.”

The first area plan went out to consultation on 2 October. Five public consultations have now closed. The first closures will be announced next week and under the current timetable the final process should be completed around the end of next year. I understand from Post Office Ltd that evidence from the initial area plans shows that on average, about 15 per cent. of the original closure proposals have been changed following input by local authorities and stakeholders.

As I said at the beginning of my remarks, the process is not easy and I appreciate the concerns raised in communities. Post office closures have been happening for some years. They are happening in other countries, too, precisely because of the lifestyle changes that I have talked about. We have tried through the process to manage the reduction in the size of the network, to ensure reasonable access criteria for the population, to introduce new access services in some areas and to give Post Office Ltd some financial certainty.

I want to ask the Minister about something that he did not cover in his response. Once the programme is complete and closures have taken place, what safeguards will be put in place to ensure that new gaps do not open up in the network?

There is always turnover in the network. Some 10 per cent. of post offices change hands every year. The process is not something to which the Government can put a stop. However, I believe that the access criteria offer some certainty for the future, which will help to ensure reasonable access to the network in both urban and rural areas.

Just over 20 years ago, Nicholas Ridley, the then Secretary of State for Transport, decided that the best way to address the declining bus industry was to deregulate services and open them up to competition. In doing so, he unleashed chaos on to our streets and sent bus usage plummeting.

The Transport Act 1985 removed the duty of local authorities to co-ordinate public passenger transport. It meant that operators could run bus services where they liked, when they liked and as they liked. There was no requirement for bus operators to consult before making changes to timetables or the position of bus stops. The criteria for registration did not include any reference to public demand or to existing services. The only place where that did not happen was London, where there has been regulated competition—competition for the market, rather than the cut-throat on-the-road competition of deregulation. Thanks to that, only Transport for London decides the routes, timetables and fares for buses in the capital.

In the majority of towns and cities deregulation has been a miserable failure. Statistics show that, since 1985, the number of bus journeys outside London has fallen. Journeys inside the capital have, however, increased significantly. Deregulation has led to reduced services, particularly in off-peak times, confused and changeable timetables and increased fares where there is a local monopoly. Since bus services are disproportionately used by the poor and those without access to a car, it is the socially excluded who are the worst hit by disruptive services.

Large operators in so-called bus wars very often use dirty and underhand tactics intended to drive out smaller competitors, rather than improve services. One such war is taking place on the streets of my constituency in Preston. The transport monster, Stagecoach, has moved in and is trying to kill off the local employee-owned Preston Bus company, which has been established for more than 100 years. It is the last employee-owned bus operator in the country and the only operator in Lancashire that has been involved in partnership schemes with the local authority. Of its 300 staff, more than 10 per cent. have worked for the company for more than 25 years, which highlights the integrity of the organisation. For three years, Stagecoach has targeted the profitable routes in Preston and undertaken an aggressive fare policy to increase pressure on Preston Bus business.

The situation intensified last summer when it emerged that Stagecoach wanted to buy Preston Bus. Selling to Stagecoach would result in serious job losses and cuts in service, so Preston Bus resoundingly said no to the proposal. During discussions with Stagecoach, Peter Bell, the managing director of Preston Bus, was left in no doubt that, if he did not agree to the sale, Stagecoach would secure the operations by hostile competitive means.

The regional director of Stagecoach, Tom Wileman, told Preston Bus that, if it did not sell, Stagecoach would take its business anyway. That resulted in the current fiasco in Preston in which Stagecoach is attempting to run Preston Bus off the road. Since their meeting, Stagecoach has waged war on Preston Bus—something that has made passenger services unreliable, disrupted and downright dangerous.

Stagecoach’s aim is to carry as many customers as possible at the expense of Preston Bus, and it has dispatched an additional 40 buses to run in the Preston area. The company’s tactics mean that it rarely keeps to registered timetables. The tactics have included keeping buses at stops until they fill with passengers; it is not unusual to have gaps of 20 minutes between services that should run every seven or eight minutes. The company has also taken an ad hoc approach to dispatching buses, so when a bus arrives at a stop without customers on board or without customers waiting, it will be sent back to the terminus to be dispatched at a busier time.

Controllers monitor the departure of Preston Bus vehicles, so that they can put a Stagecoach bus in front at key departure stops. My constituents have reported that some Stagecoach staff have driven dangerously to get in front of a Preston Bus vehicle. Those reports include one of a driver making a three-point turn on a busy main road and of one overtaking on the wrong side of the road. Some reports say that Stagecoach controllers have virtually forced passengers to board their buses rather than wait for a Preston Bus. I witnessed a controller taking a woman with a child by the elbow to get her to board a Stagecoach bus.

Stagecoach has also deliberately given false information to customers with the aim of undermining Preston Bus, including suggesting that Preston Bus was about to go bust, that its prices would be going up and that services were about to be cancelled. If manhandling and misleading customers were not enough, two Stagecoach drivers were convicted of throwing eggs at moving Preston Bus buses. The Lancashire Evening Post has reported extensively on those incidents.

I have listened carefully to the story of woe that is transport in Preston. Unfortunately, I am not shocked or surprised to hear it, because exactly the same thing happened in Manchester two years ago. Stagecoach has an appalling record. It is a subsidy junkie and a predator, and it engages in anti-competitive behaviour. Does my hon. Friend agree that we need to strengthen the Local Transport Bill, so that we can stop Stagecoach and other companies from behaving in a dangerous and anti-competitive way?

I totally agree with my hon. Friend, and I shall come to the Local Transport Bill later.

Stagecoach has altered its fares to undercut Preston Bus. It has offered free rides, and free day and weekly tickets to customers who would want to catch a Preston Bus vehicle. In September, Stagecoach increased fares in its other Lancashire operations, but froze fares that competed with Preston Bus. Those services operate at a substantial loss, but Stagecoach is a large international bus operator with some 10,000 buses, as well as major rail interests, so it can afford to spend money to gain a monopoly in Preston.

None of that enhances bus services or encourages higher patronage. Clearly, passenger satisfaction—and safety—comes a poor second to Stagecoach’s profits. Stagecoach now operates on most of Preston Bus’s most popular routes, but it provides no early morning service and limited or no evening or Sunday services. Fares have been lowered in Preston, but they are effectively subsidised by customers in other parts of Lancashire who pay a good deal more than double the new Preston rates, usually to travel on much older buses.

I should point out that Preston is only the latest city to witness such tactics. In the 20 years since deregulation, Stagecoach has resorted to bullying and hostile competitive practices around the country. Many people remember what happened in Darlington in 1995, when the local authority put its municipal bus operation up for sale. On failing to win the bid, the Darlington Transport Company was faced by Stagecoach, which rapidly recruited many of the former’s drivers, registered services from commercial routes and began to operate on a free-fares basis. The local company could not survive the onslaught and, following the withdrawal of the chosen bidder, it went bust. Stagecoach argued that the Darlington company was in trouble long before it arrived, but the Monopolies and Mergers Commission—now the Competition Commission—gave a damning verdict on its actions, stating that the company was

“predatory, deplorable and against the public interest”.

Stagecoach never apologised for the mayhem that it caused in Darlington.

Christian Wolmar, a national newspaper journalist at the time of the Darlington incident and the first reporter to break the story, noted that Stagecoach got away with similar events in Inverness and Lancaster. He also recorded that, in the decade after deregulation, Stagecoach was referred to the Office of Fair Trading some 30 times. Of those complaints, eight resulted in MMC hearings and seven found Stagecoach’s actions to be

“against the public interest”,

which forced the company either to divest or to be the subject of specific regulatory action. Of course, any action taken by the Competition Commission is welcomed, but at present it is taken painfully slowly. In many instances, punishment has been applied long after a small firm has been forced out of business, so speed of response is crucial.

Not only passengers get a raw deal out of Stagecoach’s actions; more than 1,200 bus drivers at Stagecoach in Manchester were today due to start six days of strikes. They were protesting at a pay deal that leaves them falling behind the Manchester market rate. The drivers, all members of the Unite trade union, currently earn almost 15 per cent. less than other Manchester operators. I understand that the strike has been narrowly averted. It is not surprising in such a climate that many passengers have turned to the reliability and ease of the private car.

The Government are striving to reverse declining bus patronage. Bus subsidies are at record levels, and the Transport Act 2000 improved the situation to some extent. One of the answers to the problems in Preston might be the introduction of quality contracts, which would replace open competition with a licence regime. Effectively, they are London-style franchising schemes, whereby operators bid for exclusive rights to run bus services on a route or group of routes. Under a quality contract, the local authority determines what services, including routes, timetables and fares, should be provided in an area.

An increase in the number of quality contracts would make bus networks more stable in that there would be less frequent changes to fares, timetables and frequencies; more reliable, because services would be monitored and there would be incentives for good performance; and better integrated, because having one brand, one network and one ticket would make fares simpler. Buses would be cleaner, because contracts could require bus operators to provide newer, cleaner buses and to maintain them properly. However, to date, no authority has ever applied for such a contract.

The Local Transport Bill addresses some of the issues that I have mentioned: it will allow greater flexibility to implement quality contracts, make it easier for those who want a quality contract to get one and replace the current arrangements with a new set of public interest criteria. The traffic commissioners will also have a stronger role in monitoring bus punctuality and a broader range of sanctions to impose on operators that are failing to deliver a punctual service. The Bill will also enable the traffic commissioners to hold local authorities to account for their contribution to punctuality performance, and it will allow the creation of an influential new bus passenger champion to represent the interests of bus passengers.

Quality contracts must strike the correct balance between cost and quality and, as I have said, take into account value for money, cleanliness, reliability, punctuality, staff training and vehicle environmental standards. Such contracts should also give local authorities powers to consider a company’s ties to the local community and thus its understanding of the community. Perhaps routes could be bid for in bundles, which could be packaged so that different routes were offered differently to meet the community’s needs.

Even more can be done. Traffic commissioners could be given more powers, not only to intervene and correct bad behaviour, but to work more closely with the competition authorities where quality contracts are not in place. The commissioners should be able to indicate to the competition authorities that the competitive commercial environment is leading to buses racing on inner-city roads and jostling for position and passengers at hotspots in our inner cities, with the consequent risks to passenger safety.

The competition authorities must be able to act quickly and must not wait until the competition has been killed of, as was the case in Darlington. It is only a matter of time before there are serious injuries or possible fatalities, because of cut-throat competition. Traffic commissioners should be able to work with the competition authorities where the competitive environment leads drivers and companies to adopt measures that are adverse to public safety, increase congestion and lead to dangerous driving of the type that I have described.

The competition authorities should be able to insist that the services that operators run reflect the true costs of the provision, rather than allowing routes in Preston to be effectively subsidised by customers in other parts of Lancashire or the country as a whole. Using the criterion of local market share, rather than national or even regional market share, in determining abuse of a dominant position does not take account of the true strength of a player or company in the market. Such changes are badly needed.

Members of Parliament from all parties are deeply frustrated that their constituents have so little influence over the state of their bus services. After 20 years of chaos, now is the time to allow local authorities to reclaim their streets and stop the “Wacky Races” that we see now. Only then will we put an end to bus barons blatantly disregarding passengers and public safety in favour of profits.

I congratulate my hon. Friend the Member for Preston (Mr. Hendrick) on securing a debate on a subject of such importance to his constituents and others. I hope that my remarks respond to the issues that he has raised, but if omit any, I assure him that I will write to him with further information.

Buses play a vital role in our transport system. Two thirds of all journeys on public transport are made by bus. It is important to the public—particularly those who rely on public transport—that buses work well, which for the most part means their offering a reliable and punctual service at a reasonable price. Where buses operate to their full potential, with the local authority and bus operators often in partnership, they offer a significant contribution to meeting national and local objectives. However, there are examples where, for whatever reason, bus networks are not fulfilling their potential and some communities are missing out. That is one reason why we introduced the Local Transport Bill, about which I will say more later.

Before moving on to discuss the situation in my hon. Friend’s constituency, it is perhaps worth giving a bit of the background to put it in context. As my hon. Friend has said, bus services outside London have been deregulated for more than 20 years. The majority of such services are provided on a commercial basis, without subsidy. Bus operators, most of whom are in the private sector, can register services on routes on which they wish to operate, subject to fulfilling some basic requirements, such as being licensed to operate a bus service and providing a timetable.

In general, bus services are open to competition from other companies. Such competition can benefit consumers through lower prices and improvements in the quality of the services being provided. There is no rule prohibiting big companies from competing with smaller companies: that happens in many markets. In some cases, a larger company’s ability to offer lower prices may simply be due to its being more efficient. Competition legislation—the Competition Act 1998—prohibits conduct that amounts to the abuse of a dominant position, although it does not in itself prohibit the holding of a dominant position.

I will now turn to the situation in my hon. Friend’s constituency: the so-called bus wars between Preston Bus and Stagecoach.

Will my hon. Friend the Minister respond to my point? Does not the current situation whereby the share of the market locally, rather than regionally or nationally, is considered in terms of a dominant position give a disproportionate strength to a national company at the expense of a small local company, even though the local company might have a greater share of the market in a single town, as in Preston?

My hon. Friend makes a straightforward, logical point about market distortion, which may be subject to elements that are outside the local environment. A company’s minor market share locally may not, as he says, mean that they are the smaller of the two operations, because it may be part of a much larger—indeed, a national—combine. I will return to that later.

There have been similar situations before—for instance, in nearby Manchester, as my hon. Friend the Member for Manchester, Blackley (Graham Stringer) mentioned. Whether in respect of retail business or buses, we have to determine whether competition rules are being abused in such circumstances. That is the job of the Office of Fair Trading, to which allegations of anti-competitive behaviour should be directed.

From my understanding of the local situation, the launch of new Stagecoach services in Preston around June 2007 represented, perhaps, the first large-scale competition in the Preston bus market for some 15 years. Stagecoach introduced high-frequency services with new low-floor buses and offered new ticket deals. Preston Bus responded by introducing low-floor buses of their own and began operations on traditional Stagecoach routes. On the face of it, that seems like good news for the consumer, but I recognise that there can be repercussions associated with intense competition for bus markets. Over-bussing routes, poor co-ordination of services and the absence of co-operation between operators can be detrimental to passengers, as my hon. Friend the Member for Preston said. That can also cause road safety and congestion problems.

The traffic commissioners have powers to impose traffic regulation conditions, where requested by a local authority, to prevent danger to road users or to reduce severe traffic congestion. Where a TRC is in place, all bus operators in the area must comply with it. In this case, Lancashire county council, as the local highway authority, monitored the operation of the increased bus services and felt that the situation presented potential dangers to road users. In view of that, the council applied to the traffic commissioners to introduce a TRC to prevent buses from stopping other than to pick up or set down passengers at a number of locations in Preston. That TRC came into force on 30 July.

Essentially, the aim of the TRC is to prevent buses from exceeding waiting times at bus stops in an attempt to get more passengers or block other buses. However, despite that TRC, I understand that the traffic commissioner is still receiving complaints regarding the operation of buses in Preston. The situation is being monitored. For instance, a recent survey was undertaken to assess compliance with the TRC. The commissioner is considering those complaints and whether regulatory action should be considered at a public inquiry. The county council is also holding regular meetings with representatives from both Preston Bus and Stagecoach to discuss the implications of the increased service on certain routes. There have also been complaints about the actions of some bus drivers. The traffic commissioner announced an inquiry into that matter, although it has been adjourned until the format of the hearing can be agreed.

Action is being taken locally to look into the Preston situation. We are also taking action nationally to help to prevent such occurrences from becoming more widespread. A large part of the Local Transport Bill involves giving local authorities a better range of options to improve local bus services in their area. The Bill will provide more opportunities for quality partnerships, allowing them to specify minimum frequencies and maximum fares. Operators would have to be willing partners in that, but the negotiating hand of local authorities would be strengthened.

In particular, the potential for partnership between local authorities and multiple bus operators would be improved, and experience shows that bus services work best when there are good relations between operators and local authorities. If the provision of bus services in local markets can be improved through partnership—to the benefit of consumers—the potential for future bus wars should be reduced. Bus wars might generate benefits in the short term, but they do not generally benefit consumers in the longer term.

When there is a strong case for quality contracts—the system adopted in London—we are making them a more realistic option. Local authorities must still demonstrate that the public benefits will be large enough to justify considerable influence in the market.

The Bill will also help to address some of the consequences associated with bus wars. Some stakeholders have commented that the current legislation does not provide sufficient flexibility for traffic regulation conditions to be applied until after problems have actually arisen. We have concluded that it would be useful for traffic commissioners to have the power to impose TRCs in anticipation of future safety or congestion problems, rather than having to wait for such problems to occur before taking action. As now, a TRC would still have to be requested by a local authority. In addition, we have determined that the time is now right to provide a more visible and influential voice for the bus passenger. As my hon. Friend said, the Bill includes provisions to take that forward. We plan to issue a consultation paper shortly that will outline the detailed options.

Competition between bus operators should bring benefits to consumers. However, when there are concerns about anti-competitive behaviour, the OFT should be informed. When there are concerns about the performance of buses on the roads, the traffic commissioners can take action, and they are continuing to investigate the situation in my hon. Friend’s constituency.

In conclusion, my right hon. Friend the Minister of State, Department for Transport is due to meet the chief executive of Stagecoach tomorrow, and I am sure that she will bring the debate to his attention, as I am sure that my hon. Friend the Member for Preston and I will bring it to her attention later today.

Order. As both the initiator of the debate and the Minister are present, we shall commence the debate early.

Thank you, Sir John. I am pleased to open a debate on an issue that is important to my constituents, and I am grateful to Mr. Speaker for having granted permission for it. I thank the Minister for attending; she is well known for her compassion and her understanding and for her knowledge of the NHS. I hope that the debate will be constructive, and I certainly do not intend to make any party political points.

I have been contacted by a significant number of people in my constituency who suffer from wet eye age-related macular degeneration and who have been told that they must either pay thousands of pounds for sight-saving treatments or go blind. Age-related macular degeneration is the most common cause of sight loss in the UK and accounts for 57 per cent. of all certificated visual impairment and blindness in this country. Of the two types of age-related macular degeneration—wet and dry—wet eye is the most virulent and can cause blindness in just a few months. There are some 250,000 people in the UK with wet AMD, and 24,000 new cases are diagnosed each year.

Wet AMD not only directly affects the vision; in the early stages it takes its toll on the ability to drive, read and see faces. It is the latter stage that causes blindness. However, it also restricts independence in the elderly. In fact, only arthritis and heart disease cause greater functional impairment in the elderly in this country. The difference in the case of wet AMD, however, is that it can be treated in a way that allows sufferers to continue to enjoy their independence and their sight.

Two licensed drugs for treatment of wet AMD are currently available on the market: Lucentis and Macugen. Those drugs are called anti-VEGF, and they work by neutralising the agent that causes abnormal blood vessel growth and by reducing the fluid leakage from blood vessels that causes wet AMD. Avastin is another drug used to treat wet AMD. In cases in which the local NHS provides treatment, it is the drug most commonly used. Avastin is licensed for treatment of some cancers but is also effective “off-label” in treating wet AMD, and is cheaper than Lucentis or Macugen.

The National Institute for Health and Clinical Excellence is the Government body that rations health care in England and Wales. Its soul aim is to ration or deny treatment within a nationalised health care system. None of the treatments that I have mentioned has NICE approval, although a decision on Lucentis and Macugen might be made in the spring of next year. However, NICE has been dragging its feet in providing guidance, and its delay is allowing people to go blind. Primary care trusts have an excuse not to prescribe anti-VEGF drugs as a course of treatment because they can hide behind NICE. That is where our problem lies.

The Northamptonshire Association for the Blind has stated that 80 per cent. of patients with wet AMD in this country will be denied sight-saving treatments on the NHS. The other 20 per cent. of sufferers will have to go blind in the first eye and start losing sight in the second before receiving treatment. If there is a drug to cure people, they should be treated on the NHS. After all, the elderly people whom the disease affects have paid taxes all their lives to fund the NHS.

It is true that the disease affects older people. However, one of my constituents, Lynne Smith, is just over 50, and is not receiving treatment. She has been told that she must start to go blind in her second eye before the treatment is available. Does the hon. Gentleman agree that that is totally unacceptable?

The hon. Lady’s intervention is very positive. She is correct in what she says, although I shall explain later that that policy is not universally applied across the country. There are different ways to treat wet AMD.

I should like to read a passage from a letter I received from the Northamptonshire Association for the Blind. It says:

“This appalling situation is totally unacceptable, and is, we understand, based totally on cost. The appropriate treatments, Lucentis and Macugen, are freely available in Scotland. It is almost as if England is now a third-world country when decisions about eye health and AMD are made.”

The letter refers to the crux of the problem that we have in parts of this country: cost and funding of the local NHS. My constituents go to see their GP who then refers them to a consultant who diagnoses wet AMD. The good news that they tell patients is that the patients can be treated and cured. The bad news is that treatment cannot be done on the NHS in their area, but if they go to the private hospital two miles down the road, they can be treated at £1,100 per eye per injection and their sight can probably be saved.

I do not blame the consultants; they are right to tell patients that the drugs are available privately, rather than telling them that there is no treatment at all. However, we are talking about elderly people who do not have thousands of pounds spare to save their sight. In any case, why should they have to fork out their hard-earned savings when other areas of the country prescribe anti-VEGF drugs freely? If my constituents lived in Southampton, Sheffield or Liverpool, they would be treated with sight-saving drugs on the NHS. Of course, if they lived in Scotland, I would not need to have this debate at all. The Scottish Medicines Consortium—Scotland’s equivalent to NICE—has already approved the use of Lucentis and Macugen. Indeed, Lucentis and Macugen are approved for use and reimbursement across much of mainland Europe.

My local Northamptonshire primary care trust runs a second-eye policy. That means that patients with wet AMD may be treated with photodynamic therapy in the first eye, which is a less effective treatment, if they meet the stringent criteria. Patients will not be treated with anti-VEGF drugs until they start losing their sight in the second eye. Again, they have to meet the east midlands’ exceptionally stringent regional criteria.

The decision-making process is long and bureaucratic and requires a trip to Leicester. By the time the decision is made, patients’ sight will have deteriorated considerably, or they could have gone blind. Such an alleged choice is in fact no choice at all. I suggest that that criterion, which was put in place only recently, was cobbled together solely to avoid patients suing the PCT. I believe that the decision is made not on clinical grounds but, sadly, on financial grounds.

Through recent clinical trials, Lucentis has been shown to improve sight in 70 per cent. of patients with wet AMD, and 40 per cent. of patients experience the significant improvement of three lines on a vision chart. When someone goes to an optician, they are asked to read letters on a vision chart. Let us imagine the improvement to their quality of life if, after treatment, they could suddenly read three more lines on the vision chart.

Let me give an actual example by describing how the delays and bureaucracy have affected one of my constituents. Mrs. Durrant contacted me after waiting for an unacceptably long time to hear whether she was eligible for treatment. Her consultant went through the correct procedure to try to get her treated with Lucentis on the NHS. He filled out all the necessary forms and sent them on to the east midlands specialised commissioning group for its approval. After a long wait, Mrs. Durrant was told that she was not eligible for Lucentis treatment on the NHS because she did not meet the interim criteria. However, she was also told that the criteria were now being changed and she would be referred for a second opinion. Once again, the decision took an inordinate amount of time, but this time round with devastating consequences—Mrs. Durrant went blind while waiting for a decision on her treatment.

When such decisions are made on financial grounds rather than on the basis of clinical judgment, the long-term effects on cost and funding are phenomenal. Costs for courses of treatment with Lucentis or Avastin vary greatly from hospital to hospital, but they are about £500 to £1,000 to the patient per injection. A course usually involves three injections of Avastin or six injections of Lucentis. Let us compare that to the hundreds of thousands of pounds that it costs to support someone who is registered blind. The state must support people who are registered blind with care in their daily lives. Why not save those costs and give back people’s independence by spending just a fraction of the money that would be needed to care for a blind person and giving them sight-saving treatments when needed?

One of my constituents, Mrs. Doreen Marshall, who is in her 80s and suffers from wet AMD, contacted me after being refused sight-saving treatment on the NHS. Mrs. Marshall, a lovely lady, is the main carer for her disabled husband, who is in his 90s; they live independently. Mrs. Marshall cannot afford to go blind, as she has to give her husband 24-hour care. Although the authorities were well aware of her situation, the only option that they gave her was to pay privately for treatment. She was going blind in both eyes and had no choice but to pay for treatment so that she could continue to look after her husband.

What an incredibly shocking situation. Had Mrs. Marshall not paid for treatment and gone blind, the state would have had to pay out hundreds of thousands of pounds, not only on her care but on her husband’s as well. Of course, Mrs. Marshall did not want to go blind or to be a burden on the state, so she was forced to scrape together the money to save her sight. However, there is some good news to report. Whittlebury Hall hotel and spa in Northamptonshire heard of Mrs. Marshall’s plight and has very kindly refunded the cost of her private treatment.

Another of my constituents, Mrs. Ruby Waterer, had to use savings that were meant for her funeral to pay for sight-saving drugs. Mrs. Waterer was the first of my constituents to approach me after being told that the local NHS would not treat her. She used her funeral savings to pay for her first injection of Avastin, and her family paid for the second injection. However, to complete the treatment, she needed three injections and she had no way of raising any money to pay for the final injection.

Mrs. Waterer’s situation attracted a lot of local and regional media interest, and I brought my constituent’s case up on several occasions in Parliament. Kettering general hospital, rather than the PCT, agreed to fund Mrs. Waterer’s third injection and refunded her the money for her second injection. The reason why it agreed to fund the last parts of the treatment was that there was such a delay in making a decision on her case that she was losing her sight more rapidly day by day. Congratulations to the hospital on stepping in. However, it took a huge media campaign for that to happen. I can now report that, following her course of treatment, Mrs. Waterer has regained her sight. Imagine how many other people’s sight could be saved if decisions were made on a clinical basis rather than one of cost.

My local PCT is the worst funded in the whole country, according to the national capitation formula. This year, Northamptonshire PCT was underfunded by £38 million. Over the past four years, the Government have given local health care almost £150 million less than the Government themselves say that it needs as a minimum. It is for that reason and that reason alone that sight-saving treatment in my area cannot be given on the NHS.

This is not a case of the postcode lottery. That implies that underfunding happens by chance, on an accidental basis, but it is a deliberate action by the Government not to fund health care in north Northamptonshire to the level to which it should be funded. Where PCTs are funded properly, sight-saving treatments are available; where PCTs are underfunded, such as in my area, sight-saving treatments are not available. Northamptonshire PCT must receive the level of funding that the Government say that it should receive, so that people in my area are not forced to go blind when their sight can be saved.

I very much hope that NICE will grant approval for both Lucentis and Macugen very quickly, so that PCTs cannot hide behind NICE interim guidelines any longer. That has done nothing but cause confusion to local health professionals and patients. The most recent case that I have been contacted about sums the point up perfectly. Mrs. Elderton contacted me last week in despair. In January, February and March of this year, she paid out privately for three injections of Avastin, as she was told that she could not have the treatment on the NHS. She could not really afford the treatment, as she survives on her state pension, but somehow she managed to pay the money to save her sight.

In May this year, Mrs. Elderton was told by the specialist in Leicester by letter that should her sight deteriorate, she would now be eligible for treatment on the NHS. Though her sight has deteriorated, she has now been told that the NHS will not fund her treatment because the criteria have changed since she was promised NHS treatment in May. She has been informed that she has to start losing the sight in her second eye before she will be eligible for NHS treatment. Mrs. Elderton cannot afford to pay for more sight-saving treatment privately. Moreover, my constituent was given a promise of treatment on the NHS, but now that the criteria have changed, that promise has been broken. That is just not acceptable.

I ask the Minister to do the following things to stop people in my constituency and many others throughout the country going blind unnecessarily. First, Northamptonshire PCT must be funded properly. Underfunding our local health service by £150 million in the past four years has had a profound effect on the level of health care that my constituents receive compared with those in other parts of the country. Will she undertake to ensure that in future Northamptonshire PCT will be funded to the full level of the national capitation formula? Secondly, will she put pressure on NICE to make a decision quickly on prescribing Lucentis and Macugen on clinical, not financial, grounds? Thirdly, will she intervene with Northamptonshire PCT to make it mandatory for sufferers of wet AMD to be treated on the NHS with sight-saving treatments?

PCTs across the country must be informed by the Government that sight-saving treatments must be compulsory on the NHS so that there are no loopholes or excuses that local health authorities can hide behind. If a nationalised health service is to have any point, the Government must have the power to step in and direct PCTs to undertake certain treatments, as they have correctly done in certain areas of cancer care. Will the Minister take up the sad cases of the constituents whom I have mentioned and of others in my constituency who have been affected?

Finally, I know that we have a well-respected and compassionate Minister replying to the debate. The Department of Health has already agreed to send a Health Minister to Kettering hospital to discuss health problems in the area. I hope that by the time that visit takes place we will be well on the way to solving the problem of those constituents of mine who are going blind unnecessarily.

I congratulate the hon. Member for Wellingborough (Mr. Bone) on securing this timely debate.

I am sure that we would all be greatly concerned at any risk to our sight or that of our loved ones. Approximately 26,000 new cases of wet age-related macular degeneration occur every year. As the hon. Gentleman illustrated so graphically, it is the most common cause of sight loss in people aged over 60. We can only try to understand how worrying and difficult it must be for someone who is at risk of losing their sight.

We all want to see the best treatments made available as rapidly as possible. Understandably, there is a lot of interest in the subject. Not only has the hon. Gentleman undertaken energetic work on behalf of his constituents, but other hon. Members have mentioned the issue to me. Indeed, I have constituents who have mentioned it, too. There is a lot of interest, particularly surrounding the development of new treatments that potentially offer hope to more patients.

In order to try to provide that best possible service to patients, we have a duty to ensure that new treatments used on the NHS are both clinically effective and cost-effective. I know that the hon. Gentleman would feel strongly about that. That is why NICE was set up in 1999. Before that, prescribing practice varied across the country and we still see variations. Through NICE, we are trying to ensure that guidance is issued that gives certainty, clarity and transparency to the national health service. We are trying to move away from different appraisals at local, regional and national levels, with different evidence being used, which can mean that different recommendations are given about access to treatment. It is about trying to ensure that we have coherent guidance.

NICE was asked to consider the matter of wet AMD, which is complex. It has already recommended the use of photodynamic therapy to treat wet AMD in some patients, and all PCTs are funding that treatment in accordance with the guidance. NICE is currently appraising Lucentis and Macugen for the treatment of AMD. Its appraisal committee met on 14 November to consider the responses it has received from stakeholders on the additional economic modelling for the original appraisal. The hon. Gentleman talked clearly about some of the issues to do with the interdependencies between families and communities and about what needs to be taken into account. NICE is appraising the two treatments together. That makes it more complicated. It is difficult, and NICE has to get it right if we are to have clear guidance across the NHS in England about what works and what should be available to patients, as the hon. Gentleman and I both want.

Macugen and Lucentis—I shall talk about Avastin separately—have been developed at about the same time and for the same condition, and so it is sensible to appraise the two treatments against each other to ensure that the NHS receives one piece of guidance and patients receive the most clinically effective and cost-effective treatments. That means that the appraisal is more complex. The hon. Gentleman asked me to put pressure on NICE and to encourage it to make progress, while respecting its independence. I, too, want to see a conclusion as quickly as possible, as would all hon. Members. However, we want to see it done correctly because of the difficulties and the importance of the subject.

I remind the hon. Gentleman that even while that process is taking place, doctors can prescribe Macugen or Lucentis in advance of NICE guidance if they believe it is the right treatment for their patient. The PCTs should be undertaking that. Guidance has been issued to the effect that decisions should not be based simply on cost. We have made it clear to the NHS that treatment should not be withheld simply because NICE has not issued guidance.

The Department issued guidance on managing the introduction of new health care interventions in December 2006. It advises NHS organisations that until NICE has published final guidance on a treatment, NHS bodies should continue with local arrangements for introducing new technologies based on an assessment of the available clinical evidence. The hon. Gentleman rightly mentioned variations, which are part of the system that we are trying to rectify. We have given the clearest possible guidance to ensure that all the sources of information help PCTs to make the right assessment. I cannot put it any more strongly. The hon. Gentleman asked me to balance the local accountability and decision making of the health service with the knowledge and understanding of what it needs to provide to its population. Clear national guidance about the parameters in which that should be done is aimed at ensuring that we do not have a postcode lottery like the one that he described.

The hon. Gentleman also mentioned Scotland. The Scottish Medicines Consortium approved Macugen and Lucentis and accepted them for use in the national health service in Scotland to treat wet AMD. Once NICE’s appraisal of Macugen and Lucentis has been completed, and the guidance issued, it will supersede the guidance from the Scottish Medicines Consortium on Macugen. It is crucial, therefore, to make the right decision.

Avastin is not licensed for the treatment of wet AMD, although it is used by some clinicians if patients agree. The companies involved in its making and distribution have no plans to seek a licence for its use in treating wet AMD, and no clinical trials have been conducted for that purpose. The hon. Gentleman may think that it is regrettable, but the Government have no power to make a manufacturer seek a licence for a particular drug, although clinicians can still prescribe it.

The hon. Gentleman mentioned funding for his PCT. The 2007 comprehensive spending review continues a decade of unprecedented investment through a three-year settlement for the Department, which has increased the NHS budget by four per cent. a year in real terms. That takes the total funding from £35 billion in 1997-08 to £110 billion by 2010-11. I do not blame him for pressing his point about his PCT’s funding, but he will know that the House has discussed the fact that other areas of the country are receiving considerably more than the funding formula recommendations. The Government inherited that situation.

We are trying to ensure a growth in the budgets of every PCT and that, through the pace of change programme, PCTs receive the funding suggested by the formula. The hon. Gentleman understands the complexities of those finances and will appreciate that that process must be sensitive. It is not just a question of taking money away from an over-funded area and moving it somewhere else. I assure him, however, that the Government are taking action, and will continue to do so.

This point is the most difficult for my constituents to understand: despite the fact that the Government correctly work out a national capitation formula, some areas are being overfunded. Arguments in defence of that do not wash in my area. I understand the Minister’s problem, but will she give us hope that the gap will be closed perhaps next year and that we will get our full capitation allowance?

I do not want to mislead the hon. Gentleman: that cannot be dealt with in one year. A few months ago, this House debated extensively the Government’s intention to close the gap. I know the details of that because I was a Minister replying. I am happy to write to him about our efforts to close the gap, which include an independent committee looking at the weighting in the formulae towards different PCTs.

The hon. Gentleman agrees that it is necessary for PCTs to determine how they use their funding allocations to commission services that meet the health care needs of their local populations. That has to be transparent, which should include judgments where there is no relevant NICE guidance, which we have in this case. The Government have done a great deal to make clear to all PCTs how we intend to proceed in the interim.

In conclusion, we all hope that Macugen and Lucentis fulfil their potential. It is important not to prejudge NICE’s evaluation of those drugs, which is why clear guidance has been given. I am as keen as anyone for those results to be made available as soon as possible, but they must be correct and the economic analysis and the evidence as full as possible.

I hope that my comments today, and what I shall send in writing to the hon. Gentleman, about funding and treatment for age-related macular degeneration, will be provided when a PCT judges the evidence in order to justify an intervention. I hope also that I have set out the importance of an evidence-based approach to dealing with the introduction of new treatments. On this matter in particular, I could not agree more with his points and those of my hon. Friend the Member for Halifax (Mrs. Riordan) about the importance of dealing with this condition and of sending clear messages to our communities about our determination to get this right. I hope that I have made the Government’s intentions clear. We cannot intervene directly in NICE’s work, because it is independent. If he wishes to raise further issues, I am happy to speak to or correspond with him, and I undertake to get details of the funding issues to him as quickly as possible.

Question put and agreed to.

Adjourned accordingly at three minutes to Two o’clock.