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17 Jan 2001 : Column 118WH

Radioactive Discharges (River Tamar)


Mr. Colin Breed (South-East Cornwall): I should like to say how much I support Her Majesty's dockyard at Devonport, Devonport Management Ltd--which runs the dockyard--and the naval establishment as a whole, which is not only extremely valuable to the economy of the area, but a strategic part of the defence of the country.

I also welcome HMS Raleigh, the naval training establishment in Torpoint in my constituency, and the recent transfer of the submarine school to Raleigh, skilfully organised by Commander Peter Payne-Hanlon, to make the establishment the Navy's premier training centre. But--and it is a very big but--the Ministry of Defence, the Navy and DML do not own the River Tamar, which is in an area of outstanding natural beauty. There are a number of sites of special scientific interest. It is a working river used by commercial interests, including passenger ferries, and by pleasure and leisure craft. The Navy, the MOD and DML share that river, but of course in their particular position they share a greater responsibility to all those who use the river and live close to the river and the dockyard.

Recently licences have been issued, initially to the MOD in 1968 and then to DML in 1987 and again in 1997, to allow them to discharge radioactive liquid into the River Tamar. Those discharges have obviously been carefully considered and properly controlled. At present, the Environment Agency is considering a renewal of that licence, and changes to some of its conditions. In recent times there has been a greater public concern about the whole issue of radioactivity and its effects on health. Perhaps one of the only certainties about radioactivity and health is uncertainty. As we learn more and more about the effects of radioactivity, we adjust our standards and seek to install protection.

Part of that analysis has to be an understanding of the risks. Not unnaturally, the public as a whole are not fully aware of all the scientific work that is undertaken. However, it has to be taken into account that the public support for the dockyard and the Navy cannot be taken for granted. The public wish to become more involved, and to understand more of what is involved in discharging radioactive liquid into the River Tamar.

The present licence, which is currently being considered, concerns two particular substances. DML proposes to increase the amounts of tritium discharged into the river by nearly 800 per cent. Tritium is hazardous in that, being a weaker form of radiation, it does not shoot through human cells like bullets. However, it is able to lodge in the cell and cause mutation. In effect, its weakness is its strength. Because of its weakness it can be widely dispersed around the body, giving what is termed a whole-body dose. In this way it passes through the food chain, beginning with the sea life that ingests it with the water, and can then be discharged. Tritium has a so-called half-life of a little over 12 years. It has plenty of opportunity, once expelled from the body, to re-circulate eventually into local watercourses.

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DML also plans to decrease the amount of cobalt 60 discharged into the river. Cobalt 60 is known to be a hazardous waste, and it is therefore a great advantage that we are seeing a reduction in that waste disposal. It is a powerful source of gamma rays. It kills cells. Gamma particles penetrate deep into the body and are undoubtedly hazardous. Long-term effects can bring about genetic changes and cause malfunction in offspring.

Importantly, it seems that in this case not much thought has been given to the fact that the River Tamar is a tidal estuary. Those who know that river will be aware that when the tide goes out, it exposes quite a lot of mud banks. The particles that settle down into that mud are then, when the mud dries out, capable of being blown by the wind into the air that we breathe and the food that we eat, blowing around the area immediately adjacent to the River Tamar. That area is fairly heavily populated now: 260,000 people live in Plymouth and in my constituency there are two large towns, Saltash and Torpoint, probably with a further 30,000 people. We are talking about almost 300,000 people living in reasonably close proximity.

We do not know precisely the health effects of exposure to what is known as organically bound tritium, or the details of the metabolism of OBT. Nor do we know the consequences of radiation-induced genomic instability, but it seems unlikely that it would play no part whatever in the processes that can lead to cancer. This ignorance should lead to caution about exposing any populations to ionising radiation.

Particularly worrying is the risk of permanently polluting the human gene pool. As far as tritium is concerned, it is reasonable to question whether people are being exposed to levels that could harm them. Levels of exposure to tritium currently deemed safe may, in the not too distant future, be proved to be harmful to those exposed, and to many future generations.

It is difficult not to sound alarmist on this, because DML has explained to me, and to many others that have written to it or approached it, that it has to comply with very stringent standards in respect of any liquid, and these are properly monitored by the Environment Agency. It is a little disturbing that such licences as are granted do not have any time limits. There is no limit to the length of time that DML may use its licence, although of course the Environment Agency will monitor the situation and could insist on changes. It may be time for any licences that are now granted to be subject to at least a time limit, giving standard reviews of the situation.

Time limits would be even more appropriate, given the slow creep and build-up of nuclear activity and nuclear waste in the same area. It has been suggested that Devonport may well be where decommissioned nuclear submarines will be stored for some considerable time, and that may well be the most appropriate way of storing those decommissioned units. That would increase the possibility of nuclear and radioactive discharges.

A little way along the river, a development known as RAFT--the Remote Ammunitioning Facility Tamar--is under way. I support that and firmly believe that RAFT will significantly improve the dockyard's safety and operation. Although some people are trying to

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prevent that development, I believe that it is appropriate. I see the development site from my property, so hon. Members can rest assured that I would be most concerned about any safety problems.

I want to issue a caution in respect of the way in which the RAFT development obtained permission and licensing. It was a highly controversial development and permission was given after considerable public consultation and work by the dockyard and DML. Conditions were imposed by the Environment Agency, which of course is the monitoring agency for the entire exercise. Two important conditions were that a consultation exercise involving local fishermen should be carried out and that the discharge site, where sediments would be dumped, should be properly monitored. Neither was complied with when work commenced.

I have received a letter from the Ministry of Agriculture, Fisheries and Food, stating that the Ministry of Defence had reacted quickly to offer a meeting with fishermen as soon as their concerns were raised, but that the offer was declined. The fishermen rightly had expected a consultation before the work commenced, not afterwards. Similarly, the monitoring of the dumping site was set up after work had commenced.

Another aspect of RAFT is causing environmental and safety concerns. The history of the site for that extension to the dockyard includes the presence of second world war ordnance. That was known and surveys were undertaken, but as development has proceeded, new ordnance has been discovered. A letter from the Ministry of Defence states:

Hon. Members can imagine that, in the light of all the public concerns, there is considerable consternation. Will the Environment Agency monitor the discharges properly? Can the discharges be considered for removal from the site? Is it necessary in this day and age to discharge them into the river? Is it a matter of cost that they cannot be dealt with elsewhere? Is it right for the long-term storage of decommissioned nuclear submarines not to be taken into account in relation to the other matters, which amount to a concentration of radioactive material in an area of relatively high population?

As I said at the start of the debate, I and many people in the south-east Cornwall and Plymouth area are, and probably always will be, supportive of the dockyard and its activities. It has grown up alongside them over hundreds of years. Many of us who have been there for some time actively support the dockyard and want to help it. However, it is right that it takes account of public concern. Public consultation means informed consent as to what goes on.

I hope that the MOD, DML and the Environment Agency will become more proactive in seeking public consultation by providing the information that people

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need to understand the risk assessments and to feel comfortable about what is happening. The Environment Agency has the strength of its monitoring and the regulations in place to ensure that when conditions are imposed, they are complied with, so that we see a safe dockyard and safety for local residents; demonstrated by the scientific community, but also understood by local people so that they feel comfortable. If that is not the case, I fear that some of the existing good will and support for the dockyard will begin to erode. That would be disastrous for south-east Cornwall, for Plymouth and for the whole nation.

12.46 pm

The Minister for the Armed Forces (Mr. John Spellar ): I congratulate the hon. Member for South-East Cornwall (Mr. Breed) on securing the debate and on the way in which he has raised the understandable and legitimate concerns of people in the south-west regarding nuclear discharges into the River Tamar. I particularly welcome his words on the importance of the dockyards to the area.

As everyone knows--and as the hon. Gentleman emphasised--the area around the Tamar is one of great natural beauty. Plymouth sound and its associated estuaries are an important area of international marine conservation, supporting nationally important numbers of wintering and passage wildfowl. We understand local concerns for the safety of that environment and for the health and well-being of the local population, as well as for the tens of thousands of visitors who flock to the south-west each year for the pleasure of relaxing on the beaches and taking part in other outdoor activities. Tourism contributes significantly to the local economy, so I recognise the importance of balancing the industrial demands of the region with the need to conserve the innate qualities of the area. We are fortunate in the United Kingdom to have highly effective legislation to help to protect the environment for future generations.

As the hon. Gentleman recognises, the economy of Plymouth and the surrounding area, including his constituency, benefits greatly from the Royal Navy's presence at Devonport and the ship and submarine refit and repair work undertaken there. For over 300 years, the royal dockyard at Devonport has provided constant and effective support to the Royal Navy. Nuclear submarines, of course, have an important role in today's Navy. Their ability to remain submerged and operate independently from land bases or supply ships for long periods is fundamental to the Navy's protection and deterrent operations.

Devonport not only supports the submarines of the Royal Navy in operation and maintenance, but provides a home for four decommissioned nuclear-powered submarines that have reached the end of their operational service. As hon. Members will be aware, the present Government have made proposals for moving away from the policy of storage afloat for the redundant submarines. We are therefore examining the potential for dismantling them and storing them on land--the hon. Gentleman drew attention to that.

I appreciate that aspect was only a small part of the issue raised by the hon. Gentleman, but I know that land storage of the submarines is a matter of great concern

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and interest in Plymouth. The debate gives me the opportunity to make it clear that no proposals have been made to me or to any of my ministerial colleagues suggesting that we should break up and store decommissioned nuclear submarines at Devonport, or at any other specific site. We have continually stressed that detailed investigations of the most suitable sites for the cut-out and land storage will be undertaken in the next stage of the study, which is now under way. No specific sites have been recommended.

I suppose that it is understandable that we should hear speculation from several of the nuclear "pundits" on what they think is the most likely site. However, let me make it clear again that no decisions on the site have been taken. It is our consultations with the public and the proposals that we receive that will influence any decision.

I now return to the main part of the hon. Gentleman's speech. In the early 1970s, a submarine refitting complex was built at Devonport specifically for the maintenance, refitting and refuelling of our nuclear-powered submarines. The Ministry of Defence remains committed to the refitting of nuclear submarines at Devonport, as was underlined in our strategic defence review, which also supported the continued use of nuclear submarines. Submarine refitting will provide a steady long-term work load in the area, worth more than £1 billion over the next 10 years. As the only dockyard that will refit the Royal Navy's substantially larger Vanguard class submarines, a major building and civil engineering project is under way to provide a new Vanguard facility to the latest seismic standards.

It is because of that important Vanguard work that Devonport Management Ltd, the owner and nuclear site licensee of Devonport dockyard, submitted an application to the Environment Agency last May to vary the levels of radioactive discharges from the dockyard site. The disposal of radioactive waste and effluent is, quite properly, under the regulatory control of the Environment Agency. The agency is the enforcing authority that grants disposal authorisations under the Radioactive Substances Act 1993. Nothing that I say here is intended to prejudice the Environment Agency's independent review of the issues, although I and my colleagues in the Department are wholly convinced of the benefits of continuing to develop the arrangements at Devonport.

No high-level radioactive waste is produced from the nuclear activities of the dockyard owners. When a submarine is refuelled, it is the responsibility of my Department to manage the removal of the spent nuclear fuel from the dockyard. The highly radioactive material is transported for long-term storage at the Sellafield site in Cumbria, which is run by British Nuclear Fuels Ltd. Intermediate-level waste at Devonport is stored safely and securely in a purpose-built waste store to allow radioactivity levels to decay to low levels. All low-level radioactive waste, in solid form, is eventually consigned for disposal to Drigg, which is also in Cumbria. Very low-level solid waste, such as protective clothing that is only slightly contaminated, is suitable for disposal with non-radioactive waste to licensed landfill sites. Similar procedures apply to clothing used in the medical sector.

Liquid radioactive waste generated at the dockyard may, depending on its origin and level of activity, be discharged to the dockyard sewers or into the Tamar

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estuary. I would like to stress, however, that before waste is discharged into the estuary it is treated in a specialised effluent treatment plant to remove contaminants. It is that waste water that is then discharged into the river. When planning nuclear work, DML conducts reviews to assess how much waste will be generated, and then takes every possible step to minimise that waste. In practice, DML's discharges and disposals are generally well below authorised limits.

The Centre for Environment, Fisheries and Aquaculture Science undertakes periodic monitoring in the Tamar estuary on behalf of the Food Standards Agency. In addition to that annual monitoring, DML carries out quarterly surveys. Each survey takes two days. In addition, the Defence Radiological Protection Service carries out a more extensive annual survey. The monitoring shows that the impact on the local marine environment of radioactive work in the dockyard is so low that it is below the limits of detection.

DML's current application seeks approval to vary the levels of radioactive waste that the company is currently authorised to discharge from the dockyard site. The application covers not only liquid discharges but the removal of solid waste from the site and any release into the air. We are debating one aspect of that today--the liquid discharges into the Tamar. Although the radiation dose from those discharges to members of the public will be less than four hundredths of that typically received from naturally occurring radiation sources, it is nevertheless important that the application should be rigorously scrutinised, and rightly so. As the hon. Gentleman rightly stressed, it is also important that local people should be consulted about the proposed changes. The consultation process is the responsibility of the Environment Agency.

I understand that the Environment Agency is currently preparing a consultation document. When it is ready, the agency will hold a formal three-month consultation period. That is likely to commence before spring this year. The consultation will be widely advertised, and the documents will be made available for examination at the Environment Agency public register in Exminster, the public register at Plymouth city council and at various libraries within 25 km of Devonport dockyard. The consultation documents will also be sent to town and parish councils in that area.

Soon after the consultation process commences, the Environment Agency proposes to hold a public meeting in Plymouth. Issues that have been raised will be considered as part of the formal consultation process. I understand that the date, time and venue of the public meeting will also be widely advertised.

The Ministry of Defence will be assisting in that process. Although there is a legal question as to whether the Environment Agency is required to consider whether defence nuclear programmes giving rise to radioactive discharges are justified, successive Governments have taken the view that it is a matter for Ministers, in consultation with the House. My Department will co-operate fully with the Environment Agency.

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The Environment Agency will reach a decision only after all the issues raised have been considered. The reasoning behind its decision will be set out in a decision document to be issued when the decision is taken. That document will also record the major issues raised in the consultation process, and the Environment Agency's response and views on those issues.

Approval of DML's application is necessary to enable Vanguard class nuclear submarines to be refuelled and refitted at Devonport dockyard. The first of those refits, on HMS Vanguard, is due to start in 2002, and the only facilities in the United Kingdom that can undertake that work are at Devonport. Vanguard submarines deploy Trident missiles, and the refitting of the submarines is essential to the maintenance of our independent strategic nuclear deterrent. The work can therefore be done only at Devonport.

I have said that DML's application is linked to Vanguard class submarine refitting and refuelling activities. However, I should like to explain why it is necessary to change the disposal levels. Nuclear submarines produce radioactive waste during normal operations. The water from the reactor plant in older classes of submarines has to be discharged in operation. Occasionally, that is done at sea, where the extremely low levels of radiation can be dispersed in the vastness of the oceans, or to a dedicated shore facility when the boat is berthed alongside, for example at Devonport. In both cases, these discharges are only ever made under strictly controlled conditions and after the water has been treated.

The reactor plants in Vanguard class submarines are of a new design. The coolant water, which in older classes of submarines requires to be discharged, is now retained on board. That enables it to be reused in the reactor cooling system, and effectively eliminates the requirement for discharging at sea. Because of that recycling process, there is an increase in the concentration of some radioactive contaminants in the water, such as tritium, which is a radioactive form of hydrogen. That has to be dealt with during the refitting process.

The nuclear industry is continually seeking to improve the processes for removing radionuclides from the waste stream, through the development of better extraction processes, but there is no practical method of separating out liquid tritium. However, the radiation exposure to the general public from tritium discharges at Devonport will be virtually indistinguishable from natural background radiation levels. That is the case even in those areas of the country that, unlike the south-west, have particularly low natural background levels. To illustrate that point, the quantities of tritium involved in the new discharge application are similar to those used commercially to provide illumination for compasses and dials, which the Radioactive Substances Act 1993 allows to be disposed of in local authority waste.

The hon. Gentleman also mentioned the reduction in the most radiologically significant constituent of the liquid waste stream, cobalt 60. Some cobalt 60 can now be extracted and dealt with as solid waste.

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NHS Plymouth Derriford Hospital

1 pm

Mrs. Linda Gilroy (Plymouth, Sutton): Plymouth Derriford hospital is the largest provider of tertiary health services for the Devon and Cornwall peninsula, which has a population of 1.6 million. It also provides the full range of district general hospital services for its local population, some 430,000 people in Plymouth, South Hams and west Devon and east Cornwall. The south and west region has two principal tertiary centres at Bristol and Plymouth. The Bristol trusts are a long way from the peninsula, particularly Cornwall and Plymouth. In the past four years, Plymouth Derriford hospital has received extra investment in areas that desperately needed it after 18 years of Conservative underinvestment in our health services. It received nearly £2.5 million of extra capital and revenue funding for breast cancer treatment. A further £3.5 million has been invested in a new unit for other cancer services, and we have now been designated a regional cancer centre. An extra £12 million of revenue and capital funding has been made available to cardiac care. To modernise the accident and emergency department, Derriford has been allocated £750,000. Plymouth is to receive a substantial amount of extra money, as well as money to train many of the 1,000 extra doctors that are required nationwide. We are excited that many of those doctors will be trained in Plymouth, following the founding of the new peninsula medical school.

In the lead-up to the publication of the NHS 10-year plan, I carried out a local survey in my constituency to find out how my constituents felt that the extra investment could best be used to restore and build the NHS. It will not surprise the Minister that Plymouth people recognise that the urgent need to recruit new staff is basic to improving the quality and efficiency of the service. Last summer, I spent an afternoon on the medical assessment unit in Derriford. I shadowed Sister Louise, who was in charge. In taking an interest in some aspect of admissions, I only had to blink to find myself running to keep up with her as she attended to the next pressing priority competing for her attention. At the end of the afternoon I had a good idea of just how hard-pressed health staff can be.

I also visited the pathology laboratories, and was impressed by the dedication of the staff dealing with things that are immensely important to hospital patients and the community. I was shocked by how little some of them were paid, and was not surprised to learn that there was 100 per cent. turnover in the lower grades in some sections. Last April, I presented a petition to the House calling on the Government to recognise the problems of the pathology service across Devon, especially in terms of recruitment and retention. I am delighted with the announcement made 12 days ago that all support staff not covered by the pay review bodies are to receive an above-inflation settlement of 3.7 per cent., with the laboratory staff receiving between 3 and 13 per cent. on top of that.

A further finding of my survey was that two out of three people did not know of the Conservatives' plans to introduce insurance or charges for many operations, including hip and knee replacements and cataract operations. We know that that could result in swingeing payments for the over-50s, who could be forced to take

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out insurance equivalent to paying £70 or more a week on their tax, or pay the cost of the operations--which ranges from £1,000 to £5,000--themselves. The Minister will not be surprised to know that, on finding out this information, the sensible people of Plymouth were opposed to those measures.

We are delighted to have received nearly £33 million more this year from the Government for the South and West Devon health authority, and another £33.5 million for 2001. The two other health authorities that look to Derriford to provide their tertiary and most of their secondary care services have received similarly significant increases. That money will help us to build on the significant extra sums that we have received since 1997. The 30 per cent. real-terms increase--50 per cent. in cash--announced by the Chancellor last year, to be released over the next few years, is hugely welcome.

Before I talk about the outstanding challenges that we face at Derriford, I place on the record my thanks and those of my constituents for the extra investment coming through the health action zone, which is doing good work to tackle health inequalities in the city. Much of the pressure on Derriford's services results from the gap between rich and poor areas of our city. I am sure that the Minister will recollect that the legacy of my Conservative predecessor was the poorest ward in England. She is aware of the devastating health problems that poverty brings. The inner-city ward of St. Peter in my constituency has a premature mortality rate three times that of the leafy suburbs of Plymstock Dunstone. Cancer mortality is more than twice as high for those under 75 in the St. Peter ward as it is in the Plymstock ward; emergency admissions to hospital are two thirds greater.

The action zone is working with the new deal for communities project, "Devonport People's Dreams". On Monday, I joined 100 people working on that project to hear them finalise their dream of investing £30 million in their community. Doing something about those health problems at source is high on their agenda.

Against that background of poverty and pressures, I shall describe in more detail the special circumstances and unique challenges faced by Plymouth Derriford hospital trust, which are well documented. It has the same problems that hospitals face throughout the country. Waiting list targets, winter pressures, recruitment and retention of staff and the cleanliness of wards and theatres have all been the subject of local and national press attention. As a result of those problems, there have been distressing cases of inadequate patient care and attention. Some have hit the press; some have not.

Last year, the chief executive resigned in circumstances that placed serious question marks over waiting list management and the accuracy of statistical records. Derriford's management costs are among the lowest in the country. That could be something to be proud of, but in the context of the challenges that I am outlining, I think that we have probably paid a high price for some of the consequences of those low costs.

Constituents have raised concerns about all those issues, as they no doubt do with the Minister and Members the length and breadth of the country. I am pleased that, with fresh management, we are seeing new approaches. We have some extremely good news stories

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to tell about staff at Derriford providing high-quality and some exceptional health care. It would be invidious to single out only one or two staff for praise, which is all that this short debate would permit. Perhaps the best way of reflecting the situation is to refer back to my survey, in which 75 per cent. of people said that they were satisfied or very satisfied with the health service.

I have listed the challenges at greater length than the achievements, because they are an important backdrop to the case that I want to put before the Minister. Plymouth's Derriford hospital is the largest non-teaching hospital in Europe, so it does not receive the extra resources allocated to teaching hospitals. I mentioned the successful bid for the new peninsula medical school. It will bring some £30 million a year to the local economy and improve the chances of local young people to become doctors. In Plymouth, Devon and Cornwall we have one of the lowest rates of young people entering the profession. We also have great hopes that the school will improve equity of access to a range of specialist services. People in the peninsula have the poorest rates of access to life-saving tertiary procedures in the region and substantially lower rates than the national average.

The school alone, however, will not solve the problems. It may even create extra pressures in some respects. There is simply insufficient capacity to provide, let alone improve, services across primary, secondary and tertiary care to meet the expectations of the national health service plan. The successful implementation of the plan and our modernisation agenda will require extra capacity in the form of extra beds, theatres and other facilities.

Since January 2000, bed occupancy at Derriford has been running at an average of 94 per cent., compared with an average of 84 per cent. nationally. It is running well over capacity, which is one reason why it is having great difficulty limiting waiting times. There is no prospect of ensuring that the people of Plymouth, Devon and Cornwall receive the same treatment and are subject to the same waiting times--let alone having equity of access to tertiary services--as people in other parts of England, unless that problem is addressed. It is only because of the exceptional dedication of medical and support staff that we have been able to hold the line on meeting winter pressures.

As the Minister knows, we have problems meeting the waiting list targets. That was recognised by the winter and emergency services team when it visited towards the end of last year. I know that my hon. Friend observed those problems when she visited Plymouth a few months ago. In particular, WEST praised the excellent approach of Derriford's bed management team, the flexibility of surgeons in achieving waiting list targets, and developments in primary care. The trust has worked hard with local primary care groups and social services to ensure that patients can return home with adequate support as soon as they are fit enough.

It was a huge blow to the hospital's morale to be named among the seven hospitals in the country that were failing on waiting lists. Nevertheless, the national patient access team, which was tasked to support Derriford in addressing such issues, has been welcomed. A supportive relationship soon developed with the hospital, in order to meet the challenges faced. The team

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probably recognised that an average of 94 per cent. bed occupancy, to which I referred earlier, was a challenging background.

People living in the South and West Devon health authority area have more than 15 per cent. worse access to vital procedures such as cardiac valve operations, coronary bypasses, burns services, kidney transplants and bone marrow grafts. My hon. Friend will have noticed that I mentioned kidney transplants. Despite the fact that the people of Plymouth gave huge support to Derriford's kidney unit when it was threatened with closure last year, access to kidney transplants is comparatively poor. I am pleased that we managed to retain the kidney unit, and that I and my hon. Friends the Members for Plymouth, Devonport (Mr. Jamieson) and for Falmouth and Camborne (Ms Atherton), as well as my right hon. Friend the Member for Holborn and St. Pancras (Mr. Dobson), were able to lend our not inconsiderable weight to that successful campaign. However, I am concerned that access to renal transplants remains poorer than elsewhere.

The Plymouth area has 300 fewer beds for its population than the national average, and Derriford has fewer consultants, compared with national averages, in key areas. I am concerned that the triple challenge of managing winter pressures, achieving waiting list targets, and fulfilling the role of a district general hospital as well as a tertiary service regional resource, which gives equitable access to acute services, cannot be met for ever with such a strained infrastructure. Sooner or later, something more will have to give. No scope exists for achieving targets on all fronts when strains and challenges, across almost every area of activity, are so evident. We need a significant and strategic investment in the physical infrastructure of our service, to match the welcome increase in medical staff numbers and pay and conditions.

I do not need to quote more figures to demonstrate to the Minister the specific challenges faced in Plymouth. I know that she shares my real concern about the situation, and a desire to do something about it. Plymouth Hospitals NHS trust, in conjunction with the community services trust, is bidding for one of the major hospital developments announced by the Secretary of State in the NHS plan. The strategic outline case for a new planned care centre envisages allowing acute and specialist care to be totally redesigned around the patient at Derriford. For patients, that would bring reduced lengths of stay away from home, a need for fewer visits, reduced cancellations and shorter waiting times.

I appreciate that the Minister cannot announce further investment of that type in the context of this debate, but I hope that she will recognise the exceptional challenges that the hospital faces. I welcome the amount that has already been done, but there is so much further to go.

Improvement will not happen overnight. The investment made so far and still to come on stream is absolutely vital. I wish that it could have flowed faster, but the Minister and I know that, in 1997, a shocking 43p in every pound of taxpayers' money was spent on the cost of rising debt and unemployment. The comparable figure today is only 17p. We can both look our constituents in the eye and tell them that we can build on what we started year on year--as long as we

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avoid returning to the boom-and-bust economy, which resulted in so much underinvestment in our vital public services from the beginning and almost wrecked them in the longer term.

Labour believes in the national health service as a public service in a way that the Conservatives do not. Thanks to the Chancellor's prudent management of the economy, we can put problems right over the medium term through the NHS 10-year plan.

The trust faces significant organisational and clinical challenges. I look forward to hearing the Minister's views on how the Government can help Derriford trust to play its full role in achieving a modern health service for the people of Plymouth, Devon and Cornwall. I am confident that Derriford's board, management and staff will rise to the challenge of providing a service that compares with the best available on a far greater range of its activities than it does, or can, at present. The Minister's recognition of Derriford's special needs and challenges will be appreciated at this crossroads in the history of health care in our city.

Mr. Mike Hancock (in the Chair) : I thank the hon. Lady for that well-presented case.

1.16 pm

The Parliamentary Under-Secretary of State for Health (Ms Gisela Stuart) : I congratulate my hon. Friend the Member for Plymouth, Sutton (Mrs. Gilroy) on her success in securing the debate and I acknowledge her continuing support for and active engagement in the health community. I recognise the presence of my hon. Friend the Member for Plymouth, Devonport (Mr. Jamieson) who, as Government Whip, is by convention silent in the Chambers of this House. I can assure his constituents that he is not silent when it comes to representing their needs before Ministers.

Plymouth Hospitals NHS trust provides both secondary and tertiary health services to the constituents of my hon. Friend the Member for Plymouth, Sutton; as such, it plays an extremely important part in their lives. The presence of my hon. Friend the Member for Falmouth and Cambourne (Ms Atherton) demonstrates that the trust is important not just for the city of Plymouth, but much more widely.

The trust has had its problems over the past year, but they must be placed in context. It is important to recognise the steady work being done locally to improve the situation. The trust and its staff have shown tremendous commitment and Government investment has also helped. The context of the development of the Government's vision for the NHS in the NHS plan should be recognised. Many improvements have taken place in many spheres of the trust since Labour came to office. Expenditure, activity, staff numbers and beds have all increased in the past three years and further significant service developments started in that period.

Expenditure since Labour came to office has increased by a third from just over £123 million in 1996-97 to nearly £165 million last year. That must be set against an extraordinary increase in the trust's activity--by 1999-2000 an increase of 8.2 per cent. since 1996-97, which amounts to almost 108,000 finished

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consultant episodes. The number of nurses employed at the trust since 1996-97 has increased by 386--a rise of nearly 23 per cent. This year alone has seen an extra 165 nurses and, over the past three years, more than 40 consultants--new posts, not replacements for clinicians who had left--have joined the trust.

Despite those impressive increases in medical and nursing staff, there are difficulties in Plymouth, as in other parts of the country. The major constraint on the NHS is no longer a shortage of money, but of staff. Investment in medical and nursing education and training during the 18 years of Conservative power was insufficient to meet the current needs of the modern NHS and to deliver the changes necessary in the NHS plan. The trust has a current nursing vacancy rate of 5.7 per cent., which compares favourably with that of other trusts. The success of the trust in recruiting and retaining staff is due to a number of factors: long-term recruitment initiatives, including the hiring of 91 nurses from the Philippines; the introduction of annualised hours and other flexible working arrangements and, importantly, help with child care through vouchers or the hospital nursery, which the trust is currently seeking to expand; and greatly enhanced training and development opportunities to facilitate retention.

I take the opportunity to thank everyone working in the NHS in Plymouth for their tremendous work, day in, day out. The doctors, nurses, ambulance workers, scientists, clerical and maintenance workers, laboratory staff and others who work in Plymouth have been pushed to the limit, as I saw on my visit there. It is difficult to judge a hospital only on the information received, but I saw on my visit there that the trust's staff were completely committed. We do not want them to be pushed to the limits in the long term; it is to their credit that they are so committed, but long-term developments must ease the situation.

There have been major service developments in recent years; the NHS plan recognises that merely doing more of what has always been done is not a long-term solution. The most significant of those service developments was the opening in November 1997 of the new three-theatre cardiac surgery unit to provide heart surgery in the peninsula for the first time. Patients no longer have to travel to London, Oxford or Bristol for treatment. Since its opening the unit has already expanded, with the recruitment of two additional cardiothoracic surgeons. In March this year, the trust intends to open a second cardiac catheterisation laboratory, to provide additional diagnostic procedures and interventions. That is a real benefit to all who live in and around Plymouth.

In October 1999, the trust opened a new 15-bed unit to fast track the assessment of emergency surgical admissions. In May last year, we announced a £150 million extra investment specifically for critical care--the biggest ever investment in critical care in the history of the NHS. South and West Devon health authority received more than £1.7 million, leading to an increase of 20 per cent. in the number of critical care beds at the trust.

We have already invested £115 million to modernise every accident and emergency department in England that needs it. From the funding provided by the Government, the people of Plymouth will have the benefit of a newly refurbished A & E department; at a

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cost of nearly £800,000, it will double the number of bays in the resuscitation room and provide a 12-bed observation unit. The Government are committed to ending waiting times for cancer surgery, thereby helping thousands of women waiting for breast cancer treatment, for example. As part of that commitment, in March the trust will open a new £1.46 million outpatient breast care unit and a 15-bed surgical ward for female patients.

A development that is less obvious to the patient is the substantial investment of £1 million a year for seven years to develop the trust's new patient information management system. That initiative, with the other significant investment in IT, will mean that when patients receive care the professionals treating them will be working on the best quality knowledge about their condition and available treatments. They should expect to be given up-to-date information from professionals about their condition, the treatment they are receiving and other sources of advice.

When test results are returned to the referring doctor, patients should expect to hear the results quickly. That is a step change for NHS patients from which people in Plymouth and the surrounding areas will benefit.

There have been comments in the press recently about problems in the orthopaedic and gastroenterology specialties. This year, the trust intends to appoint an additional two orthopaedic consultants and to install a laminar air flow in the orthopaedic operating theatre. In gastroenterology, the trust intends to appoint an additional consultant and nurse endoscopist to reduce waiting times for diagnostic investigation and treatment.

Ms Candy Atherton (Falmouth and Camborne): Would the Minister be kind enough to publish the numbers of new consultants, doctors and nurses across the entire peninsula? On a recent visit to a hospital trust, I was told that that information was not published as it encouraged people to take up the services provided. It is important for people to know just how many doctors and nurses the Government are providing.

Ms Stuart : I will certainly look at the information that is made publicly available. I am sure that my hon. Friend is aware of the useful device of parliamentary questions.

Developments of the kind I have described can bring their own pressures. Plymouth has in some way been the victim of its own success in opening the new cardiac unit because more patients were referred to the hospital than had been anticipated or planned for, with the result that waiting times rose. There were pressures in other parts of the hospital too, and towards the end of 1999 a number of patients were identified who had waited longer than 18 months for treatment, which breached the patients charter guarantee.

An independent investigation commissioned by the trust found that there had been manipulation of waiting list returns, which was completely unacceptable. The chief executive and deputy chief executive subsequently resigned. However, since then, the trust has been tackling those and other problems and has moved on. We must recognise that good work.

A new chief executive has been appointed and a new management team is being assembled. The number of in-patients waiting on the waiting list, which continued

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to increase until July, has been coming down. By the end of November the trust had reduced the total by over 22 per cent. Similar hard work has resulted in improvements in the number of out-patients who had been waiting over 13 weeks to see a consultant.

I recognise that the trust still faces many pressures. There is a need for more investment, more facilities and more staff. The trust has established a recovery and modernisation steering group to tackle the immediate pressures and to oversee the production of a three-year recovery and modernisation plan. That will ensure that the trust achieves financial stability and meets the waiting list and access targets set out in the NHS Plan.It is the responsibility of all those who work at Derriford, whether consultants, nurses or managers, to work in co-operation with the new management team to ensure that the trust can meet the challenges set by the NHS plan.

Let me now turn to the future. In the NHS plan the Government have set out their vision of what the NHS will be like in 10 years time. It will be an NHS focused around the needs of patients offering fast and convenient high quality care; not one that is characterised by waiting for the GP, waiting to see a consultant or waiting for tests results. Waiting times at every stage in a patient's contact with the NHS are a major cause of public discontent with the service. We have therefore set out ambitious targets in the NHS plan to deal with that.

Maximum waits for out-patients will be cut to three months by 2005. Appointment dates will be pre-booked for a date convenient for the patient. Tests and diagnosis will usually be undertaken the same day. If treatment is necessary it will be arranged there and then with a maximum wait of six months by 2005, which we hope to reduce to three months by 2008. Again the date will be pre-booked to suit the patient.

We need the resources to put these plans into action. In the Budget last year my right hon. Friend the Chancellor of the Exchequer announced the largest ever sustained increase in funding of the NHS, which will see spending increase over the next five years by one third in real terms. This year South and West Devon health authority received initial allocations that represent significant real increases. It must also be recognised that the major constraint of staffing shortages must be met with more training places. We had already announced an increase of 1,100 extra training places nationally and a further 1,000 will come on stream.

As my hon. Friend the Member for Plymouth, Sutton recognised, the creation of the peninsula medical school will be a major boost for the health community in Devon and Cornwall, not only because of the extra doctors who will be trained there, but the impetus it will give to clinicians and academics to come and work there and take part in the research. I also hope that it will encourage more local youngsters into medicine. There will be support to continue the development of tertiary services in the peninsula.

The trust has been planning how it will meet the requirements of the NHS plan, and it has submitted a strategic outline case with the support of the wider health community, for which my hon. Friend has argued so persuasively, consistently and persistently. That £100 million scheme to develop a planned care centre and to

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reconfigure Derriford hospital is being considered as part of the national prioritisation exercise for the fifth wave of PFI schemes.

I cannot comment now, but I would like to make it clear that we recognise the problems. There has been tremendous investment in the past three years.

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