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Baroness Cumberlege: My Lords, it is up to health authorities to decide where to spend their resources in the light of the needs of their particular populations. We do not think that it is appropriate for Ministers or managers to make those decisions; it should be for clinicians to decide. The incidence of heart disease in this country is still too high, but the number of people who suffer from the disease is reducing.

Baroness Gardner of Parkes: My Lords, is it not a fact that the Royal Brompton Hospital already has mobile units? Is it not also a fact that the best approach is prevention through the health education system? Can the Minister tell us how effective the health education programme for the prevention of heart disease has been?

Baroness Cumberlege: My Lords, yes. We have set out targets in The Health of the Nation policy to reduce the incidence of coronary heart disease. We are more than meeting those targets. Increasingly health authorities are aware of effective programmes to reduce coronary heart disease and are investing in them.

Lord Molloy: My Lords, will the Minister take this opportunity to congratulate Britain's heart surgeons on the remarkable job they do throughout the country under difficult situations? With regard to some of the big hospitals, perhaps a small adjacent building or even an empty shop could be taken over to enable those surgeons to carry out their operations. Patients would not then have to wait too long, as they may do in a larger hospital. That idea has been put to me by a number of heart surgeons. Perhaps it could be examined by the department.

Baroness Cumberlege: My Lords, cardio-thoracic units have to be extremely sophisticated. There are only about 41 in the country. Increasingly more and more

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people are seeing cardiologists and we are seeking to get cardiac services into the districts. The idea of carrying out such operations in a corner shop is not very appealing.

Earl Jellicoe: My Lords, in asking a question, I declare that I am President of the British Heart Foundation in order to put at rest the mind of the noble Lord, Lord Lester.

Why is the incidence of heart disease in the United Kingdom among the highest, if not the highest, in the world, while the lowest in the world is, I understand, in Japan and France? Is it attributable to genetic reasons, or to dietary reasons—perhaps wine? Such incidence is a remarkable fact. Is it not worth considering that more research should be directed to the matter?

Baroness Cumberlege: My Lords, I should like to pay a tribute to the British Heart Foundation. It is an extremely well established, progressive organisation which invests £30 million a year in research into heart disease.

I believe the reasons for coronary heart disease need further investigation. We know that they are partly to do with diet, lifestyle and whether or not people smoke. But I suspect that other factors are involved such as genetics or heredity.

Lord Annan: My Lords, does the noble Baroness agree that we spend a great deal of money on heart treatment and research whereas hundreds of thousands of people suffer from rheumatic and arthritic conditions, very often for many years? Should not more money be spent, not on heart surgery or cancer research, but on research and treatment which helps those living in pain every day who are suffering from orthopaedic and other problems including, I may say, deafness?

Baroness Cumberlege: My Lords, a quarter of all deaths are caused through coronary heart disease, so it is the biggest killer in this country. That is why we put so much effort into trying to reduce it. The noble Lord is absolutely right. There is a huge number of calls on the National Health Service. There is a great deal of pain and discomfort that we should be tackling. But the National Health Service is, of course, limited in its resources.

Lord Rea: My Lords, does the noble Baroness realise that the recognition and treatment of heart failure is a basic part of good medical training? If the situation is as my noble friend suggested, perhaps the profession may be missing some diagnoses. I am in a delicate position as a doctor. Perhaps the answer lies in postgraduate education and medical audit, to which the noble Baroness referred and preferably not through drug representatives, who call on GPs and are very clever at persuading them that they should use the latest and most expensive form of drug for heart failure rather than the cheaper and more widely used and well tested remedies which are available and are perfectly effective for most cases. Does she agree that the real answer lies in

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preventing the development of coronary heart disease, which is behind most cases of heart failure these days? As my noble friend suggested—

Noble Lords: Order!

Lord Rea: As my noble friend suggested, does the noble Baroness realise that the situation is related to social deprivation, a factor not referred to in the White Paper, The Health of the Nation?

Baroness Cumberlege: My Lords, I entirely agree with the noble Lord on postgraduate education. Indeed, the Royal Colleges, the General Medical Council, and others are responsible for that area.

I have to say that without the investment which the drug companies put into research this country would be a much poorer place.

Veal Calves: Protection

2.55 p.m.

Lord Bruce of Donington: My Lords, I have to report to the House that owing to an error which is entirely mine, and for which I apologise, the Question that appears on the Order Paper differs materially from the one that I thought I had asked Her Majesty's Government.

The Question on the Order Paper refers to a proposal,

    "providing for the rearing of calves in narrow boxes".

My Question was intended to refer to,

    "prohibiting the rearing of calves in narrow boxes".

I have already tendered my apologies to Her Majesty's Government, who must have been put to some inconvenience. I was able to tell them only about three hours ago. I apologise, too, for any inconvenience I may have caused the House.

In the hope that the House will forgive me, I beg leave to ask the following Question:

    "To ask Her Majesty's Government at which meeting of the Council of Ministers in 1989 a proposal was considered prohibiting the rearing of calves in narrow boxes; and whether they will provide particulars of the votes of the Member States on the proposal".

The Earl of Lindsay: My Lords, I am grateful for the noble Lord's apologies, which are well received, and for the correct version of the Question.

In June 1989 a proposal laying down minimum standards for the protection of calves was presented to the Council of Ministers. However, the Council did not discuss the proposal until October 1991. Although the UK opposed the directive because it did not ban the system of veal crates, the Council recorded its agreement by a qualified majority.

Lord Bruce of Donington: My Lords, I thank the noble Earl for that reply and for the Government's indulgence in the matter. Is the noble Earl aware that the Commission has a different story to tell? According to the Commission, it made a proposal in 1989 for a regulation which would have ended the rearing of calves in narrow boxes. That was blocked by France, Spain and Italy. Is the noble Earl in a position to confirm or to correct the statement made to me by the Commission?

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Will he give the House an assurance that when the matter is discussed on 20th February at a meeting of the Agricultural Ministers in Brussels, he will this time register the United Kingdom's support for the Commission's proposal to stop the practice of rearing calves in narrow boxes, no matter how many objections come from France, Spain and Italy?

The Earl of Lindsay: My Lords, as regards the noble Lord's first question, Council minutes from 1989 and 1991 are not made publicly available. We are not allowed to refer in public to the way in which other member states voted in Council. However, I can state to the House that the United Kingdom Government opposed that directive. The rules have since been changed but the change does not apply retrospectively.

In reply to the noble Lord's second question, I remind him that the agenda for the February meeting of the Council of Agricultural Ministers will specifically deal with the revision of the 1991 directive on welfare of animals during transport. That is one of the measures that my right honourable friend sought to bring to the Commission's attention.

The review of intensive production systems for calves under the EC directive has been brought forward to this year, but because of the preparation work involved, it will not be ready for discussion at the February Council meeting.

Lord Hailsham of Saint Marylebone: My Lords, can my noble friend explain how it is that the noble Lord, Lord Bruce of Donington, apparently has access to information which the Government are forbidden to tell the House?

The Earl of Lindsay: My Lords, I think that the noble Lord, Lord Bruce, has ways with the Commission that others of us do not have. If the noble Lord received that information and it is correct, it was in fact confidential.

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