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Lord Gilbert: My Lords, Her Majesty's Government have no proposals for increasing the warhead numbers which were announced by the previous government.

Lord Mason of Barnsley: My Lords, will my noble friend the Minister inform the House what percentage of defence expenditure is attributable to the Trident programme and whether he regards it as good value for money?

Lord Gilbert: My Lords, when "Vengeance" is rolled out and becomes fully operational--it should be rolled out in the middle of next year--the annual operating costs of the Trident system will be probably of the order of £200 million, which is rather less than 1 per cent. of the total defence budget. Bearing in mind

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that Trident will then be performing the role that used also to be performed by the WE-177 bombs, I regard it as excellent value for money.

Lord Judd: My Lords, does my noble friend agree that one of the greatest issues facing us all is that of proliferation; and that it is essential for the future of humanity that we win more convincing and positive support for the non-proliferation treaty? In that context, while many of us have nothing but full support for the Government's general policy in this sphere, will my noble friend therefore agree that it is crucial to demonstrate to the world that we shall deploy on Trident no more missiles and no more warheads than is absolutely essential for the policy we have enunciated?

Lord Gilbert: My Lords, I have no difficulty in giving my noble friend precisely the assurances he requests. As I pointed out a few moments ago, with the elimination of the WE-177 free-fall bombs, Trident will be performing both a strategic and sub-strategic role. Therefore we are gaining two assets, as it were, for the price of one.

I should also like to say this to my noble friend. It is equally important that we try to do something about the proliferation of chemical and biological weapons of mass destruction in addition to that of nuclear warheads.

Lord Burnham: My Lords, in the light of the noble Lord's request to the noble and gallant Lord, Lord Carver, that he await the defence review, will the Minister please tell the House the purpose of the two-day debate on defence being held today in another place and the debate in this House next week? We find ourselves in some difficulty since we do not know what will be in the defence review.

Lord Gilbert: My Lords, I congratulate the noble Lord on his appointment to his new position. I look forward to jousting with him for many months in our respective positions.

As I am sure the noble Lord realises, the Strategic Defence Review has two parts. The first part is virtually concluded and I must not anticipate the remarks of my right honourable friend in another place. The first part was Foreign Office led and related to discussions about the roles and responsibilities which we think it appropriate for this country to assume for the next 20 or so years ahead.

The second part relates to the assets necessary to fulfil those responsibilities and the resources necessary to procure those assets.

Lord Stoddart of Swindon: My Lords, will my noble friend say whether the £200 million running costs include the amortisation of the capital cost of Trident?

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Will he also say whether it will be possible for Trident to be used independently--that is, independent of the United States satellite guidance systems?

Lord Gilbert: My Lords, the answer to the first question is no. The answer to the second question is unambiguously yes.

Lord Jenkins of Putney: My Lords, is the noble Lord aware that--

The Lord Privy Seal (Lord Richard): My Lords, with great respect, I think that we should move on to the third question, in particular as my noble friend has had one bite at this cherry this afternoon.

National Health Service: Integrated Healthcare

3.5 p.m.

Baroness Rawlings asked Her Majesty's Government:

    What plans they have to promote integrated healthcare in the National Health Service over the next four and a half years.

The Minister of State, Department of Health (Baroness Jay of Paddington): My Lords, there are several different definitions of integrated healthcare. However, I believe that the noble Baroness refers to the publication of a document entitled Integrated Health Care--The Way Forward for the Next Five Years? produced by the Foundation for Integrated Medicine. It was launched by His Royal Highness the Prince of Wales at a lecture last week which both the noble Baroness and I attended. The Government welcome the publication. We shall be considering the report in great detail and with great care. Department of Health officials are arranging meetings with its main authors to discuss the detailed proposals.

Baroness Rawlings: My Lords, I thank the Minister for her helpful Answer. What proposals have Her Majesty's Government for establishing relevant centres for integrated healthcare?

Baroness Jay of Paddington: My Lords, as the noble Baroness will be aware, at this stage the report is a discussion document with no special policy indications within it. As I said in my Answer to her Question, we are discussing all the issues carefully. We shall look at the ways in which some of the healthcare suggested by the report could best be offered. My colleague, Professor Swales, who is the director of research at the Department of Health, will be meeting Professor Stephen Holgate, the main author of the research issues contained in the report, within the next few weeks.

Lord Walton of Detchant: My Lords, is the Minister aware that more and more general practitioners are now referring patients with skeletal and locomotor disorders to osteopaths and chiropractors, especially in the light

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of the comprehensive training programmes and the rigid control of qualifications which now exist in those professions with statutory regulation? It is now possible for general practitioners who are fundholders to cover the costs of such referrals. Is it the Government's policy that a similar facility will be available to GPs who will be involved in commissioning in the future?

Baroness Jay of Paddington: My Lords, first, I thank the noble Lord for the great help he has given to successive governments precisely in the area of appropriate regulation in these complementary therapies. Yes, indeed, our plans to reform the internal market, which will place greater emphasis on local co-operation and participation in the commissioning of healthcare, should make those services more responsive to patients' needs and wishes. The fact that it was exclusively patients of individual fundholders who benefited in some places from the offer of complementary therapy was not considered satisfactory. We wish to broaden that.

Baroness Hooper: My Lords, in view of the variety of definitions of integrated healthcare, will the Minister confirm whether her department is looking at the American model of integrated healthcare? It combines disease management and pharmaceutical benefits management and is leading to a number of innovative healthcare solutions.

Baroness Jay of Paddington: My Lords, I am grateful to the noble Baroness for providing another definition. One could also say that integrated healthcare might be health and social care. Indeed, the American model of disease management is of great interest. It is something that the Department of Health is looking at.

Baroness Masham of Ilton: My Lords, with the problem of antibiotics becoming resistant to various infections, what research is being undertaken on alternatives to antibiotics?

Baroness Jay of Paddington: My Lords, I shall have to write to the noble Baroness on the detail in answer to her question as regards complementary alternatives to antibiotics. However, the provision of alternative therapies, or integrated healthcare to use the term of this Question, is a matter that many practitioners have been considering.

Earl Howe: My Lords, what is the Government's policy on the question as to whether there should be statutory self-regulating bodies to oversee the professions which specialise in complementary therapy?

Baroness Jay of Paddington: My Lords, as the noble Lord, Lord Walton, mentioned, there are statutory regulations for a certain number of therapies. The question of trying to identify the precise regulation needed for others is under consideration. The noble Earl may be interested to know that a recent report on this matter by the Department of Health indicated 143

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registering or umbrella bodies covering 14 major complementary and alternative medical disciplines. To extend that number through individual statute would be a very extensive exercise indeed. The encouraging point was that most self-regulation did seem to be working; less encouraging was the indication that standards were somewhat diverse and public accountability patchy. It is a matter that we must continue to address.

Jobseekers Act: Benefit Sanctions

3.10 p.m.

Earl Russell asked Her Majesty's Government:

    Whether they are satisfied with the operation of sanctions under the Jobseekers Act.

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