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There are things wrong with the system. We are addressing them. I ask noble Lords and the citizens of London for a little more patience. We shall have in place very soon the powers for local authorities and the Greater London Authority.
The Parliamentary Under-Secretary of State, Department of Health (Lord Hunt of Kings Heath): My Lords, the UK National Screening Committee does not currently recommend prostate cancer screening based on the prostate specific antigen (PSA) test as with existing technology for treatments and testing there is no evidence that a screening programme would save lives, and evidence that it could cause large numbers of cases of impotence and incontinence. However, we believe that that this issue is of such importance that we have asked the committee to keep it under review and consider any new evidence.
Baroness Gardner of Parkes: My Lords, I thank the Minister for his reply which is contrary to the press reports this week as regards Mayor Giuliani. Does the Minister agree that there is a major difference between the level of screening of women for breast cancer and men for prostate cancer? Is that sex discrimination, a lack of men's awareness of the availability of tests, or simply the traditional unwillingness of macho man to address health issues?
Lord Clement-Jones: My Lords, the Minister described how the Government intend to proceed. The National Screening Committee has advised against universal application of the PSA test. However, Britain has one of the worst records for prostate cancer in terms of outcome. Its record is worse even than that of Estonia and Poland. Does the noble Lord have a prescription for future improvement of prostate cancer services?
Lord Hunt of Kings Heath: My Lords, it is good to hear the name of Estonia back in your Lordships' House. I assure the noble Lord that the Government are far from complacent about the impact of prostate cancer. It is important that the decision on action to be taken is made on the best available evidence. The evidence from the committee advising Ministers is that it would not be appropriate to extend testing in the way suggested. We are anxious to do all we can. We have announced that an action plan will be developed over the next few months which will take in research, diagnosis and care. We are anxious that as much information as possible is available to men so that they are able to make informed choices.
Lord Hunt of Kings Heath: My Lords, since 1997 the Government have directly committed more than £800,000 to new prostate cancer research projects. In addition, the department provides support to the NHS for research commissioned by the medical charities and the Medical Research Council. Over £60 million of that funding supports cancer research overall, with £16 million going to the Royal Marsden Hospital. The Royal Marsden Hospital estimates that nearly £1 million of that Department of Health support funding relates to work on prostate cancer.
Earl Howe: My Lords, I acknowledge that there is still uncertainty about the most effective treatment for men with early stage prostate cancer, but what role do the Government envisage for the technique known as
Lord Hunt of Kings Heath: My Lords, the National Screening Committee will keep the matter under constant review. As and when they arise, potential new tests will be considered on their merits. The National Screening Committee is charged with discussing again the whole issue of screening at its next meeting. Alongside that, the development of an action plan by the department in the summer will enable us to keep pace with developments in the UK and other countries and ensure that we keep up to date with the best available evidence. I assure the noble Earl that we shall take into account any new developments which come onstream in other countries.
Baroness Gardner of Parkes: My Lords, has the Minister seen the report in the medical column of The Times this week? It stated that there is proven evidence of a great decline in deaths from prostate cancer in the United States whereas in this country the figure is described as soaring.
Lord Hunt of Kings Heath: My Lords, I have not seen the article. However, as I said, we shall ensure that any new research which becomes available is fully considered. My figures suggest that the incident rates of prostate cancer in this country are expected to level off in future years. At the same time, it is essential that we develop screening programmes only when we have advice that it is effective to do so. That will remain the Government's policy.
Baroness Farrington of Ribbleton: My Lords, at a convenient moment after 3.30 p.m. my noble friend Lady Scotland will, with the leave of the House, repeat a Statement which is being made in another place on Zimbabwe.
Lord Rodgers of Quarry Bank rose to call attention to the provision of essential services to communities in particular need, including banking, post office facilities, transport and health; and to move for Papers.
The noble Lord said: My Lords, I beg to move the Motion standing in my name on the Order Paper. This is a debate about two nations, but not as conventionally understood. It is not a debate about the distribution of income and wealth, although I have to say that I find it deplorable that in today's affluent Britain the gap between rich and poor is widening.
The Social Exclusion Unit in the Cabinet Office recently published a report on neighbourhood renewal. In his foreword to it, the Prime Minister set out what he called four imperatives for successful regeneration. They were, first, to revive the economy. In this case, that is poor neighbourhoods. Secondly, to revive and empower the community. Thirdly, to improve key public services, particularly schools, health and the police, as well as re-engage private services such as shops and banks. Fourthly, underpinning all those, said the Prime Minister, was the need for leadership.
The Social Exclusion Unit report is concerned with the urban problem, particularly how to deal with run-down estates. Almost word for word, the Prime Minister's four imperatives could be applied to the problems of today's countryside. Reviving the economy has an immediate echo for everyone struggling with the consequences of the current disastrous farming crisis. Without a flourishing agriculture, life in rural areas as we know it will perish.
As regards improving key public services and re-engaging private ones, that is precisely the subject of today's debate. Under the umbrella of the Motion before the House, I expect my noble friends on these Benches to refer to all the matters on the Prime Minister's list and also to others, including transport. That is a notable omission when considering rural problems. I am pleased that noble Lords in most parts of the House will bring their experience and authority to the discussion, although I say with regret that judging by the speakers' list there is a startling lack of interest on the government Back Benches about these matters. We can always hope that one noble Lord from that side of the House will choose to speak in the gap.
In the past week, the Countryside Agency published its second The State of the Countryside report. I find it a fair-minded and balanced report. Its tone is calm and it does not campaign, although campaigning would be justified. The report states that the countryside is still a good place to live and mentions, for example, that people living in rural areas are as healthy as or healthier than their urban counterparts.
The report refers to homelessness and rising house prices which make it difficult for young people, even those in work, to continue to live in rural areas. It also refers to the amount of traffic on rural roads rising faster than in towns, which came as a surprise to me. It also refers to crime, with vehicle crime rising by 24 per cent between 1991 and 1995, much faster than in urban areas; faster even than in inner cities.
The report does not reflect--and given the timescale for publication it could not do so--the debate on rural crime that has followed the Tony Martin case. In an article in The Times 10 days ago, the noble Lord, Lord Rees-Mogg, spoke of the manifest and total failure of the Norfolk police. I am not in a position to judge whether that was a fair comment or a hasty one. We should certainly be careful about drawing instant conclusions of whatever kind from those events. The noble Lord was perhaps prudently more cautious in his description of his local police force in Somerset, which he says has a good reputation for professional conduct. As I cannot judge that from my direct experience, I, too, shall be cautious about it.
We all know that police houses in many villages stand empty, if they were not sold years ago. The local policeman, who everyone knew and who knew everyone, with his knowledge of how to reach outlying houses and farms, is becoming part of folk history. The local policeman was never off duty. But now, if you think you are being burgled, you may have several telephone numbers to call, some of which may be connected to voice mail. The nearest police station could be 10 miles away and open only from 10 a.m. to 1 p.m. So if you think you are being burgled, you must hope that the burglar will take his time because there could be a half-hour wait before the police arrive in response to a 999 call.
It is not just--or mainly--the incidence of crime that causes fear in the countryside, but the extent to which the forces of law and order have apparently disappeared altogether from view. Of course, the picture is not all black. Some areas are better and more openly policed than others, but there is an urgent need to rethink and to explain rural policing in order to give the reassurance that country people deserve. And if that means more resources, so be it.
Last week, under the heading of "More Money to Cut Local Crime", the Home Office invited bids for a share of £30 million in the next round of its "Reducing Burglary" initiative. It would be helpful if the Minister could confirm that bids for policing in rural areas will be encouraged.
One of the persistent and worsening problems in rural areas is public transport for those who do not own their own cars. More than 20 years ago, the government of the day published a White Paper on transport policy, for which, I confess, I had some responsibility. A chapter on rural areas stated that
That figure of over two-thirds 20 years ago is now as much as 83 per cent and the isolation of those without cars is even greater. The White Paper of 1977, which proposed increased bus revenue support, simplified licensing procedures and rural bus experiments with new legislation to facilitate community schemes. However, despite those experiments and despite that legislation, public transport in rural areas has been allowed to languish for two decades.
In the course of the debate, my noble friends will refer further to rural policing and transport. Among other things, they will also mention problems of access to healthcare, the role of public libraries, rural housing, the threat to sub-post offices (much debated in this House yesterday) and the disappearance of local banking.
With regard to local banking, in closing 171 of its rural branches on 8th April, Barclays only followed more brutally a trend which has been apparent for a long time. Gone are the days when, in the absence of a branch, representatives of a high street bank arrived at least once a week to make its facilities available for half a day at the back of the local shop. For that matter, the local shop may have gone as well, together in some cases with the local pub. They do it better abroad. In Italy, for example, there are few hill villages without banking facilities. I do not know why their banks can provide a service which seems to be beyond the capacity of ours.
As the Countryside Agency says, for many people the countryside is still a good place to live; nor is the argument from these Benches against all change. It is certainly too easy to romanticise the past when living and working conditions for the majority of those in the countryside were often harsh and the quality of life restricted.
For the comfortably-off incomers to the countryside and, even more, the affluent weekenders with a second home, there are few problems. The incomers may run small businesses from their houses or, for those with two family cars, commute 10 or 20 miles or perhaps much further to work. They have chosen where to live and generally have the means to reach all the facilities and services that they require. They have the best of both worlds.
I even recall seeing recently an advertisement for "new executive town houses in delightful rural setting"--an estate agent's oxymoron if ever there was one! As for the weekenders, they can load up the family 4x4 at Tesco's or Sainsburys and hurry home to Islington if it begins to rain. I have no complaint whatever against incomers or weekenders--I was once one myself--except where they push up the price of housing. However, they do not face the problems of those born and brought up in rural areas; those who are anchored there and cannot really choose another way of life.
Finally, I return to the paradox that rising standards of living and a better quality of life for most people in our country can further impoverish the lives of an isolated or otherwise disadvantaged minority. Poverty itself is relative, but absolute standards can also be affected by the decline of essential services that most of us take for granted. We cannot allow the two nations of haves and have-nots, as I have defined them, to grow farther and farther apart. That means that in a market economy business must exercise social responsibility if it is to justify its freedom and not simply satisfy its shareholders and overpay its bosses. It means an active role for government, which must be ready to redistribute resources to meet the cost of public services that are inadequate or under threat.
Rural decline can be stopped, just as run-down neighbourhoods can be saved. As the Prime Minister said, that needs leadership. In this case, leadership should start with the government of the day. My Lords, I beg to move for Papers.
Lord Kimball: My Lords, the noble Lord, Lord Rodgers of Quarry Bank, has certainly struck a very opportune note with his choice of subject for the debate today. He made a point about the haves and the have-nots. I hope that some of the have-nots in parts of Hampshire, at whom, I suspect, this debate is aimed, may take some note of what is said today.
I speak as deputy president of the Countryside Alliance. The Countryside Alliance recently commissioned an NOP poll which confirmed a great deal of what we already knew. The April NOP poll confirmed that only 4 per cent of all postmasters believe that the Government are doing a good job. The previous poll taken in July 1999 found that 27 per cent believed that the Government were not doing too bad a job. The drop in the past nine months from 27 per cent to 4 per cent is quite substantial. Well over half the people who run local post offices know perfectly well that the Government are doing a bad job, and 87 per cent know and believe that the Government do not understand the value of local post offices, despite what may have been said yesterday.
There are nine other elements in the rural economy. It is a question not only of the post office, but also of the pharmacy, the physician, the parson, the priest, the publican, the primary school teacher, the petrol pump attendant and the policeman. Like the noble Lord, Lord Rodgers, I should like to dwell in particular on the latter two important members of the rural community who are so essential in providing the full range of services: the petrol pump attendant and the policeman.
The rural areas are worst affected by the fuel tax. The motor car supplies the basic needs of every single person who wants to live and work in the countryside. It would be churlish not to welcome what the Government have done with regard to the fuel tax escalator. However, they may have given up the principle but they do not seem to have abandoned the practice. The Countryside Alliance's April survey also
As the noble Lord, Lord Rodgers, said, policing is the next most important problem in the countryside. Independent research for the Countryside Alliance has shown that crime is a concern equal to transport and housing for people who live in rural areas. As the noble Lord, Lord Rodgers, so rightly said, the unique element of rural crime is the terrible fear that help is unlikely to arrive in time. That is something that we in the countryside all know. Worse still is the admission by police forces in the counties that I know best--certainly in Leicestershire, Lincolnshire and Norfolk--where the police tell you that if you can identify the criminals and want to press charges, the police cannot be responsible for any subsequent action against your property. That is a really serious situation.
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