To ask the Secretary of State for Health how many hospital trusts in England have received new radiotherapy equipment in the last two years paid for predominantly out of public funds. 
[holding answer 15 October 2001]: Investment through the New Opportunities Fund and the NHS Plan will provide public funds for 102 linear accelerators for treating cancer. In the last two years 30 linear accelerators have been delivered to 20 National Health Service trusts and are expected to be treating patients by the end of the year.
In addition as part of the planned investment announced in this period, public funding has been allocated for radiotherapy treatment planning computers and simulation equipment to support these. By 2004 all of this radiotherapy equipment will be in place. In total we expect 41 of the 48 hospitals delivering radiotherapy in England to have received equipment through central funding.
To ask the Secretary of State for Health what investment has taken place in radiotherapy equipment in the NHS in each of the last four years; and what percentage of this was funded from NHS rather than voluntary sector sources. 
[holding answer 15 October 2001]: Investment in radiotherapy equipment by the National Health Service in the last four years will have come from a number of sources and will not always have been made through central purchasing channels. Radiotherapy equipment may include linear accelerators, remote afterloading equipment, superficial treatment machines,
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and treatment planning computers and simulation equipment. Provision has been through traditional capital purchasing and through leasing arrangements.
New Opportunities Fund funding of £44 million has been allocated to radiotherapy equipment over this period and further funding will be made available centrally for linear accelerators, simulation equipment and treatment planning computers, as announced in the NHS Plan.
Combined Heat and Power
To ask the Secretary of State for Health how many combined heat and power projects have been installed in NHS properties since 1997. 
[holding answer 15 October 2001]: The information requested is not collected centrally.
The Department supports the Government's commitment to reduce greenhouse gas emissions as detailed in the current climate change programme, and in the Government's target for 10,000 megawatts of electricity (Mwe) installed combined heat and power (CHP) by the year 2010. Installing CHP in National Health Service premises is an effective means of achieving the energy/carbon efficiencies required as part of this agenda for action.
Since 1990 the NHS has been working towards energy efficiency savings and successfully achieved the Government's previous target of a 20 per cent. reduction in energy use from 1990 to 2000. The new target is a 15 per cent. energy, 0.15 million tonnes carbon efficiency saving from a base year of March 2000 to March 2010. Ways of meeting this target will continue to include the introduction, where appropriate, of CHP plant.
To ask the Secretary of State for Health if he will place a copy of the Royal College of Surgeons' report into the effectiveness of heart transplant procedures in the Library. 
A copy of the Royal College of Surgeons of England's report entitled "The Report of the Working Party to Review Organ Transplantation", published in January 1999, will be placed in the Library.
To ask the Secretary of State for Health what figure he uses as the EU average expenditure on health to form the basis of his target of meeting this figure in the UK; and by when he expects to achieve that target. 
We aim to increase health expenditure in the United Kingdom up to the average of the countries of the European Union, which is around 8 per cent. of gross domestic product. By the end of the present spending review period (200304), we expect that total United Kingdom expenditure on health will have reached 7.7 per cent. of gross domestic product. Public sector spending beyond this period will be decided in future spending reviews.
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ENVIRONMENT, FOOD AND RURAL AFFAIRS
To ask the Secretary of State for Environment, Food and Rural Affairs for what reasons the inspector appointed by the Government to oversee the consultation exercise during the drawing up of the recent Essex waste plan forbade Essex county council from specifically excluding incinerators from the plan. 
[holding answer 19 July 2001]: I have been asked to reply.
The inspector did not forbid Essex county council from specifically excluding incinerators from the plan. The deposit draft plan itself, which was before the inspector at the inquiry, did not exclude incinerators. It set out a policy, W7K, which provided criteria for considering planning applications for incinerators, and at policy W8A it identified sites for major waste management facilities, which explicitly might include incinerators. In response to objections, the inspector recommended retention of these policies subject to modifications.
In a schedule of proposed changes put to the inquiry by the county council, it was proposed to delete policy W7K. But this did not amount to excluding incinerators from the plan, as the relevant criteria were proposed to be transferred, with amendments, to policy W8A. The inspector recommended against such a change for reasons set out in his report, principally that it confused the criteria to be applied to proposed incinerators with those to be applied to major waste management sites, which might not necessarily be developed for incinerators.
It would not in any case have been possible for the Inspector to have forbidden the county council for excluding incinerators. His role was to make recommendations to the county as to how they should respond to the objections made. It remained for the county council to decide whether or not to accept those recommendations.
The reasons why the Inspector did not recommend the council to exclude incinerators from the plan as some objectors would have wished are set out in his report, especially paras 27.1127.14 and 27.3627.39. To get the full picture these paragraphs should be read in the context of other parts of the report, especially the remainder of part 27 and parts 5 and 34. In summary the main reasons are:
Whatever the plan says, it cannot prevent planning applications for incinerators in Essex from being submitted. It is appropriate therefore that the plan should set out how the county council would respond to such applications. The deposit draft plan proposed to deal with this by stating criteria against which planning applications would be considered, as well as identifying sites for waste management facilities in general. The inspector supported this basic approach.
It would in theory have been possible for the plan to state a presumption against any incinerators being permitted. But this would have to be justified by land use planning considerations and take account of advice about the relationship between planning and pollution control (report para 5.12). National policy in "Waste Strategy 2000" provides for a continuing role for energy from waste, including incinerators, as part of the waste hierarchy. There was no such presumption in the deposit draft plan and the Inspector supported the county council on this.
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Attention is drawn to the modified versions of policies W7K and W8A which were recommended by the Inspector (report paras 27.49, last bullet, and 34.49, last bullet). The criteria recommended they address objectors' concerns about incineration and for these to be taken into account if planning applications for incinerators are submitted.
The paragraphs of the Inspector's report are as follows:
Extracts from Essex local plan report
5.12 For example, at the inquiry there was more than once quoted to me the parliamentary answer given to Mr. Bob Russell, MP, that "A Way With Waste" creates no obligation to include incineration within waste development plans (doc 2588/PE/1, appendix 5) (and no doubt a similar point could be made with regard to "Waste Strategy 2000"). However I think that is not the point. Nobody can prevent planning applications being submitted for incinerators, and if the plan said nothing about them then it would not provide useful guidance. It would perhaps be entitled to state a presumption against incinerators being permitted, but if it did so this would have to be justified by land use planning considerations, and take account of advice about the relationship between planning and pollution control. I say more about that in part 27. The point here is that the plan should not, in my view, dictate to the WDAs and WCAs what their strategy should be, although it can constrain that strategy within land use planning principles.
Should there be a policy on incineration?
27.11 The first issue arises because in schedule 8 the WPAs propose to delete policy W7K and incorporate policy guidance on incineration into policy W8A. The consortium's objection is withdrawn subject to this. This change might be thought to delight many others who do not want to see any policy on incineration in the plan and who quoted in support of their case the parliamentary reply to Bob Russell MP that there is no obligation to include incineration in the plan (see para 5.12). But it seems to me that having no policy on the matter will not necessarily meet objectors' cases.
27.12 There is no doubt that waste incineration is an issue in Essex and Southend. Private companies are interested in building incinerators, as evidenced by the three successful bids in the latest round of NFFO contracts (doc 2588/PE/1, appendix 3). They may decide to submit planning applications, and if the waste local plan provided no guidance as to how such applications would be dealt with, the resulting uncertainty would not be in anyone's interest. As regards household waste, the WDAs, having agreed interim contract strategies up to 2007, are in the process of deciding their strategy for post-2007. Through "Working Together", they have agreed with the WCAs a minimum recycling/composting target of 60 per cent. by 2007, but as I understand it they have not reached any decision to eliminate energy from waste incineration from their strategy. Paragraph 29 of PPG10 advises that waste local plans should ensure an adequate planning framework for the provision of facilities by the waste management industry, and should carefully consider the environmental implications of all waste management proposals. For these reasons it would not be a reasonable option for the plan to ignore incineration.
27.13 I accept that the proposed changes to policy W8A would still refer to incineration. But I do not consider that it would provide proper guidance. Firstly, this policy applies to the waste management sites identified in schedule 1. Planning applications for incinerators might be submitted on other sites, and there would be no policy basis in the plan for determining such applications. Secondly, the additions to policy W8A on incineration have no justification in the supporting text in chapter 8, and indeed, as objectors to this proposed change point out, include new matter on incineration being a last resort which is not justified anywhere in the plan. Thirdly, the supporting text to policy W7K is not proposed for deletion or amendment, yet if the policy were deleted this text would be left hanging in the air. Fourthly, all the other significant waste management processes, including landfill, have explicit policies applying to them. Simply to remove the
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incineration policy and include amended parts of it in policy W8A is not therefore in my view an appropriate response to the objections.
27.14 For these reasons I shall not recommend the deletion of policy W7K. In line with the scheme of chapter 7 of the plan for other waste processes, there should be a policy which provides clear guidance for responding to planning applications for incinerators. It is next necessary to consider the content of the policy. To address this, I shall examine in turn the matters included under the second issue listed above.
Should the policy state a presumption against incinerators? If not, what constraints should be applied?
27.36 It will be evident from my conclusions on the above issues that I do not consider that the plan should rule out incineration as a matter of principle. I also see no justification for introducing the phrase "as a last resort" proposed in schedule 8. It is not clear what this means: the question of practicable alternatives further up the waste hierarchy would be taken into account anyway under policy W3A. However clear guidance should be provided in policy W7K as to the matters that would be taken into account by the WPAs in dealing with any planning application.
27.37 The definition of these matters follows from the foregoing discussion. Where requirements are common to other forms of waste management, they should be stated in policies W8A and W8B. They would then apply to incineration also, as would be made clear by inserting a cross-reference to those policies in policy W7K. The purpose of policy W7K is to introduce additional requirements specific to incineration, namely consideration of emissions to air or water (see para 27.22) and disposal of residues (see para 27.34). A further matter that I think is best expressed as a requirement is that incineration without energy recovery will not be permitted; but in response to objection from GOER this should be worded to enable an exception to be made in specialised cases. That would conform to para 7.37 of the supporting text, incorporating the modification recommended, which explains the meaning of that term.
27.38 Policy W8B contains criteria for major waste development outside the locations identified in schedule 1. Provided an incinerator proposal met those requirements, I see no justification for precluding it solely on the grounds that it was not on an identified site. It might for example be a smaller scale project, or the location might be a suitable one even though it has not been foreseen in drafting the plan. This is the more so because later in this report I have recommended the deletion of some of the identified sites, and shown that there would be difficulties in accommodating a conventional incinerator at some of the others. It would impose an unfair burden on the remaining sites if the plan did not allow flexibility for alternative locations to come forward. My recommended wording therefore includes a reference to other locations subject to policy W8B, and I consider in part 35 how that policy should be worded. This would meet Mid Essex Gravel's objection. It is perhaps unlikely that an incinerator below 50,000 tpa capacity, to which policy W4B would apply, would be proposed, but to allow for future developments this possibility could be mentioned in supporting text.
27.39 Lastly I pick up some of the other matters raised by objectors. The limited energy efficiency of a conventional incinerator, unless it includes a combined heat and power plant, is a factor that would be taken into account in assessing whether a proposed incinerator was the BPEO, under policy W3A. This factor might be improved by technical innovations. The life of an incinerator would be taken into account at planning application stage, and also, no doubt, by the WDAs when considering waste contracts. The University of Essex and others refer to new quasi-incineration techniques such as pyrolysis or gasification: there is nothing in the plan to preclude these, and insofar as they overcame the problems of conventional incinerators they would to that extent be favoured under the policy. The problems raised by Harlow council are all matters that would be addressed at the application stage under various policies of the plan; the issue of
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EIA has been covered at part 9. The matters raised by waste industry companies, and also those raised by GOER and the Environment Agency, have already been dealt with.
Policy W7K: delete text and substitute as follows:
Proposals for incineration of waste will be permitted at the locations identified in schedule 1 (subject to compliance with the requirements of policy W8A) or at other locations (subject to the requirements of policy W8B), provided the following requirements are also met:
incineration without energy recovery will not be permitted except in specialised cases;
emissions to air and water from the process will not materially endanger human health or harm the environment. In deciding whether this requirement is met, the WPAs will assume that the necessary controls are exercised under Environmental Protection legislation and that the pollution control regime operates effectively, and will take into account whether the process proposed is the Best Practicable Environmental Option for the particular waste stream; and
provision is made for the recycling or other management of all residues, including the means of disposal to landfill where that is the BPEO.
Policy W8A: delete text and substitute as follows:
Waste management facilities will be permitted at the locations shown in schedule 1 provided all of the following criteria, where relevant, are complied with:
there is a need for the facility to manage waste arising in Essex and Southend (subject to policy W3C);
the proposal represents the Best Practicable Environmental Option for the particular waste stream, having regard to any alternative options further up the waste hierarchy;
the development complies with other relevant policies of this plan, including the policy/ies in chapter 7 for the type(s) of facility proposed;
adequate road access is provided in accordance with policy W4E. Access by rail or water will be supported if practicable;
buildings and structures are of a high standard of design, with landscaping and screening provided as necessary; and
integrated schemes for recycling, composting, materials recovery and energy recovery from waste will be supported where this is shown to provide benefits in the management of waste which would not otherwise be obtained.
To ask the Secretary of State for Environment, Food and Rural Affairs what powers inspectors appointed to oversee the drawing up of county waste plans have to overrule decisions of the councils concerned. 
[holding answer 19 July 2001]: I have been asked to reply.
The role of a Local Plan Inspector is prescribed in the Town and Country Planning (Development Plan) (England) Regulations 1999 and set out more informally in the Green Book, "Local Plans and Unitary Development Plans: A Guide to Procedures". Essentially it is to hold the inquiry and report to the council with recommendations as to the action they should take with respect to each of the objections. The council must decide whether or not to accept the Inspector's recommendations. They may decide not to do so but must give their reasons for this. The council will normally propose modifications to the Plan in accordance with their decisions on the Inspector's recommendations, prior to adopting the Plan.
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