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Mr. Gummer : Most research grants are provided by the Department of Trade and Industry and I understand from my right hon. Friend the Secretary of State that they will continue. My Ministry will continue to do what we have already done to make it possible to use straw more effectively in other ways.
Mr. Anthony Nelson (Chichester) : I, too, welcome the ban. It will bring widespread relief to constituents in cereal-growing areas such as that which I represent and it will once and for all stop the atmosphere being used as an airborne dustbin for agricultural waste. As the ban will not come into effect for two or three years, will my right hon. Friend confirm that in the meantime every effort will be made to encourage local authorities to pass model byelaws and enforce them, and to ensure that the voluntary code of practice is strictly observed?
Mr. Gummer : I thank my hon. Friend for those observations. I hope that the code of practice will be considerably tightened and widely implemented, and that prosecutions will continue to be brought where necessary.
Column 874Above all, I want the farming community to recognise that it can do a great deal for its image if only it is prepared to show the public how concerned it is about the problem.
Mr. Quentin Davies (Stamford and Spalding) : I congratulate my right hon. Friend on facing, with characteristic decisiveness, a problem which undoubtedly needed to be tackled, but may I ask him for a detailed economic assessment of the costs that the measure will impose on the British farming community? Even in Lincolnshire, part of which I represent, where we have highly efficient farming and some of the best land in the country, the farming community cannot bear increased economic burdens at present. May we have the benefit of such an economic assessment before the House considers the Bill?
Mr. Gummer : I thank my hon. Friend for his first comment. It may sound a little churlish to say that what he asks for is not possible. Over the next three years, alternatives will emerge, even in areas where alternatives are currently thought to be impossible. That has happened in my own constituency. Over the past two or three years, farmers who swore to me that it was impossible not to burn straw have found alternative methods which are less expensive than straw burning. If those cases are not atypical, I suspect that there will be many more in the next three years. Any economic assessment which did not take that into account would be unrealistic.
Mr. Henry Bellingham (Norfolk, North-West) : Is my right hon. Friend aware that, the vast majority of parish councils in west Norfolk will welcome today's statement? I am sure that many insects and species of birds, especially the English partridge, will also welcome it. Is my right hon. Friend aware that, although the vast majority of farmers will be able to alter their techniques, some small marshland farmers in the fenland area of my constituency will have problems? Will he consider their particular difficulties?
Mr. Gummer : Under the terms of what I have said, I am happy to look at any particular problems that my hon. Friend raises. I am also glad that he has taken it upon himself to become the spokesman for the insects and birds of his constituency and elsewhere. Among other problems, straw burning has deprived us of much wildlife which should be retained. Like my hon. Friend, I am especially pleased that this measure will help in the retention and expansion of the English partridge.
Several Hon. Members rose --
Mr. Barry Jones (Alyn and Deeside) : On a point of order, Mr. Speaker. May I draw to your attention questions for written answer Nos. 343 and 344 on today's Order Paper, which concern the important matter of the poll tax in Wales? They appear to be a device to bypass an accepted convention of the House--for a Cabinet Minister to explain his actions and to answer questions orally in the House. I seek your guidance. The people of Wales hate the poll tax, as the Secretary of State for Wales knows. That is why we think that he is running away and that his subterfuge is a disgrace. We seek your help and assistance.
Mr. Rowlands : Further to that point of order, Mr. Speaker. This House is founded on the fundamental principle of the financial accountability of the Executive to the House, especially when there are new fiscal impositions on our communities and people. The poll tax is a new tax, which will be double the cost of the current rates for many in my constituency. Surely there must be some remedy through you, Mr. Speaker, or perhaps you have a remedy to ensure that the question of fiscal accountablility of Ministers is considered on such a fundamental issue. You should be able to help us to make the Minister give a statement.
Mr. Win Griffiths (Bridgend) : Further to that point of order, Mr. Speaker. As I recall, my hon. Friend the Member for Alyn and Deeside (Mr. Jones) made a protest when the Secretary of State for the Environment made a statement on the poll tax for England and we were promised that there would be a statement by the Welsh Office on this matter. However, we are now being bypassed and experiencing government by press release. I hope that we have a positive--
Mr. Speaker : Order. I shall deal with this, as there is pressure on the subsequent debate. The hon. Gentleman and the whole House know that I am not responsible for whether statements are made. There has to be some balance in these matters. We have had two statements today and if we had more, very little time would be left for debate. I am not responsible ; it is a matter for the Government.
Mr. Morgan rose--
Mr. Dennis Skinner (Bolsover) : Further to that point of order, Mr. Speaker. Perhaps I can help. The Secretary of State for Wales has many duties to perform. I do not know why he has not turned up to provide the necessary information on the poll tax, but I know that he spent a lot of time yesterday in the Tea Room with a lot of Tory wets organising voting--
Mr. Ray Powell (Ogmore) : Further to that point of order, Mr. Speaker. I appreciate that it may not be within your domain to decide on this matter because we are raising the question of the Secretary of State for Wales making a statement. However, you will recall the times that we have sat in this Chamber when the Scottish poll tax has been debated and the number of times that questions were asked of the Secretary of State for Scotland. Surely you should ensure that on the issue of the poll tax in Wales the Secretary of State enables Back Bench Members in particular to question him on his deliberations and decisions.
Mr. Speaker : Order. I must repeat to the hon. Member and to other hon. Members who may be thinking of questioning me on this that it is not a matter for me. It is a matter for the Leader of the House and I am surprised that it was not raised with him earlier. There was plenty of opportunity then and he is the man responsible.
Mr. Max Madden (Bradford, West) : On a point of order, Mr. Speaker. Have you invited the hon. Member for Darlington (Mr. Fallon), who is a Whip, to stand near you during Prime Minister's Question Time? I noticed today that he seemed to be muttering names to you--
Mr. Speaker : Order. That is not the sort of question I expect and I am surprised that the hon. Gentleman should even mention such a matter. I take no notice of anyone standing at my elbow, although it is true that my secretary stands here to note whether a member of the Front Bench gets up. But I take no notice of anyone else who may stand by the Chair and I certainly do not appreciate hon. Members whispering to me at Question Time, or at any other time.
Mr. Andrew Welsh (Angus, East) : On a point of order, Mr. Speaker. I genuinely seek your guidance on a point of order regarding Standing Order No. 130 on the Select Committee on Scottish Affairs and a situation that I fear is heading towards plain unfairness. The Leader of the House said today that your ruling yesterday was in a different context from the matter that I raised regarding Standing Order No. 130. I presume that he meant the debate on 20 December 1988 in which the House decided that it
"recognises the inability of the Committee of Selection to nominate Members to serve on the Scottish Affairs Committee."--[ Official Report, 20 December 1988 ; Vol. 144, c. 393.]
The Committee is not unable to select hon. Members to serve ; there are plenty who are willing to serve. It is, rather, unwilling to nominate hon. Members to serve, which is a very different matter. How can one be bound by Standing Orders and yet not have the power to implement them? Surely all Standing Orders have equal validity and are
Column 877equally binding. In that context, I ask for a further ruling not only on Standing Order No. 20, but on Standing Order No. 130.
Mr. Speaker : I was dealing with a different matter yesterday, but I can answer the hon. Gentleman. Standing Order No. 130 states that there shall be a Select Committee, but Standing Order No. 104 states how it should be set up. The House passed a resolution on 20 December 1988 saying that the Select Committee on Scottish Affairs should not be set up.
Mr. Rowlands : On a point of order, Mr. Speaker. You chided us gently for not taking our other parliamentary opportunity with the Leader of the House. However, the answer about which we are complaining is a written answer this afternoon. As you know, no Back-Bench Member would know the reply to a parliamentary question until after 3.30 pm. We did not have the chance to take the opportunity you have mentioned.
Mr. Speaker : I received notice from a number of hon. Members before I came into the Chair at 2.30 pm that this point might be raised. The answer probably was available and should have been raised in the way I suggested.
Mr. Barry Jones : Further to that point of order, Mr. Speaker, and, I hope, in assistance to you. What has been released this afternoon by the Secretary of State for Wales is a detailed statement involving several billion pounds as it affects every adult on the poll tax in Wales and every borough, district, and county authority in Wales. Can you help in any way, Mr. Speaker, by bringing to the House now a Minister from the Welsh Office so that that Minister can answer for the serious matters mentioned in the Secretary of State's statement?
Mr. Speaker : The hon. Gentleman knows that that is not within my power. However, he has virtually done it himself by making that request. I am sure that those on the Government Front Bench will have heard what he said.
Statutory Instruments, &c.
That the draft Education Support Grants (Amendment) Regulations 1989 be referred to a Standing Committee on Statutory Instruments, &c.
That the draft National Savings Bank (Investment Deposits) (Limits) (Amendment) Order 1989 be referred to a Standing Committee on Statutory Instruments, &c.
That the Bovine Offal (Prohibition) Regulations 1989 (S.I., 1989, No. 2061) be referred to a Standing Committee on Statutory Instruments, &c.
That the Social Security (Unemployment, Sickness and Invalidity Benefit) Amendment No. 3 Regulations 1989 (S.I., 1989, No. 2122) be referred to a Standing Committee on Statutory Instruments, &c.-- [Mr. Sackville.]
That this House takes note of the 37th to 40th and 42nd to 52nd Reports of the Committee of Public Accounts of Session 1987-88, of the 1st to 33rd Reports of Session 1988-89 and of the Treasury Minutes and Northern Ireland Department of Finance and Personnel Memorandum on those Reports (Cm. 533, 563, 624, 648, 697, 717, 747, 831 and 850), with particular reference to the following Reports :-- 1987-88 :
Forty-fourth, Quality of service to the public at DHSS local offices ;
Forty-eighth, Sale of Royal Ordnance plc.
First, Management of the collections of the English national museums and galleries ;
Twenty-sixth, Coronary heart disease ;
Twenty-eighth, Backlog of maintenance of motorways and trunk roads ;
Thirty-first, Reliability and maintainability of defence equipment.
The last such debate was on 3 November 1988 when 38 reports were covered by the motion. Now we are dealing with 48 reports and nine Government replies. The motion is in my name and that of the hon. Member for Scarborough (Sir M. Shaw), who is such an assiduous and valuable member of the Committee. As on recent occasions, we have chosen a few reports to highlight, although reference to many of the others will be acceptable in the debate.
I should like to thank the Committee, which is hard-working and meets twice a week. There are many papers to read. The civil servants involved naturally present their case with a great volume of paper. Consequently, the weekends of many of my colleagues on the Committee are taken up with reading them. There is no doubt that in the distant past the Chairman on many occasions did all the work. He read all the papers and the amount of work done by other Committee members varied greatly. However, now we have a hard-working Committee which has provided great advantages to the reports that we produce. During the time covered by the reports, we have lost four Labour Members from the Committee--my hon. Friends the Members for Normanton (Mr. O'Brien), for Rhondda (Mr. Rogers), for Redcar (Ms. Mowlam) and for Fife, Central (Mr. McLeish), who have all joined the Opposition Front Bench. It looks as if the Opposition Front Bench is looking to the Public Accounts Committee for recruits. It is a measure of the type of ability that we have been able to acquire that, although the Committee has lost the advantage of having those people and their experience on the Committee, the advantage which they bring to the Opposition Front Bench is an understanding of many economic and financial matters.
Column 879Mr. Graham Allen (Nottingham, North) : It is a valuable experience. There is a vacancy on the Committee and if my hon. Friend the Member for Bolsover (Mr. Skinner) wishes to join us, he would be most welcome.
Mr. Sheldon : I shall deal with the issue raised during the statement made by the Secretary of State for Trade and Industry. I regret-- as does the Committee--the leaking of confidential memoranda. The Committee receives many confidential memoranda dealing with sensitive matters concerning defence, security and others. If it were felt that those were now in jeopardy, the work of the Committee would be seriously affected. After it receives those confidential memoranda, the Committee decides which of them shall be published and what parts should be available to public scrutiny. With the exception of only a few--and only parts of those--all our investigative sessions are in public since we believe that there is great advantage in letting the public in on our work so as to give them knowledge and understanding of what we do.
The new Financial Secretary to the Treasury is now a member of the Committee. In line with tradition, he does not attend very often but when he does--whenever time and interest allow--we welcome him. We both proceed on similar lines as the Treasury wants to obtain value for money and so does the Committee. Naturally, there are differences between members of the Committee and the Financial Secretary, but on value for money we are at one and we hope that that will long remain. The previous Financial Secretary, the right hon. Member for Kingston upon Thames (Mr. Lamont), understood that well. We have an enormous advantage in that we have unanimity within the Committee. Without exception, all our reports are unanimous.
Mr. Sheldon : It is not a problem ; it is an advantage. If we were divided, the Government need not take any notice of our reports. Unlike any other Committee, we are there to provide value for money whether it concerns Royal Ordnance factories or the sale of Rover. Many other Committees can decide on questions of policy. We are concerned not with policy but with the taxpayers' interests.
Mr. Skinner : Is my right hon. Friend saying that we come to the House to take part in the sloppy consensus which he describes in producing unanimous reports? Is he saying that, after a decade of swindles both by the Government and by private entrepreneurs, Tory Members will connive with Labour Members searching for the truth in order to embarrass the Government? There was a £200 million swindle at Ferranti over defence contracts and now there is another swindle at Rover. Despite those giant swindles, this happy consensus never arrives at a conclusion--because of the lack of conflict--until it is all over.
Mr. Sheldon : Of course it is late but we operate only after the full investigation. We cannot proceed until we obtain full information as to what happened. We then produce the report. As I have said, we have made serious criticisms of the Administration. If my hon. Friend reads
Column 880the reports he will see those criticisms. Every one of my hon. Friend's points as to the failure to obtain value for money is dealt with in those reports.
Mr. Michael Shersby (Uxbridge) : In considering the point made by the hon. Member for Bolsover (Mr. Skinner), does the right hon. Gentleman agree that often the Committee's deliberations are extremely effective? Does he recall the investigation into corruption in the Property Services Agency and the results of that investigation which led to the virtual instant dismissal of the head of that agency? Surely that is action.
Mr. Sheldon : That is true and the same applies to defence contracts. When the chairmanship of the Committee was held by Harold Wilson, he understood the importance of the Public Accounts Committee in exposing some of the Ferranti and other defence matters of the time. I pay tribute to him. He was the Chairman who initiated those investigations. There are no fewer investigations today ; if anything, there are rather more of them because the National Audit Office finds out about these matters more effectively.
The Committee has an important task in exposing occasions when there has been a failure to obtain value for money for the taxpayer. It is its dislike of the taxpayer being rooked that is the cause of the Committee's unanimity. When we leave the Committee we return to our usual political affiliations. Many of our members are vocal in this House on political matters, but when it comes to value for money we are united in our determination to achieve it.
Mr. Allen : My hon. Friend the Member for Bolsover (Mr. Skinner) has made a strong and genuine argument about the role of this House and its Committees, but if this House and its Committees are to hold the Government to account, which is our role, almost by definition we can account only for what has already happened--and the Public Accounts Committee is foremost in that role. It is a retrospective role, but I hope that all hon. Members will agree that it is a valuable one.
Mr. Sheldon : I am grateful for that remark. I wish that my hon. Friend the Member for Bolsover would pay a visit to hear some of our deliberations--attendance at the Committee is certainly open to him. I should dearly like him to see the questioning of those who are responsible for spending the money by members of the Committee. He would hear vigorous questioning by members on both sides of the Committee.
Mr. Skinner : I have to tell my right hon. Friend that there is a question of hypocrisy here. I did not agree with the setting up of Select Committees. I do not believe that the combination of Tories and Labour Members in this sort of consensus is valuable--
Mr. Skinner : This is a place where conflict between arguments takes place. Having opposed the setting up of Select Committees, I have no intention of being hypocritical and joining them. If my right hon. Friend wants to continue the work that he says is so valuable, that is for him to decide, but I have no wish to be involved. If he wants to connive with the Tories and any other rag, tag
Column 881and bobtails that is his business. I have not come here to do that : I am here to attack the Tory Government and their supporters day in and day out.
Mr. Sheldon : Select Committees have produced investigations of enormous value to everyone. Questions may be asked across the Floor of the House, and they are valuable, but they do not pursue the detail. Again and again the truth has been found by such pursuit, and only repeated questioning brings out what happened. If my hon. Friend the Member for Bolsover doubts that, I suggest that he comes along on Monday, when we begin examining the sale of Rover and when we shall discover information which he, despite his great talents for parliamentary procedure, would be unable to obtain for himself. I turn now to the work that the National Audit Office does. We work closely with it because it provides the information, and we deal with how that information came about. Why was the money spent? How could it have been spent better? How could it have been spent more efficiently and effectively? We and the NAO are a partnership. The Committee depends on the NAO's investigations, which are based on an examination of Government papers. We discuss with the NAO the lines of inquiry that it is pursuing.
I want first briefly to mention the fourth report of the Session 1988-89 which deals with the National Audit Office's estimates and corporate plan. The NAO, using fewer staff, is producing more reports and undertaking more investigations of value for money. That is a tribute to the efficiency with which the NAO, under John Bourn, is progressing. I am pleased that John Bourn's first full year as Comptroller and Auditor General has gone so well. He has complete discretion over which investigations to choose, but we also feed in our views.
John Bourn has slightly fewer than 1,000 staff, whom he needs to keep Government value for money under review. I want to mention David Wyland, who has retired as Deputy Comptroller and Auditor General after 40 years in the NAO. There is now a new head of the Northern Ireland Audit Office--Dr. Bill Jack--and he and his staff play an important role. They were rather poor relations of the NAO in Great Britain, but following Denis Calvert's work on the De Lorean affair the Northern Ireland Office became rather more important ; we discovered it had a hidden strength that we had not appreciated and the work it has done has given it a higher profile among members of our Committee.
The accounting officers--the permanent secretaries who are responsible for spending public money and who appear before us--take their responsibility seriously and spend a great deal of time preparing for meetings with the Committee so that they can answer the questions that we put to them. In the previous Session about 220 recommendations were made by the Public Accounts Committee, about 200 of which the Government accepted. The numbers are about the same for this Session.
Column 882We have the great advantage of hindsight. It is up to the Committee to ensure that we are not overwhelmed by it so that we fail to take into account how the situation appeared at the time to the permanent secretary making his or her decision. Within the bounds of what is humanly possible, we do not do too badly.
Fraud and corruption are the most important matters that we examine. I urge my hon. Friend the Member for Bolsover to acknowledge that that was one of the main reasons why the Committee was set up in the last century. However important value for money is, it must always come second to ensuring that fraud and corruption are kept to a minimum. Our most important task is to come down strongly on cases of fraud and corruption. It is not enough to reflect what happens in the country at large ; when dealing with public money we have a much greater responsibility than when dealing with private money. The Committee has always held that to be so and will continue so to do. The first report with which I shall deal is about the health services. The great advantage now is that we are taking them more seriously than we used to. We used not to examine them in detail, but now we look into them closely and we have produced a number of reports on them. Generally, our task is not difficult--we look at what the Government intend to spend their money on and ask what their objective is. How do they come to decide that they will launch a certain programme? We ask that their objectives be closely defined--it is no good coming up with a general proposition. We want clear objectives, monitoring during the implementation of the programme and an assessment of the ultimate results. We want to be able to compare objective and achievement. That is not difficult, but in practice it fails miserably on a number of occasions.
One case involved administrators in the National Health Service. The laudable aim of reducing the number of top administrators was held to be a matter of Government policy. We do not question Government policy, which is up to the Government. We want to ensure that, once the Government have decided on a policy, they carry it out in the most effective, efficient and economical manner. We found that the Government had no clear plan about how many administrators expected to go or how much it would cost. At the end of the scheme, they did not seem to know how many had actually gone. We suspected that a number of them had been re-employed in other parts of the National Health Service. Those are important matters.
I shall briefly mention the third book of Sir Leo Pliatzky who was a distinguished civil servant, a second permanent secretary to the Treasury and the permanent secretary to the Department of Trade. In the third of his splendid books, which are well worth reading and deal with public expenditure, he mentioned that the National Audit Office advocated the spending of money. With a true Treasury background, he did not agree with that. However, the National Audit Office does not really advocate that.
In a number of our reports, we say that it is worth spending money if, as a result, much more money is saved. An obvious example is the repair of the fabric of buildings. Clearly, we could let a building deteriorate and save money or have a proper system of maintaining the building's fabric which would not be spending money, but
Column 883an economical use of the building and the way in which it is dealt with. It was that sort of spending that the National Audit Office had in mind.
The auditor's role today is not what it used to be ; there has been a fundamental change. Years ago, auditors were civil servants who added up figures to ensure that the money went to the right people for the right purposes. That was splendid and crucial. However, in addition to that, the auditor's role today is to ask whether what is being done is sensible. When a company or finance director has a meeting with the auditors of the company, they tell him or her why they are proposing certain actions. They do not just add up and say that the director has to pay a certain amount of tax, but go into the matter with care. They say, "You can save money if you do it another way" or, "You can make much more effective use of your resources if you handle them in a different way." That is the role of today's auditors. The trouble is that a number of people do not realise the change that has taken place.
In the National Audit Office today, there are auditors with qualifications. One of our problems is that they are tempted away by a number of accountancy firms which want them because they have a level of expertise which will be valuable to them. With rates of pay as they are in Government or associated services, of which we are one, that is one of our problems. However, it shows that those people not only have the advantage of being auditors but, by seeing the other Government Departments, can spread information and understanding between one Department and another and between Government and the private sector about the best practices to be adopted. The relationship between the National Audit Office and the private sector is considerable, and the two are able to have a great deal of cross- fertilisation.
The first point I shall deal with in relation to the National Health Service is coronary heart disease. The twenty-sixth report of the Session 1988-89 showed that 180,000 people of working age died each year from coronary heart disease within their working lives--which is the important aspect. That cost the National Health Service £500 million a year. That is bad. What are the Government and the National Health Service doing about it? They are spending about £10 million. Therefore, the problem is costing £500 million and £10 million is being used to try to reduce the incidence of coronary heart disease.
We could look at the figures and say that they are wrong because there may be other factors involved. There are, but they are all on the same side. Ten years ago, the incidence of coronary heart disease in this country was roughly the same as in many other comparable industrial countries. During those 10 years, a number of those countries have experienced rapidly declining levels of heart disease. Our level has come down a little, but hardly at all, and in Scotland the level is still high. We can forget the money, although that obviously concerns us. Apart from the money, such disease causes misery, anxiety, worry and other problems which arise when the breadwinner, or often another member of the family, fails to make a proper recovery in hospital.
Paragraph 42 of our report states :
"We acknowledge that the medical profession have a major role to play in the development and introduction of new treatments. However, we are surprised that the Department consider that they do not have a more positive contribution to make in this area. The wider use of cost-effective treatments has major value for money implications and we would expect
Column 884the Department to keep very closely in touch with possible developments and to take positive action to encourage the introduction of new treatments once these have been shown to be both medically acceptable and cost-effective."
We hope that the Department will take a different approach to those problems.
We go on to say that there is a serious mismatch between the resources and the demand for cardiac treatment. We deal with bypass graft operations and the fact that they are in short supply. In the Treasury minute, which is the response of the Government and the National Health Service, the Government accept that many deaths and disabilities caused by the disease can be prevented or reduced. With regard to the value of preventive campaigns, we understand from the minute that the Government accept that they will be given more impetus. The development of quantified targets is also being considered.
We like quantification. We know that there are limitations, and that in some cases quantification is difficult or almost impossible. However, we like the attempt to be made to quantify if only because we can check what is being done. We realise the reasons, difficulties and limitations. We understand the way that the Government are able to work. We strongly emphasise the quantification of achievements and, particularly, targets. The Government accept that there should be more emphasis on prevention rather than treatment, and we look forward to seeing that.
The fiftieth report of the Session 1987-88 deals with the issue of operating theatres and their use in the National Health Service. We looked at this because we knew, as does every hon. Member, that serious problems exist involving bottlenecks when certain surgery is undertaken. We asked where the bottlenecks mainly occurred. The National Audit Office found that they arose essentially in operating theatres in the National Health Service. To our surprise, we found that not much more than half of the operating theatres' available use was utilised. I am talking about not weekends or evenings, but the working day and week.
Some of the reasons why the operating theatres were not available were understandable and due to patients getting better or worse. However, we found that even when this led to cancellations, a system should have been devised so that those lower down the queue could be brought forward. The failure of consultants to turn up to carry out operations was a contributory factor in the failure to make the best possible use of operating theatres.
These were serious matters and accordingly the Committee produced a number of recommendations and submitted them in the report. One recommendation was that a record should be kept of areas in which there had been some improvement as a result of carrying out checks. I was pleased to receive this morning a copy of "Efficiency of Theatre Services", which has been published by the Association of Anaesthetists of Great Britain and Ireland and the Association of Surgeons of Great Britain and Ireland.
I should explain that after the Committee's report was published we ran into much opposition. It was alleged that we were criticising the consultants. I find the summary of their recommendations extremely valuable. They say that there should be close collaboration between surgical teams