House of Commons Hansard Debates for 2 Apr 1993

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What is more, the clear evidence of financial problems is never discussed in public. Indeed, even when I ask questions in this House, the Secretary of State simply says, "There has been a meeting between all the relevant authorities, it has all been sorted out, don't worry about it." I not only worry about it : I have a deep feeling of unease about the management in my hospitals and certainly in my region. Moving someone who is incompetent from one region to another simply because his predecessor was even more incompetent is a pretty poor decision.

If the Minister is not prepared to agree to an independent assessment, we will know that the Government are not serious about setting up trusts or the delivery of health care. If they want to privatise the health service through incompetence, they are doing well ; but if they want to provide health care, the Miniser had better answer my questions today--otherwise we will know that elected Members of Parliament cannot even get answers on behalf of patients. 10.43 am

The Parliamentary Under-Secretary of State for Health (Mr. Tom Sackville) : The hon. Member for Crewe and Nantwich (Mrs. Dunwoody) began by speaking about free speech. There is no danger that she will not continue to exercise that right very effectively. Nor is there any danger that we will not continue to answer her. She touched on ministerial accountability in the health service. I must tell her that I was in my place in the early minutes of April fool's day to discuss neurosciences in Liverpool. I was back in my place in the early hours of this morning--3.30 am--to debate the London ambulance service ; I am here again now, self- evidently, to discuss a particular local hospital with the hon. Lady. I shall continue to be in my place to discuss mental health with my hon. Friend the Member for Bury St. Edmunds (Mr. Spring). Junior doctors have their little complaint about how long they work ; junior Ministers occasionally find themselves in the same position, so we empathise.

The hon. Lady raised so many different points that I do not think that I can cover all of them. However, I start with her request for an independent inquiry into the finances of the trust and the local health authority. There is likely to be a deficit of about £500,000 at the end of the year, which is just over 1 per cent. of income. It is possible that that has been caused by the recruitment of additional consultants, without the total co-operation of the purchasers.

That is not an insurmountable problem. Several trusts have overspent, but the vast majority have balanced their books. It is certainly not something which I consider to be a proper matter for independent inquiry. The position is clear and it is being dealt with, so I see no reason to accede to the hon. Lady's request. There are a great many good things about the trust. In-patient activity rose by 6 per cent. during the year, which is excellent news. It mirrors the experience of many other trusts.

Mrs. Dunwoody : Does the Minister accept the figure of £2 million that was given by the executives of the hospital?

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Mr. Sackville : I am advised that, when the figures for 1992-93 are available, it is expected that the trust will show an operating loss of about £500,000.

Mrs. Dunwoody : No.

Mr. Sackville : That is the advice that I have been given and I have no reason to doubt it.

The hon. Lady made a number of specific points, but, in particular, she raised the question of a flat that has been purchased by the regional health authority. It decided to use endowment funds to purchase the flat so that it could save money on the very high hotel bills for people who visit the region. If there is any question of impropriety, I have no doubt that the district auditor will have something to say. The matter has been raised with me on more than one occasion and I have raised it with the region. I am satisfied that it took that decision in good faith. The hon. Lady is being a little mischievous in implying that there is something wrong or strange about it.

The hon. Lady said a great deal about trusts in general. It is becoming increasingly clear that trusts are providing the proper model for the delivery of health care. The hon. Lady should realise that a hospital running itself, with its own board of local people--who, together with management, take decisions that they believe to be in the best interests of patients--is the right way to proceed. Much better that than that the hospital should find itself an adjunct to a distant bureaucracy.

The experience of trusts to date has been most encouraging. The hon. Lady should not tarnish the name of trusts on the basis of a minor financial imbalance at her local trust hospital. We are receiving the message here and from abroad that people in other parts of Europe are examining the system that we are creating with the purchaser-provider split by giving hospitals trust status and, in turn, giving health authorities the funds with which to commission health care for the populations for which they are responsible. People from other European countries are saying, "This is the model that we would like to set up." I have heard that said by officials from Spain and Germany. I am confident that others will be looking to us for the model for how to deliver internal market health care. Whether Hillary will grace us with a visit is something which is still in doubt, but I have no doubt that we shall be watched carefully by the rest of the world. As I have said, much of what the hon. Lady said about trusts was entirely unwarranted.

The hon. Lady talked about Sir Don Wilson, the regional chairman. He has done a remarkable job. The hon. Lady may disagree with some of the decisions that he has taken, but, with firm leadership, he has made a great many advances in the Mersey region that are the envy of other parts of the country. The fact that he has been asked to examine the problems of the west midlands is a further tribute to his skills. I do not know what evidence the hon. Lady can produce to cast aspersions on Sir Don Wilson's management skills.

I understand that the hon. Lady is much exercised about the proposed merger of the Crewe and Macclesfield authorities. She has described it as the merger of two awkward health authorities. I do not know whether that is a comment on the two Members concerned, but I am sure that my hon. Friend the Member for Macclesfield (Mr. Winterton) would be disappointed if he knew that he had

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been referred to in those terms. The two hon. Members, the hon. Lady and my hon. Friend, are both acknowledged experts in health care. If the merger takes place, I think that they will find it a stimulating partnership--a marriage made in heaven. I have no doubt that the people in both areas will find it greatly to their benefit. The hon. Lady knows that there are advantages in some mergers of health authorities. The idea of 192 different authorities purchasing health care, as we have had in the past, may not be the best model. It may be much better that there should be larger configurations of perhaps 500,000 or more residents, so that there is more clout when it comes to exercising the purchasing function and dealing with providers.

Health authorities, as a result of mergers, will be able to make more sensible decisions over the gamut of the local population. It will probably be of great benefit to the local population to have a larger purchaser that can make the appropriate decisions and have much more flexibility in the purchasing of health care. I think that that will turn out to be true. The hon. Lady will find from the health authorities that have already merged that some of them have found an optimum size.

Purchasing is a new skill within the health service. Many of those who work for local health authorities are only now beginning to discover that they are no longer running hospitals. They are commissioners of health care, not hospital managers. It is a skill in itself. The contracting arrangements between health authorities, trusts and providers will be an important part of the system in future.

The hon. Lady mentioned other matters, including community care. Yesterday saw the first day of the new system. It poses a considerable challenge, and it will demand a great deal of give and take on all sides, between hospitals, the NHS and local authorities, to ensure that it works, that patients are assessed quickly and efficiently, that beds are not blocked as a result of failure to assess and that the right provision is made for people coming out of hospital or for others in the community. A great spirit of co-operation will be required. I take the opportunity further to emphasise that point.

There is no reason why community care should not work. We know that we need assessment in each area, and in this instance it will be carried out by the social services, of all those requiring care in the community, whether post -hospital or otherwise.

The hon. Lady mentioned morale. She is making a great deal of what are minor financial problems locally and

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painting the blackest possible picture. There is no point in doing that. She is helping only to exacerbate the problems of morale among staff locally. I do not see that that is doing any favours to her local health service.

The hon. Lady mentioned the departure of the chief executive. I cannot comment on that or on his decision to go. I can say only that his replacement is being sought. The hon. Lady should not seek to find conspiracy theories or any other excuses to write headlines on the chief executive's departure.

I am sure that the hon. Lady will agree with me that the hospital trust has already achieved much of which it can be proud. I have said that a record number of people have been treated during its first year. Out-patient attendance has increased by 2,000 and 70,000 accident and emergency cases were dealt with. The number of patients seen was 9 per cent. above the level that the trust was contracted to provide. That is one of the reasons why many trusts this year have run into temporary financial problems. They are the victims of their own success.

The numbers of patients treated during the year has been much greater than that budgeted for, mainly on the elective side. This has meant disruptions, which is unfortunate. Sometimes, there have been temporary ward closures. On the other hand, in many instances patients have been treated earlier than they would have been. I accept that any disruption is unsatisfactory, and guidance has been sent to the health service to ensure that the contracts work more flexibly over the year. Those in the health service will be advised to monitor contracts more carefully to ensure that what happened this year does not happen again.

The hon. Lady is trying to tell the House that everything is going wrong in the local health service. She is saying that it is underfunded. It is true that her local health authority is below capitation. There is the same problem in Bolton, and that has been the position for years. There is an intention in Bolton, as in Crewe, to bring the districts that are below target up to target. As the hon. Lady well knows, if the merger with Macclesfield goes ahead, that will lead to a change in the funding arrangements in her authority, to the benefit of her constituents.

It has been useful to have the debate. I think that the hon. Lady misrepresents the situation. There is much of which to be proud. Those who work in her local hospital have done a wonderful job and I have no doubt that they will continue to do so.

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Behaviourally Disturbed People

10.59 am

Mr. Richard Spring (Bury St. Edmunds) : I am grateful for the opportunity to speak this morning. I am also most grateful to my hon. Friend the Minister for being here today to reply to the debate. Last summer, I was contacted by very distressed parents in my constituency. What was revealed to me then and continues today is an example of human tragedy and suffering which moved me considerably. It would be helpful if I summarised my constituent's difficulties. As a teenager she became pregnant and had an abortion, after which she exhibited previously non-existent behavioural difficulties. In the United States the phenomenon has been identified and described as post-abortion shock syndrome. That may have been the cause of what followed. Seven years on, her parents contacted me. They were desperate. Their daughter had been a patient in the psychiatric ward of West Suffolk hospital in Bury St. Edmunds--a ward which gives the highest standards of psychiatric care and to which I pay unqualified tribute this morning.

In the opinion of the senior psychiatristrmore, there had been violence directed against ward staff, which caused them concern and consternation. Psychiatric opinion indicated that her condition was behavioural rather than psychiatric. As she was diagnosed as suffering from an untreatable personality disorder rather than a treatable illness, it was not possible to detain her under section 3 of the Mental Health Act 1984.

My constituent was transferred to the region's medium secure unit for those with mental illness, the Norvic clinic in Norwich, which I have visited. Under the stricter regime there, she exhibited more restrained behavioural patterns. However, on discharge to a hostel, symptoms of chronic disorder reappeared and she returned to live with her parents. At home her actions including crying and wailing and banging her head incessantly against a wall. Where could she go? The psychiatric ward declined to take her because her condition was not considered pyschiatrically treatable. The district health authority was unable to help either for that reason, although it was very willing to do so.

I was advised that the criminal justice route should be explored. A previous move had simply resulted in my constituent being sent home with a fine. At this point, I should perhaps stop to say that all the routes that I explored on my constituent's behalf last summer seemed closed. My constituent has now had a baby. I am grateful to Suffolk social services for the concern that they have shown in helping her during this difficult time.

The nub of the issue is clearly this : where does someone who is not psychiatrically assessible go? Clearly, for the layman like myself and other hon. Members, there is no tangible difference between someone who appears to be psychiatrically or behaviourally disturbed and someone who is. The manifestations appear similar. Tragically, such an individual may commit an act of violence against another person, so there is clearly a public safety aspect. My great fear is that our prisons contain people who have similar problems, when prison is clearly as inappropriate response to this tragic human disorder. I have taken the advice of several forensic psychiatrists and

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I have to tell the House that my constituent is not alone in her ghastly dilemma. There are many in our country for whom there is no clear provision, because they fall outside certain definitions of mental disorder.

There is, of course, rising concern and awareness about mental illness. Indeed, that was highlighted as a key objective in "The Health of the Nation". Moreover, one of its strategic elements is the development of comprehensive local services, with local purchasing and planning arrangements which ensure continuity of health and personal care. A start has been made in Suffolk.

I have alluded to the Norvic clinic in Norwich, which is the only provider of medium secure beds in the East Anglian region. Districts do not, for example, have psychiatric teams whose specific responsibility is to provide more local services for mentally disordered patients. Indeed, at the core of the Reedport's recommendations is the view that district health authorities should be responsible for purchasing a more comprehensive spectrum of psychiatric provision for mentally disordered offenders. Clearly without the support of her parents and family, my constituent might well now be in prison herself.

The thrust of what the Reed committee reported was that mentally disordered offenders who need care and treatment should receive it from the health and social services rather than the criminal justice system. That theme and focus is not new. In 1975 the Butler report noted :

"In the face of the widely acknowledged and urgent need, we have been disturbed to learn that little progress has as yet been made in establishing needs, or even in providing temporary arrangements". Indeed, the thread in the Reed report of last year of a multi-agency review had been taken up by the Aarvold committee in 1972. It recommended that a patient leaving a special hospital should not normally be discharged direct to his family or to casual lodgings, but, wherever practicable, should go first to a local psychiatric hospital or a hostel for an initial period of rehabilitation. All those learned reports have grappled with the same problem and all have highlighted the inadequacy of bed spaces in medium secure provision. Reed's targets of 1,000 beds by 1995 and 1,500 beds as a final target was originally set at 2,000 as long ago as 1974. The present figure is some 635, considerably below recommended levels. In my region, that would suggest that another 20 bed spaces are required in the medium secure unit.

"The Health of the Nation" noted that mental illness accounted for 14 per cent. of certificated sickness absence ; 3 to 6 per cent. of adults over 16 may suffere depressive disorders ; 2 to 7 per cent. suffer anxiety states. Others, of course, suffer from schizophrenia and dementia. In 1991, there were 5,567 suicides, with a notable rise among younger men. Mental illness has a wide range of manifestations.

The figures involve substantial numbers of our fellow citizens and the number will surely rise. But I cannot stress sufficiently that clinical needs and public safety are inextricably bound together. Of course, I accept that it is difficult to make clinical distinctions about the mentally disordered. However, in cases such as that of my constituent, it has been confirmed by many conversations with psychiatrists that there appears to be a grey area which current arrangements do not satisfactorily address.

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I realise that the Reed report's recommendations that the number of spaces in medium secure units be substantially increased will be expensive. I shall explore that later. Clearly, we also need to examine how care for mentally disturbed patients can be enhanced for both existing mental patients and those who might be moved from prison to hospital. My hon. Friend will know that the Reed committee recommended a substantial transfer of prisoners into appropriate hospitals. Of course, there are dangers. For all its imperfections in this context, the criminal justice system at least offers the opportunity of a trial or, indeed, redress to an offender. Being sent to a hospital cannot and should not be undertaken without taking into account the interests of public safety. It cannot be seen as an alternative to remand in custody.

Therefore, in responding to mentally disordered offenders, the actual offence has to be responded to. A co-operative approach is needed to ensure an appropriate response. When, in the instance of my constituent, the consultant psychiatrist who took her case offered to stay in touch with the police if she was arrested, it was a generous and helpful offer, but a one- off response to my intervention. What we are talking about is a much higher level of co-ordination. I should like to dwell on the ways in which to address that problem, accepting, as Reed recommended, an increase in the number of regional secure units with bed spaces of fewer than 100, as at the Norvic in Norwich. The reason for that is that the psychiatric ward at West Suffolk hospital and other similar wards undertake treatment for mentally ill patients without physical restraint and under conditions of minimum security. Violent, aggressive or disruptive patients cannot be restrained in such an open environment. My constituent, however, was not regarded as treatable anyway. In those circumstances, therefore, all that can be done is to resort to heavy tranquillisation rather than therapy.

In 1991, the East Anglian regional health authority established a working party to investigate the problem of providing for patients with mental disorders. As a result, there is a possibility that sub-regional units could be established. From my many conversations with psychiatrists, however, I know that they would be reluctant to use them. They want a network of small, intensively staffed units in each district. The expense would be high, but current ECRs--extra contractual referrals--for mentally disordered patients are costing up to £200 per in-patient week in the private sector. The cost of processing the individual through the criminal justice system and keeping that person in prison is extremely high.

Larger institutions, such as medium secure units, have an important role to play, especially for the real offender, potential or otherwise. There still remains, however, the challenging behaviour of individuals such as my constituent. The criminal justice route is not appropriate and such individuals do not respond to psychiatric treatment either.

I have consulted a number of psychiatrists, particularly in my constituency. Individuals with behavioural difficulties require a separate unit where they can be treated with appropriate behaviour therapy. In a county such as Suffolk that would imply the provision of a unit with about 10 beds, probably located on a hospital site. Obviously, there would have to be some element of security, aided by appropriately trained staff. After

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behaviour therapy of perhaps six months or up to two years, individuals could then be discharged or transferred to a suitable residential place.

By definition, the focus would be narrow, but we are talking not about a large number of people, but about a sufficient number who have no place to go and whose lives are often marred by personal tragedy in consequence. Hope would be offered and the use of non-improving drugs could be avoided.

The whole issue of mental illness in its various manifestations is no longer something which is pushed under the carpet. The White Paper "The Health of the Nation" recognised that admirably. The Reed report has focused attention on the needs of those with mental difficulties. I greatly welcome both reports and the spotlight that they have thrown on the blighted lives of many thousands of our fellow citizens.

11.12 am

The Parliamentary Under-Secretary of State for Health (Mr. Tom Sackville) : I congratulate my hon. Friend the Member for Bury St. Edmunds (Mr. Spring) on securing time to debate the important topic of behaviourally disturbed people. I also congratulate him on doing so in such an eloquent and moving way.

This aspect of health and social care is truly multi-disciplinary and it is right that health and social care professionals, patients, people in the community and politicians regularly take stock to see whether the right sort of care is being delivered to mentally ill and emotionally disturbed people.

My hon. Friend has clearly explained the circumstances of his constituents, their adult daughter and their difficulty in securing help. Their case is tragic and he has asked, quite rightly, what our policy is for caring for mentally ill people and how we prevent people from falling through the net.

The Government fully recognise the burden carried by carers who look after sick relatives. I pay tribute to all their hard work and dedication in standing by so steadfastly members of their families who are mentally ill. It is not an easy task and, quite rightly, those carers look to the statutory and voluntary agencies for help. I should explain that, for some years, the Government have provided grant support to a number of voluntary organisations which, directly or indirectly, represent the interests of mentally ill people and their carers. If my hon. Friend would find it helpful, I can let him have the appropriate names and addresses so that his constituents can get in touch with them for support and advice.

As the House will know, we have a large agenda before us. About one person in 10 suffers from some form of mental illness in the course of a year and mental illness is as common as heart disease and perhaps three times as common as cancer. About seven people in 1,000 of the population will suffer from schizophrenia at some point in their lives and currently it affects an estimated quarter of a million people.

So what is our policy? Quite simply, it is to continue to encourage the development of locally based health and social services to meet the needs of people of all ages suffering from mental illness. The aim is to have a range of services that are local, comprehensive and sensible.

The components of such a service must be principally effective assessment of need ; community mental health

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teams supporting mentally ill people in their own homes ; an adequate range of day care services ; adequate short and long-term hospital provision ; and an adequate range of health and local authority respite services.

This policy, which is to be taken forward within the general framework of responsibilities for community care can be delivered successfully only by health and local authorities working together, in collaboration with the relevant voluntary organisations and the private sector.

The NHS's responsibilities for providing continuing care have been clearly set out in the White Paper "Caring For People" and were strongly reiterated last year in letters to regional health authorities and social service departments from the deputy chief executive of the NHS management executive and the chief inspector of social services. The form that this continuing care should take and the number of places provided must be a matter for local decision. While central Government can set the scene and establish a framework for mental illness and community care policies, it is the local agencies which will need to turn those intentions into firm positive action for the benefit of patients and carers.

Of course, at the heart of all concerns are those users and carers mentioned by my hon. Friend. The first key component for community care identified in the White Paper was services that respond flexibly and sensitively to the needs of individuals and carers. The second key component was to ensure that service providers make practical support for carers a high priority. To do that, we must all listen closely to what users and carers have to say about the services they receive so that we can learn from their experiences and develop more appropriate provision of care. I believe that we are doing this and today's debate reflects that, but, to encourage the process still further, we are setting up a national users and carers group with representatives from a wide range of clients, including mentally ill people as well as the appropriate voluntary organisations. The purpose of the group will be to give direct regular feedback to Ministers through the Department about the experience of care in the community, particularly during the early period of the new arrangements. Its remit will cover both health and social services and we will expect to hear about services provided by the independent sector as well as the statutory authorities.

The group would be able to give the centre some first-hand feedback about what is going on regionally and what the effects are for particular user groups. It could share experiences and advise us on how services can be made more responsive and how systems and management can be improved. It could also act as a focal point for advice and good practice on how service users and carers might be more effectively involved in the planning and development of community care services. It will give us at the centre a much more direct feel of how we can continue to go about achieving the central aim of community care.

None of this can be achieved without the right level of resources and the Government are firmly committed to improving services for mentally ill people. This is demonstrated by the fact that, including secure provision, about £2 billion is being spent each year on mental illness. That figure, although impressive, does not tell the whole story, because it does not show the 37 per cent. increase in

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real terms in gross expenditure on hospital and community health services since 1979 and an 86 per cent. increase in real terms in gross expenditure on local authority social services. Those figures demonstrate quite clearly that the Government are committed to policies for the mentall ill.

However, we recognise that the provision of services can be patchy and that is why we have taken a number of initiatives to improve the overall level of care. These include the introduction of the care programme approach in April 1991, two years in advance of the National Health Service and Community Care Act 1990, introducing the idea of needs assessment and care management to the care of mentally ill people.

Based on the best professional practice, it is intended to cover all patients being considered for discharge from mental illness hospitals and all new patients accepted by the specialist psychiatric services. The needs of each patient, both for continuing health and social care and for accommodation, should be systematically assessed and effective systems put in place for ensuring that agreed health and, where necessary, social care services are provided to those patients who can be treated in the community. Explicit, individually tailored care programmes are drawn up and a key worker is identified to keep in close touch with the patient and to ensure that the agreed package of health and social care is being delivered.

We have also introduced the mental illness specific grant available to local authorities which has brought about significant improvements in the social care provided to people with a mental illness In 1993-94, the grant will be £34 million in support of expenditure of some £47 million by local authorities.

In addition, we have helped to raise the awareness of mental health and push forward action by the relevant agencies by including it as one of the five key areas in "The Health of the Nation" White Paper. The main objective is to reduce ill-health and death caused by mental illness and there are specific targets to reduce suicide by 15 per cent. in the national rate and 33 per cent. for the severely mentally ill by the year 2000.

We have recently issued a mental illness handbook to put flesh on the bones of the White Paper and to help health and local authorities develop local strategies for reducing mortality and morbidity caused by mental illness. Although the information in the handbook is meant to be illustrative rather than prescriptive, it represents the most detailed description we have ever set out of what we would like to see developed in the field and how. As such, it is likely to be a major resource for many years to come.

There is a particular task in "The Health of the Nation" relating to mentally disordered offenders. Health authorities are required to include a range of secure and non-secure services for this group in their strategic and purchasing plans. The development of those plans will be influenced by the work of the Department of Health/Home Office review of services for mentally disordered offenders--the so-called Reed review to which my hon. Friend referred, whose final report we published last November.

We are still considering many recommendations made during the review, but we have already endorsed a set of principles for the future provision of services and we have greatly increased the amount of capital available centrally for medium secure services--from £3 million in 1991-92 to £17 million in 1992-93 and £22 million next year. We are also awaiting the outcome of the working groups, under

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the chairmanship of Dr. John Reed, which are looking at personality disorders and high security services. That work will be completed shortly.

To help in following up the review and in maintaining the good co-operation between agencies which it has fostered, we have established a new advisory committee on mentally disordered offenders. That committee is being formed for three years and, among other things, it will advise the Department of Health and the Home Office on follow-up action to the review.

Clearly, there is always a lot more that we could do. We still need to unlock resources from the old long-stay institutions in developing services further in the community and, to help tackle this, we set up a mental health task force in 1992 to help build up a balanced range of locally based services.

Also, it is apparent that implementation of the care programme approach is patchy and people can fall through the net. There is the problem of a small minority of mentally ill people who refuse to participate voluntarily in their care programmes. The Government are very concerned about the position of patients who slip through the net of community care and this is why we are taking a fresh look at the existing legal powers and considering whether changes are needed to the mental health legislation. A team has been set up to take this forward and a report will be made in the summer.

One point that is not always appreciated is that the Mental Health Act allows a patient to be detained in the interests of his or her own health. It is not necessary to show that they represent a danger to themselves or others. We are considering further changes to the Mental Health Act code of practice that are aimed at removing any misunderstanding about the admission criteria under the Act. I am grateful for the opportunity to respond to my hon. Friend and I congratulate him on raising the topic. It is an unfortunate fact that everyone is aware of acute services and hospital services and the problems that they are in, but fewer people are aware, or are willing to be aware, of the problems of mental health. Too many people would like to brush it under the carpet, but there is an enormous need and one which must be met. We are determined to do that.

I hope that I have been able to show what measures we are already taking to provide a high-quality service for mentally ill people and the resources that we are putting in to support this. We will continue to do all that we can to make improvements and to ensure that mental illness is given a high priority by both health and local authorities.

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Nuclear Non-proliferation Treaty

11.26 am

Mr. Harry Cohen (Leyton) : I am pleased to have this Adjournment debate on the nuclear non-proliferation treaty. The treaty was signed in 1968 and we ratified it in 1970. Now, 155 member states are signatories to it. It is reviewed every five years and there is a major re-examination after 25 years.

That major re-examination is due in 1995. There are preparatory meetings going on ahead of that re-examination conference and the first one takes place on 10 to 14 May in New York this year. That is one of the reasons why I have called for a debate on this subject. We must start work for significant progress not only at the preparatory meeting but at the 1995 conference. The 1990 review conference failed because it did not reach a consensus on the final document. The main area of contention was nuclear testing. I shall say more about that later. However, we cannot afford another failure in the treaty as we approached 1995.

The use of nuclear weapons is the ultimate amorality. The examples of Hiroshima and Nagasaki and the mass slaughter there should never be forgotten. Nuclear proliferation greatly increases the risk of nuclear war, but it is not just those states on the verge of getting nuclear weapons but the nuclear weapon states themselves that are the cause of worry. In the late 1980s, there were about 60,000 nuclear weapons in the world.

There were some achievements, some arms agreements, which we all welcomed. We welcome the intermediate nuclear force and strategic arms reduction agreements between the then Soviet Union and the United States. However, those agreements are quite small when set against the number of nuclear weapons to which I have referred. START is not due to be completed until 1998, but the nuclear warheads covered by that agreement do not have to be destroyed--merely withdrawn or stored. There is evidence that some of them are simply being recycled.

Some of the threshold states are already over the threshold for nuclear weapons. Israel is seemingly an undeclared nuclear weapon state, but I have seen reports that it has 200 to 300 nuclear weapons. In a recent statement, President De Klerk said that South Africa had made six nuclear weapons. The odds are that South Africa has made many more than that. India, Pakistan, Brazil and Argentina have probably made nuclear weapons and we know that Iran and Iraq have been trying to make them. The threshold states have probably increased their capacity to make such weapons because of the biggest event in recent years--the disintegration of the Soviet Union. That has created a series of new nuclear weapon states and has resulted in the selling of expertise and materials to states such as Iran and Iraq.

Events in North Korea have also prompted me to seek this debate. On 11 March, North Korea announced that it was leaving the non-proliferation treaty. That is an appalling precedent and we should urge action to stop Korea doing so. It signed the NPT in 1985, but it has been treated as an outcast, put out in the cold. As a result, North Korea does not respond to diplomatic and other pressures. It was silly to stop all aid and diplomatic recognition, because it has meant that we cannot use them to apply pressure. We should consider restoration of

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assistance or at least welcome North Korea back to the international fold. However, we should certainly not do that as a response to North Korea leaving the treaty.

North Korea has said that it does not believe the statement by the United States that it withdrew all its nuclear weapons from South Korea in 1991. There should be a detailed inspection to make sure that those weapons were withdrawn and North Korea should be invited to take part. We must exert maximum diplomatic pressure to persuade North Korea not to withdraw from the NPT. A stick and carrot approach should be used ; there has been so much stick that we now need a little bit of carrot.

The non-proliferation treaty was very much a bargain between the nuclear weapons states and the non-nuclear weapon states. That was well described by Lord Plant of Highfield, when he said : "the NPT involved a bargain under which they"--

that is, the non-nuclear weapon states--

"would forfeit their rights to acquire nuclear weapons in return for the nuclear weapon states engaging in a process of nuclear disarmament."--[ Official Report, House of Lords, 24 March 1993 ; Vol. 544, c. 383.]

That was part of the bargain, but there are four other aspects. Arms control negotiations to reduce the world's stock of arms and to end nuclear testing were expected of the nuclear weapon states. Security assurances for the protection of the non-nuclear weapon states against attack by nuclear weapons have been given. Free access to nuclear power for peaceful purposes was also expected. The non-nuclear weapon states thought that they were receiving those benefits under the terms of the non-proliferation treaty. There is a clear perception that the nuclear weapon states have reneged on those agreements, are reluctant to give up their nuclear weapons and have not done enough to disarm.

I mentioned the INF and START agreements, but there has been little control of nuclear weapons. Proliferation must be viewed in two ways. There is horizontal proliferation, the spread of weapons to new states, and vertical proliferation, which is a qualitative and quantitative increase in the possesion, manufacture or deployment by an individual state. In terms of vertical proliferation, Britain comes off badly : Trident is a blatant example. Trident has 512 targets, whereas Polaris had 64. That is an eightfold increase. It is capable of 4,000 Hiroshimas, whereas Polaris was capable of 400. That is an appalling example of proliferation.

Mr. Nigel Evans (Ribble Valley) : Is it still Labour policy to continue with the Trident submarines but not to arm them?

Mr. Cohen : Labour's policy is well known. My view is that there is an overwhelming case for getting rid of Trident.

Another example of vertical proliferation in Britain is the thermal oxide reprocessing plant programme for a huge increase in the production of plutonium.

When does the United Kingdom propose to become involved in arms control and disarmament negotiations? The non-nuclear weapon states have a right to ask that, because there has been no such involvement over the 14

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years of this Government. That is a scandal. Britain is a signatory to the nuclear non-proliferation treaty, of which article VI is a key component. It states :

"Each of the Parties to the Treaty undertakes to pursue negotiations in good faith on effective measures relating to cessation of the nuclear arms race at an early date and to nuclear disarmament, and on a treaty on general and complete disarmament under strict and effective international control."

That is what Britain signed up for, and if we cannot go all the way towards eliminating nuclear weapons, we should at least enter negotiations leading towards that goal. By any standards, we are clearly in breach of article VI and it seems that the United Kingdom has reneged.

I shall now deal with nuclear testing. In the other place on 11 March, the Minister's dad, Lord Hailsham, said that he tried to achieve a test ban in 1963. I congratulate him on that excellent example that he set for his son. The last treaty meeting in 1990 foundered on the issue of nuclear testing, but a comprehensive test ban treaty could be a vital cap on the nuclear arms race. The preamble to the NPT about a comprehensive test ban states : "Recalling the determination expressed by the Parties to the 1963 Treaty banning nuclear weapons tests in the atmosphere, in outer space and underwater in its preamble to seek to achieve the discontinuance of all test explosions of nuclear weapons for all time and to continue negotiations to this end."

That was the aim of the treaty.

Britain has not participated since 1980 in the negotiations referred to in this preamble. At the United Nations, Britain blocked resolutions on a partial test ban treaty as recently as 1991. That is a far cry from the Government's attitude in 1980, when the defence estimates stated :

"We believe that the proliferation of nuclear weapons would increase tensions, putting at risk international security and stability. The Non Proliferation Treaty Review Conference in August will be an important event in the continuing search to combine non-proliferation objectives with the widespread desire of nations to enjoy the benefits of nuclear power. Non- proliferation would also be served by a comprehensive ban on testing nuclear weapons, on which we have been negotiating with the United States and the Soviet Union." Clearly, in 1980 th what is the last step ; what are the steps in between?

The United States has passed new laws restricting the number of tests. They do not amount to a complete test ban, but the United States seeks such a ban after 30 September 1996 unless a foreign state conducts such tests thereafter. President Clinton is on record as supporting moves toward a ban.

The Russians have put a moratorium on testing nuclear weapons and have since extended it. France's moratorium is coming up for review. So the conditions are favourable for the British Government to support a comprehensive test ban treaty and I urge them to do so. An excellent paper on security assurances for non-nuclear weapons powers has been produced by the International Security Information Service, ISIS. The paper states :

"Britain undertakes not to use nuclear weapons against such states except in the case of an attack on the United

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