House of Commons Hansard Debates for 25 Oct 1995

Mr. Harris: Surely my hon. Friend is not suggesting that the survey was politically motivated. He would surely

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acknowledge that it would be entirely out of character with all the surveys that the Liberal Democrats have conducted in the past.

Mr. Allason: Perish the thought that it should be politically motivated. But I suppose that I should give the Liberal Democrats some credit. In the middle of an industrial dispute over the specific issue of out-of-hours working, why not conduct a survey on the specific issue?

Of all the topics that are important to GPs, what is the one issue on which the questionnaire concentrates? The answer is out-of-hours working. It must not be forgotten that it was a voluntary exercise. Equally, we must not forget that we are talking about £6,000 to £8, 000 a year for the individual GPs who undertake out-of-hours working. There is no obligation upon them, but there is a considerable financial incentive.

It is interesting that the document was compiled in the middle of an industrial dispute. Nowhere in the literature that I have read is it stated that the dispute has been settled. It was compiled at a time when all GPs were particularly concerned about the specific issue to which the survey relates. They are articulate and sophisticated, and they were given the opportunity to over-egg their case. In fact, they did not. Only a proportion of them were critical in their responses to the survey.

Mr. Harvey: The hon. Gentleman has said that the survey was conducted in the middle of the dispute. It was not. The survey took place after the dispute was ended. One of the questions was: "Do you feel the new deal does anything to ease increasing patient expectations, your workload or the particular problems faced by rural GP's?"

The survey was conducted after the deal had been struck.

Mr. Allason: No. The hon. Gentleman is wrong. The survey was conducted before the British Medical Association conference took place and before any announcement was made. We now have an example of how badly drafted the survey was. It should have referred to the deal on offer. The deal had not been accepted when the survey was conducted.

I move on to the publicity that was generated by the document. As I have said, it was not sent to health authorities or to individual Members. What was the priority for the document? In fact, it went to the media. The media were presented with press releases that described doctors working sometimes 120 hours a week.

I was concerned about that, and I telephoned the health authority in the area I represent and asked, "Do I really have GPs working 120 hours a week in my health authority area?" The response was, "Absolutely not. If there is one doctor in Torbay who is working 120 hours a week, we would like to hear urgently from that doctor. It is not the case." There are doctors, however--I spoke to one yesterday--who occasionally clock up 100 hours a week. That is not, however, 100 hours of continuous working, but 100 hours on call. I suggest that there is a considerable difference.

I do not object to the fact that the survey was conducted, although the questions are clearly politically weighted. I am surprised that so few doctors participated, given the opportunity that they were offered and the political climate as negotiations took place. I am disappointed with the way in which the issue has been exploited and presented to the media.

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Individual patients are obviously concerned when they are told that their doctors are so stressed, so overworked and so under pressure that they are unable to give a good service, and individual lives may be put at risk. That is not the case. In my judgment, in the judgment of certainly one health authority, and in the judgment of the doctors to whom I have spoken, the survey has no scientific value. It would seem that the only doctor directly quoted is one who is well known for opposing every type of national health service reform. He has had publicity going way back in opposing particular reforms. The average GP sees between 35 and 40 patients a day. In a built-up urban area with perhaps a factor of deprivation, he may be seeing between 70 and 80 a day. That is not entirely satisfactory, and health authorities recognise that. Initiatives have been taken to try to improve doctors' work loads.

Those work loads are in part a consequence of the higher expectations that patients--quite rightly--have of their doctors. Patients pay a considerable amount into the national health service and are entitled to a high standard of care from their GP, but there is, of course, the problem of inappropriate calls made to doctors, and every GP will have a funny, or perhaps tragic, story of someone who needs nothing more than a couple of Anadin but nevertheless calls his doctor in the middle of the night. That is very frustrating for doctors.

The emphasis of the report was on out-of-hours terms and conditions, and doctors took the opportunity to air many of their grievances. One can well understand that, but the situation as portrayed in the media and by the Liberal Democrats is not wholly accurate. In south Devon, the situation has improved considerably, thanks to initiatives to reduce pressure on GPs and improve out-patient care. In March 1982, when out-patient waiting lists were examined, 53 per cent. of people on those lists were seen within 13 weeks, 32 per cent. had to wait between 13 and 26 weeks, and the rest waited even longer. That situation had changed dramatically by March 1995, when 91 per cent. of the waiting list was seen within 13 weeks and just 7 per cent. were waiting between 13 and 26 weeks. Those figures reveal the efforts made to relieve the pressure on individual doctors and waiting lists at the health care trust there.

I recognise that doctors have a difficult job--no one would want to minimise the pressures on them--but to suggest that people's lives are at risk on a daily basis, or that there is a crisis at GPs' surgeries, is a betrayal of the trust of the individual doctors who work extremely hard to make the health service work.

I accordingly urge my hon. Friend the Minister to assure the House that he is aware of the way in which the survey was conducted, and that the questions were weighted. I also ask him to assure the House that he has been in touch with health authorities and GP representatives to hear their side of the distorted arguments that have been presented.

11.2 am

The Minister for Health (Mr. Gerald Malone): It is a pleasure to address the House on matters of substance, even though the debate is based on a survey which--here I agree with my hon. Friend the Member for Torbay (Mr. Allason)--has less substance than the issues themselves.

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Had I not been aware of the contents of the survey and their lack of credibility, my hon. Friend would have done the House and me a service by analysing them. I shall deal with that matter in due course.

In general terms, our family doctor service is second to none. That is true of the country as a whole and I believe it to be true of Devon and Cornwall too. I can reassure general practitioners that the Government place a high value on them, to the extent that we are building a primary-care-led national health service based on general practice, which is a fundamental change. We are committed to removing obstacles that may inhibit delivery of the services that GPs work so hard to provide.

My hon. Friend the Member for Torbay asked me to make sure that I was aware of what was happening in Cornwall and Devon and was personally familiar with the views of GPs and health authorities there. I am aware of them, not only from what I hear at the Department but at first hand, because one of the first visits I undertook on being appointed to my post was to GP practices in Exeter and Truro, where I was impressed by the enthusiasm and dedication of all those whom I met.

Those doctors proceed with enthusiasm and dedication despite the stresses and strains of their working life, which, I readily acknowledge, are not unusual in a time of change such as that which we have asked GPs to accept. What I found in Devon and Cornwall was not very different from what I found elsewhere. There are stresses and strains, but they are being dealt with.

Much of the debate today has centred on out-of-hours work, and it may be helpful if I say a few words about that. Much work has already been done to deal with the concerns that GPs have raised and which the Liberal Democrats have mentioned today, some of which were highlighted in the Devon and Cornwall survey. The new arrangements for GP out-of-hours care, recently accepted in full by the British Medical Association, will ease the burden on GPs--one of the points made forcefully by the hon. Member for Truro (Mr. Taylor). The proposals are designed to encourage GPs to co-operate more in providing out-of-hours care. I know, for example, that the South and West Devon health commission is negotiating with the local medical committee and local GPs to facilitate GP co-operatives. Similar work is under way in Cornwall with the aim of securing a countywide arrangement.

The proposals will also offer special help to rural isolated GPs. Much has rightly been made of the problems faced by such GPs. It is important to put in context the funding for special arrangements, which I want to be delivered flexibly so that the particular interests of GPs in rural areas are duly noted.

I have seen from some press reports in Cornwall and Devon that there is a suggestion that the fund is merely to be divvied up among all doctors, at some £1,500 a head. That is reportedly a comment from a chairman of one local medical committee, but it is not our intention. No decision has yet been taken. Indeed, discussions will be taking place tomorrow between representatives of the general medical services committee and my departmental officials. I hope that we can come to a solution that will adequately recognise the special burdens imposed on doctors in rural areas.

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The new settlement will also encourage patients to make more appropriate use of GP services, which I acknowledge is important. I cannot quite understand the idea that the patients charter has suddenly led to a new tranche of demand that did not exist previously. I do not imagine that, in the isolated rural cottages of Cornwall and Devon, the first thing that someone does at 3 am when he is feeling ill is pick up a copy of the patients charter and decide how to proceed.

Frankly, many of the arguments to the effect that the patients charter is provoking the difficulties now facing GPs in relation to out-of-hours calls are fanciful. It is right that patients should understand what they can expect from their GP services, but the charter acknowledges that patients have to exercise their rights responsibly when approaching their GPs.

Local initiatives are already under way. In June 1995, before we reached the settlement, the Cornwall and Isles of Scilly health authority produced a leaflet entitled "Changes to Emergency GP Services", which was directed at patients. It was distributed to every GP practice in the county. I am extremely anxious to secure a campaign conducted in conjunction with the medical profession to ensure that the public is well aware of how they should properly use GP services to reduce the personal out-of-hours work load of GPs. I deal now with some of the points about increased bureaucracy and paperwork. I assure the House that we are making strenuous efforts to reduce the weight of bureaucracy on GPs. The Liberal Democrats are, I am sure, well aware of the recent efficiency scrutiny entitled "Patients not Paper", which was carried out by a team that included four GPs--so there was a practical input into the study--and two primary care managers. The result was a number of recommendations, most of which will be fully implemented as soon as possible and, likely as not, by the end of next year.

I should like to highlight three points. There will be a reduction in claim forms by 1,700 per average practice, which is a tremendous clear-out. The bureaucracy associated with GP health promotion schemes will be cut, reducing data requirements from 122 to eight items. The flow of mail into practices will also be reduced, and the quality of communications will be improved.

I well understand that, as we seek to make the health service more accountable, there can be a natural accretion of bureaucracy, which Ministers occasionally have to curb. We intend that there will be less mail demanding statistics from GPs when he or she opens their surgery door in the morning and looks through the mail.

Mr. Allason: Is my hon. Friend aware of the information technology initiative in south Devon, which will mean that, by 1997, 80 per cent. of GPs will be on line in a health network? That too is intended to reduce bureaucracy, because it will be possible to gather statistics centrally-- information relating to individual health care will be transmitted on that network. Does he not agree that to reach the target of 80 per cent. by 1997 will be quite an achievement?

Mr. Malone: I am pleased to hear that. That scheme is part of a national initiative. Introducing technology to reduce paperwork is extremely important. Indeed, it will do more than reduce the paperwork--it will free more practice staff to provide additional support.

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I am delighted to hear what my hon. Friend says and to tell him that, as part of a national initiative, that scheme is playing its part. More than £242 million was spent in 1989-90, and more than £542 million last year--more than double--on staff, nurses and other support, including technology, which illustrates our commitment to primary care. So my hon. Friend the Member for Torbay is quite right: IT is one area in which there is substantially increasing support. In Cornwall in particular, considerable financial support has been given by the family health services authority for the improvement of GP premises by means of grants totalling £300,000 in 1994-95 and by the commitment of £250,000 for 1995-96.

Recruitment is extremely important. I acknowledge that the Government must keep it under observation, and, where there are concerns, must address them. There are some valid concerns about GP recruitment. I readily acknowledge that there has been a decline in the number of trainees in recent years. There are a number of reasons for that.

One is that, with the reduction in junior doctors' hours in hospitals, there are more places available in the hospital sector than there are ultimately in general practice. However, there were 1, 400 trainees throughout England in April 1995, which is still a significantly higher number than is needed to sustain the number of GPs overall. Of those, 243 were in the south and west region--the highest number of trainees in any region in England.

I notice that the hon. Member for Truro said that, on average--I think that he used this figure--there are four or five applicants for every post. If that is so, and they are well qualified, that is a good thing. It is better than the old days, when sometimes there were 120 applicants for every post- -most of them not able to get jobs. I agree that a balance must be struck. We must be concerned to ensure that the GP environment will attract top- flight people and be flexible, to reflect the point rightly made by the hon. Gentleman and his hon. Friend the Member for North Devon (Mr. Harvey) that, considering the percentage of women entering the profession--51 per cent. of students are female--it is important that we have a practical understanding of how that percentage will operate in the work force, and what flexible arrangements we will have to put in hand. There is a real work force issue that needs to be addressed, and work needs to be done.

As for specific recruitment difficulties in the south and west and in Devon, I can tell the House that a young GP self-help support group has been set up, through which newly qualified partners can offer help and support to each other. In Cornwall, funding has been made available for an advisory service for new GPs, whereby all new doctors are contacted by a doctor in another part of Cornwall who can act as their mentor and confidant. So at that important moment when doctors are embarking on general practice, support is available. I welcome such initiatives, especially in Devon and Cornwall. Throughout the country, we want closer working between new health authorities and GPs, and there is an opportunity for that as we move towards 1 April and the integrated health authorities come on stream. I know that Devon FHSA is encouraging GP practices to show innovation and initiative for the improvement of patient care. Good ideas are circulated to all practices to raise standards throughout the country. Cornwall FHSA meets

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quarterly with consortia of GPs--fundholding and non-fundholding--to discuss purchasing issues and address local problems, and I very much welcome that.

The Government have a policy of introducing fundholding, and it has been successful in Cornwall and Devon, but we do not take the view, and I am glad that the authorities in Cornwall and Devon do not either, that it should be done in isolation. I very much welcome what is in hand there to share best practice among fundholders and non-fundholders.

The hon. Members for Truro and for North Devon mentioned the patients charter. I very much support what the patients charter has done; it has brought substantial improvements to the quality of services provided for patients throughout the NHS, and in the areas represented by the hon. Gentlemen, because it has given a focal point and a target to which everybody needs to aspire. Three quarters of GPs now have their own practice charters--beyond what we publish on a national basis--or are in the course of developing them.

The patients charter is about doing things differently, thinking about patients as individuals, listening to what patients want, and providing a more patient-focused service. I should have thought that the whole House would welcome that. It need not necessarily cost money--in fact, doing things more efficiently and effectively can often save it. For example, looking back at the figures for 1994-95, GP fundholders in Devon achieved savings of almost £2 million in their budgets, which will be spent on other forms of patient care. In April 1995, there were 11 GP fundholding practices in Cornwall FHSA, covering 24 per cent. of the population. Although take-up was slow--I understand the reasons: small practices and rural areas--it is moving ahead, and 36 per cent. of the population are likely to be served by fundholding practices from 1 April next year. In Devon, the equivalent figure is 44 per cent. of the population; an increase on the previous uptake of 14 per cent.

So I welcome the fact that, although some general practitioners may fill in surveys in a slightly different way, they are rather optimistically taking hold in Cornwall and Devon of the advantages offered by the Government's policy, and ensuring that they exercise their new freedoms and responsibilities for the benefit of their patients.

But the situation goes further: total fundholding projects are being considered in south and west Devon. A consortium of five practices is in its shadow year as total fundholders, and will go live from 1 April 1996. I very much welcome that as a way forward. Much was made earlier in the debate about a survey. My hon. Friend the Member for Torbay told us a little about it. I would like to tell the House yet more about it, because clearly my hon. Friend, and my hon. Friend the Member for St. Ives (Mr. Harris) understood perfectly well that the survey was not politically motivated. None the less, they might be interested in knowing its genesis. In fact, it was a style survey which came from something called the "Health Campaign Pack" published by the Liberal Democrats. It explains how to conduct surveys. It is a jolly interesting style.

Mr. Matthew Taylor rose --

Mr. Malone: I shall allow the hon. Gentleman to tell us how well he followed the template when I have at least gone some way into the rather interesting territory that it explores.

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The pack explains how to carry out surveys. It says:

"In particular, the survey should publicise results which show opposition to the Government's policies and support for our alternatives."

Well, that is rather interesting--hardly the detached exercise that Liberal Democrat Members were trying to suggest.

I have read the survey, and I have also read the style guide. It is interesting that the survey compares exactly with the style suggested. It says:

" Nora Batty and the Liberal Democrat team wrote to local doctors and dentists--the people in the front-line caring for patients".

It is some sort of "Last of the Summer Wine" style--or, perhaps, in the Devon and Cornwall area, it is "Last of the Summer Cider". The key responses all assume a result. They include:

"Eighty per cent. of local doctors think the Government's record on the NHS is either bad or very bad."

Stamped across the key responses is the phrase:

"Insert your own figures."

Mr. Harris: Does the interesting document from which my hon. Friend is quoting advise local Liberal Democrats that the survey slips and questionnaires should be accompanied by a health warning?

Mr. Malone: I think the document comes with its own health warning. I was interested to read the style questionnaire. It mirrors precisely the questionnaire that was sent out in Devon and Cornwall. The Liberal Democrats take some pride in that. Although the report was supposed to be detached, the House will understand its purpose and genesis.

I know that the hon. Member for North Cornwall wishes to make a few remarks, so I will conclude by reiterating the Government's commitment to a primary-care-led NHS. It is all about

decision-making. That is what our policies have facilitated. The ability of doctors to decide what should be done for their patients is as relevant in Cornwall and Devon as in the rest of the country. Doctors are taking up that initiative with vigour.

I take this opportunity to thank GPs in Devon and Cornwall from the Dispatch Box. I understand that they face challenging and difficult times as more responsibility is given to them. To judge from what they tell me-- they are seldom slow to express their views--although there are challenges and issues that we still need to resolve, and I hope shall resolve, they understand that the Government have put them in a leading position in the NHS and given them responsibilities that reflect their professional skills as never before. That is the basis on which we move towards a primary-care- led NHS.

There is one point in the survey with which I agree. The report says that actions speak louder than words. I suggest to the House that the actions of the Government in putting right the difficulties that general practice faces speak far more loudly than the words in the survey.

11.21 am

Mr. Paul Tyler (North Cornwall): My colleagues and I are grateful to the Minister for 94 per cent.--a rough figure--of his speech, in which he referred to the

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substance of the issue. We endorse the points he made about the dedicated service that GPs give in Devon and Cornwall, as they do in other parts of the country.

The Minister is obviously better briefed by his Department than by Conservative central office. The report to which he referred was published after our survey. It was therefore entitled to take our survey as an example of what could be done in other parts of the country. The Minister got it the wrong way round.

Let us get back to the substance. Several hon. Members have attacked the survey this morning. That is not our purpose. We wish to examine the feelings and anxieties among a key part of the health service of this nation. GPs are the gatekeepers for the whole health service, perhaps especially so in more remote rural areas. That was recognised in the White Paper published last week by the Secretary of State for the Environment and the Minister of Agriculture, Fisheries and Food. It said:

"Most health care is provided through primary care, especially by GPs. We recognise that rural doctors can have smaller practices based in more than one location and may therefore need additional financial support. A number of allowances are payable to support GPs in rural areas. The rural practice payment scheme, for example, reflects the costs and pressures of practices in more sparsely populated areas." Precisely. I accept that the Government have endorsed our view that rural practices have special needs. That is at the centre of the debate today, and at the centre of our survey.

The points that the Minister made about fundholding practices are similarly well recognised. It is more difficult to qualify for fundholding in rural areas. That is one of the problems that lie behind the resources problem. I noticed that one hon. Member, in a Freudian slip, referred to fund-raising practices. There is a feeling among many GPs in smaller practices that they now have to devote so much time to finding ways to fund their activities that they cannot give so much attention as they would like to their patients.

Mr. Allason: Will the hon. Gentleman give way?

Mr. Tyler: No. I have very little time, thanks to the hon. Gentleman's late intervention.

The hon. Member for St. Ives (Mr. Harris) referred to recruitment. I was glad to hear the Minister respond positively on the issue. We all recognise that there is a difficulty with recruitment. The hon. Member for St. Ives may not have been in Cornwall when our survey was published.

One of the most fascinating things was that, contrary to our expectations, a number of authorities and GPs said that, in several respects, we underrated the severity of the crisis. The family health services authority in Cornwall, for the first time ever, is having to recruit in other EU member states for GPs. That has never happened in Cornwall before, although I understand that it has happened in other parts of the country. That is a simple litmus test of the severity of the recruitment problem.

In the few minutes that I have left, I wish to underline the views that GPs have expressed to us, to the public and to other GPs. The hon. Member for Torbay (Mr. Allason) may not know that Dr. Green, the local medical committee chairman for Devon, is one of the principal spokesmen for the profession. I understand that he comes from the hon. Gentleman's constituency.

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In response to our survey--not as part of it --he said:

"In my own town, Paignton, there have been resignations from two practices in the last year and a further early retirement for stress induced health. Eleven and 12-hour days are commonplace, followed by a night on call and another 11-hour day. The level of alertness required by this special profession cannot be sustained over time."

Mr. Allason: Will the hon. Gentleman give way on that point?

Mr. Tyler: No. The hon. Gentleman intervenes late in the debate, having arrived late. I have only three minutes left.

Mr. Allason: On a point of order, Mr. Deputy Speaker. Is it appropriate for an hon. Member to identify a particular constituent and not allow his Member of Parliament to respond, when--

Mr. Deputy Speaker (Mr. Michael Morris): Order. It is perfectly proper.

Mr. Tyler: Dr. Green also said:

"GPs work within a contract which allows new work to be added relentlessly to the working day. In recent years, we have seen Health Promotion, Early Discharge Schemes, annual reports and returns, and medical audit. No money has followed the patient into this work to allow extra staff to be employed, and where fees have been increased, the money is insidiously clawed back through the pool payment scheme. Furthermore, GPs have no ownership of this work, as the value to patients has yet to be shown."

Mr. Allason: On a point of order, Mr. Deputy Speaker.

Mr. Deputy Speaker: I hope that it is more genuine than the previous one.

Mr. Allason: It certainly is. I spoke to Dr. Philip Green yesterday evening, and I want to protest at the misrepresentation of his views.

Mr. Deputy Speaker: That was no more a point of order than the previous one. The hon. Gentleman knows

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that there are means of making such protestations which are in order. I hope that he will not trouble the Chair any further with bogus points of order.

Mr. Tyler: The chairman of the LMC in Cornwall, Dr. Andy Stewart, whom I know well, a young and dedicated doctor, has written as follows, since seeing the situation develop:

"To expect one doctor to work all day, all night and then all the next day, is totally unreasonable and just plain irresponsible. Exhausted and tired doctors should not be allowed within a mile of a sick patient. Tired doctors can make mistakes and mistakes in our trade may just turn out to be fatal. An airline pilot or bus driver would not be allowed to work for longer than 24 hours without a break because of the risk of endangering life through tiredness. So why are we so superhuman that we don't need sleep and a break from incessant stress?"

Another doctor from Devonport in Plymouth--not a rural area, but he suffers the particular stresses and strains of the inner city--says: "In the past few years expectations have risen, fuelled by the Government's `charter mentality'. This expectation has come from both the public and from management, which sometimes engage themselves in doing things of dubious value . . . At the end of the day, the day's work isn't finished, and the return to a normal life is impossible. You can imagine what it's like telling a disappointed son/daughter that you can't take them to scouts, guides or whatever. It is like letting down the other half of you."

This is not just a survey. It clearly contains the outspoken, but perfectly proper, views of a dedicated profession in a part of the country where one might think that the problems are more easily resolved than in the major cities.

We are grateful to the Minister for his positive reply to our debate today, and I know that the general practitioners in Devon and Cornwall will be as well. But the most important function of the House is to ensure that we can articulate in a public place at a national level the concerns of those who serve us so well. I hope that this morning's debate has done that, and I hope too that we will see real progress in the directions to which the Minister referred, because it cannot come too soon.

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Community Service

11.29 am

Mr. Gyles Brandreth (City of Chester): I begin this morning by saying how delighted I am to find that the Minister due to respond to today's debate is my hon. and most excellent Friend, the Member for Leeds, North-East (Mr. Kirkhope). He and I spent a happy and, I hope, useful year in harness at the Department of National Heritage, and I am delighted that we are yoked together again today. I congratulate him on his latest promotion. His previous post was Vice-Chamberlain of Her Majesty's Household, but I have no doubt that the Sovereign's real loss will be the nation's real gain.

I also take this opportunity to thank my hon. Friend's predecessor, my hon. Friend the Member for Dorset, North (Mr. Baker), for all the care and attention that he gave to every issue that came his way, and to salute him, my noble Friend the Minister of State, my right hon. and learned Friend the Home Secretary and my right hon. Friend the Prime Minister for their wholehearted and active commitment to the cause of community service, and their ready recognition of the importance of volunteering to the well-being of every community in the land.

The scale of volunteering in Britain is impressive. Four years ago, the Volunteer Centre UK, the national development agency for volunteering, commissioned a survey aimed at providing an up-to-date picture of the extent and nature of volunteering within the United Kingdom, and a comparison with the 1981 national survey of volunteering.

The latest survey showed that some 51 per cent. of respondents had taken part in at least one organised voluntary activity during the previous 12 months, showing that up to 23 million adults may be involved in formal volunteering each year. It also showed that 31 per cent. had volunteered at least once a month and 22 per cent. had volunteered in the previous week, suggesting that in any one week as many as 10 million adults may be involved in organised voluntary activity of one sort or another; an exciting thought--more people volunteering than watching "Pride and Prejudice" on television. Encouragingly, the survey showed that the proportion of the population involved had risen from 44 per cent. at the beginning of the 1980s to 51 per cent. at the beginning of the 1990s. Fund raising was the most common type of activity, and sports and exercise, children's education and health and social welfare were the most common areas for volunteering.

Most volunteers became involved because they were asked to help or because the organisation concerned was connected with their needs or interests. That said, a significant number of people simply volunteered for altruistic reasons. Three quarters of the respondents felt that volunteers offered something to society that could never be provided by the state. In addition to organised activities, more than three quarters were involved in informal voluntary activities. We need to salute every one of those people and recognise their impact on the quality of life of their fellow citizens.

Dr. Charles Goodson-Wickes (Wimbledon): I very much welcome my hon. Friend's initiative in bringing the issue of volunteering before the House and I regret that a

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constituency engagement means that I will not be able to stay for the whole debate. My hon. Friend may know that, as long ago as 1989, I proposed a motion in the House to promote the concept of active citizenship, linked to what I described as community self-help. Does my hon. Friend agree that momentum on the issue has been slightly lost in the meantime and that it is a concept wholly in tune with Conservative philosophy and the needs of today?

Mr. Brandreth: I agree totally with my hon. Friend. It is a philosophy consistent with a Conservative approach which suggests the responsibility of the individual, working from the bottom up, harnessing a community for the better good of all. I hope that today's debate will add extra impetus and momentum to the movement that my hon. Friend was attempting to initiate back in the late 1980s, and in which I believe Members on both sides of the House took a serious interest this summer when we had the all-party parliamentary hearings on citizens service back in June. I hope that today's debate will also galvanise the Government into a renewed commitment to exploring every aspect of ensuring that we become a nation full of active citizens. I salute my hon. Friend for his contribution. The contribution of volunteers in general is literally priceless. The qualities that they bring to their work cannot be paid for with any sum of money and any attempt to replace it with paid work would change its nature, replacing a relationship based on responsibility and mutual aid with one based on financial gain.

But the fact that voluntary work is priceless should not blind us to the significant contribution that it makes to the British economy. The Volunteer Centre recently had a go at assessing the economic worth of volunteering in the United Kingdom. It reckons, taking the hours worked and the rate for the job, that formal volunteering is worth in the region of £25 billion a year, and informal volunteering an additional £16 billion--£41 billion all told.

Highlighting the significant contribution that volunteering makes to the economic life of the country can help raise the profile of volunteering. That approach can also open the door to the recognition of community groups that may be viewed as less significant because they have a low cash turnover. If the amount of voluntary effort involved is recognised in terms of a monetary equivalent, the significance to the local economy becomes more apparent. The practical application of such a shift in awareness could be a widening use of volunteer time as a form of matching funds for Government, the European Union and private grants.

I think that I am right in saying that, at present, grant schemes such as Rural Action and the European Union's Leader 2 programme, which include such a provision, are the exception rather than the rule, possibly penalising groups which are volunteer rich but cash poor.

Assessing the economic value of volunteering is also part of wider moves to encourage Governments to include in national statistics indicators of factors which affect a nation's quality of life, but which are not usually recorded. Agenda 21, the action plan agreed by the 1992 Earth summit in Rio, called for unpaid productive work to be included in national accounts and economic statistics, alongside measures of environmental value.

The scale of volunteering in the United Kingdom is impressive, the scope is quite mind-blowing, and I sometimes think that the epicentre of all this activity must

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