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Clare Short: I am grateful to the hon. Gentleman for recognising the quality of my officials. May I explain that I have £10 million now. Our word is trusted. We are hiring aeroplanes from other countries over the telephone. They are being made ready immediately on our word because we have the money, we can spend it now and we can move immediately. The problem is not money; it is getting the planes, getting the logistics right and getting everything moved into the right places. In answer to the Leader of the Opposition, my right hon. Friend the Prime Minister said that he would look at the proposal. I understand that the Disasters Emergency Committee is about to launch an appeal: advertisements will go in the

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papers and collections will be made. That will take some time and that is my point. We have to spend now and get things moving now.

Mr. Dale Campbell-Savours (Workington): We all know that, true to form, my right hon. Friend will be pressing to maximise the budget that may need to be made available to her now and later. Will she ensure that the Ministry of Defence is not allowed to purloin any part of that budget in the form of charges for aircraft that it lets her Department have, as happened on a previous occasion? Also, will she relay to representatives of the Government of Albania the deepest appreciation of Members of this House for the valiant work being done by the Albanian people in helping to resolve the crisis?

Clare Short: I am grateful to my hon. Friend. He is right to say that, in the past, when the military made a contribution, the Overseas Development Administration was made to pay from its budget. Military costs are high--higher than hiring civilian aeroplanes. Since we formed our Government, the military has helped on a number of occasions and the Department has never been charged. One of the flights that I announced today is a military flight and we are not paying. The Ministry of Defence is contributing, so that is not happening.

I am also grateful to my hon. Friend for recognising the generosity of the people of Albania. It is a very poor country and it is recovering from a civil war. Many refugees have been flowing into Albania for a long time. People have been taking them into their homes--these are very poor people--and, even now, they are taking more. The Prime Minister of Albania sent a lovely, moving letter to our Prime Minister to thank us both for the military action and our other help. I will ensure that my hon. Friend's message is conveyed and I am sure that people will be grateful for it.

Mr. Douglas Hogg (Sleaford and North Hykeham): Does the right hon. Lady agree that it would be prudent at least to plan against the risk of long-term, large-scale refugee problems arising from Milosevic's present, and likely future, actions? Does she further agree that permanent refugee camps are undesirable? What steps does she propose, in concert with other countries, to facilitate the permanent resettlement of those refugees who want to be settled outside Kosovo in countries away from the frontiers of the former Yugoslavia?

Clare Short: I caution the right hon. and learned Gentleman that although he may not mean it to happen, Mr. Milosevic would be pleased at his suggestion. We are not planning to move people out of the region. People do not want to move out; they want to go home as fast as possible. They support the NATO action and want it to be successful. They need protecting now. We have plans to look after them now and to help them go home to reconstruct as fast as possible.

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Points of Order

4.22 pm

Mr. Tam Dalyell (Linlithgow): On a point of order, Mr. Deputy Speaker. In the past 80 minutes, we have heard the remarkable proposition that, by the use of air power, without ground troops, populations are to be re-established in areas from which they have been cruelly driven. I know that, technically, it would be difficult to move for a debate under Standing Order No. 20, but I understand that it could be done at 7 pm despite the statement that we expect on defence. Are you prepared to hear my request? Do you accept that several of us, with very different points of view, think that it is not proper in this situation that the House of Commons should be away next week, and that, in these dire circumstances, there should be a recall of the House?

Mr. Deputy Speaker (Mr. Michael Lord): I am not in a position to deal with the second part of the hon. Gentleman's question. On the first part, he must put such requests to Madam Speaker. It is not a matter with which I can deal.

Mr. David Faber (Westbury): On a point of order, Mr. Deputy Speaker. You will recall that, last week, the House debated the Government's roads policy, with frequent mention by me and other hon. Members of detrunking existing trunk roads. A local journalist rang to tell me that the Deputy Prime Minister is to make a statement on the detrunking of the national road network tomorrow. Is it not a common courtesy that local Members be informed of such decisions by Ministers, before they are released to the press? Is it not a coincidence that the statement is to be made on the first day of the recess, thus ensuring that the Deputy Prime Minister cannot be questioned on his plans?

Mr. Deputy Speaker: I heard what the hon. Gentleman had to say, but it is not a matter for the Chair. I have no knowledge of the matter that he raised.

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Prescription Charges (Hormone Replacement Therapy)

4.23 pm

Dr. Howard Stoate (Dartford): I beg to move,

Hormone replacement therapy has three major benefits. It effectively treats the symptoms of the menopause. There is a likely, but not yet proven, link with reducing the risk of heart disease. The most important benefit to women's long-term health is that it effectively reduces the incidence of osteoporosis in women after the menopause.

After the menopause, all women lose calcium from their bones. For many, the loss is much more severe, resulting in osteoporosis, which is often known as brittle bone disease. The condition reduces bone density and increases the likelihood of fractures, back painand curvature of the spine. It causes not only much pain and suffering but huge physical, psychological and social cost to sufferers and their families.

The effects on the national health service are also considerable. There are 60,000 hip fractures in the United Kingdom every year, or one every 10 minutes. Sadly, by the time that I have sat down, someone else will have fallen down and broken a hip. Eighty per cent. of hip fractures are in women over 50. Treating a fracturedhip costs £4,800. That is £4,800 every 10 minutes. One in five of those who suffer a hip fracture will go on to require long-term residential nursing home care costing, on average, £19,000 a year. That is one extra nursing home place taken every hour as a result of osteoporotic hip fractures alone.

At the menopause, HRT is a logical and appropriate intervention for the prevention of osteoporosis. It is proven to reduce bone loss in women, and it can delay or even prevent the onset of osteoporosis, thus significantly reducing the risk of fragility fractures.

The Department of Health local health action sheet advises GPs to counsel women on the risks and benefits of HRT at the menopause, and lists HRT as an effective drug therapy for the prevention and treatment of osteoporosis. The effectiveness of HRT in preventing reductions in bone density and reducing fractures is beyond doubt.

If we are to meet our targets set out in the Department of Health Green Paper "Our Healthier Nation" for reducing the huge burden of accidents, we need to encourage more women who would benefit from HRT to use it. Current opinion holds that giving HRT for periods of up to 10 years yields significant benefits, with minimised risk. The suggestion that HRT causes women to wear lurid outfits and to act strangely in the national media are purely anecdotal.

There are different types of HRT, and different types suit different women. Women who have undergone a hysterectomy can be prescribed the single hormone oestrogen. This attracts a single prescription charge. Women who are completely past the menopause can use combined therapy with little or no side effects. This also attracts a single prescription charge. Then there is the perimenopausal group--those women who are either still,

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or have just finished, menstruating. The other two therapies are usually not suitable for such women, and cyclical treatment is required. If unopposed oestrogen is given to such women, there is a significant risk of endometrial cancer. Thus, they must take two different hormones--oestrogen and a progestogen--separately at different times in their cycle. Although that treatment is usually contained in one treatment pack, it attracts two prescription charges.

Many of my constituents in Dartford, and several hon. Members of the House, have approached me about that anomaly. Why, they ask, should some women, for purely medical reasons, face the double charge? My experience as a GP tells me that some people find the double charge not only inexplicable but a significant cost burden which can put them off taking the treatment altogether. Professor David Purdie, of the British Menopause Society, estimates that 50 per cent. of post-menopausal women would benefit from HRT, but that only 10 per cent. of the group are using the therapy. That means that 40 per cent. of post-menopausal women are not benefiting from a therapy which could bring them relief from their current symptoms and reduce the risk of osteoporosis in later life. Our task should be to reduce the figure of 40 per cent. as much as possible by encouraging women who decide, after discussion with their GP, that HRT is right for them to use it.

Women in the group most likely to require cyclical therapy are aged 50 to 60. Although 86 per cent. of prescriptions are issued free, women in that age group are very likely to pay for their own prescriptions. Nor is this a small problem. Figures that I have obtained from the House of Commons Library show that, of the 5.8 million prescriptions for HRT in 1997, 62 per cent. were charged as one item. That means that 38 per cent., or 2.2 million prescriptions, attracted a double charge. That is a clear disincentive, preventing a wider take-up of HRT.

"Our Healthier Nation" contained welcome initiatives for reducing fractures among the elderly. Osteoporosis is a major cause of fractures, and an important plank of any strategy to tackle it has to be a greater take-up of HRT. I welcome the Green Paper and the strategies contained in it, and I congratulate the Government, and especially the Minister for Public Health, on a document that details how we can put into practice the old adage, "Prevention is better than cure."

When more women are aware of the benefits of HRT and can decide whether it is right for them, and when the double prescription charge disincentive is removed, the incidence of osteoporosis can be reduced. That will reduce the cost to the NHS of treating osteoporosis and, more important, reduce the pain and suffering that it causes.

The Bill tackles a clear anomaly in the system, and it will go a long way towards increasing the use of HRT by those women who could benefit from it. I ask hon. Members to endorse the Bill, which will directly benefit the lives of many of their constituents.

Question put and agreed to.

Bill ordered to be brought in by Dr. Howard Stoate, Ms Christine Russell, Mr. Gareth Thomas, Mr. Stephen Pound, Mrs. Teresa Gorman, Dr. Evan Harris and Mr. John Austin.

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