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Schools are aware that parents can ask their PCT for their childs height and weight following measuring.
We will take action to let parents know that they can do this.
That is a preposterous situation. This shows the value of a Select Committee-type inquiry. The Department was forced to backtrack between the time of the hearing and the time that it sent out the memorandum, but the original position remains implicit in the wording of the eventual submission.
I turn to a subject on which I want to get at the facts. I do not expect Ministers to be able to give me an answer today, as it is a very detailed issue; I will be perfectly happy if they write to the Committee subsequently. We had a recent inquiry about the gas distribution network and I asked questions about pipeline replacement. I discovered that 58,000 miles of pipe is regarded as being at risk and that it would take 51 years to replace it, although it represents a third of the total network. That does not mean that every pipe into every house, or anything like it, is at risk, and I emphasise that much of the mileage will be in the major pipelines. However, I suggested that 58,000 miles and 51 years was staggering. Mr. Buchanan replied:
It is very serious quite clearly.
Not just serious, but very serious.
Yes, very serious.
We then established that the 51 years had been reduced to 30 years to try to accelerate the replacement process. It will cost approximately £430 million over a five-year cycle to replace the pipeline.
We discovered that there were three different types of pipe. The use of the original cast iron pipes started at the beginning of the last century and continued until 1970. Those pipes are subject to corrosion but, because they are cast iron, their vulnerability can be reasonably predicted, as long as no earth movements occur. A second type of pipe, called ductile iron, was introduced in 1970 to replace the cast iron pipes. However, it emerged that, although the old, cast iron pipes were subject to predictable failure, the failure of the new pipes was unpredictable. That is clearly serious. People have no idea where to start work.
I asked whether a major part of the new piping was in new housing estates that were built since 1970, and that was the case. To be fair, the matter was not the witnesss direct responsibility. He said that he guessed that
the large majority of it would be in urban areas.
That applied to the cast iron and the ductile iron piping. I asked when the pipes would be replaced, but it was a frustrating series of questions. I asked three times when work would be completed and got no answer. Eventually, I asked for a report.
We had a written report from Ofgem, but it is not the easiest to read. It is two pages and I assure hon. Members that I shall read only a bit of it. It is important to stress that I do not want to be alarmist. The encouraging aspect of the report is:
HSE required Transco to decommission all medium pressure ductile iron... mains within 30 metres of property by 30 April 2003.
As far as I can make out from the report, that happened. We understand from the Health and Safety Executive that that resulted in more than 2,800 km1,750 miles in my non-metricated languagebeing decommissioned.
serious concerns remain about the integrity of MPDI mains; and... any additional lengths which are found or become at risk must be replaced as soon as reasonably practicable and in any case within 12 months of being found.
I appreciate that it is not the Financial Secretarys Departments responsibilityand I do not mind if a response comes from a Minister who is responsiblebut I want to ask him whether the precise serious concerns will be spelled out and whether a risk assessment will be conducted of the pipeline network.
Mr. Paul Burstow (Sutton and Cheam) (LD): I begin by paying tribute to the work of the Public Accounts Committee and the National Audit Office. They are the jewels in Parliaments ability to scrutinise the Executive and the Government. I was struck by the remarks of the right hon. Member for Swansea, West (Mr. Williams) about the development of the NAOs work and its support for other Select Committees. As a former member of the Health Committee, I can tell the Chairman of the Public Accounts Committee that some of our work would have greatly benefited from input from the NAO. We all benefit from work such as the report on hospital- acquired infections and many other issues, which the Chairman mentioned.
So many reports are outstandingin both senses of the wordand are worth the Houses time today. The hon. Member for Gainsborough (Mr. Leigh), who opened the debate, referred to the previous occasion when the House debated outstanding reports as a graveyard slot. I fear that a Thursday so close to local elections almost gets into that category. Nevertheless, it is an opportunity for good quality contributions, such as those that have already been made, to draw attention to the work of the Committee and the NAO.
I underline and echo comments not only about the value of the work of producing reports and making recommendations, but about the essential element of following up and ensuring that recommendations are acted upon. For example, the Committee has produced more than one report on hospital-acquired infections over the years and I am struck by the number of recommendations from the first report, which was published
more than 10 years ago, that were not implemented. The NAO had to upbraid the Department of Health in its subsequent report of a couple of years ago. I await with interest further reports on the subject to ascertain whether substantive progress has occurred. I fear that much remains to be done.
The Norfolk and Norwich PFI hospital is an astonishing example of Government miscalculation, perhaps even negligence. Indeed, the Chairman described it when opening the debate as taking the public sector for a ride. The Committee covered the refinancing of the Norfolk and Norwich PFI hospital in its 35th report in the last Session.
The right hon. Member for Swansea, West mentioned the role of individual Members of Parliament in using the NAO to flag up issues that it evaluates and then pursues, if it sees fit, through inquiry. The NAOs investigation of the scandal that I am considering was in response, at least in parta significant partto referral by my hon. Friend the Member for North Norfolk (Norman Lamb) who, with others, rightly drew the matter to public attention.
In 1998, Norfolk and Norwich University Hospital NHS Trust let one of the first PFI contracts to a private sector consortium, Octagon. As one of the first examples of a PFI scheme, Norfolk and Norwich was something of a guinea pig. The trust might, therefore, reasonably have expected to experience the teething problems that are normally associated with new initiatives. However, it could not have expected that, in 2003a mere two years after the completion of the hospitalOctagon would refinance the project, tripling the rate of return for its investors from 19 per cent. to a staggering 60 per cent. On the other hand, the Department of Health appears to have expected that to happen. In its response to the report, it states that the
potential for gains from a refinancing were recognised prior to the contract being signed.
while the market was still so volatile.
The Department did not want profit sharing in case it scared off potential investors. It feels as though the intention in trying to secure the implementation of this change in public policy and the financing of major capital undertakings was an attempt to grease the wheels to get the policy off the ground.
I agree with the hon. Gentlemans last comment about greasing the wheels. Does he agree that one of the most astonishing aspects of the refinancing of the Norfolk and Norwich hospitalwhich is on the borders of my constituency and which many of my constituents usewas that, at the time of the refinancing, the main contractor, Octagon, ladled on to the contract an extra £106 million of debt? This was not done in order to build an extra ward or the cardiac unit that Norfolk badly needs; it was done solely for the purpose of accelerating Octagons rate of return, thereby enabling it to get most of its profit up front without having to go through the bother of running the contract for the subsequent 33 years. What does the
hon. Gentleman think that says about the likelihood of Octagons running that contract effectively, efficiently and in the interests of the people of Norfolk, when it has already had its profit out of it?
Mr. Burstow: It says that the Public Accounts Committee and the National Audit Office will be spending many years to come looking at these issues and their impact on the public purse, and at the burden that they will place on the taxpayer. It also says something about profiteering, which was certainly a hallmark of the early pathfinders in respect of PFI.
In addition to the obvious short-sightedness involved in all this, such attitudes shows scant regard for the risks that were being faced by the public sector in these situations, not least in regard to the increasing emphasis in public health policy on being flexible and moving more services into the community. PFI locks NHS organisations into models and structures of care for many years while they are paying the debt costs involved.
The trust secured the right to receive less than one third of the total gain from refinancingjust £34 million of the £116 million gained. In exchange for that, the minimum period of the PFI contract was increased by five years, and the trust faced having to pay up to £257 million more, in the event of early termination, than originally agreed. I really must question what kind of a deal that was. While Octagon walks away with the lions share of the cash, the trust has been left to shoulder the burden of debt. This smacks of the worst kind of profiteering, and the fact that it was Government sanctioned is a disgrace. I am assured by my hon. Friend the Member for North Norfolk that the impact on the Norfolk health economy has been severe, and that the PCT now faces a £47 million deficit. No account has been taken of this in the Governments drive to balance the books in the NHS, yet it is a direct consequence of Government policy that the local NHS in Norfolk finds itself in this position.
Some lessons have been learned. PFI contracts are now expected to include provision for the profits from refinancing to be shared equally between public and private sector partners. However, there are still grounds for concern. Does the NHS have the ability, or the Department of Health the will, to prevent such profiteering from happening again? If the Government are to avoid a repeat, NHS staff must be appropriately trained, supported and instructed in how to conclude deals of this kind. The Department of Health, in response to the Committees recommendations, agrees with this proposition. It speaks of the need for staff to refer to the code of conduct and the application note, and to consult the refinancing taskforce. Codes, notes and taskforces are all very reassuring, but the Department goes on to say that staff in the trust
commissioned experienced advisers to assist them in reviewing the private sectors proposals, including the value for money of the refinancing.
This leaves a simple question: if Norfolk and Norwich had assistance from experienced advisers, how did it end up agreeing to this deal? And if other trusts have only the benefit of this kind of assistance to rely on, how can we be sure that they, too, will not find themselves involved in such refinancing fiascos? The
report acknowledges that the lot of public sector partners in PFI deals has improved as a result of what happened in Norfolk. Yet the adequacy of training and support for staff involved in these deals is still in question. The Department, and the Government as a whole, must ensure that these matters are addressed, if the taxpayer is not to be ripped off in future.
I would like to turn to the issue of urban green space, an issue that was addressed by the Committee in its 58th report of the last Session. I represent a constituency on the outskirts of London, and this is an issue of real concern there. I have seen for myself the passions that a threat to treasured open space can provoke in my constituents. Surrey county council recently sought to grab control of the management of Nonsuch park, which is adjacent to my constituency. Since its joint acquisition in the 1930s by the Sutton and Epsom borough councils and the Surrey and London county councils, the park has been managed and paid for jointly by Sutton and Epsom. For 70 years, Surrey has taken no interest in it and made no contribution towards the running costs.
Then, out of the blue, and without consulting residents, park users, local councillorsanyone, reallySurrey county council announced its intention to draw up plans for the park, including disposing of an historic house. A public outcry, the largest public demonstration that Surrey county councillors had seen in years, and a compelling legal and moral case forced a rethink. The sell-off plans have been dropped, but the unilateral action continues, and concern remains about Surreys intentions.
I refer to this local example because the report on urban green spaces highlights the importance of public engagementsomething that had been lacking in the case of Nonsuch park. The Committees report draws some interesting and alarming conclusions. In one in six of the areas assessed in the report, the quality of open space is declining. Sixty-five per cent. of authorities have not completed an audit of current green space provision, and 70 per cent. have made no assessment of future needs. Two thirds of authorities have not considered the needs of children and teenagersa key demographic when considering planning green space and, indeed, when tackling issues such as antisocial behaviour and obesity.
The report makes it clear that more must be done to target resources at the areas in most need. It also makes the point that the areas of greatest deprivation need green space the most, yet they often lack such facilities. There is a black hole in terms of provision and needs assessment. Planning policy guidance note 17 requires local authorities to plan for open space by undertaking assessments of both community need and current provision. However, the report found that, four years after the guidance was introduced, one in three urban authorities had not yet started to assess need, and one in five had yet to begin to audit current provision. Given that £700 million of public money went into green space provision in 2004-05, this lack of robust assessment should be a cause for concern.
As I have already said, the involvement of local people in decisions about the provision of green space
is crucial. Yet the report found that the needs of one group children and young peopleare
seldom well reflected in councils green space priorities.
The fact that the needs of this vital group are not even being addressed, let alone met, highlights a serious failure to engage. As the right hon. Member for Swansea, West has already pointed out, another recent Committee report, on childhood obesity, shows that the rate of obesity among children aged between two and 10 has risen from 9.9 per cent. 12 years ago to 13.4 per cent. in 2004. Save the Children, in two reports on Child Wellbeing in the UK, identified the overall decline in the amount of available play space and freedom to play between 2002 and 2005 as a key concern. The Committee report speaks to that concern and demands more action. The decline of available play space and the increase in childhood obesity are far from coincidental. In the war against childhood obesity, urban green space is a key battleground, yet the one group whose needs are not adequately addressed are young people.
The report makes it clear that Government investment in green space provision has helped to halt the decline in the quality and quantity of urban green space. However, much of that money is being wasted because of inadequate targeting, planning and engagement with key groups. It is good to see that the Department responsible for these matters accepts those findings, but it will be a critical test to see whether it will translate that into action. It is critical to the health and well-being of local communities that the Government now act.
Finally, I would like to turn to diet and exercise in prisons, which was addressed in the Committees 56th report of the last Session and in a previous report in 1998. The question of diet and exercise in prisons is important, not simply because of our duty of care for those in prison, but because of the clear link between nutrition and behaviour. In 1997, a study was carried out on 231 prisoners at Aylesbury young offenders institution. It showed a statistically significant link between a nutritious diet for prisoners and a reduction in antisocial behaviour in prison. The study is now 10 years old, yet the Committee found that the Prison Service had not acted on the findings of the research. It was felt by the Prison Service that further research was needed, but no such research has yet been undertaken. A clear evidence base has been in existence for 10 years, yet nothing has been done. The Prison Service response to those findings is, to say the least, rather vague. It speaks of efforts that are being made to commission further research and bemoans the complex and expensive nature of the research. Unfortunately, that is far from the only example of the services failure to act on the Committees recommendations. Two other key recommendations made in its 1998 report have not yet been met by an alarmingly high number of prisons.
In 1998, the Committee recommended that meals should be served within 45 minutes of cooking. Yet in 2006, 37 per cent.more than a thirdof the prisons visited by the National Audit Office failed to meet that recommendation.
On prison behaviour and diet, did the hon. Gentleman notice in one of the appendices of the report the analysis of the number of prisons in the United Kingdom where porridge is available to prisoners?
It became obvious that porridge is not available in a significant number of prisons despite the fact that it is well known not only to reduce cholesterol but to have various other life-giving properties, including the ability to help the body to produce serotonin, which lifts the spirits and reduces the appetite. Does he agree that all prisoners in the United Kingdom should have daily access, if they wish, to porridge?
Mr. Burstow: I could not but agree. Indeed, all hon. Members have access to porridge in the Members Dining Room every breakfast time. It is unfortunate that prisoners cannot avail themselves of that health-benefiting food and do their porridge in that way. Those comments reflect the work of research done in 1997 which shows clear links between behaviour and nutrition. That is why I wanted to draw the report to the attention of the House and the Minister.
Another aspect of the recommendations from the 1998 report was that prisoners should not wait more than 14 hours between meals. Yet in 2006, half of all prisons failed to meet that recommendation. Once again, the Prison Services responses are poor to say the least. On the question of the waiting time between cooking and serving, it said:
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