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Because of the current absence of a national biometric identity card, the Bill is necessary for reasons I shall set out.

Every day in Britain, hard-working shop workers ensure that we can get hold of everything from A to Z—from apples to cuddly zebras—and are involved in millions of transactions, many of which involve age-restricted items such as alcohol, cigarettes, knives and airguns. Conflict does not usually arise over sales of apples or cuddly toys but, sadly, it all too frequently arises over the sale of age-restricted items. Research shows that the refusal to sell age-restricted products is the most common cause of verbal abuse towards shop staff and that it can also provoke physical violence. It is believed that as many as 90 per cent. of shop workers have suffered some form of abuse, and many of them do so daily.

As well as verbal abuse, shop workers are often subjected to physical abuse, ranging from being spat at to violent assault. For example, a shop worker who refused to serve a bottle of beer to someone whom they thought was under age was told that they would be knifed. Other shop workers report being beaten up for refusing to sell alcohol to young lads. Thankfully, according to the most recent figures, incidents of violent abuse against shop workers have declined. That is in part owing to initiatives such as the Union of Shop, Distributive and Allied Workers’ successful “Freedom from Fear” campaign, and USDAW is today celebrating its “respect for shop workers” day. I pay tribute to it for its work in raising the profile of the millions of shop workers who serve us each and every day.

One way of addressing the problem of assault on shop workers is to foster a culture of “No ID, no sale”, so that customers know that if they look under 21, they will need to show proof of age. That would help to defuse tension and reduce opportunities for confrontation when a customer is challenged about their age.

I fear that the problems associated with selling age-restricted products will peak this autumn when the age at which tobacco products can be sold rises from 16 to 18. Many young people who are approaching their 18th birthday will have been buying cigarettes legally for almost two years but will no longer be able to do so. Similar increases in the minimum age for purchase will rightly apply to knives, airguns and crossbows.

I am particularly concerned about the availability of so-called pendant knives. They look like a piece of jewellery, but they contain two blades that fold out. I was horrified to learn that that item can be sold legally as it is not a concealed blade and the blades are not long enough to make it illegal. I fail to understand how
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such items can be justified, but I look forward to the date when at least no one under 18 can buy one.

The Bill has two key points: it proposes that we have a nationally recognised, Government-controlled proof of age scheme, and that that be compulsory for those aged 16 to 21 who wish to make restricted purchases. Let us be clear about what we are addressing. Tobacco and alcohol are not the only items whose purchase is age-restricted. Other age-restricted products include fireworks, which can cause great misery in the hands of people who misuse them, DVDs, videos and solvents—the problems associated with solvent misuse have been raised with the Prime Minister. Other items include aerosol paints—young people sometimes use them to put their tags on walls—lottery tickets, petrol and crossbows. It is right and proper that such items are sold only to those who are deemed to be of a suitable age.

It would be wrong to claim that there are no voluntary schemes already in place to train and support shop workers in order to help them meet their legal obligations and check the age of customers. Many Members will be aware of the pass scheme, and I pay tribute to all involved in that, including the drinks industry, which plays an active role. The pass scheme is supported by robust audits carried out by trading standards bodies, and only accredited cards may bear the registered hologram. About 2 million such cards are in use, and where they are applied, their use is beneficial. However, as well as the four national card schemes that are accredited by a pass, there are also about 20 local authority entitlement cards, which also provide proof of age, and numerous other non-accredited schemes. More worryingly, there are cards showing false details that can be downloaded and printed from the internet. Furthermore, in some parts of the country it is more usual for young people to use passports or driving licences to prove their age. I understand that it is estimated that about two thirds of those aged 18 and 19 have passports, and that a similar proportion have driving licences. Inevitably, there is a significant overlap between those two groups, so perhaps a quarter of all those aged 18 and 19 do not have some form of official Government proof of age.

Apart from the costs involved, what are the dangers in carrying around such documents? Identity theft dangers are heightened. Passports and other documents can easily be stolen when people are on a night out. Replacing them is both costly and time consuming. It is an administrative burden for the young person, the police and the passport agency.

There is currently a variety of proof of age cards and documents, and, although the pass hologram should be widely recognised, a young person who visits elsewhere in the country—perhaps a person from Stoke-on-Trent visiting a friend in Portsmouth—might find that his proof of age card is not recognised there. A single, national, Government-run scheme would simplify the position on proof of age by removing the myriad schemes. Its establishment would also raise the profile of the single scheme in the minds of customers.

If we were to have compulsion, that would help create the culture we need to foster whereby anyone who looks under the age of 21—I can only wish that that included me—automatically shows their proof of age when purchasing age-restricted items. If showing a
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proof of age card is compulsory, that should take off the shop worker the pressure of having to ask to see such proof. That in turn should lead to less scope for confrontation and less abuse and assault of our shop workers. Regardless of how well a voluntary scheme might be run, I do not believe that it would stop abuse of shop workers. The scheme must be compulsory.

Although we may no longer be described as a nation of shopkeepers, we should celebrate the work our shop workers do—often at times when the rest of the population is not at work, such as early in the morning, late in the evening, at weekends, and during holidays and bank holidays. Our shop workers deserve the greatest respect, and to be treated properly. My Bill would add to the protection of those hard-working men and women. I commend the Bill to the House.

Question put and agreed to.

Bill ordered to be brought in by Mr. Robert Flello, Mr. Adrian Bailey, Lyn Brown, Mr. David Kidney, Sarah McCarthy-Fry and Lynda Waltho.

Proof of Age Scheme (Purchase of Restricted Goods)

Mr. Robert Flello accordingly presented a Bill to establish a national compulsory proof of age scheme for persons aged between 16 and 21 years in connection with the purchase of alcohol, tobacco, knives, air weapons and other items; and for connected purposes: And the same was read the First time; and ordered to be read a Second time on Friday 19 October, and to be printed [Bill 143].

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Opposition Day

[16th Allotted Day]

Stroke Services

Mr. Deputy Speaker (Sir Michael Lord): We now come to the first debate on the Opposition motions. Mr. Speaker has selected the amendment in the name of the Prime Minister.

1.40 pm

Mr. Andrew Lansley (South Cambridgeshire) (Con): I beg to move,

I am grateful to my colleagues for permitting me to use Opposition time to raise the important issue of stroke. I declare an interest as chair of the all-party parliamentary group on stroke, and I am also grateful to the Secretary of State and his colleagues for their support of the all-party group and for the Government’s amendment. Unfortunately, I cannot prefer their amendment to our motion, because the latter faces up to the reality of international comparisons in stroke care and the wide discrepancies and deficiencies in it across the UK. I wish that we could have had a combined motion, because the purpose of this debate is not to engage in partisan argument, but to raise the priority of stroke care. It has been more than four years since we have had a debate on stroke in this House, including in Westminster Hall, so it is right to do so now.

I wish to pay tribute to some people who have been instrumental in raising the priority of stroke. There are voluntary organisations, including patient representative groups such as the Stroke Association and Different Strokes, and national organisations, such as the Royal College of Physicians, which through the National Sentinel stroke audit has brought forward much vital information about the quality of stroke services and helped to push forward the improvements that have been occurring. I do not want to leave out clinical leaders such as Tony Rudd at St. Thomas’, Peter Rothwell in Oxford and Gary Ford in Newcastle, or the work of the Department of Health in the past 18 months, led by Roger Boyle, the national clinical director, and the team of officials.

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Nor should we ignore the role of the National Audit Office. The report that it produced in November 2005 was a remarkable example of the value of the NAO, not only in considering issues of value for money and public expenditure, but in examining how services can be improved in ways that have radically changed attitudes in the Government about what can be achieved in stroke care.

Mr. Edward Leigh (Gainsborough) (Con): My hon. Friend kindly mentions the NAO report and I am proud of the work that it and the Public Accounts Committee have done in this area. I hope that we can do for stroke what we did for methicillin-resistant Staphylococcus aureus in bringing it to the forefront of the political agenda. I hope that we are now doing that for dementia, as well. Will he comment on our particular view that so many people are left debilitated, and therefore become an increased cost to the NHS, because of the lack of early scans in hospitals?

Mr. Lansley: I am grateful to my hon. Friend for the work of not only the NAO but the Public Accounts Committee, which has followed up on the issue in the same way as it followed up the original inquiry into health care-acquired infections. It revisited that subject and made further important recommendations, which have helped to raise the importance of the issue. He makes an important point: one of the NAO’s recommendations was the need for immediate access to screening.

At the conference organised by the NAO last October, at which my hon. Friend the Member for Gainsborough (Mr. Leigh) spoke, Professor Anthony Rudd outlined the 2006 National Sentinel audit results and explained that across England, Wales and Northern Ireland, 226 hospital sites were offering CT scanning, but only 18 per cent. were able to provide scanning within four hours. On weekdays, the vast majority of trusts were able to do a scan within 48 hours, although 7 per cent. could not. However, at weekends, 35 per cent. were taking longer than 48 hours. So scans for stroke patients are being delayed, even though we know that time lost is brain lost in those circumstances.

At that same conference, Professor Norrving from Lund university in Sweden said that his country had a virtually 100 per cent. delivery rate for CT scans within 24 hours and Professor Bladin from Melbourne, Australia described how all patients at his hospital have immediate access to scanning. Those international comparisons should serve to demonstrate to us what a dramatic difference there is in the quality of stroke care being provided in this country compared with some of the leading examples across the world.

Mr. Tim Boswell (Daventry) (Con): My hon. Friend is rightly concentrating on acute care, but does he agree, given his stated interest in public health, that it is important for the health and welfare of the nation that, wherever possible, we avoid stroke incidents at source? There is still a huge national problem of undiagnosed, undetected and unremediated hypertension. Will he encourage the Department to do everything possible, through GPs and otherwise, to ensure that that is tackled, alongside the acute services to which he rightly draws attention?

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Mr. Lansley: I am grateful to my hon. Friend. I was not intending to dwell on that important point, but the evidence, not least from Stroke Association surveys, is that the public have far too limited an awareness of what stroke is. They have become confused about the issue and perhaps just a bare majority understand that a stroke is a brain attack. Even fewer have a clear understanding of what leads to a stroke. In recent examples, such as the Food Standards Agency’s campaign on salt reduction, raising the public awareness of the need to reduce salt intake has been focused on the risk of a heart attack. That is valid, but it was done on the basis that the public did not understand the relationship between salt intake, hypertension and stroke. In fact, in terms of mortality and morbidity, stroke is the greater risk, so we need to work harder on that.

The quality and outcomes framework for general practitioners rightly includes the management of hypertension, but—as my hon. Friend suggests—many people do not yet know their blood pressure and, in cases in which it is appropriate, are not properly monitored or attempting to address the problem through diet and exercise or even medication. We need to make that happen, because reducing the incidence of stroke must be one of our key priorities. The awareness of stroke and how to prevent it should form part of our strategy, and the NAO made that clear.

Mr. Andrew Turner (Isle of Wight) (Con) rose—

Hon. Members: Hear, hear.

Mr. Turner: My hon. Friend draws attention to the need for better care for stroke sufferers. Some 110,000 people suffer from stroke each year, and last December I was among them. I was extremely lucky, because I received excellent care from the specialist stroke unit at St. Mary’s hospital on the Isle of Wight. I owe them so much for that and would like to thank them all publicly for it. Does my hon. Friend agree that other people in other places need care as good and as local as ours is on the island?

Mr. Lansley: I am delighted, on behalf of colleagues on both sides of the House, to welcome back my hon. Friend. I know that he has already been active in his constituency, but we are delighted to have him here. I share entirely his view, and we should not forget the many staff working in stroke care who are delivering excellent care. However, we need to be aware of the lack of stroke physicians and services. As the Sentinel audit recently made clear, we have limited numbers of consultant nurse posts and a quarter of hospitals have no specialist stroke nurses available. Those are essential parts of the process of delivering high-quality stroke care. However, I entirely share my hon. Friend’s view about the need to match what has been achieved on the Isle of Wight.

Mr. David Jones (Clwyd, West) (Con): Does my hon. Friend not agree that one of the most lamentable aspects of the National Sentinel audit to which he refers is the state of affairs prevailing in Wales? Only 45 per cent. of eligible hospitals in Wales have a specialist stroke unit, compared with a figure of 97 per cent. in England. The conclusion reached was that patients in
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Wales are more likely to die from stroke, and that, if they do survive, they will have higher levels of disability than patients in England or Northern Ireland. Does that not reflect the lamentable state of affairs in Wales and a failure on the part of the Welsh Assembly Government?

Mr. Lansley: I am very grateful to my hon. Friend for making that point. I was about to come to the findings of the 2006 National Sentinel audit of stroke care. The first of its top 10 recommendations is that

I am afraid that it felt compelled to say that the very low rate of stroke unit admission in Wales was unacceptable. My hon. Friend, given his responsibilities, will be pressing for precisely that priority to be given in Wales. It is important for us to recognise that today’s debate—from our point of view—is about stroke services in the United Kingdom, not just in England. I hope that the Government hear that message and communicate it to the Welsh Assembly Government. I know that my hon. Friend will do exactly that.

In looking at the Sentinel audit, I do not want to diminish the progress that is being made, in part, precisely because stroke physicians have been pressing for it. For example, there has been an increase in the number of specialist stroke units in hospitals in England—up to 91 per cent. from 79 per cent. in the previous audit—but only 62 per cent. of patients are admitted to a specialist stroke unit. However, that is an increase on previous figures. There has been an increase in the number of neurovascular clinics, which means that transient ischaemic attacks—mini-strokes, as it were—are increasingly followed up in clinics. However, we need to do more. As I said, there are too few stroke physicians and too few specialist stroke nurses, and only 22 per cent. of hospitals have an early supported discharge team.

One central issue in the development of stroke care is acute care—treating stroke as an emergency. Here, I pay tribute to the Stroke Association, which ran a campaign entitled “Stroke is a medical emergency” and uses the FAST protocol—the face, arm, speech test protocol—developed by Gary Ford and his colleagues at Newcastle university. The publishing and dissemination of such developments across the country is a vital part of raising awareness of the fact that stroke is an emergency.

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