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The Minister of State, Department for Transport (Ms Rosie Winterton): I congratulate the hon. Member for Cities of London and Westminster (Mr. Field) on securing a debate on this clearly important and topical subject, which he feels strongly about in terms of both the wider issues and his constituents. He touched in the later part of his speech on some of those wider issues but focused initially on some of the challenges of Heathrow.
We all recognise that Heathrow faces some real challengesit is the busiest international airport in the worldbut we also recognise that London and the wider UK rely heavily on good international links to support our economy. The hon. Gentleman set out many reasons why good air travel facilities at Heathrow are important for the economy and for the many people who use the airport for leisure and holidays. That is an important point.
The hon. Gentleman touched on some of the major challenges, particularly in respect of tackling capacity constraints in the face of increasing demand for air travel. In a sense, those challenges apply to all airports in the country, but particularly to Heathrow. We need to look at improving the service to passengers and, of course, to airlines as well. We also need to ensure that we are tackling the challenges, while meeting our climate change commitments and respecting the local environment around airports, particularly in respect of air quality and noise.
The hon. Gentleman was right to speak about the problems that face passengers at Heathrow. It was because of those problems that last week we published a set of proposals on how to improve the end-to-end journey experience, and we are now looking in more detail at how to tackle some of the issues that he raised. I shall touch on some of them a little later in my speech.
Ms Rosie Winterton: Before the sitting was suspended, the hon. Member for Cities of London and Westminster made a suggestion about airport capacity: that we should provide a new airport in the Thames estuary. I appreciate that developing Heathrow is not the only answer to our capacity problems, but the hon. Gentleman might recall that the construction of a new four-runway airport at Cliffe in north Kent was thoroughly considered and consulted on in the lead up to the 2003 White Paper, The Future of Air Transport.
We recognised that an estuary airport would provide benefits in not overflying large populated areas. However, in view of the relative costs both for the airport and for surface access links, the time for construction and the financial viability of that option, the Government decided in favour of pursuing further development at existing airports, rather than building an entirely new one in the Thames Gateway.
Building capacity does not focus only on Heathrow. For example, the White Paper supported a new runway at Stansted, which would be the first new runway in the south-east for many decades. I can assure the hon. Gentleman that our commitment to the new runway at Stansted has not changed. It is important to remember that the White Paper also supported making better use of regional airports, such as Birmingham and Edinburgh. Growth in regional airports has a real part to play in satisfying overall demand for air services, as I know from the new regional airport in Doncaster, which is hugely popular with local people. Despite that, however, Heathrow is the UKs No. 1 and only hub airport, and we should not walk away from that even if there are problems.
Work is in hand to tackle many of those problems. Terminal 5 will open next March, and I am pleased that BAA plans to invest some £6.2 billion modernising Heathrow in the next 10 years. By 2012, Heathrow will have a total terminal capacity of around 90 million passengerstwo out of three people will travel through terminals that are not yet open. Problems at immigration are being tackled. The hon. Gentleman mentioned the queues, and the Border and Immigration Agency is working with the Department and BAA to improve passenger flows.
On security, I am sure that the hon. Gentleman knows that the Secretary of State for Transport earlier this month set out a new industry framework to change the one-bag rule on hand luggage, without compromising security safeguards. Passengers should begin to benefit from that in early January.
The hon. Gentleman rightly drew attention to the frustration of long queues. Last week, the Civil Aviation Authority published its proposed package of price caps and incentives for Heathrow and Gatwick. Final price controls are not expected until March next year following a period of consultation, but the package will aim to incentivise BAA to deliver, in the CAAs words,
genuine service quality improvements and to invest to raise the standard of service
The proposals contain an increased range of financial incentives for the airport operator, including targets for the percentage of passengers to be security processed within five and 10 minutes. As a further measure, the Secretary of State asked the CAA for its views on how
to improve the transparency of check-in times and other aspects of performance related to getting people through an airport.
The hon. Gentleman mentioned surface access. The Governments £16 billion funding deal for Crossrail is now in place and will provide a 30-minute link to the centre of London. From 2014, we will have an enhanced Piccadilly Line. The AirTrack scheme, if approved, would be a significant addition to Heathrows rail links and provide direct services from terminal 5 to the south-west rail network via Staines.
Those measures should improve the passenger experience, both in getting passengers to the airport and inside the terminals, but the fact that demand for both departures and arrivals exceeds capacity on the current two runways remains an issuethe hon. Gentleman talked a great deal about itwhich is why the Government are consulting on a third runway.
We need to be realistic about runway capacity if we are to protect Heathrows international position. Our competitors have acted already: in contrast to Heathrows two runways, Frankfurt has three, Paris four and Amsterdam five. Although Heathrow is full and turning away new services, all three of those competitors have at least 20 per cent. spare capacity, which provides them with resilience and allows them to grow.
In principle, the Government are in favour of a third runway, but our supportI hope the hon. Gentleman is reassureddepends on achieving a noise limit such that there would be no increase in the size of the area significantly affected by aircraft noise as measured by the 2002 57 dBA Leq noise contour. It also depends on establishing air quality limits, so that we can be confident of meeting European air quality limits around the airport, and on improving public transport to the airport. The hon. Gentleman has shown concern about those issues.
Mr. Mark Field:
I mentioned that Paris has twice relocated its main airport in the past 30 yearsobviously, relocation is an element of this issuebut one of the chief concerns of many residents of the Heathrow area is night flights. I totally appreciate, for the reasons I set out, that given the increasing power of India and China and countries in south-east Asia, there will be ever more demand for flights to come in at three, four or five oclock in the morning. We need to encourage that, but I cannot understand how we could
do so with Heathrow as it is today or how it will be in future. That is one of the reasons why I am in favour of building an airport on the coast, so that we can cater for the flights that I mentioned, without disrupting the sleep of many millions of our fellow citizens.
Ms Winterton: I certainly take the hon. Gentlemans point about the importance of ensuring that those who live around the airport can get a decent nights sleep. Again, that is one reason why a third runway would be important in ensuring that the increased demand can be met, while not having to encroach on any of the night time activities.
Mr. Field: I should mention that Sipson and Harmondsworth are in the constituency of the hon. Member for Hayes and Harlington (John McDonnell) and Stanwell Moor is in the constituency of my hon. Friend the Member for Spelthorne (Mr. Wilshire). I just wanted to make the point that I have visited those areas around the airport on foot and have seen with my own eyes some of the concerns and some of the beauty and charm that those areas retain, particularly for people who have lived there for many generations.
Ms Winterton: I hope that it will give the hon. Gentleman some comfort to know that there will be the opportunity for the nice communities that he visited to respond the consultation and for the comments that I am sure that he will wish to make during the consultation to be taken into account as well.
The consultation also invites views on the introduction of mixed-mode operations as an interim measure ahead of a new runway, subject to the same local conditions as a third runway. Depending on the consultations outcome, it will be for the airport operator to obtain the necessary consents in accordance with applicable planning rules and relevant statutory and other criteria. Final policy decisions on adding capacity at Heathrow will be taken at the earliest in summer 2008, in light of the results of the consultation.
This is not papering over the cracks. Our airports strategy is long term, looking ahead to the next 20 years or more, and I am confident that, with the significant investment going into Heathrow over the next few years and the proposals set out in the consultation on adding capacity at Heathrow, we can deliver a sustainable, customer-focused programme for Heathrow that supports a growing UK economy.
Dr. Gavin Strang (Edinburgh, East) (Lab): Mr. Cook, as you know, I have had the privilege of being a Member of this House for a good many years. Indeed, I was a Member of Parliament when HIV/AIDS first became an issue in this country. The world first became aware of AIDS at the beginning of the 1980s, when it was observed that young gay men in the US were dying from rare illnesses. The first documented case in the UK was in 1981. While scientists worked to piece together how the condition was caused, Governments had to work out how to respond to the new public health challenge.
My right hon. Friend the Minister of State, Department of Health, who is replying to this debate, will remember the huge campaigns mounted by the Government: the Dont die of ignorance leaflet distributed to every household in this country, the newspaper adverts and the public information film. Of course, there was such an outcry at the time because of the fact that to become infected was a death sentence. Infection with the HIV virus resulted within a short time in the breakdown in the human bodys immunity to diseases, such as pneumonia. In Scotland in the 1980s, diagnosis with HIV was followed by death with AIDS within an average of two years.
The main sources of infection varied in different parts of the country. In some places, AIDS was very much a disease among the gay population. In other areas, HIV/AIDS was primarily a problem among injecting drug misusers. That was the situation in Edinburgh, where we had a major epidemic in the 1980s, predominantly among our injecting drug users. It is thought that a clampdown on the availability of needles led to an increase in needle-sharing, and that that in turn led to the explosion of HIV infection among Edinburghs drug-taking population.
It was because of the scale of the problem in Edinburgh that I developed an interest in the subject and, under the private Members Bill procedure, successfully introduced the AIDS (Control) Act 1987. That Act requires health authorities to publish reports annually, setting out the numbers diagnosed with HIV/AIDS, and to provide details of the work being done in their area on prevention, treatment and care. In the past year, the Government have indicated their intention to discontinue the central requirement of the Act. Health authorities would no longer be required to produce annual reports.
I understand that the epidemiological information provided by the reports is now provided centrally. However, without the reporting requirement in the 1987 Act, health authorities would no longer have to publish details of their work in the field of prevention, treatment and care. I am worried that that may reflect a wishconscious or unconsciouson the part of the authorities to downplay the continuing incidence of HIV/AIDS as a major challenge in this country. I would be grateful if my right hon. Friend set out for me how health authorities are to be held to account for their HIV/AIDS work, if the reporting requirements of the AIDS (Control) Act are to be dropped.
The nature of the epidemic in the UK has changed over the decades. The numbers of new cases diagnosed declined into the 1990s. However, from 1995, increases in heterosexual and homosexual transmission in the
UK, alongside increased numbers of people infected abroad, led to a decade of steep rises. An estimated 7,800 people were newly diagnosed with HIV in the UK in 2006. The most common route of transmission is heterosexual sex abroad, while the highest number of new cases actually transmitted within the UK is among gay men.
The total annual number of new diagnoses shows signs of stabilising, which is welcome, but within the total there remain some disturbing trends. Levels of transmission among men who have sex with men remain high, there are worrying signs of increased transmission among drug users, and the number of people becoming infected through heterosexual sex in the UK is steadily climbingfrom 232 in 2000 to 750 last year. It is wholly unsatisfactory that so many people are becoming infected and have to depend on antiretroviral therapy for the rest of their lives. We know how HIV is caused and how to prevent it from being transmitted, yet thousands of people every year still become infected with HIV in the UK.
Public knowledge of HIV and AIDS appears to have declined. While 91 per cent. of people in the UK knew that HIV was transmitted through unprotected sex in 2000, that figure fell to 79 per cent. by 2005. Our education system has a role to play here. HIV/AIDS is not a compulsory part of school education in any part of the United Kingdom. Ofsted reported this year that schools in England give insufficient emphasis to teaching about HIV/AIDS and that pupils appear less concerned about HIV/AIDS than in the past.
Funding is also key. While HIV prevention money in Scotland is still ring-fenced by the Scottish Executive, prevention funding in England and Wales can be spent at the discretion of the health authorities. Money that should be spent on HIV prevention is vulnerable to other pressures within the NHS. A survey conducted by the National AIDS Trust in 2006 indicates that, despite increasing rates of transmission, HIV prevention funding has at best stagnated and probably declined in real terms over the last decade. My right hon. Friend will be aware that there is considerable support for a return to some form of protected funding for HIV prevention work that is not at the mercy of other short-term budgetary needs. I urge her to consider those calls carefully. I would also be grateful if she could set out for me details of the implementation of the commitment in the 2004 Choosing Health White Paper to a £50 million mass sexual health awareness programme for young people.
Targeted action is also needed. One in 20 gay men in the UK is now living with HIV. The Health Protection Agency warns that prevention work among men who have sex with men is not succeeding adequately. In its annual report published last week, the HPA called for an assessment of the progress made within the NHS in commissioning soundly based services. The HPA also called for action to address the rising problem of heterosexual transmission within the UK. Such action would include targeted prevention activities alongside work to reduce stigma and discrimination within black ethnic minority communities, which are disproportionately affected.
Another aspect of prevention work is the uptake of post-exposure prophylaxis, or PEP. The number of people seeking PEP is far smaller than the number of people
who are at risk. Just over one in 100 men who responded to the 2005 gay men's sex survey had sought PEP, even though almost a third of respondents who had not tested positive had been at risk of infection. Clearly, awareness campaigns need to be continued. Furthermore, PEP is not always easy to obtain. I would be grateful for my right hon. Friends observations on the extent to which the NHS is now meeting the chief medical officer's recommendations that all primary care trusts should make PEP available.
Of the 73,000 people in the UK estimated to be living with HIV, about a third are unaware of their status. That means that over 20,000 people in the UK are HIV positive but do not know it; many of them will assume that they are HIV negative. That level of unawareness has two implications. The first is for individuals' own health, as people who do not know that they are HIV positive are not getting the treatment that they need to keep them well. At least a quarter of HIV-related deaths are among people who are tested and diagnosed too late for effective treatment. The second implication is for the spread of HIV, because people who mistakenly believe themselves to be HIV negative may be less likely to take all the steps that they should to protect their partners.
There have been improvements in this area. We have routine opt-out screening for pregnant women, and everybody attending sexual health clinics should now be offered an HIV test on their first screening, and subsequently according to risk. The Health Protection Agency's report, Testing Times, which was published last Friday, sets out the welcome increase in the number of people tested and the reduction in waiting times.
However, I am sure that my right hon. Friend will agree that there is a great deal of work still to be done in reducing the number of people who are unaware of their HIV positive status. Some 37 per cent. of HIV positive people visiting a genito-urinary medicine, or GUM, clinic still leave the clinic unaware that they have the virus. My right hon. Friend will be aware of calls for GUM clinic HIV tests to be conducted on an opt-out basis universally, and to be provided for every attendee every time they attend with a new condition.
There is considerable scope for non-HIV specialties to expand their contribution to HIV testing. The Minister will be aware of calls for routine HIV testing to be considered in certain relevant secondary care specialty centres such as TB clinics. Just last month, Scotland and England's chief medical and nursing officers wrote to all doctors and nurses seeking their help in getting more people diagnosed. As the Health Protection Agency notes:
Perceived and real HIV-related stigma and discrimination by non-HIV specialists continues to be a major barrier to both the offer and uptake of HIV testing in wider healthcare services.
There is also a funding issue. The 2004 Choosing Health White Paper pledged an additional £300 million over three years to transform England's sexual health services. In a survey of primary care trusts and clinicians in 2006, just under two thirds indicated that all or part of their Choosing Health funds had been diverted from sexual health services. The professional body, the British Association for Sexual Health and HIV, advises that most of the Choosing Health funding has been diverted to alternative causes unrelated to sexual health, notably paying off PCT financial deficits.
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