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The Prime Minister: Because we came into office and recognised that the first problem in our country was pensioner poverty. That is why we brought in the pension credit; that is why 1 million pensioners have been taken out of poverty; and that is why women who had no industrial pensions of their own and sometimes not even a full pension themselves benefited in a way that has taken them out of poverty. They were mainly widows, mainly in their 80s. But for every pensioner we also created-on top of the pension and the other measures that we have taken-the winter fuel allowance, which
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goes to every pensioner family over 60 and has given additional help to pensioners over these times. I should also mention that the biggest users of the national health service are elderly people, and we have doubled the budget of the health service.

Q15. [322432] Chris Ruane (Vale of Clwyd) (Lab): Under Labour, interest rates over the past year have been just 0.5 per cent. In the previous, Tory recession, they were 15 per cent. What impact would a thirtyfold increase in interest rates have on hard-working families paying mortgages, and on defence companies, such as Kent Periscopes in my constituency, which are looking to grow?

The Prime Minister: My hon. Friend is absolutely right. Unemployment is half what it was in the 1990s, when interest rates meant that mortgage repossessions were about three times what they are now; and there are more small businesses now than there were a year ago, whereas in the 1990s small businesses faced 15 per cent. interest rates and went under. The Conservatives say they are the party of change, but the only economic policy that they have is to go back to the 1980s.

Q9. [322426] Jo Swinson (East Dunbartonshire) (LD): When the Prime Minister last visited East Dunbartonshire, he was campaigning for my Labour predecessor at Tesco in Milngavie. Tesco now proposes a giant store in the midst of the town's conservation area, riding roughshod over local opinion. Five years on, does the Prime Minister agree that large supermarkets such as Tesco wield too much power over our communities?

The Prime Minister: We have tried to put in money and help to renovate local shopping centres in the centres of towns, including the centres of smaller towns, but I have to say that a planning decision is not a matter for this House but one for the planning authorities.

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Q10. [322427] Mr. Michael Clapham (Barnsley, West and Penistone) (Lab): May I take this opportunity to thank the Government for their recent series of changes to the way in which we will be dealing with asbestos-related diseases? Many of the victims will be grateful for the action that the Government have taken. Will the Prime Minister overturn the Law Lords' decision on pleural plaques when new medical evidence becomes available to him as Prime Minister after the next election?

The Prime Minister: If medical evidence were to become available, we would obviously reassess the situation; I give my hon. Friend that assurance. At the same time, he should know that the Justice Secretary announced a range of measures which provide real benefits for people with asbestos-related disease. These include a system of fixed payments for individuals and the creation of an employers' liability tracing office. In addition, the Government have confirmed their commitment to expand medical research in one of the most difficult areas, where lives are so often, sadly, lost. I assure my hon. Friend that if new evidence becomes available we will re-examine the situation.

Q11. [322428] Mr. Gerald Howarth (Aldershot) (Con): Charlie Whelan was copied into all the Smeargate e-mails and was apparently part of the "forces of hell" of which the Chancellor spoke. Can the Prime Minister explain why he is now back in No. 10 advising the Prime Minister, or has the Prime Minister's moral compass suffered the same fate as the telephone and other items beaten up in the bunker?

The Prime Minister: The hon. Gentleman had a chance to ask a question about his constituency, and to speak up for the people of Britain. Once again, the Conservatives are trying to turn an industrial relations dispute into a political football; they should be ashamed of themselves.

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Speaker's Statement

12.32 pm

Mr. Speaker: I have a very short-or relatively short-statement to make.

The hon. Member for Carlisle (Mr. Martlew) raised a point of order yesterday about the statement last Thursday on high-speed rail. The statement was made first in the Lords by the Secretary of State at 11.39 am and then repeated in this House by the Minister of State at 12.17 pm. The hon. Gentleman's point of order was not about the timing but about the fact that the text of the statement was not available until after the Minister of State had spoken in this House. As Members will know, the practice to date has been that the text of a statement is not released by the Vote Office until the Minister has sat down. These arrangements are essentially for the Government, who supply the copies of the statements to the Vote Office on condition that they will not be released in advance. I believe that there was a misunderstanding about this last Thursday.

It is inevitable, with two departmental Cabinet Ministers in the other place, that some statements will be made there before they are made in the House of Commons. However, it does seem illogical that the text of a statement already delivered in the Lords, and available from the Printed Paper Office there, is not available from the Vote Office in this House. I am therefore asking the Leader of the House to ensure that in future the text of statements made in the Lords should be available from the Vote Office as soon as they are available in the Lords.

The Leader of the House of Commons (Ms Harriet Harman): Further to your statement, Mr. Speaker. Of course it makes absolute sense that if a statement has been given in the House of Lords, the written copy should be available in the Vote Office for Members of this House even before the statement has been made here, so we strongly support the concern expressed by my hon. Friend the Member for Carlisle (Mr. Martlew) and your statement. It will all be sorted.

Mr. Speaker: I am extremely grateful to the Leader of the House. That is precisely the sort of co-operation that any Speaker wants to achieve.

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Points of Order

12.35 pm

Mr. Gordon Prentice (Pendle) (Lab): On a point of order, Mr. Speaker. The Public Administration Committee is meeting tomorrow to consider the circumstances surrounding the elevation of Lord Ashcroft. We have invited Lord Ashcroft and the Member for Richmond, Yorks (Mr. Hague), but we have heard nothing. Is it not a terrible discourtesy to the Committee to be ignored in this way? [Interruption.]

Mr. Speaker: Order. I am perfectly capable of dealing with the matter, and that is what I am about to do. The hon. Gentleman has made his point extremely clearly and placed his views on the record. He may not be satisfied with this, but I have to say to him that that is a matter exclusively for the Committee. His views are now very well known.

Mr. Eric Martlew (Carlisle) (Lab): On a point of order, Mr. Speaker. Thank you very much for the speedy way in which you have dealt with the issue that I raised, but is not the real reform that we need in the Palace of Westminster that Secretaries of State in the House of Lords should be obliged to come to this Chamber to make statements to the democratically elected Members and answer questions?

Mr. Speaker: There was I thinking that I had satisfied the hon. Gentleman's appetite. He is an experienced Member of this House, and he knows that that is another matter. It is an important matter, on which there has been some discussion and to which the House will doubtless in due course return. I cannot, however, say any more about it today. I hope that he will be pleased with what he has got.

Bill Presented

Dementia Strategy Bill

Presentation and First Reading (Standing Order No. 57)

Mr. Paul Burstow presented a Bill to require the Secretary of State to publish and keep under review a strategy to improve the provision of services for adults in England with dementia and their carers; to require the Secretary of State to report annually to Parliament on the implementation of the strategy; to require local authorities, the NHS and other bodies to act in accordance with relevant guidance issued by the Secretary of State; and for connected purposes.

Bill read the First time; to be read a Second time on Friday 23 April, and to be printed (Bill 90).

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Organ and Tissue Donation (Mandated Choice)

Motion for leave to introduce a Bill (Standing Order No. 23)

12.37 pm

Mr. David S. Borrow (South Ribble) (Lab): I beg to move,

It is a magnificent achievement that in 2008-09 there were more than 3,500 organ donations in the UK. In addition, more than 4,000 corneas were donated, leading to 2,711 people having their sight restored. Tragically, in the same year, more than 1,000 died an avoidable death while awaiting a life-saving organ transplant. I believe that we have a moral duty to reduce the number of avoidable deaths. The pertinent questions, therefore, are why we are allowing those deaths to occur and what we can do to change those sad statistics.

In a report published in January 2008, the organ donation taskforce identified several barriers that mean the UK is lagging behind other European countries when it comes to the number of transplants that take place. Further research published by NHS Blood and Transplant shows that four out of 10 families refuse the request for organ donation, even when a deceased relative has signed the organ donor register.

With just 27 per cent. of the UK population signed up to the register, the simple fact is that not enough people are saying yes to granting the gift of life through donation when they die. Surveys indicate that between 60 and 90 per cent. of the UK population support organ donation and personally want their organs to be used to save a life, so why is it that just 27 per cent. have given their explicit consent? What are the barriers, and why is that figure not nearer to the 60 to 90 per cent. mark? Do people intend to go online and register but forget to do so, or are they simply too busy? Do they even know that there is an online registration process? That line of questioning is endless.

One simple answer is that the current system needs to change. The opt-in system is voluntary and, by its nature, a barrier in itself, so the obvious question is: what are the alternatives? One is an opt-out system, whereby consent is assumed. Personal choice and the right to choose are fundamental in any personal decision. On organ donation, they should be paramount. A system that assumes consent therefore carries moral and ethical dilemmas that cannot and should not be ignored.

With an opt-out system, medical professionals treating a dying patient would be put in a difficult position. They must broach the subject with the family, who would be forced to consider the issue at what is always an emotional and traumatic time. There would be many instances when no discussion about organ donation had taken place, and the individual had not opted out. The medical professional must then approach the family to arrange organ donation in the absence of active consent by the potential donor. Inevitably, there will be circumstances in which the organs are used of an individual who opposes organ donation, but has failed to make his
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or her views known. Again, that raises serious ethical issues about personal choice and an individual's right to choose whether they want their organs to be used after death.

I have worked closely with Mrs. Pat Hall from Lancashire, who has campaigned for many years to increase the number of people on the organ donor register. Pat lost her son in the early 1990s, shortly after the register came into force. He was on the register and had made his choice known to the family. He was able to help several people through organ donation. I have discussed the problem of presumed consent with Pat, and she explained that many campaigners were unhappy with it. She believes that individuals should make an active decision to donate.

Pat's alternative is the mandated choice system, whereby every UK citizen would be required by law to make a declaration, one way or the other, about whether they wished their organs to be used after death. By offering the choice of saying yes or no, or leaving the decision to the family, a person's civil liberties are protected. Mandated choice has been introduced in some countries, but the choice has been only between yes or no to organ donation. The Bill proposes a third choice-essentially what we have now-of leaving the decision to the family at the time of death. There is, therefore, a status quo option, which would make a difference by making it easier for people to accept the proposal.

The practicalities of a mandated choice system obviously need to be considered. Initially, every adult will need to be approached and asked to make a choice. It would then to be necessary to ensure that individuals are asked at certain points during their lives, such as when they receive a national insurance number or register with a GP, or possibly when they obtain a driving licence. When a person explicitly states their intentions, all doubts about their wishes-and thus the wishes of a dying patient-are removed. That safeguards health care professionals as they know exactly what their patient wants. It also removes the burden on the family when a relative dies.

Reforming the current opt-in system to a mandated choice system will increase the number of people registered as organ donors. By choosing to be an organ donor, we offer patients a second chance at life. I want a system that reduces the number of avoidable deaths to an absolute minimum and reduces waiting times for people who need life-saving transplants.

I am sure that we would all be prepared to accept an organ if we needed one to carry on living. If most are prepared to receive, I would expect most to be prepared to provide. Failing to reduce the number of avoidable deaths is a tragedy and, worse, a preventable tragedy. I present the Bill to introduce a mandated choice system as the best way in which to reduce the number of avoidable deaths. I hope that it will receive the support of the House.

12.44 pm

Lembit Öpik (Montgomeryshire) (LD): I listened with great interest to the proposal for a mandated choice approach as outlined by the hon. Member for South Ribble (Mr. Borrow). I happen very much to agree with organ donation, and when I pass on, if there are any bits that are still usable, the state is perfectly
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welcome to them- [ Interruption. ] I will not be drawn by the hon. Member for Wolverhampton, South-West (Rob Marris).

However, my concern is that mandated choice will put people under moral pressure to acquiesce, even if they do not feel comfortable doing so. I am conscious that the hon. Member for South Ribble realises how sensitive the matter is and that very strong emotions can be generated, including for reasons of faith, especially at the time of death. I applaud his intent, but it is nevertheless my view that our society and culture are still at a stage at which there is insufficient buy-in to the concept of organ donation. In some ways, we do a disservice to our society if we do not work towards increasing the number of people who actively sign up.

I do not seek to press the matter to a Division, because that would be a bad use of time; I simply flag my concern that it is easy to codify such things in an administrative way, but we have some way to go as a society. I would prefer a mandatory development of an understanding of the options, without having the paperwork to go with that at this stage.

Question put (Standing Order No. 23) and agreed to.


That Mr. David S. Borrow, Jim Dobbin, Mr. Lindsay Hoyle, Mr. David Crausby, Bob Spink, Dr. Brian Iddon, Derek Twigg, Mr. Mark Hendrick and Geraldine Smith present the Bill.

Mr. David S. Borrow accordingly presented the Bill.

Bill read the First time; to be read a Second time on Friday 23 April, and to be printed (Bill 91 ).

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Cluster Munitions (Prohibitions) Bill [ Lords]

Second Reading

The Comptroller of Her Majesty's Household (Mr. John Spellar): I have it in command from Her Majesty the Queen to acquaint the House that Her Majesty, having been informed of the purport of the Cluster Munitions (Prohibitions) Bill [ Lords], has consented to place her prerogative, so far as it is affected by the Bill, at the disposal of Parliament for the purposes of the Bill.

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