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Viscount Astor: My Lords, there is no fast track as such. Applications are a matter for the distributing bodies. As the noble Viscount said, the Churchill papers have been saved for the nation. That decision was made by the National Heritage Memorial Fund; it clearly fits in with its published criteria for assessing applications. It is for the distributing bodies to assess applications and I believe they are doing so. They have had many applications and are dealing with them as fast as they are able.

Lord Hailsham of Saint Marylebone: My Lords, would it not clarify the atmosphere of civilised discussion which characterises this House if we avoided analogies from the motorway? We have already had a U-turn and a fast track. Should we not return to the Queen's English?

Viscount Astor: My Lords, that is a laudable ambition. Perhaps if my noble and learned friend can find a way of turning that into an application for lottery funds, he might find some advantage.

Lord Howell: My Lords, are the Government aware of the increasing concern as regards the distribution side? Charities in this country are losing much income as a result of the National Lottery but they have not yet had a penny distributed to them. In spite of the fact that £104 million has been allocated to charities, they will not receive any money at all until next November. Now we learn that the committee distributing money to charities is to set up 13 regional offices to advise them about that. Is that not a totally wrong use of lottery money which ought to go exclusively to charities and not be spent on bureaucracy? Furthermore, is the Minister aware that voluntary sports clubs, especially in the cities, are having great difficulty raising the 35 per cent. sum that is needed to submit a claim whereas bodies involved in the arts only have to raise 10 per cent. to qualify for a grant? Will the Minister examine that terrible discrepancy which is affecting money for sports provision?

Viscount Astor: My Lords, perhaps I may answer the noble Lord's last question first. The grants made by the Sports Council for lottery applications are a matter for that council. It has only just started distributing lottery funds and it will obviously have to take many factors into account.

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As regards the National Lottery Charities Board, I remind the noble Lord that the arrangement for regional boards is part of the National Lottery. It was debated in this House. The setting up of the boards is part of the legislative procedure on which the Government gave their assurance. It is important that the National Lottery Charities Board gets it right; it will probably receive more applications than any other body. It has decided that its primary aim for first grants will be to improve the quality of life of people in communities in this country who are disadvantaged by poverty. The board will look at further applications this autumn.

Lord Nathan: My Lords, can the Minister assist us as regards the concentration of power in the hands of those responsible for distribution? I am thinking particularly of the charities. Is a consequence of this that an industry will develop of consultants on how best to approach the matter? Does that situation arise?

Viscount Astor: No, my Lords, I do not think it does. It is for the charities boards and sub-boards to take decisions on applications for lottery funds.

Lord Annan: My Lords, does the Minister agree that we should give the bodies which distribute the moneys a fair run before we begin criticising every decision that is made? Should we not remember how often great works of art have left the country because, perfectly understandably, the government of the time thought that the taxpayer could not afford the amounts requested? Here we have a marvellous chance to retain works of art in this country. I say that with reference to the Churchill papers and many items which will come up in the future. I would greatly regret it if each donation became a target for envy.

Viscount Astor: My Lords, the noble Lord, Lord Annan, puts the case very well. It is extremely important that at a time when the distributing bodies have only just started receiving applications for grants we resist the temptation to tinker with the system just to keep a few people happy. We must give those bodies a chance to get going and operate properly.

Breast Cancer

11.22 a.m.

Lord Dubs asked Her Majesty's Government:

    What proposals they have to improve the treatment of women suffering from breast cancer.

The Parliamentary Under-Secretary of State, Department of Health (Baroness Cumberlege): My Lords, our proposals are contained in A Policy Framework for Commissioning Cancer Services, the report of the Chief Medical Officers for England and Wales Expert Advisory Group on Cancer which was published on 24th April.

Lord Dubs: My Lords, while we accept that progress has been made, is it not unthinkable that the Royal Marsden Hospital in Fulham—widely acknowledged to be Europe's centre of excellence in the treatment of cancer, particularly breast cancer—should be under threat

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of closure or at least has an uncertain future? The consequence is that the hospital has a lesser ability to attract high quality staff and there is a disastrous effect on the attitude of patients who have gone to the hospital for its high quality of treatment. That hospital, unlike others, treats patients as human beings.

Baroness Cumberlege: My Lords, I absolutely agree with the noble Lord that the Royal Marsden Hospital is a place of excellence, with a world-wide reputation. As your Lordships will be aware, it has become a trust and I am sure that health authorities will recognise that and will continue to use it.

Lord Ironside: My Lords, as the Question points to the considerable public unease about the quality of breast cancer services, I welcome the steps that my noble friend has taken to improve them. Will she say what steps she is taking to provide for the clinical treatment services and needs of a large number of women who have been permanently and adversely affected and injured by radiotherapy treatment? The Minister has already given me assurances that the clinical outcomes group in her department is considering this month, during May, the recommendations of the Royal College of Radiology to manage the treatment services which are needed. Can she say whether the clinical outcomes group has given its approval, and if not why not? There is a crying need for the services.

Baroness Cumberlege: My Lords, I should like to pay tribute to my noble friend for the work that he has done in the field, especially concerned with the organisation RAGE. The NHS Executive is at the moment considering ways of disseminating the guidance that has been prepared by the Royal College of Radiologists. That will shortly go out to the service.

Lord Ashley of Stoke: My Lords, is the Minister aware that many noble Lords will welcome the assurance that she has given in response to my noble friend, so far as it goes? If closure of the Royal Marsden came to be envisaged, will the Government actively step in and prevent the closure? May we have a guarantee of that?

Baroness Cumberlege: My Lords, if there is a change in service and if it is opposed by the local community health council, then the matter has to go for determination to the Secretary of State. It would be wrong for me to give any assurances at this time with regard to a single institution because we know the enormously rapid change in medical science, in the way that services are provided, and in the needs of the population. So although I know it would be a great comfort to many of your Lordships in this House to give some kind of cast iron assurance, I am afraid that I am unable to do so.

Lord Skelmersdale: My Lords, has my noble friend had time this morning to read the Daily Express newspaper? In it there is a report of American research suggesting that wearing a brassiere for more than 12 hours a day will increase the incidence of breast cancer by 11 per cent. Has any comparable research been done in this country or is it likely that the suggestion will become the medical flavour of the month, with imported, unchecked

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American research? Will we forget about it in a few years' time as we have done with butter and many other substances?

Lord Lyell: Do you wear them?

Baroness Cumberlege: My Lords, I heard a Member of your Lordships' House asking whether I wear them. This is a very grown up question. The answer is that I am still trying to think of ways of abandoning my liberty bodice!

I have no knowledge of any research in this country in that field. I suspect that it is an example of a newspaper anxious to fill its pages.

The Viscount of Falkland: My Lords, can the noble Baroness tell the House how the treatment of breast cancer, particularly for women between the ages of 50 and 65, compares in quality with that of other developed countries?

Baroness Cumberlege: My Lords, there has been a recent report comparing the survival rates in Europe with those in this country. In fact, we are suspicious of some of that research. In our country we have a comprehensive cancer registry system but only our country, Denmark and the Netherlands have a similar system. We also do not fully believe the basis of that research. When it was published there were qualifications made by the researchers that those who were taking part in the study were volunteers and therefore it was not a comprehensive study. It is an area which needs further research, but, as I have said, cancer registration is patchy in most of Europe.

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