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Lord Dean of Beswick: My Lords, I am grateful to my noble friend for her positive reply. The conclusion that I draw from it is that the Government will continue the policy of the previous Government and treat increasing numbers of cancer cases. That will give comfort and confidence to those who suffer from this particular disease. Will my noble friend join with me in congratulating and expressing our appreciation to centres of excellence, such as the Christie Hospital in Manchester and the Royal Marsden in London, on some of the treatments they have pioneered that are now put to beneficial use? Further, does my noble friend agree that these two hospitals and other cancer centres predict that they will be able to treat a greater number of people, which means that we can draw much comfort and benefit from what the Government are doing today?

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Baroness Jay of Paddington: My Lords, I am very happy to join my noble friend in congratulating the two hospitals that he mentions on their excellent record for treatment and research in this particular area. The whole basis on which the extension of cancer services will be arranged is to establish both cancer units and cancer specialist centres which it is hoped will bring all centres up to the level of the hospitals to which my noble friend has referred.

Baroness Gardner of Parkes: My Lords, does the Minister agree that there are many centres in the country and that those two cannot be singled out as the only ones that do such valuable work? Does the noble Baroness also agree that research is perhaps one of the most important matters, because all of us look for prevention rather than just a treatment for cancer?

Baroness Jay of Paddington: My Lords, I agree with the noble Baroness that just two hospitals cannot be singled out. There is good work going on all over the country. The aim of the Government is to bring the practice of those right up to the practice of the best. I am sure that this afternoon one could produce an enormous list if one wanted to pick out particular hospitals or units. I agree with the comment of the noble Baroness about research. As the noble Baroness, as chairman of a hospital trust, will be aware, the causes of cancer are enormously complex. The range of research that is required to undertake a specific approach to a cure or any improvement in therapy is very expensive. We intend to support all of the work that is going on in that field.

Earl Baldwin of Bewdley: My Lords, does the noble Baroness agree that, in view of the notable lack of progress in treating the major cancers over many decades, it is high time that the research agenda was widened to include complementary approaches, such as dietary, herbal, psychological and spiritual methods, which so many patients report they find effective?

Baroness Jay of Paddington: My Lords, the noble Earl and I share a positive interest in the importance of complementary medicine. I agree with him that many patients report feeling better as a result of combining complementary therapies with orthodox methods. I also agree with him that there is a possibility of carrying out more extensive research that will produce greater evidence-based results of the impact of complementary medicine. He will be aware of the establishment of the Research Council for Complementary Medicine. We very much hope that that will succeed.

Lord Winston: My Lords, does my noble friend agree that one of the problems with the rising incidence of cancer is the fact that the NHS is the victim of its own success? The rising incidence is due partly to the increasing age of the population, and, as the researches of Professor Donald show, partly to improved diagnosis. Does my noble friend further agree that reforms in the health service have posed a problem in that with decentralisation there has been the risk of less expert

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attention for cancer victims? Given the statement in the gracious Speech about decentralisation, would she be kind enough to tell us whether she intends to ensure that there will be specialised centres which maintain expertise in these treatments?

Baroness Jay of Paddington: My Lords, we will, as I said, try to expand the approach of having a network of cancer units to which people can be referred initially and cancer specialist centres of the type to which the noble Baroness and my noble friend referred in earlier remarks. I agree with my noble friend that something which breaks down the national approach to expertise in therapy and research is not to be encouraged. That is why we believe that the approach of establishing networks of care, which will also underpin research, is the best way forward.

Baroness Cumberlege: My Lords, bearing in the mind the remarks the Minister made in response to the noble Lords, Lord Dean and Lord Winston, can I interpret them as the new Government endorsing the previous Government's visionary policy encapsulated in the framework for cancer services? If that is the case, will she undertake to give the House a report within six months as to the progress of that policy? Lastly, the Minister mentioned £10 million going into cancer services, in which I am sure we all rejoice, but will she say how many jobs that will cost in terms of managers and administrators in the health service who, after all, are often the oil that keeps the machine going?

Baroness Jay of Paddington: My Lords, the noble Baroness asked several questions. On the first point about the beginnings of the policy, it is indeed the case that the Chief Medical Officer, Sir Kenneth Calman, who served under the previous Government, and continues to serve under this one, was the author of the policy of establishing networks of care which we are anxious to develop. One of the problems with regard to breast cancer is that, although Sir Kenneth and his colleagues had developed a theoretical framework, there had been no funding to establish it in practice. We have given this early indication of resources to bring it to fruition. As to the noble Baroness's third point about the number of job losses that may result, I am afraid that I do not have that information. If it is possible to obtain it, I shall of course let the noble Baroness know.

Baroness Rawlings: My Lords, as there is more and more proof, as the noble Earl, Lord Baldwin, said, that diet plays a contributory role in the increased incidence of cancer, will the Government's new agency, mentioned in the gracious Speech, look after that?

Baroness Jay of Paddington: My Lords, I am sorry I am not sure to which new agency the noble Baroness is referring. If she is referring to the whole exercise of the public health programme--

Baroness Rawlings: My Lords, the food standards agency.

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Baroness Jay of Paddington: My Lords, I thought the noble Baroness was referring to the public health programme. The food standards agency will of course need to look at the whole area of nutritional safety and its role in the underpinning of health education, which we all hope will be expanded by that agency and by the Minister responsible for public health.

Lord Mason of Barnsley: My Lords, is my noble friend aware that the House recognises that due to research, screening and tests that have taken place there have been encouraging results with breast cancer? Is she further aware of the thousands of elderly men suffering from prostate cancer? What research into prostate cancer are the Government planning? Could they introduce a screening and test system for prostate cancer?

Baroness Jay of Paddington: My Lords, I am grateful to my noble friend. Prostate cancer and other cancers such as colon, rectal and ovarian, are the subject at the moment of continuing work, both in the theory of the research that is needed to produce prevention techniques and on the most efficacious treatment for them. We hope to be able to report soon to Parliament and to anyone, such as my noble friend, who has a particular interest in this matter, on the development of a system to deal with them similar to that for breast cancer.

Scottish Parliament: Proposed Tax Powers

3.14 p.m.

Lord Mackay of Ardbrecknish asked Her Majesty's Government:

    What discussions have taken place between the Treasury and the Scottish Office on the impact of the tax-varying powers for the proposed Scottish parliament on government income from income tax.

Lord Haskel: My Lords, I appreciate the noble Lord's interests and concerns on this issue. He raised them in yesterday's debate. From that debate noble Lords will be aware that the Government intend to publish before the Summer Recess a White Paper setting out their devolution proposals for Scotland. I can however reassure him that Treasury and Scottish Office Ministers and officials are fully involved in the Government's collective consideration of their devolution proposals. That includes discussions on the tax-varying power for the Scottish parliament. Noble Lords will understand that I am unable to pre-empt those discussions.

Lord Mackay of Ardbrecknish: My Lords, is the noble Lord aware that I apologise for bringing him to the Dispatch Box again in place of the Treasury Minister, Lord Simon of Highbury, especially as he brings the Answer that he has just given to the House? If the noble Lord will look at yesterday's debate, he will see that I did not raise the matter then; I raised it in the debate on the gracious Speech. Is he aware that his

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Answer is no advance on the unsatisfactory answer I received later from the noble Baroness, Lady Jay of Paddington? The question is simple. I shall try to put it again. If the Scottish parliament reduces tax by 3p in the pound, the take by the Inland Revenue from Scottish taxpayers will be £450 million less. To make up that deficit will the Exchequer impose additional tax on English taxpayers or will it reduce the Scottish block grant under the Barnett formula by £450 million? It is a simple question. I have waited for 18 years to put it in that way. Will the Government come clean?

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