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House of Lords

Monday, 2 June 2008.

The House met at half-past two: the LORD SPEAKER on the Woolsack.

Prayers—Read by the Lord Bishop of Portsmouth.

Introduction: Lord Mogg

Lord Mogg—Sir John Frederick Mogg KCMG, having been created Baron Mogg, of Queen’s Park in the County of East Sussex, for life, was introduced between the Lord Bassam of Brighton and the Lord Brittan of Spennithorne, and made the solemn affirmation.

Health: Chronic Fatigue Syndrome/Myalgic Encephalomyelitis

2.43 pm

The Countess of Mar asked Her Majesty’s Government:

The Parliamentary Under-Secretary of State, Department of Health (Lord Darzi of Denham): My Lords, the Government recognise that CFS/ME is a poorly understood condition that can be very distressing to patients, their families and carers. The long-term conditions pathway is one of the care pathways that strategic health authorities are examining as part of the NHS next stage review. The review, which is being led by local multidisciplinary working groups, will increase awareness and ensure better care for people with CFS/ME and will help to support local delivery of the NSF for long-term neurological conditions.

The Countess of Mar: My Lords, I thank the Minister for that reply. Does he appreciate that, despite the fact that it has been 40 years since the World Health Organisation recognised ME as a neurological disease and 20 years since the Department of Health did so, adults are still sectioned or deemed as lacking in capacity and children whose parents are blamed for their illness are put on the at-risk register or are made wards of court, with people from both these groups forcibly put into mental hospitals? This has been described to me as abuse by professionals. What has been the outcome of the CMO’s 2002 recommendations on the £8.5 million supposedly spent on CFS/ME, which has apparently come to nothing, and what will happen in the future?

Lord Darzi of Denham: My Lords, the Government accept the World Health Organisation’s classification of CFS/ME as a neurological condition of an unknown cause. My ministerial colleague Ann Keen reaffirmed that position at the meeting of the All-Party Parliamentary Group on ME in January of this year. Subsequent to the CMO’s report, the Government allocated funding of £8.5 million for two years, 2004-05 and 2005-06, to set up specialist CFS/ME services where none existed previously. These centres, of which there are 13 across the country, would improve services for those with CFS/ME.

Baroness Tonge: My Lords, when I was a student, I had a professor who, when asked the cause of a very difficult disease, would usually reply, “Nobody knows, tiddly-pom”. I suspect that ME falls into the “nobody knows” category. It is welcome news that pathways are being set up to look at this condition and to decide what is to be done in the health service, but how long will it be before the condition is taken seriously and protocols are in place to deal with the very real consequences for patients of this disease?

Lord Darzi of Denham: My Lords, I thank the noble Baroness for acknowledging that for many years there has been a heated debate about CFS/ME among

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researchers, practitioners and patients. In fact, few illnesses have been discussed so extensively. The underlying issue is whether more research and development should be undertaken in this field not just on the symptomatology but on a diagnostic test so that we can at least plan different treatment protocols. In August 2007, NICE looked at the evidence relating to treatment protocols and recommended cognitive behavioural therapy and graded exercise therapy, as there was some evidence to support their suitability in the treatment of this condition.

Lord Swinfen: My Lords, so far as I could hear, the Minister failed to respond to the noble Countess’s point on patients with this disease being sectioned and children being put into care as a result. Would he be good enough to do so now?

Lord Darzi of Denham: My Lords, I have acknowledged that CFS/ME is a neurological condition, but I am not aware of the circumstances in which associated illnesses might require sectioning. The noble Countess wrote to me about one specific case and I shall respond in relation to that.

Baroness Howe of Idlicote: My Lords, can the Minister explain to the House why the Royal College of General Practitioners continues to insist on categorising CFS as a mental illness?

Lord Darzi of Denham: My Lords, the Government have made it clear that they consider that CFS/ME should be classified as a neurological condition. It is for professional bodies to look at the evidence base and I will encourage the Royal College of General Practitioners to look at the WHO classification, which, as I said earlier, is that it is a neurological rather than a mental condition.

Earl Howe: My Lords, is the Minister aware of the work of the charity Tymes Trust—I declare an interest as a patron—which specialises in supporting young people with ME, particularly with regard to their educational needs? Does he agree that recognition of CFS/ME by teachers, social workers and, indeed, GPs is of fundamental importance and that imaginative ways need to be found to help children with ME who cannot cope with mainstream schooling?

Lord Darzi of Denham: My Lords, I am aware of the charitable contributions in this important area. In fact, many charities in this field have contributed to the development of NICE guidelines specifically in relation to children. I could not agree more with the noble Earl in emphasising the importance of engaging the family, the need for a diagnosis to be confirmed by a paediatrician and the need to support a return to education. These guidelines, which were issued as part of the NICE guidelines, have been welcomed by the Association of Young People with ME and provide a positive lever in improving services for children and young people with CFS/ME.

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Lord Elystan-Morgan: My Lords, is it not the case that under Section 31 of the Children Act 1989 a child can be placed in care only if he or she is suffering significant harm or is at risk of significant harm and that therefore any connection with ME can only be on the basis of a misdiagnosis?

Lord Darzi of Denham: My Lords, I am very grateful for that intervention.

Schools: Fruit and Vegetable Scheme

2.50 pm

Baroness Walmsley asked Her Majesty’s Government:

The Parliamentary Under-Secretary of State, Department for Children, Schools and Families (Lord Adonis): My Lords, there are no current plans to extend the school fruit and vegetable scheme to maintained nursery schools. Children in under-five settings already receive free milk as part of the nursery milk scheme. That scheme is not restricted to maintained nursery schools but also extends to the private and voluntary sector at a cost, this year, of £27.5 million.

Baroness Walmsley: My Lords, I thank the Minister for his reply. Given what medical science knows about how early food preferences are established in human beings, how can he justify the fact that four year-olds in primary schools are being given the health benefits of free fruit and vegetables while children aged four in maintained nurseries, which are funded from exactly the same funding pot, are not getting that benefit? Is there a sort of postcode lottery? Secondly, will the Minister tell us when the scheme is to be evaluated and what will be the criteria for success?

Lord Adonis: My Lords, the school fruit and vegetable scheme has already been evaluated. An evaluation carried out across 37 schools in north-east England by the National Foundation for Educational Research concluded that the number of children eating their five a day had increased substantially as a result of the scheme. It compared food diaries and questionnaires of more than 1,600 children taking part in the scheme in the north-east in March 2004 with 2,000 different children in November 2006. It found 32 per cent of children eating five portions of fruit and vegetables in 2004 compared with 44 per cent of children in the 2006 study. As the noble Baroness says, the scheme has been successful. However, it is intended for primary schools. The reason why some nursery settings benefit from the scheme is simply because they are attached to primary schools. If we were to extend it to all under-five settings, the cost would rise by about £30 million a year. We do not immediately have those resources available.

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The Lord Bishop of Portsmouth: My Lords, without wanting your Lordships’ stomachs to rumble unduly, even at this early hour of the afternoon, it is good to note that 440 million pieces of fruit are given to 2 million children in 16,000 schools annually. Given the overall nature of the monitoring to which the Minister has partially alluded in the previous answer, does he agree that that does not actually reveal a great change in dietary habits? Does that not suggest that the scheme needs to be intensified and extended, both upwards and downwards in the age range? Perhaps I should declare an interest as the grandfather of a grandson who goes to nursery school and who has inherited from his grandfather an intense love of fruit-eating of all kinds.

Lord Adonis: My Lords, I am delighted to hear of the right reverend Prelate’s hereditary condition. On the impact, if resources were available we would like to be able to extend the scheme, but the scheme costs £41 million a year for primary schools and we do not immediately have the resources available to extend it. However, it is because of the benefits of ensuring that food in schools is healthier that we have carried through the very substantial investment in healthy school meals, including the establishment of the School Food Trust. That has had a beneficial effect on dietary habits in schools.

The Countess of Mar: My Lords, is it not the case that a weaned child introduced at the earliest possible age to a wide variety of fruit and vegetables will probably continue on that path for the rest of his or her life? Is it not, therefore, perhaps more important that children in nurseries are fed a broad spectrum of fruit and vegetables? Perhaps the Minister would consider, with his colleagues, the possibility of transferring the £41 million to nursery children.

Lord Adonis: My Lords, I am not sure that it would be universally popular among primary schools if we were to seek to do that. However, the nursery milk scheme reimburses early years providers for providing free milk daily to children under five attending for two hours or more. That is an important part of ensuring that children are introduced to healthy habits at the earliest possible age. The healthy start scheme also provides free vitamin supplements and weekly vouchers for milk, fresh fruit or vegetables to pregnant women and under-fours in low-income families. That supports half a million women and children a year, so we make a substantial contribution even to the under-fives, but there would be a substantial additional cost if we extended the existing school fruit and vegetable scheme to all under-five settings.

Baroness Oppenheim-Barnes: My Lords, is the Minister aware that if fruit and milk were presented to children at nursery schools in the form of smoothies, that would kill two birds with one stone and be far more palatable to the children?

Lord Adonis: My Lords, what an interesting idea.

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Baroness Sharp of Guildford: My Lords, the Minister mentioned the healthy school meals initiative. When will the Government fulfil Ruth Kelly’s promise, made when she was Secretary of State, to spend 50p per child per day on school meals for primary schools and 60p per day on ingredients in school meals in secondary schools?

Lord Adonis: My Lords, I cannot, but I should stress that it is not the Government who spend the money on meals in schools; it is the schools themselves which decide how much they spend. We have put substantial additional resources into supporting schools in investing more in the content of school meals, but it is their decision, not ours, how much they spend.

Baroness Howe of Idlicote: My Lords, in light of the fact that the Government are extending nursery places for certain groups of two to three year-olds, can we be reassured that in those circumstances there will be the sort of provision of fruit that has been mentioned?

Lord Adonis: My Lords, the nursery milk scheme will apply to extended settings as well as existing settings. I referred to the healthy start scheme, which provides milk, fresh fruit and vegetables to pregnant women and under-fours in low-income families, which will apply to a substantial number of those two year-olds who benefit from the additional nursery places that we are making available. So there will be some additional provision, but I cannot undertake that those in all additional nursery places will be eligible for fresh fruit and vegetables.

Lord Swinfen: My Lords, what proportion of the fruit and vegetables is grown in the United Kingdom?

Lord Adonis: My Lords, I do not know, but I will write to the noble Lord with the information that we have available.

Planning: Eco-towns

2.57 pm

Lord Rotherwick asked Her Majesty’s Government:

The Parliamentary Under-Secretary of State, Department for Communities and Local Government (Baroness Andrews): My Lords, planning policy for housing, planning policy statement 3, supports the priority to build more houses across the country by seeking to release more land for housing and prioritising development on brownfield sites. Planning policy statement 3 replaces planning policy guidance 3 on housing. Eco-towns will help us to deal with those challenges, will exemplify genuine sustainable living and will accord with the aims and principles set out in planning policy statement 3.

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Lord Rotherwick: My Lords, I thank the noble Baroness for her reply. Why is it, therefore, that Weston Otmoor is being considered as an eco-town when it is not consistent with PPG3, as a large part of it is the grass airfield of RAF Weston on the Green, used for parachute training and for community gliding? Further, surely the proposal is also contrary to PPG17, planning for open spaces, PPG13 for transport, PPG7, sustainable development in rural areas—

Noble Lords: Reading!

Lord Rotherwick: My Lords, I am afraid that this is rather technical and I would not like to get it wrong. Surely it is contrary to PPG2, presumption against development within the green belt. Furthermore, the proposal concerns part of a SSSI. Is not that proposal seriously flaunting the Government’s own planning provision?

Baroness Andrews: My Lords, the noble Lord probably knows that those 15 proposals are just potential sites. They were reduced from 57 to reflect areas regarded as sustainable in areas of high housing stress, which the area that the noble Lord is talking about certainly is. On airfields, in which I know that he has a particular interest, there is neither a presumption in favour of development nor a blanket exemption. On the other PPSs that he mentions, when we assess the most likely sites for the five or 10 eco-towns, we will certainly look at all those issues.

Baroness Whitaker: My Lords, to return to the general subject, can my noble friend assure us that the new eco-towns will take advantage of new design opportunities as well as sustainability?

Baroness Andrews: My Lords, I certainly can, because sustainability and design go together. What is interesting about the eco-towns is that we very much want to encourage all sorts of innovation, and design is one of the seven criteria for the eco-towns; it is in the prospectus. The noble Baroness will be particularly pleased to learn that we are working with CABE, RIBA and the Prince’s Foundation for the Built Environment to run a design competition and to challenge the standards that must be the very highest for all forms of design.

Lord Naseby: My Lords, can the Minister explain why the Government never learn from their own experience? After all, the most successful new towns were the fourth-generation new towns, which were all attached to existing communities. Surely it is much more preferable to use those existing resources and to build on them rather than on greenfield sites.

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