Westminster Hall

Wednesday 9th January 2013 Westminster Hall

Wednesday 9 January 2013

[Mr David Crausby in the Chair]

Diabetes

Wednesday 9th January 2013 Westminster Hall

Motion made, and Question proposed, That the sitting be now adjourned.—(Mark Lancaster.)

09:30

[Mr Adrian Sanders (Torbay) (LD)]

It is a pleasure to speak under your chairmanship, Mr Crausby.

I want to put on the record the difference between type 1 and type 2 diabetes, although the debate is about diabetes more generally. Type 1 diabetes develops when the body’s immune system attacks and destroys the cells that produce insulin. As a result, the body is unable to produce insulin, which leads to increased blood glucose levels and in turn can cause serious organ damage to all organ systems in the body. About 15% of people with diabetes in the UK are type 1s. I wish to declare my interest as someone who was diagnosed as type 1 nearly a quarter of a century ago, and I am still here. Type 2 diabetes develops when the body does not produce enough insulin to maintain a normal blood glucose level or is unable effectively to use the insulin produced. The long-term complications that challenge both type 1 and type 2 sufferers are much the same.

Diabetes remains one of the largest challenges to our health care system, with about 3.7 million sufferers in the UK; almost 1 million more are estimated to have the condition, although they do not know it. The numbers are expected to rise, which all makes for a significant challenge to the NHS, with an estimated spend of £10 billion a year on diabetes-related treatments. Much of that spend is unnecessary: people with the condition far too often suffer from late diagnosis, preventable complications and variations in care; they are often overlooked for specialist care when being treated for other conditions, particularly as in-patients; and they can be prevented from accessing treatment by the short-term financial ethos embedded in some primary care trusts.

None the less, we have made progress in recent years. I pay particular tribute to my right hon. Friend the Member for Sutton and Cheam (Paul Burstow) and the former ministerial team for the open and constructive way in which they pursued the issue and ensured that diabetes remained a high priority during the stormy times of NHS reform. The all-party group on diabetes, which I chair, has already met the new Minister, and I am confident that the good progress will be sustained, if not surpassed. I am already heartened by the new Secretary of State’s pledge to focus more on patient outcomes and the patient experience. Let us hope that that intention manifests itself in clear instructions for managers and commissioners.

One of the priorities on which Ministers can have a direct impact is the promotion of leadership by the Department of Health. In recent years, a problem has arisen from the apparent inability to disseminate best practice around the UK and the unwillingness of some NHS organisations to implement it.

[Keith Vaz (Leicester East) (Lab)]

I pay tribute to the hon. Gentleman for all his amazing work on diabetes over his parliamentary career. As he has done, I have tabled questions to ask simply how high the spend on diabetes was in individual PCTs last year, only to be told that the information was not available and so could not be given to me. Is not that kind of information vital for an effective strategy on diabetes?

[Mr Sanders]

That would certainly be extremely helpful and would complement the atlas of care by, in a sense, putting the actuality into the story behind the figures. It is extremely unhelpful not to be able to drill down to what is really happening on the ground; we could do that if such statistics were available.

Some of the problems of disseminating information have been offset by the work of NHS Diabetes. It has been instrumental, first, in monitoring variations in care and driving the collection of more robust data, which has culminated in an extremely important publication, the national atlas of variation; and, secondly, in working tirelessly to rectify the problems it uncovers, linking national policy intention with policy implementation on the ground, including support targeted on where the greatest improvements are necessary. It is important that that work continues, as much more could be done. I hope that the Minister will reassure me that, despite the upheavals in the commissioning architecture, NHS Diabetes will retain its central role.

[Rehman Chishti (Gillingham and Rainham) (Con)]

I, too, pay tribute to the hon. Gentleman for his fantastic work as chairman of the all-party group on diabetes. Does he agree that there need to be performance targets, like those for cancer, stroke and heart disease? At the moment, there are not the mandatory performance targets for diabetes that there are for those other diseases.

[Mr Sanders]

I am grateful to the hon. Gentleman for making that point. When one puts together speeches, they sometimes go on too long, and I had cut out that bit, so I am glad that he has raised it. The big issue is that the cause of death is sometimes recorded as stroke or heart disease when the underlying problem is diabetes. We have targets for cancer, heart disease and stroke. We really ought to look at diabetes as the root cause of other conditions for which there are targets.

The variation in care across the country is probably the largest worry for patients now, and the new implementation plan should focus on that. Failings in diabetes care cause an estimated 24,000 premature deaths each year. In 2001, the Department of Health published the national service framework for diabetes, which set out clear minimum standards for good diabetes care. Those standards include nine basic care processes that aim to end preventable complications by looking for early warning signs. Despite those targets, much of the country has seen little progress towards improving detection of type 2 diabetes and reducing the number of preventable diabetes complications. In 2009-10, results from the national diabetes audit showed wild variations in inputs and outcomes for both type 1 and type 2, including the astounding figure that the proportion of type 1s receiving the recommended nine care processes ranged from as low as 5% to 50%, with an average of 32% in England. The figures were only marginally better for type 2s. It really is not good enough.

The point about the condition is that people treat themselves 364 days a year and see a practice nurse or sometimes a general practitioner—more rarely, these days, a consultant—only once a year, although they should receive the nine care processes. The chance of developing diabetic complications can be reduced by keeping blood pressure, blood glucose levels and cholesterol levels low. Regular monitoring, backed up by periodic checks, is the key. The results from the national diabetes audit demonstrate that more needs to be done to end the postcode lottery of care for people with the condition. When as few as 5% of people with type 1 diabetes are receiving all nine care processes in some areas, there is a definite failure of care. If all health care trusts followed the national service framework, such complications as blindness and kidney disease—as well as stroke, heart and other diseases—could be prevented.

I hope that we will explore a range of best practices, but I want to highlight a couple that have scope to bring immediate improvement at very little cost. An acute issue is the provision of insulin pumps for type 1s. That is an example of where the UK should look abroad for best practice. Type 1s in other developed countries, such as France, Germany or the US, can expect to benefit from a pump if that is required for their diabetes management. Somewhere between 15% and 35% of type 1s in those countries have pumps, which enables them to lead normal lives, but in the UK the figure is less than 4%. That is clearly a failure of the commissioning structure as it is now. Will the Minister address how that is likely to improve? The Work Foundation has estimated that, if pump usage reached 12%, the NHS would save about £60 million a year.

Another example of where best practice is needed is surprisingly simple: good local leadership. Good leadership, as I have been fortunate enough to experience in my own area of Torbay, is essential to promoting effective and integrated services. Integration is key to reducing costs in the long term and, more importantly, to improving patient outcomes, which all too often get lost in the debate over health care services.

The move to clinical commissioning groups, with the potential for better scrutiny and criticism from patient groups, local authorities and health care staff could, in theory, lead something of a revolution in spurring innovation and creativity and in the striving to find best practice.

Just as educating the commissioners is crucial, so, for diabetes, is patient education, which has the happy side effect of making patients far more aware of whether they are receiving a good service and enabling them to become better advocates for their condition. I have no doubt that the great knowledge possessed by volunteers for Diabetes UK, the Juvenile Diabetes Research Foundation, INPUT and the many other groups involved in diabetes will be a considerable asset in shaping good services at a local level now that we have better scope for patient scrutiny and involvement.

In the wider sense, patient education is the core to preventing complications, which diminish the quality of life for patients and which, all too often, reduce life expectancy and increase the costs to the NHS in the long term. Good patient education programmes may require some investment, but they would pay for themselves many times over.

On a broader level, work needs to be done on detection and prevention. The number of people suffering from type 2 diabetes is set to reach a staggering 5 million by 2025. However, what many people do not know is that type 2 diabetes is a largely preventable disease. At the very least, its onset can be delayed and complications reduced.

NHS checks are vital to the detection and prevention of diabetes. In theory, such checks are available to all 40 to 74-year-olds who are seen to be at risk of developing diabetes. Shockingly, a number of primary care trusts in the UK failed to offer a single person an NHS health check last year, which demonstrates the dangerous variations in provision in the NHS. The Government can look to rectify that if they create a new national implementation plan for diabetes. Indeed they may even take up the suggestion by the hon. Member for Gillingham and Rainham (Rehman Chishti) to set targets for diabetes.

This year, the current national framework for diabetes comes to an end. It is important that we build on the successes of the framework, that we focus on reducing discrepancies in diabetes care and that the new framework emphasises the importance of health checks and prevention of the disease through simple means such as diet management. Indeed, it is essential for the Government to spell out to commissioners and to patients what services can be expected and to provide a road map to show where we want to be in a few years’ time and how to get there.

[John Pugh (Southport) (LD)]

My hon. Friend analyses the fair degree of regional variation that exists and talks about a postcode lottery. Does he think that that is primarily down to a lack of leadership at PCT level, or to the qualitative variations that we get anyway in primary care practice among GPs across the country?

[Mr Sanders]

It is a combination of both. We cannot prescribe from the centre precisely what must happen in every area. Of course local areas must reflect their own demographics and their own health picture and be able to apply priorities accordingly. However, there is something to be said for ensuring that local areas have the tools that they need, which is where NHS Diabetes did such a good job on the back of the NHS framework for diabetes.

It is equally important that health checks are used to detect diabetes in its earliest stages, as early detection and appropriate treatment can prevent the severity of the condition and the risks associated with complications such as amputations.

[Rehman Chishti]

On health checks, the hon. Gentleman must have seen the report that says that, according to Diabetes UK, nine out of 10 people do not know the four main symptoms of type 1 diabetes. Surely, therefore, the education should look at ways in which people can identify for themselves the symptoms that can lead to type 1 diabetes.

[Mr Sanders]

That is a very good point. There is the 4 Ts campaign on diabetes. If I remember correctly, the four Ts are thirst, tiredness, toilet and one other— I always remember three, but not four. Anybody who feels thirstier or more tired than usual or is visiting the toilet more often should see their GP. A simple test—it is not an invasive test—can be conducted and after an appropriate early diagnosis a patient can start to feel better very quickly. An ancient fear of great big hypodermic needles being stuck in their skin deters many people from going to a GP, but only 15% of diabetics are put on to an insulin regime on diagnosis and that is because they suffer from type 1. Most type 2 sufferers never have to take insulin via an injection device, and, in any case, those devices are subcutaneous and really nothing to fear. I speak as someone who has to inject four or more times a day, and it really is not as bad as people fear. People should see their GP. If they do not, matters will get worse, complications will set in and they will rue the day that they did not sort out the problem early on.

[The Parliamentary Under-Secretary of State for Health (Anna Soubry)]

I know that it is unusual for a Minister to intervene at this stage, but will the hon. Gentleman help me in this matter? Is it not right that there have been huge advances in the administration of insulin? A constituent of mine showed me the pump on his stomach that gives him the right amount of insulin. He even had a device on his mobile phone that could calculate from a photograph of a particular meal the amount of insulin that should be administered to his body. He clicks on the app and the insulin is given to him at the appropriate time, before or after he has his meal. Does the hon. Gentleman agree that those are wonderful devices that should be prescribed to people as much as possible?

[Mr Sanders]

I cannot fail but to agree with every word that the Minister has said, and I am absolutely delighted that she has said that. Children in particular benefit from pumps, because they can go to school and lead normal lives alongside their school friends. It is difficult for them to find the space and time to inject, and these little devices are doing the job for them all the time. The technological advances are such that we may well reach a point in the not too distant future where there is a device that both tests a person’s blood sugar level and then injects an appropriate level of insulin, without them having to check what they are eating. The little device is like having a pancreas attached to the side of the body. That is where we are going. At the moment, however, pump usage is very low in the UK. It is about having not just the pump but the services behind the pump—the trained nurses who can train and educate the person to use the pump properly, the technological support that needs to be there to back it up and the medical expertise to understand the difference between a pump regime and any other regime. That is the detail, and I am really glad that the Minister is on the ball here.

The provision of education about diabetes seems to be somewhat of a lottery in terms of who is actually receiving information and advice. There needs to be a standardised programme of education on the condition that is accessible and effective for all.

We must not miss the opportunity to encourage healthier lifestyles as a consequence of the Olympic legacy. It is essential that funding and provision for sports facilities and physical education continue to be given priority in the coming years to capitalise on increased interest in active sport. The Olympics have given people who have perhaps never before enjoyed individual or team exercise a new drive and desire for sport, which needs to be harnessed and nurtured. Gym membership and even one-off sessions for swimming still seem to be extremely pricey, which makes those forms of exercise inaccessible for many who could perhaps benefit from them. However, I am aware that some inner-city areas have set up programmes that allow residents to use facilities at a reduced rate or even at no charge. I wonder whether that idea should be taken hold of by more UK communities, and whether the Government could assist all local authorities to find ways to subsidise it, perhaps by working in partnership with private sector organisations.

Having facilities and making them affordable is an issue, which is why I find it unbelievable that some local authorities, including my own, give permission for building on sports facilities; in Torbay, the only public grass tennis courts in the local area are about to be built on. Andy Murray won his Olympic gold medal on grass and generated more interest in the sport last year, and my area has produced some of the great British tennis players down the decades, including British men and women No. 1s in Mike Sangster and Sue Barker. That makes that act by my local authority one of unforgivable short-sightedness.

I have outlined many of the issues surrounding diabetes care, but I will concentrate now on some of the things that I hope the Minister will focus on delivering in the coming years. There needs to be a comprehensive national implementation plan, containing measures to ensure that local leadership is robust and long term in its thinking. Such a plan also requires measures to focus on detection and prevention, and it needs to ensure that best practice can be effectively disseminated. Three priorities face our NHS and other health care systems around the world: prevention; diagnosis; and care. We have a long way to go to meet the challenges of each one.

[Several hon. Members]

rose—

[Mr David Crausby (in the Chair)]

I will not impose a time limit on speeches, but four Members wish to speak and I would appreciate it if they could keep their contributions to around 10 minutes, or less, so that I can call all four of them.

09:51

[Nick Smith (Blaenau Gwent) (Lab)]

Thank you, Mr Crausby, for calling me to speak. I congratulate the hon. Member for Torbay (Mr Sanders) on securing this important debate.

Sadly, we had 23 amputations from diabetes last year in my constituency of Blaenau Gwent, despite having a valued specialist foot ulcer clinic run by an advanced podiatry practitioner. So last November I asked the Leader of the House for a debate on how to prevent amputations resulting from diabetes.

The Public Accounts Committee, of which I am a member, was given evidence that the NHS spends at least £3.9 billion a year on diabetes services. It is shocking that the lion’s share of that money is swallowed up in the treatment of avoidable complications. As we know, these complications are not minor; they include amputations, blindness and kidney disease. Such complications are extremely debilitating for the sufferer and extremely expensive to treat. In the worst cases, diabetes can lead to premature death. That is a waste of both precious lives and resources.

Health professionals say that there are 125 amputations weekly because of diabetes, yet 80% of those amputations are preventable. The National Audit Office says that we could save £34 million annually if late referrals to specialist teams were halved. So, it is in the interests of patients and NHS budgets to deliver effective services, with the emphasis—as ever—on prevention and early diagnosis.

The PAC’s report on diabetes services, which was published last November, found that fewer than half the people with diabetes receive the nine basic checks identified in minimum standards of care that were established more than 10 years ago. Unlike cancer, stroke and heart disease, there are no mandatory performance targets for diabetes.

The PAC report highlighted the postcode lottery in provision for people with diabetes, and it also said—to a chorus of consensus—what needs to be done. However, it is just not happening nationwide. Put bluntly, we found that money is being wasted. There is no strong national leadership; no effective accountability arrangements for health service commissioners; no appropriate performance incentives for providers, and no evidence to assure us that the new NHS structure would address the failings that have been identified.

The Leader of the House has told me that diabetes care is a Government priority. So I hope the Government will support a specific pledge that would be widely welcomed. The Putting Feet First campaign, the supporters of which include Diabetes UK and the College of Podiatry, wants there to be a realistic target of a 50% reduction in amputations because of diabetes by 2018. That is a crucial point, because the Health Minister, Earl Howe, told the House of Lords recently that

“Diabetic foot disease accounts for more hospital bed days than all other diabetes complications”.—[Official Report, House of Lords, 29 November 2012; Vol. 741, c. 331.]

Policies to deliver that target include having a multidisciplinary foot care team in every hospital. Shockingly, in 2011 31% of hospitals had no podiatry provision at all. We also need foot protection teams in every community, which will mean more, not fewer, podiatrists in post.

We need a strong message from Government that preventable amputations must be reduced, that local variations will not be tolerated and that precious NHS resources will not be wasted. In addition, as others have already said, the importance of patient engagement cannot be stated too often. In their current consultation on diabetes, the Welsh Government highlight the benefits of having more informed and more confident diabetes patients. Education is an integral part of personalised patient care.

I will now make some concluding comments about how we can turn the tide, given that current projections show that the number of people with diabetes will rise from 3.1 million to 3.8 million by 2020.

How can we improve diet, reduce alcohol consumption and encourage physical activity? Good ideas include: a reduction in the sugar content of soft drinks; a realistic minimum price for alcohol of 50p per unit; restrictions on advertising and sports sponsorship; action to maintain nutritious school meals; teaching our children to cook, and encouraging regular sport and exercise in schools. Together, these ideas are a promising mix of radical measures, unlike the Government’s “responsibility deal”, which is just another case of the triumph of hope over experience.

Last week, a report from the Royal College of Physicians called for a senior figure in Government to take charge of obesity issues across all Departments, covering every area from agriculture to work and pensions. In the US, we have seen the mayor of New York, Michael Bloomberg, ban the sale of “super-size” drinks at entertainment venues. Similar bold and symbolic action is now urgently needed from the coalition Government here.

As I said at the beginning of my speech, there were 23 amputations in Blaenau Gwent last year because of diabetes, and across the UK there will have been many thousands of such amputations, many of which were preventable. The Government need to up their game.

09:57

[Rosie Cooper (West Lancashire) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Crausby, for this debate.

I congratulate the hon. Member for Torbay (Mr Sanders) on securing the debate on such an important issue, which affects a growing proportion of our population. Indeed, having listened to the contributions that have already been made, it is very clear that there are many facets of diabetes that could be covered during this debate, but I think that we will all probably concentrate on amputation. I will spend a few minutes focusing on the importance of podiatry services, which can reduce preventable amputations for those with diabetes.

Currently, 4% of the population live with diabetes, and a fifth of those people will develop a foot ulcer at some point. At any one time, there are 61,000 diabetics in England who have foot ulcers. A foot ulcer may not sound like a very serious condition, but for a diabetic the consequences of foot ulcers can be severe, and even fatal if the appropriate treatment is not given. Statistics for England alone show that, of those diabetics with foot ulcers, 6,000 people—that is 10% of the total number—had leg, toe or foot amputations in 2009-10. Based on current trends, that figure is projected to rise to 7,000 people by 2014-15. An amputation is devastating. If any individual loses a limb, it will have a far-reaching impact on their life. For many diabetics, an amputation can increase the likelihood of premature death.

Let me put those figures for diabetes in context. The five-year survival rate for those with breast cancer is just over 80%, but for those with a diabetic foot ulcer the five-year survival rate falls to just under 60%. For those people who have a lower limb amputation, their survival rate worsens after five years. The consequences are even more horrific when we consider that 80% of those amputations are preventable. In 2012, that is simply incredible. We are not doing everything we can to rectify that and to ensure that people have the information and services that will help them protect their limbs.

It is scandalous that with our 21st-century health care we are allowing people to go through the completely unnecessary, torturous and miserable experience of amputation. Prevention is supposed to be the watchword of the modern national health service; through prevention, people can enjoy a better quality of life and the NHS can save itself millions.

It is therefore hard to understand why better prevention is not deployed with diabetes and amputations. Why is more effective use of podiatry services not a priority for the health service? At a time when the number of diabetics is growing, and with it the costs of treatment, podiatry could be a means of improving a diabetic’s quality of life and saving the NHS money. Amputations cost the NHS considerable sums, which are estimated to be in the region of £600 million to £700 million each year.

Results from pilot projects can demonstrate the positive impact of investing in good podiatry services. A multidisciplinary foot care team for in-patients with diabetes in Southampton led to a reduction in the length of in-patient stays from 50 days to 18 days. Not only were patient outcomes improved but annual savings to the NHS of £900,000 were generated from an investment of £180,000. That savings ratio of £5 saved for every £1 invested was bettered in another example. In James Cook hospital in Middlesbrough, a multidisciplinary foot care team generated annual savings of some £250,000 at a cost of £30,000, which is a ratio of £8 saved for every £1 invested. Those figures show how it would be not only the Government and the NHS that reaped great rewards from a small investment, but diabetics and those who need podiatry care. Based on the pilot evidence, logic would suggest that even in these straitened times we should be investing in podiatry services, because that could save even more money and improve health.

There is evidence, however, that the opposite is happening and that services are not improving. The danger of the new arrangements is that important issues fall between the cracks, are left to local decision making and do not get the prioritisation they deserve. More than half of hospitals do not have a multidisciplinary foot care team. In fact, 31% of hospitals do not even have an in-patient podiatry service, according to data from the national diabetes in-patient audit in 2011. That reflects a worsening service, because in 2010 only 27% of sites had no provision. The amount of provision has dropped, and nearly a third of hospitals no longer have that service.

There is also evidence that there is a problem with GPs having no incentive to refer their patients on to a foot protection team for education or follow-up. Why is that? Why is this woeful situation tolerated? If more referrals were made, we would see a beneficial reduction in ulcer and amputation rates.

[John Pugh]

Will the hon. Lady explain why a GP would need an incentive to do what is clinically desirable in the first place?

[Rosie Cooper]

I absolutely share that concern, which is why I cannot understand the current view that doctors do only what they get paid for and if there is no money attached to something, it may not be the first thing they do. As I pointed out in Westminster Hall yesterday, when we had a debate on the Liverpool care pathway, financial rewards to clinicians should not be the driver of what happens or the pathways that are followed. That is good clinical practice. Surely to goodness, if a referral to podiatry is required, that is what should happen. It could also be said that if the services are not there or are being reduced, the GP has less incentive to refer, knowing that it will take so long to get an appointment.

The College of Podiatry is

“fearful that public expenditure constraints mean that rather than being prioritised through the QIPP”—

quality, innovation, productivity and prevention—

“agenda, current podiatric services are at best, being frozen and in some cases being reduced, with patient services including the diabetic foot service deteriorating as a consequence”.

That has massive implications for the NHS budget and for the patients themselves. During a debate in the other place on 29 November 2012, the Under-Secretary of State, Earl Howe, accepted that

“rapid access to multidisciplinary foot care teams can lead to faster healing, fewer amputations and improved survival. Savings to the NHS can substantially exceed the cost of the team.”—[Official Report, House of Lords, 29 November 2012; Vol. 741, c. 336.]

My question for the Minister is whether the NHS, which is in the throes of a reorganisation and being more localised through clinical commissioning groups, as well as being put under increasing financial pressure, will move towards or away from having more multi- disciplinary foot care teams, given that fewer than half of hospitals currently have such a team. Investment in more podiatry services would result in improved foot screening, appropriate follow-up services, enhanced care when required, better outcomes—including fewer amputations—reduced length of stay in hospitals, increased quality adjusted life years and reduced morbidity. We would all win; we would have a healthier nation and significant financial savings.

10:07

[Jim Shannon (Strangford) (DUP)]

First, I thank the hon. Member for Torbay (Mr Sanders) for bringing this issue to the House. Secondly, I declare an interest, as I am a type 2 diabetic and have been for four years. It has given me a knowledge of, and an interest in, the issue, although not a total knowledge—far from it. It has also made me more aware when constituents come to me with issues relating to diabetes and has given me an interest in those issues.

The disease has completely changed my life, as it would, because it is type 2. Diabetes is a major issue in every constituency. As someone who enjoyed the sweet trolley more than anyone else—to use Northern Ireland terminology, when there was a bun-worry going on, I was at the front of the queue—the sweet stuff was something that I indulged in regularly. Along with my stress levels, that has meant that I am a diabetic today.

The statistics have been mentioned, but they bear repeating, due to the seriousness of the UK’s problem, which is etched in everyone’s minds. The UK has the fifth highest rate in the world of children with type 1 diabetes. In Northern Ireland, we have 1,040 children with type 1 diabetes, some of whom are born with the condition. I want to give a Northern Ireland perspective, but I will bring in the UK strategy, because diabetes affects the whole UK, and that is why it is important. Some 24.5 children in every 100,000 aged 14 and under are diagnosed with the condition every year in the UK. We had a reception where we met some of those young people, and if we needed a focus, the focus was there that day for those of us who attended. I think that most of the people in the Chamber were there.

The UK’s rate is about twice as high as that in Spain, where it is 13 children in every 100,000, and in France, where it is 12.2 children in every 100,000. The league table covers only the 88 countries where the incidence of type 1 diabetes is recorded. There are 1,040 children under the age of 17 with type 1 diabetes in Northern Ireland, and almost one in four of them experienced diabetic ketoacidosis before a diagnosis was made.

Diabetic ketoacidosis can develop quickly. It occurs when a severe lack of insulin upsets the body’s normal chemical balance and causes it to produce poisonous chemicals known as ketones. If undetected, the ketones can result in serious illness, coma and even death. The diabetes itself is not the killer; it is the offshoots from it, the effects on the heart, circulation, blood pressure and sight, and the possibility of strokes and amputations.

The number of people living with type 1 and type 2 diabetes has increased by 33% in Northern Ireland. In my Strangford constituency, the number has gone up by 30%, with 800 people—I am one of them, by the way—becoming diabetic in the past seven years. That compares to 25% in England, 20% in Wales and 18% in Scotland. In our small part of the United Kingdom, the total number of adults—aged 17 and over and registered with GPs—with diabetes is 75,837, and a further 1,040 young people under the age of 17 have type 1. There has been a significant rise in that number also, with the prevalence in Northern Ireland now at more than 4%. An estimated 10,000 people in Northern Ireland have diabetes and do not know that they do. They have a ticking time bomb in their bodies; they wonder why they are not well, and the cause is diabetes.

[Mr Gregory Campbell (East Londonderry) (DUP)]

My hon. Friend is talking about the different prevalence of diabetes throughout the UK. Does he agree that best practice regarding early detection and the promotion of an active lifestyle could be a target for all the devolved regions across the UK and here in England? The Minister would do well to respond in relation to Ministers in the devolved regions taking on such best practice to combat diabetes.

[Jim Shannon]

Yes, I agree. When people make interventions, I always wonder whether they have read my script—preventive medication is the very next issue on it.

In my doctors surgery in Kircubbin and, indeed, across Northern Ireland preventive measures are in place. There are diabetic surgeries, and the matter is taken seriously. The UK strategy that we have had for the whole of the United Kingdom of Great Britain and Northern Ireland and that will come to a conclusion this calendar year has made significant progress towards reducing the potential numbers, but diabetes has increased over the same period. There are some 100 diabetics in my doctors surgery in Kircubbin.

[Rehman Chishti]

The hon. Gentleman talks about the United Kingdom strategy. Does he accept that certain people from different ethnic backgrounds are more likely to get diabetes? For example, according to the Wellcome Trust, 50% of people from south Asian and Afro-Caribbean backgrounds would have diabetes by the age of 80. Any UK strategy would therefore have to take ethnic composition into account, because such people are affected differently.

[Jim Shannon]

That is an excellent point, and I am sure that the Minister will address it in her response. There are groups in the whole of the United Kingdom in which diabetes is more prevalent, and we need to look at those target areas.

There are 3.7 million people in the UK diagnosed with type 2 diabetes. I was diagnosed four years ago. With me, it was down to bad eating habits, stress and the fact that there were no set hours to my job. I ate whatever was quickest, and that was Chinese, usually with two bottles of coke, five nights a week. That was why I was 17 stone. I am now down to 14 and a half stone because I no longer do that. The issue is eating and living styles—eating what is quickest rather than what is best.

Edwin Poots, the Minister at the Department of Health, Social Services and Public Safety in Northern Ireland, is very aware of the ticking time bomb that is diabetes. I am aware of the key initiatives in operation in Northern Ireland, and I know that the Minister here today has had discussions with the Minister in Northern Ireland. They are doing a great job, including setting aside funding to employ additional diabetic staff—specialists, nurses, dieticians and podiatrists. That is providing all the help that a diabetic needs, but it is still not enough.

We need a concerted effort across the United Kingdom, through the media, and even perhaps through the TV soaps. I am not a soap watcher. I could not tell anyone what happens in “Emmerdale” or “Coronation Street”, but my wife could. She knows everyone in them—what they are doing this week and what will happen to them next week. Could we not perhaps use the soaps to make people more aware of the issue? I understand that plenty of issues are brought up in them regularly, so perhaps we should try this one.

It is great that our children are taught about diabetes in school. It is surprising what a five or 10-year-old knows about food that their mum and dad do not. Who is educating the mums and dads at home who are making the dinner and buying the shopping? The hon. Member for Blaenau Gwent (Nick Smith) made a point about how the food coming into the house is controlled by the parents. Diabetes UK Northern Ireland is taking part in an organisation-wide campaign entitled “Putting Feet First” to raise awareness of amputations among people living with diabetes and to work to prevent unnecessary amputations.

The Minister might want to comment on the new medications that are available. In the press this week, there was talk about a new diabetic medication in tablet form that could replace—not totally but partially—type 1 injections. The figure used was a cost of £35 per month. It would be good if we could get some feedback about whether the new medications will be available across the United Kingdom and whether everyone will be able to take advantage of them.

In Northern Ireland last year, 199 diabetes-related amputations took place, and the “Putting Feet First” campaign highlights that an estimated 80% of lower- limb amputations are preventable. There must be a UK strategy to reduce diabetes-related amputations by 50% over the next five years. What can we put in place in this Chamber to highlight and support the campaign? How can we use our influence to see the number of cases of type 2 diabetes dropping, instead of this steady rise?

The links between type 2 diabetes and obesity are firmly established, and it is clear that, without appropriate intervention, obesity can develop into diabetes over a relatively short time. For instance, the risk of developing type 2 diabetes is about 20 times more likely in obese, compared to lean, people. A newspaper recently stated that academic sources have estimated that the predicted rise in obesity rates over the next 20 years will result in more than 1 million extra cases of type 2 diabetes, and that is really worrying. Can that go unchallenged, when it is within our power, as parliamentarians, to do something about it, at least by putting a strategy in place or by beefing up the ones that we already have? When the current UK-wide strategy ends, it will perhaps be time to do something more.

I live the life, as do many others, of testing my blood every day, of feeling unwell when my blood sugar is out of control and of worrying that the next visit to the doctor will bring worse news, which can be the case if we do not discipline ourselves and ensure that we do things right. That is not the life that I want to have, or the life that I want my family, friends or constituents to have. The way to take on the issue is to continue with the UK-wide strategy, with dedicated funding and with all the regions working together, which will save money in the long run and, more importantly, improve the quality of lives across the United Kingdom.

I urge the Minister to take the initiative. I believe that she will and that her response will be very positive, because she understands the issues. I urge her to work with the devolved bodies, in coming together to disarm the ticking time bomb of diabetes—the cost of which some people indicate will be £10 billion—before it explodes. Type 2 diabetes is preventable, and we must do all that we can to prevent it. Education, with attention paid by everyone in this Parliament and the regional assemblies, is the way to do that.

[John Pugh]

rose—

[Keith Vaz]

rose—

[Mr David Crausby (in the Chair)]

John Pugh.

10:18

[John Pugh (Southport) (LD)]

I am happy to give way to the right hon. Member for Leicester East (Keith Vaz)—in any case, I will make just a few remarks. I pay tribute to his efforts in the House of Commons in this area, as well as those of my hon. Friend the Member for Torbay (Mr Sanders).

I am provoked to make a few remarks by things that other hon. Members have said. I think that we all recognise that diabetes is a major problem. Rates are increasing—it is almost a worldwide epidemic—and it is a killer, linked to a series of other sorts of organ failure. We all recognise and it has been clearly stated that type 2 diabetes is rampant in our society and is lifestyle-related. Diagnosis is important, but I got the sense that that is fundamentally not the problem. We can get diagnosis right. There are clearly failures in general practice, in not picking up the condition early enough, but we do tend to find out who has it and who does not.

The issue appears to be treatment, as has been phrased by most Members. From events that I have attended from time to time in the House, I am aware that the treatment of diabetes is becoming increasingly sophisticated. A series of technology is attached to that nowadays, and we also have the advent of telehealth. All the major practitioners of telehealth are keen to provide better services for diabetics.

Additionally, there is the expert patient initiative, about which I was slightly sceptical when it was launched. The initiative is becoming very effective in connection to diabetes. The charities are playing along with that, too. A lot of good things are going on, but we are recording a variation in practice. There is something of a postcode lottery. I wonder what will prevent that. In which direction will we go?

My hon. Friend the Member for Torbay voiced concerns about the future of NHS Diabetes, but, like the hon. Member for West Lancashire (Rosie Cooper), I wonder how that will play into the new system. There seem to be two ways in which things could go. Without the local primary care trust, there may be, temporarily at any rate, an absence of leadership, because one of the PCTs’ jobs was to manage GPs, to keep them up to the mark and to assess how well they were performing. Clearly, part of the problem that we are addressing today is the failure of GPs, first, to diagnose diabetes early enough and, secondly, to treat it as effectively as they might. It is a fact that, although they are slow to admit it, GP practices in this country can be something of a lottery; they are extraordinarily variable in quality and character. Such features may be more manifest in the new structure.

My hon. Friend the Member for Torbay sketched a more optimistic scenario, however, in which the health and wellbeing boards will become ever more vigilant and keep GPs up to the mark. GPs themselves have suggested to me that one of the best ways to produce good and more standardised practice is peer review, with every GP knowing what other GPs are doing.

I am not sure which of those two outcomes is more likely, but there is great concern that the Department of Health ensures that the right one results.

I am uncomfortable with the thought, as raised by several Members today, that we could simply impose targets and that that would somehow get things right. The hon. Member for West Lancashire and I attended a debate not 24 hours ago on the Liverpool care pathway, in which we considered the corrosive and dysfunctional effects of targets. Once targets are set, we do not always get the results that we want. What, for example, would a target to reduce amputations do? Would it mean people do not do amputations in circumstances where an amputation might be desirable for the patient?

We come back to the perennial dilemma of many of our debates, particularly on specialist conditions, in that we can identify good practice—we can see it, and we miss it when it does not occur—but the national health service has never successfully found the secret of spreading good practice fast enough, which is happening again with diabetes.

10:19

[Keith Vaz (Leicester East) (Lab)]

It is a pleasure to follow the hon. Member for Southport (John Pugh). I am tempted just to say that I agree with everything that everyone has said and then to sit down, but this would not be Parliament if we were able to do that, so I will briefly contribute to the debate.

I pay tribute to the hon. Member for Torbay (Mr Sanders), who has dedicated his life in Parliament to addressing diabetes. Obviously, because he has type 1 diabetes, he has become the Commons expert on such matters, and I pay tribute to him for what he has done as chair of the all-party group on diabetes and for all his other work on diabetes.

I come to debates on diabetes as a type 2 sufferer full of optimism, because I want to hear about what other people are doing, but I hear about blindness, amputations, stroke and death, and I feel extremely depressed as I go out. In this debate, hon. Members have talked about amazing ideas and good practice in their own areas. I did not know about the specialist unit in Blaenau Gwent, and I did not know what a bun worry is—I now discover that it is a feast of sweets held in Northern Ireland, from which I am sure that the hon. Member for Strangford (Jim Shannon) is kept away. The key to such debates is that we hear about good practice that we do not hear about in other areas.

I pay tribute to both Front-Bench teams, because they both understand the importance of the subject. I am sorry that I did not get diabetes earlier, because I would have done better at harassing the previous Labour Government on the issue. I was told that I had diabetes only in 2007, and, therefore, I did not dedicate myself to it in Parliament in the way that I should. I will make up for that in the next few years.

We have high hopes for the Minister, and not only because The Times has said that she is one of the rising stars of the new intake, which gives hope to those of us who have reached middle age—I am on the way down, but she is clearly on the way up. We have confidence in her and the way in which she has addressed diabetes in the Department of Health: she has ensured that diabetes is a priority; she has asked questions of the experts, and she has brought together charities such as Diabetes UK, Silver Star and others. She is doing what all good Ministers do, which is never to accept the status quo and to ensure that the Department’s bright civil servants are using their abilities and skills to deliver what Parliament wants.

I welcome what the Government have done to support the Change4Life initiative by backing the advertisements announced only on Monday to encourage people to address obesity by ensuring that they change their diet and understand that, by taking responsibility, there can be a difference. I know it is in the nature of parliamentarians always to blame the Government or to expect the Government to do more, and, yes, we do, but it is also in the hands of individuals.

The hon. Member for Strangford carefully considers what he eats in the Tea Room—I have watched him carefully as we line up to get our lunches. When we go to the Tea Room to get a cup of tea before Prime Minister’s questions, we are faced with Club biscuits, Kit Kats and every sweet thing that can possibly be found. I do not know what the English equivalent of a bun worry is, but it is there for us in the Tea Room. Let us start in this House by ensuring that the food available is acceptable.

I also praise my hon. Friend the Member for Hackney North and Stoke Newington (Ms Abbott) for the work that she and the Labour Front-Bench team have done on the proposals not for a tax, which was the subject of my ten-minute rule Bill, but for a reduction in the sugar and salt content of foods, as announced by the shadow Secretary of State. That is a good thing and goes some way towards what Mayor Bloomberg is doing in New York. Actually, the proposal goes further—a tax was not proposed because, of course, Denmark introduced a fat tax but had to withdraw it because of lobbying from the food industry—by showing the need to do something now. The Secretary of State was on television on Sunday, and he agrees with the principles behind the proposal, although he does not support the idea of doing it through legislation. He was looking very cool, not in a suit and tie but in his cardigan, and he said, “Let’s leave it for the industry to do on a voluntary basis.” The industry has had its chance to do something, and we need to move forward.

The Opposition are right. I know that it is in the Opposition’s nature to say radical things, but they are right to press the Government on the proposal because it means that the clever civil servants and, indeed, the clever Ministers in the Department of Health, including the Minister with responsibility for diabetes, will take note and press the industry to react. Ultimately, being able to express such views is important, and I support what the Opposition are trying to do.

I have not mentioned this so far—Members of Parliament usually criticise GPs for not doing enough, and they do not do enough—but in the five or 10 minutes available when people go to their GP, there is not enough time to have a diabetes test and a long chat about diabetes issues. The hon. Member for Gillingham and Rainham (Rehman Chishti) specifically mentioned the south Asian community—the Silver Star diabetes charity, with which I am associated, and Diabetes UK take this seriously—because certain communities are more susceptible to diabetes. He is right to raise that point. However, I think we should be getting pharmacists to do much more. Before she died of diabetes complications, my mum had great faith in her local pharmacist. Pharmacists have more time to talk to people than GPs, who are very busy. We should include them in our forward plans. We have not mentioned them today, but we need to consider them for the future.

I know that the Minister is off to India to speak at a major conference on the issue in Chennai. We have the best diabetes doctors in the world. I happen to have a few in Leicester—Professor Azhar Farooqi, Professor Kamlesh Khunti, Professor Melanie Davies—and there is also Professor Naveed Sattar in Glasgow, as well as many others. They are world-class experts, and we do not use them enough. As the Minister starts on her journey—not quite without maps, because some have been provided in this debate, and the hon. Member for Torbay has one in his back pocket that he has offered to successive Governments over the past 25 years—will she please use the expertise that we have? The world looks to our medical profession as the best in the world. Let us engage them in the work that we do.

10:31

[Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)]

I congratulate the hon. Member for Torbay (Mr Sanders) on securing this debate. I am struggling with the aftermath of a new year flu, so I hope that my voice will hold out.

I should declare an interest: I have been diagnosed as a type 2 diabetic. As always, I follow humbly in the footsteps of my right hon. Friend the Member for Leicester East (Keith Vaz); I have spent 25 years doing that. I am grateful for the opportunity to speak on behalf of Her Majesty’s Opposition about diabetes, one of the leading health threats in the UK. As we have heard, there are 3.7 million people in this country living with the disease. As we have also heard, it is a particular issue for people of south Asian and African and Caribbean descent in our big cities. I am hopeful that one thing that will emerge from the changes to the NHS is more local targeting, both by clinical commissioning groups and in public health, of local issues and local demographics. We cannot engage with diabetes unless we also engage with local specifics in our cities and regions.

As we have heard, diabetes costs the NHS one tenth of its budget—more than £10 billion a year. We have heard in detail about foot care and amputations, but the general problem is that diabetes is a gateway condition to hypertension, stroke, kidney problems and amputations, leading to early death. I was struck by the figure given by my hon. Friend the Member for Blaenau Gwent (Nick Smith) of 23 amputations in Blaenau Gwent. It makes one stop to think about the human reality of diabetes in communities.

The fact that diabetes is a gateway condition makes early diagnosis and engagement so important. It is important to be mindful of the new NHS architecture. It is not just a question of asking Ministers to do more; we must also take the debate to a local level, with CCGs and directors of public health, because healthy living issues will fall to directors of public health and local authorities, rather than Government, to deliver. We can also look to local authorities that have been innovative about healthy living issues by offering free swimming lessons and so on.

We have heard about the basic health service treatments and checks that people should have. The Minister will be aware that the Public Accounts Committee’s report was critical of the management of adult diabetic services in the NHS. The report said that every year, 24,000 people with diabetes die simply because their disease has not been effectively managed. That is not a satisfactory figure in the 21st century for one of the world’s leading economies. Although people now know what needs to be done for people with diabetes, the Public Accounts Committee found that progress in delivering the recommended standards of care and achieving treatment targets has been depressingly poor.

What is the Department’s response to the Public Accounts Committee’s report? What can the Minister tell us about improvements in policy and service in line with the Committee’s recommendations? Does the Department of Health have a plan for ensuring the effective implementation of the NHS health check programme after the NHS reorganisation in April?

I would also like to say a word about children and young people with diabetes. As many as one in four young people are diagnosed with type 1 diabetes. The UK has the highest number of children diagnosed with diabetes in Europe and, sadly, the lowest number of children attaining good diabetes control. Christine Cottrell, a diabetes nurse specialist from Warwick, told The Daily Telegraph last July:

“We are even getting children as young as seven with Type 2 diabetes”.

It is an important public health issue, and the prognosis is not good:

“These children end up having heart attacks, or losing a limb, or their sight, in their 30s and 40s.”

I know that it is difficult in a Westminster Hall debate to bring up issues that cut across Departments, but has the Minister had discussions with her colleagues in the Department for Education about what support could be offered to schoolchildren and young people to manage their diabetes effectively and prevent the development of early complications? What efforts are being made to ensure that both staff and pupils are aware of the nature of diabetic epileptic attacks, which can take place in schools, and the best way to assist sufferers in an emergency?

What steps are the Government taking to increase the number of people not previously diagnosed with diabetes who receive diabetes testing? What was said earlier about the role of pharmacists was an interesting suggestion. Do the Government have a plan in place to make the public aware of the symptoms of diabetes sufferers? Are there any plans for a nationwide public awareness campaign? On prevention, we know that the new NHS commissioning board will be mandated to prevent diabetes. I know that it is perhaps not reasonable to say that GPs do not perform things that are not targeted exactly as well as things that are, but is the Department considering introducing diabetes testing targets for GPs?

The Public Accounts Committee inquiry to which I referred earlier heard that out of 20 trusts that needed to improve their diabetes care, only three accepted the offered help. That is not reassuring. How can the Minister ensure that care through health providers meets the targets set by the Secretary of State? As clinical commissioning groups and directors of public health take over some of those responsibilities, what can the Department do to ensure that diabetes is on their agenda?

On some of the more general issues around diet and healthy eating, although diabetes management, foot care and preventing diabetes from becoming a gateway to even more serious conditions are important, the most important thing that we can do in medical and public health terms is consider diet and healthy eating and other prevention matters, particularly for young people. Most experts agree that the excessive consumption of sugar is a factor in both obesity and diabetes. Increasingly, people are saying that sugar is addictive.

Colleagues have mentioned some important things to engage with in terms of policy, such as minimum pricing for alcohol, about which the Government are consulting and which is supported by Opposition Members. We suggest looking at the sugar composition of some foods, particularly those targeted at children. Most parents want to do their best, and I hope that the advertising campaign launched by the Minister will shed some light on such issues for parents. However, how many parents know that Coco Pops are one third sugar? People joke about it, but although most parents would not sit their child down to breakfast and put a bar of chocolate in front of them, they will give them a bowl of Frosties or some children’s cereal, which can have a higher proportion of sugar than a bar of chocolate. Opposition Members are saying that we need to consider legislating to ensure that the proportion of sugar in some foods that are directly targeted at children can be brought down.

I am glad to advance Her Majesty’s Opposition’s position on diabetes. I congratulate the Government on what they have done up until now, but there is more to be done, both in locking in a concern for diabetes locally when clinical commissioning groups and directors of public health take up their new responsibilities and dealing with the broader issues of healthy eating and a healthy lifestyle and the preponderance of sugar in modern processed food.

10:41

[The Parliamentary Under-Secretary of State for Health (Anna Soubry)]

It is a pleasure, as ever, to serve under your chairmanship, Mr Crausby. I pay tribute to my hon. Friend the Member for Torbay (Mr Sanders) for securing this debate and to every hon. Member who has spoken. As you may have gathered, Mr Crausby—and as those hon. Members who have heard or will hear or read about the debate will gather—this is a huge topic. We could have had a 90-minute debate simply on diabetes 1 and diabetes 2. We could have other debates about the causes of diabetes 2. I am the first to put my hands up and admit that, until I was lucky and fortunate enough to be appointed last September to the position that I hold, I did not know a great deal about diabetes, but, goodness me, I have learned a great deal in the months since my appointment. I thank the all-party group on diabetes, chaired by my hon. Friend, for all the great work that it does. I paid the APPG a flying visit and learned a lot; a number of matters were raised with me that caused me great concern.

I hope that you will forgive me, Mr Crausby, if this sounds like a mutual admiration society, because in many ways it is. The right hon. Member for Leicester East (Keith Vaz) and I go back many years. I pay tribute to him for all the work that he has done. I know about his Silver Star charity and I look forward to its coming to Beeston in my constituency and to the van doing some work there. That highlights one thing that has come out of this debate and goes to the heart of the Government’s reforms of the NHS: the remarkable work that can be done and now has to be done locally to ensure that we improve the diagnoses and treatments—in addition to other matters raised by hon. Members—because it is fair to say that, although many localities share common themes, this disease will be more prevalent in certain communities, even down to ward level. My hon. Friend the Member for Southport (John Pugh) raises concerns and, as ever, ideas. My hon. Friend the Member for Torbay makes a good point about how we can ensure that these improvements are delivered locally.

I pay tribute not only to the work of Silver Star, but to Diabetes UK, which must be an outstanding charity, because such was its ability to campaign on this issue that it persuaded Mr Paul Dawson, a constituent of mine who has suffered from diabetes 1 for many years, to visit me on Friday. I thought that that was just a remarkable coincidence, but he told me that Diabetes UK suggested that he visit me. The serious point is that he raised concerns, as a sufferer of diabetes 1, that I had heard at the APPG, so I had already taken up many of those, notably what seems to be a rationing of strips. Frankly, this is bonkers; people with diabetes who use strips need to use them and often need to use many in a day. I am not happy if there is any form of rationing of those strips. I have already met officers in the Department and inquiries are being made of primary care trusts, and beyond. Mr Dawson also told me about the great advances, which I have already alluded to, that have been made in medicine, which my hon. Friend the Member for Southport and others have mentioned.

I have been asked a number of questions and I cannot answer them all in the short time available, but I undertake to answer every question in letters.

[Ms Abbott]

The issue of rationing strips has been brought to my attention. What would the Minister suggest that people do if their general practitioner is attempting to ration strips?

[Anna Soubry]

I am concerned about it. It is unacceptable. I have already held a meeting with my officials and they are making further inquiries. I discussed with Mr Dawson what was happening locally in CCGs, which is where this will make a difference, when we see the power of our doctors and other health professionals to commission services, and the power and influence that patients and sufferers of diabetes will have. I am told that NHS Diabetes has now identified a diabetic lead in every CCG. There is an opportunity, through the reforms, to ensure that we now deliver locally as we should. All hon. Members who have contributed to this debate have identified a failure in respect of good outcomes and good practice throughout the NHS, right through to local level. That needs to be, and is being, addressed as a matter of urgency.

I have been alerted to problems with glucose meters and pumps—various new advances in technology. Some of this excites me. However, I am still concerned if there is not the availability that there should be, right across the NHS, notably for all sufferers of diabetes 1.

[Jim Shannon]

It is not just about the provision of the insulin pumps; it is also about training. There are two facets to that.

[Anna Soubry]

Indeed. I was going to end this part of my speech by saying that my constituent, Mr Dawson, paid tribute to what he described as his brilliant diabetic nurse at the Queen’s medical centre in Nottingham. He highlighted, as the hon. Gentleman has done, that it is all well and good having wonderful, great technology, but if people have access to it they need, critically, the support to be able to use it themselves. We must ensure that they have the highest-quality support, not just from their GPs, but from diabetic nurses and others who are trained and specialise in this condition.

Diabetes is common and is increasing, as hon. Members have mentioned. It is estimated that, by 2025, 4 million people will have diabetes.

[Nick Smith]

What are the Minister’s views of Mayor Bloomberg’s plan in New York to ban super-sized soft drinks in cinemas? Does she agree that that could be a good symbolic action that would help bring down diabetes?

[Anna Soubry]

It could be, but I make it clear, as I said on Monday in various media interviews, that at the moment the responsibility deal is working, which is why we have some of the lowest salt levels in the world. Other countries are coming to us to find out how we have achieved that by working with industry, retailers and manufacturers to reduce salt levels. On the reduction of trans fats, under 1% of our food now has trans fats in it. Again, we have done that by working with the manufacturers and retailers.

My natural inclination is against legislation, and I say that as an old lawyer. At the moment, I am confident that the responsibility deal is delivering in the way that I want it to. I make it clear that, if there is a need to introduce legislation, we will not hesitate to do that. I am almost firing a warning shot across the bows of the retailers and food manufacturers and saying, “Unless you get your house in order and accept responsibility, we will not hesitate to introduce legislation or regulation, because we know that we in this country have an unacceptable rise in obesity, to levels that are second only to those in America.” I will therefore consider everything. I always have an open mind. I am currently content, however, that the responsibility deal is delivering, but it has a great deal more to do. I hope that those who are signed up to the calorie reduction scheme later this month will encourage more manufacturers and retailers to sign up to the responsibility deal on calories. I want to ensure that we make some real, serious and tangible progress.

Ultimately, however, as the right hon. Member for Leicester East and the hon. Member for Strangford (Jim Shannon) identified, the responsibility is ours. Nobody forces us to eat the sugar buns or whatever it may be. When we go into the Tea Room and we are faced with the choice between fruit or a piece of cake, my natural inclination might be for a piece of cake, especially since I have developed a sweeter tooth as I have got older and since I have stopped smoking. We all make the choice whether to eat a piece of cake. The ultimate responsibility lies with us as individuals and as parents, but I always have an open mind.

Diabetes is a growing problem and a major factor in premature mortality with an estimated 24,000 avoidable deaths a year—10% of deaths annually are in people with diabetes. A variation exists in the delivery of the nine care processes, with a range of 15.9% to 71.2% achievement across PCTs, which is not acceptable. However, 75% of diabetes sufferers receive eight out of the nine care processes, which is a huge improvement. In 2003-04, only 7% of sufferers received all nine care processes. In 2010-11, that figure was at 54.3%, but there is much more to be done. In the coming months, several documents will be published to guide the NHS in delivering improved diabetes care, including the response to the Public Accounts Committee report, the work undertaken on diabetes as a long-term condition and the cardiovascular disease outcome strategy.

We must ensure that people get an early diagnosis. I must commend again the work of Diabetes UK. Other hon. Members have mentioned how it is raising awareness of the early signs and symptoms of diabetes with its latest campaign on the 4 Ts, which has my full support. One in every two people diagnosed with diabetes already has complications. I thank the hon. Members for West Lancashire (Rosie Cooper) and for Blaenau Gwent (Nick Smith) for their contributions. I will not be able to answer their points specifically in my speech, but I hear what they say and will write to them if necessary to answer their questions. I am acutely aware of the complications and the devastating effects that those can have on people’s lives.

[Mr Sanders]

Can the Minister respond to the important point made by the right hon. Member for Leicester East (Keith Vaz) about pharmacists? Some private pharmacy groups offer diabetes tests, which other pharmacies should be encouraged to do. I hope that we can see the roll-out of more collaborative working between the private sector and the health service in order to identify people with diabetes, so that they start to get treated.

[Anna Soubry]

I am grateful for that intervention not only because I was coughing but, most importantly, because I was going to mention that subject only in passing. I will now expand on that a little. I absolutely agree with the points of my hon. Friend and the right hon. Member for Leicester East about the importance of pharmacies. They are important for so much of the NHS’s work, but here is a good example of where we can link them in far more with delivering the successes, outcomes and diagnoses that we need so desperately. There is absolutely a role for pharmacies, and I look forward to clinical commissioning groups, which are already thinking in new ways about how to deliver better health care at a local level and working in exciting and imaginative ways, collaborating with pharmacies far more than has been done before. It is a good point, and I hope to see more action on it.

When people get a diagnosis, we need to ensure they are managed according to the latest clinical guidelines. The quality and outcomes framework, introduced in 2003-04, has incentivised primary care to perform the nine care processes for people with diabetes, but we know that there are difficulties—I have given the figures—and not enough people are receiving all nine. The National Institute for Health and Clinical Excellence has been asked to review the quality and outcomes framework and diabetes indicators, and we await its response and findings.

Last year, the National Audit Office reviewed the management of adult diabetes services in the NHS. While that highlighted the progress made over the past 10 years, it also highlighted the unwarranted variation that exists across the NHS and the significant challenges that we face over the next 10 years. There is no excuse for poor diabetes care. No one with diabetes should lose a leg or their vision if it can be prevented. We know what needs to be done and we need to ensure that we meet the challenge head on.

The prime objective of the NHS Commissioning Board will be to drive improvement in the quality of NHS services, and we will hold it to account for that through the NHS mandate, which makes it clear that we expect to see significant improvement in the outcomes, diagnosis and treatment of diabetes. In addition, through the NHS outcomes framework, we will be able to track the overall progress of the NHS on delivering improved health and outcomes. Diabetes is relevant to all five domains in the outcomes framework, so when work programmes are developed it is important to consider diabetes and how optimising care can deliver improvements.

My hon. Friend the Member for Torbay asked specifically about NHS Diabetes and whether it will continue to play a central role. NHS Diabetes is one of six current improvement organisations that are being replaced by the new NHS improvement body in the NHS Commissioning Board. In the overall context of what I have said, I hope that he will take comfort, will believe and be sure that diabetes is something that the NHS Commissioning Board has put much higher up its list of priorities. It is aware that much more needs to be done and is the ultimate driver of all of that.

Many hon. Members have mentioned diabetes 2, which is largely, but not always, a preventable disease. I have already paid tribute to those hon. Members who have raised the issue both in their local communities and nationally.

I want to end my comments by discussing an undoubtedly serious problem in our society, which is that almost all of us eat too much. We are overweight. Some 60% of adults are either overweight or obese. As a society, we find ourselves in a situation where one third of our 11-year-olds—our year 6 pupils—are either overweight or obese when they leave primary school. Those figures should truly shock each and every one of us, and something can be done about the problem. We can all take responsibility for how we feed our children and for our own lives and diets and what we eat and drink. The Government, however, can also do things, especially at a local level. When health and wellbeing boards identify the needs of their communities, if it is not a unitary authority, they can work with borough councils.

My hon. Friend the Member for Torbay made a good point about leisure services. We are already seeing evidence in shadow form. In my constituency, GPs are issuing prescriptions for activity, and the borough council is offering real assistance. It is almost as if there are no excuses not to go along to the various leisure centres and take up a class or gentle exercise. We even have walking football in Broxtowe. The point of all this is that local authorities are beginning to knit together all the various services to ensure that we all live longer, healthier and happier lives. The ultimate responsibility is ours, but local and national Government can do so much. It is all coming down to a local level. When we see the roll-out in the spring, I am confident that we will see great progress.

Local Government (Leadership)

Wednesday 9th January 2013 Westminster Hall

11:00

[John Stevenson (Carlisle) (Con)]

It is a pleasure, Mr Crausby, to serve under your chairmanship today. I am delighted to have the opportunity to bring to the attention of the Chamber leadership in local government and to debate it. My hon. Friend the Member for Cleethorpes (Martin Vickers) will want to contribute. A debate on leadership in councils could last for days. Many people will have many different views on leadership, good and bad, and on what is happening in councils today. However, the purpose of the debate is to consider one narrow point: leadership in councils.

When I became an MP in 2010, I visited organisations in my constituency, as did many of my colleagues in their constituencies. Some of those organisations are in the private sector, and many are large and small businesses. The key issue that struck me, having visited both private and public sector organisations and institutions, was leadership and management. My general observation was that if an organisation has one or the other—leadership or management—it can function reasonably well. If it has neither, clearly it is likely to run into difficulties. If an organisation, whether in the public or private sector, has both, it tends to be a great success, and I am aware of those in my constituency that have good leadership and good management, and are doing a terrific job.

Some local businesses are successful, and some public organisations are able and perform well. However, there is a subtle difference between the private and public sectors. If private sector organisations do not have good management and leadership, they run into difficulty and will either go bust or be taken over by another organisation. The difficulty is that, if they cannot be suddenly taken over or cannot go bust, there is a danger that they may become weak and ineffective. The importance of leadership and management should not be underestimated, and the difficulty for Governments of all political persuasions is how to deal with underperforming public bodies. Obvious examples are schools and hospitals. How can they be dealt with when they begin to fail because they have not been provided with correct leadership or good management? That is an issue for all Governments.

A key organisation that has an important bearing in all our constituencies is local government. Local authorities are subtly different from other public sector organisations because they are elected, and the beauty of elections is that they provide new leadership and new emphasis and direction. A mechanism exists for change.

[Karen Lumley (Redditch) (Con)]

I thank my hon. Friend for securing this important debate. Does he agree that, in these difficult economic times, strong leadership is vital in local government, and will he join me in congratulating Adrian Hardman, leader of Worcestershire county council, which was ranked the third highest performing council in the country, despite being the third lowest funded?

[John Stevenson]

I am grateful for my hon. Friend’s intervention. I agree that that is a prime example of good leadership in local government, and I will touch on that.

[Rehman Chishti (Gillingham and Rainham) (Con)]

I congratulate my hon. Friend on securing this important debate. He has raised the matter of strong leadership in many debates, and I also congratulate him on that. Does he agree that unitary authorities, which have a cabinet-style model of leadership, provide the best form of local government in terms of value for money? Medway council, on which I still serve—I was a cabinet member—is led by Councillor Chambers and has been rated as providing good value for services.

[John Stevenson]

My hon. Friend raises an interesting point, and we could have a separate debate on unitary councils alone. For the record, I wholeheartedly agree that unitary councils are the correct direction for local government, and I will certainly advocate that when I can.

Leadership and management in councils are central to the economic success not only of individual communities and local authorities, but of the wider economy and the whole country. They are also important for the provision of efficient and well-delivered services, which may range from collecting waste to social care. We have a tendency in this country to underestimate the importance of local government. It is extremely important and should play a much bigger role in our national affairs. It is commonly accepted, probably across the political spectrum, that the country is far too centralised. Direction and instructions come from the centre and tell local government what it should do.

I accept that the Government have tried to redress the balance. I fully support what they are doing, and I would encourage them to go further. I give them credit for the work that they have done, and I fully support them in their direction of travel. However, there are cultural barriers. At the centre, Whitehall thinks it knows best, and likes to tell local authorities so. In turn, there is a failing at town hall level. Town halls are not used to taking the initiative or providing distinct local leadership. That should change, which is why I am concentrating on local leadership.

The present regime includes many able and effective leaders—my hon. Friend the Member for Redditch (Karen Lumley) indicated that she has an able and effective county council leader—but we must accept that there are many ineffective councils with poor leadership and management, although some have difficulties because they must often deal with the machinations of local politics. Some parts of the country are effectively a one-party state. That may not be healthy for democracy, and it creates problems because of internal squabbles within political parties. In hung councils, parties compete for political leadership, and the most able people often do not lead the council because of inter-party debates and tensions. We cannot get away from the fact that some places have poor-quality councillors, and that the job does not attract the most able people. That is an issue for us all across the political spectrum.

What are the solutions? I believe that we should have more elected mayors. Do people know who their council leader is? I went along to a sixth-form school in my constituency and talked to 50 or 60 able students who were all interested in local affairs. My first question was whether any of them could name their local council leader. My second question was whether any of them could name their county council leader. Not one of them could name either, but if the same questions were asked in London and some other parts of the country with elected mayors, I suspect that at least a good proportion could name that person.

Elected mayors provide visible and clear leadership, which is transparent and accountable. People know who is in charge and responsible for local affairs. They have a four-year mandate, and they have the opportunity to carry out their manifesto commitments and to implement policy. They also provide democratic accountability, which is important. There are one-party councils throughout the country, and the introduction of an elected mayor would add a different dynamism to such areas. Independents could be elected, and a party that will never be in control of a council would have a chance to have their political views expressed through the elected mayor.

The Government have taken a top-down approach to date. After the election, they were committed to the introduction of elected mayors in 12 of our largest cities. From my perspective, I was very disappointed that they were rejected in nine of the areas where there was a referendum. Nevertheless, out of those 12 large cities, three have gone down the road of having an elected mayor. That is a 25% success rate. My view, therefore, is that we should try a bottom-up approach, by encouraging local communities to take the initiative, rather than imposing it on them.

Referendums have been held up and down the country for elected mayors, promoted by local initiatives. The success rate has again been around 25%. Some people would say that that is a poor result and that the policy is a failure, but we have to look at the nature of referendums. As a general rule in referendums, people tend to stay with the status quo. We see that time and again in this country, and certainly in other parts of the world. There is an inherent conservatism within the electorate to remain with what they know, rather than taking on something different.

Local referendums have been hindered to a large extent—dare I say?—by the self-interest of local councillors and local organisations, such as councils themselves, which have been reluctant to see elected mayors being introduced. I believe, however, that support for them is widespread and much deeper than we think. Yesterday, I was at a meeting with Lord Heseltine, interestingly enough, who is not only a big enthusiast of unitary authorities, but a strong supporter of elected mayors. He in turn has been greatly supported by Lord Adonis, who is also a great fan and supporter of them. Both believe that elected mayors are the future drivers of success in local government.

How will we achieve that bottom-up approach? We could look at the legislation. At present, legislation lays out certain criteria before the role of a mayor can come into effect. As everyone will know, there is a petition, then a referendum, and only on the success of a referendum is the structure changed. The key for any area is getting a valid petition to initiate such a referendum. At present, the requirement is 5% of the electorate, which is a barrier that, in my view, is far too high. To take my area as an example, for Carlisle district council, a petition requires 4,500 signatures, while 20,000 signatures are required for Cumbria county council. I suspect that the figures would be much higher in other areas, as ours is sparsely populated. I genuinely believe that the number is prohibitively high—5% is far too high.

What is the goal? I would like the leadership of local authorities to become more open, more accountable and far more dynamic. They should be able to provide innovation, with new ideas, and bring in a real period of local government, by taking the lead and producing political leaders who are known, respected and make a contribution to their local areas.

[Rosie Cooper (West Lancashire) (Lab)]

The hon. Gentleman has concentrated so far on local political leadership, making comments that apply to all political parties, and I very much endorse some of what has been said. However, the flipside is that, over the past few years, we have seen a contraction in the size of local government, especially smaller district and borough councils, and with that, we have experienced highly skilled chief executives leaving the sector. Does the hon. Gentleman agree that that leadership gap has seen officers over-promoted, which has been to the detriment of council tax payers and the standard of service that they receive? I agree that we should move towards unitary authorities, but it is not a one-horse race. We need both components, with really good, on-the-ball chief executives. I would probably say that I agree that unitary authorities are the way to go, but with ever smaller services and good people moving, just filling the gap will not do.

[John Stevenson]

The hon. Lady makes a very good point. I go back to my initial comments when I mentioned leadership and management, because the two go hand in hand to a certain extent. With local authorities or any organisation, whether private or public, if the two go together, the organisation ends up being fantastic. When there is only one, it can work, but it is more problematic. When there is neither, it is a problem.

[Rosie Cooper]

I wonder whether the chief executive mentioned by the hon. Member for Redditch (Karen Lumley) would like a free transfer.

[John Stevenson]

What the hon. Lady said is absolutely right, and I am concentrating principally today on leadership and political leadership. However, we could have a debate just on the management—let alone the leadership and the management—at a future date.

My view is that elected mayors are the way to help achieve real leadership in local government. We should let communities up and down the country decide whether an elected mayor is right for them, and we should make it easier to allow petitions to succeed. Does the Minister agree that leadership is vital to the success of councils? Does he support, as the Prime Minister does, the idea and concept of elected mayors, and would he like to see them spread across the country? Would he assist in making it easier to initiate such referendums?

My real question for the Minister is how we achieve that. I would like—I am interested to hear his comments—a reduction in the required percentage of local people who need to sign the petition from 5% to 1%. The previous Government contemplated lowering the threshold. Going back to my example of Carlisle, if the threshold were reduced to 1%, only 800 signatures would be required for the district council, and if I get my maths correct, 4,000 would be needed for the county council. It would then become entirely feasible and people would go out and actively seek signatures. That is my first question for the Minister.

Secondly, does the Minister agree with extending the period that a petitioner who is campaigning for this can use the signatures on the petition from one year to two years? At present, such a person has to use signatures from people who support the petition within a 12-month period. That may seem an awfully long time, but if someone is working full time and doing this on an ad hoc basis, time passes. To get the requisite number of signatures can take time, and in the example of Carlisle, even if the figure drops to 800, it is still a time-consuming business. Will the Minister consider increasing the period to two years?

Finally, in this age of modern technology, it would seem eminently sensible—indeed, people would expect it—for petitions to be online. At present, there has to be a physical signature on a piece of paper. We have lots of ways of dealing with modern communications and how we produce petitions. Doing them online would be an eminently sensible solution, and it would make it easier for people who want to push forward a petition to achieve the requisite numbers.

I might be wrong, but I believe that much of that could be dealt with by delegated legislation, and I hope that the Minister will confirm whether that is the case. I genuinely think that this is an opportunity to transform local leadership in local councils. In turn, I believe that it would transform the performance of local councils, benefiting local communities and the country at large. It would help growth in our communities, and I believe that it would help to vindicate the Government’s localism agenda. I look forward to the Minister’s response.

[Mr David Crausby (in the Chair)]

I will allow one short contribution before the Minister responds.

11:17

[Martin Vickers (Cleethorpes) (Con)]

Thank you, Mr Crausby. I congratulate my hon. Friend the Member for Carlisle (John Stevenson) on securing the debate.

I served as a councillor for 26 years, with 14 of those on a district authority, which was then transformed into a unitary authority. I entirely concur with previous comments that unitary authorities are the way forward, and I would like to see the Government make more positive moves in the right direction. I also entirely agree that it is desirable for those authorities to be led by an elected mayor. Mayoral positions attract those who have not previously been drawn into local politics. That is good, because it enlarges the pool of talent that is available, and it provides necessary links between business and politics. In the short time available, I want to add one or two points to what my hon. Friend has said.

In Lord Heseltine’s excellent report, he talks considerably about a sense of place and local identities. I know that the Government, like the previous Administration, are drawn to city regions and the boost to a local economy that they can give, and they are even, I believe, considering the possibility of elected mayors for those regions. Although I support that, the city region itself must have a sense of place. My area of Humberside most certainly does not. I, and many others, spent 20 years of our political lives fighting the previously imposed county of Humberside. There must be a clear sense of identity.

We can move on from the lost mayoral referendums of last year. I hope that areas such as my own in north-east Lincolnshire can steal a march on the cities that rejected mayors by grasping the nettle, moving forward and going for an elected mayor themselves. That is why I very much support my hon. Friend’s comments that we must bypass local councils and local councillors, who are a blockade to that; for various reasons, they oppose it. Therefore, I would very much support moves to reduce the threshold and give local activists and local people opportunities to move forward in that direction.

11:20

[The Parliamentary Under-Secretary of State for Communities and Local Government (Brandon Lewis)]

I congratulate my hon. Friend the Member for Carlisle (John Stevenson) on securing the debate and I am grateful to him for giving us the opportunity to air a hugely important issue. I join colleagues who have congratulated him not just on today’s debate, but on the way he has brought up the topic over the past few years. It is a key issue. He is right about that. Effective local leadership is vital and possibly more important today than it has ever been. Up and down the country, areas face huge challenges in local government. Service delivery is becoming increasingly complex. An ageing population presents areas with real challenges. Efficiency savings are required. Partnership working needs good, strong, clear leadership. Another challenge involves community engagement, particularly now that we are in a social media-led environment. I shall come back in a few moments to my hon. Friend’s comments on digital issues.

We face real challenges, particularly in ensuring economic growth. We believe that the best way to do that is for it to be driven locally. The key to dealing with those challenges comes from our towns and cities. It is about strong, inspirational leadership that can take the challenges on, and not just see them as challenges but make them into opportunities.

I disagree to an extent with the comments of the hon. Member for West Lancashire (Rosie Cooper) about the leadership gap when we lose chief executives. We need to be clear that in some areas and particularly some small districts, the days of big, expensive, silo management teams are gone. Just financially, they are history. People have to work together and share good chief executives to get the good management that has been commented on. I agree with the hon. Lady that good political leadership, with good management, gives that magic option, but I have to make it clear that my view is very much that the leadership of a council for an area should come from the political leaders. If we go down the road of saying that a chief executive is part of the leadership, that can only be because our councillors are not doing their job. Our councillors are there to make decisions, to deliver, to lead and to represent their community. Our officers are there to give good advice and to implement the decisions made by councillors.

The comment about directly elected mayors, which I will come to in a second, highlights the importance of leadership from the political leaders. We must never underestimate that, and we must congratulate those leaders throughout the country who put so much time and effort into their communities. Actually, that applies to all councillors, but I am thinking particularly of the leaders who step to the forefront, take that leadership seriously and move their communities forward. Whether they are mayors or just elected leaders, they do all our communities and our country a great service.

Cities are a good example of where the Government are recognising this leadership. Our belief in strong local leadership has meant that it is one of the asks for the city deals. We have made it clear that if cities want significant new powers and funding streams, they need to demonstrate clear, strong, accountable leadership. Cities with directly elected mayors have clearly shown that.

Several hon. Members have spoken in favour of mayors. My hon. Friend the Member for Carlisle has regularly made comments about directly elected mayors. Particularly in the case of single-tier authorities, they can be a hugely beneficial step forward, with real power and real ability to deliver on the ground for their communities. I share my hon. Friend’s view—I can answer that question directly—that it would be good to see more of them around the country. I am interested in looking at how we can motivate people and encourage more of that to happen. I shall come to my hon. Friend’s three specific asks in a moment.

I am pleased that we are at one on this particular issue. Directly elected mayors can and generally do provide good, strong, clear and visible local leadership. My hon. Friend highlighted that very well in his description of the meeting at the school. He makes a very strong point about the accountability of the role of mayor. A directly elected mayor does seem to have recognition in a community that goes beyond that of an elected councillor. There is, therefore, increased—clear—accountability. People understand exactly who is in charge, who is making the decisions, who is accountable. That transparency fits perfectly with the localism agenda with which we are moving forward.

There is a very strong case on this issue. Research undertaken in 2005 shows that the democratic mandate provided by directly elected mayors has

“provided a basis for a stronger, more proactive style of leadership than other models.”

We have seen how mayors around the world have reinvigorated their cities. I am thinking of places such as Frankfurt, New York and Lyon. That has also been the case on our own doorstep, in London. The mayors—the office holders—become very well known. That highlights again the clear accountability and understanding of who is responsible—who is in charge. The Mayor of London, particularly, I would say, over the past four years, has transformed the city. In the 12 years of its existence, the London mayoral office has been hailed across the world for its influence in raising the profile of the capital and for securing major projects that the city needs, from Crossrail to the Olympic games.

Of course, in addition to the Mayor of London, we now have, as my hon. Friend said, new mayors in three of our biggest cities: Leicester, Liverpool and, most recently, Bristol; I have already met the mayor of Bristol a few times. In our “Mid-Term Review”, published on Monday, hon. Members have seen that we are proud to record that we have enabled the people of those cities to join London in choosing a directly elected mayor.

My hon. Friend the Member for Carlisle has outlined a number of measures that he feels would make it easier for communities to bring about mayoral governance in their area and to see that happen from the local community up, rather than central Government deciding that an area should have a referendum. I am attracted to any measures that will allow areas to adopt good, strong, effective leadership, which an elected mayor can provide and which is vital to their success.

Let me deal with my hon. Friend’s three points directly. The first concerns the petition for governance and the idea of a change in the threshold. He is right to say that we can change that by amending existing secondary legislation, so it is not difficult to do. I shall do some further work and invite my hon. Friend to come and have a conversation with the Department about that. I am cautious about it, but I am open-minded. Let me explain why I feel some caution about it. We want to make it easy for people, when there is a genuine need and desire in a community to see clear accountable leadership, to move forward and have a vote for it. We also need to avoid small interested parties being able too easily to get something that does not have full community support. There is a balance to find on the size—the proposal is to move from 5% to 1%—and the implication that that would have in different areas. As my hon. Friend says, having to find 20,000 votes is different from having to find 1,000 votes. That depends on whether it is happening at the level of a small authority, county level or whatever it happens to be. There is a bit of work to do on that. I am happy to look at it, but I shall work with my hon. Friend to see whether we can come up with something that might deliver what he wants without going too far and getting the wrong result in the wrong areas.

My hon. Friend’s second query was about the time frame for collecting signatures. Again, I am willing to look at that, but I think that it goes in tandem with point one, in that I suspect that if we were looking at a lower threshold, there would be less need to expand the time frame. If we do not lower the threshold, there is a stronger argument for widening the time frame. It is probably one or the other. We can consider those points in tandem. As I said, I shall work with my hon. Friend on that.

With regard to e-petitions, I can be slightly more direct and positive, in that I think my hon. Friend makes a very good point. I think that we are moving towards those days when far more things will be, whether we like it or not, done online. We certainly should be looking at how we can move forward with that. The coalition’s e-petition website has already had 17 million visits, with a total of 36,000 petitions submitted and almost 6.5 million signatures. That equates to roughly 12 people signing up every minute since it came into force. I support my hon. Friend’s suggestion of allowing electors to support a petition online, and we can look at how we deliver that—how we can make it possible. It was a very good point that we should look to move with.

I agree with my hon. Friend that leadership in a local community is vital. We should give great credit to the leaders who provide that around the country for their communities. They do a great job, as do all councillors who go out and work for their communities. Where we can move forward to make that more accountable and more transparent and have clear accountability through directly elected mayors, and where that would be practical for communities and is something that they want, it could be a very good move forward for them. I am happy to work with my hon. Friend to see whether we can deliver that to strengthen our democracy and our local communities.

11:29

Sitting suspended.

Living Wage

Wednesday 9th January 2013 Westminster Hall

[Mrs Anne Main in the Chair]

14:30

[Teresa Pearce (Erith and Thamesmead) (Lab)]

It is very welcome to be serving under your chairmanship, Mrs Main. I think that this is the first time that I have done so. I thank everyone for attending what I believe is a timely debate.

The campaign for the introduction of a living wage unites many organisations, charities and people in pursuit of social justice. There is a clear moral case for a living wage: as a society, we should ensure that the minimum wage that workers are paid allows them to lead a decent life, a life with dignity, and does not require people to have, as some in my constituency do, two or three jobs to try to make ends meet, leaving them no time for their children or the rest of their family, or to contribute in any other way to society.

At the same time, there is increasing recognition of the business benefits that being a living wage employer can bring. Many living wage employers see it as almost a fair trade mark: it marks them out as separate from other employers and indicates that they are employers of choice. I think that that is very welcome. A living wage employer also attracts better-quality staff and gains a reputation for good corporate social responsibility. Paying the living wage also reduces absenteeism and staff turnover. It is about giving workers the respect and the pay that they deserve for the work that they do.

I am pleased to say that many people are now paying the living wage, including some councils, such as Lewisham council and Birmingham city council, and private sector employers, such as Aviva and my old employer, PricewaterhouseCoopers, as well as KPMG. They have already volunteered to adopt the living wage and, if the press reports from late last year are correct, three Departments are also now considering introducing it. Late last year, Labour said that it was looking at making public sector contracts conditional on workers being paid at least the living wage and possibly naming and shaming companies that pay their workers less. More MPs are also advertising internships that pay the living wage, which is a very welcome development, as we should be leading the way on fair employment practices. We should lead by example. I do not want to be part of an organisation that says, “Do as I say, not as I do.” For that reason, I do not use unpaid interns and always pay interns at least the living wage. I am very pleased that that is now becoming the practice in the House. Those have all been welcome steps towards making the living wage the norm in our labour market and they make the debate particularly timely.

However, there is one angle to the debate about introducing the living wage that I think needs to be given greater consideration and discussed. If one of the large and vastly profitable supermarket chains or fast food chains had their electricity bills paid by the taxpayer or their advertising costs greatly subsidised by the general public—the same general public who purchase goods in their stores and from whom they make their massive profits—we would expect tabloid headlines and a massive public outcry at the unfairness of it. However, week in, week out, such companies get an enormous subsidy to help with one of their major overheads—staffing costs. That is because many employees—often the majority—in these large and successful companies are paid only the minimum wage, and because the current minimum wage is not a living wage, nearly everyone on it has to claim tax credits to be able to make ends meet.

The number of working families receiving tax credits to top up their meagre incomes has risen by 50% since 2003. A Joseph Rowntree Foundation report estimates that 3.3 million people now have to claim tax credits to top up their wages because they are on the minimum wage. Those tax credits are funded by the Government—by the taxpayer. That means that the public purse has to subsidise the low-paid employees of many of our household names so that they make their high profits rather than pay their workers a decent wage.

[Mr David Lammy (Tottenham) (Lab)]

My hon. Friend is making a fantastic point. She will recognise also that there are some supermarkets where the CEO is on 500 times more than the individual on the shop floor. That must be unacceptable if they are not paying a living wage and are expecting the state in effect to pick up the bill.

[Teresa Pearce]

I thank my right hon. Friend for his intervention; I totally agree. When we compare the top and the bottom level of pay, there is often a massive difference. We need to look at getting that balance right. If a company is making that sort of profit, it is inexcusable for it not to pay a decent wage and for the taxpayer to have to subsidise its wage bill.

I am not against tax credits, but I think that more people need to understand that in many sectors the taxpayer is subsidising the wage bill of some of the biggest employers. We need a national living wage to put an end to the deeply unfair situation in which we are all subsidising poverty pay and the profits of large—often global—companies. The Secretary of State for Work and Pensions recently wrote an article about in-work benefits in The Daily Telegraph. He was blaming Labour’s payments to supplement working families’ incomes for the fact that the public finances are at “breaking point”. Although I agree that the Government should not have to subsidise low wages and in effect subsidise the profits of large companies, I disagree that the solution is to cut the only payment standing between many low-paid workers and destitution. There have been many debates in the House, and I am sure that there will be many more, about why the public finances are the way they are. Is it because we have had to bail out the banks? Is it the Government’s politics of austerity? Is it the lack of growth? Whatever side of the argument we are on, I think that we would all agree that it is not the fault of the worker in my local supermarket or the waitress in the pizza restaurant. We are not in this situation because the Government intervened to prop up poverty wages. It is not the fault of tax credits.

Nevertheless, there is some agreement across the parties that the situation needs to change, even if very different solutions are proposed. We could do as the Government plan to do and place a cap of 1% on uprating benefits such as working tax credits, far below predicted inflation, which will tip thousands more families and children into grinding poverty; or we could consider raising the national minimum wage to a level at which the extensive use of working tax credits would not be necessary.

A recent report by the Resolution Foundation and the Institute for Public Policy Research estimated that widespread use of a living wage could save the Government £2 billion a year. About £3.6 billion of the extra money paid out in higher wages under a universal living wage would go straight to the Government, in the form of extra income tax and national insurance payments, along with reduced spending on benefits and tax credits for the lowest-paid. As some of those workers would be in the public sector, their wages would cost the Government an extra £1.3 billion. However, that would still leave the Treasury with an extra net income of £2 billion.

The living wage should be adopted sooner rather than later as the national minimum wage. I do not think that it is too much to ask that workers at the bottom of the income ladder should at least be able to make ends meet. A legal minimum living wage is necessary, because although campaigners have been successful in increasing voluntary take-up, the numbers of people affected by what we are discussing are so high that they warrant more drastic action. About 5 million people are paid less than the suggested living wage and 3 million households contain at least one adult who is paid below that level. The Institute for Fiscal Studies predicts that a further 1 million children will fall into relative poverty by 2020, and that prediction was made before last night’s vote. With a living wage, we could at least try to undo some of the damage.

I realise that many people will object to what I am saying. They will say that I am anti-business. I am not, but I am anti-exploitation. If a business depends on cheap labour while making massive profits for its shareholders, there should be a mechanism—I do not think that it is beyond the wit of man to come up with one—whereby the numbers of minimum wage jobs at a profit-making company are reported to Her Majesty’s Revenue and Customs and a levy can be charged via the tax system to refund some of the subsidy. There is an argument for helping small firms or those that provide a necessary public service, but I do not believe that supermarkets and giant retail companies, which are making billions of pounds each year in profits, deserve or warrant state subsidy, because that is what this is.

People will say that I am anti-jobs, but that is nonsense. I ask them to consider the proposition that the next time one of these firms issues a press release saying that it is creating 5,000 jobs, what it really means is that it is creating increased profits while the rest of us pay part of the staffing cost for those 5,000 jobs. If a business is being operated in a modern European democracy, the people working for it and helping it to make that profit should surely earn enough to be able to live in that modern European democracy without relying on state benefits.

People will say that I am anti-free market on the basis that if employers are forced to pay decent wages, they will go out of business, but if we are realistic, we will admit that we do not really have a free market economy when companies need to be subsidised by the benefits system, when institutions such as banks are not allowed to fail because of the effect on the UK economy and when private companies contracted by Departments to provide services fail and have to be propped up financially to ensure that essential services are protected. Companies are taking the profit without bearing the risk. That is hardly a free or fair market.

Profitable employers who say that they cannot afford to pay a living wage or who depend on cheap labour do not have the business model on which we can build a recovery. We need proper, clear, informed, rational discussion. The public need to understand the extent to which such companies are helped by public funds. We need to stop calling them wealth creators and start calling them state-subsidised industries, because that is what they are. If we are serious about making work pay, the first step is to get those making and taking the profits to pay the wage bill of their own workers, who are often the true, unsung wealth creators.

14:40

[Mr Christopher Chope (Christchurch) (Con)]

It is a pleasure to participate in this debate. I congratulate the hon. Member for Erith and Thamesmead (Teresa Pearce) on securing it. I am delighted that the Minister of State, Department for Business, Innovation and Skills, my right hon. Friend the Member for Sevenoaks (Michael Fallon), is responding, because he and I belong—or belonged—to the school that believes that it is much better to leave such issues to the market than allow Government intervention, let alone legislation or regulation.

The starting point is that, if people want to prescribe a living wage and some employers wish to pay what they describe as a living wage, they should be free to do so in a free market. There is no issue. The agenda that underlies the hon. Lady bringing forward the debate is that she would like the Government to specify and introduce what has been set out as a living wage.

[Mr Lammy]

Did the hon. Gentleman advance the same arguments on the minimum wage when it was introduced a few years ago?

[Mr Chope]

I have consistently articulated the same arguments on the minimum wage. I had the pleasure of introducing the Employment Opportunities Bill, fundamental to which was the principle that people should be able to opt out of the minimum wage, thereby increasing the number of employment opportunities. I have been consistent. In fact, I argue that I have probably been more consistent than my party in saying that in this area we should allow individuals and the marketplace to do what they wish to do and we should not intervene.

I make only one concession. The argument about the living wage in a sense embraces one of my criticisms of the minimum wage. The living wage is supposedly £1 or £1.50 higher in London than it is outside London, and yet people, and the party of the right hon. Member for Tottenham (Mr Lammy) in particular, espouse the idea that a national minimum wage needs to be the same across the country. It is recognised that the living wage is different in London. The costs of living in London are higher, so the living wage in London is higher than the living wage outside London. In a sense, the argument opens up the debate about whether to have national regulation or, if there is to be regulation at all, allow regional variation. I am pleased to see some recognition on the part of the Labour party that regional variations are important.

Whether a wage is a living wage depends on who receives the wage. I would like to draw Members’ attention to Donald Hirsch’s “Working paper: uprating the out of London Living Wage in 2012”, which updates the Centre for Research in Social Policy calculations on the living wage outside London. It uses the basis first set out in 2011, produced at the request of the Living Wage Foundation, and draws on the minimum income standard for the United Kingdom. It explains the basis for the outside London living wage level announced by the Living Wage Foundation on 5 November 2012, coinciding with the updating of the London living wage as calculated by GLA Economics.

I will not take Members through all the calculations, which start by calculating minimum living costs in 2012, translate that into a wage requirement, and consider the application of a cap limiting the increase in an applied living wage in any one year. When one looks in detail at the calculations, one sees the fallacy in the hon. Lady’s argument. After carrying out all the calculations for the different types of family, living in different types of accommodation, with differing child care needs, it concludes:

“The following summarises the composition of the costs as set out above, and how this translates into wage requirements”—

in other words, what the hon. Lady would describe as a “living wage”. The hourly wage requirement is £8.38 for a single person and £6 for a couple without children or dependants—significantly below the national minimum wage.

[Mr Lammy]

rose—

[Mr Chope]

The paper then calculates the figures for lone-parent families with one child, with two children and with three children. A lone-parent family with three children, according to the research, has an hourly wage requirement of £18.57.

[Mr Lammy]

rose—

[Mr Chope]

I am not sure whether it is the policy of Her Majesty’s loyal Opposition for lone parents with three children to be entitled to £18.57 an hour.

[Mr Lammy]

rose—

[Mrs Anne Main (in the Chair)]

Order. Will the right hon. Gentleman sit down?

[Mr Chope]

As soon as we look at the figures, we can extrapolate that an individual needs a wage at a particular level in order to live. That may be so, but a wage is determined in the marketplace, which is why single parents in this country have very low—relatively speaking —labour market participation. It is not worth their while to go out to work, because their wages will not be greater than their living costs or the benefits they receive. One good thing that the Government have done is adopt a policy designed to ensure that work pays and is worth while. If we take two equivalent families—one in work and the other not—the one in work will receive more than the family not in work.

[Mr Lammy]

Will the hon. Gentleman give way?

[Mr Chope]

I will not give way to the right hon. Gentleman again, because lots of people want to participate in the debate.

Even the figures produced by supporters of the concept of a London living wage demonstrate the variation in living wage—£6 an hour each for members of a couple with no dependants, rising to £18.57 for a single parent with three dependant children. That is an annual wage requirement of £36,319 a year—pretty close to the level at which they would have to pay higher rate tax and lose their child benefit under the wholly misguided benefit arrangements the Government have introduced. That is a side story to what we are discussing.

If an individual wishes to employ someone, they offer a wage for the job and it is up to individuals applying for the job to decide whether it is worth while to undertake it at the wage offered. I hope the Minister will endorse that in his summing up. If employers just offer wages in line with the national minimum wage, they cannot differentiate between the person one might describe as the “honest plodder” and the person with a little more enterprise, flair and, potentially, loyalty to the organisation. That is why it is often in the best interests of a company to offer higher wages, and indeed why I offer gap-year students in my office significantly more than the minimum wage. I recognise that in that way I am more likely to get gap-year students who will stay the course, be conscientious and turn up for work on time than if I offer either zero wages or an internship rate.

I operate in a marketplace myself, and all I am suggesting is that other employers should be encouraged to operate in the marketplace. We should not sleepwalk into having a system of nationally set minimum wages that supposedly amount to a living wage.

[Ian Lavery (Wansbeck) (Lab)]

Will the hon. Gentleman give way?

[Mr Chope]

I will give way once to the hon. Gentleman.

[Ian Lavery]

The hon. Gentleman peddled a lot of information about the national minimum wage that was completely unfounded, and he appears to be doing exactly the same now. Does he not agree that the living wage is good for business, society and people in the workplace?

[Mr Chope]

The living wage may, in certain circumstances, be good for employers—I have just conceded that—and for employees, because they will receive more money than from another employer. I am much less certain about the overall benefits for society as a whole. Dramatic statements have been made about how, if everybody had the living wage, it would increase the amount paid to the Exchequer and therefore increase the amount of money available to fund public expenditure, but that analysis does not bear detailed scrutiny.

My point is that wages should be left to the marketplace. It is for an individual to present himself, and if he wishes to take a job for £4 an hour—[Interruption.] The hon. Member for Wansbeck (Ian Lavery) shows his scepticism, but a large number of graduates, who are out in the marketplace, are being presented with a stark choice: they either work for nothing—as an intern, basically—or do not receive the minimum wage because that is regarded by employers as unaffordable. Therefore, if an individual said to a potential employer, “I’m prepared to work for £4 an hour,” it would create an illegal situation. The purpose of my Employment Opportunities Bill was to enable people voluntarily to opt out of the requirements of the minimum wage should they so wish. I would have thought that that was pretty fundamental in an open, democratic society, but obviously the control freaks in the socialist party do not like giving people the freedom to do that. [Interruption.]

[Mrs Anne Main (in the Chair)]

Order. There is too much chatter on the Back Benches.

[Mr Chope]

There is a chasm between what is articulated by those who support the living wage and—

[Ian Lavery]

Will the hon. Gentleman give way?

[Mr Chope]

I will give way a final time, but I will then sit down, because several others want to participate.

[Ian Lavery]

I thank the hon. Gentleman for giving way a second time. Is he really suggesting that the marketplace should determine wages? Would he accept people working for £1 an hour?

[Mr Chope]

In countries overseas, many people work for less than £1 an hour, and some of them have taken jobs that would have been available to people in this country, because those jobs have been outsourced overseas. Some of the work done shows that companies based in, say, London may want to pay all their staff high salaries, which is fine, but often outsource more menial jobs to overseas locations where people are paid much less than the minimum wage operating in this country. That is an area where the market should operate.

The market for labour in Cornwall or north-east England is different from that operating in London. The market for a young single person is different from that for someone with a lot of dependants. I have constituents, as I am sure does the hon. Gentleman, who have recently been made redundant but have so many commitments that they cannot afford to take a job at a significantly reduced salary, because they would be unable to meet all those commitments. That is part of what I describe as the operation of the marketplace.

I do not feel that I am out on my own on the living wage, but we should not lose sight of the importance of allowing the market to operate in this area. Whether we call it a moral case or whatever, I do not think that someone employed at £6 an hour—taking the figures I gave earlier—should be prevented from being employed because somebody comes along and says that there shall be a national living wage in excess of £6 an hour, with employers shedding employment as a result.

Hundreds of thousands of people are self-employed. They work for far less than the minimum wage or what people might describe as a living wage, but they work hard and for long hours as self-employed people. Why should we condemn what they do, if they are operating in their own marketplace? Why should we base a living wage on a week of 37 and a half hours when, to increase their wages and standard of living, many people choose to work more hours than that? Why arbitrarily choose that number of hours as the basis for assessing a living wage, because a living income may be based on people working a lot more than 37 and a half hours?

This debate has the potential to be quite interesting. I am grateful to the hon. Member for Erith and Thamesmead for introducing it. I hope that, in summing up, my right hon. Friend the Minister will leave no room for doubt that the coalition Government are absolutely opposed to the living wage and more regulation.

14:57

[Jack Dromey (Birmingham, Erdington) (Lab)]

It is a pleasure to serve under your chairmanship, Mrs Main. I congratulate my hon. Friend the Member for Erith and Thamesmead (Teresa Pearce) on initiating this very welcome debate.

I have always believed in the dignity of labour and of work, but for millions in work and living on low pay, life can be a precarious existence that involves counting every penny. Under Labour, great progress was made. The national minimum wage transformed the lives of millions. In my former being as deputy general secretary of the Transport and General Workers Union and then of Unite, I heard heartbreaking examples of people who, having gone to work for 40, 50 or 60 hours a week, were given their wages slip and saw that they had been paid £1.50 or £2 an hour.

If it is true that the national minimum wage transformed the lives of millions, it is also true that life on the national minimum wage could be very tough, which is why the notion of the living wage was born. It was born in the east end of London, initially by TELCO—the East London Communities Organisation—which was formed by faiths and community groups, as well as by a parents’ movement, about which I shall say more later.

When I was elected deputy general secretary in 2003, one of the first things that I did was to sit down with those excellent people, and together we mounted a highly effective campaign to end poverty pay, initially in Canary Wharf and the City of London. It was nothing short of obscene that good men and women from all over the world cleaned boardrooms and toilets in those giant tower blocks—in which average wages were frequently £150,000, £200,000, £500,000 or £1 million a year—on the national minimum wage, with statutory sick pay, no pension and the basic minimum entitlement to holidays. That powerful movement changed the lives of 4,000 cleaners in Canary Wharf and the City of London.

Interestingly, an alliance of organised labour and faiths initially drove the process, but as we broke through, first one and then the other, we had more and more employers coming out and saying, “This is right, and we should have done it earlier.”

[Gloria De Piero (Ashfield) (Lab)]

I just want to put it on the record that it is right to praise people and organisations such as Barclays, KPMG and the many Labour councils across the country, including my own Ashfield district council, for introducing a living wage.

[Jack Dromey]

More and more employers are embracing the living wage. The next landmark in our campaign was the organisation of the first strike in the history of the House of Commons—it was of the cleaners. I have the manifesto that was produced by those cleaners. Let me remind Members of where we were just four years ago. We were talking about wages of £4.85 to £5 an hour, 12 days holidays plus statutory days, statutory sick pay only and no pension. I am pleased to say that, with the support of MPs from all parties, we broke through and now those cleaners earn the living wage.

More than 130 employers in London have embraced the living wage, and that is increasingly happening elsewhere in the country—in areas such as Ashfield. In London, all three parties in the Greater London assembly have supported the living wage, and as a result, tens of millions of pounds have gone to the low-paid.

Let me put the case for the living wage. First, it is good for business. There is no question but that it has a substantial impact on productivity. Indeed, in surveys of employers that have introduced the living wage, some 80% have said that there was a discernible improvement in the quality of work and that absenteeism fell by 25%. Two thirds of the employers said that they had seen dramatic improvements in recruitment and retention, with far less churn in their work force than previously, and 70% said that it had been good for the standing and the reputation of their company. Frequently, employers seek to sell themselves as being reputable and ethical, and the fact that they are living wage employers contributes to that. As for the business case, job quality, productivity, service delivery and reputation have all been improved, with a relatively minor increase in costs on the part of those companies.

A living wage is good for the individual, because dignity in work is enhanced by a living wage. Interestingly, in the surveys that have been done of employees in living wage companies, 50% have said that they have been much more willing to embrace change within their companies as a consequence of the fact that, at last, their labour is being recognised by way of the living wage.

The living wage is good for society. Returning to the origins of the living wage campaign in east London in 2001, 2002 and 2003, the parents’ groups were a powerful driver. They argued that having to take on two or three jobs to be able to pay their bills was an enemy of family life. The evidence is that, in London alone, 15,000 families have been lifted out of poverty by the introduction of a living wage. If we look at the principal beneficiaries, we see that 88% are women. A living wage is also good for the taxpayer. By definition, if people are getting a living wage, they are less likely to need to depend on benefits and tax credits.

I am proud to say that Birmingham, like Ashfield and many other local authorities, is now driving forward with the living wage. It was the first pledge to be honoured by the incoming Labour administration last May. There were three stages. The first stage took in the 3,000 directly employed employees in Birmingham, such as the wonderful Elaine Hook. They were previously paid just a penny above the national minimum wage of £6.19. They then received a £1 an hour increase, putting up the wage to £7.45 an hour. Time and again, Elaine Hook has said that she cannot describe the difference it has made to the quality of her life.

The second stage, which is under way right now, relates to the council’s procurement power. I have a strong view that taxpayers and council tax payers are entitled to feel confident that contracts are let to decent and reputable employers—employers who pay the living wage. Such a policy is now being rolled out in Birmingham, but not just by way of insisting that any contract let includes the living wage for goods or services. The council is also building Birmingham’s business base by maximising the letting of contracts in the area and following other noble objectives, such as more employment opportunities for disabled workers.

The third stage is the leadership that we give in the city as a whole and the power of advocacy, working with a wide coalition of interests. Put simply, the argument is that Brummies are worth more than the minimum wage; every one of them is entitled to the living wage.

We are also talking about the sort of society that we are. It is wrong simply to see this as a moral issue. From my own experience in the world of work, I know that there is a powerful business case for the living wage. There is also a powerful economic case, because low-paid workers who move on to a living wage do not salt away their money in tax havens; they spend it in local shops and local businesses.

None the less, there is, unashamedly, a moral case. As part of the great drive for the living wage in Canary Wharf and the City of London, we had, for four consecutive years, multi-denominational faith events in Westminster cathedral. Hosted by the Catholic Church, the events had all the churches, mosques and synagogues coming together. Some 4,000 people would turn up on the feast of St Joseph the Worker, or May day. On one occasion, Cardinal Cormac Murphy-O’Connor and Canon John Armitage, the chair of London Citizens, gave two magnificent sermons. They summed up the history of the drive of the faiths and organised labour for the dignity of labour, going back to the 1889 dock strike for the dockers’ tanner. They said that there is a powerful moral case for the living wage. As John Armitage said, markets without morality contain the seeds of their own destruction. The time for the living wage has come.

[Mrs Anne Main (in the Chair)]

There is just over 30 minutes before the start of wind-ups, and six Members wish to catch my eye.

15:08

[Kwasi Kwarteng (Spelthorne) (Con)]

I am pleased to serve under your chairmanship, Mrs Main.

I agree with many of the remarks made by my hon. Friend the Member for Christchurch (Mr Chope), who put his case trenchantly. We are having a very simple argument: it boils down to whether we want free enterprise and a free market system or whether we think that state intervention is the way to achieve better economic outcomes for the people of this country. It seems to me that this debate has been taking place for years in Britain. Until recently, there had been a general presumption in favour of the markets.

I am pleased that the hon. Member for Birmingham, Erdington (Jack Dromey) referred to May day as a great rallying point, because of course it was a great socialist parade. Those of us who remember the cold war will recall that May day was the Soviet Union’s big day, when tanks drove through Red square; it was very much something that the Soviet Union celebrated. I am sure that the hon. Gentleman would love to go back to those days, but many of us have moved on. I make the point perhaps a little flippantly, but there is a serious argument about whether one feels that better outcomes can be achieved through state diktat.

[Meg Hillier (Hackney South and Shoreditch) (Lab/Co-op)]

The hon. Gentleman is talking about state intervention. Many people in my constituency and across London must effectively be subsidised through in-work benefits because of their low wages. There is therefore state subsidy and a cost to the state with the current regime.

[Kwasi Kwarteng]

We could have a separate argument about the efficacy of—[Interruption.] Let us stick with this theoretical idea.

[Mr Lammy]

Will the hon. Gentleman give way?

[Kwasi Kwarteng]

No, I have given way once, and I need to proceed. The notion that one can improve outcomes simply by passing laws about the level of pay is false. The one way—

[Anas Sarwar (Glasgow Central) (Lab)]

Will the hon. Gentleman give way?

[Kwasi Kwarteng]

No. Let me—[Interruption.]

[Mrs Anne Main (in the Chair)]

Order. The hon. Gentleman is not giving way. I would appreciate it if he were not barracked.

[Kwasi Kwarteng]

The reason wages have gone up over the past 50 years is economic growth; that is what has driven the rise in real wages, not laws passed by Governments, the minimum wage or anything like that. The one way to secure economic growth is to create a situation in which businesses can thrive. I would like to see lower taxes and more people taken out of taxation—the Government have successfully done that—so that they can spend more of their own money. I would also like the burdens placed on employers through national insurance to be reduced. Such measures will be far more effective in driving up our workers’ standards of living than Westminster or Whitehall imposing a living wage right through the country.

I am pleased that my hon. Friend the Member for Christchurch mentioned that there was some regional variation between London and the rest of the country. In the debates about the minimum wage, it was seen as a national minimum wage that did not recognise any variation in the cost of living between London and rural Scotland.

[Anas Sarwar]

Just to clarify, the hon. Gentleman’s argument is exactly the same argument that was made against the minimum wage in 1997. Does he support the minimum wage?

[Kwasi Kwarteng]

I support it now, because it is a fact of life. To address the hon. Gentleman’s comment directly, the minimum wage is not set at a level that is damaging to business. It is set at a reasonable level, although I am not saying that it is the best level. I want people to earn more—of course I want them to be more affluent—but the way to achieve greater prosperity is to allow businesses to do well, to flourish and to employ people, and that will not happen as a result of the state demanding a certain level of wages. We have been there: in the ’70s, we had national incomes policy and price policy, but that all failed—it was a complete disaster. It is baffling, in 2013, that we are hearing the same old socialist arguments for Government intervention and control.

I appreciate that many others want to speak, so I will finish on this point.

[Ian Lavery]

Is it a socialist ideal or policy to support having a decent living wage so that people can put bread on the table for their kids?

[Kwasi Kwarteng]

I have said this about three times in my speech: everybody wants people to have higher wages—[Interruption.]

[Mrs Anne Main (in the Chair)]

Order.

[Kwasi Kwarteng]

No one is arguing against higher wages. We are arguing about the most effective way of raising living standards and economic prosperity for the whole country. I am suggesting, as a matter of theory, history and experience, that the socialist approach of using Government diktat is not the most effective way of dealing with this issue.

We can argue about this specific issue. Parties in London are suggesting that we have a living wage, but that is something for companies and councils. I object to the idea that Whitehall and Westminster should set a national living wage that applies right through the country.

Let me finish where I started—with the theoretical debate. There is a big debate about whether a free market system will produce better outcomes than an essentially state-controlled system. All through the world, the most successful economies are free market systems.

[Mr Iain Wright (Hartlepool) (Lab)]

China.

[Kwasi Kwarteng]

In China, the state contributes only 20% of spending. In terms of state spending as a proportion of GDP, China is a far more private sector-driven economy than the UK or other western European countries.

[Mrs Anne Main (in the Chair)]

Order. May I ask the hon. Gentleman to bring his remarks to a close?

[Kwasi Kwarteng]

The notion that we can go back to socialism and that that will somehow increase living standards is false, but I fear that that is what this living wage proposal is about. It is simply trying to impose more regulation, more rules and more of a straitjacket on business, thereby inevitably impeding and impairing our ability to grow the economy and create genuine prosperity.

15:16

[Lisa Nandy (Wigan) (Lab)]

I will try not to be distracted by some of the more bizarre arguments I have just heard. Needless to say, I am unashamed to say that I am a proud socialist, like my hon. Friend the Member for Erith and Thamesmead (Teresa Pearce), and to stand up for the people I represent, who work—

[Kwasi Kwarteng]

Will the hon. Lady give way?

[Lisa Nandy]

I will give way in a moment. Let me finish my sentence. I am unashamed to stand up for the people I represent, who, after a long week at work, do not earn enough to pay for basic necessities.

[Kwasi Kwarteng]

It is rare that we have such candour on this estate, so I am glad to hear what the hon. Lady says. I congratulate her on putting her hand up and saying that she is actually a socialist. That is what this debate is about.

[Lisa Nandy]

Forgive me, but I thought it was about the living wage and the conditions of the lowest paid in this country.

I congratulate my hon. Friend on helping to put some momentum behind an incredibly important issue. Last year, the council in my area, Wigan council, became one of many around the country to pledge to pay the living wage. That will have profound and important consequences for the 565 people who work for it, but who do not currently earn the living wage. For those who were previously on the minimum wage, the change will put an extra £40 a week in their pockets. The significance of that for the lowest paid cannot be overestimated.

I say to Conservative Members that there is no political fissure on this issue, although they seem to be trying to create one. Although the majority of councils across Greater Manchester that have agreed to pay the living wage are Labour run, Trafford council has done the same, and it is run by the Conservatives. In London, of course, the Mayor, Boris Johnson, has also spoken on this issue.

[Kwasi Kwarteng]

Will the hon. Lady give way on that specific point?

[Lisa Nandy]

No, I will not give way, because several people want to speak, and the hon. Gentleman has had his turn.

We know the difference the living wage will make for the 4.4 million people across the country who earn less than £7 an hour, and so do the hon. Gentleman’s colleagues on Conservative-run councils. We also know the difference it will make for their families. The Child Poverty Action Group has calculated that two parents on the minimum wage can meet only 82% of the basic costs of bringing up their children. Essentially, we are telling those parents, “Go to work, work hard and work long hours. When you come home, your children will still go without the basic essentials they need to have decent childhoods.” The Institute for Fiscal Studies calculates that one in four children will grow up in poverty by 2020, which is a disgrace and a scandal. In Greater Manchester, part of which I represent, 40% of children already grow up in poverty.

The failure to pay the living wage strikes at many of the Government’s objectives. Their strategy to tackle child poverty is based on trying to get parents into employment, but 58% of children growing up in poverty have a parent who works. The point is this: if work does not pay, we will not be able to tackle child poverty. As my hon. Friend the Member for Birmingham, Erdington (Jack Dromey) said so eloquently, on behalf of his constituent, Elaine, the living wage means that parents and children get to spend time together. That is why Save the Children and so many other children’s charities support it. There is also a clear economic case. The costs of child poverty have been estimated at some £25 billion a year. Taking action on this issue is an urgent economic necessity, not just a moral one.

I want to take on one of the points that Government Members have made, which is about helping businesses. My hon. Friend the Member for Erith and Thamesmead also alluded to that. In my constituency, the public and private sectors are completely interdependent. Some two thirds of my constituents are employed by small and medium-sized businesses. The other third—until the Government were elected—were employed by the public sector. Small and medium-sized businesses rely on the public sector; they rely on people being in work in it, in decently paid jobs, so that they can spend in their businesses and flourish. The fact that my council has taken a lead and said, “We will ensure that all the people in our employ are able to have enough money to go out and spend it in the local economy,” will be a tremendous boost to the small and medium-sized businesses that I am keen to support.

There is a growing army of people in my constituency who work part-time hours, despite desperately wanting to work for longer, or have zero-hour contracts or are in agency work. As the Joseph Rowntree Foundation’s recent report so compellingly illustrated, the divide between those in work earning poverty pay and those out of work getting poverty benefits is completely false, because those two groups are one and the same, and they are moving in and out of employment at an alarming rate. Trying to create a divide between the private and public sectors and between people in work and out of work is simply false.

Many of the solutions that have appeared with the growth in poverty in the past few years are from charities. One aspect of that rise has been the alarming and distressing growth of food banks around the Greater Manchester area. Many of those food banks are supported by supermarkets and I pay tribute to them for stepping up and doing that, but those very same supermarkets must ensure that they are not part of the problem, and that they do not refuse to take people on for anything other than part-time work or to pay a living wage. That would help stimulate the economy and meet their employees’ basic needs.

Finally, to set this in the context of what has happened largely over the course of my lifetime, we have seen the earnings of people at the bottom of society stagnate while the earnings of those at the very top have increased significantly. Between 1986 and 2012, incomes in the top 10% increased by 81%, while the bottom 10% increased by only 47%. Research has shown that if the national minimum wage had kept pace with the salaries of CEOs in FTSE 100 companies since 1999, it would now stand at £18.89 an hour.

We know that inequality is bad for society—that has been compellingly demonstrated by “The Spirit Level”—and we see it all the time in our own constituencies. Several Members of Parliament, including my right hon. Friend the Member for Tottenham (Mr Lammy) and I, have been trying to advance the case that, as in America, the pay ratios of the top two average earners in FTSE 100 companies should be published on the front page of their annual reports, so that we can see whether companies are fairly distributing reward. The trouble with that proposal is that, although it may compress and restrain wages at the top, it does not do very much for the lowest paid.

The living wage is becoming an urgent priority in Wigan, in Erith and Thamesmead and up and down the country. The living wage would be an effective and simple way of helping tackle the lengthening queues at food banks, the growing numbers of children growing up in poverty and the families that lack the means to make ends meet. My hon. Friend the Member for Erith and Thamesmead talked about ironing out some of the difficulties that have been raised by the living wage. The situation should not be allowed to continue; it is immoral and bad economics. I would like the Minister to begin by committing to at least ensuring that the living wage is extended to the Government’s employees across the board and to working with companies contracted by Government so that they also pay the living wage to their staff.

15:24

[Steve Reed (Croydon North) (Lab)]

I thank my hon. Friend the Member for Erith and Thamesmead (Teresa Pearce) for introducing the debate. It is important, not least because life is becoming increasingly stressful for many low-paid workers.

The Equality and Human Rights Commission’s 2011 review of home care for older people highlighted cases of physical abuse, theft, neglect and disregard for privacy and dignity. Last April, the Low Pay Commission reported that 10% of home care workers are paid below the minimum wage, let alone the living wage, with some workers paid per visit rather than per hour, with no reimbursement of travel costs.

There is a link between the findings of those two high-profile studies. Too many home care workers, encouraged to complete each visit as quickly as possible and therefore with their pay as low as possible, are unable to form relationships with the older people they care for and feel pressured to complete the visit too quickly. That dehumanises the service being provided and makes instances of neglect more likely. The worker has little or no job satisfaction, little incentive to do a better job, little spare cash at the end of a tough working week and increasing levels of stress. Unsurprisingly, levels of sickness absence are high and so is employee turnover. When the stress gets too much and illness follows, some workers move on to long-term sickness benefit. It is not only care workers; similar examples exist in almost any low-paid, high-stress employment. We are, in effect, pathologising poverty.

There is another way. Organisations such as Care and Share Associates and Sunderland Home Care Associates have found that they can cut both sick leave and staff turnover by giving their staff better terms and conditions, including liveable incomes. The quality of care provided improves; sickness, including long-term sickness and incapacity, reduces, and the cost to the rest of society is lowered, while the individual worker’s quality of life improves. Many Labour councils in London, including Lewisham, Hackney and Lambeth, have recognised the value of paying the London living wage and have been accredited as living wage employers. Despite support from the Conservative Mayor of London, it is disappointing that no Conservative-controlled councils in London have yet been accredited. I support the campaign by London Citizens, which is part of Citizens UK, alongside The East London Communities Organisation, to persuade Croydon council, which covers my constituency, to sign up to the living wage, both for its own directly employed staff and for staff employed by contractors and sub-contractors.

Employers who implement the living wage have reported improved recruitment and retention of staff, higher work morale and increased productivity. Those all represent increased value for money for the services provided, which is important in these straitened times. Lambeth council found—I was leading it at the time—that when it tendered its facilities management contract on a living wage basis, the market responded positively and came up with innovative ways to meet the requirement within the funds available and without loss of jobs. Many public services are procured through consortia, and we can encourage the market to innovate in ways that allow workers the decency of a living wage by harnessing the purchasing power of those groupings. It is important that the Government recognise their role in encouraging that to happen, because leaving it to the market alone will not result in all those benefits.

There is immense value in ensuring that work pays. People in work should never be forced to live in poverty. That is not just a moral argument; it is about value for money and improving the quality of public services. There are costs to society as a whole, including financial ones, as well as to the individual workers affected, if we force hard-working people into poverty and illness by paying them less than is necessary to meet the basic needs of their lives.

15:28

[John McDonnell (Hayes and Harlington) (Lab)]

My concern before Christmas, when the welfare Bill debate started, was the absolute gulf between the views of Members and some of the constituents whom we represent. I organised a group of cleaners to come into the House of Commons before Christmas. They were represented by the National Union of Rail, Maritime and Transport Workers, the Industrial Workers of Great Britain, the Public and Commercial Services Union and others. I asked the cleaners to explain what was happening to them at the time, because for them, the market is not working.

I went on the picket lines outside Schroders bank in the City and outside John Lewis as well, whose cleaners are also paid the minimum wage or, in some instances, just above. I found that all of them were doing extra shifts—on average two extra a week. Their working hours were then 50 to 60 hours a week, at a minimum. Some 50% of them had second jobs and some had three jobs. The cleaners were getting up at 3 or 4 o’clock in the morning and travelling to work by bus because the tube was too expensive for them. Some of them worked until 7, 8, 9 or 10 o’clock at night, which was absolutely staggering.

One group was employed by a company called trainpeople. They brought their contracts along with them. They were not on zero-hours contracts but on eight-hour contracts, so they were guaranteed only eight hours of work a week. They were on a minimum wage; they had to sign up to travel to anywhere in the country to work; they were on a probation period of 12 weeks; and if they left during that 12-week period they themselves had to pay £200 back to the company. Again, the experiences of these people are just absolutely staggering.

I was then involved with some of the other London living wage campaigns. For example, we won at the London School of Economics, securing the London living wage there. However, what then happened was that the company involved cut the hours of the other workers by 20%. In other words, they were trying to consolidate their profits by cutting jobs and cutting work themselves.

Also, we are consistently finding that, when the living wage goes up—Boris Johnson announced the figure of £8.55 and I am grateful to him for the support that he has given throughout this campaign—the companies involved delay payment of the increase of the wage, too. That is another way of keeping wages suppressed, while at the same time maximising their profits.

The general expression that was used by the cleaners in these cases was, “We are treated like dirt.” They also said, “We are managed in a brutal way, often harassed and have no alternatives.”

There is now a new alliance being put together, in terms of trade unions supporting the London living wage campaign, because people cannot take it any more. Yes, people are seeking to organise and to negotiate, but they are also taking direct action now. The PCS, the IWGB, the RMT and others closed Oxford street before Christmas, because they could not get into negotiations with a company to increase the wages that its employees were on; the employees were arguing for an increase in their wages as they could not survive on their existing wages.

We now have direct action campaigns, such as the UK Uncut campaign, whereby firms are being occupied by workers because those workers are not getting any response from the companies themselves to their requests to increase their wages and improve their conditions. There are other things going on. One union is now planning to set up soup kitchens outside the homes of directors of companies that are making vast profits but paying poverty wages to their workers.

All that activity confirms that the market is not working and that there is a need for state intervention at times—not always, but at times—at least to secure people’s ability to survive in a civilised society with some decency. That is why I welcome this debate today, which will further that campaign.

15:30

[Meg Hillier (Hackney South and Shoreditch) (Lab/Co-op)]

Thank you very much, Mrs Main, for calling me to speak. It is a pleasure to serve under your chairmanship.

I congratulate my hon. Friend the Member for Erith and Thamesmead (Teresa Pearce) on securing this debate on a very important issue. I represent a constituency in the part of London—east London—that was the birthplace of the living wage campaign. I think that we would all agree—Labour Members would certainly agree and perhaps even some Government Members would agree— that a fair wage for a fair day’s work is something that we support. I was slightly disturbed by the hon. Member for Christchurch (Mr Chope) seemingly comparing people abroad working for £1 an hour or less with people here in Britain, as though that was an option for people here. I hope that he did not mean it quite that way, but that is how it came across.

Let us remember that it was the Conservative Government of the ’80s who abolished the mechanism for setting fair pay, the wages council. I am very proud that I am a Labour MP and that it was a Labour Government who introduced the minimum wage because of the abysmal failure of having a complete free rein on wages.

[Kwasi Kwarteng]

Is the hon. Lady suggesting that we go back to the ’70s and the kinds of industrial relations that we had then?

[Meg Hillier]

I cannot understand how the hon. Gentleman makes a jump to reach that conclusion from my suggesting that we do not want to go back to a complete free rein on pay. That is not what I am saying at all, as he well knows. It is mischievous of him to suggest that I am saying that.

[John McDonnell]

Can I suggest that what the hon. Gentleman is saying is that he wants a free market but he does not want free trade unions?

[Meg Hillier]

I think that we can certainly infer that from the hon. Gentleman’s comments.

[Several hon. Members]

rose—

[Meg Hillier]

I will just make a little progress before I take interventions.

I am also delighted that it is my party that is seeking to ensure that, in constituencies such as my own, a living wage will enable people to work. Let us be clear about something, before we run away with the idea that a living wage will be very damaging to lots of small businesses. A living wage is not something that a Labour Government would force upon business, or certainly not upon small businesses. There are businesses such as Moo.com in Tech city, which employs people in its warehouse in EC2, providing good, valuable jobs locally. Those people are on the minimum wage for the first part of their contract, until they have been there for a while, and then the company increases their wage. Flexibility is built into the Labour policy to ensure that the system will work.

I will offer one word of caution. We need to look at the hourly gross rate of pay. That is obviously important, because it reflects the day-to-day money that people take home to live on, but we also need to consider pensions and other work benefits. When we assess what is fair pay, those benefits need to be brought into the round. My point is that, if a company pays a little lower than the living wage but pays a pension, we need to be watchful. As a Labour Government, we will need to be clear that the pressure, or indeed the kudos, of paying the living wage does not lead to the erosion of other benefits that are a type of payment in kind. My hon. Friend the Member for Hayes and Harlington (John McDonnell) made some very good points about that.

[Kwasi Kwarteng]

rose—

[Meg Hillier]

I will give way one last time.

[Kwasi Kwarteng]

I am very grateful to the hon. Lady for giving way; she is being very generous in allowing interventions. What would she think about a Member of Parliament, for example, or someone else advertising for an apprentice at £3 an hour, which I understand one of her colleagues on the Labour Benches has done?

[Meg Hillier]

I would be appalled, and indeed I am appalled. I am part of the campaign in Parliament to ensure that all of us—from whatever party—pay people in our offices a fair rate. I like to think that I lead by example on that; in fact, I know I lead by example on the issue, alongside a number of my other colleagues. I think that we can all agree that what the hon. Gentleman just referred to is not something that we would want to see in the mother of Parliaments.

Let me relate this debate to real life, because we could have a theoretical discussion in Parliament about the economics of the issue. A kitchen porter came to my surgery and he was very upset. Being a kitchen porter is low-wage employment, but he was seeking work because he was out of work. However, his jobcentre was asking him to travel further afield in order to take a job as a kitchen porter. One could say that that was quite reasonable. However, because of the low wages for that type of job, the extra costs to travel out of the borough and the extra child care needed because of the longer hours spent travelling, it was not a viable option.

Let us be clear—that man is no shirker. However, the hon. Member for Christchurch suggests that the market would solve that problem, perhaps by single people taking that work. However, my constituent has a family to support; he wants to support them but is unable to do so under the current regime, except that the state will subsidise matters to a degree by providing benefits. So we are talking in the round here. There is always a cost to the state, whichever way we do things, and actually giving people the dignity of earning a living wage with which they can support their family and make choices for their family on their own is very much at the heart of Labour’s policy in this area.

I could add to that kitchen porter many other of my constituents, even some on higher salaries. The tube price hikes and the bus fare hikes by the Mayor of London, and the cost-capping—we had the vote yesterday in Parliament on in-work benefits—all put pressures on people’s ability to pay their costs of living. That is why a living wage gives people the dignity of being able to make their own choices.

We also need to look at national insurance contributions. That is something that we will need to work through as a party, as we flesh out the policy on the living wage. NICs are now more than 13% of total gross pay for small employers, which is more than employees contribute. The on-costs for a small employer are significant and we need to think about how we might want to encourage and support small employers, to get people into work, yes, but also to increase their pay gradually so that they are on a living wage. There is a real interest for business, but some of those start-ups in my constituency will be worried if they foresee a suggestion that overnight they will have to increase wages. We need to handle that issue carefully, because the jobs that are being created in my constituency and elsewhere are important.

I am proud that my local council, Hackney council, is one of those councils that are accredited as paying the living wage, because we in Hackney see the impact on people’s lives of that policy. We are living what is happening. However, it was interesting that when I asked the Deputy Prime Minister at Prime Minister’s questions in November how many Liberal Democrat councils were paying the living wage, answer came there none.

[Mr Iain Wright]

Where are the Liberal Democrats?

[Meg Hillier]

Indeed. Today, not a single Liberal Democrat MP is here in Westminster Hall, even though the Deputy Prime Minister has pledged his support for the policy of a living wage; he has pledged his support, but words can be very empty.

As I say, there is not a single Liberal Democrat MP here in Westminster Hall today, but since November I have discovered that there is actually one small Liberal Democrat-run district council that pays the living wage. In a show of cross-party support, we should congratulate that council on that and hope that it has some influence on the party leader in ensuring that a living wage system is rolled out more widely.

We also need to look at the most profitable companies, which in London are being subsidised—as I mentioned earlier—by taxpayers through tax credits and benefits. There is not a nil cost to lower pay. In fact, it was the current Chief Whip of the Government, the right hon. Member for North West Hampshire (Sir George Young), who talked about housing benefit “taking the strain” back in the ’90s. Housing benefit has still been “taking the strain” despite attempts by both the last Labour Government and this Government to change the approach. It is housing benefit that subsidised so many people in their lifestyle, because wages are not high enough.

In London, we cannot raise wages enough to cover all housing costs; I recognise that, before Government Members leap up and suggest that that is what I am saying. I am not saying that, but we must recognise that people need to be paid a rate that they can actually afford to live on and that there is no nil cost to the Exchequer.

Labour’s voluntary model is a moderate one. It says to companies, “Publish. Be transparent about who you’re paying and what you’re paying them.” People can then make judgments for themselves. We have already seen some companies, such as KPMG, lead by example, and if some can do it why not all of them?

15:39

[Mr Iain Wright (Hartlepool) (Lab)]

It is a pleasure to serve under your chairmanship, Mrs Main, and I wish you and all Members who have contributed to the debate a happy new year, particularly my hon. Friend the Member for Erith and Thamesmead (Teresa Pearce). I congratulate her on securing such an important and passionate debate.

As my hon. Friend mentioned, the living wage is an important means by which greater dignity and fairness can be offered to people, by lifting them and their families out of poverty while at the same time helping them to become less reliant on state benefits. She talked, as did my hon. Friends the Members for Wigan (Lisa Nandy) and for Hackney South and Shoreditch (Meg Hillier), about decent, hard-working people doing the right thing and going out to work to provide for themselves and their families. People having aspirations, and striving for a better future for themselves, their families, their communities and their country, should be rewarded. Hard work and effort should be appropriately remunerated in the form of a decent and dignified rate of pay, to avoid the misery and desperation of in-work poverty.

As Labour Members have mentioned several times, the national minimum wage, introduced by a Labour Government, has done a huge amount by providing the protection of a legal pay floor for more than 1 million people. However, although the minimum wage is an important achievement, it should not, as my right hon. Friend the Leader of the Opposition has said, be the summit of our ambitions. Indeed, he has been at the forefront of discussions about the living wage.

The living wage complements and reinforces the vision of a one-nation economy, in which everyone in society plays a part and has a stake, and where prosperity is fairly shared. I would like to think that this country, and the manner in which its economy is organised, has the ability to move on from an old-fashioned and outdated form of capitalism, which is what we have heard from the hon. Members for Christchurch (Mr Chope) and for Spelthorne (Kwasi Kwarteng) today. That form of capitalism sees a confrontational, divisive and somewhat inefficient “them and us” attitude between employee and employer, which prioritises the erosion of employment rights. A race to the bottom in relation to workers’ rights or wage rates will not help this country to improve our competitive position in the 21st-century global economy, or achieve greater fairness and social justice. I do not understand why people on the highest possible rate of pay are motivated by being paid more, while people on the lowest possible rate, who are struggling barely to make a living and feed their families, are motivated by being paid less. That seems fundamentally wrong.

[Kwasi Kwarteng]

Is the hon. Gentleman suggesting that state legislation will make Britain more competitive in the global economy?

[Mr Wright]

As I said, the national minimum wage has helped to lift people out of poverty, and as my hon. Friend the Member for Birmingham, Erdington (Jack Dromey) said, people on the lowest levels of pay tend to spend their money in the economy. The multiplier effect will, therefore, probably help benefits, jobs, prospects and economic positions—it certainly has a beneficial role to play in the economy.

Several hon. Friends have mentioned that local authorities, such as Islington, Lambeth—which was very well led by my hon. Friend the Member for Croydon North (Steve Reed)—Wigan, Camden, Oxford, Preston, Southwark and Hackney have introduced a living wage, and others are set to follow, including Newcastle city council in my own north-east region. In difficult financial times for local government, those local authorities should be applauded for doing the right thing for their employees. I hope that, despite the appalling financial settlement it received from the Government last month—the 2.2% cut being the highest in the region—my own local authority, Hartlepool borough council, will be able to follow suit.

This should not, however, be about local government, or even about the public sector—such an approach is entirely wrong. Wherever possible, a living wage should be adopted in the private sector. It might be more difficult for small businesses, as my hon. Friend the Member for Hackney South and Shoreditch mentioned, but it should be considered almost automatically by larger enterprises. Credit should be given to the likes of Barclays, Deutsche bank, PricewaterhouseCoopers and KPMG, which have become living wage employers. The nature of those firms’ business models and the sectors in which they operate, as well as the size of the companies, might mean that they have relatively fewer low-paid workers than other companies, particularly in sectors such as retail. Therefore, all credit must be given to Westfield shopping centre, Lush and the InterContinental Hotels Group, whose business models, on adopting a living wage, will rely more heavily on low-paid workers.

Hon. Members, particularly my hon. Friend who introduced the debate, have rightly mentioned the net savings to the Exchequer as a result of the implementation of a living wage. My hon. Friend mentioned that research by the Resolution Foundation and the Institute for Public Policy Research found that the Treasury would benefit by about £3.6 billion each year in the form of higher income tax payments and national insurance contributions, and lower benefits spending.

As my hon. Friend the Member for Croydon North and other Members have said, there is also anecdotal evidence that businesses will benefit from the introduction of a living wage, and will become more productive. There will be improved staff recruitment and retention and associated cost savings, higher worker morale and therefore improved productivity, and an enhanced corporate reputation in the marketplace. Wendy Cuthbert, head of UK corporate real estate services for Barclays, has said that since the company adopted the living wage in 2007 catering staff retention rates have increased to 77%, compared to an industry norm of 54%, and the rates for cleaning staff have increased to 92%, compared to the industry average of just 35%. She has commented:

“Now when we train our staff we know that the money isn’t being wasted. They don’t want to leave and they no longer have to do two jobs just to survive...Employers need to look at the whole cost of employment not just the cost-per-hour. We don’t understand why more companies don’t do this.”

Guy Stallard, head of facilities at KPMG, has stated:

“We’ve found that paying the Living Wage is a smart business move as increasing wages has reduced staff turnover and absenteeism, whilst productivity and professionalism have subsequently increased.”

I have a number of questions for the Minister. On Government policy, the Minister in the other place, the one who did not resign yesterday, the noble Lord Gardiner of Kimble, has confirmed that the

“Government back the idea of a living wage and we encourage businesses, where possible, to take it up.”—[Official Report, House of Lords, 8 November 2012; Vol. 740, c. 1092.]

Can the Minister confirm that that is still the case and that it is Government policy, despite the comments from his Back Benchers this afternoon?

[Kwasi Kwarteng]

No one has an issue with individual companies deciding to pay the living wage. That is entirely how a market should work.

[Mr Wright]

Let me come on to that in my questions to the Minister.

How is that encouragement that was mentioned by the Government in the other place manifesting itself in tangible and practical action? What are the Government actually doing to encourage businesses to consider becoming living wage employers? What meetings has the Minister had with businesses and business organisations to discuss the matter? Has he met with colleagues across Government, such as the Secretary of State for Communities and Local Government, to ascertain how organisations in other sectors have successfully implemented a living wage? Has he, or have his officials, met with Citizens UK, for example, to discuss what practical steps can be taken? Citizens UK is an organisation that is doing an awful lot of work in relation to the living wage campaign. Has the Minister considered a promotional campaign, sponsored by his Department, to raise awareness about the issue with businesses? Has he considered amending corporate governance rules, to ensure that large listed companies can report specifically on whether they have paid the living wage, as a means of encouraging take-up by larger companies?

The Prime Minister has said:

“Where government leads, others will follow”,

and business will legitimately look to the Government to see whether their actions match their rhetoric. As I understand it, and as has been said, the Department for Work and Pensions is the only Department that has announced that it will pay the London living wage, although two others, the Cabinet Office and the Ministry of Justice, might follow suit. Could the Minister inform the House how many Departments plan to pay the living wage, and when? Given that the Minister is in the Department for Business, Innovation and Skills, and another Minister has said that the Government will encourage businesses to take up the living wage, does the Minister’s own Department have any plans to ensure that all its employees and contracted workers are paid the living wage? What work is he doing with non-departmental public bodies sponsored by his Department to look into the possibility of their becoming living wage employers too?

I raised earlier the issue of research and the collection of evidence on the savings to the public purse and the positive impact on business. Has the Minister commissioned any research into the effect of the living wage, including the possible social, economic and business impacts?

One of the most powerful levers at the Government’s disposal is not regulation or legislation but procurement, and that has been mentioned a number of times in the debate today. My right hon. Friend the Leader of the Opposition has suggested that Departments could give preferential treatment to contractors who pay the living wage. My understanding is that No. 10 quickly dismissed my right hon. Friend’s suggestion, stating that such a move would breach EU procurement rules. The European Commission, however, has explicitly stated:

“Living-wage conditions may be included in the contract performance clauses of a public procurement contract ‘provided they are not directly or indirectly discriminatory and are indicated in the contract notice or in the contract documents’.”

There is no problem or obstacle in European law, so will the Minister confirm that what the European Commission said is already the case? In that light, will he outline the actions he will take to ensure that employers who pay the living wage are considered favourably in public procurement?

The living wage is an important social and economic lever in which everyone has a stake, people in work have a more dignified and higher standard of living than would otherwise be the case and prosperity is better and more fairly shared. I hope that the Minister will outline how he will advance the introduction of a living wage across businesses and across society more generally.

15:50

[The Minister of State, Department for Business, Innovation and Skills (Michael Fallon)]

I congratulate the hon. Member for Erith and Thamesmead (Teresa Pearce) on securing this debate. She has long championed the living wage, and it is a tribute to her work that she has been able to attract such a large participation in today’s debate and, as the hon. Member for Hartlepool (Mr Wright) said, such a passionate exchange of views. The living wage is a subject that arouses great passions.

The hon. Member for Hackney South and Shoreditch (Meg Hillier) asked about the absence of Liberal Democrat Members. I cannot speak for the Liberal Democrats—I am not very good at that—but the Under-Secretary of State for Business, Innovation and Skills, my hon. Friend the Member for East Dunbartonshire (Jo Swinson), is responsible for this portfolio in the Department for Business, Innovation and Skills, and she is answering the debate in the main Chamber at this very moment, which is why, Mrs Main, you and the others in attendance have to put up with a stand-in.

We would all like people to be paid more, but obviously there is concern that requiring all businesses, large and small, to pay a living wage as proposed would price people out of work, particularly young people. Encouragement is a better approach than compulsion, because the alternative would reduce the flexibility of businesses and could ultimately be bad for jobs.

We already have a national minimum wage that we require all businesses to pay, and the Government fully support that. The minimum wage is the national rate that the Government of the day—including the previous Labour Government—judge, based on the independent Low Pay Commission’s recommendations, as striking the appropriate statutory balance, trying to increase workers’ take-home pay without damaging employment or other elements such as prices. The adult national minimum wage that we inherited, £5.80 an hour, has now reached £6.19 an hour. That is a 6.7% increase, which is faster than the growth in average earnings over the same period.

The Government have targeted further help at the take-home pay of the low-paid by cutting their taxes. When the coalition Government came into power, the personal tax allowance stood at just £6,475. The Government are committed to making the first £10,000 of income free from income tax by the end of the Parliament. April 2013 will see the next step of that commitment: the personal allowance will increase by £1,335, the largest ever increase, to £9,440 to support hard-working individuals. Those tax cuts for the low-paid have taken 2 million people out of income tax altogether. Those still paying tax will be taking home £57 more each week in April and more than £67 more each week by the end of the Parliament. Under this Government, people working full time on the minimum wage will have seen their income tax bill cut in half.

In difficult times, the Government have, therefore, clearly given priority to the lowest-paid by providing strong support for the national minimum wage, which aims to maximise the pay of low-paid workers without damaging employment, and tax cuts focused directly on the low-paid through raising the tax allowance to £10,000 a year by the end of the Parliament.

That is not all. The Government are continuing to take steps to support households with the cost of living. We have frozen council tax for the third year running. We have cancelled the 3p fuel duty increase planned for this month—average pump prices are 10p a litre lower than under Labour’s fuel duty plans—and we have capped rail fare increases, which will benefit 250,000 annual season ticket holders. That is in marked contrast to Labour, which doubled council tax, doubled gas prices and increased fuel duty 12 times.

Raising the minimum hourly rate to the proposed living wage rate would have consequences. If those consequences make things worse rather than better, it would make no sense to introduce the living wage. The biggest danger is pricing people out of work because the business concerned cannot sustain the higher labour costs of the living wage. In that case, the individuals who lose out are socially excluded from the world of work; the business will be less able to compete and earn profits; and the Government will lose out because growth is lower, tax receipts are less and benefit payments are higher.

The national minimum wage raises awkward questions about the proposed living wage. In particular, the remit that Parliament, under the previous Labour Government, gave to the Low Pay Commission has the primary aim of setting the maximum hourly national rate possible without any adverse effect on employment. The current adult national minimum wage of £6.19 an hour is substantially below the suggested 2011 living wage rate outside London of £7.45 and even further below the £8.55 London rate. Requiring all businesses to pay the living wage would increase wage costs by approximately 20% outside London and by approximately 38% in London. That is without taking into account other increases in labour costs, such as national insurance.

The picture becomes much starker when we look at the position of those under the age of 21. There are separate, lower, minimum wage rates for younger workers because of the previous Government’s concern that a higher rate would damage their employment prospects; there is no such distinction in the proposed living wage. That means that the difference between the minimum wage and the proposed living wage for someone working in London aged between 18 and 20 would be some £3.57, an increase of 72%. For someone aged between 16 and 17, the difference would be £4.87, an increase of 130%.

The Low Pay Commission is concerned to ensure that minimum wage increases do not have adverse effects on employment. The commission’s most recent recommendations have been for a 1.8% increase in the adult rate and a freeze in the youth rates. It stated that

“we concluded that in the current difficult economic circumstances caution is essential.”

These differences imply that if the proposed living wage rates were imposed universally, they would inevitably price some people out of work. Those who keep their jobs will receive at least the increased living wage, of course, but they might prefer to keep more of their colleagues working alongside them. The Government, like the previous Government, believe there is no case for imposing a higher minimum wage across the country by statute.

Some argue that it would be easier to implement the living wage in the public sector than in the private sector. That is only true, however, if the effect of implementing the living wage does not lead to higher procurement costs. Otherwise, implementing the deficit-reduction plan will be more difficult, with either greater public sector job losses elsewhere or higher taxes, which would make it more difficult to reduce the taxes of the lower-paid.

Opposition Members have claimed the living wage is an issue of fairness, but last night we saw that the Labour party wants benefits to rise faster than workers’ wages, which is not fair. Labour’s plan would inevitably mean more borrowing and more debt.

In contrast, our priority is to increase the take-home pay of low-paid people. The key elements of that are the national minimum wage and raising the tax allowance to £10,000 by the end of the Parliament. We believe that workers and businesses are best placed to determine the pay and working conditions that both suit the workers and deliver success for the business. The level of unemployment among young people that we inherited is already too high.

Special Educational Needs (Wirral)

Wednesday 9th January 2013 Westminster Hall

16:00

[Alison McGovern (Wirral South) (Lab)]

I am grateful for the opportunity to have this debate and hear the Government’s view. The issue affects a few people in my constituency, but its importance is in no way diminished by the number of people affected. Those of us who have listened to the parents of children with significant disabilities can never meet them without feeling a great responsibility to listen to them and understand their concerns, which I will attempt to relay in this debate.

I am not a specialist by any means in special educational needs and assisting children with disabilities and their families, which is another reason why I requested the debate, but whenever I meet my constituents who have children with profound and multiple learning disabilities, I am struck by their commitment and dedication. I have no doubt that every MP thinks that their constituents are special and important, but those constituents of mine are some of the most dedicated people in our society, and they deserve our full respect and appreciation. Their children are deeply important members of our community.

For those reasons, I want to refer to education from the ages of two to 19 in schools in Wirral and specifically the Lyndale school, which I have visited several times, as did my predecessor. I am sure that I speak for him when I say that we have been struck in recent years by how fantastic a place the school is. It has about 20 children, so it is a very small school, and it specialises in education for children with profound and multiple learning difficulties. They are the children coping with the most complex difficulties and profound disabilities. All 20 of them use wheelchairs, seven of the children require oxygen, six require suctioning and many have epilepsy.

In 2010, I visited the school to present it with an award from a national epilepsy charity for the care that it gives to children with epilepsy. I was pleased and proud to do so. Although the school is small, it is an expert environment. I understand that some of the children need the help of up to 30 professionals. They may come into contact with lots of different people, which can be stressful. Parents must constantly retell their child’s story. I understand how frustrating, difficult and at times upsetting they must find that.

Having listened to those parents, I understand why they can conclude that the best environment in which to educate their child is one that is more constant than the primary-secondary model. I will refer to the change between primary school, which serves the ages of two to 11, and secondary school, which serves the age of 11 upwards, as transition. Parents have described to me their uncertainty whether they want transition for their child. It can be stressful. They have explained to me that their child’s needs are so complex that they feel that a two-to-19 environment might be better. It is not specifically about a fixed idea that their child should be in one environment throughout that age range; rather, it is the idea that the transition should come at a time that is right for the child and that there should be flexibility around the needs of the family rather than a transition that is decided on in advance.

I should say at this point that although I am not an expert, I understand that the question of a transition for all children is one on which different professionals take different views. I do not presume to know the right answer; my aim is to relay to the Government the views of my constituents. They feel that a transition is not right for them, and they would like Wirral council to consider helping the Lyndale school become two-to-19 if it wishes. Clearly, it is not for the Minister to say what the right decision is for Wirral to take, but I would be grateful for advice and assistance from the Government—I will come to specific asks—to help my constituents to address the question.

I understand that a significant minority of special schools in the country are two-to-19 schools. In its 2006 report on special educational needs, Ofsted found that the crucial factor in the successful education of children with special needs is not the type of school but the quality of the environment and the education that they receive. That makes sense to me. Having visited various schools, I know that what is important is not necessarily the name on the door or the structure within which the school operates, but rather the expertise of the people assisting the children. That is reflected in my constituents’ desire for their children to be looked after in a way that centres on their needs. They are children for whom the challenges are greatest. We as a community have the biggest responsibility to assist them, given the complexity of their needs.

Expertise states that the transition between primary and secondary school is less of a priority for parents than their children’s specific needs. Those views should be listened to, as we should listen to all parents about their concerns for their child’s needs. I hope that there is cross-party acceptance of that basic principle. As has been explained to me, some professionals in the Wirral view transition as important. However, one of our neighbouring authorities, Cheshire West and Chester, has several two-to-19 schools. If a school such as the Lyndale, which has expertise, wants to go in that direction, it is important to consider how we can empower it to do so.

Before I delineate how I hope that the Government, the Minister and civil servants might help us address the concerns of parents at the Lyndale school, I note that the funding system for all schools—specifically, special schools—is changing. As we can all understand, those changes will affect the smallest and most specialised schools the most. A small fluctuation in numbers can have large consequences for them. Additionally, because those small specialist schools assist children with the greatest and most complicated difficulties, such changes can cause a lot of stress that does not happen in a normal school environment. I have tried to consider the issue in the light of future funding changes and how they might force a need for change.

I have two questions for the Minister and a request for help. First, professionals take different views on whether a transition is required or advisable and parents feel differently about that. The assistance that we can give children with disabilities is changing all the time and expertise is developing. I should be grateful to the Minister if he confirmed whether the Department can help us in Wirral with some expert advice on whether to transition and how a two-to-19 environment might assist children with profound and multiple learning difficulties with the most complex of needs. Will he say how we can access more advice and whether there are national specialists who may be able to help us in the Wirral?

I am conscious that nearby authorities do things slightly differently and that schools throughout the country may have already looked at how to assist children with profound and multiple learning difficulties and considered whether they should transition. Ministers and civil servants may be aware of other factors, in terms of the advances that are being made helping children facing the most difficult educational challenges.

Secondly, how will the new funding arrangements affect the smallest schools? No doubt, the Government will be aware of other small schools—for example, those in rural areas where it is not realistic to ask children to travel—when considering the new funding arrangements. I should also like the Minister to say how this impact can be borne in mind in relation to schools, such as Lyndale, where parents already deal with significant challenges: their working lives are made more complex by their family’s needs and the rest of their family life will be affected by the needs of one child. It is our duty, as politicians, to understand those needs and do everything that we can to support those children and the wider family and help parents—having listened to and understood them—to make decisions about their child’s education.

Funding changes will affect the smallest schools the most, particularly special schools, and parents of children at such schools will have more stresses, and so on, to think about than the average family. I should be grateful to the Minister if he said what has been considered in respect of how funding changes will affect schools, including the Lyndale in my constituency.

We have a responsibility to give care and attention to children with profound and multiple learning difficulties, to understand them as individuals and to try to give them the most expert care that we can. To do that we need to listen to their parents, who know them best and understand their needs. We in the Wirral are wrestling with the somewhat technical point about whether there should be transition. I ask the Minister and the Government what expertise they can help to bring to bear in that regard, so that we can resolve this question and truly give the parents of those children the best possible service.

16:14

[The Parliamentary Under-Secretary of State for Education (Mr Edward Timpson)]

I congratulate the hon. Member for Wirral South (Alison McGovern) on securing this important debate. As a near neighbour, I thank her both for showing a profound interest in what is happening in her constituency with regard to the provision for children and young people with special educational needs and for discussing the issue more generally, as it affects the close to 1.62 million children who are designated as having special educational needs.

Before I say what the Government are doing to deal with current systemic difficulties, I should like to deal with the two points that the hon. Lady raised. Clearly, she has taken a keen interest in the situation at Lyndale special school and has spoken to parents who are caring for their children with profound difficulties and disabilities and coping with those things. I put on record my appreciation and praise for the dedication that they show as carers. Sometimes, it is easy to underestimate that role, but it is not something that they have to do on the odd day; they do it day to day, continuously. The short-break money that we have provided—about £800 million—is an important part of the package available to parents, such as those of children at the Lyndale school, to ensure that they get the support that they need, so that they can continue to provide the best possible care for their children.

It is not for the Government to interfere in the circumstances surrounding the school and the process that Wirral council is also grappling with. The school has other freedoms available to it and may want to consider applying to the Secretary of State for the freedom to change its status as a school through the academy process. On the evidence and expert advice about the periods of transition and what the right model is for certain children who require specialist provision in an educational environment, there is a wealth of research out there and differing views about whether such provision should be in the mainstream or in a specialist environment.

The hon. Lady requested support from the Department so that she and her constituents might be better informed about what works best. I can offer an arrangement for her to meet officials in my Department, particularly the professional SEN adviser, to discuss the matter in a little more detail, providing her with opportunities to explore it further and to provide some answers to questions asked by her and her constituents about how the best provision for the children can manifest itself in the type of environment that is available to them locally.

We are going through a period of funding reform, as the hon. Lady mentioned, but the funding arrangements for special schools will combine place funding with funding for each individual child, so there is still emphasis on the individual child in deciding the overall sum that would be available to meet the needs and support required for that child through education. That place funding protects schools, and funding for individual children ensures that resources are used to meet their needs. It is incumbent on local authorities to have a good dialogue with all schools, including the Lyndale special school, to ensure that the transition—we are in the realms of transition—from the current funding regime to the new one does not undermine the potential for the Lyndale special school to provide what the hon. Lady has said is an expert environment—I have no reason to think that that is incorrect—for some children with profound difficulties.

The hon. Lady mentioned parents’ struggles with the SEN system—that reflects the outcome of the consultation and Green Paper exercise that the Government have undertaken—particularly parents’ and children’s views being taken seriously, and being heavily involved in the initial assessment process and the delivery and implementation of what, at the moment, is called a statement but will be called an education, health and care plan.

The hon. Lady also mentioned points of transition, where children move from one part of their education to another, particularly at key stages, such as from primary to secondary and on to further education. At the moment, there is a separate system. A hallmark of the reforms that we want to introduce is that it will become a single system, with a single assessment process. Many parents, including those in the hon. Lady’s constituency, will welcome that.

The Government’s aim is that all children and young people with special educational needs or disabilities have the opportunity to reach their full potential in school and that they are supported to make a successful transition into adulthood, whether in employment, further or higher education, or training. With the current system not working well enough for parents or for children and young people with SEN, it is important that we address that. It has been more than 30 years since the last reform to the SEN system.

As the hon. Lady said, the system often works against the wishes of families, and although it is now much more child-centred, we must not forget that parents and carers form much of that child’s life and we must ensure that they also get the necessary support. Such support is often identified too late. Families are made to put up with a culture of low expectations about what their child can achieve at school, and that is illustrated by the huge gap in attainment at every key stage between children with SEN and their peers. That gap is persistent, and although there have been some notable improvements in recent years, especially with the assistance of the achievement for all model—the evidence-based model supported and funded by the Government that is now in more than 1,000 schools—the gap is still too great, and more needs to be done to bridge it.

In the Green Paper, “Support and aspiration: A new approach to Special Educational Needs and Disability”, published last year, a strong case was made for moving to a single system that goes not only from two to 19, but from nought to 25, because early and continued support is more likely to produce the outcomes that we want for children and young people who find themselves needing that extra support to achieve the educational attainment that we all know they can reach.

It is important not only that the system picks up and identifies as early as possible the support that is needed, but that that support is put in place as quickly as possible and in a way that is as integrated and co-ordinated as is achievable. One of the flaws in the current system is that it has been too fragmented. The hon. Lady pointed out that many parents and young people are assessed incessantly and that that assessment is duplicated; they have to repeat themselves again and again. We want a much more integrated approach in which education, health and social care work closely together. They will have a duty to co-operate and to commission their services jointly, to ensure that the delivery of those services is much more joined up and that parents do not have to grapple with a system that is incoherent and difficult to navigate.

We have drafted legislation that was published in September. We have just been through a process of pre-legislative scrutiny, which involved my having the pleasure of presenting myself in front of the Select Committee on Education to give evidence. That process culminated in the Education Committee’s report, which I encourage the hon. Lady to look at, and the response will shortly be provided to the Committee. In conjunction with that and to ensure that the measures are not only a legislative vehicle but make the changes on the ground that parents want to see, including in the Wirral, we have set up 20 pathfinders across 31 local authorities. That is not happening in the hon. Lady’s local authority and, indeed, not in mine, but it is close by in Wigan, Oldham, Manchester, Rochdale and Trafford, as well as elsewhere throughout the country.

The aim is to improve choice and control within the system for parents and young people to help to drive better outcomes. The findings from those programmes are informing not only the legislation, the code of practice and the regulations that will follow, but how we can improve practice on the ground. The pathfinders will be trailblazers and champions for innovative approaches, so that other local authorities nearby can adopt similar tactics to improve their offer to young people with SEN and disabilities.

To ensure that that process continues after the Bill has been through both Houses, we decided to extend the pathfinder programme for an additional 18 months, which will give us a richer wealth of experience to draw on to ensure that we get the legislation right, that it delivers on the ground and that there is no disconnect between what we do in Westminster and what actually happens in schools throughout the country.

We are developing a new system that will be built on a much stronger and more streamlined assessment process, which importantly, as the hon. Lady mentioned, includes parents, children and young people. We are even piloting the prospect of children themselves being able to appeal against a decision made by a local authority not to provide them with an education, health and care plan or not to adhere to a request for an assessment. That is quite an advance on the current system. We want to ensure that the assessment process is integrated and that it is a quality assessment. That will help to ensure that, right from the start, parents and children are confident that their support will reflect what they believe is necessary and that it is provided by professionals who are talking to and engaging with each other and delivering it collectively, rather than in individual silos, as happened too often in the past.

In Solihull, for example, the pathfinder has already made progress on improving the assessment process, which has been shortened from 26 weeks to 14 weeks. In Southampton, a single assessment process for the education, health and care plan is being developed and tested for children with high medical needs but no significant educational needs. We sometimes work on the premise that a child with special educational needs and disabilities can be categorised one way or the other, but there is a whole spectrum of children in that group. The hon. Lady mentioned the Lyndale school, which deals with children with particularly profound difficulties, and it should look at this good innovation as it starts to develop its own assessment and planning process for children in its area.

It is also important for those children who are not statemented at the moment and who would not necessarily require in future the support that an education, health and care plan delivers that the transparency and accountability of the services on offer to other children with special educational needs are clear to parents and that they know how to seek redress should they not receive the services that they require. That is why we are going to improve the local offer and make it transparent both in content and delivery. Parents will be involved in its formulation, and we are looking at how the monitoring will include parents to ensure that they are far more in control of the services being delivered locally.

The work does not stop there. So much more needs to be done to the system outside the legislative process. We have funded more than 10,000 SEN co-ordinators. We have increased the amount spent on further education around special educational needs and additional learning support. We have launched a £3 million trial of supported internships, so that children and young people with special educational needs who want to go on to further education have the necessary support to enable them to do so.

We have a packed programme to ensure that we move to a system that deals with some of the fundamental issues that the hon. Lady has raised, such as ensuring that parents have knowledge at their fingertips and are involved in the process of ensuring that their child receives the necessary support throughout their whole educational experience and before and after from nought to 25, so that they achieve the outcomes that we all want.

Clearly, issues have been raised that are specific to Wirral and the school in which the hon. Lady has taken a keen interest. In a spirit of being as co-operative and helpful as possible, I am sure that she will be delighted to take up my offer to come and meet officials and professionals in my Department who, if they cannot advise her on her specific point, may be able to point her in the direction of information to give her and her constituents the confidence that they are in a better position to understand and challenge the local authority on its approach.

Finally, the hon. Lady’s constituents may want to consider the fact that the new system will enable every parent and young person to name a school in their plan, which may help them to obtain the provision that they want for their children throughout their education and beyond.

Antibiotics (Intensive Farms)

Wednesday 9th January 2013 Westminster Hall

16:30

[Zac Goldsmith (Richmond Park) (Con)]

It is a pleasure, Mrs Main, to serve under your chairmanship. I will make a short speech, and allow as much time as possible for interventions.

Clearly, everyone is concerned about the rise in the number of cases of bacterial infection, whether campylobacter, MRSA or blood poisoning from E. coli, cases of which have increased by nearly 400% in the last 20 years. What makes the problem so much more alarming is the accompanying rise in resistance to those infections. As the Minister will know, antibiotic resistance is a growing worldwide problem. We cannot yet call it a crisis in the UK, but some indications are ominous, particularly as no new antibiotics are in the development pipeline to treat some important infections. It should be noted that, when resistance problems occur, the cost to the NHS of successfully treating a patient may increase between 10 and 100 times.

The Government’s assessment is that most of the resistance problems that affect UK patients can be blamed on the inappropriate use of antibiotics in human medicine. I am sure that is true, but the antibiotics used in veterinary and human medicine are closely related, and a growing body of evidence indicates that, for some serious infections, the inappropriate use of antibiotics on farms leads to the development of resistance among farm animals that can and does pass to humans. Sir Liam Donaldson, former chief medical officer, starkly acknowledged that in his annual report three years ago in 2009, when he said of antibiotics:

“every inappropriate or unnecessary use in animals or agriculture is potentially signing a death warrant for a future patient.”

For far too long, the link between the overuse and misuse of antibiotics in intensive farming and the serious threat from antibiotic resistance have been utterly ignored. For example, although I welcomed last year’s public warning from the current chief medical officer—

16:32

Sitting suspended for a Division in the House.

16:42

On resuming—

[Zac Goldsmith]

I had just quoted Sir Liam Donaldson, on

“a death warrant for a future patient”,

as a result of the overuse of antibiotics, and I had complained that the British Government have routinely ignored the link between antibiotics in intensive farming and the public health threat. I was about to cite the current chief medical officer, Professor Dame Sally Davies, on the growing problems of resistant strains of bugs, as well as the Health Protection Agency in November. It was striking that the message focused 100% on over-prescribing by doctors, with zero mention of the use of antibiotics in the livestock industry.

Similarly, when I tabled a parliamentary question to the Department of Health on what funding it provided for research into drug-resistant bacteria, the answer from the Under-Secretary of State for Health, my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter), explicitly mentioned hospital-acquired infections, but not the use of antibiotics in farming. I was encouraged, however, by a reply from the then Secretary of State for Health, my right hon. Friend the Member for South Cambridgeshire (Mr Lansley), when I asked him about the link between E. coli resistance to antibiotics and record antibiotic usage on farms. He said:

“Indeed, I was interested to see analysis some years ago of the extent of antibiotic resistance in hospitals in the Netherlands. Resistance was clearly much more prevalent in parts of Friesland where there was much greater antibiotic usage in farming. I therefore completely understand, and my colleagues in DEFRA understand this too. Just as we are looking for the responsible and appropriate prescribing of antibiotics in the health service, my colleagues feel strongly about the proper use of antibiotics in farming.”—[Official Report, 17 July 2012; Vol. 548, c. 842.]

However, since then, we have had a near complete clean sweep of Ministers at both Departments—the Department of Health and the Department for Environment, Food and Rural Affairs.

[Mr Andrew Smith (Oxford East) (Lab)]

I congratulate the hon. Gentleman on raising a very important subject. Is his argument, at least in part, that the collaboration cross-departmentally, which should take place through the chief scientific advisers committee, is not happening, or is what they are considering simply not being taken proper notice of?

[Zac Goldsmith]

I thank the right hon. Gentleman for his intervention. I suspect that that is part of the problem, but as I will come to later, I think it is also the case that the agribusiness sector in this country has had a disproportionate impact on policy. That is a point that I hope to impress during the debate.

As I was saying, there has been a near clean sweep of Ministers at both Departments, so this debate provides an opportunity to clarify Government policy. The Government are right to insist on better infection control in hospitals and changes in the way that antibiotics are prescribed by doctors. However, other than the brief answer that I quoted from the former Secretary of State, there has been virtually nothing from the Government that could in any way encourage vets and farmers to be similarly prudent. Not surprisingly, therefore, there has been little progress; on the contrary, analysis by the Soil Association of the Government’s statistics indicates that the overall use of antibiotics per animal on UK farms increased by 18% between 2000 and 2010, while the farm use of third and fourth-generation cephalosporins—drugs described by the Health Protection Agency as hospital workhorses—increased by over 500%.

Furthermore, recently published data from the Veterinary Medicines Directorate show that sales of fluoroquinolone antibiotics for use in veterinary medicine over the past two years have been 70% higher than they were in 2000. It is worth noting that when fluoroquinolones were first licensed for use in poultry in the UK in 1993, there was no registered antibiotic-resistant campylobacter in people who had not been treated with the antibiotics, but by 2007, almost half—46%—the campylobacter food poisoning cases caused by the most common strain were resistant. It is worth noting also that in 2008, the European Food Safety Authority said:

“A major source of human exposure to fluoroquinolone resistance via food appears to be poultry”.

Clearly, antimicrobials should be used to treat sick animals, and I do not think anyone would argue against that.

[Jim Shannon (Strangford) (DUP)]

I congratulate the hon. Gentleman on securing the debate. Does he feel that the use by the farming sectors—whether pig, poultry or beef—of antibiotics is unnecessary, because there is a blanket use, rather than reacting to disease? Does he feel that that has a direct impact on us as human beings? Many people come to me and say that the antibiotics are not working, and they are getting three doses from the doctor. Is that feeding off what is happening?

[Zac Goldsmith]

Again, I absolutely agree with the hon. Gentleman’s point, and I thank him for making it. I will come to that in more detail shortly.

There is no argument against treating sick animals with antimicrobials but, surely, not the most modern and medically important ones, especially when other antibiotics, which are not as critically important in human medicine, are available. I recognise that this topic does not lend itself easily to tabloid news, but there is a real, worrying chance that that could change. By overusing antibiotics, we risk ruining for future generations one of the great discoveries of our species. In short, we risk entering the post-antibiotics age.

My hon. Friend the Minister will know that some antibiotics have already been lost to resistance: for example, penicillin for staphylococcal wound infections, ampicillin for infections of the urinary tract and ciprofloxacin for treating gonorrhoea. Many more are under threat, and new antibiotics are increasingly hard to find and license. We are now using our reserve antibiotics, and worryingly, seeing the spread of resistance to them as well. For example, rises in resistance, such as those seen for E. coli, force doctors to use carbapenems, which were previously the reserve antibiotics for use when other treatments had completely failed. However, we are now using carbapenems much more and seeing the spread of resistance to them as well.

University of Cambridge researchers revealed the first cases in UK livestock of a new strain of the multi-resistant superbug MRSA. It is called ST398, and it has become endemic in European and north American pig populations and has spread to poultry and cattle. It is significant because, unlike most strains of staphylococcus aureus found in farm animals, it is readily able to transfer to humans. If not checked, that is likely to lead to rising community-acquired MRSA, just at the time that hospital-acquired MRSA is falling, due to sterling efforts by health professionals.

[Caroline Lucas (Brighton, Pavilion) (Green)]

I congratulate the hon. Gentleman on securing this important debate. In the light of the very real health risks and the strong words from a former chief medical officer, as the hon. Gentleman has said, about the unnecessary use of antibiotics being nothing less than

“a death warrant for a future patient”,

does he agree that we need a legally binding timetable for the phased ending of all routine, prophylactic, non-therapeutic use of antibiotics in animals?

[Zac Goldsmith]

I do, and I will be coming to that point as well, but I absolutely agree with the hon. Lady’s intervention.

Clearly, we need to continue with efforts to reduce the inappropriate use of antibiotics by doctors, but the European Food Safety Authority was spot-on—I do not often say that—last year when it warned that

“it is…of high priority to decrease the total antimicrobial use in animal production in the EU.”

To date, the UK Government’s antibiotic resistance strategy, as I have said, has focused exclusively on over-prescribing by doctors, with zero mention of antibiotics in the livestock industry. Although they have spent money trying to understand why we are seeing a rise in bacterial infections, they are spending nothing, as far as I know, to understand the rise in resistance, which is clearly the issue of importance.

The Department of Health is currently developing its new cross-Government, five-year antimicrobial resistance strategy and action plan for 2013 to 2018, so I ask the Minister these questions today. Will she promise that it will give significant consideration to the use of antibiotics on farms and to the link between farm use and resistance? Will the Government work with the veterinary profession and the agricultural industry, as they have done in recent years with the medical profession? Does she agree that we need better data on antibiotic use, published by antibiotic family and by animal species, as is already done in France? If we do not know the type and quantity of antibiotics used and how they are used, there is very little chance of our being able to understand the emergence of resistance.

Furthermore, will the Minister lobby vigorously her ministerial colleagues at DEFRA to take urgent action to restrict the prophylactic use of antibiotics, to limit the prescription and use of antimicrobials for the herd treatment of animals to cases in which a vet has assessed that there is a clear clinical justification and to limit the use of critically important antibiotics to cases in which no other type of antimicrobials will be effective?

Will the Minister call on DEFRA to ban the use of fluoroquinolone antibiotics in poultry production to reduce the risk of antibiotic resistance in E. coli, campylobacter and other infections in humans? Incidentally, it is worth pointing out that campylobacter is the most common cause of food poisoning in the UK, affecting some 350,000 people a year, and poultry is the source of between 50% and 80% of those cases. A ban of that sort would bring the UK into line with the US, where the Food and Drug Administration stopped the use of those antibiotics in poultry in 2005, because of increasing resistance in campylobacter. Denmark, Finland and Australia also do not use fluoroquinolones in poultry. All those countries have lower levels of resistance in humans.

I mentioned Denmark, and it is worth taking a moment to consider the Danish situation. The latest Danish disease surveillance report showed that, although the presence of antibiotic-resistant bacteria in the country’s pig population had decreased since the tighter restrictions came into effect, including the banning of cephalosporins, the level of antibiotic-resistant bacteria in meats being imported into the country is higher than in its domestic meat. Nearly half the tested samples of chicken meat imported into Denmark in 2011 contained resistant bacteria. The Danish Government, quite rightly, have taken their concerns to Brussels, complaining that their national approach has been undermined by other EU states’ continued overuse of antibiotics.

Almost certainly, excessive antibiotic use on farms is linked to the intensive manner in which animals are kept. Improving animal health and welfare by limiting overcrowding and the worst excesses of factory farming must therefore become key components of the Government’s antibiotic resistance strategy. Disease prevention should be achieved through good hygiene, husbandry and housing, without recourse to the regular prophylactic use of antimicrobials—a point that has been made by two hon. Members. I recognise that factory farming interests have wielded enormous influence on Government policy for many years and that any move to restrict the use of antibiotics today will be fiercely resisted by them.

[Simon Hart (Carmarthen West and South Pembrokeshire) (Con)]

Does my hon. Friend have any evidence to suggest that this problem is more prevalent in what he describes as factory farming than in what I would call farming more generally?

[Zac Goldsmith]

I thank my hon. Friend for his intervention. I will come to that point in about 20 seconds if he does not mind, because I want to demonstrate the vigour with which the industry has in the past resisted and will continue to resist any change such as I have described. Indeed, I had a briefing yesterday from the British Poultry Council that included some fascinating statements. In it, the BPC says:

“There is no scientific evidence that intensive farming systems contribute more to the overall risk of antibiotic resistance than extensive farming systems.”

On the contrary, two DEFRA-funded reports find that antibiotic resistance is roughly 10 times lower in organic chickens and pigs than in conventional equivalents. The BPC says in the same report:

“The industry is not aware of any recent evidence that ESBLs”—

extended-spectrum beta-lactamases—

“(E.COLI) are increasing in chicken farms across the UK.”

[Glyn Davies (Montgomeryshire) (Con)]

I would like to pursue this point a little further. The reference made then was to organic farming. I was an extensive farmer and I have always had the view that the sloppy use of antibiotics was every bit as bad in extensive farming as in intensive units. I can understand the point in relation to organic farming, but not to extensive farming.

[Zac Goldsmith]

The difficulty is that it is very hard to measure antibiotic use in extensive farming of the sort that my hon. Friend describes, whereas in organic farming there is quite clear regulation—self-regulation, in effect—which enables that comparison to be made. He is probably right, but I cannot authenticate what he says, because the data simply do not exist.

The second BPC quote that I read out cannot be true. The BPC must be aware of DEFRA’s statement last year that as many ESBLs were found in chickens in the first half of last year than in the entire previous year, so what it has said to me in its briefing simply is not true.

The BPC also says:

“Antibiotics may only be used on a farm if they have been prescribed by a veterinary surgeon”.

But it knows that producers often go straight to the feed mill, which will write out the prescription, send it to the vet’s at the eleventh hour and put pressure on them to sign it immediately. We know that because a number of vets have complained to the Veterinary Medicines Directorate about just that.

Finally, the BPC says:

“Scientific evidence increasingly recognises that the problem of antibiotic resistance in humans comes largely from the use of antibiotics in human medicine.”

That is true, as I have already acknowledged, but for certain bacteria—salmonella, campylobacter and E. coli—the farm use probably accounts for more than half the problem. It certainly accounts for a very significant chunk of the problem. With MRSA, it is probably accounting at the moment for only a few per cent. of cases, but if it is allowed to get established in UK livestock, that situation could very easily change, and dramatically.

The briefing adds, approvingly, that the use of growth-promoting antibiotics was banned 10 years ago in this country. It is probably worth pointing out that that ban came into force only in 2006 and was vigorously opposed by the BPC at the time. Perhaps for that reason, the British Government of the time, initially at least, was the only EU member state Government to oppose the ban. That is another example, I would suggest, of the industry calling the shots on this issue.

I must acknowledge that, 12 months ago, the BPC agreed to introduce a voluntary ban on the use of cephalosporins in poultry production and to stop giving fluoroquinolones to day-old chicks. That does not go nearly far enough, but it is an important step forward and demonstrates an acknowledgment by the BPC, albeit a reluctant one, of the problem.

There is no excuse to delay. The warning has been there since 1945, when, on accepting his part of the Nobel prize in medicine for the discovery and isolation of penicillin, Alexander Fleming said that

“there is the danger that the ignorant man may easily underdose himself and by exposing his microbes to non-lethal quantities of the drug make them resistant.”

If we continue to ignore this risk for fear of upsetting vested interests, we will be complicit in robbing future generations of one of the great discoveries of our species and propelling us—apologies for repeating myself—into a truly frightening, post-antibiotic age. It is surely time for the Government to act.

[Mrs Anne Main (in the Chair)]

For clarification to those participating in the debate, it will finish at 5.10 pm.

16:57

[The Parliamentary Under-Secretary of State for Health (Anna Soubry)]

It is a pleasure to serve under your chairmanship, Mrs Main. I congratulate my hon. Friend the Member for Richmond Park (Zac Goldsmith) on securing the debate, which is on an important subject. I shall say at the outset that, although I just about heard all the many questions that he asked me, I can say with complete confidence that I fear that I will be unable to answer any—well, a large number of them—in my speech this afternoon, but I undertake to ensure that he receives full written answers to them all. As you will understand, Mrs Main, and as I am sure he will too, it is impossible to answer them all in this short debate, especially because it is such a technical matter, with so many important questions that require technical, detailed responses.

I must begin by saying that of course we all recognise that antimicrobial resistance poses a threat to human and animal health. I can assure my hon. Friend and others that the Government take this resistance very seriously. DEFRA and its agencies have been collaborating for many years with the Department of Health, the Health Protection Agency and the Food Standards Agency on this issue. The Government’s collective objective is to ensure that antibiotic use in animals does not become a significant clinical problem for human health. I am told that there is little evidence on antimicrobial resistance transmission routes from animals to humans. The concern is that if bacteria in food-producing and companion animals develop resistance to drugs used in human medicine, those could be transferred to humans via food or through direct contact.

Controls in the veterinary sector need to be carefully balanced to minimise undesirable animal welfare issues and not hamper the efficiency of UK food production in a way that could disadvantage the industry in relation to other countries where controls may be implemented less well or less effectively enforced. Good farm management, biosecurity measures and animal husbandry systems underpin the health and welfare of food-producing animals. When applied appropriately, they enable the use of antibiotics to be minimised. We all want and welcome that.

We agree that the routine use of antibiotics in animals is unacceptable. I am assured that relevant guidance and regulation is given to the sector to make that absolutely clear. I will ask my hon. Friend the Minister of State, Department for Environment, Food and Rural Affairs, to consider whether current guidance on the responsible use of antibiotics can be strengthened to make it clear that the routine administration of antibiotics is not acceptable. I am also told that intensive farming systems do not necessarily use large amounts of antibiotics. Some have high health status livestock and so use very limited quantities of antibiotics.

The Government fully appreciate that effective controls are needed in the environmental, agricultural, food production, animal and human health sectors. Failure to act promptly and comprehensively could mean that we face impending problems with implications for animal health and welfare and knock-on effects for food supply and safety, as well as, ultimately, human health and patient safety.

Although the link between antimicrobial use in animals and the spread of resistance in humans is not well understood, there is scientific consensus that the use of antimicrobials in human medicine is the main driving force for antimicrobial-resistant human infections. The majority of resistant strains affecting humans are different from those affecting animals. Bearing that in mind, we have developed an integrated strategy to tackle the challenge of antibiotic resistance, and resistance to other antimicrobials, such as antifungals.

We have been working with DEFRA and other stakeholders to develop a new UK five-year antimicrobial resistance strategy and action plan, which we aim to publish shortly. The strategy will address all sectors, including veterinary use. To have maximum impact, the new integrated strategy will focus on a wide range of intervention measures to safeguard human and animal health, including: promoting responsible prescribing; improving infection prevention and control; raising awareness of the problem; improving the scientific evidence base; facilitating the development of new treatments; strengthening surveillance, and strengthening collaboration, data and technology.

There is general agreement that responsible prescribing is central to slowing down the development of antimicrobial resistance in humans and animals. Antibiotics, used responsibly, remain a vital part of the veterinary surgeons’ toolbox, without which animals suffering from a bacterial infection could not be treated effectively. The use of antibiotics in veterinary medicine is controlled by veterinary prescription and is equivalent to arrangements for humans. In that way, we are encouraging the responsible use of antibiotics and minimising their routine use.

In addition, the use of antibiotics as growth promoters has been banned in the EU since 2006, as my hon. Friend the Member for Richmond Park informed us. In the dairy industry, if a cow has been treated with antibiotics, the milk should be isolated, and there is regular routine testing of tanks to ensure that there are no traces of antibiotics. Those are some of the many checks in place to ensure that antibiotics do not get into the human food chain.

[Zac Goldsmith]

Antibiotic use on farms is increasing not decreasing, so despite the initiatives and efforts we have heard about, the trends are heading in the wrong direction. Will my hon. Friend commit on the record to reviewing and reading the references, with which I will provide her at the end of the debate, for all the points I made in my speech and checking the science behind them, so that she is certain that the brief she received from her Department is accurate?

[Anna Soubry]

I am more than happy to do all those things. As my hon. Friend will appreciate, I am no expert in this field and would not pretend to be for one moment. I shall make a very important point: my briefing does not come from the Department of Health only; we work in collaboration with the Department for Environment, Food and Rural Affairs.

One important thing about this debate is that my hon. Friend rightly asked for a Minister from the Department of Health to respond, so I am not, as others might have thought, someone from DEFRA. Many people are concerned about whether how an animal is treated has an impact on them if they consume some or part of it. Although we might not always make too many friends in the farming industry, we are all responsible for ensuring that we know what we are putting into our bodies and feeding our families. We bear that responsibility, so we need good, informed advice. Many people, but often those with the financial means to do so, will not buy fresh meat unless they know its antecedents—that it has come from a good butcher and a good beast.

[Caroline Lucas]

I am grateful to the Minister for her openness to looking at more of the evidence that the hon. Member for Richmond Park presented. Having examined the greater body of evidence, will she also consider the need for legally binding measures as well as more information and awareness raising? The trends are going in the wrong direction, and we therefore need legally binding measures.

[Anna Soubry]

I am sort of grateful for that intervention; I fear that I could be in terrible danger of agreeing to do almost anything, and so would be able to do nothing else, because I would spend most of my time on this. I will do all that I can. It is very important. As individuals and parents, we all should be concerned, as many of us are, about what we eat and what we feed our children and loved ones. This is as much a public health issue as an animal welfare issue.

The Government have published a code of practice on the responsible use of medicines on the farm and a leaflet on antibiotics, which, like the above code, is on the Veterinary Medicines Directorate’s website. We just have to hope and pray that such things are read, but in my experience, responsible producers pay heed to all such advice. There are also regulations.

We continue to work actively with the farming industry to promote the responsible use of antibiotics in farmed animals, and industry organisations have also developed guidance. Furthermore, I am pleased to say that the Veterinary Medicines Regulations 2011 will be changed this year to prohibit the advertising of antibiotic products to professional keepers of animals. In addition, as my hon. Friend the Member for Richmond Park mentioned, from January 2012, the British Poultry Council introduced a voluntary ban on the use of certain critically important antibiotics in chick production, which should be welcomed.

Veterinary use of antibiotics is also being addressed at a European level. It forms a significant component of both the 2011 EU action plan against the rising threats from antimicrobial resistance and the 2012 EU Council conclusions. The EU legislation on veterinary medicines is currently under revision, and the UK, with other member states and the Commission, is examining the available evidence to establish whether there is a need for additional controls on antibiotics used in animals. The Government will continue to press for measures to strengthen controls on antibiotics that are critically important for human health, to make it clear that they should be used for animals only when no effective alternatives exist.

The Veterinary Medicines Directorate at DEFRA closely monitors the use of veterinary medicines in the UK. It analyses samples from food producing animals and their products for residues of veterinary medicines and environmental contaminants. There is no conclusive scientific evidence that food-producing animals form a reservoir of infection in the UK. Food is not considered a major source of infections resistant to antibiotics. Any bacteria associated with food or the environment can be reduced by thorough washing and cooking.

As I mentioned, the scientific consensus is that veterinary use of antibiotics is not a significant driver for human multiresistant infections. However, we are keen to see greater improvements in prescribing in all sectors and are actively working to encourage that. A wide programme of work to tackle antimicrobial resistance has been under way across the UK in the human and animal health sectors for several years. Although much has been achieved, I fully acknowledge that there are a number of areas that require attention and more radical thinking, if we are to have an even greater impact. I am confident that the new UK strategy will move us forward in that respect.

I undertake to write to any hon. Member who raised a question in the debate. Again, I congratulate my hon. Friend and assure him that I will answer all his questions. It now seems that I will read a great many documents and other evidence, but it is important work. If I feel that there is any need to make any changes, I will make them.

17:09

Sitting adjourned without Question put (Standing Order No. 10(13)).