Westminster Hall

Wednesday 23rd January 2013 Westminster Hall

Wednesday 23 January 2013

[Martin Caton in the Chair]

Terminal Illness (Access to Medicines)

Wednesday 23rd January 2013 Westminster Hall

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

09:30

[Geoffrey Clifton-Brown (The Cotswolds) (Con)]

May I thank you, Mr Caton, and Mr Speaker for allowing me to hold this important debate today and particularly my hon. Friend the Minister for being here to respond? I am pleased to introduce this debate on such an important subject. A number of people have worked hard on this issue for a long time, and I am glad that their work has now come to fruition in this debate. The debate is on access to medicine for people with terminal illness, which is a subject that I and others have wanted to raise.

Ensuring that people with a terminal illness have access to medicine should concern us all. Unfortunately, such illnesses will affect many people, including many people in Westminster Hall today. It is unacceptable that so many people, when they are diagnosed with an illness, find that no drugs are available to help them to overcome their condition.

I hope that it is an area of common ground that we need to speed up the development and availability of drugs to treat life-threatening illnesses. The current testing and development process is too long, cumbersome and expensive. The Minister and I would agree on that, although we may differ slightly about what needs to be done about it.

A recent report from the Office of Health Economics found that, on average, it takes five years after the launch of a new drug for it to win approval from the National Institute for Health and Clinical Excellence. That amount of time can be more than doubled when added to the time taken for a new drug to go from the development stage through to phase 3 and beyond. It is also very expensive, incurring costs of more than £1 billion, and it can take more than 10 years to bring a new drug to market.

The impetus for this debate came from a meeting I had with one of my constituents, Les Halpin, in Portcullis House last year. The way in which Les set out his views on drug development inspired me to do all that I can for him and his campaign. He convinced me that a great deal of political pressure needs to be applied, to ensure that change is made.

Sadly, Les was diagnosed with motor neurone disease in May 2012. He has a doctorate in statistics, and following his diagnosis, he began to conduct a huge amount of research and talked to as many experts as he could to

“understand the disease that is probably going to kill me.”

Indeed, Les had an interview on BBC Radio Gloucestershire this morning and he was barely audible. However, we have kept in constant contact since we met, and I admire his bravery.

Les told me that, equipped with his research, he began to understand MND better than many medical professionals, which is not surprising given his intellectual ability. The internet is a resource that enables many patients, especially those who suffer from a rare disease, to do the same type of research to some degree. Les poses the question on behalf of patients in similar situations:

“Why should they not be allowed to make informed decisions about their treatment?”

MND is an example of a rare disease for which there is no cure. It is a horrible disease, involving—over a period—all the organs of the body shutting down, leading inevitably to death. About 5,000 people in the UK suffer from MND; one in every 100,000 or so people will be diagnosed with it each year. The condition affects twice as many men as women.

The outlook for people with MND is very poor. People with limb-onset MND will live for three to five years, and people with bulbar-onset and respiratory-onset MND will live for even less time—probably two to three years—but slightly more fortunately, people with other less common types of MND can live for much longer and some people have lived with MND for decades; for example, the physicist Stephen Hawking, who was diagnosed with MND more than 40 years ago.

One medication, called riluzole, can extend the lifespan of some people with MND, but it has a very limited effect; on average, it only extends life expectancy by about three to six months. The drug was developed more than 20 years ago, and in the subsequent years, no new drug for MND has been developed or approved. So the real purpose of the debate is to highlight the lack of new drug development for people with rare and life-threatening diseases.

Having applied his statistical approach to the problem and having talked to leading experts from around the world, Les has concluded that it is very probable that it will require more than one drug to treat MND effectively. The problem is that clinical drug trials normally only test a single drug, which ignores the possibility that, as with the treatment of HIV, a cocktail of more than one drug is required. That is the key. Reform of how we develop, test and approve drugs is therefore crucial. Les sums it up in his own words:

“Imagine a world where MND patients worldwide have access to drugs at this stage of testing—they are proven safe for humans, and possibly known to be efficacious in other neurological diseases, just not for MND specifically. Patients are given the freedom to choose which drugs they think might help them; the process is monitored, and patients and doctors alike can report on their effects. Data is stored centrally, and thus can be analysed to determine the effects of individual drugs and of drug combinations. Ideally this requires some way of objectively measuring the progress of the disease—something which has not been possible in the case of MND in the past.

However, huge strides have been made recently in determining biomarkers for MND—measurable characteristics that reflect the progress of the disease. Biomarkers are also being developed or are available for other rare diseases that would benefit from this approach. Once a volume of data has been collected from thousands of patients worldwide, this can then be analysed and used to inform future research into these diseases, and influence investment from pharmaceutical companies.”

To his immense credit, Les has initiated a campaign to bring focus to such issues. It is called Empower: Access to Medicine and is designed to provide a new platform to open up the debate about the lack of drug development for patients with rare or life-threatening conditions. I am proud to be a trustee of the campaign, which is now a registered charity.

The campaign has already sought out the views and ideas of a range of respected individuals and organisations. For example, Dr Richard Barker, director of the Centre for the Advancement of Sustainable Medical Innovation, has rightly remarked that

“opening up the discussion around the lack of availability of effective drugs for rare and life-threatening diseases is a vital first step on the path towards accelerating new innovative drugs.”

I hosted an event in the House last June to enable a wide range of such people to meet Les and discuss his thoughts. I was particularly grateful to Lord Howe for meeting Les on the same day to discuss his thoughts in more detail.

As a patient-led movement, I believe that the Empower: Access to Medicine campaign has a real role to play in bringing all the stakeholders together. Also, I echo the words of Baroness Masham in a debate in the other place on 20 November last year, when she said that the campaign is

“a unique one, created for patients by patients. It is a powerful voice, rarely heard, but one that I believe could have a real impact on how pharmaceutical companies, regulators, politicians and the general public view drug development.”—[Official Report, House of Lords, 20 November 2012; Vol. 740, c. 1785.]

I will now take a few minutes to raise some of the issues that I believe require consideration by the Minister and her officials.

All drugs can have side effects. It is only through a full understanding of the efficacy of a drug or treatment that a patient can make an informed decision about what they want. From my conversations with Les, I have been struck by the fact that, for patients with life-threatening illnesses, the risk ratio—this is an important point—of “doing nothing”, as Les puts it, is hugely significant. Patients should have the ability to access all information on a drug, even if the risk of adverse effects or failure is great.

The director of Genetic Alliance UK, Dr Alastair Kent, sums it up well:

“Given that there is no such thing as a completely safe drug, the issue becomes one of establishing whether or not the anticipated health gains for patients are sufficient to outweigh the risks inevitably associated with prescribing a powerful (and potentially somewhat toxic) medicine to a patient with a serious and possibly life limiting disease.

Traditionally the evaluation”

of drug safety

“has been made by committees of experts—scientists, ethicists, clinicians etc sitting without patient and family input to their processes in order to reach a conclusion about whether or not patients can be allowed to take the risk. While it is clear that these experts have an important contribution to make, patients and families are”

in these days of openness and information

“increasingly demanding a say in this decision making process.”

The real kernel of the debate is that we address the risk aversion that can too often hold back the development of a new drug. Professor Sir Peter Lachmann, a former president of the Academy of Medical Sciences, and professor of immunology at the university of Cambridge, has argued that risk aversion has

“led to a false perception that most prescription drugs on the shelf are almost entirely safe. Unfortunately this is not (and never will be) the case. This misconception has meant that when things do go wrong people often, if understandably, look for someone to blame. This blame normally involves litigation; and that normally involves significant cost.”

In a recent article for QJM: An International Journal of Medicine, Professor Lachmann sets out his argument in more detail, and I warn Members that this bit of my speech is slightly legalistic. He focuses on the change in legislation in the 1980s, when the Consumer Safety Act 1978 was supplanted by the Consumer Protection Act 1987, which introduced the European product liability directive into UK law. In Professor Lachmann’s view, under the Consumer Safety Act, if a patient agreed to take a medicine that they knew had not been fully tested and thereby assumed the risk themselves, that prohibited any claim by them if some harm later materialised. Unfortunately, the Consumer Protection Act changed that, by introducing a system of strict liability, under which a person or company is legally responsible for the damage or loss caused by their acts or omissions, regardless of culpability.

Professor Lachmann rightly concluded that it is often the fear of litigation that drives a great deal of the regulation of medicines and, therefore, a significant amount of the cost behind drug development. Let us not forget that the cost of new drugs is also preventing small and medium-sized enterprises in the life sciences sector—many of them in our constituencies—from developing in the way that they should.

Professor Lachmann sets out four solutions, and I should be grateful to the Minister if she considered them carefully. First, we should abolish strict liability in this area and replace it with liability based on negligence. Secondly, we should revise the definition of negligence, so that in deciding whether it was negligent to seek to develop a new drug, account is taken of the consequences of doing nothing, as well as the consequences of trying to do something. Thirdly, we should change the law on waivers, so that any patient who is prepared to try a new medicine, with the risk that it may have unknown side effects, is at liberty to do so. Finally, we should, at least in this area, abolish the no win, no fee arrangements.

I was pleased to introduce Les to Lord Howe at a meeting in the Department of Health last June. I should therefore be grateful to the Minister if she set out the latest progress on the early-access scheme, which was first mentioned in the life sciences strategy published in 2011. As Lord Willis of Knaresborough said in the other place recently, the scheme could allow earlier access to drugs than the current regime permits. That is promising, but will the Minister confirm that the Government aim for the scheme is to produce just two to five new drugs a year? What can the Government do to significantly scale that up?

I would appreciate an update on adaptive licensing. There are different interpretations of what it means; but, in essence, it is a more flexible and streamlined approach to research and, I hope, the licensing of new drugs. One objective of the European Medicines Agency is to pilot a new approach along those lines, and my hon. Friend the Minister is to be commended for her decision to bid to host the pilot. Will she therefore outline the latest situation and what plans the Government have to ensure that the UK continues to take a lead on this issue?

I turn now to the report by the Select Committee on Health on NICE. The report, published on 16 January, touched on issues that are highly relevant to the debate. The Committee was highly critical of the delay in setting out precisely what a value-based pricing system for drugs entails. I share its concern, yet the section of the report focusing on research data and access to clinical trial data troubled me most. It is deeply concerning that drug companies have been allowed to withhold information about drug trials. Members should think about that for a minute. If a drug is developed, but it has unwarranted side effects and does not do the job it is supposed to, no one will know about research. Other drug companies will come along, do exactly the same research all over again and will have exactly the same problems. Surely, therefore, it is in everyone’s interests that the information is published.

I therefore fully support the Committee’s recommendation that there should be a professional and legal obligation to ensure that all regulators, including NICE, have access to all available research data about the efficacy and safety of new pharmaceutical products. Stephen Whitehead of the Association of the British Pharmaceutical Industry summed it up well when he told the Committee:

“negative trials often give you as much information that is helpful as positive trials.”

Few people would disagree with the Committee’s argument that it should be neither legal nor ethical to withhold research data about pharmaceutical products that are in clinical use. The Department will respond to the Committee’s report in the coming weeks, and I urge the Minister to reflect on this issue, even if she cannot say anything about it because her response to the Committee is still pending.

The ongoing consultation on the NHS constitution is another opportunity to strengthen patient rights and enshrine them in law. In particular, I urge the Government to seize the opportunity offered by the consultation to give more weight to individual patient choice and to allow patients greater freedom to determine what existing and new medical treatments they undertake. Will the Minister say when the Government will respond to the consultation on the NHS constitution and whether any proposed changes to it will be approved by Parliament?

I want now to move to a slightly different issue, because it would be relevant to mention the accessibility of end-of-life care. If it were not for the fantastic work that nurses and others do, many people who have had an experience similar to that of Les would have suffered a great deal more than was necessary. Some 73% of people, when they reach the terminal stage of an illness, want to die at home, surrounded and comforted by their family and friends, and it is a dismal fact that only 27% are currently able to do so. Access to a community or specialist nurse is a requirement for those who want access to medicine but who are unable to self-administer. This is a twofold problem, which can be solved only when adequate time is spent on the issues of access to medicine and end-of-life care.

I hope that the debate will ensure that these issues remain firmly on the agenda of my hon. Friend and her fellow Ministers. Many colleagues, from all parties and in both Houses, have taken a keen interest in these and related issues. Through his Medical Innovation Bill, my noble Friend Lord Saatchi seeks to address the issues that hold back innovative practice in the treatment of patients with life-threatening conditions. He has spoken movingly of his experience and that of his wife in this regard.

If the debate can in any way contribute to that process, it will be a fitting legacy for Les Halpin and his excellent campaign. Several people have asked me what the debate is all about, and the answer is simple: how would any of us who, God forbid, might develop a terminal illness gain access to an effective medicine? In future, what we need are not terminal illnesses, but treatable illnesses.

09:49

[Jim Shannon (Strangford) (DUP)]

I congratulate the hon. Member for The Cotswolds (Geoffrey Clifton-Brown) on bringing the matter to the House. I want to focus on the end-of-life issues that he dealt with in the second part of his speech. Obviously those concern us all, but I want to concentrate on them because of several interactions that I have had with constituents on the subject, and because there is a need for drugs. I am confident that the Minister will respond positively and I look forward to her comments.

I have spoken recently about ending the so-called GP death list—a term that I use very carefully; some people see end-of-life issues in that way and are concerned. I was shocked when I read an article that stated that thousands of patients have already been put on those so-called registers,

“which single them out to be allowed to die in comfort rather than be given life-saving treatment in hospital”.

That is one thing that has emerged from discussions that have taken place. The article states that nearly 3,000 doctors have promised to draw up a list of patients they believe are likely to pass away within a year. It is claimed:

“As part of an unpublicised campaign endorsed by ministers, GPs have been encouraged to make lists—officially known as End of Life Care Registers”—

which the hon. Gentleman mentioned towards the end of his speech—

“of people they believe are going to die soon and should be helped to do so in comfort.”

That is the terminology that is used. In my opinion if a patient refuses further treatment this is their decision, not the doctor’s. Treatments must be made available throughout the NHS to those who want and need them—those who need care.

How many times have we heard of patients with no hope suddenly going into remission? An example concerning a child with cancer recently came to my attention. The doctor advised no more treatment, but the sister of the little boy was not ready to say goodbye, and for her sake the family asked for one more course of chemo to prolong the time left and prepare the other child for the expected death. The little boy responded to the chemo that was given in the hope of allowing a few more weeks of life; but that time has turned into six months. Who knows what the future holds? The point I am making is that there are probably many examples from across the United Kingdom where a wee bit of extra effort can be made and where it may not be necessary to prepare for the inevitability of death, if there is also a possibility of life through drug treatment. Imagine if that family had not been allowed to ask for, or the doctor had had the power simply to refuse, the last bout of chemotherapy. That is not an everyday occurrence, but it does happen and it should give us reason to pause and think before making drastic moves.

In 2008 the Labour Government announced a range of proposals aimed at improving the care available to patients with life-threatening conditions. They stated that a key part of the new proposals was a change to the way the National Institute for Health and Clinical Excellence decides which medicines are approved for diseases that affect only small numbers of people. The hon. Gentleman focused in his speech on some diseases that do not kill a great many people in the United Kingdom, and on which, therefore, drugs companies do not spend money; but perhaps they should. I want to discuss that issue. What has changed in the past five years? Is there a greater availability of drugs? I am not sure that that is the case, and would appreciate confirmation from the Minister of how many more medicines have been approved on the list. Many UK universities do great work investigating drugs and conducting research with pharmaceutical companies, and Queen’s university Belfast is one of them, at the forefront of the good work being done on new drugs for ailments including cancer, diabetes, and dementia and Alzheimer’s. Students come from all over the world to do research and to learn there. I commend the university, which has been able to source individual funding, and the many other UK universities doing similar work.

The campaign Empower: Access to Medicine, set up by a man suffering from motor neurone disease, recently caught my eye. The campaign calls for a review of the law and ethics on drug development, as it takes many years and billions of pounds to take a new drug to market from A to Z. The last drug licensed for motor neurone disease, which damages the nervous system, leaving muscles wasted and weak, was riluzole, which has been in use for 20 years. Can there have been no scientific advances since then? I do not believe that. Les Halpin has commented that

“to see primarily it’s the regulations that are slowing the whole process down, it just means we could be waiting an awful long time until a new drug is produced.”

I have a dear friend, whom I have known for many years, who has motor neurone disease. I have seen a healthy man go from being a fun person in the peak of health to someone wasting away in a chair. The drugs have given him a longer life, and perhaps a better quality of life latterly, but they cannot stop the onslaught of the disease. The finality of what will happen to him is clear.

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

Does my hon. Friend agree that beyond the difficult and onerous issue of NICE approval of drugs that he and the hon. Member for The Cotswolds (Geoffrey Clifton-Brown) outlined, and which needs to be resolved, is the cost of drugs, post-approval? We need more work to be done on dragging down the cost, to make them more accessible.

[Jim Shannon]

There are parts of the world where drugs can be made more cheaply, and they include India. The drugs in India are equal to those made in the USA, for example, but can be made more cheaply. Why do not we obtain those similar drugs, at a cheaper price, so that we can provide the relevant care, as my hon. Friend has suggested? We should take that on board.

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

I hope that the hon. Gentleman will be interested to know that last week I went to India where I had that precise conversation with several organisations. We hope that a memorandum of understanding will emerge, involving the regulatory bodies with which I had meetings. The hon. Gentleman is right to point out that we can take advantage of the great work being done in India to produce medicines that are just as good as those made anywhere else, and often at a fraction of the price.

[Jim Shannon]

Those are the sort of responses we hope to hear, because they show that the Government are working. The Minister, as we knew she would, has come up with a practical, physical response, and is doing the things that we have been hoping will come out of the debate. I thank her for initiating the process she outlined, and for moving things forward.

I am pleased to support the hon. Member for The Cotswolds in his cause of drawing attention to motor neurone disease, cancer and other illnesses, so that a treatment path will not be simply a step along the road to the end of life, but may enhance the quality of life. Perhaps a successful treatment path can be developed. According to Empower: Access to Medicine,

“Speeding up the development and availability of drugs that treat life-threatening diseases would benefit everyone in society.”

I believe that too. Everyone present will know people whom new drugs could help. The current testing and development process is long, cumbersome and expensive. In fact, a recent report by the Office of Health Economics found that it takes five years, on average, after the launch of a new drug, to win NICE approval. That time scale can be more than doubled when the time taken for a new drug to go from the development stage through to phase 3 and beyond is added. As an example, no new drug has been approved for motor neurone disease since riluzole was approved 20 years ago. Are we happy to sit back and rely on that one drug, or should there be more research? We need more research; we need to fund it, and we need it to be made possible.

Currently, pharmaceutical companies do not have a financial incentive to invest in developing new drugs for rare or “orphan” diseases—I am being careful in my terminology—because of the small number of the population who are affected and the high and uncertain costs of the drug development process. The drug regulatory regime is therefore clearly having a significant impact on those with life-threatening and rare diseases.

Just yesterday, the shadow Secretary of State held a meeting on special commissioning. Five speakers introduced the issues. The gentleman who spoke on cystic fibrosis said that drugs are available only in certain parts of the United Kingdom. He is worried that we are setting an imbalance, which I have taken up with my colleague back home, Edwin Poots, the Minister of Health, Social Services and Public Safety, to ensure that cystic fibrosis drugs are available to sufferers when they need them not only in England, but in Northern Ireland, Scotland and Wales.

The panel hosted by the shadow Secretary of State outlined the need for drugs allocation. There was a guy representing HIV patients, and 100,000 people in the United Kingdom are receiving HIV drugs to prolong their life. The man who spoke yesterday has lived for 20 years with the drugs that are available, but are those drugs available across the whole United Kingdom?

[Geoffrey Clifton-Brown]

I am extremely grateful to the hon. Gentleman for making those extremely good points. The point he makes about cystic fibrosis crystallises the health service’s dilemma. A small drug company came to me the other day, and told me that it has developed an absolute cure for a certain type of cystic fibrosis if it is caught very early in life. The problem is that the drug will have to be administered for life, and the life cost of the drug for the very small number of people whom the drug will absolutely cure, and whose quality of life it will improve, is £180,000. That is why his remarks on the need to drive down the cost of developing drugs in this country are so important.

[Jim Shannon]

I thank the hon. Gentleman for his constructive intervention. I take his comments on board, and I believe the Minister has a willing ear, too.

[Geoffrey Clifton-Brown]

My hon. Friend the Minister reminds me sotto voce that I was corresponding with her, and I am extremely pleased to say that she has approved the drug I mentioned. So that small number of people will now have an absolute cure.

[Jim Shannon]

If this goes on much longer, I would want the Minister to reply to every Westminster Hall debate, because we have asked for two things and got them both, which is good news.

I will now illustrate the need for drugs for three categories of people. The first category is those with dementia. There has been debate in the House and in the papers over the past week on dementia treatment. In Northern Ireland, we do not have the highest diagnosis rate for dementia in the United Kingdom, but at 63% the diagnosis rate is high. The support services are perhaps not as equal to that as they should be, which we will take up with the Minister to see how we can improve.

The facts are that some 370,000 people have not yet been diagnosed for dementia treatment—first it is diagnosis, and then it is drugs—so there is a combination of how the health system works best. People are given drugs including Aricept, which reduces symptoms and slows progression. The drugs might not always cure the ailment or disease, but they certainly can improve life and make it a wee bit more amenable.

The second category is cancer, and there will not be a family in the whole country that has not been touched in some way by cancer. The Government have set up what they refer to as a “fast track” for cancer patients. There is some indication that the fast track is perhaps not working in the way that it should, but the Government have a £750 million cancer strategy, which plays a key role. As with dementia, the strategy is diagnosis, early intervention and prevention through all the surgeries and clinics across the United Kingdom.

The third category is breast cancer. A new breast cancer drug has had some coverage in the press over the past few weeks. The Minister has been tremendous in her response to our points, and perhaps she could give us some indication of how that drug will be made available to those with breast cancer. The drug has the potential to prolong life. The papers have said that, for some people, the drug can prolong life for 20 years. Such drugs must be available if that is the case. I am keen to hear how that will go.

It is long past time to take active steps to ensure that terminally ill patients or patients with life-threatening conditions are not simply given a form of end-of-life care—it has to be more than that—but are treated for their conditions. New drugs and medications should be actively sought, instead of accepting a diagnosis of illness as a death sentence.

The hon. Member for The Cotswolds mentioned hospice care. We are fortunate to have so many organisations, and if I name some, I will leave some out, so I am not going to name any. They all do tremendous work. The hospice care those organisations deliver to the person who is dying or recuperating and the help they give to families is tremendous. We owe them a lot.

I support the hon. Gentleman in this debate, and I am disappointed there are not more people here, because it is a debate that affects us all. Our constituents would be keen to ensure that we are involved in this debate.

We have been fortunate this morning to have very positive responses from the Minister, and I look for more. What steps are this Government, and our Government in Northern Ireland, taking to ensure that another five years are not lost and that we can make a change to bring hope, instead of despair, to those who refuse to accept a one-size-fits-all diagnosis and who wish to have access to the best drugs available at a price we can afford and that delivers more treatment and care for everyone?

09:59

[John Pugh (Southport) (LD)]

I thank the hon. Member for The Cotswolds (Geoffrey Clifton-Brown) for introducing the debate and explaining this important issue so well. I also pay tribute to Les Halpin, whom I had the privilege to meet. I use the word “privilege” exactly, because it was a privilege to meet someone who is so afflicted and yet so thoroughly constructive.

I once had the opportunity to attend a session with the National Institute for Health and Clinical Excellence when it was investigating a particular drug for a complaint called ankylosing spondylitis—I have not written that in my notes, so Hansard is on its own. The session was robustly and impressively chaired, and the drug and issues concerning it were thoroughly examined. During my period in Parliament, NICE has come up again and again, and various complaints have been raised by Members of Parliament, the pharmaceutical industry and patient groups. One complaint is about the inordinate time it often takes to develop a drug, which certainly appears to be the case; the other complaint, made by big pharma, is the cost that NICE adds to the development of drugs.

The example of India has been cited, but I am not sure that that is a good parallel. I have been to India and spoken to pharmaceutical companies out there, and they seem to specialise not in developing the more esoteric lines of drugs but in developing and marketing lines of generic drugs or taking up drugs that are out of patent and producing them at less cost than their western counterparts.

NICE would genuinely acknowledge that it adds to the cost of development, but there is also a question about its rigorous but circumscribed methodology. There were many debates in this place a few years ago about Alzheimer’s drugs, and the issue appeared to be not that the drugs do not work, but that they do not work for everyone in a sufficiently predictable way for NICE to approve them; although I have met constituents who can genuinely testify to the benefit of a drug that NICE is not prepared to go with. Of course, there are similar cases in which people genuinely disagree with NICE’s decisions. Most Members of Parliament will, at some time during their career, write a letter on behalf of a constituent who simply cannot get a drug because a primary care trust is sheltering behind the mantra that NICE does not approve. All that set aside, NICE represents a model that has been emulated worldwide, because with NICE we end up with cost-effective, efficacious and safe drugs.

To go back to the case I witnessed in NICE headquarters many years ago, I was surprised that sufferers with that particular complaint were in the room and thoroughly involved in the process. As the process went on, however, I discovered that one of the people—the reference point, as it were, for the piece of research—had died during the project. That, perforce, will happen many times if one enlists people already diagnosed with a terminal illness; some people’s needs are more urgent, some have less to lose and in the case of terminally ill people, some are not classified in that way unless there is no available cure.

A reasonable case can be made for relaxing the rules, to have more trials and to get more innovation in such circumstances; patients, science, medicine and future patients would all benefit, provided, of course, that the patient was genuinely a volunteer and properly advised of the risks. Another proviso I have just thought of, as India was mentioned, is that the volunteer was afflicted with the particular complaint, because in no way would we be happy with a world where people were trialling drugs for reasons other than their own benefit.

The question is, should we have a more flexible system than the orthodox one that we have put in place through NICE? I was at a breakfast this morning about NHS research, and I was pleased to learn that over the past decade or so, the number of NHS patients featuring in research has increased appreciably. Apparently, a decade or so ago, only about 2% of cancer patients featured in a clinical trial or piece of research, whereas now the figure is some 20%, which is a significant improvement, so we must not kid ourselves that even in the orthodox setting of the NHS valuable pieces of research are not being conducted.

As I see it, there are still arguments against what Les is suggesting, and he must be acutely aware of the force of some of those arguments. The Minister is a lawyer and, even with a disclaimer in advance, it is difficult to avoid the spectre of litigation if a drug that has not been thoroughly stress-tested is in use; it is hard to assure oneself that it is not at least a possibility. Cost might still be an issue, if the drug is very expensive, and the NHS has to consider carefully whether to spend a lot of money, perhaps to no effect. There is always the possibility of an unsafe medicine or of one that has not been thoroughly tested having catastrophic effects and worsening someone’s decline. That can happen even when the drug is tested; everyone can recall that thalidomide was tested, quite thoroughly in some respects, but not to the nth degree, with disastrous consequences.

Such entirely valid considerations are not a case against a different regime in principle, they are a case against what might be regarded as a gung-ho approach. After all, as the hon. Gentleman said, all medicines have side effects. The worst thing someone can do when prescribed a medicine is to take out of its box the long sheet listing all the possible side effects; if they read it, they simply would not take the medicine, regarding themselves as safer by not taking it. Where a drug has no known side effects and there are genuine grounds for belief in its potential benefits, some sort of pre-approval system is genuinely arguable for terminally ill patients, rather than having to wait for full NICE approval—the full works. Flexibility is not a non-legitimate demand in any context. We have to bear in mind that although there are general rules, there will always have to be sensible provisos, exceptions and caveats about an application.

I am reminded of the forthcoming ban on the use of opiates when driving. I am obviously keen that people under the influence of methadone or heroin do not take those drugs and then get in a car. Some people, however, have long-term, chronic conditions and are taking an opiate, but they are well used to the symptoms provoked and could or should be safely allowed to drive a car. I am sure that they would drive the car with no difficulty at all. Whatever rules we have need to be flexible for such cases. Likewise, whatever rules we have about the safety of medicines need to recognise that for some people, the environment in which they are taking the medicines, their circumstances and the risks they face are quite different. We need flexibility, where the risks are limited and where the benefits to science and the individual are potentially massive. There has to be an intelligible response of some sort to the sincere request made by the hon. Gentleman and by Les Halpin.

Furthermore, I agree with the hon. Gentleman on another extremely important issue—I did not expect him to raise it, but he did. If we are looking at a more innovative, research-based NHS, it would help enormously if pharmaceutical companies signposted the dead ends they have been down, indicating where things had not worked. That would save enormous sums of money, possibly for their competitors but certainly for the health of the nation and the NHS. I congratulate the hon. Gentleman and reiterate my sincere tribute to Les Halpin. I hope that he is in good shape today and listening to the debate, and that we can get a result for him.

00:00

[Mr Jamie Reed (Copeland) (Lab)]

It is a pleasure to be called to speak under your chairmanship again, Mr Caton.

I extend my sincere thanks to the hon. Member for The Cotswolds (Geoffrey Clifton-Brown) for securing this important, emotive and timely debate. He laid out the issues in a compelling fashion, complemented by the testimony of other Members from across the House. The debate comes a day after my right hon. Friend the shadow Secretary of State held a specialist commissioning summit in the House to discuss some of the very issues before us today.

When dealing with terminal illnesses, it is important to recognise all of the lives affected by terminal and degenerative illness. It is important that stories and experiences of those with such diseases inform our debate, so that we do not focus purely on statistics. Behind every statistic is an individual and a family with real human issues that wear no party colours, and they may have no interest in our party colours. I am sure that all hon. Members have experience of constituents who have suffered from such debilitating illnesses and realise the importance of doing whatever we can whenever we can to improve their access to treatments that could improve their quality of life. I express my most sincere best wishes to those people dealing with terminal conditions today, and to their families, carers and everyone whose lives they touch.

I also praise the constituent of the hon. Gentleman, Mr Halpin, for the work that he does to highlight the issue and to push for improvements and greater access to drugs to improve palliative care. Today’s debate is proof that this place can be influenced by the public and by individuals—individuals can make a difference. We must look at what we can do to improve access to medicines and we must continue to explore ways and methods to encourage the synthesis of new drugs and to make those available to patients as soon as possible, while also maintaining the fundamental focus on patient safety, as has been said. That is a fine balance to strike and I look forward to learning how the Minister plans to address it.

Making new, safe and effective treatments available to all patients who require them must be the end goal, but it cannot be an isolated goal. We must look at ways to increase the availability of already licensed drugs and we must look at non-drug-based treatments as well, which can vastly improve the quality of life for patients in need. A number of charities have expressed a view that a move to adaptive licensing of drugs could benefit patients. The European Medicines Agency suggests:

“Adaptive Licensing seeks to maximise the positive impact of new drugs on public health by balancing timely access for patients with the need to provide adequate evolving information on benefits and harms”.

It must be recognised that adaptive licensing would bring a number of benefits, such as encouraging pharmaceutical industries to develop new drugs and to bring them into service quickly. It is suggested that new drugs could be available after phase 2 testing, the main focus of which is safety rather than efficacy.

There are, however, a number of issues with that approach. After phase 2 testing, drugs might be expected to be safe for human consumption, but the efficacy of any drug would still not be proven. Going on to prove efficacy at stage 3 could raise some ethical and personal difficulties. At present, a phase 3 trial is needed to demonstrate that any drug is effective. Under adaptive licensing, would those with early access be classified as part of a conventional phase 3 trial? If early access formed part of a conventional phase 3 trial, would existing trial guidelines be maintained for the use of data received on early access recipients? Clearly, ethical and personal issues would arise from both questions.

First, how can the efficacy of one drug be compared with that of another, existing drug, or with a placebo? Using blind tests in which one drug is administered to one group, and another drug or placebo is administered to another group would raise ethical issues. Doctors might knowingly deny access to a drug that has been proven to be effective because of the chance that a new drug could also be effective. Secondly, on a personal level, how could we be sure that patients are fully comfortable with and aware of the risks of taking medicines before they are fully approved under the current system? I acknowledge the point made by the hon. Gentleman about the patient being in charge of the choices with which they are presented, and more fundamentally in charge of their own treatment and destiny.

We must be careful not to suggest that adaptive licensing is risk-free and the only logical solution to a problem. Patients participating in early adoption of medicines might have better access, but there would be clear and obvious risks. That is not to say that we should discourage the synthesis of drugs that are less effective than those that already exist. The development of drugs is clearly a highly precise science, but the application and treatment of medicines sometimes resembles an art form. For some patients, the most effective available drugs are useless and, for want of a better phrase, less effective drugs could be invaluable.

I raise these issues not because we should oppose the introduction of adaptive licensing, but because we must fully explore the ramifications of introducing a change on this scale, and I look forward to hearing how the Minister plans to tackle these delicate and fine issues. We must also understand what it would mean for our life sciences and our research and development capability in the UK, but first and foremost, and fundamentally, what it would mean for patients and patient choice.

In the spirit of this debate, we should look at ways to improve care and provision of other types of available treatment, such as care facilities in communities, and assistance for patients at home. The care a patient receives does not depend solely on the medicines they receive, although clearly that is hugely important, and we should continue to explore ways in which that can be widened.

It must be noted that, as other hon. Members have said, very few drug options are available to people with terminal illnesses such as multiple sclerosis and motor neurone disease. As well as doing everything we can to speed up the development of new drugs while protecting patients’ well-being, we should explore other methods of treatment for those with terminal illnesses. We must all acknowledge that the NHS is always changing as society changes. The art of drug and medicine application demands a more bespoke and tailored patient experience and more wide-ranging treatments.

The principle behind adaptive licensing is commendable, and one that anyone would find difficult to oppose. It would ensure better access to drugs, but it would not necessarily alter things that much. As has been said, pharmacology recycling bins are filled with trials for promising new medicines that ultimately proved to be ineffective or even dangerous. Loosening access to trial drugs requires greater peer reviewing of early data and methodology to ensure patient safety.

There is a strong argument for allowing more off-label prescribing of drugs that have already passed safety tests. They could be an option open to doctors and patients if they are believed to be effective in treating a condition they were not originally intended for, and I would be extremely interested in hearing what the Minister has to say about that. Even if adaptive licensing was adopted now with a robust system of safeguards in place to protect the well-being of patients, those with terminal illnesses would not start to see improved access for a number of years. We are all aware that drug manufacturing does not happen overnight.

One of the harsh realities of debates such as this is that changing regulations today will not benefit patients tomorrow or the day after. What we need right now is improved care for those with terminal illnesses, and support for their carers. Improved facilities offering specialised care would go some way to improving patients’ quality of life, as would earlier, faster diagnosis of terminal conditions. All Members of Parliament have heard of cases of suffering that could have been prevented, and diagnosis that could have been earlier, resulting in a better experience for patients and their families.

Access to drugs may vary throughout the country and that cannot be tackled by a fractured system. That is a huge concern as we move towards April and beyond. I hope the Minister will explain how she can guarantee that a clinical commissioning group in Cornwall meets the same standard in access to medicine as a group in Cumbria. Adaptive licensing would improve access to drugs, but not without risks, and I hope the Minister will be able to outline a safe and secure framework that could be put to the House for greater scrutiny. At this stage, not enough research has been done to guarantee that access to drugs can be expanded through adaptive licensing without exposing patients to ineffective and potentially dangerous drugs. I hope that much more work will be done to show that a patient’s well-being and quality of life can be protected while ensuring that more drugs are made available.

[Geoffrey Clifton-Brown]

The hon. Gentleman has touched on an important matter than has not yet arisen in this debate: the possibility of different protocols for prescription of medicines by different clinical commissioning groups. My gentle suggestion to the Minister is that it would be unacceptable if the new system developed a postcode lottery whereby people in some areas had access to a new drug, but people in others did not.

[Mr Reed]

I thank the hon. Gentleman for his contribution. He is entirely right, and I do not believe that any hon. Member in the House would want that. Many of us have seen and read accounts of the problem he illustrates, and we must not hasten any further move towards that. We should all seek to address such issues as and when they occur.

The hon. Gentleman intervened just as I was coming to the end of my remarks, and I look forward to hearing the Minister’s response.

10:26

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

It is a pleasure, Mr Caton, to serve under your chairmanship. I congratulate my hon. Friend the Member for The Cotswolds (Geoffrey Clifton-Brown) on securing this debate on a subject of which he clearly has considerable knowledge. I thank other hon. Members who have spoken, and pay tribute to the work done by Empower: Access to Medicine, particularly that of Mr Les Halpin, who has been spoken about in glowing terms. I add my good wishes to him to those of my hon. Friends the Members for The Cotswolds and for Southport (John Pugh)—the latter is giving me a thumbs-up, as I remembered the correct name of his constituency. A great failing of mine is not to remember it. I hope that Mr Halpin is able to watch this debate, and I know that he and many others will want to read it.

If I may say so, the debate is a good example of Parliament at its absolute best. Yet again, there is a story in one of the papers criticising Members of Parliament for expenses properly incurred. If only the press, instead of printing another knocking story, would come along and listen to debates such as this when important issues are put into the public domain with care and considerable knowledge. As is often the case in such debates in Westminster Hall, there has been an outbreak of political unity. Political parties play no part in this issue, and Members properly ask the Government tough questions. I pay tribute again to my hon. Friend the Member for The Cotswolds because he is a pleasant thorn in the Government’s side, and properly so. He has raised and is championing an issue that a constituent brought to his attention, and is holding the Government to account.

I fear—well, I know—that I cannot answer all the questions that my hon. Friend and the hon. Member for Copeland (Mr Reed) have asked and, as is the usual rule, if I cannot do so, my excellent officials will provide written responses. The matter is not in my portfolio—I am not making excuses—so I am not particularly familiar with it, and I am grateful for the excellent briefing that has been provided by my officials. Perhaps I will be forgiven for reading out a large part of my speech, which I do not normally do because I like to look as though I understand everything I am speaking about, but the subject is important and technical.

I would like to take credit for the approval of Kalydeco, a drug for cystic fibrosis users, but it was the National Institute for Health and Clinical Excellence that gave approval for it to be prescribed. The only reason I know anything about it is because one of my constituents wrote to me. A cystic fibrosis campaigning group has quite properly been contacting Members of Parliament, urging them to make all the representations that they can about the benefits of the drug. A very small number of people will benefit, because it relates to those who have cystic fibrosis because of a particular genetic disorder, but it will undoubtedly revolutionise their lives. I was certainly pleased to see that it will now be available for prescription.

The development of new medicines is a long and expensive process, as we all agree. The Association of the British Pharmaceutical Industry estimates that only one in 5,000 researched new compounds receive regulatory authority approval, taking 10 to 12 years on average. That is the scale of the research and the difficulties, in many respects.

The life sciences industry is undergoing rapid change. The time and cost involved in developing new medicines is rising, and the old “big pharma” model of having thousands of highly paid researchers working on a pipeline of blockbuster drugs is declining. A new model of collaboration, about the outsourcing of research and early clinical trials on patients, has emerged. Many patients with serious or life-threatening illnesses, who understandably expect that they should be able to access the latest and most effective treatments, feel that regulatory procedures can hamper access.

Turning to life sciences strategy, this country has a strong history of drug discovery and development, and improving access to medicines has long been a Government priority. The “Strategy for UK Life Sciences” was launched in December 2011. Recognising the issues facing the life sciences, the 10-year strategy includes measures to support innovation and early-stage development. My right hon. Friend the Prime Minister published a progress report and refresh of the strategy only last month.

My hon. Friend talked about adaptive licensing, as did other hon. Members. I would like to set out the arrangements that we are putting in place for an adaptive licensing pilot programme, with the objective of advancing and maximising the potential of existing flexibilities in the drug licensing processes to improve public health and stimulate innovative drug development.

The Medicines and Healthcare products Regulatory Agency—I shall refer to it as the MHRA, as opposed to its otherwise very long name—has convened an expert group on innovation in the regulation of health care and agreed to a tripartite programme to take that work forward. It includes work at EU level on how the existing flexibilities in EU regulation can be used to bring forward innovative products; work at national level exploring options to help companies maximise the potential of existing drug licensing processes; and work at arm’s length from the MHRA and Government. The co-ordination of some other activities required for the pilot will be undertaken by the Centre for the Advancement of Sustainable Medical Innovation, including the exploration of suitable candidate products. However, pharmaceutical companies must come forward and nominate candidates for adaptive licensing.

Last year, we consulted on an early access scheme to make certain new and promising medicines available to patients in the UK before they are formally licensed. The MHRA is currently assessing the consultation responses. If introduced, the early access scheme would be designed for promising new medicines that will treat, diagnose or prevent life-threatening, chronic or seriously debilitating conditions without licensed treatment options. It would provide a scientific opinion from the MHRA on the benefits and risks of a new medicine about a year before the licensing process was completed. That additional information would assist both clinicians and patients in making treatment decisions in areas of unmet need, such as those described earlier by my hon. Friend. Both programmes are in a very early stage of development, as I think we all appreciate, and we will have more to say on that in the near future.

Turning to stratified medicines and genomics—I cannot pronounce it, but I am sure that Hansard will correct me if I get the word wrong—ongoing work on stratified medicines will improve our understanding of why groups of people with particular diseases respond differently to treatments. That point was very well made by my hon. Friend the Member for Southport. Our initiative to sequence 100,000 whole genomes from NHS patients will provide valuable information for researchers to gather new insights into health and disease and to develop new diagnostic tools and treatments.

Rare diseases are classified as conditions affecting no more than five in 10,000 people in the EU. Patients with rare conditions deserve the same quality, safety and efficacy in medicines as those with more common conditions. Since the pharmaceutical industry has little interest, under normal market conditions, in developing medicines intended for small numbers of patients, the EU offers a range of incentives to encourage the development of what are called “orphan” medicines in order to address the unmet clinical need.

Applications for the designation of orphan medicines are reviewed by the European Medicines Agency’s Committee for Orphan Medicinal Products—in its short form, the COMP. Via the MHRA, the UK takes an active role in the decision-making processes at the COMP, ensuring that applications for orphan drug designation are appropriately recognised and encouraging companies to develop their products further. Taking that one step further, I join the hon. Member for Strangford (Jim Shannon) in paying tribute to the research being undertaken at Queen’s university Belfast, and I know that many other universities throughout the whole United Kingdom are doing research into that sort of medicinal pharmaceutical advancement. They do not have some of the constraints of pharmaceutical companies, or perhaps the desire that some of those companies have to make a profit, so it is often universities that are best placed to do some of that invaluable research and development.

[Jim Shannon]

The work that is done at Queen’s university could not happen without partnership with the pharmaceutical groups, and clearly, they can use the partnerships to their advantage in creating new medicines. Partnerships are what life is very much about. A partnership is how we can work together to make it better, and that is a partnership that can work.

[Anna Soubry]

I am grateful for that intervention and I completely agree. It is great when we see business working with our universities on research. It can be highly productive and undoubtedly mutually beneficial, including to the rest of society, and that collaborative approach is much to be welcomed. It is fair to say that many universities, at first, had a bit of resistance to working with business, seeing it somehow as sullying themselves. However, over time they have recognised the absolute mutual benefit to both and, of course, that includes, should it be successful, a benefit to society.

[Mr Jamie Reed]

I am grateful to the Minister for her contribution. It is clear that there is an emerging cross-party consensus—dare I say it, a coalition—which is a tremendous sight to behold for everyone who cares about this issue. She talks about the difficulties posed by the research and development sector when it comes to manufacturing medicines for orphan diseases, and the costs inherent in producing them because of the market basis on which they are produced—no argument there. However, could she explain how that might affect the commissioning choices of clinical commissioning groups when it comes to purchasing those very same medicines, given the inherently inflated costs?

[Anna Soubry]

I cannot give a short answer in this debate, but that is important and it has been raised by a number of hon. Members. On that basis, I will ensure that a proper and full written response is given, both to the hon. Gentleman and all other hon. Members—I suspect that my hon. Friend the Member for Southport and the hon. Member for Strangford will also be interested in the answer. All present will certainly get a written answer to that, because it is an important point; clarity is clearly being sought, and it will be given.

Returning to NICE, once effective new drugs are brought to market, it is important, as we all know, that they are made available to the patients who will benefit most from them on terms that represent value to the NHS—that means, of course, value to the taxpayer. NICE has played an important role in that by providing robust, evidence-based guidance to the NHS on drugs and treatments. In the great majority of cases, NICE now publishes draft or final guidance on significant new drugs within a few months of their launch. In 2011, for drugs appraised using its single technology appraisal methodology—the methodology used for the great majority of new drugs—NICE issued draft or final guidance an average of four months after the date of market authorisation. The end-of-life flexibilities introduced into NICE’s appraisal process from 2009 have allowed a number of important drugs for terminal illnesses affecting a small number of patients to be made available on the NHS.

The NHS constitution sets out patients’ rights to medicines positively appraised by NICE, underpinned by a statutory funding direction. In December 2011, the NHS chief executive’s report, entitled “Innovation, Health and Wealth”, introduced a NICE compliance regime to help to ensure that medicines approved by NICE are made available on the NHS quickly and consistently. Furthermore, since the cancer drugs fund started operating in October 2010, more than 25,000 patients have received cancer drugs that they would previously have been denied. Our priority is to give NHS patients better access to effective and innovative medicines. That is why we will move to a system of value-based pricing for new branded medicines from January 2014, following the end of the current pharmaceutical price regulation scheme.

[Geoffrey Clifton-Brown]

I am grateful to the Minister for giving way, because I sense that she is coming to the end of her speech. Could she comment on two aspects that I raised? The first is the early access to medicines scheme. Quite rightly, the current licensing scheme is intended to eliminate all risk, but could there not be a system whereby, for people with a terminal illness, a drug might be given a provisional licence on a fully informed patient basis so that it could be trialled by those people, perhaps for the benefit of others coming along afterwards? Secondly, could she comment on the issue of strict liability—the legal liability for drugs of this sort being given, which makes it very difficult for people to use such techniques?

[Anna Soubry]

I am very grateful to my hon. Friend for raising those points. As he will understand, I cannot give a commitment either way on them, but they are very important points—points that I took not only out of his speech, but out of the speech of my hon. Friend the Member for Southport, who referred to me as a lawyer. I am a criminal lawyer, but I am not trying to take any responsibility for this, because it is a long time since I studied negligence and strict liability. However, I absolutely accept that there is a very strong argument to be made that the current state of the law does not help. Equally, there is a strong argument, as has been advanced, about people with a terminal illness being able to be prescribed medicines on a provisional basis, in precisely the sorts of conditions that my hon. Friend the Member for The Cotswolds described.

The hon. Member for Strangford, in particular, raised end-of-life care. That is a very difficult issue. It is the subject of almost endless debate in this place, or at least it should be. For what it is worth, my personal view is that often these matters should be the subject of discussion between a patient and their GP. Although it was many years ago that my father faced a terminal illness, he spoke at length, before the final stages of his illness, with our then general practitioner, who was utterly brilliant, about his death and how that death could be in some way planned for, if it is ever possible to do such a thing. Sometimes that can be done. There is sometimes a certain amount of flexibility to be able to plan a death and to say what one does and does not want. These are intensely personal matters. I sometimes think that there is a danger of over-regulation and almost too much transparency, if there can ever be too much transparency. Sometimes it prevents what should be very private discussions.

The other thing to say is that families, too, often feel excluded from many of these decisions. It is important that families are involved as much as possible, especially when the person is quite elderly. We all know the sorts of case that exist. Perhaps this is an old-fashioned view, but I think that the unique and very special relationship between a patient and their GP—perhaps their nurse as well—is incredibly important, and there should almost be an acceptance that it is between the two of them in the final stages.

Like many Members, I suspect, as a constituency MP I have received letters from constituents who have spoken with real distress about their hopes for the final stages of a loved one’s life just not being recognised. I think that it was the hon. Member for Strangford, or perhaps it was my hon. Friend the Member for The Cotswolds, who talked about the number of people who wanted to die at home but were not able to do so. [Interruption.] It was my hon. Friend, but I am sure that the hon. Gentleman would take up the point as well. As I said, a number of my constituents have spoken very movingly about this. I am thinking of one particular case in which a woman described how she had sat and talked with her late husband about the desire for him to die at home. They were sensible people who had thought these things through, but as it happened, because of a failing in palliative care—we have not got it all right, by any means—that did not happen. That is terribly sad and, frankly, in many cases there are no excuses for it. I am digressing, Mr Caton—forgive me—but I think that we should be able to have a more open and honest debate, which would then bring up the very issues that my hon. Friend has raised.

I have almost concluded my remarks, but I want to touch on a very important point raised by my hon. Friend the Member for Southport about India. I think that I am right in saying that he said that, in his opinion, India did not have a particular history of innovation in creating new drugs. But my view is that it does have a remarkable capacity to look at existing drugs and produce them considerably more cheaply than other countries, including ourselves.

When I went to India last week, one of the things that I came away with was that what drives the Indians is affordability. As might be imagined with a population of 1.2 billion, there are excruciatingly high levels of poverty and deprivation, but there is also an emerging health care system. I know that there is a great deal of research, which is being led by the desire of doctors to improve clinical outcomes. The doctors often go to great research institutions and say, “How can you help us to develop this?” or “How can we solve this problem?” There is therefore innovation in India but my hon. Friend’s point was a good one.

I understand that the development of new drugs for rare and life-threatening diseases is vital, and it is important to the coalition Government. I hope that I have been able to illustrate the breadth of the work that the Government are undertaking to improve access to new and existing medicines for NHS patients and to encourage the development of important new drugs to treat life-threatening diseases. I can assure my hon. Friend the Member for The Cotswolds and others that the Government’s priority is to ensure that NHS patients are able to access the most appropriate treatments to treat and manage their conditions.

10:47

Sitting suspended.

Housing Benefit and Disabled People

Wednesday 23rd January 2013 Westminster Hall

11:00

[Jeremy Lefroy (Stafford) (Con)]

It is a pleasure to serve under your chairmanship, Mr Caton. I welcome the Minister to her place and offer belated congratulations on her appointment. I wish to raise with her the effect of the changes to housing benefit on people in the social rented sector who are deemed to be under-occupying a property. I thank my constituents John Turner and Matthew Hancock, Karen Armitage of Stafford and Rural Homes, and my colleague Pauline Ingall for bringing this matter to my attention.

From April 2013, size criteria for new and existing working-age housing benefit claimants will be introduced; they will replicate the size criteria that apply to housing benefit claimants in the private rented sector. The Department for Work and Pensions’ impact assessment estimates that out of 660,000 claimants affected by the new rules, some 420,000 are disabled. The impact assessment offers the explanation that

“Disabled claimants are, on average, older than non-disabled claimants. One consequence of this is that disabled claimants are also less likely to live in households with children… Fewer people living in a household means that large accommodation cannot be justified under the size criteria, and Housing Benefit entitlement is reduced.”

In the debate on the Welfare Reform Bill last year, I raised the matter of disabled people sometimes needing more rooms than provided for by the rules. One family in my constituency with disabled adults and children needed separate rooms for the couple and a separate room for one of the children under the age of 10. The then Minister for disabled people, my right hon. Friend the Member for Basingstoke (Maria Miller), gave a clear answer. She said that

“if a disabled person has the need for an overnight carer, additional rooms can be allocated. Indeed, if there are disabled people in the house who require rooms, there will be clear support there for them to be able to have those rooms.”—[Official Report, 1 February 2012; Vol. 539, c. 937.]

I also raised the question of adaptations, which have sometimes had many thousands of pounds spent on them to enable a disabled person to live in the property. It does not make sense for people to move from such properties to others that will themselves require costly adaptations. I therefore welcomed the fact that of the additional £30 million per annum being added to the discretionary housing payment scheme by the Government from April this year, £25 million is intended to be used

“specifically to assist those disabled claimants who are in properties where a significant adaptation has been made to cater for their individual needs.”

I have contacted the two councils in my constituency to ask them how they intend to allocate the additional funding. Stafford borough council has been working with housing associations to identify tenants affected by the new legislation. It will be concentrating its extra funding, which I estimate to be some £75,000, on disabled people whose property has been adapted and on foster carers; the support will be for 12 months. South Staffordshire district council, which has an additional £64,000 funding, will give short-term support, one to three months, to disabled people with property adaptations. The support is short term, because the council wishes to assess the situation before it commits to the longer term.

Both councils have been proactive in arranging mutual exchanges of properties between those who have spare rooms and those who are overcrowded—they have been doing exactly what the Government wish to encourage. However, both councils face serious shortages of one-bedroom properties for couples or singles, as much of the housing in the area has two bedrooms. That raises two questions for the Minister. First, can councils be sure that they will continue to receive at least the level of additional funding each year for discretionary housing payments that has been granted in 2013-14? Given that much of the funding will be for disabled claimants in adapted properties in which they are likely to live for many years, the need for DHPs will continue. Secondly, is the guidance for the assessment of the number of rooms required by disabled people being set out in the terms that the Minister used to me in the House last year? In addition to the case I mentioned, there are instances where disabled people live on their own or as a couple in a two-bedroom property with little or no storage space, and they tend to use the second room, which is often small, to store equipment that they need—perhaps a wheelchair or a mobility scooter. My understanding of the Minister’s comments in the House last year is that the second room should not be counted as a bedroom.

[Ian Lucas (Wrexham) (Lab)]

The hon. Gentleman is making a compelling case. Some of the individuals affected are severely disabled and the uncertainty that he has outlined is creating great worry, and not just for them; some parents of disabled people are also concerned about the situation. Is it not imperative that an element of certainty is introduced to the system?

[Jeremy Lefroy]

I thank the hon. Gentleman for that intervention and I agree with him. Certainty is vital, which is why I am asking for clarification, and hopefully clarification in the terms used by the then Minister for disabled people in the House of Commons last year.

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

I thank the hon. Gentleman on behalf of the whole House for pursuing this matter so consistently, and I congratulate him on having the benefit of having as a constituent John Turner, who I know is an assiduous campaigner on this matter.

Consistency across the country is also necessary. There needs to be monitoring by central Government of how the policy is being applied, because I think we will discover, as we are already discovering in some areas, inconsistency of approach by individual councils.

[Jeremy Lefroy]

I thank the hon. Gentleman for his intervention. He is right: in the two cases that I have outlined of Stafford borough council and South Staffordshire district council, we can already see some differences. Those differences have arisen not for ideological reasons, but because each council takes a slightly different approach. I am all in favour of local councils making their own decisions, but if we end up with a situation wherein some councils’ conditions for DHPs are drastically different from those of other councils, there will be serious problems. Of course, there is also the question of the different profile of housing stocks in different parts of the country, which has an impact on what the hon. Gentleman has said.

To continue discussing space, the size of the rooms also needs to be considered, but the rules specifically rule that out. A typical tenancy agreement may describe the bedrooms as “two plus one plus one”—in other words, one double bedroom and two single bedrooms. The single bedrooms are described as single for a reason—they are often very, very small, as I have seen for myself. Yet a family comprising, for example, a couple and two boys under 16 would be considered as under-occupying that type of property. The rules encourage that family to move to a two-bedroom property, which may itself be described as “two plus one” and where they would effectively be in breach of the tenancy. Surely, size of rooms needs to be taken into account when determining whether there is under-occupancy. I ask the Minister to reconsider the rules.

Of course, the family that I have just spoken about might not be able to find a such a property. In many areas, there is a shortage of suitable housing into which tenants can downsize, which is a serious problem, and it is probably the most significant reason why disabled people are by far the most likely to be affected by the changes to the housing benefit rules, given that, as the impact assessment stated, disabled people will tend to be in smaller households. There is nothing that disabled people, or indeed anyone else who is affected, can do about that situation. They cannot move into properties that do not exist.

[Anas Sarwar (Glasgow Central) (Lab)]

I congratulate the hon. Gentleman on securing this important debate. Obviously, this is a massive issue for disabled families, but more widely there are 660,000 people on housing benefit who are likely to be affected by the changes, mostly those who are living in two or three-bedroom properties who will need to move to a one-bedroom property; they will be penalised, by an average of £728. Does he think it is fair that those people will be penalised in such a way when there is such a shortage of one-bedroom properties?

[Jeremy Lefroy]

It is a very difficult situation. I fully understand the Government’s need to get to grips with the housing benefit bill, and I will come on to that issue in a moment. I know that my right hon. Friend the Secretary of State for Work and Pensions considers these matters extremely carefully, and I have had personal discussions with him about them. I agree that there is a need to try to free up the larger housing stock for those people who are over-occupying properties—people who are overcrowded; I also have constituents coming to me with that problem. However, I agree with the hon. Gentleman that there is a problem of the kind he describes.

Will the Minister say whether, in allocating DHPs between councils, any allowance has been made for those areas in which there is short supply of the one-bedroom housing that is most suited to disabled people who are living on their own or as couples without the need for a carer? If no such allowance has been made, that needs to be taken into consideration, at least for a while, until councils or housing associations have been able to provide such one-bedroom properties.

Two of the reasons for introducing the rules are to encourage greater mobility within the social rented sector and to make better use of the housing sector stock. Those are important reasons at a time when families are struggling in overcrowded accommodation—a situation I am sure that all Members know of from their surgeries. The problem is in the application for existing tenants who are affected by the changes, two thirds of whom, as we have seen, are disabled. It is difficult to see the purpose in encouraging a family with, say, two girls, one of whom will be 16 in a year or two, to move away—even if they can find a smaller property—only for them to need to move back into a larger property when the under-occupancy deduction no longer applies.

If family incomes were such that an additional £12 or so a week was affordable, there would be no cause for concern, but for families in which one person is disabled, income is more than likely to be limited, and the need for a discretionary housing payment therefore grows. It is to deal with such cases that I encourage the Minister to increase the additional funding for discretionary housing payments. If £25 million is set aside to offset the reduction in housing benefit for disabled people whose homes have been adapted—that sum may in itself be insufficient—there will be little left for other difficult situations.

On another matter, a constituent visited me two weekends ago to put the case of fathers who live apart from the mother of their children but look after the children for, say, three nights a week. The bedroom they have kept for their children is considered spare, and hence subject to the reduction in housing benefit. I do not believe that a bedroom that is occupied by one’s children for almost half the week can be described as spare. The fathers therefore face a choice between paying the weekly amount while trying to live on jobseeker’s allowance or employment and support allowance, and going into debt—those are their own words—or not having their children to stay. They all say they will do the former—go into debt—rather than not have the children to stay. I do not believe it was the original intention of the changes to force them into such a choice. We must not put obstacles in the way of fathers remaining in touch with their children. I ask the Minister to look again at the rule that does not count a bedroom used by children for two or three nights a week as part of the occupancy of the home.

The housing benefit bill rose from £11 billion in 2000-01 to £21 billion in 2010-11. Even in real terms, that is an increase of £6 billion a year. I fully appreciate the need to get a grip on this, but ultimately it is growth in the economy, improving incomes and a massive programme of building social and affordable homes, which I hope all Members will support, that will bring that bill down. In the meantime, I ask the Minister seriously to consider changing the rules as I have proposed in respect of children of parents living apart, and the minimum size of rooms that are expected to accommodate more than one child. I also ask that the Government ensure that the statement by my right hon. Friend the Member for Basingstoke when she was Minister for disabled people about there being “clear support” for disabled people to have the rooms they require is properly implemented.

At the same time, I ask the Minister to consider making an additional amount available to local councils’ DHP funds. That will give councils the opportunity to assist those whom the additional £12 or so a week, which they cannot avoid because of the lack of suitable properties to move into, takes over a tipping point at which their finances become unmanageable, potentially leading them toward eviction and homelessness.

11:13

[The Parliamentary Under-Secretary of State for Work and Pensions (Esther McVey)]

It is a pleasure to take part in a debate on such an important issue, and I congratulate my hon. Friend the Member for Stafford (Jeremy Lefroy) on securing it. It is also a pleasure to serve under your chairmanship, Mr Caton. I believe that it is the first time that I have done so.

As we have heard, there is considerable interest among hon. Members in all parts of the House in housing benefit and how the benefits system supports disabled people, and it is important that we make time to discuss those issues in detail. Before I address some of the specific issues that have been raised, I will set out the Government’s approach to housing provision for disabled people.

As hon. Members will be aware, the Government are in the process of reforming the welfare system that will result in housing benefit for working-age people being replaced by universal credit. Current housing benefit arrangements include specific provisions for disabled people that mirror those for other means-tested benefits. They include, for example, a range of disability premiums, earnings disregards and permitted-work rules. With universal credit, we are simplifying the current arrangements to ensure that disabled people benefit from improved work incentives and a smoother transition into work.

My hon. Friend is right to point out that the cost of housing benefit has increased by about 50% in real terms over the past decade, with expenditure totalling £23 billion in 2011-12. That is simply unaffordable in the current economic climate. To begin to address it, the emergency Budget in June 2010 introduced a series of reforms to housing benefit paid to claimants in both the private and social rented sectors. Starting in April 2011, and finishing last month, we set up a series of reforms to local housing allowance, which is the basis for housing benefit awards made to people renting in the private sector. Those changes are intended to exert downward pressure on rents and introduce fairness into the system—for example, by setting caps on the benefit that is paid to ensure that the benefit system is not funding accommodation that many hard-working families could not afford.

Disabled people are not exempt from the reforms, but steps have been taken to provide some additional support to minimise potential adverse impacts on them. My hon. Friend mentioned the number of people affected by the social sector size criteria who are disabled. It is important to stress, however, that that reflects the general proportion of disabled people living in social sector housing overall. In answer to his question, I can confirm to my hon. Friend that the criteria allow for an extra room where a household has an overnight carer.

I am pleased to hear that Stafford borough council and South Staffordshire district council have been working proactively with tenants to identify, for example, where there may be scope for a mutual exchange. I have had other reports in the Department for Work and Pensions of such direct engagement with tenants. I must stress that many other options may be open to people, including those that they arrive at privately to deal with their own circumstances. Things that people can do—and are already doing—include moving somewhere smaller, finding the extra money required, or taking in a lodger. We are now waiving the income tax on that up to £4,250 a year. No tax would be payable on that sum. It is important to note that the private sector may have a supply of different sized properties and that people could move out of the social and into the private sector. When properties without the right number of bedrooms are not available in the social sector, they might be available in the private sector.

[Anas Sarwar]

Is the Minister seriously suggesting that people who are among the poorest and most vulnerable in our communities will be able to find £728, on average, from their annual income, to make up for the deficit in the housing benefit that they will get?

[Esther McVey]

I am not being specific about what people should or should not do. I am saying that there is an array of options, from which someone will find their best solution. The hon. Gentleman will, like me, have met people at surgeries who have said that they have come together as a family to work on the best solution for everyone. It is not a question of one person in isolation but the whole family. Many options are available. As we have said, we are living in tough financial times. What I am talking about is not something that we can take on board easily. We must just consider the fact that there are 1 million spare bedrooms in the current housing situation, but that 250,000 families live in overcrowded houses. We must ask what we can do to support those people.

[Anas Sarwar]

Will the Minister give way?

[Esther McVey]

I will proceed a bit further, and then if the hon. Gentleman wants to ask a further question he can.

There are always specific cases where the options in question may not be sensible or appropriate, and that is why we have trebled funding—a considerable amount—for discretionary housing payments, to give local authorities more flexibility to help people affected by the changes. Overall discretionary housing payment funding in 2013-14 will total £155 million. The funding has been allocated to support the bedding in of specific reforms, but we have listened to feedback from local authorities and as a result have built in flexibility that will allow authorities to allocate funding based on local needs. That flexibility includes, for example, helping disabled people who have made adaptations to their homes to remain in them, as was mentioned by my hon. Friend.

As I have said, there will be provision for those disabled people who need overnight, non-residential carers to receive additional payments for an extra bedroom. The hon. Gentleman pointed out that we are giving many types of support. The trebling of the discretionary benefit really does go to support the people most in need.

[Anas Sarwar]

On flexibility, is the Minister open to the idea of introducing a safeguard for people who cannot reasonably move to another local property because of the lack of availability and of sanctioning them only if they refuse a reasonable request? Is she open to that safeguard?

[Esther McVey]

The hon. Gentleman is speaking hypothetically. We have put in extra discretionary funds, because local councils will know exactly who those individuals are. We have put in extra money, and we have said that it is possible to move between the social and private sectors. With all the options that we have put in place, we believe that we will find solutions for all cases.

[Jeremy Lefroy]

I am grateful to the Minister for her answers. Will she give us some assurance that the additional discretionary funding, which we need to look at again to see whether it is adequate, will be continued through 2014-15 and 2015-16? Often the adaptations are such that it is not possible for a disabled person to move property in the next year or two. One of my constituents has adaptations worth some £30,000. It does not make any sense for them to move from their property.

[Esther McVey]

My hon. Friend makes a good point, and I will come on to that a little bit later and explain in detail what we are doing. He will also appreciate that I cannot make spending commitments into the next Parliament. None the less, with regard to the discretionary housing payment, the Government are committed to ensuring that the reforms are well implemented. We are working closely with local authorities and the Local Government Association regarding this payment usage. As part of the review of these reforms, we are taking ongoing feedback, and I will be pleased to pass on the points raised here today and any further evidence that emerges as the reforms are rolled out. We will continue to monitor and evaluate the impact of the changes.

I should like to put it on the record that a lot of the negative impacts that people talked about last year, such as an explosion of homelessness and mass migration, have simply not emerged. We all want to ensure that there is a smooth transition and that the change is affordable. Of course we are using common sense. My hon. Friend talks about expensive modifications. We know that we have to take that into account, which is precisely why we have trebled the discretionary fund.

We have also made arguments for exempting certain categories from the social sector size criteria measure. However, we do not believe that blanket exemptions are the most effective and affordable approach to targeting resources, because they do not take into account local knowledge. We have therefore avoided exemptions where possible and favoured the discretionary housing payment, because local decision makers are best placed to make decisions based on individual circumstances.

[Ian Lucas]

The Minister is being generous in giving way. Can she foresee circumstances in which someone who requires an overnight carer is not allowed an extra room within the housing benefit provisions?

[Esther McVey]

That is precisely why we are monitoring and evaluating the scheme, and we will continue to do so for two years to see what extra support might be needed. Of course we are watching and observing what is going on. [Interruption.] I will complete my comments here. However, we are committed to undertaking the independent evaluation of all housing reforms. The first report on the private sector is due to be published later this year, and work on evaluating the social sector changes will be implemented in April, with initial findings being available next year.

I trust that I have answered many of the questions that have been raised today. On other specific matters, I will get back to my hon. Friend. As I have already said, this is an important debate, and it is crucial that we closely monitor the situation. We are considering the most vulnerable people in society, and we have a commitment to them.

[John McDonnell]

I do not want the Minister to sit down thinking that there is no housing crisis out there. She referred to the predictions on housing benefit not coming true, but they have in my constituency. I have the worst housing crisis since the second world war. Nevertheless, she has mentioned monitoring, which is critical. Will she give an assurance that that monitoring will be published regularly, so that the House can receive and debate it? The points raised by the hon. Member for Stafford (Jeremy Lefroy) are critical. We must see what is happening on the ground, because a number of local authorities might want to work with Government to plan a transition over time. There will be a number of families for whom alternative private accommodation or social housing is not available and might not be available for years. An assurance that the monitoring will be published and that we will be able to debate it in the House would be helpful.

[Esther McVey]

The hon. Gentleman makes a good point. Of course, we have to monitor the situation, and I have confirmation from colleagues that the monitoring and evaluation will be made public. At the moment, there is much speculation about what might happen, but that is hypothetical. We do not know about that, but by monitoring closely, by introducing a discretionary fund and by working in a common-sense way with people on the ground who know best about local needs, we can get this right.

[Jeremy Lefroy]

I welcome the Minister’s commitment to monitoring, which is important. Will she say a few words about fathers who, unfortunately, are separated from the mothers of their children and who are not allowed to count the presence of their children in their home for up to three nights a week as part of the occupancy of that home? That is an important point. She and I, and I think all hon. Members present, feel that it is important for children to have regular access to both their parents—in this case, to their fathers.

[Esther McVey]

Again, my hon. Friend asks a key question. The heart of the matter is that we do not want children to suffer. Children must have what is right for them, but where a tenant has non-residential children, housing benefit may already pay for a room for the child or children in the place where they usually reside. Funding an additional room in both parents’ properties could be a double provision, but discretionary payments are the best way to address specific complex cases, which we are talking about here.

I am glad that all those points have been highlighted, and they will all be closely monitored. I thank my hon. Friend for bringing such an important debate to the House.

11:28

Sitting suspended.

Housing Benefit Entitlement

Wednesday 23rd January 2013 Westminster Hall

[Hugh Bayley in the Chair]

14:30

[Phil Wilson (Sedgefield) (Lab)]

It is a pleasure to see you in the Chair this afternoon, Mr Bayley. I wanted to select the rules on the under-occupancy of social housing and housing benefit entitlement, which start this April, for this debate today because the Government’s proposal is divisive legislation. In fact, it is not only divisive but arbitrary, spiteful and deeply cynical. It has been devised either by those who have no understanding, knowledge or experience of social housing and do not care, or by those who have understanding, knowledge and experience of social housing and should know better.

The under-occupancy rules say all that anyone needs to know about this Government—tax cuts for the rich and a bedroom tax for the poor. The bedroom tax is being created by a mindset that believes only those who own their own homes can live in a community and those who rent with Government support, even though many of them are in work, are deemed to be a burden on that community and not entitled to, or deserving of a home and that they should be moved at the behest of others and not themselves.

What do the under-occupancy rules mean for social housing and council tenants? If a household rents from a social landlord and is in receipt of housing benefit, and it is deemed to have one spare bedroom, the property is seen to be under-occupied. The tenant’s housing benefit is reduced by 14% for one bedroom and by 25% for two bedrooms. It has been estimated that about 660,000 tenants will lose an average of £728 a year, starting from April.

[Mr Kevan Jones (North Durham) (Lab)]

Does my hon. Friend agree that these proposals will also affect those who are in work? I had a constituent in my surgery a couple of Saturdays ago who had been made unemployed. He had gone out and got a part-time job in a filling station. His wife is a local carer as well, and because they live in a three-bedroom house—they have lived there for 30 years—and their family have left, they will be affected by the bedroom tax. Is that fair for striving people like that?

[Phil Wilson]

It is obviously not fair, but the bedroom tax is hitting people whether or not they are in work. This regulation is just plain wrong. The reality is that if a married couple have lived in a three-bedroom house for many years and had two children who have grown up and left home, the two children’s bedrooms are now deemed to be spare. The house is seen as under-occupied and the couple’s housing benefit entitlement is cut accordingly.

[Julie Elliott (Sunderland Central) (Lab)]

The biggest social landlord in my city of Sunderland, Gentoo, has informed people who will be affected by this change, and even if those people are saying, “We’re happy to move to smaller premises,” there simply are not the smaller premises to move to. Is that fair?

[Phil Wilson]

That is a very good point, and it is something that I will come on to later in my speech.

As I was saying, a married couple with a three-bedroom house, which they have lived in for a long time, will need to top up their rent from another source if they want to stay in the home and obviously, since the family is receiving housing benefit, any sources of additional income are extremely limited. That is something that this cynical Government are fully aware of.

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

In my constituency, which is very young, there are a number of families who have two children of the same gender living in a three-bedroom property. Under the new rules, they would only qualify for a two-bedroom property. What would my hon. Friend’s advice be to them? Or perhaps I should ask what the Minister’s advice would be to a family who have a 15-year-old boy and a 12-year-old boy, with the 15-year-old about to turn 16 in a few months’ time, but in the meantime—from April onwards—the family will have to find that extra rent. Will that drive the family into the hands of moneylenders, or do the Government have a plan?

[Phil Wilson]

We should wait until the Minister responds to the debate to find out exactly what the Government propose for that situation, but I do not think that it will be very much really.

Basically, the hypothetical family who I am talking about could be forced to leave the family home, and that is exactly what it is—a family home, not just a house. They will have no space for their grandchildren, who will not be able to stay with their grandparents. For families who are forced to downsize because of the cuts in housing benefit and who are in need of a one-bedroom property, the National Housing Federation has found that, although approximately 180,000 social tenants are under-occupying two-bedroom homes, less than 85,000 one-bedroom social homes are available.

[Jonathan Reynolds (Stalybridge and Hyde) (Lab/Co-op)]

I am grateful to my hon. Friend for giving way; he will have a few applications to intervene on him, given the interest in the debate. I completely agree with his analysis of the general impact of the proposal, but will he say something about the complete lack of any exemption? Foster carers, who are doing everything they can for society, will be hit by the proposal between placements. It is absolutely unconscionable. Surely, this cannot be the way for the Government to proceed.

[Phil Wilson]

My hon. Friend is absolutely right, and I will come on to foster carers in a little while.

The lack of mobility in this sector—between two-bedroom properties and one-bedroom properties, for example—is a product not of tenants needlessly under-occupying larger homes, but of the logjam created by a national shortage of affordable homes, particularly two and one-bedroom properties.

[Dame Anne Begg (Aberdeen South) (Lab)]

I spoke to the Glasgow Housing Association last week, which is the largest provider of social housing anywhere in the UK. It reckons that the shortfall that it will face could mean that 700 houses that it would have built each year will now not be built. So, rather than helping with the housing shortage, the proposal is making things worse.

[Phil Wilson]

That is another good point. I will come on to discuss that situation, which is also affecting my own local social housing providers in County Durham.

I understand that the Department for Work and Pensions has recognised the lack of available smaller properties. In its impact assessment, it notes that there is a mismatch between household size and the availability of suitable homes in the social sector for under-occupying claimants to downsize. I will now look at how that will affect County Durham, especially my constituents in Sedgefield.

[Nic Dakin (Scunthorpe) (Lab)]

I congratulate my hon. Friend on securing this important debate. In north Lincolnshire, North Lincolnshire Homes—the social housing provider—has 1,500 people who are deemed to be under-occupying properties and only 40 single-bedroom properties become available every year. People in huge distress are coming to see us about this matter, and it is very distressing.

[Phil Wilson]

It is very distressing, and the point that my hon. Friend raises again about the lack of one-bedroom properties will be starkly set out in the next part of my speech.

Livin, which used to be called Sedgefield Borough Homes, has about 8,500 properties, and about 1,609 of those households will be affected by the bedroom tax: 1,365 households are under-occupied by one bedroom and the remainder are under-occupied by two bedrooms. Livin only has 204 available one-bedroom properties. East Durham Homes—another housing association, which covers the communities of Wingate, Wheatley Hill, Thornley and Deaf Hill in my constituency—has said that it would take seven years for it to re-house all the tenants affected by the bedroom tax. For Livin, the period required to re-house affected tenants would be much longer. Both East Durham Homes and Livin estimate that the bedroom tax would mean that the 2,977 of their households that would be affected would have to find almost £1.8 million from elsewhere to go towards paying the rent on their existing homes, or the people in those households would have to go into arrears or move out, but there are not enough one-bedroom properties.

[Helen Goodman (Bishop Auckland) (Lab)]

My constituency, which is a neighbouring constituency to that of my hon. Friend, is similarly affected. There is another housing association in my constituency, Dale and Valley Homes, and there are a further 875 people affected in this way. Some of those individuals are being pushed to live on as little as £23 a week. Does he not think that that is utterly disgraceful?

[Phil Wilson]

At the beginning of the 21st century, it obviously is. Bishop Auckland, the constituency that my hon. Friend represents, shares some of the statistics regarding Livin, because it covers both our constituencies, and it is concerned because of the proposal that its rent arrears could double from 4% to 8% in the future. In a briefing note prepared by Livin, it said:

“Rent arrears will increase, affecting cash flow, which could mean that the loan facility made available to Livin for improvements and development of the housing stock may be required to fund administration. This could only be considered as a temporary position and Livin would need to readjust its spending to avoid borrowing for ongoing day to day costs.”

I said earlier that the impact of these new rules would be arbitrary on families and communities. Here are a couple of examples. The DWP’s equality impact assessment shows that 66% of claimants who will be affected by the bedroom tax are disabled. Although recipients of disability living allowance are exempt from the overall benefit cap, the DWP has chosen not to exempt them from the bedroom tax.

[Kate Green (Stretford and Urmston) (Lab)]

I am grateful to my hon. Friend for mentioning disabled people. He may be aware that Ministers have made much of access to discretionary housing payments for disabled people. Indeed, Ministers have implied that the money has been allocated specifically to meet the needs of disabled people. But, of course, the money is temporary and limited, and the discretion of local authorities whether to pay only to disabled people cannot be fettered. Is it not totally misleading to imply that discretionary housing payments will in any way compensate for what has been lost?

[Phil Wilson]

My hon. Friend is absolutely right. I will address that in my speech, which many hon. Members seem to have read. The Minister will probably say that that budget is being increased, but it is not ring-fenced.

A man came into my constituency office. He is divorced, and he cares for his children for part of the week. He receives housing benefit and lives in a two-bedroom house. The children’s mother, however, is deemed to be the main carer, so his housing benefit will be docked by 14%. He will need to move into a one-bedroom property, if he can find one. His main problem is that, if he moves into a one-bedroom house, how will he look after his children for part of the week?

[Jonathan Ashworth (Leicester South) (Lab)]

Is it not extraordinary that no Conservative Members are here, other than the Parliamentary Private Secretary, to defend the policy?

A couple came to my constituency office, and they live in a specially adapted bungalow. The wife has to have morphine through the evening, so the husband has to sleep in another room. Under the proposals, they will have to move out of that specially adapted bungalow, all because some politicians want to say that they are getting tough on scroungers. That is not about fairness; it is about cheap, nasty politics.

[Phil Wilson]

My hon. Friend makes an excellent point with which I do not think any Opposition Member would disagree.

The gentleman who came into my constituency office is an example that exposes the modern Conservative party and, indeed, the coalition. Conservatives like to see themselves as the party of the family, but they are not the party of poor people who need support to keep their family together.

To address those issues, the Government have offered additional discretionary housing payments to help people with disabilities remain in properties adapted for their needs. As those payments are often limited to just a few months, however, they are not a viable long-term solution, because they fail to give people with disabilities the assurance that their housing needs are secure. Also, the payments are made from budget-limited discretionary funds. The payment budget distributed by local authorities will come under significant pressure, following major cuts to local housing allowance for private sector tenants, and local authorities might choose to prioritise those who are at risk of homelessness, rather than social tenants with disabilities.

The Fostering Network—the voice of foster carers throughout the country—successfully campaigned for a £5 million addition to the discretionary housing fund to compensate foster carers who may have their housing benefit cut from April. The network is hearing from foster carers who have received under-occupancy letters. Some housing departments either do not know about the fund or will not use the money for foster carers. The network reports that 9,000 foster families are needed to meet the foster carer shortfall in 2013. There is already a recruitment crisis, and the network is concerned that the situation will worsen as a result of housing benefit reform.

The Minister will no doubt say that the under-occupancy rules will bring the social housing sector into line with the private sector, but the new rules are retrospective and penalise people who brought up their families in a council house in which they may have lived for years—the average tenancy for social housing is some seven years. The bedroom tax penalises couples who have done the right thing and who over the years may have spent their own money on decorating and maintaining the property. The property is not theirs to keep, but they have respect for what is their home anyway.

No doubt the Minister will also say that the change is required to help to pay off the deficit, because the Government expect the bedroom tax to save £450 million to £500 million. The Government’s plans are spiteful and cynical, because the only way that the £500 million will be saved is if those who live in under-occupied properties cut their standard of living still further by trying to remain in their home, by not downsizing and by paying the additional rent. The Government are trying to get tenants to pay their own housing benefit out of money that they do not have.

[Mr Kevan Jones]

My hon. Friend’s constituency, like mine, is a recruitment area for the British armed forces. Is he aware of the case raised by my hon. Friend the Member for Middlesbrough South and East Cleveland (Tom Blenkinsop)? A mother, whose son has joined the armed forces and is fighting in Afghanistan, will be hit by the tax because her son is not at home and she has an extra bedroom. Is that fair from a Government who say they are standing up for our armed forces?

[Phil Wilson]

That is not the way to treat the armed forces, especially when they are on active service in Afghanistan and elsewhere.

The Government say that they are trying to save money, but that is impossible for the great majority, who will be forced to choose between their home and a basic standard of living. There is a shortage of one-bedroom properties. If people choose to move into the private sector, rents and housing benefit claims might be higher. The changes hit right across the board, including members of the armed forces, the disabled, the vulnerable and sick people who sometimes, but not always, need a carer.

[Meg Hillier]

In my constituency, private sector rents are so much higher than in the social rented sector that moving is not an option for people in such circumstances. Does my hon. Friend agree that in my constituency, and I am sure in other constituencies too, many people do not understand that the change will happen from 1 April, or from when their tenancy renews? Does he foresee a big social problem arising from the Government’s lack of ability to communicate this invidious policy?

[Phil Wilson]

My hon. Friend makes a valid point. As MPs, we are seeing a great increase in benefit casework. As we get closer to 1 April, the casework will get even harder.

The under-occupancy rules are the manifestation of the Government’s appalling manipulation of the welfare debate. The language is the same old narrative that we have had down the ages: to secure their own position, the Tories pit one section of the community against the other. Once, it was the deserving poor and the undeserving poor; now it is strivers versus shirkers.

This legislation is unbecoming of a civilised society: it is born of ignorance and raised by prejudice. What is deserving of a civilised society is a new house-building programme, decent jobs, a growing economy and one nation in which we truly are all in it together. The legislation is wrong and should be repealed at the earliest opportunity.

[Hugh Bayley (in the Chair)]

I intend to start the wind-ups at 3.40 pm, which gives us 53 minutes or so. Eleven Members are on my list as seeking to speak, so I will impose a time limit of five minutes to begin with. I warn Members that that might leave some of them at the end with slightly less than five minutes, and if there are interventions even less still.

14:39

[Yvonne Fovargue (Makerfield) (Lab)]

I congratulate my hon. Friend the Member for Sedgefield (Phil Wilson) on securing this important debate.

This policy, more than any other, except perhaps direct payment, will have a major impact on local housing associations and social housing providers. Wigan and Leigh Housing manages 22,600 properties, and 68% of our tenants are on housing benefit. Of those properties, 4,571 are under-occupied and in receipt of housing benefit. Nearly £3 million in housing benefit payments will be lost to that social housing provider, and our shortfall is in one-bedroom and two-bedroom accommodation. For example, our one-bedroom stock is 5,591. In 2011-12, 852 properties were void, and demand for those properties was 2,089 people. We simply cannot re-house people in one-bedroom properties.

If, as predicted by the Cambridge Centre for Housing and Planning Research study, 32% wish to downsize and move to the private sector, that will not offer any savings. In fact, more will be paid for a two-bedroom property in the private sector in Wigan than is paid for a three-bedroom property in the social sector. We have an oversupply of three-bedroom properties. The cumulative effect of the council tax changes will be some £3.50 a week for exactly the same group of people. The study estimates that 26% of tenants will not be able to pay the under-occupancy charge. If 42%, as estimated by the study, do not pay, the ultimate sanction will be eviction.

Has the Minister tested the courts’ view of a tenant who has requested a move, for whom no property is available and who cannot pay? What will be the courts’ opinion? If such people are evicted, based on an average eviction cost of £6,852 per person, my local social housing provider will lose £13.1 million. That £13.1 million will not be spent on building houses, repaying debt or improving stock for tenants. Wigan has done some modelling and made some assumptions about what will happen if the under-occupancy tax goes through as planned, and the change will cost the Department for Work and Pensions £229,000 per annum and, as I said, the authority a possible £30 million in eviction costs. There is no saving for the Department—it is not a policy aimed to save money.

Moreover, as my hon. Friend the Member for Sedgefield mentioned, the reassurances about the discretionary housing payments will certainly not meet people’s shortfall. The total budget for Wigan is £456,000, which will assist with only 15% of the charge. If the amendment proposed by Lord Best was agreed—a penalty only for under-occupation by two bedrooms or more—the situation in Wigan would be mitigated somewhat and the DWP savings would be delivered. In Wigan, if one bedroom could be under-occupied, the savings to the DWP would be £371,000 and the scheme would reduce the number of tenants affected to about 1,000, potential bad debt to £249,000 and eviction costs to close to £3 million. That is not a great policy, and it would pass central savings to the local budget, but it would be more manageable in areas such as Wigan.

What modelling has been made for areas such as Wigan of that amendment and the increased savings for the DWP? Has all the modelling been London-centric? Will the Minister consider looking at Wigan and other areas in the north and north-west, where there is a shortage of smaller housing, to mitigate at least the effect on communities and tenants?

The under-occupation tax is trying to solve a problem that simply does not exist in my area and other such areas. In doing so, it is creating massive problems for individuals, social landlords and communities.

14:52

[Lisa Nandy (Wigan) (Lab)]

I am losing my voice, as you can probably tell, Mr Bayley, but I was so upset and incensed by the proposals that I am doing my best to speak on behalf of the 4,000 Wigan households that will be affected from April. Collectively, those households will have to find nearly £55,000 a week in extra rent. I am clear that the vast majority will not be able to manage, so they will have to downsize. As we have just heard, however, we have a problem: we do not have one and two-bedroom properties available. The demand for them already far outstrips demand for other properties; for example, 62 households are waiting for four-bedroom homes and 2,000 for one-bedroom flats.

Put simply, downsizing is not an option, so tenants will be forced into the private sector, where rents are between £20 and £40 a month higher. If only half of tenants make that move and claim the local housing allowance, the Department for Work and Pensions will not save a single penny, but those families will have had their lives disrupted, leaving the homes that they have grown up in and with children forced to move schools and childhoods destroyed.

I have little doubt that Ministers are aware of such implications of the policy. Last year, I wrote to the then Minister to ask whether a constituent would be expected to move in April—his mother had recently died from cancer, leaving him under-occupying, and he is now suffering from terminal cancer himself. The Minister did not give me a commitment that my constituent, a man with only up to two years to live, would not have to move. The policy, to use the words of my hon. Friend the Member for Sedgefield (Phil Wilson), is one of the most spiteful and callous that I have ever seen enacted by a Government.

In Wigan, it is not clear whether people will be able to find homes in the private sector, because larger properties make up 75% of the stock. It will take 33 years, at current building rates, for private and social housing collectively to meet needs. The situation is unclear, but if those people simply cannot afford to live in their properties, they may well have grounds for being re-housed as unintentionally homeless. Can the Minister tell me where he expects a housing authority such as mine, without access to smaller properties, to put those people? How on earth can creating this unnecessary, callous revolving door of homelessness, destroying people’s lives in the process, possibly be a moral policy to pursue?

Finally, I want to make a specific point about foster children, to which my hon. Friend alluded. It is absolutely scandalous and a damning indictment of the Government’s lack of commitment to the most vulnerable children that, apparently, no thought at all was given to foster children when the policy was devised. Foster children simply do not count—they are invisible—for the purposes of the policy and the purposes of a spare room. The money that has since been made available through a discretionary fund, as my hon. Friend said, is not widely known about among foster carers or local authorities. Furthermore, that pot amounts to only £100 per child, which is woefully inadequate for the foster children already in the system, let alone for the many more whom the Minister’s colleagues in the Department for Education are rightly seeking to place.

We have a huge shortage of foster carers in this country, and the situation for children waiting in the care system must be urgently rectified. Where is the thought given to those children, or the commitment from their Government? Why did the Government overlook those children in the first place? Why do those children simply not count? Why has so little money been made available? Despite concerns expressed by the Under-Secretary of State for Education, the hon. Member for Crewe and Nantwich (Mr Timpson), why has the policy not been reversed? Why was the money for such children not ring-fenced? It might not even be used to help their situation. Can the Minister, if he will not reverse such appalling regulations, at least commit to amending them, so that they do not make the situation worse for some of the most disadvantaged children in this country?

14:56

[Rosie Cooper (West Lancashire) (Lab)]

It is a pleasure to serve under your chairmanship today, Mr Bayley. I congratulate my hon. Friend the Member for Sedgefield (Phil Wilson) on securing the debate, which gives Members the opportunity to highlight the abject failure and inherent contradictions that lie at the heart of the Government’s housing benefit reforms. Lord Freud, in response to hon. Members’ letters, suggests that the reforms are aimed at encouraging mobility within the social rented sector, at strengthening work incentives and at making better use of social housing. My response is clear: they don’t, they won’t and they can’t.

I will highlight, through constituents’ cases, how the policy is nothing more than a crude and naked attempt to place an ever greater burden on some of the most vulnerable people in our communities by slashing budgets. I get the sense that, as an abstract idea, reducing the welfare bill by cutting housing benefit to all the supposed scroungers living in houses far bigger than they need is a policy that will press all the Government’s public relations buttons. The problem is that we are not talking about abstractions; we are talking about families, people’s homes and perhaps forcing people to choose between food, heating and paying the rent.

I have 103 families affected, and I wish to race through three examples. One such constituent is accepted by the council as unintentionally homeless. She has a five-year-old child, is pregnant and is in receipt of jobseeker’s allowance. She could be a perfect example of the type of person whom the Government are seeking to characterise, stigmatise and castigate. Yet, when the local authority comes back to her, it is with an offer of a four-bedroom property, so her housing benefit will be reduced by 25%. That constituent and her young family will go from being homeless to facing extra financial burdens. In the long term, that means increasing her debt, so she faces possible eviction by the very people who gave her the house, because she cannot pay the 25% contribution required as a result of being given a property that was too big in the first place.

West Lancashire borough council, as the housing body, is, by its allocation policy, complicit in the inappropriate letting of properties. That allocation policy perpetuates the exact problem that the Government claim that they intend to solve by reforming housing benefit. If I were being kind, I could suggest that the case highlights the fact that social landlords and councils do not have the range of housing stock to meet the challenges that the Government are setting. People are making short-term decisions to put a roof over their heads and neglecting the long-term consequences of under-occupancy. Why is my constituent left to face the consequences of a decision that will be forced on her?

My second example is that of a disabled man living in a two-bedroom property—it was a three-bedroom property, but it was adapted. His daughter is in the armed forces, so he technically has two bedrooms empty. If he moves to a smaller flat—there are none available, by the way—the council will have to pay for adaptations to be made to the new flat, while removing the adaptations from the original flat to make it available for re-letting.

Another case involves a constituent who is separated. He has his children to stay on alternate weekends and midweek. The Government say they defend families and put them at the core of what they do, but this policy does not show that at all. The February 2012 impact assessment says:

“savings in Housing Benefit expenditure will only be realised in full if social tenants do not seek to move from the homes they are under-occupying”.

Rather than wanting people to move, the Government would prefer them, ideally, to stay where they are and pay the increased costs, even if they do not have the money.

This policy is absolutely unfair, and that has been shown by the contributions made so far. The Government are abjectly failing to offer people the range of accommodation or the jobs that would enable them to alter their situations. I do not call it fair when the Government place greater burdens on the most vulnerable.

15:01

[Simon Danczuk (Rochdale) (Lab)]

I thank my hon. Friend the Member for Sedgefield (Phil Wilson) for securing this important debate on a critical issue. I want to talk about two families who came to see me in Rochdale, but they are just two of the many who have come to see me. I also want to speak briefly about the impact on community cohesion and the role of housing providers.

Mr Berry and his family came to see me relatively recently. After a serious accident 17 years ago, Mr Berry and his wife had no choice but to take the council home offered to them. Since then, they have brought up their two children—a boy and a girl—in the three-bedroom property. They have made modifications, and they have made the house into their home. They are very much part of the local community. However, the Government’s bedroom tax means that they will have to move out of their house. After 17 years, the family are being pulled out of the community in which they have lived for so long. That leads me to the first point I want to make.

Families who have lived for decades on council estates in places such as Rochdale are being forced to move. Homes are being taken away from people, and they will be filled by Asian or Afro-Caribbean families, because that is the nature of the demographics in places such as Rochdale. That will have a direct impact on community cohesion, and that impact should not be underestimated. It will create tensions, and there is the potential for conflict. The Government’s impact assessment on this policy took no account whatever of community cohesion. It is as though the policy has not been thought through.

Let me turn to the second family who came to see me, just before Christmas. The husband is a paraplegic. They have lived in their property for 15 years. The council has spent £18,500 adapting it. It has three bedrooms, one of which is used to accommodate a lift. The other two bedrooms are used by each of the individuals in the home. They have been visited by Rochdale Boroughwide Housing, and they have been told that they will have to pay £22 a week extra or they will have to move out. The family described that as the last straw. They have been through so much in their lives. The lady was crying in my surgery on the eve of Christmas, because of the Government’s policy.

I explained to the family the possibility of receiving temporary discretionary housing payments, but they are not enough. The Government do not seem to understand the misery that they are creating. They have housing providers such as RBH running around implementing their policy, which is having a devastating effect on families and communities. That leads me to my second point.

Housing providers such as RBH have an excellent track record in managing their stock. RBH has mixed communities, because it focuses on creating a balance. It takes into account people’s individual needs, and it constantly reviews under-occupancy and acts on it. The Government should leave housing providers to manage their stock; it is not for the Government to micro-manage such things.

Let me finish by making two important points. First, there is the potential for community conflict as a result of this policy. Secondly, if this is such a good Government policy, why is there not a single Conservative or Liberal Democrat Back-Bench MP here to defend it?

15:05

[Dr Eilidh Whiteford (Banff and Buchan) (SNP)]

I congratulate the hon. Member for Sedgefield (Phil Wilson) on bringing such an important issue before us. It will have huge unintended and unpredictable consequences for at least 80,000 people in Scotland, some of whom are among the most economically impoverished in our community.

The problem with the way in which the Government have sought to frame the debate on changes to the occupancy rules is that it fails to acknowledge that that debate takes place against the backdrop of changing population demographics and underlying problems in the supply of affordable housing. It is also being implemented against the backdrop of a labour market in which jobseekers far outnumber vacancies, and increasing numbers of jobs are seasonal, temporary or based on zero-hours contracts. All this talk about subsidised spare bedrooms is yet another attempt to vilify people on low incomes in a vain effort to justify their having to pay the price for the financial crisis and the double-dip recession.

To debate this issue properly, we need to acknowledge that there is a fundamental mismatch between the social housing stock available and the needs of tenants and prospective tenants. Most of our social housing stock was built at a time when families were much larger and the population was less mobile. Across Scotland, about 44% of social tenants require a one-bedroom home, but only 24% of the homes available are that size. In other words, many tenants have no choice but to live in a home that is larger than they need. An estimated 69,000 tenants in Scotland cannot currently be accommodated in a suitably sized house in the social rented sector.

In Aberdeenshire—my own patch—we have a growing population and a depleted stock of public sector housing, and there is a chronic shortage of affordable property to rent. There are more than 7,000 people on the waiting list. Many of them have little prospect of being offered a house any time soon. Although Aberdeenshire has a much higher percentage of one-bedroom properties than most local authorities, it still does not meet demand. People desperate for a house will take any house offered, whether or not it is the appropriate size.

The main issue I want to talk about is the unintended consequences of the bedroom tax on individuals, social landlords and the wider economy. It is hard to predict how tenants in receipt of housing benefit will respond to the cuts, bearing in mind that the real-terms cut in working-age benefits will also put the finances of most of them under considerable strain. We can probably assume that some of those who can move, will move. Some might seek to absorb the cuts within their existing finances, while some might take out loans to cover the gap between their rent and their income, which is a risky short-term strategy. It is highly unlikely that housing association tenants will mitigate the impact by taking in lodgers, because many are explicitly prevented from doing so by the terms of their tenancy agreements. We have to face the fact that some tenants will fall into arrears. When we consider the bedroom tax in tandem with the move away from direct payments to landlords and other benefit cuts, we have a recipe for significant problems with rent arrears, and a possible rise in evictions in the social and private rented sectors.

Housing associations fear that financial instability and cash-flow problems could affect their credit ratings, and I echo the point made by the Chair of the Select Committee on Work and Pensions, the hon. Member for Aberdeen South (Dame Anne Begg). Social landlords need to be able to borrow to invest in new properties and maintain their existing properties. If lenders start to see them as a higher risk, their borrowing costs will rise, which will inevitably put inflationary pressures on the rents of existing tenants and thwart the investment that is so badly needed.

The bedroom tax threatens to undermine the progress that has been made in Scotland over recent years in introducing new, affordable social housing to deal with rising demand. It is a mean and miserable measure that will cause real financial hardship to people on low incomes. It will drive people into rent arrears and into debts they will struggle to repay. It will also drive people from their homes and uproot them from their communities. Too many of the people affected by the measure are moving in and out of low-paid, insecure, temporary short-term work. Because of the bedroom tax, not only will they have no job security; they will lose housing stability as well. Coming hard on the heels of real-terms cuts in financial support for low-income households, the changes will exacerbate our existing economic malaise, by taking money out of the very communities that need it most. They will make it more difficult for non-governmental actors to invest in quality, affordable housing.

I urge Ministers to think again and to look at the Benches that are empty of people prepared to defend the policy. If Ministers are devoid of empathy, I encourage them to take a hard-headed look at the unintended economic impact of the bedroom tax, and to consider the unacceptable social costs.

15:09

[Ann Coffey (Stockport) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Bayley. I congratulate my hon. Friend the Member for Sedgefield (Phil Wilson) on obtaining this important and well supported debate.

I quite understand that at a time of housing shortage it is important, particularly in Stockport, which has more than 7,000 people on the social housing waiting list, to ensure that people have the appropriate housing and to address issues of under-occupancy. My problem with the policy is the way it is being implemented, and the lack of local flexibility for the families and individuals who, through no fault of their own, will be disproportionately affected. It is always a problem with blanket policy changes. No central edict can take account of people’s varying individual circumstances, and inevitably the result will be that some will be put in desperate circumstances.

I will give only one example. I have a constituent who lives in a two-bedroom flat and who receives housing benefit. He is under the care of Manchester royal infirmary renal team, and is about to start dialysis at home, while awaiting a kidney transplant. He needs the extra room for the dialysis machine and to store fluids. He told me:

“My concern is when the new rule comes into effect this year, I’ll need to downgrade to a one bedroom flat as the housing benefit won’t pay for the extra room”.

I took up his case and have been told that he is not exempt, but that if he had an overnight carer staying in his flat he would be exempt. I am sure that the Minister would agree with me that it is very disruptive for someone who has a long-term illness to move home, and possibly area. I do not think that the Government intended the policy to have such an adverse effect on seriously ill and vulnerable individuals. However, part of the problem is the lack of flexibility given to organisations such as Stockport Homes to respond in a way that gives them discretion in those very difficult cases.

Stockport has 1,500 tenants affected by the rule, who now need rehousing in one-bedroom flats; but we have a turnover of only 300 one-bedroom properties a year. Where are people expected to go? The alternative, of course, is the private rented sector, but recently there has been an increase in private rented sector repossessions in Stockport, and landlords are not keen on taking people in receipt of housing benefit. Also, we have a smaller private rented sector than elsewhere. That means that people will inevitably have to move out of the area.

Different areas have had different local housing policies. For example, under previous housing policies, families in Stockport have been offered a three-bedroom flat or house if they have a boy and a girl both over five years old. However, the new policy means that if they receive housing benefit they can have a three-bedroom flat only if they have a boy and a girl over 10, so families currently living in three-bedroom flats or houses in my constituency will be hit by the rule. Moving out will be very disruptive for children, who will have to change schools. They will lose their friends and their parents will lose family and community links. Often, those are the very families that other agencies are concerned to support in a settled environment.

It does not make sense to me that the policy of one Department can so adversely affect the policy of another. Localism, and local partnerships working together to support families, should mean that some flexibility is given to local social landlords about the implementation of the policy. That would mitigate some of the disruptive impact on families who, through no fault of their own, were rehoused under previous housing policies.

[Kate Green]

On the point about discretion, the local authority will be able to use the discretionary housing payment, to the extent that there is money in the pot; but does my hon. Friend agree that it will be first come, first served? If her constituents’ circumstances are presented late in the financial year, there will be no money to enable the discretion to be exercised.

[Ann Coffey]

My hon. Friend makes an important point; and the payment is meant to be temporary. It will not support someone on a long-term dialysis programme.

Finally, it is difficult for Stockport Homes to let two-bedroom flats, and that is the reason for the current under-occupancy. Now it is going to have to advertise outside the area for tenants for those properties. It is a strange social policy that results in people having to leave the area where they have family and community links to make way for people to come in, from outside, to an area where they have no such links. That is another unintended but serious consequence of the proposals. My plea to the Minister is that he will consider giving social landlords some discretion so that the worst of the consequences to vulnerable individuals and families, who we all agree should not be affected, can be mitigated.

15:16

[Andy McDonald (Middlesbrough) (Lab)]

I too congratulate my hon. Friend the Member for Sedgefield (Phil Wilson) on securing this important debate.

One of the justifications for the changes is that they will bring about a better use of currently available housing stock and that somehow penalties for under-occupancy will force tenants to leave their homes—I stress they are homes, not houses—releasing two-bedroom properties and thereby alleviating overcrowding. The theory might get off the ground if there was evidence that such exchanges were possible and practical; but the evidence is that whereas 180,000 social tenants are allegedly under-occupying, just under 68,000 single-bedroom properties became available last year. We have heard today that it would take an age to achieve what is intended. There simply are not the properties to go round. That analysis does not even begin to take into consideration new entrants to the market. The waiting lists are considerable. The policy simply does not stack up.

In Middlesbrough the policy will have an impact on 2,410 claimants. The reduction in benefits across the piece will be something short of £1.5 million. Of course in the areas of my constituency where people are already struggling, and finding things hard, the additional burden will be the final straw for some. There will be untold misery. I heard from Citizens Advice recently about my constituent David Holdsworth, who lives in a three-bedroom property with his wife and severely disabled 33-year-old daughter. He is paralysed from the waist down and has continence issues. His wife is his full-time carer and sleeps in the spare room. Because of his disability it is not practical for her to stay with him. They have been informed that the bedroom tax will affect him, because they have a spare room. He cannot afford the cut to his benefits, and the solution that has been put to them is that he and his daughter should move into a home and his wife should move into a one-bedroom property, breaking up the family.

Another example concerns a gentleman who lives in a three-bedroom property. He is the father of triplets and his three daughters live with their mother, but during the school term they stay with him for periods in the week. One of his daughters is autistic, and he says that she needs her own room, for reasons specific to the family. According to the bedroom tax he has two spare rooms, and his benefit will be cut by nearly £30 a week.

Some weeks ago my hon. Friend and I called at the door of a lady in Pallister park in my constituency, who was living in what had been her family home. She and her husband and daughter had lived there 38 years. Her husband had passed away, and her daughter had moved on to life with a husband and family. My constituent has been told, after 38 years, that she has a spare room and must leave. In reality, that resource—that home—is used. She is a grandma and takes the two children so her daughter can go out to work. Now she is being told she must leave the house. No one-bedroom properties are available to her, so her only option is to go miles away, and disrupt that family unit totally and utterly. That is a consequence of this terrible measure.

Anxiety is an issue. Not everyone knows what is coming, but many people are getting used to the idea and are knocking on the doors of constituency offices, and going to their citizens advice bureau. The terror and worry of thinking that they will lose their home is something that hon. Members who should be in the empty seats on the Government Benches do not begin to understand.

Niall Cooper, national co-ordinator for Church Action on Poverty said:

“There is a real danger that people will be pushed into the hands of loan sharks by the housing benefit cuts…For some this will push them over the edge”.

We know where they are going with the annual percentage rates that they may face—into spiralling debt with homelessness on the horizon. This dreadful provision should be revoked immediately, and people should come to their senses before it is too late.

15:19

[Sheila Gilmore (Edinburgh East) (Lab)]

I thank my hon. Friend the Member for Sedgefield (Phil Wilson) for this debate. We could be here for much longer, as is increasingly the case with our debates on these so-called reforms. I hope that when the Minister replies, he will not waste time pretending that the aim of the measure is to re-allocate social housing. There are other ways of doing that, and building more houses is one of the more important ones. However, the measure does not do that. If every local authority successfully reshuffled people in houses, almost certainly the same proportion would be on housing benefit, so there would be no saving. The Government have the saving in their budget, so it is not about that and they should not bother to pretend that it is.

A constituent who is in her 50s lives in a two-bedroom housing association house near the city centre, and has been there for six years. She has received a letter suggesting that she could take in a lodger. Her second bedroom is very much a single bedroom and very small. I do not know whether most people who support the measure ever go into the sort of houses that are being built. The kitchen is off the living room, which is fine for a family, but how does that work with a lodger who may be a stranger? Not only would she be sharing a bathroom, perhaps with a younger person whom she had never previously met, she would be sharing a kitchen off the living room. That is not even semi-practical, and my constituent was outraged at the prospect, but £50 from her benefit is very steep.

Many local authorities will do their best to help people, as will housing associations. They will look at the allocation policy to see whether they can make things easier, although they will merely be moving the deck chairs on the Titanic. They may manage to move some people, but the majority of homeless applicants are single people who will have to be housed in one-bedroom houses if they need housing benefit. Local authorities will be juggling one group of people with another. Even if some tenants in two-bedroom houses are moved into one-bedroom houses, homeless people who are waiting for one-bedroom houses but cannot be moved into those two-bedroom houses will wait even longer.

This week, I looked at what was available not just in my constituency, but throughout my city. Some 36 one-bedroom properties are advertised. The council and all the housing associations, bar two very small ones, advertise together. Ten of those properties are sheltered housing, and people who are not eligible cannot be housed in those houses, so that is 10 out of the way already. Another 11 properties are ground-floor flats, which are mostly allocated to people with what is called gold priority—top medical priority—for housing, because they are on the ground floor and if a ramp is necessary it can be put in.

Some people with gold priority may also be affected by the bedroom tax, which might be convenient, but the chances are that they will not. If we give those ground-floor flats to able-bodied people who do not need them, people who are waiting to get out of a third or fourth-floor flat for medical reasons will become angry. People frequently bend my ear about that if they think it is happening. People who must be moved because of the bedroom tax cannot be prioritised.

That leaves 15 houses available for let this week. A one-bedroom third-floor flat has attracted 110 online bids—that is not the total because paper bids can also be made—since last Friday. A one-bedroom first-floor flat in the city centre attracted 303 bids. Even a one-bedroom flat in a multi-storey building has attracted 35 bids. Those are active bidders, not people on a waiting list that might be described as not real. Those people are probably not yet affected by the bedroom tax, but the houses are simply not available. The real reason for the spiralling housing benefit bill is not under-occupancy of social housing; it is the huge expansion of the private rented sector and its high rents. That is what the Government should be addressing to bring down the housing benefit bill.

15:25

[Ian Lucas (Wrexham) (Lab)]

This is the third debate I have attended on this issue in the past two days, which gives an indication of its seriousness. The Minister replied to one of those debates yesterday so he should be increasingly aware of the concern about it. I shall focus on the occupancy provisions as they affect disabled people, because we have heard much from other hon. Members about other issues.

I shall refer to two cases, having been approached by parents of adults with disabilities who will be profoundly and specifically affected by the changes. One, Mrs Rosemary Burslem, asked me to specify the particulars of her son’s case. She is in her 60s and has an adult child, David, who has severe disabilities. He has autism and needs overnight sleep-in staff, as well as one-to-one staff support during the day and two-to-one support when he goes out in the community.

In the view of David’s mother, who has looked after him for many years, it would be inappropriate for him to share a house with anyone with a learning disability because his behaviour is very challenging. He regularly takes food out of the fridge, as well as cutlery and crockery to bedrooms for no apparent reason. He flushes the toilet regularly, and switches electrical items on and off. His behaviour is regularly obsessional, which makes it virtually impossible for him to share accommodation with anyone. David has what Mrs Burslem describes as mega-tantrums. She says they are like the tantrums of the terrible twos, but 30 times worse because he is in his 30s. He is angry, frustrated and feels unwell, and is unable to work or live easily with other people. He then acts for no apparent reason, and all that makes it extremely difficult for him to live with anyone else.

The difficulty with the proposals is that they do not recognise or take account of such circumstances. I know that there are discretionary housing payments, but the reality is that that family is coping now with the uncertainty arising from the proposal.

[The Minister of State, Department for Work and Pensions (Steve Webb)]

Without full details of the case it is difficult to discuss it, but the hon. Gentleman said that the lady is in her 60s. Will he clarify whether she is above or below state pension age?

[Ian Lucas]

She does not live with David, so I am not sure whether that is relevant.

The problem is that the proposal is causing uncertainty to the family now, and there is no certainty about whether discretionary housing payments will be for an extended period or affect them permanently. I will forward full details of the case to the Minister. I do not expect a specific answer now.

I have been contacted about another case of adult parents who share a house with an individual who suffers from spina bifida and hydrocephalus. An additional room in their house is used for the storage of oxygen and other disability aids, and a separate room is used as a living room by the individual concerned, who has specific and profound additional needs. Under these proposals, none of the particular circumstances for those individuals is taken into account, and they are some of the people who we all think—and I am sure the Minister thinks—should have our support, but they have no guarantee that they will continue to receive it. The fact is that this set of proposals is creating enormous worry for people who have huge burdens in caring for people whom they care profoundly about. They have contributed enormously to society by helping to look after those people for very many years, and we are letting them down badly.

I implore the Minister to look at the particular applications of the rules in those cases to ensure that those people can be looked after. When they came to me and said, “Look into these matters,” I could not believe for one moment that the system would not include discretion to cover individual cases such as those. The proposals are ill-conceived and are causing enormous distress up and down the country. The Government, and I am sure the Minister, did not intend to create such situations. He needs to look at the proposals again.

I heard the Minister’s response yesterday, and in it, he referred to the deficit, but the reality is that the Government, at the same time as they are letting those people down, have chosen to give a tax cut to the richest people in the country. That is the type of political choice that we all have to make, and the reality is that the Minister has supported that choice. He needs to get his act together to change his approach and support the people who need support, and not the people who have most.

[Hugh Bayley (in the Chair)]

All Members have been very disciplined in their speeches, so we are almost on time. It seems to me that in a debate of this kind it would be a shame, and wrong, to cut the time for the two remaining Back Benchers, so they will each have five minutes, and the Front Benchers therefore will have nine minutes each.

15:32

[Gemma Doyle (West Dunbartonshire) (Lab/Co-op)]

It is a pleasure to serve under your chairmanship today, Mr Bayley, and I congratulate my hon. Friend the Member for Sedgefield (Phil Wilson) on securing the debate.

Like other hon. Members, over the past few months, I have been contacted by many of my constituents who simply do not know what to do about the policy’s implications. There is not a smaller house for them to move into, and they are not going to be able to afford their rent.

One of my constituents lives in a three-bedroom house, which he needs, as he looks after his children at weekends—similar to some other examples we have heard—but his housing benefit will be cut. If he has to move to a one-bedroom house, does it mean that it is right that his children only get to see him if they all sleep in the living room at weekends? Where should they do their homework? Would he even get access to see his children if he does not have somewhere for them to sleep, if the courts were involved in making a decision?

I have also been contacted by a couple who foster up to six children at a time, and again, they are not exempt from the cut. Is the Government’s policy honestly to cut housing benefit for foster parents, which means that they have to downsize and that they cannot foster children any more? What on earth are the Minister’s plans for the children who will then not be able to be placed with foster parents? Another constituent has sent me his monthly expenditure breakdown. The only thing he has left to cut is his contents insurance, and even then, that will not make up the difference.

What about tenants whose house has been specially adapted for them? Councils do not have the money to adapt another tranche of houses for all the people who have an extra bedroom. Some councils are considering knocking down a whole block of flats—from two-bedroom flats into one-bedroom flats—to try and deal with this. The Minister is nodding his head. Does he honestly think that that is what councils should be spending their money on? Okay, he does. We have that on record. I am a bit shocked about that.

I also want to raise the impact of the bedroom tax on serving members of the armed forces and their families, as alluded to by my hon. Friend the Member for North Durham (Mr Jones). A prisoner can be away from home for up to 52 weeks and not have their housing benefit docked, but if someone is a serving member of the armed forces, their housing benefit will be docked if they are away for 13 weeks or more. It is astonishing that Ministers are giving prisoners more flexibility to claim those benefits than serving personnel. They are choosing prisoners over patriots. Some 96,000 members of the regular forces do not live in service accommodation, and I want to know how many of them will be affected. The Minister seems to be indicating that they will not be affected. Perhaps he can explain how that is, because we are aware of examples where they will be. Service families and personnel could be hit for doing their duty for their country.

Reservists will be affected too. They do not live in forces accommodation, so surely an even higher percentage of them will be hit. The Government are trying to increase recruitment to the reserve, so how do they think the prospect of having a housing benefit cut will affect those plans? They must publish the impact of the bedroom tax and set out very clearly who will be affected. It is the least they can do to clear the matter up for our forces. Either Ministers do not realise that serving personnel and their families will be affected, or they think that it is right that prisoners should have an exemption, while those protecting our country do not.

I want to read out a couple of lines from an e-mail that I received from a constituent about the impact that the policy will have on him:

“I am 40 years old, receiving incapacity Benefit, and live alone in a 2-bedroom flat. I struggle to make ends meet as it is at the moment, and literally keep track of every penny I spend. I do not drink, or smoke, or go on holidays, or socialise—my existence…consists of hiding from the world in a cold flat (I cannot afford to use the central heating) and reading. I cannot even visit my parents because I cannot afford £4 bus fare.

Come next April, I will no longer be able to afford to live. I do not enjoy my life, but have struggled to retain it. These changes are likely to be the proverbial straw that breaks the camel’s back, and I am sure I am not the only person considering this.

I would like to know, in your opinion, what I can realistically do next year to survive.”

I have replied to my constituent, but I could not tell him how he can survive when the impact of this policy is felt, so I wonder whether the Minister could tell my constituent what he can do.

15:37

[Julie Hilling (Bolton West) (Lab)]

I start by congratulating my hon. Friend the Member for Sedgefield (Phil Wilson) on securing this most important debate. I, for one, am not surprised to see the Government Benches empty, because people cannot defend the indefensible.

I want to speak on behalf of the 2,400 tenants of Bolton at Home and more than 4,500 tenants of Wigan and Leigh Housing who will face unaffordable bills because the Government have decided that the poor should pay the price of the wrongs of the rich. The policy demonstrates an absolute lack of understanding of the nature of social housing and communities.

The majority of social housing in the north-west is three-bedroom, and families with two children have rightly been allocated three-bedroom houses so that each child can have their own room, and also, because that is the available housing stock. Please remember that many of those families have one or both parents in work, in low-paid jobs. Housing benefit is an in-work benefit.

What is going to happen now to constituents with a boy and a girl? They are currently nicely housed in a three-bedroom house. Is it the Minister’s expectation that they would move into a two-bedroom house until one of the children reaches the age of 10, when they would have to move into a three-bedroom house? What happens when one of the children moves out? Are they then expected to move back into a two-bedroom house, and then into a one-bedroom house when both the children move out? That is even if all the housing stock is available. Just imagine the monetary costs—how could people on low wages or benefits afford new carpets and curtains each time they have to move house, or does the Minister expect them to have bare floorboards and newspaper at the windows? What about the children’s schooling? Will they have to keep moving schools, or will the family have to find additional money for transport to school? Fundamentally, what about the community? Social housing is not only somewhere that you sleep; it is where you live and become part of a community—a community that will be fractured by this ridiculous, ignorant policy. The policy will also have a perverse effect. Already in Bolton, groups of three young men are applying for three-bedroom family houses, so that they can each claim shared-room rate.

Hon. Members have talked about many other aspects of this policy, so I will finish by talking about Isobel, who came to see me about her situation—I have changed her name. Isobel lives in a three-bedroom house. She has a daughter who has just moved out, into a fairly insecure relationship, and she has a 17-year old son with Down’s syndrome. Isobel is a full-time carer and she herself understandably suffers from stress and depression. Isobel’s son—I shall call him Carl—is severely affected by Down’s syndrome. He has what I can best describe as autism-like symptoms. He cannot cope with change to his routine or environment. He needs everything to be in its place and everything to be done in the same way at the same time every day. Indeed, while Isobel was visiting me in the surgery, she received two phone calls to come home as quickly as possible because Carl was becoming extremely agitated by her absence.

Isobel has told me that Carl could not cope with a move. Moreover, Isobel gets support from her community. Neighbours understand Carl’s behaviour and support her both physically and morally. What is she supposed to do? She cannot work; she cannot move. What is the Minister’s answer to that question? I hope he will not say that she could get a discretionary housing payment. Bolton at Home does not yet know how much it will get, but it has already worked out that it will not have enough money to support everyone in need.

The Government do not seem to understand that social housing is a positive choice for low-paid workers, for carers and for a number of others. It is not something that is transient. It is the home in which someone wants to live their life and to bring up their children until they move into their bungalow or sheltered housing. Surely the Minister cannot continue with this mean, ignorant and, frankly, incompetent policy.

[Hugh Bayley (in the Chair)]

We have made up a minute, so the Front Benchers now have nine and a half minutes each.

15:41

[Ian Austin (Dudley North) (Lab)]

I not only congratulate but thank my hon. Friend the Member for Sedgefield (Phil Wilson) for calling this debate. The number of my hon. Friends who have taken part and the brilliant, passionate and well informed speeches that they have made show how important this issue is for so many of their constituents.

We agree with the Government in wanting less overcrowded and less under-occupied social housing. We want to see sensible, practical welfare reform. We also agree that the housing benefit bill needs to be reduced. The problem with the Government’s plan is that it is unlikely to ease housing supply or to save money. In fact, it could end up costing more. It could also mean, as so many of my hon. Friends have said, that disabled people, war widows, foster carers and the families of members of the armed forces all lose out. As we have heard, some could even be made homeless.

However, despite all the criticisms, defeats in the House of Lords and warnings from housing associations, local authorities and experts at charities such as Shelter and Crisis and organisations such as the National Housing Federation, Ministers are determined to press ahead. As a result, in a few months, about 660,000 tenants will be charged up to £20 a week for bedrooms that Ministers say they should not have or they will be forced to move. Ministers claim that living in a council flat with a spare bedroom is

“a luxury the country can no longer afford”.

I will set aside the nauseating spectacle of a millionaire Minister telling poor people that they are living in luxury and will instead consider whether the policy will work. It is supposed to make under-occupiers move into smaller accommodation, but the Government’s own impact assessment makes it clear that all the savings that it is estimated the policy could make are based on the assumption that no one will actually move at all. Instead, all the savings come from reductions in people’s benefits. This policy is literally based on making some of the poorest people in Britain poorer, and it is being implemented, as we have heard, at precisely the moment when millionaires and the super-rich are getting a tax cut.

Let us consider a practical example. Someone with terminal cancer who is receiving employment and support allowance and is in the support group, which is for people who are not expected to work again, has a spare bedroom in a two-bedroom council house because their child moved out recently. They would be happy to move into a smaller home, but the council does not have one available. According to the National Housing Federation, although 180,000 social tenants in England are under-occupying two-bedroom homes, only 68,000 one-bedroom social homes became available for letting in 2009-10.

Usually, there simply will not be a one-bedroom social home for the cancer patient to move into, and more one-bedroom homes will not become available as a result of the policy because, after all, it is not possible to under-occupy a one-bedroom flat. Therefore, they would lose £14 a week, on average, which they would need to make up to their landlord from their benefit income. That is £60 a month straight out of the pocket of someone with terminal cancer. How are they supposed to cope with that loss of income? The Government suggest that they work to make up the difference, or take in a lodger. For people with terminal cancer or the most genuinely disabled people, work is often not much of an option, and it certainly should not be forced on them. Taking in a lodger simply is not an option for many vulnerable households either.

Therefore, one of three things could happen, not just to the family I am talking about, but to hundreds of thousands of others, too. First, they could lose income and be pushed into poverty. Secondly, they could move out to a smaller home in the private sector, but that means higher rent and higher housing benefit bills, and a policy that is supposed to be saving money will end up costing much more. Thirdly, they could end up in rent arrears, be evicted and even end up homeless.

Let us be honest: homelessness is a real possibility. Even the office of the Secretary of State for Communities and Local Government—a man not known as a bleeding-heart liberal—warned that the Government’s housing benefit reforms could make 40,000 people homeless and that the policy could cost more than it saves. The Government claim that discretionary housing payments will help to make up the shortfall between housing benefit and rent, but both the National Audit Office and the Child Poverty Action Group find that the funding available is likely to be woefully inadequate.

I would therefore like to ask the Minister a few questions—first, about the cost of this policy. We have heard already that the policy will make savings only if it does not work, and it is set to push people into private rented accommodation, making supporting them all the more expensive. Will he tell us why the Government have estimated the costs of the policy on the basis that no one moves, but loses benefit instead? Will he tell us what estimates they have made of the number of people likely to move into expensive private rented accommodation? Given the serious concerns about the cost of the policy, can he give us an assurance that under-occupancy deductions will not be increased if the Government do not make the expected savings?

The Government seem to have casually accepted that as many as 40,000 people could be made homeless by the policy. What does the Minister say to the housing association that has told us that it expects to have to evict one third of its tenants? How many children does the Minister think will have to move school as a result of the policy? Have the Government put any measures in place to ensure that local authorities can cope with the increase in the number of homeless people? What estimate has been made of the cost of supporting homeless people and getting them back into housing?

I would also like to ask some questions about the people who will be forced to rely on discretionary housing payments after the changes. The Government have indicated that they expect disabled people with adapted housing and foster carers to apply for the funding. Why should they face the prospect of being moved out of adapted homes on the basis of whether their local authority has enough money left in the DHP pot? Surely, that is a monumental waste when significant time and money has already been invested in their homes. Discretionary housing payments are short term, and new applications must be made every few months, so how are disabled people and foster carers supposed to plan their lives when they cannot be sure that they will be able to afford their house in a few months’ time? Local authorities desperately need to know how much funding they will have, to plan their responses to the changes, so why did the Minister tell the House at the end of October that the Government still have no idea how much money will be allocated to local authorities for the next two years?

It has also emerged that not just disabled people and carers might be forced to rely on short-term discretionary housing payments, but soldiers. The Daily Telegraph recently reported, as we heard earlier, that the families of service personnel will face deductions if they keep a room for a family member away on duty. Why should brave men and women serving their country in the armed forces have no room to come home to, because under-occupancy deductions have caused their family to move? What assessment have the Government made of whether the policy contravenes section C.4 of the armed forces covenant, which states:

“Members of the Armed Forces Community should have the same access to social housing and other housing schemes as any other citizen, and not be disadvantaged in that respect by the requirement for mobility whilst in Service.”

Can the Minister tell us what discussions he has had with the Ministry of Defence on this issue?

As I said, there is no dispute about wanting to tackle overcrowding and under-occupancy or the need to get the housing benefit bill under control, but as Labour Members have shown, the current plans are unlikely to ease housing supply or to save money and could end up costing more. Worse still, they will put people in debt and risk making them homeless. Labour’s alternative where under-occupiers would face deductions if they had been offered a smaller property and refused it would have worked and would have saved money. The fundamental truth is that the best way to get the benefits bill down is not to attack the families of disabled people, soldiers or poor tenants, but to get everyone back to work. That is what Labour’s jobs guarantee would do. Britain needs reform that is tough, fair and, most of all, works.

15:48

[The Minister of State, Department for Work and Pensions (Steve Webb)]

I congratulate the hon. Member for Sedgefield (Phil Wilson) on securing the debate. This is indeed an important issue. This is the second debate on it this week to which I have responded. It is good to have the opportunity to put on record the response to a number of the issues that have been raised and to deal with the myths that are growing up around service personnel, but it is worth briefly setting this debate in context. Most of my remarks will be about the specific matter in hand, but it is almost being implied that the Government woke up one morning and thought, “Wouldn’t it be great if we could take some housing benefit off people?” It is important to understand why this is being done.

In the final year of the last Labour Government, every time the Government raised £3, they spent £4. The word “morality” has been used extensively in this debate. Borrowing money that we expect our children to pay back is not a progressive thing to do. Parents who go out and blow money on their credit card and say to the kids, “When you grow up, you can pay it off” would be regarded as irresponsible. That is what we have to deal with now. Whichever party had taken control in 2010—

[Sheila Gilmore]

rose—

[Steve Webb]

No, I will not give way. Both parties set out deficit reduction plans, which involved spending cuts worth tens of billions of pounds. Public spending consists fundamentally of public sector pay and social security and tax credits—those are the two big areas. Both sides agree that public sector pay has to be held back, but benefits and tax credits also have to be part of the mix. Within the benefits budget, where could we have looked? Where is the low-hanging fruit? Where are the easy things to cut? Of course there is precious little of that. Housing benefit is a large part of the benefits budget and it has been rising fast, so is there an area in the housing benefit budget—

[Sheila Gilmore]

rose—

[Steve Webb]

No, I will not give way. Is there an area in the housing benefit budget where we can save money and tackle some of our housing problems?

[Sheila Gilmore]

rose—

[Steve Webb]

I have said that I am not giving way. This is an area of the housing benefit budget where we can better manage the housing stock. Let me give a specific example. It has been said in this debate that for housing benefit not to cover a spare room is immoral; that is the tenor of what has been said. When Labour introduced the local housing allowance, private sector tenants did not get housing benefit for a spare bedroom. Where is the morality in saying to private tenants that they cannot have a spare room, when social tenants, who are paying a subsidised rent, can? They could be living next door to each other, and we are favouring the social tenant over the private tenant. Why should housing benefit not cover spare rooms for private tenants when it does for social tenants? It is simply not fair.

The second unfairness that we have to tackle is overcrowding. A quarter of a million households in England are overcrowded, and they have had no voice in this debate. They are trying to get family homes, and homes that they need. They are living in overcrowded accommodation—

[Lisa Nandy]

Build some houses.

[Steve Webb]

I should like to point out that the shortage of affordable social housing did not start in 2010. Somebody had 13 years to sort that out, and it needs to be tackled now.

[Hugh Bayley (in the Chair)]

Order. May I ask Members not to make remarks from a sedentary position? The Minister has quite a lot of points to respond to, and he has made it clear that he does not want to give way.

[Steve Webb]

Thank you, Mr Bayley. The second unfairness that we must tackle is the needs of people who live in overcrowded accommodation. A quarter of a million of them need to have a voice in this debate, because all too often they do not, and we must tackle that.

People have rightly said that these are family homes. They are not just houses; people have lived their lives in them. I accept that, which is why we have exempted people over state pension credit age. Essentially, someone who is a pensioner is not affected by these changes; we are talking about people of working age.

How will people respond to the change? There are a range of responses. It has been mentioned that housing benefit is an in-work benefit in some cases. Nationally, the average loss from this policy is £14 a week. For someone who is in work on a minimum wage, that is the equivalent of about two and half hours of additional work; it is not quite that because of tapers and so on, but we are talking about a few hours of extra work as one option—

[Lisa Nandy]

Where is the work?

[Steve Webb]

Again, the hon. Lady is talking from a sedentary position. She cannot control herself. On the day that we have published yet another set of figures showing another fall in unemployment and record growth in employment, she asks, “Where is the work?” The myth that there are no jobs available when we have more people in employment than ever before needs to be countered.

For some people, taking a job or working extra hours is an important part of the solution. It has been mentioned that taking in a lodger or a sub-tenant is not an option for some people, but for many it will be. The hon. Member for Banff and Buchan (Dr Whiteford) said that that might be an issue. In general, housing associations and social landlords should allow orderly sub-tenancies—a person cannot just take someone in and tell the landlord after the event. There has to be a strong reason to refuse such an option. The presumption is that it can be done, so it is part of the mix.

I had a constituent who was a single person living in a three-bedroom social housing accommodation. She had a letter about under-occupation, so she phoned me up. She said that she had a brother and sister-in-law who could live with her. That is a better use of the housing stock; it meets their housing need and covers the shortfall. Such improved use of the housing stock benefits us all.

I want to address discretionary housing payments, which were raised by the hon. Member for Stockport (Ann Coffey) in her thoughtful contribution. The hon. Member for Wrexham (Ian Lucas) also mentioned discretion. We are being asked to do contradictory things here. Where people have identified groups such as foster carers or people with major disability adaptations to their property, rather than central Government defining exactly what that means in every case, we have allocated the money that we think is needed to deal with the problem and given it to local authorities to respond on a case-by-case basis.

We think that such local discretion is right, but we have been asked to give local discretion, except in every such case also to have an absolute right to make a discretionary housing payment or to exempt people. That is the tension. There are all sorts of individuals whom we might think should be exempt. Trying to sit down and write a regulation or a statutory instrument to define exactly who all those people are does not work, which is why we have allocated discretionary housing payments—this year of £60 million and next year of £155 million—to local authorities. Let me take as an example Durham’s local authority. Last year, it had £177,000 of DHPs. Next year, it will be £880,000 of DHPs to respond to the sorts of people whom hon. Members have mentioned.

I want to respond to the issue about service personnel. I assume that the things that have been said are based on ignorance, rather than on an intent to mislead. Let us take the example of a married serviceman or woman. If one goes away, it does not matter, because there is still a one-bedroom need, so married service personnel are not an issue. Service personnel who live in service accommodation are also not an issue, because they are not social tenants on housing benefit.

We are talking here about service personnel who live in social rented accommodation with their parents and who are on housing benefit, so we are getting to narrower and narrower groups. If a member of the armed forces who is on a wage is living at home with his mum and dad, the benefit system says, “Ah, there is somebody in the house on a wage.” We expect that person to pay up to £70 a week towards the rent—it is called a non-dependant reduction. When the serviceman or woman goes to the front line, and if they are away for a long period, we no longer treat them as a non-dependant in the household, so we no longer deduct £70 from the housing benefit. When a young person goes away to fight for a long period, the parents’ housing benefit will in general go up. That is not the story that the Labour party has been putting out today.

We have been asked about foster carers. We think that the discretionary housing money that we have made available will assist around 5,000 foster carers. Let us bear in mind, though, that this is not all foster carers. I am talking about foster carers who might be in social rented accommodation, on housing benefit and in need of a spare bedroom, so a subset of all fosterers. Of course the fostering organisations would prefer a total exemption; I accept that. Failing that, their estimate is that these are about the right numbers of people, and we have had meetings and discussions with the fostering organisations.

The important issue of children was raised. The majority of people who are affected by this measure do not have dependent children. We are generally talking about older people. None the less, the position of families with children is important. It was suggested that two teenagers of the same gender should not be expected to share a bedroom. I do not follow that argument. I shared a bedroom with my brother until we were 18, and I do not think that it did us any harm. At a time when we have a great shortage of affordable accommodation, I cannot see what the problem is with older teenagers of the same gender sharing a bedroom.

An important question has been asked about whether DHPs are temporary or permanent. In the past, DHPs were a temporary fix. If someone had a short-term problem, they needed a bit of DHP to bail them out and then they moved or did something about it. Under the new system, DHPs can be for the long term, because some situations will not change. If someone lives in a house that has been substantially adapted, that will not change. Local authorities are getting revised guidance and will have to think about DHPs differently, because some people need longer-term certainty, as has been properly said.

The hon. Member for Banff and Buchan said that we had a size mismatch, and indeed we do. When a council is doing something about it—building houses to match the housing need—the hon. Lady asks how I can possibly think that that is a good thing.

[Dr Whiteford]

Will the Minister give way?

[Steve Webb]

I have just 60 seconds to go. When councils build houses of the right size to match housing need, they should be applauded and not condemned.

The hon. Member for Dudley North (Ian Austin) said that we need to manage over-occupation and under-occupation. We have had decades to do something about that, but nothing has happened. Some housing associations have welcomed the opportunity to look at the housing allocations to make better use of the precious resource of social housing. I fully accept that there will be disruption as a result of this measure, which is why we have a two-year programme looking at all this work, evaluating the impact and publishing the research. If we need to make changes to the system as we go because there are perhaps groups or impacts that we have not thought of, we will be in a position to do that. The matter will be thoroughly researched, and we will publish the results. At a time when we need to save money, being fairer to people in the social sector and the private sector and tackling overcrowding as well as under-occupation is a fair way to reduce the spending deficit that we were handed by the Opposition.

[Hugh Bayley (in the Chair)]

I congratulate all Members—Back Benchers and Front Benchers—on sticking to the time limits, so everyone was able to get in.

Global Hunger

Wednesday 23rd January 2013 Westminster Hall

16:00

[Mr Tom Clarke (Coatbridge, Chryston and Bellshill) (Lab)]

It is a great pleasure to see you in the Chair, Mr Bayley, and I welcome the opportunity to debate this issue. I thank Mr Speaker for granting such an important debate, which could not come at a more appropriate time.

This is the year for the UK to take decisive action to end the worst scandal of our time, the blight of hunger. It is also fitting that this is the year when we take the leadership of the G8, nearly 10 years on from our pledge to make poverty history. It is time that we assessed our progress and made a further commitment to the world’s poor.

In the past decade, we have come a long way towards eradicating poverty in the world’s poorest regions. More than 50 million children have started going to school in sub-Saharan Africa, while deaths from killer diseases such as malaria have fallen by almost 75%. But we have not gone far enough. While one in eight women, men and children go to bed hungry every night, and each year 2.3 million children still die from malnutrition, the inhuman tragedy is unacceptable and we simply cannot rest on our achievements.

It is clear that the most vulnerable in our society are still not benefiting from our efforts to make poverty history. The millennium development goals have not yet delivered the structural changes that are so desperately needed. For that reason, today I will outline a vision that I believe this country can turn into reality, provided we seize this very important moment. We need to join the 100 organisations that are launching their campaign today to call on the UK Government to take action.

[Sir Tony Cunningham (Workington) (Lab)]

Does my right hon. Friend agree that this is a unique point in history and that we desperately need to seize this unique opportunity?

[Mr Clarke]

I absolutely agree with my hon. Friend. I am delighted that he is shadow Minister for International Development, and I know that he will pursue these points with great enthusiasm.

[Mark Lazarowicz (Edinburgh North and Leith) (Lab/Co-op)]

It is a pleasure to intervene in a debate called by my right hon. Friend, precisely because he, perhaps more than any other Member of the House, has committed himself to this issue over decades. That is recognised across the House, by Members from all parties.

My right hon. Friend referred to the new campaign that is being launched by non-governmental organisations. Leading up to Gleneagles seven years ago, the “Make Poverty History” campaign applied pressure and made a real difference, not only in mobilising public opinion but in affecting Governments. Does he hope that we will see similar public support for a massive new campaign that leads to the kind of changes we need?

[Mr Clarke]

Yes, I absolutely agree. My hon. Friend makes an excellent point. I hope I might be forgiven for not giving way later on, because I hope to give the Minister at least 15 minutes—or as near to that as possible—to respond to the debate.

I return to the thoughts I was offering. Food prices are more volatile than they have ever been, and even here in our own country hard-working families are struggling to feed their children. The message is simple: there is enough food in the world for everyone if we act now to address the structural causes of poverty. Hunger and malnutrition are not caused by a shortage of resources but by our inability to see beyond our own immediate needs. The time has come to look beyond politics, country borders and economic partnerships, and to make a decisive leap forward for the sake of humanity.

However, that prompts a question: what are the structural causes of poverty? They are the political choices made by Governments throughout the developed world that ingrain inequality and injustice. We have a global mission and duty to ensure that the poor do not become poorer while the rich become richer.

Small-scale farmers in the developing world produce more than half the world’s food—a staggering figure—but look at what is happening to their land. Obviously, sizable and suitable land is vital for farmers to grow food, but globally, in the past decade, an area eight times the size of the UK has been sold off or leased out. Such land deals, done behind closed doors and with no transparency or participation by the people affected, often see local people unfairly lose their homes, land and access to the resources that are vital for them to be able to grow or buy enough food.

[Robert Halfon (Harlow) (Con)]

Will the right hon. Gentleman give way?

[Mr Clarke]

I am sorry; I said earlier that I wanted to give the Minister a reasonable amount of time.

The situation seems to me to be absolutely disgraceful. Beyond the way land is bought, sold and used, the system is opaque. Once food is produced, it enters the global market, which is dominated by a handful of multinational companies in a system with little transparency. That is not to say that those companies are inherently bad, but we would be foolish to overlook their incredible power. For example, 90% of the global trade in grain is controlled by five companies. Who benefits from that control? Shareholders, or people who are hungry? Companies have more information about us than ever before, yet as global citizens we have little useful information about their social and environmental impact. There are reporting requirements under the Companies Act 2006, but they are not useful to investors, producers, Government or civil society. Decisions continue to be made in the shadows, without participation by the people they affect. That cannot be right.

We in the UK could take a leading role to end the scandal. With the Prime Minister at the head of the G8, we can do a great deal. We could take action to ensure that small-scale farmers keep hold of their land to grow food. We could crack down on the tax dodgers depriving poor countries of resources to ensure the right to food.

[Sir Tony Cunningham]

rose—

[Mr Clarke]

I said that I would not give way, but I will on this one point.

[Sir Tony Cunningham]

I was in Zambia recently, when a British company owed the Zambian Government £70 million in unpaid tax. Imagine how many hospitals, schools, clinics, vaccinations, mosquito nets and so on could be made available to the Zambian people for that much money.

[Mr Clarke]

I am glad that my hon. Friend managed to make that important point.

We could work for global agreement on new sources of climate finance, which is important. We could underpin everything with transparency, the rule of law and strong institutions. To do all that, we must fulfil our existing commitments on aid and investment for agriculture and nutrition, the very basis of a functioning society.

If we look back in the history of our great nation, to the time of social writers such as Charles Dickens, hunger was a plague on our society, but political leadership took Britain out of that abyss. If we look at the world we live in today, there are still many challenges. The poverty in our own country is very real. The recession hits the poorest families hardest, and resources are scant. There is always the temptation to see no further than our immediate needs, but I sincerely urge the Government and the people of our country not to make that mistake.

Britain is where it is today because of key political choices made during times that were also hard; the NHS and the welfare state were created when the country had barely recovered from the second world war. Now is the time, during hardship, when our effort counts most. As Martin Luther King, Junior, once said:

“Human progress is neither automatic nor inevitable...Every step toward the goal of justice requires sacrifice, suffering, and struggle; the tireless exertions and passionate concern of dedicated individuals.”

We can make a difference. If the Government were to commit to enshrining in legislation the promise to spend 0.7% of our gross national income on aid, they would ensure that the UK is one of the first to reach a promise made 42 years ago, setting an outstanding example for others to follow. I will put that into meaningful context. Once reached, the 0.7% target amounts to 1.6p in every pound spent by Government, compared with 5.8p for defence, nearly 20p for health and just over 30p for welfare. That contribution would take us one step closer to a world free from hunger, but it is not enough; we must go further.

In the midst of a crisis, the UK has a vital opportunity in 2013 to lead a new drive to tackle global poverty and hunger. We will be one of the first major countries to reach 0.7%; we are the chair of the open government partnership; we will be working closely with the current presidency of the EU, the Irish Government; and, above all, we have the presidency of the G8. We must lead other countries at the G8 in increasing contributions to address hunger. We must collectively commit, at the very least, an additional £417 million a year to sustainable small-scale agriculture to achieve food security for more than 418,500 people.

Will the Minister tell us whether the UK plans to take forward those commitments? Of equal importance, it is crucial to establish when the Government will put aside parliamentary time to pass the 0.7% Bill, thereby fulfilling their promise.

Women and children in the world’s most fragile places are the furthest from meeting the millennium development goals, and their well-being must be our priority. That is not only a moral duty; it makes economic sense. In 2006, the World Bank estimated that malnutrition causes a 10% loss in lifetime earnings for individuals, and reduces gross domestic product by as much as 3%. An estimated 20% of deaths related to lack of nutrition are caused by short stature, which is an outcome of childhood malnutrition. That is not a failure of production; it is a failure in the way we process, distribute, buy, sell and consume food and manage waste. In other words, the global food system is broken, and it is killing people.

According to the United Nations Children’s Fund, approximately 195 million children globally are stunted, and data from previous years show that almost 80% of those children live in just 24 countries. Studies have shown that if basic affordable measures are introduced to address key immediate causes, child death could drop by as much as 25%. It is by investing in children in the countries most affected by hunger that we will make the biggest impact.

Our children are our future, and to neglect those in greatest need is to harbour the resentment and bitterness that later erupts into the wars that we now see spreading across Africa and elsewhere. I am delighted that today our non-governmental organisations and charities are coming together for the first time in eight years to launch a major new campaign, which shows the politicians who believe in it that we are not alone. I hope colleagues can attend the launch tonight in Mr Speaker’s house.

Those charities and agencies are there every day, on the ground, all over the world helping people in need on our behalf, as I have seen for myself. Their supporters, the people of the United Kingdom, have time and again dug deep into their pockets, and generosity and compassion have prevailed. They are, therefore, in a strong position to invite politicians to add to what they have been doing, and they are about to do so again. Their call this time is that we do everything we can to close the widening gap and fix the food system for our common future.

Beyond state action, we need to ensure that every powerful force in the food system plays a positive role, including multinational companies. We can do that through creating transparency, which leads to accountability. By updating the Companies Act with a simple reference to human rights, the information that companies have to disclose about the impact of their operations can be made useful, and paint an honest picture rather than showing edited highlights. It is not too much to ask that those with great power are held to account. Transparency is about highlighting good practice and exposing bad practice, encouraging businesses to take a longer-term view of their business models and practices. At the same time, we can demand more transparency in how the Governments of developing countries spend their money—a type of transparency that we enjoy here at home—so that their citizens can also hold them to account, and so that we can ensure our money is well spent.

Campaigning is not always comfortable for Governments and politicians, but we can reflect upon what we can achieve: Live Aid, the jubilee debt campaign, the millennium development goals, the Make Poverty History campaign and the Green Climate Fund. Those things changed the world for the better, and we can do that again.

Timing is vital; the scale of the challenge should fill us with urgency. If we do not act now, the situation will get a great deal worse as food prices become more volatile and environmental shocks become more frequent and destructive, not to mention another generation’s full potential being lost to the scourge of starvation.

That sense of urgency should also make us hopeful, not only because of the opportunities that are before us this year or because of the commitment of our people, but because of the commitment here in Parliament. While world hunger is high up our agenda, and rightly so, it is time that we all worked together, using all our skills, resources and commitment to get child hunger off the table.

16:17

[The Minister of State, Department for International Development (Mr Alan Duncan)]

I thank the Labour Front-Bench spokesman, the hon. Member for Workington (Sir Tony Cunningham), and hon. Members for their restraint in speaking, so as to give me adequate time to answer the right hon. Member for Coatbridge, Chryston and Bellshill (Mr Clarke). Indeed, I also thank him for securing this important debate, which is very timely, because today UK NGOs will launch their IF campaign, which highlights the precise issue that we are debating this afternoon—global hunger. In fact, my right hon. Friend the Secretary of State for International Development is looking forward to speaking at the launch of the IF campaign this evening.

The Government recognise that global hunger represents a human tragedy that happens every day on a massive scale. Around 870 million people simply do not have enough food to eat, 165 million children are chronically malnourished and 2 million children die needlessly every year from malnutrition. So I am pleased to have this opportunity to set out the ways the Government are addressing the problem in 2013, a year in which the UK can play a transformative role in helping to end hunger.

The UK has a good, strong track record of taking action to prevent hunger. By 2012, the UK had met in full its commitments, made at the G8 L’Aquila summit in 2009, to provide resources to improve global food security. That has helped millions of people to fight chronic hunger and malnutrition in more than 20 countries. We expect to continue to provide a similar level of resources for the foreseeable future.

Looking to the future, the Government have committed to reach 20 million pregnant women and children under the age of five through our nutrition programmes; to help to ensure that 6 million of the world’s poorest people escape extreme poverty; and to ensure that by 2015 another 4 million people have enough food throughout the year.

Tackling hunger and malnutrition involves increasing the availability of food by boosting agricultural productivity. The UK Government support the agricultural research network—CGIAR—with resources for research to improve agricultural productivity, which will help to feed millions of people.

On the issue of land and its increasing attraction to investors, the Government believe that private sector investment in poor countries is key to achieving global food security and economic growth. We also believe that responsible commercial investment in small and large-scale agriculture has the potential to be transformational. However, it is vital that the rights and interests of people living and working on that land are taken fully into account.

[Anas Sarwar (Glasgow Central) (Lab)]

I congratulate my right hon. Friend the Member for Coatbridge, Chryston and Bellshill (Mr Clarke) on securing the debate, and the organisations that have put together the IF campaign. By 2025, nearly 1 billion young people will face poverty because of malnutrition and hunger during their youth. The Minister rightly mentioned agriculture and the use of land. What work are the Government doing to ensure that Governments in developing countries and large corporations are actively working with an effective and ethical tax system to ensure that money stays in those countries for sustainable development?

[Mr Duncan]

Let me complete what I was saying about land, and I will then turn to tax. On the land issue, the key point is that we welcome the successful negotiation of the voluntary guidelines on responsible governance of tenure, which were concluded by the Committee on World Food Security last year.

The UK Government absolutely recognise the importance of tax transparency in development. As the Prime Minister said at Question Time today, the UK will use its G8 presidency this year to tackle tax evasion and aggressive avoidance.

[Jeremy Lefroy (Stafford) (Con)]

The Department for International Development has an excellent programme in Rwanda for registering the land of smallholders. Is there a possibility of rolling it out in other countries to ensure that smallholders have their title registered for security?

[Mr Duncan]

Absolutely. A proper legal framework for ownership of land is crucial if property rights are to be exercised fairly, particularly among some of the poorest people. That building block in any country’s framework of law is crucial for the guarantee of such rights.

To tackle hunger, we need to improve poor people’s access to food. They spend a large proportion of their income on food, so are least able to cope when food prices rise unpredictably. UK aid provides money to a consortium, led by FARM Africa and Self Help Africa, which aims to increase the production and returns of nearly 1 million smallholders. We also provide support for safety nets so that the poorest people have a buffer to help them to survive and recover from economic or natural shocks that threaten their ability to feed themselves and their families. For example, DFID supports the Ethiopian Government’s productive safety net programme, which provides predictable cash or food payments to around 8 million people.

[Robert Halfon]

I fully support the campaign for enough food for everyone, and I particularly congratulate Save the Children. Does my right hon. Friend agree that the UK should support increased fiscal transparency in developing countries so that their citizens can hold their Governments to account and press for greater civil participation for local citizens to see better how their money is spent to increase food supply?

Mr Duncan: I share my hon. Friend’s enthusiasm for such transparency, and indeed part of the menu of DFID’s activities in many of our bilateral country programmes is to enhance such political accountability and better governance of the people their politicians serve. We want to help countries to extend accountability, which we take for granted in this country, to their own people wherever possible.

Ultimately, our aim is to ensure that poor households, particularly those with young children, do not suffer from the sort of malnutrition that the right hon. Gentleman described. DFID is scaling up its nutrition programmes in more than 10 countries. We recently announced a new three-year £35 million programme in Yemen, for example, to treat and prevent under-nutrition among 1.65 million women and children. I take a particular interest in that country, where it is thought that perhaps a third of all children under five are malnourished.

We also contribute to research and development to improve the nutritional content of staple food crops. In Africa and Asia, with UK support, HarvestPlus is providing seeds and tubers nutritionally enriched with vitamin A, zinc and iron, which should benefit more than 3 million people.

Of course, no country or Government can tackle global hunger alone. Last year, the UK supported the launch of the G8’s new alliance for food security and nutrition, which aims to lift 50 million people in Africa out of poverty through economic growth and agriculture. This year, during our G8 presidency, the Government will attempt to improve and expand the new alliance. We will work to bring in more African countries and deepen its impact; for example, providing a strong focus on empowering women, who make up 40% of the world’s agricultural work force, and on promoting responsible private sector investment in African agriculture.

[Catherine McKinnell (Newcastle upon Tyne North) (Lab)]

I am grateful to the Minister for giving way; he is being generous. An issue that he has not yet touched on in any detail is the importance of tackling corruption, ensuring that any money, whether tax or aid, is used to deal with economic development and poverty. Can he include a comment about that?

[Mr Duncan]

Certainly. There are two aspects of the overarching label of corruption. First is the risk of our taxpayers’ money being fraudulently diverted, which happens minimally and against which we have the most rigorous safeguards in all our practices in the Department. The second is a broader issue. In many of the countries where we work, there is endemic or pervasive corruption in society and among politicians. We will therefore soon be publishing, as recommended by the Independent Commission for Aid Impact, corruption strategies for each of the countries where we work, primarily directed at the pervasive corruption in the country itself but always with an eye on how our own funds are properly used, I hope, in that country. The hon. Lady is absolutely right, because ultimately those who suffer from corruption are the poorest.

The UK is a partner of the Scaling Up Nutrition movement, which is a coalition of developing countries, donors, international agencies, NGOs and businesses, spearheading efforts to build an effective international response to the problem of under-nutrition. As part of our Olympic legacy, in 2013 the Government will host a follow-up to last year’s hunger event to continue our focus and that of the world on the issue. NGOs play a vital role on the ground delivering key food and nutrition services. They help to build national awareness and consensus on problems that are often complex. The NGOs’ IF campaign will therefore provide welcome momentum.

While working hard to tackle global hunger, the UK will continue to provide humanitarian relief and respond to emergencies as they arise. This year, for instance, we will provide £15 million to support more than 500,000 people in five Sahel countries. Furthermore, the Prime Minister has a role as the co-chair of the UN Secretary-General’s high-level panel on the post-2015 development agenda. The Government will have a role in shaping the future of development and an end to poverty. Finally, again this year, the UK will be the first G8 country to meet the commitment to spend 0.7% of its gross national income on official development assistance, giving us greater capacity to address the challenge of hunger and poverty, among many other such challenges. In conclusion, I assure the House that the Government’s commitment to tackling global hunger for the very poor will continue with renewed purpose in 2013 and beyond.

[Hugh Bayley (in the Chair)]

An excellent debate, which I am very glad to have heard. At the launch later this evening, I hope to see some of the Members who participated, including those who were present throughout the debate but were unable to speak, such as the hon. Members for Upper Bann (David Simpson), for Banbury (Sir Tony Baldry) and for Ipswich (Ben Gummer).

Progressive Supranuclear Palsy

Wednesday 23rd January 2013 Westminster Hall

16:30

[Andrea Leadsom (South Northamptonshire) (Con)]

It is a pleasure to serve under your chairmanship, Mr Bayley. I am delighted to have secured this debate, in which I will draw to the Chamber’s attention the needs of a specific group of people who need us to take action on their behalf.

In Towcester, in my constituency of South Northamptonshire, there is a national charity called the PSP Association, which is the only charity in the UK working solely for people with the neurological conditions progressive supranuclear palsy and the related disease corticobasal degeneration and those who care for them. PSP and CBD are diseases closely related to motor neurone disease and Parkinson’s disease.

[Amber Rudd (Hastings and Rye) (Con)]

Will my hon. Friend clarify how many people suffer from PSP compared with motor neurone disease?

[Andrea Leadsom]

I will address that later, but my hon. Friend is right to make that point, because it is believed that more people suffer from PSP than from MND, despite the fact that the latter disease is much more commonly known in general society.

PSP and CBD are similar diseases, and PSP is often used as shorthand for both conditions. In progressive supranuclear palsy, progressive means that it gets steadily worse over time; supranuclear means that it damages parts of the brain above the pea-sized nuclei that control eye movement; and palsy means that it causes weakness. Members may never have come across PSP before, but, sadly, it takes many lives.

PSP is caused by the progressive death of nerve cells in the brain, leading to difficulty with balance, movement, vision, speech and swallowing. Over time, PSP can rob people of the ability to walk, talk, feed themselves and communicate effectively. The average life expectancy is seven years from the point of diagnosis. Those who are diagnosed with PSP suffer severe and unpredictable impairments that have an enormous impact on the individual and their family. PSP is a dreadful disease.

I am pleased that since 2010, having written several times to the Department of Health, there is now better recording of PSP on death certificates, giving a clearer indication of the number of sufferers. Our attention, however, must now turn to diagnosis. Statistics show that some 4,000 people are living with PSP in the UK, but because diagnosis is still so uncertain, neurologists believe the figure could be as high as 10,000. Astonishingly, as my hon. Friend mentioned, there may be more PSP sufferers than sufferers of MND in the UK today.

[Andrew Percy (Brigg and Goole) (Con)]

I congratulate my hon. Friend on securing this debate. She has mentioned the relatively small number of people living with PSP, but is not part of the problem that many health care and social care professionals do not fully understand the condition?

[Andrea Leadsom]

Yes, my hon. Friend is right. That is one of the points that I want to put to the Minister today.

The PSP Association offers advice, support and information to people living with the disease. The association also funds research to find potential treatments for the condition. The charity’s aim is to ensure that people affected by PSP do not feel that they have to face the future alone.

Although the PSP Association operates with few resources and no statutory funding, it supports people living with the disease and their carers through a variety of means. The association has a telephone helpline and information advisory service, for example, and it offers support groups across the country and a small team of specialist care advisers. It produces a wide range of publications and communications.

The PSP Association is active in scientific research, and it has given projects £2.5 million in funding over the past 15 years to find causes, treatments and an eventual cure for PSP. I sincerely congratulate the association on its wonderful work, and I am delighted that many PSP supporters are here today.

I will share the story of one recent fundraising event. As patron of the PSP Association, I was delighted to be invited to the Dorchester—Sebastian Coe was the guest of honour—as the guest of Brigadier Michael Koe, the association’s founder and former chairman, and Christopher Kemball, the current chairman.

The tragic irony of PSP is that Brigadier Michael Koe, who is a constituent of mine, lost his wife to PSP. His four sons, who were determined to do something to raise awareness of the disease, decided to run in the London marathon. The brigadier blagged his way in to Lord Coe’s offices when he was still a Member of Parliament, using the fact that they shared the same surname although not the same spelling, to ask for help in promoting awareness of PSP.

Lord Coe offered his help. He went out and had photos taken of himself training with Brigadier Koe’s sons. For the next few years, he supported them in that way only to find that on the fourth anniversary of his involvement, his own mother was diagnosed with PSP, so he ended up with his own bitter experience of how PSP can affect families. He has kindly sent a short quotation for today’s debate, which I would like to share with hon. Members. He says:

“I am always pleased when an opportunity to raise awareness of PSP and the challenges faced by those affected arises. My mother lived with PSP for a number of years so I know only too well how important it is to receive the appropriate and timely support from health and social care, and the difference it can make to the individual affected and their family.”

Although many sad stories were told at the Dorchester that evening, the event was a huge success. Lord Coe had invited many sporting legends such as Daley Thompson and Steve Cram, as well as some of the current Olympians. It was quite an amazing evening and they raised more than £200,000 for the worthwhile cause.

The work of Brigadier Michael Koe and his family and their determination to honour the memory of his wife is truly touching. I pay tribute to the fantastic work that he has done in promoting the importance of the awareness of PSP.

[Jim Shannon (Strangford) (DUP)]

I congratulate the hon. Lady on bringing this very important matter to Westminster Hall. Does she agree—I suspect that she does—that physio and aids should be made available at an early stage of diagnosis, so that those in the last few years of this debilitating disease have a quality of life and a relationship with their families at a time when they need it most?

[Andrea Leadsom]

The hon. Gentleman makes an extremely good point. He raises issues that I want to come on to in terms of calls to action for the Minister. Sadly, the speed of degeneration of PSP sufferers often means that the need for extra resources quite rapidly increases, so it is important that the right care pathway is put in place.

The association is developing a UK-wide research network to allow researchers to share their knowledge, experience and data from their studies into the condition and to increase the number of people with PSP that individual researchers can have contact with.

In 2011, the association commissioned a UK-wide needs mapping exercise for people with PSP and their carers. The results highlighted that the nature and rapidity of PSP means that the needs of those living with the condition are very specific. For example, the palliative care that would be deemed to be required in the late stages of many conditions or at the end of life may very well be required for someone with PSP for almost half of the time that they live with the condition. The rapid progression of the disease and often early onset of communication and cognitive problems have a huge impact. Advance decision making on end-of-life issues needs to take place much earlier with PSP than with many other conditions.

The ongoing needs of a sufferer are ever-changing, and so is their need to see a range of health and social care professionals who can provide the right care, support and equipment at the right time. It is not easy for the carers of people with PSP who face equally difficult challenges trying to navigate their way through the labyrinth of health and social care services and to keep up with the pace of the disease and the ever-changing needs of those for whom they are caring.

As a charity, the PSP Association is indebted to other organisations such as the Neurological Alliance and Carers UK for championing the needs of carers at every level. Although the work of such organisations is critical, it should not replace the needs of carers also being addressed by the statutory services.

In April this year, we will see the introduction of clinical commissioning groups, which will hold the purse strings for our local health services and will be responsible for commissioning the health and social care services for their local population. We are awaiting the imminent appointment of the national clinical director responsible for championing patient involvement and improvement to neurological services in England. Those reforms of our health and social care services are very much welcomed by the PSP Association, but with a caveat, which is that it is essential that people with PSP, their carers and other people living with similar neurological conditions have a voice locally.

The PSP Association has developed a care pathway guide for PSP that outlines the standards of care and support that sufferers will need from diagnosis onwards. It is intended to inform and educate health commissioners and social care professionals to ensure that people with PSP are made as comfortable as possible. Care must also be co-ordinated, as it is essential that it involves a multidisciplinary approach and a regular assessment of the patient’s ongoing needs. That is not only about commissioning services locally, but about saving the NHS funds used in unnecessary emergency admissions to hospitals.

A recent report by the National Audit Office found that the number of emergency neurological admissions to hospital had doubled since 2005. Between 2004-05 and 2009-10, the number of neurological emergency admissions increased by 32% compared with a 17% increase in general emergency admissions over the same period. As well as putting a significant strain on the NHS, that has a severe impact on the well-being of patients and their families. The PSP Association is proactive in helping to predict the care needs of patients in the future. That is vital in reducing emergency hospital admissions with increased awareness of PSP.

As MPs representing our constituents, we need to support neurological charities such as the PSP Association and ensure that people suffering from neurological conditions are fully understood and considered in the proposals for health and social care reform and in the commissioning of services locally and nationally. Access to timely, co-ordinated care and improved integration across health and social care services should be seen as a priority, to enable quality of life for people with PSP and those who care for them.

I should be grateful to my hon. Friend the Minister if he responded on four key points. First, how are people with PSP and other rare neurological conditions being considered in the proposals for health and social care reforms? Secondly, what support is available not only to the individual, but to the carer, especially as the needs of PSP sufferers are quite specific in terms of palliative care? Thirdly, what education and training is given to health and social care professionals, so that they are aware of the specific condition and can respond to the needs of sufferers and their carers? Finally, what can be done to ensure that more research into PSP is carried out, so that the diagnosis is quicker and more accurate?

I am grateful to the Minister for being here today. I look forward to his response and, I hope, the answers to some of those questions.

16:43

[The Minister of State, Department of Health (Norman Lamb)]

It is a pleasure to serve under your chairmanship, Mr Bayley, and I congratulate my hon. Friend the Member for South Northamptonshire (Andrea Leadsom) on securing the debate.

A great value of these Westminster Hall debates is that, on something such as this, Ministers are forced to think about a specific issue that might not otherwise come across the radar and to devote some time and attention to it. They also get officials thinking about things as well, so I am grateful to the hon. Lady for securing the debate and for speaking so clearly and passionately about it. I know that she is a patron of the PSP Association, and I welcome anyone here who is from the association or associated with it in any way. It is so good to have you present this afternoon.

I join my hon. Friend in paying tribute to the work of the association. She described the support that it can give families who have a loved one with this condition. For those individuals, it is a lifeline of critical importance. The great value that disease-specific organisations can provide is in this real attention to detail and an understanding of the condition that the statutory services often cannot offer. Their role in supplementing the formal NHS is therefore of critical value. I pay warm tribute to the work that they undertake.

My hon. Friend mentioned Lord Coe. It is great to have someone such as him as an advocate for the condition and for the PSP Association. It was an extraordinary and unhappy chance that his own mother ended up with the condition and died from it. I should also, of course, pay tribute to the work of Brigadier Koe, who clearly has made a big impact in advancing the cause of better care and treatment of people with this condition.

Voluntary sector organisations will have a crucial role to play, offering their expertise, as in the care pathway guide that I know the PSP Association has pioneered. The expertise of such organisations will be invaluable locally to clinical commissioning groups, to which my hon. Friend referred, and the new health and wellbeing boards, which will be a crucial local forum for discussion of a range of conditions, including rare conditions. Such organisations will also offer their expertise at national level to the NHS Commissioning Board, the National Institute for Health and Clinical Excellence and others.

The Neurological Alliance is the collective voice of more than 80 brain and spine charities and, through its national leadership group and network of regional alliances, is an influential player in this field. I understand that the PSP Association is a member of the alliance and I would encourage it to feed into the alliance’s work as a means of getting its voice heard. That is clearly a very important route.

I turn to the question of research. With no cure as of now, research offers a source of hope for those living with PSP. The Department of Health funds NHS research and development through the National Institute for Health Research. In addition, the Medical Research Council funds a broad portfolio of medical research. Neither the NIHR nor the MRC usually ring-fences funds for expenditure on particular topics. Research proposals in all areas compete for funding, based on their strength as a proposal. Both organisations welcome applications for research into any aspect of human health. Those are subject to peer review and judged in an open competition, with awards being made on the basis of the scientific quality of the proposals made. The principle that decisions on individual research proposals are best taken by researchers through peer review is a cornerstone of science funding in the UK and is strongly supported by the coalition Government. Such decisions are rightly left to those best placed to evaluate the scientific quality, excellence and likely impact of the proposals under consideration.

My hon. Friend asked how people with PSP would benefit in April this year, when our new health and care reforms take effect. Through our reforms, we are aiming to ensure that, as far as possible, people with conditions such as PSP can maintain or enhance their quality of life. This Government are committed to providing the best possible quality of care for people with rare conditions. When we took office in 2010, we endorsed the right in the NHS constitution that says that no one should be left behind just because of the rarity of their condition. I recognise that there is often a problem within health services of a lack of knowledge among the clinicians themselves. I think that point was made in an intervention. It is always a challenge to ensure that we spread understanding and awareness.

From April 2013, the NHS Commissioning Board will directly commission services for people with rare conditions on a national basis. Those new arrangements for commissioning will bring real benefits to people with rare conditions such as PSP. By commissioning these services just once rather than reinventing the wheel all over the country, we will be able to avoid duplication in planning and ensure that the highest level of care is commissioned for patients, regardless of their geographical location. With rare conditions, that is the best way to ensure that there is a real concentration of expertise, so as to ensure that commissioning is carried out in the best possible way.

The NHS Commissioning Board will host four new strategic clinical networks for up to five years, including a clinical network covering mental health, dementia and neurological conditions. These clinical networks are potentially of enormous value. We have seen the value of them in treating cancer and other conditions. Now there is the potential for benefits to be gained in the treatment of neurological conditions. Through this particular network for mental health, dementia and neurological conditions, the board itself and clinical commissioning groups will have access to a broad range of expert clinical advice to inform decisions about the way that care for local populations is planned and delivered.

Through quality standards developed by the National Institute for Health and Clinical Excellence, commissioners, clinicians and providers of services will have evidence-based descriptions of what good care and support should look like. We have asked NICE to develop a quality standard on relatively uncommon neurological conditions, as part of a library of approximately 180 NHS quality standards. In addition, people with PSP will also benefit from the cross-cutting quality standards, which have already been published and which cover end-of-life care and patient experience in adult NHS services, the point being that a number of these standards are applicable across a range of different conditions. So people with PSP will also benefit from the quality standard on long-term conditions and people with co-morbidities and complex needs, which we have also referred to NICE for development.

My hon. Friend also discussed the importance of the patient voice within the local health system. That is of critical importance. As we move away from a paternalistic health system to a personal health system, listening to what the patient actually wants and what their priorities are will be vital. The theme of patient empowerment and voice is central to our health and care reforms, and local HealthWatch organisations—together with their national body, HealthWatch England—will champion patient voice in the health and care system.

I should also mention that in the mandate, which is the Government’s statement of our priorities for the NHS and which the NHS Commissioning Board is legally obliged to seek to implement, there is a specific requirement for people with long-term conditions to have a personal care plan, and they themselves will be involved in the preparation of that plan. That happens in places already, but it does not happen uniformly, and we must make it the norm rather than the exception. We have to absolutely recognise that everything must be focused on the patient’s interests in shaping the system to deliver that care.

Consequently I encourage those with PSP to feed their views into local HealthWatch organisations—the local patient voice—which formally take up their responsibilities on 1 April. Local HealthWatch organisations will have a seat on the new health and wellbeing boards, and through that they will be able to ensure that patient and public views are represented and can help to shape local health and care services.

I turn now to end-of-life care. My hon. Friend also spoke about the importance of palliative care. As she described, rapidly advancing diseases such as PSP may require palliative care throughout the progression of the disease, in order to support patients, as they face a declining physical and mental state, and their families. We know that the current system of care does not work well enough. Some patients receive excellent care and their families receive excellent support, while others miss out. This is partly a reflection of the origins of specialist palliative care as a discipline in the care of people with cancer, and that remains the main focus of palliative care services, but those services must be appropriate for all conditions, obviously including PSP.

We have highlighted the need to extend services to those with other conditions or diseases. The end-of-life care strategy aims to improve care for people approaching the end of life whatever their diagnosis and wherever they are, including enabling more people to be cared for and to die at home, if they wish. About 50% of people still die in hospital, although most people want to be able to die at home if that is possible, and we must ensure that their interests and priorities are respected in that regard. The National End of Life Care Programme has developed an end-of-life care pathway for neurological conditions, working with the Neurological Alliance and the National Council for Palliative Care. The pathway, which was published in 2010, sets out a framework to support the provision of improved care for that group, including those with PSP.

We are committed to increasing awareness of rare conditions—a point made by my hon. Friend in her speech—including PSP. That commitment has been demonstrated through the development of the UK plan for rare diseases. The plan will bring together a number of recommendations designed to improve the co-ordination of care and to lead to better outcomes for everyone with a rare disease, including people with PSP. We have consulted on the rare disease plan, and we published a summary of the consultation responses in November last year. Work is on track to produce the plan by the end of this year, which will help people with PSP and many others with rare conditions.

My hon. Friend also focused on education and training. Our doctors and other staff across the NHS receive some of the best training in the world, and as my hon. Friend recognises, it is important for that to include the right information and techniques to alert them to the possible presence of a rare disease when a patient presents to them. We must recognise that PSP is a rare condition, one among the hundreds that a health professional may see during their career, and it may not be feasible or practical to draw particular attention to it above all those other conditions. That said, we recognise the difficulties and, as part of our consultation on the UK rare diseases plan, we invited ideas on what more can be done to train doctors in the identification of rare diseases and on whether there are innovative ways of familiarising health professionals with rare diseases in their professional training. Furthermore, the consultation identified that training for all NHS staff to raise wider awareness and understanding of rare diseases was also important in promoting equality and in combating the stigma and discrimination sometimes associated with such diseases.

I entirely agree with my hon. Friend when she drew attention to the vital role that carers play in supporting people with conditions such as PSP. Between 2011 and 2015, the Department is providing the NHS with an additional £400 million to support individuals in their role as carers. The “Recognised, valued and supported: next steps for the Carers Strategy” document sets out Government priorities in the area, reinforced in the 2012-13 NHS operating framework, which sets out the priorities for that year.

My hon. Friend described the labyrinth that people with conditions and their carers often find themselves trying to negotiate. One aspect of the reform legislation, which I very much welcome, is the focus on integrated care. Too often, carers are in silos, and people are pushed from pillar to post. They can so easily fall into the gap. If we can develop a much more integrated approach to support people with a rare condition such as PSP, with clinicians at primary and secondary level working together much more closely, everyone would benefit.

I am grateful to my hon. Friend for raising the issue. As I said, the value of this debate is to draw the matter to Ministers’ attention and to obtain a wider airing for and focus on such conditions which would not otherwise be the case. I am happy to continue to engage with my hon. Friend to ensure that people with PSP receive the treatment and care that they deserve.

Question put and agreed to.

16:59

Sitting adjourned.