Westminster Hall

Wednesday 20th November 2013 Westminster Hall

Wednesday 20 November 2013

[Dr William McCrea in the Chair]

Pharmacies and the NHS

Wednesday 20th November 2013 Westminster Hall

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

09:30

[Ben Gummer (Ipswich) (Con)]

Dr McCrea, it is a pleasure to speak under your chairmanship in my first Adjournment debate. It is also a great pleasure to address the assembled hon. Members—this is a good turnout for a 9.30 am sitting on a Wednesday—and especially the Minister, not only because he is an excellent Health Minister, but because he is my constituency neighbour in Ipswich and will recognise the local issues that I shall mention.

This debate came out of a discussion that I first had with Miss Michelle Claridge, a pharmacist in my constituency; I admit that my knowledge of pharmacies and pharmaceutical services was close to zero before that. As with so many incidents in our lives as Members of Parliament, I learned something immediately from talking to a constituent who brought a new experience—a new query—to my attention. She explained something that I had not appreciated. Perhaps you know, Dr McCrea, because you are no doubt a far more experienced MP than I, that a pharmacy’s appearing on a street, especially a new one, is not the work of a simple entrepreneurial decision. It is a minor miracle, and I will explain why.

As the Minister knows, in the centre of Ipswich there is a new development on the waterfront, encompassing several thousand new apartments and a few houses. This new community is demanding new pharmacy services. Michelle Claridge, an entrepreneur, says, “I would like to set up a pharmacy in this area, to service the new community.” But it is not that simple. People cannot just get a retail unit for which they have planning permission and start a pharmacy; it does not work like that. The system is arranged by the Pharmaceutical Services Negotiating Committee. Hon. Members will understand that, from this moment, we will begin speaking as if we were in East Germany. It will be a time warp.

We start with the PSNC. People have to apply to be on the pharmaceutical list, which is now run by the NHS England area team—when Miss Claridge applied, it was run by the primary care trust—which manages it in consultation with the health and wellbeing board for the area and determines whether there is a need for a pharmacy in an area. It draws a circle around the existing pharmacies and says, “Is there a particular need, for this population in this area?”

When Miss Claridge started, the PSNC said that there was not a need because its map did not show the several thousand new apartments and houses on the waterfront area. Even a simple consultation with the Google maps travel distance calculator could have shown that most of its calculations about walking time were defective. The first problem is that the system starts with a group of no doubt well meaning and intelligent bureaucrats having to work out whether there is a need for a pharmacy in an area.

Once people decide that they want to set up a pharmacy, they have to apply to NHS England with 21 different forms, the shortest—section 21—being five sides long and the longest being 13 sides long. In total, they have to submit about 200 sides of application forms just to say, “I think there is a need in this area for this new pharmaceutical practice.”

After that, the application can either be accepted or rejected. If it is accepted, people can go ahead and if it is rejected they can appeal, via the local pharmaceutical committee, to which other local pharmacies can also make applications, perhaps saying, “This pharmacy is coming into my patch. It is far too close.” They can make whatever objection they feel is necessary.

The system is already completely regulated from the centre. It is a state-controlled system—contracted out to pharmacists, who are working in it—even at the geographical level, before we get on to buying and selling drugs. I do not intend to offer any radical solutions. I just want to open up the matter as a Member of Parliament. I want to explain my experiences in trying to deal with this system and talk about what I have found out, as a layman with none of the medical expertise of the Minister or hon. Members in this Chamber who are members of all-party groups. I want to explain what I saw as I examined this system.

I turned over a stone and found a lot of interesting bodies lying underneath. There are serious questions about the state’s ability to buy medicines. This is not a small bill. We spend £12 billion a year on drugs, via the NHS—a huge amount. The whole thing, from beginning to end, is run by a state bureaucracy, which, in its scale, complication and anticipation of market forces, would make the North Korean Government proud.

How do we comprehend this extraordinary system and what are the problems in it? First, I have been helped very much today by NHS Southwark clinical commissioning group—in London, I live in Southwark—which posted a useful piece of information through my door yesterday. It contains a nice map showing all the general practitioner practices and mentions lots of interesting things about what it wants to do, all of them worthy. In the middle, under a heading, “Our Vision”, it states:

“Our aim is simple—we want to work with the hospitals, community teams and GPs who provide care locally to make sure that the people of Southwark receive the best care possible and live longer, healthier, happy lives.

We will work to make sure that all Southwark residents receive high-quality, safe and accessible health services and that, over time, we narrow the gap in life expectancy between the richest and poorest people.”

All good stuff, but hon. Members will notice that one significant service provider is omitted: the pharmacist, which does not even bear a mention in this list of different health providers for NHS Southwark.

I understand that this is a common problem throughout the country. Indeed, only 10% of clinical commissioning groups have a contracting relationship for additional services with pharmacies. That is unusual in the European context. As is so often the case in health care provision, this country is somewhat behind our European neighbours.

Highly qualified people are centred where they can serve local populations, yet in so many cases they cannot offer the kind of medical services that they could offer if they were in France, Germany or the Netherlands, or some more enlightened parts of this country. Pharmacists could offer such services easily and relieve pressure on general practitioners and hospitals. The scale of what they could do is significant. Why can they not offer basic diabetic treatment or flu jabs? One could—I am sure not you, Dr McCrea—go to the pharmacist for emergency contraception, but not for various other treatments that they could offer, depending on the area.

Michelle Claridge has experienced this situation. She said, “I want to set up GP provision in this new community, linked to my pharmacy.” That is sensible, but—oh, no—people cannot just hire a locum in a pharmacy, providing a medical and pharmaceutical service to a new community, because there would be a series of new arrangements and contracts to go through with the NHS area team to allow that to be done. Therein lies another problem. The contracting relationship between the two is so complicated and separate that the area for innovation in what is not really a market at all is limited. That seems to me a great sadness and a missed opportunity, and I am sure the Minister will agree. So how do we loosen things up? I will address that in a second, because we first need to examine how pharmacists sell drugs and purchase them from the various wholesalers who sell the drugs on behalf of pharmaceutical companies.

There are essentially three categories of drugs. First, there are the so-called “special drugs”—not the special drugs that you might be aware of in Northern Ireland or in the rest of the country, Dr McCrea, but special drugs as defined by the NHS. Those drugs are outside the normal regulatory regime. They are called unregulated but, of course, this being the NHS, they are regulated.

Secondly, there are the regulated drugs—the vast majority. They are drugs that are within patent and a few other sectors. Finally, there are the category M drugs, which have come off patent. The NHS tries to derive benefits from their coming off patent by ensuring that there is not excessive profiteering in the sector. I hope I have explained that properly. No doubt I am making a series of solecisms, but I hope Members will excuse me.

[David Simpson (Upper Bann) (DUP)]

I congratulate the hon. Gentleman on obtaining this debate. He mentions special drugs, which are addressed in the research papers that we have received. I am sure he agrees that it is a scandal that the suppliers of those drugs issue invoices of, for example, £600, as it says here, when the actual cost of the drugs is £300. The NHS refunds the £600, and the pharmacy or the supplier pockets the other £300. Multiply that by the billions of pounds out there in the supply chain, and it is a scandal. Something must be done.

[Ben Gummer]

I could not agree more with the hon. Gentleman. I will address that point.

There are three separate groups that each present different and particular problems. The scandal to which the hon. Gentleman alludes, which was uncovered recently by an excellent piece of journalism in The Daily Telegraph, shows how the NHS, customers and taxpayers have been ripped off by the drug companies that are coming in and double invoicing—they are issuing credit notes to pharmacists but invoicing full amounts to the NHS. That situation is outrageous, but it is inevitable when the market is so complicated and lacking in transparency. That is the first of several problems with special drugs.

Category M drugs are incredibly complicated. In the parallel trading of pharmaceuticals across the European Union—just to take one issue—it was often beneficial to import drugs from Greece or southern Europe to the UK because of the price differences between the pound and the euro. The reverse is now true, which means that there is sometimes a shortage of supply in the United Kingdom.

The situation is addressed by a quota system imposed by the pharmaceutical companies, which inevitably causes difficulties for pharmacists because sometimes five people, rather than three, want a particular drug one week. At that point, the pharmacist rings up the wholesaler and says, “I need two more prescriptions.” The wholesaler will then say, “Actually, I don’t have them.” The pharmacist will then have to phone the supplier to ask for two prescriptions, and if the pharmacist cannot get the prescriptions from the supplier, they have to go into the secondary market to buy from another pharmacist who is keeping the prescriptions in stock. The other pharmacist, completely understandably, takes a margin on selling the drug to the pharmacist who requires the prescription.

[Oliver Colvile (Plymouth, Sutton and Devonport) (Con)]

My hon. Friend might be aware that I am vice-chairman of the all-party group on pharmacy. The right hon. Member for Rother Valley (Mr Barron) and I considered the issue about 18 months ago, and we produced a report. Unfortunately, the Department of Health does not seem to have taken an awful lot of action and has rather pushed the report into the bottom drawer. Perhaps my hon. Friend might be willing to meet the chairman of the all-party group and me so that we can share our report.

[Ben Gummer]

My hon. Friend wrote and published his report before the Minister was appointed to his position, so I am sure my hon. Friend is calling on new ears and eyes that are able to consider the problem afresh.

Another problem is that pharmacists are completely at the mercy of the demographic that they happen to serve. The averaging of pricing operated by the PSNC means that if pharmacists happen to be selling a particular pharmaceutical in their area because of a high incidence of diabetes and are making a loss, and if they are not selling many drugs on which they might otherwise make a profit that allowed them to break even or make a small margin, they are immediately disadvantaged—just because of their geography.

If, however, a pharmacist happens to be in another location with a low incidence of diabetes but a high incidence of another condition that requires a high-margin drug, the pharmacist will do very well—not because of business acumen, not because they are running a particularly good service, not because they are friendly to customers, who want to come to see them, but just because of where they happen to be and the health indicators of their particular area. That cannot be right.

The third problem with the regulated market is that, because of the price changes of particular pharmaceuticals that happen every day and every week, it is impossible for businesses to plan, as they are uncertain of their future margins.

Those are all classic problems of trying to regulate a market. It would be good for the Opposition spokesman, the hon. Member for Copeland (Mr Reed), to take note of what happens when people try to regulate a market to the degree that his party—not him, I am sure; he is one of the more sensible members of his party—wishes to on energy prices. Such regulation results in inflated prices across the spectrum, as has happened in many instances in the drugs market in the United Kingdom. Good customer service is not incentivised, and good pharmacists are crying out to be rewarded for quality. Furthermore, innovation and supply are restricted.

I could go into those problems in far greater detail across the sector. The problems frustrate pharmacists and, no doubt, Ministers, who ultimately have to write the cheque on behalf of the taxpayer.

The third area I will address before I give others an opportunity to contribute is the essential problem at the heart of the debate. Of course it is understandable that we have ended up with a regulated system, because there is only one customer for most drugs. Indeed, if I understand things correctly, 80% of prescription drugs are bought by the NHS on behalf of people who are entitled to free prescriptions. Because of the way in which we have set up our health service in this country, it is impossible to extract the kind of value from the big pharmaceutical companies that other countries are able to extract, as there is only one purchaser. I do not know why in this country we have not got to a position of questioning the business motives and ethics of big pharmaceutical companies, as the United States has for many years.

I should qualify all that by saying that, of course, within the pharmaceutical sector there are the most fantastic companies that are innovating, contributing upwards of £12 billion a year to the UK economy and employing thousands of brilliant people across the country. We should be proud of those companies, but it is surprising that we have such an unquestioning attitude to those enormous interests, which have a relationship with the NHS and general practitioners that could be generously described as corporatist. That is unhealthy in driving innovation, in encouraging responsibility and, most importantly, in ensuring transparency. That is precisely why we get scandals such as the one raised by the hon. Member for Upper Bann (David Simpson). If there is an opaque market, frauds will be committed against the interests of the taxpayer.

I have, I hope, opened up the debate a little so that we can discuss some of the issues. I do not have any prescriptions for how we might deal with them, other than the general principle, which I hope the Opposition will agree with, that liberalisation is generally a good thing. If we deregulate this market—not the quality of the people dispensing pharmaceuticals, but the commercial side of the market—to allow pharmacists to offer more services more innovatively and more cheaply, and if we encourage competition in NHS purchasing and price-setting, we will do something on behalf of taxpayers and patients. I have put forward a group of questions to open up the debate, and I am grateful for the contributions that will follow mine.

09:50

[Mr Kevin Barron (Rother Valley) (Lab)]

I congratulate the hon. Member for Ipswich (Ben Gummer) on applying for and securing the debate at this opportune time. He will know that the change from primary care trusts to clinical commissioning groups means that there is indeed scrutiny in local communities of the worth of local pharmacists and of what they have been doing over many years.

I should put it on record that I chair the all-party group on pharmacy. The group receives financial support from the Company Chemists Association, the National Pharmacy Association, the Pharmaceutical Services Negotiating Committee and the Royal Pharmaceutical Society. The lobbyists Luther Pendragon provide the group with administrative assistance. I have no personal interest in the group, other than chairing it, but I thought I should put those details on record.

Community pharmacy sits at the heart of our communities, and pharmacists are trusted, professional and competent partners in supporting individual, family and community health. An estimated 1.6 million people visit a pharmacy each day, of whom 1.2 million do so for health reasons, making pharmacists the most accessible health care professionals.

I was not really surprised to hear the hon. Gentleman say that pharmacists were not mentioned in the information he got from Southwark. Pharmacists tend to be a little add-on, and we had an example last week, with the publication of the report on A and E, which said that pharmacists might be able to help with some of the issues it raised.

Like GPs, dentists and optometrists, community pharmacies are private organisations contracted to provide NHS services to the public on behalf of NHS England. However, that is not really understood by the public. A 2011 survey by Pharmacy Voice found that 88% of people regarded GP practices as public bodies, when the vast majority are, of course, private businesses. However, only 32% of people regarded pharmacies as public bodies, which is extraordinary, given their impact on our communities.

More than 90% of the average community pharmacist’s turnover comes from the NHS. That is a higher percentage than for GPs in some parts of the country, and even some NHS hospitals do not get that much of their income from the NHS. Pharmacies often provide advice to patients free of charge, with one in seven community pharmacy consultations not resulting in a sale.

The hon. Gentleman said that we do not use pharmacies in the way people do abroad. Many years ago, when my children were quite young, and we were on holiday in places such as Spain or Portugal, the pharmacist was the first health professional people were asked to go to but, sadly, that is not the case in this country. The pharmacist was there with powers to help.

Community pharmacists are the face of the NHS in communities and on the high street, having more engagement with the public than other health care professionals. Some 99% of the population, including even those living in the most deprived areas, can get to a pharmacy by car within 20 minutes, and 96% can get to one by walking or by public transport. Pharmacists can reduce A and E waiting times by dealing with people with common conditions. The hon. Member for Plymouth—

[Oliver Colvile]

Plymouth, Sutton and Devonport.

[Mr Barron]

I am sure Hansard will put that right anyway—I could have said “somewhere in the south”. The hon. Gentleman mentioned the all-party group, and we had a session on pharmacies easing the burden of emergency care. We had several witnesses, one of whom—Paula Wilkinson—was the chief pharmacist at Mid Essex Clinical Commissioning Group. She showed us a publication that the CCG was sending round mid-Essex called “Why wait to see your doctor or nurse? See your pharmacist first!” It is part of the health care on the high street initiative that the CCG is running, and she focused the majority of her comments on that initiative, which she said nudged—that is very much Government-speak—people towards using the pharmacy first. Like another witness, she focused on the expanded role that pharmacies could play in serving patients with minor ailments.

Paula said—this is quite interesting, and I would be interested in the Minister’s comments—that for people on low incomes, prescriptions often provided a way of gaining free access to medicines that are otherwise available over the counter without a prescription. She said that meant that patients on low incomes were perversely incentivised to attend their GP or an A and E service to get prescriptions. She believed consideration should be given to providing some free medicines without prescription to those on low incomes. Clearly, if a patient has been on a medicine for a long time, that would not be that challenging, and a professional such as a pharmacist could extend the period without having to go through any rigmarole and clogging up the rest of the system.

The A and E report that came out last week showed that 40% of people who attend A and E have nothing whatever done to them, which is an extraordinary statistic. Indeed, 50% of people who are blue-lighted—an ambulance or paramedic goes out to them—are not admitted to hospital. We need to look at certain issues in primary care services and, to some extent, in the acute sector if we are to deal with such people.

Community pharmacy provides a common ailments service—we call it a minor ailments service in Rotherham —in 10% of England, and people are encouraged to go to the community pharmacy as part of that. A nationally commissioned service would reduce pressure on GP surgeries and, subsequently, on A and E. Recent reports suggest that 56 million to 57 million visits a year could be managed by pharmacists, freeing up GPs to manage more complex cases, and I agree.

Pharmacists support people with long-term conditions to manage their symptoms, improving access to care for people in the most deprived areas and increasing capacity to treat patients out of hours and in the community. The Minister will be well aware of this, but about 75% of NHS expenditure goes on people with long-term conditions. This winter, quite a lot of them are likely to end up going to A and E and clogging up the system because they have, for whatever reason—they may be forgetful as a result of other problems, such as dementia—not adhered to their drugs regime at home. Managing such people in the community using professionals such as GPs, nurses and pharmacists is a better way of caring for such people. We have few systems to deal with these things, although the hon. Member for Plymouth, Sutton and Devonport (Oliver Colvile) will no doubt tell us what is going on in his constituency with healthy living pharmacies, so I will not go into that. These are, however, major issues, and the strengths of pharmacists should be used a bit more.

I mentioned the question of medicines adherence. Under the present general pharmacy contract, it is pharmacists’ duty—and they are paid for this—to take in unused medicines. It is extraordinary that every year medicines costing hundreds of millions of pounds are prescribed and then are unused, for whatever reason. It is a difficult situation. The 2010 report by the York health economics consortium and the school of pharmacy at the university of London suggested that up to £500 million could be generated in England in just five therapeutic areas—asthma, diabetes, raised blood pressure, vascular disease and the care of people with schizophrenia—if medicines were used optimally. Those are all long-term conditions on which taxpayers’ money is spent. The report rightly said that sub-optimal use of medicines and waste undermine the £12 billion investment in medicines by the NHS.

Pharmacists do quite a lot of work which, although it is contracted to the NHS, is not always laid out nationally or used by local health partnerships. The hon. Member for Ipswich pointed out that pharmacists were not included in the publication that he cited. A medicines use review is a review of a patient’s medicines—prescribed and non-prescribed—to promote adherence and to support the optimal use of medicines; 2.8 million MURs were provided by community pharmacies in England in 2012-13. Since 2011, pharmacies have offered a new medicine service to provide additional support to patients who are starting to take certain medicines for long-term conditions. An evaluation of the effectiveness of the NMS is due soon, and more than 640,000 people starting to take new medicines have benefited. That is adherence —making sure that people do as their prescription sets out.

The York and London review, which is entitled “Evaluation of the Scale, Causes and Costs of Waste Medicines”, goes into the question in great depth, and clearly the problem will never be eliminated altogether. Nevertheless it is clear that in this country people sit and write out prescriptions and people take them away and effectively put them on the shelf. The patient might use the medicine for a couple of days. Perhaps they do not like the side-effects, and indeed that is unavoidable on occasion. However, some medicines are stored in bathroom cabinets, and when they are emptied the medicines are taken back to the pharmacist or thrown away, which costs the nation hundreds of millions of pounds. We must question whether some of those medicines, given that they are not used, should be prescribed in the first place. However, that is a wider issue for health professionals, not me.

More than 57 million GP consultations a year involve minor ailments. If we rolled out the scheme that currently covers about 10% of England, we could greatly reduce pressure on those services, and GPs could get on with more important things. The patients could be moved to pharmacies, and more than £812 million of GP capacity could be freed for other things.

In 2009-10, 140,000 people chose their community pharmacy to set a quit date and 62,000 had successfully quit smoking by the fourth week, which was a 13% increase on the previous year. Pharmacists give support in a wide variety of public health roles, including flu vaccinations, international normalised ratio-testing clinics—monitoring and adjusting the dose of the blood-thinning medicine warfarin—and asthma clinics.

There has been much debate in Parliament about changes in the Health and Social Care Act 2012. The Minister was on the Committee that considered the measure. Two things were writ large in that Act. First, we have now put into statute the need to reduce health inequalities—but they are not reducing. Everyone is living longer, but in terms of social class things are still going downwards. Pharmacists could work on reducing health inequalities in areas where there is known deprivation. That should be a major aim. Secondly, the Minister will remember the emphasis on population health. In view of the statistics that I have read out, I think pharmacy has a major role to play in improving population health.

Public health problems were very bad 150 years ago, and they involved the environment—bad housing, bad sanitation and bad water. The public health issues that this century will suffer from will be to do with individual lifestyles. I read out some statistics about smoking cessation and pharmacies, and I believe that community pharmacists are the gatekeepers to the national health service. Far more people visit them than any other part of the NHS and they have a major role to play. The sooner we alter the current mode of contact and move away from the situation where pharmacists get the bulk of their money just churning out prescriptions to one where they cover wider issues within communities and look after the health of the population, the better we shall be.

09:59

[Oliver Colvile (Plymouth, Sutton and Devonport) (Con)]

It is a pleasure to serve under your chairmanship this morning, Dr McCrea. I congratulate my hon. Friend the Member for Ipswich (Ben Gummer) on securing the debate. I have tried on one or two occasions to get a debate on pharmacy, and he has beaten me to it and introduced the debate very successfully. No doubt he has more pull with the Speaker’s Office than I do. I thank the Minister for attending, too.

I got involved in the pharmacy story when in the 1990s resale price maintenance on non-prescription medicines became a big issue. The chief executive of Asda—I do not think that he was a Member at the time—was very keen to get rid of RPM on non-prescription medicines because he felt the market should be much more open. Quite a debate has taken place over the years on how to liberalise the pharmacy market in a big way.

At that time, community pharmacists were concerned about whether their trade would be reduced and the effect on their livelihoods. We must recognise that community pharmacies play a significant role in the high street economy. People are regularly drawn into town and city centres to spend money and visit the community pharmacy at the same time. I have followed developments with interest. I congratulate and support pharmacists, who do an incredible job. As the right hon. Member for Rother Valley (Mr Barron) pointed out, they are the first point of contact for people who need help.

I understand the concern of my hon. Friend the Member for Ipswich about the lack of liberalisation in the market and the need for transparency. I am always one for a lot of transparency—more sunlight normally produces it. During the 1980s and 1990s, the Conservative Government made sure that town centre retail developments and new supermarkets were assessed, to find out the implications for other supermarkets and food retailers. Regulation of town centres has been going on for a while. That was also to do with the sequential test.

[Steve Baker (Wycombe) (Con)]

My hon. Friend reminds me that we often complain that our town centres are in decline; he may have given us the reason.

[Oliver Colvile]

I agree that supermarkets have had an impact, but my point is about trying to protect small businesses in town and city centres.

[Steve Baker]

That is not quite what I meant. I pointed out that our town centres have been regulated for a long time, and that they are now in decline. Perhaps we should liberalise more consistently, and should have done so for a long time.

[Oliver Colvile]

The bigger issue, frankly, is car parking in town centres. Outside town centres people do not pay charges for car parking, but they do in town centres: so where do they go? In my constituency, I suspect that they end up at the Marsh Mills Sainsbury’s or elsewhere.

Two other big issues affect the pharmacy profession, one of which is the criminalisation of dispensing errors. If pharmacists make a mistake, they can be prosecuted and potentially sent to prison, whereas GPs, for whom I have a great deal of time, do not suffer the same prospect. The Department of Health is looking at that, and I hope that it will come to a conclusion on how we can equalise the situation and ensure a more level playing field.

The other issue is the sharing of data between pharmacists and GPs. I raised the matter during a recent statement from the Secretary of State for Health on the whole business of how pharmacists could play a part in helping to relieve accident and emergency units. The Government are keen to ensure that more and better data sharing takes place. I have a slight concern in that my understanding is that the process would be run by the Department of Health, but I recently read in an article that the Department was suggesting that the responsibility would lie much more with the local commissioning boards. If the Minister can respond to that confusion, that will be helpful.

We need to ensure that pharmacies play a much better role. They need to be the first point of call for people seeking help from professionals, as that would help to relieve GPs. During the summer recess, I visited the Keyham healthy living pharmacy, which is a brilliant organisation in a deprived community. Life expectancy differs by 11 years between the suburbs of Plymouth and Devonport, which is where the Keyham pharmacy is located. The pharmacy offers not only flu vaccinations, but also smoking cessation services and other such things. It is a service that certainly needs to be available.

Finally, there is concern about how we can improve how people feel about pharmacies to ensure that they are used in a much better way. If pharmacies were used to deliver flu vaccinations, that would take some pressure off our accident and emergency units over the winter. We have discussed an important issue this morning, and I am delighted that you, Dr McCrea, have been in the Chair to ensure that we get some positive comments.

10:13

[Jim Shannon (Strangford) (DUP)]

I congratulate the hon. Member for Ipswich (Ben Gummer) on bringing this matter for our consideration today. Although I agree with him on many things, his football team, Ipswich Town, is playing my team, Leicester City, on Saturday, so our opinions will differ on that.

[David Simpson]

You’ll get beat.

[Jim Shannon]

Well, I hope we won’t.

To return to the matter in hand, having run my own business, I can well understand the pressures on businesses—the need to make profit and to pay the bills at home. I can also understand the principle behind paying for what you get and that a good service needs to be paid for. At the same time, however, from what I have read in the media and the considerable background information to the debate today, the scandal of double-invoicing and cashback to the detriment of the NHS cannot ever be accepted.

I take my hat off to the whistleblowers who have highlighted the practice, which it is claimed has robbed the NHS of up to £120 million. The headlines are clear: “Pricing scandal sees NHS pay £89 for cod-liver oil capsules”; “Firms boast of profits on drugs that cost ‘pennies’”; “‘There’s a lot of flexibility over prices’”; “Pharmacies and suppliers accused of price rigging”, and last, but not least, “The NHS, the drug firms and the price racket”. All those headlines are cause for concern.

I have asked several questions of the Secretary of State regarding the provision of new cancer drugs, Alzheimer’s drugs or any number of other new drugs that are not accessible on the NHS. How do I tell my young constituent suffering from cancer that there is no funding for a drug that has been proven in other countries to help when she is reading about double-invoicing? Is the cost of her life so little for the House that we can allow the practice to continue? I have asked those questions of myself and my constituents ask me them, too.

I was angered when I read about £10,000 monthly kickbacks and other horror stories. It is clear that any agreement needs to stop that from being able to happen. I have the greatest respect for the Minister and I am sure he will hit on such issues in his response. If we need new legislation that enables the NHS to go deeper than merely checking invoices, so be it. It concerns me greatly to think of the number of families who could have received life-changing help this year with the money—our money, our constituents’ money—that has been lost to those who are working the system. That has to stop.

Many heads should hang in shame over how bills have been creatively put together by providers, but I cannot simply allow the Government not to understand that they need to do more.

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

Does my hon. Friend agree that one of the most significant recent statements in the press was when a senior executive of one of the large companies said that it would be more than happy to agree to a 70% discount if that is what it took to get the contract? That is a damning indictment of the original price.

[Jim Shannon]

I thank my hon. Friend for that helpful contribution. The contributions from him, my hon. Friend the Member for Upper Bann (David Simpson) and others may focus the Minister’s attention.

On the availability of medicines, I have read that the National Institute for Health and Care Excellence has approved fewer than one in three medicines since 2005. A recent letter from nine major pharmaceutical companies to The Daily Telegraph started with something that I agree with. I am sure that any Member and, more importantly, any doctor or care worker in the NHS, will also agree with it:

“Medicines should not just be seen as a cost.”

They should first and foremost be about healing and curing illnesses. The letter continues:

“They are an investment and an essential part of improving patient outcomes. Yet…the proportion of medicines refused by NICE is only increasing.”

That is a concern for me, too. Jonathan Emms, UK managing director at Pfizer, has said:

“Right now NICE is saying ‘no’ too often. It is blocking many innovative new medicines from reaching the UK patients who need them most, medicines that are often readily available in Europe.”

Will the Minister say what contact he has had with NICE about not making available in the UK drugs that are available in other parts of Europe?

Although it is hoped that the agreed deal will save the NHS £1 billion over two years, it is essential that that saving goes into making more drugs available for the healing of those who need them and not simply the healing of the deficit. Will the Minister assure me and the House that the savings made will go into the provision in the UK of drugs that have been widely tested and that are widely available in Europe?

[Oliver Colvile]

Does the hon. Gentleman recognise that drugs and medicines can be dangerous if they get into the wrong hands? Pharmacies also have to face people using the internet to acquire drugs, which is an option that does not carry the same regulation that we expect in the domestic market.

[Jim Shannon]

I thank the hon. Gentleman for that contribution. It is something that many of us have highlighted and I know that the Minister has spoken about it in the past. The availability of drugs on the internet is an anomaly in the system, and perhaps the Minister can give us an indication of how best to deal with it.

Back in April, we were told that the number of cancer drugs on the approved list was to be halved. Will the Minister commit to ensuring that the savings will be used to increase the amount of drugs that might save lives and give a better quality of life?

I read the story of a mother with terminal cancer, who was forced to fund herself a drug that she believed would give her extra time with her young children, after being refused by a special Government fund. I find such stories incredible, hearing about the real heartache and issues that impact on family lives, and yet we—as collective representatives—are unable to help and assist as we should. In America, Obama is trying to bring in a health care system similar to ours. It is referred to as Obamacare—people say that it will make or break him, and it probably will. We, however, seem to be turning ourselves into an American system, whereby we have to fundraise to get treatment. That is certainly not what my constituents or I pay our taxes for, and I am sure that others agree with me.

I want to make a quick comment about Northern Ireland, where our Health Minister abolished prescription charges. That was done on the understanding that cheap generic drugs were not prescribed. Health is a devolved matter in Northern Ireland, and our Minister made a decision, which I support entirely. Will this Minister—I ask this with respect—liaise with the Northern Ireland Minister, Edwin Poots, to ascertain how the scheme is working and how we have been able to stick within our budget in Northern Ireland on prescription drugs?

The right hon. Member for Rother Valley (Mr Barron) made a valuable contribution today. One of the things that he referred to was the drugs that people have and do not use; they sit until they go out of date and are then dumped. In Northern Ireland, the Minister, the GP surgeries and so on have taken steps to ensure that the prescription of drugs is better controlled. Sometimes, people might run out of drugs, rather than having extra in the cupboard, but such steps help and take away wastage in the system. The right hon. Gentleman made that clear in his contribution.

Over the years in Northern Ireland, through the Minister and in co-operation with the pharmacies, we have also tried to reduce the number of people attending accident and emergency. If people have a minor ailment, they should go to their pharmacist or chemist; he or she will be able to give some direction on what needs to be done. There are ways and means of good practice, to which I have referred on many occasions. I say what we do in Northern Ireland with humility, but we actually do some things very well. If such things are done well, they can be a marker for elsewhere.

Time is flying past, but changes clearly need to be made soon. Yes, pharmaceutical companies and pharmacies need to make a profit, but that must be done in the right way; we need legislation in place to ensure that that is done in such a way. Yes, NICE must protect people from drugs that promise all, but deliver nothing, and yet that cannot be used to count pennies and to justify saying no to drugs that will make a difference.

Finally, yes, Government must make savings, but those cannot be taken from the most vulnerable by denying them treatment; any savings should be used for new drugs, to give people a better chance of life, for the sake of our constituents in the whole of the United Kingdom of Great Britain and Northern Ireland. We are not talking simply about numbers on a hospital list—the changes need to be made, and made soon.

10:23

[Steve Baker (Wycombe) (Con)]

I congratulate my hon. Friend the Member for Ipswich (Ben Gummer) on provoking a stimulating debate, and one in which I have learned a great deal. In particular, he emphasised the local impact that pharmacies can have, while the right hon. Member for Rother Valley (Mr Barron) clearly explained some of the opportunities that can be seized through pharmacies.

In Lane End in my constituency, a pharmacy opened alongside a dispensing GP practice, but if I remember the circumstances correctly, the practice was forbidden from serving local people; we had an absurd situation in which the purpose of the regulation made my constituents’ lives less convenient and less easy, in the interests of somehow distributing profit fairly. The debate has brought in some of the wider aspects for society and some of the things that a heavily regulatory state has messed up.

The purpose of prices, profit and loss in a market society is to guide individuals and voluntary associations into best serving society. If pharmacists wish to open a pharmacy, they should simply be able to do so, if they can find a place to do it, can do so within the law and are selling lawful products. They should be able to get on with it and serve whomever comes through the door. Instead, we have the situation described by my hon. Friend—people have to fill in a 200-page application form and might subsequently find themselves subject to particular restrictions on whom they may or may not supply.

One of the issues with a market system is that business men are profit-maximising, which is both a problem and a benefit. The problem is that business men do not like competition much, because that is what drives down prices and therefore profit. That is the crux of the matter. The purpose of the Government is not to entrench in law and regulation the tendency of business men to seek rent—excess income through capturing the state—but that is just what is happening when competition is inhibited by restrictions placed on a dispensing practice simply because a neighbour has opened a pharmacy. Certainly, on the siting of pharmacies, the Minister should seek to abolish rules and controls wherever he can, because they are getting in the way.

[Ben Gummer]

In my address, I omitted to mention the whole range of practice payments paid to pharmacists simply for, in effect, being open. The problem is that the opening of a new pharmacy creates a liability for the NHS to pay those practice payments, no matter who does or does not go through its doors. That shows the rather extraordinary situation that we have ended up with in respect of how pharmacies are remunerated.

[Steve Baker]

My hon. Friend is absolutely right and I am extremely grateful to him for bringing that up. We pretend that we live in a capitalist society—I have said this in the House before—but if our system is capitalism, I am not a capitalist. We have an absurd hybrid system, in which the state constantly intervenes in order to give people rents. It is peculiar that we call it a free market society.

The purpose of our all being here, of course, is to improve our constituents’ lives. When I say such things, my intention is to ensure that my constituents—all our constituents—have better access to pharmacies. In the House, we have a real consensus about an increase in the services offered by pharmacists being of benefit to all our constituents. What I want is for the Government to get out of the way, not to use taxpayers’ money to provide the payments that my hon. Friend mentioned and to allow pharmacists to get on and best serve the public in a way that is in the public’s best interests—a way that can be discovered only through experimentation and entrepreneurship.

On pricing, I want to make the point that in this country we are not good at haggling. We should haggle over prices and drive them down. The hon. Member for Strangford (Jim Shannon) talked about the scandal of some simple and inexpensive medicines that ought to cost pennies, but cost very much more. What I see at work there could be something that I witnessed when I was a contractor working with Government: Departments are not good at driving down prices. They tend to accept the price that they are given—“Oh, that must be the market price.” No—they should set the market price by demanding that they are charged less and, if suppliers do not provide the goods at a lower price, they should go elsewhere.

That brings me to generics and parallel imports, a subject touched on earlier. We ought to be making sure that the big pharmaceutical firms do not hold the NHS over a barrel. I have heard some of their arguments, and of course producing a new drug is an expensive business, but we should not be held over a barrel. In a market society, people should be held to account to drive down costs and drive up quality.

Johnson & Johnson, based in my constituency, has a wonderful credo, which was written when the basis of a free society was under threat in an earlier time. That credo sets out the principles on which the industry should be founded, and one such should be: no legal privileges, wherever possible.

[Oliver Colvile]

During the all-party group inquiry, we looked at that issue. One suggestion for easy identification of who was exporting and importing pharmaceutical products in this country was to look at VAT returns—when I ran a small business and was VAT registered, I had to fill in a piece of paper that recorded what level of EU trade I had ended up doing. I approached the Treasury on the matter, but it was not willing to participate and help, but that seems to me to be a way in which we could identify who the offenders are. We had some difficulty in identifying the offenders.

[Steve Baker]

My hon. Friend has identified what might be a missed opportunity because an enormous effort is going into preventing that fraud. With the opportunities that electronic communication offers today, it should be possible to use some of that information in other contexts. With that in mind, I will turn to the internet.

Clearly, everyone wants to ensure that prescribing takes place properly, but when people have been prescribed medicines it should be possible for them to buy over the internet in appropriate circumstances. I am particularly aware that homeopaths have had great difficulty with the internet because of the need for people to present physically to buy a medicine.

We cannot have it both ways on homeopathy—either the medicines are relatively harmless and can be treated with scorn by the medical profession, in which case they should be freely available on the internet, or they are dangerous and should be tightly regulated. Homeopaths’ experience suggests that people can take responsibility for themselves and buy products on the internet.

[Ben Gummer]

My hon. Friend touches on an interesting issue. Given the fact that the Government are going to great lengths to try to get GPs to do more consultations on the internet and Skype—great news for many of my constituents, especially those in busy jobs with difficult hours—it seems obvious to extend such innovation to the dispensing of pharmaceuticals.

[Steve Baker]

My hon. Friend is right. In the 21st century, we should be waking up to the opportunities to use technology to drive down costs and drive up service. People are so busy today, so why can they not have consultations in their offices with Skype, and why can pharmacists not prescribe to offices with Skype? The solution to these problems is for the Government to abolish whatever rules and controls they can and wherever they can, and to liberalise when abolition is not possible.

[Mr Barron]

The majority of patented goods that the national health service buys are a recognition not just of cost, but of the pharmaceutical industry’s worth to the British economy—including exports, manufacturing base and so on. We export around £7 billion of pharmaceutical goods a year. Might a free market endanger that?

[Steve Baker]

We may be in danger of straying into philosophically deep water about what free markets do and do not do. Clearly, because of the moral imperatives of health care, we cannot have an unimpeded market. We have made political decisions to ensure that no one goes without health care. That has consequences, and we should accept them.

The way to deploy scarce resources in the service of the public is to allow the price system, as well as profit and loss, to run as freely as possible. When we talk about something’s worth, price is too often ascribed to things that are not subject to market transactions. Only through exchange can it be established how people value things. I do not want to go on for too long, so I will leave that to another debate, perhaps the one on the Budget.

I want to encourage the Government to liberalise and to look more closely at what can be done to enable pharmacists to set up wherever they need to in order to serve the public best.

10:33

[Mr Jamie Reed (Copeland) (Lab)]

I thank the hon. Member for Ipswich (Ben Gummer) for bringing this debate to the whole of Parliament today—we often forget that Westminster Hall is Parliament. Issues of the utmost importance have been raised regarding pharmacies and the pharmaceutical industry, and shocking allegations have been made. The House of Commons has a duty to learn the facts and to act accordingly, whether by expanding the role of the pharmaceutical industry and pharmacies or by remedying any wrongdoing in existing price structures.

The hon. Gentleman is right to extol the virtues of community pharmacies for many reasons and I will touch on them in due course. He is right to open up an extremely broad debate, and we have touched on its potential breadth. We need to explore the scandal of what The Daily Telegraph called the drug price racket. I can understand a patient missing an appointment which regrettably wastes the time of clinicians and costs the NHS money. I can understand the worried well occupying GPs’ time when they have no real need to do so. I can understand patients not taking a full course of antibiotics or keeping the medicine cabinet at home filled with prescribed drugs for which they have no real need. All those behaviours cost the NHS money, but individuals will not be aware of the costs they are incurring for the NHS, nor do they intend to divert scarce resources. There is no deliberate disregard for the NHS, for other patients, or for the taxpayer in these instances, but clearly more work needs to be done to reduce these costs.

Let us consider one of the central allegations before us today—the drug price racket. Some private interests—pharmaceutical companies and pharmacies—are knowingly and deliberately committing fraud. We live in a world that is very different from the pre-crisis world that existed before the global economic crash. We live in an era that is set to be defined by austerity, and public finances are still in a parlous state. In society at large, not just in Parliament and across the political spectrum, but at the school gate, in the high street, and in the boardroom, it is understood that public money is valuable and scarce, and that it should be spent wisely and prudently.

Drug price fraud is happening in our most valued public service at a time of economic crisis, and it has occurred by design and not accident. Those responsible are not simply undertaking a grotesque financial deceit of patients and taxpayers, but are probably depriving the NHS of resources that could and should be used for patient care. To take the point to its logical conclusion, these parties have fraudulently diverted from the NHS resources that could have saved lives.

A few years ago, the Prime Minister referred to lobbying as

“the next big scandal waiting to happen”.

We now know that he was wrong. Shamefully, in recent months and again today, we may have unearthed the next big scandal that the Prime Minister warned of. My hon. Friend the Member for Islington South and Finsbury (Emily Thornberry), the shadow Attorney-General, wrote to the Serious Fraud Office about the drug price racket in July:

“You will be aware that the Telegraph has brought to light extremely serious allegations that pharmaceutical companies in collusion with chemists have been rigging the market in prescription drugs that are generally not covered by NHS price regulations…If the allegations are substantiated it will mean that the NHS has been systematically overcharged hundreds of millions of pounds. This would represent a colossal fraud on the taxpayer. An offence of that magnitude would surely warrant the attention of the Serious Fraud Office and not just an internal inquiry of the counter-fraud department of the NHS. I would be grateful if you could let me know what steps, if any, the SFO intends to take on what appears to be prima facie evidence of conspiracy to defraud.”

David Green, CB QC, of the Serious Fraud Office responded on July 19 and concluded:

“The SFO are working closely with NHS Protect and the allegations that have been made are the subject of careful consideration. If, having considered the available information, evidence of fraud is identified, further consideration will be given as to which agency is the most appropriate to investigate these matters.”

My hon. Friend has received no other communications from the Serious Fraud Office in the intervening period, and I have today written to Mr Green asking what progress the SFO has made with its considerations. I have also written to the Chairs of the Select Committee on Health and of the Public Accounts Committee to alert them to these issues with a view to their undertaking their own inquiries.

The Daily Telegraph should be congratulated on its investigative journalism. There is absolute consent on that. It has provided a great service to the public and the NHS. We should be cognisant of the awful parallel that it rightly exposed: the parliamentary expenses scandal. That was another truly remarkable service entirely within the public interest. It is an apt comparison. The abuse of public money represented by the parliamentary expenses scandal resulted in the jailing of Members of Parliament and of peers. Shocking as that was to the public and seismic as it was to the political establishment, the fraud and false accounting pales into insignificance in monetary terms compared with the sheer scale of the embezzlement that is now being alleged in the drug price racket.

I repeat that this is not just a get-rich-quick caper, but the knowing and deliberate abuse of public money that should have been used to save lives. That is the scale of the allegations. We need the pharmaceutical industry, and we need pharmacies and pharmacists. We need the pharmaceutical industry to help to deliver our national life sciences strategy. We need it to help to underpin academia so that we can continue to break new ground in medicine research and to develop new treatments, new drugs and new medicines. We need to recognise and reward the public good that that represents.

We need to expand the role of community pharmacies if we are better to deliver a more integrated, efficient and effective health care system. We need to make better use of the 1.6 million interactions that will take place today between the population in England alone and pharmacies. The average person visits the pharmacist 14 times a year—more than once a month—and we need to capture better and utilise those interactions for improved individual and public health. Of that, there is absolutely no doubt.

However, for us to do any of that, we need to be able to trust the motives and actions of all the groups involved. Let me say to the pharmacists and pharmaceutical companies that are doing no wrong—clearly, that is the overwhelming majority—that I regret the distress that this issue will inevitably cause them, but it is essential for all of us involved with the sector to leave no stone unturned in establishing the facts, if we are to be able to maintain the faith and trust of the public. I know that the Minister, for whom I have genuine respect, will be as appalled by the revelations as anybody else, and I hope that he will be able to answer the questions that I put to him today. If not, I would appreciate a written reply.

The Daily Telegraph describes the Government announcement of drug-pricing caps in 2011 as “a ‘hallelujah’ moment” that has led to significant fraud. Does the Minister consider that that is the case, and will he investigate why it is that those disposed to committing fraud are using the announcement as the basis on which they are able to defraud the NHS? On 20 July, the Secretary of State for Health told The Daily Telegraph that he had ordered an investigation into the allegations. Will the Minister tell us where those investigations are up to? What has been investigated? What is the scope of the investigation? When will the investigation be completed? The Minister will note that Serco has been made to repay £24 million to the Treasury for financial wrongdoing in the course of delivering public services. Will the Minister support repayments to the NHS if price fraud allegations are proven?

Finally, we all want to develop the role of community pharmacies. We all want to help our pharmaceutical industry to thrive and innovate, and we all have a duty to spend public money effectively, properly and honestly. I look forward to the Minister’s reply.

10:41

[The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)]

We have had a wide-ranging debate today on issues such as the deregulation and regulation of pharmacies, the local provision of pharmaceutical services and the extension of the role of pharmacists and what they do in our communities. Importantly, we have also discussed pricing and behaviour that, if not fraudulent, is certainly very irregular on behalf of some pharmacists and drugs companies. I hope that I will have time to deal with all those issues, but I will write in more detail to any Member here today who feels that more points need to be answered.

Before I go any further, may I say that it is a pleasure, as always, to serve under your chairmanship, Dr McCrea? We took part in many sittings together when the Health and Social Care Act 2012 was considered in Committee, and it is always a pleasure to serve under your chairmanship. I congratulate my hon. Friend the Member for Ipswich (Ben Gummer), my constituency neighbour, on securing today’s debate. It is important to recognise that our NHS is not only about doctors and nurses, but about midwives, physiotherapists, occupational therapists, heath care assistants and all the other people who contribute to the health of the nation every day, including pharmacists, who play an increasingly important role in delivering high-quality local health care and who are embracing the enhanced role that they have been offered under the 2012 Act. It is right that we put on record our thanks for the work that pharmacists do every day.

The right hon. Member for Rother Valley (Mr Barron), in an excellent, considered speech, made some very good points. In particular, he said that community pharmacists are the face of our NHS in many communities. He is absolutely right in saying that because, particularly in more deprived areas of the country, pharmacists are often the first point of call for advice—whether on simple details about medications or for important primary health care advice. Pharmacists perform that role every day. We should be grateful to them for what they do, and I put on record my thanks for that work.

It is important to put on record that pharmacies are in robust health. Although we debate deregulation and difficulties, we know that there are more NHS community pharmacies than ever before—more than 11,400 in England—and they are offering health care, treatment and healthy lifestyle advice and support throughout the country. They dispensed more than 900 million prescription items last year, which is up 53% from 10 years ago, and about 2 million prescriptions are handed out every day by pharmacists. Therefore, we have an industry, as part of our NHS and in its commercial activities and other work, that is in robust health and is performing a valuable service for our NHS.

Of course, we could get into the issues that the right hon. Gentleman rightly raised on the appropriateness of prescribing medication. The chief medical officer talked in some detail in a report about the need for GPs to look sometimes at the appropriateness of the antibiotics that they prescribe and about how we need to look at antimicrobial resistance in this country. The right hon. Gentleman made his points very well, but I hope that he will forgive the fact that I shall not address them directly in today’s remarks. However, he was right to make them and the chief medical officer certainly agrees with him, as do I.

I shall deal with other points that have been made, but initially, I would like to address the important points made by my hon. Friend the Member for Ipswich. We rightly value the innovation and the opportunities that pharmacists have to innovate and support their local communities in different ways. Because they are centred in the community, only pharmacists are able to use such methods. I had the pleasure of attending the annual pharmacy awards and looking at some of those ways. I saw pharmacies, embedded in local communities, making a real difference in providing health and lifestyle advice and improving the quality of care available to local patients.

At the same time, although we want to encourage and support innovation—the pharmaceutical price regulation scheme, or the PPRS, was recently renegotiated and enhanced to give pharmacists the opportunity to innovate exactly as I have described—we also need to recognise that we have a publicly funded national health service, which is a point that has been made across the Chamber today, and we are very proud of it. It is free at the point of need, and it is important to ensure that the money that is given to the health service, whether to pharmacies or to other parts of the NHS, is properly spent, and there is also a role in ensuring that services are provided in a safe and effective way. I shall come on to some of those points later.

My hon. Friend the Member for Plymouth, Sutton and Devonport (Oliver Colvile) has been a consistently strong advocate for the role of pharmacists, and he made his points very well today. The hon. Member for Strangford (Jim Shannon) also made a useful and powerful contribution, which was picked up by the hon. Member for Copeland (Mr Reed) a few moments ago, about the importance of ensuring that there is no fraud in the system and that pharmacists always behave appropriately. I am sure that the majority of the time pharmacists behave appropriately and make a very valuable contribution. When there may be fraudulent behaviour, it is right to pick up on that and investigate it. I will come back to that in a moment, because we all want to see high value for money from our NHS and to make sure that the money is spent on patients and not wasted. I think that that is something that we all agree with and believe in across the House.

I turn to the important issue of pricing. The vast majority of drugs that are prescribed are either covered by the PPRS or are generics, where competition helps to keep the price down. We recently introduced a price for common specialists, but a small number of prescriptions, as has been mentioned in the debate, fall outside the pricing mechanisms that are in place. We are working with the Pharmaceutical Services Negotiating Committee to find a better mechanism to encourage pharmacists to seek lower prices.

Where there may be cases of fraud, it is right that we investigate them, and they are investigated. NHS Protect exists to safeguard—to protect—against fraud in the NHS. That has been a consistent policy; it was followed by the previous Government, and it has been followed by the current Government. The reason why we need services such as NHS Protect is to ensure that if there is fraudulent practice—in this case, potentially in the behaviour of a small number of pharmacists in dealing with small, unique areas of pricing—it is investigated properly. I will ensure that either I or Earl Howe, who is the Minister responsible, writes to the hon. Member for Copeland to inform him of where we have got to with the investigation.

The other point, which was made by the hon. Member for Strangford and is very important, is that we want to ensure that money goes on patients. There is increasing demand for drugs. It is very good that the NHS is continually innovating and developing more treatments, better surgical techniques and improved drugs and mechanisms. Of course, when drugs are used in the NHS, they need to be evidence-based, but I hope that he will agree that it is good that we have set up the cancer drugs fund, which has helped to increase the speed at which people with cancer receive drugs. More than 30,000 people have benefited from the cancer drugs fund and received cancer drugs. We should all be pleased about that and proud of it.

[Jim Shannon]

I thank the Minister for that positive response. I outlined in my contribution a couple of examples of people who did not access the cancer drugs fund, but in my mind clearly should have qualified. Is he prepared to look at that issue to satisfy those people who need drugs urgently because of the time they have left on this earth?

[Dr Poulter]

On how drugs are accessed, one of the problems—this was why the cancer drugs fund was set up—was that some people, as the hon. Gentleman rightly outlined, had been receiving drugs in other countries for many years, but we in this country were a little slower to respond to some of those innovations. But of course we need to ensure that, whatever fund we set up for providing medications, those medications are shown to be effective and there is an evidence base for them. However we do things, there will always be new treatments on the horizon that we would like to get through to people more quickly, and we need to ensure that those treatments are always evidence-based. I think that we can be pleased that the cancer drugs fund has made a significant difference by providing treatments in a more effective and much quicker manner, but if the hon. Gentleman would like to discus the matter further, I would be very happy to see him and talk it through in more detail.

I think that it would be useful for me, picking up on the points raised early in the debate, to outline the processes involved in opening a pharmacy. Anyone can open a pharmacy anywhere, subject to the premises being registered with the General Pharmaceutical Council, when the owner’s service model includes the sale or supply of pharmacy medicines or prescription-only medicines against prescriptions from that pharmacy. However, there are extra criteria for providing NHS pharmaceutical services. Anyone wanting to provide NHS pharmaceutical services is required to apply to the NHS to be included on a pharmaceutical list.

Before September 2012, there were control of entry requirements. The NHS (Pharmaceutical Services) Regulations 2005 determined whether a pharmaceutical contractor could provide NHS pharmaceutical services. In England, no new contractor could be entered on to a PCT pharmaceutical list unless it was “necessary or expedient” to secure the adequate provision of pharmaceutical services locally. That was the control of entry test. If a new service provider was judged neither necessary nor expedient, the NHS, or the PCT in question, had to refuse the application. There were rights of appeal to the family health services appeal unit, which is run by the NHS Litigation Authority. That was available if there was a concern.

Part of the reason for the strict criteria relates to the pricing mechanism and how pharmacists are paid, which I will come to later. Obviously, the local health economy is an issue, and pharmacists are not paid just for the number of prescriptions that they provide; they are also given a baseline fee. When we have a publicly funded health service and we need to ensure that need and demand are aligned, it is important that we look at this in the round. I sympathise very strongly with the points about the need to de-bureaucratise the NHS where possible—those were good points well made—but we also have to recognise that this is not just about arbitrary mapping; it is about aligning need and demand for a service within the pricing framework in place. That is not just about the number of prescriptions that are provided; it is a much more complex mechanism. I will come to those points later.

[Mr Jamie Reed]

I am grateful to the Minister for giving way; he is being typically generous. On pharmacy numbers, does he think that we have too few or too many, or is the number about right?

[Dr Poulter]

The hon. Gentleman will be aware that under the previous Government, the Office of Fair Trading did a review and recommended total deregulation of the pharmacy industry. That was in 2003. The previous Government put in place a strong package of reforms to recognise that we need some degree of what my hon. Friend the Member for Ipswich would call market forces but I would probably refer to more as patient choice. We need to support patient choice as much as we can, but within the context in which we have a publicly funded service that needs to be regulated. It is a health care service; it is treating and looking after patients. We need not only to secure good value for the taxpayer, as part of how we fund that service, but to ensure that there is independent regulation and some regulation by Government as well. That is about ensuring that we have the highest-quality services available.

Given that I am running short of time, I will write to my hon. Friend or I would be happy to meet him—whichever he prefers—to talk through the specifics of the context of mapping out a local needs assessment, which is now carried out by health and wellbeing boards. That is a pharmaceutical needs assessment. I am happy to talk through with him in detail how that interrelates with the pricing mechanism and how we need to ensure that the two are kept in balance in the context of the conversation that the hon. Member for Copeland and I have just had.

It is worth highlighting the fact that pharmacists and pharmacies play an increasingly important role in our NHS. Many pharmacies now provide additional services. They are contracted to do so outside those pricing frameworks. That is done locally by clinical commissioning groups. Health and wellbeing boards or local authorities can also contract pharmacists to provide services. As my hon. Friend will be aware, responsibility for public health—40% of that budget—has now passed to local authorities. Given that public health responsibility, there is a strong role for local authorities in commissioning local health care services if they feel that that would be in the interests of the local population.

Under the Health and Social Care Act 2012, other providers of health care services, outside the traditional framework of GP and community services and secondary care, were given more of an opportunity to put themselves forward and offer to provide valuable services. This is a real opportunity for pharmacists to bring forward to CCGs what they do and to make the case that they can provide many services in a way that will be focused on primary prevention and that will save the local health economy money but also deliver better care. The track record of pharmacies and pharmacists is very good in delivering community care—whether looking after people with diabetes or providing simple services for other patient groups. Under the 2012 Act, there is now a much greater opportunity for pharmacists to come forward and put in offers, within an integrated health service, and make the case about how they can provide services. They may be able to do that in a much better way, as they are often embedded in their communities, than some of the traditional mechanisms in the NHS.

I hope that my hon. Friend will be reassured by the fact that the legislation that we have put in place as a Government has given pharmacists a much greater opportunity to contribute to their local health economy, not just in economic terms and in terms of the economic benefits that that will bring for pharmacists, but by delivering the very good care that we know they can deliver.

We have had a wide-ranging debate. I think that we can be sure that there is in place a robust pricing mechanism, which on the whole works very well and secures good value for the taxpayer and for local patients, but there are issues about certain items that pharmacists can prescribe, and we do need to look into them. There is a role for NHS Protect in doing that. We value the innovation that pharmacists provide locally in delivering better—higher-quality—patient-centred care, and the 2012 Act has put us in a better place to support local pharmacists in delivering the kind of patient care that we all want to see in our local communities.

[Dr William McCrea (in the Chair)]

I thank Members for the courteous manner in which they conducted the debate.

Internet Governance

Wednesday 20th November 2013 Westminster Hall

11:00

[Alun Cairns (Vale of Glamorgan) (Con)]

It is a pleasure to serve under your chairmanship, Dr McCrea—I think for the first time. A number of colleagues have remarked that this is a peculiar subject for debate and have asked me to clarify the debate’s purpose. I should make it clear that that group does not include the Minister, who has positioned himself as a driving influence on internet governance. He has attended the past three meetings of the Internet Governance Forum—an organisation that I will come to later in my remarks—where his contributions have been valued greatly, so demonstrating that the UK is a leading contributor to the development and evolution of the internet. Nevertheless, it is worth explaining why I have chosen this subject for debate and why it is so important to us all.

The internet is a tool that crosses all spheres of life. It is hard to believe that it is only 30 years old, and even younger to the mass population. At the outset, it was a network used by academics to connect research and academic institutions; now it is central to all personal and commercial activities in our lives. It allows better communication, permits transactions and can help to generate wealth and support freedom. It has been central to the overturning of Governments in the interests of democracy around the world, but has, sadly, facilitated the spread of terrorism at the same time. We must always be aware that it can be used for malevolent purposes.

The governance of such an instrument is obviously relevant to us all and any changes to that are a matter for us all to comment on. Child protection online has dominated the political agenda of late in the United Kingdom and is an obvious example of why internet governance is important and relevant to individuals, families and organisations. It is not a techie thing: its implications are far reaching. Trust and identity, security and cyber-security are just a few issues that show why Governments and individuals need to be equally interested in internet governance.

The internet’s roots in academia mean that its governance structure has simply evolved, and that evolution has generally taken place in the absence of Government interference, probably because it took Governments some time to understand the internet’s potential. If Governments had been more involved, the internet would have taken much longer to develop and would be less free, less innovative and less revolutionary—in every sense of the word. The freedom of the internet has led to its innovation. If Governments had been in control, we would not be where we are today and the world would, without question, be a different place.

In effect, the internet has developed according to what has been labelled a multi-stakeholder agenda: the private sector, civil society, academic groups, technical communities and the voluntary sector have all played their part, as well as Governments, with all stakeholders contributing on an equal footing. That situation gave rise to the Internet Governance Forum—an annual conference that stemmed from the United Nations world summit on the information society in 2005. Its purpose is to bring together a wide range of individuals and organisations to discuss internet governance issues. It recognises the need for partnership, consensus building and innovation to respond to improvements in technology, together with the new opportunities and challenges that those changes and improvements bring.

The Internet Governance Forum, or IGF, offers a neutral space. Although it does not result in a negotiated outcome, the organisations that it gathers together develop thinking that is implemented by the international multi-stakeholder community. The IGF provides an excellent framework for understanding internet issues, where difficult balances often need to be maintained. The UK has been at the forefront of parliamentary engagement with the issue, and MPs from around the world have played an active role in shaping discussions over the years. I would encourage continued participation.

I have had the privilege of attending two meetings of the Internet Governance Forum and draw Members’ attention to the relevant entry in the Register of Members’ Financial Interests. Nominet, the internet registry company that manages the .uk domain space, has sponsored MPs from all parties to attend over the past seven years, recognising the forum’s importance.

I pay tribute to Nominet’s role in the organisation itself. It plays a full part in developing thinking about internet governance and ensures that the UK’s interests are heard at the centre of the decision-making process. It is also worth noting that the United Kingdom Internet Governance Forum, or UK-IGF—the organisation that develops thinking on internet governance here in the UK—would not happen without Nominet’s support, so Nominet plays a much bigger part than simply managing the .uk domain registry.

The UK-IGF also takes a neutral position, allowing and encouraging all attendees to contribute freely and to develop independent thinking. I had the privilege of chairing this year’s meeting of the UK-IGF, which, among other issues, highlighted child protection, youth engagement and identity and trust. That event was central to the contributions made by UK representatives at the IGF. Attending the past two IGF meetings has given me an opportunity better to understand international influences and cultures and how they form part of the internet governance process.

For me, this year’s IGF was markedly different to the meeting a year earlier. Among the range of subjects under discussion, which included trust and identity, cyber-security, human rights and protection of children online, the structure and governance of the internet itself was dominant. That is why I wanted to secure today’s debate, to ensure that the issues that were considered there are on the record here in Parliament.

When I say, “The structure and governance of the internet,” I am referring to the calls by some Governments and some nations to have a greater say in how the internet is governed—perhaps, according to their agenda, I should say managed. Before I explain the risks that entails, it is worth commenting on the governance structure of the internet as it stands. The Internet Corporation for Assigned Names and Numbers, or ICANN, co-ordinates the Internet Assigned Numbers Authority, or IANA. IANA is the department of ICANN responsible for co-ordinating some of the key elements that keep the internet running smoothly. It allocates and maintains unique codes and numbering systems that are used in the technical standards that drive the internet and enable it to work. Although the internet is renowned for being a worldwide network that is free from central co-ordination, there is a technical need for some key parts of the internet to be globally co-ordinated; that co-ordination role is undertaken by IANA. ICANN performs the IANA functions under a US Government contract—a fact that is particularly relevant.

It is that relationship with the US Government that some organisations and nations are concerned about and are seeking to change. The fallout from the Edward Snowden revelations was a genuine concern to some at the IGF, but it is being used by others as an opportunity to gain stronger control of the internet. Some Governments are calling for changes to the way in which the internet is governed, potentially risking the freedoms that it has brought about, and using information shared by Edward Snowden as the reason—or should I say as the excuse?—to do so.

I believe that the internet must remain open with oversight that derives from the joint action of international organisations, industry and civil society, but I am concerned that other nations are calling for control that could limit the internet’s contents and, as a result, its potential for innovation, ingenuity and investment. Next April, the Brazilian Government are hosting a summit to consider the issue. It is not yet clear what the exact purpose of that summit is, but it is clear that some nations see it as a key step to increasing their power and influence, and that of Governments in general, over the internet.

If those Governments are successful, that will raise serious issues for us all. The great freedoms that have come from the internet as we know it may well be under threat. To give credit to the Minister and to the Foreign Office, the UK Government have already played a leading role in promoting internet freedoms. I refer to the positive response that I received from the Minister of State, Foreign and Commonwealth Office, my right hon. Friend the Member for Faversham and Mid Kent (Hugh Robertson) to a written parliamentary question:

“At the heart of the Government’s vision for the future of cyberspace is an open, borderless internet that benefits from collective oversight between Governments, international organisations, industry and civil society.”—[Official Report, 11 November 2013; Vol. 570, c. 447W.]

That is exactly what I want to support and underline. It is critical that no single body controls all the functions that govern the internet. That was set out by the UK Government in 2011, when the Foreign Secretary launched what has become known as the London process of international conferences on cyberspace.

It was good to see that the Government underscored their position again in South Korea earlier this year. The Government, working with other stakeholders including Nominet, Internet Society England, BT and Global Partners Digital, have an excellent track record in shaping the discussions, and I am sure that they will continue to take a leading role in preparation for the conference in Brazil and in discussions in the United Nations, where some Governments seek to establish intergovernmental control. The multi-stakeholder approach, as opposed to the multilateral approach that is urged on us by some people, must be preserved.

The Snowden case has led some nations to question the US Government’s relationship with the internet, but let us remember that they have an enviable reputation in defending human rights and freedom of expression that many who seek to influence the internet governance debate do not. We must recognise that the environment has changed, however, and bear that in mind in preparing for the forthcoming discussions at the International Telecommunications Union in Brazil and in the UN General Assembly.

We must continue to support ICANN, and we must maintain the integrity of the system, including the all-important IANA function. Without careful and accountable management of those critical operations, we put at risk the integrity of the internet and its ability to evolve and expand. ICANN must develop internationally, and it can only do so if we assure the accountability of the organisation. An important part of that is to ensure active, multi-stakeholder engagement in shaping the future development of the organisation. The IGF, which is central to that, must also evolve. It is the only UN-mandated forum that brings together the experts who shape and develop the internet with the policy makers, Governments, legislators and regulators.

I am pleased that the Government are taking this role seriously. The Department for Culture, Media and Sport, the Foreign Office and the Ministry of Defence are all taking the matter very seriously, because although some people may consider it to be a technical subject, it is relevant to us all.

11:12

[The Parliamentary Under-Secretary of State for Culture, Media and Sport (Mr Edward Vaizey)]

It is a pleasure to serve under your chairmanship this morning, Dr McCrea. I thank my hon. Friend the Member for Vale of Glamorgan (Alun Cairns) for calling this important debate. He said that it was a vital issue, but apparently it is not one on which our colleagues feel well briefed. As I gazed round the room and realised that we were alone, until my hon. Friend the Member for Montgomeryshire (Glyn Davies)—the one colleague who is interested in the subject—joined us, I thought that that spoke volumes about parliamentary participation. As we constantly tell our constituents, however, our physical absence does not necessarily indicate that we are not interested in an issue.

My hon. Friend the Member for Vale of Glamorgan has brought this matter to the attention of the House with his absolutely superb speech. I am sure that what I am about to say will come out the wrong way, but I could not have given a better speech myself. He articulated all the key issues that surround the slightly esoteric question of internet governance, and he illustrated why it is a vital issue for politicians in this country and across the globe who value a free and open internet and who recognise the astonishing benefits that the internet has brought.

I always begin such speeches by discussing the remarkable benefits that the internet has brought, and it is a cliché and a truism to say that over the past 20 years, it has begun to completely transform the way in which we do business and communicate. It has brought the globe closer together. It will drive economic growth, not only in this country—one of the most tech-savvy and internet-engaged nations in the world; the British consumer adapts well to new technology and e-commerce is a significant part of our retail landscape—but, perhaps more importantly, in the developed world. We all know how Africa has been able to leapfrog the fixed infrastructure found in developed countries on to a mobile infrastructure, which has enabled rural businesses in Africa in particular to trade and fundamentally remodel the way in which they do business. Such rapid innovation makes a massive difference to the developing world. Our message about a free and open internet, which is often misinterpreted as being a self-interested message on behalf of the west, is actually a message to the world about how the current model for internet governance secures the innovation that is transforming lives across the world.

As a result of that model, the internet is open, global and borderless; its technical standards are open and developed by consensus; and it is open to new devices, applications and services. There is no centralised or overarching global framework of top- down intergovernmental control or oversight. The key stakeholders that have made the internet such a success continue to have a voice: businesses, civil society, the technical community and the academic institutions where the internet was born. Governments can work with those stakeholders to share knowledge, experience, skills and best practice. Governments alone would not have the expertise that other stakeholders can provide.

My hon. Friend referred to the United Nations world summit on the information society that was held in 2005, which affirmed the multi-stakeholder model as the best way forward. That model, which is based on collaboration, consensus and partnership-building, ensures that the internet continues to be dynamic, innovative and robust. He rightly highlighted the continuing challenges to the model, and the challenges faced by those of us who believe in a free and open internet. The protection of children online, for example, is a massively important issue.

[Glyn Davies (Montgomeryshire) (Con)]

That is an important issue in my constituency. I hope the Minister agrees that although we need an open and dynamic internet, the Government must be aware of the areas in which there is a real danger and do what they can—within reasonable powers and without damaging the internet—to exercise control and protect children from content that is extremely damaging.

[Mr Vaizey]

My hon. Friend is completely correct. The rule of law applies to the internet, and that which is illegal in the physical world is illegal in the online world. That is why a zero-tolerance policy towards child abuse images does not pose a threat to internet freedom. Those images are vile and illegal, and we must do everything in our power to remove them from the internet and catch those who exchange them. That is why we have worked with internet service providers to give parents the tools they need to protect their children online, and we will continue to apply the law on pornography online as well as offline. There are other issues: consumer protection, intellectual property rights, data protection, legal and regulatory frameworks and business models have had to adapt. They are all factors in our approach to internet policies.

There are challenges and opportunities, such as the need to promote greater multilingualism on the internet, so that more people around the world can access it in their own language. As I said, we need to support the developing world in expanding its capacity and internet infrastructure. That is why I am delighted that the Department for International Development, for example, supports the Alliance for an Affordable Internet in that area. The key point, which our approach to child protection highlights, is that no one stakeholder or Government acting alone can tackle the issues. Everyone needs to work together and collaborate, which emphasises why we are supportive of the multi-stakeholder model.

As my hon. Friend the Member for Vale of Glamorgan pointed out, there have been calls from some countries for a fundamental change in the international internet governance model. Some have called for Governments to have direct oversight of the internet and for a new intergovernmental organisation to create treaty-based rules. That sounds perfectly sensible at first blush—a superficially easy solution to some of the difficult challenges that we face with the internet and internet governance. Our strong view is that that top-down model would not work and would put the internet at risk for three reasons.

First, such formal institutional decision-making models would not be able to keep pace with the rapid technological change that is characteristic of the internet and the rapidly evolving needs and desires of internet users. Such a model would act as a brake on innovation and stifle the dynamism that has allowed the internet to deliver many benefits and opportunities for economic growth and social welfare. Secondly, the internet is an adaptive technology. It is not a single entity but a network of networks with no centralised control. It is questionable from a technical point of view how top-down control of the internet by Governments would work. Finally, as I said in my opening remarks, the internet is a tool that affects nearly all aspects of life. Any new intergovernmental organisation would at best duplicate the mandates of existing international organisations and at worst lead to significant confusion.

The World Trade Organisation, the World Intellectual Property Organisation, Interpol and many other international organisations have over recent years expanded their capacity to deal with internet-related issues in their areas of expertise. That seems to be a sensible way forward. We do not support the establishment of a new intergovernmental body, but that does not mean to say that we should resist all change. The international internet governance model needs to be kept fit for purpose, and as the internet develops, we must ensure that the existing processes we support can adapt to keep pace with future opportunities. Work is already under way in that respect.

My hon. Friend mentioned the IGF. I attended the past three forums. I missed the first one when I was a Minister, but I have been to every one since. The most recent took place last month. This debate is an opportunity for me to pay tribute to a number of players. The previous Labour Minister with responsibility for telecoms, Alun Michael, now a police and crime commissioner, helped to establish the IGF after the world summit on the information society. I pay tribute to him as a former Minister who maintained his interest and expertise in the area. He kept the issue alive in Parliament as well as supporting the creation of the UK-IGF. I echo the praise that my hon. Friend lavished on Nominet, the charity responsible for UK domain names, ably led by Lesley Cowley. It does a fantastic job in showing that the multi-stakeholder model is effective and that a private not-for-profit organisation can play a key role and respond to pressures and challenges sensibly. I pay tribute to the charity and its leadership.

May I also pay tribute to my hon. Friend? Since the departure of Alun Michael, he has stepped up, as it were, to become Mr Internet Governance in Parliament. He does a superb job chairing the UK-IGF parliamentary meeting and takes a keen interest in all the issues. As his remarks show, he displays a deep understanding, which is incredibly valuable to my work and the work of other Ministers.

The IGF plays a valuable role in bringing together a broad range of stakeholders to discuss issues of common concern and, having attended the past three forums, I know that it is effective. It has taken steps, which we support, to improve its effectiveness. The UN Commission on Science and Technology for Development has established a working group to look at how enhanced co-operation with Governments works and whether changes or adaptations are needed. We look forward to seeing the results of that work next year. My hon. Friend also mentioned ICANN, which has taken steps to internationalise its presence, under the new and able leadership of Fadi Chehadé, and open up the domain name system. We encourage it to continue that process. In 2015, the United Nations will conduct a 10-year review of the actions that came out of the world summit on the information society. We hope that that work will feed into the development of the millennium development goals. We continue to support such international processes.

My hon. Friend also mentioned the Brazilian summit. The Brazilian Government are proposing further international discussions on internet governance in April or May next year. Brazil has played a positive and valuable role in internet governance for many years. The Brazilian internet steering committee has published a set of principles for the governance and use of the internet. Those principles have been a helpful contribution to the debate, which many countries, including the UK, broadly support. We look forward to hearing more details about any event in Brazil next year and we stand ready to engage in that important process.

As I have said, perhaps repeatedly, we are sceptical about greater control of the internet by Governments or by an intergovernmental organisation. We are committed to engaging in discussions about how we can ensure that the current model remains fit for purpose. The tests we should apply to any proposed change to the internet governance model must ultimately be practical. Does it allow us to maintain the internet as an open, robust and technically secure service? Does it help us to find sustainable and consensus-based solutions to the challenges that we face? Does it allow the internet to continue to develop and innovate and offer social and economic benefits to more people around the world? The internet has been a huge success and continues to transform all aspects of our lives. We must work to maintain and strengthen the multi-stakeholder model of internet governance that has sustained that success and ensure that it is fit for purpose in the future.

11:27

Sitting suspended.

Cost of Child Care

Wednesday 20th November 2013 Westminster Hall

[Mr Jim Hood in the Chair]

14:30

[Bridget Phillipson (Houghton and Sunderland South) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Hood. I am grateful for this opportunity to lead this afternoon’s debate on the cost of child care—a growing concern to many Members across the House. Perhaps I should start by declaring an interest as the proud mother of a little girl. Like many Members, I have come to realise how difficult it can be for families to find the right kind of child care place. I am in the fortunate position of not having to make the same kinds of financial decision about what works for my family. I am very lucky, but I am conscious that many people face difficult situations.

Once again, it is the Labour party that is highlighting the cost of living crisis. We are all too familiar with the challenges that our constituents find in accessing affordable child care and the increasing burden that they face. The failure to keep down the cost of child care has put immense pressure on household budgets and directly contributed to the cost of living crisis facing so many families across our communities. That failure applies equally to pre-school provision and provision for school-age children.

By 2015, families with children will have lost up to £7 billion a year of support. Right now, families with pre-school children face a triple blow of spiralling child care costs, a reduction in nursery places and a cut in financial assistance. Some of those families are losing up to £1,500 a year due to tax credits changes.

Parents often say that child care can really become a logistical nightmare once children reach school age. Despite that, the previous Labour Government’s programme to support school-age children has been abandoned by the Department for Education, leaving many parents struggling to juggle work and family life. The Minister will no doubt claim that the Government are making progress; unfortunately, however, creative number crunching cannot hide the fact that the Government’s plans are failing to support the majority of families. It has been left to Labour to respond to the current crisis, with our proposals to extend child care for working parents of three and four-year-olds and to introduce a legal guarantee for primary schools to make child care available from 8 am to 6 pm.

The previous Labour Government understood the importance of the issue. The 1998 national child care strategy recognised for the first time that child care was not just a private family matter, but one where Government had a role to play in ensuring the affordability, availability and accessibility of high-quality child care places. Much was achieved during those 13 years of Labour Governments.

[Dr Thérèse Coffey (Suffolk Coastal) (Con)]

I should say to the hon. Lady and other Labour Members that the number of child minders fell significantly during their party’s time in office. It will be interesting to hear more about availability.

[Bridget Phillipson]

I am grateful to the hon. Lady, for whom I have a lot of respect. She takes a keen interest in these matters and wants to make sure that families have real choice among the options available when finding child care places for their children. I will make the very point put to her during yesterday’s debate: we need to make sure that child minders are of the right quality and can provide the best possible care for children. Unfortunately, some child minders, who are no longer registered, were not able to make that leap forward in providing the best possible high-quality care that we all want for the youngest children in our society.

The early-years entitlement was pioneered for four-year-olds in 1998 and it was extended to three-year-olds in 2004. Labour introduced the extended schools programme to help meet the needs of children, families and the wider community. Labour created Sure Start children’s centres and established more than 3,500 of them across the country.

Before the last general election, I was, like many others, relieved to hear the current Prime Minister acknowledge that Labour was right to prioritise child care support for families and pledge to protect Sure Start. However, like so many people, I have been bitterly disappointed that more than 500 Sure Start centres have closed since 2010 and that more than half of those still open are no longer providing on-site child care. All we heard today from the Prime Minister was a confirmation of that.

[Chloe Smith (Norwich North) (Con)]

Is the hon. Lady familiar with the situation in Norfolk—a fine county that is home to my constituency and that of the Minister? Its current Labour administration refuses to give any protection to libraries in carrying out the cuts that it now has to make. Does she share my concern that libraries are also used by many families with young children, who need those services? The Conservatives did protect those libraries when they were in a position to do so.

[Bridget Phillipson]

Perhaps the hon. Lady could have a chat with a colleague at the Department for Communities and Local Government about the disproportionate cuts passed on to local councils. My local council is facing some of the biggest cuts in the country, having been given a disproportionate and unfair burden. Councils are being forced to take really difficult decisions about the kinds of services that they can provide.

I value the important role that libraries play in our community, just as I value Sure Start children’s centres. However, councils face impossible demands and are really struggling to balance the books. I suggest that the hon. Lady continues to lobby for her constituents, but it is her Government who are passing on those significant cuts—

[Ben Gummer (Ipswich) (Con)]

There were no cuts in Suffolk.

[Mr Jim Hood (in the Chair)]

Order. I ask the Parliamentary Private Secretary not to interrupt speakers.

[Bridget Phillipson]

A significant body of evidence shows that pre-school years are critical to a child’s development. Despite that, pre-school child care is becoming inaccessible to an increasing number of families. The cost of nursery places has risen by more than 30% since the last election—five times faster than the rise in wages over the equivalent period. It now costs, on average, £107 a week for a 25-hour nursery place. Parents working part time on average wages now have to work from Monday to Thursday before they have paid off their weekly child care costs.

To make matters worse, all this has happened while there have been 35,000 fewer child care places than in 2010. The fact is that for many parents, especially single parents, there is no longer a viable choice. With prices rising faster than wages, thousands of parents are being forced to stay at home to look after their children when they want the opportunity to work.

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

Against that backdrop, is it not regrettable that, as part of their plans for universal credit, the Government intend to put the lowest-earning parents in the position of being helped with only 70% of their child care costs? Better-off parents, however, will receive help with 85% of such costs. Is that not perverse?

[Bridget Phillipson]

My hon. Friend makes an important point. She has consistently raised such concerns with Ministers and she continues to challenge the Government about them. Her point is of particular concern. We want to support the poorest families to access child care, but what she has mentioned will no doubt make that a lot harder.

The reality is that it is predominantly women who have been hardest hit by the rising cost of child care. Female unemployment is at its highest for a generation. According to the Office for National Statistics, more than 1 million women in the UK are out of work—an increase of 82,000 since May 2010. Affordable child care gives women the independence to make choices that are right for them and for their families. Every woman who is forced out of the workplace suffers a significant personal blow, while the rest of society loses her talent, knowledge and expertise.

As we heard in yesterday’s debate on this issue, the Government’s own social mobility and child poverty commission is clear that, for many low-income parents, cost, rather than quality, was the main factor in choosing child care. A recent survey by Asda showed that child care costs prevent 70% of stay-at-home mums from working.

I am sure that the Minister will agree that, in economic terms, it is absurd to lose the valuable contribution of women in the workplace. Higher unemployment rates increase the benefits bill and reduce tax revenues, while higher rates of women’s employment support stronger economic growth.

If the economic recovery is to harness everyone’s potential, the Government should ensure that work pays for all families. That is why Labour is proposing targeted measures to bring down child care costs. Our plan has two major components. First, child care for three and four-year-olds will be extended from 15 to 25 hours per week for working parents. That support will be made available both to single-parent working households and two-parent households where both parents work. Those plans will be fully funded through the bank levy.

In the last financial year, the banks paid a staggering £2.7 billion less in overall tax than they did in 2010, while over the last two years the Government’s bank levy has raised £1.6 billion less than they said it would. I hope the Minister agrees that, at a time when resources are tight and families are under pressure, that cannot be right.

The second component of Labour’s plan will be a focus on the primary school guarantee. Some 62% of parents with children of school age say that they want to be able to combine working and family life. For that to happen, they need to be able to access care before the school day begins, after it ends and during holiday periods. Nearly 30% of those who need such care were unable to find it. That is unacceptable.

Research from the Minister’s own Department backs that up. In September 2011, the Department published research highlighting that extended services provision can have an important positive impact on children, families, communities and schools themselves. Under the previous Government, 99% of schools provided access to breakfast clubs and after-school clubs, but more than a third of local authorities have reported that that has been scaled back in their area in the past three years. That is why Labour will legislate to guarantee that parents can access child care from 8 am to 6 pm if they choose.

Tackling the cost of child care is only one part of the solution. We must also consider how we can improve its availability and accessibility. Evidence shows that families from lower-income backgrounds, including in parts of my constituency, are among the least likely to use formal child care. We need to help our constituents understand the support that is available and how they can access it, along with the benefits that can come from having a child in nursery or child care provision. Furthermore, many parents in my local area work shifts, so child care services must become much more flexible to meet their needs and the circumstances of their employment.

The location of child care services is another important consideration. For many people in my constituency, transport is a major problem, owing to a lack of train services and a limited and expensive bus network, and I have been campaigning to change that.

We need a joined-up approach to child care. We need health visitors working with housing and child care providers, and councils working with the Government. Of course, families will always have the freedom to make arrangements that best suit their circumstances, preferences and needs, but the Government’s role is to ensure that every effort is made to provide support that is affordable and available when needed and accessible where needed.

Labour is the only party listening to parents and acting on their concerns. Child care is as important to the future of this country as investment in infrastructure. High-quality child care is key to tackling child poverty and improving social mobility. Labour has a clear plan for delivering that. It is the right thing for families, and it is the best thing for our country.

14:42

[Dr Thérèse Coffey (Suffolk Coastal) (Con)]

It is a pleasure to contribute to the debate. I congratulate the hon. Member for Sunderland upon Tyne South—

[Bridget Phillipson]

Houghton and Sunderland South.

[Dr Coffey]

I got that wrong—I apologise to the hon. Member for Houghton and Sunderland South (Bridget Phillipson), whom I congratulate on securing this debate. I appreciate that we had a debate yesterday on a similar topic, and I welcome this opportunity to contribute again on this important matter.

I thought that, rather than just reading out my entire transcript from yesterday’s Hansard, I would spend a bit more time saying a little more on the issue. The aspirations set out by the hon. Lady—affordability, availability and accessibility—are critical. As she said in the answer that she kindly provided me, the reason why so many child minders fell out of the system in the 13 years of Labour Governments was quality. She is absolutely right; we need to ensure that high quality—in fact, world-class quality—child care is widely available.

That is why I support what the Government are doing to try to raise the quality of child care. The issue is also about improving our young children’s access to education. As has been pointed out by many on both sides of the House, it is key that we do our best with our youngsters to ensure that they are able to access the opportunities available to everyone. That is also an important part of social mobility.

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

The figures on child minders have been cited on a number of occasions. Does the hon. Lady accept, as the Minister did yesterday, that the figures have declined in the three years under this Government? There are 2,423 fewer child minders in the system now than in 2010.

[Dr Coffey]

I understand that, but having 2,400 fewer since 2010 is a little different from having 53,000 fewer in 13 years. I am not going to go over again the ground that we have already discussed.

It is fair to say that there are an extra 800,000 nursery places through schools.

[Catherine McKinnell]

Is the hon. Lady suggesting that those additional places were created in the past three years?

[Dr Coffey]

My understanding is that the provision has grown in that time. I am sure that the hon. Lady will correct me if she thinks I am wrong. I meant “grown”, not “groan”, unlike the joke yesterday.

Returning to affordability, there is no doubt that the cost of child care has risen significantly. Some of that will have been due to supply and demand; there is no question about that, where demand exceeds supply. It is important to expand the number of child minders to help with that.

One of the things that the Government are doing right is allowing schools to shed some of the regulatory burden on the ability to provide a wider range of child care opportunities on site. Labour suggests that legislation is required to have a primary school guarantee, but I do not believe that. What is important is that a school should not have to register separately with Ofsted if it offers provision for under-four-year-olds or that it should not need such tight planning when it wishes to expand. The same should apply when existing nurseries of good and outstanding quality wish to expand.

We are changing things so that Ofsted-registered and good or outstanding nurseries will start to receive funding directly, cutting out the recycling of money through the local council. That is another good measure to accelerate the needed provision of high quality child care.

Another good thing—the Minister may talk at more length about some of these—would be to streamline qualifications for early years, instead of having a choice of about 400 potential qualifications. In that way, parents could readily and easily check the quality rather than have to do their own research. Having an accreditation with fewer qualifications is a streamlining simplification that will help not only providers of child care but parents to make an appropriate assessment of what the right thing is.

On the cost of child care, I think the Government accept that having some of the most expensive child care in Europe—we are second highest behind Switzerland —is not sustainable. We need to address that. Coming from a Conservative tradition, I would try to do that not just by constantly upping the subsidy, but by providing wider choice, which will bring down cost. However, I commend the tax-free child care scheme, which will be available to working families.

I am sure that Government Members would be delighted if we could persuade the Chancellor to bring that scheme forward by a year, but I accept the fiscal constraints under which the Government operate. In any case, I am pleased that the scheme will be forthcoming in April 2015. That is a real positive for working mothers and fathers.

Other useful measures that the Government are introducing include shared parental leave. I understand that our coalition partners are keen to extend that even further; that is a debate for another time. I am pleased that we are pressing forward with that important development, and I am sure that Opposition Members welcome it too.

The reason why I do not think we need legislation to implement the primary school guarantee is that we can just get on with the scheme if that is what primary schools wish to do. We may require a statutory duty to force that to happen, and we have to consider that, but I see leading schools providing it already.

One point that I made yesterday is key. Governing bodies should work with head teachers and parents to ensure that the school day is not artificially reduced simply to have as short a lunch time as legally possible, but to ensure that time spent at school is available for extra-curricular activities and to be mindful of the fact that parents are working.

On Sure Start, we can have the back-and-forth. I have not had time since yesterday’s debate to go into the full detail, constituency by constituency, on the back-and-forth about whether 500 or just 45 have closed. As I said yesterday, I am happy to rely on the Minister’s assurance.

We are talking about choices. Yesterday, the hon. Member for Newcastle upon Tyne North (Catherine McKinnell)—I got that constituency right—talked about the level of cuts, an issue referred to today by the hon. Member for Houghton and Sunderland South. I have looked briefly at the website of the Department for Communities and Local Government. Using the spending power formula, which the Local Government Association recommended to the Government, I am able to say that spending in Newcastle upon Tyne has gone down by 1.4% this year; in Sunderland by 1.5%; and in Middlesbrough —I see that the hon. Member for Middlesbrough South and East Cleveland (Tom Blenkinsop) is present—by 0.5%. I did not have time to look at Wolverhampton.

Those figures come from the spreadsheet that I have opened. Meanwhile, spending has decreased in Norfolk by 1.6% and in Suffolk by 2.1%. In spite of that, Suffolk county council is keeping open its Sure Start centres. Yes, the management of some centres has been merged. The two in Felixstowe are run by one lady, the magnificent Jennifer Clarke-Pearson, who is working hard with families in Felixstowe to make that happen.

As I reiterated yesterday, it is important that in this wider debate about public services, which my hon. Friend the Member for Norwich North (Chloe Smith) mentioned, we must ensure that front-line services are protected—as constituency champions, all hon. Members in this Chamber will continue to do that. However, we should not get hung up solely on bricks and mortar. We must focus on the outcomes.

[Kate Green]

I agree that we should not just focus on bricks and mortar. However, although centres in my local authority in Trafford are being merged, as the hon. Lady described, the availability of services has been significantly reduced. A number of programmes that were appreciated by families, some of which were available universally in the past, are now not available.

[Dr Thérèse Coffey]

I am genuinely sorry to hear that; I am not being flippant. It is important that local councils continue to provide valuable services that are doing good for local families, but, again, sometimes the Whitehall solution does not always work in the constituency or council area. The Department for Education issued statutory guidance in April to try to encourage councils and children’s centres to refocus—not on universality, perhaps, but on the families that Sure Start was originally set up to help.

[Catherine McKinnell]

indicated dissent.

[Dr Coffey]

That is my understanding, although the hon. Lady shakes her head.

I praise the valuable work of Home-Start, locally—certainly in Suffolk. It is going into the homes of people that Sure Start is not attracting into its centres. If Sure Start is stage two for these families and parents, that is to be welcomed. Sure Start should be focusing on the needs of more vulnerable families and less wealthy families, rather than being a universal thing, when other providers can provide child care. We have heard that Sure Start centres provide only 1% of child care opportunities.

[Catherine McKinnell]

I am not sure which year the figures the hon. Lady cited relate to; I suspect it is the financial year 2013-14. The point that I was making yesterday—she mentioned the speech I made yesterday—is that councils have to look two, three or four years ahead, to work out how to manage their finances. The cuts that we are talking about have not yet come.

[Dr Coffey]

I accept that point. The hon. Lady is accurate in saying that I was referring to 2013-14.

More widely, I appreciate councils’ concerns. Our own councils are going through this challenge; it is not unique to councils in the north-east, Trafford or wherever else. It is happening across the country. However, we need to be mindful that reducing support to local councils is being made up for, in some part, by other opportunities for councils to raise money. That may not be popular; it is certainly not popular with one of my constituents, who complained that they were going to have to start paying council tax on a house that had lain empty for three years. Such policies are not always popular, but they are revenue opportunities, as is business rates retention, which I am sure the hon. Lady supports. That is to encourage new start-up companies in areas such as hers and to attract companies’ inward investment, through relocation to the north-east, for example.

I shall bring my remarks to a conclusion, because I appreciate that many hon. Members want to participate. All parties are united on affordability, availability, accessibility and quality, which the hon. Member for Houghton and Sunderland South mentioned accurately at the start, although we have different ways of achieving those things. But all our reforms are working and I hope that they will continue to blossom. I look forward to the Minister’s explaining in further detail why we in the Government are leading the child care revolution.

14:54

[Mr Pat McFadden (Wolverhampton South East) (Lab)]

It is a pleasure to serve under your chairmanship today, Mr Hood.

Like my hon. Friend the Member for Houghton and Sunderland South (Bridget Phillipson), I declare an interest. I have a four-year-old and a two-year-old. One is still going through the nursery system and one has recently done so. As well as declaring my interest, I also confess that before I had children I did not appreciate the importance of this issue to families or the costs or choices that people were forced into when trying to organise and pay for child care.

Before talking about costs, I want say something about the benefits. A good-quality nursery education can be hugely beneficial for young children. It can contribute enormously to their social confidence; it gives them their first friendships outside the immediate family; it helps them to learn the basic building blocks—colours, shapes and numbers—and it improves their speech. It is hugely beneficial. It enables them to be more confident, outgoing children. That is important, because we should all agree that we want children to get a good start in life. We know that it is in the early years, and the early months, of a child’s life that the first inequality often sets in. Good-quality early years care can be important in improving life chances and extending opportunity.

In a recent speech, the chair of Ofsted said that some children begin school 18 to 19 months behind in their development, compared with other children. Any society that cares about equality of opportunity or life chances should be concerned by that stark statistic. This is about cost, but it is also about quality and opportunity.

We cannot have a situation where some are effectively able to pull up the drawbridge on children who do not get good life chances, and allow these patterns of inequality to remain unaddressed. I do not seek to blame the present Government for that pattern. Inequality of opportunity is deep-seated and has existed for a long time. However, as my hon. Friend said, things are getting harder, with the closure of Sure Start centres and rising costs.

Let me turn to the costs and the choice faced by working families. We now have decent maternity provision in the UK. We used to be pretty much at the bottom of the European league. We are not at the top of the league, but we are in a respectable mid-table position. Mothers are entitled to 52 weeks leave, of which they will be paid for 39 weeks, although only the first six weeks is to be paid at the high rate of 90% of their salary. After that, mothers are dependent on contractual provision, which varies among employers. Fathers are now entitled to paternity leave for the first time, which is a welcome change introduced by the Government of whom I was a member. Before that, there was no recognition at all in the system of the role that dads might play around the time of birth or of the degree of support that they could offer to new mums.

The costs of child care really kick in when maternity leave comes to an end and mums want to go back to work. In London, a full-time nursery place can easily cost £1,300 to £1,400 a month. Let us pause and think about that. That is £15,000 a year, cash up front. There is a little bit of tax relief for this, but it is essentially cash up front. If people have two children in nursery, which is not uncommon, the cost may fall a little as the child turns two and three and the 15 free hours kick in, but a family could easily be looking at a cash figure of £25,000 a year for two children in nursery. That means that someone with two children would have to earn some £40,000, well above the national full-time average salary, just to pay for child care.

Outside London, the costs are lower, but still expensive. In my Wolverhampton constituency, a full-time nursery place costs about £600 to £700 a month or around £8,000 a year. It has to be remembered that that is £8,000 a year in a constituency where full-time average salaries are just over £20,000 a year. Even though child care is cheaper outside the capital, it is still a huge proportion of a full-time salary. No wonder that mums, particularly mums with two or more young children, are quickly forced into a choice between working and looking after the children. It is sometimes dads, but mostly it is mums who are taking longer parental leave and making that choice.

Some parents may want, and are able to afford, to stay at home, which is their choice, but most families need two salaries to survive. Facing such costs, mothers end up either working for very little—often because they fear that years out of the labour market will make it difficult for them to go back and that they will lose all sorts of opportunities—or being forced to give up their job simply because they cannot afford the child care. That is a huge waste of talent and experience. If capable people who are willing to work cannot do so because the costs of child care prove an insurmountable barrier, we have to care and do something about it because the country is losing out by forcing women into that choice.

This has gone on for far too long. I expect the Minister will stand up at the end of our debate and extol the importance of the 15-hour offer for three and four-year-olds and tell us how it has been extended to some two-year-olds. The offer was introduced by the previous Labour Government, and it makes a really big difference by giving important help to parents. Even I, as a member of that Government, do not pretend that the offer is the whole answer. The offer is often made in five chunks of three hours, which does not allow someone in a part-time job to rely solely on that child care; they still have to top up with other paid-for hours. What we need is child care built around the working day, which would be most valuable for working parents. The 15-hour offer is valuable and important, but I do not pretend that it is the full answer.

I am often struck by the comparison between how we fund early years and how we fund higher education. The time spent by children in nursery and by students doing a degree is pretty similar—typically three years in both cases. The costs are now similar. A full-time nursery place in Wolverhampton costs £8,000, and studying at university costs a similar amount. The difference is that the further south someone goes, even if they study at one of the best universities in the country, the cost of a nursery place becomes higher than the cost of a student place. For higher education students, there is a system of subsidised loans, with repayment terms contingent on earnings and forgiveness of the debt after a number of years if they do not earn enough. No such help exists for working parents, who are paying similar, and in some cases higher, costs. Working parents are expected to meet all those costs up front. They get almost no help other than a little bit of tax relief at the margins, which has a hugely damaging effect on the labour market and our economy.

There is an urgent need for more affordable places and for the same amount of national policy attention and energy to go into child care as has gone into higher education over the years. The truth is that child care has not received such attention and energy. When the costs of higher education go up, we often see students marching on the street. I confess that, when I was a student, I marched on the street for various causes. If the parents of one, two and three-year-olds were not so busy looking after their children and having to cope with the choices that we are talking about today, they would be marching on the street too.

Parents need our help. They need the same amount of policy attention as has gone into the costs at another point in young people’s lives. That is the priority that we should give to child care. Children need a good start in life, and parents need help. It is time that we made that a much higher priority.

14:59

[Chloe Smith (Norwich North) (Con)]

It is a pleasure to follow the right hon. Member for Wolverhampton South East (Mr McFadden), whose surname I have just acquired, with an extra z, from his fellow Scot, my husband.

Parents in Norwich North are taxpayers, too, and in this debate we must think about what they are paying. I am delighted that the Government I support have taken many of the lowest-earning parents out of income tax altogether, which is a good thing, but we ought to approach the debate honestly. Those young parents, who, as the right hon. Gentleman rightly said, are very busy, do not necessarily have time in between looking after their youngsters to take an extremely close interest in the goings on of this Chamber, but they should not be paid the disrespect of our talking dishonestly about the size of the pot and who pays for it.

Like my hon. Friend the Member for Suffolk Coastal (Dr Coffey), I am grateful to the hon. Member for Houghton and Sunderland South (Bridget Phillipson) for calling this debate, which gives us an opportunity to talk about these important issues. The hon. Lady might not be surprised if I begin by saying that, if she knew how hard it was going to be to reduce the deficit, she might have thought twice about her support for her party’s running up of the deficit in the first place. I know of no woman or man, no mother or father—indeed, no rational person—who would desire to leave debt to their children without having had the courage to address it themselves. It ought to be commonplace in this debate to say that addressing the deficit now ensures that future generations are not burdened with unsustainable debt, higher taxes or diminished public services. Of course, I will address the public service aspect today.

Among the many claims and counterclaims that have been made in recent weeks, the salient point, with respect to the taxpayers who have to trust us to do such things for them, is that the Leader of the Opposition has pledged to extend free child care for three and four-year-olds, but he is trying to pay for it using a concept of money that he has already used more than 10 times. It is just not good enough to face young parents with such false accounting, and I am confident that the Minister agrees. It is not good enough to say, “Yes, we’ll borrow more to fund it,” because that borrowing only comes back on the children who we might otherwise be trying to help.

I am pleased that the introduction of tax-free child care that the Minister has so passionately advocated will mean that parents get £1,200 towards each child’s child care costs in addition to both our extension of the hours of free child care and our cutting red tape for schools, so that they can offer more affordable care after school and in the holidays. Those are practical and affordable actions, and we must have this debate in that context. We have to take decisive action for the reasons that we have all tried to set out, but we have to do that by addressing the cost and quality of child care and by having respect for those who entrust us with the job of honest politics.

It is essential that the Government maximise the contribution that women can make to the economy, not because of political correctness but because it is an economic reality. Growth will get this country back to where it ought to be after Labour left it lying in a ditch. Such growth will come about only if we have women in the workplace doing their best for themselves and their family and gaining satisfaction from the careers that we would all like to see. We must remove barriers to the workplace, which is why I am here today to add my voice to the support for what the Government are doing to promote child care policies that help women get back into the workplace.

That leads me to yet another of the numbers that we might want to focus on in the debate. Yesterday, in the main Chamber, a couple of points were made about the number of women in work and the way we might look at the statistics. One statistic, which is important to use in today’s debate, is that almost 200,000 women in coupled families with dependent children have re-entered the workplace since 2011, compared with 185,000 between 1996 and 2011. Earlier, my hon. Friend the Member for Suffolk Coastal had to deal with the notion that a few years of achievement now are worth more than 13 years of non-achievement in the past, and that point stands on the same side of the argument.

[Catherine McKinnell]

Does the hon. Lady acknowledge that many of the women who are entering the work force are doing so in part-time jobs, although they probably need more hours to pay their bills, and on zero-hours contracts and poor wages, terms and conditions? Seven out of 10 women say they cannot go back to work, because the child care costs are so high that they deter them from doing so, while those who do go back are simply not earning enough to pay their bills.

[Chloe Smith]

I think that the hon. Lady knows all too well that we will deal with the point inside the policy only by tackling the cost of child care, and my hon. Friend the Minister has set out plans to do that. I think that the hon. Lady also knows all too well that we will tackle the far bigger point that sits outside this issue only by securing an economic recovery, and that is what I want to point my comments at on behalf of the taxpayers and families in my constituency.

[Catherine McKinnell]

I am interested to hear the hon. Lady’s economic arguments, but I must correct her on one thing. She suggested that the Labour party left the economy in the doldrums in 2010. In fact, the economy was growing in 2010, but we have had complete economic stagnation since. It would be more honest if she acknowledged that point before continuing.

[Mr Jim Hood (in the Chair)]

Order. I am sure the hon. Member for Norwich North (Chloe Smith) will want to get back to the subject of the debate, which is child care.

[Chloe Smith]

Mr Hood, I will be only too delighted to get back to the subject of child care.

The point on which I want to finish is about having honesty in politics for the families who we might wish to help. It is not honest to ignore the fact that Labour doubled the national debt or to try to spend the same amount 10 times.

[Tom Blenkinsop (Middlesbrough South and East Cleveland) (Lab)]

Will the hon. Lady give way?

[Chloe Smith]

I am terribly sorry, but I need to finish my comments, so that other Members can speak.

I want to finish on the point that false claims, scaremongering and, worst of all, false accounting do young families absolutely no good. Younger people—various polls and statistics show that this is demonstrably true—are turning away from traditional party politics. Some will become parents and seek to take care of their children, and it will do none of them any good whatever to hear the false numbers that are being put about in this debate. It will not help a single child, parent or citizen to regain faith in what politics is for if we cannot have a slightly more honest debate today.

15:09

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

It is a pleasure to speak in this timely and important debate, and I congratulate my hon. Friend the Member for Houghton and Sunderland South (Bridget Phillipson) on securing it. I appreciate that we had an opportunity to debate some of these issues yesterday, but it is incredibly useful to have an opportunity not only to expand on some of them, but to reinforce some of the points that were made and, in particular, to get some clarity from the Minister on issues that were left unclear at the end of that debate, certainly in my mind.

It would be right for me to declare an interest, as other hon. Members have done. I am the mother of two children aged six and four. Although they are of school age, they rely on child care, which supports my working hours and those of my husband. Obviously, I have an interest in securing good-quality child care at an affordable price for all my constituents, who are deeply concerned about this issue.

Hon. Members have drawn on a number of aspects in explaining why this is such an important debate, and we touched on a number of issues yesterday. Child care is important for the children, because of the pre-school support, confidence and education they get, which give them the right start in life. I have visited child care facilities across a range of areas in my constituency, and it is evident how vital that pre-school support is in ensuring children reaching school age do not start out disadvantaged compared with children from perhaps more economically fortunate backgrounds. All children should have that pre-school input, and the child care offer and the child care debate are crucial to ensuring that we see that equality across the board.

Child care is also crucial for women. I am therefore pleased we have such a great showing of male MPs in the debate, as we did yesterday. That is vital because this is increasingly an issue for fathers as well as mothers, and rightly so. The Labour Government introduced a lot of changes to ensure that we reach the goal of equality between men and women and on child care responsibilities. Ultimately, we know that we are not there yet, and child care is still very much an issue for mothers and women generally.

As a result of child care responsibilities, women are unable to stay in work, and they fall out of the workplace. Many choose not to work, and that should be supported, but we are talking about child care, so it is right to focus on those women who would like to stay in the workplace but are unable to do so. I mentioned the figures from a survey that Asda undertook, and I find them startling. It should prompt any Government to action to know that seven out of 10 mums say they cannot go back to work because the cost of child care makes it too expensive.

[Tom Blenkinsop]

My hon. Friend makes an excellent point, which I raised in yesterday’s debate, about female unemployment. In May 2010, female unemployment in our region—the north-east—was 20,657. It is now 25,973. That is a 25.7% increase. What does my hon. Friend think is the main cause?

[Catherine McKinnell]

That is a deeply disturbing figure, and we know that women have borne the brunt of the cuts in public services. Many more women than men work in the public services, so they have suffered redundancy and unemployment as a consequence. We have not seen a matching increase in private sector employment for women. As we know, women have lost out in the jobs market as a result of many of the changes we have seen in the past three years.

[Tom Blenkinsop]

Does my hon. Friend think that the fact that we have had £30 billion less investment in small and medium-sized enterprises since this Government came to power in 2011 is a cause of the lack of employment in the private sector among not only women but men?

[Catherine McKinnell]

That is a deeply concerning statistic. I know the issue is close to my hon. Friend’s heart, and he is extremely passionate about having the case heard. On the other side of the coin, a lot of women who would like to work have fallen out of the workplace because child care costs are prohibitive. However, women have also suffered pregnancy discrimination, sex discrimination or maternity discrimination. One deeply concerning issue is the additional barriers the Government have put in the way of women who want to seek redress for such unfairness. I am surprised because members of the Government—particularly female ones—should be deeply concerned at additional barriers such as charges for going to a tribunal being put up for women seeking redress for such discrimination. I hope that the Government will listen and take that seriously, because it is nothing short of a scandal.

[Bridget Phillipson]

Is my hon. Friend concerned, as I am, about the fact that many families, in addition to dealing with the cost of child care, are responsible for the care of older relatives? That affects women in particular. They must try to combine looking after elderly parents or other relatives, when there is pressure on social care, with trying to make ends meet for their children. That is a great pressure at the moment.

[Catherine McKinnell]

Women have suffered a triple whammy. Many have suffered unemployment because of public service cuts. They are also dealing with the reduction in the availability of child care, and increasing costs because of increased demand. As well as that, they are picking up the pieces where public services can no longer provide support and must step back because of reductions in funding. It is often women who step into the breach. They must juggle their ability to provide family support of both kinds. Many women do that willingly, happily and lovingly, but as a society we must question whether that is the future we want, or whether we are taking a step back on equality by pushing more and more women who want to stay in work and progress economically back home and into caring roles. Women are still not equal to men in economic terms.

The issue that I raised yesterday was not just the quality of child care, which has been touched on today, but its availability. There has been much debate about child care figures and availability, but the number of places has reduced in the past three years, which is a big concern. The Government are making various promises of things to come, but whether they will be able to deliver is deeply in doubt when we consider what is looming on the horizon. When we consider how children’s centres and Sure Start centres are at risk at the moment, the Government cannot bury their head in the sand much longer.

[Jim Shannon (Strangford) (DUP)]

I apologise for not being here earlier: I had a Committee meeting and could not get here in time.

I understand that figures show that 5.8 million women are working mothers and that their average child care costs are 22% of their wages. Does the hon. Lady feel that it should be a priority for the Government to address the issue, to keep women in their job and enable others to obtain employment?

[Catherine McKinnell]

The hon. Gentleman makes a passionate case and is right; it makes sense for equality, women and the individuals involved, but also for the economy. The shadow Minister, my hon. Friend the Member for Manchester Central (Lucy Powell), is keen to stress the fact that the cost of child care is not a soft issue, but a key issue for the economy. It affects whether we get economic productivity or waste the resources of women who would choose to work, but are prevented from doing so or do not bring home enough money at the end of the month. I know many women working all the hours they can, whose earnings are taken up in child care costs to such an extent that they ask every week, or sometimes every day, “Is this actually worth it?” The cost of juggling caring responsibilities with work is a challenge in itself, even without the challenge of bringing home very little pay. Often there is a short-term crisis for a family for the sake of a long-term economic benefit for the individual, the family and the children. It is a key area and the Government should take it seriously.

I am concerned that many more Sure Start closures are looming than the 579 that have already happened. The Government dispute those figures, but their database of children’s centres shows that there are 3,053, while the official Department for Education figures in April 2010 showed that there were 3,632. Will the Minister clarify when she winds up—

[The Parliamentary Under-Secretary of State for Education (Elizabeth Truss)]

I am happy to do so now.

[Catherine McKinnell]

I have a series of questions, so perhaps the Minister can answer them all.

Where have the missing 579 centres gone? There is an obligation on local authorities to keep the figures updated. According to the Government’s figures, in black and white, those centres have gone, and the Government’s denial that they ever existed is causing confusion. What assessment has the Minister made of the anticipated number of closures over the next two years? In Oxfordshire, for example, 37 may be closed, and in my local authority area the closure of a large number is being considered and all 20 are under review. Presumably such things are happening elsewhere in the country, and I wonder whether the Government have a handle on it.

[Mr McFadden]

Does my hon. Friend agree that the issue is not just the total number of Sure Starts? It is what they are doing. Many have stayed open but have had to cut back what they offer. The argument about numbers is important, but it is not the whole story. The diminished offer from some Sure Starts that have managed to stay open is part of it.

[Catherine McKinnell]

Perhaps the Minister can respond not only to my questions but to the issue outlined by my right hon. Friend.

[Elizabeth Truss]

I shall make the point about numbers again in my closing remarks, as I intended, but I am puzzled by Opposition comments because currently Sure Start provides 1% of child care places and schools provide 30%. Why have the Opposition not talked about places for under-fives in schools but about Sure Start centres, which provide far fewer places? It is a strange way to approach a debate about child care.

[Mr Jim Hood (in the Chair)]

Order. Before the hon. Lady responds, I remind right hon. and hon. Members that I shall call the Front-Benchers at 3.40 pm at the latest, to give them 10 minutes each. I have one speaker left on my list who may want some time.

[Catherine McKinnell]

Thank you for that clarification, Mr Hood, and for your management of the debate.

I appreciate the Minister’s point, but the Government promise a roll-out of additional places for two-year-olds and I know for a fact that many schools do not have the capacity to provide pre-schooling places for three-year-olds at the moment, let alone for the two-year-olds to whom the Government aspire to give places. It would therefore seem logical for Sure Start to be among the places where child care places are provided. That is why I question the Government not only about the broader picture for Sure Start—including its important early intervention work and the fact that it is available and accessible for new mums and communities—but about the loss of child care places when Sure Start centres go.

Can the Minister also clarify the guidance on the provision of children’s centres published in April? It states that children’s centres and their services should be

“within reasonable reach of all families with young children”.

However, there seems to be no clarity on what “reasonable reach” means. What journey by public transport might be deemed reasonable? What are the reasonable changes a family would be expected to make? If they were travelling with a pram or buggy, which presumably they would be, given that young children are involved, is that reasonable? How frequent must a bus service be to be deemed reasonable? How much should it cost a young family to travel by public transport to a children’s centre? I would be grateful if the Minister provided some clarity on those issues, which would help to inform the debate around not only child care but Sure Start more widely.

15:30

[Nic Dakin (Scunthorpe) (Lab)]

May I apologise, Mr Hood, for not being here at the beginning of the debate as I was in a delegated legislation Committee? I am sure, however, that my hon. Friend the Member for Houghton and Sunderland South (Bridget Phillipson) gave an excellent speech and I congratulate her on securing the debate. Such debates are little like buses: we do not have a debate on child care and then two come along at once. The quality of debate both yesterday and today reflects the quality of debate in the country. The issue is important and central to families up and down the land, both in the constituencies represented in the debates and in those not represented.

I want to begin with a statistic to which my right hon. Friend the Member for Wolverhampton South East (Mr McFadden) has already alluded. It is the thing that has affected me the most over the past month. Ofsted has stated that five-year-olds from the least affluent backgrounds are 19 months behind five-year-olds from the most affluent backgrounds in development terms. That is a shocking statistic, and it alone should be a call to arms for all of us to roll up our sleeves and to put child care centre stage. The costs of child care should not be a barrier to addressing that inequality.

If I had a penny for every time I have heard Members of Parliament on both sides of the House refer to the need to close the inequality gap, I would be a very rich person. There is a theoretical commitment to doing something, but we need to turn that belief in principle into a belief in practice. Only through practical effects can we change the situation for those five-year-olds who become tomorrow’s adults and leaders. The hon. Member for Norwich North (Chloe Smith), for whom I have a lot of respect, appeared to say that we perhaps cannot afford to do the right thing, but the Ofsted statistic tells us that we cannot afford not to do the right thing. We need to find the finance, whatever the situation, to address the issue. It is absolutely crucial.

I have visited many nursery settings in my Scunthorpe constituency over the past month, and I was struck by the vast variety and diversity of those settings. As the Minister mentioned, many of them are nurseries attached to schools, which provide a very important part of that landscape. I visited Messingham farm nursery, which is a new business in my constituency that meets the needs of a particular community and does a fantastic job. As the name suggests, it is about not only child care, but also using animal care to provide a particular experience for young people. I also visited the Ark family centre, which is run in partnership with the Baptist Church and delivers very good nursery care. Finally, last week, I took advantage of what was laughingly called a “mini-recess” to go to the Ashby Sure Start children’s centre, which is a fantastic facility that was created as a result of the previous Government’s Sure Start initiative. It is transforming the lives of the children in an area of my constituency where such a service is most needed.

I am always impressed by the quality, professionalism and commitment of the people working with children in such settings and by the way in which they divide up their time based on specific skill sets to address the needs of children at different stages of development. At the Ashby children’s centre last week, I was shown the files in which each child’s progress is carefully measured. Interestingly, I was told that schools are now more interested in receiving that information and building on it. The transition to the next stage of education should therefore be more secure, which was perhaps not the case a few years ago. We can see how the investment in nursery education is making a real difference.

I want to refer to the recent concerns of the Children’s Society about tax-free child care replacing the employer-supported child care vouchers. The Minister will hopefully take this opportunity to address the society’s concerns, because it is clearly focused on children’s well-being. Parents on universal credit will not be eligible to receive tax-free child care. Instead, they will receive a component of universal credit up to 85% of child care costs. Working parents on the lowest incomes will receive help with up to 70% of costs. It seems odd to me and to the Children’s Society that working parents on the lowest incomes will get the lowest level of support. If its concern is accurate, I hope the Minister will address that point.

The Children’s Society is also concerned that the complexity of having two systems of child care support for working parents and issues around the threshold may cause the same sort of difficulties that many of us experienced in relation to the Child Support Agency. If the Government provide help with only 70% of child care costs to those on the lowest incomes, can they still guarantee that every hour of work will pay for those on universal credit if there is an increase in the tax threshold? There may be an unforeseen consequence that we would all want to avoid. Children’s charities, including the Children’s Society, have asked for 85% support for those on universal credit, and I hope that the Government will examine that and ensure that that is the case for all parents on universal credit.

I will end with some points of concern. The cost of nursery places has risen by 30% since the last general election, which is five times faster than pay. At the same time, the same families are seeing their budgets squeezed by the rise in energy prices and transport costs and by general inflation. The average bill for a part-time nursery place of 25 hours a week has gone up to £107, and parents working part-time on average wages would have to work from Monday to Thursday before they paid off their weekly child care costs.

There are 576 fewer Sure Start centres, with three being lost on average every week. The Minister and I might disagree about the numbers, but I think we agree that Sure Start centres have been closed and have had their functions changed, which is clearly evidenced by what people across the country tell us. There are 35,000 fewer child care places than at the time of the last election.

The Government’s initiative of offering places to disadvantaged two-year-olds is positive. It did have teething problems when it was initially rolled out due to a qualification around Ofsted reports, which are often five or six years old. Fortunately, in my area that problem has been overcome. However, I am sure the shadow Minister and the Minister will wish to address those issues of practicality to ensure that together we take the opportunity to do something about the 19-month difference, before it is too late.

15:40

[Lucy Powell (Manchester Central) (Lab/Co-op)]

It is a pleasure to be here under your chairmanship, Mr Hood. I had hoped for my first outing as a Front-Bench spokesperson to be in this Chamber, but we had a similar debate in the main Chamber yesterday. I am hoping that today will be slightly less boisterous than some of our exchanges then.

I thank my hon. Friend the Member for Houghton and Sunderland South (Bridget Phillipson) for securing this extremely important debate. I declare, as she did, an interest—in fact, our children play together at the same nursery, here in the House of Commons. Many Members present share such an interest, in that our children are in child care. Over the past few days, we have seen how important the issue is for many of our constituents, as a debate is now raging throughout the country.

For the record, the Labour party is proud of what we achieved on early years during our time in office, but there was still much to do when we left government. There is no silver bullet or panacea to resolve such difficult and complex issues. The point, however, is the direction of travel, which under the Labour Government was positive and in the right direction, but under this Government has turned back. Ensuring that we have good, affordable and flexible child care is not only critical to families and to closing some of those inequality gaps, but to the economy as a whole, as we have heard from Members today. That is why we need to do more about it.

Instead of repeating the arguments that we had yesterday, I want to take the opportunity to discuss further some of the issues that have been mentioned. We heard from my hon. Friend a cogent argument about the triple whammy facing families: rising costs, falling places and cuts to support.

Since 2010, the number of child care places has fallen by more than 35,000. As the Minister agreed yesterday, we now have 2,423 fewer childminders than in 2009, so places are going down under this Government. We had some debate about Labour’s record on childminders, but I want to put on the record at least once a quote from the chief executive of the Professional Association for Childcare and Early Years, when she gave evidence to the Children and Families Bill Committee:

“The statistic…often…quoted…is not one we recognise in terms of the scale of downsizing of registered childminders in the period that the Minister talks about”—

when Labour was in government.

“Pre-Ofsted registration, childminders were managed by local authorities and registered locally”,

and,

“when Ofsted took over that registration, there was a clearout of a lot of data on individuals who were not practising childminders.”––[Official Report, Children and Families Public Bill Committee, 7 March 2013; c. 99, Q208.]

The Minister also asked why we were not discussing school nursery provision, but we are very much doing so. First, Labour policy is to extend nursery provision to three and four-year-olds for 15 hours a week, which is leading to school nurseries being able to offer that to parents. Members present today, such as my right hon. Friend the Member for Wolverhampton South East (Mr McFadden), mentioned the provision of offers for three and four-year-olds in school nurseries. Our policy pledge is about extending that offer further still.

The figures that we were talking about are for childminders and child care places, but if the Minister wishes to take some credit for Labour’s policy for three and four-year-olds, I am happy for her to do so.

[Elizabeth Truss]

My specific point was that the 35,000 figure cited by the hon. Lady is only that from the Ofsted early years register; there are also nursery places on the schools register for Ofsted, which have not been counted in her numbers. The claim was that there are 1.3 million child care places, but there are actually 2 million, because the two registers were not added together by the Opposition; Labour used only one of the registers in its analysis, so its numbers are wrong.

[Lucy Powell]

I do not want to get into a stats war with the Minister, but the point is that families up and down this country know that it is getting harder and harder to find childminders and quality early-years provision. As the Minister knows, there is also massively increased demand: the birth rate has been rising by more than 125,000 year on year while the Government have been in office. The sector is therefore facing significantly increased demand as well.

On Sure Start, my hon. Friend the Member for Newcastle upon Tyne North (Catherine McKinnell) rightly asked the Minister about the figures. The Department for Education’s own press release from June 2010 stated that there were 3,621 Sure Start centres; recently, the Directgov website showed that there were only 3,053. That is where our figures come from—they are the Minister’s own figures. The point being made today, however, is that the issue is not only about the numbers, but about the services being offered, because many Sure Start centres are being downgraded.

I do not want to confuse matters, because there are two separate issues: Sure Start centres and their provision for early-years intervention work; and Sure Start and child care provision. The Policy Exchange paper showed that, in the poorest areas, child care provision is of the poorest quality—that is why the Sure Start provision of child care is of particular importance. It has focused on some of the most deprived areas, where child care quality is at its worst. That is where it is most needed. We still need Sure Start centres that are able to provide child care.

On the model more broadly, the early intervention grant, which provides the funding for children’s centres, will be halved between 2010 and 2015, going from £3 billion a year to £1.5 billion a year. That is what is having such an impact on the services that Sure Start centres are able to provide to new mums. Those centres play a critical role.

I asked a further question about the Sure Start model yesterday, which I hope the Minister can answer today. It was about another critical component of delivering that essential support for new mums—the role of health visitors. The Prime Minister said before the election that we would have 4,200 new health visitors by 2015. Will the Minister update us today on what progress has been made?

I will skip past some of my other points, but I will repeat the request for an answer to the questions asked by my hon. Friends the Members for Stretford and Urmston (Kate Green) and for Scunthorpe (Nic Dakin) about universal credit and its impact on whether the lowest-income families can meet child care costs. Will the Minister also answer those questions?

The Government response seems to have been to do little in their time in office—[Interruption.] I am sorry, but the Minister’s own flagship policy on child care ratios has now been resoundingly dumped by her colleague; we welcome the extension of the free offer to two-year-olds, but delivery problems remain; and childminder agencies are an unknown quantity and an experiment. We will see how they pan out.

The Government’s main flagship policy now seems to be the tax-free child care policy, but that is too little, too late. The scheme is not coming in until the autumn of 2015, and the people who will benefit most from it will be the highest paid—the more people spend on child care and the more they earn, the more they will benefit. It will do absolutely nothing about cost. In fact, there is evidence to suggest that the scheme—putting so much into the system on the demand side, rather than on the supply side—will lead to costs going up further still. I hope for reassurance from the Minister on that today.

Labour has new policies to extend the three and four-year-old offer from 15 to 25 hours a week and around guaranteeing wrap-around care—welcome policies that are a step in the right direction and will help families to meet the child care crunch that they face. As my right hon. Friend the Member for Wolverhampton South East so eloquently put it, such policies are only steps in the right direction—as a country, we face a big challenge, and we will need bigger and bolder policies to address it. Under this Government, we are going in the wrong direction.

15:49

[The Parliamentary Under-Secretary of State for Education (Elizabeth Truss)]

I congratulate the hon. Member for Houghton and Sunderland South (Bridget Phillipson) on securing today’s debate. I associate myself very much with the comments made by all parents here today; I am the proud mother of two daughters. We need more parents representing people in the House. I am a great supporter of the changes that we have made to parliamentary hours, but we could do more to make the House of Commons a parent-friendly place. It is important to have representatives who are also mothers or fathers.

I am afraid that I cannot agree, however, with the hon. Lady’s analysis of the Government’s policies or indeed of the previous Government’s record. As my hon. Friend the Member for Norwich North (Chloe Smith) pointed out, that Government left the biggest budget deficit of any major economy, and as a result we were borrowing £1 for every £4 that we spent. In those circumstances, the support that the Government have given to parents and families is excellent. We have increased total spending on child care and early-years education: it was almost £5 billion but will be over £6 billion. We have increased the number of hours of free early-years education for three and four-year-olds from 12.5 hours to 15 hours a week, which is worth £400 per child for parents. We have extended support to two-year-olds, and tax-free child care, available from 2015, will be worth up to £1,200 per child. That provision is flexible between the ages of nought and five so parents can spend the allowance in the way that they see fit. We are providing support to families in tough times.

I want to comment briefly on the claims made about child care places. There is a genuine issue here, and we need to be clear about the figures. There are two different registers upon which child care places are based under Ofsted. The most accurate figures can be found in the Department for Education early-years providers survey from 2011—that is the most recent of those surveys, which are biennial. I am concerned that the Opposition’s figures do not include the 800,000 places in school nurseries. In places such as London, about 50% of all places are based in schools. As Baroness Morgan, an Opposition peer, has pointed out, school provision gives a strong basis for future progression and avoids some of the issues with transition that Opposition Members have raised. I would like to point out that our survey shows that over 200,000 places are available across the country. It is wrong to say that there is a shortage of places. Of course, I agree that we need to do more work on supply and quality.

[Catherine McKinnell]

Will the Minister give way?

[Elizabeth Truss]

I am sorry, but I will not be able to take interventions at the moment because I want to try to answer all the many questions hon. Members have raised.

Labour claims that costs have risen by 30% since the Government took office. The study that was mentioned also suggested that costs had risen by 50% under the previous Labour Government. Child care costs have been rising year on year, but other recent studies suggest that those costs are now stabilising and have been flat in real terms for the past two years. Across the political spectrum, we need to analyse why we put the same amount of money into our child care system as countries such as France and Germany but parents in those countries pay a lot less—they pay about half the costs that parents here pay. It is not just about the money that the Government are putting in; it is about the efficiency of provision, competition in the child care market and how that market works. I have spent a lot of time thinking about that as a Minister, and some of my plans are aimed at addressing those specific issues.

[Lucy Powell]

Will the Minister give way on that point?

[Elizabeth Truss]

I will briefly, but I want to try to answer all the questions raised.

[Lucy Powell]

I appreciate that the Minister is being generous in giving way. On the basis of the analysis that she has just given, how does she think that giving a tax-free child care offer will address the costs?

[Elizabeth Truss]

That offer will help parents to pay towards the costs of child care. Our reforms to encourage more childminders, more school-based care and more private and voluntary nurseries are aimed at expanding supply. Those two policies go hand in hand.

The hon. Member for Houghton and Sunderland South is not right in her analysis that after-school clubs have declined. In fact, our most recent study shows that they have increased by 5%. One of the issues with the extended schools policy that Labour had before the election was that schools could simply put a link to a child care provider on their website, or something like that, and that would count as providing an extended school place; the school had ticked the box, but there was not really any all-day provision. We are working on aligning requirements during the school day and afterwards, as well as making it easier for schools to collaborate with outside providers, so that they can provide real care on the school site.

It is important that schools are encouraged to use their assets better. It helps children to learn more and supports working parents. We are working hard to encourage more schools to do that. I am pleased to say that, for example, the Harris academy chain has agreed that all its new primary schools will have a school day of 8 am to 6 pm. We need to make provision in a sustainable way that enables schools to mix and match with their school day, so that children have extra learning and extra opportunities for creativity, sports and after-school activities. We are keen to encourage that approach.

A lot of claims have been made about children’s centres. As I said in the debate in the House yesterday, the figures on the Department for Education website are about the management structures of children’s centres. There have been only 45 outright closures. A lot of management structures have been merged but with the centres remaining open. In fact, a record number of parents are using children’s centres—over 1 million this year. That shows the success of those centres.

I wanted to respond briefly to the excellent comments that the right hon. Member for Wolverhampton South East (Mr McFadden), the hon. Members for Scunthorpe (Nic Dakin) and for Newcastle upon Tyne North (Catherine McKinnell) and my hon. Friend the Member for Suffolk Coastal (Dr Coffey) all made about the importance of quality in early-years provision. I could not agree more. We need more highly qualified people in that area. That is why we have developed the early-years educator qualification and are offering bursaries this year for early-years educators—that is, young people with good qualifications who wish to enter the professions of child care and early-years education. We have also matched the entry requirements for early-years teachers to those for teachers. This year we have seen an increase of 25% in registrations on our early-years teacher course because of the higher profile that it has had. That will encourage more good people into early-years education.

This year, we have also started Teach First for early-years provision. For the first time, we have high-quality graduates going into the Teach First programme and working with three and four-year-olds. Some will be working with two-year-olds as well, as those places are rolled out in schools. For example, starting in January, the Oasis academy in Hadley is offering 40 places for two-year-olds with a Teach First early-years teacher. Exciting things are happening in schools to get highly qualified people working with our youngest children. Of course, that is being done in an age-appropriate way; when I visited the class of two-year-olds based there already, they were having their feet painted then running around, and doing other things like that. It is certainly not about two-year-olds studying trigonometry. Some of Baroness Morgan’s comments on the matter have been misinterpreted: the aim is to develop early language skills.

The Opposition have proposals on child care places for three and four-year-olds. My hon. Friend the Member for Norwich North covered those proposals well when she said that the Opposition have already spent the bank levy 11 times. There is no magic money tree for policies such as that one. We have to make sure that we use our existing assets better. We are using schools better and giving new planning freedoms, so that shops and offices can be converted into new nurseries.

We also particularly want to see a revival in the number of childminders. I agree with the hon. Member for Manchester Central (Lucy Powell) that we need more high-quality childminders. One issue is that new people have not been joining the childminding profession and the average age within it is gradually rising. We need good ways to attract new people into childminding. Childminding agencies are one of the ways in which we will be able to do that. The hon. Lady will be interested to hear that we are working on involving children’s centres in our attempts to increase childminder numbers, because we think those centres can help to provide a network and training for childminders. We must also make sure that we use nursery facilities and school nursery facilities better.

The hon. Member for Scunthorpe asked a lot of questions about universal credit. I will reply in writing to him, as I do not think I will be able to answer them in the 15 seconds I have left to speak. But there is a lot of common ground in this debate, and I am happy to share more of the figures and details on this matter with the Opposition to make sure that we are debating on the same terms.

Gay-to-straight Conversion Therapy

Wednesday 20th November 2013 Westminster Hall

16:00

[Sandra Osborne (Ayr, Carrick and Cumnock) (Lab)]

It is a great pleasure, Mr Hood, to serve under your chairmanship. I am raising this debate as part of an ongoing discussion on gay-to-straight conversion therapy, and I refer to my early-day motion, which attracted 52 signatures; the petition presented to the House by my hon. Friend the Member for Kingston upon Hull North (Diana Johnson); and the private Member’s Bill, the Counsellors and Psychotherapists (Regulation) Bill, which was introduced by my hon. Friend the Member for Swansea West (Geraint Davies).

[Diana Johnson (Kingston upon Hull North) (Lab)]

I congratulate my hon. Friend on securing this debate. I want to put on record the enormously helpful work of Tom Stevens and Colin Levitt, who live in Hull and were behind the petition that was presented to Parliament because they felt strongly about the matter and decided something had to be done.

[Sandra Osborne]

I, too, have reason to be grateful to those people.

I want to place on the record the fact that several hon. Members indicated that they wanted to attend this debate but had other commitments.

[Geraint Davies (Swansea West) (Lab/Co-op)]

As my hon. Friend was so kind as to mention my Bill, does she agree that our joint ambition to get rid of gay-to-straight conversion therapy needs to be embraced in a regulatory context so that all psychotherapists are regulated, which they are not at present?

[Sandra Osborne]

I agree, and I will go into that further. Conversion or reparative therapy is the attempt by individuals, often posing as professionals, to alter the sexuality of lesbian, gay or bisexual patients. Virtually every major national and international professional organisation has condemned the practice as ineffective and potentially extremely harmful to patients.

[Simon Kirby (Brighton, Kemptown) (Con)]

I want to place on the record the fact that I am proud to represent some 6,000 gay men in my constituency, and that conversion of any sort is unacceptable in this day and age.

[Sandra Osborne]

I thank the hon. Gentleman for his intervention.

The prevalence of conversion therapy in Britain has been the subject of recent interest in Parliament. Hon. Members will have received a recent communiqué from the pro-conversion group, Core Issues, calling on us not to support the private Member’s Bill introduced by my hon. Friend the Member for Swansea West on the regulation of counsellors and psychotherapists. The people in Core Issues are the very same who tried and, fortunately, failed to put up posters on London buses advertising conversion therapy. On 30 January, alongside Christian Concern, they hosted a debate on conversion therapy in a Committee Room of this House. One of the speakers at that debate, Canadian psychiatrist Dr Joseph Berger, is on the record as advocating the bullying of cross-dressing children in schools.

[Iain Stewart (Milton Keynes South) (Con)]

Does the hon. Lady agree that such courses are particularly dangerous for young people who are struggling with their sexuality? When I was a teenager, I had great difficulty reconciling who I was. The variability of those courses places an enormous burden on young people who are already frightened about the consequences of being open about who they are.

[Mr Jim Hood (in the Chair)]

Order. I remind hon. Members that this is a 30-minute debate, and interventions should be brief to allow the hon. Member whose debate it is to speak.

[Sandra Osborne]

Thank you, Mr Hood.

I want to focus on the main aspects of the problem of conversion therapy, and to debunk three common myths: first, that conversion therapy is something that happens only in America; secondly, that conversion therapy is carried out only by religious fundamentalists operating outside professional channels; thirdly, that the debate about conversion therapy is a simplistic one between allowing people freely to choose conversion therapy and infringing people’s personal choices. On the contrary, I hope to show that conversion therapy is a real and present danger in Britain, and that instead of being a problem just among religious fundamentalists, it is an issue for the national health service and the professional sector. This is not a simplistic debate about freedom to choose. If lesbian, gay, bisexual and transgender community patients are coaxed into undertaking therapy by peer pressure or referred to conversion therapists after approaching professionals, that is hardly free choice.

[Mike Freer (Finchley and Golders Green) (Con)]

Does the hon. Lady agree that until now the Department of Health has been weak on the matter? Instead of condoning it, it should ban the voodoo medicine and conversion therapy.

[Sandra Osborne]

I agree with the hon. Gentleman and I hope to get some answers from the Minister.

Conversion therapy used to be a much greater and more systemic problem in Britain than it is today. In the 1950s and ’60s, LGBT patients were routinely forwarded by teachers, GPs and, as in the case of Alan Turing, criminal courts to NHS so-called specialists in sexual orientation treatment. During that period, all branches of psychology from the cognitive to the behavioural and the psychodynamic had their own cruel and unpalatable methods of dealing with same-sex attraction.

The watershed moment came when homosexuality was removed from the American “Diagnostic and Statistical Manual of Mental Disorders” in 1973. However, simply changing the rules does not change an entire system overnight. Conversion therapy persisted and psychotherapy remains an unregulated profession in Britain. Anyone in the country can set up as a psychotherapist without being part of a professional body, and there are professionals practising in the NHS and therapy sectors who received their training well before homosexuality ceased to be classed a mental illness. Even the new intake of therapists is a cause for concern.

In 2008, a survey of 226 British psychology undergraduates was published in the Journal of Homosexuality and found that only 66% agreed with an equal age of consent. That is the context in which we should view the extent of conversion therapy in Britain. In a 2009 survey of more than 1,300 accredited mental health professionals, nearly 300 willingly admitted to having attempted to change at least one patient’s sexuality. Even more shocking, the therapists admitted that some 35% of the patients they treated were referred to them for treatment by GPs, and 40% were treated inside an NHS practice.

[Nia Griffith (Llanelli) (Lab)]

Does my hon. Friend agree that it is very serious that the issue is so widespread among GPs and other professionals, and that we must tackle that when regulating psychotherapy and the health professionals who refer people?

[Sandra Osborne]

The issue is serious and it is not recognised to the extent it should be, which is one reason why I am so pleased that we are having this debate.

In 2010, Patrick Strudwick of The Independent carried out an undercover investigation. One psychotherapist who attempted to “cure” him, Lesley Pilkington, readily admitted that most of her clients were referred to her from her local GP’s surgery. Many professionals receive little training in what to do when a gay person approaches them expressing uneasiness about their sexuality. There is legitimate concern that some professionals in the NHS and elsewhere are referring LGBT patients to conversion therapists.

Addressing the problem of conversion therapy in Britain requires a range of measures. In the therapeutic profession, affirmative therapy, which begins from the premise that no efforts should be made to change sexuality and that homosexuality is perfectly normal, should be promoted as the appropriate, healthy way of assisting LGBT patients who feel uneasy about their sexuality. To promote this therapy, we must ensure that therapists and students are properly trained in LGBT-friendly mental health provision.

The public sector equality duty mandates the public sector to address inequality and is vital to drive forward reform. That is why recent Government calls to review the duty are particularly concerning. It is important to consider the role that the public sector equality duty can play in improving the quality of care for LGBT patients. What initiatives has the Department of Health supported from the Equality and Human Rights Commission, for example, and from non-governmental organisations such as Stonewall, to identify and promote good practice in relation to the public sector equality duty and LGBT patients? We know that when public bodies are proactive, it can make a real difference.

We need to explore the regulation of psychotherapy. At the very least, it has to become a protected profession in which nobody can legally call themselves a psychotherapist without being accredited by a professional body. We also need to ensure that professional bodies have an appropriate complaints procedure, so that LGBT patients who undergo conversion therapy can achieve justice. Patrick Strudwick, to whom I referred, has raised concerns about the complex bureaucratic process that he had to go through to ensure that the conversion therapist who treated him was struck off her professional body.

We need to ensure that psychotherapists who are not members of those professional bodies that explicitly have a position against conversion therapy are not commissioned by the NHS. Will the Minister tell us whether groups without professional affiliations are commissioned by the NHS for services? What about the advertising to which I referred earlier? A New York Times advert in the ’90s for conversion therapy is credited with causing a revival in the practice. That is why restricting advertisements for conversion therapies is vital and should be explored. What is the Minister’s view on that?

At the very least, the Government must force practitioner full disclosure, which was advocated as the desired alternative to the model of Health Professions Council regulation in the Maresfield report of 2009, and involves

“the establishment of an independent body to administer a register of therapists, with the statutory requirement that anyone practising a therapy supply full details of training and professional history.”

The Government’s regulatory model for psychotherapy falls far short of PFD. Why?

Finally, I want to raise the question of the role of the law in tackling the practice of conversion therapy. The Government could opt to ban conversion therapy for all under-18s and go further with an all-out ban for all age groups, as happens in other countries.

[Stephen Gilbert (St Austell and Newquay) (LD)]

I congratulate the hon. Lady on the measures that she has outlined and support her fully. Is it not the case that in 21st-century Britain, no lesbian, gay, bisexual or transsexual individual should be accessing this kind of voodoo psychology? Instead, we should provide services that help to give confidence and which support them in discovering their sexuality and about themselves, rather than making them feel more ashamed about it.

[Sandra Osborne]

I totally agree, and thank the hon. Gentleman for his contribution. In addition to a ban, we must go further in the training of professionals who are dealing with LGBT patients and provide friendly public service provision.

Other than a solitary remark from the Government that they do “not condone” conversion therapy, made in response to a written question tabled by my hon. Friend the Member for Kingston upon Hull North, the Government have said nothing about their views on conversion therapy. I look forward to the contribution of other Members and, in particular, to the Minister’s reply on the issues that I have raised.

[Mr Jim Hood (in the Chair)]

I have received a letter from the hon. Member for Washington and Sunderland West (Mrs Hodgson) requesting permission to speak in the debate. She assures me that she has had the agreement of the hon. Member for Ayr, Carrick and Cumnock (Sandra Osborne), and the Minister has told me that he agrees. To be fair to the Minister, he has to have the same time as the hon. Member for Ayr, Carrick and Cumnock had in opening the debate, so I ask the hon. Member for Washington and Sunderland West to take only a few minutes, which will hopefully leave time for the Minister.

16:14

[Mrs Sharon Hodgson (Washington and Sunderland West) (Lab)]

I congratulate my hon. Friend the Member for Ayr, Carrick and Cumnock (Sandra Osborne) on securing the debate, and on her powerful speech setting out the problem that we are hoping the Government can solve. I thank her, the Chair and the Minister for allowing me and other hon. Members to make small contributions to the debate.

I should also pay tribute to the many Members on both sides who have campaigned on the issue, particularly my hon. Friend the Member for Swansea West (Geraint Davies) for his excellent private Member’s Bill, and my hon. Friend the Member for Kingston upon Hull North (Diana Johnson), who did a national petition on the matter.

This debate comes during an important week for the LGBT community. On Monday, we celebrated the 10th anniversary of the abolition of the wretched section 28, and today is the annual transgender day of remembrance, when we remember the thousands of transgender people across the world who have paid the ultimate price, simply for seeking to be themselves. Those men and women have lost their lives at the hands of hate-filled zealots, because they had the courage to be who they wanted to be.

Pushing conversion therapy on people who are homosexual might not be on the same level as physical attacks on a member of the LGBT community, but it is certainly part of the wider problem of discrimination against them. That said, the psychological harm that medical professionals have recognised as a side effect of such attempts to change or tone down sexuality could well lead to the same end result.

Let us be absolutely clear: allowing the continuation of so-called therapists offering gay cures is, first, saying that being gay is problem that needs to be cured, and secondly, that it can be cured. Being gay is not an affliction. The only higher power that I defer to on the matter is the World Health Organisation, which has categorically confirmed that fact. Being gay cannot be cured any more than any other aspect of someone’s personality can be changed without doing that person serious damage.

What we want from the Government is similarly clear. The action taken last year by the British Association for Counselling and Psychotherapy, and in 2010 by the UK Council for Psychotherapy, is welcome. However, they cannot solve the problems themselves if the people they strike off their registers can still legally continue to call themselves therapists.

We need a system to ensure that counsellors and therapists are properly accountable. A statutory register has been put forward in the past as a solution to the problem, and in the absence of any better ideas, I still think that that is the way to go. However, I would be grateful for any other solution that the Minister can put forward that would have the same effect.

While such a system is set up, no doctor practising in this country—and certainly no doctor paid by our NHS—should be sending any of their patients to conversion therapy. Even if that patient begs to be referred, doctors swear an oath to do no harm, not to do whatever their patient asks them to do. We know that conversion therapy is harmful and doctors should know that too. We also know that the majority of people who request conversion therapy do so because of pressure or abuse from family or peers—

[Mr Jim Hood (in the Chair)]

Order. I now call the Minister.

16:17

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

Thank you, Mr Hood. I congratulate the hon. Member for Ayr, Carrick and Cumnock (Sandra Osborne) on securing the debate and thank the hon. Member for Washington and Sunderland West (Mrs Hodgson) for her contribution, which I was pleased to hear as well. I found myself agreeing with the vast bulk of what has been said and with the interventions that have been made—in fact, I agreed with everything that has been said.

Personally, I find the practice utterly abhorrent and it has no place in a modern society. That is my personal view, and many of the questions that have been asked are questions that I have asked officials about the powers that might be available. If hon. Members would welcome it, I would be very happy to meet with all of them or a group of them to discuss the matter further. That is an open offer, which I make genuinely.

The Government have a proud record of supporting the rights of lesbian, gay and bisexual people. Most recently, we witnessed and welcomed the enactment of the Marriage (Same Sex Couples) Act 2013. Our support for the legislation demonstrates absolutely our belief that extending the right to marry to lesbians and gay men is part of recognising that loving and committed relationships and families in modern Britain come in all shapes and sizes and should be celebrated.

[Sandra Osborne]

Is the Minister aware that today in the Scottish Parliament the same-sex marriage Bill is being introduced? Does he not think that that is ironic, given that we are discussing this matter?

[Norman Lamb]

I thank the hon. Lady for that intervention, and I note her point. Being lesbian, gay or bisexual is not an illness—it is sad that we need to state that, but it needs to be stated. It is not an illness to be treated or cured. Way back in 1973, the American Psychiatric Association removed homosexuality from its diagnostic glossary of mental disorders. Thankfully, the international classification of diseases produced by the World Health Organisation eventually followed suit in 1992; there was quite a long delay before that happened. Therefore, we are concerned about the issue of so-called gay-to-straight conversion therapy.

The Department of Health has received 15 or so letters in the past few months about the issue. All but one of those letters have been supportive of gay people and against the notion of gay-to-straight conversion therapy. That surely reflects the fact that most people in society today are far more relaxed and understanding about people’s sexuality than they ever were in the past.

We are not aware that the NHS commissions this type of therapy. It is completely inappropriate for any GP to be referring a patient for such a thing. It is unacceptable that that should happen through someone working in our national health service.

[Geraint Davies]

Is the Minister aware that the number of people who go to psychotherapists has tripled under this Government to 1 million? Given that number and given that we have heard evidence about people being referred by GPs, is it not now high time for regulation to stop abuse and potential abuse?

[Norman Lamb]

I will come to that. I do not think that the fact that numbers have increased can be blamed on this Government.

We are not aware that the NHS commissions this type of therapy. In my replies to correspondence, I have confirmed that the Department of Health does not recommend the use of conversion therapy—I have made clear today my personal view on that—and it is not a National Institute for Health and Care Excellence-recommended treatment. That is self-evident. Furthermore, the main national professional associations for psycho- therapy have declared that they regard conversion therapy as wrong.

In February 2010, the UK Council for Psychotherapy said:

“UKCP does not consider homosexuality or bisexuality, or transsexual and transgendered states, to be pathologies, mental disorders or indicative of developmental arrest. These are not symptoms to be treated by psychotherapists, in the sense of attempting to change or remove them.

It follows”—

this is very important—

“that no responsible psychotherapist will attempt to ‘convert’ a client from homosexuality to heterosexuality”.

Similarly, in September 2012, the British Association for Counselling and Psychotherapy set out the following:

“The…Association…is dedicated to social diversity, equality and inclusivity of treatment without discrimination of any kind. BACP opposes any psychological treatment such as ‘reparative’ or ‘conversion’ therapy which is based upon the assumption that homosexuality is a mental disorder, or based on the premise that the client/patient should change his/her sexuality.”

In January 2013, the British Psychological Society published a position statement that opposed any psychological, psychotherapeutic or counselling treatments or interventions that view same-sex sexual orientations as diagnosable illnesses. It declared:

“This includes freedom from harassment or discrimination in any sphere, and a right to protection from therapies that are potentially damaging”—

that point was made by hon. Members—

“particularly those that purport to change or ‘convert’ sexual orientation.”

This issue is clearly causing a great deal of concern in the House, and rightly so. The hon. Member for Ayr, Carrick and Cumnock, as well as sponsoring this important debate, tabled an early-day motion in June. It called on the Government to take steps to ban gay conversion therapy and to investigate NHS links to conversion therapists. Several hon. Members present have referred to that motion and put their names to it.

The hon. Member for Swansea West (Geraint Davies) tabled a second early-day motion, calling on the Government to regulate counsellors and psychotherapists. There have also been a number of parliamentary questions on the issue. As hon. Members will know, the hon. Member for Swansea West has also introduced a private Member’s Bill seeking regulation of therapists. That is scheduled for Second Reading this Friday.

The Government have already said that there are no plans at this stage to introduce statutory regulation of psychotherapists. We do not believe that regulation would necessarily prevent this type of counselling in any case, as it would not depend on the type of therapy offered.

The Command Paper entitled “Enabling Excellence: Autonomy and Accountability for Healthcare Workers, Social Workers and Social Care Workers”, which we published in February 2011, sets out the Government’s vision for the future of work force regulation. That paper makes clear our continuing view that, although statutory regulation is sometimes necessary, it is not always the most proportionate or effective means of assuring the safe and effective care of patients or social care service users. That is why we provided powers to the Professional Standards Authority for Health and Social Care in the Health and Social Care Act 2012.

The Professional Standards Authority oversees the work of the health care profession regulators, including the Health and Care Professions Council. Those powers facilitated the establishment of voluntary registers for unregulated health care professionals and health care workers in the UK, social care workers in England and certain students.

The accredited voluntary registration scheme to which I am referring is not a form of regulation, nor is the PSA a regulator. To be accredited, organisations must provide evidence to the PSA that they are well run and they require registrants to meet high standards of personal behaviour, technical competence and, where relevant, business practice, but the scheme does not endorse any particular therapy as effective and it makes it clear that accreditation does not imply that it has done so. However, organisations seeking to be accredited can set their own rules about what therapies their members can or cannot offer.

As accredited voluntary registration appears to be gaining momentum and is proportionate to the risk, we believe that statutory regulation would not be appropriate and the costs to registrants or the taxpayer could not be justified. This is not to say that we are ruling out statutory regulation for this group for ever. We will continue to assess the need for it. I give an absolute assurance about that.

This is not to say that lesbians, gay men and bisexual people cannot seek counselling or therapy because they are distressed about a particular aspect of their sexuality—that is very important—or that a therapist should not try to help their patient with whatever is causing them distress, which may involve helping them to come to terms with their sexuality, family arguments over their sexuality, or hostility from other people. Supporting people through aspects of their lives that are difficult or challenging is a large part of what therapists do. I think that my hon. Friend the Member for St Austell and Newquay (Stephen Gilbert) made that point in his intervention.

We want to minimise the risk that lesbians, gay men and bisexual people who seek counselling about their sexuality will face therapists attempting to change their sexual orientation because the therapist considers that being gay is wrong. That, of course, is completely unacceptable. That is why Department of Health officials last week met representatives from the UK Council for Psychotherapy to discuss a way forward on this important and sensitive issue. Officials will work in partnership with the council in the following ways.

First, the UK Council for Psychotherapy has agreed to draft, in consultation with the other relevant professional bodies, a public statement on conversion therapy that provides information and outlines the views held by those organisations. That is incredibly important. Once produced, that statement will be widely publicised and placed on relevant websites to ensure that individuals seeking a counsellor or therapist will be aware of those bodies’ views on gay conversion therapy.

Secondly, the Department of Health will host a round-table event in the spring to which it will invite relevant individuals and organisations in order to discuss ways to achieve greater quality and consistency across the profession in general, as well as on this specific issue. Thirdly, and subject to the progress of the private Member’s Bill, the Department will consider writing to statutory regulators, setting out key principles, to be agreed with the professional bodies.

In addition, although we are not aware of such therapies being commissioned by the NHS, my officials will explore with NHS England what actions it can take to ensure that clinical commissioning groups are not commissioning them locally. That is one of the issues that I am happy to discuss with hon. Members. I totally agree that it is not something that public money should have anything to do with.

I hope that I have assured those who have spoken passionately and persuasively in today’s debate that the Government are listening and taking action. I repeat my offer to meet hon. Members. We have a lot to be proud of. The UK is once again recognised as No. 1 in Europe on lesbian, gay, bisexual and transgender equality by the International Lesbian and Gay Association, and we continue to make great strides forward on equality. I hope that that reassures hon. Members both that this Government are strongly committed to advancing lesbian, gay and bisexual equality and that we are taking the issue of gay conversion therapy extremely seriously.

South Worcestershire Development Plan

Wednesday 20th November 2013 Westminster Hall

16:30

[Harriett Baldwin (West Worcestershire) (Con)]

It is a pleasure to serve under your chairmanship, Mr Hood. I start by declaring that I have an interest in the South Worcestershire development plan, because I am fortunate enough to be a home owner in the beautiful Malvern Hills district. On 24 October, in this Chamber, I discussed the matter with the Under-Secretary of State for Communities and Local Government, my hon. Friend the Member for Grantham and Stamford (Nick Boles), who has responsibility for planning. There were some unanswered questions on that occasion, and since then we have had an initial opinion from the inspector, hence my request for today’s debate.

Planning is in a much better place than it was under the top-down regional spatial strategies of the previous Government. I fully support the need to build new homes to meet the pent-up demand for property in south Worcestershire, which has resulted in an average house sale price of £224,500 in the past quarter—well above the national average for affordability. I also appreciate the importance of house building for jobs and growth in the construction industry, which is only now recovering from the economic shocks inflicted on the country by the previous Government.

In south Worcestershire, our three local councils—Worcester city council, Malvern Hills district council and Wychavon district council, which my hon. Friend the Minister with responsibility for planning visited recently—have been working in partnership for seven years to develop an ambitious and sound local plan for housing growth. After the 2010 election, and in light of the planned revocation of the west midlands regional spatial strategy in the coalition agreement, they immediately and presciently commissioned expert projections of local population growth. In so doing, they perhaps got a head start on other councils, and their evidence base is fresh and up to date.

All three local councils democratically agreed the plan last December. Although it caused much controversy at the time, one of the factors that encouraged councillors to vote in favour of the plan was that it would allow them to secure a plan-led system, which would provide certainty on the amount and location of development until 2030. The plan was submitted for examination in public on 28 May, and on 28 October the inspector issued his interim thoughts about stage 1 of the inspection.

[Mr Robin Walker (Worcester) (Con)]

I congratulate my hon. Friend on securing this important debate, to which she has already made a strong introduction. One of the welcome things from the inspector’s report was the support for the job numbers that were being targeted in the South Worcestershire development plan. Does she agree that it is vital for us to be able to take the plan forward to provide the local jobs and growth that our county badly needs?

[Harriett Baldwin]

My hon. Friend makes a powerful point. The plan is so ambitious for jobs and growth in south Worcestershire that we even had some complaints from Birmingham city council. It is a proactive and positive plan for growth in our area.

The inspector recognises in his initial assessment that the legal duty of the councils to co-operate has been met. He recognises that economic forecasting is notoriously difficult—some of us might say that it was impossible—and that none of the other six analyses of housing need presented to the examination by the development industry provides a sufficiently firm basis on which to derive an overall housing requirement for the plan period.

[Karen Lumley (Redditch) (Con)]

I congratulate my hon. Friend on securing this important debate. Does she agree that the plan must be adopted as soon as possible to stop speculative developments, such as that in Hanbury in my constituency, being put in to our planning authorities? Such developments can cost councils a great deal of money in appeal costs.

[Harriett Baldwin]

I am not familiar with the details of the Hanbury proposals, but I know that there is no stronger champion of the interests of Hanbury residents than my hon. Friend. She seems to be in complete agreement with the gist of my speech.

[Peter Luff (Mid Worcestershire) (Con)]

I join in the accolades to my hon. Friend on this important debate. On the subject of speed and speculative development, which my hon. Friend the Member for Redditch (Karen Lumley) rightly raised, is it not crucial for the plan to be delivered as quickly as possible? It is an ambitious plan for growth, but delay is destroying faith in local democracy because councils appear to find speculative development, in places where it is not appropriate, to be irresistible. Speed is of the essence in getting the plan adopted.

[Harriett Baldwin]

My hon. Friend makes a powerful point about the importance of localism and local democracy, and I completely agree with him. The plan has been locally agreed, not set down from on high. He also makes the point that the protracted appeal period is slowing down growth and construction in our constituencies and that much-needed housing is not being built as a result.

The inspector has effectively rejected all seven of the econometric methodologies presented to him, which surely demonstrates a significant flaw in the process. Across the country, there are disagreements over the amount of development required to meet needs, and such differences of opinion concerning circumstances many years in the future are wasting very scarce resources.

The test should be that the plans and projections are competent, not that they are perfect. We do not possess perfect foresight; if we did, we would all be able to retire as billionaires tomorrow, because we would know exactly what tomorrow’s closing stock prices would be. Particularly when there is opportunity for a revision during the plan period, can we agree that in a time of constrained resources it is inequitable to place such a high evidential and process bar on councils, and that to do so is a disproportionate use of resources?

The plan-making system does not appear to recognise efficiency of process to minimise the impact on the taxpayer. Can the Minister issue clear guidance on the methodology that should be used to calculate housing needs, so that other councils do not suffer the same delay and costs as the south Worcestershire authorities have?

The inspector highlights the difficulties of economic forecasting, particularly beyond 2021. He makes a range of helpful technical points about past under-supply, affordable housing provision, windfall provision, non-delivery allowances, phasing and buffers. He discusses bringing empty housing back into use and whether C2 extra care provision should count towards a council’s housing supply. On that point, the provision of extra care to include C2 accommodation is a key priority in our area, and we are keen to attract such development. If the housing allocation in the plan were x thousand, and y% of the units were for C2 extra care, will the Minister confirm that that would meet housing need and would not be considered as double counting?

On Monday this week, I learned that the three south Worcestershire councils have published a timetable for the additional technical work requested, which will take until the end of January 2014. The inspector has decided “in the interests of natural justice”, as he puts it, that further hearing sessions will be required and that the earliest that they could start would be the week commencing March 10 2014. Only once the inspector has reached his conclusions on stage 1 will he be able to give details of the time scales for stage 2. It sounds as though the process might easily run until the end of 2014. Frankly, world war two took less time than getting through the bureaucracy and red tape that surrounds the local plan.

To make matters worse, all that bureaucracy and red tape is strangling housing growth in the area. Because the plan has not been agreed, developers are submitting speculative planning applications in areas that are not in the plan, and applications are being determined simply on a first come, first served basis, despite the potential of other, more favourable sites to meet local housing need. That leads not to the house building that we want to see, but to a long series of legal disputes between developers and the council. When such appeals occur, it appears to be for each planning inspector to decide how much weight should be given to the emerging plan and how much to the old—we thought defunct—regional spatial strategy.

For example, a planning inspector referring to an appeal about Abberley common in the Malvern hills said on only 18 October:

“The policies within the SWDP carry some weight given its reasonably advanced stage of preparation. Nonetheless, there are a number of outstanding objections to its strategy for the delivery of housing, including the overall housing requirements. These will be considered at the examination which will determine whether the approach in the SWDP is sound, or whether an alternative housing strategy should be adopted. For this reason, having regard to the guidance within the Framework I attribute the housing targets within the SWDP limited weight. I consider this approach to be consistent with the ‘Axminster decision’ referred to by the Council where the Court found that although the emerging plan was a material consideration, the weight to be accorded to it was a matter for the decision-maker.”

Please can the Minister issue guidance that an emerging plan such as ours, where the disagreements are mainly about housing projections in 10 years’ time, should be given almost full weight today? If not, why not?

[Peter Luff]

I strongly endorse what my hon. Friend says. Is she as concerned as I am that developers are building up land banks with planning permission they would never normally get? They are not building, but just land banking and trading among themselves, making a fat profit for developers, without building a single house in Worcestershire.

[Harriett Baldwin]

My hon. Friend speaks passionately of our desire to see home building start according to our democratically agreed local plan, which provides a sound basis for the next few years’ growth and the development of the south Worcestershire area. Clearly, some minor tweaks need to be made—in particular, to the forecasts affecting housing numbers between 2020 and 2030—but our local councils are keen to enable local growth without unnecessary delay. Why can we not proceed on the basis of the emerging plan, while simultaneously making tweaks to distant years, especially as the councils are planning to review progress in 2019?

Turning now to neighbourhood planning, may I ask the Minister for his thoughts on how we as MPs can best support emerging neighbourhood plans? I love neighbourhood planning. It is an excellent way to give power to local people, to bring back an organic approach to planning and to reduce the need for vast swathes of land to be swallowed up by urban extensions.

[Mr Robin Walker]

My hon. Friend brings up a key element. Proper neighbourhood planning will allow us to protect the green spaces around places such as St Peter the Great and Battenhall in Worcester, which are valued by local people, while going ahead with the development that we need to provide affordable homes. I urge all power to her arm in pressing the case for real neighbourhood plans.

[Harriett Baldwin]

Provided that my hon. Friend’s constituents are consistent with the overall parameters of the local plan and the plan still provides the housing that we need, a neighbourhood plan is an excellent way for local people to have some control over how their villages develop. Villages such as Lower Broadheath in my constituency have been put off by the complication and complexity and the possible powerlessness that they interpret in the current rules. Will the Minister reassure villagers in Lower Broadheath and other parishes that, once they have agreed their neighbourhood plan and won a vote on it in a referendum, it will take precedence over the local plan, even if that local plan has been adopted? Will he elaborate on the remarks made to The Sunday Times this weekend by his colleague, the Under-Secretary of State for Communities and Local Government, my hon. Friend the Member for Grantham and Stamford, who said that he will make the process of neighbourhood planning easier for villages and other neighbourhoods?

What can the Minister say to the octogenarian farmer in my local area who lives in a draughty five-bedroom home, owns land nearby and wants nothing more than to build a bungalow in the field next door for the final years of his life? Under today’s rules, such building is prohibited in open countryside. If a neighbourhood plan permits such single homes inside settlement boundaries, will my farmer have any hope that he can build his bungalow? Will individuals be able to get planning permission to build a single home on land that they own in the countryside? That is how our beautiful villages originally developed. Can a parish put that in their neighbourhood plan?

To conclude, I have come to the view that the planning process still remains extraordinarily baroque and subject to the whim of distant bureaucrats with no stake in the locality. Planning lawyers surely rub their hands in glee at all the legal fees involved. One local parish, Powick, raised £10,000 for its own lawyer. How is that a good use of family budgets? How does it help the economy? In balancing the interests of tomorrow’s population with the interests of today’s home owners and home builders, we are strangling growth in south Worcestershire, preventing house building and stalling construction in my constituency and elsewhere. I look forward to hearing from the Minister about his and the Secretary of State’s plans to unblock the Byzantine process.

16:44

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

I congratulate my hon. Friend the Member for West Worcestershire (Harriett Baldwin) on securing the debate. I should explain at the outset that, although I am speaking on behalf of the Department for Communities and Local Government, I am sure that when she requested the debate, she hoped that the Under-Secretary of State for Communities and Local Government, my hon. Friend the Member for Grantham and Stamford (Nick Boles), would reply, as he is the planning Minister. He is unable to be in London today, so I shall reply to the debate.

I acknowledge the passion with which my hon. Friend the Member for West Worcestershire put her case. I have heard the planning system described in many ways, but the use of the words “baroque” and “Byzantine” in the same speech is quite an achievement. I will try to answer her questions, but I hope she will understand the dual constraint I am under: I am not the planning Minister, but even if I were, due to the quasi-judicial nature of the Secretary of State’s position, I would not be able to comment in depth on some of her points or certain individual cases that she raises.

National planning policy places local plans at the heart of the planning system. Those plans set out a vision and framework for the future development of an area. The Government urge councils to get on with their local plans: 51% have now adopted a local plan and 76% have reached at least publication stage. As my hon. Friend acknowledged, that represents good progress over the past three years. When the Government came to office, only 17% of councils had an adopted plan that complied with the 2004 legislation, which is an extraordinary state of affairs. When I became a Minister in the Department, I was surprised to find that in 2010, 83% of local authorities had not adopted an up-to-date local plan, despite the fact that six years had passed since the legislation. In the general context of what she says, that fact might support the idea that the planning system is both baroque and Byzantine to some of those trying to navigate their way through it.

The purpose of the local plan is to identify what development is needed and assess where and how that can best be delivered. That gives local people more control over the planning decisions that affect them. I cannot comment on the details of the plan in south Worcestershire or housing needs there in particular, because the plan is currently before the Planning Inspectorate. The Government have removed top-down targets for housing delivery. My hon. Friend mentioned the west midlands regional spatial strategy. When I was an MP in the previous Parliament—you may remember this, Mr Hood—Westminster Hall was often full of west midlands MPs, in the case of my hon. Friend, and west country MPs, in my case, complaining about regional spatial strategies and how they had been imposed by fiat from central Government. They were often resisted by MPs of all political complexions. The fact that the coalition Government removed them is welcome.

Targets did not incentivise housing delivery. As a country, there is a significant problem that we must counter: we simply have not been building enough houses to meet our needs. The latest household projections suggest a need for 221,000 homes a year. In the most recent year for which figures are available, 2012-13, the number of first-time buyers in England who were able to buy a home without their parents’ help fell to one third—the lowest level since we began recording such information. My hon. Friends from Worcestershire will have come across that issue when dealing with their constituents. I am sure that we all come across that problem whatever area we represent, whether cities such as mine, more rural areas or a cathedral city such as that of my hon. Friend the Member for Worcester (Mr Walker). I recognise the issue that my hon. Friend the Member for West Worcestershire raised: we desperately need more housing to be built.

[Harriett Baldwin]

I thank the Minister for his opening remarks. I would like to press a particular question. He alluded to the quasi-judicial role of the Secretary of State. I would hate to allege that he is hiding behind that to any extent, but he and the Secretary of State can issue guidance and influence the overall weight given to emerging plans. Will he elaborate on what power the Secretary of State has to try to speed up the delivery of homes, which he has rightly pointed out are needed in our area?

[Stephen Williams]

I will shortly be coming on to the weight that should be given to emerging plans. Assessment of objectively assessed need is not an exact science; the regional spatial strategy proved that. It depends on a number of assumptions about future conditions, so the examination of any local plan must test those assumptions. Agreement on housing need involves difficult decisions, but such decisions bring a security that the plan will steer development to where people agree it should go. If need is underestimated, housing shortages will be perpetuated for decades.

Regarding the methodology for calculating housing need, the draft national planning practice guidance suite has expanded on the requirements for assessing objectively assessed housing need, and aims to provide clarity. To answer a specific point raised by my hon. Friend the Member for West Worcestershire, we are currently considering comments on the guidance and will issue the final guidance shortly. [Interruption.] I hear a snigger coming from a former Minister. None the less, those are the words that I have been given.

[Peter Luff]

Will the Minister give way?

[Stephen Williams]

I will press on for just a moment.

A balance must be struck between applying a fixed methodology and the need to give flexibility to adjust for local circumstances. One methodology is unlikely to suit all circumstances. We favour local flexibility, underpinned by robust evidence of local circumstances.

My hon. Friend the Member for West Worcestershire mentioned C2 accommodation and extra care homes in particular. The planning Minister is certainly aware of that issue. He fully supports the need to ensure that housing for elderly people is properly planned and provided. My hon. Friend the Member for Worcester said that he too wants to see that in his area.

[Mr Robin Walker]

In Worcester, we have a lot of extra care planned. Does the Minister agree, in principle, that where extra care enables people to vacate homes for families, it can be valuable in dealing with the overall housing shortage as well as the housing shortage for elderly people?

[Stephen Williams]

I agree with my hon. Friend, and would extrapolate from that across the Government’s welfare reform policies. One planning decision certainly can have the beneficial effects elsewhere that we are trying to achieve.

The planning Minister is considering whether clarity can be afforded on extra care housing and housing supply in forthcoming planning guidance. The message to my hon. Friend the Member for West Worcestershire is that there are revisions and new guidance in the pipeline. Perhaps the planning Minister will write to her with a timetable on when the guidance will be issued.

The thrust of what my hon. Friend was saying concerned the time taken to put the South Worcestershire development plan in place. Clearly, we all want plans to be put in place as quickly as possible. However, the length of time taken at an examination depends on many factors, including the complexity of the issues and the level of objection. It is quicker in the long run for the inspector to give the council an opportunity to revisit evidence. The alternative is withdrawal from examination, which will leave councils without a plan for a longer period.

My hon. Friend asked some questions about what weight should be given to emerging plans. I cannot comment on the individual cases and areas she mentioned, but I can say that Government policy sets out the fact that plans become more robust as they evolve through the plan-making process. Decision makers, whether they are councils or inspectors, can consider whether they should give weight to emerging policies in local plans. That weight will increase as the plan evolves.

We need to strike the right balance. We cannot have a situation where development decisions are put on hold whenever a plan is in preparation. It would not be sensible to have some form of moratorium on development during that period. It would not be advisable to give draft plans the same weight as an adopted plan. Applying such weight to a draft plan would allow councils to postpone examination, perhaps indefinitely, leaving uncertainty for all concerned. Our draft planning guidance sets out what we think is an appropriate way forward. It establishes the exceptional circumstances under which applications should be considered, but we need to consider carefully the comments made on the draft guidance before reaching a final view.

My hon. Friend mentioned neighbourhood planning, and I am glad that she said that she loves neighbourhood planning. Before I became a Minister in this Department, I was involved with the preparation of the Old Market neighbourhood plan in my constituency of Bristol West—even writing its foreword. I share her enthusiasm for neighbourhood planning, a major reform introduced by the coalition Government in the Localism Act 2011. There is a growing momentum behind neighbourhood plans. I think there are more than 700 plans at the beginning of their journey. At the moment, four have gone all the way to the end—to a referendum.

I asked one of my officials in the Department to show me the voting figures in those referendums. Interestingly, even when the referendum was coterminous—on the same day—with a local government election, the turnout in the referendums was higher than in the election of a councillor for the same area. That shows the enthusiasm of local people in engaging with the process. That is what the Government are all about in this area: trying to grow organic, grass-roots activity to get people involved in shaping their own community.

[Harriett Baldwin]

I appreciate the enthusiasm that the Minister shares with me on neighbourhood planning. What would he say to the parishes in my constituency that are in the process of developing neighbourhood plans and are concerned about the timetable and other obstacles in their way? Will we be hearing in the guidance soon about how the process will—

[Peter Luff]

Shortly.

[Harriett Baldwin]

Is shortly longer than soon? I can never remember.

Will we be hearing in the guidance about how the process will be made simpler, easier, quicker and less complex for smaller villages to develop their plans?

[Stephen Williams]

I will see whether my concluding remarks will satisfy my hon. Friend.

My hon. Friend also asked about the role of Members of Parliament in delivering neighbourhood plans. I have mentioned my own role in my local plan before I became a Minister, and I would certainly encourage all Members of Parliament to take an active interest in neighbourhood planning—not to have a top-down approach, but to involve people. Often as constituency MPs, we know our communities in great detail, so there is a role for us on the ground, perhaps to bring people together and to act as mediators between local businesses, amenity groups, residents groups and local planning authorities.

On the legal status of a neighbourhood plan—my hon. Friend mentioned Lower Broadheath in particular—neighbourhood plans should implement the strategic policies set by the local plan. I appreciate that in this case the local plan is out of date, and where an up-to-date local plan is not in place, the community and the local authority should work together to produce complementary neighbourhood and local plans. The law requires the decision maker to favour the most recently adopted plan where there is any conflict.

Regarding my hon. Friend’s invitation to comment on the planning Minister’s comments in The Sunday Times about putting neighbourhood plans in place, I must say that the planning Minister makes quite a lot of controversial comments in newspaper articles, some of which are not very complimentary about her party leader—or my party leader—but we will not go into that.

We are learning from the process of neighbourhood planning. I said that 700 were in their early stages and four have gone all the way. The Department takes great interest in how the plans develop. I chaired a round table with another Minister recently with all sorts of groups interested in the whole suite of community rights. We are certainly encouraging neighbourhood and campaign groups, such as the Campaign for Real Ale, Supporters Direct and other amenity groups and civic societies, to come forward to give us their experience on how the whole suite of community rights under the Localism Act has been adopted.

Finally, on the farmer and his bungalow, I am afraid that I have to disappoint my hon. Friend and say that I cannot comment on individual cases. However, I suggest that she looks at the Upper Eden neighbourhood plan, which has gone all the way through, to see how people have dealt with that issue.

Question put and agreed to.

16:59

Sitting adjourned.