House of Commons

Thursday 15th January 2015 Commons Chamber

Thursday 15 January 2015

The House met at half-past Nine o’clock

Prayers

Thursday 15th January 2015 Commons Chamber

[Mr Speaker in the Chair]

Oral Answers to Questions

Thursday 15th January 2015 Commons Chamber

The Secretary of State for Culture, Media and Sport was asked—

[Henry Smith (Crawley) (Con)]

1. What estimate he has made of the contribution of tourism to the economy.

[The Secretary of State for Culture, Media and Sport (Sajid Javid)]

The Office for National Statistics estimates that the direct contribution of the tourism sector to the economy in 2013 was £56 billion. Taking account of indirect benefits, Deloitte estimates that in the same year the sector was worth £127 billion gross value added to the UK economy, supporting 3.1 million jobs.

[Henry Smith]

I welcome that response. As my right hon. Friend will know, Crawley contains Gatwick airport, which is a major gateway to the UK. What more can the tourism industry do to ensure that people coming to the UK travel on to other destinations and take advantage of the many benefits and tourist attractions in Crawley and West Sussex?

[Sajid Javid]

My hon. Friend raises an important point. He will be aware that Gatwick is already a major local economic driver, generating some 23,000 jobs at the airport alone, and he is right to ask what more it could do to attract visitors to Crawley and Sussex. He will be aware of Visit Sussex, and I encourage the town to work more closely with that and with Tourism South East, to see what more it can do to show its local attractions.

[Tracey Crouch (Chatham and Aylesford) (Con)]

The Secretary of State will be aware that across Kent tourism accounts for the direct employment of nearly 65,000 people. Tourism VAT rates across the EU are much lower than in the UK, and if VAT on accommodation was reduced to 5% that would boost jobs and bring a further £1 million into Kent. What conversations has he had with the Treasury about the benefits of a future cut to VAT, as that would bring jobs and growth into Kent and the UK as a whole?

[Sajid Javid]

My hon. Friend has raised that issue before and I know she feels passionately about it. She will know that tax is an issue for the Treasury, and we have ongoing discussions with the Treasury on a number of issues. I am sure she will join me in welcoming the fact that in 2013, because of the support the Government have provided to the sector, we saw record levels of tourism, and it looks as if 2014 will be another record year.

[Roger Williams (Brecon and Radnorshire) (LD)]

Tourism is particularly important in rural areas. What can we do to encourage VisitBritain to highlight the excellent hotels, holiday accommodation and visitor attractions in rural Wales, and indeed the entire west of England, to make it a tourist destination for people coming from abroad?

[Sajid Javid]

My hon. Friend is right to say that tourism is vital for local economies, and I have a big ambition to get more people out of the cities and visiting our fantastic countryside. He will be pleased to know that one week from today we will launch the Countryside is Great campaign in New York, with the fantastic Katherine Jenkins performing. That will help make clearer to international tourists exactly what our fantastic countryside has to offer, including in Wales.

[Mr Graham Allen (Nottingham North) (Lab)]

2. What steps he is taking to encourage the development of creative industries to help regenerate outer-city estates.

[The Secretary of State for Culture, Media and Sport (Sajid Javid)]

Economic estimates for the creative industries published this week have shown that the sector plays a leading role in our long-term economic plan. The figures estimated that in 2013 there were 84,000 jobs in the creative industries in the east midlands, and the Government continue to work closely with the sector so that it can produce further jobs and growth across Britain.

[Mr Allen]

Welcome as those figures are, does the Secretary of State agree that there is sometimes an imbalance with the creative industries necessarily being located in the inner cities, city centres and business districts for tourism, heritage and media, and that very few go to the outer-city estates and working-class areas of the sort I represent? I chair the Rebalancing Nottingham North charity. Will he find some time in his busy diary to meet me and discuss how we can balance the expansion of creative industries so that everyone can benefit?

[Sajid Javid]

The hon. Gentleman is right to highlight that important point, and I commend his excellent work in taking forward the Rebalancing the Outer Estates Foundation. He will know that the Arts Council supports many regions around the country and helps with that rebalancing effort, but there is always more we can do, and I or the Minister for Culture and the Digital Economy would be happy to meet him to take that issue forward.

[John Robertson (Glasgow North West) (Lab)]

The BBC has an excellent building in Glasgow, as does STV, and a lot of money has been put in by these large companies. One thing that has been missed is localism within the creative industries, and although a certain amount of action is supposed to take place outside the M25 corridor, we are not seeing that north of the border.

[Sajid Javid]

I referred earlier to a report published this week, which shows strong growth in the creative industries throughout the UK in every region, including Scotland. I encourage the hon. Gentleman to take a look at it. If he has any fresh ideas that he thinks we should look at, I would be happy to speak to him.

[Kerry McCarthy (Bristol East) (Lab)]

3. What discussions he has had with the Chancellor of the Exchequer on the effect on musicians and other creative professionals of EU proposals to change the way VAT is charged on digital services.

[The Minister for Culture and the Digital Economy (Mr Edward Vaizey)]

The changes relate to the announcement in the 2013 Budget and came into effect on 1 January 2015. Her Majesty’s Revenue and Customs established an external working group to consider their effect on small and medium-sized businesses. The Treasury and HMRC are actively engaging with it.

[Kerry McCarthy]

I thank the Minister for that response and for agreeing to reinstate the question after his officials tried to transfer it to the Treasury. That was very kind of him. As he will know, musicians are very concerned that they will end up having to fill out quarterly VAT returns for very small sources of income. If they sell their music through iTunes or Bandcamp, they will perhaps do the administration for them, but it is a real issue if musicians have to handle it themselves. I urge the Minister to take part in those discussions with the Treasury and ensure that the voices of musicians and other people in the creative sector are heard.

[Mr Vaizey]

I would never dodge a question from the hon. Lady, particularly as she represents the constituency of Bristol East, where I stood famously in the 1997 election and turned a 5,000 Labour majority into a 17,000 Labour majority. The changes will protect and increase revenue. The hon. Lady is a great champion for the music industry. I take on board her point and I will certainly engage with HMRC.

[Siobhain McDonagh (Mitcham and Morden) (Lab)]

4. If he will discuss with Ofcom steps to ensure that television programmes which contain promotion of hatred against Ahmadi Muslims cannot be received in the UK.

[The Minister for Culture and the Digital Economy (Mr Edward Vaizey)]

Ofcom has strict rules, set out in the broadcasting code, forbidding the broadcast of harmful extremist material and hate speech. This includes the promotion of hatred against the Ahmadi Muslim community, which is well represented in the hon. Lady’s constituency.

[Siobhain McDonagh]

On 22 December, Geo TV broadcast a programme that incited hatred against the Ahmadi Muslim community. Five days later, an Ahmadi Muslim was murdered in Gujranwala, Pakistan. We know that Ofcom has an enormous job to do, given the large number of satellite TV channels, in many languages and dialects, that come into the UK. What help can the Government give Ofcom to monitor hatred that might lead to the radicalisation of some of our young people in the UK?

[Mr Vaizey]

Ofcom does important work in this area. It is worth recording that it fined Takbeer TV £25,000 for abusing Ahmadis. Ofcom has also required it to broadcast a summary of that decision. Ofcom is investigating complaints that have been raised recently. It will assess them as quickly as possible and come to a conclusion.

[Ms Harriet Harman (Camberwell and Peckham) (Lab)]

After the horrific murders in France last week, it has never been more important unequivocally to assert our commitment to the right of free speech and a free press, and the right to be provocative and even offensive, including the right to lampoon religion. After last week, however, the reality is that a shadow hangs over broadcasters, bloggers, journalists and satirists. They and their staff should not have to look over their shoulder, fearing violence. Will the Minister tell the House what the Secretary of State has done to reassure them not only of the Government’s in-principle support, but that every step is being taken to give them the security they need to exercise their rights in our democratic society? Has the Secretary of State spoken directly with the media about their concerns? What discussions has the Secretary of State had with the Prime Minister and the Home Secretary?

[Mr Vaizey]

The Secretary of State made very clear his views in an article in The Times on Saturday. I commend that article, and his very clear commitment to free speech and freedom of expression, to hon. Members. The security of the media and all citizens is a vital issue, one that the Prime Minister and the Home Secretary take extremely seriously. As Ministers in the Department for Culture, Media and Sport, we will play our part in working with them to ensure the appropriate levels of security for anyone who champions freedom of expression.

[Ian Lucas (Wrexham) (Lab)]

5. What assessment he has made of the potential benefits of the introduction of a local television service in north-east Wales.

[The Minister for Culture and the Digital Economy (Mr Edward Vaizey)]

Local TV will increase the range and availability of local news, information and other local programming. Ofcom awarded the local TV licence for Mold, which covers parts of north-east Wales, in January 2014. The successful bidder for the licence, Bay TV, has two years from the licence award to begin broadcasting.

[Ian Lucas (Wrexham) (Lab)]

The licence granted does not cover Wrexham, which is the largest town in north-east Wales. MPs from all parties in north Wales support the extension of the current licence to cover the largest population centre, which all parties believe would be in the best interest of improving the very limited broadcasting that exists in north Wales—we have no BBC local radio, for example. Will the Minister please meet north Wales MPs in order to take this forward?

[Mr Vaizey]

I know that the hon. Gentleman and, indeed, other MPs met Ofcom at the end of last year. There are some technical difficulties involved in broadcasting to Wrexham. Unfortunately, because of those technical difficulties to do with spectrum, local TV cannot broadcast in all areas. I know that Ofcom will write to the hon. Gentleman. I would, of course, be delighted to have a meeting with him and any other interested MPs to discuss the issue further.

[Mr Jim Cunningham (Coventry South) (Lab)]

6. If he will discuss with the organisers of the Rugby World Cup the use of non-playing facilities at the Ricoh arena for events connected to that tournament.

[The Parliamentary Under-Secretary of State for Culture, Media and Sport (Mrs Helen Grant)]

The selection of host city venues and team training camps is a matter for England 2015, the tournament organisers.

[Mr Cunningham]

Is the Minister aware of the wonderful facilities at the Ricoh arena in Coventry, particularly for sport? There are also restaurants and tourist facilities there. I would like to say that Ministers have been very helpful to Coventry in respect of the Charterhouse project for tourists.

[Mrs Grant]

I do know of the wonderful facilities in Coventry, and I am confident that there will be opportunities for Coventry to benefit from England hosting the rugby world cup. That could include participation in the domestic trophy tour in the Festival of Rugby. I recommend that local authority venues in cities, including the Ricoh arena in Coventry, continue to discuss opportunities with England Rugby 2015.

[Tom Greatrex (Rutherglen and Hamilton West) (Lab/Co-op)]

7. What progress has been made by the Government’s Expert Working Group on Football Supporter Ownership and Engagement Group.

[The Parliamentary Under-Secretary of State for Culture, Media and Sport (Mrs Helen Grant)]

The group had its first meeting on 25 November and shortly after issued a call for evidence. I expect to publish its initial findings in the coming months and a full report later this year.

[Tom Greatrex]

I am pleased that although it has taken since 2011, when one of the Minister’s predecessors promised it would happen, the working group is now finally up and running. She will be aware of the concern of many football fans—I declare an interest as a Fulham fan—that their club grounds are potentially worth more for purposes other than football and there is uncertainty about clubs maintaining their links with their communities. Fortunately for Fulham, despite misguided property speculators and ill-advised owners in the past, we have managed to survive at Craven Cottage, which is an iconic football ground and part of the English football fabric. Is the Minister aware of the concerns of fans, and does she think it is a good idea to have statutory consultation, ensuring that any change of use of football grounds is done with the fans in mind to protect grounds from asset stripping?

[Mrs Grant]

There were a few issues in that question. The hon. Gentleman makes an important point. This expert group is being set up so that fans can air their views. It will give them profile and a good platform. I am sure that issues such as this will be raised and reported to me in due course. I would be happy to meet the hon. Gentleman to discuss his point in more detail.

[Mr John Leech (Manchester, Withington) (LD)]

This year marks the 10th anniversary of the controversial Glazer family takeover at Manchester United—against the wishes of the vast majority of United fans. This saddled the club with vast debts to pay for the takeover. Does the Minister agree that football clubs and their supporters should be better protected from these predatory takeovers that can threaten the long-term viability of many of our football clubs?

[Mrs Grant]

The hon. Gentleman makes an important point, and responsible club ownership is important to all of us. The football authorities take it very seriously, and I am pleased that the owners and directors test has been strengthened. Following two debates here late last year, I asked the football authorities if there was a way of tightening this important test.

[Kevin Brennan (Cardiff West) (Lab)]

Is not the importance of listening to fans and of supporter engagement shown by the welcome decision taken by the Cardiff City board to put Cardiff City back in blue? I was delighted to be there on Saturday to see the club beat Fulham 1-0—in their traditional blue colours.

[Mrs Grant]

Blue is one of my favourite colours. [Hon. Members: “Hear, hear.”] Fans are the lifeblood of football and it is important that they are engaged with and listened to.

[Mr Barry Sheerman (Huddersfield) (Lab/Co-op)]

8. What steps he is taking to increase investment in film, theatre and the arts in the UK.

[The Secretary of State for Culture, Media and Sport (Sajid Javid)]

The Government have an excellent record of creating new opportunities for investing in the arts and creative industries. Following the success of UK film tax credits, which have generated billions in investment since 2010, we have introduced new tax reliefs for TV, video games, animation and theatres, and continue to invest in skills and innovation.

[Mr Barry Sheerman (Huddersfield) (Lab/Co-op)]

Huddersfield Town, one of the most famous football clubs, plays in blue as well.

There are some very good things going on in the arts, such as the international film awards. But the community arts scene, certainly in places such as Yorkshire, is really feeling the pinch. A lot of our talent starts off in little community groups and grows but there is an absolute desert at the grass roots of the arts for lack of funding.

[Sajid Javid]

First, I welcome the hon. Gentleman’s support for what has been achieved in the arts under this Government. He makes a good point. If I remember correctly, he raised recently the issue of social investment tax relief, which can help community arts activities as well as other charitable activities. He had called for an increase in the cap and he will know that the Chancellor announced just that in the last autumn statement. He can see from that that the Government are listening and doing what we can to help community arts.

[Miss Anne McIntosh (Thirsk and Malton) (Con)]

I congratulate the Government on their investment through tax credits and the wonderful boost that that has given to the UK film industry. Will he join me in celebrating the investment made by small cinemas such as the Ritz in Thirsk and the Palace in Malton to bring digital cinema to a wider rural community and giving people a great night out?

[Sajid Javid]

I support everyone having a great night out and if the Government can help with that, it is a good thing. But seriously Mr Speaker, my hon. Friend is right to point out the support that the Government have provided to the film industry. Just in the last year, the Government have helped support over 300 films made in the UK with expenditure of almost £3 billion across the country, which is a good thing for us all.

[Simon Danczuk (Rochdale) (Lab)]

Does the Secretary of State agree that one way to increase investment in the creative industries is through retransmission fees? Where are we with the consultation on those fees?

[Sajid Javid]

We will be launching a consultation within weeks on this issue. I have spoken about it before, the last time being at the Royal Television Society. I agree that it is an important issue that has not been looked at for years. It is about time we did.

[Mr Philip Hollobone (Kettering) (Con)]

9. What progress he has made on improving mobile telephone coverage in (a) Northamptonshire and (b) England.

[Sajid Javid]

Last month we reached a landmark agreement with mobile operators to deliver improvements across the UK by 2017, including in England. This locks in £5 billion of investment and each operator will cover at least 90% of the UK landmass.

[Mr Hollobone]

Not spots are particularly frustrating not only for those who live in isolated villages where mobile phone coverage is often essential, but for those who are on the move by road or by train. What is the Secretary of State doing to tackle the problem of not spots?

[Sajid Javid]

My hon. Friend is right to raise the issue of trains and communications, which is why the Government have made a commitment to improve connectivity on trains. He may be aware that Network Rail is in the middle of a competition to work out the best solution to the problem. On Government support, my right hon. Friend the Secretary of State for Transport announced a few months back £53 million of funding for the programme, with money that Network Rail was supposed to return to the Government. I will also ask my right hon. Friend to give my hon. Friend an update.

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

The Secretary of State has taken some bold steps to push mobile telephone companies to increase coverage in not spots. However, even in areas such as mine in Shoreditch, with mobile coverage, wi-fi and broadband, there is a real issue about planning permission for buildings that are tall enough to allow other technologies to flourish. Will he update the House on conversations he is having or will be having with the Secretary of State for Communities and Local Government about changing planning permission to allow these other technologies to flourish?

[Sajid Javid]

The hon. Lady has raised an important issue. We are having ongoing discussions, and we have ongoing plans to improve the situation. As the hon. Lady may know, the deal that was announced last month with mobile phone operators included an agreement by the Government to give them access, at market prices, to Government-owned property on which we have the freehold, and I think that that is a positive step.

[Mr Nigel Evans (Ribble Valley) (Con)]

It seems rather bizarre that commercial airlines flying over the Ribble valley are now able to use mobile phones, while, below them, rural parts of my constituency have no coverage whatsoever. Will the Secretary of State encourage mobile phone operators to use the new technologies that are available, to ensure that rural England has full coverage?

[Sajid Javid]

My hon. Friend is right, but, as he will know, although the deal announced last month is voluntary, it is binding on each of the operators because of licence changes that are to be made. It will massively increase coverage throughout the United Kingdom, halving the number of what are known as partial not spots, and reducing the number of total not spots by two thirds. There will be improved coverage of data as well as voice.

[Chris Bryant (Rhondda) (Lab)]

Members on both sides of the House have rightly pointed out that not spots are not only infuriating for individuals but bad for businesses, especially small businesses, in many cities as well as rural areas. Unfortunately, the Government left it until the dying moments of this Parliament before taking action. What the Secretary of State described a moment ago as a landmark agreement is falling apart. Will he confirm that mobile network operators have told him, as they have told us, that he has reneged on the promises that he made about the electronic communications code—the amendments to the Infrastructure Bill that he has tabled at the last minute are wholly inadequate—and that he cannot tell the taxpayer whether this will cost us all £1 billion in lost revenues to Ofcom? Is not the truth of the matter that we now need a Labour Government to do the job properly?

[Sajid Javid]

Some things never change. I am afraid that the hon. Gentleman is clutching at straws. He has a reputation for opposing everything that comes before him, even if it is blindingly obvious that it will be great for everyone in the country. Given that he is new in his present role, having been kicked out of his old one, and that it is the start of a new year, we thought that he might have turned over a new leaf, but no such luck. I am sure, however, that he is intelligent enough to look at the deal carefully, and when he does so, he will see that it is a good result for everyone in the United Kingdom—including his constituents, who currently have some of the worst mobile phone coverage in the country.

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

10. What assessment he has made of the effect of government spending on culture and the arts outside London.

[The Minister for Culture and the Digital Economy (Mr Edward Vaizey)]

Normal service is now resuming.

The Government strongly support the fair distribution of funding for culture and arts throughout the country to increase opportunities for access and participation. We recently announced new cultural investment in the north of England. The Arts Council intends to build on its current trend of 60% grant in aid and 70% lottery investment outside London. That will, of course, include Hull, which will become the UK city of culture in 2017.

[Diana Johnson]

Despite the continuing imbalance of arts funding in favour of London, I am pleased that Rosie Millard and Martin Green are to lead our preparations for 2017. They are doing an excellent job. Will the Minister tell me, however, what discussions he has had with the Secretary of State for Communities and Local Government about the disproportionate cuts that Hull has suffered under his regime—I believe that a further £24 million was cut in December—and about the impact that they will have on Hull’s ability to lead our national celebrations in 2017?

[Mr Vaizey]

The hon. Lady’s question raises the much wider issue of the work that the Government are having to do to clean up the chaos and mess left by the Labour Government and balance the books. It is highly hypocritical—that is, it is very odd to hear her mention this matter, given that Labour Members trooped through the Lobby with us to secure the cuts that were necessary to balance the budget in the next three years.

We cannot put up with the chaos that is emanating from the Labour Benches. Last week they were tweeting that they supported cuts in the arts, boasting about them, while at the same time pretending that they opposed them.

[Robert Halfon (Harlow) (Con)]

Is my hon. Friend aware that Harlow is the cultural oasis of the east of England? We have the Gibberd gallery, the beautiful Parndon mill, the Harlow museum and much more besides, and we are also a sculpture town. Will he consider what he can do to support our beautiful town and culture and arts in Harlow?

[Mr Vaizey]

The first thing we need to do is designate my hon. Friend as a national treasure, and the second thing I am going to do is send the Secretary of State to Harlow. He will be visiting shortly.

[Mr Speaker]

Well, the junior Minister clearly has a keen sense of his own power.

[David Rutley (Macclesfield) (Con)]

12. What steps he is taking to support outdoor recreation.

[The Parliamentary Under-Secretary of State for Culture, Media and Sport (Mrs Helen Grant)]

Via Sport England, we invest nearly £70 million each year in outdoor sporting activities, and through VisitEngland and VisitBritain we will be promoting visits to the great outdoors through our “Countryside is Great” campaign.

[David Rutley]

Given the importance of tackling the increasing challenge of physical inactivity and given the potential of tourism in rural communities, does my hon. Friend agree that this is a good time to consider establishing a national strategy for outdoor recreation to sit alongside the Government’s successful sports strategy, to get more people active outdoors?

[Mrs Grant]

I agree absolutely with my hon. Friend that outdoor recreation is fantastic for our country, and we very much appreciate the work he does in promoting the benefits. I have had several meetings across Government on this issue, and I am engaging with the sector more widely. I will present more on this vision soon, and will be happy to update him in due course.

[Derek Twigg (Halton) (Lab)]

What are the Government doing to encourage more women and girls to get involved in outdoor recreation and sport? There is a particular problem of girls leaving school and never doing sport again.

[Mrs Grant]

We are doing a lot to get girls participating in sport and outdoor activity—I am sure the hon. Gentleman has heard of the £10 million Sport England “This Girl Can” campaign, which was launched this week. It is a cutting-edge consumer campaign aiming to normalise sport and outdoor activity, and I think it will do very well in increasing participation, and also deal with the health and emotional well-being issues that we have got to get to grips with.

[Caroline Dinenage (Gosport) (Con)]

Will the Minister join me in sending our support and condolences to Alex Thomson from Gosport, the yachtsman who was dramatically demasted last night while leading the Barcelona world race? Fortunately, none of the crew was hurt. In a place such as Gosport, where we have a world-class marine scene, he is one of our true champions.

[Mrs Grant]

I am very sorry to hear about that, and my thoughts and prayers go to him and his family and friends.

[Clive Efford (Eltham) (Lab)]

I join the Minister in welcoming the Sport England “This Girl Can” campaign designed to encourage more women and girls to get active, but in order to have a lasting impact we must inspire the next generation, so she must feel shamed by the Youth Sport Trust survey figures published yesterday showing a fall in the time spent by children doing sport in schools since 2010. It is too late to put things right at the fag-end of this Parliament, but is it not clear that this Government squandered a golden legacy in sport and failed to inspire the next generation?

[Mrs Grant]

I cannot believe what I am hearing. We have more young people participating in sport now than we did when we bid for the Olympics in 2005, we invest £450 million in the school sport premium, which ignites an interest in sport from an early age, we invest £150 million in school sports, which brings competition back into schools, and we have nearly 17,000 schools participating, so I really do not recognise the very gloomy picture the shadow Minister is desperately trying to paint.

[Sheila Gilmore (Edinburgh East) (Lab)]

13. What recent steps he has taken to tackle nuisance calls.

[The Minister for Culture and the Digital Economy (Mr Edward Vaizey)]

In spring last year we published the first ever nuisance calls action plan, which includes both legislative and other proposals to tackle the problem, so we are taking measures. We have, for example, recently consulted on lowering—or, indeed, removing—the legal threshold for the Information Commissioner’s Office, and we will be publishing our response to that consultation very soon.

[Sheila Gilmore]

I thank the Minister for that reply, but there is an insufficient sense of urgency on this. To some people these calls are not merely a nuisance; particularly for older people, they are a source of great distress, worry and anxiety, to the extent that some people will not answer their landlines at all, which is a safety issue in some cases. What are we doing to address the fact that existing regulations are not strong enough, which results in our getting all these robot calls and calls from people supposedly doing surveys? What are the Government going to do about that?

[Mr Vaizey]

I regularly meet a range of stakeholders involved in this matter. We have allowed the ICO and Ofcom to share information, and we are going to lower or remove the threshold for taking action. We have also massively increased the level of fines that can be levied. We work with telecoms companies on technology solutions and we have worked with the consumer group Which? on a range of reforms. Only yesterday, I met the hon. Member for Edinburgh West (Mike Crockart) to talk about how we can help vulnerable people with call-blocking technology, so we are engaged with this issue.

[Mr David Nuttall (Bury North) (Con)]

The Minister referred to the nuisance calls taskforce report prepared by Which? on the Government’s behalf, which was published last month. He and I were at the report’s launch. Has he found its 15 recommendations useful, and if so, what plans does he have to implement them?

[Mr Vaizey]

We work closely with Which? on this issue, and I was delighted to see my hon. Friend at the launch of the report. It contains a number of recommendations, which we are looking at, and I am particularly taken by the idea of holding members of the board of a company responsible for this issue, so that someone is accountable. We will evaluate the recommendations and implement those that are suitable.

[Douglas Carswell (Clacton) (UKIP)]

14. If he will increase sources of private finance and sponsorship for museums and galleries.

[The Secretary of State for Culture, Media and Sport (Sajid Javid)]

This Government have done more than any of their predecessors to cultivate philanthropy and corporate sponsorship in support of our cultural sector. I commend all those individuals, businesses, trusts and foundations that support museums and galleries across the country.

[Douglas Carswell]

Museums and galleries right across the country—not just those in London—have never been busier or more successful. Does the Secretary of State agree with the principle of more tax breaks to encourage philanthropic support, and should the magnificent approach taken by the British Museum be encouraged by introducing wider tax breaks elsewhere?

[Sajid Javid]

The hon. Gentleman makes an important point. Tax breaks are part of the incentives and the action that the Government can take to encourage more giving. The cultural gift scheme is an example, as is the increase in the annual cap on tax relief that the Government have implemented. We have also simplified the gift aid scheme, but there is always more that we can do. If he has any ideas, I would be happy to listen.

[Andrew Jones (Harrogate and Knaresborough) (Con)]

T1. If he will make a statement on his departmental responsibilities.

[The Secretary of State for Culture, Media and Sport (Sajid Javid)]

The year 2014 ended on a high note for the Department as we secured a landmark deal to improve mobile phone coverage right across the UK. The new year has also got off to a good start: official figures released this week show that Britain’s creative industries grew at a rate of almost 10% in 2013 and delivered 66,000 new jobs. This is further proof that culture has a vital role to play in the Government’s long-term economic plan.

[Andrew Jones]

I thank my right hon. Friend for that answer. Superfast North Yorkshire has done a great job of rolling out superfast broadband across our county, making it one of the best connected in the country. I am now pressing for as many business parks as possible to be included in future plans. Does my right hon. Friend agree that it is vital for as many small and medium-sized businesses as possible to have access to superfast broadband so that they can conduct their business as efficiently as possible?

[Sajid Javid]

My hon. Friend has taken a strong interest in this issue on behalf of his constituents and I agree with him wholeheartedly. He is right to praise Superfast North Yorkshire; the project is making excellent progress. Phase 1 is expected to complete in March this year, taking coverage in the county to 87%. Phase 2 will increase coverage to 89%.

[Fiona Mactaggart (Slough) (Lab)]

T4. When research by the Responsible Gambling Trust reveals that a third of fixed-odds betting terminal users have a problem with gambling, is it not time to end the £100 maximum stake, which means that a person in my constituency can spend his whole income in just four spins?

[The Parliamentary Under-Secretary of State for Culture, Media and Sport (Mrs Helen Grant)]

I know that the hon. Lady is concerned about these issues, and so am I. The Responsible Gambling Trust report endorsed the precautionary approach that we took in April, when we introduced proportionate and measured reforms that gave local authorities more power. I can also tell her that I shall be meeting the chief executives of all the betting industry companies in a few weeks’ time to see what more they are prepared to do.

[Mary Macleod (Brentford and Isleworth) (Con)]

T2. The Minister with responsibility for sport visited Osterley and Chiswick on Monday to meet some of Brentford football club’s community sports trust’s fantastic apprentices. Does the Secretary of State agree that apprenticeships in sport are incredibly valuable for building the knowledge and skills needed for a successful career in the industry, and that we should encourage even more of them?

[Sajid Javid]

I know that Brentford is having probably one of its best years on the pitch. I am pleased to say that the club has done excellent work off the pitch too, which the Under-Secretary, my hon. Friend the Member for Maidstone and The Weald (Mrs Grant), went to see for herself. I agree with my hon. Friend the Member for Brentford and Isleworth (Mary Macleod) on the importance of apprenticeships in sport and the great opportunity they offer for individuals to develop important skills. That is why I am pleased with the support that Sport England already provides. Brentford FC is a good example to many others, showing what clubs can do to help their local community.

[Pat Glass (North West Durham) (Lab)]

T5. The Minister and I entertained one another in a debate on nuisance phone calls about 18 months ago, when his response was, “It’s okay, guys. I’m on top of this. Something’s going to happen really quickly.” Since then we have had an action plan and lots of talking, but nothing has changed. When will he commit to a communications Bill to deal with the problem?

[The Minister for Culture and the Digital Economy (Mr Edward Vaizey)]

I remember our entertaining exchange, and I take exception to the accusation that nothing has happened. We have already passed one piece of legislation and we are about to put through some more legislation to bring about some of the changes that people have called for. We do a lot of work with companies and with telecoms companies, and we have made a real impact on nuisance calls.

[Pauline Latham (Mid Derbyshire) (Con)]

T3. What assessment has my hon. Friend made of the roll-out of superfast broadband in Mid Derbyshire, especially in Oakwood, Belper and Morley, where Morley school, for instance, cannot teach the national curriculum properly using the internet because of the unreliability? [Interruption.]

[Mr Vaizey]

Members on the Labour Front Bench are saying that the situation is absolutely fine and it is completely marvellous. I would not go that far, but that is a good assessment of our rural broadband programme. I know that in Belper, for example, at the end of last year 1,500 premises were connected, thanks to the rural broadband programme. I hear what my hon. Friend says about Morley school and I will be happy to engage with her on the specifics of that issue.

[John Robertson (Glasgow North West) (Lab)]

T7. Superfast broadband seems to be a popular topic today. Does the Minister agree with the BT group strategy, policy and portfolio director that getting superfast broadband to 95% of the country might take until 2018? This was stated in an answer from the Department for Environment, Food and Rural Affairs on 3 December. The gap between superfast broadband availability—73%—and take-up is 21%, so there is a shortfall of 52%. Does the Minister agree that superfast broadband might be priced just a little too high? What is he doing to close the gap between the 21% and the 73%?

[Chris Bryant]

Absolutely nothing.

[Mr Vaizey]

I do enjoy the running commentary that we get from the hon. Member for Rhondda (Chris Bryant) throughout questions. Like the Duracell bunny, will he ever run out of energy? It is really impressive.

In this country we have some of the lowest costs for superfast broadband, but I know that the hon. Member for Glasgow North West (John Robertson), along with the hon. Member for Rhondda, will welcome our fantastic advertising campaign for superfast broadband, which I hope will bridge the gap between availability and take-up.

[Nick Herbert (Arundel and South Downs) (Con)]

T6. There are too many rural communities in my South Downs constituency that have no broadband access. West Sussex county council’s plan to achieve 95% superfast coverage by 2017 is excellent, but is it not important to ensure that the remaining 5%, which will cover many rural areas, have digital access? Public subsidy should be directed at those areas first.

[Mr Vaizey]

We are doing well in my right hon. Friend’s part of the world. West Sussex will get 94% superfast broadband coverage by the end of phase 1. That is £12 million worth of investment. My right hon. Friend is an experienced parliamentarian and I take what he says very seriously.

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

As we are well into the 100-year commemorations of the first world war, will the Minister assure the House, veterans in my area and my local armed forces network that she will ask Sky to reconsider the scheduling of the broadcast of matches on Remembrance Sunday, which has happened in Sunderland two years in a row, and instead schedule the games for the Saturday so as to respect the original intentions of that special day—remembering those who gave their lives for our country?

[Mrs Grant]

It is a very special day and it is important always to remember those who sacrificed their lives for our country. I am very happy to have a discussion with the hon. Lady about those issues.

[Rory Stewart (Penrith and The Border) (Con)]

T8. I thank the Secretary of State very much for the focus that has gone on broadband in Cumbria. We have, however, faced a serious challenge with the European regional development fund. May I have his assurance that we will focus relentlessly on overcoming those problems to make sure that we can get the extension and deliver the broadband, as promised?

[Sajid Javid]

My hon. Friend has been working very hard on this issue, and I commend him for the work he has done on behalf of his constituents and for bringing this matter to my attention again and again. My Department is working closely with the Department for Communities and Local Government, Cumbria county council and BT to ensure that the problem is resolved. I can also tell him that, following initial discussions, I am confident that the project can be fully delivered to give a great result for residents and businesses in Cumbria.

[Kerry McCarthy (Bristol East) (Lab)]

Channel 4 has just launched its 360° charter, which is making a real commitment to improving diversity, to the extent that executives will lose their bonuses if they do not meet the targets. What is the Secretary of State doing to ensure that other companies follow suit?

[Sajid Javid]

The hon. Lady rightly raises a very important point. My hon. Friend the Minister for Culture and the Digital Economy was at that launch. I have spoken a number of times about seeing more diversity in the media. For example, I talked about it just last month on Radio 4, mentioning both the work that Channel 4 is doing, which is a huge improvement on the past, and that done by the BBC, Sky and others. More can always be done, and if the hon. Lady also has some ideas, I would be happy to talk to her.

[Mr David Heath (Somerton and Frome) (LD)]

I often ask questions about the provision of high-speed broadband in rural areas, but mobile phone coverage is just as bad. If I want to get a signal in my house, I have to clamber up on top of the kitchen unit or else trudge up the lane. Does the Minister realise that when we talk about 90% or 95% coverage, the 10% or 15% of people who are left out are always the same people—the people who live in rural Britain?

[Mr Speaker]

I think the House is worried about that kitchen unit.

[Mr Vaizey]

As part of our commitment from the Department of Health to get Britain moving, we might have to leave my hon. Friend’s home out of our rural broadband roll-out, so that he keeps moving about the house rather than taking calls from a sedentary position. [Interruption.] I am waiting to establish what point the Labour Front-Bench team are trying to make.

[Chris Bryant (Rhondda) (Lab)]

We want you to speed up!

[Mr Vaizey]

They want me to speed up. I can take as long as you want, Mr Speaker. As has been repeatedly stated from this Dispatch Box, a landmark deal at the end of last year with mobile phone companies will see partial not spots reduced by two thirds and not spots reduced by half.

[Derek Twigg (Halton) (Lab)]

May I return to the question I asked the Under-Secretary about sport? Clearly there is a problem with getting young people to continue to take part in sport once they leave school, and that is particularly the case for young girls. She referred to a number of programmes, so may I ask her how her Department is monitoring whether there has been a significant increase in the number of young people, particularly girls, taking part in sport after they have left school?

[Mrs Grant]

Our £1 billion youth and community strategy is helping to make sure that more young people, especially girls, participate in sport. Sport England is also running a very good campaign, the satellite community sports club campaign, which tries to bridge the gap between young girls doing sport at school and continuing to do those sports in the community when they leave school.

[Philip Davies (Shipley) (Con)]

After the great success of the Tour de France in Yorkshire last year, which gave an estimated £100 million boost to the Yorkshire economy, is the Secretary of State as excited as everybody else in Yorkshire about the route to be declared next week for the Tour de Yorkshire, the new international cycling race which is being introduced? Will he join me in congratulating Gary Verity on the role he has played in organising that, as well as on bringing the Tour de France to Yorkshire, and support my campaign for him to receive a knighthood in the next honours list?

[Sajid Javid]

I agree very much with what my hon. Friend says. I remember visiting the Tour and being hugely impressed by the participation; people of all ages turned out for that spectator sport. It has been a great thing for Yorkshire and the new initiative is very welcome. I very much agree with his comments about what Gary Verity has achieved for Yorkshire; my hon. Friend’s point should be looked at.

The Minister for Women and Equalities was asked—

[Mr Barry Sheerman (Huddersfield) (Lab/Co-op)]

1. What steps she is taking to promote equality of opportunity for women in the workplace.

[The Minister for Women and Equalities (Nicky Morgan)]

Women make up almost 47% of the work force, but their representation falls in more senior positions. We want to ensure that women can take advantage of all the opportunities that their workplace offers them. For example, we are ensuring that parents can balance work and family life through measures such as extending flexible working and introducing shared parental leave and tax-free child care. We are also working with business to implement the recommendations in the Lord Davies report.

[Mr Sheerman]

May I push the Minister on that? We still lag behind France and the Scandinavian countries in how we allow women to release their potential as managers, members of corporation boards, scientists and engineers. We are lagging behind the competition, so why did she and her party not support the Bill promoted by my hon. Friend the Member for Rotherham (Sarah Champion) which would at least have provided equal pay in the workplace?

[Nicky Morgan]

The hon. Gentleman knows that the gender pay gap has narrowed again under this Government. For workers under the age of 40 it has almost been eliminated. He also knows that there are more systemic reasons for the continuing pay gap between men and women. Part of that is about the inspiration and advice that our young women get when they are at school. I am talking about the options, the careers and the subjects that they should be taking. That is a long-term systemic problem, which is part of the reason why, as Secretary of State for Education, I announced before Christmas that we were backing an independent careers enterprise company.

[Mary Macleod (Brentford and Isleworth) (Con)]

This Government have made the most progress ever on increasing the numbers of women on boards, but does the Secretary of State agree that it is still unacceptable to have only five female chief executives in the FTSE 100? Does she believe, as I do, that there is more to be done on the executive pipeline?

[Nicky Morgan]

I very much agree with my hon. Friend. We need only 24 more women on boards to reach Lord Davies’ target of 25% of women on FTSE 100 boards. We now have no all-male boards in the FTSE 100. It is important to bear in mind that not all women want to become FTSE 100 board directors, but we should ensure that equality of opportunity goes right the way through all our workplaces.

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

On promoting equality, what will the Minister do about the 91% drop in claims for sex discrimination that have gone to an employment tribunal since her Government introduced the fee of £1,200 to take a case?

[Nicky Morgan]

In 2011-12, there were 1,700 employment tribunal claims which included, for example, maternity rights-based claims. Of those, 900 were ACAS-conciliated, 120 were successful at hearing and 430 were withdrawn. A claim can be launched with a payment of just over £200. It is right that people still have the option to go to employment tribunals, but the fact that the ACAS numbers are so high shows that it is possible to reach agreement between employers and employees.

[Pauline Latham (Mid Derbyshire) (Con)]

Does my right hon. Friend agree that greater transparency on pay is vital in giving women in my constituency the best chance to reach their potential?

[Nicky Morgan]

I very much agree that transparency is extremely important, which is why this Government have backed the Think, Act, Report initiative that encourages companies to think very hard about equality and diversity, including pay, right the way through their organisations. We now have more than 270 employers signed up covering 2.5 million employees.

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

2. What assessment she has made of the implications for her policies of the appointment by the Church of England of its first female bishop; and if she will make a statement.

[The Minister for Skills and Equalities (Nick Boles)]

I thank my hon. Friend for his question and I congratulate Libby Lane on becoming the new Bishop of Stockport and the first female bishop in the Church of England. I am delighted to see the Church of England moving into the 21st century, at least in this respect.

[Mike Freer]

Does the Minister agree that at last we have a great role model for the Church of England and girls in this country?

[Nick Boles]

I do agree with my hon. Friend. Role models such as Libby Lane are very important, which is why the Government are supporting schemes such as “Your Life” and “Inspiring Women”, which is led by the formidably impressive lawyer, Miriam Gonzales. I believe that her husband has a job, too, but I think we can all agree that she is the role model in that family.

[John Howell (Henley) (Con)]

3. What steps she is taking to close the gender pay gap.

[Mr Nigel Evans (Ribble Valley) (Con)]

6. What steps she is taking to close the gender pay gap.

[The Secretary of State for Education (Nicky Morgan)]

The gender pay gap is at its narrowest ever and has been entirely eliminated among full-time workers under the age of 40. Of course the gender pay gap is still too wide, which is why we are closing it further by encouraging girls and young women to consider a wider range of careers, including well-paid careers in technology and engineering.

[John Howell]

Does the Minister agree that closing the pay gap further means that businesses could still do more to ensure that they recruit, retain and promote the best women?

[Nicky Morgan]

I agree with my hon. Friend. Successful businesses know that they cannot afford to miss out on the talents and experiences of half our population, and the Government are working closely with business on that, especially through the Women’s Business Council, which was established by this Government in 2012. We are helping businesses to ensure that women can fully contribute to the country’s economic growth.

[Mr Evans]

It is great that the pay gap has been eradicated for women under the age of 40, but if a woman happens to be aged between 40 and 49, the pay gap is 13.9%, and if they are aged between 50 and 59, it is over 18%. That is clearly unacceptable. Will the Minister now direct her attention towards ensuring the eradication of the pay gap for those aged over 40?

[Nicky Morgan]

As I have already mentioned, research shows that the pay gap is mostly not about direct discrimination, but about the jobs and sectors that women enter and the progress that they make, particularly if they take time out of the labour market. In November, we announced that we were investing over £2 million in helping women, especially women over 40 and those working part time, to move from low-paid, low-skilled work to higher paid, higher-skill work. That programme of work is delivered by the UK Commission for Employment and Skills, which will start by focusing on helping women to develop skills in science, technology, engineering and maths, retail, hospitality and the agricultural sector.

[Fiona Mactaggart (Slough) (Lab)]

Chartered Institute of Personnel and Development research shows that people stuck in low pay—women who have been in low-paid jobs for 10 years—are more likely to be unable to escape it. I have not heard from the Minister any strategy to help those older women escape low pay. It is all very well talking about money, but what is happening on the ground to help older women?

[Nicky Morgan]

The hon. Lady did not listen to the answer that I have just given. We are investing money, working with organisations such as the UK Commission for Employment and Skills, and particularly looking at enabling women in low-paid, low-skill work to develop further skills, for exactly the reasons that she cited—so that they can have higher paid jobs, which obviously provides more security for them and their families.

[Sheila Gilmore (Edinburgh East) (Lab)]

I wonder whether the Minister would accept that the Government made a mistake in not implementing compulsory reporting on gender pay. Not enough businesses have voluntarily taken up such reporting. It is not too late to make the change; perhaps she would like to commit to doing so.

[Nicky Morgan]

We as a Government have always said that we would keep that section under review, but I believe that it will be much better, and we shall achieve much more systemic change, with companies thinking very hard about the pay that they offer their employees and about the diversity in their work force, if we work with them on the voluntary approach—the Think, Act, Report approach—rather than burdening them with more regulations.

[Douglas Carswell (Clacton) (UKIP)]

4. What steps her Department is taking to reduce homophobic bullying of young people in England and Wales.

[The Parliamentary Under-Secretary of State for Women and Equalities (Jo Swinson)]

Homophobic bullying is absolutely unacceptable and we are committed to eliminating it. That is why we have announced £2 million of grant funding to support schools to address the issue more effectively. That, of course, complements the £4 million that the Department for Education currently provides to charitable organisations to tackle all forms of bullying. Schools policy in Wales, including bullying, is a matter for the Welsh Government.

[Douglas Carswell]

Only yesterday, another concerned Clacton parent contacted me about bullying. Obviously, and quite rightly, academies are self-governing. Notwithstanding that, is there specific advice that the Minister might like to give to academies to try to address that problem?

[Jo Swinson]

There is plenty of guidance available, but the point of the work that we are funding is to help develop further the evidence base on the most appropriate and effective forms of intervention, which we will be able to share more widely with schools, so that they know how best to tackle such bullying. I welcome the hon. Gentleman’s commitment to these important issues; I only wish that the rest of his party’s members took the same approach.

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

According to Stonewall’s latest figures, more than half of secondary school teachers fail to challenge homophobic bullying, while 17% feel they are inadequately trained to tackle such bullying. Therefore, does the Minister acknowledge that the Government’s failure to make sexual relationships education compulsory in the curriculum in mainstream teacher training has failed lesbian, gay, bisexual, and transgender young people, as teachers feel ill equipped to deal with homophobia in the classroom, or to advise children who approach them in confidence?

[Jo Swinson]

Sexual relationships education is compulsory, but the hon. Lady raises an important point about training, and about ensuring that teachers feel comfortable in discussing these issues and know the best way to do so. We recognise that more can be done; that is why we have announced the project to develop that evidence base, so that teachers can see what best practice is, and how they can develop the confidence to tackle these issues effectively in the classroom. [Official Report, 21 January 2015, Vol. 591, c. 2MC.]

[Nic Dakin (Scunthorpe) (Lab)]

5. What assessment she has made of the effect of the under-occupancy penalty on disabled people.

[The Minister for Disabled People (Mr Mark Harper)]

The spare room subsidy is about ensuring that the same rules apply in the social housing sector as in the private sector. Of course, the hon. Gentleman will know that the Government have made available significant amounts of discretionary housing payments so that local authorities can deal with cases in which they think the specific circumstances are appropriate.

[Nic Dakin]

The hon. Gentleman is a good Minister, but he will know that that is a nonsense answer. According to the Government’s own interim evaluation report, disabled people in adapted homes hit by the bedroom tax are not being awarded discretionary housing payments, because their disability benefits are causing them to fail the test. The Minister needs to look at this a bit more carefully.

[Mr Harper]

The hon. Gentleman is a little churlish in his response to my answer. I have looked at the discretionary housing payment guidance in significant detail and it gives local authorities complete discretion. Local authorities are the ones considering specific cases and they are in possession of all the facts. I trust them to make good, sensible decisions.

[Mr Philip Hollobone (Kettering) (Con)]

Is there a list of local authorities that compares the number of disabled people who might require such discretionary help with the discretionary help they are receiving?

[Mr Harper]

My hon. Friend raised a similar question at the previous Question Time and I put in the Library information on the amount of money the Government have made available to each local authority in the country compared with what they are spending. We do not have a list broken down by local authority of every single person affected by the removal of the spare room subsidy and their level of disability, so I cannot give my hon. Friend the exact information he requires, but I think I have done the best that I can.

[Kerry McCarthy (Bristol East) (Lab)]

7. What steps her Department is taking to reduce inequality arising from socio-economic background.

[The Parliamentary Under-Secretary of State for Women and Equalities (Jo Swinson)]

The Government are committed to improving social mobility. That is why we have extended free early education to disadvantaged two-year-olds, introduced a £2.5 billion a year investment in the pupil premium, delivered 2 million apprenticeship starts within this Parliament and have more than 180 major employers signed up to the social mobility business compact to inspire young people and improve access to employment opportunities.

[Kerry McCarthy]

Bristol’s fairness commission reported last year and described Bristol as a “tale of two cities,” with some areas facing “persistent deprivation.” When the Government entered power, they refused to implement clause 1 of the Equality Act 2010, the socio-economic duty, which would have placed a duty on all public bodies to have awareness of the effect of economic inequality on their policies. Will the Government reconsider that, because it is an issue that they have completely overlooked?

[Jo Swinson]

It is not the Government’s intention to do so at the moment, but of course local authorities have plenty of discretion, powers and tools to tackle these issues. The hon. Lady rightly highlights that there are important issues of deprivation within local authorities and it is vital that they are tackled.

[Pamela Nash (Airdrie and Shotts) (Lab)]

8. What estimate she has made of the number of women in low-paid work.

[The Parliamentary Under-Secretary of State for Women and Equalities (Jo Swinson)]

According to the annual survey of hours and earnings, 24.6% of women were paid below two thirds of the median wage in 2014. Although that is still too high, we are making progress as the percentage of women in low-paid work is falling compared with 2010, when the rate was 25.9%.

[Pamela Nash]

I thank the Minister for that answer, but she will know, as we do, that according to the House of Commons Library women have lost six times as much financially as men under the policies of this Government. Does she think that is fair and what is she going to do about it?

[Jo Swinson]

I would be very interested to see the report, which I understand has been requested by the Opposition and has not been forthcoming. We have cut income tax for people on low pay, many of whom are women, and in particular, the majority of the 3 million people who have been taken out of paying income tax at all are women. The Government take these issues seriously to ensure that women and indeed men are protected in these difficult economic times.

[Gloria De Piero (Ashfield) (Lab)]

I was reading about the case of a woman who is told by her boss each day whether or not she has work by a text with a picture of a happy face or a sad face. Should those practices be banned?

[Jo Swinson]

As employment relations Minister I certainly would not endorse that as good employment practice. There are clearly significant issues with zero-hours contracts and the Government recognise that, which is why we are legislating through the Small Business, Enterprise and Employment Bill to make exclusivity clauses illegal. It is also why we are taking further steps to work with industry sectors to produce guidance so that best practice is followed in using such contracts, which work for some people, as the surveys from the CIPD clearly show. We need to ensure that the contracts are used properly and I agree with the hon. Lady when she points out that there are examples of bad practice in that area.

Petition

Thursday 15th January 2015 Commons Chamber

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

- Hansard - - Excerpts

I rise to present a petition opposing the sale of land at Parklands school in Sketty, Swansea, following a similar petition of 254 local petitioners.

The petition states:

The Petitioners therefore request that the House of Commons urges the Government to encourage the City and County of Swansea Council to reconsider plans to sell the land at Parklands School in Sketty.

Following is the full text of the petition:

[The Petition of residents of the UK,

Declares that there are plans to sell land at Parklands School in Sketty, Swansea; further that Parklands School is oversubscribed and faces increasing demand; further that it is the only school land sale that proposes to dissect a school site; further that the proposal under-estimates the school roll as consisting of 420 pupil places when it is currently 480 plus nursery places; further that the planned sale would disproportionately affect pupils with disabilities; further that the proposal has not yet been consulted upon; and further that a local petition on this matter has been signed by 2054 residents of the Swansea West constituency.

The Petitioners therefore request that the House of Commons urges the Government to encourage the City and County of Swansea Council to reconsider plans to sell the land at Parklands School in Sketty.

And the Petitioners remain, etc.][P001422]

Business of the House

Thursday 15th January 2015 Commons Chamber

10:34

[Ms Angela Eagle (Wallasey) (Lab)]

Will the Leader of the House give us the business for next week?

[The First Secretary of State and Leader of the House of Commons (Mr William Hague)]

The business for next week is as follows:

Monday 19 January—Consideration of an allocation of time motion, followed by all stages of the Lords Spiritual (Women) Bill.

Tuesday 20 January—Opposition day (13th allotted day). There will be a debate on a motion in the name of Plaid Cymru and the Scottish National party on Trident renewal.

Wednesday 21 January—Opposition day (14th allotted day). There will be a debate on an Opposition motion, subject to be announced, followed by a motion to approve a statutory instrument relating to terrorism.

Thursday 22 January—Debate on a motion relating to the governance of the House of Commons.

Friday 23 January—Private Members’ Bills.

The provisional business for the week commencing 26 January will include:

Monday 26 January—Remaining stages of the Infrastructure Bill [Lords].

Tuesday 27 January—Second Reading of the Corporation Tax (Northern Ireland) Bill, followed by a debate on a motion relating to accommodation for young people in care. The subject for this debate was determined by the Backbench Business Committee.

Wednesday 28 January—Opposition day (15th allotted day). There will be a debate on an Opposition motion. Subject to be announced.

Thursday 29 January—Debate on a motion relating to the Iraq inquiry, followed by a general debate on financial support available for restoration of open-cast coal sites. The subjects for both debates were determined by the Backbench Business Committee.

Friday 30 January—The House will not be sitting.

I should also like to inform the House that the business in Westminster Hall for the remainder of January will be:

Thursday 22 January—Debate on the third report from the Energy and Climate Change Committee on the green deal, followed by a debate on the first report from the Justice Committee on crime reduction policies.

Thursday 29 January—Debate on the second report from the Home Affairs Select Committee on female genital mutilation, followed by a debate on the second report from the Science and Technology Committee on UK blood safety and the risk of variant Creutzfeldt-Jakob disease.

[Ms Eagle]

May I thank the Leader of the House for announcing next week’s business, including all stages of the Lords Spiritual (Women) Bill next Monday?

Even those of us who feel that the unelected and supersized Chamber at the other end of the building is in need of more radical reform can welcome this Bill. Prior to the creation of Labour’s senate of the nations and regions, it is only right that the Lords Spiritual should consist of women bishops as well as men.

I also welcome the debate that the Leader of the House has scheduled for next Thursday on the report from the Governance Committee. I hope that the House will not only agree to the recommendations but agree on a timetable for implementing them so that we have a new management system in place before Dissolution. Will the Leader of the House tell the House how this will be accomplished if the motion is carried?

The Committee stage of the Infrastructure Bill is due to conclude upstairs today, and the Leader of the House has announced that we will debate it on Report on 26 January. It is over seven months since consideration of the Bill began in the other place, so will he explain why last Friday 60 pages of amendments reforming the electronic communications code appeared out of nowhere? Why is the drafting of the amendments so bad that mobile phone operators have thrown into doubt the Government’s uncosted deal with them to extend mobile phone coverage? Will he now consider extending the Report stage to give the House the time it needs to improve these badly drafted amendments? Is this yet another example of this Government’s competence, or is it simply more chaos?

Despite repeated Government promises that free speech would be protected, last week the Electoral Commission wrote to a range of political blogs warning them about falling foul of the Government’s lobbying Act. Bishop Harries’ commission on civil society and democratic engagement has said that the law is already having a widespread chilling effect on campaigning by charities and other organisations in the run-up to the general election. When does the Leader of the House intend to put section 39 of the Act into effect, as he has only a few days left? Will he now admit that despite all the false promises from Government Front Benchers, this law is having the effect they desired in silencing criticism of the Government and suppressing healthy democratic debate? Does he accept that the only reasonable thing to do now is to repeal this disgraceful assault on free speech?

The Conservative election campaign continues to lurch from one embarrassment to another. First, we had the fiasco of the German road that, it now turns out, was airbrushed to remove all the potholes. This week the Conservatives have unveiled six election priorities, which, amazingly, make no mention of the NHS.

Such is the Conservatives’ popularity that they have been caught spending tens of thousands of pounds buying their own Facebook friends, and now they are so confident of victory that the Prime Minister is running scared of each and every chance to be held to account in debates. He promised to be interviewed by Bite the Ballot in front of first-time voters, which every other party leader has now done, including leaders of the minor parties, such as the Deputy Prime Minister—even he turned up to his appointment with Bite the Ballot. The Prime Minister, however, has suddenly pulled out, absurdly claiming that of the 111 days left until the election there are

“no dates that would work.”

Then we have the saga of the TV debates. The Prime Minister has been clucking for days that he will not do them without the Greens, but he is actually frightened that he would be in for a roasting. Is not it blindingly obvious that that is a fowl excuse?

The Liberal Democrats are not doing much better. After the Prime Minister rebuked the Tory Chief Whip for messing with his mobile phone in Cabinet, the Chief Secretary decided to take the secretary part of his job very seriously and leapt to reinforce the Prime Minister’s message, pointing out that he too had spotted others using their phones during Cabinet. Doesn’t everyone just love a teacher’s pet?

I think that the Business Secretary is jealous. After being unceremoniously dumped as economic spokesman from the farcical Liberal Democrat cabinet within a Cabinet that is apparently designed to shadow the Cabinet while actually propping up the Cabinet, he has insisted that he is still economic spokesman and that his demotion is just a “minor internal matter.” That sounds like how the Tories refer to the Liberal Democrats.

In just a few hours we will learn who has been nominated for an Oscar, and this year I think us Brits have got at least one in the bag: this Government will win the award for best farce.

[Mr Hague]

I welcome the opening remarks of the shadow Leader of the House: we are united in our support of the Lords Spiritual (Women) Bill and there will be a good deal of time to debate it next Monday. The allocation of time motion will provide for that, including a four-hour Second Reading debate. I hope it will enjoy the unanimous support of the House. We shall see.

When it comes to the debate on the governance of the House, it will be important for us all to listen to the views of the House. The hon. Lady and I have both signed the motion tabled by the members of the Governance Committee. There is a great deal of support for their recommendations, some of which will require legislation in order to implement them, but the majority of them can be proceeded with very speedily. If the motion is passed, the relevant authorities will be empowered and, in effect, instructed to get on with those actions and the necessary recruitment processes.

On the Infrastructure Bill, the Culture Secretary has been working on a tremendous improvement in mobile phone coverage in this country. The hon. Lady asked for more time on Report to discuss amendments. I might have considered that differently had the Opposition used the time they had asked for and obtained on other Report stages, but they did not do so. For instance, they asked for, and we provided, six days’ debate on the Counter-Terrorism and Security Bill, including two days on Report, but the House rose early on both of those days by several hours. I think the time we have provided will be adequate to discuss the Infrastructure Bill.

I will look at the point raised by the hon. Lady about section 39 of the transparency of lobbying Act, but some vigorous campaigning is already going on without anybody being silenced in the run-up to the general election campaign.

The shadow Leader of the House mentioned the Government’s competence. I pay tribute to her, as I often do, because at least she can remember what she is meant to be talking about when she comes to the House. However, the Leader of the Opposition is having increasing problems recalling things, including whether he said he would “weaponise” the national health service, despite being asked seven times on television on Sunday and being challenged in this House. He could not remember the main issue—the biggest problem facing the country—in his party conference speech, and now he cannot remember what he said about the issue he has most often raised, which makes us wonder whether he would remember anything he was meant to do if he became Prime Minister of this country or, indeed, what the day was on any particular day. She is clearly in a stronger position.

I am sure that the Leader of the Opposition remembers that he promised to freeze energy prices, and that when he stood at the Dispatch Box only 15 months ago he said:

“Nothing less than a price freeze will do”.—[Official Report, 30 October 2013; Vol. 569, c. 912.]

Yesterday, the awful realisation at last dawned on the Opposition that had we had a price freeze when they asked for it, energy prices would not now be falling, as they are. The cheapest energy tariff is now £100 cheaper than it was a year ago, meaning that it would be £100 more expensive had we frozen energy prices when they asked for that. [Interruption.] It is no good Labour Members shaking their heads about wanting a freeze because it is all there in motions they tabled in this House. Such motions demanded nothing other than a freeze, including one on 18 June, which stated:

“That this House notes the policy of Her Majesty’s Official Opposition to freeze energy prices for 20 months”.—[Official Report, 18 June 2014; Vol. 582, c. 1185.]

Seven months later, energy prices are falling, which would not have been possible. Yesterday, they decided that a freeze meant a cap, but that was the first time they had done so. From my own experience, I can tell the Leader of the Opposition that reaching for a cap when in difficulty is not always a good idea.

I pointed out last week that the Opposition have dropped 12 policies in under 10 days, and they have now been joined by a 13th policy. The Opposition have started to announce their policies in secret, such as their latest one to carpet the countryside with unnecessary wind turbines if they win the next general election, to which they do not want to give any publicity.

The real story about what has happened this week is one of competence: the World Bank has confirmed that the UK is the fastest-growing G7 economy; UK manufacturing is now performing at levels not seen since 2002; and the pensioner bonds launched today will reward people who have worked hard and saved hard throughout their lives.

[Mr David Nuttall (Bury North) (Con)]

Please may we have a debate on the accurate use of words and phrases? It would give Members the chance to make clear that there is a difference between the deficit and the debt, that positive action or positive discrimination is still discrimination, and that tax avoidance is legal while tax evasion is illegal.

[Mr Hague]

I am not sure, with only 40 sitting days until the Dissolution of Parliament, that there will be time for a debate, but it would be very beneficial to discuss such things at every opportunity. Of course, to know whether you are talking about the deficit or the debt, you must remember that you intended to talk about it in the first place, which is a particularly serious difficulty for the Leader of the Opposition.

[Mr Jack Straw (Blackburn) (Lab)]

May I first invite the Leader of the House to examine the physics of freezing? Water can be frozen at any point between zero and absolute zero, which is minus 273° C, so I offer him the thought that our metaphor of a freeze is consistent with both prices being level and prices falling.

May I express my gratitude to the Leader of the House and his private office, as well as to my hon. Friend the shadow Leader of the House, for their very active co-operation in working with my Committee to agree the motion—he has tabled motion 91, to which I have added my name—for debate on Thursday? I hope, if there is agreement, that we can indeed make rapid progress towards implementing the House of Commons Governance Committee’s recommendations, including for pushing the minor changes in legislation through both Houses.

[Mr Hague]

The right hon. Gentleman has given by far the best description from the Opposition Benches of what a freeze is meant to mean, but sadly it was not included in the motion on 18 June last year. I can see why Labour Members are thinking of water running out beneath them and ice cracking on top—I think that is what he was describing—because that is what is currently happening to their policy. Perhaps we have taken this physics discussion far enough.

I pay tribute again to the right hon. Gentleman and his Committee for putting together such a well thought out report that commands a great deal of support across the House. It is on the governance of the House, and Opposition Members who were paying attention would have been able to follow that. As he may know, I am also looking at how, even this Session before the end of this Parliament, we can pass the small piece of legislation required by the report.

[Mr Alan Reid (Argyll and Bute) (LD)]

Following a storm more than a month ago, BT has still not restored a landline service to many of my constituents. Mobile phone services are also affected—for example, it took Vodafone 20 days to repair a fault in December, and a large part of Argyll has been without a Vodafone mobile service since last Thursday. Such delays are unacceptable. May we have an urgent statement from the Department for Culture, Media and Sport on what can be done to make those companies carry out repairs more quickly in future?

[Mr Hague]

As I recall, this is the second time my hon. Friend has found it necessary to raise that issue, which is clearly a serious problem in his constituency, and I hope that BT and all those responsible will take full note of his raising the matter in the House. We have just had questions to DCMS Ministers, and I will alert them to the problem he raises.

[Cathy Jamieson (Kilmarnock and Loudoun) (Lab/Co-op)]

Might we expect a statement from the Government on the potential job losses announced by BP today? If so, will it include the implications of those job losses, and the potential impact on the supply chain for that sector across the United Kingdom?

[Mr Hague]

Overall, as the House will recognise, the reduction in oil prices is beneficial to the British economy and indeed the world economy, but as those announcements show it can also have a damaging effect on employment in the North sea industry. That is why in the autumn statement the Chancellor reduced taxes on the industry, and he showed considerable foresight in doing so. The Energy and Climate Change Secretary is in Aberdeen today discussing the situation with industry leaders, and the Government are taking the situation seriously.

[Fiona Bruce (Congleton) (Con)]

Will the Leader of the House please confirm that, as indicated by the Under-Secretary of State for Health (Jane Ellison) last March, there will be a debate on the Government’s proposed mitochondrial donation regulations before Members are asked to vote on them?

[Mr Hague]

Regulations to allow the clinical use of those techniques for the first time were laid in Parliament on 17 December, as my hon. Friend knows. The regulations are affirmative and therefore subject to a debate in both Houses of Parliament. We are working on how to schedule that debate and where it will take place, and I hope to update the House soon.

[Richard Burden (Birmingham, Northfield) (Lab)]

May I support what the shadow Leader of the House said about having two days on Report for the Infrastructure Bill? When it came before the House on Second Reading, the Bill already covered areas that required great scrutiny such as shale gas, Highways Agency reform and zero-carbon homes. Since it has been in Committee, new amendments have been tabled on mayoral powers, reforms to the Electricity Act 1989, and a range of other areas, including the electronic communications code that my hon. Friend the Member for Wallasey (Ms Eagle) mentioned. Some of those issues were not covered by the long title, or by debate in the House of Lords or on Second Reading. Is it too much to say that if those measures are to get the scrutiny they need, we should have two days on Report?

[Mr Hague]

I always take seriously requests for further time on important Bills, but as I stressed to the shadow Leader of the House, my experience in my short time as Leader of the House—six months so far—is that when additional time has been asked for on Report, the days have not been fully used, and that affects how we regard further requests for time on other Bills.

[Martin Vickers (Cleethorpes) (Con)]

Has my right hon. Friend had the opportunity of noting the Westminster Hall debate last week on the economy of coastal towns? The importance of the coastal communities fund was raised by Members on all sides of the House. Can he find time for a debate on the future of the coastal communities fund, which is very important to constituencies such as mine?

[Mr Hague]

That was an important debate on coastal communities. It will have been an important opportunity for hon. Members, such as my hon. Friend, to raise many of the issues that come up in their constituencies. I cannot promise a further debate on these issues, but he can use all the normal means, including the Backbench Business Committee, to ask for such a debate. He is a very strong champion of coastal communities.

[Pete Wishart (Perth and North Perthshire) (SNP)]

For Tuesday’s debate on Trident renewal, would it be an idea to reorganise the furniture of the House, so that we have the Westminster establishment parties of Tory and Labour on one side arguing the case for £100 billion to be spent on Trident while indulging in austerity, and the progressive alliance of Greens, Scottish National party and Plaid Cymru on the other proving the case for why that money should be spent not on weapons of mass destruction but on social programmes?

[Mr Hague]

I am sure hon. Members will be able to take part in the debate from whatever point of view and wherever they are sitting. It will not be necessary to reorganise the furniture. Of course, the basic furniture of the British constitution was supported by the people of Scotland when they voted to remain part of the United Kingdom, including those who live in the area represented by the hon. Gentleman.

[Mr Peter Bone (Wellingborough) (Con)]

Will the Leader of the House arrange a statement next week on the leaders’ debate? The Prime Minister is absolutely right that national parties should be included, including the Greens. I understand that the Scottish National party is considering running candidates in England. If so, could it be included in the debate? If it runs in north Northamptonshire it will get more votes than the Liberal Democrats.

[Mr Hague]

I think it is fair to say that that suggestion will receive a mixed reception in the coalition Government, but I absolutely agree with my hon. Friend on the importance of the Green party also being able to take part in the debates if other parties that are not the long-recognised major parties of the country do so. I do not know why the Labour party is so afraid of having the Green party take part in the debates.

[Mr Barry Sheerman (Huddersfield) (Lab/Co-op)]

I add my voice to the congratulations to the Leader of the House on the speed with which he has reacted to the Governance Committee report, chaired by my right hon. Friend the Member for Blackburn (Mr Straw). Those of us who were able to give oral and written evidence are very pleased, although I still remember the expression on my right hon. Friend’s face when I said that I wanted this place to be run more like John Lewis.

May I join the call for two days of debate on the Infrastructure Bill? Has the Leader of the House seen the Consumers Association analysis published this morning that the taxpayer and the traveller will be burdened with £200 billion-plus to pay for this infrastructure? Is it not time we reconsidered HS2, the costs of which are adding up to £80 billion, money that could be spent on the national health service?

[Mr Hague]

There was a lot in that question. I have not heard the governance of the House being linked to HS2 before. That was an artful journey through many different matters. I am pleased that the hon. Gentleman is pleased with the Governance Committee report. Many right hon. and hon. Members contributed, as he did, to its thinking and they were right do so. I will look at the analysis from the Consumers Association. I will, however, make the point I have made before: the time requested for the Report stage of Bills has so far not been well taken up.

[Philip Davies (Shipley) (Con)]

The Ministry of Justice has a woeful record on answering parliamentary questions on time, to such an extent that it has been chastised by the Procedure Committee. On 18 November I asked the Secretary of State for Justice how many prisoners convicted of terrorist-related offences had been released on temporary licence in each of the past five years. It is bad enough that that question has still not been answered, but given the nature of the question and the appalling events in Paris is it not essential that the Government are on top of how many prisoners convicted of terrorist offences have been released on temporary licence? Will the Leader of the House urge the Justice Secretary not only to answer the question, but to make a statement to the House so that we can see what risk this country faces from these kinds of people?

[Mr Hague]

My hon. Friend knows that the Home Secretary made a statement yesterday about our preparedness to counter terrorist attacks. It is important that Departments give timely answers to questions. I certainly attach a great deal of importance to that, as does the Procedure Committee. I believe that my right hon. Friend the Justice Secretary has explained to the Procedure Committee the measures that he is taking to improve the performance of the Ministry of Justice on this. While that is taking place, I will remind my right hon. Friend of the specific question that my hon. Friend has asked.

[Jeremy Corbyn (Islington North) (Lab)]

At the end of this month, the Foreign Office will receive a copy of the consultant’s report on the feasibility of the Chagos islanders returning to their homeland from which they were disgracefully removed many decades ago. Will the Leader of the House confirm that that is the case, that there will be an imminent statement from the Foreign Office shortly after the report is received and that there will be an opportunity before the end of this Parliament for a full debate on the situation facing the Chagos islanders and the assertion of their right to return to the islands from which they were so wrongly removed all those decades ago?

[Mr Hague]

The hon. Gentleman is a long-standing campaigner on this issue and I had discussions with him when I was Foreign Secretary. Indeed it was my decision as Foreign Secretary to set up this further feasibility study about the Chagos islands. It has always been intended that it would report at the beginning of this year; in other words, very soon. He will have to ask a Foreign Office Minister specifically about the Department’s approach. It is Foreign and Commonwealth Office questions on Tuesday, so he might have an opportunity to do so then, but I will remind the FCO that there is considerable interest in the House as to how the report will be handled and the FCO response to it.

[Bob Blackman (Harrow East) (Con)]

This week marks the 25th anniversary of the expulsion and ethnic cleansing from the Kashmir valley of Hindu Pandits, who were forcibly removed from homes they had occupied for thousands of years. This weekend there will be a peace march ending at Trafalgar square, and in several Hindu temples across the country there will be services commemorating this evil event. Will my right hon. Friend arrange for a statement or debate on this subject so that the attitude of the British Government to this terrible event can be put on the record?

[Mr Hague]

My hon. Friend will be aware of the long-standing position of the UK on this, which is that it is for India and Pakistan to find a lasting resolution to the situation in Kashmir, taking into account the wishes of the Kashmiri people. It is not for us to try to prescribe a solution or to mediate in finding one, but we continue to follow developments in the region closely. I know that my hon. Friend has raised the issue before in debate and he will be aware of the further opportunities there are to continue to bring it to the attention of the House, as he has done today.

[Joan Walley (Stoke-on-Trent North) (Lab)]

There is growing concern in Stoke-on-Trent and north Staffordshire about the awarding of a contract for a PET scanner to a private company, Alliance. Given that local MPs have asked for a meeting with the chief executive of NHS England about this and so far have not had a reply, may I ask for an urgent debate in the House on the issue of procurement in the NHS and the wider implications it has for the reconfiguration of services?

[Mr Hague]

As the hon. Lady knows, matters of procurement in the NHS are regularly debated with Health Ministers and regularly come up at Health questions. There are many opportunities to raise it. She mentioned that she has raised it specifically with NHS England and I hope it will respond to her. It will owe her a quick response, given that people are clearly concerned.

[Robert Jenrick (Newark) (Con)]

We all know that ISIS is taking lives throughout Syria and Iraq, but what is less well known is that it is also trying to take the soul of the region through a systematic and epic looting of antiquities and works of art on a scale that has not been seen since the end of the second world war. What is more, this is believed to be the third-greatest source of revenue for ISIS after energy and bank robbing. It is a national security issue, as well as an issue of great cultural concern to the world. Will my right hon. Friend agree to a debate in the House on the issue, and perhaps enlist the support of his friend Angelina Jolie to give some international support to what is a really important issue?

[Mr Hague]

My hon. Friend is quite right to raise this issue. I cannot pledge Angelina Jolie to engage with issues other than those on which I already work with her, but he is absolutely right that what is happening in that region involves the devastation of antiquities as well as so many atrocities inflicted on human beings, which are, of course, our top concern—particularly the enslavement of people and the tyrannical and brutal treatment of people living in areas taken over by ISIS, or ISIL. It shows the importance of the action we have taken with other nations, working with the Government of Iraq and with the Kurdish Regional Government. As my hon. Friend knows, that action is having some success in turning back the advance of ISIS, or ISIL. He will be able to raise the issue with Foreign Office Ministers at questions on Tuesday—if he catches your eye, Mr Speaker.

[Chris Bryant (Rhondda) (Lab)]

We all want to sort out mobile telephony coverage around the country, but the way in which the Government have proceeded by introducing significant amendments to the electronic communications code at the very last stage of the Infrastructure Bill is a wholly inappropriate way of doing business. The mobile network operators are furious about it, and we will not be able to support the changes, even though we would love to see proper change. Without two days for Report, it is going to be impossible to get this right. The danger is that we will then not have the change that the Government, the Opposition, the mobile network operators and everybody wants. The Government may lose in the House of Lords and lose their Bill.

[Mr Hague]

The hon. Gentleman raises the same point as others, including the shadow Leader of the House. I do not have much more to add to what I said earlier. I said I would look at the evidence and representations on the matter and will always listen to concerns about adequate time for debating legislation. On any Bill for which representations are made for more time and more time is given, it is important to use that time—otherwise it takes up time to debate for other matters. [Interruption.] That has been the pattern so far.

[Mr Speaker]

The hon. Member for Rhondda (Chris Bryant) says that he will use it—assuming he catches the eye, of course.

[Mr Nigel Evans (Ribble Valley) (Con)]

Is it possible to have an early debate on the plight of the dairy industry in the United Kingdom? I welcome the fact that inflation is running at 0.5%, but when supermarkets advertise milk at 89p for four pints—considerably cheaper than the price of water on their shelves—something is clearly going wrong. As my right hon. Friend knows, many farmers did not get paid for several weeks and the wholesale price they are paid has collapsed. May we have an urgent debate to ensure that the vitality of this important industry is preserved?

[Mr Hague]

My hon. Friend will be able to pursue the need for debate through all the normal methods, with which he is extremely familiar. Today, the farming Minister, the Under-Secretary of State for Environment, Food and Rural Affairs, our hon. Friend the Member for Camborne and Redruth (George Eustice), is discussing with the industry and the National Farmers Union how to help manage the volatility of prices, such as through the creation of a futures market. We recognise that milk prices continue to fall and that it is a concerning time for British dairy farmers. My hon. Friend the Member for Ribble Valley (Mr Evans) will know that we have worked with the industry to open up new export markets, and exports are rising. We have given dairy farmers the opportunity to unite in producer organisations so that they have greater clout in the marketplace. As I said, the Minister is discussing with the industry and the unions what further we can do.

[Grahame M. Morris (Easington) (Lab)]

Notwithstanding the representations made by the shadow Leader of the House and other hon. Members in respect of the Infrastructure Bill, would the Leader of the House consider having a specific debate about the merits of, and safety factors involved in, undersea coal gasification? I have raised the issue in questions with the Department of Energy and Climate Change and I am told that an internal working group has been established, but would it not be beneficial, in the interest of transparency, to have a full debate, perhaps in Government time, so that my constituents and others can better understand the merits and potential benefits as well as the risks to the local economy?

[Mr Hague]

It is perfectly reasonable to request time to debate such matters, but, as the hon. Gentleman knows, the main opportunities for debates of that kind are now provided by the Backbench Business Committee, the Adjournment and Westminster Hall, and I suggest that he use those channels. Government time is not available for such general debates, important and interesting though they might be.

[Jason McCartney (Colne Valley) (Con)]

Tesco is pulling out of a planned store in Huddersfield, and Yorkshire-based Morrisons has announced that it is to close a store at Ravensthorpe, near Huddersfield. May we have a debate on the state of the UK’s supermarket industry, and its relationships with both suppliers and customers?

[Mr Hague]

Steps to promote independent retail were debated in Westminster Hall last year, but my hon. Friend raises the wider issue of supermarkets, and the grocery market is obviously undergoing a great deal of structural change. A further debate would allow the Government to give further details of our support for high streets and market towns—for instance, the £2.3 million that we are providing for the 27 Portas pilots and 330 town teams across England, the £10 million high street innovation fund, and our work on business improvement districts—so it could indeed be very beneficial.

[Huw Irranca-Davies (Ogmore) (Lab)]

Today, in Nottingham, Rural Community Action Nottinghamshire will celebrate 90 years of partnership work in rural communities, and celebrations will continue throughout the country this year. Much of that work depends on rural community councils, and much of their own work depends on advice, support and funding from the rural community network organisation Action with Communities in Rural England, or ACRE. However, ACRE has been informed out of the blue, with no notice, that its funding will be discontinued from this March, and the decision may be made by Ministers behind closed doors as early as next week.

Will the Leader of the House urge the Secretary of State for Environment, Food and Rural Affairs—who is in China at the moment—or other Ministers in the Department to provide the House with a full impact assessment before any such decision is made, and to make a statement to the House? A decision that could cause as many as a third of rural community councils to shut up shop and a further third to restrict their activities should not be made behind closed doors.

[Mr Hague]

The Secretary of State is indeed in China, but I will of course inform DEFRA Ministers of the issue that the hon. Gentleman has just succeeded in raising on the Floor of the House. No doubt they will wish to respond to him directly.

[Jeremy Lefroy (Stafford) (Con)]

There are extraordinary pressures on A and E departments in Stoke and the north midlands, although the excellent staff at Stafford County and Royal Stoke University hospitals are working hard to deal with them. Furthermore, a speedy return to 24/7 A and E services in Stafford is essential owing to the long-term acute pressures that will result from the doubling of the number of people aged over 85 in south Staffordshire and Stafford by 2030. May we have a debate on regional A and E provision, in the light of the increased number of complex medical emergencies?

[Mr Hague]

There has already been a good deal of discussion in the House about A and E services—indeed, the Health Secretary spoke about them in the House last week—and my hon. Friend will be aware of all the action that the Government are taking to try to relieve pressure on those services, nationally and in his own region. However, he is right to refer to local pressures, and I shall ensure that the Health Secretary is aware of the point that he has raised.

[Tom Greatrex (Rutherglen and Hamilton West) (Lab/Co-op)]

May I return the Leader of the House to the subject of the Infrastructure Bill? In an earlier answer, he mentioned that the Secretary of State for Energy and Climate Change was in Aberdeen today, talking to representatives of the oil and gas industry. What he will hear from them is that the implementation of the Wood review and the establishment of the new Oil and Gas Authority, which has the support of all parties, including the Scottish National party, should be seen as a matter of priority, given the urgency of the situation in the North sea. That is one of a number of issues raised by the Bill.

As several Labour Members have pointed out, there is a real risk that the authority will not be up and running when it should be, which would have a material effect on that industry. May I reinforce their pleas for a two-day debate on this important Bill on Report, given the range of issues that it covers?

[Mr Hague]

I can assure the hon. Gentleman, and indeed the industry, that the Government are determined to ensure that the Infrastructure Bill is passed into law before our Session comes to an end in just over two months’ time, so I do not think there should be alarm in the industry about that. On the time for the debate, I made my point earlier and I do not want to add anything further to that at the moment.

[Mary Macleod (Brentford and Isleworth) (Con)]

Chiswick school in my constituency has done some excellent work in linking up students with local businesses, which is of course incredibly important in encouraging aspiration in the next generation, but there is often inconsistency in establishing such links in London and across the country. May we have a statement from the Secretary of State for Education to look at the progress being made in careers advice in schools and also to see how many schools have a business champion on their governing bodies?

[Mr Hague]

These are important issues, and the Government’s focus is on preparing young people for the world of work more effectively and ensuring that businesses are engaged with schools in meaningful ways. Governors have a very strong role to play in that. As my hon. Friend knows, on 10 December last year the Education Secretary announced the establishment of a new employer-led careers and enterprise company with a specific remit to build up all this work. The Education Secretary also gave evidence on this to the Select Committee on Education recently, and I am sure that there will be other opportunities to raise these matters in the House.

[Mr Khalid Mahmood (Birmingham, Perry Barr) (Lab)]

My constituent Julie Hambleton and her family, along with the families of all the victims of the 1974 pub bombings in Birmingham, have been suffering for 40 years and continue to suffer as the perpetrators of that heinous act have not been brought to justice. They have tried to make an appointment to see the Prime Minister but that has not been possible. May we have a debate in this House so that the Home Secretary can directly address this issue, to at least give them some comfort?

[Mr Hague]

The hon. Gentleman raises an important issue for his constituents and he will have opportunities to raise this, such as with the Home Secretary at the next Home Office questions. I will of course make sure that the Home Office is aware of his concerns. I know my right hon. Friends the Home Secretary and the Prime Minister take these matters very seriously, so I will make sure they are aware of the point the hon. Gentleman has made today.

[Henry Smith (Crawley) (Con)]

Perhaps because I am a vexillologist MP, I have been approached by the office of the majority leader in the US House of Representatives to see whether it might be possible to facilitate an exchange of the Union flag flying over the Victoria Tower and the flag flying over the US Capitol to mark the long historical and friendship links between the United Kingdom and the United States. I would be grateful for the advice of my right hon. Friend the Leader of the House—and indeed you, Mr Speaker—as to how that might be facilitated.

[Mr Hague]

Personally, I am a great enthusiast for reinforcing and commemorating the intimate links between the United States and the United Kingdom. The US is our most important bilateral relationship and our greatest ally in the world, so we must take this request seriously. I will have to discuss—no doubt with you, Mr Speaker, and others in the House—how we go about facilitating and deciding on any such flag exchange, so I will come back to my hon. Friend on this point.

[Kevin Brennan (Cardiff West) (Lab)]

May I congratulate the Leader of the House on his decision to move to Wales when he leaves the House? I hope he and Ffion are very happy at Cyfronydd hall.

May we have a debate on improving Members’ knowledge of “Erskine May”, because the right hon. Gentleman will know—as will you, Mr Speaker—that on 19 March 1872 the Speaker condemned the imitation of the crowing of cocks and other barnyard noises in the House? If hon. Members knew their “Erskine May” better, would they not be less likely to greet the Prime Minister with a chorus of chicken noises for ducking the leadership debates?

[Mr Hague]

I thank the hon. Gentleman for his personal good wishes. My wife and I are looking forward to spending a good deal of time in Wales after the general election, and I thank him for his welcome. I am also grateful to him for pointing out the importance of “Erskine May”. There were some farmyard noises in the House yesterday, and I am sure that when the Labour party has stopped being chicken about debating with the Green party, there will be less need for such things in the House.

[Caroline Dinenage (Gosport) (Con)]

There has been a lot of discussion recently about the impact of falling oil prices on energy bills, but does the Leader of the House agree that transport companies should also be urgently considering how they can pass on any savings to their passengers? May we have a debate on that subject?

[Mr Hague]

This is an important point. People immediately think of the price of fuel for motorists, which is vividly displayed on every forecourt around the country, but it is also important that companies right across the energy sector pass on any reduction in prices. As we discussed earlier, the suppliers of energy to households are starting to do that, but it will be important for transport providers to do so as well, and I know that my right hon. Friends the Chancellor and the Energy Secretary will be keen to promote that.

[Several hon. Members]

rose—

[Mr Speaker]

What a delicious choice! I call Diana Johnson.

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

Disappointingly, Morrison’s have decided to close their store at Bransholme in Hull, which will involve a loss of jobs. Surprisingly, I have just received an e-mail from the site managing agent criticising me for raising concerns about those job losses. This is at a time when the 14 new jobs at Siemens in Hull attracted 1,000 applicants. May we have a debate on the jobs situation, especially in northern cities? Also, two years ago, the Government scrapped the gathering of statistics to show how many jobseekers were chasing each vacancy. May we have those figures reinstated, please?

[Mr Hague]

The hon. Lady is entitled to raise issues from her constituency, including concerns about local employment, and I defend her right to say whatever she wants on that. On the question of employment in general, there will be job losses even in a growing economy, and there have been big changes in the grocery sector, as we were discussing a few moments ago. Nevertheless, the overall outlook in all regions of the country is very strong, with record numbers of people in work, including across the north and in Yorkshire and the Humber. The unemployed claimant count is down nearly 600,000, and is now at its lowest since July 2008. So the overall outlook is very good, and we will always be able to discuss that when we discuss economic matters in the House.

[Robert Halfon (Harlow) (Con)]

May we have a statement on street lights in Essex? I am currently campaigning for Essex council to allow Harlow council to turn the lights back on, following Essex council’s decision to turn them off after midnight. Will my right hon. Friend look into this matter, and will he ask the Secretary of State for Communities and Local Government to speak to Essex council, to see how Harlow can be helped?

[Mr Hague]

My hon. Friend has raised this issue before, and I welcome the work that he does on behalf of his constituents—as I am sure they do—on this important matter. He understands all too well that street lighting in Harlow is the responsibility of Essex county council, as the local highway authority, and that central Government are unable to intervene in local matters such as this. I encourage him to continue to make representations to the county council so that it can consider this important issue further and perhaps reach an agreement on street lighting in Harlow.

[Kerry McCarthy (Bristol East) (Lab)]

The Electoral Commission has written to political blogs, including the excellent “LabourList”, to warn them about complying with the Transparency of Lobbying, Non-Party Campaigning and Trade Union Administration Act 2014 and telling them that what they do could be interpreted as regulated campaign activity. May we have an urgent debate to ensure that blogs are not prevented from reporting and commenting on the election campaign as they see fit, just as the mainstream print media will be able to do?

[Mr Hague]

We have had many debates. During the passage of the relevant Act through the House, it was extensively—if not exhaustively—debated, with many different opinions expressed. Nevertheless, it did not lack for debate and it was passed by Parliament. I have not noticed any reduction in the vast variety of opinions, information and disagreements coming forth on the blogs, all engaging already in the election campaign.

[Mr Philip Hollobone (Kettering) (Con)]

I bring good news from Kettering, because the shops in Kettering had a great Christmas. Footfall in the main shopping centre in Kettering town centre was up 6.5%. In the month before Christmas the footfall for the east midlands rose by 12%, nationally by 15%, but in Kettering by a massive 24%. With far fewer empty shops than the national average and falling car parking charges, it is clear that Kettering is outperforming its rivals. May we have a debate in Government time about the optimistic future for our town centres, against the background of rapidly falling unemployment, increases in real living standards and the fastest growing economy in the G7?

[Mr Hague]

I pay tribute to the retailers of Kettering for attracting all those people, and to my hon. Friend for his encouragement of them. Perhaps all that footfall is people visiting Kettering to shake the hand of the Member of Parliament and to catch a glimpse of him themselves. He raises an important point. The Government have done a great deal to help retailers, particularly with the measures that the Chancellor has taken on business rate relief and the removal of employers national insurance for small businesses. These things are helping our high street stores, and I hope they will go on to even greater success in Kettering.

[Derek Twigg (Halton) (Lab)]

I have been talking to staff at our local hospitals this week and it is clear that the pressure remains relentless. One of the biggest problems is that hospitals are not able to discharge elderly patients back into the community. Despite what the Secretary of State for Health said earlier this week, the system is not working. Will the Leader of the House find time to allow the Secretary of State to come back to the House next week to make an urgent statement on what is being done to try to solve the problem?

[Mr Hague]

As the hon. Gentleman says, the Secretary of State for Health did refer to the issue and set out what the Government are doing on it. On the question of whether or not such things are working, I have no doubt that the Secretary of State for Health will want to return to the House whenever appropriate on all these issues, particularly if there are continuing problems. I will make him aware of the concerns raised in the House today.

[Andrew Jones (Harrogate and Knaresborough) (Con)]

Last week I visited Marton-cum-Grafton primary school, a fantastic village school in my constituency, to congratulate the team on its outstanding Ofsted result. Please may we have a debate on how we can further support rural schools to improve their standards in the way that Marton-cum-Grafton has, as these schools often face very different challenges from urban schools?

[Mr Hague]

Rural schools do indeed face different challenges. My hon. Friend and I, in our work in north Yorkshire, have always strongly defended rural schools, some of which can be very small but still do an extraordinary job. It is important that they are maintained for the future, given some of the distances involved. We value small schools, and we recognise that they are often essential to the communities they serve. We have introduced a sparsity factor to allow local authorities greater flexibility to target funding at small rural schools, and local authorities can choose to apply this factor if they wish and target further funds as well. The Government are very committed on these issues, and I pay tribute to my hon. Friend for being such a strong campaigner for the rural schools in his constituency.

Backbench Business

Thursday 15th January 2015 Commons Chamber

[Mr Speaker]

Colleagues will be aware that two debates are to take place today. It might be for the convenience of the House to know that both are heavily subscribed and, although there is no formal limit on the opening speech, on the strength of discussion with other occupants of the Chair and reflection this morning in our meeting about the business of the House for the day, I feel it necessary to say to the House that the opening speech should be self-contained and as self-disciplined as possible—10 minutes if possible, but certainly no more than 15. The former Minister opening the debate is an immensely accomplished parliamentarian and I know that he can tailor his remarks accordingly. We look forward to hearing those remarks.

Contaminated Blood

Thursday 15th January 2015 Commons Chamber

11:29

[Alistair Burt (North East Bedfordshire) (Con)]

I beg to move,

That this House supports a further review of the circumstances surrounding the passing of infection via blood products to those with haemophilia and others during the 1970s and 1980s; notes the recent report from the All Party Parliamentary Group on Haemophilia and Contaminated Blood into the support arrangements provided for those who contracted blood-borne viruses as a result; also notes that the Penrose Inquiry into these events will shortly be publishing its findings in Scotland; further notes that those who contracted viruses and their partners and dependants continue to be profoundly affected by what happened; therefore welcomes the Prime Minister’s commitment to look again at this issue; and calls on the Government to respond positively to the APPG report and engage actively with those affected with a view to seeking closure to these long standing events.

I will do my very best to stick to the rules, Mr Speaker, as I know other colleagues wish to speak. There is a lot to say and interventions matter, but I will do my level best. My first task is to express my thanks to a number of people. First, I thank members of the Backbench Business Committee for being good enough to allow this debate. Secondly, I thank the large number of colleagues who supported the calling of the debate: those who attended the Backbench Business Committee last week; the many others who have signed today’s motion; those who have been in contact with me; and those other colleagues closely involved. Thirdly, I give a big thanks to the all-party group on haemophilia and contaminated blood, particularly my hon. Friend the Member for Colne Valley (Jason McCartney) and the hon. Member for Kingston upon Hull North (Diana Johnson), not only for their support today, but for the immense amount of work they have put into this issue over a number of years.

Fourthly, I thank a small group of colleagues who have worked particularly closely with me: my right hon. Friend the Member for Cardiff Central (Jenny Willott); the hon. Member for Foyle (Mark Durkan); my hon. Friend the Member for Stratford-on-Avon (Nadhim Zahawi), who has been immensely helpful through his company; and a number of others. May I also welcome the Under-Secretary of State for Health, my hon. Friend the Member for Battersea (Jane Ellison) to her place on the Front Bench? She and I have had a number of conversations about this issue since she was appointed to her role and she has been concerned and engaged with it. We have worked with No 10 and the Prime Minister’s advisers directly, of which more later.

I am also acutely conscious that all of us follow in distinguished footsteps we alas hear no more, from Peter Archer or Alf Morris, or, most recently, our friends Jim Dobbin and Paul Goggins, who respectively chaired and led the last debate held in Westminster Hall in October 2013. Paul, who had supported his constituents over a 16-year period before his death, is a particularly hard act for any of us to follow. In this regard, Paul’s great friend the shadow Secretary of State for Health is here to speak for the Opposition, and that is particularly welcome and important, emphasising how personally many of us have become engaged with the issue and how it has become one where both the Government and the Opposition feel a collective burden of responsibility for the events of the past. I hope they share a similar determination to reach a more satisfactory conclusion.

Like almost any of us here today, I could fill most of the three hours allocated with ease, but that is not the way this debate must proceed. I will therefore briefly outline a history that we and those watching are wearily familiar with, and move on to discuss why the debate is taking place today, what our main issues are and what our hopes may be. I will, where possible, illustrate with some of the words of those who have been in contact with us, as this is a debate for them and for their voices.

First, let me read from the opening to Lord Archer’s report, just to set the scene. He said:

“Throughout the 1970s and the first half of the 1980s, many in the UK who suffered from haemophilia were treated with blood and blood products which carried what came to be known as Hepatitis C, and some 4,670 patients became infected. Between 1983 and the early 1990s some 1,200 patients were infected with HIV, also through blood products. These infections had caused at least 1,757 deaths in the haemophilia community by the time this Inquiry started in February 2007, and more have occurred subsequently.”

Those figures can, of course, be updated for current circumstances. He continued:

“By the mid 1970s it was known in medical and Government circles that blood products carried a danger of infection with Hepatitis and that commercially manufactured products from the USA were particularly suspect. By the mid-1980s there were warnings of a similar situation in respect of HIV. But the products continued to be imported and used, often with tragic consequences. The reasons for the chain of decisions that led to this situation, and the alternative options which might have given rise to a different outcome, have been debated since that time.”

Yes indeed they have.

[Mrs Anne Main (St Albans) (Con)]

It is fantastic that my right hon. Friend has brought this debate before the House, and I was pleased to support him at the Backbench Business Committee. Does he recall that when we made our presentation to the Committee its members were surprised that this was still going on, after such a long time? That is the crux of today’s debate: now is the time.

[Alistair Burt]

My hon. Friend is right about that. I will go on to say why this debate is happening today, and that is one of the reasons. This issue has not gone away, and even more colleagues are now aware of it.

Since the Archer report there has been some positive recognition by the state of its responsibility. Over the years, efforts have been made for financial provision, but a complex and incomplete patchwork has been the result. Some people have been left behind—those bereaved and dependants in particular. Treatments for the severest infections have improved markedly, which has, in general, of course, been good news, but they also bring their own ironic consequences in giving longer life to those with originally no expectation of it and not always a quality of life for which we would all hope.

Efforts by the state to redeem itself have been hampered by a chronic inability to admit the past, to ensure that all the material was available for public scrutiny, and to give an opportunity to family members to ask the question that any one of us would need to ask: why and how has my loved one died? Its evasion of a public inquiry, the loss of key papers, the slow drawing out of what paperwork there was, and the failure to submit to questioning have left a mark of suspicion that lasts to this day.

Before I turn to the why-now question, let me dwell a moment on the scale of this tragedy. One of the most moving speeches heard in this or any other Session of Parliament was when the hon. Member for Liverpool, Walton (Steve Rotheram) read out, unforgettably, the names of the Liverpool 96. He did so to let the world know that behind the tragic statistics that the 96 had become were people with names, lives and hopes. Consider this: for me to do the same would mean that I would be reading out nearly 1,800 names. We will hear some of their stories today, but I ask the House to reflect on the scale of this. In terms of death toll, this is the 15th biggest peacetime disaster in British history in which the black death, at 3.5 million, is the worst. The awful Aberfan, the name of which we all know, is but the 142nd, with 144 lives lost. Contaminated blood has killed 12 times more.

[Jenny Willott (Cardiff Central) (LD)]

Does my right hon. Friend share my concern that in cases where haemophilia is passed down through the generations, entire families have been affected by this terrible scandal? The Lewis family in my constituency is one such example. Hayden Lewis tragically passed away. His brother was also infected and has also since died. Hayden infected his wife Gaynor with HIV before he was diagnosed, which will have an impact down the generations. That is why these families deserve far, far better treatment than they have so far received.

[Alistair Burt]

My right hon. Friend has been a doughty campaigner on this issue, and I have been grateful to her for her support. Let me put some flesh on what she has just said and on those figures. I will start with Hayden. His wife wrote to a friend of mine and said:

“I would dearly like to see an end to the campaigning and put this issue to bed. There needs to be an apology, there needs to be a big overhaul of the various Trusts… definitely not to make you feel as though you are going ‘cap in hand’ to them. That’s disgraceful. I want to go to Hayden’s grave and say once and for all ‘it’s sorted.’ Then I will know he is resting in peace.”

[Nadhim Zahawi (Stratford-on-Avon) (Con)]

On the point about the support mechanism, does my right hon. Friend agree that it is unacceptable that the very organisations that were set up to support individuals, such as the MacFarlane Trust, do not treat beneficiaries equitably? My constituent who went to the trust and questioned the response times was branded a troublemaker and her applications for grants were either delayed or, in some cases, frustrated completely. That is the reality on the ground. Will he say something about some of those organisations?

[Alistair Burt]

My hon. Friend is right that many beneficiaries have expressed deep concern about the workings of the trust. The all-party group report that came out yesterday will be addressed by other colleagues. On the MacFarlane Trust in particular he should know that I share his concerns. I do not believe that that trust is salvageable or saveable, and I will speak about that later.

[Albert Owen (Ynys Môn) (Lab)]

The right hon. Gentleman read out a list of people to whom he wished to pay tribute. May I add his name to the list? I am here today because constituents came forward after he sent out the letter on behalf of the all-party group. I pay tribute to him for that. When we talk about trusts across the United Kingdom, I feel that, because this matter predates devolution, there needs to be a UK response so that the Welsh Assembly and devolved Governments are not bearing the brunt of the problem themselves. This is a UK problem, and the UK Government should look either to work with those Administrations or to take the lead.

[Alistair Burt]

There is no doubt that these matters predated devolution. As most colleagues are aware, there is a Scottish inquiry going on. Almost inevitably when it reports, it must report on things that pertain to the United Kingdom Government. I notice that the Secretary of State for Health has joined us, which illustrates the importance of this issue to all of us. He is enormously welcome, especially given the burdens that he carries. The UK dimension of this is indeed very real.

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

rose—

[Alistair Burt]

I will give way, but I hope that Mr Speaker will be understanding.

[Mr Clarke]

The right hon. Gentleman mentioned the Penrose inquiry. We are all awaiting that report with great interest. Given his discussions with the Prime Minister, is he in a position to tell us when that report is expected?

[Alistair Burt]

My latest understanding is that the Penrose inquiry has said that later this month it will announce when it will report so I think that by the end of January the leader of the inquiry will have announced when publication will take place. I will touch on that later; the non-reporting so far is one problem that we have had to deal with.

Let me give one further brief story as part of the background to the statistics. I have been privileged to work with one family where three brothers died. To give an indication of what that meant, the sister wrote to me:

“the story of my three brothers, all dead, as a direct result of the treatment given to them by the NHS. The impact on the family? A devastation that time has not and never will heal, owing to the lack of acknowledgement over these deaths by both the Government and the medical profession…Family life is never the same with any bereavement, and we can only cherish their memories and their offspring, but there are still so many un-answered questions as to the decisions made”.

Each of us has a number of stories that we could raise, and I apologise for not being able to read out more.

Why now? The answer is that there has been a lot going on in recent times. This Parliament began with the very first Back-Bench debate, initiated by the hon. Member for Coventry North West (Mr Robinson), who I am pleased to see in his place. I am sure that that helped lead to an announcement in January 2011 by the then Secretary of State of further changes to the funds providing payments, but underlying issues remained outstanding. We were all approached.

On 18 October 2013, I asked the Prime Minister a question on the issue. I will not repeat the detail, but it got a warm response from the Prime Minister who understood the problem and promised that he would put support into it, meet the gentleman that I wanted him to see, and take it up. To put this in historical context, the reason for approaching him was that the scale of the tragedy is certainly on a par with those issues for which the Prime Minister has apologised in this Parliament—Hillsborough and Bloody Sunday—having the bravery to recognise what had been done in the past, with the authority that only a Prime Minister could have.

We took the Prime Minister at his word. I was proud to take my friend, my constituent and his colleague to that meeting. We said we needed No. 10 to offer to work on what more might be done to close off the issue, and since then the Prime Minister has indeed put members of his policy team to work, together with my hon. Friend the Minister. I am grateful for the Prime Minister’s engagement and I am, of course, hopeful. I hope that my hon. Friend the Minister will say more about that work.

My question was followed up infinitely more powerfully by a debate on 29 October led by Paul Goggins, in which he outlined some of the issues that we agree are still to be settled. He spoke principally about the funds and people’s finances, the bureaucracy and inconsistency of the funds, the discrimination suffered by those who did not fit certain categories, the crude distinction between stage 1 and stage 2 hepatitis C sufferers, the inadequacy of funds for making discretionary payments, and the absence of transparency and accountability over the years. He suggested that if the Government were to continue to reject a public inquiry, there should be an alternative process, including:

“In addition to fair financial support, those who have suffered so much are still owed a full explanation and a sincere, profound apology.”—[Official Report, 29 October 2013; Vol. 569, c. 201WH.]

Hovering in the background of all our deliberations were a Government who were prepared to take on a public inquiry. In 2008, the then Health Minister for Scotland, now the First Minister, announced to her great credit the sort of judicial investigative inquiry on the transmission of infectious disease via transfusions in Scotland that has not been held for the UK as a whole. It covers effectively all the major issues dealt with by Archer, and will very likely have comments to make that will have a bearing on UK-wide policy. It may well have implications for financial considerations in respect of responsibility for what happens and what needs to be done.

As I told the right hon. Member for Coatbridge, Chryston and Bellshill (Mr Clarke), we do not yet have that report, but while MPs have waited for it we have not been idle. In April the all-party group and additional colleagues working with me, held two public meetings at Westminster. We wanted to keep the community informed of what was happening, discuss expectations and hear from them. As MPs attacked the issue yet again, we were asking the Government to focus on the key issues. Those meetings helped to reinforce our sense that we were talking about the right themes—the changes that life had brought for people who had not expected to live, and the financial considerations that that now brought them. There is the problem of leaving anything; the problem of mortgage and insurance; and the problem of the bereaved and the dependants, which we all know very well. They all have to be in the front of the Government’s mind as they approach this.

[Mr Jim Cunningham (Coventry South) (Lab)]

I thank the right hon. Gentleman for giving way and pay tribute to him for the tremendous amount of work he has done on the issue. It would be fair to say that since he has been involved there has been a degree of progress, although not total progress, because we will not have that until we get some action. Does he agree that many of the families feel very strongly about this and often feel frustrated by the lack of progress?

[Alistair Burt]

I am grateful to the hon. Gentleman for his kind remarks and I appreciate them very much. Yes, one thing we were told in our meetings in April was that people are sick of coming to Parliament. They have been coming for many years and many of them will feel that even today, but this is the best we can do as Members of Parliament. We know that those on both Front Benches are listening.

[Zac Goldsmith (Richmond Park) (Con)]

I must admit that this issue was not on the radar for me until recently, when I had a discussion with a constituent who was one of three siblings all of whom were contaminated as a consequence of this blunder. I want to put on record my gratitude for the work that my right hon. Friend has done and my support for this campaign. I wish him all the best and all my support as it progresses.

[Alistair Burt]

I am deeply grateful to my hon. Friend, but the gratitude should actually be given to the sufferers and their beneficiaries who have made an attempt to approach MPs, sometimes for the first time. This year, we were able to bring it home to people that despite all the privacy and other reservations they might have had—some have not been able to tell family or close friends what they have been suffering—there is a need to approach MPs such as my hon. Friend to make them aware of the issue. That has been a new element of the campaign and is another reason for this debate.

[Mr Andy Slaughter (Hammersmith) (Lab)]

I do not wish to embarrass the right hon. Gentleman, who has cross-party support on this issue, but I think that he is being very modest and that his intervention with the Prime Minister has helped to galvanise the position. Given that it now looks as though Penrose will not be published until late March, is there sufficient time to get that settlement before the general election campaign and the election itself?

[Alistair Burt]

Again, I am grateful to the hon. Gentleman for his kind remarks. I do not think there is time, because I think it is possible that Penrose will have such far-reaching implications that no Government could make sensible decisions on future financial considerations until it had reported. I hope that my hon. Friend the Minister might be able to say a little more today about what might be done outside the financial considerations. I think that a conclusive settlement cannot now be reached. Penrose was originally supposed to report in March last year, which would have given time. That was the timetable we were all hoping to work to, but needs must and we are where we are.

[Jenny Willott]

On the point that my right hon. Friend was just making about what could be done without any more money being made available in the interim, does he share my concerns about the process that people have to go through to access the support that is already available, how invasive and demeaning the processes often are and how much that upsets those who are already in a very difficult position, when they are simply trying to get what they should be getting anyway?

[Alistair Burt]

I thank my hon. Friend. The report by my hon. Friend the Member for Colne Valley and the hon. Member for Kingston upon Hull North, who I will call my hon. Friend for these purposes, covered those issues in some detail. I am sure that my hon. Friend the Member for Kingston upon Hull North will speak about some of the practical issues to do with financial provision.

Following the public meetings, we decided to take the opportunity to use new technology. Both the all-party group and my group of colleagues went out with surveys to as many people as we could find. I am deeply grateful for support given by YouGov and the personal support given by my hon. Friend the Member for Stratford-on-Avon, whose commitment and resource allowed us to do this job. It is a measure of the impact of this problem that about 1,000 people responded to our surveys, which is statistically way above the normal response to such surveys. We are profoundly grateful to those who responded so honestly and no doubt with much pain as they went over difficult and hurtful circumstances in an effort to inform us and the Government of what they had experienced. Key findings in our survey included the ideas that lump sums rather than ongoing payments might suit some sufferers better, that ongoing support for widowed partners and spouses was vital and that some form of inquiry was still relevant. All our findings have been reported to Government.

We then asked more people to contact their Members of Parliament, as my hon. Friend the Member for Richmond Park (Zac Goldsmith) has just mentioned. The number of colleagues now involved is well into three figures, and the number who have signed our motion can be seen on the Order Paper. I have colleagues who wanted to be here but could not—the hon. Member for Central Ayrshire (Mr Donohoe) and my hon. Friends the Members for West Worcestershire (Harriett Baldwin), for Ipswich (Ben Gummer) and for Erewash (Jessica Lee). I could go on about their stories for some time.

I do not expect the Minister to deal with the possibility of further financial relief today. I accept that the delay to Penrose means it is possible that it could report in such a way as to require some form of response from the Government that might have financial implications which it would be unwise to commit to now and have to revise again quite soon. However, I put it on record that I do not expect that closure can be effected without some further financial provision. There will always be inevitable arguments about money. The truth for a Government is always that at any one moment there is money and no money. When the banks needed to be bailed out, money was found. When we needed to compensate those who had lost their futures through Equitable Life, even if all the money could not be found, over £1 billion was found. If, God forbid, the country were to have a catastrophe tomorrow, we would find money. A catastrophe? Perhaps 1,800 dead is a catastrophe.

[Sir Gerald Howarth (Aldershot) (Con)]

Like other colleagues, I pay tribute to the work that my right hon. Friend has done on this. I do not have any constituents who are affected, but I have served in this House, along with him, since 1983, and I feel that this is business that neither the House nor successive Governments have properly resolved. Does he agree that as this blood was provided by the national health service—by the state—it is therefore the responsibility of the state to sort out the affliction that has affected these people over decades?

[Alistair Burt]

My hon. Friend puts it very well. He is yet another example of an MP who does not have a constituency interest but has recognised the responsibility that we all share, and the state shares, for what has happened.

Only this morning we saw in one of the newspapers that local authorities had spent £5 billion on consultants. As I say, at any one time a Government will have no money or can find money.

[Mr Gordon Marsden (Blackpool South) (Lab)]

I apologise for not having been here at the beginning of the right hon. Gentleman’s speech. I want to touch on his point about payments. My constituency has four times the national mortality rate from hepatitis C—of course, not all of it acquired from contaminated blood—and a number of constituents who are living with the condition have written to me about it over the years. The latest comments have been about getting a conclusion to this process as fast as possible. One of them says:

“Existing mechanisms should be disbanded and replaced as quickly as possible with a new improved arrangement for processing payments.”

Is that not a short-term consideration to go with the longer-term ones?

[Alistair Burt]

I personally think that it is. That process will be informed by what the all-party group has spoken of, and its members will speak today. I thank the hon. Gentleman for his intervention.

As I said to my hon. Friend the Member for Stratford-on-Avon, I am not sure that I fully share the conclusions of the all-party group’s report with regard to the MacFarlane Trust. There is a great deal of detail in the report. As I was not responsible for compiling it, I can be lavish in my praise of the effort that went into it. A lot of hard work was done by a lot of people connected with the offices of the hon. Member for Kingston upon Hull North and my hon. Friend the Member for Colne Valley, and I am grateful for that. On the basis of information contained in the report and other information that we have, I do not believe that the MacFarlane Trust is saveable or capable of reform. I and others have seen a copy of a letter to the Secretary of State from two former trustees that is quite damning of its leadership, and one from some 68 beneficiaries that is equally uncompromising.

It would be unfair to go into more detail now. It may be that the trust has an impossible role. However, there should be no doubt that a body set up to support beneficiaries and those who have been victims of what happened is anything other than on their side—not an arm of Government, nor seen to be, and prepared to take on the Government to argue for the funds it needs without fearing a conflict of interest. The Department of Health has contributed to the situation by structuring too cosy a relationship, possibly in its own interests, and that has to stop.

[Caroline Dinenage (Gosport) (Con)]

My right hon. Friend has worked very hard on this issue, as has the all-party group on haemophilia and contaminated blood. I attended a public meeting yesterday with survivors and their families, and there was a very strong feeling that they have just had enough. They have been through a series of betrayals and disappointments at the hands of those who were supposed to help them, including trusts, departments and the Government. Does my right hon. Friend agree that this is our last chance to get this right for those people who have to suffer so very much?

[Alistair Burt]

I thank my hon. Friend for her kind words, and I agree with her. I will come to the trust invested in us in a moment, but, given the effort that has been put in, the work being done by Members on both Front Benches and the acknowledgement that we all share this responsibility, perhaps there is a chance that we will get to where we want to be.

Mr Speaker has been very generous with time, so let me finish. Last week, on the day that we circulated information about today’s debate to the community, I received the following e-mail, which was addressed to all of us as MPs:

“Thank you for your continued persistence in this issue. I wish to continue to be informed of any developments but I am very bitter that my husband of 21 years who got Hep C as a child from being a Haemophiliac sadly lost his fight and passed away yesterday after years of suffering due to Hep C. He never had an apology for all the years of ill health, he was a fighter right up to the end but it was also a fight he should never have had to deal with. Again on behalf of my husband, my daughter and myself thank you for your continued support and I hope a speedy result is had for those who still continue to struggle with the physical and mental stress this situation has caused.”

Finally, a friend who was told as a child that he had HIV and hep C, and a life expectancy of four years if he was lucky, says:

“I find each and every day is like being on death row for a crime I didn’t commit. I long for the day that I can wake up in the morning and not have to fight the Gov’t for the right to have a better life. Imagine what it’s like to believe for years that what we have been given was an accident. The medical staff constantly told us ‘it was an unavoidable accident’ only for us to learn the truth for ourselves. Where did my human rights go at 12 years old. And WHY do I still not have any?

When you are stripped of your pride, your dignity, your finances, your job, career, your future, what do you have left? Your spirit and your fight, that’s what. Which is why we will be sitting there on Thursday and we will keep coming back until justice is done or the last one of us dies.”

As MPs, we have been privileged to be given the deepest, most personal details of these people and their loved ones. Some of us have been given family medical records, people’s deepest, darkest secrets and their hopes and fears. We have been privileged to have that. The words “devastation” and “struggle” appear far too often in the stories we deal with. We are not talking about a tiny handful of people, but about thousands who still feel wronged. As Members on both Front Benches prepare for an election, let us ensure that this Parliament as a whole remains committed to providing, finally, the best closure for those who trust us to do so.

[Several hon. Members]

rose—

[Mr Speaker]

Order. In order to try to accommodate everyone who wishes to contribute to this important debate, I have thought it necessary to impose, with immediate effect, a seven-minute limit on Back-Bench speeches. Such limit may have to be reviewed, probably downwards, in the course of the debate.

11:58

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

May I start by thanking the right hon. Member for North East Bedfordshire (Alistair Burt) for securing this debate and for all his incredibly hard work over the past year or so in championing this cause? I also thank him for his kind remarks about the late Paul Goggins, the late Jim Dobbin and the late Lord Morris.

I co-chair, along with the hon. Member for Colne Valley (Jason McCartney), the all-party group on haemophilia and contaminated blood, and it has been a privilege to be involved in putting together the report. I think I speak for both of us when I say that many of the contributions made by the nearly 1,000 people who gave evidence to the APPG were harrowing and at times very moving. The substantive report would simply not have been possible without those submissions. They are quoted throughout the report and highlight in vivid detail how the current system of support is not fit for purpose. Our report is clear that there needs to be dramatic change to the level of support people get, and the way in which it is managed, before we can even hope to achieve closure for these people. Needless to say, my biggest thanks go out to the whole community of people who have been affected by this tragedy.

In addition, I thank YouGov and the hon. Member for Stratford-on-Avon (Nadhim Zahawi), who generously helped put together the survey; the Haemophilia Society, which provides the all-party group’s secretariat, and particularly its chief executive, Liz Carroll, without whose help we could not have conducted the inquiry or produced and printed the report; and Fiona McAndrew and Thomas Stephens, who both worked so hard to put the report together. I am also pleased that my right hon. Friend the Member for Leigh (Andy Burnham) is on the Labour Front Bench, and that the Secretary of State for Health and his Minister, who has direct responsibility for this area, are also present.

I want to highlight two matters. First, I want to clarify the issue about the number of people infected with hepatitis C. Since we concluded our inquiry, several people have got in touch about the figures. We state at the beginning of the report that, historically, it was estimated that more than 30,000 people were infected with the virus during the relevant period, and the figure was given in the Government’s 2011 review of support for those affected. Figures for the numbers affected by haemophilia derive from the United Kingdom Haemophilia Centre Doctors Organisation, and those for the number of people without bleeding disorders who are infected are estimates from an academic study.

I want to make it clear that no support package would extend to anywhere near such a number, because many of those originally infected have—unfortunately and sadly—died, while some cleared hepatitis C at the acute stage and others, especially those infected through a blood transfusion, would find it very difficult to link their hepatitis C infection with a single period of NHS treatment and so could never qualify for help in practice. It would be a shame if any Government used such a figure to argue that it is too costly to expand support. In practice, trust-based assistance would cover only a much smaller number of people—fewer than 6,000—and any consideration of the costs of extending the support package should take that into account.

Secondly, I want to highlight the case of my constituent Glenn Wilkinson, who was infected with hepatitis C from NHS-supplied blood products. Without Glenn, I would never have become involved in the all-party group. He is a resolute and determined activist, and he has campaigned vigorously for more support for those affected. We all owe him a huge debt of gratitude for keeping on going, and for fighting for what is right.

As a minimum, Glenn would like a number of measures taken to reach a full and final settlement for all. I will set out what he has told me in the past few days and how it fits with what we said in the report. First, he wants to remove the distinction between stage 1 and stage 2 hepatitis C, because the majority of people in stage 1 do not receive ongoing payments. The distinction is based on a decision that those in stage 1 are not in a state of ongoing need, but our inquiry clearly showed that they are in need. The accounts we received show that the Government need to rethink the current system, which denies ongoing support to those in stage 1. We therefore recommend that the Government provide ongoing payments to all people with stage 1 hepatitis C at a level to be set by a public health doctor.

Secondly, Glenn wants all widows and family members of deceased infectees to have equal access to financial support, irrespective of the infection that caused the virus. We recommend that all widows of hepatitis C infectees, who are currently denied any ongoing support, get the same support as those of HIV infectees. We also recommend that the families of deceased hepatitis C infectees should get the same support for at least nine months after the primary beneficiary dies, as is already the case for those with HIV. Thirdly, Glenn wants the support to be simplified and administered by just one trust, rather than by the five trusts that currently exist. Our report recommends that the Government review the support provided, because it is a mishmash and a hotch-potch.

[Kerry McCarthy (Bristol East) (Lab)]

I congratulate my hon. Friend and other Members involved in producing this excellent report. One of my constituents affected, Councillor Bill Payne, has praised the report. On her point about the piecemeal nature of the support available, I must say that I was really struck by that when I read the report. It is difficult enough to deal with the health care system and the welfare system without the additional burden of bureaucracy, and it seems that some of the organisations involved are not very good at responding to people’s needs, so I agree that that needs to be addressed urgently.

[Diana Johnson]

I am grateful for that intervention. I think I should be allocated an additional minute that has not been put on the clock. [Interruption.] Thank you, Madam Deputy Speaker.

Fourthly, Glenn told me that he thinks it would be fair to see priority access to NHS treatments for those affected, and that is rightly one of our recommendations. He also wants automatic passporting to employment and support allowance and disability benefits for all infectees. Because this is an all-party group, that recommendation is not included in the report, but I think it should be considered by the Government. Just today I received a message from someone who said that the money they get from one of the trusts is now being spent on paying the bedroom tax—I am sure the Minister does not think that that is what trust money should be used for. Once the Penrose inquiry is published, we hope there will be no further delays, or that any delays will be minimised in any inquiries that the Department of Health and Government need to make.

I will end with a quote from a person I think was very brave to come forward. She is an HIV infectee and the widow of an HIV-infected husband:

“I refuse to be a victim. Despite everything I cherish my life and count my blessings. I have faith that this will end soon and maybe then, my talents, intelligence, spirit, sense of justice, experience and energies can be better directed at contributing towards and being part of a better society. I pray for the day when this Trust is out of my life. I do not think that is much to ask.”

12:06

[Jason McCartney (Colne Valley) (Con)]

As co-sponsor of this important debate I thank the Backbench Business Committee for scheduling it. I also thank the Health Secretary and the shadow Health Secretary for their attendance in the Chamber, which shows the significance and importance of this issue.

One of my first speeches as MP for Colne Valley came on 14 October 2010 in a Backbench Business Committee debate on contaminated blood. Four years and a few months on, and we are still asking for a similar conclusion to this scandalous saga: for the Penrose inquiry to be published; for the trust offering financial assistance to operate in a fairer and more transparent way; and for a final settlement and an apology to the infected community from the Government of the day.

By 2010, 1,800 of the 4,800 people infected with hepatitis C had died, and of the 1,243 people who contracted HIV, only 345 remained. Today the number of survivors has fallen even further, and with each month of delay more of the infected community will not live to see any closure to this scandal. The date for the publication of the Penrose report will be announced shortly, and as it covers pre-devolution Scotland’s NHS treatment it will have implications across the United Kingdom. I implore the Government to respond positively to its findings.

My right hon. Friend the Member for North East Bedfordshire (Alistair Burt) has been working tirelessly with No. 10 on behalf of the infected constituents to try to get a final settlement, and I praise him for that work. As the motion suggests, I praise and welcome the Prime Minister’s commitment to look into this situation, which for too long has been ignored by Administrations.

As the Penrose inquiry is imminent and discussions on a final settlement are under way, the all-party group on haemophilia and contaminated blood, which I co-chair with the hon. Member for Kingston upon Hull North (Diana Johnson), set up a survey with the infected community to ask how it felt about current financial arrangements organised through the Skipton Fund, the MacFarlane and Eileen Trusts, and the Caxton Foundation. The survey received 961 responses, the majority of which were unhappy with current arrangements. I thank Tom Stephens, and my hon. Friend the Member for Stratford-on-Avon (Nadhim Zahawi) for his co-operation, and of course Liz Carroll and the Haemophilia Society for their help in compiling this important report.

The human stories from the infected community are the most poignant, and the replies to the survey contained hundreds of pages of heartfelt responses from those who have faced hardship and tragedy due to their illnesses. A woman from my local area asked me to relay her story to the Health Minister. Melanie was infected when she was a child undergoing surgery. Her parents received the terrible news that she was HIV-positive when she was just eight years old. Now 36, Melanie has been unable to fulfil her aspiration of becoming a paediatric nurse or a play specialist. Instead, she must rely on Government support and assistance from the Eileen Trust. She wants what many in the infected community desire: closure to the contaminated blood scandal, so they can live the rest of their lives in dignity and without having to beg for each bit of support. It is her and others I am thinking of today.

Another constituent, who wished to remain anonymous, described the 30 years of hopelessness, pain and medication that followed his infection with HIV, hepatitis B and C, and blood containing variant CJD, when he was just 12 years old. Not only has that severely limited what he could achieve in adulthood in terms of a career and a family, but he describes the stigma surrounding the diseases and the fear of discovery by those ignorant of the circumstances involved in the initial infection. The all-party group’s report on the survey makes a number of recommendations to improve conditions. I hope the Health Minister will respond positively to them, so that we can move forward. That is very important.

Finally, while this Administration have been open to improving the situation for those infected with contaminated blood, what those people really need is a final resolution. The Prime Minister has shown great courage and great strength in apologising to the victims of Hillsborough and Bloody Sunday. He can now take the lead on this issue and apologise on behalf of the nation to those infected with contaminated blood. With the work of other Back-Bench Members, the publication of the all-party group report and imminent publication of the Penrose report, there will be no better time for the Government to commit to improving the conditions of those infected. We have waited long enough.

[Several hon. Members]

rose—

[Madam Deputy Speaker (Dame Dawn Primarolo)]

Order. Before I call any more speakers, it may not have escaped the notice of Members that there is a problem with the clocks in terms of each Member’s allotted time this afternoon. May I reassure Members that I will also be timing speeches to ensure that they have the correct amount of time and are not short-changed? I appreciate that seven minutes is a short period of time. If the clock indicates that you do not have any more time, I advise you to keep talking until I ask you to resume your seat. I understand entirely that this is not what normally happens, but I want to be fair to every Member. Hopefully, the fault will be corrected. None the less, Members should keep an eye on when they start speaking. Adding seven minutes to the clock is not really that challenging, I hope.

12:13

[Jessica Morden (Newport East) (Lab)]

I went to the launch of the report by the all-party group yesterday. On behalf of my constituents who are affected, may I say a very big thank you to hon. Members and former hon. Members who have pursued this issue over the years, in particular my hon. Friend the Member for Kingston upon Hull North (Diana Johnson) and the hon. Member for Colne Valley (Jason McCartney)? It is hard to believe that, after all these years, this is the first survey of those affected by this scandalous tragedy. I support wholeheartedly the efforts of the right hon. Member for North East Bedfordshire (Alistair Burt) to secure this debate and all the work he has done. Even though the Penrose report has been delayed, we cannot delay talking about this matter—it has taken far too long already.

I support the recommendations in the report that deal with the experiences that constituents such as Lynn Ashcroft have had. I spoke to her last night on the phone. She had been reading the report and described it as “very comprehensive and moving”. Lynn’s late husband, Bill Dumbelton, was a haemophiliac. Bill was one of the first haemophiliacs to treat himself at home with cryoprecipitate. He contracted HIV and hepatitis C from the blood he was given. He lost his job with BT in the 1980s after he told the occupational health department about his HIV status.

Sadly, Bill died at the age of 49 and Lynn was widowed at 35. Bill had no life cover. As Lynn explained, because of his haemophilia no one would insure “people like him”. As well as having to come to terms with the loss of her beloved husband, Lynn was left with the mortgage and other financial challenges. Lynn did receive money through the Skipton Fund, although she feels she had to jump through many hoops to get it. It took her two years to get to stage one, during which vital medical records were lost. In her words, the Skipton Fund process was “brutal”. Several appeals in three to four monthly intervals over two years made her grieve all over again. It took a huge toll on her personally. As Lynn says, the Government cannot bring back the dead or restore their health, but they can award a financial package that will ensure survivors and their families are financially secure for life. In her words, she wants to see no more charities, no more funds and no more begging. Lynn has been helping other widows to get through the overly complicated system. I hope that, as a consequence of the report, the Government will act on its recommendations.

Bill died in the same year as Colin Smith. Colin’s parents, Janet and Colin, live in my constituency. Colin’s tragic story is on the “Tainted Blood” website, as is Bill’s, and the story of his extremely short life illustrates why we need a public apology, which is long overdue. Colin went into hospital at eight months of age for a minor ear condition. As a haemophiliac, he received factor VIII, which the family learnt following a freedom of information request came from a batch from a prison in Arkansas. He spent his short life fighting illness. He died, aged seven, of AIDS and hepatitis C. The family did not know he had hepatitis C until three years after his death. That was kept secret, as so much has been kept hidden. It was a real battle to discover that.

On behalf of the family, may I say they are angry that there was never a public inquiry and that the full findings of Archer were not accepted? They passionately believe that more should be done to help those still living with the consequences of what Lord Winston described as the worst treatment disaster in the NHS. They have taken comfort in the friends they have made through the “Tainted Blood” campaign, but say they have not felt strong enough to attend the constant funerals, as their friends pass away. The Smith family and others need and deserve closure.

Two days ago, it was the 25th anniversary since Colin’s death. This was the tribute on the “Tainted Blood” Facebook page:

“Today marks the 25th anniversary of the death of Colin Smith. He was a haemophiliac, but despite that lived a normal fun-filled life, along with his two brothers and his mum and dad. Then, in the middle of the AIDS crisis, he was given a non-emergency operation, during which he was given a batch of blood product. Colin died of AIDS, aged seven, in Janet’s arms, weighing around the same as a baby. His family have never recovered from it, and never will.

Please, as you read tomorrow’s APPG report and as you watch the debate…remember Colin and all of those who, like him can’t be there with us. Please remember all of those who might not see the end of this year…Thousands of people, like Colin, simply didn’t make it this far. He never had the chance to join the cubs, play football for his school, have a girlfriend, go travelling or get married…Instead, his short life was filled with hospitals, doctors and illness. He was just a little boy, but a very special one who we, at TB, always keep in mind as we campaign.”

While long overdue, it is time for a public apology and a final settlement. Anything less will just continue to hurt the innocent victims and their families who, through absolutely no fault of their own, have had their lives torn apart by this national scandal.

12:18

[Sir Oliver Heald (North East Hertfordshire) (Con)]

The hon. Member for Newport East (Jessica Morden) has explained this tragedy extremely well. I first became aware of the issue in the early 2000s when I was a member of the all-party group on hepatitis C. I would like to pay tribute to the work of Jim Dobbin, whose memorial service it was yesterday. He was a great campaigner on a number of health issues and will be sadly missed.

I congratulate my right hon. Friend the Member for North East Bedfordshire (Alistair Burt) on doing a wonderful job to secure the debate, and on working so hard on this issue. A constituent of mine recently told me that attending a meeting chaired by him in the House had left her more reassured than ever that he, and the group of MPs involved, would eventually obtain a decent settlement for all victims and their families.

I have a very old friend who has haemophilia. He has kept me informed on the issue over many years but is not very well these days. I would like to pay tribute to my constituent Mrs Ward. She campaigns on the issue on behalf of her family, who have been very badly affected by it. It is an issue of compassion; it is an issue for our generation; it is an injustice and a scar on the NHS. It has to be resolved.

We all feel for the people who are continuing to struggle with the aftermath of this decades-old mistake. The right hon. Member for Cardiff Central (Jenny Willott) made the point that this blight can run down the family for years. Obviously we understand the background of the original lack of understanding and the medical challenge to treat people with haemophilia, not knowing with security that the blood was safe. It is good that Governments have now recognised the extreme harm and the disaster that this was for victims, for which compensation was necessary. The arrangements put in place in 2011 were a major step forward.

I want to make three points. The first is that the APPG’s excellent report highlights the confusing system for compensation, with the five separate bodies all receiving Department for Health funding. There are two private companies and three registered charities; it is too opaque. I hope Ministers will see whether there is some way of improving the signposting to ensure that people can find their way through it.

The second point is that even if one understands the funding to which one is entitled, the process of claiming it is difficult, confusing and onerous.

[Mark Tami (Alyn and Deeside) (Lab)]

Does the hon. and learned Gentleman agree that people need help through the difficult and complex process to ensure they get the outcome they deserve?

[Sir Oliver Heald]

Yes, I do agree. The hon. Gentleman will know that there were people who underwent treatment for hepatitis C, but somehow the NHS has lost their records. That affects their applications. As the hon. Gentleman says, some way must be found to support people in this complex process.

One of my constituents tells me that new treatments for curing genotype 1 hepatitis C have been approved, but access seems to be granted only on “compassionate grounds”. Apparently, that excludes that constituent. She describes it as a “painful irony” that the problems that led to the NHS providing contaminated blood in the first place are now denying a survivor the appropriate treatment. I hope the Minister will look into this case, so that rather than having to prove compassionate grounds it can be dealt with as an entitlement.

The tragedy of this is deeply upsetting, and we must step up to tackle its legacy. The Penrose inquiry is expected to report soon, and its findings will, I am sure, be considered carefully by the Government. We are all pleased that these steps are being taken and that there has been progress, but this has not yet led to closure. That is necessary for the survivors, and it is necessary for the survivors and their families to have the support and dignity that they deserve. It is incumbent on our generation to sort this out, and this is the place to do it.

12:23

[Graeme Morrice (Livingston) (Lab)]

May I say from the outset how pleased I am that the right hon. Member for North East Bedfordshire (Alistair Burt) has secured a debate on an issue that has had profound and devastating consequences on the lives of at least two of my constituents and indeed thousands of individuals and families across the country?

I hope that through my contribution I will be able to give a voice to my constituents who have been affected by contaminated blood and who, up until now, have had no answers to what is considered to be one of the worst tragedies in modern health care. The experiences of my constituents echo many of the findings in the APPG report, particularly in terms of the inadequacy of the support available and the difficulties encountered when applying for entitlements from the Skipton Fund. I want to take this opportunity to praise the work of the APPG for haemophilia and contaminated blood.

I was deeply saddened to hear of the plight of two of my constituents who received contaminated blood during the 1980s.

[Mr Tom Clarke]

My hon. Friend will be aware that some of us who have sought for many years to get legislation through the House but have not yet achieved it feel that whoever wins the next election should make sure that time is available for this. Does he agree with that objective?

[Graeme Morrice]

Yes, I certainly concur with my right hon. Friend and commend him for his work in this field.

My constituent Mr Billy Cannon of West Calder suffered from a burst ulcer in 1986, which meant he required two blood transfusions. Mr Cannon was fine after the operation and recovered. However, it was not until August 2010, some 24 years later, when he was diagnosed with advanced liver cancer that he discovered he had hepatitis C. Sadly, after a brave battle, Billy Cannon, aged 57, passed away in February 2013. The loss of Billy, understandably, has been devastating for the Cannon family and I wish to take this opportunity to pass on my sincere condolences to Linda, Billy’s wife, who has shown great courage in the face of a very difficult set of circumstances.

It is the circumstances around Mr Cannon’s death that are so hard to accept because there have been no answers, no apology and no acknowledgement that mistakes were made that led to his untimely death. His wife recognises that apportioning blame will not bring back her beloved husband. Nevertheless, the death of Billy has had such profound consequences for many different aspects of her life and leaves so many questions unanswered.

Like Billy Cannon, another constituent, Vera Gaskin of Livingston, also contracted hepatitis C from contaminated blood. You, Madam Deputy Speaker, may recall that I raised her circumstances with the Prime Minister in the House a few years back. Mrs Gaskin received a blood transfusion during her treatment for cancer in 1985. Fortunately, Vera recovered from the cancer. However, later in 1996 when she began to feel unwell, it was revealed that she too had hepatitis C. Again, no explanation was given to Mrs Gaskin of how she had been infected with contaminated blood.

What is evident in the case of both of my constituents is the lack of information on the circumstances surrounding the passing of hepatitis C through contaminated blood. It is for this very reason that it is so important that there is a review of the events and decisions that led to the tragedy.

Luckily, Mrs Gaskin was in the early stages of the virus when she was first diagnosed and could therefore receive treatment. Nevertheless, living with hepatitis C has been particularly difficult for her and has impacted on all aspects of her life and that of her husband and family. The stigma alone of having hepatitis C has been mentally draining for Mrs Gaskin and her quality of life has been greatly reduced. The hepatitis C has denied her many opportunities and brought many difficulties.

What makes Vera Gaskin’s story even more upsetting is that she has not only had to come to terms with the devastation of her diagnosis, but has had to deal with an inadequate support system, further adding to her distress. Her view of the Skipton Fund, set up to help those affected by the tragedy, is:

“It is not fit for purpose, does not serve the victim and is causing more harm than good”.

I believe that this speaks volumes about the effectiveness of the support arrangements put in place following the tragedy.

I recognise that some improvements have been made to the support and compensation available to those affected, but changes are still clearly required in two areas: first, in the criteria used to determine entitlement for payment from the Skipton Fund, and, secondly, in the amount of financial support available. Despite having the medical proof that she had cirrhosis—the medical criteria required in order to receive further compensation—Mrs Gaskin was denied her stage 2 payment from the Skipton Fund.

She is not alone in encountering such difficulties. The APPG report revealed that 16% of all claims considered by Skipton have been deferred or rejected, many on the basis of insufficient proof. It was not until after a year-long battle that Mrs Gaskin’s application to receive her second stage payment was approved. What is evident from my constituent’s experience is that the criteria used by the Skipton Fund are too strict and only make it more difficult for victims to receive funds that they are perfectly entitled to. In response, I would urge the Government to take action to improve the system of allocating funds and to review the criteria, making it easier for those affected to provide proof.

The second important issue about the support arrangements is the amount of compensation available. Although no amount of money will be able to take away the pain experienced on a daily basis by those affected, it is clear that the amount of compensation available is simply not enough. Many individuals living with hep C continue to experience hardship and financial difficulties, despite the existence of Government-established funds, which is why I would urge the Government to reconsider the amount available with a view to increasing it so that individuals can maintain a good quality of life.

In conclusion, I am sure all Members would agree that what my constituents and others across the country went through is tragic and cannot be undone. That said, I am hopeful that a positive outcome can be reached in the form of a review of the circumstances and the support arrangements available—for the sake of those who are sadly no longer with us and for the sake of those who continue to suffer. The all-party group report makes some important recommendations, to which I hope the Government will respond carefully and positively. I strongly support the report’s recommendations, particularly the calls for a public apology from the Prime Minister on behalf of successive Governments. I hope that, following this debate and, most importantly, following the publication of the Penrose inquiry, some form of justice will be delivered for each and every individual and family across the country who continue to have to deal with the consequences of this awful tragedy.

12:31

[Chloe Smith (Norwich North) (Con)]

I have attended today’s debate for three reasons. First, I know of two constituents who have suffered from the contaminated blood scandal. Secondly, the Backbench Business Committee is doing good by returning to the subject of one of its earliest debates in 2010, so we can take this as a test of what sort of progress can and should be made during a Parliament. Thirdly and most seriously, I share the view of many in the Chamber that this issue is a national disgrace and a national tragedy. The victims have suffered long enough. I endorse the calls in the comprehensive inquiry by the APPG and I thank the various hon. Members who contributed to it. I also endorse its view that a public inquiry is necessary to establish culpability.

I shall use this time to tell the story of my constituents, and much of what I say will be direct quotations from them. They asked me to attend this debate, to speak for them and to support their interests. One in particular thanked me for such forms of support, saying:

“You have no idea how importantly we, in this contaminated blood community, who are very sick and ill, hold them.”

She wanted to make sure that we know that

“they are ill and exhausted and do not want to be constantly fighting and campaigning.”

Anne had an operation in 1974 that required three pints of blood. She knew by 2001 that she had been infected with hepatitis C, and she is now a stage 2 Skipton Fund recipient. She has suffered decompensated hepatitis C cirrhosis, end-stage liver disease, cancer, osteoporosis with weak teeth and a compression fracture of the spine, portal hypertension and oesophageal bleeding for which, she says,

“the procedures had recently are no cure, they simply stop the likelihood of my bleeding to death from the mouth and will return.”

She has splenomegaly, with her spleen twice the size it should be; in her words,

“it…‘eats’ platelets, red blood cells and immune giving chemicals.”

She has extreme fatigue and often describes her inability do anything more than be in bed all day, which is very hard when the treating hospital is several hours’ travel away. She has had four rounds of interferon injections—a drug that she says is “like chemo”—and pills that

“kill all your cells good and bad”.

Anne has most recently had a liver transplant, for which her consultant cheered her up with three things to worry about: No. 1, dying on the list to get the transplant; No. 2, not surviving the 10-hour operation; and No. 3, rejecting the new liver. She has had a drug regime that has helped to remove the virus. Indeed, when I spoke to her since the transplant, she sounded like a new woman, even when she almost cheerily told me:

“I still have cancer, but the Hep C has gone!”

Anne has been concerned about funeral payments so that her family do not need to worry. She explains the daily humiliation of waiting until last in a doctor’s or dentist’s surgery because she is infectious; she says she is being “treated like a leper”. She describes the

“stigma of cirrhosis and a disease associated with drugs”.

Anne would like priority support for survivors, although the majority will already be dead. In particular, she wants access to liver transplants and access to new drugs. She would like a national strategy for GPs to understand better the complexity of hepatitis C infection. She would also like better advocacy, because so many people affected are not in a position to speak for themselves.

[Sir Peter Bottomley (Worthing West) (Con)]

A point put to me is how infuriating and occasionally humiliating it is when, on meeting a new clinician, someone has to go through their whole life history, explaining that they do not drink too much and so forth. There should be some way of flagging up the fact that these people do not need to be asked ordinary clerking questions when their condition is perfectly plain.

[Chloe Smith]

I thank my hon. Friend for that point. It speaks directly about an issue I am coming on to. Anne has told me that she faced that problem, along with others such as getting a benefits processing centre to understand how the Skipton Fund works and the fact that she and others like her are fatally ill. She would like to see the “passporting” of prescriptions, which connects with what my hon. Friend just said.

My second constituent is a haemophiliac, and he was infected with hepatitis C in 1978 from an operation on arthritis. He realised the result in the 1990s. I am sorry to say that he had been part of Skipton stage 1 until last year, but he was then diagnosed with cirrhosis of the liver, which he had feared for many years. He, too, has been treated with interferon, a “truly awful drug”, and he is hoping for a new generation of drugs in a couple of years’ time.

My constituent has lived in fear of his disease worsening and of passing it on inadvertently to his wife and children. At first, he was told

“not to worry, as Hep C was like flu”.

He explained:

“Later they said that was wrong and it would probably kill him one day—unless…something else got him first.”

He told me:

“It’s funny how as you clock on a bit you get told you don’t need to worry as something else will kill you first. One does begin to fear this thing that’s going to get you first!”

He has been angered by the distinction drawn between stages 1 and 2 of hepatitis C in the lingo of the fund. The APPG’s report backs his view, and indeed my other constituent, Anne, agrees in the sense that many sufferers sadly progress from stage 1 to stage 2.

My second constituent would like three things: a full judicial inquiry; improved administration by the Skipton Fund; and better compensation, which he believes to be poor for the death and suffering caused in comparison with payments that other victims of other tragedies have received. He is hugely cynical that any Government will do something about this “hidden scandal”, which, as he calmly says,

“is a great pity for an awful lot of people.”

Let me come to my own views. I think the APPG’s report is a strong piece of work which holds many sensible recommendations that I would back. As I said, I would back the holding of a public inquiry, as this is one of the last remaining great scandals for which culpability ought to be clear, acknowledged and apologised for. I back the motion and pay tribute to my right hon. Friend the Member for North East Bedfordshire (Alistair Burt) and all the others who have made today possible.

I add one comparison drawn from Anne’s comments, and this speaks to what my hon. Friend the Member for Worthing West (Sir Peter Bottomley) challenged me on.

[Sir Peter Bottomley]

I did not challenge; I added.

[Chloe Smith]

Added, quite right.

We honour our military with a covenant. For the sacrifices they make for us— facing danger, injury and death—we give our respect, our support and fair treatment. We acknowledge a moral obligation. This Government should be congratulated on aiming to ensure that no disadvantage is suffered in gaining public services, and they acknowledge that there can be a case for special treatment in certain cases.

In no way do I try to cheapen either of those situations—the need for a military covenant or the needs of the people whom we are talking about today—but it is clear to me as a constituency MP that my constituent Anne seeks much the same as the sort of help that I have tried to get for veterans: doctors to act on the wider effects of their illness; getting the benefits system to see what they are suffering; and getting public services in general to join the dots of what they know.

I know it is controversial in the military covenant to emphasise preferential treatment, but in the case of Anne, who has wanted drugs and a new liver against the might of the NICE guidelines, when her appalling, sapping illness was no fault of her own, I think that she, too, and many like her, should receive respect, support and fair treatment. I see a moral obligation and every moral argument for doing as she asks. Perhaps the Government might consider having a covenant for contaminated blood.

12:39

[Mr George Howarth (Knowsley) (Lab)]

I congratulate the right hon. Member for North East Bedfordshire (Alistair Burt) on the typically thoughtful and sensitive way in which he introduced and framed the debate. I think we are all grateful to him for that. I also thank the all-party group, co-chaired by my hon. Friend the Member for Kingston upon Hull North (Diana Johnson), for its important work and for what I consider to be a very important report.

Once in every generation, a handful of issues arise that I tend to describe as debts of honour. The right hon. Gentleman mentioned Hillsborough, I could mention the thalidomide scandal, and I am sure that other examples have already been given or will be given during the debate. I shall give two examples from my constituency, which, I think, underline the fact that this is a debt of honour that needs to be addressed.

My first example concerns a lady called Mrs Phoenix. In 1980, Mrs Phoenix had an operation on her jaw at Broadgreen hospital in Liverpool, during which she received contaminated blood. In 1995—15 years later—she was diagnosed with hepatitis C, after which she began a course of interferon that lasted for approximately a year. That failed to eradicate the virus. In 2003-04, she began a further course of interferon, and, thankfully, this time the virus was eradicated.

In subsequent years, Mrs Phoenix was told repeatedly that she was not entitled to claim compensation for the hepatitis C that she had contracted from contaminated blood, because the medical professionals had not been aware at the time that the disease was being transmitted from person to person through blood transfusions. In 2011 her solicitor told her about the Skipton Fund, but when she tried to complete the relevant forms in order to submit a claim to the fund, she was told that the details of her NHS operation had gone missing. That is a not unfamiliar story. Luckily, she was able to carry out the necessary research and appeal against the decision, and her appeal was successful.

This is what Mrs Phoenix has asked me to tell the House:

“As far back as the 1950s some US doctors were raising concerns about paid blood donations from so called ‘skid row’ donors. I feel health officials here cannot cloud the issue by claiming ignorance of risks buying in blood from the USA. Personally I do not want to rely on charity, I don’t want tweaks to the current system, I would like a full and final settlement. This has been called the worst treatment disaster in the NHS; warnings were ignored and I feel gross maladministration is to blame.”

Mrs Phoenix has made three requests. First, she wants the Department of Health to acknowledge that purchasing blood products from the United States, including blood products from inside the US prison system, without testing them was negligent. Secondly, she seeks what many others have called for—an apology—and thirdly, she seeks adequate financial compensation.

[Mr Richard Bacon (South Norfolk) (Con)]

I have listened to many of these stories with growing anger. Constituents of mine have also been affected. Does the right hon. Gentleman agree that Governments of both parties have failed our constituents for many years, and that the House will have no patience with any Government of any party who do not produce a final resolution of these matters?

[Mr Howarth]

In a word, yes.

[Mark Durkan (Foyle) (SDLP)]

The right hon. Gentleman has said that the risks must have been known. Is he aware that the move to set up a compensation scheme in the Irish Republic was made before full state liability was recognised? That liability was recognised only when a second inquiry showed that the state had known there was a risk, but had continued to use contaminated blood products on the basis that, because the United Kingdom and others were using them, it could carry the risk.

[Mr Howarth]

The hon. Gentleman has made an important point, which I fully accept.

My second example comes from a constituent who wishes to remain anonymous. Her husband, who was a haemophiliac, died at the age of 59 after contracting hepatitis A, B and C through contaminated blood administered in the late 1970s and early 1980s. As a result of receiving that contaminated blood, he had developed cirrhosis of the liver, oesophageal varices, ascites, encephalopathy and liver cancer. Understandably, my constituent says, his quality of life deteriorated year by year and month by month until his eventual and sad death. His haemophilia had prevented him from accessing insurance products such as mortgage protection, and the early retirement necessitated by his ill health had decimated his pension, which had left both him and his wife struggling financially.

My constituent had close family members who also died as a result of receiving contaminated blood. The family has been hit hard by a terrible scandal. Twenty years after the death of her husband, my constituent is still campaigning for justice. The family has been given no explanation of why the scandal was allowed to happen, and why the medical records went missing at local hospitals and in the NHS.

My constituent is now 76 years old, and is herself in ill health. She is looking for answers to a number of questions that are still arising, and she hopes to receive those answers in her lifetime and as soon as possible. The family sent me the following statement, which they asked me to read out:

“My family holds that what has long been needed is for this tragedy, which has already directly claimed the lives of 2,000 haemophiliacs”

to be addressed and put into perspective, in terms of its “scale” and in terms of “financial support”. The statement continues:

“We believe that this disaster…is finally seen as one event…the ‘UK Contaminated Blood Scandal’….the scandal is already Britain and Ireland’s 15th biggest peacetime disaster in terms of death toll, since records began, yet very few people know about it…the UK Contaminated Blood Scandal claimed the third biggest collective peacetime death toll in the UK in the 20th Century. My family believes that until this tragedy is finally seen in the proper terms of its fatalities, and is recorded as such…very few people outside of those whose lives have been obliterated will ever be able to grasp the enormity of a scandal”.

The family make two specific requests. First, they call for the current support groups to be disbanded and a new, comprehensive method of support to be introduced to replace the support schemes that are currently available, which they consider to be confusing and unfit for purpose. Secondly, they call for substantial, regular financial support that will meet the care needs of those affected.

I began my speech by saying that this was a debt of honour. I end it by saying that it is a debt of honour that should now be redeemed in full.

12:48

[Sir Edward Leigh (Gainsborough) (Con)]

I echo the right hon. Member for Knowsley (Mr Howarth) in describing this as a debt of honour. That, I think, sums up what the debate is all about. We caused this. We did not cause it personally, of course, but it was caused by the state and the national health service, so we are responsible.

I congratulate all Members who have spoken—particularly, of course, my right hon. Friend the Member for North East Bedfordshire (Alistair Burt), who has campaigned so effectively. I also pay tribute to my late friend Jim Dobbin. As has already been mentioned, his memorial service took place yesterday, and, in paying tribute to him, the Bishop of Southwark described him as an MP of causes. I know the House of Commons and politicians are often criticised, perhaps quite rightly, but I think this debate shows the House of Commons at its best. There are many MPs, like Jim, who do not necessarily see their political life as one of holding high office but who realise we are here to try to promote causes, particularly as, because of our constituency system, when we speak here we often do so because our constituents have approached us. In other political systems Members of national Parliaments are perhaps more remote.

One national politician who is not remote is the shadow Secretary of State, the right hon. Member for Leigh (Andy Burnham). We are all very grateful that he is here today given his other responsibilities, and I am working with him on another issue where people’s lives have been ruined through no fault of their own. We value his presence here today.

I have said that many of us are here today because of constituents, and I am here because of my constituent Gary Jones from Scotter, who has raised this issue with me several times. I want to share some of his thoughts with the House. First, however, may I make an apology: I am on the Panel of Chairs and quite soon I will have to go and chair a private Bill, so I may miss the winding-up speeches.

As I have said, I want to talk about the issues Gary Jones has raised and, in particular the Irish compensation scheme. Before doing so, however, I want to echo and emphasise what my hon. Friend the Member for Aldershot (Sir Gerald Howarth) said in an intervention as it makes the point very clearly. I have already said this once and I will say it again, and it will be said several times during this debate: let right be done.

We caused this, and we have to put it right. The state—or the establishment—is responsible. I do not know who is really responsible—probably no particular individual; no doubt everybody was trying their best—but there has been gross negligence over several decades, since perhaps as early as the 1940s when the viral risks associated with the blood products in question were known and patients were not informed. One of the greatest scandals in all this is that so many patients have been kept in the dark.

[Richard Fuller (Bedford) (Con)]

My hon. Friend said that this was an example of gross negligence by the state. In addition to what the Penrose inquiry will show that is specific to the contaminated blood issue, does he agree this is also an opportunity for us to set some guidelines and rules for those occasions when there are failures by the state health service on how it will deal with compensation so that we avoid a patchwork of problems similar to those that affected our constituents?

[Sir Edward Leigh]

I entirely agree, and I do not think this is just a question of money. If we attack the Government just in terms of money, we might not succeed in this campaign. It is also a question of learning lessons, and what the victims want above all is some sense of involvement in future schemes. We must learn lessons, and I am sure we are doing so.

The screening of blood donors was totally inadequate, allowing those with a history of jaundice to donate. Even in response to the rise of AIDS the Government failed to implement the best technology available at the time to render blood products safe. The results of this neglect have been appalling: the infection of over 5,000 haemophiliacs with hepatitis B and C, over 1,000 of whom were also infected with HIV from NHS blood products, resulting in 2,500 deaths. Although there has been compensation in many cases, it has been inadequate—indeed, they would claim it has been miserly. For instance, although there is a one-off payment available for hepatitis stage 1, there is no ongoing payment. All this is plainly unacceptable; I think everybody who has spoken agrees with that. It is also obvious that there must be a suitable scheme for compensation to the victims—not that any monetary amount can repair the damage that has been done.

The Irish scheme has perhaps not received as much attention as it should have done in this debate so far, and again I am quoting here from the arguments given to me by my constituent. It is not, as I am afraid some of my hon. and right hon. Friends on the Front Bench have suggested, that we want to link the UK compensation payment scheme to that which exists in Ireland. It is worth repeating that campaigners have never expressed a wish to place the Government’s funding of any compensation scheme in Irish hands. For myself, I do not suggest that the compensation should be exactly the same, but the Irish scheme is worth looking at in terms of compassion: it puts compassion first; it accepts liability; and it is substantial enough for the victims to gain closure. So I encourage Ministers to look further into the compensation scheme the Republic of Ireland has established and to see what lessons might be applicable to us here in the UK.

[Jenny Willott]

Does the hon. Gentleman agree that, because we are talking about quite a small number of people, fairly generous packages of compensation would be affordable? We are not looking at millions of people; we are looking at a small number of people who have suffered very seriously as a result of the NHS.

[Sir Edward Leigh]

Yes, I want to deal with that point, and I am glad that the hon. Lady has made that intervention. I can quite understand where the Government are coming from, but both my hon. Friend the Member for Aldershot and I—and others who have spoken—cannot ever be accused of wanting to waste public money. We are very aware of the pressures on Government. Again I am grateful to my constituent for some of the figures that have been given to me. He says—and I hope the Minister will reply to this point—that:

“The figures quoted in the Written Ministerial Statement are completely incorrect. The Government have refuted suggestions that they based their calculations on a typographical error in the Archer Report and claim that the costings were based on an average of £750,000 per person. The CEO of the Irish Haemophilia Society has confirmed that the average figures paid out in Ireland was ‘around €350,000’ per person.”

So the total figure we are talking about here is £1.5 billion. That is very similar to the compensation paid to the victims of Equitable Life. I have campaigned on Equitable Life, as we all have, and it is pretty awful for someone to lose their life savings and there was appalling suffering, but at the end of the day they have lost their savings; they have not lost their life. So if we are prepared to pay this sort of compensation to the victims of Equitable Life, why do we baulk at similar figures for those whose whole lives have been ruined, and ultimately many of them lost?

My hon. Friend the Member for Gosport (Caroline Dinenage) put it very well:

“I recently met a delegation of people who had suffered through the Equitable Life disaster. Although I have every sympathy with their plight, today’s debate puts that matter into perspective because we are talking not about the loss of life savings, but about the loss of life itself, loss of livelihood and of the chance to grow old, and losing the chance to become a parent and see one’s children grow up.”—[Official Report, 14 October 2010; Vol. 516, c. 556-7.]

I could not put it any better, and I end on the following point. We recognise that we are at fault. We recognise that these people’s lives have been ruined. We recognise that the current compensation scheme has not fulfilled their expectations and is not fair. Let right be done.

12:58

[Mike Kane (Wythenshawe and Sale East) (Lab)]

I stand in this House in the footsteps of giants. My predecessor Paul Goggins was a tireless campaigner on this issue, and his predecessor, Lord Morris of Manchester and former Member for Wythenshawe, was also a tireless campaigner on it, so I am humbled to stand before the House as their successor.

I pay tribute to the right hon. Member for North East Bedfordshire (Alistair Burt) for securing the debate and congratulate him on his work. There are days in this Chamber, particularly as we approach a general election with the cut and thrust of politics, when I do not know what we do here. Today is not one of those days. The hon. Member for Gainsborough (Sir Edward Leigh) summed it up correctly: this debate shows the House of Commons at its best.

I want to relate the tale of a few constituents of mine: Fred and Eleanor Bates and Peter Mossman. I have been working with them over the few months that I have been a Member of Parliament and we have had the full support of my right hon. Friend the Member for Leigh (Andy Burnham), for which we are grateful. Eleanor is now 60 years old. She has been married to Fred for 38 years. Fred is a haemophiliac who used to have a 5% clotting factor but now has a 0.0001% clotting factor. It is believed that this reduction is a result of the contamination. Before 1982-83, he received plasma and cryoprecipitate on demand when he had a bleed. After that, he was switched to factor VIII. In 1991, he was visited by another constituent of mine, Peter Mossman of the north-west group of the Haemophilia Society, who brought Fred a leaflet about hepatitis C. Fred visited the hospital to check this out and discovered that he did indeed have the condition. In fact, the hospital had known about his condition for almost a decade. Frightened and worried, Fred and Eleanor researched the main symptoms of hepatitis C: fatigue, sclerosis of the liver, liver cancer and ultimately death. They believe that the disease is now having an impact on Fred’s short-term memory function.

Fred worked as a weigher at C. H. Johnson on Bradnor road on the Sharston industrial estate in my constituency. In 1980, he was given a choice by his consultant: he could carry on working and face possible death within a year or retire and live longer. Fred was 31 years of age when he faced that choice. The choice was made more complicated by the fact that he and Eleanor were raising two small children. His income went from a respectable £145 a week to £45 in state benefit.

With hardly any clotting agent left, Fred now receives prophylactic treatment every other day, in the form of 1,500 units of factor VIII. It is not just the victims of this injustice that suffer; it is often their carers as well. Eleanor was unable to return to work after the kids fled the nest, because hepatitis C is an unpredictable disease. Fred can be fine at 8 am but have a bleed half an hour later and have to go back to bed. Eleanor has to dress his wounds, as well as doing the cooking and cleaning. She has felt unemployable for a numbers of years because of her home care duties.

Fred and Eleanor now have to deal with the Caxton Foundation. May I make this promise to the House? If I am ever fortunate enough to stand at either of those Dispatch Boxes, I will never hide behind the fact that we have set up a third-party organisation to pass the buck to. We should accept responsibility here in this House; this is where the buck should stop. Eleanor has described the Caxton Foundation to me as a sheer and utter waste of time; she feels as though she is begging when claiming. The system does not allow a retrospective claim. She put in for a respite holiday, but it did not come through, so she missed her holiday slot. Other issues have been identified. There are no separate forms for carers to apply for their own grants, and winter fuel payments are counted as income. The stress has ruined the lives of many carers of those who suffer from this condition.

I want to talk about some of the organisers. I mentioned Peter Mossman earlier. He is 71 years old, and he has a 5% clotting factor. He was a woodcutter, a machinist and a professional driver with Goodwin’s coaches in Manchester. Like Fred, he too faced the choice between giving up work and carrying on. He gave up work when he was 42. He has searched high and low for answers on the disease. His kids have only ever known him fighting. Working with Alf Morris, he set up the Manor House support group, and I pay tribute to him and Alf for that. He lost his sister, Margaret, recently. She was an affected carrier, and she died at the age of 63, her liver ravaged.

These campaigners believe that there should be no differentiation between stages 1 and 2 when it comes to payments. As has been mentioned, we are one of the few countries not to have adequately compensated the victims. There should be a decent one-off payment with subsequent annual payments.

[Richard Fuller]

A constituent of mine has also raised this point. Does the hon. Gentleman not find it odd that, as a result of this failure by the Government, the victims have to apply for a discretionary payment and that there is no substantial up-front payment? There seems to be a complete imbalance between right and wrong.

[Mike Kane]

I agree with the hon. Gentleman.

Many of the victims have lost the will to fight. There should be greater anger there, but they cannot deal with that anger and fight at the same time. Fred, Eleanor and Peter tell me that they will fight until they die. They have seen their stock of affected friends die horribly, and they feel that that is all they have to look forward to. They believe that it is time to admit that we made a mistake, and to allow those people to get on with their lives. Hope is real. There is no such thing as false hope. There might be false science, and there might have been false starts, but hope is real for those people. We in this Chamber today should help them to reignite that hope.

13:04

[Mrs Anne Main (St Albans) (Con)]

Today’s debate has been very well informed, and I pay tribute to my right hon. Friend the Member for North East Bedfordshire (Alistair Burt) for bringing it to the House. This is about justice, and justice delayed is justice denied. Justice that has been delayed for such a long time is really no justice at all.

It has been noted that we are coming up to the general election, and I know that the NHS will be on the front of many of our leaflets. Our political literature will talk about the NHS and what it means to us and to our families, and about our hopes for it and the amount of money that we hope to spend on it. I do not want contaminated blood to be a subject of debate only for today.

This is about the trust that we and our families put in the NHS, but that trust was broken many years ago for many families, including one that I want to talk about today. It is important to recognise that we expect the NHS to give us the best medical treatment and advice available at the time. Many Members have pointed out that that advice was often ignored or pushed under the carpet; it was covered up even though it was known about. That is simply not good enough.

This tragedy has affected multiple members of many families. It has affected the quality of people’s lives and their aspirations over many years. People have described the situation to me as being forced by the state to join a club of whose existence they were unaware with rules that they did not understand, and being denied the ability to call it to account. People, including children, were unaware that they were being subjected—that is the right word—to treatment that was not in their best interests or appropriate for their condition. That failure by the state has been left to fester for too long, and it has left them with a legacy that is a disgrace and a stain on this House and on the NHS. Whoever is in the next Government, if they have used the term “NHS” on their leaflets, they must bear in mind that this debate today has joined the House in saying that we want better for those families.

I concur with what my right hon. Friend the Member for North East Bedfordshire said about reading out 1,800 names. In fact, we could read out the names of all the family members and carers involved. They are all victims; they have all lost a huge amount. We should not read out all those names, however, because many people do not want their names linked to the debate and made public. I am going to talk about my constituent, Nicola Enstone Jones. I asked her permission to use her name today, because I know that many people do not wish to have the stigma of being associated with all this, and with having to go cap in hand to get their rights recognised. I should like to give the House a flavour of some of the hardships that Nicola’s family have had to endure, and of the unfairness of a system that has no transparency.

Like many other Members, I have campaigned for Equitable Life victims. We have had many strong debates in the House about whether people’s estates should be included when the compensation payments were being made and about coming up with fair formulas. I have not heard the same zeal applied to this subject, although this is about people losing their lives, not their livelihoods. This is about people losing their hopes and dreams—just as the Equitable Life people did—but often losing them at a very young age.

I want to give Nicola’s story a brief airing today. It mirrors many of the stories that we have heard today, and it is important that we record as many of them as possible, because they show the unfairness, the anomalies and the degree to which families have to scrape to get a degree of justice. We have heard mention of very young children being affected, and Nicola was diagnosed with haemophilia at the age of seven or eight. In 1978 and 1979, she had tooth extractions—not exactly a hazardous thing—and treatment for a broken arm. In 1980, after a tonsillectomy, this young child was given factor VIII. It was by then known to be contaminated. Since that very day, her health has deteriorated, with symptoms associated with hepatitis C. Despite her mother’s concerns, she was told at the time that her daughter’s problems were psychological. Things were covered up. Throughout the years she continued to receive factor VIII for other operations and her health was always poor.

Over the years Nicola has lobbied me, as other hon. Members have been lobbied. When the Skipton Fund was announced, she was told that she could apply, but because in 1997 a consultant had stated that the virus had cleared, 17 years after she had been infected, she suddenly did not seem to meet the criteria. She has been turned down “on the balance of probabilities” by the Skipton Fund because her condition had been cleared for six months. Her mother, Mrs Enstone Jones, lived with that all those years, but because of a brief period when the virus was thought to have cleared, Nicola did not meet the criteria. She has been let down by the Skipton fund.

The report which has been mentioned so many times in the Chamber today stressed that the fund—the “third arm”, as I think it was called by the hon. Member for Wythenshawe and Sale East (Mike Kane), whose predecessor, Paul Goggins, worked tirelessly on the issue—is creating a barrier to justice, not facilitating justice. We must have a better system so that people do not feel that they have to jump through hoops, justify themselves, or make early applications in order to be able to go on holiday or get essential funding. The funds set up to deal with the issue are not dealing with it and, if anything, are trying to avoid dealing with it if they can and keep money back.

We do not wish to save the state money because, as the right hon. Member for Cardiff Central (Jenny Willott) said, we are speaking about a relatively small number of people. Let us get the matter sorted. Let us put in place a fair system. Let us make sure that all the other Enstone Joneses and all the other names that we cannot mention today for reasons of privacy do not feel that they have somebody acting against them, instead of acting for them. If nothing else comes of the debate in the House today, we should remember not just the NHS, but what the NHS means to those affected and their families. They trusted their health to the NHS many years ago, and the issue is as relevant today as it was then. Any of us who campaigns on the NHS in a few months’ time should remember that and pledge to do something about it if they are part of the next Government.

13:11

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

I apologise for my cold, but I promised my constituent, John Prior from Moodiesburn, this morning that I would seek to put on record a very controversial letter—some would say a lengthy letter—which he sent to me and which I thought I should share with the House.

Before doing that, I congratulate the all-party group on its comprehensive report and the right hon. Member for North East Bedfordshire (Alistair Burt) on the way in which he introduced the debate and on the work that he is doing. I welcome the other speeches that we have heard, including the one from my hon. Friend the Member for Kingston upon Hull North (Diana Johnson).

I turn to the letter from my constituent, a voice that I think should be heard. John Prior said this:

“I was told aged 20 in 1994 that I had chronic hepatitis C by my haemophilia consultant at the Glasgow Royal Infirmary. I had been given contaminated blood as a child at Yorkhill children’s hospital in Glasgow.

The blood was donated from pooled donations of thousands of donors including prisoners in US jails. The haemophilia doctor told me I would eventually need a liver transplant but did not know when. He said it could be 3 months, 3 years or 30 years. I was in complete shock, myself and my family thought I had AIDS. It’s been like living on death row not knowing when I would need a liver transplant.

To my horror, my GP wrote to my employer and told them I had hepatitis C and did not expect me to work for more than 7 years due to my infection. The letter was dated one year before I was told I had hepatitis C, so my work knew about my infection before myself.

As an adult I kept my hepatitis C status to myself and close friends and family. I never told my colleagues. I only told one of my bosses as I was struggling in work, I couldn’t concentrate and kept nodding off at my desk. He’s been very supportive and lets me do menial jobs that don’t require much thought. My sick record at work is horrendous and I’m lucky to still have a job.

Relationships were virtually impossible for me as I felt worthless and frightened I would infect someone. I could not get a mortgage, and life insurance and travel insurance are prohibitive.

My treatment at one stage was 20 tablets a day and 2 injections a week into my stomach which I did myself for 6 months. It was a horrific experience and I felt I just wanted to die. At one point the nurse took blood from me for part of a study into why people with hepatitis C are dying at different rates. She told me she was surprised I was not taking anti-depressants.

My liver consultant applied to Skipton for the stage 2 payment but my application was rejected because I had not reached the ‘crisis’ point. How can a charity ignore the recommendations of a liver consultant? My experience with Caxton was just as bad. It would take numerous emails and phone calls to get in contact with them. I felt like I was begging the way, they treated me, they insisted I provide a letter from my consultant to confirm I was on treatment. It was I who had to run around seriously ill arranging everything for Caxton. I will never contact Caxton again. These charities are not fit for purpose”.

My constituent goes on to make other comments which I think it best not to repeat. His letter goes on to say:

“Over 80% of victims do not receive any ongoing financial help from Skipton yet we are ill.”

He concludes:

“After all that’s happened to myself I will have to be reassessed by the DWP for my entitlement to DLA which I use for my Motability car. I was originally awarded DLA for life 24 years ago. I am worried sick that I will lose my car as I need it to get me to work/hospital appointments. Does my Government expect me to take infected dirty syringes onto a bus? My health will only deteriorate. There is no cure for severe haemophilia. Government policy gave me hepatitis C yet they want to reassess me for DLA.”

That took some time, but I do not apologise. It is right that people who have had such experience should have their voices heard.

I referred earlier to legislation. So complex are the issues and so long have they gone on that legislation is necessary. I attempted to carry through this House the Alf Morris Bill which had made its way through the House of Lords. Unfortunately, we ran out of time. In March last year I succeeded in introducing a ten-minute rule Bill, which went a little further than the report. For example, it included the need for an NHS compensation card, which would lead to priority treatment. Following that, I had a meeting with the then Leader of the House, where it was made clear to me that time would not be made available. I am not sure that he shared the sense of urgency that I tried to impart.

I believe profoundly that an apology, important though it is, is not enough. Compensation is appropriate. There ought to be closer working between the DWP and the NHS. We have many lessons to learn from Ireland and elsewhere. I acknowledge those who have worked so very hard on this issue, especially Lord Morris, whom we remember with great affection today. We owe it to them to deliver.

13:19

[Fiona Bruce (Congleton) (Con)]

In supporting this motion, I congratulate my right hon. Friend the Member for North East Bedfordshire (Alistair Burt) on securing this important debate. I praise him and the all-party group on haemophilia and contaminated blood for leading their campaigns to ensure that those infected by contaminated blood in the 1970s and 1980s, and their families, receive the support and justice they deserve. It is justice for which they have waited far too long. We often hear in this House the statement, “Justice delayed is justice denied”, but it is rarely so apt as in this case.

Like many Members here today, I was first alerted to this terrible situation by a constituent. My constituent’s father had been jointly infected by hepatitis C and HIV via contaminated blood products. My constituent told me:

“My father lost his battle with these joint diseases on the 17 January 2000, after 19 years of suffering…His story is a long one with distressing details.”

I do not propose to go into those details, but I will say that it is a heartbreaking, twisted tragedy that my constituent’s father could go to hospital to receive treatment to help with haemophilia and yet it would be that very treatment that would kill him, having caused him 19 years of suffering. It is a tragedy for that man and for his whole family, one similarly suffered by nearly 5,000 people in 5,000 families, so many of them going to our own national health service hospitals to be treated but receiving what would turn out to be lethal injections.

If proper support and a proper inquiry had been provided in 2000, it would, even then, have been tragically too late for my constituent’s father. This Saturday will mark 15 years since he passed away, and here we are still—in 2015—with no proper inquiry, unsatisfactory support for survivors, unsatisfactory support for families, inadequate compensation provision and, not least, no apology. Not only is this tragedy heartbreaking, but it is a double tragedy and a double scandal. The first is that anyone—let alone 5,000 people—was infected through contaminated blood. The second is that decades later— 24 years after my constituent’s father was contaminated and 15 years after his death—we find that my constituent and his family, and so many others like them, still have received no satisfactory response or justice. That must change. It is nothing less than appalling that successive Governments have failed to address this issue: a situation caused by a failure in our NHS provision.

My constituent’s letter continued by saying that

“it is the survivors and the widows who most need help now, and those who have died need a voice. The largest tragedy of this is that unlike other countries, there has never been a public inquiry.”

As a member of the Select Committee on International Development, it is my privilege to travel the world, and wherever I go I hear people admiring the high standards of our country’s justice system, rule of law and provision of access to justice. This country is respected globally for those things, yet it is a terrible stain on our reputation, of which we should feel ashamed and embarrassed, that we have failed as a nation, by such a long way and over such a long time, to adhere to those high standards of justice expected by our constituents, and which they deserve.

What now needs to be done is clear, thanks to the work of my right hon. Friend the Member for North East Bedfordshire and the all-party group, who have identified the main priorities of those who suffered from these situations and their relatives. The priorities are reasonable, just, possible, necessary and, above all, urgent, because, as we have been reminded today, justice delayed is justice denied—indeed, it is no justice at all. Let us hope that today’s debate signals the beginning of the end of this terrible scandal. In closing, may I apologise for the fact that I may miss the wind-ups, because I am shortly hoping to speak in another debate?

13:23

[Mr Geoffrey Robinson (Coventry North West) (Lab)]

Like other Members, it is appropriate that I should pay tribute to the right hon. Member for North East Bedfordshire (Alistair Burt) and the hon. Member for Colne Valley (Jason McCartney), who secured today’s debate, and, most of all, to my hon. Friend the Member for Kingston upon Hull North (Diana Johnson), who has been responsible for getting the all-party group report out earlier this month. While we support and congratulate each other, we have to remember that the real victims in all this are those who have been infected and suffered this terrible disaster and tragedy, which has now been with us for more than 30 years. It is unique in one way, in that it is, alone in the health field, the fault of successive Governments. In no sense is this a party political debate, and the tone of today’s debate is a great credit to the Members who have taken part. It shows the growing awareness throughout the House and, I hope the civil service, too, of the seriousness of what took place all those years ago and the extent of our maladministration—let me put no finer point on it—in the handling of it since then.

The wide geographical spread of constituencies represented today is a testimony to the impact that this issue has had throughout the country. It has been pleasing to see two new Labour Members, my hon. Friends the Members for Wythenshawe and Sale East (Mike Kane) and for Heywood and Middleton (Liz McInnes), who have clearly taken on the role of successor MPs in the campaigning sense to their predecessors. My hon. Friend the Member for Wythenshawe and Sale East has already spoken to great effect, and he follows in the footsteps of Lord Morris and Paul Goggins, both of whom campaigned with us very effectively. Sadly, however, we have not really been successful yet. One point I wish to make to the new Members in the House is that they should not think we are starting all over again, because we are really at the end of this campaign now and they will, I hope, see the—I was going to say fruits, but there are none to reap here—thing brought to some sort of satisfactory conclusion, after all this time.

[Liz McInnes (Heywood and Middleton) (Lab)]

I thank my hon. Friend for his kind comments and I wish to pay tribute to the tireless work of the late Jim Dobbin on this campaign. Let me add that I have been contacted by two constituents who praised the work that Jim had done and asked me specifically to attend this debate. They do not want their names to be made public, but they wanted me to be here and to take in what was said, and I will be meeting my constituents afterwards.

[Mr Robinson]

I am grateful for that intervention. I was about to discuss Jim Dobbin, so my hon. Friend fortunately anticipates me. Jim was a good friend of mine for many years, and we had his memorial service yesterday, as she will know. He, alongside Peter Archer, Alf Morris and Paul Goggins, as well as others from the Government side of the House, was one of a series of outstanding campaigners that we have had on this issue. The fact that it is an all-party campaign enables us to get together to seek some resolution. This has been going on for an awfully long time and it has been very unsatisfactory, under all Governments. I must emphasise that all Governments are equally to blame, Labour and Tory Governments going back even to before Margaret Thatcher—I mention a name that will immediately resonate on both sides of the House.

As has been said, some of those who have been terribly affected have not wanted their names to be mentioned. Among those affected has been one of my constituents, Mr Joseph Peaty, whom I visited in his home only a few weeks ago. I believe he is here watching today’s debate and I would like to read to the House two brief extracts from his most recent letter to me. I am pleased to say that he is now the chairman of the Tainted Blood group, one of the campaigning groups that have been very effective on this matter. He wrote to me just reviewing the 30 years he has been infected. The House will be interested to know that he is now 49 years old and was first infected when he was 16. He has lived all his life in my Coventry constituency. He wrote to me recently—I got the letter only yesterday—to say the following:

“I miss being able to contribute to a productive career...Perhaps because of my age when I was first affected, my hopes and expectations, that were much like anyone else’s (education, home, partner, children, career, travel, ‘make a difference to the world’) were taken from me. I am now just a shadow of the potential I once held, struggling to exist let alone live a purposeful, fulfilling life, worrying what the next viral complication will be.”

In his case there is a shadow overhanging him, after all these tragedies, and after the terrible suffering, pain and treatments that have had to be gone through; he faces the prospect, having been infected by both Hepatitis C and HIV and undergone all the treatments, that he could now have to deal with some transmutation into CJD—mad cow disease. We just do not know. It is as bad as that.

The tone of Joseph Peaty’s letter is much better than these extracts perhaps reveal. There is nothing self-pitying about Joseph Peaty. He is in every sense a man of immense dignity and tremendous forbearance in the face of suffering that was inflicted on him by the very organisation that was meant to be treating his ill health. He writes:

“By supporting the haemophilia community in the pursuit of justice and financial recompense, I have learnt far more about the background to the introduction of pooled blood products than we were ever told prior to their administration. As a result I find the evidence overwhelming that the governments of the day knew of the infection risks, did not take adequate steps to mitigate onward transmission, failed to prevent non-consensual testing on patients, failed to inform patients of the risk, and put costs ahead of patient safety. The government were responsible for ensuring the safety of their citizens and failed disastrously in this primary duty.”

That is a terrible indictment, but it is true; it is factual, undeniable and incontestable in every respect. Joseph is referring to the entirety of his adult career since he was 16 years old. He lived in Coventry and that is the sum total of what he can point to in his life.

I do not wish to strike a discordant note when I mildly disagree with the right hon. Member for North East Bedfordshire—I congratulate him on securing the debate and on the way in which he introduced it—about the need for more reports. We do not need the Penrose report as we have already had the Archer report. All sorts of investigations have proved beyond doubt that this is the Government’s responsibility, that the extent of the tragedy is tremendous and that the provision we have made so far has been inadequate. That is the end of the story. What we now need is a resolution.

We are pleased that the Secretary of State attended the debate. Obviously, he is no longer in his place as he has other matters to which he needs to attend. I am also delighted to see my right hon. Friend the shadow Secretary of State in his place. We are all aware that the Prime Minister, in a moment of generosity, said that he would try to resolve this matter by the end of the year. I fear that he will not be able to do so—we know the pressures that Governments work under—and that is a great pity. The one useful thing that the coalition Government could do is to settle issues such as this. Indeed, when I raised the matter with the Deputy Prime Minister when he was deputising for the Prime Minister at Question Time, he said that he would take on the matter personally. I thought that we would at last have a more productive encounter between the two in the name of the sufferers in this tragedy. I hope that such a meeting can take place. If it cannot, the next Administration, whatever form they take—who knows what that will be—should take on the matter and settle it early. There will never be a good time. The only time is the earlier the better.

13:32

[Sarah Newton (Truro and Falmouth) (Con)]

I am grateful to my colleagues inside and outside Parliament for working so effectively with the victims of blood contamination and raising these matters so effectively. Without their support, I would not be here—I would not have found out about this issue—so I am grateful to them. I also wish to recognise the work of my hon. Friend the Member for Guildford (Anne Milton) while she was Health Minister. I know also that the Under-Secretary of State for Health, my hon. Friend the Member for Battersea (Jane Ellison), takes a great interest in this very important subject, and I am particularly pleased that the Prime Minister has indicated that he now wants to take action. I am sure that the work of the Minister and the all-party group will be listened to very carefully by the Prime Minister as they come together to find out what further action can be taken.

I will not go over all the salient points from the findings of the inquiries and the all-party group as they have already been discussed. One of the most important roles of a Member of Parliament, and one that I take very seriously, is to give a voice to the voiceless. In my brief contribution today, I want to do just that for one of my constituents. In a letter to me, she said:

“I would be incredibly grateful if you had the opportunity to express my hurt and disappointment and help strengthen the case for better treatment of others. My name being spoken publicly terrifies me, especially as I in the past have been subject to such ill treatment by the NHS and the court system.”

My constituent contracted hep C as a result of a blood transfusion shortly after giving birth to her son. Sadly, her hep C was not detected until 2004. She has received some help from the Skipton Fund. I do not have time to catalogue the sequence of poor treatment that she has received and her continuing fear for herself and her children. She says:

“At this point in time, none of my three children has been checked for hep C. It is a bridge, they say, they don’t yet want to face. I worry…To try and quantify how this has affected my life would be near impossible. Perhaps with this inquiry, the Government will make sure that those affected have what’s left of their futures made easier.”

Today, in this place, we must make sure we do that.

13:35

[Mr Andy Slaughter (Hammersmith) (Lab)]

In preparing for this debate, I looked at the debate that my hon. Friend the Member for Coventry North West (Mr Robinson) sponsored at the beginning of this Parliament—in October 2010. I noticed that I, like a number of Members, said that action was needed more than contemplation. Since then, we have had many further debates. Indeed, we had a debate last week on hepatitis C in Westminster Hall, to which the Minister responded. We have had other such debates, the ongoing Penrose inquiry in Scotland, attempts to reform the existing arrangements and the very good report yesterday from the all-party group.

Tributes have been paid to the right hon. Member for North East Bedfordshire (Alistair Burt) for his sterling efforts to work towards a final solution. I note also that there is further legal action. Today, a letter for action has gone to the Department of Health from three sufferers of hepatitis C through contaminated blood about the inequity of their treatment compared with those suffering from HIV. The issue is not that nothing has been going on, but how much further on we are after four and a half years. I think the answer is not that much. It is easy to say that that is no one’s fault or everybody’s fault, but we must take some responsibility here. It is the role of this House to hold the Government to account when they are not living up to their moral obligation, which they are not at present.

Let me say one quick word about the existing arrangements. The report is good. It produces a lot of evidence for why the current schemes are not working, and we have heard individual criticisms of Macfarlane, Caxton and Skipton. Having read the report, my conclusion is that none of the trusts and funds is fit for purpose. If they are to continue while we await a final settlement, we must have root and branch reform and the funds must be resolved into one effective body. The politics is wrong. The funds purport to be independent bodies, but they appear to be too close to the Department of Health, meaning they have neither the benefits of independence nor the clout of accountability that should lie with the Department of Health. At the same time, they have become part of this degrading process where sufferers, who are largely reliant on benefits, are effectively begging for resources and often living in a state of penury.

That is only one part of the ongoing situation, which includes Penrose. The same situation has happened in the past, where we have been waiting on a report for consideration. Both the final conclusion on a financial settlement and the clear identification of culpability and responsibility are awaiting an outcome. I am grateful to my constituent, Andrew March, for giving me a very thorough briefing for this debate. Off the top of his head, he set down 14 reasons why unfairness has been caused to sufferers. They include the failure to act by successive Governments, which meant that products were not banned early enough and contaminated products were not withdrawn; that haemophiliacs were tested for both HIV and hepatitis C without their consent and not informed of the result; that haemophiliac children were subjected to hepatitis in infectivity trials; that minors were informed of their status without their parents being told; and that individuals were told of their status either by letter through the post or in public places. I could go on. Those are disgraceful actions. We need closure and an inquiry that will bring those matters to light.

I understand that we are to be told later today that the Penrose inquiry will report on 25 March. That is just before the purdah period and, as the right hon. Member for North East Bedfordshire said, leaves very little time for any conclusions based on those findings to be released before the election. That is deeply to be regretted, because whoever is in government after May will have many pressures on their time. I hope that this issue, if it is still not resolved by then, will not be lost. I would like to hear from both Front-Bench teams today that it will be a priority, whoever is in government, not to let the work that is done, if it is not resolved by then, fall foul of where we are.

[Diana Johnson]

My hon. Friend makes a good point about the difficulty produced by Penrose’s not reporting much earlier. The APPG was hoping that when we produced our report the Penrose report would be available, and that we could then have the conclusion to the negotiations in Downing street. The delay from Penrose has been very frustrating.

[Mr Slaughter]

It has been. It is, I think, tragic that we may go into another Parliament without a solution to these issues. If I had to say one thing, it would be this. Yes, we do need a public inquiry. We do need to identify responsibility and culpability. We do need to have the fullest apology based on the clearest evidence of what has gone wrong. We do need to make sure that interim and existing arrangements work properly, and we do need transparency. But, above all, I think we need compensation, and that cannot be delayed, perhaps for years, while all those processes are worked through.

I will, if I may, read a short statement from Andrew March, who will be familiar to many campaigners on this issue. He was the applicant in the judicial review case. He has studiously and devotedly pursued these matters for many years. He says:

“I am one of only 300 HIV positive haemophiliacs who remain alive and was infected at only nine years of age. Of those originally infected in the 1980s, more than three-quarters have died during the course of the past 3 decades. Many of them were my friends. I was also infected with Hepatitis B and C, and despite treatment, I continue to live with the adverse effects of cirrhosis of the liver. I am also one of the 3,872 haemophiliacs…who have been notified as being considered ‘At-Risk’ of variant CJD…Despite the authorities always maintaining that the risk was merely ‘theoretical’, I was shocked to learn in February 2009, that an elderly haemophiliac had been found with vCJD…in his body during post mortem…This news was not entirely unexpected, but I still became very worried that vCJD had the capability to become yet another ravaging illness.

More recently, I was informed by my doctors that I had been exposed to yet another pathogen, this time, Hepatitis E…As I sigh in disbelief that there seems to be no end to the multiple infections, I try to keep looking forward with some degree of hope that this will, one day, be sorted out once and for all.”

Those are the words of an extremely brave and resolute man. He and all the other sufferers deserve respect—which they are not getting from the current financing arrangements—they deserve justice and they deserve a full and proper compensation package. That should include compensation for family members. It should deal with all conditions, and it should remove the stigma of means-testing, ATOS assessments and so on. That is the least that we, as a country, can do for people who have suffered as a consequence of the state’s action.

13:43

[Dr Julian Lewis (New Forest East) (Con)]

Mr Deputy Speaker, having come late to the debate because of a clash with a meeting of a parliamentary Committee on which I serve, I am grateful for the indulgence of the Chair in allowing me to make a brief contribution.

I wish to focus on three points. The first is that people are still, even now, long after the event, being discovered to have been infected with contaminated blood; the second is that momentum for a settlement is in danger of being lost; and the third is that the best treatment is not always available for those who have been infected.

I was struck by what the right hon. Member for Coatbridge, Chryston and Bellshill (Mr Clarke) and others said about the debate being a chance to give a voice to individual constituents. I was also struck by the question asked on 10 December of the Deputy Prime Minister, who was standing in for the Prime Minister, by the hon. Member for Coventry North West (Mr Robinson), because he said in that question what he repeated today—that the scandal had reflected badly on successive Governments, possibly going back as far as that of Harold Wilson, if not further. In the context of momentum being lost, he said that the Prime Minister had undertaken in June to look at and rectify the situation. In fact, according to my constituent, Mrs Lesley Hughes, who only a week before he asked his question had got in touch with me about this very issue, the Prime Minister had apparently told one of his own constituents who was affected by this that he hoped to have a resolution within six months. This would have meant the end of the last calendar year.

I said that my first point was that people are still being discovered who were infected long ago, and that is Lesley Hughes’s situation. In 1970, she and her future husband were involved in a very serious road traffic accident in London, and she had to receive no fewer than 44 pints of blood. For many years she knew nothing about the fact that she had been infected, although over those years she had many visits to GPs and hospitals with numerous symptoms of illness, and considerable pain and suffering. Only last year was it finally discovered that she had been infected with hepatitis C by NHS contaminated blood. Her main concern in writing to me initially was that, given that the Prime Minister had said that he hoped to wrap the issue up himself, she was really anxious that we should not get to the general election—which is, after all, scheduled to be about five months after the deadline that the Prime Minister had set himself—without reaching a resolution.

[Mr Robinson]

I am not sure that the exact undertaking that the Prime Minister gave is recorded anywhere, but it is recorded in exactly those terms by my constituent, Joseph Peaty, as well. Does the hon. Gentleman agree, though, that the impression was left that the Prime Minister would do his very best to get a settlement by the end of the year? We are past that deadline now. Does he agree that, irrespective of the reports being compiled, we do now have the means necessary to settle the issue, and that is what the Prime Minister should try to do?

[Dr Lewis]

That is exactly my view, and for that reason I wrote to the Secretary of State for Health, drawing attention to the matter. I received a reply dated 12 January from the Minister who will reply to this debate. Of course she was sympathetic in the terms that she used, but the important part of her letter was the conclusion, which was that

“this issue is being looked at very seriously, and…an announcement will be made to affected individuals and MPs once work has been concluded.”

My simple question to the Minister is, when will that work be concluded, and will she and the Prime Minister undertake to get this work concluded, on behalf of my constituent and many others, before this Parliament comes to an end? Otherwise, we are back to square one—a cycle which I am sure has been repeated over and over again.

Finally, I said that I would mention the other point about how the best treatment is not always available. I understand from Lesley, whom I have not met yet but whom I believe to be present with her husband today, and whom I hope to meet after the debate, that there are problems with the fact that many people suffering from infection are offered the older interferon and ribavirin-based treatment, and that not everybody can tolerate that, particularly as it takes a long time to clear the system, and particularly if they are people who are at a later stage of their life.

If the Minister cannot answer today, will she perhaps write to me later about the situation of patients in that position? Kinder and more effective treatments are available, but are not always sanctioned for reasons of cost either by NICE or by individual health trusts. I wish to give others the opportunity to speak, but once again I thank my constituent for her bravery in allowing me to tell her story and attribute it to her, and I thank the House for its indulgence in allowing me to contribute to the debate at such a late stage.

13:50

[Huw Irranca-Davies (Ogmore) (Lab)]

I pay tribute to the right hon. Member for North East Bedfordshire (Alistair Burt) and others who have worked on this issue for some time, as well as those whose names are on the Order Paper today, those who contributed to the report of the all-party parliamentary group and all hon. Members who have spoken today.

I will not name any names in my speech—my constituents have asked me not to do so because of their continuing fear of stigmatisation. I shall use their words, however, because, frankly, I have nothing more powerful to say.

[Jessica Morden]

I thank my hon. Friend for giving way so early in his speech. He, like me, is the Member for a Welsh constituency. Does he agree that it is important that as we move forward the Government work closely with the Welsh Government, particularly on things such as treatments, so that there is help for those Welsh constituents now that health is devolved?

[Huw Irranca-Davies]

I agree very much with my hon. Friend. We need a UK solution because this is a UK problem, so work must be done in concert with the devolved Administrations and Governments.

My constituent says that in 1982:

“We were called into consultant’s office, at the…Hospital…My future wife was pregnant and we were strongly advised to have a termination. However, he was not specific about reasons why, other than the possibility of our child either having or carrying haemophilia, so we refused.

1983—Our son was born and they wanted to take a blood test from him. It was after this they told us of my…HIV infection, at this early stage they had no idea what it entailed. We were advised not to mention to other patients at the hospital and to refrain from sexual intercourse until they knew more. Thankfully our son did not have the virus. Feeling uncertain about the future, it was awful to be told we had to keep this to ourselves. At this time it was very much publicised in the media and friends of ours, who knew of my Haemophilia began questioning us on whether or not I had been affected. Suffice to say I felt I was on borrowed time and on my own admittance, went off the rails and neglected my son and new wife.

1985—My wife fell pregnant again and convinced I was going to die sometime soon, the fear and uncertainty about the future made us feel we had no option but to have a termination.”

He goes on to say that a support group was set up and:

“We began attending meetings with the group and felt better for the support but sadly the participants began dying at an alarming rate and it just made the situation worse.

1991—My brother, who also had Haemophilia and HIV passed away. Prior to this we had undergone clinical trials at the hospital and because we were brothers, he was given the placebo. The guilt I felt because I was taking the actual product and had survived was indescribable. The following year my second brother was tragically killed.

1993—In short I had given up, I knew I was going to die and felt I could fight no longer. I ended up in hospital with PCP pneumonia and my wife was told I had a matter of weeks. Even though I had given up on myself thankfully my family and the hospital staff hadn’t…and I eventually pulled through.”

He goes on to describe their three-and-a-half-year fight from 1995 to become the first couple with HIV status in the UK to adopt despite being told no, no and no again. He continues:

“2001—We were asked to consider adopting two more children”,

in addition to the one they had adopted during that period,

“a boy and a girl aged five and seven. We agreed and my wife finally had the family she had been craving. It was just after this, I was told I had also contracted Hepatitis C and possibly vCJD. Obviously we were devastated and all the old uncertainties we had pushed to the back of our minds pushed forward with force. However, all was not lost I was assured a treatment was available.

2002—Late in the year, I began treatment for Hepatitis C. We had been warned prior to this, I wasn’t going to be easy to live with but looking back now I feel this was an understatement. The two children we had living with us, had severe psychological problems and their behaviour just served to exacerbate the situation and subsequently the placement broke down.

2003—The two children went back into care and I found myself unable to cope with my grieving wife and my two existing children. I wasn’t in a very good place at this time and my wife and I came very close to separation. It was only because we had been together since we were sixteen and married at seventeen, we worked to stay together. The treatment reacted with my HIV drugs and I ended up in High Dependency with Pancreatitis. Following this, my wife had to sell her business as I was ill and unable to cope at home without significant help.”

[Diana Johnson]

My hon. Friend is making an incredibly powerful case, but what strikes me is that not only the individual is suffering but the family members are, too—the wife, the children and everyone else. It is striking.

[Huw Irranca-Davies]

Absolutely. It rips through not only the individual but their families, friends and every other aspect of their life.

I will continue to the end of my constituent’s story, as it goes on to this day. In 2004, the selling of the business meant that they had limited income and were unable to meet their bills. The debts piled up during their financial struggles and this put additional strain on the marriage. He goes on:

“2005—Our debt situation was spiralling out of control and as I felt a little better in myself my wife, who had studied for a degree while she was out of work could now get a…job as a care manager and she went back to work full time.

2006—We were asked about taking another child for adoption. Understandably following the breakdown of the last placement we were wary but agreed as everything seemed far better than it had been. It was in 2007 we had our second adopted daughter.”

From 2006 to 2010 they saved what they could to clear the debts they had accumulated since 2003. For the next few years, because of his deteriorating health, his wife had to return to part-time work rather than full time and the debts accumulated again. To bring this up to date:

“We have cleared our debts and with my wife working part time we are managing day to day to keep our heads above water. We have the basics we cannot save money or enjoy holidays. We keep away from past friends as I am well aware of how ill I look and do not want to answer their questions. I take a great deal of medication and am trying to live with the side effects, as is my wife!

The Macfarlane Trust had recently sent us a ‘disbursement of reserves’ form, requiring personal and in depth information to enable us to possibly have some money for home improvements. My wife and I felt it was an extremely unjust and unfair way of attempting to distribute funds amongst sufferers of HIV and their families. Not everyone would, or could qualify as they were in rental accommodation, or perhaps their home was not in need of improvements. It was causing a divide amongst the few that have survived this atrocity and we refused to complete it as any reserves we felt need to be distributed equally amongst those of us that are left. It seems the discrimination, separation and sheer lack of consideration for the primary beneficiaries is still very much in evidence.”

My constituents, like those mentioned in so many stories today, are asking not to have to go out with a begging bowl in complex situations, having to prove that they are worthy. This is an entitlement, not something to be begged for. They want some form of inquiry and a clear apology and there is a crying need for root and branch reform of the structures that have been put in place to help them. This is not working satisfactorily.

My constituents’ story will be reflected in the story of every person and every family affected. The disease does not simply affect them; it forces many into penury, marital difficulty and so many other social problems. It is time to sort this out once and for all.

13:58

[Richard Fuller (Bedford) (Con)]

I shall try to restrict my speech to two minutes, because I know that we want to hear the speeches from the two Front Benchers and, of course, from my neighbour, my right hon. Friend the Member for North East Bedfordshire (Alistair Burt), who so nobly started this constructive debate, which will be a great comfort to my constituent, whose family life was devastated when she lost her husband at a young age with a very young family.

The debate has been constructive and we have heard of a number of measures that have been taken over a number of years. We also have the constructive recommendations from the all-party parliamentary group, which have featured heavily. I do not wish to sound a discordant note in this constructive debate, but I believe that despite all that there remains a suspicion to which I want to give voice. The suspicion is that all the responses from the Department of Health over the years have had to be drawn out of it and have not been freely given. The measures are often seen as a contrivance to ensure that a full answer has never been given, and people do not know why. The compensation provided is a construction of a response, but there is a belief that beneath this lies a darkness—a darkness that breeds suspicion about the root causes of all we have talked about today and about who was responsible, and about the feeling that those people remain faceless and nameless, fearing exposure for actions that may have led to what might have been a mighty, mighty wrong, and having an absence of courage to repent of those actions.

We all have to remember that it is our NHS. It does not belong to a political party or to the Department’s officials—it belongs to the people. My request to the two Front Benchers is: will they, to the extent of their powers, shine a light on this darkness and, beyond any financial consideration, provide that comfort to the hearts and memories of the victims?

14:00

[Andy Burnham (Leigh) (Lab)]

We have heard a series of fine speeches today—as has been said, Parliament truly at its best—but none more powerful and affecting than that of the right hon. Member for North East Bedfordshire (Alistair Burt) in leading the debate. Many of the things he said will have affected people greatly, but the words that remain with me now are those that he quoted from a letter he had received: “Every day is like a day on death row for a crime I did not commit.” If that does not convey the sense of injustice we are dealing with, nothing else will, because it really is that appalling.

When historians come to look back at the 2010-15 Parliament, it will be seen to be characterised by a welcome drive to correct historical injustice. First, we saw the apology in relation to the events of Bloody Sunday. We have seen a range of ongoing inquiries related to historical child abuse. There was the action on the injustice that I know too well from my own personal background—the death of 96 innocent people at Hillsborough. The right hon. Gentleman was absolutely right to pay tribute to my hon. Friend the Member for Liverpool, Walton (Steve Rotheram), who put those names on the record. But we cannot put on record the names of the people in this case who have suffered such devastation—not just the people who have died but those whose lives have been ruined as a result of this scandal, and it is a scandal.

What opened up those other injustices has not been the Government voluntarily moving to correct those wrongs, but Parliament. The resolution to those other injustices began here. It is beholden on each and every one of us here today to remember that and to use the power that we have from the office that we hold to work together across the Floor of this House to find a resolution for the thousands of people whose lives have been ruined by this scandal. If we hold to the cross-party spirit that delivered the beginnings of justice in those other campaigns, then we will do so in this case too. The right hon. Gentleman described it as the 15th worst peacetime disaster—like Hillsborough, entirely man-made. To add to that, Lord Winston has described it as

“the worst treatment disaster in the history of the NHS.”

We must resolve today, even if we cannot do it in the time that remains in this Parliament, to make sure that this injustice and this scandal is resolved early in the next Parliament, and that the people who have suffered finally have truth and justice.

I want to explain why I am standing at this Dispatch Box today. Like many others who have spoken, I have constituents who have been victims, including somebody who does not want to be named who speaks of having lived for more than 30 years seeking justice and support, and who contracted HIV and hepatitis C through contaminated blood in the 1970s and ’80s; and my constituent Simon Carter, whose father died and left the family facing a whole range of financial problems—people whose lives have been for ever altered and devastated by the scandal.

There is another reason I am here today. It goes back to a time towards the end of the previous Parliament, when somebody who has been mentioned by Members in all parts of the House, my good, late friend Paul Goggins, asked me to meet him and his constituents Fred and Eleanor Bates and Peter Mossman—now the constituents of my hon. Friend the Member for Wythenshawe and Sale East (Mike Kane) whom he mentioned so movingly—in my constituency office in Leigh, and I did. I had no real understanding of what they had been through, and were going through, until I sat down with them, at Paul’s request, and listened to what they said. That campaign mattered hugely to Paul, whom I miss every day. I will continue to work in his memory to get justice not just for his former constituents but for everybody who has been mentioned in the debate. I want to signal the seriousness with which I will address this issue by speaking in this debate today.

As people have said, it is not that nothing has been done. Plenty has been done. There have been well-meaning attempts in all parts of the House down the years to put in place mechanisms to try to lessen the hardship and address the problems that people face in their daily lives. However, as many hon. Members have said, that has left a patchwork of support that is complex and bureaucratic—that, in the end, is about handing out bits and pieces, with people having to go cap in hand, not even given the dignity they should now have in having the problems that they were given rectified in a proper manner.

As a result of that meeting with Paul and his then constituents in my office in 2010, I reopened the issue at the end of the previous Parliament. Many Members have mentioned the Archer report. A resolution was put in place after that report, but it was not good enough, and that was recognised in all parts of the House. Paul asked me to look again at the issue, and I did.

I want to bring a new perspective to this debate—that of a former Minister who tried to do something; indeed, a former Secretary of State, because that is what I was at the time. I do not say this to blame any individual in the Department of Health, but more in terms of speaking as I found as I tried to lift the shutters that had been pulled down on an issue that the Department wanted to go away. The hon. Member for South Norfolk (Mr Bacon), who is no longer in his place, said that Governments of both parties have failed, and that is absolutely right— they have; there is no debate about that. But I do not detect the failure being caused by Members of Parliament or, indeed, Ministers; I have met many who want to resolve this in the right way. I have to say that in my experience the resistance is found in the civil service within Government. That is often the case in examples such as this; I found the same with Hillsborough too. It is very hard to move that machine to face up to historical injustice.

[Mr Robinson]

My right hon. Friend is making a very important point. Nobody wants to point the finger of blame, but he has gone to the heart of a problem in Government. He speaks with great authority as a previous Secretary of State. He says that it is hard to get officials to do what a Minister wants, and that is certainly true, but is it not also the case, and therefore a failure of successive Governments, in the plural, and Ministers, in the plural, that officials advise and Ministers decide? That is part of the failure so far.

[Andy Burnham]

I believe that it is. The hon. Member for Bedford (Richard Fuller) made this point. Perhaps there is a resistance that comes from not wanting to point the finger or to show the culpability of people who perhaps did not do their jobs as well as they might, but that is unacceptable. That is not something that anybody elected to serve in this place should accept. On a personal level, I know how hard it is when faced with such resistance. The way to help a Minister in that position is by giving them the sort of support that has been expressed throughout this Chamber today. That is what gives a Minister the power to have the courage to make a change.

The result of my efforts led to a review of the Skipton Fund, and I give credit to the current Government for continuing that work. It led to a small improvement, which has been mentioned, but, by God, it was hard enough to get that, so I do not underestimate how difficult it will be to move things forward.

Part of the problem is that the people dealing with the issue inside Government are insulated from the people we sit alongside in our constituencies and whose stories we listen to. Could there be a more heart-breaking story than that told by my hon. Friend the Member for Ogmore (Huw Irranca-Davies) about the damage that this scandal has caused down the years? People need to hear and listen to what is being said, to understand why it is immoral to allow the situation to persist and go uncorrected.

I will not go through all the problems raised by colleagues about the inadequacy of the current process of applying for support, but I will pay tribute to the all-party group on haemophilia and contaminated blood, which, under the leadership of my hon. Friend the Member for Kingston upon Hull North (Diana Johnson), produced an outstanding report yesterday. I believe it will further reinforce the case for truth and justice.

I wish to draw the House’s attention to another development, which has not been mentioned today, namely the filing of a legal case by three unnamed victims. They have written to the Health Secretary, asking him to come forward with a settlement before full legal proceedings take place. Of course, it should not have to come to that, but, as colleagues have said, people are still waiting and they have waited long enough. We hope the Health Secretary will listen to that request and take action as soon as he can.

If the Minister, working with the Secretary of State, is able to find a solution, she will have the support of Labour Front Benchers and, I am sure, Members throughout the House. We will offer our good offices to ensure that a settlement can be reached. There needs to be a proper and fair resolution. None of us can predict what the make-up of the House or, indeed, the Government will be after the coming election, but I personally commit to working towards that full and final settlement for which people have waited long enough. I hope that Members on both sides of the House will make a similar commitment. As Paul Goggins said in the Westminster Hall debate mentioned by the right hon. Member for North East Bedfordshire,

“no debate about the issue should omit the need for a proper acknowledgement of what took place and why, and a profound and sincere apology for the suffering created by the disaster.”—[Official Report, 29 October 2013; Vol. 569, c. 201WH.]

The full and final settlement should have four components. First, there must be a national apology for the suffering down the years. Secondly, to echo what my hon. Friend the Member for Hammersmith (Mr Slaughter) has said, there must be an inquiry. Whether it should be a public inquiry or not is a matter to be debated, but, having been involved in the campaign for justice for the 96 victims of the Hillsborough disaster, I know that other forms of inquiry can reach the truth and unlock a campaign for justice. There may be other ways to do it, but people need disclosure: they need to understand how this was allowed to happen. In my view, all papers held by the Department of Health should be released so that people can begin to see the full truth of what went wrong. I do not believe there is any reason at all to prevent that from happening.

The third element is, of course, a proper settlement for all those who have suffered—not just those who are still suffering, but families who suffered greatly as a result of the disruption caused to their lives. Fourthly, as my hon. Friend the Member for Kingston upon Hull North has said, we must give the best treatment possible to those who are still suffering.

The all-party group’s report quoted somebody infected with hepatitis C:

“You can’t give us back our health. But you can give us back our dignity. This tortured road has been too long for many of us. But for the rest of us, please let this be the final road to closure.”

Everybody present needs to listen to those words and act on them. Sadly, many of those affected have died and are not able to listen to our proceedings, but they, those who remain and the families they have left behind deserve the dignity of a full and lasting settlement.

14:15

[The Parliamentary Under-Secretary of State for Health (Jane Ellison)]

I welcome the tone with which the shadow Secretary of State responded to the debate on behalf of the Opposition. I also congratulate my right hon. Friend the Member for North East Bedfordshire (Alistair Burt) on securing this debate and on his hard work and commitment—as a Minister, I am well aware of it—over the past year. The same is true of so many colleagues who have worked on behalf of those infected with NHS-supplied blood or blood products before 1991.

I thank all hon. Members who have contributed to the debate, which has been conducted in a constructive and thoughtful way, and, of course, distinguished former colleagues who championed their constituents so ably in the past. As we have heard, many of those constituents have been profoundly affected by this issue. I attended the last debate on it when I was a Back Bencher, and today I have heard once again about the impact these infections have had on the lives of individuals and families.

I will focus mainly on the current situation rather than the past, not because the past does not matter, but because it has been ably covered and because I want to add to the knowledge of the situation as it is now and give an indication of the way forward. I hope Members will understand that. If there are any issues that I do not address, I will, of course, write to Members, and if their concerns involve other Departments, I will seek to get a response from them.

There have been calls for a further inquiry and review. That subject has come up before, with calls to look at the historic circumstances of these events. There are various ways in which that could be done and I acknowledge the suggestion made by the shadow Secretary of State. I stress that the Government wish to be as transparent as possible about these events, but I remind the House that they have already been repeatedly examined in a number of different ways, including in court on a number of occasions, and the Department of Health has already published on its website all the relevant documents held for the period up to 1986. I acknowledge that there might be more to do, some of which relates to Lord Penrose’s work.

The Penrose inquiry has loomed over this debate. Let me give the House a sense of my frustration. When I came into office, I was advised that the original date of publication would be June 2014. Let me also give the House a sense of the seriousness with which I took the preparation for that report. I met Scottish Health Ministers last spring to discuss it and other issues. Obviously, work is taking place in Scotland and the publication of the final report has been delayed. The inquiry now expects to announce a publication date this month. There has been no formal confirmation, although a date has been offered during the course of the debate. I understand that Lord Penrose will examine any particular adverse consequences for infected patients and their families, and identify lessons and implications for the future. That is why we feel we need to wait to see the report.

As the events under discussion took place before devolution, the final report of the inquiry will clearly be of interest to the Government and we await its recommendations. I am extremely frustrated by the continued delay and accept that it will have an impact on the scope of our response in this Parliament.

As has been touched on, the Government, like their predecessors, provide ex-gratia financial and other support through the system of payment schemes that is in place.

[Mr Robinson]

The Minister has touched on the nub of the issue, namely the Penrose report and the delayed decision. Does she agree that we do not really need that? The broad aspect of the financial settlement that ought to be made is well known to the Government. It is a matter of getting a decision now.

[Jane Ellison]

I will come on to why I do not entirely agree with the hon. Gentleman, but my concern is essentially that after families have endured so much, I would hate to tell them the way forward only for that to be unpicked and revisited in the light of any recommendations by Penrose. I am afraid that I do not agree with him, because it is important to consider the report.

[Mr Slaughter]

A moment ago, the Minister said that, given the late reporting of Penrose, she would have to consider the scope of the Government response. Will she be a little more specific: what are the Government likely to say and how far will they go before the election?

[Jane Ellison]

I will come on to that. Although I cannot be as specific as I would like, I will try to give the House some sense of the way forward.

I stress that the support currently provided is over and above any other state benefits that infected individuals and their families may receive, and moneys paid under the schemes are not subject to tax. Some hon. Members have raised issues relating to the DWP, and I will of course bring those concerns to its attention.

I am aware that many hon. Members have concerns, which they have expressed in some detail, about the way that support for those affected is delivered. During the past year, I have listened to and actively considered the thoughts of all colleagues about how to improve the system. I have met the officers of the all-party group, and spoken a number of times to my right hon. Friend the Member for North East Bedfordshire.

I acknowledge that there is scope for reviewing the support system. I have been open with hon. Members about the fact that I share their concerns about the charitable basis of that support. I thank my right hon. Friend and the all-party group for the survey on which they recently collaborated. This is the first large-scale effort to consult beneficiaries, their families and the wider public on the current system. I will certainly consider its findings—I have looked at the executive summary of the report, which was only published yesterday—and all the other sources of information. From my conversations with Members over the past year, I have a good sense of the report’s direction of travel and of their concerns.

As I have said, in considering possible reforms to the current system, we must take into account Lord Penrose’s findings and recommendations before any specific proposals are made, but I have been ably supported by my civil servants in looking at possible reforms. His report is likely to be lengthy: to give the House some sense of that, the interim report published in 2010 exceeded 600 pages.

If Penrose does not publish until shortly before the House rises, it will be challenging, as Members have recognised, to provide a considered and thoughtful Government response in such a short time. I want to give due respect and consideration to Lord Penrose and his report, not least because it matters so much to so many individuals and families. As I have said, after all they have been through, it would be terrible for us to announce measures that then had to be unpicked or revisited. I reassure the House that however late in the Parliament Penrose reports, we will make a response, although that will inevitably have to be an interim response.

Having acknowledged that not everyone is satisfied—far from it—with the current system of support, it is extremely important to remember that the system makes an enormous difference to the lives of many beneficiaries. To date, more than £365 million in support has been paid to more than 5,000 people in the UK affected by HIV and hepatitis C and their families. Through the reforms made in January 2011, which some Members have mentioned, the Government have improved the system of support. Since they were introduced, more than £70 million in extra funding has been made available in England.

Something that is new since the House last debated this issue is the therapies that are coming through. Members have spoken about the side effects and impacts of existing therapies. Many of the new therapies have a much higher cure rate than existing ones, with far fewer side effects. We understand that cure rates for new therapies are between 90% and 95%, and that the courses of treatment are much shorter. Those figures are based on clinical trials. New data from the early access programme will be evaluated to confirm the robustness of that finding, but it is obviously encouraging news.

I am encouraged by some of the improvements that we can make to the quality of life of those who have suffered from their infections for so long. New treatments for hepatitis C are becoming available through the NHS. While we have been waiting for NICE to publish its final appraisal of the first of the new drugs—Sofosbuvir and Simeprevir—NHS England has taken two important steps to ensure that eligible patients with late-stage hepatitis C can expect to have received treatment by the end of 2015. In April 2014, it published an interim clinical commissioning policy statement to provide access to the new therapies for patients with liver failure. More than 700 patients have already been treated through this policy, at a cost of £38 million. Specialist centres were procured to deliver this early access treatment around the country.

The NHS is developing a further interim clinical commissioning policy for patients with compensated cirrhosis to reduce the risk of their developing decompensated cirrhosis or liver cancer. Subject to its internal approval processes, the NHS is aiming to have that in place from this April. I have confirmed with the clinical director that if any hon. Members are approached by constituents with hepatitis C, they should advise them to consult their GP about a referral to a hepatology specialist to determine whether they have developed cirrhosis.

Medical advances continue to improve the ways in which HIV and hepatitis C can be treated and managed, and I want to take this opportunity to assure the House that the UK now has one of the safest blood supplies in the world, and independent experts continually review current safeguards.

This debate has again allowed me to hear about the issues with which many of those affected live daily. I of course recognise that improvements must be made to the system that provides financial assistance, and I have given considerable thought to that over the past year. Together with those we represent, we need to be realistic about the challenge of making changes that are fair and sustainable. It is very welcome that we can work on a cross-party basis—that is absolutely vital—and it is most reassuring that several hon. Members have emphasised that.

I am hugely frustrated that the much longed-for closure cannot realistically be achieved in this Parliament. Nevertheless, a new Parliament is imminent, and it will provide an opportunity for the next Government to provide closure.

[Mr Tom Clarke]

The Minister will recall that my right hon. Friend the shadow Secretary of State made some profound comments about the role of the civil service in dealing with these problems. Will she take time to respond to them?

[Jane Ellison]

I have noted the comments of the shadow Secretary of State. I can only speak from my own experience and say that in all the ways in which I have wished to consider this issue—those have ranged widely over the past year—I have been ably supported by my civil servants. Ultimately, this decision is a political one.

The issue needs to be resolved once and for all. I assure hon. Members that the Prime Minister, the Secretary of State and I continue to work towards that vital aim. I have said that however late Penrose reports, we will respond while the House is sitting. Inevitably, that will have to be an interim response. However, I hope that we can give the House some sense of the work undertaken over the past year and, at that time, respond to the direction of travel signalled in the all-party group’s report and the work of my right hon. Friend the Member for North East Bedfordshire.

In conclusion, I want to say that this was an utterly appalling tragedy, which has caused grief and sadness to many people and their families, as we have so often heard. The Government must do right by those people on whose behalf so many Members have spoken today. I will take away everything that has been said, and as long as I am in my current office, I will continue to work to bring to Parliament the conclusion that so many Members have said they want.

14:28

[Alistair Burt]

I thank all Members who have spoken. What I am most proud of is my role in enabling this debate to take place, which has provided the opportunity for so many speeches. The best contributions were made not just by hon. Members, but by our constituents, because in very many cases we used the words that they have given to us so that we could be their voices. If memorable phrases from today’s debate are remembered, they will be theirs.

I warmly thank all colleagues for their hard work, and I thank those who have worked on the report, not least my secretary Sam Mackewn, who has done a great deal of work in the background. I say a huge thank you to all those in the community of sufferers and beneficiaries who have helped us.

If I have thought of anything during the debate, it is that there is a moment when one feels things shifting. The shadow Secretary of State was right: this Parliament is known for a number of things, but as we have seen through elected Select Committees and their Chairs, it exercises greater power than it used to, as was evidenced by what we heard today. We have all been involved in this issue for a long time—I have been involved with it for more than a decade—and I got the sense that Members of Parliament have just been here too long and listened too many times to the same things. There is almost a sense, not of anger, but of the frustration becoming something else, and I do not think that a future Parliament will wear a Government of any stripe who do not do something about it.

My hon. Friend the Member for South Norfolk (Mr Bacon) put things plainly, and with his support and the imprimatur of another couple of colleagues who are known to be restrictive about public finances, I think we are into a new age on this issue. Having seen that something is wrong, and that finance is needed to put it right, I get the sense that Parliament will demand that of its Government. If the Government cannot respond before the election—as I made clear, I entirely understand and accept what the Minister said—then all the parties have manifestos to write. We could all put something in our manifestos that gives a clear commitment about what will happen should we form part of a Government in the future, and there is no reason why that should not be done with some degree of co-operation. Those who have been so faithful in pursuing this issue, in circumstances that we heard described today, will know that at last they have a Parliament that will no longer take no for an answer.

Question put and agreed to.

Resolved,

That this House supports a further review of the circumstances surrounding the passing of infection via blood products to those with haemophilia and others during the 1970s and 1980s; notes the recent report from the All Party Parliamentary Group on Haemophilia and Contaminated Blood into the support arrangements provided for those who contracted blood-borne viruses as a result; also notes that the Penrose Inquiry into these events will shortly be publishing its findings in Scotland; further notes that those who contracted viruses and their partners and dependants continue to be profoundly affected by what happened; therefore welcomes the Prime Minister’s commitment to look again at this issue; and calls on the Government to respond positively to the APPG report and engage actively with those affected with a view to seeking closure to these long standing events.

Transatlantic Trade and Investment Partnership

Thursday 15th January 2015 Commons Chamber

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

I inform the House that the amendment in the name of the hon. Member for Brighton, Pavilion (Caroline Lucas) has not been selected. I call Geraint Davies, who has 10 to 15 minutes to move the motion.

14:31

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

I beg to move,

That this House believes that the Transatlantic Trade and Investment Partnership and any associated investor-state dispute settlement provisions should be subject to scrutiny in the European Parliament and the UK Parliament.

I thank the 60 or so MPs who supported this Backbench Business Committee debate, as well as the Committee’s Chair and those who supported the early-day motion and my International Trade Agreements (Scrutiny) Bill. This debate is supported by trade unions, business and environmental movements, and 38 Degrees has also got involved. Many people are encouraged and Members are glad that they are able to engage with hundreds of constituents on this important issue.

This issue is fundamental to the balance of power between democracy and multinational giants who want to impose their interests on our democratic rights. Our right to scrutinise this very important and strategic trade agreement, which will have global ramifications into the future, is imperative. If we end up with a situation where multinational companies are able to sue democratically elected Governments over laws they have passed to protect their citizens, we will be in the wrong place altogether.

[Mrs Anne Main (St Albans) (Con)]

Hundreds of my constituents have contacted me about this issue, and there is concern about things being stitched up behind closed doors, such as the use of genetically modified crops and so on. It is welcome that the issue is debated and kept under scrutiny by this Parliament.

[Geraint Davies]

I very much welcome that intervention. The harsh reality is that this deal is being stitched up behind closed doors by negotiators, with the influence of big corporations and the dark arts of corporate lawyers. They are stitching up rules that would be outside contract law and common law, and outside the shining light of democracy, to give powers to multinationals to sue Governments over laws that were designed to protect their citizens.

[Dr Julian Huppert (Cambridge) (LD)]

I congratulate the hon. Gentleman on securing this debate. Does he welcome, as I do, the suspension of the investor-state dispute settlement section of the negotiations, and does that hopefully mean that we can be in a better place, without some of the concerns to which he has correctly alluded?

[Geraint Davies]

I will move on to those issues and I do, of course, agree.

There is a current risk that the agreement struck behind closed doors is only subjected to yes or no—take it or leave it—in the European Parliament, and that ratification in this House occurs after the implementation of the Transatlantic Trade and Investment Partnership. That is hardly democracy. Today I am calling—it is not much of a call—simply for parliamentarians here and in Europe to have the right to scrutiny. The mechanics for that would be to empower us to recommend amendments that could be made by other representatives in Europe.

[Julian Smith (Skipton and Ripon) (Con)]

Will the hon. Gentleman confirm to the House who has access to the reading room in Brussels for the documents on this treaty? There is significant access, and I hope he will clarify how many people, and who, can look at those documents.

[Geraint Davies]

Until recently, it was just Lord Livingston from our point of view. He could go in without any photocopier or camera and try to memorise what was there, and move out. More recently, access has been enabled for some of our MEPs. However, this is a case of thousands of people—indeed, 1.2 million people have signed a petition because they are concerned about TTIP—banging on the door and wanting access, and realising belatedly the real risks in front of us.

[Mr John Spellar (Warley) (Lab)]

Will my hon. Friend give way?

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

Order. Sixteen people want to speak in the debate, as well as those on the Front Benches. Those who are intervening also want to speak, and they are in danger of dropping down the list. I am trying to keep the debate tight, so I hope Members will think about their interventions. It is up to Geraint Davies whether he gives way to Mr Spellar.

[Geraint Davies]

indicated assent.

[Mr Spellar]

Briefly, does my hon. Friend think that this will be a mixed competence agreement?

[Geraint Davies]

I very much hope it will be, as I said, but I do not know, and that is the whole point. We do not know whether it will be mixed competence— in other words, we do not know whether it will be railroaded through without any ratification here before implementation, as was the case with the Peruvian and Colombian treaties. This has not been made up; this is the sort of lack of democracy that has already been railroaded through, and there is real fear that it will happen again. I say that because we face austerity in Europe in the aftermath of the banking crisis, and a Prime Minister who has naturally said that he can see the flashing red lights on the front of the global economy, and that he wants to put a rocket booster under TTIP. There is enormous pressure to have a quick deal.

I am in favour of trade. I think trade is good, and anyone with a rudimentary knowledge of economics—I like to think that the Minister has that—will know that the law of comparative advantage will normally generate the fruits of trade. Those fruits are meant to be something in the order of £93 billion per year for Europe, and £74 billion to the United States. Cecilia Malmström, the negotiator and commissioner on this, has said that there will be growth and jobs, although I realise that there is a lot of controversy and different figures are being thrown around. However, it is generally accepted that trade generates added value.

One question for us concerns where the fruits of trade go. Do they go to the many, or are they stockpiled offshore by multinational giants in untaxed profits? Fundamentally, we are talking about whether the trade deal will undermine our democracy, our public services, our rights, our health, our environment and so on.

[Huw Irranca-Davies (Ogmore) (Lab)]

Will my hon. Friend give way?

[Geraint Davies]

Briefly. I am aware of the time constraints.

[Huw Irranca-Davies]

I thank my hon. Friend for his generosity in giving way to so many interventions. The ripples of laughter from Government Members at somebody on the Opposition Benches supporting the free market are surprising. One area of TTIP is food and food production, the biggest manufacturing sector and employer in the UK. TTIP could have huge opportunities for the food sector, but only if it involves a race to the top in standards, protection of animal welfare and standards of food hygiene, and not a race to the bottom. Does my hon. Friend agree that we can support good competition and trade agreements, but we have to ensure that standards applied are good?

[Geraint Davies]

I completely agree. We certainly do not want to open the backdoor to genetically modified foods or cloned meat or “McClonie” burgers or whatever they happen to be. We want to keep standards up. This is part of getting all the detail right and having a proper level of scrutiny. I am not complaining about TTIP itself. It could be a vehicle to deliver prosperity and regulate globalisation. Globalisation is occurring and it needs regulation. Who better to engage with that than the most developed and civilised part of the world, which is of course Europe?

[Mr George Howarth (Knowsley) (Lab)]

I want to return to the principle my hon. Friend enunciated a few moments ago. It is possible to be in favour of free trade, but not in favour of raising the potential for public services to be up for grabs for anyone who cares to bid for them. Does he agree that that is the essential principle?

[Geraint Davies]

That is very important indeed. I agree with my right hon. Friend. The thorn in the rose is the investor-state dispute settlement—the ISDS. As has been mentioned, this is an opportunity for deals to be struck behind closed doors to empower multinational companies, within a new system of law outside the law with which we govern ourselves, to sue democratically elected Governments for passing laws that protect people.

[Mr Jim Cunningham (Coventry South) (Lab)]

Following on from the point made by my right hon. Friend the Member for Knowsley (Mr Howarth) about public services, is there not another issue we have to careful about: the erosion of employment rights?

[Geraint Davies]

My hon. Friend is completely right. There are people who say there is no risk from ISDS, but there is a lot of evidence and a track record of multinationals using the powers at their disposal to extract money where laws are passed undermining future profit flows. Philip Morris is the obvious example: it is suing Uruguay and Australia for something like $100 million. Lone Pine is suing the Canadian Government for about $250 million, because Quebec wants a moratorium on fracking. Achmea, the Dutch insurer, is suing the Slovakian Government who tried to reverse some of their health privatisations. Argentina has paid more than $1 billion to US and EU energy giants, because it froze energy and water prices. If these powers are available, they will be used to fleece the taxpayer. In my view, they are unnecessary. I accept that some protection may be needed between developed economies and democracies and rogue states, but rogue states are certainly not the United States. Mature democracies and economies, namely the EU and the US, do not need anything more than contract law to protect investors.

[Mr Robert Walter (North Dorset) (Con)]

The hon. Gentleman may be aware that the United Kingdom is a party to some 90 international trade deals that involve the investor-state dispute settlement mechanism. Does he know how many cases the United Kingdom has ever lost using the mechanism?

[Geraint Davies]

I do not have the numbers to hand.

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

I can tell the hon. Member for North Dorset (Mr Walter) that the Czech Republic, Slovakia and Poland, which are in trade agreements that include this kind of investor-state relationship, have been sued 127 times and have lost an amount of money that could have employed 300,000 nurses for a year. The idea that this is not a problem is patently wrong. This is about a corporate takeover and that is why it is right to oppose this particular mechanism.

[Geraint Davies]

I am grateful to the hon. Lady for that intervention, which underlines why, of the 155,000 people who contributed to the consultation by the Commission on TTIP and the ISDS, 97% were against the ISDS. As has been pointed out in other interventions, there are dangers to our procurement, food standards, rights at work and environmental protection. My personal view is that we should pull the teeth of corporate wolves scratching at the door of TTIP by scrapping the ISDS rules, so we can get on with the trade agreement without this threat over our shoulder.

[Mr Angus Brendan MacNeil (Na h-Eileanan an Iar) (SNP)]

Is not one of the main concerns, which I am sure the hon. Gentleman shares as he is from Wales, that the UK has four different health services? There is no member state health service, so if one of those health services opens a certain door, the other health services could also be open and vulnerable.

[Geraint Davies]

All sorts of assurances have been given on health and social care but they are by no means watertight. We have not got a copper-bottomed agreement like, for example, Finland has with the United States and with Canada, which explicitly excludes all public and private social care and health. As case law has not been established in Britain, the NHS remains at risk. The opening door created by the endless privatisations from the coalition Government creates more scope and risk for intervention, which could lead to possibly billions of pounds-worth of legal action if a future Labour Government reversed a lot of the privatisation that has already occurred. Frankly, that would be in contrast to, and conflict with, the democratic wishes of the British people—if we get in.

[Chi Onwurah (Newcastle upon Tyne Central) (Lab)]

I thank my hon. Friend for giving way and congratulate him on his remarks so far. Does he agree that the combination of opening up the NHS to competition law through the Health and Social Care Act, together with the refusal to exempt the NHS from TTIP, makes this effectively a privatisation of our NHS?

[Geraint Davies]

There have been various assurances about trying to close the door on the NHS but it is fundamentally at risk. Due to the lack of case law, at any point a judge could say “Here is an area where there is already private competition. We will allow TTIP; why shouldn’t we?” The more it goes forward, the more we are exposed, which is a real problem.

[Dr Matthew Offord (Hendon) (Con)]

Will the hon. Gentleman give way?

[Geraint Davies]

I must continue as I will be told off by Mr Deputy Speaker if I do not. I will try to give way later.

MPs should have the right to scrutinise the TTIP Trojan horse and remove from it the ISDS weapons from the corporate lawyers inside.

[Andrew Bingham (High Peak) (Con)]

Will the hon. Gentleman give way?

[Geraint Davies]

The hon. Gentleman has been waiting so I shall give way.

[Andrew Bingham]

The hon. Gentleman, like me, is a member of the European Scrutiny Committee and I am sure he is aware that Lord Livingston is coming to the Committee on 11 February, which gives the Committee a chance to conduct some scrutiny. I assume that he, like me, will be at that meeting, as will, I am sure, the hon. Member for Llanelli (Nia Griffith).

[Geraint Davies]

I will be at that meeting.

The Labour party is standing on a pledge of freezing energy prices; again there could be a risk of challenge. If we wanted a one-off tax on privatised utilities, such as the one introduced by my right hon. Friend the Member for Kirkcaldy and Cowdenbeath (Mr Brown), on, for instance, Royal Mail, we could be at risk. If there were a move to partial or actual renationalisation of the railways or whatever, it could be subject to fines. The point is not whether one agrees with these policies; it is whether one thinks that we have the democratic right here on behalf of the people to pass those laws and not face financial intimidation.

In conclusion, I know that much of what I have said is shared by the Green party. The difference is that it would like to abandon the trade talks altogether and to freeze what we are doing. I would say that we cannot pretend that globalisation is not there. There are risks that I have identified, but it is our duty and opportunity to regulate globalisation with gold standards to protect democracy, public services and people’s rights. This is not just for Europe; it is for the world. What we do will be the benchmark for the future to protect ourselves and others from the possible crack of the whip of corporate giants.

I agree with fair trade. In 1945 Clement Attlee put forward the general agreement on tariffs and trade as the forerunner of the World Trade Organisation. We need to engage and regulate and not have the law of the jungle. As part of that process, I hope that all Members—whatever they think about the balance between public and private, or about the level of protection for the environment, health or workers’ rights—agree that these matters should be decided by democratically elected parliamentarians, and not by corporations with the whip hand of financial intimidation, and that they will agree wholeheartedly with my call for scrutiny in this place and in the European Parliament.

[Several hon. Members]

rose—

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

Order. There will be a six-minute limit. Members should try to stick to that; otherwise it will go down.

14:49

[Mr Robin Walker (Worcester) (Con)]

I agree with the hon. Member for Swansea West (Geraint Davies) that this is an important debate, I congratulate him on securing it and I welcome the fact that the Backbench Business Committee has granted it. I think the hon. Gentleman has drafted a motion with which no Back-Bench Member could disagree—whatever their views on the value or otherwise of TTIP. [Interruption.] I am glad to hear that the same goes for Front-Bench Members. There can be no doubt that having more parliamentary scrutiny is a good thing.

I shall talk about the Select Committee scrutiny that has taken place. The European Scrutiny Committee and its work have already been mentioned. I am a member of the Select Committee on Business, Innovation and Skills, which has an ongoing inquiry into this issue. As a member, I have been engaged in this work, and I believe we will be able to produce a balanced and useful report. I pay tribute to the hon. Member for West Bromwich West (Mr Bailey) who has conducted the inquiry so far in an even-handed and rational way. We still have some sessions to go and I do not want to prejudge the outcome of the inquiry, but I would say that on the issue of ISDS, my hon. Friend the Member for North Dorset (Mr Walter) was absolutely right to mention the precedent of all the free trade deals in which the UK has ever been involved and ISDS has played a part—and the fact that the UK has never lost a case.

That said, we heard from a lot of different bodies—the CBI, for example, the Institute of Directors, which provided written evidence, and the TUC, which has acknowledged the benefits that could come from the deal while having genuine concerns about it. I welcome the way in which most of those bodies engaged with us. Even some on the Conservative side of the Committee have concerns that TTIP is not sufficiently transparent. Much of that relates to the fact that the negotiations are being conducted by an unaccountable European Commission rather than Ministers directly accountable to this House and capable of answering questions.

[Caroline Lucas]

Does the hon. Gentleman agree that the only possible justification for having a separate judicial system for business is that existing courts are failing to arbitrate business claims fairly? If that is the case, we really need it, so can he provide some examples of where the courts in the countries involved in trying to get TTIP off the ground have been unable to secure the proper judicial remedies?

[Mr Walker]

I give the hon. Lady the example of the fact that the UK has never lost a case in ISDS resolutions, showing that this system is functioning in almost all trade deals around the world. Some of the purported threats I have heard simply do not stand up.

Moving on, I want to address a real concern about parliamentary scrutiny of this issue, particularly in respect of one particular organisation that has given evidence to our Select Committee and caused a significant amount of distress to members of all parties on that Committee. I regret to say that that organisation is the executive—not the members—of 38 Degrees. We heard from a wide variety of interests, including many who approached us with a view to getting their concerns discussed, accepting that parliamentary scrutiny is important. I really welcome that approach being taken by so many organisations.

Like many Members, I get letters from 38 Degrees and respect the concerns that their members raise. I have met 38 Degrees members in my constituency to discuss their concerns. I do not always agree with their campaigns, but I respect the interest in political discourse that they are encouraging. However, when it came to their evidence to the BIS Committee, I am afraid that the executive of 38 Degrees has let its members down. The attitude that their representative arrived with appeared to be that parliamentary scrutiny—the very purpose of this motion and the object of our inquiry— was secondary to the campaign in which he was engaged, and that it was for MPs to passively accept the views that he was there to express and in no way to question them.

When asked by the Committee Chairman about the approach the organisation had taken to the campaign, the spokesman immediately became defensive and started to attack politicians in general and the parliamentary process in particular. When asked whether public or official information that disagreed with their assertions was being provided to 38 Degrees members, he first sought to avoid the question and then misled the Select Committee.

The specific issue in point here is the letter from Commissioner Bercero to the right hon. Member for Wentworth and Dearne (John Healey) in which the Commissioner actually handling the TTIP negotiations at the time answered concerns that the Labour party had legitimately raised about the impact of TTIP on the NHS. The letter made it clear that there was no threat of privatisation of the NHS as a result of TTIP, and that as a public service it could be protected. It said that it was up to the UK Government and UK political parties what changes they made to the UK laws affected by it. On the issue of a risk about which Labour was concerned—the ability to change the Health and Social Care Act 2012 owing to ISDS—the letter said:

“If a future UK Government, or a public body to which power has been devolved, were to reverse decisions taken under a previous Government, for example by discontinuing services provided by a foreign operator, it would be entirely at liberty to do so.  However, it would have to respect applicable UK law.”

Having been briefed about this letter and seen it in the brief for our Select Committee, I did not think it was unreasonable to ask whether this information had been shared with 38 Degrees members to reassure them where they had concerns on this issue. The response of Mr Babbs was immediately to say, “Yes, we have shared that.” However, in supplementary evidence sent to the Committee a few weeks after the meeting, a representative of 38 Degrees had to admit that that this was untrue, writing:

“The Committee has requested further information about a letter from John Healey that I said I believed was on our website. Having reviewed all of the information on our website (as you will have seen, there is a lot there), I can confirm that this letter is in fact not on the website.”

Misleading a Select Committee is a serious matter, but I am sure that, if that were the only case, we would all understand that mistakes can be made. However, in the same conversation, Mr Babbs was asked about an article on Buzzfeed which bore the 38 Degrees logo, was headed “TTIP—Four ways a four letter word could ruin your life” and included the headline “Goodbye NHS hello permanent privatisation”. He disclaimed all knowledge of this article, and sought to imply that members of the Committee were out of touch if they did not understand that organisations have no editorial control over what appears on the internet, saying:

“I do not know if you are familiar with the way Buzzfeed works. Anyone can create a Buzzfeed article. It is not something that 38 Degrees produces. I have not seen that piece, so I cannot comment on it.”

In supplementary evidence, 38 Degrees has now written to the Committee as follows:

“I can confirm that the article was written and uploaded by a member of staff at 38 Degrees.”

It is, perhaps, welcome that 38 Degrees has acknowledged its mistakes and accepted some responsibility for the arguments that it has published. However, despite repeated questioning from a number of members of the Committee, the representative of 38 Degrees was not prepared to acknowledge any flaws in the way in which it had presented its arguments. Indeed, it has launched an aggressive campaign of letter-writing and intimidation. A Labour colleague’s researcher has been reduced to tears, and a Conservative colleague who is always softly spoken and reasonable has been accused of being a harridan. I do not think that that type of campaigning strengthens parliamentary scrutiny, or our ability in this place to hold the Government or the European Commission to account.

14:56

[Mr John Spellar (Warley) (Lab)]

I congratulate my hon. Friend the Member for Swansea West (Geraint Davies) not only on securing the debate but on making it clear in his introduction that he is in favour of trade, and free trade. However, I think he must also accept that he is in some strange company with that particular argument. Many of those campaigning on this issue are definitely not in favour of trade, and I have been on public platforms where they have actually declared as much. I think that they are also against capitalism, and they are definitely against anything to do with the United States. It is interesting to note that, whereas we have a huge number of trade agreements, this issue has only become contentious when the United States has become involved.

We are talking about the creation of a free trade area and a trading and investing bloc amounting to about half the world’s GDP. That is significant to all of us who argue strongly that engagement in the European Union as part of a wider market is enormously important to working people in this country. Engagement in that much wider market, and, in particular, setting better benchmarks for world trade, is also enormously important, but it does not seem to have any impact on organisations such as 38 Degrees. Like other Members who have spoken, I have a slightly ambivalent attitude to 38 Degrees. It has some very decent supporters, many of whom are very concerned and engaged citizens, but it also has a nihilist, hysterical leadership.

[Mr Robin Walker]

I should just like to put on the record—

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

Order. If the hon. Gentleman is taking advantage of the Chamber’s good nature, I should say to him that to intervene immediately after making a speech is slightly unfair.

[Mr Spellar]

I note that all these publications mention a number of cases, including that of Philip Morris Australia. That case has been proceeding for some time. Can anyone tell me what is happening to it? Has it gone anywhere? Anyone can sue, but securing an outcome is very different, whether or not the case is being heard in the domestic courts. I understand that it is not classified as a trade deal, but is governed by World Trade Organisation rules. In any event, I do not think that that case and a number of others have gone anywhere.

I do not exonerate the Department for Business, Innovation and Skills, which has not dealt with the matter. I raised it with the former trade Minister, and I have raised it with the current trade Minister. Various cases are cited—normally the same cases—but no one seems to come up with any explanation of what they are actually about. If they are about breach of contract, that is one thing. Regrettably, in my view, but perfectly legitimately, or lawfully, the Government are entering into long-term contracts in the probation service. If a new Government wanted to change that, there would be breach of contract proceedings, and they might well be better dealt with in domestic courts, but they also might be better dealt with through arbitration, which we have in a whole number of other areas. We have industrial relations courts and we have various arbitration systems in this country. Therefore, having the full panoply might not be right, but I do accept that there are concerns. There are concerns about whether there would be a ratchet effect. That is why it is very commendable that the EU has been undertaking consultation, and that is also why it is very welcome that there is a possible pause at the moment, because we need to be assured that, for example, changes made to the NHS would be reversible, although I have to say that—this message should be very clear between now and 7 May—the biggest threat of privatisation of the NHS is the re-election of this Conservative Government.

In many respects the effect of TTIP on this has been dealt with in letters to the hon. Member for Totnes (Dr Wollaston) and my right hon. Friend the Member for Wentworth and Dearne (John Healey) from the EU, spelling out the protections there.

[Clive Efford (Eltham) (Lab)]

Does my right my hon. Friend accept, however, that there is a disagreement between many eminent lawyers as to whether TTIP will apply to the NHS, regardless of what the Government say? The other thing not in the Government’s favour when they argue about protecting the NHS is that the intent of many of the provisions in the Health and Social Care Act 2012 is to impose marketisation on our NHS, so the direction of travel is very much in favour of trade under TTIP. That undermines the Government’s case against it.

[Mr Spellar]

They are not in favour of trade; they are in favour of privatisation—and that would be true with domestic companies as well, by the way. That is the major threat, but my hon. Friend is right that we need to insist on an absolutely clear exemption of the NHS from these provisions.

At the same time we also need to be arguing about the benefits of trade, however. Trade has not only been the basis on which the wealth and prosperity of this country and our people have been built, but over the course of just about 20 years hundreds of millions of people in China have been lifted out of poverty by the favourable impact of trade, in what has probably been the biggest movement of social progress in numbers terms in history. That is why the new Indian Government are seeking to open up their economy as well.

Who benefits from trade restrictions? It is not the workers, nor the consumers. The people who benefit have almost universally been—this has been the argument for the last two centuries in this House between and within parties—the monopolists, the middlemen, and the incompetent or corrupt bureaucrats. We need only look at the situation in Africa where a very small percentage of trade is between African countries because of restrictions there. That is why it is so regrettable that the Bali agreement to free up that trade has not happened; the stalling of that is undesirable.

Those are the benefits, and they are benefits for our engineering companies and many of our food manufacturing companies. That is why it is so important that we resolve these other issues, because the benefits are there and the prizes are great.

There are those who are against this agreement on principle. I am in favour of trade on principle and in favour of this agreement, but in order for it to be effective we must make sure that we get these safeguards.

15:04

[Mr Robert Walter (North Dorset) (Con)]

It is a pleasure to follow the right hon. Member for Warley (Mr Spellar), who has made a convincing argument in favour of this trade deal. I support the motion of the hon. Member for Swansea West (Geraint Davies) because I, too, am a democrat and I believe in parliamentary scrutiny. I believe the European Commission should ensure the regular publication of documents on the state of the negotiations and they should include more detailed information on what TTIP is all about. The current information that is floating around is based on leaked, rather than officially released, documents and therefore on myths rather than on facts. As the motion suggests, this House—and the other place—should be closely involved in the process, and I hope that the Minister will reassure us that the Government are committed to it.

We must also encourage the European Parliament to pursue its involvement in the negotiations. I hope that the European Commission will live up to its promise to give Members of the European Parliament access to all the negotiation documents. I also hope that, in the forthcoming meetings between the United States and the European Union, the negotiation teams will take into consideration the concerns that we have raised. I hope that the European Commission will secure an agreement on safeguards for the highest environmental and consumer standards, which are already in place here in the European Union and in the United States. I am convinced that achieving a satisfactory compromise on both sides of the Atlantic is both possible and desirable. The European Union has already successfully established an internal market among its 28 member states, but bridging the space between the United States and the European Union by adapting common rules and standards while maintaining the highest levels of regulatory protection is a challenge. I do not believe that it is an impossible task, however.

Today’s debate should be about the substance of the transatlantic trade and investment partnership. It provides a once-in-a-lifetime opportunity to enhance the economic security and prosperity of the British people while at the same time making a real contribution to the welfare of the peoples of Europe, north America and beyond. I wholeheartedly believe in free trade, and I subscribe to the goal of global trade that is both free and fair. However, achieving that goal is a slow and grinding process. In my view, it will be many decades before there is any meaningful World Trade Organisation-led, top-down framework that we can call global free trade. That is because the parties involved range from the richest nations on the planet to the poorest, and from the prairie farmers of north America to the subsistence agriculture of sub-Saharan Africa.

If we truly believe in free trade, we should use the building blocks that we have today. The European Union is the world’s largest market, and we are part of it. It is the biggest building block in this equation. Let us consider the numbers. European Union GDP is 19.4% of world GDP, and United States GDP is 18.9% of world GDP, so together that makes nearly 40% of the world’s productive wealth. Between us, however, we still maintain some of the most stringent tariff and non-tariff barriers to trade. Below the wire, 30% of the European Union’s stock of foreign direct investment is in the United States, and 29% of the United States’ FDI is in the European Union.

I believe that this debate is a no-brainer. If we can create free trade across the Atlantic—with Canada as well, of course—and have a transatlantic trade and investment partnership, that will be good for world trade, for the United States, for Europe and for Britain. There are some who want us to turn our backs on all this and leave the European Union, and therefore leave a trade deal representing 40% of world GDP. The TTIP negotiations will not be easy, because there are many vested interests, as well as the many concerns that have prompted this debate today. I am optimistic that we can achieve this, however, because the prize is so great and the balance of power so favourable to a deal. Of course, as some eurosceptics would argue in spite of the hard facts, we would still be better off out and better off negotiating our own free trade deal with the US alone. That is a fantasy. Can the UK afford to squander the strategic and economic opportunity that is TTIP? I do not believe we can.

I reiterate my support for the Government’s commitment to keeping us firmly in the European Union, and for the Government’s commitment to making sure that these TTIP negotiations are a success. I believe this House should have a role to play in that.

15:10

[Mr David Anderson (Blaydon) (Lab)]

I support fair trade, but properly regulated trade. Countries that trade are less likely to end up fighting each other. We would be daft, as the hon. Member for North Dorset (Mr Walter) said, to turn our back on a market that includes the biggest consumer society in the world. If we have the opportunity to work those people properly, why would we not do so?

However, experience tells us to be wary. At the heart of the matter is trust, or the lack of it, in the people we deal with, the failure to be able to hold people accountable, and the worry that the power of Government and big business will be used to abuse people, exploit people and get away with things that it should not get away with.

I have personal experience of going to the World Trade Organisation summit in Seattle in 1999 and the one in Qatar in 2001. The 1999 summit was a summit of hope. People from around the world went there with a belief that we would make great strides. The big stride that we were looking for from the labour movement was to build into trade negotiations core labour standards whereby nations that wanted to trade with the rest of the world would not use child labour or slave labour. Unfortunately, those talks fell apart because of the behaviour of some people on the ground and the over-reaction of the Seattle police, which led to the stalling of the conference.

Two years later in Qatar there was no such hope. Two years later, in the aftermath of 9/11, there was only one game in town—George W. Bush wanted to go through Pakistan to Afghanistan to chase al-Qaeda. Nothing else mattered. The Pakistanis, who were crucial to a discussion on core labour standards, did not engage at all with anybody. Because they did not engage, the Americans did not engage. That led to the failure of that round, which has resulted in the stalling of world trade discussions ever since.

We are now 15 years on. The hon. Member for North Dorset described the process as slow and grinding. It is not slow and grinding; it has virtually halted. That is why we are talking today about another way round what went on or did not go on in those discussions. To have any chance of going forward, we need safeguards, as my hon. Friend the Member for Swansea West (Geraint Davies) pointed out. We need the right of scrutiny and the people need reassurance. When he was in opposition, the Prime Minister lectured the Labour party time and again about the need for transparency and the benefits of letting the sunshine in. That is what we are talking about here.

It would have been better if, since he became Prime Minister, the right hon. Gentleman had put that policy into practice—for example, by releasing the papers relating to the miners strike and behaviour of people at the Orgreave coke works, and the papers that go back 42 years to the Shrewsbury pickets. Some of those men are now nearly 90 years old and still cannot access the papers held in the Cabinet Office and other Government buildings that would prove they were innocent.

Lectures on transparency do not work; facts do. If there is nothing to hide in the negotiations, give us the scrutiny we need. Give us the scrutiny we demand and deserve. Cut out the secrecy and closed doors, and stop using the confidentiality claim. Shine a light so that people can see what is going on.

Let us be clear. The huge doubt that exists is not engendered solely by organisations such as 38 Degrees or the trade union movement. There is huge doubt in the public mind about the role of these trade negotiations in undermining vital public services.

[Mr Andy Slaughter (Hammersmith) (Lab)]

Will my hon. Friend give way?

[Mr Anderson]

No. There is not much time.

The truth is that people in this country are sick to death of the way public services have been treated over the past three decades. We have the nationalised train companies of other countries running our train services. We have multinational energy companies fleecing the old and poor in this country who are trying to keep their lights on and their houses warm. We have foreign postal companies undermining the universal service obligation. We have water companies—dealing with the basis of human life—that do not know where the people they provide the service to live. We have a coal industry where 200,000 people lost their jobs and communities were devastated, and we buy in coal from some of the most unstable regimes on earth. And now we worry that the health service will be fragmented before our very eyes.

That is why people do not trust, and are very worried about, these negotiations. That is why they are saying to us, “We are sick to death of seeing privateers feast on the goodies of privatisation. If TTIP is another opportunity for them to do the same, we do not want it.” The Government—and my party, if it wants to get behind this—have to say to the people of this country, “We are going into these negotiations in the proper manner. We will open them up to people in this House and Europe”—MEPs from all parties have said they are concerned about the lack of scrutiny—“We will do it properly. We will come back to the House and the country and say, ‘This agreement is sound. It covers your concerns. It works in these areas, but we will not allow it to work in these other areas.’” If we do not do that, TTIP will not deserve the support of ourselves, the nation or the EU.

15:15

[Julian Smith (Skipton and Ripon) (Con)]

I rise to challenge the premise of this rather cynical motion, which is yet another example of a cynical approach to scaremongering on many aspects of what is, in essence, an exceptionally positive deal for our country. The motion seeks to add to the many worries that our constituents are writing to us about, and it completely avoids looking at the work that has been done over the past 18 months since the deal began being discussed.

If we look at the press release—

[Mark Durkan (Foyle) (SDLP)]

rose—

[Julian Smith]

I will give way shortly. If we look at the press release from the sponsor of this motion, we see that the hon. Member for Swansea West (Geraint Davies) ends by saying:

“We need to engage responsibly to deliver regulation of trade and to avoid the social and economic Darwinism that is the inevitable result of disengagement.”

I say to him that there has been nothing but engagement from this place on this deal. This is the third debate in this Chamber about TTIP. The House of Commons European Scrutiny Committee has already had one and it is to have a second. TTIP was discussed during the Bill on the NHS promoted by the hon. Member for Eltham (Clive Efford). There has been a House of Lords—

[Mr Slaughter]

rose—

[Julian Smith]

There has been a House of Lords report on TTIP and a Government response to it. The Select Committee on Business, Innovation and Skills has interrogated Ministers about TTIP. The all-party group on European Union-United States trade and investment, of which I am the deputy chair and which the right hon. Member for Wentworth and Dearne (John Healey) chairs, has had multiple meetings, in Brussels, London and America, with the negotiator, with Members of Congress, with members of the US Administration and with the EU trade negotiator, Ignacio Garcia. There has been nothing but engagement, both from Brussels and from our Government on TTIP.

[Geraint Davies]

Will the hon. Gentleman give way?

[Julian Smith]

I will give way later. On the issue of parliamentary scrutiny when the deal is done, I ask hon. Members to look at a letter written by the Secretary of State for Business, Innovation and Skills, the right hon. Member for Twickenham (Vince Cable), on 22 September, in which he says:

“The UK Parliament, including the House of Lords…will have a full opportunity to scrutinise the deal before it is finalised.”

There does not seem to be anything but clarity in that statement.

On the investor-state dispute mechanism, we have heard earlier that the EU has made it clear on multiple occasions that the freedom of national Governments to regulate would be explicitly protected. The investor-state dispute settlement provisions being discussed cannot overturn policy laws; the purpose is to protect our investors from discriminatory treatment by protectionist Governments. There are 90 other examples of ISDS in deals we have around the world. As we have heard, there have been two cases against Britain, neither of which was successful.

[Several hon. Members]

rose—

[Julian Smith]

I will give way later. The Commission itself has consulted carefully on the issue, and that consultation will be coming to a conclusion shortly. On the NHS, the chair of the all-party group, the right hon. Member for Wentworth and Dearne, has had a letter from the European Commission. It says that,

“we can already state with confidence that any ISDS provisions in TTIP could have no impact on the UK sovereign right to make changes to the NHS.”

Our Government have made it clear that there is no threat to the NHS from TTIP. The focus is on allowing innovation between companies in the EU and the US on health-related issues. It is not about changing policy on free-at-the-point-of-delivery national services.

[Mr Andy Slaughter]

Will the hon. Gentleman give way?

[Julian Smith]

I will give way later. What surprises me about the hon. Member for Swansea West, who at the start of this Parliament wanted to be head of the Business, Innovation and Skills Committee, is that he has not given any focus to the benefits of TTIP. This is our biggest export partner; the biggest trading relationship that we have. The huge focus of our attention here should be on saying and explaining that this deal will mean hundreds of pounds less for British consumers when they buy their jeans, cars and other products. It will primarily benefit not big corporations, but small businesses—the businesses that we have in our constituencies. TTIP will made trade easier with the most easy market to trade with—that which speaks our language—the United States of America. I say to the hon. Gentleman that this is a ridiculous motion. He should focus on the benefits of the partnership. It is a key part of this Government’s long-term economic plan and he should be celebrating this deal when it comes to a conclusion.

15:21

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

May I start by commending the hon. Member for Swansea West (Geraint Davies) for bringing this debate to the House? Like others, I have had hundreds of constituents in touch with me about TTIP, particularly about the potential implications for the NHS. That brings home to me not just how preciously people hold their access to health care and how anxious they are about the future of the NHS, but that we are debating a treaty that does not actually exist yet, and that we are not yet in a position to analyse or assess. That is exactly why this process should be open to more effective scrutiny now, and we need to have a much wider debate.

Having waded through some of the papers released by the European institutions—the Commission and others—in recent days, I do not think that they provide definitive answers to the key questions I am being asked, and we really need better answers. When it comes down to it, we need an explicit exclusion of public health care and associated services from TTIP.

Ministers must try to understand why there is such public concern. The negotiations have been shrouded in secrecy, and Ministers have failed to address fully the questions posed by the devolved Governments that arise as a consequence of the distinctive structures and policies of the NHS in the home nations. We need more transparency in this process and cast iron assurances that the treaty will not be a route to the backdoor privatisation of our NHS.

The bottom line is that Scotland must not be bound by a trade deal that could undermine public ownership of our NHS and our ability to make accountable, democratic decisions about public health care and that could usher in creeping clandestine privatisation.

[Mr Walter]

I do not know whether the hon. Lady received the same letter as I did on 19 December from the Secretary of State for Business. It said:

“And the new Commissioner, Cecilia Malmstrom, has also stated explicitly that ‘public service, including health, education and water management, are not on the agenda.’”

[Dr Whiteford]

I have read those documents, and I am glad that the hon. Gentleman raises that point. What we have had repeatedly are assertions. I read the Commission’s latest publications, which do appear to indicate that state monopolies will be protected. But elsewhere in the text, relating to services of general economic interest—namely utilities and public services—it says that they would be governed by normal competition law

“in so far as the application of such rules does not obstruct the performance in law, or in fact, of the particular tasks assigned to the enterprises in question.”

That does seem to water down the seemingly categorical assurances we have heard elsewhere. In reality, it is not at all clear that the requirement will protect public services in the absence of an explicit opt-out.

[Mark Durkan]

The hon. Lady heard the hon. Member for Crawley (Henry Smith) quote many assurances, which came from many different sources. Does she believe that they are any more reliable than the promises of the hon. Member for Skipton and Ripon (Julian Smith) to give way “later”?

[Dr Whiteford]

As ever, the hon. Gentleman makes an astute and telling point.

We need to know that there will be no obligation to open up the NHS in Scotland to US private providers, even if that is what England’s NHS decides to do, and we need to know that there is no chance whatever that the treaty will expose the Scottish Government to investor-state dispute settlement mechanisms.

People’s legitimate fears are not being assuaged. The Commission has sounded a note of caution regarding these mechanisms, because they are being misused around the world. We have seen an escalation in the number of aggressive cases being brought against countries that have made perfectly legitimate decisions. The fact that it has only happened a couple of times here does not mean that it will not happen more in future. That is why we need to debate the issues now.

I appreciate that Members will hold profoundly different views about the wisdom of opening the NHS to privatisation; indeed, some Members might see it as a one-way street, but in Scotland we have chosen a different direction of travel, and we need to be sure that that will not be derailed by complacency over the drafting of a trade agreement. I am also of the view that any disputes need to be resolved in our domestic courts, not through ISDS mechanisms.

Before I finish, I want to address some of the implications of TTIP for Scottish agriculture. There are undoubtedly potential benefits from better market access for our food and drink producers, but a number of non-tariff issues have potential downsides. My questions to the Government today focus on how they plan to address and mitigate those issues. I am particularly concerned about our livestock sector—which is key to the economy of my constituency—where risks as well as opportunities are likely to emerge from TTIP.

For example, Aberdeenshire produces some of the best beef in the world—Scotch beef that commands premium prices, is fully traceable and is produced to the highest standards of animal welfare. US beef is notably cheaper to produce. Producers in the US have some economies of scale, climate, and less rigorous compliance regimes, and they are allowed to use hormone growth promoters that are not permitted in the EU. I would like an assurance from the Minister today that TTIP will not lead to a dumbing down of production values, whether in the way animals are farmed or in the quality of the food that ends up on our plates.

It has also been suggested that protected geographic indicator labels could be a stumbling block within the TTIP negotiations. For many of our most iconic food and drink products, their origin is a core factor in the success of their brand and, critically, in the premium price it is able to command. Protected geographic indicators are essential to sustaining the livelihood of smaller-scale producers who rely on the high quality and uniqueness of their product to add value. Will the Government take the opportunity today to outline what they will be doing to ensure that PGIs are not undermined in the TTIP process, and assure Scottish beef and lamb producers that the markets for their distinctive premium products will not be harmed by opening the market to cheaper imports?

[Mr MacNeil]

My hon. Friend makes a good point. From my own experience, I would want to ensure that Stornoway black pudding, for instance, had its protected status maintained.

[Dr Whiteford]

Marag is, as my hon. Friend knows, the food of the gods, and any steps should be taken to protect that vital aspect of our culture and economy.

Governments need to legislate and regulate in the public interest—not in the interests of corporations or shareholders, but in the interests of citizens. As things stand, there are entirely legitimate fears that the Transatlantic Trade and Investment Partnership could significantly restrict our ability to do that. Until the Government can provide meaningful and detailed assurances, public scepticism is unlikely to be assuaged, and I urge the Government to take a lot more action to spell out the detail of how it will affect different sectors of our economy.

15:28

[Dr Sarah Wollaston (Totnes) (Con)]

It is a pleasure to follow the hon. Member for Banff and Buchan (Dr Whiteford). I hope to be able to respond to some of the concerns she voiced. I congratulate the hon. Member for Swansea West (Geraint Davies) on initiating this important debate.

I share the sentiment, which was expressed by many hon. Members, that trade is the cornerstone of our national wealth. We heard my hon. Friend the Member for North Dorset (Mr Walter) speak about its impact on our economy. Without that trade and our national wealth, there would not be funding for vital services such as our NHS; it is that long-term economic plan that will guarantee its future. However, I would like to speak today about the NHS and express some of my concerns.

The Leader of the Opposition has spoken of his desire to weaponise the NHS. It is shameful in itself, but it also detracts from some of the genuine arguments and important issues that we need to raise about health within TTIP.

Initially, I would like to clear up the points raised by the hon. Member for Banff and Buchan. They are important and I would not support the deal if I thought that it would have the effects she outlined, but I think that they have been rather used as part of that weapon to try to damn this partnership and to damn the Government’s record. That is regrettable.

After reading the letter from the European Commission about the NHS, I wrote back because I wanted to clarify some points. As Chair of the Select Committee on Health, I heard back from Jean-Luc Demarty, the director-general for trade. He wrote to me on 11 December and a copy of that letter is available on the Health Committee’s website if people want to look at it in detail. He made it absolutely clear that all publicly funded health services, including NHS services, would be protected under TTIP.

I pressed him further on that point, asking about the definition of publicly funded health services—in other words, would they include organisations such as those in the third sector? He was very clear that as long as the services are publicly funded, it does not matter how they are delivered. That is an important point of clarity. He also made the point that any investor-state dispute settlement provisions in TTIP could have no impact on the UK’s sovereign right to make changes to the NHS. In other words, that deals with the concerns that have been raised that this is somehow a one-way street and that no future Government would be able to change policy. He is very clear on that point and I urge Members to look at his letter. The issue of ratchet clauses is also very important, and the ratchet clause will not apply in this case.

[Jeremy Corbyn (Islington North) (Lab)]

If an incoming Government decided to terminate a contract in the NHS or in the public social care sector under which that company claimed that a very large investment had been made in building a care home or something similar, would the company not be able to use TTIP to prosecute the Government for the potential loss of investment?

[Dr Wollaston]

Already within domestic contract law there are provisions that mean that one cannot arbitrarily reverse a contract. A state would be able to announce that it was changing policy and moving forward, but the point about TTIP is that it works on both sides of the Atlantic. We would not wish to have British companies arbitrarily lose their investment in the US. It is about that; it is not some conspiracy of an evil empire, which is how it has been portrayed. I think that that would be a reasonable process.

[Margot James (Stourbridge) (Con)]

May I make the point that an ISDS tribunal is empowered to award compensation for genuine loss but is not empowered to overturn policy or national regulation?

[Dr Wollaston]

Indeed, and that is the point that we want to make clear.

The concern is legitimate and if the NHS were threatened by TTIP we should be explicit about that, but it is not. We need to be clear about that and it would be helpful if Opposition Members withdrew the insinuation that is constantly being put out to our constituents that this is a conspiracy to do so.

I also pressed the Commission on whether it would be sensible for the Government explicitly to ask to exclude the NHS, and it could not have been clearer that it was not necessary because it was going to do so itself. May we please bring that aspect of the debate to an end and focus on the issues that matter?

[Mr Slaughter]

Will the hon. Lady give way?

[Dr Wollaston]

I am afraid I do not have time to take further interventions, so I apologise to the hon. Gentleman.

The issues I think are important are those to do with public health in areas such as smoking and alcohol. Other Members have pointed out the impact on the Uruguayan Government of their being sued by a tobacco company. The company’s profits dwarf the domestic product of Uruguay. We cannot allow that to happen. This has serious implications. I would like the Minister to respond specifically on whether, during these negotiations, the tobacco industry—an industry that kills half its customers—can be specifically prevented from using the investor state dispute procedures in such a manner.

I would also like protections in relation to alcohol. Of course, part of our transatlantic trade should legitimately cover alcohol, a product enjoyed by many. However, the Scotch Whisky Association has been able to use legal mechanisms to delay the proposed minimum pricing measures which are desperately needed in Scotland and which I fully support. I would like further detail on what measures the Government propose to protect public health as TTIP goes forward.

Finally, I would like to make a point on behalf of transition town Totnes. Will the Minister explain the implications of this for our obligations under the climate change legislation? The transition towns movement has done a huge amount of work on local food networks and sustainability. Will he assure me that he will continue to look after the interests of those vital food networks and make sure that that they are protected alongside trade? We need to strike a balance. I know that it is a difficult issue, but it is important.

15:36

[Liz McInnes (Heywood and Middleton) (Lab)]

In my previous employment as an NHS scientist, I was extremely concerned about the implications of TTIP for our NHS, and for all our public services, and I remain so. In my new job, I have been contacted by many constituents expressing their concern about TTIP, which is a subject on which the public appear to be very well informed.

[Mr Slaughter]

My hon. Friend has hit the nail on the head. Members of Parliament are not putting pressure on their constituents, as the hon. Member for Totnes (Dr Wollaston) claimed; rather, constituents are saying that they are concerned. They are concerned, for example, that small businesses are being disadvantaged in comparison with large businesses, that monopolies are being encouraged among pharmaceutical companies, and that the NHS is in danger of privatisation. We have a duty to give them an explanation. There is huge disquiet out there among the public, and we ought to address it. There is terrible complacency among Government Members about this.

[Liz McInnes]

I thank my hon. Friend for his comments; he has pre-empted what I was about to say. I am not going out scaremongering; my constituents and my previous colleagues are expressing to me their real and legitimate concerns about this agreement.

As I said, this is a subject on which the public appear to be very well informed. That surprises me, given that a major concern expressed to me is that the negotiations seem to be taking place in secret. Perhaps there is a lesson here: the more secretive a deal appears to be, the more effort people will make to try to seek out the truth. If ever we needed an argument for openness and transparency, this is it.

We have already heard a lot about the ISDS mechanism, which is causing my constituents and ex-colleagues major concern, particularly in relation to our public services—specifically, our NHS. People are telling me— again, this is not about me going out scaremongering—that they are really worried that this could result in private companies seeking compensation from our public bodies for loss of potential earnings. We have already heard about mechanisms in agreements in other countries whereby those countries are being sued for things such as regulating medicine and energy prices, raising minimum wages, and putting health warnings on cigarette packets, to name but a few. There is a real fear that this mechanism is not about enforcing contracts but about giving businesses huge new powers to intimidate policy makers. There is major concern that the ISDS provisions could lead to enforced privatisation of our NHS and other public services. Governments have a right to be able to legislate in the public interest, and that should be protected in any dispute resolution mechanisms.

The European Commission has instigated several changes that have improved the transparency of the agreement, and that is welcome. However, it is right that the Commission has decided temporarily to suspend negotiation on ISDS until the final stages of the negotiations. I urge the Government to use this opportunity to call for greater transparency on exclusion for legislation that is in the public interest, such as that relating to the NHS.

An online consultation by the European Commission has revealed huge public opposition to TTIP. Again, this is not about me or any other member of my party going around scaremongering. The Commission received an unprecedented 150,000 responses, more than a third of which were from the UK, mainly opposing TTIP and many calling for the NHS and other public services to be exempt from it.

Other countries have sought to exempt areas from the agreement, but this Government have not done so. Instead, their position on the NHS and TTIP has been muddled. They have told the British Medical Association that the NHS will be “protected”, and the Department of Health has said:

“We have no intention of allowing the TTIP to dictate the opening up of NHS services to further competition, and it will not do so.”

However, the Minister for Trade and Investment, Lord Livingston, said in September that TTIP would not have any impact on the NHS and therefore the UK negotiation team would not be pushing for its exclusion. Those mixed messages are of great concern and are troubling. This Government need to commit to the NHS being exempt from the final TTIP agreement and look carefully at its impact on other public services.

15:41

[Margot James (Stourbridge) (Con)]

I congratulate the hon. Member for Swansea West (Geraint Davies) on securing the debate and agree about the ongoing need for scrutiny of this and other important trade deals.

The US is the UK’s biggest single trading partner, accounting for nearly £90 billion of exports in 2013. With both economies doing so well, the opportunity afforded by TTIP has huge potential, with the right safeguards in place, for growth on both sides of the Atlantic.

At present, a lot of non-tariff barriers, as well as tariffs, are making it impossible for some companies—and far too difficult for others—to export to the US. The food and drink industry is our largest manufacturing sector, but many of its brands are too little seen in American supermarkets. The cost for food and drink companies in complying with US tariffs and regulations is equivalent to a tax of 13%. That is the tip of an iceberg that the trade negotiations are seeking to address. As other Members have said, if successful the trade agreement will generate GDP growth of £10 billion a year to the UK.

In my region, the automotive industry alone estimates that its exports to the US would grow by £1.4 billion more than would be the case without a deal. Production would increase by 7%, which would create jobs in the supply chain to the bigger companies that are so important to my constituency.

Building exports to the US is a sure-fire way to create growth and jobs. Last year I visited a company called Vee Bee Filtration in my constituency. Some 90% of the filtration systems it manufactures are exported, mainly to the US. It got started in the US with help from UK Export Finance in 2012, and since then sales have grown exponentially.

The growth that will be generated by a free trade agreement will benefit not just companies big and small, but employees, people taking up new jobs, families and consumers. The benefit in money terms to households in my constituency is estimated to be the equivalent of £400 a year.

Many of my constituents travel to the US for work and pleasure, and they often express frustration at how much cheaper consumer goods in many sectors are there. So far, I have talked about the benefits in terms of increased exports, but there are benefits for consumers from the potential removal of EU tariffs on American goods in that cars imported from the US would be 10% cheaper and jeans would be 12% cheaper. A free trade agreement, properly negotiated, will improve people’s standards of living in many ways, so it is very important to overcome any barriers to its successful conclusion.

I am not complacent about the difficulties. I agree that the negotiations should be subject to ongoing scrutiny. I have mentioned that the food and drink industry faces particularly costly barriers. I want the elimination of tariffs, but it is important to do so without jeopardising food safety, or the rights of Governments to establish public health policies, such as to prevent the increased use of trans fats in packaged foods.

Some of my constituents have raised concerns about the possible impact of TTIP on public services, particularly the NHS. I commend the right hon. Member for Wentworth and Dearne (John Healey) for his work as chair of the all-party group on TTIP, and for the reassurance he sought and has received directly from the European Commission on many points.

The Commission has confirmed that existing EU bilateral trade agreements either exclude or make specific reservations for the delivery of publicly funded services. Furthermore, the letter to the right hon. Gentleman reassured us that all member states are free to maintain measures, and even to adopt new ones, to control access to their health service by foreign suppliers—without constraints—under existing EU trade agreements. The Commission has confirmed in writing that the EU will not change its approach to health services in negotiations for TTIP. The provision of publicly funded health services will not be affected by the ISDS regime either. The Commission has guaranteed the rights of Governments to legislate in the public interest and to prevent unjustified claims. Virtually all of our 94 bilateral investment treaties include an ISDS regime, and the UK Government have never lost a case brought under the regime. Many safeguards are therefore already in place.

Members should be more positive about the benefits in jobs, growth and the standard of living of our constituents that TTIP offers, and they should grasp this opportunity, but with open eyes.

15:47

[Sheila Gilmore (Edinburgh East) (Lab)]

Had it not been for a great deal of campaigning, I suspect that we would not have been able to debate either TTIP or many other things. The hon. Member for Skipton and Ripon (Julian Smith) suggested that there has been plenty of parliamentary debate of this issue. There has been some debate, and perhaps the amount is increasing, but it is largely because people have raised the issue and kept campaigning on it that we have got to this stage. The Government have not initiated the debate or said what they are trying to achieve, and it seems that Ministers at times answer questions only grudgingly.

When TTIP was first raised with me a considerable time ago—a year ago, if not more—by members of a constituency peace and justice group that is involved in international development issues, I confess that I had not heard about it. I did not know what they were talking about, and I had to research and find out about it; it was not on our agenda in this place. We must give credit to such people, even if we sometimes think that they get particularly exercised about such issues. I am firmly convinced that we would not be having this debate had it not been for them.

We have to ask our Government: if we do not need to worry about such issues, what is the problem with stating that explicitly? Some months ago, when the Prime Minister made a statement on a recent summit, he said, “No, we don’t need to worry about the health service in all of this.” I asked him whether that could be explicitly stated in the agreement. I did not get a clear answer that that was his position. It was more, “Well, it’ll be all right because it is understood by everyone in some way that it will not be included.” If we are saying that the health service and public services are safe and will not be undermined by the treaty in any way, there is no harm in making that explicit in the wording of the treaty, because apparently there is no problem.

I am concerned about what constitutes a public service: it is not just the NHS; there are many other public services. Many countries, including the UK, have a mixed provision of services, and whether we think that is good, bad or indifferent, it exists. For example, a lot of social care services are provided by private companies and sometimes third sector companies. Whether good or bad, are those covered by the exclusion for public services? We must be clear about that because more and more is being provided by private companies that, perhaps rather oddly, describe themselves as “public service companies” and provide a variety of services in various fields. We must be clear about the definition of public services—I think the hon. Member for Totnes (Dr Wollaston) suggested that such a definition should exist for something that is publicly funded, but we need that to be explicit in the treaty.

[Dr Wollaston]

To reassure the hon. Lady, it was not that I said the definition should exist, but that I was reassured by Jean-Luc Demarty that it would exist. It is about who funds the service, not who provides it.

[Sheila Gilmore]

That would be clear if such a definition was in the treaty and there were no caveats, provisos or wiggle room. The same point applies to opportunities that might exist for companies to sue outwith our normal courts. I agree that if there is a clear breach of contract under our existing law, people have the right to take action to protect their financial interests. We do not always like that and it sometimes causes problems when a Government change, or indeed change their course, but on the whole we accept that because we can see clearly where it is happening, what criteria are being applied, and it is publicly reported. That is the concern about the potential tribunals.

The reason often given for having special tribunals to deal with such issues is that certain countries with whom we may be trading may not have a legal system that we trust to uphold the agreement and protect our traders. That is not the case with this treaty, given the countries involved. If that was the derivation of this provision, I argue that we do not need it, and if we do not need it, it should not be there. It is not good enough to say, “It will be there, but it will not cover this or that; it will be all right because we have always won in the past.” If we do not need the treaty because we are equal partners—perhaps not entirely equal, but much more equal than has been the case with some trade treaties—we do not need a special regime. I do not say that there will never be a need to litigate. If some of our companies felt that they were being barred illegitimately from the United States despite the terms of the treaty, they might want to litigate, but I argue that the opportunity to do that through normal court processes in the United States exists and we do not need anything special.

This treaty must be as public and open as possible. That is the purpose of the motion, but it must also be ongoing. The people who contact us are deeply concerned and want to know that their interests are being protected. The onus is on the Government of the day who are negotiating the treaty to bring it back at regular intervals and update us on what is happening and what provisions they have managed to include. They should not expect us and our constituents to accept some reassurance that things are all right and we should not be worried or frightened. If we have nothing to be frightened of, the Government have nothing to be afraid of in keeping us fully abreast of negotiations.

15:54

[Zac Goldsmith (Richmond Park) (Con)]

I congratulate the hon. Member for Swansea West (Geraint Davies) on securing the debate.

TTIP, if it goes ahead, will be the biggest and boldest free trade agreement of all time. Like it or hate it, it is huge and it will impact on our constituents in any number of ways. It is therefore welcome that we are discussing it, albeit on the very margins of the parliamentary calendar, but we are nothing like as involved as we should be. If trends continue, we will find ourselves bound into a staggeringly far-reaching agreement without having given it anything like the kind of scrutiny it merits. We should be grateful to the public, both here and abroad, who have understood the significance of TTIP. Well over 1 million European citizens have signed a petition calling for, among other things, greater transparency. In response, the EU has reluctantly agreed to publish some, but not all, the texts relating to the TTIP negotiations. At this stage, no one can talk with any real certainty about the minutiae of TTIP—that is just not possible—but we can see the direction of travel. For my part, I think it is incredibly worrying.

The most obvious concern relates to the investor state dispute settlement mechanism, which has already been discussed. Up until a few days ago, it was an absolutely core component of the proposal. I welcome the fact that public pressure is forcing a rethink on that for now. The ISDS effectively allows foreign businesses to sue Governments for policy decisions that impact on their future profits. That would happen not through our domestic courts, but through new investor tribunals.

The ISDS is not, as many hon. Members have pointed out, a new concept. It exists in other free trade agreements. There are many examples of countries having been sued successfully for policy changes they have made: limiting coal mining in sensitive areas in Indonesia; attempts to raise standards for coal power plants in Germany; attempts to impose oil spill controls in South America and so on. The best known example, which we have already heard about, relates to Australia being sued by tobacco giants for taking measures to dissuade people from smoking. There are many other examples. Canada has been sued 35 times under current ISDS mechanisms. In one appalling case, Canada was sued by Ethyl Corporation for $250 million, via an ISDS mechanism, after it banned the highly toxic chemical MMT, which is an additive for fuel. Despite unequivocal evidence of harm—no one disputes the scientific case—Canada not only had to settle with Ethyl but reverse its ban. I accept that the ISDS has a role to play in limited circumstances. It exists to help companies do business in volatile countries with unreliable judiciaries, but the mechanism being proposed in TTIP will apply here, not in Venezuela or the Democratic Republic of the Congo.

I have asked the Government repeatedly for any examples of EU companies in the US, or US companies in the EU, being discriminated against by the courts of the host nation in the past five years. The answer is always the same:

“The Government does not have access to relevant information.”

If we do not have that information, how on earth can the Government make the case for ISDS? One fundamental problem with ISDS is that its very existence would act as a permanent inhibitor for legislators. Where new evidence emerges, for example, of the dangers of a pesticide, Governments would have to think twice before introducing a new regulation. Essentially, it will give the companies that are big enough to use this system the power to freeze policy evolution and buy what is effectively a risk-free environment.

The power that vests in giant international corporations is hard to exaggerate, but it does not stop there. I understand that massive public pressure has meant that ISDS has been suspended and will not be part of next month’s negotiations. I do not believe that the issue has been resolved but, with or without ISDS, I believe TTIP is still structurally geared towards satisfying the interests of multinational corporations above all else. I do not see this as a question of trade or no trade; this is a question of basic democracy.

Let us consider the so-called regulatory co-operation councils being proposed by the EU as part of TTIP. They involve formally giving stakeholders early opportunities to intervene in the regulatory process; that is, seeing proposed legalisation before it is handled by Parliaments. Hon. Members do not need to be told what kind of stakeholders will end up on that council. It is worth considering what changes we might see under TTIP. What is it that big business wants? Free trade agreements are normally about reducing trade tariffs—taxes on imports and exports. There are very few tariffs between us and the US, so the focus will be on standards. In many respects, it is hard to imagine a harmonisation of standards between the US and EU resulting in better standards for us.

Food is, I think, the best example. Our standards are undeniably higher than the standards that apply in the US on a whole range of issues; hormones in beef, milk and pork, the use of steroids, chlorine-treated chicken meat and the clear labelling of processed food. We have a fundamentally different approach. We are told by our Government that food standards are safe and that nothing will happen. Try telling that to US agribusiness giants who have been engaging in an orgy of lobbying and have very high expectations.

[Mark Durkan]

On food, the hon. Gentleman will know that many in the food sector are very keen to trade significantly but really do worry about the implications of the treaty and the terms under which it is done. They feel that it will potentially undermine them rather than giving them a floor of confidence on which they can trade.

[Zac Goldsmith]

I very much agree and the same is true of chemical regulation. In Europe, our approach, while being very far from perfect, puts an emphasis on the precautionary principle. Again, we are told that our approach will not be affected, but there is plenty of evidence—including today—that that is not true. For example, the EU proposed in 2013 that endocrine-disrupting chemicals—chemicals that mess with the sexual development of children—should be banned, at least until they are proven to be safe. For the record, there is no scientific doubt at all about the effect of endocrine disruptors; none at all. But on the back of savage lobbying by the chemical industry, the US Government weighed in and pressed the EU to consider the impact of their proposals on fledgling trade negotiations. Bingo; a few months later, the proposals were suspended. The lobby groups had won. Our Government, to their shame, were involved in that process; the first European Government to step forward on the side of the lobby groups and say, “Yes, let’s back off and not jeopardise our trade deals.”

[Geraint Davies]

I agree with the hon. Gentleman about the precautionary principle in the EU. Does he agree that there is a risk to air and water safety from fracking and that we will get sub-standard environmental controls, as there are in the United States, through the back door of TTIP, with ISDS?

[Zac Goldsmith]

I am going to skip the question of fracking as I am running out of time but, for the record, the hon. Gentleman makes a valid point.

So why are we moving heaven and earth for this vast trade deal? We are told that it is about jobs and growth, and that Europe might benefit by £100 billion. But there are any number of reports that say the opposite. But it is all nonsense. We have no idea. The history of these sorts of predictions in relation to big free trade deals is pretty woeful. We were told that the north American free trade agreement, for example, would create a million new jobs. There is more or less a consensus now that it cost America 870,000 jobs.

What specific problems will TTIP resolve that merit ceding our sovereignty in this spectacular fashion? I ask Members of my own party specifically; why is it not okay to hand the reins of our ancient democracy to an unelected EU bureaucracy, but absolutely fine and great to allow those same unelected Eurocrats to delegate our democracy to multinational corporations?

I wonder how much support there would be in my party or on the Opposition Benches for this treaty if people fully and truly understood the implications. I remember interviewing the famous consumer activist Ralph Nader for The Ecologist about NAFTA. He told me that he was reaching the end of the campaign and that Congress was going to give it a green light. He did not believe that anyone in Congress had read the report. He said that he would give a cash reward to anyone who could answer his questions. Months passed. Finally, Senator Brown of Colorado accepted the challenge and got every question right, to everyone’s amazement. He then turned to the cameras and said that having read the report he was going to vote against it as he could see how dangerous it was.

I believe that any self-respecting Member of this House should demand–no, insist—not only transparency and scrutiny by this House, but the right to approve or reject this treaty before our country is bound to it.

16:03

[Phil Wilson (Sedgefield) (Lab)]

First, I congratulate my hon. Friend the Member for Swansea West (Geraint Davies) on securing a debate on an issue that is important for the future economy of the UK and of Europe and for globalisation. We should broadly welcome the principles behind TTIP but obviously we need to take into consideration a lot of the issues raised by Members, especially the hon. Member for Richmond Park (Zac Goldsmith), and to ensure that we have continued parliamentary scrutiny.

Any trade agreement that can give the UK and Europe greater access to US markets can only be welcomed. There are obviously certain caveats to that and I will come on to them. I believe that this agreement has the potential to help regulate a globalised economy so that it is pro-business but also pro-fairness. It is also critical that we take part in the negotiations from the start and continue with them because we cannot close the door on the world. To be opposed to TTIP as a matter of principle without any regard to jobs and investment opportunities is counter-productive. It would seem to me to be fundamentally wrong to say no to something before the negotiations have really started and a framework decided upon.

I shall say a few things about the importance of US-UK trade and investment. US investment in the UK in 2013 was $571 billion. UK investment in the US was $519 billion. US exports to the UK were $107 billion, while US imports from the UK were £101 billion. With $1 trillion in investment and £204 billion each year in trade, the UK-US economic relationship is one of the largest and most important anywhere in the world. The US and the UK are each other’s largest foreign investors, and this investment supports over 1 million jobs in each country, and the Government estimate that TTIP could boost the UK economy by as much as £10 billion a year.

As far as trade and investment is concerned, the UK can benefit the most through TTIP in comparison with any other EU economy. The impact on the north-east, where my constituency is based, could be significant, too. Some £2.4 billion of north-east exports go to our single biggest market—the US—which is equivalent to 66% of all north-east air freight. The North East chamber of commerce estimates that 42% of its members want to export to the US in the next 24 months, while the trend for the numbers of exporters in the north-east is increasing every year to the point where more than 2,500 businesses are exporting to Europe. Over 200 medium and large US-owned companies in the north-east exports products around the world.

US-owned companies such as Sevcon, Caterpillar, AAF Ltd, Esterline Darchem, GE Wellstream and Union Electric Steel are all based in the north-east of England. Newcastle airport is starting direct flights to New York to prove the significance of the north-east/US relationship. Any deal that can bring down business tariffs and raise standards by harmonising regulation, including the labour market, and that can promote trade and investment can only be worth negotiating.

It is not only US companies that can benefit; UK-based companies can, too. I am thinking of Kromek in my constituency; it is based at Netpark, which is a science park. It produces systems for airline security and state-of-the-art X-ray technology, which has great trade significance for the US.

There is obviously some scepticism about the deal, especially concerning ISDS. However, EU Trade Commissioner Malström has said:

“Let me be clear: the TTIP that the European Commission will negotiate and present for ratification will be an agreement that is good for citizens—good for growth and jobs here in Europe. It will be an agreement which strengthens Europe’s influence in the world, and which would help us protect our strict standards. The European Commission would never even consider an agreement which would lower our standards or limit our governments’ right to regulate. Neither would EU Member States, nor the European Parliament.”

A letter from another Commissioner to my right hon. Friend the Member for Wentworth and Dearne (John Healey), who chairs the all-party group on TTIP, says on the question of ISDS:

“We can already state with confidence that any ISDS provisions in TTIP could have no impact on the UK’s sovereign right to make changes to the NHS.”

I hope that this information clearly demonstrates that there is no reason to fear either for the NHS as it stands today or for changes to the NHS in future as a result of TTIP.

It seems to me that the problem is not with TTIP, but with the Government. Judith Kirton-Darling, Labour MEP for the north-east, has said:

“The European Commission mandate prevents it from including services that are still publicly funded…TTIP must guarantee our full ability to provide any service publicly if the British people choose to do so. The coalition government claim that the NHS is safe but refuse to specifically exclude it from the draft text. That can only lead…to the conclusion that the biggest threat to our NHS is not TTIP but the Tory-led government.”

Finally, let me say that TTIP is something on which we have to negotiate. It was Clem Attlee 70 years ago who got us involved with the general agreement on tariffs and trade because he wanted to regulate the global economy. That was 70 years ago—and we want an opportunity to do exactly the same now.

[Several hon. Members]

rose—

[Madam Deputy Speaker (Mrs Eleanor Laing)]

Order. I am afraid that I must reduce the time limit for Back-Bench speeches to five minutes,

16:09

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

I, too, congratulate the hon. Member for Swansea West (Geraint Davies). I will of course give his motion my full backing.

Eighteen months ago, TTIP was little more than an obscure European Union acronym. Barely a word of caution had been uttered in the House, and barely a headline had been written about the risks that it poses to our democracy. How fast things change when people realise how much is at stake! I have received hundreds of e-mails from residents in my constituency who are concerned about TTIP—and yes, one of the things that concerns them is the national health service. I believe that TTIP and its investor protection provisions still pose an unacceptable threat to the ability of future Governments to, for example, repeal the Health and Social Care Act 2012, and reverse creeping privatisation in the public health sector.

We have heard assurances from the European Union, and from advocates of TTIP on both sides of the House, that such fears are unfounded, but I think it significant that, less than a month ago, the British Medical Association confirmed that it was continuing to lobby against the inclusion of health in TTIP. We are not helped by the fact that the Commission seems to convey a whole set of mixed messages when it talks about the issue. I think that, when that is added to the general secrecy that surrounds all this, we have grounds to be deeply concerned.

However, the case against TTIP, like the concern felt by my constituents, goes far beyond that. It comes down to an issue that many Members have raised today, the issue of the investor state dispute settlement. People are increasingly opposed to an agreement that could fatally undermine democratic law making in relation to food standards, animal welfare and environmental protection. Workers’ rights, consumer protection and education policy are also in the firing line.

Much has come to light about the true nature of the investor state dispute mechanism. Its central purpose is to give private companies new rights to sue Governments, in secret tribunals, for passing laws or regulations in the public interest if that might get in the way of making higher profits. I am not the only person to say that. A rampantly pro-TTIP briefing from a lobby group representing the City—bankers, private equity firms and so forth—is quite illuminating. It emphasises the central importance of so-called investor rights, and makes it clear that TTIP would

“set a precedent for future trade and investment agreements” .

Perhaps most alarming is what it says about how those investor rights should be upheld, namely:

“Some critics have suggested that investors should seek redress through the judicial system of the country where the investment is made before asserting a claim in investor-state arbitration. Such a requirement undermines the very reason why ISDS is included in most investment agreements—to depoliticise the issue in dispute and to provide for a neutral panel to examine whether a host government has breached its treaty obligations.”

Most of us would probably have assumed that our own judicial system, along with those in all the other member states, was designed precisely to guarantee neutrality and freedom from political interference. Why should we need a separate, corporate-only mechanism? No one has explained why it is required. The idea that it somehow depoliticises the issue strikes me as completely wrong. I believe that the aim is actually to remove issues from public scrutiny.

The briefing appears to suggest that the current judicial system with which we all live in our various member states is fine for our constituents—those who can still gain access to it after the cuts in legal aid—but private companies are somehow entitled to something that they should think is better. I find that disregard for the independence of our judiciary incredibly worrying, and there is no justification for it. Pieter de Pous, the policy director of the European Environmental Bureau and a member of the EU’s TTIP advisory group, has said:

“The EU and US have well-developed legal systems which have more than adequately handled foreign direct investment until now. ISDS would only lead to the erosion of laws that deliver public benefits, notably those that protect consumers’ and workers’ rights and the environment.”

I am still waiting to hear from someone, in the Chamber or elsewhere, who can explain why we need a separate corporate-led dispute settlement mechanism. I am glad that it is on hold—and that is not despite but because of huge civil society outrage in the United Kingdom and throughout the European Union. I think that we should be grateful to the campaigners who have helped to put the issue centre stage, and that we should not be complacent until the mechanism has been ditched completely. This week, the results of the European Commission’s public consultation showed that more than 97% of the 150,000 respondents opposed its inclusion in TTIP.

Even if we spent the rest of this so-called zombie Parliament scrutinising TTIP in minute detail, the ISDS would simply not be an acceptable proposition. Fashionable as it is—in some circles—to have a pop at the EU, let us make sure that we point the finger in the right direction. It is the Commission on which we should focus: it should be listening to the public, not dismissing and overruling them.

16:14

[Nia Griffith (Llanelli) (Lab)]

I congratulate my hon. Friend the Member for Swansea West (Geraint Davies) on securing this debate and also on his work in the European Scrutiny Committee whenever we have had the opportunity to meet Foreign Ministers from other EU countries and MEPs. I should stress, however, that TTIP is not being decided by the ESC, and that is one of the big concerns we all have. I am very pro-European, and I think we have done an enormous amount across Europe to raise uniform standards for manufacturers so they are not different in every country but protect the consumer, but this agreement seems to be rushed through with huge secrecy, whereas normally there is significant consultation.

I am certainly not against a trade agreement. Trade is important and we want to make sure that the way forward is through trade, but we must get the balance of power right between big business and democratically elected Governments. That is the key point here, particularly in respect of the ISDS mechanism. It is only through public pressure that we have had this pause for consultation on the mechanism and the report that was produced this week. I am pleased to hear Commissioner Malmström say:

“The consultation clearly shows that there is huge scepticism against the ISDS. We need to have an open and frank discussion about investment protection and ISDS in TTIP with EU governments, with the European Parliament and civil society before launching any policy recommendations in this area.”

We need to make sure that happens.

We must use this opportunity to rethink the whole issue of ISDS. Numerous examples have been given by hon. Members, including the hon. Member for Richmond Park (Zac Goldsmith), who has just left his seat, such as on the issue of forcing the reversal of environmental legislation. We have courts and the US has courts, so there are perfectly legitimate ways in which breaches of contract can be raised. The question is: why do we need the ISDS mechanism at all in this trade agreement?

We in the UK strive to develop high food quality and animal welfare standards and try to have a level playing field across Europe. Recently, UK poultry farmers, who have implemented higher standards for cages for hens here, have raised concerns that some European countries are dragging their feet, thereby distorting the level playing field, but obviously we will get that put right by the EU. Our standards are in many respects higher than those in the US, and the great danger in TTIP is that the standards in the US and the EU might be mutually recognised, so we would have to accept US goods even if they did not meet our standards. That would create an enormous problem for us. It would create a very uneven playing field and the obvious solution for many farmers here would be to want to downgrade standards to meet US standards. It is very unlikely that that would be working the other way round because of the pressure of price.

If anyone thinks this is just some myth we have dreamed up, we should note that the US Agriculture Secretary has said the EU needs to

“rethink its current bans on chlorine-washed chicken and beef from cattle raised with growth hormones.”

So we know there is huge pressure coming from the US to try and drive its standards forward at the expense of our higher standards. The same goes for protecting labour rights. We know there have been some weak outcomes already in trade agreements on workers’ rights abroad, so we have to be very careful.

I am not going to repeat some of the examples already mentioned about the problems with the ISDS, but I want us to make sure that we are not complacent about the NHS. It worries me that Lord Livingston said in September that TTIP would not impact on the NHS so the Government will not push for its exclusion. We want to be absolutely certain about that. It is no good leaving it to some future secret court to decide. We need to be absolutely certain that the NHS is not in any way compromised by TTIP.

The NHS European Office is part of the NHS Confederation. It has tried to be as balanced as it can be, and it says:

“If the final agreement includes ISDS, we would wish to see very strong safeguards built in so that this mechanism cannot be used to frustrate the public policy intentions of elected member state governments.”

It also states:

“There is a need to be vigilant that the TTIP wording does not lower standards for the approval of pharmaceuticals”,

in the same way as we have talked about for food standards.

I urge the Minister to make certain that the UK is fully involved in those negotiations, and that we do not leave any i undotted or t uncrossed, and we make sure that we safeguard our NHS, our food standards and our environmental standards.

16:19

[Jeremy Corbyn (Islington North) (Lab)]

I commend my hon. Friend the Member for Swansea West (Geraint Davies) for securing this debate. It is long overdue, so well done to him for pressing for it. I also want to thank all the campaigning groups that have done so much work on this subject, including War on Want, the Global Justice Movement and the TUC. To the irritation of Conservative Members, I also want to thank 38 Degrees. There is no harm in members of the public e-mailing us. There is no harm in them getting together and asking MPs what they think, what they are doing and, above all, what they intend to do about a particular issue. That is what an interactive democracy is about, and modern technology gives us the opportunity to do these things. We should not be afraid of that; we should welcome it, even if it means replying to 300 or 400 e-mails at a time. That is not complicated, and I am sure that Members will eventually get used to the idea that there is going to be a lot more interaction in the future.

The Government have sent—perhaps only to Conservative Members, I do not know—a very unhelpful document called “Transatlantic Trade and Investment Partnership: separating myth from fact”. It actually raises far more questions than it answers. It states rhetorically that it is being suggested that

“TTIP is being agreed by a European institution which was not democratically elected”.

Its response is:

“The UK Parliament will have an opportunity to scrutinise the final agreement through debates in both Houses.”

However, it goes on to say that the eventual deal will be agreed by the EU Council and the European Parliament—which is of course not the same as a national Parliament—and prays in aid the fact that

“TTIP is also the subject of a House of Lords enquiry and an All-Party Parliamentary Group.”

That is hardly a wholehearted endorsement of the democratic scrutiny of an arrangement that will be crucial to the work and ordinary lives of the people of this country.

What is the objective of TTIP? It is to increase trade between Europe and north America, but that trade is not without a cost. It benefits the companies that undertake it and, yes, that could be beneficial if it means more jobs. But let us look at other trade agreements that claimed in advance that they would offer the same great advantages. An example is the North American Free Trade Agreement between Canada, the United States and Mexico. Severally, companies in those countries were all told that free trade would increase trade and opportunities and help to eliminate poverty. Who have been the losers? Those who have been de-industrialised in what is now, unfortunately, known as the rust belt in the USA; those who have seen their working conditions damaged in Canada; and those working for companies that have been set up in Mexico in a virtual tax haven zone on the border, who are paid disgracefully low wages and have appalling working conditions. Has NAFTA actually benefited any of the people it was claimed it would benefit, or has it in fact enriched those who were already doing very nicely, thank you very much? There are some serious questions to be answered there.

There are seven areas of concern: food, climate change, small businesses, policy making, medicines, jobs, and public services. All of them would be affected by TTIP, and all are examples of areas in which private businesses would become empowered to prosecute Governments if they took decisions that were seen to be damaging to private interests. Do we think that this is a cri de coeur? Well, yes it is. It is a cri de coeur for democracy and for the right of people to elect a Government who can decide what goes on in their country. Let us examine the power of global corporations to attack the Government of South Africa for trying to buy generic anti-retroviral drugs, the Government of Ecuador for trying to protect the environment, or the Government of Argentina when the vulture funds bought up debts and are now penalising the people of that country. There are many other places where similar things are happening.

I conclude by asking why there is secrecy surrounding the negotiations. Is it because there are ante-rooms on either side of the Atlantic stuffed full of highly effective corporate lobbyists doing their best to develop their own interests? Should we not instead be demanding a free trade agreement that narrows the gap between the rich and the poor, that protects the advance of public services such as the national health service, that fundamentally protects food production, and that ensures that the best standards become the universal standards, rather than engaging in a race to the bottom that results in the worst standards becoming the norm on both sides of the Atlantic? I hope that the House will reject TTIP.

16:24

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

In my traditional role as the last Back-Bench speaker, I thank my hon. Friend the Member for Swansea West (Geraint Davies), as others have done, for bringing the subject before us.

These Back-Bench debates enable us to come to a view on a particular matter. It does not look as though there will be a vote today, apart from a shouted vote, in favour of my hon. Friend’s proposal, which aims for some element of democratic involvement in the process. For the record and for my constituents, if there were a vote today with regard to TTIP, I would vote against it. I think the majority of Members would vote against it because it is a pig in a poke. We do not know what it is.

I agree with my right hon. Friend the Member for Warley (Mr Spellar). It is a good job that he is not here, as he would probably have a heart attack hearing that. He described TTIP as the establishment of the biggest institutional trade agreement since we joined the Common Market. That is true. If one considers the scale of this agreement, the population that it covers and the immensity of the world trade that it covers, it is bigger than the Common Market agreement. I cannot understand why we are not going through the same process. When we entered the Common Market, we went through a lengthy process. There were Green Papers and White Papers. There were consultation papers that went to every household, and there was eventually a referendum because we thought it had such significance for the sovereignty of the people of this country.

The TTIP agreement passes over economic sovereignty on a scale that is equivalent to the establishment of the Common Market and the European Union, so I cannot understand why the Government are allowing that to happen without the full involvement of the people. Well, I think I can understand it, because most people have guessed it by now. This is about the corporate capture of policy making in this country and in parts of Europe. The only direct response MPs have had from the Government dates back to last September, when our constituents started contacting us. Eventually we got a letter from the Secretary of State for Business, Innovation and Skills trying to assuage the anxieties expressed to us by our constituents. He went through a series of points.

We need to start having a real debate with our constituents on the points that the Secretary of State made. He argued that there would be immense economic benefits. We heard that today—at least £10 billion of increased trade as a benefit to this country, and a significant number of jobs. The bizarre thing about it is that the work commissioned by the Government and the Centre for Economic Policy Research states that there is a risk of a million jobs being lost in this country overall.

Each point the Secretary of State made is now contested. On small businesses, he argued in his letter that the trade agreement would be good for small business in this country. That is contested by the small business lobby in this country and right across Europe in every sector, particularly agriculture. On deregulation, the Secretary of State tried to allay fears about deregulation and said that there would be a levelling up rather than a levelling down. We heard today from a range of speakers. I commend my hon. Friend the Member for Heywood and Middleton (Liz McInnes) and the hon. Member for Richmond Park (Zac Goldsmith), who went through a series of areas where there is a risk to the standards we have set in this country across the provision of services.

With regard to the NHS being under attack and the assurances that we have been given, the person who said that TTIP would cover the NHS was not on the Opposition Benches. It was the right hon. and learned Member for Rushcliffe (Mr Clarke). He was asked whether the NHS would come within the ambit of the agreement and he confirmed that it would. We have had assurances since then, but the hon. Member for Banff and Buchan (Dr Whiteford) pointed out that if we look at the detail of the paperwork provided to us at last, it demonstrates that there is a series of caveats. That means that the NHS is still at risk.

We come to the main issue at stake, the ISDS process. This is a transfer of power and decision making from democratically elected sovereign bodies to a group of corporate lawyers sitting in private and in secret. This country might not have lost cases, but in countries where this process has operated and where sovereign Governments have made decisions about the provision of public services, the countries have lost out, and it has cost them billions. In some instances, it has impoverished whole countries and whole sectors of a particular industry.

TTIP presents a huge risk. I hope that if we pass the motion today unopposed, the Government will recognise that there needs to be a democratic process in place, not just for this House to scrutinise at each stage, but for the people of this country to be involved in the process. That is why I commend all those who pressurised us to have this debate today.

16:29

[Ian Murray (Edinburgh South) (Lab)]

It is always a great pleasure to follow my hon. Friend the Member for Hayes and Harlington (John McDonnell)—indeed, I always follow him because he always seems to be called last in these debates. I do not know what he has done to upset someone in this House, but I am sure Santa delivered him some presents last month. He rightly pointed out the concerns about TTIP, and the Minister might wish to reflect that my hon. Friend and my right hon. Friend the Member for Warley (Mr Spellar) are agreeing on something, which shows there must be significant problems with the TTIP negotiations. I hope that the Minister realises that people have significant concerns across the House, and those have been expressed today.

I pay tribute to my hon. Friend the Member for Swansea West (Geraint Davies) for bringing this important debate to the House. Everything he said in his opening remarks has been reflected across all the contributions made this afternoon, and I am glad he stated at the end of his contribution that his aspiration was for a gold standard in trade deals to properly regulate trade from the EU and across the Atlantic. That is the way we want this to go, and the proper debate in this House is about ensuring that we can get the information, the scrutiny and the transparency we need to make those proper decisions on behalf of our constituents.

TTIP does command considerable public interest, and I was slightly disappointed that the hon. Member for Worcester (Mr Walker) railed against 38 Degrees. I appreciate that there have been some problems on this issue but, as my hon. Friend the Member for Islington North (Jeremy Corbyn) rightly says, if constituents are e-mailing us with concerns and the information they are getting is inaccurate, that gives us an opportunity. I am glad they e-mailed me in their thousands, because that gives me an opportunity to put the record straight and give them further information.

[Mr Robin Walker]

Let me reassure the hon. Gentleman that I agree with him completely; I am always glad of the opportunity to put the correct facts to my constituents. The problem occurs where a group is misleading its own members, and I do think it is legitimate to raise concerns about that, especially where a Select Committee has been misled on a number of occasions.

[Ian Murray]

I agree with the hon. Gentleman to a certain degree, but as for the way the campaign has been run by a number of organisations, let me say that they are rightly raising concerns. That is a symptom of the transparency and the debate in this House, and the fact that Members have not been given the information that their constituents are seeking. It is incredibly disappointing that this is the third debate we have had in this House but each has been brought by Back-Bench Opposition Members. We really need the Government to debate this properly and in a much more transparent fashion.

The truth is that this place lacks proper ways to hold Ministers to account for what they do or decide in Europe on these trade deals. This is not just a criticism of this place and the Government, because the EU has also had to be persuaded to be more transparent. Although it has improved transparency to a certain extent on TTIP, the EU has an incredibly long way to go to give the public confidence that it is actually responding to their concerns.

[Mark Tami (Alyn and Deeside) (Lab)]

In what has been termed a “zombie Parliament”, the Government can hardly argue that we do not have time to spare to talk about very important issues such as TTIP.

[Ian Murray]

My hon. Friend is absolutely right; we often talk about the zombie Parliament. We seem to have done very little in this House for the past year to 18 months, and we could have used some of that Government time to explore these issues. Perhaps if we had done so, we would not have had some of the misinformation that is perceived to be around, and we would have been able to address some of the concerns of the constituents who have e-mailed us in great numbers. That was rightly emphasised by my hon. Friend the Member for Heywood and Middleton (Liz McInnes), who stressed that a lack of scrutiny and transparency had led to widespread suspicions about TTIP, and those have to be addressed.

The economic impact of TTIP is debated, but it is important to bear it in mind that it will entirely depend on the final scope of the deal. To a certain extent I agree with the hon. Member for Skipton and Ripon (Julian Smith); we have to analyse this on the basis of benefits and we have to make sure that they are actually tangible benefits to our constituents. We know from recent history that balanced trade deals have a positive impact on economic activity and job creation, but people’s concerns mean that we are here to debate them and whether or not those positive impacts are actually real. Until we address those, we cannot get on to what the positive impacts might be—and there should be such impacts, because Europe and the US are our most important markets today.

Indeed, the US is the UK’s biggest export market and TTIP could be transformative, but only if it is allowed to be and only if the deal is good for the UK. It does provide a real opportunity to regulate global trade, and it could benefit the UK. We should not shy away from that, because unregulated trade creates a race to the bottom. Many Members have stated in this debate that it is the race to the bottom that concerns them, and it is this process that is creating that race to the bottom, especially when it comes to standards and the way that the negotiations are perceived to be progressing.

As many Members have mentioned, including my hon. Friend the Member for Sedgefield (Phil Wilson), Labour Governments, going back to the Attlee Administration, have engaged positively in attempting to regulate global trade, making trade agreements to ensure that everyone benefits, and that is an important point to make.

Labour lends its support to the principle of TTIP and trade, but not unqualified support. We should not accept any deal that is not beneficial to the British people, and the benefits from any deal must filter down to consumers and small businesses. That point was made by the Federation of Small Businesses in the submission that it sent to all Members. We are not prepared to accept a deal that does not protect our public services and the NHS, and which does not satisfy the concerns that we have heard this afternoon on safety, food and environmental and labour standards. That was a point that was made quite forcefully by my right hon. Friend the Member for Warley (Mr Spellar). We must have a deal that has transparency and accountability at its heart.

There is widespread interest in these negotiations. Organisations such as Global Justice Now deserve tremendous credit for ensuring that TTIP is in the consciousness of both the public and politicians. It is the topic on which I have received the most correspondence as a Member of Parliament, which shows the thirst that the public has for gaining more information on what this trade deal means for them personally.

What is clear is that this cannot be a backroom trade deal done between Brussels and Washington. In a debate last February, my right hon. Friend the Member for Wentworth and Dearne (John Healey) said:

“Like justice, good trade policy must not only be done but must now be seen to be done.” —[Official Report, 25 February 2014; Vol. 576, c. 189.]

Any legitimate agreement must command broad-based confidence that it will deliver on the benefits that it has claimed.

Pressure from interested politicians and the public through some of the campaigns has led to advancements in the deal. Let me start by mentioning the NHS and public services. We have said all along that unless the NHS and public services are fully protected we cannot and will not support any TTIP deal. It was Labour and my right hon. Friend the Member for Wentworth and Dearne who were the first to insist on full protection for the NHS. With Labour colleagues in the UK and European Parliaments, we have been campaigning hard for this guarantee, and it is that campaigning that has secured the commitment from the EU chief negotiator that the NHS can and will be fully protected. He said that

“full policy space has been reserved for publicly funded health services”

and, further, that any provision will have

“no impact on the UK’s sovereign right to make changes to the NHS.”

However, Labour will not support a deal unless that commitment is totally honoured. It will take a strong UK Government in the EU to ensure that that is delivered, but Government Ministers have done nothing to secure that commitment at EU level. What is clear is that the biggest threat to the NHS and public services in the UK—this has been said by many of my hon. Friends—is not this or any trade agreement, but the re-election of a Conservative Government in May. Of course EU negotiators need the agreement of member state Governments to be able to take these things forward. Will the Minister confirm that the Government will not support any TTIP treaty that includes the NHS and public services? He can give that commitment at the Dispatch Box this afternoon and take the matter off the table.

As my hon. Friend the Member for Edinburgh East (Sheila Gilmore) said, if the Government are so convinced that the NHS and other public services are not to be included in the deal, why do they not take a belt and braces approach and put it into the negative list to give everyone the comfort that they seek? This is important not just for the NHS and public services but because Labour will repeal the Health and Social Care Act 2012 in May 2015 without impediment. The failure to put public services, including the NHS, on the negative list might, as my hon. Friend the Member for Sedgefield said, undermine the assurances we have been given. So it would be very good to get the Minister’s response to that.

The second area that many Members have focused on is ISDS. There is a case for saying that private arbitration mechanisms are best used among partners with uneven levels of protection and where a due process of law cannot be guaranteed, but that is not the case in either the US or the EU, and many Members have said that in those particular advanced jurisdictions, contract law should suffice. There are huge concerns that ISDS would prevent Governments from legislating for the benefit of the country. TTIP must not challenge the ability of this House, and of elected Members, to adopt and implement laws and regulations as we see fit and as we are elected to do.

[Zac Goldsmith]

If the Labour party were given an opportunity and were in charge of these negotiations at any point in the near future, would they insist on the removal of ISDS from TTIP? Is that a red line for them?

[Ian Murray]

We have said clearly that ISDS in its current form is not desirable in this trade deal, and the Government have said they do not think that ISDS will ever be used in the context of an EU-US trade deal, so my question would be, if it will not be used, why have it in that deal? We very much welcome the European Commission’s consultation. We very much welcome yesterday’s announcement that ISDS has been suspended, but we are unconvinced at this stage that ISDS in its current form is either necessary or desirable in the agreement, and we would have to see what its pausing would do.

On the basis of that intervention, my question to the Minister would be: how will he respond to the pausing and suspension of the ISDS negotiations in the trade deal yesterday, and what will the UK Government be doing to express the serious concerns on those issues expressed in the House today?

I shall mention some of the views expressed by my hon. Friends. My hon. Friend the Member for Blaydon (Mr Anderson) emphasised that we want free trade but that it is important to engage to ensure that it is fair and regulated. He was right to talk about the power of trade agreements to drive up standards, and to say that that should be the goal, and that we should not support the dilution of standards. He gave personal examples of where that has happened. I absolutely agree with the hon. Member for Banff and Buchan (Dr Whiteford), who highlighted the potential benefits for the Scottish agricultural industry, but spoke about what the impact would be, in that particular economy, on food standards.

I was slightly confused by the hon. Member for Totnes (Dr Wollaston), who seemed to say that the NHS was completely and utterly secure, but then argued that the tobacco industry should be removed from the deal in case it could use ISDS provisions to sue the UK Government for acting on public health grounds. That was a slightly contradictory response. That highlights the fact that ISDS is a real problem as regards what TTIP is intended to deliver.

As time is running out, I shall pose some questions to the Minister, who may be able to answer them in his reply. What plans do the Government have to ensure that this House is kept fully informed as to the content of those negotiations and the Government’s response to them? Will he keep the public informed and engaged, because it is clear from this afternoon’s debate that the public are not engaged in this process directly by the Government but by other organisations? Will he outline how the business community will stay engaged in this debate and how he will respond to what looks as though it will be the unanimous passing of the motion moved by my hon. Friend from Cardiff West?

[Geraint Davies]

Swansea West.

[Ian Murray]

I am sorry. That is a slip that should never be made in this House, but never mind. Cardiff West is probably the best place to be. I have often been called the Member for Glasgow South, and been very happy to be so.

We need more engagement on TTIP in this House and at EU level, and I hope the Government will respond positively to this debate so that everyone can benefit from a robust and effective treaty, and so that the concerns that were exposed this afternoon can be dealt with properly.

16:44

[The Minister for Business and Enterprise (Matthew Hancock)]

It is a pleasure to respond to this crucial debate on TTIP. We must set the debate in the context of Britain’s great trading history, from the wool trade of the middle ages and the spice routes of the 17th century to the Pax Britannica in Victorian times, which saw the Navy deployed to keep the lanes of trade open around the world. As a nation, we are deeply committed to free and fair exchange, and with remarkably few exceptions that was the consensus in today’s debate. With the abolition of the corn laws by a Conservative Prime Minister, we were the first country in the world to open ourselves up to foreign competition. Peel knew that one tackles the cost of living not by fixing markets but by setting them free, and that is a lesson that holds true today.

[Mark Reckless (Rochester and Strood) (UKIP)]

Is—[Interruption.] Is TTIP really about setting markets free, or is it about having a single regulatory system across the Atlantic whereby people will be forbidden from selling things unless they comply with those regulations?

[Madam Deputy Speaker (Mrs Eleanor Laing)]

Order. Before the Minister replies, if the hon. Gentleman has not been in the Chamber for the debate, and I judge by the mood of the House that that might well be the case, he should think carefully before intervening on the Minister and taking up time.

[Matthew Hancock]

TTIP is about fair and free trade and since 1970 the percentage of people worldwide who live on less than $1 a day has fallen by 80% when adjusted for inflation, not because of public works or central planning but because of the dawn of market liberalism in countries that once embraced state control. That point was made by Members on both sides of the House. Indeed, the hon. Member for Swansea West (Geraint Davies), whom I congratulate on obtaining the debate, set out how TTIP can demonstrate trade liberalisation and, alongside the trans-Pacific trade partnership, or TPP, which is proposed between the US and countries around the Pacific, and the EU-Canada deal, can form the basis of a global free trade area with global standards to which others could aspire. I very much agree with him on that point.

[Geraint Davies]

Does the Minister agree that there is a strong case for a trade relationship with Africa, particularly north Africa, given that a lot of the pressure for migration comes from inequality? We should be sharing the fruits of global trade rather than hoarding it for the rich nations.

[Matthew Hancock]

Yes, I agree wholeheartedly, not just about Africa but about progress on the India trade deal. This raising from grinding poverty of billions of people has come about because they have been able to access the world market economy. That is a vital way of fighting poverty around the world.

[Caroline Lucas]

Will the Minister explain why the Government’s leaflet on “TTIP myths” claims that a family of four would benefit by £400 a year yet makes no mention of the peer-reviewed paper from Tufts university that predicts that over 10 years the average working Briton will be more than £3,000 worse off as a result of the lower wages that TTIP will fuel? Why is that not included in his myths?

[Matthew Hancock]

The conclusion that trade raises wages and prosperity is borne out not only in the theory but in the evidence. The evidence of my lifetime has been that enhancing trade increases prosperity. That has happened in the decades for which I have been on this earth in a greater way than in any other time in history. About £1.5 billion in goods and services is traded between the US and Europe every day and 13 million jobs are linked to that. This ambitious agreement has the target, which it could meet, of adding as much as £10 billion to the UK. What does that figure mean? It is almost meaningless to all but the very largest companies.

This is what it means. Let us picture a small business owner who, five years ago, might nearly have gone under through no fault of his own thanks, in part, to the economic circumstances. Like so many smaller business owners, he did not give up and recently things have got better. The recovery might have delivered for him here, but he might want to expand and take on more staff and he might find people in America who want to be customers. He wants to sell his product to more people, but if margins are tight the prohibitive extra cost of the trade barriers means that that simply is not an option. Now, let us picture a post-TTIP world in which those costs do not exist. We have not only increased the UK’s GDP but managed to ensure that someone can trade, creating an apprenticeship or a job to fulfil those orders, and in America somebody can get a product that they could not get before. That reciprocity—that “something for something”—explains why free and fair exchange makes us all better off.

So how do we make that a reality? First, we must significantly reduce cost differences in regulations by promoting greater compatibility while maintaining high standards of health and safety and environmental protection, especially for cars, pharmaceuticals, food—which was mentioned by Members in all parts of the House—and financial services. Secondly, while tariffs are low on many goods, we must tackle the high remaining tariffs on, for instance, food, clothing and other goods that impede exports and hurt consumers. Thirdly, we must push for better market access for service companies, which make up almost three quarters of the UK economy. Where possible, we will seek a guarantee that our service companies are treated in exactly the same way as US providers and do not face any additional regulatory requirements beyond those that US businesses face. Fourthly, we must have more open and transparent public procurement opportunities. Why, for instance, should US rules require that only US steel is used in certain projects? Fifthly, we will target trade facilitation, removing some of the red tape and bureaucracy at borders, and cut unnecessary costs while speeding up the movement of goods.

This is a historic deal. I want to tackle some of the challenges and objections head on. Several Members raised concerns about regulation. In fact, TTIP provides an opportunity to take stock of existing rules on both sides of the Atlantic and to remove unnecessary duplication while ultimately making sure that we support a well-regulated market. This will be done without lowering environmental, labour or consumer safety standards. Nor will the inclusion of the ISDS provisions affect the ability of Governments to regulate. As many Members mentioned—my hon. Friend the Member for North Dorset (Mr Walter) brought it up first—we already have 90 such agreements in place and there has never been a successful claim brought against the UK.

Others expressed concern about the impact on jobs, yet time and experience show that trade creates jobs and supports higher wages. This is backed up by independent assessment. The overall impact on labour markets will be positive in the EU and the US, as real wages, whether of unskilled or skilled workers, will be able to increase.

[Mark Durkan]

The Minister relies on history in saying that the UK has never lost an ISDS case. With regard to the way in which the ISDS regime will operate under this treaty, whether or not one can be confident that the UK will not lose a case, if a case is lost by another member state, or a firm in another member state, what would be the implications for the UK?

[Matthew Hancock]

If a case is lost in another member state on its domestic regulation, I would not expect that to have any implications for the UK.

As on regulation, so on the NHS, which has been brought up many times. We are quite clear that there is no threat to the NHS from TTIP. Public services and publicly funded health services are not included in any of the EU trade commitments. I will go further and read what the former Trade Commissioner said to the BBC:

“Public services are always exempted—there is no problem about exemption. The argument is abused in your country for political reasons but it has no grounds.”

My hon. Friend the Member for Totnes (Dr Wollaston), the Chair of the Health Committee, gave a very clear enunciation of the exemption of the NHS set out by not only the EU but the US side in these negotiations. I would say this to anybody who continues to campaign against the inclusion of the NHS in TTIP: you have already achieved your aim, and continuing to campaign is continuing actively to mislead, because public services and publicly funded health services are not included in this negotiation.

[Bob Stewart (Beckenham) (Con)]

May I clarify one thing? It is probably not as important as the whole thrust of this debate, but when I was badly hurt in the Army and the NHS took responsibility for helping me get better, we used an American system to put me back on my feet. I hope, and assume, that use of American techniques and systems by the NHS is still allowed.

[Matthew Hancock]

Of course that will be allowed, but the point is that we would still have control over our public health policy. I can give that reassurance, which was sought by the hon. Member for Edinburgh South (Ian Murray) on the Labour Front Bench, so I hope he will now remove that objection. I do not want to conclude that some Opposition Members do not want to be reassured, but increasingly that is the only view I can reasonably come to.

[Ian Murray]

That was not the question I posed to the Minister. The question I asked was: if there is any threat whatsoever to the NHS and the UK’s wider public services, will the Minister and the Government sign a TTIP trade deal?

[Matthew Hancock]

The Health Secretary has already made it clear that if a trade deal threatened the NHS, he would not support it. However, as the former Trade Commissioner has said:

“Public services are always exempted”.

I am glad that we can finally put that issue to bed. I doubt that Labour Front Benchers will raise it again, because they now know that they would be misleading the nation if they did so.

[Geraint Davies]

Would the Minister sign a deal without ISDS? Does he think that ISDS is a necessary part of TTIP?

[Matthew Hancock]

The reason for the inclusion of ISDS is to make sure that people who want to make investments have the confidence do so because they know that recourse is available.

In the couple of minutes remaining, I want to address the issue of scrutiny. As my hon. Friend the Member for Skipton and Ripon (Julian Smith) has said, there has been huge scrutiny and engagement, including four debates in both Houses; four Select Committee inquiries; regular updates to the Chair of the European Scrutiny Committee and the chair of the all-party group on TTIP, the right hon. Member for Wentworth and Dearne (John Healey); regular stakeholder meetings; endless piles of letters that I and the Minister for Trade and Investment have signed; constant consultation with the European Parliament; four online public consultations by the Commission; and we even have a TTIP roadshow.

Let no one be in any doubt: enormous consultation is taking place both inside and outside this House. The commissioners have come to this Palace. Last week, 150 pages of text, eight proposals for legal text and 15 position papers were published. Following the passage of this motion, we will ensure that I and other Ministers continue to engage with this House.

Let us once more assume our historic role as the pioneers of free trade, not only for the sake of the British people, but for the sake of all people around the world for whom liberty and prosperity go hand in hand.

16:57

[Geraint Davies]

I briefly thank Members for the massive attendance at this very important debate. We have heard a series of excellent speeches focusing on the benefits of trade, particularly if it is done on the right terms. On ISDS, however, no argument has been made as to why it is a good idea, other than that it has not been used against us, which sounds like the argument that there should be no gun control because we have not been shot.

This has been an informative debate and we should now unite as one to demand more scrutiny and to determine a future without multinationals breathing down our necks while we make democratic decisions on behalf of our constituents. Yes, we should trade, but we should not trade our democracy, public services or the rights that we have enjoyed and should bequeath to our sons and daughters across Europe. We want more trade, which is good for everyone as long as it is done on the right terms. We are elected here by our constituents to ensure that fair trade is delivered in the future.

Question put and agreed to.

Resolved,

That this House believes that the Transatlantic Trade and Investment Partnership and any associated investor-state dispute settlement provisions should be subject to scrutiny in the European Parliament and the UK Parliament.

Sale of Land at Parklands School in Swansea

Thursday 15th January 2015 Commons Chamber

16:59

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

I rise to present a petition opposing the sale of land at Parklands school in Sketty, Swansea, following a similar petition of 254 local petitioners.

The petition states:

The Petitioners therefore request that the House of Commons urges the Government to encourage the City and County of Swansea Council to reconsider plans to sell the land at Parklands School in Sketty.

Following is the full text of the petition:

[The Petition of residents of the UK,

Declares that there are plans to sell land at Parklands School in Sketty, Swansea; further that Parklands School is oversubscribed and faces increasing demand; further that it is the only school land sale that proposes to dissect a school site; further that the proposal under-estimates the school roll as consisting of 420 pupil places when it is currently 480 plus nursery places; further that the planned sale would disproportionately affect pupils with disabilities; further that the proposal has not yet been consulted upon; and further that a local petition on this matter has been signed by 2054 residents of the Swansea West constituency.

The Petitioners therefore request that the House of Commons urges the Government to encourage the City and County of Swansea Council to reconsider plans to sell the land at Parklands School in Sketty.

And the Petitioners remain, etc.][P001422]

Pancreatic Cancer

Thursday 15th January 2015 Commons Chamber

Motion made, and Question proposed, That this House do now adjourn—(Mark Lancaster.)

17:00

[Nic Dakin (Scunthorpe) (Lab)]

There have been several parliamentary debates on pancreatic cancer over the past year, not least the one in Westminster Hall in September in response to the e-petition launched by my constituent, Maggie Watts, which gained more than 100,000 signatures. The petition called for more to be done to improve public awareness and early diagnosis of, and increased research into, pancreatic cancer. It was a positive, constructive debate, with many Members from across the House showing their passion and commitment to upping our game on tackling pancreatic cancer.

The Minister and hon. Members in the Chamber are well aware of the issues, but it is important to put on the record again the seriousness of this disease. Pancreatic cancer is the fifth largest cause of cancer deaths in the UK today, and is set to overtake breast cancer as the fourth biggest cancer killer by 2030. Some 8,800 people are diagnosed with the disease each year, and 8,700 people die from it each year. Five-year survival rates are less than 4%—the worst rate for any of the 21 most common cancers—and have barely changed during the past 40 years. While mortality rates have fallen for most forms of cancer, sadly, those for pancreatic cancer are rising. That is largely due to late diagnosis, with half of all diagnoses made via emergency admissions, which means that less than 20% of patients are diagnosed at a stage when curative surgery remains an option.

Thankfully, these days a majority of cancer patients survive for 10 years. Sadly, that is not the case for pancreatic cancer patients, of whom fewer than 1% survive 10 years. That is why future medical support for pancreatic cancer—greater awareness, early diagnosis, new treatments and faster access to treatments—is so important.

The debate this week is fortuitous as it follows Monday’s announcement that the cancer drugs fund has removed 25 drugs from its approved list. As the Minister will know, there was real anxiety about the pancreatic cancer drug Abraxane being removed. That drug has been shown to extend patients’ lives by an average of about two months, and in some cases by significantly more. It is routinely used around the world as a basic standard of care for pancreatic cancer patients. If it is removed from the CDF, there is a real danger that English patients will be hugely disadvantaged. It was positive news that Abraxane has not been removed from the CDF list.

However, from reading the small print of the CDF decision, it appears that the drug is still under threat of removal. The CDF panel has merely granted a stay of execution while more evidence on Abraxane is gathered. Do not get me wrong: the extra time is welcome—I hope, once more evidence has been provided, that the CDF panel will agree to keep Abraxane for the longer term—but at the moment we are in a state of limbo.

Will the Minister clarify just how much time will be allowed for the drug manufacturer to provide additional evidence to the CDF panel? What specifically needs to be provided for a positive decision? Importantly, will clinicians dealing with pancreatic cancer day to day and patient organisations be allowed to feed into the process and submit their observable evidence to the CDF? I hope that the Minister will agree that an appropriate period should be allowed for sufficient evidence to be collated, presented and analysed. Ideally, gathering evidence over a period from clinicians, using the drug at the coal face, would be the best way to trial commissioning through evaluation. Does the Minister support that approach?

The truth is that the CDF’s decision not immediately to delist Abraxane on Monday is more important than ever because over the Christmas break NICE announced that it would not fund Abraxane routinely on the NHS. Consequently, if Abraxane were no longer on the CDF list, patients in England would not be able to access the drug for free. Its place on the CDF list is now, literally, the last lifeline for some patients.

NICE rejected the drug on cost grounds, yet it costs only £8,000 per patient—much less than some other specialist drugs, which run to tens of thousands of pounds. The issue is the way that NICE calculates cost benefit through its system of quality adjusted life years, which in reality works against cancer drugs, especially for those cancers with poor prognoses such as pancreatic cancer. In this instance I understand that the drug was not even assessed or considered under NICE’s less prescriptive end-of-life criteria. That seems rather strange when the disease we are talking about has the worst survival rate of any common cancer, with the average survival time for metastatic pancreatic cancer patients just two to six months.

Questions have been raised about the effectiveness of the NICE drug appraisal system, with 60% of cancer drugs rejected by NICE in 2012—an increase on figures for 2010. Despite the excellent work that NICE and the CDF have done, there is a strong argument for reform, and I know that a number of models have been considered in the last few years. I urge the Minister to bring together NICE, the CDF, the NHS, charities, the industry, and others to thrash out as soon as possible a new, workable drug appraisal model that everybody has confidence in.

Important as they are in extending life, chemotherapy drugs are not the be-all and end-all. In fact, for pancreatic cancer survival rates to increase substantially we need earlier diagnosis of the disease, and new types of treatment made available to patients as a matter of priority. Will the Minister prioritise a public awareness campaign? Campaigners such as my constituent, Maggie Watts, and fantastic pancreatic cancer charities such as Pancreatic Cancer Action and Pancreatic Cancer UK would, I am sure, be keen to work with the Department, and others, to promote a public awareness campaign that leads to earlier diagnosis.

Some of the trial measures for early diagnosis announced by NHS England last weekend, including direct GP access to CT scans, direct patient referral to specialists, and multi-disciplinary diagnostic centres, are welcome. Measures that are designed to speed referral pathways and stop patients being “ping-ponged” backwards and forwards between GPs and different specialists were raised in the Westminster Hall e-petition debate.

Self-referral may end the tragic cases of patients who get so fed up with being ignored by their GP or hospital that they end up paying for a private scan to confirm one way or another whether they have cancer, and I am optimistic that progress can be made. Perhaps the Minister can provide us with more details about the trials, which I know are being implemented jointly with Cancer Research UK and Macmillan Cancer Support. How many trial areas will be selected? Where will they be? How can patients take part? Perhaps importantly for this debate, will access to tests for pancreatic cancer, such as CT scans, be included in the pilots?

One issue raised in the September debate was the need to prioritise promising new technologies for treating cancers of unmet need—such as pancreatic cancer—as soon as possible. It was welcome when the Minister said in response to that debate that a new NHS England and Cancer Research UK trial into stereotactic ablative radiotherapy—treatments such as CyberKnife—would include pancreatic cancer. That, and other treatments such as NanoKnife, can precisely target tumours, potentially making them very important in the fight against pancreatic cancer where the location of the tumour sometimes makes curative surgery impossible—for instance, when the tumour has grown very close to an artery. Those new technologies could therefore help to reduce the size of the tumour on so-called borderline resectable patients, subsequently making them eligible for full curative surgery. The confirmation over the weekend that NHS England will be carrying out the SABR trial is most welcome. Will the Minister confirm that the trial will include pancreatic cancer? Will she confirm how many patients will be recruited and which centres will carry out the trial? When will it start recruiting?

One of the ways we might gain more rapid data on the efficacy of technologies such as CyberKnife and NanoKnife and benefit patients at the same time is through the commissioning through evaluation programme. The Minister will be aware that the all-party group on pancreatic cancer produced a report in October that made a number of recommendations about how to boost research into pancreatic cancer. I am grateful to the Minister for copying me in to her response to the hon. Member for Lancaster and Fleetwood (Eric Ollerenshaw), who is in his place. He has done an outstanding job of chairing the all-party group and raising issues both in this House and outside relating to this difficult matter. One recommendation suggested including both NanoKnife and CyberKnife in the NHS England commissioning through evaluation programme as a matter of priority. Will the Minister update us on the current funding status for commissioning through evaluation? What consideration will be given to the all-party group’s recommendation to include those technologies in the scheme as a priority?

On a similar subject, and referring to another recommendation from the recent all-party group’s research report, the Minister will know that Genomics England is funding a huge project to sequence the genomes of people with rare diseases and cancer. As things stand, I believe only six types of cancer are included in that project and that pancreatic cancer is not one of them. I therefore ask the Minister to include pancreatic cancer as a priority area as part of that project. Failing that, will she confirm that, under their service specifications with Genomics England, individual centres have the flexibility to add to the types of disease from which they collect and sequence samples? If individual centres were agreeable, they could themselves decide to add pancreatic cancer to their work areas above and beyond the six cancer types agreed nationally.

I note that a new independent cancer taskforce has been established to produce a new national cancer strategy for the next five years. That is truly welcome news. I understand it will look at areas such as early diagnosis, access to treatment, improvements to care, and, vitally, research and innovation. As part of that development, will the Minister consider making sure that the new strategy has a particular focus on prioritising cancers of unmet need? If we are to make real inroads into improving overall cancer survival rates, we must prioritise building research and innovation to better tackle the most difficult-to-treat cancers—those with the lowest survival rates such as lung cancer, brain tumours, oesophageal cancer and, of course, pancreatic cancer.

In conclusion, hopefully in the coming months we will receive confirmation that Abraxane stays on the cancer drugs fund list for the longer term. This is a short-term, but important, step. I hope we will see new treatments, such as CyberKnife and NanoKnife, made quickly available to pancreatic cancer patients, perhaps through the commissioning through evaluation process. I hope clinical trials and research projects, such as the Genomics England project, will prioritise pancreatic cancer for research, and that a new national cancer strategy might prioritise research and innovation into tackling the cancers with the worst survival outcomes. Lastly, I hope the Government will work with all interested parties to introduce a public awareness campaign to maximise early presentation, followed by early diagnosis, leading to earlier action and transforming outcomes for patients with pancreatic cancer.

17:14

[Eric Ollerenshaw (Lancaster and Fleetwood) (Con)]

I am grateful for the opportunity to speak in this Adjournment debate and to my friend the hon. Member for Scunthorpe (Nic Dakin), the deputy chair of the all-party group, for his constant work. He introduced the Westminster Hall debate and it seems that we merry three—the Minister, the hon. Member for Scunthorpe and myself—meet frequently in these debates. But we make no excuses for that.

With the permission of the hon. Member for Scunthorpe, I will let the Minister into a secret; we deliberately went for this debate not knowing the outcome of the cancer drugs fund decision. We must thank everyone involved in the decision to keep Abraxane. Those include the people who signed the petition, and my hon. Friends the Members for Romford (Andrew Rosindell) and for Milton Keynes South (Iain Stewart), the right hon. Member for Hazel Grove (Sir Andrew Stunell) and my hon. Friend the Member for Mid Derbyshire (Pauline Latham), who accompanied me to No. 10 to hand in the petition. I thank also Pancreatic Cancer UK, Pancreatic Cancer Action—as mentioned by the hon. Member for Scunthorpe—Pancreatic Research UK and Maggie Blanks. I thank everybody who put so much effort into this. But as the hon. Gentleman said, it is temporary and we expect something more.

Reference has been made to the period of two months but in terms of the average, that could double the survival rates of most people with pancreatic cancer. I will not repeat the figures but, on average, 24 people today will be diagnosed with pancreatic cancer. Of those 24, 23 will die within a year. That is the situation.

I also thank the Minister and, as the hon. Member for Scunthorpe mentioned—he seemed to mention everything—there is the five-year action plan. We talked about unmet need and the Americans have talked about recalcitrant cancer strategy, but I add my support to the hon. Gentleman that that becomes part of the responsibilities of the taskforce.

I welcome the announcement last month by NHS England that one-year survival rates from cancer would become a measurement for the new clinical commissioning groups from 2015. I believe that that will make a huge difference; not just with pancreatic cancer but with every cancer. Given that that is the only disease that will be measured in those terms, I thank the Minister and her colleagues for getting that through. I also commend the work of the all-party group on cancer led by my hon. Friend the Member for Basildon and Billericay (Mr Baron), which has worked constantly on early diagnosis. That will be a fundamental key in the revolution that is happening in cancer, and we would like to see it happen for pancreatic cancer.

I also thank the Minister for her detailed reply to the all-party group’s report on pancreatic research, “A Roadmap to Change.” We are grateful for that and the group will try to come back on it. But I have one last request; when I met the Minister, we were promised that the chief medical officer would at some point come to the all-party group and discuss the findings. I would be grateful if she used her good offices to ensure that that happens.

17:18

[The Parliamentary Under-Secretary of State for Health (Jane Ellison)]

I return to the Dispatch Box very rapidly after the debate earlier this afternoon, and on an important topic; one of the most important in my portfolio. I congratulate once again the hon. Member for Scunthorpe (Nic Dakin) on securing the debate. As ever, he is ably assisted by my hon. Friend the Member for Lancaster and Fleetwood (Eric Ollerenshaw). They and their colleagues in the all-party group have achieved much in this Parliament in highlighting the needs associated with this dreadful disease and in raising awareness of it.

I have said many times before at the Dispatch Box that improving cancer outcomes is a major priority for the Government and as the annual report on our cancer outcomes strategy in December showed, we are on track to save an extra 12,000 lives by 2015. Sadly too few of them are those suffering from pancreatic cancer, so while we want to see the best possible results for all cancer patients, I appreciate—as we have discussed before—that outcomes are particularly poor for patients with pancreatic cancer. We need to do a lot better.

I was delighted that on Sunday 11 January NHS England announced a new independent cancer task force to develop a five-year action plan for cancer services that will build on the existing work to improve survival rates and save thousands more lives. The taskforce has been set up to produce a new cross-system, national cancer strategy to take us through the next five years to 2020, building on NHS England’s vision for improving outcomes as set out in the NHS five-year forward view. The taskforce will be set up in partnership with the cancer charities and the health system leaders, and chaired by Dr Harpal Kumar, the chief executive of Cancer Research UK. The all-party group might like to consider how it, too, can participate in, and contribute to, the taskforce.

The new strategy will set a clear direction covering the following areas: prevention; early and faster diagnosis; better treatment and care for all; recovery, re-ablement and living with and beyond cancer; research and innovation; end-of-life care; data and metrics; and work force. The taskforce will produce a statement of intent by March this year, with the new strategy published in the summer.

Tackling late diagnosis is, as we have often said, a very important element in achieving our ambition to improve all cancer outcomes. As the hon. Member for Scunthorpe said, however, there is currently no easy way of detecting pancreatic cancer and it can be particularly difficult for GPs to detect and diagnose, especially in its early stages. Symptoms can be complicated by the fact that they are shared with a wide range of benign conditions.

My ears pricked up when, as part of the taskforce announcement last weekend, NHS England launched a major early diagnosis programme, working with Cancer Research UK and Macmillan Cancer Support, to test new approaches to identifying cancer more quickly. These include offering patients the option to self-refer for diagnostic tests, as the hon. Gentleman said; lowering the threshold for GP referrals; creating a diagnostic pathway for vague symptoms like tiredness, which is particularly important for hard-to-spot cancers such as pancreatic cancer; and setting up multidisciplinary diagnostic centres so patients can have several tests done on the same day at the same place—not the ping-ponging around, which can be so debilitating for someone already feeling very poorly. NHS England’s aim is to evaluate these innovative initiatives across more than 60 centres around England, collecting evidence on approaches with a view to implementation from 2016-17.

Turning to the awareness campaign, we have debated the possibility of pancreatic cancer being part of the “Be Clear on Cancer” campaign set before. Since 2010-11, the Department has undertaken a series of local, regional and national campaigns. Public Health England now leads on this work with the Department, NHS England, charities and relevant stakeholder groups.

It has always been difficult to give a positive response with regard to pancreatic cancer to date, because the focus has so far been on those cancers with the largest number of avoidable deaths. As colleagues know, these campaigns are under constant review, and we work with the relevant experts to see what more can be done. All the time, there are small trials going on to see where we can tackle other cancers. Pancreatic is obviously one that experts will keep under review.

The group that makes decisions about the campaigns, the public awareness and primary care steering group, chaired by our national cancer director, Sean Duffy, has considered pancreatic cancer for a possible campaign. To date, it has been unable to recommend it owing to the problems we mentioned about symptoms, but members would be very happy to look at it again if there were new evidence. I sense from all the things going on—particularly some recent announcements—that that point might not be too far in the future.

[Nic Dakin]

I thank the Minister for everything she has said to date. On the issue of a public awareness campaign on pancreatic cancer, is there a way in which those with pancreatic cancers could engage with that body to see if there is a way forward?

[Jane Ellison]

If I recall my diary correctly, I have a meeting with Sean Duffy coming up, and I would be happy to raise that issue with him, along with any other points arising from this debate. It will certainly be on my agenda for discussions with him. I have touched on the matter briefly with him before, but I will pick it up again.

The problems with late diagnosis have been explored before, and it is critical that we get people the most appropriate treatment early. We have discussed radiotherapy before. It can be a very helpful treatment for some patients. As part of its recent announcement, NHS England committed a further £15 million over three years to evaluate and treat patients with a modern, more precise type of radiotherapy— stereotactic ablative radiotherapy or SABR, as the hon. Gentleman mentioned. That evaluation programme will mean a significant increase in the number of cancer patients eligible to access this treatment by around 750 a year, and the programme will widen the number of cancers being treated by SABR, including cancer that has spread to another part of the body.

The new investment is in addition to NHS England’s pledge to provide up to £6 million over the next five years to cover NHS treatment costs of SABR clinical trials, most of which are being led by Cancer Research UK and one of which—as the hon. Gentleman knows from our debate last September—relates to pancreatic cancer. As for the hon. Gentleman’s suggestion regarding commissioning through evaluation, I shall raise it with NHS England. I am afraid that we do not yet know which centres or how many patients will take part in the trials to assess the effectiveness of SABR in comparison with conventional radiotherapy or surgery, but I understand that we are likely to have that information in the coming weeks. I will certainly make the decision-makers involved aware of the debate, and of the interest in the outcome of their deliberations.

NHS England’s chemotherapy clinical reference group has set out service specifications defining what NHS England expects to be in place to enable providers to offer evidence-based, safe and effective chemotherapy services. NICE has issued technology appraisal guidance which recommends Gemzar as an option for treating patients with advanced or metastatic adenocarcinoma of the pancreas who meet certain clinical criteria. NICE is also appraising a number of new drugs for pancreatic cancer. NHS commissioners are legally required to fund treatments recommended by NICE in its technology appraisal guidance.

Understandably, the cancer drugs fund has been mentioned this evening. The Government’s reasons for establishing the fund are well documented. At the end of August 2014 it received an additional £160 million, and I welcome the announcement on 12 January by NHS England, which is now responsible for the fund’s operational management, that it too would provide extra money. The CDF panel has decided that further consideration of Abraxane for the treatment of pancreatic cancer is needed, and it will remain on the national CDF list until that has been concluded. I am not yet sure about the timings, but I will undertake to update the all-party group, including the hon. Members for Scunthorpe and my hon. Friend the Member for Lancaster and Fleetwood, in due course.

Let me now say something about NICE appraisals. Representatives of the Department, NICE, 10 key cancer charities and the pharmaceutical industry met in December to discuss the future of cancer drugs commissioning. They committed themselves to establishing a working group to develop a robust process to support the sustainable, long-term commissioning of cancer drugs. The group will meet for the first time, opportunely, on Monday 19 January.

I am glad that the hon. Member for Scunthorpe found the letter about research useful. He and I, along with my hon. Friend the Member for Lancaster and Fleetwood, had a very good meeting with the chief medical officer, and we have followed that up with a response to the all-party group’s excellent report, which was published last October. At our meeting, the chief medical officer said that she would be happy to attend a meeting of the all-party group. I will remind her of that, but I suggest that the hon. Gentleman and my hon. Friend get in touch with her. We would respond positively to that.

The Government are investing a record £800 million over the five years to 2017 in a series of biomedical research centres and units, including £6.5 million of funding for the Liverpool pancreas biomedical research unit. The unit is working in partnership with industry and leading research institutions to develop new treatments and diagnostic strategies for pancreatic cancer. The National Cancer Research Institute brings together clinicians, scientists, statisticians and lay representatives. Its upper gastro-intestinal cancer clinical studies group has a pancreas sub-group, which plays a vital role in the development of trials.

Late in 2012, the Prime Minister launched the 100,000 genomes project, which will sequence 100,000 whole genomes from NHS patients by 2017. It focuses on patients with rare diseases and their families, as well as on patients with some types of cancer. We believe that the six cancers that will be covered will give us knowledge and understanding that can be applied to all cancers. Although pancreatic cancer is not one of the six, we expect the project to make a useful contribution in that regard.

I thank both Members who have spoken this evening, I thank the all-party group, and I thank all those who campaign tirelessly for progress on pancreatic cancer. We know that achieving improved outcomes for people with the disease is a huge challenge, but I believe that the change that we all desperately want to see will come. I welcome the new cancer taskforce, which will be leading the way, and I undertake to write to its independent chairman, drawing his attention to this evening’s important debate and the work of the all-party group.

Question put and agreed to.

17:29

House adjourned.

Westminster Hall

Thursday 15th January 2015 Westminster Hall

Thursday 15 January 2015

[Sir David Amess in the Chair]

Backbench Business

Thursday 15th January 2015 Westminster Hall

NHS Specialised Services

Thursday 15th January 2015 Westminster Hall

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

[Sir David Amess (in the Chair)]

Our subject for debate is the national commissioning of NHS specialised services. There is clearly great interest in the debate and I am sure colleagues can work out how much time is at our disposal. Obviously, I want to call everyone who would like to speak.

13:30

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

It is a pleasure to open this debate and to serve under your chairmanship, Sir David. May I be one of the first to congratulate you on your recent knighthood? “Sir David Amess” looks very good on the name plate. I welcome the many hon. and right hon. Members who have made the time today to come and discuss this important issue. I know that there are many Members who would have been here today, but have other commitments, including my hon. Friend the Member for Meon Valley (George Hollingbery) and my right hon. Friend the Member for North West Hampshire (Sir George Young). They have both contacted me about particular cases and share the general concerns that we will be expressing this afternoon, and I am sure they are not the only ones.

I want to speak up for patients and reflect the concerns of those with rare and complex conditions, whose voice is often not heard. There are two principal issues here: concern over changes to commissioning arrangements for specialised health care and whether it is right that morbid obesity and renal dialysis are no longer considered to be specialised services. The debate comes at a vital time. We are in the middle of a six-month period during which NHS England is developing plans to change radically the way specialised services are planned and funded. NHS England is doing that with remarkable secrecy, militating against external scrutiny. Today is an opportunity to discuss what we know and to test its fitness for purpose.

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

I have to declare an interest as someone with a rare condition. Although I live in Scotland, I benefit from a specialised service delivered by NHS England in Cambridge. Does the hon. Gentleman agree that the importance of specialised services means that they should be managed nationally so that they are not competing against local priorities? That is particularly important for cross-border matters. National management builds expertise—few people know a great deal about my condition—and ensures that there are national standards across the whole of the United Kingdom, and not just in one part.

[Stephen Gilbert]

The hon. Lady is absolutely right. It is a testament to the value of the House being made up of people from all walks of life and with different experiences that she can bring personal experience to the debate. She underlines many of the points that I will go on to make.

I will reflect the views of patient groups and seek a number of reassurances from the Minister, but first let us define specialised services. They can often be thought of as relatively niche or peripheral and of interest only to those with genetic conditions. Those conditions are of course important, but specialised services extend far beyond that and are relevant to everyone. Collectively, tens of thousands of people call upon specialised services for such things as HIV, cystic fibrosis, multiple sclerosis, muscular dystrophy, epilepsy, haemophilia, leukaemia and other cancers, renal dialysis and hepatitis C, among many other conditions. Indeed, any one of us could have need of specialised services for spinal injury, severe burns or brain injury. It is therefore not simply the rarity of the condition that defines specialised services, although they do serve the smallest patient populations too, but the considerable specialist expertise and cost needed to deliver high-quality services, strategically planned and procured across the country.

Specialised services are a major component of the NHS. Their collective budget for 2015-16 is £14.6 billion, which represents more than 14% of the total NHS budget. Specialised services include some of the most advanced technologies and procedures and play a crucial role in fostering innovation across the NHS with clinical expertise to match. Most importantly, many of the most vulnerable patients rely upon specialised services and would face a life of unmitigated disability and often shortened duration if those services were not procured in a proper way. In short, specialised services help patients and their families in their greatest need and are crucial in keeping the NHS as the world-class service we all want it to be.

As a result, specialised services individually and collectively need careful planning. We are reminded by NHS England to

“think like a patient and act like a taxpayer”,

and with both hats on it makes most sense to ensure that specialised services are planned and managed at the most efficient level, with the requisite expertise and as little duplication of effort as possible. For those reasons, the Health and Social Care Act 2012 introduced significant reforms to the commissioning process—the planning and funding of specialised services. Those particular changes met with unique cross-party support, as well as enthusiastic endorsement from patient groups.

In summary, the commissioning of specialised services was centralised at a national level as a direct responsibility of NHS England. The Government’s impact statement on the 2012 Act said that that was intended to

“reduce management costs and deliver improved outcomes through…streamlining decision-making, funding, planning and commissioning...greater consistency and reducing unacceptable and inequitable access...pooling…expertise, reducing administration costs and a tier of bureaucracy; and enabling consistent approach to service specifications to contain costs and get best value for money”.

That is exactly the point that the hon. Lady made on national standards and having consistent patient experiences across the country.

NHS England was duly established in April 2013, and by the following March it had begun to deliver the Government’s intentions. An NHS England report in March 2014 on hospital compliance with national standards, which sadly is unpublished, said:

“The development of this set of new national specifications and policies, for our services, is a significant achievement given that there was limited national consistency prior to the establishment of NHS England...The development of this set of new national standards and policies is only the beginning of what will be a continuous drive for improvement across all of the services NHS England commissions.”

There was, therefore, a clear picture of how specialised commissioning was developing up to the first half of last year. National funding offered the chance to make improvements across the board, albeit with a recognition that the new system would need some time to bed in and deliver progress in all parts of the country.

We need to talk about what has changed and what the threat is. Since May 2014, NHS England has engaged in a wholesale internal review of its specialised commissioning function. A major driver of that was a deficit in the specialised budget, due primarily to a widely predicted underestimate of what had been spent on specialised services prior to April 2013 and an overspend on the cancer drugs fund. The first of those issues was rectified in December 2014, when the deficit was eliminated by an increase in the baseline budget for specialised commissioning for 2015-16.

That was a welcome development, but what was less welcome were the results of that earlier review and the plans being taken forward by NHS England at the highest level. No commissioning model is perfect and there are benefits and disbenefits to each, but in separating out specialised from non-specialised commissioning, the 2012 Act prioritised excellence in commissioning over a unified commissioning function. In other words, each service was allocated to the commissioning level most competent in meeting the requirements. For example, routine respiratory problems are dealt with by local clinical commissioning groups, but complex and expensive respiratory disorders are planned and managed nationally on behalf of all patients in England.

Asking local commissioners to plan and procure the complex facilities required for rare disorders has been unsuccessful in the past. The high cost of the services and the unpredictability of demand for them can be financially destabilising to local commissioners. It makes no sense for local commissioners in Cornwall or Norfolk to retain expertise in so many fields when they may have few or no patients requiring them. Local commissioners are then at a clear disadvantage in dealing with the large tertiary trusts that possess that expertise and are sighted on their entire customer base across the country.

All that is not to deny that NHS England and local commissioners need to work collaboratively. Indeed, patient groups and others have long called for NHS England to work more closely with local commissioners as it commissions specialised health care. In developing proposals to co-commission specialised services with local clinical commissioning groups, NHS England is going far beyond mere collaboration.

[Mr Russell Brown (Dumfries and Galloway) (Lab)]

The hon. Gentleman and my hon. Friend the Member for Aberdeen South (Dame Anne Begg) have spoken about consistent service delivery. Does he see co-commissioning as something of a problem in delivering that?

[Stephen Gilbert]

There is a huge danger that we will move away from the improved patient experience that we have seen during the past year while national commissioning has been in place for specialised services towards more of a patchwork quilt approach in which patients may not get the same care in different parts of the country or the same pathways to care.

[Dame Anne Begg]

A number of rare diseases are genetic and, therefore, they often come in pockets, which means that some local health commissioners may face a heavy burden while others face none. The beauty of the specialist commissioning is that the cost is spread across the whole country, rather than falling on individual commissioning bodies.

[Stephen Gilbert]

The hon. Lady is entirely right. I will continue to set out the case that she so powerfully makes from personal experience.

In a board paper last November, NHS England published its next steps on specialised commissioning. Frankly, that was to the dismay of patient organisations, some of whom have been involved with specialised services for more than a decade, yet none was contacted or engaged with about the paper’s contents. It set out several principles for co-commissioning, perhaps the most alarming of which was the intention to move towards population accountability and lay the groundwork for place-based population budgets. That would essentially represent a return to the status quo ante under primary care trusts and, therefore, contravene Parliament’s wishes as embodied in the Health and Social Care Act 2012.

In particular, budgets allocated to local populations will usher in that patchwork quilt of provision for patients throughout England that hon. Members have referred to, with varying standards of care to match. NHS England suggests that its national standards would continue to apply, but experience shows that that would be untenable. The history of the PCTs is likely to be repeated, with the clinical commissioning groups going their own ways.

Despite opposition from key stakeholders, which I will touch on shortly, NHS England seems determined to implement its proposals. In December it took the unprecedented step of publishing notional local allocations of its own specialised commissioning budget. The sums have already been done and NHS England is now showing local CCGs the sheer scale of the budget that it expects to make accessible to them. Remarkably, only £1 billion of the £14.6 billion of allocated expenditure for 2015-16 is exclusively for national commissioning. Therefore, more than £13 billion of services that are currently commissioned nationally will be subject to co-commissioning. That is a huge transfer of resources and responsibility in the making, which surely requires prior, not retrospective, parliamentary and public scrutiny. Remember: that is funding for complex heart surgery, teenage cancers and chronic liver and blood diseases that affect some of the most vulnerable people in our community.

Why is this move so risky? First, we can say with certainty that local commissioning of such services does not work. As I alluded to already, before April 2013 responsibility for those services was with local commissioners. The 2006 Carter report brought about significant improvements, but the results remained mixed at best. The Select Committee on Health produced a report on commissioning in March 2010 that reviewed local primary care trusts’ performance in funding specialised services. It found that

“many PCTs are still disengaged from specialised commissioning…In addition, specialised commissioning is weakened by the fact that as a pooled responsibility between PCTs, it sits in a ‘limbo’, where it is not properly regulated, performance managed, scrutinised or held to account.”

In view of NHS England’s intention to move towards place-based budgets, it is also worth quoting the Committee’s remarks on the

“danger that the low priority”

given to specialised services by local commissioners

“will mean that funding for specialised commissioning will be disproportionately cut in the coming period of financial restraint.”

Perhaps because of that, patients’ groups and others have been emphatic in their opposition to local control of the specialised budget. Last year, the Specialised Healthcare Alliance, a coalition of more than 100 patient-related organisations and 15 corporate members that has campaigned on behalf of people who use specialised services for more than a decade, ran a survey of more than 100 representatives of patient groups, companies and expert clinicians that sought views on potential changes to commissioning arrangements for specialised services. It found that 90% of respondents preferred their service to remain part of specialised commissioning at a national level and none favoured leaving specialised commissioning arrangements. It also found that 82% favoured either no change to commissioning responsibilities for their service or for more of their service to be incorporated within specialised commissioning. Only 9% opted for more commissioning responsibilities to fall to CCGs. On co-commissioning, while respondents were open to collaboration between NHS England and local commissioners, only 15% would be happy to see that include pooling of budgets with CCGs.

I am grateful to the Muscular Dystrophy Campaign, the British Kidney Patient Association, the Cystic Fibrosis Trust, the Motor Neurone Disease Association, the Association of British Pharmaceutical Industry, the Royal College of Physicians, the NHS Clinical Commissioners, NHS Providers, the Medical Technology Group, AbbVie and Novartis for engaging with the debate. Uniquely, all the groups that have been in discussion with me share my concerns about the timing and content of these proposals.

Despite the clear views being expressed by the patient community and others, neither NHS England nor the Department of Health has opened any consultation on the developments. No stakeholder events have been held and NHS England has not even published full and explicit details of its plans for co-commissioning.

Given the magnitude of the plans, I hope that my right hon. Friend the Minister will give us assurances today. I ask for specific guarantees to satisfy the concerns that have been raised with me. First, will he commit to ensuring that NHS England will remain the sole budget holder for specialised services? Specifically, will he commit to that not just for 2015-16, but for the years that follow? That is crucial to clear accountability and consistency in those specialised services.

Secondly, will the Minister guarantee that national service standards and clinical access policies will remain in force throughout England, with no variation from the core standards permitted? Again, will he specifically give these assurances not just for 2015-16, but for future years?

[Sir Bob Russell (Colchester) (LD)]

My hon. Friend has been making a powerful case. As he draws to a close, will he join with me and agree that the work of the Prescription Charges Coalition is associated with his comments? Many people with lifetime illnesses and conditions are being subjected to paying prescription charges.

[Stephen Gilbert]

I thank my hon. Friend for his remarks, which are exactly on the money. Every organisation that I engaged with expressed real concern about the proposals. He puts on the record a further organisation that shares concerns on the direction in which NHS England is taking specialised health services.

Will the Minister give a commitment to openness, transparency and public engagement? The Government so often talk about that, yet NHS England has failed to demonstrate it. Will he also promise that any changes to specialised commissioning, including co-commissioning or collaborative commissioning, will be consulted on with patients, providers and the public before they are implemented?

In its leader article this week, the Health Service Journal asks whether specialised services should “pay the price” of NHS changes. It suggests that while that may be NHS England’s strategy, key decisions are being shunted until after the election to keep them out of the spotlight. I submit that this matter is too important to the House for us to see it treated in such a way. We all know that the NHS faces challenges, including those in specialised commissioning, but a policy of stealth is no way to proceed.

I leave the final word to my constituent, Nicola Hawkins, who has been on renal dialysis for eight years and secured more than 35,000 signatures to a petition about plans to remove renal dialysis from specialised provision altogether. She is just one of tens of thousands of people who will be affected. She says:

“I am a single mother of a 13 year old girl, I work full time hours to try and pay the mortgage and I am really struggling. I don’t understand why the changes are being made and I don’t know what the impact will be on my life. I’ve tried to engage with Government but heard nothing back, despite a 35,000 name petition. I don’t have an explanation of why the changes are happening or what they mean for me. I am worried that these changes could mean negative consequences for my health and wellbeing, my ability to support my family and that my care will fall to local GPs who don’t have expertise in my condition. I’m confused about the changes and frightened about the future.”

The changes are happening too fast and without proper consultation. Almost unanimously, they are seen to be a backward step. Nicola and the tens of thousands of people like her throughout our country deserve better.

13:50

[Mr David Anderson (Blaydon) (Lab)]

I congratulate you, Sir David, on your knighthood, which is well deserved. I also congratulate the hon. Member for St Austell and Newquay (Stephen Gilbert) on the very good way in which he introduced this serious issue; I disagree with nothing that he said.

I apologise, Sir David, because as I told you earlier I am one of the co-signatories of the debate that is to take place in the main Chamber. I think this is the first time since the setting up of the Backbench Business Committee, which we both sit on, that proceedings in the Chamber have not been extended by questions or statements, so they will run to time for the first time. Unfortunately, I will have to leave, although I will get back for the wind-ups, if possible, or even before.

I want to pick up on three things: the work that I am involved in as the chair of the all-party group for muscular dystrophy; issues brought to my attention by the Northern Neurological Alliance in the north-east; and some specific concerns about NHS England and what it is involved in.

The APG for muscular dystrophy has in effect been carrying out an investigation for more than a year into national commissioning. We worked closely with various groups before the change in the law, developing good working relationships and trying to ensure that people with these relatively rare diseases are looked after properly and that the commissioning works properly in their interests. We have had full engagement and good commitment from patients, carers, the NHS professionals, politicians—and, it has to be said, health service Ministers.

What has become clear, as will come up in the report that will probably be launched in the House on 24 March, is that there are many gaps in specialised neuromuscular care, which will be highlighted, at least, by the inquiry, but will need addressing by people such as the Minister, although hopefully under another Administration a few weeks later.

For example, in my region, the north-east, we have world-class, cutting-edge neuromuscular specialists working in multi-disciplinary care at the specialist muscle centre in Newcastle. On the grounds of urgent need for more support, however, we need additional neuromuscular care, advice and support to provide essential services to people living at home with such problems. We need an additional neuromuscular consultant and the psychological support necessary for people who live with these problems. Will the Minister meet me and the rest of the APG for muscular dystrophy to discuss not only the issues in the north-east, which are examples of the type of cases being brought before the investigation, but the problems throughout the country, to see what we can to do to improve care for these people?

The hon. Member for St Austell and Newquay expressed concerns about co-commissioning and the provision of specialised services between NHS England and the CCGs. That is a real worry. Problems have been identified and raised with us in the implementation and interpretation of the neuromuscular annex of NHS England’s neurosciences service specifications. Some commissioners and hospital trusts appear to believe that the neuromuscular annex is a wish list, rather than a requirement. We are clear: it should be a requirement, not a wish list. Will the Minister address those points, if he can, in winding up? What action will he take to ensure that the neuromuscular annex of the service specification is fulfilled by NHS trusts listed in the specification as a compulsory requirement? If he can make that clear to the people on the ground, that would be a great step forward with the problems.

I also want to raise some issues brought to me by the Northern Neurological Alliance, a charity that operates in Northumberland, Tyne and Wear and County Durham. It aims to improve the lives of people with long-term neurological conditions, or LTNCs, and their carers. It does so by seeking their views on the quality of services received and then campaigning for improvements where necessary. The charity calculates that in the north-east of England at least 50,000 people are living with one of the 15 most common LTNCs, such as multiple sclerosis, Parkinson’s disease and acquired brain injury. Many LTNCs, however, are less common.

Many people experience reductions in their quality of life as a result of such conditions. Many examples have been given of loss of independence, poor mobility leading to social isolation, and, clearly, financial challenges. In addition to those who have such conditions, there are the many family members who act as carers. As a result, the total number of people in the north-east affected by LTNCs is much greater than the 50,000 who actually have the conditions.

Without doubt, services for such people need to be improved. In 2011 the National Audit Office published a report that looked at the services provided for the some 2 million people who are assessed to be suffering with a neurological condition. They found evidence of poor co-ordination of services between health and social care, and a nationwide postcode lottery of specialist services. Unfortunately, it would appear that things have not improved a great deal.

The Neurological Alliance has contacted the CCGs for information about how they target resources for people with neurological conditions. The findings show that only 14.7% of CCGs have assessed local costs for the provision of neurology services; that only 20.4% and 26.2% of CCGs have assessed, respectively, the number of people using neurological services and the prevalence of neurological conditions within their area; and that such issues have a significant impact on patient care, with 58.1% of patients having experienced problems in accessing the services or treatment they need—clearly, a big group of people.

LTNCs have not attracted the same national priority as conditions such as cancer or heart disease, which is possibly understandable because of the greater prevalence of such diseases. However, for people who live with LTNCs, it is equally important to get looked after properly, too. They clearly wait much longer for services to come through. The impact can be serious for many of them. The need for clear and determined national leadership is urgent to achieve the requisite improvements that I hope everyone in the Chamber agrees we should be seeking.

Finally, I want to pick up an issue that has arisen in the past few days; I spoke about it yesterday with the Prime Minister. It involves some of the problems with NHS England. A new drug called Translarna can treat a small group of young boys who suffer from a strain of muscular dystrophy known as Duchenne muscular dystrophy. In August 2014, the European Commission granted conditional approval for Translarna. It is the first licensed drug that can treat an underlying genetic cause of Duchenne ever to have been approved anywhere in the world. It was a landmark decision for the community of those suffering from Duchenne.

Translarna treats boys whose Duchenne is caused by what is known as a nonsense mutation—if anyone wants me to explain that, I had better leave now! The mutation accounts for 10% to 15% of the boys who suffer with Duchenne. The truth is that those young men have no chance of being cured of the disease once they have it, but we try to enhance and extend their lives. Some great work has been done in this country and even better work done in countries such as Denmark. Translarna will have a huge impact on that 10% to 15% of the boys suffering from the disease. To qualify for the treatment, however, young boys must be aged over five and still walking. Clinical trials indicate that Translarna could slow the progression of the condition and keep the boys walking for longer. It has already been made available in European countries such as Spain, Germany, France and Italy.

We understand that there are different regimes and that we have to go through our regime. Translarna was being assessed by NHS England, which has the final decision on whether the drug will be approved and, as we hope, funded for boys in England. The families understood clearly that a decision was to be taken last September, making the treatment—really important for the young people affected—possibly available from April. Unfortunately, however, due to the threat of a legal challenge, NHS England has stopped the assessment of the drug while it reassesses its process. An internal debate within NHS England has stopped the assessment of a drug that could mean at the very least that a number of those boys could be walking for much longer than was otherwise thought possible.

Yesterday, more than 100 families, along with a lot of colleagues from both this House and the other place, came together to lobby and deliver a petition of over 23,000 signatures to the Prime Minister in Downing street. To his credit, he answered my question yesterday positively and also met us outside Downing street, where he gave a commitment to the families that he would do all he could, adding that he would speak to the Secretary of State before going to America. He was supportive of what we are trying to do.

The reality is that we cannot allow an internal discussion within NHS England to stop the treatment. The difference could literally be that the boys concerned will stop walking when that does not have to happen. I could not personally live with that. We must do something about it.

I ask the Minister to give us an assurance today that the Department of Health and NHS England will work together to see whether they can move the situation forward. Yesterday, the Prime Minister said—he did not mean it disrespectfully—that he had given NHS England a lot of work to do recently. We all understand that. Although we might kick around in here and have an argument between ourselves about it as if it was a political football, the NHS is about helping people such as the young people I am talking about. It cannot save their lives, but their lives can be improved and, we hope, extended. Translarna could do that, so I hope that between us we can find a way to make things work.

14:01

[Fiona Bruce (Congleton) (Con)]

May I first add my most sincere congratulations to you, Sir David, on your recent elevation?

I will be brief. I pay tribute to the hon. Member for St Austell and Newquay (Stephen Gilbert) for securing this debate. Ahead of it, I have been contacted by an exceptional charity in my constituency, the Raynaud’s and Scleroderma Association, of which it is my privilege to have been patron for many years. That outstanding charity was founded and is based in Alsager in my constituency, and it is the only charity providing national support, research and help for people suffering from Raynaud’s and scleroderma—two debilitating conditions that affect the digits and the autoimmune system. The charity also supplies support to their carers.

I am glad to take the chance today to pay tribute to the work that the RSA does every day for people suffering from those debilitating conditions. Despite working from a tiny terraced house on limited resources, it has raised millions of pounds to fund national treatment and vital research. It has helped the country’s understanding of the conditions, as I have heard personally from clinicians and doctors. As a result, I believe that the RSA’s concerns about the proposals that we are discussing today demand a hearing.

The RSA’s work makes a huge difference to the lives of those affected by the conditions, especially those with Raynaud’s when their condition develops into scleroderma, which is rarer and more serious. The progress the association has made in research into and treatment of the conditions is outlined on its website. Its chief executive officer, Elizabeth Bevins, contacted me prior to the debate because she is concerned about the plans we are debating, which could reverse the progress that has been made over recent years on services for these rare conditions. I will quote from Elizabeth’s letter to me:

“Having followed the development of NHS England with interest since its launch…and having welcomed Specialised Services commissioning at national rather than local level as an important cornerstone of the plan to help eradicate any ‘postcode lottery’ issues, I am now concerned at the proposed changes on national commissioning for specialised services.”

She added that she shared the concerns of the Specialised Healthcare Alliance, which she thought had articulated the position well in the statement it released on the issue. That statement says:

“Specialised services are best planned on a national level–in the past patients experienced very different levels of access to specialised care.”

Elizabeth is concerned that NHS England’s plans to let local commissioners share responsibility for commissioning such complex services, thereby incentivising them to direct funding to local priorities, could result in a patchwork quilt of provision. An example is the prescription of the drug Bosentan for scleroderma. The drug can often help to prevent the formation of digital ulcers. The RSA is extremely concerned that access to that drug and others for the rare conditions to which I have referred should continue to be “equitable and consistent”.

These diseases are rare, so shared knowledge across clinicians nationwide is essential. Scleroderma affects only about 8,000 patients in the UK. The RSA has stated that

“treatment is best and most effectively made from a few specialist hospitals across the UK…who work with a patient’s local hospital to manage what can be killer diseases.”

I hope that, in continuing with the proposals, Ministers will take into account the concerns of the RSA.

14:05

[Jim Fitzpatrick (Poplar and Limehouse) (Lab)]

It is a pleasure to see you in the Chair this afternoon, Sir David. I am sure you took huge pleasure from your ennoblement. I am also sure that you took some pleasure from West Ham’s good cup win on Tuesday night—at least we are both smiling as a result of that experience.

I congratulate the hon. Member for St Austell and Newquay (Stephen Gilbert) on the strong case that he made to the Minister. I look forward to hearing the responses of both Front Benchers to that contribution in due course. It is a pleasure to follow the hon. Member for Congleton (Fiona Bruce), who made an eloquent plea on behalf of the RSA in her constituency and nationally.

I will raise two issues. The first is sickle cell disease, an issue raised with me by two constituents who suffer from that condition and are worried that the change to local commissioning might affect the care that they receive. I promised that I would mention their concerns in my contribution today, and a simple statement of reassurance from the Minister would be very welcome.

The second issue I wish to raise—in greater depth but not too lengthily—is neurological and headache services. We have corresponded on the issue before, so I will just remind the Minister that I am chair of the all-party group on primary headache disorders. I should acknowledge the assistance that the all-party group receives from the Migraine Trust, which offers great support through Wendy Thomas, its chief executive, and Drew Lindon, who acts as our administrative secretary.

The all-party group recently concluded an inquiry into headache services in England. The Minister has a copy of our report, and I hope the shadow Minister has one as well. I put on the record my thanks to the parliamentary participants in the inquiry, as well as to the witnesses—many of them eminent clinicians—and to Hannah Verghese of the Migraine Trust, who all gave up their time to make sure that the sessions were useful and worthwhile and that the report would be a useful tool for the Government and for anybody interested in the issue.

I will not go into any real detail, but the report’s main conclusions were that there are large gains to be made in the NHS by treating headache appropriately—gains for the patient, for the NHS and for the wider economy. The report also makes well the argument for the need for

“a national strategy to improve the provision for headache sufferers in England.”

There is a lot of good provision on the ground, but it needs to be more evenly spread across the country.

Our report makes 10 recommendations. Again, I will not go into detail about them all but members of the group would like to meet the Minister and/or his officials at some point over the next few months to discuss the issues. We will also put a bid in to meet the shadow Minister and his colleagues; given that the general election is coming up, he might well be sitting in the Minister’s position in only a few months—certainly many of us expect that to happen—either as part of a new ministerial team running the country or perhaps sharing the running of the country with others, in which case the Minister might still be there. At any rate, we want to take the issue forward and would be grateful to engage with both Front-Bench teams. I have corresponded with the offices of the Minister and the Secretary of State for Health, on 12 January and 23 July last year, respectively, raising some of the issues that we have identified.

Headache disorders cost the UK economy an estimated £5 billion to £7 billion per annum. They are the most common neurological reason for accident and emergency attendance, with more than 19,000 finished emergency admissions in 2012-13. Indeed, 90% of the public are affected by a headache at some point, and approximately 6 million people live with migraines. In 2012, the Public Accounts Committee identified that 70% of clinical commissioning groups have not produced a needs assessment of people with neurological conditions and have no plans to do so.

The Minister will have seen the Neurological Alliance’s report, “The Invisible Patients”, which included the findings that only 14.7% of CCGs have assessed local costs relating to the provision of neurology services; only 20.4% of CCGs have assessed the number of people using neurological services and only 26.2% have assessed the prevalence of neurological conditions in their area; and only 33% of CCGs obtain vital feedback from patients about the neurological services that they commission. The report sets out a number of recommendations in response, which I am sure the Minister has seen.

I should declare an interest: I am a sufferer of trigeminal neuralgia. I have personally accessed the neurology services of the Barts Health NHS Trust, and had neurosurgery at the National Hospital for Neurosurgery and Neurology at Queen square in 2009. I am grateful to all the clinicians who assisted me, as well as to the Trigeminal Neuralgia Association UK—TNA UK—a charity that tries to help suffers and their families and campaigns on the condition.

In conclusion, we need a national strategy, including an appropriate and targeted public awareness campaign for primary headache disorders, as well as better diagnosis and treatment by GPs, specialised clinics and clearly defined local headache pathways. If we had that, the burden of headache disorders might finally receive the attention that the all-party group thinks would be helpful for individuals, the NHS and society.

Time is short before the general election, but I repeat my request for a meeting, which, I assure the Minister, would not take long. We would be grateful if he found half an hour in his diary before the end of March. We extend that request to the shadow Minister as well, so that we can take these issues forward and try to give greater assurance to those who are suffering that matters are being taken seriously.

14:12

[Sir Bob Russell (Colchester) (LD)]

It was indeed a good night for Essex, Sir David; I congratulate you on your well-deserved elevation.

I want to endorse all the comments made by previous speakers. Members will have gathered from my intervention that I do not think that we should look at this matter in isolation. The national health service has a problem: on the one hand, we want local decision making, but on the other, that local decision making is occasionally counter-productive to the interests of patients, so a national framework is required. Clearly, if we have two people in one area and two in another and the decisions are made locally, those decisions could well be different. We all have experiences with mainstream medical services where the postcode lottery kicks in; I fear that that will be exaggerated on a bigger scale for the individual, even though the numbers of people with each condition in each constituency are not that great.

I want to reinforce the arguments that have been made. Last year, I introduced a debate on long-term conditions and prescription charges and concentrated on cystic fibrosis, a condition that I have raised throughout my parliamentary career—I hope that I will be able to continue to do so after May. The point I want to make is that those who have chronic illnesses have not chosen to have them yet, as the Prescription Charges Coalition—a group of more than 30 organisations—has identified, when it comes to prescription charges, there is discrimination against those to whom mother nature has not been kind. At the same time, the NHS falls over itself to assist people who are guilty of self-inflicted wounds, by which I mean illegal drug taking, binge drinking and so on. We have an extraordinary situation in which the NHS gives greater attention, time and resources to those who have brought about their own ill health than to those who did not choose theirs.

My message to my right hon. Friend the Minister is that a powerful case has been made by my hon. Friend the Member for St Austell and Newquay (Stephen Gilbert) and others and that he should look at the case I made in my Adjournment debate last year on prescription charges, with the emphasis on cystic fibrosis. What we have heard today about the ongoing inquiry tells me that the NHS is in danger of moving in the wrong direction. I hope that the Minister, my good friend and fellow East Anglian colleague, will ensure that, regardless of party politics, we are not going to see a worsening of the discrimination currently experienced by many people with chronic illnesses—it is already bad enough.

14:16

[Siobhain McDonagh (Mitcham and Morden) (Lab)]

I too congratulate you on your knighthood, Sir David. I am not quite sure what it is about Essex MPs and knighthoods, but perhaps we could be let in on the secret. I congratulate the hon. Member for St Austell and Newquay (Stephen Gilbert) on securing the debate. I would like to start with an apology, because it always seems a good thing to start with: I am sorry, but I will not be present for the wind-ups due to a long-standing agreement. However, I will be really interested to read the report of what everyone has to say.

I would like to concentrate my comments on brain injuries and the way in which any reconfiguration of commissioning might affect brain injury services. In addition to representing people in my constituency who have been affected by a brain injury, my interest is twofold. First, I was a member of the Health Committee when it conducted its inquiry into head injury rehabilitation. Our report was published in 2001, and our findings demonstrated the importance of good quality rehabilitation in improving patient outcomes. Rehabilitation can also save the NHS money by enabling people to move along the care pathway from acute care services, when appropriate, and, in the longer term, by reducing ongoing dependency and care costs. It is a shame that rehabilitation services remain under-funded all these years later. That must be addressed, regardless of commissioning arrangements.

My second interest is that my constituency contains the London office of Headway, the brain injury association, the estimable chief executive of which, Peter McCabe, has been my friend, colleague and constituent for longer than either of us would care to remember. The charity supports individuals and families affected by brain injury and, as such, is ideally placed to comment on the discussion on commissioning arrangements. As many of us know, brain injuries can leave people with a broad range of cognitive and physical issues, including communication, memory, emotional and mobility problems, each of which requires specialist yet integrated treatment and rehabilitation from the earliest possible stage to enable the best recovery.

In such a complex area of health care, the views of organisations such as Headway that provide services to people with brain injuries are of vital importance in discussions about how specialised commissioning might be reconfigured. Headway’s front-line services include a nurse-led helpline that takes thousands of calls each year, and acute trauma support nurses who provide valuable assistance to families of loved ones in the acute stage of care. It also has an emergency fund that provides vital financial support to families who are unable to afford to visit their loved ones in specialist brain injury units, which are often many miles from the family home, along with a network of more than 125 groups and branches across the UK that provide local support and services to brain injury survivors and their families.

Ahead of this debate, Headway reported to me that it has had discussions with experts in the field of acquired brain injury about the proposals, and that there are differing views as to whether changing the way in which brain injury services are commissioned would be beneficial or detrimental to brain injury patients. Some have questioned the wisdom of another reorganisation at this stage, yet most accept that encouraging those with commissioning responsibility at both a national and local level to co-operate and develop joined-up pathways of care for patients could provide real benefits. There is a great deal of concern, however, that the driving force may be to reduce expenditure. I seek assurances from the Minister that the potential reconfiguration of commissioning is about improving patient outcomes rather than cost-cutting.

The present level of detail on how brain injury commissioning changes may work in practice is also of concern. Without that, it is difficult for organisations representing patients to provide views as to what such changes might mean. Experts suggest that it could be helpful if it led to more investment in rehabilitation services. That is supported by an article in the Evening Standard this week quoting Robert Bentley, director of trauma at King’s College hospital, who explains that trauma units can struggle greatly to move patients back to local rehabilitation due to a lack of rehabilitation beds, and that that leads to a blockage in trauma units. Rehabilitation services must be invested in at a local level to encourage patient flow at a national, regional or tertiary level.

I ask that NHS England provides more detailed information on how any reconfiguration of commissioning may impact on survivors of a brain injury. I also ask that any move to restructure is subject to consultation with appropriate and relevant organisations; it is important that experts and patient groups are able to feed into the plans, so that the interests of patients are protected and consideration is given to the law of unintended consequences.

It is also important to state how imperative it is that CCGs, if they are to become more involved in the commissioning of specialist services, are supported to increase their expertise in these areas of health, so that they are able to make effective and well-informed decisions. That would also help to ensure a consistent quality in services across the country.

To pick up on the points made by my hon. Friend the Member for Poplar and Limehouse (Jim Fitzpatrick), I note that the Neurological Alliance highlighted that only 26.2% of CCGs responded to its audit looking at what specialist levels of understanding they have in that area of care, and that just 20.4% had explored the number of people using local neurological services. If the approach to commissioning services for these conditions is to be changed, CCGs will need to increase their knowledge of the level of need in their areas and the types of provision required. That might benefit from input from experts and patient groups, and should brain injury services move to a different form of commissioning, organisations such as Headway and its local groups should be engaged as part of the process.

I conclude by saying that the detail of these plans and how they are executed if they are put in place are of vital importance—as is always the case, the devil will be in the detail. The reality is that any one of us may suffer a life-changing brain injury. Those facing such difficulties need the assurance that they will receive the best possible acute care and rehabilitation to maximise their recovery, regardless of who commissions or pays for it.

14:23

[Kerry McCarthy (Bristol East) (Lab)]

I congratulate you on your knighthood, Sir David, and I also congratulate you on West Ham’s success. I tend to follow West Ham, as my little nephew, Oliver, is a great fan, but as I gather you are next up against Bristol City, I am afraid that this is one occasion when I am not allowed to express support.

I am pleased to follow my colleagues in speaking on this issue. I know that my hon. Friend the Member for Blaydon (Mr Anderson) has had to leave for the debate in the main Chamber, but I want to mention briefly the Muscular Dystrophy Campaign. It has spoken to me many times about the need for the national commissioning of specialised services, so it is obviously concerned that that may be under threat. I have a constituent with Duchenne muscular dystrophy, so I am pleased that my hon. Friend brought up the issue of access to Translarna.

I was in the Chamber for the start of the debate on contaminated blood. We heard some very sad stories about haemophiliacs contracting hepatitis C and HIV/AIDS as a result of receiving infected blood. Haemophiliacs are another group who benefit from these services, as indeed do people with HIV/AIDS.

I particularly want to raise some points today on behalf of the Cystic Fibrosis Trust, which, as the Minister will know, does excellent work. It has already been mentioned by the hon. Member for Colchester (Sir Bob Russell). Cystic fibrosis is not among the rarest of conditions; it is actually the most common life-threatening, inherited disease and affects over 10,000 people in the UK. However, it is very complex, and because of the associated conditions that go with it, it requires very much a co-ordinated holistic approach. Patient care includes physiotherapy, nutrition, antibiotics and, often, a long wait on the lung transplant list, which is something that I have raised in the Commons before.

Cystic fibrosis patients need a dedicated team of specialist consultants, nurses, dieticians, physiotherapists, pharmacists, social workers and psychologists. Their susceptibility to cross-infection also means that they need to avoid other cystic fibrosis patients, so it is particularly difficult to provide services for them. I have spoken before about how invaluable it is for cystic fibrosis patients to have a dedicated service, and we are very fortunate in Bristol to have the Bristol Adult Cystic Fibrosis Centre, and also a special paediatric unit at Bristol children’s hospital. In recognition of the different needs of patient groups at different ages, NHS England has two service specifications for CF—one for adults and one for children to ensure that the services meet their needs.

I want to talk briefly about the concerns that the Cystic Fibrosis Trust raised with me about the consequences of co-commissioning. Specialised services, such as Bristol’s, are becoming increasingly important as the life expectancy for people with CF increases and as patient numbers expand. It used to be very much a childhood illness, which is why the issue of people with cystic fibrosis having to pay prescription charges is an anomaly. It used to be that they did not survive into adulthood, so the issue of paying prescription charges did not come up, whereas now, their life expectancy is much longer, although it is still very much a serious illness.

When I visited Bristol Royal infirmary to look at its unit last year, it was clear that capacity and managing its bed allocation was becoming a bigger problem because there are more patients around. Arguably, that means that specialised commissioning will become increasingly important. The Cystic Fibrosis Trust is concerned that a move towards co-commissioning, rather than expanding the availability of specialised units, will be a retrograde step for the care and treatment of CF. Given the proposal to incentivise CCGs to reduce spending on specialised services, the trust is concerned that a move to co-commissioning is

“a veiled attempt at cost-cutting”.

The Cystic Fibrosis Trust argues that the current arrangements have delivered economies of scale through the focus on fewer, larger units; that they facilitate clear accountability in commissioning; and that they provide, together with the clinical reference group, the potential for continuous improvement and innovation. They also ensure consistency and equity of access across the country, something that again, is very much missing from the organ transplant system, and the trust has been campaigning for some time for a national lung transplant allocation system. It has also been highlighting the issue of national access to drug therapy, which will become increasingly important if, as we hope, new drugs are developed. The trust warns that, without the necessary national approach, we will see worrying postcode lotteries, and that

“overstretched clinical commissioning groups may not be able to support the level of service required in specialist centres, complete with integrated patient pathways and multidisciplinary expertise.”

I want to end by asking the Minister a number of questions. He may not be able to reply to them today, but I would be grateful if he could pick them up in writing. Given that CF care is provided by a single, multidisciplinary team, funded by a year-of-care tariff, what would co-commissioning look like for cystic fibrosis services? Just how will co-commissioning work for a condition such as CF without undermining the key principles of the existing nationally commissioned service—avoidance of duplication, the consistent standard of care and facilities across the country, and a joined-up approach to future treatments? If cystic fibrosis is co-commissioned, what aspects of the service would be commissioned nationally and which would be commissioned locally? Is the Minister at all concerned that local CCGs may not have the expertise to commission aspects of care for a condition as complex as cystic fibrosis?

To conclude, given the vulnerability of patients who currently rely on specialised commissioning, I hope that the Minister will work with organisations such as the Cystic Fibrosis Trust and other members of the Specialised Healthcare Alliance, and give due consideration to their call to maintain mandatory national service standards.

14:29

[Valerie Vaz (Walsall South) (Lab)]

May I be the next person to congratulate you on your elevation, Sir David? You have always been very kind to me since I entered Parliament in 2010, so I think it is well deserved.

I thank the hon. Member for St Austell and Newquay (Stephen Gilbert) for bringing a very timely debate to the Chamber. He has given us all a shove to make us realise how important this issue is. We have all had to concentrate on, and speak to our constituents about, what is going on. I also want to say something about the two Front-Bench spokespersons, who are probably two of the nicest Ministers and shadow Ministers. It is, of course, always a pleasure to follow my hon. Friend the Member for Bristol East (Kerry McCarthy).

Every hon. Member making a speech here today speaks on behalf of people who suffer from rare conditions because those people cannot do so themselves. They have complex conditions; by their very nature, they are not run of the mill. They require highly specialised and very skilled clinical responses. Many other hon. Members have concentrated on specific areas. As a member of the all-party group on epilepsy, which also considers related conditions, I shall focus on that. Epilepsy encompasses so many variations, and there are a lot of unknowns about these conditions. Sometimes epilepsy is a forgotten condition because there are no shops on the high street to remind us of how many people—children and adults—suffer from it.

The document from Epilepsy Action’s trawl around all the CCGs was put on my desk and it explains why the debate is so important. I am not sure whether the Minister has seen it. It is entitled “Epilepsy in England: The local picture”. It is quite alarming. I shall highlight just three of the major issues. Epilepsy Action says that only 10% of CCGs have a written needs assessment for people with epilepsy; just three out of 140 health and wellbeing boards are making plans for people with epilepsy; and 78% of CCGs have not developed, or do not intend to develop, a needs assessment for people with epilepsy.

According to epilepsy charities, there are also problems with the current national service specification for adult specialised neuroscience services. The problem is that it is an interim document. It was produced in 2013 and requires updating. More importantly, it does not specify which parts of epilepsy services are specialised and which are not. There seems to be a lack of accountability between CCGs and NHS England as to which are neurological services. The CCGs are interpreting, wrongly, that they have no responsibility for some neurological services but they have for others. That is why this debate is so important. How does the Minister intend to deal with that discrepancy? Will the specification be updated, and can he review that before he rolls out the programme?

The situation makes a mockery of my final point, which is about the tariff. NHS England and Monitor will bring in marginal rates of 50% for specialised services above the stated baseline. That, in effect, means that access may be rationed. Worse still, CCGs, if they underspend on their budget, can keep that money. That means that there is a perverse incentive not to commission the more expensive rather than the less costly procedures. Let us think about the kind of procedures required for epilepsy. Brain surgery is complex and highly skilled, and sometimes it is the only option for people with the condition.

I am not sure why specialised commissioning needs to change. I do not know whether the Minister is aware of the survey that the Specialised Healthcare Alliance carried out among patient organisations, expert clinicians and the industry in late 2014. It says that 90% of respondents want their service as part of specialised commissioning, not co-commissioning, and 82% do not want any change. I urge the Minister to listen to those patients and to those affected.

14:34

[Kelvin Hopkins (Luton North) (Lab)]

I, too, congratulate you on your knighthood, Sir David, which is well deserved. It is a pleasure to serve under your chairmanship. I also congratulate the hon. Member for St Austell and Newquay (Stephen Gilbert) on launching and promoting this very important debate.

I want to speak up for robot-assisted surgery, which should be the subject of national commissioning and should not be localised. The case for it is very powerful indeed. Some 500,000 robot-assisted surgical procedures took place in the world in 2013, and 5,000 of those were in Britain—but 5,000 is quite a small number when compared with the total number of operations across the whole field of health during a year. These operations are very specialised; a small number of very specialised surgeons do them. Clearly, such surgery is wholly inappropriate for local decision making, local funding and local commissioning. My hon. Friend the Member for Bristol East (Kerry McCarthy) made the point very strongly: these operations should be part of a national service, where we can get economies of scale and a focus on centres of quality and expertise.

The operations are used, among other things, to treat patients with prostate cancer, kidney cancer and bladder cancer and, to a lesser extent, in the areas of colorectal surgery and gynaecology. Having seen some of the operations on film, I know how incredibly precise and difficult they are and what miracles can be worked by robotic surgery. It cannot be done by human beings: however brilliant a surgeon is and however delicate their hands are, they cannot be as precise as a robot. Robots will increasingly become part of the way we operate on human beings more broadly.

My reason for being so interested in this issue is personal. Over the last four years, I have been invited to speak, briefly, at an international symposium on surgical robotics at the Royal Geographical Society. It has been led by my noble Friend Lord Darzi, of another place. As we all know, he is a gifted and brilliant surgeon himself. I make a brief address at the beginning—not because I am a medic myself or know anything about these things, but because my late father was Professor Harold Hopkins FRS. He was a gifted scientist who designed the first successful optical endoscopes. Flexible fibre optics were his, as were rod lens cystoscopes and all the endoscopes that followed from them.

If anyone has ever had a colonoscopy or a gastroscopy—or, indeed, had their bladder inspected through the urethra—they will have had one of those instruments poked inside them. I have experienced more than one of them, but fortunately I was in perfect health, so I was pleased about that. I also had the unusual experience of seeing the first ever clear picture of bladder cancer; my father showed it to me when the first endoscope was used to take it. It was an historic moment.

The point I want to make is how important it is that these procedures are promoted within the national health service, because Britain must be at the forefront of this technology. We have brilliant surgeons and brilliant designers and scientists designing these things, but when my father first invented his cystoscopes, his endoscopes, he could not get them produced in Britain. Eventually, he met a man called Storz in Germany, who manufactured the endoscopes and made millions of pounds from them.

The Deutsches Museum in Bonn has a case devoted to those instruments in a part of the museum for foreigners who have made a contribution to the German economy. It could all have been done in Britain, but it was not. I fear that if we do not keep funding this cutting-edge technology—“cutting” is perhaps an unfortunate word—we will lose our position in the world at the head of all these developments. It is so important for Britain, as an economy, that we sustain these things, but they will not be sustained if we have penny-pinching local commissioning, which will undermine the procedures and their availability.

These are very serious concerns. Sadly, my father died of prostate cancer himself some 20 years ago. There is a hereditary component in prostate cancer, so I have a personal interest in making sure that all these operations are available and that we have the best possible technologies to deal with the disease.

A recent front-page report in The Guardian or The Independent—I forget which—showed that prostate cancer treatment varies enormously from area to area, and death rates are higher in some areas than in others because some treatments are not available nationally. Some treatments, such as implanting into the prostate small radiation-generating components that kill off cancer cells, are not available to all sufferers, and they should be.

There are all sorts of reasons for national commissioning to ensure consistency of provision across the country and that people do not die unnecessarily of dreadful diseases. There is a powerful case in many other fields for national rather than local commissioning. We are talking not about hip replacements and tonsillectomies, but about very specialised operations, sometimes for rare diseases and conditions, using technology that is not available in every area. There should be national centres for such things.

That is my case, although I could speak at much greater length. I want to finish on the question of funding for the health service. There has been a lot of press comment and alarm about the state of the health service, and quite rightly so. I do not speak for my Front-Bench team—I only wish I did, and from time to time I try to persuade them that I should—but I believe that NHS spending must be increased. We spend at least 2% less of GDP on health than do the French or the Germans, and 2% of GDP is the equivalent of approximately £60 million per constituency. I would like to see an extra £60 million spent on health in Luton North, as I would in Luton South and in every other constituency. That would simply match the current situation in Germany and France.

The NHS does a wonderful job and is incredibly efficient, despite what people say. It has a high level of productivity, although that is being damaged by fragmentation and creeping privatisation. It is a remarkable organisation, envied across the world. It is still, in many ways, the best health provision in the world, but it is in danger from underfunding. I want us at least to match what the French and Germans do, especially as our economy is now evidently stronger than theirs.

There is a possibility of spending more. The population regularly indicate in polls that for certain areas, particularly health, they would be prepared to pay a little more tax to make sure that they are safe. I look forward to the next Labour Government, who should be in office in the next few weeks. We will then be able to move forward and properly fund the NHS.

[Sir David Amess (in the Chair)]

I call Mr Mark Tami, who, as it turns out, has plenty of time at his disposal.

14:43

[Mark Tami (Alyn and Deeside) (Lab)]

Thank you, Sir David. I thought that I would probably be next. Your knighthood was the very least that you should have been awarded; I think that that was even more creeping than everybody else’s contributions. I thank the hon. Member for St Austell and Newquay (Stephen Gilbert) for securing this important debate.

I will confine my comments to stem-cell transplants. As many other hon. Members have done, I declare an interest, because I am the joint chair of the all-party group on stem-cell transplantation. My eldest son, Max, had a stem-cell transplant some seven years ago, so I also speak from personal experience. Approximately 1,600 patients a year receive a transplant from an unrelated donor or a family member. Transplants are certainly not an easy option. When my son had one, someone asked me, “Why did you take the easy route?” If that is the easy route, I cannot imagine what the difficult route is like. It certainly was not easy; it is a highly risky process and there remains a high chance of mortality. Success rates have improved, however, and great progress has been made over the years. For many patients, a transplant is the only choice that they have to save their lives.

Most blood cancer patients will receive the protocol of chemotherapy and other drug treatments. That will be the preferred route for most patients, and most now have very successful outcomes. For some, however, the protocol is not appropriate and it will not work. Depending on their particular condition, the long-term outcome under that therapy is that they will relapse, so transplant is the only option. Some patients for whom chemotherapy was seen as the correct option will also relapse, and once that has happened, transplant is the preferred option. I emphasise that that is the case for a limited number of people.

Patient experiences and outcomes from transplant are very varied. Some will suffer a whole host of problems, and some may not. There is not a uniform outcome for every patient. The transplant episode, from an NHS point of view, is defined as a period beginning 30 days before transplant and ending 100 days after transplant, and services are commissioned nationally. After that period, funding for patient care returns to the local level, although patients will probably still get ongoing treatment at specialist transplant centres. The period of 100 days may be appropriate for many patients, but it is not appropriate for all. Some patients will have a very different experience and respond differently, and they will not come out the other end fine.

More than 50% of patients will experience graft-versus-host disease. Some minor graft-versus-host is expected, and it at least shows that the transplant has taken and that something is going on; it is fighting to establish a proper graft. If it gets out of hand, however, it can cause organ failure and, in the worst cases, death. The severity of the disease depends on how close a match the transplant is. The best match is always sought, but it can sometimes be difficult. I put on record the great work done by Anthony Nolan in getting people on the register. I emphasise that this is one of the few areas in which it is possible to save a life by giving something without having lost one’s own life, and it is an incredible experience.

[Sir Bob Russell]

Anthony Nolan asking people to go on the donations register is a wonderful aspect of life in the 21st century. Does the hon. Gentleman agree that there is a specific issue for people from ethnic minorities, and specifically for people of mixed ethnicity, because the number of people who can be matched is so small?

[Mark Tami]

I agree, and that is a fact that few people know. A white person has a 70% to 80% chance of finding a match. For some ethnic groups, the chance of finding a match can be as low as 30%. For those of mixed race, depending on what that mix is, it can be even worse. We need to do much more work in those areas to try to explain that. It is the same with giving blood, where there is also a problem. The two are connected, but there is a big problem there, and we need to do a lot of work on it. Transplants are also being used for sickle cell disease, which is an important area that has already been mentioned.

Many of the graft-versus-host issues appear during the early days, but that is not always the case. Flare-ups can happen many years later. Hopefully they will become less severe as time goes on, but we cannot say that they will stop at a particular time—100 days or any other arbitrary figure. GVH is not the only problem; most transplant patients will contract a series of infections due to their immune system being compromised as a result of the treatment they have to receive to ensure that the transplant is in the best position to take. Those infections might not prove particularly dangerous to the rest of us, but they could prove fatal to a transplant patient. In the longer term, secondary cancers are another issue that has to be faced. However, without the transplant these patients would not be alive even to think about such issues, so we always need to put matters into proportion.

We have talked a lot about the physical impact of a transplant, but the psychological effects are often ignored, and there is perhaps a lack of support. Transplants are a difficult process, particularly for children. My son was in hospital, off and on, for two years, which is a big chunk of a nine-year-old’s life. Even for adults, transplants are a major step. We need to do a lot more to address the psychological effects by providing better counselling. Some support is provided in hospitals, and I have experience of that, but once people leave hospital they have to search long and hard to get support. It is a fact that transplant patients have a higher rate of suicide than the rest of the public.

[Kerry McCarthy]

I visited the cystic fibrosis unit at Bristol, and one of the key problems for people from remoter, rural areas is accessing the ongoing support, or even the drugs, that they need. In the cities there may be a concentration of patients with the same illness or a unit that specialises in treating it, and one of my concerns about co-commissioning is that a CF patient somewhere in Devon or Cornwall will have very few other patients nearby. The problems that such patients already have with being remote from the hospitals that treat them will be exacerbated if there is a local element.

[Mark Tami]

I totally agree. Thankfully, not many people have these conditions, so particularly in rural areas, someone might be the only person with the condition, and accessing support may be much more difficult.

After the 100-day cut off it becomes far more problematic for both the patient and the health provider. The term “postcode lottery” has been mentioned a lot today, and it is certainly the case when accessing support. After such a traumatic procedure, a postcode lottery is the last thing that people need. We must move away from the arbitrary 100 days, which does not fit what the patient actually needs. We need a more flexible approach that focuses on the patient, rather than just some figure that we seem to think may or may not cover the majority of people.

Support should go arm in arm with a proper transplant pathway that addresses how we look after transplant patients after those 100 days, or whatever figure is used, for as long as necessary. I have always been struck by the fact that we spend a vast sum on each transplant on the medical and hospital side, probably hundreds of thousands of pounds by the time we finish, but when the patient leaves that environment, the level of support is very poor. We need a more joined-up approach, particularly for children. A few years ago I spoke in an Adjournment debate in the House on support for children who have had cancer and are returning to the school environment. I was shocked that there are no national guidelines on how we reintroduce children. It is a scary, traumatic process not only for them but for their classmates, particularly if they are very young. Their classmates might suddenly see a child they have not seen for a while looking very different. Some schools are very good and some are absolutely hopeless in the support that they give. I am going slightly off the subject but the Department of Health and the Department for Education must work together, rather than arguing about who is responsible for providing such support.

My last point concerns patients who have had a transplant but unfortunately have relapsed. A transplant is not an easy option, and it is traumatic enough, but when the transplant fails, perhaps a year or two down the road, the patient is faced with a bleak outcome unless another transplant is available. Indeed, when a transplant is first performed, a proportion of the cells will be kept to have another go, if I can put it in those terms, in the event of such an outcome. That will obviously apply only to a limited number of people, but for that limited number of people it is their only hope. In the past we have seen that a second transplant tends to go ahead because the number of people affected is not particularly vast, but in England a second transplant now has to be provided by the NHS England individual funding request process. I understand that in recent months a number of those requests have been declined. I also believe that NHS England does not intend to address the issue until April 2015 at the earliest, although it recognises that there is an issue. When it does, I do not know how long it will take to decide what to do or, indeed, what the outcome will be. That is unacceptable. It is not too dramatic to say that lives are being lost because of that delay and this unnecessary process.

14:58

[Mr Jamie Reed (Copeland) (Lab)]

It is a pleasure to serve under your chairmanship, I think for the first time, Sir David, although you do look an awful lot like someone we used to call Mr Amess. I extend my genuine thanks to the hon. Member for St Austell and Newquay (Stephen Gilbert), whom I congratulate on securing this debate and on raising these issues in such detail. That is extremely important.

I pay tribute to all hon. Members who have spoken today. I single out my hon. Friend the Member for Luton North (Kelvin Hopkins), who made a superb contribution. He will be pleased to know that a Labour Government would increase spending on the NHS, more so than any other party. I am keen to give my hon. Friend the Member for Poplar and Limehouse (Jim Fitzpatrick) the engagement that he seeks at a time of his convenience. I commend my hon. Friend the Member for Alyn and Deeside (Mark Tami) for his compelling personal testimony. Every contribution has been very important. I also pay tribute to the Backbench Business Committee for ensuring that this and other important debates go ahead.

[Mr Peter Bone in the Chair]

Tens of thousands of people across the country rely on specialised health services. Far from being for the very rarest conditions, those with relatively common illnesses and diseases regularly depend upon specialised services. Those conditions and services include, but are by no means limited to, epilepsy, haemophilia, many cancers, HIV and cystic fibrosis. The list also includes fertility treatments such as in vitro fertilisation. The hon. Member for St Austell and Newquay gave a much more detailed list. The issue not only covers a wide range of conditions but accounts for £14.6 billion of the NHS budget, meaning that more than £1 in every £7 spent by the NHS is on specialised health care.

How those services are commissioned and provided is not a peripheral issue. It has a meaningful impact on the health and well-being of many thousands of families throughout the country. As we have heard today, we represent many constituents who require such specialised services. That is why it is right that these issues are debated in detail.

What is of real concern to those of us who use the NHS is the ability to access high-quality care and services. While access is available, many will not be concerned by the commissioning process, but widespread changes to the process could damage services and therefore patient care. The fundamental issues being debated today are the proposed co-commissioning of specialised services and, as has been mentioned, the proposed tariff change for these services. Each presents challenges that the Government must address. I am sure that the Minister will speak at length about how it is now the responsibility of NHS England, but Government must share responsibility for services and their performance. The public and the House expect it.

The Health and Social Care Act 2012 made NHS England the sole national commissioner for prescribed specialised services. The intended effect was to ensure that access and services were uniformly available across the country. It was meant to ensure that all patients would have access to available treatments. The rationale behind the change was that local funding and commissioning of specialised services had led to variable access and quality for patients.

National service specifications ensure that all patients, no matter where they live, have access to the same standard of care. They are currently underpinned by national access policies, expert advisory groups and national accountability for services. The proposed changes that we are discussing and the adoption of co-commissioning could pose a risk to those national standards. Many stakeholders have expressed concerns that specialised services are not easy to plan for on a local level. The Specialised Healthcare Alliance has said that

“given the highly variable incidence of rare and complex conditions, individual CCG allocations will not be aligned with actual need in-year.”

The Government should give assurances to hon. Members, stakeholders and patients about plans to change how such services are commissioned. For example, where will the budget rest? Will it be divided between NHS England and local clinical commissioning groups? Will clinical commissioning groups have any degree of autonomy in decisions about which services to commission in their locality? Why does the Minister believe that the changes will not result, as hon. Members have said they will, in a postcode lottery of services where patients in one area will have no access to some services on which they rely, but other patients will?

On 30 September last year, NHS England published its commissioning intentions 2015-16 for prescribed specialised services. Section 11 states clearly that NHS England has recommended to the prescribed services advisory group that renal dialysis should no longer be commissioned by NHS England and should instead be commissioned by CCGs. The National Kidney Foundation and its members have expressed deep concerns about the change. Patients are anxious about how the changes will affect services that keep them alive. There are 52 centres at present, each with a number of CCGs. How would those arrangements change as a result of the new commissioning framework?

The Cystic Fibrosis Trust has also echoed similar concerns. It is worried that the result of the changes could be

“ a lack of accountability and wide differences in provision of care across the country.”

Will the Minister reassure those stakeholder groups that that will not be the case as a result of the proposals?

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

I apologise that I could not be here for most of this debate, but among the conditions that my hon. Friend is mentioning, I urge him and the Minister not to forget sickle-cell anaemia. Sufferers feel that there is a damaging variability in the quality of treatment available throughout the country and feel that a move away from national commissioning to local-only commissioning might exacerbate that problem.

[Mr Reed]

I thank my right hon. Friend for that intervention. He will be pleased to learn that other hon. Members have made that point as well. Sickle-cell anaemia and the needs of people with that condition must be at the forefront of commissioning intentions and guidance.

It is absolutely clear that there is widespread opposition to the changes among key stakeholders. When the Specialised Healthcare Alliance conducted a survey of patient organisations, expert clinicians and industry representatives, asking for their views on specialised commissioning, 90% of respondents preferred their services to remain part of specialised commissioning. Co-operation between NHS England and CCGs should be welcomed in order to ensure best outcomes for patients, but wherever there is a risk that provision could suffer, NHS England must clearly retain sole responsibility for such services.

Patient care is central to the debate, as it is to all health debates. CCGs could not accurately predict the demand on some key services across a small population, so they are not in a position accurately to commission those services. Many CCGs are already overwhelmed; are they truly capable of doing what is being proposed? The ability to commission effectively will inevitably differ from CCG to CCG, which runs contrary to the initial intentions behind specialised commissioning.

Another concern is the speed with which the proposed changes will be implemented. NHS England plans to begin implementing co-commissioning arrangements in April this year, but it has yet to confirm which services will be co-commissioned. Such fog is damaging for patients and medical professionals alike. The Government and NHS England must be clear about their intentions to allow for proper planning and effective service provision. Perhaps the lessons of the 111 fiasco, for which the Minister was in no way responsible—the service was rolled out even though Ministers knew it was not ready—should now be heeded. These are real concerns expressed by those who will be most affected by the changes, and I hope that the Minister will reflect on that.

On the proposed tariff changes, in November 2014, NHS England and Monitor published a consultation notice on the national tariff payment system 2015-16. The consultation notice included a proposal for a 50:50 gain and loss share arrangement between NHS England and providers of acute prescribed services, meaning that for any service whose value exceeds national base levels, providers would receive payment only for the national base plus 50% of the difference, whereas on any service costing less than national base levels, the commissioner could save 50% of the difference between the actual value and the national base. That will give commissioners a financial incentive to restrict access to treatments for non-clinical reasons, which I find unacceptable.

Given the financial difficulties facing many CCGs throughout the country, that incentive might proving damaging and counterproductive in some cases. Will the Minister commit to undertaking an impact assessment on the tariff change and publish that assessment? If the tariff change has any detrimental impact on patient care, it cannot continue. I hope that when he responds to the debate, he will tell us whether he accepts that view. Will he also consider the views of the specialist hospital network? There is potential to do real damage to such hospitals: not only to the service that they provide, but to their research and development work as well, as my hon. Friend the Member for Luton North mentioned.

The Government’s engagement with stakeholders on health policy throughout this Parliament has been woeful. At best, it has been characterised by a refusal to engage in discussions about what is best for services, professionals and patients; at worst, by wilful ignorance of what experts, clinicians and patients need. A “carry on regardless” attitude has permeated most Government policy across all Departments, but nowhere is it more prevalent than within the national health service. The proposals represent the end of “no decision about me without me”. Stakeholder after stakeholder is calling on the Government to rethink their plans for the commissioning of specialised services.

The 2012 Act is seemingly never-ending; it appears to be changing yet again. The NHS has been plunged into never-ending reorganisation. It is an object lesson in bad law. Again, in fairness to the Minister, that happened before he arrived in post. Let us try to restore consensus on this issue and give commissioners the comfort, certainty and predictability that they and patients deserve. Let us put patients first and stop what could be a retrograde step. I look forward to the Minister’s response.

15:08

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

It is a pleasure to serve under your chairmanship, Mr Bone. Your arrival has removed the opportunity for me to be accused of sycophancy along with everyone else who has commended your predecessor in the Chair on his knighthood. None the less, I join in congratulating him, even in his absence. It is good to see you this afternoon.

I congratulate my hon. Friend the Member for St Austell and Newquay (Stephen Gilbert) on securing this debate. His speech was impressive and compelling in making his case, and I hope that I can go some way towards reassuring him. However, I am happy to discuss with him further the concerns that he rightly raised, to ensure that commissioning is done in the best possible way.

Various hon. Members said that any change should be based only on improving care, not simply on cutting cost. Of course, everyone needs to be engaged in the debate about how we make the most effective use of money in the NHS, but we should not do things that damage care, simply to cut cost.

Before I go into the detail of my response to my hon. Friend, let me respond to some of the points made by other hon. Members. I will write to all hon. Members who have participated in the debate to deal with all the points of substance that have been made. The hon. Member for Bristol East (Kerry McCarthy), for example, made a number of key points at the end of her contribution. Hon. Members have had a good opportunity to raise concerns about specific conditions and patient groups, and they have done so constructively.

The hon. Member for Blaydon (Mr Anderson) raised important concerns about neuromuscular care and mentioned the Newcastle centre, and I would be happy to see him at one of my Monday evening MP advice sessions to discuss his concerns further. He also raised concerns about the drug Translarna. My colleague, the Under-Secretary of State for Business, Innovation and Skills, the hon. Member for Mid Norfolk (George Freeman), who is responsible for life sciences, has committed to convene further meetings to seek a resolution of the dispute, and I hope that goes some way towards reassuring the hon. Gentleman.

The hon. Member for Congleton (Fiona Bruce) highlighted the brilliant work of the RSA—an organisation based in her constituency. She said that it had raised millions of pounds for treatments and research and that it was important that such groups have a voice and are heard. I completely accept that, and I hope to provide further reassurance in due course.

A number of concerns were raised by the hon. Member for Poplar and Limehouse (Jim Fitzpatrick)—or is he a right hon. Member? [Interruption.] I think that he deserves to be called right honourable. He referred to sickle cell disease—an important condition that was mentioned by the right hon. Member for Wolverhampton South East (Mr McFadden)—or is he an hon. Member? [Interruption.] He certainly deserves to be called right honourable, and he has clearly been rewarded. He highlighted the need to improve the care and treatment of people who suffer from sickle cell disease.

The hon. Member for Poplar and Limehouse also referred to headache disorders. My wife is one of the many people across our country who suffer from headaches and migraines, so I very much understand their impact on well-being. The hon. Gentleman asked specifically about the possibility of a meeting. Again, I would be happy to see him at one of my Monday evening sessions, but I would also be happy to make sure he and his group are put in touch with officials. I am conscious that the Department’s diary up to the end of March is chock-a-block, but I am sure he could meet officials to take the matter further, as well as meeting me on a Monday evening. I hope that is some reassurance.

My hon. Friend the Member for Colchester (Sir Bob Russell) raised the issue of prescription charges. He is right that there are anomalies—there is no point denying that—and they have existed for a long time. The previous Government looked at the issue, but they did not quite get round to doing anything in relation to long-term conditions, and this Government have also not acted. The constant problem is the pressure on resources in the NHS. People on low incomes are, of course, protected, but he made a valid and legitimate point, and the debate is, rightly, bound to continue. The other point that he made, by analogy, is that any move NHS England makes on this front must not do more damage to people with long-term conditions. I hope to reassure him that that will not happen.

[Sir Bob Russell]

Will the Minister explain what possible justification there can be for somebody with cystic fibrosis having to pay a prescription charge, when they would not have to do so if they had diabetes and cystic fibrosis?

[Norman Lamb]

My hon. Friend makes a legitimate challenge. These anomalies have not been addressed so far, but they need to be at some point. I do not seek to deny his point.

The hon. Member for Mitcham and Morden (Siobhain McDonagh) highlighted the work of Headway, which provides incredible support for people with brain injuries and their families. She mentioned the helpline and the emergency fund, which will be of enormous help to families in the incredibly difficult circumstances they face.

The hon. Member for Bristol East mentioned the Cystic Fibrosis Trust—another amazing patient organisation that does extraordinarily important work. She talked about the importance of equity of access, and it is incredibly important that that principle is maintained in any changes that take place. We do not want to return to the postcode lottery that existed in the past. Again, I am happy to try to provide responses to the questions she asked at the end of her speech.

The hon. Member for Walsall South (Valerie Vaz) was incredibly generous in her remarks about the shadow Minister, and I feel the same about him—let us be blunt about that. I appreciate her kind remarks about me—indeed, the feeling is entirely mutual. She made some really important points about epilepsy and Epilepsy Action. She highlighted concerns about many CCGs and health and wellbeing boards not yet engaging fully in work on epilepsy. That critical issue goes beyond this debate, but I completely take the point that there needs to be a lot more understanding and recognition of the importance of good epilepsy care that follows good practice and addresses the awful problem of so many people losing their lives unnecessarily to this condition.

[Valerie Vaz]

The issue is actually within the scope of the debate. We are talking about co-commissioning, but CCGs are not ready.

[Norman Lamb]

I totally accept the point. Again, I hope to reassure the hon. Lady.

The hon. Member for Luton North (Kelvin Hopkins) referred to robotic assistive surgery. I do not want to give him any particular hope, but it is always possible for new procedures to be added to the list of those that come within specialised commissioning. The prescribed specialist services advisory group keeps the list under review. Just as there are proposals to remove procedures, there is always the possibility, if the case is made and the four conditions that need to be taken into account are met, that additional areas can be included.

[Kelvin Hopkins]

I should have mentioned that robotics make possible an increase in non-invasive surgery, which is not only better for the patient, but much cheaper for the NHS, because there is less recovery time and so on.

[Norman Lamb]

I totally take that point. The hon. Gentleman is absolutely right that the NHS must be, as he put it, at the cutting edge of new technologies and new ways to reduce the invasiveness of procedures, although I add that having things in specialised commissioning is not the only way for the NHS to do so.

The hon. Gentleman was at risk of going into too much detail when he started talking about various procedures. Despite being a Health Minister, I am at risk of passing out on such occasions, so I was glad that he stopped when he did.

[Kelvin Hopkins]

rose—

[Hon. Members]

No!

[Norman Lamb]

I have hon. Members pleading with me not to give way, but if the hon. Gentleman insists, I will. No—that comes as an enormous relief to everyone.

The hon. Member for Alyn and Deeside (Mark Tami) made some important points about blood cancers and bone marrow transplants. I was interested in his point about the need for more joined-up approaches and services, not only within health, but between health and education. At its best, the proposition being put forward has the potential to achieve that, but I am with him on the ambition for much more integration between public services.

I want now to respond to some key points made by my hon. Friend the Member for St Austell and Newquay. NHS England is responsible for commissioning 147 prescribed medical services on a national basis. Those are specialised services for rare and complex conditions. The services are set out in legislation and commissioned directly by NHS England, through 10 area teams. By commissioning those services nationally, NHS England can commission each service to a single national standard, with single national access criteria, and ensure that patients have the same access to specialised services regardless of where they live in England.

The specialised services that NHS England commissions provide for people with rare or very rare conditions. Therefore, it is necessary to commission those services across a wider population than most CCGs cover—for example, in excess of 1 million people. Specialised services tend to be provided by larger hospitals that are able to recruit and retain clinical and support staff with sufficient specialised knowledge, expertise and leadership. That maximises the provision and co-ordination of care for the relevant patients. The list of prescribed specialised services is kept under review and therefore has the flexibility to change with advances in technology and treatment—such as those that the hon. Member for Luton North referred to.

It is for Ministers to take the final decision on which services should be included on the prescribed specialised services list in legislation and therefore which services are directly commissioned by NHS England. Those decisions are not taken lightly. Expert advice is provided by the prescribed specialised services advisory group—a Department of Health-appointed expert committee established in 2013. NHS England established a specialised commissioning taskforce in April 2014, which my hon. Friend the Member for St Austell and Newquay referred to, to make some immediate improvements to the way in which it commissioned specialised services and to put commissioning arrangements on a stronger footing for the long term. Of course, as I think everyone recognises, such services must be sustainable.

The taskforce aims to improve ways of working and to ensure that the commissioning of specialised services is undertaken in the most efficient and effective way possible. Additional resource from within NHS England has been diverted to the taskforce to ensure that it has the right mix of skills and expertise to enable it to meet its objectives.

[Stephen Gilbert]

As my right hon. Friend will be aware, the taskforce has just suggested that renal dialysis and morbid obesity should come off the list of prescribed specialised services. The decision has been taken over a short period and is due for implementation before the general election, on 1 April. Will he speak to his officials and NHS England about whether further consultation is needed on the decision and whether it could be delayed?

[Norman Lamb]

I take the concerns seriously. My hon. Friend discussed the need for more time in his speech. I will put his representations to officials and NHS England. I cannot go further than that, but I recognise the importance of the issues that he raises and I pay tribute to the work of his constituent Nicola Hawkins in collecting many names on her petition.

Following the work of the taskforce and conversations with key stakeholders last year—from individual patients and patient groups to CCG leaders, area teams and providers of services—NHS England has identified opportunities for improvement. That will affect both what is commissioned and how the services are commissioned.

The NHS England taskforce has identified two areas where there is potential for improvement, and that must be what the process is about. First, it has identified commonly-delivered services that it may be appropriate to devolve to CCGs for local commissioning. Formal responsibility for commissioning those services would be transferred to CCGs. Secondly, in line with the vision of the five-year forward view, NHS England proposes a more collaborative approach to commissioning specialised services, whereby it jointly commissions services with CCGs. That is not a transfer to CCGs—it is joint commissioning. While some highly specialised services will continue to be commissioned entirely nationally, CCGs will be invited to have a greater say over the commissioning of the majority of specialised services.

My hon. Friend intervened on the transfer of commissioning responsibility. The PSSAG met and formulated its recommendations on 30 September. Following proposals from NHS England, it concluded that renal dialysis services and morbid obesity bariatric surgery services did not meet the four statutory requirements—debated in Parliament—for commissioning nationally as part of the prescribed specialised services list, and that therefore commissioning responsibility should be devolved to CCGs. Ministers were minded to accept its advice on changes to the list of prescribed specialised services. Given the changes involved, they felt it was important to engage with stakeholders on the practicalities of transferring the commissioning responsibilities.

The Department of Health launched a public consultation on the logistics and timing of the transfer, which ran from November to 9 January. The consultation asked respondents to consider how a transfer of commissioning responsibility from NHS England to local CCGs could take place, and what would need to happen to ensure a smooth transition while service standards and patient safety were maintained.

We are carefully considering all responses to the consultation, and will respond in due course. NHS England has assured me that it is absolutely committed to issuing guidance to ensure the safe transfer of commissioning responsibility from nationally commissioned services to locally commissioned services, where that is recommended by the PSSAG. It is anticipated that a range of products would make up that commissioning guidance, including national service specifications, national standards and contracting information.

Concerns have been raised and views expressed today and through the consultation about the transfer of renal dialysis services, which I think are the subject of the petition that my hon. Friend referred to. I assure hon. Members that NHS England is in dialogue with stakeholders about both the opportunities and the challenges of transferring responsibility for renal services. Indeed, Dr Paul Watson, the specialised services taskforce lead in NHS England, met stakeholders from renal service representative groups on 18 November to hear their concerns. My noble Friend Lord Howe, an Under-Secretary of State, also recently met all-party kidney group. I repeat that I will relay my hon. Friend’s plea for more time and of course respond to him and other hon. Members.

In addition to the proposals for formal transfer of commissioning responsibilities, NHS England is currently exploring collaborative commissioning—which is what most of this afternoon’s speeches have been about—between NHS England and CCGs, for most specialised services. NHS England has identified the fact that some services will always need to be commissioned on a national basis, including, for example, services that were under the previous arrangements commissioned as highly specialised services. However, a number of services on the current list could potentially benefit from being commissioned on a smaller footprint with greater local involvement, to make joined-up services possible across the care pathway, while maintaining national standards.

One faces a danger when separating off some procedures for national commissioning if other parts of the pathway are commissioned at a local level; that is the case with obesity services, because preventive services are commissioned locally whereas bariatric surgery is commissioned nationally. The danger is that one creates false or artificial divides in the patient pathway, which can damage patient care and create perverse incentives. We have to be cognisant of that and see whether there are better ways of doing things.

NHS England is looking to provide an opportunity for CCGs to begin collaboratively commissioning a number of services in the prescribed specialised services list from April. The approach being taken is a deliberative one that does not impose things on the tight time scale that my hon. Friend was concerned about. Collaborative commissioning would likely be carried out through joint NHS England and CCG committees. It would maintain the expertise—the specialism—but there would be the potential to spread that expertise and build capacity at a local level, which could be in the interests of everyone.

NHS England is aware of several CCGs that would welcome the opportunity to become involved in specialised commissioning, but it is equally aware that many CCGs will not be in a position to take on such increased commitments from 2015-16. There is therefore no question of a return to the previous arrangements.

[Stephen Gilbert]

I remain grateful to my right hon. Friend for giving way, and to other colleagues; this is the last time that I will intervene. I hear what my right hon. Friend is saying. It is reassuring that he is using language about improvements to patient care and the benefits that patients will feel, because there is a danger—I think it is felt by all the patient groups that we have talked about this afternoon—that collaboration becomes buck-passing. I would be reassured if he was giving the undertaking that NHS England will continue to engage with those groups that feel they have not been engaged with already and that improvement to the patient experience is the bottom line in relation to some of these changes.

[Norman Lamb]

I can reassure my hon. Friend on both those points. Openness, transparency and engagement with patient groups are incredibly important, and I would always argue the case for them.

Collaborative commissioning would be an open offer; it would be an opportunity to keep up momentum for high-performing CCGs that are keen to deliver more for their local communities. NHS England is looking to pilot or trial these innovative arrangements in 2015-16—nothing more than that.

NHS England has established a specialised commissioning co-design group, including members of the NHS commissioning assembly, with advice coming from clinical and patient experts, to develop further the details of the collaborative commissioning approach. NHS England will also support CCGs to ensure that the commissioning system remains stable during the transition to any new arrangements.

NHS England is now embarking on a comprehensive programme of patient and stakeholder engagement to support the implementation of these changes; I think the hon. Member for Mitcham and Morden made a plea for that engagement to happen.

[Mark Tami]

It all sounds very good; localism is always thrown around as being a positive thing. My concern is that it still creates uncertainty. From the patient’s point of view, the uncertainty must be whether they will be able to access the treatment they need where they live.

[Norman Lamb]

That is a legitimate concern and fear, but the arrangements have the potential to avoid that risk, so that those concerns and fears are not realised; I will expand on that in a moment.

Guidance will be issued later this month setting out the detail of the proposed changes, alongside the criteria that determines which service is commissioned at which level. The engagement programme will include a number of patient and public engagement events and workshops in February, led by regional and area teams, to help to co-design the process for implementing the changes with CCGs. I encourage involvement with that programme, and as part of it NHS England will seek views on the criteria to decide which service is best commissioned at which level.

NHS England acknowledges that people are concerned about the re-emergence of a “postcode lottery”—the hon. Member for Alyn and Deeside specifically mentioned that point—as a result of a more collaborative approach. In particular, people are concerned that specialised services could once again be commissioned in a variety of ways across the country, resulting in patients experiencing difficulties in accessing services.

I totally understand why people have that anxiety, but let me be clear that NHS England would remain the accountable commissioner for any services commissioned collaboratively with CCGs. My hon. Friend the Member for St Austell and Newquay referred to the Health Committee’s concerns about the previous arrangements. However, because NHS England would remain the accountable commissioner and because commissioning would be done collaboratively, I think that concern has been sufficiently addressed.

Since April 2013, NHS England has achieved significant progress in developing a set of nationally consistent service standards and commissioning policies, which have been widely welcomed. They ensure equity of access to high quality services; the point about access was referred to by a number of hon. Members. These standards and policies will still apply for specialised services that are jointly commissioned by NHS England and CCGs, and NHS England will continue to improve on those in the years to come. I think that the shadow Minister, the hon. Member for Copeland (Mr Reed), also raised concerns about access and I hope that he finds what I have said about it reassuring.

For any services that are fully devolved to CCGs, allocations will be made on the basis of activity. Data from NHS England area teams would be used to trace historical activity levels and CCG funding allocations would be based on those, with adequate adjustments for population increase.

The purpose of the move to collaborative commissioning is to support more effective joint working and to allow discussions about service redesign to take place across the local health economy, engaging both national level and local level to try to build capacity.

In the short term, patients should not notice any difference to the service they receive, and in the medium to long term NHS England is confident that these changes should result in improvements, rather than a deterioration—including improved outcomes for patients, more integrated pathways and a better patient experience. We continue to work closely with NHS England as it develops these proposals and engages with all those involved in the commissioning of specialised services, including CCGs, individual patients and—critically—patient groups, area team commissioners and providers of services.

I thank all hon. Members and the sole right hon. Member here today, the right hon. Member for Wolverhampton South East, for contributing to this debate in a constructive way. The issues that have been discussed are of real concern, and it is right that they should have been raised. However, I think we have the potential to improve the way in which the system operates.

[Mr Peter Bone (in the Chair)]

I thank all right hon. and hon. Members for this excellent debate.

Question put and agreed to.

15:38

Sitting adjourned.

Written Statements

Thursday 15th January 2015 Written Statements

Thursday 15 January 2015

Corporate Transparency

Thursday 15th January 2015 Written Statements

[The Parliamentary Under-Secretary of State for Business, Innovation and Skills (Jo Swinson)]

I have today published our current plans for the implementation of parts 7 (Companies: Transparency) and 8 (Company filing requirements) of the Small Business, Enterprise and Employment Bill.

These timings are obviously subject to the will of Parliament. However, we want to make sure those affected by reform have as much notice as possible. In summary, we intend to implement proposals in three main stages—two months after Royal Assent, October 2015 and April 2016. Companies will be required to keep a register of people with significant control from January 2016. They will need to file this information at Companies House from April 2016.

These are significant changes and we are thinking carefully about the secondary legislation, systems changes, guidance and communication requirements we will need to give effect to them.

In October 2014 I published a discussion paper on core elements of the PSC register policy, seeking views on the statutory and non-statutory guidance needed to support understanding of the new requirements; the way that a person’s control over a company is recorded on the PSC register; and the process by which people at serious risk of harm can apply to have their information protected from public disclosure on the PSC register.

The paper closed on 9 December and I am grateful to all those who responded. I look forward to continued dialogue and engagement as we develop the draft regulations.

The responses confirmed the need for clear guidance to support implementation of the PSC register. I therefore intend to create a working group with a broad membership, including business representative bodies and civil society groups, to oversee the development of the general guidance required by companies and others. I have asked Peter Swabey of the Institute of Chartered Secretaries and Administrators (ICSA) to chair this working group, given ICSA’s experience in developing company law guidance. I have today published the draft terms of reference for that group.

I also intend to ask a select group of experts, composed of company law specialists, to form an “expert working panel” to draft the statutory guidance required to set out what is meant by “significant influence or control” in the context of the PSC register.

On the question of recording control on the PSC register, there was strong support for further Government regulation. I intend to adopt a business-friendly approach, requiring people to state which one or more of the “specified conditions” for being a person with significant control they meet. This will ensure consistency in terms of the information on the register and provide clarity for companies and others.

The process by which individuals may apply to have their information suppressed from public disclosure in exceptional circumstances is a key factor of the secondary legislation implementing the PSC register. The discussion paper sought views on a number of elements of the regime and we received a wide range of views. We will continue to develop this complex and important area over the coming months.

I am minded to limit those able to apply for protection to individuals at serious risk of violence or intimidation as a result of a company’s activities. We are continuing to consider this point. However, we do not anticipate extending the regime to cover purely economic risks.

I agree with the majority of respondents who felt that applications should be able to be made by third parties on behalf of people with significant control—such as the person’s legal representative. We also agree there is merit in allowing people to apply in advance of becoming a PSC, so that they can ensure the protection will apply from day one.

[HCWS188]

Insolvency Proceedings

Thursday 15th January 2015 Written Statements

[The Parliamentary Under-Secretary of State for Business, Innovation and Skills (Jo Swinson)]

In August 2014 I announced a call for evidence in order to review the way in which debt relief orders have performed since they were introduced in 2009, including looking at the eligibility limits for applying for a debt relief order. This call for evidence also asked for views on the creditor petition limit for bankruptcy, which was set at £750 in 1986. We asked whether this figure should be increased and, if so, to what level. We also undertook a survey of debtors who had applied for debt relief orders.

The responses to both the call for evidence and the survey of users showed that debt relief orders are thought to be working well and have provided an important additional route for debt relief for vulnerable people, with benefits for mental health and family relationships as well as allowing a fresh financial start.

Following the call for evidence, it was apparent that it was widely believed that some of the limits on debt relief orders needed to be increased. Bankruptcy is considerably more expensive than applying for a debt relief order and I was made aware that there may be people who are unable to apply for bankruptcy but have very low assets and income and creditors would therefore not be likely to receive any payment.

The Government have therefore decided to increase the debt relief order eligibility criteria, the maximum debt level increasing from £15,000 to £20,000 and asset limit from £300 to £1,000. This will allow more people to access debt relief. No change will be made to the maximum level of surplus income allowed.

With regards to the creditor petition limit for bankruptcy, there was also a strong body of views that this should be considerably increased. Bankruptcy is the strongest of insolvency tools and I believe that someone should only be put into bankruptcy by a creditor for a significant level of debt, especially taking into account that various other debt collection methods, such as county court judgements, are available. Having taken account of all the responses, the Government have decided that the creditor petition level should be raised from £750 to £5,000.

I am today laying statutory instruments to give effect to these changes from 1 October 2015.

We also received a number of helpful suggestions relating to the how the debt relief order process works. We will ensure that those at risk of violence are sufficiently protected when applying for a debt relief order. We will also undertake some monitoring to ensure consistency on process between competent authorities who assist debtors in their applications. We will provide more options of how payments can be made when applying for a debt relief order. We are also contributing to work to ensure common guidance across all financial organisations with regards to how surplus income is calculated for different debt relief purposes, ensuring fairness and transparency.

It is important to me to ensure that those who require debt relief have access to it, while taking account of creditors’ interests, and that creditors’ powers to collect debts are set appropriately. These policy changes will ensure that this is the case and this will continue to be monitored and a review will be carried out after two years of operation.

[HCWS189]

Economic Policy

Thursday 15th January 2015 Written Statements

[The Chancellor of the Exchequer (Mr George Osborne)]

I sent yesterday evening to the Governor of the Bank of England a letter setting out the updated remit for the Monetary Policy Committee (MPC).

I have reconfirmed the inflation target as 2% as measured by the 12-month increase in the consumer prices index (CPI).

I have also confirmed that the economic policy objective of the Government is to achieve strong, sustainable and balanced growth that is more evenly shared across the country and between industries.

In the event of CPI inflation moving away from the target by more than 1 percentage point in either direction, the updated remit ensures that the inflation open letter will be sent alongside the first routine publication of the MPC after the meeting that follows the publication of CPI inflation.

In conjunction with the Treasury’s responsibilities under the Bank of England Act, copies of the updated remit for the Monetary Policy Committee have been laid before Parliament.

[HCWS190]

Foreign Affairs Council

Thursday 15th January 2015 Written Statements

[The Minister for Europe (Mr David Lidington)]

My right hon. Friend the Secretary of State for Foreign and Commonwealth Affairs will attend the Foreign Affairs Council on 19 January. The Foreign Affairs Council will be chaired by the High Representative of the European Union for Foreign Affairs and Security Policy, Federica Mogherini. The meeting will be held in Brussels.

Russia

This discussion will focus on the EU’s relationship with Russia, which has deteriorated rapidly following Russia’s illegal actions in Ukraine. The UK will argue that the EU must continue to lead the way in holding Russia to account for its actions. There must be full implementation of the Minsk agreements before any reduction of sanctions measures against Russia. Any new relationship with Russia must recognise that Russia can no longer be considered a strategic partner to the EU and that business must be conducted with full implementation of national and EU law.

Climate change

The high representative will update Ministers on the UN climate negotiations. Ministers will discuss the aims for co-ordinated EU climate diplomacy activity in 2015 ahead of negotiations to agree a global deal on climate change at the conference of the parties to the UN framework convention on climate change in December. The UK will stress that climate change, with the risks it presents to international prosperity and security, must remain a foreign policy priority for the EU and that the EU needs to demonstrate leadership in the pursuit of an ambitious global climate deal in 2015.

Libya

Discussions on Libya will focus on the deteriorating security situation. The Secretary-General of the Arab League, Nabil Elaraby, may join Ministers for part of this discussion. The UK remains deeply concerned by increasing violence and political polarisation in Libya and its impact on the wider region. The UK’s priority will be to ensure the continued support of member states for the efforts of the Special Representative of the UN Secretary-General for Libya, Bernardino Leon, to resolve the political crisis and pave the way for peaceful political dialogue.

[HCWS194]

Code of Practice: Mental Health Act 1983

Thursday 15th January 2015 Written Statements

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

Following a public consultation, the Government have today laid a revised Code of Practice: Mental Health Act 1983 before Parliament. We intend that the revised code becomes effective from 1 April 2015.

The code, which applies in England, is important because it underpins the Mental Health Act 1983 which affects the lives and liberty of many people with a mental disorder, impacting upon them and their families, friends and carers. In 2013-14, there were more than 53,000 detentions in hospital in England under the Act. The revised code does not include any changes to primary legislation.

The code routinely informs the practice of health and social care professionals: it helps to safeguard patients’ rights and ensures compliance with the law. The code can help make sure that anyone experiencing mental disorder and being treated under the Act gets the right care, treatment and support, knows what their rights are, what they can expect in certain situations and what to do if things are not done correctly.

Since the code was last published in 2008, there have been substantial changes and updates in legislation, policy, case law, and professional practice. The revised code now reflects and embeds developments since 2008 in areas including the use of restrictive interventions; use of police powers to detain people in places of safety; and the use of community treatment orders.

When we published “Transforming care: A national response to Winterbourne View Hospital and Closing the Gap: Priorities for Essential Change in Mental Health”, we committed to improving mental health services. “Closing the Gap” set out 25 priority actions to improve the provision of mental health care, promote recovery and the experience of patients, their families and carers. “Transforming Care” also committed the Department to review and consult on a revised code to address the need to improve the quality of care received by patients detained under the Act.

We remain committed to ensuring that high quality care is always provided for all patients treated under the Act. Care should always be a means to promote recovery, be of the shortest duration, be as least restrictive as possible and keep the patient and other people safe.

The revised is available in the Library of the House. It can also be found on the gov.uk website at: https://www. gov.uk/government/publications/code-of-practice-mental-health-act-1983

[HCWS195]

Advisory Committee on Clinical Excellence Awards

Thursday 15th January 2015 Written Statements

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

I am today announcing the start of the triennial review of the Advisory Committee on Clinical Excellence Awards (ACCEA).

All Government Departments are required to review their non-departmental public bodies (NDPBs) at least once every three years. Due to the wide-ranging reforms made by the Health and Social Care Act 2012, the Department was exempt from the first round of reviews in 2011-14. In order to ensure that the Department is an effective system steward and can be assured of all the bodies it is responsible for, we have extended the programme of reviews over the next three years to all its arm’s length bodies and Executive agencies.

The review of the ACCEA has been selected to commence during the first year of the programme (2014-15). The review will consider the committee’s functions and corporate form, as well as performance and capability, governance and opportunities for greater efficiencies. The Department will be working with a wide range of stakeholders throughout the review.

[HCWS192]

Disclosure and Barring Service

Thursday 15th January 2015 Written Statements

[The Minister for Crime Prevention (Lynne Featherstone)]

My hon. Friend the Parliamentary Under-Secretary of State, Home Office (Lord Bates) has today made the following written ministerial statement:

The 2013-14 Annual Report and Accounts for the Disclosure and Barring Service is being laid before the House today and published on www.gov.uk. Copies will be available in the Vote Office.

[HCWS196]

Property Boundary Disputes

Thursday 15th January 2015 Written Statements

[The Parliamentary Under-Secretary of State for Justice (Mr Shailesh Vara)]

My noble friend the Minister of State for Civil Justice and Legal Policy (Lord Faulks QC) has made the following written ministerial statement.

The Government are today publishing an initial scoping study on property boundary disputes. This fulfils a commitment given by the Ministry of Justice in response to a written parliamentary question from Charlie Elphicke MP on 14 February 2013 (Commons Hansard, 14 February 2013, Column 874W).

The scoping study was undertaken because of concern that such disputes are all too often disproportionately bitter, protracted and expensive. The study took the form of interviews with a small number of key stakeholders and the distribution of a questionnaire to 30 organisations with an interest in land law issues including boundary disputes. Input was also received during the period of the study from a number of individuals involved in boundary disputes.

The study reflects the views expressed in the responses received on the nature, frequency and causes of boundary disputes, the effectiveness of current resolution methods, and the problems that currently arise and what could be done to address them. It discusses a number of options for legal or procedural change, and concludes that the Ministry of Justice should carry out further work to assess the feasibility of improvements in a number of areas, including in particular the use of mediation and expert determination, the spreading of best practice and the provision of better information with a view to reaching more definite conclusions in 2015, but that more radical reform is not currently justified.

Copies of the scoping study are being placed in the Libraries of both Houses.

It is also available online at: http://www.parliament.uk/writtenstatements.

[HCWS193]

Parliamentary Assembly of the Council of Europe: UK Delegation

Thursday 15th January 2015 Written Statements

[The Prime Minister (Mr David Cameron)]

The right hon. Member for Ross, Skye and Lochaber (Charles Kennedy) has been appointed as a full member of the United Kingdom delegation to the Parliamentary Assembly of the Council of Europe in place of the hon. Member for Portsmouth South (Mike Hancock). The hon. Member for Taunton Deane (Jeremy Browne) has been appointed as a substitute Member.

[HCWS191]

Grand Committee

Thursday 15th January 2015 Grand Committee

Thursday, 15 January 2015.

13:00

Cadet Units in Schools

Thursday 15th January 2015 Grand Committee

Question for Short Debate

Asked by

[Lord Lingfield]

To ask Her Majesty’s Government what plans they have to promote more cadet units in schools.

[Baroness Garden of Frognal (LD)]

My Lords, will Members making speeches limited to four minutes please sit down as soon as the Clock reads four, and preferably a few seconds before. Thank you.

[Lord Lingfield (Con)]

My Lords, I begin by declaring an interest as the chairman of a charity, CVQO, the Cadet Vocational Qualification Organisation, an appointment in which I was proud to succeed Admiral West—the noble Lord, Lord West of Spithead. The Combined Cadet Force has a long and honourable history. It finds its roots in the rifle volunteer battalions for home defence which, in the early 1860s, acquired some school units. They numbered 90 by the beginning of the Great War. By 1938, that number had doubled. During the Second World War, Royal Navy and RAF sections were added, and shortly after the war they were combined into the Combined Cadet Force. Her Majesty the Queen became its Captain General early in her reign. Today, we have about 46,000 cadets in 260 schools and there are about 2,800 adult instructors and officers

In 2008, I and other supporters of cadets—I was an honorary colonel at the time—were very pleased indeed when Gordon Brown revealed his plans to increase the number of cadet units in state secondary schools. In May last year, David Cameron announced the cadet expansion programme, which was planned to deliver another 100 cadet school units by September this year. It was with dismay, therefore, that we received the news in July that the MoD proposed that funding as it currently happens should cease and that, indeed—presumably to pay for those new units to be created—the cadet grant should end next September; that the year after that, remuneration for cadet officers and other adults should end; and that the year after that, a government charge of £75 per cadet should be made and should double the year after that.

The consultation which followed suggested that about 60% of schools with cadet corps would not be able to continue them, leading to a loss of probably half to two-thirds of the current number of cadets. It was clear that the department had failed to take into account the fact that schools already contribute considerable resources to cadets and that further funds from their general expenditure would not be possible. That was not where the Prime Minister’s initiative was meant to lead.

It was with pleasure, therefore, that I received a letter on 10 December from the noble Lord, Lord Astor of Hever, from the MoD, which said that those proposals would not go forward and that funding as currently conceived would continue and would extend to the new school cadets. That was very good news indeed, as was the news that I heard later that the schools expansion programme was on time and back on track and that we have about 60 new schools ready to open their cadet corps in September, with another 50-odd in the pipeline. That was good news, as was the cadet bursary fund, of which I know that the Minister is himself a great supporter. That is meant to support the expansion of cadets, and to raise £8 million over the next four years. I would be grateful if the Minister would indicate, when he replies, where that fund is and the prognosis for the future.

If last July’s proposals were indeed misconceived, the MoD was right to subject cadet funding to some scrutiny. That was absolutely proper. Cadets cost annually about £160 million, of which £28 million is spent on school cadets, with the rest going on cadets in the community—the Army Cadet Force, the Air Training Corps and the Sea Cadets. We have to ask ourselves: are they worth it? Are those sums of money justified? In my view, they certainly are.

Not very long ago, I was speaking at a national competition to a young man from one of our northern cities. He was badged as a guardsman and dressed in the scarlet of a drum major. It became clear during our conversation that he had left school with just one poor GCSE and had had a little intermittent work since, cleaning cars. It was also clear that his cadet unit—with its regular attendance, discipline, uniform, and its opportunity for leadership skills and for taking BTEC and other qualifications, which he had started to do—was the only way that he could show any self-worth at all and gain any self-esteem. He said to me, “If it hadn’t been for the cadets, it would be drugs and trouble for me”, and he was beginning to do well.

Stories such as that are legion, and they tend to suggest that every penny we spend on cadets is worth while and could save money in other areas of public expenditure. My own organisation, the CVQO, puts thousands of cadets each year through BTECs and other similar diplomas. They acquire at the same time those life competences of punctuality and a can-do attitude. They are most likely then to go into work and on to higher vocational qualifications. They are less likely to be NEETs or benefit claimants, or indeed to encounter the youth justice system. It is also not too far-fetched to say that the NHS saves money from cadets, because they tend to be healthier, fitter and less obese. Certainly, they make good recruits to the Armed Forces, in both the Regular Forces and the Reserve Forces. There is also some indication that in later lives they are more inclined towards volunteering in their communities. However, all that is anecdotal. We seriously require a study of the social impact of cadets and of their value for money. I very much hope that the Minister will indicate whether such a study might be possible.

Finally, I mention another excellent government scheme, the military ethos in schools programme, in which my own organisation, among many others, takes part. Typically, some dozen young pupils are selected in each school. They tend to be those who are having problems with discipline and have low achievement. They benefit enormously from the cadet-type work that they do, supervised by cadet instructors, which is usually part-time. Their schools are hugely supportive of this and report better attendance among those pupils, improved self-worth and an increase in levels of literacy and numeracy.

Finally, cadets were created some 150 years ago with the object of making better soldiers. Today, the object is to make them better citizens, and long may they be enabled to do so.

13:10

[Lord Jones (Lab)]

My Lords, in a very long public life, most of it in these two Houses, I have not encountered better provision for youth than that proffered by the nation’s cadet force associations. From my own observations, I can say that what is done by the Army for young women and men is magnificent. They are provided with excellent opportunities, facilities, training and mentoring. There are many successes and Wales is a determined partner in this success. I attend cadet camps throughout the length and breadth of England and see these achievements. The Committee owes the noble Lord, Lord Lingfield, a debt of gratitude for securing this debate. I sincerely support him wholeheartedly. He has made the case for cadet units in our schools and defended them. I thank him for his insightful, loyal and committed remarks.

I also acknowledge the professionalism of Brigadier David Short, the ACFA chief executive officer, for his élan, vigour, experience and enthusiasm. I do not say that for nothing, as he commanded Apache attack helicopters in British squadrons. We are in good hands.

I declare my interests as president of the Army Cadet Forces Association Wales, as president of the training ship “Tuscan”, and my very long-standing association with 2247 Squadron ATC, both of the latter in Flintshire. I have seen a lot of them.

In Wales we have a leadership team dedicated to the best interests of the cadets. I offer praise to Colonel Commandant AV Jones in Clwyd and Gwynedd, covering the communities of the Snowdonian massif and industrial north-east Wales. I also praise Colonel Commandant David Hammond, a very distinguished professional soldier, who leads over the seascapes of Dyfed and the city of Swansea, and Colonel Commandant Rob Hughes, who copes with the vast interior of Powys and the eastern valleys of Gwent. Our splendid chairman is Colonel John Brunt, himself a former commandant. The colonel of cadets is the ubiquitous Colonel Mike Mullis. We recently welcomed our new secretary, Colonel Naysmith, saying goodbye to a wonderful secretary of 10 years—Major John Carter, to whom I owe a great deal. This team faces up very boldly to the constant challenges of distance, climate and topography. We are a very varied people in Wales with distinctive approaches, but I think that the movement is a splendid success in my homeland.

I place on record my thanks to the right honourable Secretary of State Iain Duncan Smith for receiving my deputation concerning the outreach programme. He also commanded his civil service unit to be present. Outreach is a generous gift from the Army. It reaches out to the young underprivileged and offers a way forward to boys and girls in our high schools, who, for example, may have encountered the police and the magistrates’ youth court. They then do very well on the course. Time is of the essence, so I shall sit down.

13:15

[Lord Burnett (LD)]

My Lords, I congratulate my noble friend Lord Lingfield on securing this debate and for the wholehearted support he gives to the cadets. I also thank my noble friend Lord Astor of Hever for his great support for the cadets.

Life is full of coincidences. I was up on Dartmoor last Saturday. I spend a great deal of time there; not, I hasten to add, in the prison, though I have been there a few times—I made guest appearances only. While up on Dartmoor I came across 60 cadets who were learning to do a six mile or so advance to contact in hostile conditions, on hostile terrain and in hostile weather. It was raining and very cold. They were in cold-weather clothing, though their instructor, I am proud to say, Corporal Credicott of the Royal Marines, was in shirt-sleeve order: noble Lords must remember that it was not quite freezing. Corporal Credicott had come up from Commando Training Centre Royal Marines to instruct the cadets.

These 60 or so cadets were from Tavistock and two other units. They need not have come; they were all volunteers, all dedicated and enthusiastic. They were giving up their free time to learn leadership skills, how to work together in adversity and many other lessons, including initiative and self-discipline. I was immensely impressed and proud of them. I believe, as my noble friend Lord Lingfield said, that other departments of state should contribute to the cost of the cadets.

It is a shame that we have only four minutes in which to speak, but I also want to thank Lieutenant General Sir Robert Fulton, a former commandant-general of the Royal Marines, a corps in which I had the honour to serve, for briefing me. I congratulate the Ministry of Defence and our Secretary of State on recognising the importance of the cadets. He saw them at first hand when the Royal Marines Cadets were at Buckingham Palace last summer. The year 2014 was the 350th anniversary of the formation of the Royal Marines. Due to the tireless work and commitment of many, particularly Colonel Cautley of the Royal Marines Reserve, Her Majesty the Queen last year instructed that henceforth all cadets who are entitled to wear the Royal Marine uniform will be called Royal Marines Cadets. Some 500 or so Royal Marines Cadets and instructors marched behind the band of Her Majesty’s Royal Marines from Horse Guards to the gardens of Buckingham Palace, where his Royal Highness Prince Philip, the Duke of Edinburgh, took the salute. I shall end by reading an excerpt from his Royal Highness’s address. He said of the Royal Marines Cadets:

“They have a very special reputation of their own which reflects the reputation and achievement of Her Majesty’s Corps of Royal Marines”.

13:18

[Lord Freeman (Con)]

My Lords, like my noble friend Lord Lingfield, I am a very strong supporter of the cadet forces. We need more cadet units and I am very grateful for and appreciative of the efforts taken by the Ministry of Defence and, in particular, by my noble friend Lord Astor to ensure that we are on an upward and, I hope, sustainable track in supporting more cadet units. My experience, like that of many of your Lordships, was at school, having served in the Combined Cadet Force. Then it was compulsory. I am not in favour of compulsion, but everyone was in full uniform and received weapon training. That is very expensive, partly because of the cost of provision of armouries, let alone safety; those were the days. Today there are many fewer combined cadet forces and, clearly, cost is a factor. So I ally myself behind those, and with those, who call for a further expansion and I am delighted at the support that has been given.

I will very briefly mention one initiative which I am associated with: the military ethos in schools programme. That involves former military personnel—who I am told are already in 460 schools throughout the United Kingdom—explaining the ethos of the military and explaining and using the discipline and determination that is expressed so well by many in our Armed Forces, helping to improve not only the self-discipline but the ambitions of more than 16,000 children. I thank Her Majesty’s Government for their continuing support for that programme.

Finally, I will touch on the connection I have, partly because I have served as president of the Council of the Reserve Forces and Cadets Association. At the time I served in that association it had 50,000 reservists. Today we have an ambition to get back to something like 30,000, which is a very tall order. I hope that increasing the activities and numbers of school cadet forces will feed through to participation in our Reserve Forces in later life. It is vital that we have 30,000 reservists as soon as possible, because our Regular Forces are being reduced significantly. Initiatives taken at school, and school cadet forces, can help.

13:21

[Lord Ramsbotham (CB)]

My Lords, I, too, congratulate the noble Lord, Lord Lingfield, and thank him for obtaining this debate. I also congratulate him on his leadership of the CVQO, which I know is much appreciated.

I make no apologies for diverting slightly, but the noble Lord mentioned the youth justice system. Recently the Secretary of State for Justice announced that he wants to put education at the heart of the youth justice system. I therefore feel that there is a connection between the subject of this debate and what is wanted in the youth justice system. I will explain some of the things that have happened in the past which give me encouragement to speak like this. Before I do so, I join the salute to the noble Lord, Lord Astor, for all he has done, and say how welcome that letter was. I cannot believe that it resulted from anything other than a great deal of work on his behalf, so I thank him for that.

When I took over as Chief Inspector of Prisons in 1995, very soon afterwards the then Home Secretary told me that he wanted to impose what he called a “boot camp regime” based on what he had seen in America. He thought that the only place where he might find that was in the military prison at Colchester. I told him that that military prison was not a prison—it was the Military Corrective Training Centre and that it had two parts: one was a sort of resettlement prison, returning people to civilian life, and the other gave a second start to people who had made a bad start in their careers. They therefore did basic training again, which resulted in an 84% success rate. Indeed, the MCTC counts 11 regimental sergeant majors among its successes.

One of the very interesting facts about the population of the MCTC was that virtually none of the people who came through that programme had ever been in the cadets. Having been in a regiment which strongly supported the cadets and indeed welcomed people with cadet experience because they had had, as it were, a flying start to their regimental career, I was very interested in that. Therefore one of the things I hoped was that, as a result of the experience of sending young offenders to the MCTC—where they grew up amazingly and responded to military discipline in a way which was immediately recognised by their parents, quite apart from their instructors—perhaps a cadet force might be formed in a young offender institution. Indeed, one was started at Feltham. It has not taken off as well as it might, but I suspect that that is as much because of lack of encouragement rather than lack of opportunity.

Recently, there was the idea of setting up, for instance, a secure foundation, which is a local area responsibility in a one-hour radius by public transport for young offenders. Incidentally, all the local councils, in seeking what the place should do, all wished a cadet force to be part of the curriculum because of what it offered the young people. Therefore, my plea to the Minister is that he should contact his colleagues in the Ministry of Justice, commend to them that the military ethos in schools programme should be extended to young offender institutions, because it clearly works, and do all that he can to encourage this. You never know, out of the youth justice system we might rescue some people for the Armed Forces, quite apart from anything else, and nothing has a better track record of dealing with young people and building up their self-esteem than the cadet force.

13:25

[Baroness Seccombe (Con)]

My Lords, I add my congratulations to my noble friend for giving us this opportunity to debate this important issue. First, I want to declare an interest as my son is chairman of the West Midlands Reserve Forces’ and Cadets’ Association.

When I was at school I was a Sea Ranger, which was odd as I lived in the centre of England as far away from the coast as you could be. We were instructed by a retired naval officer who was a great believer in the power of marching and all its intricate moves. I loved it and could see that we all gained from working together with great precision. We were the best and proudest of anyone as we marched along The Mall for the then Princess Elizabeth. Noble Lords may question what this has got to do with the subject. All I know is that I benefited from it and it was all that was on offer at the time. We had to spend two hours each day in some form of sporting activity. Children do not have that chance today but now they have this splendid opportunity through membership of a cadet detachment to combine active involvement while developing important life skills. I believe in today’s hazardous world it is really important that young people learn more about the military and voluntary ethos. The cadet expansion scheme gives that opportunity to learn about self-discipline, teamwork, punctuality and self-confidence—all so useful throughout life.

The cadet movement has always been part of life in independent schools, so I was delighted when last year the Government agreed, at last, to fund a scheme with £1 million added to the £10 million already pledged to help state schools cover the setting-up and running costs of 100 new cadet units within a year. The sum is being matched by the private sector. I understand that the initiative is going well and I agree with my noble friend that it would be good to have an update from the Minister. It seems to me that this would be a principled cause to motivate charities and philanthropists in generous donations as well as then following up with interest. Of course, in any exercise of this kind so much must depend on head teachers. They are the ones who must first excite the students and the parents on the benefits of the cadet experience and then drive the project forward. They must explain what will be gained by being part of a team, developing particularly self-confidence and self-discipline. This will be important as the students face all the new challenges that this will offer them. They will be able to go on expeditions, do activities such as sailing, and develop skills in advanced first aid and, most importantly, leadership. Other critical individuals are the adult volunteers who, I understand, are coming forward in encouraging numbers. Perhaps the Minister could update us on this also.

I believe that, whether participation in the scheme leads to a life in the services or not, these young people will enter adulthood as well rounded citizens. They will have had invaluable experience to test themselves in many ways and will emerge more self-confident and, I believe, more understanding, ready to take their place in society. I am sure we all wish we could have had the opportunity in our own school days.

13:29

[Lord Rogan (UUP)]

My Lords, through my involvement in politics and with a personal interest, I have had the good fortune to spend time with the men and women of our Armed Forces. I know that the noble Lord, Lord Burnett, is especially pleased that some of that time was spent with his Royal Marines. I have had the privilege of watching the modern Army at work. As an honorary colonel of a signals regiment, I have come to greatly admire the character of those who serve. I have listened to many tales from serving soldiers about what the Army has done for them—how it shaped and moulded their character and gave them the skills to fulfil their potential.

George Washington said:

“Discipline is the soul of an army”,

and that one of its outworkings was “esteem for all”. Words such as “discipline” and “respect” have formed a common refrain in this debate and that is as it should be. While the Army Cadet Force is very deliberately a youth organisation, and not some junior version of the Army Reserve, it does share some common genes with military service—genes which we would do well to encourage throughout society.

People like to complain about the young. It is the natural order of things and has been ever thus. Every generation has shaken its head disdainfully at the prevailing trends of youth culture. Punks, mods, rockers and even the flappers of the 1920s have all been cited as evidence of moral rot. In the 21st century our terminology is less gracious and headline writers are never happier than when writing about the “feral youth” running amok across society.

Clearly, young people are not undermining the fabric of society but I do think that the very nature of modern society is helping to undermine the prevalence of characteristics that are for the common good. Today’s society is more atomised and less community-orientated than at any time I can recall. The ties of tradition, family and religion have loosened. We live in an instant age and are prone to live in the moment and for the moment. We are less patient, less thrifty, less structured, less active and more self-centred—and that applies to the not so young as well as to the young. We live in an era of dichotomy, where medical advances that would have seemed beyond possibility to the post-war generation are accompanied by the plague of obesity. In our relative culture of plenty we have all become concerned with rights rather than duties. We have never had more, but are we really more content or happier?

Frankly, “discipline” and “self-reliance” are not the watchwords of modern Britain’s zeitgeist. You could almost say that they are countercultural. That is why I have no hesitation in supporting the Motion of the noble Lord, Lord Lingfield, to encourage more cadet units in schools. In an age where virtuous and liberating characteristics, such as self-control, hard work, camaraderie and discipline are hard-pressed, we should encourage activities, especially among our youth, which help push back against the prevailing headwinds.

Cadet units build self-confidence, they prepare people for work, they teach respect for the self and for others, they encourage fitness, and, as has been mentioned, the financial cost of involvement is minimal. Sometimes you do not have to reinvent the wheel to solve a problem. School cadet units are an excellent outlet for 12 to 18 year-olds, and many more of them should have the opportunity to get involved.

13:34

[Lord Lexden (Con)]

My Lords, this is indeed a most valuable debate, for which we are indebted to my noble friend Lord Lingfield. Sadly, my career in the school cadet force long ago was an utterly inglorious episode, all details of which must be suppressed.

I have nothing but praise for the Government’s plans—now well advanced—to enable more maintained schools to establish cadet units. A number of those schools already have them but, like the excellent state boarding schools, they are among the nation’s best kept secrets. Their ranks should be swelled, and now they will be.

The increase in the number of cadet units is surely to be welcomed on two grounds above all. First, it will confer benefits on many more youngsters, assisting the shaping of responsible character and the provision of otherwise unattainable opportunities. Secondly, it will assist the national interest. Our defence in the years ahead will rest on the Territorial Army to a much greater extent than in the recent past. The expansion of cadet units will help furnish the recruits that the TA will need.

I have just one principal objective in this short debate: to advocate greater collaboration between independent and maintained schools. I should add that I have long been associated with the independent sector of education. Collaboration is already flourishing in a number of places. The head of an independent school in York wrote recently that it has,

“pupils from a neighbouring state school training alongside our cadets every week”.

Another head teacher in Cheltenham described how a contingent formed recently in a nearby academy has been developed in partnership with his school’s CCF,

“using our experience and resources, and they are bringing some superb talents to the team”.

I am sure that the Minister will agree that such partnership ventures should be encouraged throughout the country.

Of course, not all independent schools have attained the highest standards throughout their histories. One school magazine reported on 3 May 1888:

“The majority think it monstrous if they are obliged to attend twenty drills in the summer term. The consequence is that whenever the corps makes its appearance the drilling is bad, the marching is slovenly, and it becomes the laughing stock of the school”.

The school in question was Harrow, and its cadet force was about to secure a new recruit: Winston Churchill. He swiftly transformed it, making it what would today be called a model of good practice. It was therefore so very appropriate that contingents of cadets were prominent at his state funeral 50 years ago this month. We can be sure that he would have been much in favour of the expansion of the number of cadet units which is now taking place. He always said that the opportunities available to the few in public schools should be extended throughout the nation.

13:37

[Earl Attlee (Con)]

My Lords, I am grateful to my noble friend Lord Lingfield for introducing this Question for Short Debate about cadets. On the point about recruitment, I point out that the cadets are a youth movement, and the cadet force is worth while even if the Armed Forces get no recruits from it. We would just need to find another way of funding the cadets.

I started my military involvement with Stowe School CCF and, as I observed at Second Reading of the Social Action, Responsibility and Heroism Bill, in the mid-1970s I was allowed to do things as a cadet that would be absolutely out of the question now. For instance, I was allowed to go off on my own on a TA internal security exercise, and I took exactly the same physical risks as adult TA soldiers. Yes, risks were taken because military exercises are inherently hazardous, even though we try to reduce the risk as much as possible. I hope that the Committee will agree that it was worth taking those modest and controlled risks.

In my career, one thing led to another. Being a cadet led me to the TA, a point made by my noble friend, Lord Freeman. For me, the TA involved logistics and leadership, and that led me to running an NGO in Rwanda. That meant that I had utility to the regular army for peacekeeping operations in the Balkans and, of course, that I had utility to your Lordships’ House. Of course, this argument that one thing leads to another is not unique to someone with the privileged background which I have. It applies to everyone, no matter what their background.

There is one problem I would like to draw to the attention of the Committee and the Ministers. I understand that the maximum age of cadets was 18 and a half, but it has been reduced to 18. Apparently, the reason is that adults are not allowed to share accommodation with cadets, and I can understand the reason for that. Noble Lords might think that this is a small change, but an attractive activity for cadets is target rifle shooting, and competitions are held nationally and internationally. The problem is that other nations can field a team with cadets aged up to 19, and it is difficult for 18 year-olds to compete with a 19 year-old because at that age an extra year of maturity, concentration and everything else makes a significant difference. This is, of course, a matter for both Ministers—my noble friend Lord Nash for education, and my noble friend Lord Astor of Hever, who I am sure we are all grateful to see in his place. A touch of ministerial direction in order to allow cadets at the age of 18 and a half might be worth thinking about. It would be extremely beneficial with negligible risk attached.

When I was in the CCF in the 1970s, many teachers had military experience, and some had operational experience in the Second World War. Two challenges now arise: first, the lack of military experience of the instructors, which is not necessarily a huge problem; and secondly, an increasing requirement for adult instructors to be course trained. As ever, some of this is sensible. For instance, I would take my wife walking on Snowden but I would not take a group of cadets or adult soldiers there because I am not qualified by training or experience. Simply, I do not know what I am doing. However, an instructor may have a qualification but not the right one. In other words, he knows what he is doing but does not have the right piece of paper. I understand that the cadet movement is facing increased bureaucratic demands. I hope that the Ministers can have a look at that.

13:41

[Baroness King of Bow (Lab)]

My Lords, I congratulate the noble Lord, Lord Lingfield, on securing this debate. Even more important than that is securing the funding that he outlined, and I am therefore particularly glad to be able to congratulate him and his colleagues who have worked on this issue and secured the funding stream. In a moment, I should like to ask the Minister a few questions about how far the funding will reach.

First, however, I should say that it is encouraging that both Labour and Conservative Prime Ministers have given their personal backing to the cadet forces. It is also encouraging, as the noble Lord, Lord Lexden, outlined, that partnerships between schools are in place to help strengthen and expand the cadet forces. After all, the cadets, when one looks at what they actually do, are one of the most—possibly the most—fantastic youth service we have in this country. The service they provide is extraordinary. The skills and training on offer are second to none, and then there are all the other things being done—not just allowing young people to jump off mountains or use gliders, although I would have loved to have had that opportunity myself. In terms of promoting active citizenship, committed citizens with high self-esteem, mentoring, volunteering, fitness, personal and social development, and leadership skills—who would have thought that the noble Earl, Lord Attlee, would have ended up in Rwanda?—all these extras that one gets from this funding makes it extremely well spent. In particular, the employment skills around punctuality, reliability and discipline are extremely important.

The other area that we should dwell on was touched upon by the noble Lord, Lord Ramsbotham—the youth justice system. I was struck by his comments. As my noble friend Lord Jones said, the cadet force is, above all else in some senses, an outreach programme that connects young people to the Army, although, as we have heard, it is not a formal Army organisation. I commend my noble friend and others who have spoken on their long association with the cadets and the military. It is really important for young people to have a positive experience of authority at an early age. I cannot underline enough how important that is for young people who come from areas such as the one in which I live in Tower Hamlets, for example. I know that the first words that a police officer said to me were very derogatory and included my skin colour. I remember thinking, “I’m not that black and, anyway, why is he saying that?”. The cadets offer the exact opposite approach and avenue for young people to come into contact with authority and we cannot underestimate how important that is.

I have a couple of questions. First, I understand that there are 3,280 cadet units across the UK, but only 10% of those are in state schools, which is why this programme seeks to increase the numbers. I assume that the 60 new cadet units that are to open this September are all in state schools. I would like clarification, although I believe that they are. Secondly, is the Department for Education encouraging schools to collaborate in a more concrete way, so that a relatively small network within the state sector can reach further? The Government’s website mentions that the cadets can promote social mobility. That is yet another reason to support cadets in schools, both now and in the future.

13:45

[The Parliamentary Under-Secretary of State for Schools (Lord Nash) (Con)]

My Lords, I thank my noble friend Lord Lingfield for securing this important debate. I pay tribute to him in his role as chairman of the Cadet Vocational Qualification Organisation and the fine work that it does to ensure that the skills gained through cadet forces are recognised. I would also like to thank all noble Lords for their valuable contributions today.

As part of driving education reforms to address our slide down international league tables, we need to equip our young people with the character, grit and determination that they need to make their own way in life. We need to give them the opportunities to develop the leadership, team working and other social skills that are so vital to employers. As we have heard, many of our most respected independent and some state schools have for over 100 years looked to military-themed activities to give their pupils a sense of discipline, adventure and achievement.

Such life-changing experiences should not be the preserve only of the fortunate. It is young people in schools in the most disadvantaged communities who most need greater strength of character to cope with the challenge they face to succeed in life. Contrast the organisation, routine, structure and discipline that come from a service life with the chaotic home lives which, sadly, so many of our children and young people experience today, with no structure or routine and a background that is literally scatty, with poor eating and sleeping habits, and so on.

One of the charities I was actively involved in before I took this job looks after boys on the edge of exclusion. Virtually all of those would be in a single-parent situation. We surveyed these parents to ask whether any of them had systems or routines at home for times for eating, homework, television or sleeping, or times that they had to be in by. More than 80% of parents replied that they had none; but more than 80% also replied that they would love to hear about such a system if somebody could explain it to them. That shows the chaos in many of our homes today.

The other important thing that the forces can bring to schools is men. Of course, women forces personnel are extremely good role models, particularly for girls in schools; but sadly a large proportion of young people today are brought up in what we politely call single-parent households, which almost certainly normally means a single mother. Some 27% of primary schools have no male teachers in them at all; only 15% of primary school teachers are male, though there has been a 10% increase under this Government; and only 4% of teaching assistants in primary schools are male. This means that many children have a total absence of male role models in their lives, which can be just as damaging for girls as for boys. If a girl has never experienced the love of a man, the dangers that this can represent in her teenage years in terms of unsuitable relationships and teenage pregnancy are clear.

As an important strand of our work to raise standards for all in the English education system, this Government want to see as many pupils as possible benefiting from the same quality of life-changing military activity offered in many of the best independent and state schools in the country. That is why we have put in place such an ambitious programme to expand school-based cadet units. Starting from a base of 190 independent school units and 66 state school units, the MoD and DfE have been working closely together since 2012 towards our shared ambition of adding 100 new cadet units by this September. I am pleased to confirm that, despite pressures on funding, the Government have committed the necessary money. As a former police cadet myself, I am delighted that state schools across the country are eager to embrace this opportunity for their pupils. To date, 65 new units in state schools have already been approved and opened, and we are actively working with a further 54 schools towards approval over the next nine months. We have also had interest from a further 77 schools. Many head teachers can already give testimony to the positive impact of their cadet unit on attendance, behaviour and discipline, on educational engagement and attainment, and on the relationship between staff and students. As my noble friend Lady Seccombe has highlighted, head teachers have a vital role to play in exciting parents, pupils and staff about the benefits of a cadet unit.

The Government believe in the important societal benefits of cadet units as well as other military ethos programmes such as the excellent SkillForce, of which my noble friend Lord Freeman is chairman. I pay tribute to his work in this regard. These benefits are a significant driver for our continued investment in cadets. They have been clearly articulated today by my noble friends Lord Lingfield and Lady Seccombe, by the noble Lord, Lord Jones, and in studies undertaken by the University of Southampton. I hope that my noble friend Lord Lingfield will be pleased to hear that my department has commissioned research to further strengthen the evidence base for these benefits. When that work reports in May this year, my expectation is that it will support further expansion in the number of cadet units in schools by convincing more head teachers and others about the benefits. In addition, officials are currently considering the feasibility of a further in-depth cost-benefit analysis of the value for money of the cadet experience.

Despite the clear benefits, schools can face significant challenges and barriers to establishing and running a cadet unit, particularly in relation to financial and human resources. In June last year, the Prime Minister launched the cadet bursary fund, a charitable fund pump-primed with £1 million of funds from LIBOR fines to help schools with the cost of their new units. I am delighted to say that, so far, £3.1 million has been raised, which has enabled the fund to award £2 million to 46 schools. A further funding round may be launched later this spring. However, only £180,000 has been raised from private donors, so I would be grateful for any support noble Lords can give directly or indirectly in this regard. To support the long-term stability of the fund, my department continues to fund a professional fundraising activity. As my noble friend Lord Lingfield has mentioned, the MoD has recently announced that rather than proceed with the per-cadet charges schools were expected to pay, it will find efficiencies and absorb the costs of the first 100 units. This is excellent news because it levels up the playing field with schools that already have a cadet unit which are not being charged, thus reducing the financial barriers to new schools. I would like to thank my noble friend Lord Astor for everything he has done in this regard.

My noble friend Lady Seccombe is correct to say that adult volunteers are another critical factor in the success of a unit. This is why round 1 of the cadet bursary fund has had a specific focus on supporting the cost of specialised instructors, and offering incentives or supply cover for volunteers and staff. I record my thanks to all those schools with established cadet units which have partnered with a state school to enable them to offer the cadet experience to their pupils, to which my noble friend Lord Lexden referred. This is particularly valuable where new schools have no prior military experience and helps to transfer important skills. To date, 23 of the 65 state schools approved to establish cadet units under our cadet expansion programme are benefiting from such a partnership, and many existing units are willing to enter into such partnerships. Those who have grown up through the cadet force are themselves ideally placed to inspire and support cadet units and are those who become volunteers themselves when they reach the age of 18.

My noble friend Lord Attlee talked about the benefits of risk taking. I have a poem on the wall of my office which talks about just those benefits, but he did note some implications in the fact that young people can remain cadets only until their 18th birthday. While I acknowledge these points, child protection and safeguarding must be our highest priority, but I will look at this further and discuss it with my noble friend Lord Astor. I would like to see many more state schools including the running of their cadet unit within the employment contracts of their staff, but there is also an important role for adults from outside the school community. The MoD includes information on becoming a cadet force adult volunteer in its resettlement support for those leaving the services and is looking at how to encourage better integration between reservists and cadet units.

The noble Lord, Lord Ramsbotham, referred to the youth justice system, on which he is of course a renowned expert, and I will contact colleagues in the MoJ and commend to them the military ethos programme being extended to youth offenders. The noble Lord, Lord Jones, president of the Army Cadet Force Association Wales, has already highlighted and thanked those involved in cadet units in Wales. I would like to give recognition and thanks to all those involved in running cadet units. They are delivering a truly life-changing experience to their pupils.

The Government’s cadet expansion programme is ensuring that 100 more state-funded schools have the opportunity to do the same. The Government welcome the engagement of forces and ex-forces personnel in the school system. We have demonstrated this not only in our considerable expansion of the cadet programme but through our engagement with organisations such as SkillForce, Challenger Troop and Commando Joe’s, and our Troops to Teachers programme. I firmly hope that in the coming years we can build on this success to give many more children the life chances they deserve. Again, I thank all noble Lords who participated in this debate.

13:55

Sitting suspended.

Criminal Bar: Funding

Thursday 15th January 2015 Grand Committee

Question for Short Debate

14:00

Asked by

[Lord Morris of Aberavon]

To ask Her Majesty’s Government what assessment they have made of the long-term impact of current levels of funding of the criminal Bar.

[Baroness Garden of Frognal (LD)]

My Lords, as this debate is very tight, it will be much appreciated if noble Lords keep to the time that they have been allocated.

[Lord Morris of Aberavon (Lab)]

My Lords, I am delighted to initiate this short debate. I have no present interest to declare save for those on the register. As Attorney-General, I attended the monthly meetings of the Bar Council and, as head of the Bar, I presided over the annual meetings. On one occasion, I even had to exercise my casting vote, which pleased exactly 50% of those attending, but probably not the other 50%.

It was the Lord Chancellor who told the Commons Justice Committee:

“It is very important that the independent criminal Bar has a good future”.

I have not sought this debate to argue for more money for the profession that I had the privilege to practise in over a working lifetime; that is for others to argue. My hope is that, in this short debate, we can get confirmation from the Minister, who understands the profession well, that the Lord Chancellor meant what he said, and that he will spell out his hopes that, in the face of today’s difficulties, on his watch we will not see the decimation of a part of a profession that helps to underpin our freedoms.

It was Mr Nicholas Lavender QC, the chairman of the Bar, who said last year that the Bar was astonished that, on the Government’s figures and allowing for inflation, there had been a 37% cut in the funding of defence advocates’ fees in the Crown Court in six years. He maintained that he was,

“not aware of any other area of public expenditure where individuals have been asked to, and have, put up with cuts on this scale”.

The Bar took unprecedented steps to show how strongly it felt. It was encouraging that the Government decided that there would be no cuts that year in the advocates’ graduated fee scheme. Can we be assured that none will be proposed in immediate future years? The years have resulted in a massive reduction in expenditure on Crown Court advocacy. Fortunately, wise brokering broke the impasse highlighted in the Operation Cotton case. Sir Brian Leveson, on giving judgment in that case, said:

“We have no doubt that it is critical that there remains a thriving cadre of advocates capable of undertaking all types of publicly funded work developing their skills from the straightforward work until they are able to undertake the most complex”.

Sir Bill Jeffrey, who is not a lawyer, was commissioned by the Lord Chancellor to report on the market for criminal advocacy services. He reported that,

“the market could scarcely be argued to be operating competitively or in such a way as to optimise quality”.

When Sir Bill visited Crown Court centres and spoke to Crown Court judges who carry out the bulk of judicial criminal work at that level, he found that the “main area of concern” was that of,

“relatively inexperienced solicitor advocates being fielded by their firms (for what were presumed to be commercial reasons) in cases beyond their capacity”.

Sir Bill described the judges’ views as,

“remarkably consistent and strongly expressed”,

and said that in his view it would be a “mistake to discount them”.

I think I have said enough about the problems. It is no surprise that the relations between the defence criminal Bar and the ministry have been turbulent. It was my old friend, Kenneth Clarke MP, who, as Lord Chancellor, was one of the first to accept the Chancellor of the Exchequer’s proposals at the beginning of this Parliament. I do not know what brownie points he got for being first in the field, but, given the breadth of his responsibilities, it is no surprise that the profession is reaping the results of his alacrity.

Only a few weeks ago, your Lordships voted overwhelmingly against the limitation of judges’ discretion in judicial review cases. I believed, as did the House, that in a country that does not have a Bill of Rights judicial review was one of the bastions of the rule of law. An independent Bar, ready and willing to take up the cudgels on behalf of citizens, is vital to ensure that there is no infringement of the rights of the individual. Likewise at the criminal Bar, however odious the case, all parties who find themselves before the courts should have proper representation.

My experience, like many others, is that from time to time your non-lawyer friends will ask you, “How could you represent such an obnoxious individual?”. History is littered with such examples. My old friend the late Lord Hooson was defence counsel in the moors case. I am sure that he had to explain the role of counsel many, many times. A more recent example might be the Shipman case. Over the years those of us at the criminal Bar have had similar if less startling experiences. In my own experience it was of the upmost importance in the Broadwater Farm case that the prosecution was properly probed and challenged at every stage, as it was. One of the important pistons to the effective working of the engine of representation to ensure fairness is the sometimes questioned cab-rank rule.

Against the background of the horrific atrocities in France in recent days, the need for representation, as in our unhappy years of terrorist activity, will be more important than ever. I note and welcome the comments made by the Lord Chancellor in the reply that he gave in the House of Commons on 6 January to Jeffrey’s criticism and the letter to the chairman of the Bar Council on 22 December. The cab-rank principle has been described by many. I like very much the words of the noble and learned Lord, Lord Hoffmann:

“It is a valuable professional ethic of the English Bar that a barrister may not refuse to act for the client on the ground that he disapproves of him or his case. Every barrister not otherwise engaged is available for hire by any client willing and able to pay an appropriate fee. This rule protects barristers against being criticised for giving their services to a client with a bad reputation and enables unpopular causes to obtain representation in court”.

Against this background I wonder if it was the best use of the funds of the Legal Services Board to commission two professors to work out the impact of the rule. Sir Sydney Kentridge systematically destroyed the methodology and conclusions of this very academic review. The rule with all its practical implications is ingrained in young barristers from the day they begin to practise. The most persuasive evidence comes in a footnote to Sir Sydney’s opinion:

“I can say from my own experience that in political trials in South Africa in the apartheid years it was essential and invaluable”.

I would hope for some endorsement in the ringing tones of the Lord Chancellor’s comments which I have already referred to.

14:08

[Lord Brown of Eaton-under-Heywood (CB)]

My Lords, I begin by congratulating the noble and learned Lord, Lord Morris of Aberavon, on securing this debate and opening it so skilfully. He was himself, of course, in his time a great ornament of the criminal Bar. He has recounted something of the history of the savage cuts that have already been made over the years in criminal legal aid funding and there is of course, following the election in May, to be another review of the fate of the criminal Bar. I suggest it would be catastrophic if, following this review and in the light of the Sir Bill Jeffrey report and other reports, further cuts were to be made. There is time today to make just four brief points.

First, of all the specialist Bars, the criminal Bar is the most important. Of course it does not earn for its practitioners, or even for the Exchequer, the huge sums earned, for example, by the commercial Bar, the companies Bar, the patent Bar or the revenue Bar; however, the work undertaken by the criminal Bar is the most valuable of all. The outcomes of commercial disputes largely result in book entries—the adjustment of balance sheets—but the administration of criminal justice goes to the very heart of the rule of law, and directly and immediately impacts on the day-to-day lives and liberty of all. I quote Geoffrey Cox QC MP in a debate more than four years ago:

“The efficient conduct of cases in the courts is the essential pivot around which revolves the entire administration of justice. Incompetence and poor quality in the representation of prosecution or defence will inevitably lead to the failure of justice, prolonged delays, aborted trials, appeals and much greater cost”.—[Official Report, Commons, 15/9/10; col. 245WH.]

It is all-important to assist the judiciary in its task of achieving justice. That is why the judiciary strongly traditionally supports a strong criminal Bar.

Secondly, the criminal Bar has for many years been the poor relation of the various specialist Bars. The effect of recent funding cuts is “ruinous”—I quote what a member of my old chambers said to me yesterday. Others have spoken of a crisis of confidence in the economic viability and the long-term future of the criminal Bar. Predictably, all this has had a devastating effect on the recruitment of real talent to that Bar. The number of pupillages has fallen, and all this is on top of the loss of student grants and the increasing levels of student debt. How today could one conscientiously encourage some able and ambitious young graduate to the criminal Bar? Rather, one has to advise them to steer clear of it and direct them instead to commercial or public law chambers or one of the other Bars.

Thirdly, even if financial considerations do not deflect some of the wealthier among the Bar’s potential recruits—those with money, trust-backed grants or family funds—assuredly they put off those who have no financial support and are burdened with heavy debt. The consequences for the Bar’s commendable long-standing efforts to promote diversity and social mobility need no emphasis. They are all too obvious.

Finally, the young criminal bar is the seed-corn for the next generation of experienced criminal Silks and justices. It is small wonder that in paragraph 9.11 of his report, Sir Bill Jeffrey stated that,

“concerns about the future ‘talent pipeline’ for criminal QCs and judges are not, in my view, fanciful”.

In the following paragraph, under the heading “How much does this matter?”, he expressed his conclusion. I shall not read that paragraph in full, although I hope that others may do so later in the debate. Put shortly it was, unsurprisingly, Sir Bill’s conclusion that it obviously matters a great deal. It is imperative that any future Government recognise that they should do nothing to further imperil the future of the criminal Bar, which is truly one of the great assets of our proud legal heritage.

14:14

[Lord Thomas of Gresford (LD)]

My Lords, I, too, thank the noble and learned Lord, Lord Morris of Aberavon, for introducing this debate. My interests are declared. I started off as a salaried partner in a small country solicitors’ office in north Wales in 1961 on a salary of £1,000 a year. Despite our limitations, we could provide for our clients the highest quality of representation in criminal cases via the availability of legal aid and the existence of a strong and expert independent Bar. I could and did instruct on behalf of legally aided clients Lord Elwyn-Jones, Lord Hooson, Sir Ronald Waterhouse, Sir Robin David and other distinguished barristers of the Wales and Chester circuit. Incidentally, I was present with Lord Hooson on the last day of the Moors murder trial. I took him for a cup of tea afterwards, which he almost certainly needed after sentencing.

In every serious criminal case, there was a team on both the prosecution and the defence side led by outstanding silks who were capable of guiding the preparation of cases, were accustomed to taking big decisions and to giving wholly independent advice. In those days, there were the resources of time and money to ensure that cases were properly prepared and presented by experienced people, and I believe that the interests of justice and of the community were properly served. I like to think that my own generation at the Bar preserved those traditions and that the quality of service in Wales with outstanding advocacy from Gareth Williams, Alex Carlile and others has made sure that those traditions continue. Those who have succeeded us have struggled with increasing cutbacks. The input of an experienced solicitor in court disappeared long ago, and it is not only on the defence side that standards have slipped. A lack of resources on the prosecution side has also increased delays and wasted time and money.

But while there were difficulties in the recent past, there was nothing on the scale of the cutbacks now being pursued by the Lord Chancellor. In my view, they will destroy the criminal Bar. Like the noble and learned Lord, Lord Brown, I could not possibly advise a bright youngster to embark on such a career at the present time. There is nothing in it; there are no glittering prizes to reward years of study and struggle. Certificates for leading counsel are granted by judges through gritted teeth, and the fees are a fraction of what they once were.

Solicitors concerned in criminal work now have to become solicitor advocates in order to survive financially, and routinely take the work on which entrants to the criminal Bar would in former days have depended, and it does not stop there. If leading counsel today has a junior at all, it is like as not a solicitor advocate with a direct financial interest in the instructing firm. This often leads to inexperienced and insufficiently qualified persons in that important role. If anyone doubts that, I recall a recent case in a court adjoining the one in which I was appearing where the solicitor advocate junior applied immediately for an adjournment when he was called upon to cover for his temporarily absent leader.

Barristers’ fees in the Crown Court account for around £300 million of the criminal legal aid budget. They have been effectively static since 1997, during which period retail prices have increased by 54% and public sector pay by 49.9%. The average annual payment to criminal barristers made by the Legal Services Commission, including all graduated and VHCC cases in the year 2011-12 was £52,000, from which they paid all their expenses, including up to 20% for chambers’ fees.

The Next Steps consultation by the Ministry of Justice was found to be defective in the High Court on judicial review. That consultation paper was introduced with the following statement by the Minister:

“This is a comprehensive package of reform, based on extensive consultation. I believe it offers value for the taxpayer, stability for the professions and access to justice for all”.

I absolutely and profoundly disagree. In that paper, no attempt was made to evaluate the financial consequences of the proposed changes. They were said to be “uncertain”. They are not at all uncertain. They will do significant harm to the criminal justice system by damaging the supply and the quality of the criminal advocacy service. As a result of the judicial review application, last September the Ministry of Justice was forced to disclose the KPMG report which it had commissioned to advise it. Only then did it appear that the ministry had told KPMG to make broad assumptions about cost savings, profit margins and the availability of investment capital for restructuring businesses which appear to have been plucked out of the air and were completely without evidential foundation. Yet after a further three-week consultation forced upon them last September, the Lord Chancellor persisted in adhering broadly to his original cuts, and his conclusions are now again subject to renewed judicial review application. Are the public to be properly served?

When I look around the area designated in north-east Wales, from Llandudno to Llangollen, an hour and a half’s travel, and consider that the two custody suites are at St Asaph and Wrexham, some 35 miles apart, I find it impossible to conceive that the interests of the public in access to justice, whether in the English or Welsh language, can be served by the wholesale reduction of legal aid contracts to two firms of solicitors. The knock-on effect on the local Bar in Chester will be considerable.

The response to the original Next Steps consultation by Treasury counsel, which conducts the most serious and complex prosecutions in this country at the Old Bailey, put the position very well, saying that:

“skilled and experienced defence advocates, whose capacity and ability inspires the confidence of the court, the prosecution and their professional and lay clients … shorten, straighten, sustain and hasten the trial process: their continued presence is nothing less than vital”.

As the noble and learned Lord, Lord Brown, pointed out, our judiciary is largely drawn from experienced counsel. Destroy the Bar and the whole foundation of our judicial system is put at risk.

14:21

[Lord Judge (CB)]

My Lords, I declare an interest as treasurer of the Middle Temple last year; my intervention in this debate reflects that experience.

In some ways what I am going to say is entirely repetitious, but it is worth drawing public attention to the fact that for many years now the Inns of Court have been dedicated—that is the word—to ensuring that no one should be deterred from entering the profession of barrister on financial grounds. The fact that they or their families may be financially humble was not to be an obstruction. The end result has been extremely successful. The way in which the Middle Temple achieved that—the same process applies to all the other Inns—is that the large majority of the money we have each year is spent on scholarships. Last year we spent in the region of £900,000, which is much the biggest expense we have. The objective: to get every boy or girl of talent who wishes to come to the Bar through the expensive process of getting to the Bar if they are good enough to do so. Nowadays we even have scholarships, chosen on merit, but the funding that is provided for the scholarships reflects the financial needs of the individual concerned.

The take-up has been very great and very successful. My time as treasurer was spent having a good deal of contact with some exceptionally bright young men and women who wish to make a career at the Bar. However, there is one subject on which it is extremely difficult to conduct an exchange with them: what about crime? These are not greedy young men and women; many of them are inspired by a wish to see that the administration of justice works and that they play their part in it as advocates. What about the possibility of an innocent man being convicted—somebody spending years in custody? What about the possibility of a guilty man escaping justice when he richly deserves to be convicted? The same of course applies to women, but there are far fewer women defendants. This matters, and when you discuss it with them, they see the point, but many of them say, “There is no point—there’s no future in the criminal Bar. Look at what’s happened to it in the last few years”.

If you forget the cuts which have already been described by noble and learned Lords—and I am not forgetting them—there are no pupillages in criminal chambers, or very few of them, therefore what is the point of even starting to try to find a non-existent pupillage? Those young men and women have already committed themselves to the Bar and many of them will be called. The reality is that in the present climate, very few of the very best will do criminal law.

We are having a debate at the Middle Temple about whether we are spending our money wisely, as so much of it is wasted. So much of it goes to people who in the end cannot find a pupillage or, ultimately, a tenancy. We are looking at the possibility of reducing the amount of money that we give to boys and girls to get them called to the Bar in order to provide more money to support the young men and women who have got to the Bar and who have a pupillage in criminal chambers, and who then have a year or two in criminal chambers in which they hope to make enough just to cover the expenses.

That debate will take place, and it will have to recognise that if we adopt that process it will inevitably reduce the money available to encourage young men and women from a humble financial background to even try for the Bar. I think that that is a very sad possibility. When we are considering the impact of this, let us be in no doubt that if we do so the pool of talent will be reduced and the quality of talent will be diminished. The national asset identified by Sir Bill Jeffrey will be dissipated. Being called to the Bar and practising at the criminal Bar will become a matter of means, rather than merit. That is a shocking possibility.

The long-term impact has already been described by noble and learned Lords. The results in criminal trials will be affected; trials will take longer; and trials will take longer to come on. That means that defendants will wait longer for their trials and witnesses will have to wait longer and longer before they can give their evidence, in many cases in very distressing circumstances. At the same time, the long-term future of our efforts to ensure a more diverse judiciary—that is to say, a judiciary coming from every element of the citizens of this country—will be undermined. In 20 years from now, young men and young women from a financially humble background will not be available as candidates for judicial appointment. That will be to the public disadvantage.

14:27

[Lord Woolf (CB)]

My Lords, like other members of my former profession who have addressed the Committee today, I speak from long experience. I congratulate the noble and learned Lord, Lord Morris of Aberavon, on obtaining this debate.

This is a very appropriate time for us to discuss these matters. I was very pleased to read in my Times today Frances Gibb’s article about what is being done to provide technology for the courts, and I am very glad to be able to say that I am pleased about what is happening. I emphasise that this is very much needed, and it is about time that it was provided. I say that it is about time because I am very conscious that in the report published in the mid-1990s into access to justice for which I was responsible, I emphasised the importance of that technology being provided. Many of my report’s recommendations were accepted. When I delivered my report we were assured by those responsible in the then Lord Chancellor’s department—which was the equivalent of the Ministry of Justice—that this technology would be forthcoming. Alas, it was not, and some of the problems of the justice system today are because of that delay in provision. None the less, it is important that it should be provided now. I suggest to the Committee that the message to draw from those who have spoken already in this debate is that we are now in a situation in which positive action is needed to improve the position of the criminal Bar in particular, not in the interest of the criminal Bar but in the interest of the public. As has been made clear by those who have already addressed your Lordships, there is a real need for an efficient and effective criminal Bar if this country is to continue to ensure the high standards of justice which are so much a part of this country.

We are all still reeling from the events that took place so recently in Paris. I suggest to the Committee that one cause of disaffection of a country’s young is that they feel that the society in which they live is not just. Fortunately, in this country most people who have been brought up here can rejoice in the fact that they live in a society that can say it provides justice for its citizens, but unless something is done to arrest the present decline of the criminal Bar, I believe that that will not continue.

Although the criminal Bar is the subject of this debate, as the noble Lord, Lord Thomas, made clear, it is not only the criminal Bar; the civil solicitors who provide legal advice and assistance up and down the country are also critically affected. When somebody is faced with a criminal charge he needs to have ready access to someone who can give him, or her, the advice that they need. A situation cannot be allowed to arise in which that is no longer the position. It cannot be allowed to arise because of those who are entitled to and need advice, but also because an efficient system—one that makes the best use of the limited resources available—is made so difficult if those who appear before the court are not of the quality that is required.

The problem, which is why I suggest that this is such a critical time, is that once we have a slide of the sort described it is so much more difficult to restore the position that was once there. Things can be done with the resources available now which will at least arrest the decline. I think that when the Minister comes to reply he should show that the Ministry of Justice is aware of the extent of the problem and that something more than sticking plaster is required. There needs to be a rethink of the approach to the funding of a profession which is of vital importance to this country and to every citizen in it.

14:33

[Lord Bach (Lab)]

My Lords, I congratulate my noble and learned friend Lord Morris of Aberavon on securing the debate. It is an important debate, made much more significant by the experience and status of those who have chosen to speak. These include two former Lord Chief Justices, one of whom, of course, was Master of the Rolls too, one former Supreme Court judge, one former Attorney-General—my noble and learned friend Lord Morris of Aberavon himself—and two distinguished and successful silks, if I may call them that, including the Minister. I practised as a member of the criminal Bar for many years and am proud to have done so. Slightly to my surprise, and certainly much more to other people’s surprise, I find myself now in the position of shadow Attorney-General.

The years I practised in just about covered what I describe as the golden years for the criminal Bar. They were pretty golden, I have to say. There was the emergence of the Crown Court; there was plenty of work; there were not many members of the criminal Bar around; it was pretty well paid; and it was effectively a monopoly for members of the Bar at that stage. I would argue that that state of affairs has now been over for many years; perhaps 20 or a few more than 20. The important point to remember is that those golden years are not coming back. Any politician of any party who says that they are, or hints that they might be, is to be viewed with a healthy degree of scepticism, at the very least—and the criminal Bar was always very good at being sceptical about pronouncements being made. Therefore, any discussion of the criminal Bar has to happen in the context of today rather than looking back too much at a time that has gone.

As my noble and learned friend Lord Morris pointed out, over a long period the rewards for criminal practitioners have without doubt declined sharply. That is due not just to cuts or long rises in fees, although, of course, they play an important part in what has happened. As Sir Bill Jeffrey, who has been quoted already in this debate, concludes in his report of May last year, crime is down, fewer cases reach the Crown Courts and there are more guilty pleas. He says:

“There is substantially less work for advocates to do. Its character is different, with more straightforward cases and fewer contested trials”.

Of course, there are many more solicitor advocates. Sir Bill goes on to say,

“There are now many more criminal advocates than there is work for them to do”.

He goes on to make proposals for the future, all of which are well thought out, very interesting and should be considered carefully. My first question to the Minister is this: What can he tell us today about Her Majesty’s Government’s response to the Jeffrey report, both in general terms and, if possible, in more detail?

Sir Bill talks about the future of the Bar being less clear. He says that there are signs that, away from the self-employed Bar, the tide may be turning, but he fears that the Bar’s lack of confidence in the future of criminal work, or its unwillingness to adjust to compete for it, may become a self-fulfilling prophecy. I think that the following passage was referred to by the noble and learned Lord, Lord Brown. It is worth quoting. It states:

“This matters, because the particular strengths of the English and Welsh criminal Bar are a substantial national asset, which could not easily be replicated. There is also a distinct national interest in having sufficient top-end advocates to undertake the most complex and serious trials, and senior judges with deep criminal experience”.

It is very hard for anyone to argue with that view. When Her Majesty’s Government did their deal, if I may call it that, with the Bar last spring—agreeing a VHCC cut and leaving until after the election a cut in the graduated fee, with an agreement to discuss the future of both those causes to be continued until the summer of 2015—they were following a well trodden path in two respects. First, some issues were put into what might crudely be called the long grass to escape criticism for actually taking action; and secondly—and more importantly—they actually split the legal profession. The solicitor criminal practitioners were offered no equivalent agreement and some would argue that they were left hanging out to dry. Cuts have been implemented in that field and the imposition of a new and controversial system of criminal legal aid is being attempted. Instead of talks to determine the future, therefore, we actually have, as we speak this afternoon, solicitor practitioners and the Law Society itself traditionally reviewing the Ministry of Justice in court. To put it mildly, this is a deeply unsatisfactory position for our criminal justice system. To set one branch of the legal profession against another is wrong both in principle and in practice, and it does not help either branch or, indeed, the criminal justice system itself.

If my party wins the general election, we will set in train a review of the criminal justice system, concerning not just funding but the way the system works for victims, defendants, the general public and, of course, practitioners. Obviously, we are not making any promises about funding but one thing is clear: there is no future for the Criminal Bar, the criminal solicitors’ profession or even the criminal justice system itself if the Government of the day play off one branch against another. There are obviously going to be natural tensions between the various branches and the Government of the day; that will always happen. But no system will work unless all parties, including the Government, work together.

14:40

[The Minister of State, Ministry of Justice (Lord Faulks) (Con)]

My Lords, I congratulate the noble and learned Lord, Lord Morris, on bringing forward this debate and on attracting such a very high calibre of speakers, as was acknowledged by the noble Lord, Lord Bach. A great deal of experience and expertise has been brought to bear on what is an extremely important subject. It is important because it goes beyond the interests of the criminal Bar as such and has important ramifications for our country, for our system and for the future. I found very little to disagree with in what was said in the debate.

The criminal advocacy market has changed significantly over recent years. I am glad that the noble Lord, Lord Bach, whom I congratulate on his recent appointment, acknowledged that we are not going to return to that golden age. The reduction in cases going to trial and the growing number of advocates, including solicitor advocates, have presented particular challenges to the future of the independent criminal Bar in its current form.

I note what was said about the judicial review and the noble Lord, Lord Bach, told us, quite rightly, that it is ongoing. It refers to the contract in relation to solicitors. It is not appropriate for me to comment on that in view of the fact that is it ongoing. If one reads the Jeffrey report, one can see that it is inevitable that there will be—and there is—a degree of tension between the role of solicitors and the role of barristers in providing advocacy services at the Crown Court. That is one of the challenges that have to be faced in the future: how the public can be best served by preserving the roles of both solicitors and criminal advocates. One of the Jeffrey recommendations, which I do not think anyone would find hard to accept, is the improvement in the teaching of advocacy at the solicitor level if solicitors are going to function in the same field as barristers. There is clearly a disparity that ought to be remedied.

The Government have found it necessary to make reforms to the legal aid system. The financial climate and the tackling of the deficit have forced some difficult decisions on the coalition. It has been important to try to ensure quality public services while balancing the books. But it is clear, and I am happy to confirm this, that the Government want to protect the provision of quality advocacy services. We have engaged extensively with the profession. Clearly, some of the engagement not always been as happily reported as it might have been. The current chairman of the Bar has confirmed that the current relationship is a good one and I hope that the engagement will prove profitable in the future.

Certainly, the engagement that took place led to several adaptations to the original proposals, including the changes to the graduated fee scheme and the commission of Sir Bill Jeffrey’s report, to which there has been much reference. He identified in his report a number of structural problems related to the history and development of the criminal Bar. He found that the criminal advocacy market is not working,

“competitively or in such a way as to optimise quality”.

There are all sorts of reasons for this and time does not allow me to engage with all of them. The decrease in the amount of crime is clearly one. There is now a rather unsatisfactory state of affairs whereby fewer younger barristers are joining professions. There is a bulge of those in their 40s and 50s. This has significant long-term risks, I accept, for the profession in terms of, “Where are we going to get senior barristers from? Where are we going to get judges with the relevant experience?”. However, as has been made clear, it is not obviously attractive for young people to go into the criminal Bar at the moment. I note what the noble and learned Lord, Lord Judge, said about diverting scholarship funds from the Middle Temple; that seems a highly constructive way in which to encourage people through those difficult years.

The Government recognise that this is a period of great transition. They have endeavoured to listen to the profession, and care was taken in developing proposals that would minimise the effect of the changes on the particularly vulnerable section of the profession—the junior part. The consultation paper Transforming Legal Aid, published in April 2013, included proposals for the graduated fee scheme, which covers most advocacy in the Crown Court, and to reduce fees paid on very high cost cases by 30%. Together, these proposals sought to target the fee reductions at the highest earners; we know that barristers who work on the most complex, longest-running type of cases receive more in fee income than others. Furthermore, the original proposals had the effect of protecting the fee income of the most junior members of the Bar. We amended our proposals, following consultation, and have amended the very high-cost cases scheme while still ensuring that the fees were within planned budgets.

The second consultation, Transforming Legal Aid: Next Steps, published in September 2013, included two options. The first was an adjusted version of the original proposal, and the second was a model based on that put forward by the Bar Council, which was based on the CPS payment scheme. The outcome of that consultation was that the Government decided to implement the CPS-like model. This would still have the benefit of focusing reductions on the higher earners.

Following further engagement with the profession in early 2014, the Government announced the deferral of changes to the advocates graduated fee scheme until summer 2015, to align with the second fee reduction for litigators. This will allow us to take into account the outcomes of the review by Sir Bill Jeffrey, as well as any impact on legal aid spend from falling crime rates, and earlier remuneration changes.

Beyond the review by Sir Bill Jeffrey requested by the Secretary of State, the Lord Chief Justice has asked Sir Brian Leveson to undertake a review of the length of criminal proceedings. He has been tasked with suggesting ways to streamline the trial process, identifying ways to reduce to the minimum the number of pre-trial hearings that necessitate advocates attending court. However, the review goes much further and is likely to produce some real gains in terms of the criminal process as a whole. I note that the noble Lord, Lord Bach, committed his Government—should it be his Government after the election—to look again at criminal procedure. I suspect that whichever Government come to power will find the report of Sir Brian Leveson on criminal procedure a valuable basis on which to review this vital part of our system. The report will also impact on the further consideration of the advocates graduate fee scheme.

We have also recognised the need to regularly monitor the criminal legal aid market. That is why the Government have committed to publishing regular data reports on fee payments received by criminal advocates from public sources. The data gathering collated from the CPS and the Legal Aid Agency will help us to meet the need to collate more data on the market and facilitate a better understanding of the way in which the market is operating. I know how irritating it can be for information that is only partially accurate about barristers’ fees to be published, which can give a rather misleading picture of what are relatively modest earnings for most barristers. I have conveyed that to officials, who confirm that, in fact, much of the information is published as a result of freedom of information requests by journalists, who are not, of course, terribly interested in providing a full and accurate picture, including the facts that there are chambers’ expenses and clerks’ fees. The figures may be out of kilter because payment is made over several years. It is important that the Ministry of Justice should be responsible for accurate figures, so that the public appreciates the nature of the payments that are in fact received and gets a real picture of the criminal Bar.

It is undoubtedly true that fees have fallen in real terms. It is the Ministry of Justice’s case that they remain reasonable, although I entirely accept that compared with the other opportunities in the legal profession—at the Bar and elsewhere—they remain extremely modest. In 2013-14, mean fee payments for barristers doing publicly funded legal aid work was £70,200, including VAT and disbursements, and the median was £57,400. In the last financial year, 18% of advocates received less than £10,000, while 25% received more than £100,000. That gives a very rough picture of the range. Those are modest sums.

The Government’s response to Jeffrey is that he identifies a number of challenges for the advocacy market, but he does not in fact put forward any positive suggestions, apart from the education factor, and not all of his recommendations are for the Government to address—they are largely matters for the professional regulators of both the Bar and the solicitors’ profession. The Lord Chancellor has made clear that he is committed to working with the profession in the first half of this year, and I am sure that any future Lord Chancellor will also wish to do so. The cab rank rule referred to by the noble and learned Lord, Lord Morris, is a cardinal principle of the Bar. Of course, it is subject to exceptions, but as a principle it is very important and must be respected in the way that legal services are provided.

We are particularly anxious to ensure that defendants are aware of the choices available to them in representation. That was a factor identified in the Jeffrey report as an unfortunate by-product of the way that cases were assigned to solicitors, and is something that the professional bodies need to look at, because it is in everybody’s interests that individuals have their best opportunity to be represented.

This is a time of unprecedented change in a context of continuing financial pressure. I am glad that the noble Lord, Lord Bach, did not make any extravagant promises as to the future. It is imperative to reform the system to adapt it to the modern reality of reduced public funds and greater efficiency. The Ministry of Justice welcomes the engagement that we have with the Bar on the issue. We are concerned to maintain those constructive discussions over the coming months. At a time of major financial changes which are being felt by businesses and households across the country, the criminal advocacy profession cannot be immune from the Government’s commitment to get better value. However, while committed to finding savings within the system, we are also committed to maintaining the high standards of the criminal Bar, which, as many noble Lords pointed out, plays a vital part in our society.

[The Deputy Chairman of Committees (Lord Skelmersdale) (Con)]

My Lords, the Committee stands adjourned until three o’clock.

14:54

Sitting suspended.

Property Boundaries

Thursday 15th January 2015 Grand Committee

Question for Short Debate

15:00

Asked by

[The Earl of Lytton]

To ask Her Majesty’s Government what proposals they have for the settlement of unclear or disputed property boundaries.

[The Earl of Lytton (CB)]

My Lords, I am most grateful for this opportunity to debate the matter of property boundaries and I thank the Minister both for his willingness to meet Charlie Elphicke, MP for Dover and Deal, and me on more than one occasion in the recent past, and for forewarning us of the Government’s scoping study published today. I am also grateful to other noble Lords, particularly noble and learned Lords, who are to speak today. I declare my interest as a practising chartered surveyor. I also chair the Boundaries and Party Walls Panel of my professional body, the Royal Institution of Chartered Surveyors. I am very much indebted to the groundwork of Mr Elphicke, who raised the matter in the Commons some time ago. Although his Bill did not progress, it triggered the formation of an expert panel of practitioners who took away the original Bill and have comprehensively revised it. The question now is whether the Government are minded to give this some time and support were it to be formally introduced.

An eminent boundary surveyor once prefaced a learned treatise by saying that when he met potential clients for the first time, he would advise how very expensive boundary disputes can be—so expensive in fact that for the money one could purchase a very good family holiday in the sun or even construct a swimming pool in the back garden. He would add that, fortunately for him, most clients ignored the advice which is why he had lots of foreign holidays and a large swimming pool.

Although the need for resolving boundary issues is most evident in the few cases that go to court, this is not representative of the whole picture. There is a hierarchy of needs in relation to boundary matters, which could simply be to facilitate voluntary registration at HM Land Registry, for the purposes of fence erection, because of a wish to transfer a property or sell it free from doubt as to where the boundaries lie, through to a wish to build or develop land in respect of which the boundary position may be economically important, the purposes contentious and the planning mechanism adversarial. Competing interests in land as to extent and intensity often breed acrimonious and hotly contested situations, although these remain a minority. However, as soon as you raise the issue of a boundary position quite innocently with a neighbour, the balloon often quite literally goes up. Innocent enquiry is fettered and the consequences can be very serious, if not disastrous.

Much of the problem lies in the distant past. Although the paper documents involved with the transaction of land have a long history in this country, actual boundaries are often extremely poorly defined. Maybe in the 19th century everyone knew where the boundaries of Farmer White’s property at Blackacre Farm happened to lie but later, when it mattered for other reasons, everybody seemed to have forgotten. Therefore, the legacy of poor descriptions and even worse plans drawn up by feckless trainees in surveyors’ or solicitors’ offices—I used to be one—adds to the problem.

More recent data are also at fault. Before the general use of digital survey techniques, properties were often sold off-plan and the interests of prospective purchasers and their mortgagees registered against a master plan before a dwelling was ever built. However, nobody thought to check the as-built result. The fencing sub-contractor, with his usual incomplete regard for the legality of boundaries, often added to the problems, as I have encountered professionally. Years ago, I attended a meeting of bigwigs to discuss e-conveyancing and the digitisation of the Land Registry and was unwise enough to suggest that this legacy would henceforward travel at the speed of light and be treated as holy writ thereby. Eyes narrowed perceptibly on the other side of the table. However, I pay tribute to the Land Registry for a remarkable performance in spite of this backcloth of defective raw data.

Land registration works to a general boundaries rule that gives an approximate boundary indication only, except for the very few cases where a formal determined boundary has been registered. The data are plotted on an Ordnance Survey base to either a 1:2500 or a 1:1250 scale, and it has to be noted that OS plans themselves are expressly not definitive of legal boundaries. Note, too, that for a 1:2500 scale a line 0.3 millimetres thick on the OS plan equates to 750 millimetres on the ground, and features closer to each other than about two metres are not shown as separate items on the OS plan at all. This begs the question as to what feature or part of it the OS plans were intended to represent. The Land Registry does not always hold adequate pre-registration documents and many original documents have either not been retained or worse—because they are part of social history—have been deliberately destroyed. Far from everything, of course, is actually registered; much uninterrupted historic ownership, along with a good deal of community, parish and highway land, never mind overriding interests of one sort or another, is simply not registered at all.

In many situations, the boundary may be physically self-evident and identifiably long-standing. Some lack of precision may even be of benefit in allowing a degree of flexibility and evolution, especially when coping with the work of garden fencing contractors. However, in cases of dispute, and especially on tight urban sites, matters are compounded by a substantial legacy of poor or simply inaccurate title documents. Boundary disputes have, I believe, been increasing over a number of years and although, as I say, relatively few cases get to the courts, those that do are often ruinously expensive. The problem of costs in the action frequently and rapidly outstrips the financial value of the disputed land, which raises the stakes and makes it ever more difficult for the parties to settle.

Many cases, of course, collapse without getting to court simply because one party can no longer afford to pursue the matter. That is not in the interests of justice and seems to me to be inherently unsatisfactory. If advice as to likely costs is taken on board right at the start, people often decide simply to accept the fact and roll over in the face of reality—something sometimes taken advantage of by aggressive neighbours. Moreover, in many non-contentious situations where there is just a simple need to know the correct boundary, even raising it with a neighbour can be dangerous. As I have said, planning applications often give rise to such queries.

Unclear boundaries—and, worse, unresolved boundary disputes—are, of course, a material barrier to sale. Nobody wants to buy a property where there is an unresolved boundary dispute. This can be deployed by unscrupulous owners against their neighbours. Then there is the mistaken belief that unregistered land is somehow ownerless—often aided and abetted by some unscrupulous companies, it has to be said—and therefore up for grabs in some way. That causes problems. Latent uncertainty impedes development or redevelopment proposals, as well as necessary alterations, adaptations and even basic maintenance. For instance, I know of situations where the ownership and control of historic ditches has importance for the long-term drainage of development sites or for preventing neighbours filling them with rubbish or building over them. As the eminent boundary expert David Powell said in an e-mail to me earlier this week, the visible instances of court cases are believed to be but the tip of a much larger iceberg.

Clear boundaries are as essential to property ownership and value as permitted use. Owners need to be able to rely on where their boundaries are situated and who owns a boundary feature or has responsibility for a hedge, ditch, boundary, retaining wall or roadside embankment. People often assume, erroneously, that formal land registration guarantees title; regrettably, it does no such thing. The matter is made worse by the law on adverse possession, with its combination of motive and opportunity, and the high costs of resisting it.

Australia recognised this problem long ago and although I believe that the matter is dealt with nationally under something called the Dividing Fences Act, an effective, workable system occurs on a state-by-state basis. The noble Baroness, Lady Gardner of Parkes, who is not able to be here today, was kind enough to obtain for me some information about this. At present, a formal determined boundary can be achieved only by mutual agreement between neighbours. This makes it impractical for cases where it is not in the collective interests of both owners from the outset. It is certainly of no use when a dispute has arisen. Land Registry adjudication, as I understand it, generally concerns only the accuracy of the register.

As properties become more valuable and urban space scarcer, the position of boundaries becomes more crucial. I believe that the mark 2 Bill that has been drafted, a copy of which I have circulated and placed in the Library, would solve this. I am aware that the Minister may feel that it is unnecessary. The same was said, of course, of the Party Wall etc Bill that I had the privilege of taking through all its parliamentary stages in this House back in the 1990s. The mark 2 Bill can and would be of assistance in removing many disputes from the courts and providing better self-regulation and a cost-effective starting point in the event of the court having to intervene. The formula that is proposed would enable the end product to be recorded without recourse to conventional litigation. It would start with a system of notification of a boundary proposal which, if disputed, would trigger a dispute resolution procedure. I believe that it is in the public interest and that it would be a good thing for the maintenance of property and the removal of contention from what should be the peace and tranquillity of people’s own homes.

15:09

[Lord Hope of Craighead (CB)]

My Lords, I begin by congratulating the noble Earl on securing this debate. I put my name down to speak because the issue he has raised is quite an important one and deserves to be broadened out a bit from the original list of speakers, which until recently was only three. Having looked more closely at the subject over the past two or three days, I am not sure that I am all that well qualified to express an opinion on the point. My background is that of a lawyer rather than a surveyor, and in this debate we are talking about English law, while my training and experience is largely in Scots law. One thing I learnt when I came south was that Scots law and English law differ most fundamentally of all in the area of property law, and it is very difficult for a Scots lawyer to understand the details, let alone the structure, of the way in which English property law operates.

However, I encountered quite a number of boundary disputes when I was in practice at the Bar in Scotland, and even one or two when I was sitting as a Law Lord here in this House and was introduced to, among other things, the wonderful presumption known as the hedge and ditch presumption, which I very much enjoyed examining. I also encountered a number of surveyors during the course of my practice, as a result of which I should say that I have a great deal of respect for the noble Earl’s profession. There were many cases on which we worked together as a team, although it is fair to say that they were largely in the area of valuation for rating rather than surveying in the more strict sense.

We are not being asked to consider the law of Scotland today, and in any case I am quite sure that the Minister would not wish to comment on it since it is a devolved matter. However, it may be of interest if I sketch in a little the way that issues are apt to arise in that jurisdiction. It does tend to show that the problem here in England and Wales is much more acute than it is under the system I was used to in Scotland, and that underlines the importance of the issue raised by the noble Earl.

Scotland has had a system of recording land tenure in a public register called the Sasine Register since the early 17th century. There were attempts to create a register earlier than that, but the position today is that for well over 300 years, every single property in the country has been the subject of a recorded title, or more accurately, a registered title, which can be examined by every member of the public on payment of a suitable fee. It is in the course of being replaced by a modernised system of registration of title, but the Sasine Register still exists and it is the source from which the relevant information can be derived when moving to the new system. There is a complete account of all deeds, which enables anyone to identify the extent of ownership of any holder of land, and includes all deeds which affect the security of land—the title to the land—that is, deeds which are in the form of security for debt, deeds that record rights of way, and what in Scotland are called servitude and England easements. Everything that affects a title has to go on to the register to be effective at all. It is therefore a very complete record of the present situation of any landowner’s title.

Every title that is put on to the register has to have a description. For a long time the practice has been to describe the property that goes on to the register by reference to boundaries. The early deeds did that by reference to natural features such as walls and gables. Occasionally resort was made to plans, which were always described as taxative—in other words, they were made to be definitive as to the extent of the title. Once a title containing the information had been registered, the titles that derived from it simply tended to refer back to the original deed, so that in practice one has to search the register quite diligently to find out the limits of where the property lie. The result is that from time to time mistakes occur. Someone sets out to design a new definition, but has not correctly recorded what was in the earlier deeds from which the title is derived. It is in that kind of situation that a boundary dispute arises.

Where mistakes of that kind arise there are two kinds of problems. First, there is the problem of searching the register and understanding how the titles have been defined. To some extent that is a task for a lawyer, given that a lot of work is being done through titles, which only lawyers can really understand. It may be that measurements and things of that kind are needed, for which a surveyor might be used. However, there is another aspect of this: in Scotland it is called positive prescription. The noble Earl referred to adverse possession and it is the same concept. If somebody has occupied land without objection for 10 years—“nec vi, nec clam, nec precario” is the Latin phrase—he has an absolute right to remain in possession, even if the description in his title conflicts with his neighbour and the neighbour can show that actually he ought to have been able to occupy that land himself. If he does not take the initiative within the 10 years, he loses the right to do so. In that sort of situation very difficult issues of fact may arise. The question is whether the present possession has been adverse for the necessary period, and in that situation a surveyor, frankly, is not the person to whom one would turn. It would probably be a solicitor instructing a member of the Bar to prepare and argue the case all the way through. Therefore the situation is quite complex. In Scotland, these issues can arise in various forms, but the basic situation is one of a complete register of all the land and we therefore do not have the problem that arises in England—and, no doubt, in Wales—where a substantial amount of property is not on the register at all.

What about England and Wales? My noble and learned friend Lord Brown of Eaton-under-Heywood said to me this morning that the courts would be quite delighted were Mr Elphicke’s draft Bill to be enacted and the courts were relieved of the heavy responsibility, which he described, of having to deal with these cases. My own experience as an advocate was that these cases were really quite enjoyable and therefore I would be rather sad to see them go. There is a difference of view between counsel and the judge. However, I am not absolutely sure that the situation is quite as easy as the draft Bill is suggesting or that the public would be well served if the law were to be reformed in the way that it proposes.

I stress that I do not for a moment doubt that there is a problem. Indeed, since the pattern of land-holding in England and Wales is much less neat and accessible than it is in Scotland, the problem is indeed acute. But my impression is that the Land Registry does an excellent job. Having studied its website, it offers much helpful advice and guidance for people who find themselves in dispute, which they would be well advised to follow. There is the right that everyone has, under Section 73 of the 2003 Act, to object to an application for registration. If there is an objection, there is a tribunal to which the matter can go. No doubt, it will take many decades before the system can settle down to the extent that it has in Scotland; nevertheless, the Land Registry is there to improve the situation and assist the public, as I have attempted to describe.

My main point is that I am not entirely convinced that making it compulsory for every such dispute to be resolved by reference to a panel of surveyors and excluding the courts entirely—as I think the draft Bill seeks to do—is either necessary or desirable. There will be cases where the title deeds alone will provide the answer and it may be that agreements can be reached; but I am not entirely sure that understanding these deeds is within the exclusive competence of a surveyor. There is then the problem of how to deal with other evidence about the way the property has been used, which may be hotly disputed and requires analysis, presentation of evidence, cross-examination of witnesses and so on. There is also the matter of adverse possession, which could raise very difficult issues.

While I am absolutely sure that the noble Earl has raised some interesting and important issues, I am not sure that the suggested solution is the right one. I look forward very much to what the Minister has to say in his reply and, in due course, to reading the scoping study that has appeared on my BlackBerry, but which I have not yet had a chance to read.

15:19

[Lord Kennedy of Southwark (Lab)]

My Lords, I start my remarks by thanking and paying tribute to the noble Earl, Lord Lytton, for putting down this important question for debate today. In preparing for this debate, I read a number of very useful documents that gave sensible and practical advice on dealing with property boundaries. The overriding theme I picked up was the importance of discussion and communication with your neighbour, and of seeking to find a solution on a reasonable basis. The last place that anyone should want to find themselves in seeking to deal with these matters is a court of law. That, in my opinion, is very sensible advice. Every now and again a case is reported in the media in which a boundary dispute got completely out of hand, and both sides became involved in expensive litigation which cost far more than the worth of the boundary they were actually arguing about. This is, of course, in addition to the stress and anxiety people suffer in dealing with such matters.

In his remarks to the Grand Committee, the noble Earl highlighted the point that in many cases the boundaries for registered and unregistered properties are poorly defined. That is where the problems start. Relying on the Land Registry against a backdrop of Ordnance Survey mapping of the general position of the boundary may not provide the detail required to resolve the problem. I am an elected member of Lewisham Council, and at a recent planning committee meeting which discussed an application for an extension to a resident’s house it emerged that most of the garden was actually owned by Lewisham Council, which owned a long strip of land that went through a number of gardens behind properties. No one seemed to have any idea why the council owned the land or for how long it had owned it, but own it it did. It was not a huge problem in that case, but it illustrated to me how in many cases property boundaries can be ill defined and that, as the noble Earl said, can bring significant difficulties.

Clear boundaries are important, and it is good advice to get the boundaries of your property clear with your neighbours. As I said, and as the noble Earl mentioned earlier, relying on a Land Registry guarantee of title is not the protection that some people think it is. The noble and learned Lord, Lord Hope of Craighead, usefully outlined the position in Scotland. Not for the first time, we could learn valuable lessons from how property law operates in Scotland. To resolve any dispute, speaking to your neighbours is of paramount importance, as is not taking action that would be seen as inflammatory, such as submitting a planning application or using any other means to reclaim land. Reaching an amicable solution to the dispute is in the interests of all parties.

Problems can occur when boundaries are not clear or have become confused over time. Hedges, fences, stone walls or other physical barriers might not be the actual boundary at all but have become seen as the boundary. As I said earlier, minor disagreements can quickly escalate into major disputes involving solicitors and expensive litigation. When agreement cannot be reached between the parties themselves, the objective should be to resolve the dispute at the lowest common denominator. For example, that could involve chartered land surveyors or chartered surveyors who specialise in boundary work making an expert determination. That could be legally binding on the parties concerned if they agree that it is to be so. There are a number of advantages to this method, which is confidential, speedy, cost effective and final, but actually this procedure is not very popular or often used. I am not sure why that is. Perhaps it is because people are not aware of it, and by the time that professional people get involved lawyers are often needed, as it has come to a court action.

As with other disputes it is possible to go through a process of mediation, by which a settlement is negotiated between the parties that they can live with. However, for this to work there has to be a willingness to negotiate. That involves give and take, and being prepared to enter into the process with an open mind about the discussion and the options for reaching a solution. It is possible that at the end of a mediation process one party will feel that the outcome is unsatisfactory, but if people enter the process with an open mind it can resolve matters. It is also worth noting that the advantages of mediation are that the parties arrive at the agreement themselves, and in reaching that agreement hopefully get a better understanding of the position of the other side.

Moving on from these ways of seeking agreement, people can often find themselves at the land registration service of the Tribunals Service, the county court or the High Court, in certain circumstances. All those options begin to cost quite a lot of money. It does no good to enter into disputes before courts and tribunals that, in the end, cost more to resolve than the value of the land or boundary in question.

The Government need to act on this, and the noble Earl, Lord Lytton, has made the case today with a sensible solution to the problem before us. We need an effective link between the public and the Land Registry so that, where required, the position of boundaries can be formally established and recorded without recourse to litigation of the type I outlined earlier.

As the noble Earl suggested, to achieve that there should be a system of notification of a boundary proposal to neighbours which, if disputed or ignored, would trigger a dispute resolution system backed by a requirement to register the outcome with the Land Registry as a formal determined boundary. It would be similar to the process that operates under the Party Wall Act 1996. It would ensure that the vast majority of boundary disputes were removed from the courts, but without in any way preventing an appeal in appropriate cases. We have only to look at how many party wall cases are appealed to the courts to see the effectiveness of such a measure.

In conclusion, I again thank the noble Earl for raising this issue and I look forward to the response of the noble Lord, Lord Faulks.

15:25

[The Minister of State, Ministry of Justice (Lord Faulks) (Con)]

My Lords, I, too, am grateful to the noble Earl for raising this important issue for debate and for the clear way in which he outlined the problem. I am grateful to him also for acknowledging the fact that he, I and Charlie Elphicke, who brought forward a Private Member’s Bill, had a number of meetings in which he helpfully outlined of the nature of the problem as he sees it, and the possible solution presented by the Bill. This has been a useful exercise informing the ministry and my officials.

Property boundary disputes relate to the legal position of a boundary between two properties and the ownership of the relevant land. There are many millions of boundaries between properties in England and Wales. This is not a hyperbola—there are 24 million registered properties. The vast majority are probably never the subject of a dispute. However, as we have correctly heard, where neighbours disagree about the line of the boundary, the disputes can be very difficult indeed to resolve.

We cannot realistically create a world in which neighbours do not from time to time fall out over the precise position of a boundary. There are all sorts of reasons for the disputes, not all to do with a precise evaluation of the boundary itself. What we can aim to do is provide effective ways to resolve the disputes that occur. A first step is to try to identify why they seem to be so difficult to resolve.

It is perhaps regrettable that boundaries are rarely precisely defined in England and Wales, and the standard of property descriptions in conveyances and the matching of plans to the situation on the ground has historically too often been poor. In addition, boundaries may be changed by the application of the principle of adverse possession, to which there has been reference in this debate. Those rules are complicated and the time periods applicable depend on whether the title to the land is registered but, basically, a person can become the owner of land by uncontested continuous use over a lengthy period of years. The noble and learned Lord, Lord Hope, correctly referred to the Latin maxim. If this happens, the line of the legal boundary will change.

The fact that adverse possession involved evaluation of the facts is one of the reasons why the Government respectfully agree with what the noble and learned Lord, Lord Hope, said about the difficulty in the otherwise initially attractive solution of having the matter determined effectively by surveyors. An undesirable side effect of this lack of precision is that, unless a certain give and take is observed between neighbours, the resultant boundary disputes are often bitter, protracted and expensive. On occasions, the costs, as the noble Lord, Lord Kennedy, rightly said, can be out of proportion to what is at issue. There are all sorts of reasons for this.

As we have heard, it was concern about the disproportionate cost and bitterness of disputes based on the experience of his constituents and others that prompted Charlie Elphicke to bring forward his Bill. It proposed—if I may condense a 17-clause Bill, which I know has been amended—that disputes relating to the exact location of a boundary between adjoining properties in England and Wales must be referred to an independent adjudicator for final determination at the earliest opportunity, subject only to a right of appeal to the county court. In the light of the concerns raised, the Government decided to carry out an initial scoping study on the issue. The result of the study was published today; it is on the Blackberry of the noble and learned Lord, Lord Hope, I think the noble Earl has received it, and if the noble Lord, Lord Kennedy, has not received it, he will do so shortly. We have placed a copy in the Library, but I will briefly summarise its content.

The study took the form of interviews with a small number of key stakeholders and the distribution of a questionnaire to 30 organisations with an interest in land law issues involving boundary disputes. Input was also received during the period of the study from a number of individuals who had themselves been involved in such disputes. The study reflects the views expressed in the responses received on the nature, frequency and causes of boundary disputes, the effectiveness of the resolution methods, the problems that arise and what could be done to address them. It discusses a number of options for legal or procedural change. Incidentally, I accept that it is difficult to calculate quite how many disputes there are because they can vary between a full-blown boundary dispute which reaches the High Court and even beyond, and an initial disagreement which may be relatively easily resolved, and there are very many steps along the way.

Boundary disputes can be mediated by a range of methods, either through the county court or the land registration division of the Property Chamber of the First-tier Tribunal, as part of legal proceedings or separately by mediation, as referred to by the noble Lord, Lord Kennedy. Independent expert determination is also used in a very small number of cases. I noted from the RICS document, which was part of the very helpful Library Note put together for this debate, that there is a RICS Neighbour Disputes Service, which provides access to a specialist panel of expert members with experience of resolving neighbourly boundary disputes. The service can involve expert determination and mediation of a dispute, and therefore there is an alternative to formal litigation if any doubt or uncertainty exists between parties on the correct boundary line. The RICS advises those who might wish to seek a slightly cheaper way to resolve their problems.

The core conclusions reached in the study are that there is merit in the Government carrying out further work to assess the feasibility of improvements as regards a number of aspects of the current system, including the use of mediation and expert determination, the spreading of best practice and the provision of better information, but that more radical reform such as that argued for by the noble Earl, Lord Lytton, would not currently be justified. The particular approach the noble Earl advocates is the introduction of a mandatory system for resolving disputes similar to that used under the Party Wall etc. Act 1996. That would involve the appointment by parties at as early a stage as possible of an independent expert, normally a surveyor, to determine the position of the boundary. In the event that either party was dissatisfied, it would be open to them to appeal against it to a court.

It will be useful if I explain why the Government do not consider that requiring everyone involved to follow such an approach would be beneficial. First, the determination of the legal position of a boundary in the absence of agreement is normally a matter for a judge, as it determines a person’s legal rights. A surveyor, no matter how expert in technical issues—I entirely agree with the noble and learned Lord, Lord Hope, although my own experience with surveyors is that they very often are extremely expert and supplement the often inadequate understanding that lawyers have of these issues—will not necessarily have the legal expertise to deal with cases that involve more complex legal issues such as adverse possession. Allied to this is the fact that, unlike party wall cases, which are essentially based on a mutual need between the owners of the adjoining properties for work to be done efficiently, boundary disputes are much more likely to produce a “winner” and a “loser”. In addition, as contributors to this debate have acknowledged, boundary disputes can generate considerable bitterness.

The combination of these factors means that in our view the likelihood of appeals being brought against decisions would be high. It would mean that in many cases the suggestion would simply add a further layer to the proceedings, which would add to the costs rather than reduce them. In some cases the early appointment of experts could itself front-load costs where the dispute might have been resolved in other ways, and, perhaps, permit stronger and legally astute parties to steal an advantage over more easygoing neighbours. That does not mean that the Government are in any way complacent about the problems that can arise in boundary disputes, or about the possibility of improving relevant civil procedures more generally.

In the course of this Parliament, we have made considerable efforts to rein in the costs of civil litigation in general so that they are more proportionate, including through a new civil procedure rule to ensure that costs which are disproportionate will not be recoverable, even when they are reasonably or necessarily incurred. We have also introduced new provisions for costs management and costs budgeting. These and other steps should help to reduce the amount of costs so that they do not become disproportionate to the issue.

We believe that rather than restricting the flexibility of the current system and the range of methods that can be used to resolve these disputes, it is preferable for us to explore the feasibility of making further improvements. As I have indicated, there are a number of approaches we wish to examine aimed at developing and encouraging the use of mediation or other methods of alternative dispute resolution, supporting robust and timely case management and improving the quality and availability of guidance and information to increase awareness of the issues and the options available. I am grateful to the noble and learned Lord, Lord Hope, for reminding us of what the Land Registry provides by way of assistance to those who wish to have boundaries clarified.

On the question of general boundaries, which was referred to in the debate, I am advised that when land registration was first introduced there was an experiment with general boundaries from 1862 to 1875, when it was abandoned because it caused so many disputes.

On the question of what we can learn from Scotland, of course, it is always useful to learn from other jurisdictions. I am advised that a local deeds registry existed in Yorkshire and Middlesex until the late 20th century. We will consider, among other things, what we can learn from practice in Scotland, and, indeed, from practice in Australia. Our core aim will be to reduce the costs without in any way impeding the proper opportunity for people to dispute boundaries where they must do so. We intend to take forward consideration of how action can best be focused in these areas in the light of the findings of the scoping study in order to reach more definite conclusions on next steps in the year ahead. I thank the noble Earl for his contribution to the debate and all those who have contributed to our enlightenment on this important issue. As I have said, we are by no means complacent about this issue and the debate has been most helpful.

15:37

Sitting suspended.

Chancel Repairs

Thursday 15th January 2015 Grand Committee

Question for Short Debate

16:00

Asked by

[Lord Avebury]

To ask Her Majesty’s Government what steps they are taking to abolish the liability of private householders and others for chancel repairs.

[Lord Avebury (LD)]

My Lords, a consensus that reform of the law on chancel repairs is long overdue has emerged from discussions with the church, the Law Commission, the Law Society, the Country Landowners’ Association and the National Secular Society. Since the Chancel Repairs Bill will not make further progress until after the general election, a preliminary debate on the issues is useful now.

By the 12th century, the liability to pay for chancel repairs, the CRL, was already linked to the tithes being received by the rectors of certain parishes. At the Reformation, Henry VIII sold the right to the tithes to lay people, who became liable for chancel repairs as “lay rectors”. Under the current law, the Tithe Act 1936, some lay rectors are still responsible for those repairs, but the tithes which originally enabled them to make a profit from the transaction were abolished. The unfortunate remnants were those who owned land that was not relieved of the burden in 1936, or their successors in title, who have been living under a sword of Damocles for the past 78 years. It is for discussion whether major institutions such as the schools of Eton and Winchester or the colleges of Oxford and Cambridge should continue to be required to pay long-standing non land-based CRL, but it is unreasonable for the owners of generally small plots of land in some 2,500 Anglican parishes in England—around half of them—to be potentially liable for the charge, which is without limit.

The Chancel Repairs Act 1932 reasserted the little-used right to enforce CRL but transferred enforcement from the ecclesiastical courts to the county courts after a lay rector was sentenced to prison by the High Court for contempt of the ecclesiastical court for non-payment of CRL. It was seldom recovered during the succeeding half-century, and in 1981 the General Synod accepted the recommendation of its standing committee, headed by the late Archbishop of Canterbury Lord Runcie, to phase it out. In moving to receive the committee’s report, Mr Clark of Southwark said:

“So I hope we shall support the suggestion that we phase out these liabilities, just as the Church of the 1830s agreed reluctantly to tithes being phased out”.

The synod approved the recommendation but declined to use its legislative powers to implement it. Soon after, and with Church of England involvement, the Law Commission recommended the abolition of CRL by statute after a 10-year notice period, which would by now have long expired. That recommendation, made in a well argued paper, was not implemented, but if the synod itself agreed to ending CRL, thinking it unlikely that compensation would be forthcoming from the Government in 1982, it would be even less realistic in this age of austerity to expect the taxpayer to reimburse parishes for the loss of a doubtful future income. Given the furore over even the registration of CRL of properties in the roughly one in 20 parishes thought eligible to do so, parochial church councils have wisely refrained from enforcing their legal rights since 2003, so are they worth anything?

The state already contributes hugely to the upkeep of churches through gift aid worth some £84 million; the Listed Places of Worship Grant Scheme worth £42 million; the National Heritage Memorial Fund, currently funding repairs to Winchester Cathedral costing £14 million and of York Minster at £18.3 million; further grants to cathedrals recently announced worth £8 million; Heritage Lottery Fund grants to churches of £300 million in the 10 years to 2004, the lion’s share to the Church of England; and finally, £15 million recently announced by the Chancellor of the Exchequer for repairs to church roofs and rainwater pipes under the Listed Places of Worship Roof Repair Fund.

In 2003, following a refusal by English Heritage to fund repairs to the church in Aston Cantlow in Warwickshire, the local PCC refused an offer of £25,000 from the lay rectors, Mr and Mrs Wallbank, and the parish took the case all the way to the House of Lords, with the active support of the Archbishops’ Council. There, the Wallbanks lost, and had to sell their farm to pay the CRL and costs approaching £500,000.

Parliament reacted with an order providing for registration of CRL at the Land Registry to alert buyers to land being subject to the liability, since it was rarely shown on deeds, but lawyers doubt whether buyers of unregistered land are protected as envisaged when the order was enacted. The church warned PCCs that failure to register under the order might render trustees personally liable, so it is little wonder that an estimated 17,000 titles in a few hundred parishes have been registered. The vast majority are owned by ordinary householders, not major landowners.

Attempts were made to mitigate the harm to the mission of the church that registration caused. Titles were singled out where the return seemed most lucrative or there was likely to be opposition. PCCs often announced that there was no intention of enforcing the liability. However, assurances are not legally binding and can be rescinded at the stroke of a pen. Even cancellation of the registration does not extinguish the right to enforcement.

PCCs were ill equipped for the laborious and exacting work of registration, often involving missing, archaic or inaccurate documents. Unsurprisingly, thousands of registrations have been made in error, compounding the distress caused to householders. This happened, for example, in Gorleston in Norfolk, where all of the nearly 1,000 registrations had to be withdrawn.

Given the hostility to registration reported by the media, churches would find it extraordinarily difficult and counterproductive in terms of their relationships with their parishes to sue for recovery of CRL. It appears not to have been attempted since Aston Cantlow. Registration is literally a medieval anomaly that undermines the value and saleability of land, creating lasting animosity towards the church, without achieving the objective of improving the funding of chancel repairs. It aims at taxing citizens who may not even be Christian or belong to any religion, for the purposes of one faith out of dozens in our multicultural society.

Even more harmful for many landowners than the exposure to unquantifiable and theoretically limitless CRL is the blight of registration, significantly reducing the sale price and even making the property unsaleable, particularly to buyers requiring mortgages. Since Aston Cantlow, purchasers of land have routinely taken out insurance against having to pay CRL, and this has proved very lucrative to the insurance industry, given that payouts have been minimal. But for property blighted by registration, premiums are astronomical or insurance is totally unavailable.

The only fair solution is abolition, modelled on the Law Commission’s recommendation, but until that can be effected, a much greater availability is needed of compounding—the ability to buy out the liability to CRL, at low cost and minimal professional fees. At Edingale in the diocese of Lichfield, the diocese agreed after long and stressful negotiations to accept just £45 from a householder to extinguish her liability to pay CRL of thousands of times that amount if it had been recoverable. Without compounding, any would-be purchaser would have had to take into account the probability that, ultimately, the church would be able to enforce the claim, as it did in Aston Cantlow.

Some dioceses already recommend compounding, but a uniform countrywide scheme would be the ideal, possibly by way of amendments to the Ecclesiastical Dilapidations Measure 1923. The initiatives of the Reverend Greg Yerbury, team rector of Penkridge, Staffs, might provide a useful model. In any case, based on the principle that half a loaf is better than no bread, it might be sensible for the church to devise a workable national scheme for compounding before we return to the Chancel Repairs Bill, abolishing CRL altogether after the general election.

16:09

[Baroness Wilcox (Con)]

My Lords, I thank my noble friend Lord Avebury for bringing this subject to the attention of the Committee and thereby giving us all the opportunity to discuss a very important matter—chancel repair liability. In my role as chairman of the London Diocesan Advisory Committee and as an active member of my parish church in Cornwall, I see more of the varied picture that the Church of England presents than do most people. The views I have heard from the members and officers of the Church of England on the subject of chancel repair liability are equally varied. I speak now as an individual member of the church, not on behalf of any church body.

As we have heard from my noble friend Lord Avebury, this matter is one that can come between churches and their local communities, and it has long been understood that something must be done to remove the element of surprise from the situation. Those of us within the church had been resting on the assumption that something has been done. In 2002, Her Majesty’s Government brought the Land Registration Act on to the statute book, giving the church 10 years to get its house in order and register legitimate chancel repair liability, after which the door would shut in October 2013. That was the date that we all had in mind: October 2013. After that, it would be settled, with no more scope for nasty surprises—surprises for churches seeking grant funding that are coerced into researching historic liabilities, and, of course, surprises for the owners of properties affected by those liabilities.

There are two sides to every story, of course. In fact, many registered chancel repair liabilities are against wealthy institutions, the church authorities themselves or others who are well able to pay. Those landowners would no doubt be pleased to see the value of their asset rise as a result of the abolition of chancel repair liabilities. However, the worst-case scenario is more often quoted. An unsuspecting person of modest means buys an unassuming house only to discover, despite having taken all possible precautions, that they are liable for a bill of a quarter of a million pounds to mend the church roof. That nasty element of surprise is undoubtedly one of the worst aspects of the current state of affairs, but I wonder how often it actually occurs. I do not have the numbers, but I hope that my noble friend may have the list to hand when he replies to the questions which I and others are asking.

It was precisely that problem which Her Majesty’s Government sought to tackle in the Land Registration Act 2002. At least, that was the popular understanding among my church friends. I think that it is fair to say that in practice the law is not what we all hoped for, a view supported by the Law Society in its parliamentary briefing. Its principal limitation is that it applies only to properties sold since October 2013. All property which has not been sold since October 2013 continues to dwell under a cloud of uncertainty. Even worse, the point of sale being the completion of the sale means that, at least in theory, it is possible to discover and register a new chancel repair liability between exchange of contracts and completion. That means that even when a property search has been returned blank, there remains a risk. Unsurprisingly, the insurance industry has risen to the challenge, and chancel repair liability insurance remains a lucrative business. In practice, the 2002 Act has not met the needs of churches, landowners or potential purchasers.

To my mind, the neatest, fairest and best solution to all this is to bring forward a law to fulfil what we hoped was the ambition behind the 2002 Act: to remove uncertainty and any further possibility of nasty surprises. However, to abolish chancel repair liability altogether without compensation to the churches concerned would not send the right message to the volunteers struggling to maintain our church heritage.

I do not dispute that the present Government have been generous in their funding for church buildings, but in the European context, where many countries’ churches are funded largely by the state to the tune of billions, we get extremely good value for money. The volunteers of the Church of England care for 12,500 listed buildings—more than 10 times as many as the National Trust and English Heritage combined. While churches can apply to certain grant funding pots, there is no guaranteed state funding at all for this substantial part of our national heritage.

While grand country houses and ruined castles are, at best, noble works of art and, at worst, symbols of local oppression, our historic churches represent the very best hopes and aspirations of the communities that built them, celebrated their lives in them, and were ultimately called to that final act of parish communion in their churchyards. In seeking to legislate further to end the undoubted unfairness of the present system of chancel repair liabilities, I urge the Minister to ensure that hard-pressed individual congregations tasked with caring for this very significant part of our heritage are not put at a disadvantage as a result.

16:15

[Lord Cashman (Lab)]

I, too, congratulate the noble Lord on enabling this important debate on an issue which should have been settled years ago but that I hope will be settled soon. I know that I am not alone in having received supportive calls for the repeal, or at least the reform, of this liability from, among others, the Law Society of England and Wales and the National Secular Society. The Law Society is calling for reform of chancel repair liability for a number of reasons, but primarily to reduce the financial burden on purchasers of land and speed up the conveyancing process. It also puts the case that, more widely, reform could help to improve the UK’s standing in the World Bank rankings of ease of doing business. Interestingly, in the section on registering property, we are currently ranked 68th, against an overall ranking of eighth. Much more, clearly, needs to be done.

More widely, the number of property titles blighted by CRL per parish ranges from as few as one to hundreds or even thousands. Where it is a small number, the people singled out will feel doubly vulnerable because of the several nature of CRL—that, in many cases, any one landowner can be sued for the entirety of the repairs needed, as happened in the previously-cited case of Aston Cantlow. Where the number of CRL registrations in a parish is large, untold distress is caused to a significant proportion of the community, including many without the knowledge or resources to cope with it.

In Lytham St Annes, more than 6,000 titles were reportedly registered by the church, the largest number in the country. I believe that the parish with the second largest number of registrations, approaching 1,000, is Gorleston on the Suffolk coast, a town I know well. It is a town with a high proportion of elderly residents, and not a wealthy one; 20% of people are on benefits, compared with 13% for England as a whole. With so many properties sharing the CRL burden, the individual sums recoverable would, one could argue, have hardly been worth collecting or registering, but much as in Lytham, the church in Gorleston gave the impression that the registrations were made just to follow orders, or as the vicar said, “in order to comply with the requirements of the Charity Commission placed on the trustees of charitable organisations”.

The tale goes on. The vicar offered property owners a way out: pay the parish £50 and receive what he described as a “certificate of exemption”. He promoted this as being cheaper than insurance. The recognised way, of course, of buying out CRL is through the Ecclesiastical Dilapidations Measure 1923, under which the money goes to the diocese. These exemption proceeds went to the parish, and an acknowledged expert on CRL has seriously challenged the exemption’s validity. The vicar, too, seems to have had second thoughts, for he has refunded the £50 contributions, which he had said were better than insurance, seemingly whether or not the property owners wanted to lose the exemption they assumed that they had contractually secured. The parish has, it seems, thrown in the towel. I quote this as an example of damage done to the many. It has thrown in the towel because every registration has been revoked, but only after about a year of heartache and uncertainty for those whose properties were registered.

Although I imagine that some owners may reasonably assume that the Church’s right to sue for CRL is thereby removed, the PCC remains free at any time in future to reregister or, more importantly, to sue for it. I hope that I have put the case not only for reform but for repeal. I believe sincerely that CRL is a pernicious, medieval relic and the time is long past for the curtain to be dropped rather heavily upon it.

16:20

[Lord Taverne (LD)]

My Lords, until I found out from my noble friend Lord Avebury what his debate was about, I must confess that I had never heard of CRL. Then I discovered that this ancient, medieval, ecclesiastical relic still exists and can have potentially catastrophic effects on thousands of owners of mainly small plots of land in some 2,500 Anglican parishes. Owners can be held responsible for the cost of repairs to churches amounting to tens of thousands of pounds and that potential liability can make their house unsaleable. The liability is perpetual and can be annulled only by compounding—that is, by buying it out. This can involve large legal, surveyors’ and insurance costs, if it can be insured against at all.

Churches have argued that owners knew or should have known about this when they bought the land but they generally did not know, or they would have avoided making the purchase. In time registration of land was made an option for churches so that owners would know about their liability for CRL, recorded in the Land Registry, but many bought their property before registration. For example, 30 families in Broadway found out about it only when they received a letter from the Land Registry. It was a traumatic discovery causing an outcry of anguish, duly reported by their Member of Parliament, and in the end registration of their property was withdrawn because of its effect on the reputation of the church.

That unlikely adverse publicity for churches has meant that since the Aston Cantlow case they have not asserted their right to sue landowners, but its existence still blights owners’ property. One landowner was nearly driven to suicide because he lost his principal assets. Sometimes registration by the local church has proved ineffective because the archives holding the records are difficult to trace. Some people have therefore tried to get registration overturned, but the costs are huge and the task is impossible for laypersons because of the legal complexities and because the owner might need to find the relevant archives which are kept in different locations. It is no wonder that the Synod recommended in 1981 that CRL should be phased out. Unfortunately, it did not press the issue.

The case for abolition of this oppressive anachronism is overwhelming. It can ruin lives and I am told that the legal position, even of those who have not had their properties registered, is uncertain. It should go the way of tithes, and I hope that the right reverend Prelate will pass on to the most reverend Primate the Archbishop of Canterbury, who has shown deep concern about social justice, our pleas that this anachronous imposition of huge burdens on possibly thousands of landowners should be ended as soon as possible.

16:23

[The Earl of Lytton (CB)]

My Lords, I, too, welcome this debate and thank the noble Lord, Lord Avebury, for the opportunity. In rising to support him, I declare an interest as a chartered surveyor, as an occasional provider of quinquennial surveys on ecclesiastical property and as a valuer—not in the matter of professional involvement with CRL but rather the implications for valuation and the philosophy of this ancient impost more generally.

In every consideration of property valuation the question of risk looms large and often has a disproportionate effect on net present value. Typically, that is reflected in a discount rate or the rate of accumulation applied in a valuation. This is not just theoretical science but reflects the real world of human response to risk and reward over extended timescales and observed over centuries. CRL affects land value because of how the liability is transmitted and how it attaches to owners.

There is one thing more potent in valuation than a perceived liability and that is a liability that cannot be quantified. To counter it often requires the adoption of a worst case scenario. CRL, to quote Donald Rumsfeld, is full of “known unknowns” and here are some of them. First, whether it applies at all is far from obvious. The basis of liability—is it keeping a chancel windproof and watertight, or is it something more elaborate?—has been the subject of a more recent decision. What is the resultant amount of the liability and its calculation? Is it shared or individual—joint or several, to use the technical term? The timing of its imposition and the inability to defer or amortise regardless of impact is significant. The reliability of safeguards such as insurance and the implications for professionals, which have been raised by the Law Society, are certainly uppermost in my mind as a professional myself. There is the difficulty of buying out the liability—or compounding, to use the correct term—at a fair sum and at a time of one’s choosing. There is the absence of a right of appeal against either the impost or the quantum. There is the potential for expensive delay at critical moments, with consequential market-value effects, and it can be a severe impediment to transactions. Unfortunately, as the noble Baroness, Lady Wilcox, mentioned, the Land Registration Act 2002 has not resolved the issue; it has simply put a large part of it into the long grass.

Liability falling on wealthy landowners may be one thing but when it falls on unsuspecting householders, reluctantly deemed by the PCC to be the most amenable of various possible pockets, that is clearly something else. The selectively capricious manner of its imposition hugely adds to the risk and to the disproportionate resultant contagion. It can destabilise family finances, destroy livelihoods and wreck lives, as we have heard. The ability to pay matters not one jot. I cannot prove this but I suspect that CRL has the potential to destroy more third party property value than it confers in benefit in terms of chancel repair.

I am no great moralist, but if CRL were in the hands of private landowners, such non-recourse powers would have long since been outlawed as contrary to the public interest. I was raised in the Roman Catholic faith. I know very well that desirable ends of maintaining places of worship exist but they do not necessarily justify capricious or inequitable means of financing them. Part of the problem is that although there is a perception of the great wealth of the established church, administered under the auspices of the Church Commissioners, this does not inure for the benefit of parochial church councils, which are legally obliged to shoulder the funding of church repairs from their own resources and congregations. Although the real estate, if I can term it that, belongs to the diocese and is administered centrally, it is the parochial church council that has the unfortunate business at the sharp end of imposing CRL. This is a fairly invidious state of affairs. Clever financial minds—I do not single out the Church of England for this; far from it—have segregated asset from parish burden, and this is part of the issue.

Like the noble Lord, Lord Avebury, I ponder the message that this sends out. It seems to me that there is a consensus that CRL should be abolished, and I hope the Government will get on with it.

16:28

[Lord Rooker (Lab)]

My Lords, I am very happy to support the noble Lord, Lord Avebury. I want to tell your Lordships a story. It is the story of Helen Bailey from Staffordshire, whom I spoke to yesterday evening.

Helen Bailey said: “The parish church officials in Edingale, Staffs, seemed entirely ignorant of the consequences of registration on title holders, and they appear to have given the affected individuals not one iota of thought and were utterly insensitive. They appeared not to have had any guidance regarding the human impact of CRL from the Lichfield diocese or from the church centrally, and seemed to be treating it as some sort of purely legal and technical matter. No attempt was made by the church to consult with owners, as had been the case in the adjacent parish of Alrewas, as a result of which registration was not proceeded with. Having decided in principle to register, it apparently did not occur to the Edingale Parochial Church Council to establish whether there were any extenuating circumstances rendering registration an act of callousness or even inhumanity. The church officials did not even observe the most basic courtesy of informing us”—that is, Helen Bailey and her neighbours—“of what they were about to do, or even had just done. The first I learnt about registration was when the letter arrived from the Land Registry. The next day I met one of my neighbours who had also received a letter; she looked as white as a sheet and had clearly not slept. The owners of the adjacent farm, who own the bulk of the affected land, received no notification. The land was not registered, so they got no notification from the Land Registry and it was only much later, at the insistence of the affected homeowners, that the church took any steps to inform them.

“Some weeks after registration a church official appeared on my doorstep, clearly very proud of his prowess in having navigated the mechanics of registering CRL and apparently expecting me to congratulate him. He seemed astonished when instead of being impressed, I expressed my anger and concern and acquainted him with the consequences of his actions. The church council appeared not to have done the basic internet research into CRL, which would have revealed its potential to blight the lives of affected individuals.

“Fortunately, my background as an accountant and experienced CAB adviser and as an advocate equipped me to do some research. Initially what I learnt served only to create increased anxiety as the full implications became clear. Recognising that CRL would in all probability make my property unmortgageable—and therefore potentially unsaleable—I had no choice but to try to find a solution. Initial letters to the church yielded nothing beyond denials of responsibility and hollow sympathy; there was an almost bewildering refusal to engage in the distress it had caused. The local vicar was more genuinely sympathetic but had no idea how to resolve the damage inflicted on my neighbours and me. In the end I was very fortunate to find myself in contact with the Reverend Greg Yerbury, whose integrity, expertise and kind assistance proved invaluable.

“My researches revealed that the historical proofs relating to CRL in Edingale were less than unequivocal but sadly also revealed that my neighbours and I had to disprove liability rather than the other way around, something we could not possibly afford to do. Assurances by the PCC that they had no intention of ever enforcing CRL were of no value at all as they did not remove the blight. Insurance was no longer available now that the liability notices had been registered and we eventually concluded that the only truly effective way to get rid of the blight was to buy out the liability via compounding under the 1923 legislation”—which has already been referred to.

“Again with Greg Yerbury’s support, I approached the church regarding compounding. Its initial response was unfortunately pretty unhelpful as it would involve fees for solicitors, accountants and surveyors which would have run into thousands and been quite unaffordable, even if shared. Eventually, and only after considerable effort, a more pragmatic solution was arrived at by Reverend Yerbury on the basis of a calculation proposed and agreed with all parties. Because Edingale parish church is small, relatively modern and the chancel is in good repair, the compounding cost ended up being calculated at around £50 per acre. In the end I succeeded in arranging compounding and it cost me £45”.

Helen Bailey continued, “It has been suggested to me that this trivial settlement sum proves that I was making an unnecessary fuss about nothing, but the absolute reverse is true. The settlement sum demonstrates the financial sabotage of CRL and the true idiocy of enforcing this ancient and anachronistic legislation. The church has gained practically nothing. For the sake of £45 they wrought disproportionate destruction on the value of my home and brought misery to my neighbours and me. Had I not drawn attention to this in the media and tracked down Greg Yerbury, who has been most helpful”—he seems to deserve a medal, I might add—“I am sure that my neighbours and I would still be in this invidious position”.

It is time for this legislation to go. I am in favour of preserving our church buildings, although I am not a churchgoer. I have two lumps of stone from St Laurence’s in my back garden, bought at auction to support the refurbishment of the church. I have no problem about that, but this legislation has to go.

16:34

[The Lord Bishop of Derby]

My Lords, how do I follow that? I thank the noble Lord, Lord Avebury, for introducing this debate. As a number of noble Lords have said, the Church of England is on record as supporting the principle of abolishing what has helpfully been called CRL, to put it into shorthand. It is very important to stress that. We are on record as saying that we support abolition in principle. The question is how and on what terms. Clearly, it is in no one’s interests to hear stories such as the one we just heard from the noble Lord, Lord Rooker. How could CRL be abolished? The fact is that property—not only the properties under CRL—is often subject to rights and restrictions. This is not new, and it is not unusual. In the Wallbank case in 2003 the House of Lords recognised that this was a right commensurate with other rights. In the 2003 judgment, Lord Rodger of Earlsferry stated that,

“in principle I do not find it possible to distinguish”,

CRL,

“from the liability which would attach to the owner of land which is purchased subject to a mortgage, restrictive covenant or other incumbrance created by a predecessor in title”.

It may feel anachronistic, but the fact is that it is not unusual for properties to be subject to these kinds of restrictions and challenges. In law, the most recent judgment we have from the House of Lords found that it was not easy to distinguish this from others. We can distinguish the pastoral effects of the cases, but in terms of good practice in the management of property and of rights it is a much more complicated issue.

The noble Lord, Lord Avebury, made important statements about the amount of funding the Church of England receives from the Government, and that is very welcome. However, as the noble Baroness, Lady Wilcox, said, the churches have to put in an enormous effort to maintain the buildings. They are not just a vital part of our built environment, but a facility that is there for people when they want it, as they want it and on their terms. A very few of us keep these buildings fit for purpose as a spiritual resource and a spiritual sign.

It is interesting that the Tithe Act 1936 did not abolish CRL. Parishes are often willing to come to a sensible arrangement, although in the story we have just heard it was a very tortuous route. For instance, in my own diocese in Derby, one of the former Dukes of Devonshire had quite a lot of liability in a number of parishes of which he was a patron. Years ago he commuted this responsibility in return for a financial payment, and he now has no liability at all. I make that point because, of course, if we suddenly abolish all this, some people have paid compensation in good faith and in recognition of that right and that the Church needs to be recompensed in some way. We have heard again that trustees have a liability to maximise assets. Again, I do not endorse the way in which this was done in the story which the noble Lord, Lord Rooker, gave us. That showed the wrong enthusiasm, but you have to be enthusiastic for maximising the assets that you oversee.

How can we proceed to get rid of the CRL and all the problems it causes? The advice we received is that—under the European Convention on Human Rights and the Human Rights Act, and taking into account the previous practice of the Government, the Tithe Act, and the previous practice of individuals such as the Devonshires—in all those cases such a right is commuted in return for some kind of compensation. That is the principle by which legislation would need to proceed. It is a well known constitutional principle that Parliament does not deprive a subject of a right in the nature of property without providing compensation.

I propose that we have to proceed to change. All the speeches have made that clear. This has to be done on the basis of compensation. This would be fair to the current liabilities that property owners hold, because they are legal liabilities. It would be fair to give parishes notice and some kind of recompense for having to take on an even greater burden of the maintenance of buildings. This would be fair to current legislation and good practice in the administration of property and of property law, as Lord Rodger reaffirmed in 2003. We are fully behind this. It is just a question of how it is done. There is a very strong case that there needs to be some element of compensation to be fair to all concerned.

16:39

[Lord Kennedy of Southwark (Lab)]

My Lords, like other noble Lords who have spoken, I thank the noble Lord, Lord Avebury, for tabling this Question for Short Debate today. It is a most timely discussion.

As we have heard, chancel repair liability derives from the disposal of church lands following the Reformation. Previously, the rector had the obligation for the repair and upkeep of the church and was able to raise sums of money—tithes—from parishioners. After the Reformation, much church land was passed to lay landowners but the liability for upkeep remained, and this is the problem in effect. The lay landowner with the liability to pay for chancel repairs has no means to cover the costs.

Some progress has been made to deal with this anomaly, most recently in 2003 when the then Labour Government changed the law, as other noble Lords have mentioned, so that after 13 October 2013, where interest has not been noted at the Land Registry, any purchaser of land to which the liability previously attached will not be subject to it, although the current owners in such cases would remain liable. That is some progress but we need to go much further.

We are fortunate in this country to have beautiful buildings of all ages and types. They tell the story of our history and they should be preserved. Our system of listing buildings helps protect them. I note that the Church of England is responsible for maintaining 45% of the grade 1 listed buildings in the country and that the majority of all parish churches are grade 2 or higher. The right reverend Prelate the Bishop of Derby made reference to this obligation. We have to find another way to fund the upkeep of these buildings and phase out the chancel repair liability, particularly for individuals.

Looking at the Wallbank case, referred to by the noble Lord, Lord Avebury, which went all the way to your Lordships’ House—which found against the Wallbanks and left them with a repair bill that amounted to £250,000 including VAT, and legal fees of £200,000—you can have every sympathy with individuals who find chancel repair liability claims served on them, and it illustrates how unsatisfactory the present position is. The case established that chancel repair liability, although ancient, is an enforceable part of the land law of England and Wales, whereby property owners can be compelled to pay for the repairs to the chancel of a church.

The noble Lord, Lord Avebury, introduced a Private Member’s Bill into the House of Lords on 14 July 2014, the effect of which, on becoming law, would be to abolish the liability on lay rectors for chancel repair. With so few days left in this Parliament before it is dissolved at the end of March, I do not think the Bill is going to make much progress, as the noble Lord himself suggested. What the Bill is proposing to do goes in the right direction, but for it to make real progress in the next Parliament there also have to be provisions to identify replacement funding, and that is where the Government come in.

Responding to a debate in the other place on 17 October 2012, Helen Grant did not offer much comfort and generally took the line that the provisions in place as a result of the 2002 Act have achieved a “better balance” and that the Government were not “persuaded” of the need for change. I contend that the Government need to move on from that position and try to find a lasting solution. Not to do so would continue to make certain properties unsaleable, bringing blight and distress to people, and that cannot be right.

I hope that the noble Lord, Lord Ashton of Hyde, when he responds to the debate, will be able to give a commitment that the Government recognise that there is a real issue here that needs to be addressed; that abolishing the liability in its entirety or at least for private individuals is long overdue; and that they will work with the noble Lord, Lord Avebury, and the Church of England to enable him to bring forward another Bill early in the next Parliament that resolves this question finally and provides a mechanism for replacement funding to be identified. That could just be the Government ensuring that, when the liability is removed, the Church of England will be able to apply for other funding streams. If the Government committed to working with the noble Lord, Lord Avebury, and the Church of England in a similar way to that in which they have worked with the noble Lord, Lord Naseby, on the Mutuals’ Deferred Shares Bill, they could make much progress here, which would be to their credit.

The noble Lord, Lord Ashton of Hyde, has heard the right reverend Prelate the Bishop of Derby say that the Church of England wants to get rid of the chancel repair liability. I therefore hope that he will take up my suggestion and work to resolve this, and not just tell the Grand Committee that the Government are going to keep the matter under review, because we all know what that means—that the Government are going to do nothing at all about it, which is not acceptable in this case.

16:45

[Lord Ashton of Hyde (Con)]

My Lords, I am grateful to my noble friend Lord Avebury for raising the issue of chancel repair liability for debate today. I am also grateful for the interesting contributions of other noble Lords who have spoken. I feel, in some ways, that the right reverend Prelate should be here, I will not say in the dock, but here with me to answer some of the speeches, which were all on the theme of changing the present situation. I listened carefully to the concerns expressed about chancel repair liability and I am sure that the Ministry of Justice will consider them in detail, but I must make clear—I trust that this will not come as too much of a shock to noble Lords, except, perhaps, to the noble Lord, Lord Kennedy—that the Government have no plans to change the law at present. None the less, it is because we take the concerns seriously that we are keeping the situation under review.

I do not have time to go through the long history of chancel repair liability. In fact, my noble friend Lord Avebury has dealt with that admirably, as have other noble Lords. The Law Commission has considered the liability a number of times since the 1960s. The present legal position is that chancel repair liability is an ancient but valid right that enables the owner, who, in England, is usually the PCC, to enforce the liability. This right can play an important part in the finances of the 5,000 or so churches with the benefit of the liability. In earlier times, the main problem was that the liability was sometimes difficult, if not impossible, for a prospective buyer to discover. Now, following the removal of its status as an overriding interest in October 2013, its existence is readily discoverable. This is a major improvement, as my noble friend Lady Wilcox said.

On the other hand, the unpredictability of the incidence of the liability, its open-ended size and particularly its joint and several nature, mentioned by the noble Lords, Lord Cashman and Lord Rooker, still attract criticism. It is, however, unclear how far these potential problems are causing widespread real difficulties in practice. The Ministry of Justice’s impression is that enforcement, now and for some time past, against ordinary homeowners is rare. This may be a consequence of the relatively small number of chancels, probably about 500 to 600, where the liability falls on individual property owners. It may also be because PCCs are reluctant to enforce the liability. Their wider mission may, perhaps, not be best served by imposing financial hardship on individual members of the local community. That is, however, a decision for individual PCCs, who can get advice from the church and the Charity Commission, as well as their own legal advice.

Under Section 110 of the Charities Act 2011, trustees can get reassurance from the Charity Commission that they are acting in accordance with their duties. It may also be that the level of concern about the liability has been temporarily increased by the registration. My noble friend Lady Wilcox asked how many ordinary householders are affected by this liability. We do not have the statistics indicating how many ordinary householders are affected, but the Land Registry has received about 9,000 applications for registration of notices and 160 applications for the registration of a caution against first registration. What we can be sure about is that there are enough people who may be affected to take this subject seriously.

The Government appreciate that homeowners who were unaware that their home was subject to the liability may well have been worried by the notice. The speech by the noble Lord, Lord Rooker, reminded us of the effects to real people, not just in theory, but the reality is that their legal position has not changed. The fears that were expressed leading up to the deadline of October 2013 that the registration of a notice can render a property unsaleable or unmortgageable do not seem to have materialised, nor does the market in chancel repair liability insurance seem to have disappeared. That is not to say that chancel repair liability cannot or will not cause major problems for some homeowners, but at present it is not clear that that liability is doing so in practice.

Even if reform is necessary, it may not be straightforward, as the right reverend Prelate made clear in a very measured speech. Abolition, as advocated by the noble Lords, Lord Avebury, Lord Cashman, Lord Rooker and others, would almost certainly require compensation to be paid because chancel repair liability is a property right protected by the Human Rights Act, as confirmed by the House of Lords. The sums involved in aggregate might run to hundreds of millions of pounds. The right reverend Prelate suggested that compensation is the way to abolition but he did not mention by whom. The noble Lord, Lord Kennedy of Southwark, said that that is where the Government come in.

Schemes for release, redemption or compounding might be created or present ones, as outlined in the Ecclesiastical Dilapidations Measure 1923, improved, but their cost and attractiveness to prospective users would have to be considered carefully. The noble Earl, Lord Lytton, mentioned some of the difficulties in estimating a compounded amount, taking into account the net present value for an unlimited liability stretching forever. What discount rate, for example, would one use, taking into account the average interest rate across all years forever?

I know that my noble friend Lord Avebury and other noble Lords will be disappointed that the Government are not developing any proposals for reform at present but I assure noble Lords that the Ministry of Justice will consider evidence of actual hardship or general problems that the law may cause and will keep the situation under review.

[Lord Kennedy of Southwark]

Having heard the contributions of noble Lords, in particular from the right reverend Prelate the Bishop of Derby, that is a most disappointing response from the Government and makes no attempt to deal with the issue.

[Lord Ashton of Hyde]

The problem is that nobody has come up with a simple way of how to do it, except by providing compensation, because it is a property right under the Human Rights Act. The issue is: who provides compensation to the people who own the right? We have decided that there is no necessity to do that when there is no actual example of hardship taking place at the moment. The reason that I said that we will keep it under review is that if there is evidence of actual hardship taking place, we will consider this measure.

[Lord Avebury]

As we have a couple of minutes, I ask the Minister whether the Government will encourage the church to consider the schemes of compensation that I mentioned at the end of my speech, which have been successful in certain parishes? As we heard, one householder managed to compound his liability for the sum of £45. If the church could be encouraged to consider that sort of solution, it might solve the financial problem.

[Lord Ashton of Hyde]

I believe that the church is in discussions with the National Secular Society, for example, in dealing with this. The Government have said that they are prepared to join in those discussions or to take account of them. Beyond that, I am not able to commit the Government but I know that we will be interested to listen to what they have to say and we are prepared to take part in those discussions.

[Lord Kennedy of Southwark]

Is it not possible for the Minister to say today that he would welcome discussions between his officials, the noble Lord, Lord Avebury, and the Church of England? If this could be resolved, everyone would be happier. I do not see why he cannot even offer that to the Committee.

[Lord Ashton of Hyde]

I did indicate that when it comes to dealing with the church and the National Secular Society, we would take part in discussions if required. I also made clear that if there was evidence of hardship, the Ministry of Justice would consider it. I do not think that that is unreasonable in the absence of any actual evidence of hardship at the moment. If there is evidence of hardship, we will discuss it, and of course we are always willing to talk to the noble Lord, Lord Avebury, or any other noble Lords at any time.

16:55

Sitting suspended.

London Health Commission: Smoking

Thursday 15th January 2015 Grand Committee

Question for Short Debate

17:00

Asked by

[Lord Darzi of Denham]

To ask Her Majesty’s Government what plans they have to support the recommendations of the London Health Commission with regard to combatting the impact of smoking on health.

[Lord Darzi of Denham (Lab)]

My Lords, in opening the debate, I declare my interests as in the register. Over the past year, I had the privilege to chair the London Health Commission at the request of the mayor, Boris Johnson. I express my thanks to the mayor for giving me the opportunity to do so. As a politician, the mayor took a brave step by establishing an independent commission, tasking it with examining the evidence and giving my fellow commissioners and I the freedom to make the right recommendations for London.

I also express my thanks to the thousands of health and care professionals and Londoners who contributed to the commission. They were generous with their time and their ideas. The work of the commission and the report, Better Health for London, are the expression of the passion and the ambition that Londoners have for better health. London can be the healthiest major global city. As our nation’s capital, London should be a leader and set an example for other cities in Britain. London should not be an exception, and the proposals set out by the commission could, and indeed should, apply to other cities in our country.

We all want to lead healthy lives. Our health is determined by all different parts of our lives—what we eat and drink, whether we choose to smoke or drink and how much, how we travel to school or work, and how we choose to spend our leisure time. Yet we can lead healthy lives only by working together to improve health—schools, employers, charities and voluntary groups, local and regional government, transport, the NHS and, above all, individuals and families. We each can choose to invest in our own health and we can help each other to choose better health.

At the heart of the commission’s vision of a healthy city lies a very simple idea: making healthy choices should be easier. Making those choices easier requires action from us all. The healthiest choice is not always easy or obvious. Every day, we make hundreds of choices that affect our health: how we get to and from school or work, what we choose to eat and how we spend our free time. The goal is to make each of those millions of individual choices that little bit easier, because in that difference is everything: making small changes individually will make a huge difference collectively.

Smoking is one of the worst choices for health. Every year, in London alone, about 8,000 people die prematurely due to smoking and more than 80,000 people die prematurely across the country as a whole. The consequences of smoking cost society as a whole at least £2.7 billion a year. Smoking does not simply cause an earlier death; it causes poorer quality of life. Tobacco does enormous harm to health and limits life’s possibilities. Tragically, about 45% of cigarettes that are smoked are consumed by people with mental illness, contributing to life expectancy that is 10 to 15 years shorter than in the population as a whole.

Hundreds of children take up smoking every week—two classrooms’ full a day. With advertising outlawed, they do so inspired by the adults they see. Once they start, they continue, as cigarettes are more powerfully addictive than narcotics. It is little surprise that in places where more adults smoke, more children begin to smoke as well.

Just as smokers’ lungs are polluted, the lungs of our city—our parks and green spaces—are polluted by smoking. London should lead the way for Britain, and the mayor should lead the way for London by acting to make our public spaces smoke-free. Our parks and green spaces account for nearly 40% of the capital, the equivalent of 20,000 football pitches—imagine that space completely smoke-free. I also believe that Trafalgar Square and Parliament Square should be rid of smoking. It would be a powerful message for the iconic centre of our city and the political heart of our country to become smoke-free. Indeed, such a measure would make our capital and our country an exemplar for the world.

Many noble Lords will have seen the launch of the commission’s report last October, when the mayor and I played a game of football with a classroom of schoolchildren. Of course, noble Lords may have seen it for all the wrong reasons, as it featured the rather entertaining sight of the mayor fouling a nine year-old boy. What was so striking was what the children had to say, not about the foul, but about making parks smoke-free. They were universally stridently in favour of the idea. They were far better advocates than I. One said, “It’s horrible when people come and smoke where we are playing football. I hate it”. Another said, “They leave all their cigarette ends on the floor”, and another young child said, “It’s really disgusting. I wish they wouldn’t do it”.

That is what London schoolchildren think. Making parks smoke-free will not only help smokers to make better choices by reducing the opportunities to smoke, it will help children to make the right choice to never start smoking. Yet this is more serious than childish debate. The question of making parks smoke-free exists precisely at the boundaries of the proper role of the state. I understand and I acknowledge that different people will hold different beliefs. Our parks are public. They are shared spaces that we should enjoy together. We already accept some limitations on our actions within them. There are restrictions on letting dogs foul, dropping litter or consuming alcohol. I believe that our parks should be spaces that promote healthy behaviour, such as exercise.

As a cancer surgeon, I see the pain and suffering of people afflicted by smoking-related diseases, as well as that of their friends and families. True compassion for their experience lacks authenticity if it is not joined with resolute action. I have not come across a single patient who did not wish that they had never smoked. I contest the notion that it is a question of liberty. Cigarettes are more powerfully addictive than narcotics, as I said. There is no freedom in addiction. Indeed, addiction is the antithesis of freedom. I have always been struck by that great revolutionary rallying call, “Give me liberty or give me death”. The advocates of smokers’ rights are generous enough to give them both.

I have no doubt that parks will become smoke-free by the end of this decade. Thirty years ago, it would have been unthinkable that pubs and restaurants would be smoke-free. Today, it is unthinkable that we would ever return to smoking indoors. The 2007 smoking ban was a major achievement of the previous Government and the present Government have continued the good work with new measures to control advertising at the point of sale and to stop smoking in cars with children. These measures are very welcome and I applaud the Government for having taken them. None the less, it is vital that the work continues.

As part of the work of the commission, we examined cities around the world that have made progress in the fight against smoking. New York City has famously led the way. Noble Lords who have visited New York recently will know that Central Park and all the city’s parks are smoke-free. Today, significantly fewer New Yorkers smoke than Londoners. The lesson of two decades of pioneering tobacco control in New York is that the fight must be sustained with new measures and initiatives. When it is not, smoking rates creep back up again. For that reason, I urge the Government to progress their plans for plain packaging of cigarettes in a timely manner so that the regulations are made within this Parliament. If they do, they will surely be saving lives. With the election so uncertain a few months from now, Ministers, Members of the other place and noble Lords can proudly know that they will have saved lives. Other than the protection of corporate interests, I can see no earthly reason to protect the brand value of tobacco.

As I close, I encourage noble Lords to take a moment to read the findings of the commission. I am an advocate for smoke-free parks, yet the report presents a broader range of measures to make our capital the healthiest major global city. Progress for better health can be made only through bold aspirations. I thank noble Lords for their contributions today and for demonstrating their commitment to better health for all the people of this land.

17:09

[Lord Naseby (Con)]

The question before us this afternoon is contained in the report of the London Health Commission, chaired by the noble Lord, Lord Darzi, which says under the headline “Smoke free London”:

“Each year, more and more Londoners are choosing to quit smoking, improving and lengthening their lives”.

To my mind the question is: will the banning of smoking in parks and green spaces actually result in a reduction in smoking or not?

It will not surprise colleagues that I had a quick look at what has happened in Australia on plain packaging. The policy has been in existence for two years there. The targets were to reduce youth smoking, to reduce overall smoking rates and to increase the effectiveness of health warnings. Yet the evidence from the Australian Government after two years is that youth smoking has not declined; it has grown to reach a seven-year high. Plain packaging has had absolutely no effect on the sales of legal tobacco or on adult smoking and the imports of illegal tobacco have grown, which is perhaps a side issue. That shows that if we are influenced by modern policy which is not based on science, we are going to find that we are wasting our time.

First, as regards the situation here, we are not talking about the direct effect on people’s lungs from smoking; we are talking about second-hand smoke, otherwise known as environmental tobacco smoke or ETS. This is in two parts: it is a mixture of exhaled mainstream smoke and side-stream smoke released from a smouldering cigarette and diluted by the ambient air. It is not the same as smoke inhaled by a smoker. So what are the risks? Some scientific work has been done—one lot in Egypt, for which I am happy to provide noble Lords with the source, and the other one in Boston where Professor Michael Siegel of Boston University’s School of Public Health says:

“No evidence demonstrates that the duration of outdoor exposure in places where people can move freely about is long enough to cause substantial health damage. … In trying to convince people that even transient exposure to second-hand smoke is a potentially deadly hazard, smoking opponents risk losing scientific credibility”.

We must be very careful here in Parliament that we do not undermine the scientists.

Secondly, if this did happen, what effect would it have on London’s tourism? On the front page of today’s Evening Standard the figures are pretty stark. Tourism is vital to the success of London. A record £3.56 billion is spent by tourists over the three-month summer period and £8.9 billion over nine months, with tourism up by 6.6%. I suggest that what tourists like to do is go to the park, have a break, maybe have a drink because they usually have a backpack with them, and have a smoke. If that smoking is not going to undermine our smoking policy, tourists will not be allowed to smoke in green parks and that will put them off. Or, if this policy does come in, it will result in people smoking in doorways, which we know is a terrible nuisance for those people who are working and going in and out of these doorways.

There are some things that can positively be done. I used to be the leader of the London Borough of Islington. There are things that local government can do. A number of local authorities are doing some very good work, putting money into the provision of publicity targeted at encouraging people to cease smoking. If we could spend money on that, I am willing to bet that would be far more effective than banning smoking in parks. We can use the existing police community support officers’ legislation to make sure that any smokers aged under 16 are marched out or told to stop. We can improve the provision of public refuse facilities. We have moved on from that era where you could not hand in anything. There are facilities now, although they could be improved. And finally, we can amend the law to enable the provision of indoor ventilated smoking rooms in pubs, as in other parts of Europe. That will keep the smokers away from doorways and gardens. So I ask my noble friends to think again. This will not work and it will deter the tourists.

17:14

[Lord Faulkner of Worcester (Lab)]

My Lords, I think that the noble Lord, Lord Naseby, will find that he is a lone voice in this debate. I will not attempt to counter all the points, but when he comes to reply, perhaps the Minister will have something to say about the so-called evidence adduced from Australia, which so far as I am aware has been produced only by the tobacco industry itself. It funded the research. Perhaps the Minister will be able to confirm that.

I shall start by congratulating my noble friend Lord Darzi on securing the debate and on contributing to a brilliant report which, if it is implemented, will help London set the lead for all of us to lead healthier lives in the future. I agree with absolutely everything he said in his speech.

As a direct result of the measures taken by Parliament, and particularly in this House, the UK is now a world leader in tobacco control legislation. Smoking by people aged 16 years and over has reduced over the past decade by more than a fifth, from 26% to under 20%. As a result, there are almost 2 million fewer smokers than a decade ago. Your Lordships will recall that all the tobacco control measures contained in the Children and Families Act 2014 began their lives not in the House of Commons but in this Committee Room, and were the subject of amendments proposed by Members from all parties. Three of them are here today, and I am delighted to see that the noble Baroness, Lady Finlay of Llandaff, is to speak and that the noble Baroness, Lady Tyler of Enfield, has joined the debate. It was to the Minister’s great credit that he accepted the principle for adopting standard packaging for tobacco products here, and he graciously responded to the defeat in the House on smoking in cars when children are present by ensuring that the House of Commons was given the opportunity to vote on it too. I understand that the regulations to give effect to that will be with us shortly.

However, like my noble friend Lord Darzi, I am concerned that there seems to be some doubt about the Government’s resolve on standard packs. My understanding is that to ensure that Parliament is allowed its say before the general election, the Government must ensure that regulations are laid this month so that they can go through parliamentary scrutiny by the Joint Committee on Statutory Instruments and the Secondary Legislation Scrutiny Committee in time. I really hope that the Minister will be able to confirm today that this is their intention. To delay a vote on standard packaging until after the election would be seen by the tobacco industry as a significant victory and would seriously damage the Government’s credibility on health issues.

The case for standard packs is simple. Cigarettes are the only legal products sold in the UK that kill their consumers when used exactly as the manufacturer intends. No company should be allowed to promote such a product through advertising and marketing. Thanks to our efforts here and those of the public health community, packaging is the tobacco industry’s last remaining avenue to lure vulnerable children into starting to smoke. It must therefore be made as unattractive as possible. Contrary to what the noble Lord, Lord Naseby, says, it is a policy that works. Recent evidence from Australia, which was the first country to introduce standardised packaging, shows that soon after standard packs began to appear in shops, smokers reported finding cigarettes in these packs less appealing or satisfying. Research has also shown that smokers consuming cigarettes from standard packs were 81% more likely to have thought about quitting at least once a day during the previous week.

Standardised packaging is intended to protect children and young people from starting to smoke. Young people are a vital market for the tobacco industry, particularly young women. The marketing message is this: smoking is cool, glamorous, and constitutes adult behaviour. Some two-thirds of smokers start before they are 18 and the vast majority while still teenagers. Every day, hundreds of children in the UK start smoking. Standardised packaging would remove the existing attractive promotional aspects and require the appearance of all tobacco packs to be uniform, including the colour of the pack. They are not going to be plain packs, as the noble Lord, Lord Naseby, says; they will allow for the promotion of strong anti-smoking and health messages. Studies from around the world show that plain, standardised packs are less appealing, make health warnings more effectively, and reduce the ability of the packaging to mislead customers about the harm caused by smoking. In April this year, Sir Cyril Chantler’s government-commissioned independent and comprehensive review of evidence reported that there is a strong public health case for the policy, concluding that,

“the body of evidence shows that standardised packaging … is very likely to lead to a modest but important reduction over time on the uptake and prevalence of smoking and thus have a positive impact on public health”.

If I had a little more time, I would widen the debate and talk about the tobacco control plan for England, which expires at the end of the year, and ask the Minister to give an assurance that it is his intention that it will be taken forward after it expires. I also hope that he will be able to say positive things about the measures contained in the London Health Commission’s report, including the licensing of retailers for tobacco.

I will finish with the comment of the Chief Medical Officer, Professor Sally Davies, who supports the smoke-free park plan, saying that it will stop,

“role modelling in front of children”.

It is children and young people that this policy must be directed towards.

17:21

[Lord Rennard (LD)]

My Lords, I, too, congratulate the noble Lord, Lord Darzi, on initiating this opportunity to debate the important issue of the harm done by smoking, and the best ways for it to be eradicated.

In recent weeks, the world has been shocked by the loss of life in events such as the terrible murders in France, and in Nigeria, and by accident in the recent AirAsia plane crash. Approximately 2,200 human beings lost their lives in those events. People have rightly been outraged by the murders, and anxious to prevent such loss of life, whether caused by evil people or air accidents, in future.

Today we are discussing how we can prevent many avoidable deaths and much suffering resulting from a legal product, but one which we now know to be anything but safe. I have drawn attention to the approximate number of people who lost their lives in those terrible events because it is a comparable figure to the number of people who in the UK alone lose their lives each week as a result of smoking-related diseases. Despite many years of progress, smoking-related disease still claims 272 lives prematurely every day in the UK, causing approximately 100,000 deaths annually. This is something about which we can take action—to reduce the loss of life; to create substantial health benefits that will raise the quality of life for many people; and to reduce poverty and increase opportunity for many of the least well-off people in our country.

The tobacco industry works furiously hard to avoid erosion of its profits because its products result in the early death of one in two of its customers. It needs to continually recruit new smokers to maintain its profits. However, its new customers are nearly always children or young people. Two-thirds of regular smokers start before the age of 18 and two-fifths of them start before 16. I wholeheartedly welcome the recommendations made in the London Health Commission’s report. It is clear from the findings of the noble Lord, Lord Darzi, that London needs to do more to tackle smoking, which is the major cause of preventable premature death in the capital. Measures such as smoke-free parks and a strengthening of work on illicit tobacco are very welcome, but many other important measures must be implemented if we are to continue to drive down smoking prevalence in the future, as we have done so successfully in the recent past.

This House took important steps, tabling amendments to the Children and Families Bill, subsequently taken up by the Government, to prohibit smoking in cars with children and to require all cigarettes to be put in plain, standardised packaging. However, while the regulations on smoking in cars have been laid and, once voted on, will be implemented this year, there remains a silence from the Government about standardised packaging. I hope that the Minister will break that silence this afternoon.

The Tobacco Advertising and Promotion Act has been effective in reducing children’s exposure to promotional activity and has brought about a consequent reduction in awareness of tobacco marketing among young people. Between 2003 and 2013—very much contrary to the arguments put by the noble Lord, Lord Naseby, when he opposed restrictions on tobacco advertising—regular smoking among young people declined from 10% to 3% in the UK. However, we must do much more.

Tobacco packaging is now the most prevalent form of tobacco advertising. Smokers display the branding every time they take out their packs. In doing so they are making a statement about how they want to be seen by others as they display, and endorse, the brand that they have chosen. The arguments put forward by the tobacco industry to oppose plain paper packaging are completely undermined by the vehemence of their opposition to it. The industry’s credibility was undermined long ago by its denials about the link between smoking and lung cancer, the addictiveness of nicotine and the effects of passive smoking. The tobacco industry now claims that standardised packs will lead to an increase in tobacco smuggling.

The hypocrisy of the industry on this issue was well exposed by the disclosures about its own role in organising tobacco smuggling. I noted that the noble Lord, Lord Naseby, was reading from the brief of the Tobacco Manufacturers’ Association, which can hardly be considered to be objective in this matter. The association claims that there has been an increase in tobacco sales in Australia since the introduction of standardised packaging, but it ignores the increase in population in Australia in that time. Adjusted for population, tobacco sales per person in Australia have in fact fallen since the introduction of standard packs.

The strong cross-party support for the tobacco control measures contained in the Children and Families Act amply demonstrates the strength of feeling of parliamentarians on this issue. I know that my party wants to see that time is allocated for the required debate and a vote on the introduction of standardised packaging before Parliament rises for the general election.

There is a choice ahead of us between promoting public health or rewarding the tobacco lobbyists. It will be greatly to the discredit of this Government if they do not ensure that the necessary regulations for plain paper packaging are laid before Parliament, in time for the regulations to be voted on as soon as the notification to Europe process comes to an end on 2 March. It would be a public health disaster if the views of the tobacco industry and a small minority of parliamentarians sympathetic to it stopped the clearly expressed will of Parliament on this issue from being implemented.

17:27

[Baroness Finlay of Llandaff (CB)]

My Lords, like other noble Lords, I welcome this debate and congratulate the noble Lord, Lord Darzi, both on securing the debate and of course on his work on the important report from the London Health Commission. I, also, have had many conversations with patients dying from tobacco-related diseases. I have never had a patient who is glad that they smoked and that their life has been shortened by it, but I have had enormous numbers of patients who regret that they are leaving children orphaned early, because their lives are coming to an end prematurely and there is no way that that can be stopped.

I strongly support the findings of the London Health Commission report and, as has already been said, the Royal Parks becoming smoke-free sets a very clear example and message that these are open spaces—we are fortunate enough to have fresh air in London. I question the assertion from the noble Lord, Lord Naseby, as regards New York, because I have not seen any evidence that the tourist industry there has suffered at all. In fact, anecdotally, I have heard people say it is welcome that in Central Park there is smoke-free and a sporting open area.

The advantage of Parliament setting an example to the rest of us by having Parliament Square Garden smoke-free is of course clear. The city-wide working against illicit tobacco certainly needs to be strengthened, but that is a secondary part of tackling the issue of tobacco overall. As the report states, there are still 1.2 million smokers in London and smoking-related disease causes 8,400 premature deaths in the city and more than 51,000 hospital admissions. We have heard in recent weeks how the whole NHS is creaking under the strain—in London as much as anywhere, though it is widespread. Boroughs with a high prevalence of smoking are also among the poorest, and smoking remains a cause of health inequalities.

The NHS needs a radical upgrade in prevention and public health, as was stated in the NHS Five Year Forward View. The cause of preventable deaths through tobacco is the same as the next six causes put together, including alcohol, obesity and illegal drugs. I hope that the Government will undertake to renew their very successful coalition Government’s Tobacco Control Plan when it expires.

We do, indeed, have the necessary measures to tackle this in the Children and Families Act 2014. There is evidence that two-thirds of smokers start before the age of 18. In 2011, it was estimated that more than 200,000 children aged 11 to 15 started smoking. I warmly welcome the regulations to prohibit smoking in cars that were laid before Parliament in December last year and are due to come into effect this October. I urge the Government to set a date for the regulations to be voted on at the earliest opportunity.

I shall take a moment to address e-cigarettes because I am concerned that they contain nicotine, which is a highly addictive element in cigarettes. That risk certainly needs to be assessed and tackled. There is evidence that e-cigarettes are helping people who are smokers to quit smoking, but I was worried by the Trading Standards Institute’s finding that 40% of retailers are willing to sell these products to young people under 18, despite the fact that the vast majority—about 80%—of the products carry warnings that they should not be sold to people under 18. The consultation on the regulations to bring forward the primary legislation in the Children and Families Act enabling regulations to prohibit the sale of e-cigarettes to under-18s was launched before Christmas. I hope that that will proceed without delay.

Perhaps I may turn to the issue of standardised packs. More than half a million children have taken up smoking since the Government first announced in 2011 that they would consult on this measure. A vote on the necessary regulations has to happen before the general election. If the Government table them immediately this can happen. I am concerned that we have been told that we cannot have them laid before the end of the period of notification to Europe on 2 March this year. That is, in fact, a red herring. I do not understand why they cannot be laid now, so that as soon as 2 March is past a vote can be held. In the extremely unlikely event of an amendment being required, a short timeframe could be used to review whatever recommendation comes out from the relevant committees. I was interested to hear on the “Today” programme this morning that Labour now plans to incorporate this in its manifesto, if I have understood correctly. Perhaps other noble Lords will clarify that.

The security markings on the proposed packs would be no easier to counterfeit than the current security markings. The evidence from Australia has been overwhelmingly positive. Over the last few weeks, more than 4,000 doctors and allied medical professionals have called on the Government to stop dragging their feet on regulations. Section 94 of the Children and Families Act allows the Secretary of State to introduce regulations for these packs and was overwhelmingly passed in both the House of Lords—nem con—and the House of Commons, where only 24 MPs voted against the move. A poll on support for standard packs conducted for ASH found that 64% of adults in Britain were in favour; but what I found interesting is that in Australia the number of smokers supporting the measure has risen from 28.2% before its introduction to 49% after implementation. Therefore, I hope that, in answering today’s debate, the Minister will have some good news for us about the progress on standardised packs.

17:34

[Baroness Tyler of Enfield (LD)]

My Lords, I rise to speak briefly in the gap. The UK is a world leader in tobacco control, of which I feel very proud. I have worked and lived in London for virtually all my life, and I would love to see London set a real lead and a real example by becoming a smoke-free city in the way described by the noble Lord, Lord Darzi. I congratulate the noble Lord on securing this debate, on all his work and on the recommendations of the London Health Commission, which were very far-reaching.

I also pay tribute to the Government for all their work on tobacco control and, indeed, to the Minister personally for everything that he has done. I remember very clearly the strength of feeling in this House when we debated the Children and Families Act 2014 around the standardised packaging of tobacco and about banning smoking in cars carrying children. The way the Government responded to that strength of feeling, looked at the evidence and then came back and accepted those things was an example of Parliament at its very best. The fact that the work was done very much on a cross-party basis really showed what can be done in this House when people come together and work together very sensibly.

I had the great privilege during that period of briefly meeting with the Minister in Australia, who was personally involved in steering this measure through in her country. It was wonderful to hear from her how they had got that through and the impact that it was starting to have. I want to add my voice to others in this afternoon’s debate to say how important it is that the standardised packaging regulations are laid in sufficient time for them to be considered, and for a vote to take place before the election. I also hope that the Minister will be able to give us some comfort on that because so much has been achieved in this Parliament that it would be a real travesty if we fell at the final hurdle.

17:37

[Lord Hunt of Kings Heath (Lab)]

My Lords, I start by reminding the Committee of my presidency of the Royal Society of Public Health. Of course I very much welcome my noble friend’s debate and, indeed, the excellent report. I like the aspirations and ambitions contained in it. Coming from Birmingham, I rather wish that we could have a similar report, and I will try to persuade my noble friend to come and write one. It strikes me that the traditional joint strategic needs assessments produced by directors of public health are often dry documents that do not really capture, in their very succinct message, the challenges and what needs to be done about them. I would love to see other parts of the country follow this model.

In Birmingham, 22% of young people are obese, and we know that that is going to store up huge problems for the future. Yet, looking at my noble friend’s paper, the figures are even worse for London. He mentions that:

“London has the highest rate of childhood obesity of any peer global city, and the highest proportion of obese children in all the regions of England. In London almost 1 in 4 children in Reception and more than1 in 3 children in Year 6 are overweight or obese”.

If you think about the scale of that problem, it is imperative that we start to do something about it. On smoking, my noble friend points out that:

“London boroughs with high smoking prevalence are also some of the poorest boroughs. Although there is a downward trend across most of London, there is a difference of 10% between the best and worst performing boroughs, and stark health inequalities are caused by smoking rates being much higher amongst people who work in manual or routine occupations”.

That is matched by the inequality experienced by children born today in different parts of London, who can have very wide differences indeed in their life expectancy.

The aspirations and ambitions seem to me to be excellent. I like many of the proposals. The idea of boosting the number of active Londoners to 80% is quite a goal. Gaining 1.5 million working days a year by improving employees’ health and well-being offers a very apt illustration of the link between health, well-being and the general economy. It is something that we need to really work on. I like the ambition to have the lowest death rates in the world for the top three killers. I agree that GP practices in London should be open from 8 am to 8 pm and that services should be delivered in modern, purpose-built and designed facilities. My noble friend told us how to do that quite a few years ago and it is to my eternal regret that we did not make enough progress on it. Anyone looking at the problems we are now facing in primary care and wanting to see the solution need not look much further than my noble friend’s report.

It is coincidental, though I would like to think that we planned it together, that the Labour Party today announced the public health programme that we wish to take forward post-election. It is very much dual-pronged in the sense that we see a really positive role in, rather than finger-wagging at adults, actually helping them to be empowered with information to make healthier choices and supported to get active, along with all the other things needed to improve their health. However, in the case of children, we wish to see statutory action and we particularly emphasise maximum limits to be set on levels of fat, salt and sugar in food marketed substantially to children. That would have a very big impact on obesity issues, alongside many more programmes around lifestyle in schools, particularly in physical activity.

On smoking, we wish to reduce smoking prevalence to 10% by 2025. We will have a goal that children born in 2015 will become the first smoke-free generation in hundreds of years. I was very proud to move the amendment to ban smoking in cars with children and I received support from almost every noble Lord present in the debate today. It was very good to see. I was struck by the overwhelming public support for that measure: it shows that the public will support these kinds of measures. We are also keen to introduce a levy on tobacco companies to be used to ensure that they make a greater contribution to the cost of tackling tobacco-related harm.

There is nothing further I could say about standardised packaging that has not been said already. I simply remind noble Lords that this was done on the basis of the report undertaken by Sir Cyril Chantler, who concluded that the body of evidence shows that standardised packaging is very likely to lead to a modest but important reduction over time. I stand behind Sir Cyril Chantler’s report.

I hope that the noble Earl is going to give us good news today. He will understand that there is a mite of scepticism about the Government’s approach to these matters. There is a suspicion that the Government are rather too close to some of the tobacco companies and rather too much under their influence. He could, at a stroke, put that right by telling noble Lords that these regulations are going to be laid within the next few days. I hope that he will do so.

17:43

[The Parliamentary Under-Secretary of State, Department of Health (Earl Howe) (Con)]

My Lords, I thank the noble Lord, Lord Darzi, for securing this important debate. As we have heard, the Mayor of London set up the London Health Commission in September 2013, with the noble Lord, Lord Darzi, as chairman, to review the health of the capital, from the provision of services to what Londoners themselves can do to help make London the healthiest major global city. In October, the London Health Commission published its report, Better Health for London, with a range of recommendations for the Mayor of London to consider. I congratulate the noble Lord, Lord Darzi, and the members of the London Health Commission on their well considered and thought-provoking report.

Local government has responsibility for improving health and well-being in its communities, including reducing rates of tobacco use. Noble Lords will understand that it is not for me as Health Minister to respond to the London Health Commission’s report. That is for the Mayor of London, for whom the London Health Commission prepared its report. I will, however, be very interested to see how the mayor progresses the recommendations that have been made.

Nevertheless, given the Government’s commitment to tobacco control, I particularly welcome this opportunity to tell your Lordships more about the work we are doing to tackle tobacco use. Tobacco remains one of our most significant public health challenges. Smoking is a leading cause of cancer, cardiovascular and respiratory disease; smoking is the primary preventable cause of morbidity and premature death; smoking is a significant driver of health inequalities and remains the biggest cause of inequalities in death rates between the richest and poorest in our communities; and smoking places an enormous strain on the NHS, while the overall economic burden of tobacco use to society is estimated at more than £13 billion a year. We must also remember that tobacco use is harmful not only to individual smokers, but to others around them.

Reducing smoking rates is a public health priority for this Government. In early 2011, we published the Tobacco Control Plan for England, which set out a comprehensive package of evidence-based action to be implemented at national level to support local areas in driving down rates of tobacco use. We also set out in the plan the importance of our efforts to reshape social norms around tobacco use to promote health and well-being. The noble Lord, Lord Faulkner, and the noble Baroness, Lady Finlay, asked what our plans were for refreshing the tobacco control plan. As they said, the plan sets out action until the end of this year. Like both noble Lords, I, too, hope that whoever are in government after the election continue to take comprehensive and effective action on smoking. However, it will be, essentially, for the next Government to take that decision.

From the outset, we ought to reflect the enormous amount of progress that we have made over the past decade. Smoking rates in England are at their lowest since records began. Today, around 18 per cent of adults are smokers, down from around half of adults smoking in the 1970s. Almost 2 million fewer people in England are smokers compared to a decade ago, and London has some of the lowest smoking rates in the country. We know that the majority of smokers take up smoking when they are teenagers. Most smokers were regularly smoking before turning 18 years of age—before they were able to make informed, adult decisions about tobacco use.

The good news is that rates of regular smoking by children in England between the ages of 11 and 15 years have declined by some 70 per cent since 2000. However, I want to be clear that continuing to reduce the uptake of smoking by children is essential. Research published in 2013 shows that every day around 600 children aged between 11 and 15 years start smoking in the United Kingdom.

The Government have taken action to protect young people from tobacco and nicotine addiction and a range of new powers relating to smoking were introduced through the Children and Families Act 2014. We have laid regulations to end smoking in private vehicles carrying children in England, which shortly will be considered in your Lordships’ House and in the other place. New legislation will stop adults buying tobacco on behalf of children.

The Department of Health is currently consulting on proposed regulations to bring the same age-of-sale requirements into place for electronic cigarettes that exist for tobacco. I would just say, on electronic cigarettes—mentioned by the noble Baroness, Lady Finlay—that while there is emerging evidence that e-cigarettes may be helpful to some people wishing to quit smoking, the quality of products on the market remains highly variable. We continue to work towards a regulatory framework that ensures for those smokers who want to use e-cigarettes to cut down or quit that they meet quality standards and are accompanied by sufficient information to enable informed choices. However, e-cigarettes are not risk free. We do not know enough about the long-term health effects of adults, let alone children, using e-cigarettes. Furthermore, as there have been no long-term studies to examine whether e-cigarettes serve as a gateway to tobacco use, we cannot be certain at this stage about whether there is a gateway effect from the use of e-cigarettes into tobacco smoking, so further research is needed to answer that question definitively.

The display of tobacco products in shops can promote smoking by young people and undermine the resolve of adult smokers trying to quit. Legislation to end tobacco displays has already been implemented for large shops such as supermarkets. All other shops selling tobacco, including corner shops, will need to end their displays of tobacco on 6 April.

The issue of standardised packaging for tobacco has been raised by almost every Peer who has spoken. I want to be clear that the Government have not made a final decision on whether to introduce legislation for standardised packaging. We held a final, short consultation that closed in August and the results are informing decision-making. It is important that the Government have time to carefully consider all issues relevant to the policy. I assure noble Lords that a decision will be made in due course. However, in saying that, I reassure your Lordships that we in the Department of Health are, as I speak, very actively working towards a decision. The draft regulations for standardised packaging were notified to the European Commission under the technical standards directive on 29 August. We have received detailed opinions from 11 member states, which extends the “standstill” period to six months. This will expire on 2 March 2015 and until then we are unable to make regulations, although I hear what the noble Baroness, Lady Finlay, says about laying regulations.

As regards evidence from Australia—

[Lord Faulkner of Worcester]

Before the noble Earl moves on, will he confirm that Sir Cyril Chantler’s report, which he commissioned, is helpful to him in coming to a view as to whether or not standardised packaging should be introduced? Does he accept the report and its conclusions?

[Earl Howe]

Undoubtedly it is extremely helpful although I am sure that the noble Lord would be the first to acknowledge that there are considerations that Sir Cyril did not address, which we obviously have to do across government before taking a final decision.

[Lord Naseby]

Can my noble friend assure those of us who take a detailed interest in this that the decision will be based on the independent evidence from Australia after two years of implementation against the yardsticks that that Government set?

[Earl Howe]

I am grateful to my noble friend. I was about to answer the question posed by the noble Lord, Lord Faulkner, on exactly that point. Evidence and experience continue to emerge from Australia, as my noble friend rightly said. I can reassure noble Lords that my department is looking very carefully at the evidence as it emerges. We will introduce standardised tobacco packaging if, having considered the evidence both here and around the world and other relevant information, we are satisfied—I emphasise “satisfied”—that there are sufficient grounds to do so.

The UK leads the world in supporting smokers to quit, and local authorities are now responsible for providing “stop smoking” services in their communities. The Government have continued to invest in tobacco marketing campaigns to encourage smokers to quit. Your Lordships may have seen Public Health England’s latest campaign that is currently running. Our “Stoptober” campaign has become hugely successful, encouraging smokers to quit for a whole month, giving them a significantly better chance of remaining smoke-free for good. Today, we offer smokers information and support through a range of media, including through the internet and mobile telephone applications.

A new European tobacco products directive has been agreed and will come into force in 2016. The new measures cover labelling, ingredients, tracking and tracing, e-cigarettes, cross-border distance sales and herbal products for smoking.

Making tobacco less affordable is proven to be an effective way of reducing smoking prevalence. The Government continue to follow a policy of using tax to maintain the high price of tobacco at levels that have an impact on smoking prevalence. In the Autumn Statement, my right honourable friend the Chancellor of the Exchequer announced that the Government will consult on whether to introduce a levy on tobacco manufacturers and importers. That consultation is now under way.

The Government have taken sustained action to reduce levels of illicit tobacco, and over the past decade, the illicit market has declined significantly. In the past two years, nearly 3.6 billion illicit cigarettes and 1,050 tonnes of rolling tobacco have been seized. Local authorities continue to take their own action against illicit tobacco, which is to be welcomed.

Smoke-free legislation, implemented in 2007, has had beneficial impacts on health. I would say to my noble friend Lord Naseby, who mentioned this, that the legislation has been highly successful in terms of public health and it continues to be popular and well complied-with, on the whole. The Government have no intention of amending this important legislation along the lines suggested by my noble friend. As I said, levels of compliance and public support for the law are high. While smoke-free legislation covers enclosed work and public places, local authorities may wish to take action to limit smoking in open-area environments. That is a recommendation in the London Health Commission’s report. However, I do not believe that changes to smoke-free legislation would be needed to achieve this. I commend local authorities across England for the commitment they have shown to reducing tobacco use; for example, more than 80 councils have signed the Smokefree Action Coalition’s Local Government Declaration on Tobacco Control.

My time is up. I will finish by saying that the Department of Health has worked actively to support the implementation of the World Health Organization’s Framework Convention on Tobacco Control, including protecting tobacco control from vested interests, and is today regarded as a global leader in the implementation of effective tobacco control policies. The UK deserves that reputation and I am proud to be able to share with your Lordships the news that the Department of Health has just been named as the winner of the American Cancer Society’s prestigious Luther L Terry Award for exemplary leadership by a government ministry in the field of tobacco control.

[Noble Lords]

Hear, hear!

[Earl Howe]

With that, my Lords, I end by thanking the noble Lord, Lord Darzi, once again for this debate.

Committee adjourned at 5.57 pm.

House of Lords

Thursday 15th January 2015 Lords Chamber

Thursday, 15 January 2015.

11:00

Prayers—read by the Lord Bishop of Lichfield.

HIV

Thursday 15th January 2015 Lords Chamber

Question

11:06

Asked by

[Lord Fowler]

To ask Her Majesty’s Government what estimate they have made of the proportion of people living with HIV who are undiagnosed.

[The Parliamentary Under-Secretary of State, Department of Health (Earl Howe) (Con)]

My Lords, Public Health England estimates that in 2013 107,800 people were living with HIV in the United Kingdom. Of these, 24%, some 26,100, down from 25% in 2012, were undiagnosed and unaware of their infection. Early diagnosis is important to ensure people can get early treatment and to prevent them infecting others.

[Lord Fowler (Con)]

My Lords, surely we cannot ever eradicate HIV in Britain, which currently is costing the health service something like £650 million a year, when there are at any one time, as my noble friend has just said, 26,000 people who have contracted HIV but are undiagnosed and untested and can obviously spread the infection further. Will my noble friend consider setting up a working party to report on how testing in this country can be improved, which would be of benefit to those people affected and also to the benefit of the public generally?

[Earl Howe]

I will gladly take that suggestion from my noble friend away and give it consideration and I am grateful to him for it. The position on testing is, however, quite encouraging. We have seen more than 1 million HIV tests in sexual health clinics in 2013, which is up 5% from the previous year, and that is only in sexual health clinics. As my noble friend knows, there are other routes to testing through GP surgeries, self-sampling kits and so on. Additional testing is vital if we are going to make sufficient inroads into diagnosing this condition.

[Baroness Barker (LD)]

My Lords, the organisation Halve It reported in a survey last year that one-third of GPs who are in high-prevalence HIV areas were unaware that that is where they worked and consequently were not testing people for HIV routinely. Can the Government work with Public Health England and the RCGP to remedy that?

[Earl Howe]

My Lords, I pay tribute to the work of the Halve It coalition in raising awareness about the importance of increasing HIV testing. My noble friend is right that apart from ignorance often GPs are reluctant to discuss HIV testing or are unaware of the importance of early diagnosis and possible indicator symptoms. My department was pleased to fund the Medical Foundation for AIDS and Sexual Health’s HIV testing in primary care project that provides a web-based interactive resource for GPs in primary care to help make testing easier in GP surgeries.

[Baroness McIntosh of Hudnall (Lab)]

My Lords, does the Minister agree that one of the biggest disincentives to testing is the amount of stigma that still remains against those who are known to have HIV? Alongside encouraging people to have tests, can he say what Public Health England is doing to combat that stigma?

[Earl Howe]

The noble Baroness is absolutely right. If we were to single out three things that are important in this context, they would be prevention, testing and tackling stigma and discrimination. The NHS, local authorities, government, community and faith groups, the media and individuals themselves all have a part to play in eliminating HIV-related stigma. Our framework for sexual health improvement is clear that action needs to continue to eradicate prejudice based on sexual orientation. That depends on building an open and honest culture where everyone can make informed decisions and responsible choices about relationships.

[Baroness Gardner of Parkes (Con)]

My Lords, is it not a fact that there has been a great change in attitudes about HIV, and not only because of the treatments that are now available? I recall the days when people went into a hospice because it was a terminal condition. I have sat on various inquiries and know that people used to hide—in the fridge, for example —any evidence that they had HIV because they were frightened of other people knowing. Because that no longer applies, there is a great opportunity for people to have testing without any embarrassment at all.

[Earl Howe]

My noble friend is right. I think that we have come a long way since my noble friend Lord Fowler was Secretary of State, when stigma and discrimination were very apparent in virtually all sections of society. We do not see that so much now, I am glad to say, as evidenced by the fact that we are reporting a continuing reduction in late diagnosis. It was down to 42% last year from 47% in 2012, and that is a key indicator in this context.

[Lord Collins of Highbury (Lab)]

My Lords, the UK is a leading supporter of research and development into universal prevention methods, including HIV microbiocides and vaccines. With 19 million people globally remaining unaware of their HIV status today, will the noble Earl tell us how the Department of Health is working with the Department for International Development to support this research and development work?

[Earl Howe]

My Lords, in November 2013 DfID conducted a review of our 2011 HIV position paper. The review paper highlighted three areas of particular focus in the international context. They were to identify the key affected populations—girls and women—and the integration of HIV responses into the wider health system, as well as broader development priorities. That of course includes tackling stigma and the unacceptable things that we see in certain overseas countries, including discriminatory legislation.

[Lord Patel (CB)]

My Lords, did the Minister refer to 26,000 people being undiagnosed? What is that number based on?

[Earl Howe]

My Lords, these figures inevitably have to be estimates but they rely on data from three surveys that measure undiagnosed HIV infection among sexual health clinic attendees, pregnant women and people who inject drugs. Comprehensive clinical data from sexual health clinics relating to patients newly diagnosed with HIV are also used to infer the risk of undiagnosed infection.

[Lord McConnell of Glenscorrodale (Lab)]

My Lords, moving the focus from sub-Saharan Africa, where we have been so focused over recent years, is the Minister aware of the increase in the incidence of HIV/AIDS in south-east Asia? Are the Government looking at advice to British tourists travelling to that area in the light of this increase in the incidence?

[Earl Howe]

My Lords, I believe I am right in saying that there is advice on the FCO website for tourists to that part of the world. However, if I may, I will write to the noble Lord with details of the factors that obtain in south-east Asia.

Personal Independence Payments

Thursday 15th January 2015 Lords Chamber

Question

11:14

Asked by

[Lord Dubs]

To ask Her Majesty’s Government what steps they are taking to ensure that people facing delays in receiving personal independence payments do not endure financial hardship.

[Lord Bourne of Aberystwyth (Con)]

My Lords, personal independence payment is not an income replacement benefit; it contributes towards the extra costs associated with disability. Employment support allowance provides financial support for those who are ill or disabled and unable to work. We appreciate the difficulties associated with claims for PIP, and we are absolutely committed to reducing the backlog, and waiting times. Monthly clearances have quadrupled over the past year, and the backlog is falling. All successful new PIP claims are backdated.

[Lord Dubs (Lab)]

I thank the Minister for that reply, but will he nevertheless confirm that, as recently as last month, some 670,000 people had registered for PIP but 300,000 people were still waiting for their claim to be processed, some of whom had been waiting for six months or longer? The system is not fit for purpose, yet the Government are still rolling out the scheme. Is it not right for them to stop the rollout until the system is working, to assess the negative impact on hundreds and thousands of handicapped disabled people, and to make sure that it is fit for purpose before they proceed?

[Lord Bourne of Aberystwyth]

My Lords, I dispute those figures. The backlog stands at 107,000 at the moment, and 65,000 claims are being processed every month. Help is available in other areas—such as JSA, ESA, local authority help and NHS help—for those who are awaiting an assessment. The system is not failing; it is succeeding, and the backlog is being cleared.

[Baroness Eaton (Con)]

May I ask the Minister what assessment Her Majesty’s Government have made of the recent report from the all-party parliamentary inquiry into hunger and food poverty?

[Lord Bourne of Aberystwyth]

My Lords, the Government have looked closely at the all-party parliamentary group’s report on food banks and food poverty. It is a complex issue; there is no doubt about that. We have, of course, identified ways in which we can further publicise hardship payments, and we are doing that. We are also looking, with food retailers, at how we can ensure that food waste is minimised. The private sector has a role to play there.

[Lord Touhig (Lab)]

My Lords, many claimants with autism lack insight into their own condition, and a family member or companion can help fill in the gaps during the PIP interview. But the National Autistic Society, of which I am a vice-president, tells me that a number of assessors are refusing to allow that. Will the Minister look into this? It is discrimination. Will he ensure that people who are autistic are not adversely affected by this attitude?

[Lord Bourne of Aberystwyth]

The noble Lord does notable work in the area of autism, as is well known. The guidelines on the medical assessments related to PIP indicate that all these conditions should be taken account of. I have no evidence of this being a particular problem, but if the noble Lord would like to write to me about it, I will ensure that it is looked at.

[Baroness Sherlock (Lab)]

My Lords, last June, Iain Duncan Smith told MPs that by the end of 2014 nobody would be waiting more than 16 weeks for a PIP assessment. Can the Minister tell the House precisely when that target will be met? I do not believe that it was met by the end of 2014. As the target was only for when people would get an assessment, can he also tell the House how long people will have to wait to get a final decision, and their money? He seemed to be reassuring the House that people would get their money backdated when they eventually got it, but is it not the case that, even though PIP is backdated, passported benefits such as blue badges and carer’s allowance are not?

[Lord Bourne of Aberystwyth]

The noble Baroness has asked a range of questions, and if I fail to answer all of them now, no doubt we can speak later. We are clearing the backlog and, as she will know, there has been significant progress. I shall repeat the figures: the backlog is coming down and we are clearing 65,000 claims a month. The Minister in another place, Mark Harper, will report on progress to the Work and Pensions Select Committee on 28 January. The rate of clearances is improving month on month, and the number of outstanding cases in the system has been falling significantly.

[Lord Hylton (CB)]

Last year, food banks served 500,000 people in six months. If people cannot even afford food, does that not show that there is acute financial hardship? Will the Government therefore try to reduce the number of people suffering sanctions and make sure that sanctions last for the minimum possible period?

[Lord Bourne of Aberystwyth]

The noble Lord draws attention to the important role that food banks are fulfilling. Food banks have existed for well over a decade throughout western Europe, the USA and Canada. The reasons for using food banks are many and complex, and I pay tribute to what they are doing. As I say, to address some of the concerns we are publicising much more the possibility of early payment of hardship benefit and so on, and we are working with food retailers on food waste.

[Lord German (LD)]

My Lords—

[Lord McFall of Alcluith (Lab)]

My Lords—

[The Lord Privy Seal (Baroness Stowell of Beeston) (Con)]

My Lords, we have heard from several Peers from the Labour Benches on this Question and we have not yet heard from a Liberal Democrat Member.

[Lord German]

My Lords, the loss of a Motability car can mean the loss of independence for a disabled person. Is my noble friend confident that the personal independence payment assessors are prompting claimants as to whether they can walk more than 20 metres safely to an acceptable standard repeatedly and in a reasonable time, which are the crucial criteria put into statute by this House? Unless these criteria are followed, thousands of disabled people will not be eligible for a Motability car and those being retested may lose their car and their independence.

[Lord Bourne of Aberystwyth]

My noble friend raises important issues on the subject of Motability cars. It is worth noting that the Motability payment will continue while it is being reassessed. Those four criteria are looked at very closely. The legislation requires the assessors to consider whether a claimant can carry out each activity reliably. They will do that by means of observation, discussion and medical evidence—often just on the basis of medical evidence. I am satisfied that those criteria are being followed.

United States: Haggis Ban

Thursday 15th January 2015 Lords Chamber

Question

11:21

Asked by

[Lord McColl of Dulwich]

To ask Her Majesty’s Government what steps they are taking to persuade the United States to lift its ban on the import of haggis.

[The Parliamentary Under-Secretary of State, Department for Environment, Food and Rural Affairs (Lord De Mauley) (Con)]

My Lords, the United States Food and Drug Administration does not allow animal lungs in products for human consumption. My right honourable friend the former Secretary of State Owen Paterson lobbied the US authorities during his visit in the summer, and we continue to encourage them to adjust their ban on haggis containing sheep lungs as part of the wider European Union negotiations on lifting the transmissible spongiform encephalopathy restrictions on EU lamb.

[Lord McColl of Dulwich (Con)]

I thank the noble Lord for his usual courteous and informative reply. Is he aware that the United States Government are depriving 24 million American Scots of this wholesome food, which satisfies hunger very much more than the junk food the Americans consume? It would help to deal with the greatest epidemic they have—the obesity epidemic, which is killing millions, costing billions of dollars, and for which the cure is free. Will the Minister encourage the Government to redouble their efforts to persuade the American Government to have much freer trade and lift the 1971 ban on the wholesome haggis?

[Lord De Mauley]

Well, my Lords, there is quite a lot in that. Perhaps it would help if I explained that two hurdles are involved in what the noble Lord proposes. We have to get over, first, the US restrictions on the import of lamb. We are working with the US authorities towards achieving approval to lift those restrictions with, I think, good prospects. Secondly, there is the US’s unwillingness to recognise animal lungs as an acceptable foodstuff. In this regard the most promising avenue in the short term is the production of haggis omitting the inclusion of lung—and the Scottish Government recognise this.

[Lord Purvis of Tweed (LD)]

My Lords, I appreciate that not everyone fully understands the haggis. Once for a Burns supper in Germany, Burns’s,

“Great chieftain o’ the puddin-race!”,

was translated into German and then retranslated back as, “Mighty Führer of the sausage people”. Will the Minister make sure that this ridiculous ban comes to an end? If it is not too late, I see that the Prime Minister is with President Obama today, so can my noble friend send an urgent message to make sure that this visit is a triumph by having a private word with the President to make sure that the ban is now lifted?

[Lord De Mauley]

Unfortunately, I cannot guarantee a rapid resolution of the problem, but I hope I have made clear that we are working extremely hard towards it. Promoting food and drink exports more generally is a key government priority. We are working hard to champion UK food and drink overseas with, I think, considerable success. My right honourable friend the Secretary of State is currently in China doing just that.

[Lord Winston (Lab)]

My Lords, I confess to being a little surprised that one of the most senior qualified medical practitioners in the Chamber is asking this Question, seeing that there is a questionable issue about haggis—which I, personally, find a revolting food. Would not charity be better at home? If haggis does indeed deal with obesity, perhaps we should promote it a little in Glasgow.

[Lord De Mauley]

My Lords, what a good idea. As the noble Lord does not appear to like the taste of the,

“Great chieftain o’ the pudding-race”,

I recommend a large tot of whisky.

[Lord Forsyth of Drumlean (Con)]

My Lords, given the seriousness of this matter, should the Government not consider appointing a special envoy with energy and imagination to go to the United States and stay there until this matter is resolved? Could I suggest that Alex Salmond is currently looking for work?

[Lord De Mauley]

My Lords, I was going to say that it is a question of priorities, but that is an eminently sensible suggestion.

[Lord Cormack (Con)]

My Lords, what is served at the British embassy on Burns Night?

[Lord De Mauley]

What else, my Lords? Haggis.

Milk Production

Thursday 15th January 2015 Lords Chamber

Question

11:26

Asked by

[The Lord Bishop of St Albans]

To ask Her Majesty’s Government what steps they are taking to ensure the long-term sustainability of milk production in the United Kingdom.

[The Parliamentary Under-Secretary of State, Department for Environment, Food and Rural Affairs (Lord De Mauley) (Con)]

My Lords, we share farmers’ concerns over the pressures on milk prices caused by the volatility of the global market and we are working closely with industry. It is important to remember that the long-term prospects are good, with exports at record levels. We are helping the dairy industry take advantage of opportunities such as opening new export markets and pushing for better country of origin labelling for British dairy products.

[The Lord Bishop of St Albans]

I thank the Minister for his Answer. Does he agree that, should we lose any of our capacity to produce milk due to the very low prices of imported milk at the moment, the nature of the dairy industry is such that you cannot quickly and efficiently turn it back on again when another shortage occurs—as there clearly will be at some point? What are Her Majesty’s Government doing to draw together dairy farmers, processors and, above all, retailers so that we can guarantee the long-term viability of our dairy industry and also ensure that the prices of milk reflect the costs of production?

[Lord De Mauley]

My Lords, to address the short-term problem, my honourable friend George Eustice, the farms Minister, yesterday held a farming resilience summit precisely so that this subject could be a central focus. Noble Lords may also have seen that DairyCo has offered advice and assistance to farmers in cash-flow planning and volatility management. Other actions in hand include investigating whether the seasonal cyclicality of prices lends itself to the use of futures markets to smooth the price curve, and we are putting pressure on the commissioner to accelerate the improvement of country-of-origin labelling.

[Lord Wigley (PC)]

Does the Minister accept that there is a need for long-term stability for the dairy sector to flourish, and that a price below 29 pence a litre at farm gate, which was the average price in November, is not sustainable? Does he accept that action needs to be taken? Does he believe that the steps to which he referred with regard to co-operation with our European partners in dairy matters on the question of labelling is enough to deliver what is needed for that stability?

[Lord De Mauley]

I certainly agree with the first half of what the noble Lord has said. I am not suggesting that the work on labelling is by any means the only tool. That is why, as I have said, we are looking at the use of futures markets, because there is evidence of a seasonal cyclicality of milk prices. At certain times of the year a crunch tends to be worse, and such crunches can be foreseen, so we want to smooth that curve. But crucial is our work on exports, and noble Lords will be interested to know that exports to non-EU markets of dairy products are up by 47% year on year.

[The Earl of Shrewsbury (Con)]

My Lords, is it not the case that one of the ways forward could be the model used by Tesco which has a margin-plus deal with farmers where at least farmers have an idea of what the future looks like and they get a decent price for their milk?

[Lord De Mauley]

Yes, my Lords. Certainly, innovative deals such as that are of real value to farmers. Sadly, not all farmers are able to negotiate those deals, but we are working with them, as I have said, on various ways to resolve the problem.

[Lord Curry of Kirkharle (CB)]

My Lords, as the Minister knows, I was at the summit yesterday hosted by his colleague George Eustice. While the long-term prospects for the dairy sector would appear to be good, what is also clear is that volatility is now an ongoing feature of global trading. I am concerned, as is the right reverend Prelate, about the long-term sustainability of the British dairy industry and the fact that we may lose market share. I understand that the Irish Government have introduced five-year tax averaging for businesses, which has existed in Denmark for a long time. Would the Minister consider approaching the Treasury to see whether that might be possible?

[Lord De Mauley]

My Lords, I am very happy to take that back.

[Baroness Miller of Chilthorne Domer (LD)]

My Lords—

[Lord Berkeley (Lab)]

My Lords—

[Baroness Miller of Chilthorne Domer]

This side. This side.

[The Lord Privy Seal (Baroness Stowell of Beeston) (Con)]

Order. We need less of the shouting of “This side, this side” during Question Time. If we are going to follow the convention of sides, which is not the only convention we follow at Question Time, it is the turn of the Labour Benches, so we should hear from the noble Lord, Lord Berkeley.

[Lord Berkeley]

I am grateful to the noble Baroness. Does the Minister agree that one way of reducing the cost of production would be to introduce mega-dairies and very big units in the way that has been done for poultry and pigs? Does he have a view on that and what sort of size would the Government welcome?

[Lord De Mauley]

Certainly, my Lords, some producers are able to produce milk at a much lower rate—I met a farmer the other day who claimed to be producing milk in the mid-teens. We do not have strong views on the size of units of farms. What matters is stockmanship.

[Baroness Miller of Chilthorne Domer]

My Lords, does my noble friend agree that milk coming from grass-fed cows kept out of doors is of a superior nutritional quality? Further, will he say how important that is to the look of the countryside in all those areas dependent on tourism? Does he think that that would be answered by large industrial units?

[Lord De Mauley]

My Lords, there is a strong case for extensive farming. We see it in this country and some farmers are practising it very profitably. It depends to a large extent on the part of the country—on the rainfall, the quality of the grass and so forth. As I have said before, we think that there is a place for various different types of farming.

[Lord Trees (CB)]

My Lords, notwithstanding the voluntary codes by Tesco and so forth referred to earlier, which are to be commended, they apply only to a minority of dairy farmers. Is there not a case for extending the Groceries Code to primary producers of such vital products as milk? Most dairy farms are not protected under the code because they do not directly supply retailers; they supply processors.

[Lord De Mauley]

I have considered that point carefully, my Lords. The scope of the Groceries Code Adjudicator is based on a report from the Competition Commission, which found that the most significant problems in the area were experienced by direct suppliers to the UK’s 10 largest supermarkets. As a result, the Competition Commission recommended the creation of the GCA and limited its jurisdiction to the relationships between those 10 largest supermarkets and their direct suppliers. Any change to that would require primary legislation. It is a little premature to take the next step, because there is a mechanism in place for conducting a review and the first one of those is set for 31 March 2016.

[Baroness O'Cathain (Con)]

My Lords, the Question talks about the sustainability of the dairy industry. I am sure my noble friend is aware that the milk cheque is one of the most important ways of keeping agriculture going in this country. The number of dairy farmers has reduced from 30,000 about 15 years ago to 10,000 now. It seems that people are giving up. Can we impress this point on the Treasury, or whoever, and particularly on the retailers? Instead of having five private planes—in the case of one of our leading retailers—could not the retailers consider the future of agriculture in terms of the food supply to them in this country?

[Lord De Mauley]

My Lords, my noble friend, as always, puts her finger on a key part of the problem. I have outlined a number of measures that we are taking. I can also add to that the use of the RDP—the Rural Development Programme—to foster improvement of competitiveness and profitability, for example, by increased emphasis on value-added products, such as cheese and yoghurt. I think that is really important to our market. Once again I have to come back to you on the real importance of our work on exports.

[Baroness McIntosh of Hudnall (Lab)]

Does the Minister agree that cash flow, which he touched on in an earlier answer, is a critical matter, both for farmers and co-operatives? Can he say whether he feels that the banks are playing their part in sustaining the farming industry by supporting them through volatility in cash flow?

[Lord De Mauley]

The noble Baroness is absolutely right. Cash flow is crucial. You can be as profitable as you like, but if you have no money in the bank, you cannot pay the bills. The noble Baroness is alluding to the cash-flow problems that face not only farmers but co-operatives. First Milk is a co-operative, wholly owned by farmers, and it is in the interests of farmers that it should survive and thrive. Work such as that being done by Dairy UK, which I referred to earlier, on helping farmers with cash flow is really important. Some of the banks are doing similar work.

Business of the House

Thursday 15th January 2015 Lords Chamber

Timing of Debates

11:36

Moved by Baroness Stowell of Beeston

That the debates on the Motions in the names of Baroness Bakewell of Hardington Mandeville and Baroness Tyler of Enfield set down for today shall each be limited to 2½ hours.

Motion agreed.

Natural Environment

Thursday 15th January 2015 Lords Chamber

Motion to Take Note

11:37

Moved by

[Baroness Bakewell of Hardington Mandeville]

That this House takes note of the natural environment and the case for reducing polluting emissions, improving green transport and protecting wildlife and green spaces.

[Baroness Bakewell of Hardington Mandeville (LD)]

My Lords, I am delighted to be able to lead the debate this morning. This is a very wide-ranging topic and one which can cause strong views to be taken on differing sides of the argument. However, the debate is really about planning for the future. How do we maintain our green environment for future generations and how do we put in place the infrastructure to make the best use of green technology as it becomes available?

Some believe that the effects of climate change are with us. Others believe that it is all part of the natural cyclical process of the earth and can point to events in history which mirror our current predicaments. There are those taking part in the debate whose credentials are excellent and far outweigh my own interest in this matter. I look forward to hearing from them and also to the maiden speech of my noble friend Lord Callanan.

On an almost weekly basis, we can see examples of global natural disasters on our television screens; whether excessive flood waters, extreme droughts or the melting of the Arctic polar ice cap. Last winter saw unprecedented rain falling on Britain, resulting in distressing floods in Somerset, on the land around the Thames and in many other areas. In 2010 the country suffered an extreme cold spell around Christmas, with large areas of the country under snow. Temperatures were recorded at RNAS Yeovilton of minus 17 degrees centigrade. During this period, despite the central heating and the Aga being left on, I suffered a burst pipe in the roof. Gallons of water descended through our cottage, bringing lath and plaster ceilings down and flooding the downstairs to a depth of three inches, so I have every sympathy with those who were flooded last winter. My saving grace was that the water in my home was clean and not foul, smelly and muddy water brought by rainwater flooding. We were in temporary accommodation for six months. Many of those flooded last winter are still out of their homes. I therefore have first-hand experience of the extreme effects of changes of weather.

The Climate Change Act 2008 has shown the benefits of a clear legislative framework to meet the country’s carbon emission reduction target. I am delighted that my right honourable friend Ed Davey, the Secretary of State, has led the way on these issues. The green agenda has long been dear to the heart of Liberal Democrats, and we have plans in the next Parliament to take this further by setting legislative frameworks on five green laws.

It is essential for the country to have a zero-carbon Britain Bill. This will toughen up climate change targets in the light of experience and be coupled with a global climate change treaty to ensure that the mechanisms are in place to meet targets. A nature Bill will introduce legal targets for biodiversity, clean air and clean water, and will establish a natural capital committee in law. The country must also move towards becoming a zero-waste Britain. It is essential to reuse all our scarce resources and create a circular economy. It is not enough just to talk about this; we need to set binding targets, with a clear action plan to reduce waste and end landfill. Our island must not be allowed to sink under the weight of the rubbish we produce. A green transport Bill will set clear targets for when we will see petrol and diesel-driven cars banned from using our roads and for rail electrification, as well as promoting cycling, walking and public transport. Other colleagues will talk about our green transport policies and no doubt share some excellent examples of good practice. An energy saving and renewable heat Bill will help to reduce energy bills by bringing in tough new energy efficiency standards and boosting renewable heat and district heating programmes. I shall give examples of this later in my speech.

The zero-carbon Britain Bill will include a new legally binding target for zero-carbon Britain by 2050, to be monitored and audited by the Committee on Climate Change. It is also important that we look not just at measures to prevent climate change but at how we protect our natural environment, for example by establishing an office for accelerated low-carbon innovation to support the fast-tracking of less mature but key green technologies, including tidal and wave power, such as the Wave Hub off the coast of Cornwall, sponsored by the previous regional development agency. In addition, we should look at a renewable heat route to modern district heating, ultra-low emission vehicles, energy storage and CCS—carbon capture and storage—as well as continuing to apply emissions performance standards to existing coal plants from 2025 to guarantee that unabated coal generation ceases and to stimulate innovation in CCS. It will be important to extend full borrowing powers to the Green Investment Bank to boost further investment in low-carbon technologies.

The nature Bill will include measures to identify those natural resources that we are harvesting at an unsustainable level, for example peat and wood. The peat industry has long been established in Somerset. Measures are already present to protect the environment, but these need strengthening to safeguard it for future generations. In order to protect the environment it will be necessary to increase the penalties for the enforcement and punishment of environment crime, such as deliberate water pollution, and wildlife crime. The proceeds from these increased penalties should be used to fund the National Wildlife Crime Unit and the sector of the Environment Agency which tackles pollution-related crime.

Everyone enjoys the country’s forests and it is important to provide continued support for British forests by placing them in a trust to safeguard them against future potential sales. This is included in the coalition’s forthcoming draft forestry Bill.

Green accessible spaces are much valued by local communities and introducing a new designation of national nature parks is one way of protecting this valuable asset for future generations. The right to roam is similarly valued by residents; thus including the national forests and other publicly owned land, while examining the viability of opening up inaccessible habitats that are in private ownership, is also key to the nature Bill. It is important to examine how we put in place the infrastructure we need to build a low-carbon, green future.

I turn to the zero-waste Britain Bill. In south Somerset we are proud of our recycling collections. Waste lorries come every week to collect separated, recyclable plastic, cardboard, glass, tin and foil. Putrescent waste is also collected weekly to go to on-farm composting. The residual waste is collected fortnightly. The vast majority of residents are happy with the arrangement and know they are contributing to reducing landfill. Nevertheless, this is a drop in the ocean and it will be necessary to do more countrywide. We will commission a Stern report on reducing the UK’s consumption of natural resources in order to facilitate the circular economy, facilitating waste minimisation and ensuring that only non-recyclable waste is incinerated. We will also argue for faster development of EU sustainable design and production standards. Coupled with this, the banning of biodegradable waste from landfill by 2020 will be key.

As the House already knows, we will bring in the 5p plastic bag charge announced in this Parliament. Consumers will pay for each new single-use plastic carrier bag they use at the point of sale. After administrative costs have been met, the supermarkets will donate the remaining money to charity. We will scrap all the exemptions, such as for SMEs and paper, associated with this ban.

I turn finally to an energy-saving and renewable heat Bill which invests in the future. Measures included in this Bill will be low-carbon infrastructure investment in, for example, heat networks, energy storage systems, hydrogen distribution and carbon disposal systems. These will be classified as utilities for infrastructure development purposes. A new legal framework will be set up to require all relevant regulators to facilitate the development of deep geothermal heat, large-scale heat pumps and waste industrial heat and energy storage systems. Ofgem’s remit and powers will be revised to enable it to regulate all heat forms and heat networks so that it can provide, for example, protections for heat network and heating oil customers. There will be new efficiency incentives to help people cut their energy bills permanently. For example, the vast majority will be able to cut their council tax bill when they invest in energy-saving home improvements.

I am sure that many of your Lordships live in areas where there are listed properties, some with thatched roofs and mullioned windows. It is extremely difficult for home owners or landlords of such properties to improve their energy efficiency without putting in double-glazing and others measures not permitted by conservation officers. Does the Minister have any solutions to offer for these properties?

New energy-efficiency regulations will come into place, for example when people make certain home improvements requiring planning permission. They must also include energy-saving improvements and new higher energy-efficiency standards within building regulations for lighting, motors and cooling and ventilation products. In addition, new heat-saving regulations will apply. For example, when people change their heating system, other low-cost heat-saving investment would become mandatory.

Ensuring that everyone, including those on very low incomes, is helped to reduce their energy costs is essential. There will be new, long-term legal targets for assisting domestic homes, starting with social housing and then moving to privately rented and then owner-occupier homes. In the south Somerset area, the housing providers already take steps to ensure that their homes are energy efficient, both as new build and as retrofit. They know that if their tenants are able to reduce energy bills they are more likely to be able to afford rent, buy food and live fulfilled lives. It is important that we have flexibility in all things. On zero-carbon housing, if a developer is not able to make a home fit the zero-carbon standard, does the Minister agree that allowable solutions should include an obligation to retrofit another house?

The coalition Government have already set out that fuel-poor homes would have to meet the band C minimum standard by 2030 regardless of tenure, with relevant government and industry subsidy and support. We are currently consulting on setting a standard for privately rented homes for 2018 and beyond. Liberal Democrats would propose that this standard should be band C by 2030. We would also consult on setting a standard of band C for social homes by 2025. The clear aspiration would be for owner-occupier homes to be band C by 2035. In all cases the standard would, as far as reasonably practicable, be subject to testing—your Lordships would expect nothing less—as it is recognised that some homes cannot be brought up to band C at a reasonable cost.

I am pleased to be able to report that, earlier this week, Wiltshire Council passed a motion proposed by Liberal Democrat councillors to reduce energy consumption by creating a Wiltshire energy-efficiency board, with the remit to work with partners across the county to develop a joint strategy to achieve increased energy savings, and the consequential economic savings to match, and then to exceed the south-west average. The motion was supported locally by my colleague Duncan Hames MP from the other place.

I am also pleased to be able to tell the House about an energy society which has been set up in south Somerset—the south Somerset energy society. It is in embryonic form but is applying for a rural community energy grant to start its feasibility study. This society, working on a similar model to that used by the Plymouth energy society, hopes to raise share capital for its investments in businesses, schools and community facilities to enable it to access cheaper energy. I am sure that there are many similar examples throughout the country of local initiatives striving to cut energy costs. I look forward to the contributions of other noble Lords, and I beg to move.

11:49

[The Earl of Selborne (Con)]

My Lords, the whole House will be grateful to my noble friend Lady Bakewell of Hardington Mandeville for giving us an opportunity to hold what I predict will be a wide-ranging debate on the natural environment. I would like to look at the implications of environmental change in the widest sense, not just climate change, remembering of course that the United Kingdom’s natural environment is the product of centuries of management. Whether it is agricultural land, woodland, forest, heaths, moors, coasts, green spaces or urban areas, all are products of our management. The only area of wilderness in the United Kingdom is perhaps the flow country of Caithness and Sutherland, an area of blanket bog. If we look at the steady loss of biodiversity in most habitats, it is evident that we have much to do to stabilise wildlife populations.

Increasingly, we are recognising the importance of protecting ecosystem services on which we ultimately depend, whether for food production, flood prevention, pollination of crops, air purification, raw materials recycling and much else. The United Kingdom National Ecosystem Assessment was carried out between mid-2009 and early 2011. It was the first analysis of the United Kingdom’s natural environment in terms of the benefits that it provides to society and its continuing prosperity. This assessment should set the agenda for future consideration as to how we monitor, conserve and enhance ecosystem services.

A particularly interesting issue, although it is difficult to grapple with, is the extent to which we rely on or could benefit from the correlation between human health and the environment. It is a statement of the obvious to say that we benefit from a contact with nature, but it is not easy to measure the relationship between green space and the health of population levels. Here, if anywhere, is an area where much more research is needed on the positive aspects. There is much research on the negative consequences: it is easy to demonstrate that degraded and contaminated environments impact adversely on our health, particularly our mental health.

Another aspect that states the obvious and of which we are all well aware is that since the Second World War there has been a dramatic change in United Kingdom land use. It is because our national priorities changed with the intensification of agriculture, urbanisation and transport development. Some 90% of semi-natural vegetation has been converted to arable use. You cannot change the use of land without dramatic and major impacts on ecosystems, and therefore the delivery of ecosystem services. Unless you are very careful you will cause the disruption of flood regimes, river basins and coastal wetlands. These are the issues with which we must deal. They are related not just to climate change but also to land use and the impacts of an expanding economy, which of course we welcome.

It is easy to cast gloom and doom over the natural environment, but we should also remember some positive aspects during the period since the war, about which I have been talking. There are the Clean Air Act 1956, the Wildlife and Countryside Act 1981, and EU directives such as the 1979 birds directive and 1992 habitats directive. These have all played an important role in helping us to take our responsibilities more seriously and with a degree of continuity.

In reference to the Clear Air Act, while cleaner air can be described as a success story, it remains at the regional level a serious issue, especially in urban areas. Ambient air quality has improved but diffuse sources of atmospheric pollution remain a challenge. As our Motion today identifies, transport is a major source of pollutants, as are power generation and industrial emissions. Air quality needs to go up the environmental agenda. The Government could lead the way in raising the priority attached to air quality in all government departments. In another place the Environmental Audit Committee calculated that poor air quality will reduce average life expectancy in this country by an average of seven to eight months, and that up to 50,000 people a year may die prematurely because of poor air quality.

On our record on national biodiversity loss, there is good news. Some species have done really rather well. There is the reintroduction of the red kite, a bird with which we are now all familiar; at one time, it was isolated in Wales. There are also buzzards, deer, badgers, otters and some non-specialist butterflies, for example. They have all expanded their range. These tend to be generalist species. The specialist species have done far less well. Since 1995, 70% of butterfly species, 50% of bird species and 28% of plant species have declined in abundance. Those are sobering figures and need to be considered against a background of some over-optimistic targets to which we have signed up, at national and international levels. As a result of the Earth Summit in Rio de Janeiro, we became a signatory to the Convention on Biological Diversity. There were also millennium development goal 7.B and the EU targets for 2010. All have been a history of failure to meet targets. They had good intentions, but without thinking through how we might reduce our impacts we will never meet these targets. At present we are signed up to the Aichi targets, which were set in Japan, for 2020, but it would be a brave person who predicted that we were going to meet them.

The key to this will be when we ultimately work out how we determine the ownership and distribution of property rights for natural capital assets, which is a highly contentious issue but one on which the Natural Capital Committee, which provides advice to government on the state of England's natural capital, is giving advice. If we could get into our national consciousness and the balance sheets of each and every company in the country an assessment of what impact for better or worse they are making on our natural capital, it would be something of a game-changer. There would be lasting benefits to the United Kingdom if we could demonstrate the value to society of our natural capital and reward those who protect and enhance the desired ecosystem services. This does not have to be done with new subsidies or grants from government; it can be done by adjusting the tax system to reward those who are looking after future generations.

I return to transport, which is mentioned in the Motion. My second game-changer would be to look at the development of hydrogen. We are already there: we have cars, buses and boats fuelled by hydrogen. The problem is, of course, the high cost of fuel cells and the absence of a refuelling infrastructure. The Government recently announced an £11 million investment in United Kingdom hydrogen vehicle infrastructure and £2 million of funding for public sector hydrogen vehicles. I think it is quite realistic to think that in 10 years’ time hydrogen will be competitive in price with petrol and diesel. It will certainly reduce pollutants in the air and, provided the electricity which produces the hydrogen is from renewable sources, it will make a contribution to a reduction in greenhouse gases. There is a challenge: if in the run-up to the general election any political party can commit itself to travel only by hydrogen-fuelled vehicles, it will be doing us a service.

11:58

[Lord Whitty (Lab)]

My Lords, I, too, thank the noble Baroness for initiating this very wide-ranging debate. I thank her also for giving us a quick preview of what would be the Queen’s Speech of a Liberal Democrat Government—some of which sounds vaguely attractive, and I might support it.

The title of this debate ranges from the very local to the international, and we do not know where to begin. The noble Baroness began, as I rather suspected she might, with the situation in Somerset and the Somerset levels and the disastrous, distressful floods. There was a terrible impact on both the people there and the environment. However, as the noble Earl, Lord Selborne, said, the key thing about the Somerset levels is that they are not, in a strict sense, a natural environment. They have been created by manmade measures over the centuries: intricate water management, successive different forms of farming putting pressure on the system, deforestation, local pollarding of trees and so forth, and ever-changing farming practices. They all put pressure on the system. All those efforts gave an economic base to the area and the landscape that we love, but the levels are not a natural environment. They need to be protected, but we need a different system of human management for such areas.

The storms of last year which caused the floods in Somerset and elsewhere were a unique event and were unprecedented in their form. While one cannot ascribe any individual extreme weather event to climate change, climate change means that we are going to get more of them. The likelihood is therefore that the UK and the world will face greater storms, floods, droughts and other disasters, and we need human management to deal with that. In order to protect our environment, we need a change in intervention. As in 19th century Sicily, unless there is change, things cannot remain the same. We therefore need to recognise that the challenge of global climate change will mean a lot of new, local interventions. I do not want to be too despondent, but the world has largely failed on climate change. The conference in Paris this year may be the last-chance saloon to stop average global temperatures going over the 2 degrees level.

There are some fairly worrying indications. The fall in the oil price means that people and markets are switching back to fossil fuels. The development of shale gas and shale oil has displaced coal in America. On balance, this is a positive thing, but it has reduced the price of coal, which is being exported to markets at a low cost, as is US oil. The net result is that the price of fossil fuels, relative to nuclear and renewables, is changing. The problem is not just in places like China, where coal-fired power stations are coming on stream every month, or India where the explicit objective of the new Government’s policy is to exploit to the full India’s domestic coal resources—most of which are lignite, the worst form of coal. It is also true within Europe, where Polish and German lignite is now being used to a greater degree: even green Germany is opening new coal-fired power stations.

In aggregate, the global subsidies for coal far outweigh those for renewables or nuclear energy. The markets and, in some cases, government policy, are moving in the wrong direction. Over the years, the UK Government have, commendably, taken the lead in both establishing targets and introducing policies designed to offset this. However, most of those policies have not delivered to the extent that they should. The noble Baroness mentioned issues of energy efficiency in residential and other property, but so far the measures are faltering. The ECO is not working as it should, nor is the Green Deal, and take-up of the RHI is very limited. A report which I was partly responsible for found that there are very few pressures in the commercial and industrial sectors for increasing the environmental efficiency—and therefore the energy use—of commercial buildings, old and new.

As the noble Baroness said, we need intensified policies in all of these areas. We also need them on land management: how we use land and water. We need to plant more, appropriate trees on many of our hillsides; we need more effective water management by catchment; we need to reform the abstraction regime for water in our uplands. We cannot defer this, as we have done for many years. Some of these interventions, and some on the energy side, will be seen by some as detrimental to the natural environment, but that will only be in the short term. In the long term, they will protect our natural environment.

I am not saying that we should give up trying to mitigate the rise in carbon and greenhouse gas emissions. That objective is still there, but we need to recognise that a significant rise in global temperatures—probably over 2 degrees—is now almost inevitable. We therefore need to look at adaptation in the way that we have looked at attempts to mitigate. On the mitigation side, the Climate Change Committee has indicated that the next Budget will require us to cut, between now and 2025, by another 28%. We succeeded in meeting the first budget targets only because of the recession. The underlying change is nowhere near close to achieving those ends. That means that even in the UK—which is leading in this area—we are not likely to make our contribution to reducing carbon.

We therefore need to focus as well on mitigation. That will need capital expenditure by both public and private sectors. We know that the way in which projects are assessed in the private sector tends to focus on the short term. We know that the immediate fiscal problem with regard to public expenditure is limiting the amount of public investment in things such as flood defence, resilience of infrastructure and the whole area of protection of our countryside. Unless we put the money in and give some priority to that form of investment, we will neither protect what we call our natural environment nor avoid the major problems that are facing us through the process of climate change.

12:10

[Baroness Miller of Chilthorne Domer (LD)]

My Lords, my noble friend, whom I congratulate on securing this debate, outlined the proposed nature Bill in her admirably comprehensive introduction. I shall concentrate my remarks on green space, which, as the noble Lord, Lord Whitty, pointed out, is not necessarily a natural environment as we might have found 2,000 years ago—that exists probably nowhere in the UK. There are wilderness areas or wilder areas, as in the national parks, but much green space is what we share with other species. With the decline in biodiversity that has tracked the whole of my lifetime, through the 20th century, there has been an increasing pressure on all the places where other species lived, to the point when they often ended up with nowhere to live and breed.

Successive Governments this century have made some very good efforts, and I commend the Labour Government, when the noble Lord, Lord Whitty, was a Minister, for the Countryside and Rights of Way Act, because there is nothing like getting the public involved in being a major part of the protection of green spaces. One of the major steps for this Government was the report from John Lawton, Making Space for Nature, which talked about protecting what we have, the SSSIs and the EU habitats, which of course we are obliged to protect. In mentioning the EU habitats, I say to noble Lords who are Eurosceptics that without the EU’s input into areas such as water pollution and protection of species we would be in a much worse place than we are in now. The EU can claim enormous credit for turning around what was a pretty grim picture in the 1960s and 1970s.

We should expand and join up these spaces for nature with wildlife corridors. That was Sir John Lawton’s contention. The babies that came out of that report were the nature improvement areas, of which there are currently 12—and that is a start. In their assessment of 2013, the Government found that each pound invested by the Government results in nearly £6.80 of additional support from communities, businesses and individuals. It is actually very good value. However, there is still a tremendous amount more that can be done. One area that has been overlooked until now is local wildlife sites, which are important havens, identified and selected locally for their high-nature conservation value and with great public support from the people on whose doorsteps they are. The Wildlife Trusts, which I must commend for their work, because their mission is to connect the public with wildlife and to protect that wildlife, produced a report entitled, Secret Spaces: the Status of Local Wildlife Sites 2014. It found enormous pressures on those sites. It may surprise your Lordships to know that, although they are recognised within the planning system, local wildlife sites are not protected by law. That was one of the recommendations—that greater protection should be given to them—that Professor Sir John Lawton came out with. It would be one thing at the top of my list of things to be done.

Of course, we have had lots of strategies beyond the ones that I have mentioned. We had a biodiversity strategy from Defra in 2011 and the important natural environment White Paper, as well as the work on eco- systems services, all of which are important contributions. However, I would agree that putting the work of the Natural Capital Committee on a statutory basis is one of the most important steps that we can take now, because its work values the synergies that we find between, for example, farming benefiting wildlife, clean water and more absorbent soil, as well as more interesting landscapes. We have found that there are lots of indicators of the health of an ecosystem: pollinators, for example, which is an issue that we have debated in your Lordships’ Chamber before, frogs and farmland birds. The Government are committed to reversing the long-term decline in the UK farmland bird indicator, which is made up of 19 species. Noble Lords will be aware of the different reasons for that decline, particularly different farming methods.

I would particularly like to mention one initiative from LEAF—Linking Environment and Farming—that is important in helping to reverse this decline. It is starting its big farmland bird count within the next month and will involve farmers. It is looking at what can be achieved by the adoption of simple management techniques to improve habitats and bird numbers and includes information on bird identification, because it is not a given that every land manager can identify all the species. There is much work to be done. The mistle thrush and the yellowhammer have declined enormously since the 1970s here in England, but oddly in Scotland, that decline has now reversed and the populations are becoming much healthier. Perhaps there is something that we can learn from Scotland.

To conclude, I would like to talk about bats, which are the subject of a Private Member’s Bill in the other place on Friday of this week. The Bat Habitats Regulation Bill is sadly geared toward preventing bats from living in churches. There have been many claims that bats are contributing to a health hazard—which Public Health England denies—but why do bats need special protection in the first place? It is easy to kill a whole roost of bats, and people have often had a prejudice against them. They, perhaps more than any other species, have suffered from declining habitats, with barn conversions and so on. The Bill, which perhaps will come before your Lordships’ House, refers to enhancing the protection available for bat habitats in the non-built environment. That is all very well, but then it refers to limiting the protection available for bat habitats in the built environment,

“located inside a building used for public worship”.

That is a very dangerous precedent. Anyone who does not like bats can claim that people are gathering to worship. I hope the right reverend Prelate will take this up, as I think it is a very sad comment on the churches’ attitude towards wildlife. There is a simple solution: if bat faeces are falling in an embarrassing place, you simply need to nail a board under that, as many people have learnt to do in their own homes.

12:18

[Lord Callanan (Con) (Maiden Speech)]

My Lords, I join in the congratulations to the noble Baroness, Lady Bakewell, on securing this debate today on such an important subject, giving me the opportunity to make my maiden contribution to the debates in this House. I begin by thanking noble Lords on all sides for being so helpful and welcoming, and for so politely pointing out my many mistakes so far, the most serious of which was rising to leave the Chamber when the Lord Speaker was on her feet. I shall not be doing that again.

Let me particularly thank my two sponsors, my noble friends Lord Bates and Lord Inglewood. I first met my noble friend Lord Bates 30 years ago; we both attended the same Gateshead comprehensive school and joined Gateshead Young Conservatives at about the same time. I do not know what prompted him to do so: Gateshead was hardly then, or even now, a hotbed of Conservatism; but in my case, the late Lady Thatcher was entirely responsible for my decision to join the party. I am profoundly sorry that I never had the privilege of serving in this House alongside her. After that, the political careers of my noble friend Lord Bates and I went in different directions. I served on Tyne and Wear County Council, Gateshead Council and then in the European Parliament; he, of course, served in the other place. I am also grateful to him for one other thing—for leaving the title of our home ward, Low Fell, for me to take.

I was proud to represent the north-east of England in the European Parliament for 15 years, where for part of that time I also served alongside my noble friend Lord Inglewood, who represented the north-west. We often travelled to Brussels and Strasbourg together and spent many a happy hour debating the latest political scandals in the departure lounge of Newcastle Airport.

In the European Parliament our speeches are often time-limited to two minutes, or sometimes even one, so I am delighted to be in a Parliament where one sometimes gets the opportunity to speak for what seems like an eternity of eight minutes. I sincerely hope that noble Lords will not wish, at the end of my contribution, that I had spoken for only one minute. Another great advantage of this House is that all the debates are—ostensibly, at least—in the same language.

Turning to the subject of today’s debate, for most of my time in the European Parliament I served as Conservative environment spokesman and worked on many of the emissions and climate change directives, including the Euro 5 and Euro 6 engine standards and the emissions trading system in all its many complicated incarnations. I know that a maiden speech is not the time to burden your Lordships with some of the complicated detail of such directives, so I will merely say that I always took the view that our environmental ambition should not be achieved at the expense of damaging the competitiveness of some of our excellent British and European manufacturing industries.

I am fortunate to come from the north-east, a part of England with many economic difficulties, but also blessed with some of the most beautiful countryside and magnificent natural environments in our nation. I sincerely hope to use my time in this House to contribute in some small way to help to resolve the former and to sustain the latter.

12:22

[Lord Bradshaw (LD)]

My Lords, we were very glad to hear from the noble Lord, Lord Callanan. He brings two things with him. First, he is an engineer. Both Houses of Parliament are woefully short of people with technical knowledge in the various engineering fields. Secondly, he comes from the north-east. One has only to sit and listen to recent introductions to notice how many come from Greater London. This House is very short of people who have a regional perspective on things. To this particular House he brings a third quality: he must feel a lot younger than he did before he came here, being surrounded by so many more mature people.

I will concentrate my remarks on two or three things. First is the question of emissions. Emissions in town and city centres concern me greatly. A lot of work is being done on the Euro 5 and Euro 6 engines, to which the noble Lord, Lord Callanan, referred. However, a great deal of the pollution in our towns and cities comes from the refrigeration and cooling units on lorries that deliver food and other perishables to shops and airports. These refrigeration engines, which are diesel-powered, do not have the means to send their exhaust through the exhaust cleaning system of the engine. You might clean up the engine that is propelling the lorry, but you have an extremely polluting cooling system attached.

I am aware from a letter I received from the Minister this morning that there is work going on in Europe on non-road mobile machinery mechanisms, but there is a solution to the problem I have outlined. It is to use compressed air or compressed nitrogen engines to run the cooling units that are so prevalent in the traffic of today. The plethora of delivery vehicles running round from various shops, delivering goods to your home, is all very well but the vehicles bring a lot of pollution with them and this is scarcely recognised. Can the Minister say whether this non-road mobile machinery includes supplementary engines mounted on the road vehicles? I am not sure that it does. The happier news is that there is a technical solution. It is a British solution that has been developed and is going through, I think, the advanced stage of trials. If it is adopted—I am not an engineer and cannot comment on the technology—it will make a huge contribution to cleaning up the air in cities. I know there is debate about the effects of climate change but there is no debate about the health hazards of vehicle emissions.

The second thing I would like to ask the Minister concerns low emission zones. There are low emission zones in a few places and I have noticed that the Mayor of London intends to make the City—or the whole of London, actually—a low emission zone by 2020. It is important to give people fair warning of these things. Up to a few years ago, they had been encouraged to buy diesel cars. Suddenly to reverse that and say that these cars will now be prohibited is very hard, but if you give notice people can adjust. They sell and buy cars and adjustments can be made, as they have had to be made to buses. I have been involved in the bus industry, as I think is fairly well known.

I put this point and to some extent I turn to the remarks of the noble Lord, Lord Callanan, about the competitiveness of British industry. There is a lack of inventiveness and a lack of capacity to ensure that good ideas are developed here and exported around the world because they are seen to be necessary and good value. The point about stimulating research, innovation and development here is one that I have heard echoed round this Chamber on many occasions, but it is absolutely important for industries in the area from which the noble Lord, Lord Callanan, comes.

I will not keep noble Lords any longer but I will be pleased to give the Minister the information I have on air engines, and I would be glad to send it to anybody else who is interested.

12:28

[Lord Framlingham (Con)]

My Lords, I add my congratulations to the noble Lord, Lord Callanan, on his excellent maiden speech and I am sure we look forward to further contributions from him.

I am extremely grateful to the noble Baroness, Lady Bakewell, for obtaining this debate today which allows me to talk about one of my favourite topics: trees, particularly ones in urban areas in what are currently called hard landscapes. Trees are like the humble bee. They do a massive job in the environment and are taken for granted by most people, yet without them our very survival would be threatened. I remind you what an incredible job trees do. They look attractive. They take in our waste carbon dioxide and give us in return precious oxygen. They provide shelter and are barriers to both pollution and noise. They help to cool the urban environment and manage storm-water run-off. They have been shown to have a positive effect on the nation’s health. In short, they are quite simply indispensible.

Yet the question that I want to pose is: are we making the most of this incredible asset? We use trees to adorn and enhance our finest buildings and to hide and camouflage our ugliest. When applying for planning permission, architects embellish their drawings with pictures of mature trees, yet so often, when the development takes place, for reasons of finance or inadequate aftercare the trees as envisaged never appear.

It must be obvious from what I have said already that what is needed is a nationally co-ordinated approach to the design and management of hard landscapes. This would ensure the maximum and most imaginative use of trees and guarantee both their planting and their aftercare—to decide not just what type of tree to plant but to take into consideration its ultimate size, crown spread, root spread, disease resistance, the soil type in which it will flourish and its proximity to underground utilities, as well as things such as its leaf drop, fruit production and aftercare needs, and 1,001 other issues.

Clearly the Government have a role to play in this, although I am not quite sure which department it currently comes under. However, help is also at hand in the form of an organisation called TDAG, the Trees and Design Action Group. This organisation, now a charity, was formed in 2007 with the ambition to create a very broad network of expertise across the built and natural environment, sharing a common understanding that trees have a major role to play in the health of our cities.

Perhaps I should declare an interest—one that is not in any way financial. Many years ago, I was for some time the president of the Arboricultural Association, which is a member of TDAG. The group contains the widest possible spectrum of organisations concerned with these issues, from local authorities to landscape architects, from civil engineers to nurserymen, and from banks to the Forestry Commission—too many to mention but all with the same aim: to get more healthy trees in our cities and thus improve the health of those who live there.

TDAG has produced two excellent publications: Trees in the Townscape and, last October, Trees in Hard Landscapes: A Guide for Delivery, which I am sure the Minister will be aware of, since his colleague, the noble Baroness, Lady Kramer, wrote the foreword for it. I urge him, if he is not already doing so, to lend his weight to the distribution of these guides, or more particularly their contents, so as to co-ordinate and encourage the most enlightened and best practice everywhere.

We must use all the experience available to us, together with our imaginations, to break new ground and to break out of our sometimes routine thought processes. Many years ago on a lecture tour in the United States, I found myself in Philadelphia. In those days, Ginkgo biloba, the maidenhair tree, was relatively rare in the United Kingdom. To my astonishment, in Philadelphia it was used as a street tree. It was everywhere. If it was an ideal street tree there, why not here? That is a lesson I have never forgotten. I believe it is now called “thinking outside the box”.

It is not just housing, office or town-centre develop- ments that present challenges and opportunities. What about business parks, industrial sites, motorway and railway embankments, and roundabouts? Opportunities abound not always with big trees but sometimes with small trees, shrubs and low-maintenance ground cover, but always with a mixture of experience and imagination to produce the best possible use of the ground available for the maximum effect.

I should like to deal briefly with two other important topics: tree importation and woodland protection. Following the importation of ash dieback from Europe, there was a call, including one from me, for a reduction in the number of imported trees and for much more reliance on home-grown stock to reduce the ever present and very real danger to our tree population. Sadly, figures that I obtained through a Written Question show that in the last planting season we imported more trees than ever. I acknowledge that this is not a simple matter. It involves long-term planning, with appropriate commitments and contracts. But trees are a long-term business, and getting it wrong again would be disastrous.

Perhaps a quarantine system is the answer, at least in the short term. A company called Barcham Trees, based in East Anglia, has introduced its own quarantine system. It says that it will not import trees and sell to customers for immediate planting, and that,

“All imported trees will be held on the nursery for one full growing season during which time they will be subjected to rigorous inspection for pest and disease. This includes systematic and regular DEFRA visits”.

I do not know whether other companies are doing this, but if it is not already happening, perhaps the Minister could look into the merits of that system. Audit trails for trees are also important, so that trees sold by any particular nursery can be easily traced.

Caring for existing trees is vital, not just in urban areas but in woodlands too, particularly ancient woodlands. Houses can be demolished and rebuilt in a matter of months, but an invaluable ancient woodland, if lost, is lost for ever. The Woodland Trust tells me that it is currently fighting 400 cases where woodlands are under threat. I know the Minister has a great interest in woodland, and I urge him to do all he can to preserve it wherever possible.

We must care for all our trees, old and new. I would say to the Minister, who I am sure loves his trees, “Don’t listen to those who say you never see the results of tree planting in your lifetime”. Trees make their presence felt in a few short years, and what better legacy could a Minister leave than to have significantly increased the nation’s tree cover, particularly in our towns and cities?

12:36

[Lord Greaves (LD)]

My Lords, I, too, thank my noble friend Lady Bakewell of Hardington Mandeville for introducing this debate and setting out so eloquently the nature of a nature Bill, which the Liberal Democrats would like to introduce in the next Parliament. I look forward to working closely with the noble Lord, Lord Whitty, when that Bill comes forward. I should remind the House of my registered interests as a councillor and as an active member of various access organisations.

I shall talk first about the “natural environment” part of the Motion, and particularly about access to the natural environment. In the nearly 15 years for which I have been a Member of your Lordships’ House, the number of occasions on which we as a House have contributed to the extension of people’s ability to access the natural environment has been a great pleasure to me. The very first Bill that I was really involved with was the Countryside and Rights of Way Bill in 2000, for which the noble Lord, Lord Whitty, was responsible in this House. That set a pattern that we have followed since.

However, there is now a real threat to vital countryside and rights of way services—the access services provided by local authorities—as a result of the cuts, many of them drastic, that local authorities are having to cope with. Many of them see the rights of way staff and services as not being part of their core service. This really began to bite last year, when some authorities were even proposing to close down the service altogether. I do not think that they can do that, because it is a statutory service, but many authorities are subjecting their services to cuts. We do not know yet what will be the effect of the current round of local authority budget making for 2015-16, but it seems that further cutbacks in many areas are inevitable.

Some of the more flexible, and perhaps enlightened, authorities have been able to make a link with the new health and well-being boards and their public health functions, and use a certain amount of public health money for the promotion and support of active outdoor recreation. Clearly, that is to be welcomed. But the pressures are everywhere. In my own local authority of Pendle in Lancashire, we have one of the densest networks of public footpaths in the country, which are vital to tourism, local recreation and the health of the local population. Because we have been able to maintain an agency service where the district council carries out the rights of way service on behalf of the county council, with subsidy from the county council but topped up by the district council, we have the highest standard of service in the county and our paths are in the best condition of any in the county. But the county council, like all other local authorities, has been under pressure and put forward a proposal to stop the agency and significantly reduce the service. We had some fairly vigorous and interesting discussions and I am pleased to say that we came to a compromise. We have been able to fight off the idea that because our footpaths are in the best condition of any in the county we do not need to do much to them for the next few years—until, presumably, they get back to the mediocre standard of other areas.

This is the kind of debate that is happening on so many services in local government at the moment, and the rights of way service is not in any way immune. I want to ask the Minister a question, which I am sure he will not be able to answer today, but perhaps he can dig out what information the Government have and write to me and other Members. What impact have the cuts already had on rights of way and countryside access services throughout England? Do the Government know what the situation is so far, to provide a baseline from which to go forward?

The second area I want to talk about is referred to in my noble friend’s Motion as “protecting green spaces”. I particularly want to talk about urban green spaces. The promotion of new urban green spaces is something for which the Liberal Democrats, in particular, have been pressing for a number of years. The proposal for a new designation under the planning system first appeared in the Liberal Democrat manifesto at the last general election. That led to a number of references to urban green spaces in the coalition agreement, a copy of which I have with me. It is an historic document that no one seems to pay much attention to any more, which is an interesting lesson for the future. Coalition agreements at the beginning of a five-year Parliament are regarded as being extremely important for a while, fairly important for two or three years, and then forgotten.

I have a copy of the agreement, which is still on various websites, including the government website. Under the heading, “Environment, food and rural affairs”, the coalition agreement states:

“We will introduce measures to protect wildlife and promote green spaces and wildlife corridors in order to halt the loss of habitats and restore biodiversity”.

Under the section on “Communities and local government”, it says:

“We will maintain the Green Belt, Sites of Special Scientific Interest … and other environmental protections, and create a new designation—similar to SSSIs—to protect green areas of particular importance to local communities”.

The results of this appear in paragraph 76 of the National Planning Policy Framework, which is a document that people pay rather more attention to nowadays than they do to the coalition agreement. It states:

“Local communities through local and neighbourhood plans should be able to identify for special protection green areas of particular importance to them. By designating land as Local Green Space local communities will be able to rule out new development other than in very special circumstances. Identifying land as Local Green Space should therefore be consistent with the local planning of sustainable development and complement investment in sufficient homes, jobs and other essential services. Local Green Spaces should only be designated when a plan is prepared or reviewed, and be capable of enduring beyond the end of the plan period”.

It was clearly intended that these new local green spaces should be an important part of the planning system.

I have another question which the Minister will not be able to answer today, but perhaps the Government can tell us what information they have. To what extent is this actually happening in all the local plans that local authorities have been producing and taking to inspection and adoption within the past two or three years? I have a sense that this has been a bit of a damp squib in many cases and that local authorities have not really grasped this new ability to, in effect, declare new parkland in parts of their areas, particularly their urban areas. This is something that our party will want to continue to stress and to press for and perhaps give greater prominence to in future. I have run out of time so I will say no more.

12:46

[Lord Borwick (Con)]

My Lords, I declare my interests as they appear in the register, particularly that I am a trustee of the British Lung Foundation. I welcome this debate, as all too often the push to reduce emissions and improve our green spaces means that we spend a lot of money on the wrong things. The result is more regulations and higher taxes, which push up the cost of living. The hardest hit are often the poor and the elderly, who spend more of their incomes on electricity and gas. Indeed, taxes can make up 15% to 20% of the cost of power to a household. If we are trying to reduce emissions and improve air quality, we have to think of other ways of doing it than imposing new or higher taxes.

However, none of those points detracts from the fact that we need to reduce emissions, improve green spaces, protect wildlife and think about how we travel in the future. It is very important that Parliament stays ahead of changes and developments in this issue. That is why I have proposed to the Chairman of Committees the creation of an ad hoc committee on air pollution. From the great stink of 1858 to the great smog of 1952, population growth and industrialisation have reduced the quality of the air in the UK, especially in big cities. The Clean Air Act 1956 was perhaps the earliest significant attempt to enshrine in law the protection of air quality. Now that science is delivering more local knowledge on air pollution, we have to be aware and preparing for the pressures that that will bring.

Within a short time, we will be able to get a smartphone app to tell us the levels of air pollution within a local area, measured from space. This means that your sat-nav directions might include the option of the quickest route, the shortest route and, in the future, the cleanest route. When citizens get the knowledge that their home area has bad air pollution, they are going to demand that the Government do something about it. Individuals tend to think—probably rightly—that they cannot improve air quality through their own actions alone. The same can arguably be said for government departments. That is why it is vital that collaborative work is done on this problem across government. The Department of Energy and Climate Change is, of course, interested in climate change but not sufficiently in emissions. The Department for Environment, Food and Rural Affairs, the Department of Health, the Department for Transport, the Department for Business, Innovation and Skills and the Department for Education are all responsible in part for emissions.

Lung diseases are strongly correlated with poverty. There are rich people who die of lung diseases, but they die mainly of heart problems. It is poorer people who smoke too much and live in areas where they suffer from bad air quality—and many from tuberculosis. The climate change problem has been regarded as so important that we put every effort into reducing CO₂ emissions. Many car manufacturers switched to diesel in whole or in part, and we now have extra nitric oxide and nitrogen dioxide in the air. Perhaps it is fair to say that Britain is doing quite well on global warming, better than the world generally, but are more people going to die of lung poisoning as a result of some of those changes?

So, the level of emissions in the UK is having a very harmful effect on both the environment and on human health. While much is known about CO₂ and its impact on the environment, there is far less awareness of the harm to public health caused by particulate matter in the air. Exposure to these poisonous particulates can lead to inflammation of the airways, and cardiovascular and respiratory illness. In April 2014, a Public Health England report found that approximately 29,000 deaths per year in the UK could be attributed to man-made particulate matter pollution. Air pollution is also expected to reduce the life expectancy of everyone in the UK by six months.

We know that the noxious villain of NO_x is the car exhaust, and what do we do with our car exhausts? We cover them in shiny plating to make them look attractive and stick them out the back of the car, where the pedestrian or cyclist can breathe the fumes. There is an old-established saying in management that if you do not look at a problem, you will not solve it, and we place the exhaust in the one place that the driver can never see directly, so he cannot tell if his engine is misbehaving. What would happen if we required that exhausts finished in the front of the car, so that the driver could see them? I bet they would be cleaned up rather quickly. What, furthermore, if we required that exhausts finished on the inside of the car? If I have to breathe in his poisonous exhaust fumes, why does the driver not have to breathe them in?

Roadside emissions are a particular problem in urban areas of the UK. The index level for PM2.5 in London this morning is 67. Yesterday it peaked at 85. London’s Marylebone Road had the highest concentration of PM2.5 in the whole of Europe in 2012, with a concentration of almost 94 micrograms per cubic metre of air. Furthermore, the UK has failed to meet its recent EU air quality target for NO₂—and the annual average for NO₂ was exceeded in 38 out of 43 air quality zones. The health benefits in improving air quality are clear, so I ask my noble friend, when will the Government respond to the recommendations presented by the Environmental Audit Committee report of the other place published shortly before Christmas?

New technologies will provide the key to improving air quality and developing greener transport. When I was a manufacturer of London taxis, I sold thousands of diesel engines. But after that, I spent a fortune on trying to make electric vehicles work, and every penny I made from diesel engine taxis was spent twice over on electric trucks. I started an electric truck business and sold about 400 vehicles worldwide, and I was grateful to UPS, FedEx and Tesco for buying the first ones. This was a great product which worked really well, but to get consumers to change to electric vehicles is a huge leap, and we were just too early.

When I was trying to sell zero-emission vehicles, I thought of a single product which I believe every British consumer would applaud. Particularly in these election days, I think British people want to find a zero-emission politician.

12:53

[Lord Berkeley (Lab)]

My Lords, I welcome participating in this debate and listening to what I think is the start of the Liberal Democrat manifesto from the noble Lord, Lord Greaves, and the noble Baroness. I also welcome another engineer to the House of Lords in the shape of the noble Lord, Lord Callanan. I welcome his speech. There are not many of us and he has added quite a high percentage because of that.

The noble Baroness and my noble friend Lord Whitty made a powerful case for change, which I fully support. I want to outline some of the difficulties that we will have in achieving it, especially when people have the time, energy and resources to fight for or against it. Sometimes, of course, even those who are in favour of a particular green or environmental initiative actually spend more time fighting each other than achieving their objective.

I will give two examples. First, I will say a little more about air pollution, on which the noble Lord, Lord Borwick, gave us some very interesting data. The noble Earl, Lord Selborne, and the noble Lord, Lord Bradshaw, also mentioned this. We started off with a Question on 6 January which I put down about the premature deaths caused by nitrous oxide and the PM2.5 from diesel engines. We can all disagree on the exact number of people who may have died prematurely nationwide. The figure I cited was 55,000 people nationwide, with an average loss of life expectancy of more than 10 years. Other people have different figures, but I do not think it really matters. We can go on discussing the figures ad nauseam, but I think we all agree that the figure is very high and it could be reduced.

Again supporting the statement by the noble Lord, Lord Borwick, Dr David Carslaw, who is a highly respected scientist, has said that the pollution in Oxford Street is the highest in the world. That is a pretty challenging statement to make. I suspect he is right. The NO₂ annual concentrations and the hourly exceedances in Brixton Road may exceed those in Oxford Street in 2014. It is easy just to talk about London, but I think the problem is just as bad in many other cities.

The easy solution is to get rid of the polluting diesels, as the noble Lord has said. But how are we going to know where the problem is? The solution, of course, is by the network of measuring stations that, at the moment, local authorities are required to run. I have it on good authority that, before the London Olympics, the Mayor of London covered up the stations that were reading a bit high. Otherwise, the Olympics would have been performed allegedly in an atmosphere that was worse than that of Beijing four years previously. Whether that is true, I do not know.

Of course, it is much easier to deal with the problem by removing the evidence. I think it is extraordinary that Defra wants to remove the requirement for local authorities to keep maintaining such measuring points. It is going to be very easy for a future Government to say, “Well, there is no evidence of air pollution”. The noble Lord may be right that we will be able to measure it on our mobile phones. However, at the moment, having some official statistics is extremely important, because it is easy to say, “Well, there is no evidence, therefore we don’t need to tackle the problem”. Are the Government really allowing 55,000, or whatever the number is, premature deaths to continue because they will not only not ban diesels in the worst polluting areas but now want to remove the source of evidence as to where they should act?

My second example is railways—no great surprise there—an environmentally friendly type of transport and probably the best one, apart from walking and cycling, if people feel the need to move around. The issue of nimbyism is, I am afraid, as rife as ever. We have seen it in all the debates on High Speed 2. People even complain when the railway is in a tunnel, under- ground, two or three miles from their house; they say it will still affect them.

I have heard a more recent example in Bath, which I think is more serious. Noble Lords will know that the Great Western railway is being electrified. When you are putting wires above the trains, you need extra height, which means that you either lower the tracks or you raise the bridges. There is a very famous tunnel, which Brunel built, called Box tunnel, where the tracks have to be lowered to get the wires in. The problem is that there are bats in the tunnel. I love bats and have many friends who love bats. They seem to have survived and prospered in this tunnel for 150 years or so, even when 125 miles per hour trains are rushing through every 15 or 30 minutes.

The only time that Network Rail is allowed to lower the tracks in this tunnel is in July and August, due to the bat breeding season or something—it will do a lot of other work at the same time, which I could explain but will not now. That means that the railway through Bath has to be closed for two months in the summer. Bath, as we all know, is a World Heritage Site and summer is a good time of the year for tourists from around the world to come to Bath. However, because there are no trains, and Network Rail obviously finds it necessary to help move passengers around, it has to use buses. I am told that there will be 200 buses going in and out of Bath for two months in July and August.

We have to have a specially designed catenary because it is a World Heritage Site. We have to drop the track, which may end up on an old Roman ruin, which will probably close the line for another six months while the archaeologists dig. The question is: what price progress? This is one of the reasons why the cost of electrification has doubled around there. It is not Network Rail’s fault, because it has been told to do it this way, but one rather thinks that if the people of Bath and the people who are requiring all these changes do not want electrification, we should give them a steam train instead. We can let the people of Bristol get to London on the other route through Bristol Parkway and have a chuff-chuff between Bristol, Bath and Chippenham. They can pollute their town with smoke instead. Is it really justified for the bats, which clearly have to be protected to the extent that they can have a tunnel dug up only in August, although they survive all the rest of the year round with all this noise going through?

It is a question of what price we pay for progress, a debate that we will continue to have for a long time. There is an added cost and there are a lot of people who feel very strongly about this, but we have to have a balance. I hope in the future we will get a better balance.

13:02

[Baroness Janke (LD)]

My Lords, coming from Bristol, I would not dream of speaking for colleagues in Bath, but we have always had a great aspiration for this improvement and I certainly add my support to it.

It is a great pleasure to speak in this debate as a former leader of Bristol, which is the 2015 European Green Capital. The Green Capital bid was based on all-party support. Bristol’s success in winning has led to greater developments on the green agenda—which is of course, as my noble friend Lady Bakewell said, a key Liberal Democrat priority, whether nationally or locally. One of the success criteria in the Green Capital award is the need to demonstrate ways that achievements have been made to help other cities and communities reach key European targets in carbon reduction, energy conservation and increasing the use of renewable energy. Bristol has the lowest carbon emissions of any of the core cities and has achieved a reduction of 20% per person over the period from 2005 to 2012.

Strategic leadership has been important, and the council leadership has been acknowledged for establishing some key strategic projects such as a comprehensive programme of energy efficiency, a successful bid for the cycling city and, of course, the local energy supply company. The energy efficiency project has insulated 30,000 homes. As a result of the cycling city project, we have three times the number of cyclists as the core city average. The city council has taken a strong lead in exploiting its own energy through solar panels and the wind turbines at Avonmouth, enabling the establishment of the energy supply company.

However, it is important that people from all sections of our communities can contribute to these targets and to achieving a greater quality of environment. We have to change hearts and minds as well as providing strategic leadership. There have been some innovative and energetic projects in the city, some of which I would like to tell your Lordships about. In some of the poorest areas of the city, we have a project called smart metering, which enables people to measure energy usage using the wi-fi hotspots that we have created there and by using recycled computers. This has made a valuable contribution to awareness of energy use and to future energy use within those communities, and has motivated much more learning about how people, within their communities, can make real changes. The council also started a green volunteer scheme, which links organisations with would-be volunteers. In conjunction with that, we set up an annual award scheme to recognise volunteering across the city, so that individuals and community groups that use volunteers and companies which support volunteering from their staff can be accredited, acknowledged and thanked.

Local sustainable food, and educating people about local food, has moved quickly up the agenda in recent years, with the Green Capital year being a catalyst for many local food projects being instigated in Bristol—I hope that many of your Lordships have heard about the food programme that comes from Bristol and some of the very innovative projects that we have there. One example is the Severn Project, which works with socially excluded individuals to reduce anti-social behaviour by using the production of food as a vehicle to provide education, training and employment. The organisation has a temporary lease on a derelict area of land near the station that is earmarked for development. Despite the site being severely contaminated, the project has installed polytunnels and put down membranes to bring in compost to grow salad crops, which are then sold on to local restaurants and businesses in the city.

Another unique feature is the Bristol pound, which I think is the UK’s first citywide local currency, the first to have electronic accounts managed by a regulated financial institution and the first that can be used to pay some local taxes. It was set up by a community group and supported initially by a small grant from Bristol City Council. It has now grown thanks to EU funding and other sources, and nearly 1,000 traders in the city accept the currency. For people who do not quite understand how this contributes, it is a way of boosting independent producers and creating local sustainability within the local economy.

There is still a great deal to be done in relation to our international competitors. However, to make real progress it is important to change hearts and minds and to involve all the people and communities, groups and enthusiasts, wherever they are. With strong local and national leaderships, we can harness the energy of individuals and groups and achieve immense benefits in terms of the quality of the environment, as well as reduction of emissions, generation of green energy and conservation of energy—all of which bring huge benefits in terms not only of the quality of life but of the health and well-being of people and communities.

13:08

[Lord Smith of Finsbury (Non-Afl)]

My Lords, I join in thanking the noble Baroness, Lady Bakewell, and congratulating her on initiating this debate. Her Motion does a crucially important thing, because it helpfully links the challenge and impact of global climate change with the importance of the local environment that we all live, work and play in. It is a hugely important link to make.

Climate change is of course very much with us. Thirteen of the 14 warmest years on record globally have happened in the 21st century. The sea level rise over the last two decades across the world has been 3.2 millimetres per year—nearly twice the average rate for the 20th century. Here in the UK, we have, as the noble Baroness alluded to, experienced extreme weather events over the last couple of years. I lived through the last winter as chairman of the Environment Agency. It was a traumatic period, especially for those people who were tragically affected by the flooding that occurred. That was a result of the biggest surge in the North Sea that we have seen in 60 years. There were violent storms over the course of Christmas and the new year, and the wettest January and February we have ever experienced in 250 years had an extreme impact on people with businesses around the country.

It is not just flooding. We are seeing more extremes of weather, both floods and droughts. In March 2012, when we were facing the imminent prospect of serious drought, the River South Tyne was running at 28% of its normal flow level for that time of year. Three months later, in June 2012, it was running at 406%. We are increasingly experiencing these extreme weather patterns. Over the last 30 years river temperatures across England have risen, on average, by 0.6 degrees.

We are seeing an impact on species too. The vendace, which is a very beautiful coldwater fish, has lived in the Lake District for centuries. We have now had to move them to higher lochs in Scotland in order to ensure they have the cold water that they depend on. Damsel-flies are now being found 40 or 50 miles further north than ever before. They are moving with the temperature. All this shows something of the impact that a changing climate is having on habitats, species, the nature of our countryside, the quality of our rivers and on the fate of the environment around us.

The importance of that natural environment needs to be emphasised again and again. I am delighted that the Government have realised some of this. The natural environment White Paper and the establishment of the Natural Capital Committee are welcome initiatives. The environment is not just something for us to wonder at, to enjoy, to find pleasure and to seek recreation in. It is also part of the natural capital on which we all depend. It is a resource, an essential part of our economic and social life. It is something we cannot do without and that we endanger at our peril.

Yet do we fully understand the importance of this natural bank of capital when we make decisions about what happens to our landscape, green spaces, trees and rivers? When we think about how we address the growing impact and prospect of climate change? I fear that, too often, we do not. The noble Lord, Lord Framlingham, talked movingly about the importance of trees. I could say exactly the same thing about our rivers. They are, of course, a source of life. They provide us all with water, but they also sustain industry, irrigate crops and permit agriculture in places where it would otherwise be impossible. They are also an ecological resource—a place for insects, fish and water-bank mammals—and we need to look after our rivers in order to sustain it. This includes responding effectively to floods and droughts in order to protect not just our water supplies but this rich diversity of habitat, too. Let no one tell me that European intervention has nothing to offer, when it is precisely things such as the habitats directive and the water framework directive that have provided the underpinning for a lot of the environmental protection that we need and value in this country.

This brings me back to those links between the enormous issue of climate change and our own local environment. Why is it that the environment rates so low among current public political concerns? Surely it is because we tend to speak of it in abstract terms. However, when you ask people about their own, personal, local patch of environment, they become really passionate about it. Their own piece of green space and the river at the bottom of their town are bits of the environment that they really value. We need to ensure that we link the value placed on those with the big, global issues that we also need to address.

The Royal Society for the Protection of Birds does this rather powerfully and brilliantly. I sometimes remind my former political colleagues that the RSPB has more than twice as many members as all the political parties in Britain put together. They do something that is very radical and progressive. They take people and say, “You are interested in something very small, very fragile—a dipper. If you are interested in a dipper, you need to understand about what happens to its habitat, to the rivers, hedgerows and fields. If you want to understand about what happens to those, you need to understand about the planning and development pressures, about agricultural production and what is happening to it and about the framework of local plans that decide what should happen to landscape and habitat. Then you need to understand the national framework that operates to determine and protect all this, what the European Union is up to and the international agreements that are reached in places such as Kyoto, Lima and, hopefully, Paris”. Before you know where you are, you have taken people from something very tiny—a dipper—to an understanding of the global forces that shape the importance of our environment. It is an understanding of how everything, from top to bottom, is interlinked. That is the realisation we need to capture. This debate has helped us to do precisely that.

13:16

[Baroness Ludford (LD)]

My Lords, I, too, congratulate my noble friend Lady Bakewell on introducing this debate. I will follow other noble Lords in concentrating on air pollution, especially from vehicles.

As another former Member of the European Parliament, it is a pleasure to welcome my noble friend Lord Callanan. We will both have to get used to calling each other that.

I, too, am grateful for the recent Environmental Audit Committee report in another place. As time is short, I would just urge noble Lords to read it. I broadly agree with it. It is nearly 60 years since the Clean Air Act and more than 40 years since the Control of Pollution Act. I was, briefly, a very junior civil servant and worked on drafting the latter. It is a scandal that, all these decades later, we are not dealing with what has become the number one environmental health challenge. It is estimated to cause 29,000 premature deaths a year in this country and 7 million or 8 million worldwide. It is not just diesel exhaust but air pollution as a whole that is classed as carcinogenic by the World Health Organization. London seems to have the highest monitored nitrogen dioxide levels in the world—three times WHO limits, especially on Oxford Street and Marylebone Road.

Quite rightly, there has been great emphasis on carbon dioxide limits in the tackling of climate change—no one, certainly not a Liberal Democrat, would quarrel with that. However, there has been an overlooking of the problems and challenges of air pollution. I agree with the noble Earl, Lord Selborne, that it needs to go very fast up the policy and political agenda. I applaud the Healthy Air Campaign, which is run by a group of non-governmental organisations, and also Living Streets, which emphasises how tackling air pollution can make life much pleasanter and safer for pedestrians.

Liberal Democrats have long championed the need to tackle air pollution as well as climate change. Perhaps I may quote from a document which is headed “Localised Air Pollution”. It says that, “There is increasing evidence that many people in the UK become exposed to concentrations of pollution above World Health Organization guidelines as the result of emissions from road vehicles. This includes ground-level ozone, which is a problem in both rural and urban areas, nitrogen dioxide at urban sites, PM10s —the fine particulate emissions from diesel engines”. That was in a Liberal Democrat policy paper of 20 years ago. The working group was chaired by my now noble friend Lord Bradshaw. My noble friend Lord Tyler was also a member of that group. So, we are not Johnny-come-latelys when it comes to tackling air pollution.

I congratulate the successive holders of the post of Secretary of State for Energy and Climate Change in the current Government. I believe that they have been more active than their counterparts at Defra in dealing with air pollution and that there has been some complacency at Defra on the issue. One of the most urgent requirements is to update the air quality strategy in this country. We need a holistic approach and a clear demarcation of responsibilities and resources as between central government departments and between central and local government. One rather simple thing that could be done is to incorporate pollution warnings into weather forecasts as happens with pollen counts. There seems to be a curious contrast in those things. The planning framework needs to place much more emphasis on air quality matters. Locating schools and new homes away from main roads is one example.

Although I cannot enumerate all the issues that need attention, one of them, of course, is airport construction. We need explicit air quality objectives for the current Airports Commission appraisal framework. Liberal Democrats believe, of course, that aviation expansion must not further damage health. That is the reason for our negative response to suggestions to build new airports, particularly in the south-east. As others have said—including, I think, the noble Lord, Lord Berkeley—we must not allow the Red Tape Challenge to undermine local air quality monitoring.

As others have also said—I will not dwell on this—the main problem is diesel engines. Although there were undoubtedly good reasons for encouraging diesel, it is way past time for a radical change in policy direction. That will mean giving attention to the fiscal and other frameworks—such as fuel duty, vehicle excise duty and so on—under which people have been encouraged to go for diesel. I do not own a car but sheepishly admit that, as a member of a car club called Zipcar, I find myself involuntarily driving cars with diesel engines. I do not drive frequently but when I do, the engines always seem to be diesel. Can my noble friend say what the Government are doing to remove the loopholes whereby diesel particle filters are removed after being factory fitted? People are apparently managing to remove them through these loopholes, so I would very much welcome a specific answer on that. We need to aim for the adoption of zero-carbon technology in motor vehicles and in London. Liberal Democrats propose having a big switch to 100% electric buses, taxis and vans. We regard the Mayor of London’s ambitions for the ultra-low emission zone as lacking both urgency and stringency. We need to go much further and much faster.

We work in a European context because air pollution does not recognise national boundaries. The coalition agreement pledged compliance with EU clean air laws but the UK is massively in breach of these laws and is thus subject to legal action. We are 20 to 25 years late in the schedule. My noble friend Lord Callanan and I are not quite on the same page on this matter. He says that air quality rules must not impede economic growth but that is a false choice. I also venture to suggest that the engineering companies of the north-east could make big business out of clean technology.

My last question to the Minister is therefore to ask whether he will update us on the Government’s efforts to ensure that the EU’s ambitions for clean air will continue and to dissuade the Commission from withdrawing its proposals for new air quality directives. Unfortunately, I believe that there is a lack of consensus in the European Parliament to pass a resolution now to urge the Commission not to withdraw these measures. It was disappointing that the Environment Secretary was not a signatory of a letter from the national Environment Ministers to the Commission President urging against withdrawal. Will my noble friend tell us whether the Government are determined to press forward to meet EU laws?

13:25

[Lord Grantchester (Lab)]

My Lords, this has been a wide-ranging debate, covering many aspects of our modern environment and touching on the policies of many government departments. I thank the noble Baroness, Lady Bakewell, for introducing it and declare my interest as a farmer, and my previous experiences of being involved along the food supply chain with various organisations.

The noble Baroness, Lady Bakewell, was quite right to frame the debate around climate change. In the UK, the most significant impacts of climate change are likely to be further increases in the frequency and severity of extreme weather, heat waves and drought, as well as storms and flooding. How we respond and adapt to this is critical. The sixth annual report to Parliament of the Committee on Climate Change scoped out the progress towards meeting carbon budgets and emission reduction targets, and reflected on the progress across the main government departments of energy, local government, transport, business and the environment, as well as in the Treasury and the devolved Administrations. This throws up a clear challenge for joined-up action and co-ordination. The warning is clear: the committee considers that the underlying pace of emissions reduction, allowing for the impacts of the recession through the first carbon budget period and in 2013, is insufficient to meet future carbon targets and budgets.

Meeting the legislated fourth carbon budget in the 2020s to reduce emissions by a further 31%—that is, by 50% from the 1990 levels—will require further strengthening of policies, which speakers throughout the debate have highlighted. On the energy front, there are the policies for energy efficiency and power decarbonisation; on the transport side, it is those for the electrification of transport; on local government policies, they are for infrastructure and green spaces; and on Treasury policies, they are for financial incentives across other departments’ policies.

In the Minister’s own Department for Environment, Food and Rural Affairs, it is therefore extremely disappointing that the Government’s failure to get to grips with the increasing threat of climate change is putting more homes at risk from flooding. I am sure that the Minister will be regretting the previous Secretary of State’s removal of “preparing for and responding to flood risk” from the department’s list of priorities and the consequential ideological cutting of the budget. Since 2010, the Government have cut the Environment Agency’s flood defence budget by £138 million, a 21% reduction. It was especially instructive to hear from the noble Lord, Lord Smith, about his experiences at the Environment Agency.

The next Labour Government will reinstate flood protection as a core departmental responsibility and establish an independent national infrastructure commission to identify the UK’s long-term infrastructure needs, including on flood defences. The next Labour Government will also introduce a new national adaptation plan across government to ensure that all sectors of the economy are adapting to climate change. This will build on the work on the adaptation sub-committee of the Committee on Climate Change, whose 2014 report underlined the importance of infrastructure resilience, the risks to businesses, well-being and public health, and emergency planning—especially in this area of flood risk.

The Government should introduce without further delay the Flood and Water Management Act’s provisions to require sustainable drainage in new development, as recommended by the Pitt review. They should also now evaluate whether local flood risk management arrangements are in place across the country, in line with this review. The adaptation sub-committee found that some funding provided by Defra to lead local flood authorities is being diverted to other council services. Statutory local flood-risk management strategies have yet to be published in many areas. Will the Minister initiate and publish an assessment on local action plans? Does he also regret the abolition of the Cabinet committee on improving the country’s ability to deal with flooding and the national resilience forums? In addition, does he agree that the Government should bring forward the reform of the water abstraction regime to encourage water efficiency and protect the environment?

The noble Earl, Lord Selborne, raised the issue of air quality, which was further taken up by the noble Lord, Lord Borwick, my noble friend Lord Berkeley and the noble Baroness, Lady Ludford. Air pollution in our towns and cities causes 29,000 people in the UK to die prematurely. Rather than simply devolving the responsibility to local authorities, making them liable to million-pound fines for exceeding EU air pollution limits, what are the Government doing to devolve the power to local authorities willing to take action against this public health crisis?

The next Labour Government will deliver a national framework for low emission zones to enable local authorities to tackle the problem by encouraging cleaner, greener and less polluting vehicles. Currently there is no such framework, despite the majority of councils calling for one. The next Labour Government will devolve the power, not just the responsibility, to take action against air pollution to local authorities. Can the Minister update the House on discussions with the EU Commission and other Governments to ensure that the EU delivers a widely reformed, tougher clean air package?

Transport-vehicle emissions are clearly critical in this regard. I certainly enjoyed the maiden contribution from the noble Lord, Lord Callanan, and hearing of his experiences drafting EU emissions standards, which I agree should not be set so that they damage British interests. The theme of further encouragement of good British innovation and development was taken up by the noble Lord, Lord Bradshaw.

Biodiversity and the importance of trees and wildlife were also key themes throughout the debate. Again, clearly the Minister’s department has struggled to provide the required leadership. The noble Lord, Lord Framlingham, highlighted the role of trees. Can the Minister update the House on the protections that his Government are now taking following the importation last year of diseased stock with ash dieback?

On wildlife protection, can the Minister update the House on legislation on the control of trade in endangered species? It is now nearly a year since his department conducted consultations. Does the Minister have any timing for when his department will bring forward measures to combat wildlife crime? Does his department have any plan to publish the report of the National Wildlife Crime Unit?

The noble Lord, Lord Greaves, was keen to understand how cuts at Defra have undermined key services. He mentioned footpaths and green spaces. With important considerations of environmental concerns across government departments, how is the Minister’s department co-ordinating scarce resources so that the public purse can be leveraged to meet important considerations, as has been debated today?

13:33

[The Parliamentary Under-Secretary of State, Department for Environment, Food and Rural Affairs (Lord De Mauley) (Con)]

My Lords, I thank my noble friend Lady Bakewell of Hardington Mandeville for raising a range of important matters today. I warmly welcome the chance to discuss the importance of our natural environment, and the need to reduce emissions, improve green transport and protect wildlife and green spaces.

Most people agree that the environment is important for its own sake. In addition to this intrinsic value, we recognise that the environment provides a range of essential services to society. We all rely on it for our clean air, water, food, energy, opportunities for recreation, and for the contribution that it makes to our well-being. We are deeply committed to improving our natural environment. We have set out that we want ours to be the first generation that leaves the natural environment of England in a better state than when we inherited it.

We know that our environmental goals are challenging and long term, and that they cannot be achieved easily or overnight. Furthermore, government cannot do this alone. We need individuals, businesses, farmers, land managers, community groups and NGOs to work together. We have put in place an ambitious programme of environmental policies to protect the environment for future generations, including bringing forward the first White Paper on the natural environment in 20 years. This has a strong focus on changing how we view the natural environment and on taking better account in decision-making of the many benefits that nature provides to people. We have already implemented the majority of the White Paper’s commitments, putting in place foundations for the longer term.

We are making progress in many areas. For example, our rivers and coastal bathing waters are getting cleaner. Background concentrations of key air pollutants, such as nitrogen dioxide and particulate matter, halved in the 20 years up to 2012. We have introduced marine plans for the first time and greatly increased the network of marine-protected areas. We have supported the planting of more than 8 million trees, and woodland cover is at its highest level in 700 years. We have also recently published our pollinator strategy. Looking ahead, we will be investing more than £3 billion from 2014 to 2020 to deliver environmental benefits through the new Rural Development Programme for England. This is in fact a larger share of the overall budget than previously.

My noble friend Lady Bakewell raised the need to reduce emissions, about which we can all strongly agree. The UK is committed under the Climate Change Act to cut emissions by 80% by 2050 and the Government take this extremely seriously. We want to make sure that the UK makes a cost-effective transition to that target. We were pleased to be able to announce in February last year that the UK had met the first carbon budget for the period 2008 to 2012. Furthermore, the latest published projections show that the UK is on track to meet the next two carbon budgets, up to 2022. The Act has helped drive the UK to reduce emissions by almost a quarter since 1990. The Climate Change Act was the first of its kind. Almost 500 climate laws have now been passed in 66 of the largest emitting countries around the world.

My noble friend Lady Bakewell also mentioned green transport. It is well recognised that air quality can affect people’s health, which is why we are investing heavily in measures to improve it. We have committed £2 billion to increase the uptake of ultra-low emission vehicles, sustainable travel and green transport initiatives. Overall, air quality has improved significantly in recent decades and the UK currently meets the EU limits for almost all pollutants—though of course we recognise that more needs to be done.

We are also taking action for England’s wildlife through our biodiversity 2020 strategy. For example, since 2010 we have set in hand the creation of nearly 150,000 acres of wildlife habitat, such as field margins, wetlands and woodlands. As part of our strategy, we have established a new, more joined-up approach to conservation—to which my noble friend Lady Miller of Chilthorne Domer referred—through the 12 government-funded nature improvement areas, which are now starting to deliver real improvements on the ground.

Earlier, I mentioned the essential services that nature provides. One important example, to which I have already briefly referred, is pollinators. We are taking action to support bees and other pollinators through our national pollinator strategy, launched in November. The strategy includes actions to improve habitats for pollinators across all land uses in England, enhance our response to pests and diseases, and improve our evidence base, particularly on the current status of pollinators and trends. We have also established a local green-space designation within the planning regime to enable communities to identify green areas of particular importance to them for special protection. My noble friend Lord Greaves referred to that.

I will now address some of the matters raised by noble Lords during the debate. My noble friend Lady Bakewell spoke of allowable solutions and zero-carbon homes. The Government consider that retrofitting existing properties with energy-efficiency measures could indeed be an allowable solution that housebuilders can support in order to contribute to the zero-carbon homes target that will be introduced from 2016. New homes from 2016 will still have to meet minimum energy performance requirements, which will be more demanding than those currently required by building regulations.

The noble Baroness spoke about energy efficiency and listed buildings, particularly those with thatched roofs and those unable to take double glazing. Green Deal assessors are trained to assess the energy efficiency needs of all property types and to make recommendations suited to the building, including listed buildings or those with a thatched roof. If a Green Deal plan is put in place, there are specific requirements within the code of practice for Green Deal providers to ensure that the energy-efficient measures are suitable for older or traditional-style buildings.

My noble friend Lord Selborne mentioned the Aichi targets for biodiversity, which form part of the Convention on Biological Diversity strategic plan agreed in 2010. The UK has reported to the convention on its implementation of this plan. The report set out that we are making progress in most areas of the five strategic goals of the plan with substantial progress in some areas. My noble friend asked about the Natural Capital Committee, which we established to advise us on the sustainable use of natural assets and on our priorities for action to improve and protect nature. It is intended to support a transformation in the way we view and value our natural assets. Its third report is due on 27 January. The Government will consider it carefully when it is received before deciding on their response.

My noble friend spoke about hydrogen in the context of transport. We are technology neutral, and we believe that hydrogen fuel cell vehicles have a potential role to play alongside battery electric vehicles and plug-in vehicles. In October, we launched the hydrogen technology advancement programme which will see investment from government and industry in new and upgraded hydrogen refuelling stations and support the deployment of hydrogen fuel cell electric vehicles in public sector fleets. My noble friend Lord Callanan, whose maiden speech we all enjoyed so much, will be pleased that these will contribute to growth and exports in those areas.

My noble friend Lady Miller and the noble Lord, Lord Berkeley, spoke about bats. What is needed is for wildlife and humans to be able to exist in harmony. It is about balance. I am unconvinced that the Private Member’s Bill that my noble friend referred to will achieve that. She will be pleased to hear that we have worked closely with the churches. I visited a church in Norfolk where the damage was very extensive indeed. I am pleased that we have been making important progress with equipment using light and sound to move bats to places where they do less damage. I will look at the railway problem that the noble Lord, Lord Berkeley, raised.

My noble friend Lord Bradshaw was one of several noble Lords who focused on air pollution. He is right that emissions from small diesel engines of the type used to power mobile refrigeration units are not currently regulated. The European Commission recently published a proposal to revise the legislation related to exhaust emissions from engines used to power small diesel engines of this type. That proposal, if adopted, would bring those engines into scope. The revision is currently in the early stages of negotiation in the Council and we are considering the proposal, but the general consensus among member states is favourable towards it. My noble friend’s solution is interesting. It is primarily for industry to take forward, but I would be very interested to see the papers he offered.

My noble friend and the noble Lord, Lord Grantchester, raised the matter of low emission zones. We are working with local authorities on the feasibility and design of such zones and have provided guidance, such as on what vehicles should be covered and what emission standards they should meet. So far, London, Oxford, Norwich and Brighton have introduced low emission zones. While the main reason for poor air quality is vehicle pollution, sources vary from place to place, so measures need to be tailored to local circumstances. My noble friend raised a point about adequate notice, and I take it.

My noble friend Lord Framlingham and the noble Lord, Lord Whitty, spoke about trees. As my noble friend kindly acknowledged, I share his passion for trees. I should perhaps declare an interest as I planted 50,000 of them in 2004-05. The forestry and woodlands policy statement sets out our vision for the future of England’s forests, based around the core hierarchy of protecting, improving and expanding our national woodland resources. We have made plant health one of Defra’s highest priorities and taken steps to improve biosecurity through, for example, our biosecurity strategy and our tree health action plan as well as our plant health risk register, which now assesses upwards of 700 pests and pathogens. We have also worked hard on enhanced contingency planning. We have supported the planting of more than 8 million trees, 1 million of them in urban areas, and England now has 10% woodland cover—the highest level in 700 years.

The noble Lord, Lord Greaves, asked about local green space. The important thing is that it is for communities to decide. It would typically be land that is in reasonably close proximity to the community it serves, is local in character and holds a particular significance for that community—for example, because of its beauty, historic significance, recreational value, tranquillity or richness in wildlife. Local green spaces should be designated when a local or neighbourhood plan is prepared, and they are potentially a very powerful tool for communities. Many communities that are preparing neighbourhood plans are seeking to designate green or open areas of significance to them as local green space.

The noble Lord also spoke of the impact of local authority budgets on rights of way. It is the responsibility of local authorities to complete maps of rights of way. Through the Deregulation Bill, we are introducing a streamlined process for recording them to reduce the burden on local authorities in managing this work.

My noble friend Lord Borwick spoke of the effect of air pollution on lungs. Evidence linking air pollution with adverse effects on the respiratory and cardiovascular systems continues to accumulate, and the review by the World Health Organization also notes emerging evidence suggesting a possible association with adverse effects on other body systems, including the endocrine system and the nervous system. The World Health Organization has concluded that the evidence suggests that ambient concentrations of nitrogen dioxide have direct effects, particularly on respiratory outcomes.

My noble friend asked when we will respond to the Economic Affairs Committee report. I anticipate that, in line with the usual timetable, we will be responding in February. I can confirm that of course my department works very closely with the Department for Transport, the Department of Health, the Department for Communities and Local Government, the Department of Energy and Climate Change and Public Health England on air quality.

The noble Lord, Lord Berkeley, suggested an interpretation of the proposals that could lead to a downgrading of the local air quality monitoring network. The aim of our review is to reduce administrative burdens to free local authority time and resources so that they can focus on taking action to address air quality. It is important that the consultation proposes the removal of the requirement in regulations for local authorities to report on four pollutants that have been well within limits for many years, and monitoring them will remain at national level. The second part contains a number of proposals to do with improvements to guidance and includes proposals to streamline the local air quality management reporting system for local authorities.

My noble friend Lady Janke spoke of her pride at Bristol having been awarded the title of the European Green Capital of the year. It is the first UK city to have this title. I share her pride in that. It recognises that great city’s environmental performance and vision. We are pleased to be supporting Bristol as the European Green Capital with some extra funding to be invested in a range of projects that will help Bristol remain at the centre of green investment and urban sustainability. We wish Bristol every success with the year’s programme of activities.

My noble friend Lady Ludford raised a number of suggestions for Defra, and I will raise them with my honourable friend Dan Rogerson, the Minister responsible. We are very keen to work in partnership with local authorities and the Commission to avoid any prospect of fines levied from the infraction that she referred to. The main reason for not achieving limit values for nitrogen dioxide is the failure of EU emission standards for diesel engines to deliver the expected emission reductions in real-world driving conditions, and the Commission acknowledges that.

The increase in the number of diesel cars has, of course, exacerbated the problem. All member states, including the UK, are facing difficulties in addressing air pollution. In 2012, 17 out of 27 member states were non-compliant with the annual mean nitrogen dioxide limit value. We are compliant with EU legislation for nearly all air pollutants, although we still face a significant challenge in meeting the nitrogen dioxide limit and we are working very hard on that.

The noble Lord, Lord Grantchester, should know that defence against floods is alive and well among Defra’s strategic priorities. That is why we have introduced an unprecedented six-year plan, to which more than £2 billion has been pledged.

If I have not been able to address noble Lords’ points and questions I will, of course, write to them. We remain deeply committed to improving our natural environment, which is a vital foundation to both our economy and our future well-being. We know that our environmental goals and ambitions are challenging and long-term. We also know that there is much more to be done and that it will require support from others, not just government. We have put an ambitious programme of environmental policies in place to protect the environment for future generations and we will continue to strive, with a wide range of people and organisations, to ensure that it is achieved.

13:51

[Baroness Bakewell of Hardington Mandeville]

My Lords, I thank my noble friend for his very comprehensive reply. There was a great deal of detail in his response to Members’ questions. I also thank all those who have taken part in this very wide-ranging debate. I have been very heartened that we all seem to be on the same page, even if we are covering slightly different subjects. Everyone seems to agree that we need to do something about climate change and work together to make that happen. In particular, I congratulate the noble Lord, Lord Callanan, on his maiden speech, and I look forward to his contributions in future.

I was particularly heartened by the speeches about trees and to hear about the TDAG. I will look further into that organisation. A lot of noble Lords spoke about air pollution: trees are essential in helping us deal with air quality. I will not mention every speaker by name or go through all their speeches because we would be here for ever, but I thank everyone for taking part.

Motion agreed.

NHS: Accident and Emergency Services

Thursday 15th January 2015 Lords Chamber

Question for Short Debate

13:53

Asked by

[The Lord Bishop of St Albans]

To ask Her Majesty’s Government what is their assessment of the pressures facing accident and emergency services.

[The Lord Bishop of St Albans]

My Lords, I come to this debate not as a doctor with specialist medical knowledge nor with any special insights into the complex processes which hospital managers have to manage. I approach it as someone from an institution, the church, which has been concerned for healing, in its broadest sense, from its very foundation and I live opposite what is left of the great medieval monastery of St Albans, which for centuries was a centre of healing, with its infirmary and herbarium. In my present role, I have regular contact with the hospitals across Hertfordshire, Bedfordshire, Luton and Barnet, which make up the diocese of St Albans.

I also come as someone who has received the benefits of A&E departments in my own family. Not many years ago, my eldest nephew was diagnosed with a brain tumour and had to have serious surgery on several occasions. Sadly, he has since died from the tumour. About five years ago, he and all the extended family were staying with me for Christmas and, in the early hours of Boxing Day, he had a fit. I remember vividly the intense panic as we were all roused out of sleep to find what was going on; as we waited anxiously for the ambulance, willing it to come because we all felt so helpless; as he was rushed into Watford General Hospital A&E department. What a relief it was, in that terrible time, to feel there were people around who knew what they were doing. I am well aware from talking to doctors and nurses and visiting hospitals that the widespread coverage in the media about A&E departments has not only been frustrating for many of those front-line people but profoundly demoralising. I pay tribute to all who work in such departments and thank them for their tireless service, not least those in Watford General Hospital.

The House will be aware that pressures on A&E services have been mounting over a number of years. While the NHS always faces pressures in the winter, these have been compounded by our ageing population. We now have 350,000 more over-75s than four years ago. This rise has occurred simultaneously with a significant increase in A&E attendances and a greater level of sickness among those who arrive, leading to an increase in emergency admissions of nearly 6% on last year. In my own diocese, the A&E departments are facing these challenges with varying degrees of success. For the week of 5 January, Watford General Hospital fell below the Government’s target of 95% of patients seen in four hours, while Luton and Dunstable University Hospital exceeded this target, in line with its track record as one of the top 10 trusts in the country.

What is causing this? Attendances are up, but the problems go much deeper. Reports have emerged of people in some places having difficulty getting appointments with their GPs. There have been discussions about changes in social care leaving some elderly and frail people without the necessary support. There are staff shortages and recruitment difficulties in A&E units. Many in your Lordships’ House will be aware of A&E’s three main areas of activity: triage, treatment and referral. Problems tend to arise in bottlenecks at the triage and referral stages. Effective triage is compromised by the presence of patients whose needs do not fit the current services offered in A&E departments. Until quite recently, these individuals were often referred to as “inappropriate attenders”, but current research suggests that it is not the patients who are inappropriate, but the services that emergency departments provide. Estimates vary that between 15% and 40% of patients require services other than those offered by an emergency department and it is the presence of these patients that creates part of the bottleneck at the triage stage.

At the other end, efficient referral after treatment is compromised by problems in bed allocation in acute medical and surgical wards as well as by accessing appropriate services. In many cases, A&E doctors admit patients for further diagnostic tests or when the additional expertise of medical or surgical staff is required. Around 20% of referrals from A&E to acute wards involve patients whose conditions could be treated appropriately by their GPs or in the community. Up to 40% of patients referred to acute wards are discharged within a few hours of admission. The Department of Health says that the effective management of the flow of patients through the health system is at the heart of reducing unnecessary emergency admissions and managing those patients who are admitted. The problem is how to identify how this can best be done.

Much of the debate in the other place has, not surprisingly, been highly politicised because we are approaching an election. I hope that, in this debate, this House can stand back and take a more dispassionate view, drawing especially on the huge knowledge and experience of some noble Lords who have intimate, personal working experience in the National Health Service. I hope that we can set this debate in a slightly wider and longer term context. Certainly, it needs to be set against the background that A&E services across Europe are facing similar challenges.

Until recently, some emphasis has been placed on attempts to demagnetise emergency departments, even though it has long been established that this tactic meets with little success. Both self-referrals and referrals from GPs willing to short cut protocols have resulted in increased numbers of patients presenting for treatment. Some 20% of A&E patients decide to attend a day in advance, the majority do not consider going first to their GPs, and 80% fail to make use of advice services such as NHS Direct. While there has been a change in people’s expectations and preparedness to wait for an appointment with their GP, we must not overstate the extent to which A&E services are being clogged up by misuse. The vast majority of A&E users are not inappropriate attenders; that is to say, they should be within the health service.

Recently, some pilot projects have begun to change the range of services available in A&E departments. For example, some GPs co-locate in emergency departments as primary care physicians while others locate out-of-hours GP services adjacent to A&E departments. Other GP practices have supplemented NHS Direct with their own telephone consultation services, enabling patients to speak with their own doctors. There is growing evidence over the past decade that these approaches relieve pressure on A&E staff and enable efficient triaging at the front door. Similarly, pilot projects that locate acute medical and surgical staff in or approximate to A&E departments at peak times have enabled improved patient flow as additional diagnostic expertise has resulted in inappropriate admissions to acute wards being minimised. Co-location of acute assessment units has also enabled patients to be monitored and assessed without them either remaining in A&E or by being admitted to acute wards. These approaches require strong leadership, close co-operation among health professionals, focus on patient care and strategic implementation. What more can be done to enable every hospital to have its own 24-hour GP practice?

Ultimately, resolving the current and on-going A&E crisis involves a systematic change to the ways in which health and social care are organised. Access to good social and community care can relieve pressure on GPs, enabling them to play a greater, proactive role in emergency medicine. Allied with a willingness to break down barriers within hospitals between emergency departments and acute wards, strain on A&E staff can be alleviated and patient experience improved. I hope that this debate will play a small part in exploring the complex reasons for the current problems and help us in addressing the challenges facing A&E departments today.

14:03

[Lord McColl of Dulwich (Con)]

My Lords, I thank the right reverend Prelate for initiating this important debate. He has set exactly the right tone—let us keep petty party politics out of this and concentrate on the patients. It is important to stress that the staff in A&E departments—nurses, doctors and administrators—are doing a very good job indeed under difficult circumstances. Having worked a lot myself in accident and emergency departments, I know only too well how difficult it is. Patients come in, one is not sure what is going wrong with them, and it takes a little while to sort them out.

There were some political shenanigans some years ago when there were complaints about people waiting on trolleys far too long in casualty. I produced a paper when I worked in No. 10 entitled Off Your Trolley. The answer was that if you are really ill and they do not know what is wrong with you, stay in the casualty department where all the expertise is—the expert equipment and the doctors and nurses—until an accurate diagnosis has been made. If it worries people that they are on trolleys, they should take the wheels off after 20 minutes and the trolleys will then constitute a bed, so people will not fuss about it.

Things have improved enormously in this service from the days when I first worked in casualty. I remember once going through the accident and emergency department of a hospital that shall be nameless, where there was a man groaning on a trolley. I went up to him and asked how he was, and he said, “I’m in terrible pain in my shoulder, it’s dislocated, I’ve been here for three hours and I have not seen anyone”. I said, “I could put you in a very comfortable position where you’d be free of pain. Would you like that? I’m not working in the department, but we can get on and do it”. So I put him on his face with his arm hanging over the side of the trolley and the moment when he was in that position he said, “Ah, I’m free of pain”. I said, “Now you’re free of pain, the muscles will relax and the thing may go back on its own, without any anaesthetic—so you go off to sleep and I’ll come back in half an hour and see how things are”. When I came back, he was sound asleep and snoring, so I crept up on him and very gently manipulated the arm. Suddenly, clunk, it went back—and he woke up and said, “Oh, it’s gone back”. I said, “Yes, you can go home now, but perhaps we ought to tell somebody what we’ve been doing”. Things are much better than that now, because we have rapid assessment. Somebody senior goes around the A&E departments, assessing things quickly, so that sort of thing no longer happens.

There has been an enormous increase in the number of people attending, and we do not know why. As we do not know why, it is quite wrong to start blaming any group of people. It is very demoralising if you are a doctor, nurse or administrator working for the NHS and people start attacking and accusing you of this and that when they really do not know the cause of the increase in the work. What is true is that more resources are being put in and more staff are being recruited, which is good news. But we must stop blaming people and pointing the finger. The blame culture has to go, and we have to be more constructive.

What is the answer? Preventive medicine is one of the great emphases in the Department of Health, and it certainly helps. We have the worst epidemic that we have had for 95 years in this country—the obesity epidemic—and we need to get people thinned down. They have to eat less and take more exercise. We have to improve people’s health, which will tend to reduce the problem. But we also have to have an alternative way of funding the NHS.

14:07

[Baroness Gale (Lab)]

My Lords, I, too, thank the right reverend Prelate for bringing this important debate before us today. I may take a slightly different angle from other noble Lords. We are all aware of the problems facing accident and emergency services, but the current pressures on them are exacerbated by a consistent failure to properly support people with long-term conditions such as Parkinson’s, both before and after hospital admission.

In 2012-13, people with Parkinson’s had more than 65,000 unplanned or emergency admissions to hospital, often due to falls, infections or cognitive issues. In England, those over 65 with Parkinson’s are three times more likely to have an unplanned admission to hospital than other people of the same age. In addition to creating serious pressures on already overstretched hospitals, this costs the NHS around £177 million each year. However, with proper support at an early stage, many of these admissions could be avoided.

Giving people with Parkinson’s the right information and equipment can often help them to manage their condition, rather than relying on accident and emergency services once they reach crisis point. Services such as physiotherapy, dietician support or falls prevention are also a great help in averting health crises, yet access to these services remains inconsistent. Good quality early intervention would significantly reduce the high number of people with Parkinson’s coming into accident and emergency departments in the first place, thereby relieving some of the pressures that hospitals are now facing.

There is also an urgent need to improve care for people with Parkinson’s once they are admitted to hospital, in order to reduce both avoidable harm and the length of time they are required to stay. Patients with this condition currently spend around 75% longer in hospitals than others of a similar age, equating to more than 128,000 excess bed-days a year. In 2012-13, these excess days cost the NHS more than £20 million. A key reason for this is that many people with Parkinson’s who are admitted to hospital often experience serious disruption to their medication. Parkinson’s medication regimes are often complex, sometimes requiring up to 30 doses at specific points throughout the day. It is vital that people receive their medication on time, because delays can rapidly worsen their symptoms. We have discussed many times in your Lordships’ House the need for these patients to get their medication on time, every time. Anyone with Parkinson’s who does not receive their medication on time is put at risk, and these incidents can create a vicious cycle of escalating care needs for patients with Parkinson’s and overwhelming pressures on hospital staff.

However, there are a number of straightforward and cost-effective steps that hospitals can take to reduce medication errors and excess bed-days for people with the condition. They include giving patients the option to administer their own medication, as recommended under existing guidelines; taking up Parkinson’s UK’s training opportunities on the importance of medication timing; and making sure that there is always a supply of Parkinson’s drugs in emergency medication cupboards so that they are easily accessible when someone with the condition is admitted.

I am sure the Minister recognises that there is a clear link between the lack of adequate support for people with long-term conditions like Parkinson’s, and the serious pressures being experienced by accident and emergency services. Taking steps to reduce both avoidable admissions and avoidable harm will protect individuals, alleviate the strain on hospitals, and benefit our health service as a whole. I hope that the Minister will take the opportunity to outline how these problems can be addressed as part of the Government’s wider response to the current situation.

14:12

[Lord Jones of Cheltenham (LD)]

My Lords, I, too, congratulate the right reverend Prelate on securing this timely and important debate. I should like to focus my remarks on the situation at the Gloucestershire Hospitals NHS Foundation Trust and the critical incidents at A&E at Gloucestershire Royal and Cheltenham General Hospitals. The latest critical incident lasted for more than a week and was lifted only yesterday. Presumably in that time, hundreds of routine operations and admissions were cancelled and have stacked up. This was the second such critical incident at GHT in a month and went on longer than those at other trusts in the country. We need to understand why.

It is complicated and not simply to do with money. We know that the coalition Government have increased NHS spending overall from £95 billion in 2010 to £115 billion this year, giving GHT £3.6 million for winter pressure this year; so what are the problems? Are too many 111 calls going into A&E? Anecdotal evidence from local doctors says that they are, and certainly the non-medical call-handlers have a naturally risk-averse system that will direct people to a doctor when in doubt. The Prime Minister, in response to a Question from my honourable friend Martin Horwood, said that only 7% of 111 calls ended in A&E. I believe that that was a statistic from October; it would be helpful if the Minister could tell us whether that is increasing and what it has been in the last month or two.

GHT has implemented what is called the UTOPIA system of routing all unplanned admissions through A&E. Has this made things worse? The theory is that people see a doctor sooner than in direct admission, when they have to wait for the next ward round, but in practice you need enough capacity in the emergency department to handle cases, which GHT pretty obviously does not have. I wonder whether the June 2013 decision to remove doctor cover from Cheltenham A&E at night and route blue-light admissions to Gloucestershire made matters worse. I understand that these decisions were made not due to a lack of money, but simply to the failure to recruit sufficient staff. Is there something wrong with the salary structure within the NHS that particularly affects Gloucestershire? At night, Cheltenham General Hospital is now really a minor injuries unit, although I understand that it still gets help from GPs in the out-of-hours service based at CGH .

I have spent more time than I care to remember as a patient in Cheltenham A&E. In January 2000, I was there following a sword attack in my constituency office which left my assistant dead and my hands in need of repair with 57 stitches. Then, in 2002, 2003 and 2006 I had three events of flash pulmonary oedema, all at night. This is a deeply unpleasant experience in which the heart goes into a ridiculous non-rhythm and stops pumping and one’s lungs quickly fill up with fluid. Fortunately, I was at home when these events occurred; I am grateful for the prompt response of the ambulance paramedics who rushed me to Cheltenham A&E. On two of these occasions my wife was called out of the family room and told to prepare herself for the worst; but thanks to the skill of the truly wonderful doctors and nurses—and, no doubt, a lot of praying in the family room—I survived. I do not know what the doctors did: I was out at the time, but I understand that a super-dose of frusemide was involved. If the recent downgrade of Cheltenham A&E had been in operation then, it would have taken an extra 15 minutes to get me to Gloucestershire Royal. I would probably not have survived and would not be here now addressing your Lordships’ House. Therefore, will the Minister ask the regulators and the Care Quality Commission to look into the difficulties in Gloucestershire to give answers as to why we have experienced these critical incident periods? Will he please ask the Gloucestershire Hospitals Trust to reinstate round-the-clock A&E services at Cheltenham General Hospital and ensure that it has the capability to recruit sufficient doctors, nurses and technicians?

14:17

[The Lord Bishop of Ely]

My Lords, I am very grateful to the noble Lord, Lord McColl, for reminding me how pleased I was to be off my trolley in February 2013, when I was admitted as an emergency patient to Addenbrooke’s Hospital in Cambridge. Were it not for the skill and dedication of the surgeons and nurses—and the grace of God—I would not be here now. Like the right reverend Prelate the Bishop of St Albans, I pay tribute to the dedication of staff in our hospitals, not least Addenbrooke’s, from which no one needing emergency treatment is turned away.

I support the thrust of what the right reverend Prelate has already said. The immediate problem for Addenbrooke’s recently, in its critical incident over accident and emergency, was the high intake of unusually frail elderly patients in December. They took up more than 300 of the 700 adult beds available. The number of elderly admissions is bound to double—so the chief executive tells me—in the next 20 years. The only immediate resolution was provided by a release of funding and access to beds in social care by the county council.

I am pleased to commend the even closer co-operation of trusts and social care providers to ease the pressure on A&E and to provide even more joined-up care for the frail and elderly, both in their homes and in nursing environments. The new frailty assessment unit at Addenbrooke’s seems to me a way ahead in offering an overhaul of how hospitals care for the physically and mentally frail patients, and how to keep patients in hospital for the shortest possible time by having such units next to A&E with a resident multidisciplinary team.

I am also very concerned about the CQC’s report on Hinchingbrooke Hospital in Huntingdon. Without wanting to support poor performance, Hinchingbrooke’s best asset is its dedicated staff. The chaplaincy was one department that was praised in the report. I shall visit staff at the weekend with the chaplain. I mention the Hinchingbrooke situation because a longer-term response to this debate needs to be an urgent approach to even closer synchronicity between regional hubs and district hospitals. This will be one such opportunity.

Very importantly, alongside having GP services available in hospitals, we need to rethink how we recruit younger GPs to market towns and semi-rural settings, such as most of my diocese. In Ely itself, an older profile of GP practice is desperately seeking younger colleagues to take on the profoundly important and complex care needs of the very elderly. The experience of Ely is that recruits are not easy to find. When they are found, they do not often stay, because they are not prepared for the multiple and heavy demands placed on GPs providing clinical, social and pastoral care for elderly patients who are desperate to stay in their own homes, which is much to be commended. We need to support our GPs, as I know Simon Stevens plans to do in his proposed strategy for the future of the NHS. However, this needs to be rooted on the ground in how younger people are formed and prepared for the reality of GP ministry among the elderly in our communities.

In December, the chief executive of Addenbrooke’s, the clinical commissioning groups and the county council presented improvement plans to Simon Stevens and the chief executive of Monitor. Here was an opportunity to pool together the most effective joint services and investment in a lively, real and continuous approach, beyond any change of government, to how we unite our health services properly to get beyond immediate crises to a careful and thoughtful response, particularly for the most elderly members of our communities.

14:22

[Viscount Simon (Lab)]

My Lords, in opening the debate the right reverend Prelate mentioned people having to wait in ambulances outside A&E departments, in addition to which some patients have to wait at home for ambulances to arrive because ambulances are not available. I wonder how many patients’ conditions, when they arrive seriously ill at hospital, have worsened due to the delay.

Until recently St John Ambulance could provide a rapid response to patients where and when required, thus keeping conventional ambulances free for other work. It could also provide immediate life-saving intervention in more serious incidents where ambulances were delayed in reaching the patient and when it was nearer. It was able to use blue lights and sirens. It could also use motorcycle units when required, in addition to which motorcycles were used to transport emergency equipment, medicines or other parts very urgently.

However, following a judgment handed down in the Court of Appeal last March, all response services not involving a conventional ambulance have ceased. The judgment has also applied to many other operating response cars, support vehicles, emergency equipment tenders and the like. Consequently, they can no longer exceed speed limits, go through red lights or do anything else that they used to do under an exemption. A special order under Section 44 of the Road Traffic Act 1988 refers to the use of sirens and lights. It runs from 6 June 2014 until 5 June 2016 and permits vehicles constructed for medical response emergencies that are not emergency vehicles to operate within the meaning of the various vehicle lighting and construction regulations. A list has been provided of the ambulance services covered that are associated with NHS trusts.

As St John Ambulance vehicles are appropriately constructed, I wonder why they have not been included in the list. Is there any possibility of this being amended? It also has very robust driver training standards and compliance. St John Ambulance used to be very useful and very helpful to the accident and emergency services and it still could be if the exemptions that it and other like-minded organisations used to have for vehicles used “for ambulance purposes” were restored.

14:25

[Lord Greaves (LD)]

My Lords, I will follow up the remarks that have just been made by the noble Viscount, Lord Simon, on ambulance response times.

Pendle Borough Council in Lancashire—I declare an interest and remind the House that I am a member of it—has made full use of its new statutory scrutiny powers concerning the health service as laid down in the Health and Social Care Act. A meeting of its health scrutiny panel this week received evidence from councillors and members of the public. For Pendle as a whole, in the three months at the end of last year the number of ambulances arriving within eight minutes was only just over half, at 55.7%. However, in the West Craven area of Pendle—the towns of Barnoldswick and Earby and surrounding villages on what might be called the Lancashire-Yorkshire border country—it was 10.7%, which is clearly not satisfactory.

Evidence was also received from members of the public on 999 calls that on at least two occasions, on 17 November and 14 December, 999 calls were put through to the ambulance service, but then went on to an answering machine. Clearly that is totally unsatisfactory. I wonder whether the Minister will have a quiet word and find out whether something is seriously wrong in this part of the North West Ambulance Service.

The rest of what I want to say comes from a hands-on account by a worker at a Greater Manchester hospital who works nights in A&E, which I have very kindly been supplied by UNISON North West. I would like to read out the account that this worker has provided, which shows the pressure that workers such as this are under. The account says:

“We work as a team—there are doctors, nurses, mental health specialists, radiologists. It’s challenging and rewarding work. Staff work 12 hour shifts and rarely get to take their scheduled breaks. I just have to grab something to eat and keep going.

We never know what we’re going to encounter … but some things are predictable … a lot of alcohol-related cases up until about 3am. From 5am we begin to get broken hip or fractured neck cases where elderly people have had a fall. These are often people in care homes who are having ‘unwitnessed falls’ when they get up. I think that if there were enough staff in care homes some of these accidents would never happen.

Sometimes people come in with minor ailments like colds because they can’t get a GP appointment … But our main problem is that we don’t have enough capacity for people who really need to be admitted.

We see most patients within 4 hours. If they need to be admitted they should then go to the MAU (Medical Assessment Unit) for the first 24 hours, but sometimes there isn’t space … We have some bays on A&E where people can wait on trolley beds, but if we have too many then patients can have to wait for 2 or 3 hours on corridors. Ambulance paramedics help to provide the care that patients need while they wait, but it is a frustration to us that they are not being treated in the right environment. Detaining the paramedics also has a knock-on effect for the time it takes to respond to new emergency calls.

When MAU is full, the registrar will come to A&E and discharge people when they can. This can be a problem and we can sometimes see the same people in A&E the next night and even the night after that.

If they need to be admitted and there is no room in MAU, patients might be moved out of MAU after less than 24 hours. Other patients who are sleeping on wards can be moved during the night to make space for them to be accommodated. It can be that people end up on a ward that is not best placed to meet their needs.

We are struggling to provide the level of care that we want to because we don’t have enough capacity. We want to provide the best but the service is always stretched … We feel that we have to work flat out all the time just to keep things going … I sometimes can see that staff are so stressed that they should really be off work, but they won’t take time off as they know that will make things even worse for their colleagues”.

In a sense, that shows the strength of what is traditionally known as the public service ethos but really it indicates that it is not just when the four hour target is being breached that these kinds of stressful situations and pressures exist, but week-in, week-out through the year, as many of us know from the experience of the people we speak to.

14:30

[Lord Hunt of Kings Heath (Lab)]

My Lords, this has been an excellent debate. I congratulate the right reverend Prelate on his very penetrating analysis of the challenges facing the NHS at the moment.

Like other noble Lords, I pay tribute to staff in the emergency services, indeed in the whole of the health and social care system, for the way that they are responding to the enormous pressure. The noble Lord, Lord Greaves, really put his finger on it when he talked about some of the pressures. We know that junior hospital doctors are at the moment not being attracted into emergency departments. Can the noble Earl tell me whether the Government have a strategy for finding ways in which we can both encourage new doctors into emergency departments and also relieve some of the pressure on them so that they do not burn out and find it overwhelming when they face situations as they do today? Will he also respond to my noble friend Lord Simon on the contribution of St John Ambulance and other services like it?

On the actual pressures, my noble friend Lady Gale spoke very eloquently about the pressures in relation to people with Parkinson’s. The right reverend Prelate the Bishop of Ely talked about the doubling of admissions over 20 years. Can the noble Earl say what the Government expect in relation to flows of patients through hospitals through A&E? He will know that the five year plans of NHS trusts and foundation trusts are all predicated on reducing capacity on the basis that something will happen elsewhere so that patients no longer need to go to hospital. There is very little sign that that is going to happen, and I would like to hear what the noble Earl has to say about that.

I understand the point about politics. I gently point out to the House that this yearly increase is nothing new. In the previous Government we managed to cope with it and keep within our targets. There is no doubt that something has happened. I have no doubt that the restructuring has had an impact. The one thing that is missing above all else at the moment is someone being in charge locally. There is no one single person in a health and care system you can go to and say, “You are in charge. You are responsible”. We desperately need to get that local leadership back.

On the 111 issue, which the noble Lord, Lord Jones, raised, are the Government going to undertake a review of it? Has the noble Earl seen the evidence given yesterday by Cliff Mann, the president of the College of Emergency Medicine, when he said that the “absurd” 111 helpline is to blame for overloading A&E with patients?

I also pull up the point made by the noble Lord, Lord Greaves, about the ambulance service. Is the Minister as alarmed as I am by reports today of ambulance staff from the East of England Ambulance Service leaving the dead body of a man on the floor so they could finish their shift on time and indeed the report yesterday of staff there on their own volition apparently not following procedures in relation to the maximum call-out times? What is going on in the East of England Ambulance Service? We need an external review of it. On ambulance services I also ask the Minister about the policy of some services very insensitively called “drop and run” where patients are left at the door of A&E without a proper handing over to A&E staff after a certain time limit of 30 to 45 minutes.

On the weekly A&E data, one trust last week hit only 53.7% against the 95% target. What impact does the noble Earl think that will have on mortality rates? Is monitoring going on to see what impact that is having on safety and quality?

Finally, does the noble Earl agree that there are all sorts of issues such as 111, primary care and people’s predilection to come through the door more often because A&E is a place where they are going to get high-quality care from a lot of staff which is not available out of hours elsewhere? However, when it comes down to it one single issue is clearly responsible for most of our problems—the swingeing cuts made by the Government to local authorities and the impact on social care. The real issue is that patients cannot be discharged into the community because the community facilities have gone. What is the noble Earl going to do about that?

14:36

[The Parliamentary Under-Secretary of State, Department of Health (Earl Howe) (Con)]

My Lords, I very much welcome the opportunity to debate this important issue and I pay tribute to the right reverend Prelate the Bishop of St Albans for introducing it so admirably. The NHS is facing unprecedented demand with record numbers of people attending A&E and the ambulance services providing record numbers of emergency journeys. Despite this, the NHS is still providing high-quality care, and alongside the right reverend Prelate the Bishop of St Albans and other noble Lords, I place on the record my thanks to all NHS staff for their hard work in responding to this challenging time.

Winter is always challenging and this year it comes on top of a general increase in A&E attendances. In 2013-14 these were up one-third on 2003-04. So far this year, A&E attendances have been higher than in any year since 2010 with, on average, almost 3,500 more people a day attending. This has led to an increase in emergency admissions of nearly 6% on last year. The noble Lord, Lord Hunt, said that this was nothing new. I have to tell him that it is. It is about double the trend of increase that we have seen in recent years.

There is no single cause of the increase in A&E attendances. Healthcare is a system and problems that arise in one part of the system will impact elsewhere. Commissioners and providers need to look at what is happening not just in hospitals but more widely, and address the issues that are most salient in the particular area. That is what they have done in drawing up local plans to spend the £700 million of additional support mentioned by my noble friend Lord McColl that the Government have made available to the NHS so it can ensure urgent and emergency care services are sustainable year round and ready for the pressures of winter. In addition to providing more staff and beds, the money has funded local initiatives including: local information campaigns so people are better informed on where and how to access the services they need; seven-day pharmacy services; enhanced NHS 111 and GP out-of-hours services; and schemes to help people recover in the comfort of their own home after surgery. Some £50 million of the winter money was specifically to support ambulance trusts.

I have set out what the Government have done in response to the immediate winter pressures. However, we recognise fully that we require system-level change to ensure that services can be delivered on a long-term sustainable basis. I will now set out our longer-term plans to achieve this goal. The right reverend Prelate the Bishop of St Albans called for a systematic review and that is already under way. NHS England’s urgent and emergency care review should improve access to, and the availability of, services outside hospitals. This will involve providing consistent and same-day access to primary and community services.

The vision for the review is simple. For people with urgent but non-life-threatening needs, the NHS must provide highly responsive, effective and personalised services outside hospital and deliver care in or as close to people’s homes as possible, minimising disruption and inconvenience for patients and their families. For people with more serious or life-threatening emergency needs, the NHS should ensure that they are treated in centres with the very best expertise and facilities in order to maximise their chances of survival and a good recovery. If the NHS gets the first part right, it will relieve pressure on hospital-based emergency services, so that the focus can be on delivering excellent care.

NHS 111 plays an important role in ensuring that people get access to the right care when they need it. Only around 8% of calls handled by NHS 111 result in advice to attend A&E. In November the figure was in fact 6%. Moreover, 30% of callers say that they would have attended A&E if NHS 111 had not been available. That indicates that NHS 111 is instrumental in diverting people from A&E rather than adding to those attending. It is a myth that NHS 111 makes matters worse.

Implementation of the urgent and emergency care review will include enhancing NHS 111 so that it becomes the smart call to make, offering a 24-hour, personalised priority contact service. The service will have access to people’s medical history and allow them to speak directly to a nurse, doctor or other healthcare professional if that is the help and advice that they need. NHS 111 will also be able to directly book a telephone call-back service.

Another key aspect of improving services outside hospitals is providing seven-day access as a matter of course. Currently, not all services are delivered at weekends, and sometimes staff cannot get the advice and decisions that they need from more senior colleagues on Saturdays or Sundays. Delivering the vision of seven-day services could improve the clinical outcome for patients. NHS England is therefore working with NHS employers and staff to develop plans on how seven-day services can be delivered. This should improve outcomes and experiences for patients as well.

I should like to move on to the better care fund. For the first time, this Government will join up health and social care services through the £5.3 billion better care fund. I can say to the noble Baroness, Lady Gale, in particular, and to the right reverend Prelate the Bishop of Ely that the vast majority of this money is being spent on social care and out-of-hospital community health services. These aim to keep people—especially the frail elderly—out of hospital and, if they have to be admitted to hospital, support them to leave safely as soon as they are well enough to do so.

Underlying the new approach are improvements in seven-day working across health and social care to help quicker, more appropriate discharge from hospital. One of the metrics for the fund is the number of people supported to remain at home at least three months after discharge from hospital. Plans project that over two years, the number of older people supported to remain at home at least three months after discharge from hospital will increase by 33.7%. That will be good for those patients but it will also save a great deal of money. Schemes in plans typically focus on things such as increasing capacity in reablement or intermediate care services, or multidisciplinary emergency response teams, which focus on avoiding unnecessary admissions to hospital.

I now turn to our plans for access to primary care. We are offering 7.5 million more people extra evening and weekend appointments, as well as e-mail and Skype consultations, through the Prime Minister’s Challenge Fund, and by 2020 we will offer seven-day GP services to everyone in England. We have announced a £1 billion primary and community care infrastructure fund, which will improve access for millions more people through introducing new models of care and improving estates and infrastructure—including, I am sure, GPs’ surgeries. There are now more than 1,000 more GPs working and training in the NHS compared with the position in September 2010, and there are 40 million more appointments every year than there were in 2008-09.

I turn to some of the questions that were asked during the debate and, as usual, I shall write to noble Lords whose questions I cannot answer today. The noble Lord, Lord Hunt, made me prick up my ears when he said that the problem is that no one is actually in charge of the system. I contend that the system is now more co-ordinated than it has ever been with the system resilience groups that we see in every single area of the health service. These groups comprise commissioners, acute providers, social care and all the players in the system so that they can genuinely co-ordinate their actions and assess the risks and priorities that they need to address.

The right reverend Prelate the Bishop of St Albans said that people are turning up at A&E when they could go elsewhere, and he is absolutely right about that. The urgent and emergency care review that I referred to noted that it had been estimated that about one-quarter of A&E attendees could have been treated elsewhere. A number of local areas are taking action to make people aware of the range of different urgent and emergency care services that are available and the circumstances in which they should be used, as well as the alternatives, such as pharmacies, that are open to people.

The right reverend Prelate also asked about staffing, especially doctors—a point also raised by the noble Lord, Lord Hunt. Compared with last year, more than 260 more new doctors will be available in A&E. That is good news. It includes British trainees but also senior staff from other countries, including India, the UAE, Egypt and Malaysia.

A number of noble Lords, including the right reverend Prelate the Bishop of St Albans, called for more collocation of services. I fully agree with the wisdom of that suggestion. As part of the urgent and emergency care review, NHS England is supporting the collocation of community-based urgent care services in co-ordinated urgent care centres. He may like to know that 112 out of 143 NHS hospitals already have GPs working in, or collocated with, A&E departments.

My time is nearly up but I want to touch briefly on ambulances. The department is working closely with NHS England, Monitor and the NHS Trust Development Authority to improve performance, and the Government have provided an extra £50 million of funding to ambulance services. However, these services are facing unprecedented levels of demand, with an additional 2,000 emergency journeys a day. Despite that, they are still providing high-quality care. We have introduced the ability to fine providers where handover delays at hospitals are unacceptable. Since then, those delays have gone down markedly.

I will respond to my noble friend Lord Greaves about the North West Ambulance Service, and I will also respond on the incident of the dead body, which the noble Lord, Lord Hunt, mentioned in relation to the East of England Ambulance Service.

My time is up but I hope that noble Lords have been able to glean from what I have said that there is a great deal going on. We are gripping the issue. There is no one cause of the increasing pressure on A&E, but we have comprehensive plans, which I have just covered in some detail, to relieve the pressure that we are currently seeing on our A&E services.

Mental Health

Thursday 15th January 2015 Lords Chamber

Motion to Take Note

14:49

Moved by

[Baroness Tyler of Enfield]

That this House takes note of mental health care provision.

[Baroness Tyler of Enfield (LD)]

My Lords, I am delighted to have secured this debate, and with it such an array of knowledgeable and, I know, passionate speakers. I am particularly looking forward to hearing the maiden speech of my noble friend Lord Suri. For too long, the subject of mental health has been ignored, marginalised or left to the realm of social experiment or institutional stigma. Why does this matter? Just as we all have physical health, we all have mental health. Mental health problems affect one in four people in any given year, and the numbers continue to rise. In 2013, referrals to community mental health teams were up by 13%, and up by 16% for crisis services. As a consequence, services are often unable to cope, and people are not getting the support they need.

While 75% of people with a physical health condition get treatment, just 65% of people with psychotic disorders, and a mere 25% of those with depression and anxiety, successfully access treatment. John Lucas, a campaigner for the mental health charity Mind, has been diagnosed with both mental and physical health conditions, and speaks compellingly about the discrepancy between the care people receive for mental and physical health problems. He asks:

“Why does the NHS pull out all stops to stop me dying of physical health problems but does not care if I die of mental health problems?”.

Importantly, mental health problems are estimated to cost the country £105 billion a year through lost working days, benefits, lost tax receipts and the cost of treatment. So there is also a very strong economic case for investing in well-being, resilience and mental health. It is therefore highly appropriate that this debate takes place at a time when, although a lot of progress has been made, there is still much more to be done. We need to ensure that mental health services are equipped to respond to people with all sorts of mental health needs, ranging from preventive work and early intervention through to crisis care. We need to make sure that people who need mental health services, like those who use physical health services, can access care quickly, and have choices about what kind of care they receive.

This Parliament has seen real progress in mental health at national policy level. We have made real strides in awareness and public attitudes towards mental health. I pay tribute to my right honourable friends Paul Burstow and Norman Lamb for all that they have done in this area. Specifically, the cross-government strategy No Health Without Mental Health marked a breakthrough moment for mental health, and led the way for the commitment to parity of esteem between physical and mental health which is now enshrined in legislation and in the Government’s mandate to the NHS.

What has happened as a result? Last year, building on the £400 million investment in talking therapies, the introduction of the first ever access and waiting time standards for talking therapies and early intervention in psychosis, backed up by additional cash, was a welcome and long overdue step towards achieving parity of access to treatment for people with mental health problems. The mental health crisis care concordat should ensure that no one is left without support in a mental health crisis.

All localities have made declarations about working together across agencies to improve crisis care, and progress is already happening on the ground. For example, in Birmingham there has been a marked reduction in the use of police custody as a place of safety. I am sure we can all agree that a police cell can never be an appropriate environment for someone in a mental health crisis.

Of course, good mental health care is not just about treatment, but about empowering people to lead better lives. Recognising this, we now have more peer support workers in mental health trusts, and some 30 recovery colleges in place, to help people with mental health problems develop and achieve their own goals for recovery.

We have seen a real sea-change in the way people think about mental health. The MPs who participated in that famous debate in the House of Commons, and spoke so openly and movingly of their own mental health experiences, deserve much praise. Noble Lords in this House have also been open about their experiences. The courage of those in such positions in being open about their own mental health problems has undoubtedly raised the profile of mental health in Parliament—and, I hope, made it easier for others to speak out. Meanwhile, the Time to Change programme, England’s biggest anti-stigma programme, run jointly by the charities Mind and Rethink Mental Illness, is making a real impact both on public understanding and, perhaps more importantly, on people’s experiences of discrimination.

However, I am a realist, and despite this commendable progress, there is still a long way to go to achieve genuine parity for mental health in the NHS, and an equal chance in life for people with mental health problems. After generations of missed opportunities, I guess this is inevitable. So what are the remaining barriers that need addressing? To put it bluntly, funding for mental health services has faced disproportionate cuts compared with other services. Mental health services have always been known as a Cinderella service because of their chronic underfunding, and mental health receives only 13% of NHS health expenditure, despite making up 23% of what is called the burden of disease. Austerity has hit mental health services particularly hard. Mental health has seen real-terms cuts three years in a row. At the same time, demand is rising. By 2030 there will be approximately 2 million more adults with mental health problems in the UK than there are today.

Early intervention services are often the first target for cuts, but surely this is a false economy, because people’s problems then get worse, and they need more intensive and costly support. With their new public health responsibilities, local authorities have a real opportunity to prevent mental health problems developing in their communities. It is encouraging that some 35 authorities now have a mental health champion. However, research suggests that on average, councils are spending only 1.5% of their ring-fenced public health budget on mental health.

Even when people receive care, it is not always helpful. When we are unwell we are often told to see our GP in the first instance, and 90% of people with mental health problems are treated in primary care. But GPs themselves admit they do not always have the training they need to support people with mental health problems. I think all primary care services urgently need GPs and practice nurses with the confidence and expertise to improve people’s experience of primary care.

Evidence shows that a choice of care improves treatment outcomes, but people often do not receive the type of care they want. Talking therapy is the preferred choice of a majority of people with mental health problems, but only one in seven receive it. That is why I would like to see the right for patients to choose the type of treatment they receive enshrined in the NHS constitution—and for those who would rather have talking therapies than medication, there should be a choice of evidence-based therapies available, backed up by high-quality information.

I suspect that we can all agree that children and young people’s mental health services are a matter of real concern. Some 10% of children aged five to 15 have a mental health problem, yet funding for CAMHS has fallen by over 6% in real terms since 2010, and the commissioning of these services is far too fragmented, resulting in too many children and young people falling through the cracks. Too often they are taken hundreds of miles away from their home for treatment, or are admitted to adult wards. The Government are committed to fund more children’s beds, which is welcome, and have invested £150 million to improve support for eating disorders. We eagerly await the report of the Children and Young People’s Mental Health and Wellbeing Taskforce—a very long title. Can the Minister say when that is likely to be published?

Of course, children’s mental health begins at birth. It is critical to children’s mental health and resilience that they develop a secure relationship with their primary care giver—but are we doing enough to support new mothers who develop mental health problems during their pregnancy? More than one in 10 women will experience mental health difficulties during and after pregnancy, which often go unrecognised and untreated. According to the National Childbirth Trust, only 3% of CCGs report having a perinatal mental health strategy. I suggest that we could improve mothers’ access to mental health support by committing to including measurable objectives in the NHS mandate.

What else could and should be done? Schools have a golden opportunity to protect and promote children’s mental health and emotional well-being, at the same time as helping them achieve good educational outcomes. I would like the next Government to commit to raising awareness of mental health and well-being among young people by ensuring that mental health and emotional well-being form part of an enhanced and mandatory part of the curriculum for all schools, irrespective of their status. Yes, PSHE will be central to this, but such an approach needs to be embedded in the mainstream of the curriculum and the whole ethos of the school. As counselling can be an effective early intervention for young people experiencing mental health problems, and improve students’ attendance, attainment and behaviour, I would like to see all children in England having access to counselling, as children in Wales and Northern Ireland do.

People with mental health problems also face difficulties finding and keeping employment—2.3 million people with a mental health condition are out of work. Almost half of those receiving employment and support allowance are claiming primarily because of mental health problems, yet research shows that the vast majority want to work. It is clear that back-to-work schemes have little understanding of people with mental health problems and often assume that they lack motivation and willingness to work. What we need is personalised and specialist support to help them back into work, designed around the specific needs of people with mental health problems.

Finally, parity of esteem needs to be genuinely inclusive and work for all, including those who find themselves excluded or marginalised from society—those who are isolated or that third of people living with a long-term physical condition who also have a mental health problem. Certain black and minority ethnic groups and people with multiple and complex needs are often overlooked. People with a dual diagnosis—for example, those who have been diagnosed with a drug and alcohol problem as well as with another mental illness—are often denied access to mental health care on the ground that their substance abuse makes treatment impossible. When they are in crisis, they are more likely to be taken to a police cell than a health setting. It should not have to be that way.

Charities working together as part of the Make Every Adult Matter coalition, which I chair, have shown that by effective joint working, better care can be achieved for people with complex needs. I am pleased that the Department of Health is currently reviewing the 2002 guidance on dual diagnosis and hope that the continued rollout of liaison and diversion schemes will also start to address the issue of drug and alcohol abuse.

The next Parliament should set out an ambitious agenda for mental health. What should it be? Here is my starter for 10: mental health is not just a health issue. Therefore, we need a truly cross-governmental mental health and well-being strategy embracing issues such as employment, welfare, policing and criminal justice, housing, education and planning, as well as seeing Public Health England lead with the establishment of a national well-being programme championing preventive action. To lead this charge I would like to see a dedicated Minister for mental health with a cross-government remit and, indeed, the Secretary of State for Health reporting annually to Parliament on progress towards achieving parity of esteem between mental and physical health.

Next, we should rewrite the current system which discriminates against mental health and leads to institutional bias, including: making the NHS constitution fairer; introducing a wider range of access and waiting-time standards, along with entitlement to NICE-approved treatments for mental health problems; revising payment systems to put mental and physical health on an equal footing; and better aligned NHS public health and social care outcomes frameworks which put much greater emphasis on mental health. Finally, and perhaps most importantly, we should rebalance the NHS budget to ensure that mental health services for children and adults receive their fair share of funding and that metal health services see real-terms increases in investment in each year of the next Parliament.

To conclude, much progress has been made in mental health over this Parliament. The next Government—of whatever complexion or, indeed, combination—have a real opportunity to build on this momentum and transform the way in which we approach mental health in this country. It will take strong and courageous leadership both politically and from within the NHS, but the prize in terms of the nation’s well-being could be immense. I very much look forward to hearing what other noble Lords have to say on the matter. I beg to move.

15:02

[Lord Goodlad (Con)]

My Lords, I congratulate my noble friend Lady Tyler on securing this debate and on her very wise words.

I speak from the perspective of one whose home for the first 14 years of my life was a mental illness hospital: the Lawn in Lincoln—founded by the Willis family in 1819, following the successful treatment of King George III—of which my late father was for many years the medical superintendent. People have said to me, “What an unusual upbringing that must have been”—to which my only reply is, in the spirit of Elvis Presley, “She’s a distant cousin but she ain’t too distant with me”. An unusual upbringing it may have been, but it was not unusual for me. As I look back on those years, the memories of friendships with patients and staff remain with me as if it was yesterday. I see that part of my life through rose-coloured spectacles. My father wanted me to follow in his footsteps, as for some years did I. When that was not to be, grudgingly he said that my upbringing had been as good a preparation as any for life in the other place.

To be serious, much has changed since those days, most of it for the better. Public attitudes toward mental health have changed enormously, led I like to think by government and parliamentary action, and certainly reflected in Westminster today. There is a limited amount that the Government can do to influence public attitudes, and there is regrettably a very long way to go. In many ways, although progress has been made over the past 50 years, the glass is at least half empty. One in four adults during their life is traumatised by anxiety, depression, OCD, schizophrenia, dementia or another mental health condition.

The report of the noble Lord, Lord Layard, published by the LSE, sets out some stark evidence. Mental illness is now nearly half of all ill health suffered by people under 65 and it is more disabling than most physical disease. Yet only a quarter of those involved are in any form of treatment. The report of the noble Lord, Lord Layard, also pointed out that 23% of all ill health in the UK—the largest single cause of disability—is mental ill health, yet only 11% of England’s annual secondary care health budget is spent on mental health services.

My noble friend set out some of the costs—£100 billion a year, including 70 million lost working days, additional welfare benefits, lost tax receipts and the cost of treating avoidable illness. No price can be put on the suffering of those involved. Most of the millions of people suffering from depression, and children with behaviour problems, received no treatment, despite NICE’s recommendations. I hope that the Minister will be able to indicate how she thinks local authorities and clinical commissioning groups will deal with mental health care commissioning plans in the future.

There is, of course, support for the glass half full view of the situation. Premature death of people with serious mental illness has declined, although it is still too high, particularly for schizophrenia sufferers—20 years. The quality of life of many mentally ill people has improved, as has the experience of healthcare. The Royal College of General Practitioners has committed to making improved care for people with mental health problems a training priority. I well remember as a child accompanying my father in his car as we followed the tail lights of general practitioners in rural Lincolnshire on domiciliary visits. Perhaps this will not have to happen so much in future, and reference to community health teams will be quicker.

I do not doubt the good intentions of the Government and I pay tribute to the recent work of Jeremy Hunt, Norman Lamb and Simon Stevens. The Government have legislated for the first time for parity of esteem between physical and mental health. The intention is that most patients needing a talking therapy will be guaranteed treatment within six weeks, with a maximum wait of 18 weeks, and that patients experiencing their first episodes of psychosis will receive treatment within two weeks. Let us hope that these aspirations result in action—fine words butter no parsnips.

The children and young people’s mental health and well-being task force has been established. The mental health crisis concordat has been signed by 20 national organisations. The Government have announced that everyone who receives mental health care should have a named, accountable clinician. Mental health has now been made part of the new national measure of well-being so that it is more likely to be taken into account when government departments are developing and implementing policy.

My late father was one of the pioneers of day care. I am not sure that, seeing the outcome of care in the community in some of our inner cities, despite the deep commitment of carers, social workers and health workers, he would be convinced that an adequate solution has been found. What is required is a holistic approach, co-ordinating social care, general practice, liaison psychiatric and mental health specialist organisations, housing and education authorities and prisons. What we need is not just talk in Whitehall but action.

The Health and Social Care Act for the first time in statute places a duty on the NHS to promote research. It is in the context of research that I turn to schizophrenia. I pay tribute to the work of charities such as Rethink, Mind and SANE—Schizophrenia, A National Emergency —founded and so ably run for many years by Marjorie Wallace, and of which I was a director for some time. There is now a schizophrenia audit, and depressing reading it will make.

The exact causes of schizophrenia psychoses are unknown. They are among the commonest and most serious mental health conditions. Only one in 10 people who are diagnosed with schizophrenia is in work. Stigma still attaches to the condition. The human cost is colossal, the financial cost in terms of resources used is enormous and the distress to sufferers and their families is inconceivable. Schizophrenia affects about one person in 100 at some point in their life. It is estimated that it costs the UK taxpayers about £2 billion a year in care and treatment, together with the vast personal cost, both financial and in terms of suffering, for patients and family members. The global drugs bill alone is estimated to be £12.5 billion a year, not including hospital stays.

So where are we now? Last year the Harvard Gazette published an article saying that there had been little innovation in drug development for the treatment of schizophrenia in more than 60 years. It went on to report on efforts to identify,

“more than 100 locations in the human genome associated with the risk of developing schizophrenia”.

The hope is that this might lead to the development of new drugs. Despite the pressing need for treatment, medications currently on the market treat only one of the symptoms of the disorder—psychosis—and do not address the debilitating cognitive symptoms. Treatment options are limited because the biological mechanisms underlying the illness have not been understood. The sole drug target for existing treatment was found serendipitously, and no medications with fundamentally new mechanisms of action have been developed since the 1950s.

Great work is going on in the United States, financed by foundations and philanthropic donations, and there is an international project on genomes. On this side of the Atlantic, mental health has always been a poor relation in the charitable sector, with the exceptions of Alzheimer’s and autism. Mental health charities will not, in the foreseeable future, be able to compete with physical health charities, such as those devoted to cancer. That puts the Government in the firing line. The Institute of Psychiatry at King’s College London has been given £5 million for a project, but nothing will come from that, I understand, for a decade. So there we are: little progress over 60 years.

I hope that the Minister will give me some comfort that the Government understand the urgency of further research into the causes of schizophrenia psychoses and the crucial role of the Government and the NHS in promoting it. Mental health has been described, with justification, as the Cinderella of the NHS—but let us remember with hope that Cinderella had a happy ending.

15:13

[Lord Storey (LD)]

My Lords, I am very grateful to my noble friend Lady Tyler for securing this debate. With three children in every classroom experiencing mental health problems, teachers need the right training and support to identify issues early and ensure that young people get the help that they need to recover and thrive. I would like to use my time to focus on mental health care and support in schools and on the creation of an ethos that does not ignore mental health problems but has the readily available resources and support to help children and young people proactively. Making such support available and accessible will not only be life changing for the pupil but head off later problems and lead to later savings in human and financial costs.

A recent survey by CentreForum, as part of its mental health commission, concluded that 54% of head teachers found,

“mental health services ineffective in supporting pupils”,

while, at the same time, mental health issues are on the rise in schools. Confidence in child and adolescent mental health services, or CAMHS, was even lower among head teachers at pupil referral units, at 37%, and at special educational needs schools, at 43%. Sixty-five per cent of schools do not assess the severity of mental health needs among their pupils, yet where such screening tools are available 85% of schools reported it to be effective.

As the Deputy Prime Minister rightly said,

“Schools would never ignore a child with a physical health problem, so the same should be true of mental ill health too”.

He went on to say:

“Early intervention is crucial in tackling mental health problems”.

So early identification and the provision of effective support systems are paramount in dealing with mental health problems. However, two-thirds of local authorities have cut their child and adolescent mental health services, and, unfortunately, the largest cuts have been to early intervention services.

We need to provide alternative solutions which benefit families and young people affected by mental health problems and which take into account the existing responsibilities of teachers. For example, the Well Centre in Streatham, south London, provides drop-in one-to-one counselling, structured therapy, peer group work and digital services. Since CAMHS budgets have been reduced, we must look to investing in alternatives, such as linking up schools with these youth health centres in order to reach out to young people who may not have the confidence to ask for themselves.

As a Government, we have been successful in introducing free childcare for increasing numbers of disadvantaged children, implementing education, health and care plans to enable quality and consistency for all young people with special educational needs and providing for further integration of crucial services that affect the well-being of children from birth throughout their education. However, mental health care for under-25s still makes up only 6% of the overall NHS mental health care budget. We must therefore continue to work towards preventing the suffering of those children with emotional, behavioural and psychological problems.

I believe this can be achieved by creating the conditions that allow for early diagnosis. It can also be achieved by addressing the factors that can contribute to the stigmas surrounding mental health and maintaining high standards of mental health services for every child and family. It is our responsibility to enable every child to receive the best possible start in life. The only way that we can safeguard this right is by ensuring that education and healthcare services are equipped to tackle the underlying causes and contributory factors of mental illness. In doing this, we can help pave the way for improved physical and mental health for our children and, further still, support opportunities for all young people to learn effectively.

We all believe that education and care for young people should provide the best start in life for every child, regardless of their background, their living circumstances or the socioeconomic status of their parents. Over the years, we have seen that early years and childhood experiences can have profound and long-lasting consequences for an individual’s health. We know that the life chances of a child are greatly influenced between the ages of three and five, and that their future chances are often predicated on their development in the first five years of life. If undiagnosed, mental health problems can continue to affect young people throughout their life, affecting their personal development, educational attainment and overall well-being.

During my time as a head teacher, it was often clear to see that children from disadvantaged backgrounds were arriving at school, on their very first day, already a few steps behind their more fortunate peers. This had severe implications for their learning capacity, their ability to interact with classmates and even their literacy and numeracy attainment levels. While we tend to presume that such disadvantage is primarily caused by social and material circumstances such as poverty, family structure and demographics, all too often we neglect the role that mental health plays in child well-being. Yet around one in 10 of the nation’s children are affected by mental health issues, with significantly higher levels evident in certain groups of young people.

Many education providers, parents and children alike find themselves confronted with the challenging realities that are presented by mental health care provision, and teachers are increasingly placed under considerable pressure to take responsibility for such demands. It is vital that education, youth services and healthcare providers have the capacity to work together in identifying mental health problems at the earliest possible point, in order to offer early diagnosis and professional, collaborative support.

Furthermore, early diagnosis and support for affected children and families can significantly reduce costs to society in the long term, as well as empowering those who are affected to help themselves. Targeted interventions and the provision of integrated services at an early age are key strategies that have been proven to help reduce low educational attainment, unemployment, crime, and anti-social behaviour in the long run. The benefits of interventions during the early years of childhood are therefore realised both in the short term and over the entire life course of the child. As such, we should see the provision of mental health care in the foundational years as a valuable investment.

We need to look specifically at the treatment of mental health for young people, and make sure that this treatment is accessible to high-risk groups. We need to ensure that there are flexible, sustainable and workable plans in place for young people affected by emotional illness from birth, and that care continues to be accessible throughout their lives.

Finally, we need to cut right to the core of the issue, and act on the advice of medical professionals who emphasise the influence of perinatal mental health on a child’s upbringing. If mental health problems are identified and treated quickly, efficiently and effectively, many of these serious long-term human and economic costs can ultimately be avoided.

I thank noble Lords here for their dedication in debating the importance of mental health care provision, and urge us all to consider further investment and accessibility in services for young people, as a crucial way in which we can prevent emotional disturbances from affecting the life chances of children from all walks of life. It is reassuring to see the progress that we have made in firmly placing mental health care provision on the agenda, and I look forward to seeing the Government, local authorities, trained professionals, and parents continuing to uphold the highest standard of care for young people.

As Dame Sue Bailey, chair of the Children and Young People’s Mental Health Coalition, said:

“School is a critical environment where young people should be able to flourish across all domains of their lives. The gaps and concerns this report so clearly identifies reinforce the need to provide young people with the help, support and self-empowerment to develop and maintain resilience to stay mentally healthy in order to achieve and develop to their full potential”.

I say, “Hear, hear”.

15:22

[Lord Suri (Con) (Maiden Speech)]

My Lords, I would like to thank all noble Lords on all sides of the House and the staff of this House for their immense kindness and friendliness in making me so welcome to this honourable establishment, navigating me through the protocols and giving me advice and guidance to enable me to fulfill my new role in this House. In particular, I would like to express my heartfelt gratitude and thanks to my supporters, my noble friends Lord Popat and Lord Leigh of Hurley, for introducing me to your Lordships’ House.

Little did I know back in 1974 when I emigrated from Kenya to the UK that I would be bestowed with this great honour to work alongside your Lordships to continue contributing towards building a cohesive multicultural society in this country. I am humbled to join this House and family, which strives to represent the diversity of the population in this great nation. I am the second turbaned Sikh who has been elevated to the upper House. This great British institution has taken a praiseworthy step by bringing into its fold people of different faiths.

I have spent all my working life as a businessman, with a career that started in Kenya as an importer of educational supplies. This was the start of my liaisons with the United Kingdom, dealing with long-established British publishers. In 1974, having decided to migrate with my family to the United Kingdom, I pursued my business ambitions and challenged myself to a new business venture. I decided to enter into the fashion accessories trade, and much to my disbelief I encountered a harsh reality not previously experienced. The estate agents who offered me business premises to rent strongly advised me not to be the front man in a fashion accessories boutique as customers would not be forthcoming. Instead, my wife was recruited and she ran our boutique full time while I ventured onwards looking for further trading opportunities.

We were determined to stand on our own feet and to earn our living without committing to the state for benefits. In 1977, I established a wholesale fashion jewelry and accessories business, and through its success I built up a sound property portfolio. The company is still trading strongly.

Through my selfless and entrepreneurial approach to business, I have always remained actively involved with many charities, social action projects and social initiatives. This is in keeping with my firm belief that people should contribute back to society to help others in less fortunate positions. Service to charitable and voluntary works has always been deeply rooted in my ethos on life. Service to mankind and praying for the welfare of all is one of the principal pillars of the Sikh religion.

I have been treading on this noble road to serve others from a very young age. Over the years I have championed community work and have held posts including justice of the peace, general commissioner of income tax, serving on the Middlesex Probation Committee and the Home Office Advisory Council on Race Relations, being a member of the board of visitors of HM Prison Pentonville and mentor to the Prince’s Trust youth business trust.

I thank my noble friend Lady Tyler of Enfield for putting down the Motion for today’s debate on the importance of mental health care provision. Good mental health, as well as good physical health, is essential in enabling us to contribute to the socioeconomics of society. The relevance of today’s debate endorses over five decades of my contributing to the community, voluntary services and charities, starting in Kenya and continued in Britain with unremitting devotion.

During my involvement as a voluntary associate at HM Prison Wormwood Scrubs, prior to commencing my voluntary career in probation and magistracy, it was evident that poor mental health and the lack of mental health care provision hindered people from making the journey to recovery. I would like to share with your Lordships a particular case where I supported a fellow Sikh who was imprisoned for having committed murder. This individual, who I will call Tej, which is not his real name, was further isolated in this environment through lack of communication, as he was not literate and unable to converse in English. Tej was fluent in his mother tongue Punjabi, which limited his interactions and intensified his isolation and sense of hopelessness, contributing to his depression and placing him at a high risk of suicide.

Through my weekly visits, we established a rapport. Over time, Tej was persuaded to join literacy classes in the prison, which reduced some of the isolation and frequency of suicidal thoughts. Through continual support, Tej was transferred to a prison nearer to his home town in order to rebuild his relationship with his family, who had severed all links with him.

My work within the prison environment led me to visiting the young people at Feltham young offender institution. These young men were institutionalised as a result of their criminal activities, with an outlook of further poor outcomes in the future, and once again the state of their mental health contributed to the sense of despair and low aspirations. It could be said that the young people were like tender green shoots waiting to be trained along a framework that would build on their aspirations. They would acquire new skills and knowledge through education, which would be utilised in a productive way to reduce the cost to society.

It has been important to me to have put my business skills into the field and mentored young people through the Prince’s Trust youth business trust, sharing my knowledge and experience of starting businesses, thereby giving them the tools to take the first steps in building a new life and contributing to their community but also to the economy of the country.

Education has a multidimensional impact on every member of society and should be for all to take on board as a lifelong journey of learning, discovery and character building. In 1956, I had the privilege of meeting the President of the Republic of India at that time, Mr Sarvepalli Radhakrishnan, who was visiting Kenya to open the Mahatma Gandhi academy. In his speech, he emphasized that, although he was an academic, philosopher and statesman, he still considered that the world was his school. This analogy has influenced my thinking on education, which has brought me here today. I am sure that the provision of mental health services will remain high on the agenda of this House.

15:41

[Lord Patel (CB)]

My Lords, it is a great pleasure on behalf of the whole House to congratulate the noble Lord, Lord Suri, on his maiden speech. As he mentioned, he is the second Sikh to enter the House of Lords. He has also represented 450,000 Sikhs through his honorary secretaryship of the Sikh forum. No doubt, he brings his experience and wisdom from that time of representing Sikhs who contribute so widely to this society. He evaluated the many contributions he has made to the wider society in faith and commerce. He has also been a magistrate for over a decade, so he has many talents. Today he has demonstrated his commitment to mental health and his experiences in supporting prisoners. We welcome him to the House and look forward to hearing from him on many occasions.

I am going to concentrate mainly on what parity of esteem means. I declare two interests. I am an honorary fellow of the Royal College of Psychiatrists, not because I have contributed much to mental health but for reasons I do not understand. The second is why I am interested in parity of esteem. Some noble Lords will remember that, during the debate on the Health and Social Care Bill 2012, I spoke on an amendment to give mental health parity of esteem. I was the third name on the amendment. The first name was that of the noble and learned Lord, Lord Mackay of Clashfern, and the second was that of the noble Baroness, Lady Hollins, one of the most respected psychiatrists in the land. Neither of them could attend that day and it was by chance that I called a vote which was won by four votes. Parity of esteem is now in the statute because of those four votes and the fact that the other place did not overturn it, presumably because of the wisdom of the coalition Government—I emphasise coalition.

Much has been said in the past two years about parity of esteem. It has almost become a slogan. Whenever anybody speaks about mental health, whether they work in the mental health field or in health services generally, they talk about parity of esteem. It means different things to different people, but it probably means nothing at all to the public, the patients and their families. Turning the slogan into the practicality of what it should be will make the families and patients feel what parity of esteem for mental health is.

The duty to ensure parity of esteem was enshrined in the Health and Social Care Act 2012, by securing improvement,

“in the physical and mental health of the people of England, and … the prevention, diagnosis and treatment of physical and mental illness”.

This duty provided a legal backing for the commitment to parity of esteem within the Government’s 2011 mental health strategy, No Health Without Mental Health. However, parity of esteem in mental health refers to a broad range of issues which reflect the role of mental health across all the different areas of our lives. “Parity” therefore refers not only to equivalent levels of funding for mental health but to a whole range of areas which affect our mental health—in and out of mental health services. Furthermore, parity of esteem needs to address “parity within parity”. By that, I mean the inequalities within mental health in terms both of the differential prevalence of mental ill health within marginalised groups and of achieving fair and equal access to services.

Parity of esteem and its applications may come in different forms. When we look at parity between physical and mental health, we see a persistent mortality gap between people with a diagnosis of bipolar disorder or schizophrenia and the general population, as has already been mentioned. Measuring the parity gap may focus on the excess mortality that patients with mental ill health suffer. They die 15 to 20 years earlier than those who do not have mental ill health. The parity measurement gap may also refer to the burden of disease. One-quarter of the NHS disease burden and disability is due to mental health.

The parity gap can also be measured by the treatment gap; that is, the number of people who may have a condition, but do not get the treatment for it. It is as low for common mental disorders as 24%, compared to 85% for a broken hip. The parity gap in treatment is therefore considerable.

In cases such as schizophrenia, the gap in the general population is widening among certain groups. Problems such as diagnostic overshadowing mean that the physical health needs of people with mental health problems are not sufficiently investigated. Only recently have waiting time targets been introduced for psychological therapies, already mentioned, in contrast to long-standing physical health waiting times. In mental health, we currently see one in 10 people waiting up to a year to receive treatment, particularly for psychological therapies. It is still hard to get the full range of NICE-recommended psychological therapies—only 15% of people are offered the full choice of approved therapies.

Mental health must also have an equal footing with physical health in public health strategies. There is clear evidence and a convincing economic case for investing in public mental health. Parity in funding has already been mentioned. Mental health has been historically underfunded compared to physical health. At present mental health accounts for only 13% of NHS spend on health, despite accounting for 23% of the burden of disease. Mental ill health is also the single largest cause of disability in the UK. Investment in mental health research is key to advancing parity of treatment for mental health.

Despite mental health problems affecting one in four of us, funding for mental health stands at less than 6% of all health research funding. A commitment to parity in funding must be consistent across government and health services. In 2014 Monitor announced a funding decision to cut mental health services by 20% more than NHS hospital trusts. I know that Ministers did not approve of that, or like it, but none the less, the funding was cut. Reports found that 77% of clinical commissioning groups have frozen or cut their children and adolescent mental health services budget between 2013-14 and 2014-15, alongside 60% of local authorities in England having cut or frozen their budgets since 2012.

Mental health services must see real-terms funding increases to be equipped to meet increasing demand and unmet needs for both adults and children. Parity within mental health is essential to ensure that anyone who experiences a mental health problem has fair and equal access to treatment, especially among marginalised groups. This includes adapting services to make sure that they are inclusive of all. There are no hard-to-reach people—there are only hard-to-reach services.

One way to address this is through the coproduction of services. Outcomes for people with complex needs and from minority-ethnic communities are unacceptably poor. This also means that mental health services should be appropriate for people across the life course, from children to later life. Young people need to be given the skills to address life’s challenges with the confidence to manage their well-being, and older people need services that are accessible and appropriate. Health inequality increases the likelihood of experiencing mental ill health, and addressing inequalities can promote the population’s mental health.

Parity and stigma is another issue, which some noble Lords have already mentioned. Nine out of 10 people with a mental health problem experience stigma and discrimination. It is essential that the work of the Time to Change programme continues to improve public and professional attitudes to mental health. It is essential to eradicate the stigma surrounding mental health in professional health settings, as stigma affects the esteem in which professionals are held.

I have two questions for the Minister. First, what steps are the Government taking to reduce the imbalance in the provision of publicly funded research into mental health? Secondly, what are the Government’s plans to ensure that mental health services are appropriate for people across the life course?

15:42

[Lord Farmer (Con)]

My Lords, once again the noble Baroness, Lady Tyler, has secured a debate of vital national importance, for which I thank her. I take this opportunity also to congratulate my noble friend Lord Suri on a very fine contribution to this debate. I am aware of the considerable expertise that lies within your Lordships’ House on the issue of mental health, so it is with some humility that I approach the subject—but also with a conviction that there are neglected issues, and it is at these that I will pitch my comments.

My overriding concern is with the drivers of our high levels of mental disease—I use that term deliberately. When a nation as great as ours has prevalence rates of one in six adults at any one time suffering profound mental distress, as well as one in 10 children and young people, this surely reveals an underlying and widespread societal dis-ease. Mental illness does not just happen: very often there are preventable causes, and this is where a new wave of public health effort needs to focus.

We have just heard from the noble Lord, Lord Patel, that mental health is the single largest cause of disability in the UK. It is responsible for a quarter of the disease burden and 13% of the NHS budget. Although that disparity will, I am sure, be the concern of others here today, I would ask us simply to pause for a moment and consider how much is already being spent, and how much human misery it represents, rather than simply asking for more money. Moreover, it is a fraction of the overall cost to society, estimated by the Centre for Mental Health at £105 billion every year. We simply cannot afford these eye-watering costs and loss of human potential, so I emphasise the importance not just of treating mental illness but of preventing it from occurring—or recurring.

It is now widely accepted that we need to adopt a bio-psychosocial model to understand the causes of poor mental health. To put it more simply, it is not just about genetic predisposition, it is also about the kinds of families and communities people grow up and live in, the character of schools and workplaces, and societal attitudes. If we are serious about preventing mental dis-ease, we have to step back and ask some fundamental and searching questions about the kind of society we want our children and grandchildren to be born into, grow up in and grow old in. First and foremost, it should be one where the unique human worth of every individual is appreciated and which places a very high premium on relationships. With this as a backdrop, I will now unpack what is meant by a bio-psychosocial model, highlight key issues in these three areas where we need to see profound cultural change and recommend how this might be achieved.

First, in terms of biological drivers, drug misuse can be both a cause and effect of mental illness. The British Journal of Psychiatry reports that 80% of first-episode psychiatric disorders, schizophrenia or schizophrenia-like illnesses occur in either heavy or dependent cannabis users. Individuals using cannabis are doubling their risk of developing schizophrenia. This undeniable risk to mental health is why I am so strongly opposed to legalising cannabis. We need to send a clear and unambiguous signal to our young people that drug use, which many of them think is somewhat cool, is strongly implicated in the development of mental health problems—which everyone would agree are deeply uncool.

Similarly, I consider it highly appropriate for the Government to fund information campaigns such as Time to Change, which the noble Lord, Lord Patel, just referred to, which address the stigma of mental ill health. This deters many people from coming forward for treatment when problems are at an earlier and possibly more manageable stage. Stigma has to be seen alongside the second area of social factors, which include isolation and loneliness, unsupportive and hostile communities, poor housing, inadequate healthcare, financial poverty and sexual or racial discrimination.

The risk of psychosis among Black African-Caribbean groups is seven times higher than among the general population. They are more than twice as likely to commit suicide and three times more likely to be admitted to hospital. They are more than 40% more likely to be sectioned—in other words, detained without their consent under mental health legislation.

Prevention of hospitalisation is a worthy goal for financial as well as therapeutic reasons. I will describe how voluntary sector organisations can do just that. Recent polling found that, of those with experience of hospitalisation, more than half did not feel the settings and facilities aided recovery; 44% felt that the treatment they received was fairly or very ineffective; and 14% felt very unsafe. People who feel unsafe in hospitals are not necessarily simply nervous types. I have heard how returning soldiers with post-traumatic stress disorder consider UK hospital settings more dangerous than the Iraq or Afghanistan front line. It should not be possible to spend one’s days in a mental health ward, hunched up on the floor against the wall, alone with one’s troubling thoughts, while nurses busy themselves with bureaucratic tasks. One study found that only 16% of patients’ time was passed in what is loosely termed “therapeutic interaction”. The remaining 84% was characterised by a distinct lack of purpose.

I understand how much pressure mental health professionals are under. The Mental Health Act Commission found that nurses were unhappy about being too busy to develop therapeutic rapport with patients. The commission concluded that all hospital wards caring for detained patients should ensure that they have “protected engagement time” with nursing staff. I endorse that recommendation. Everyone needs to feel that they are significant, that they are worth spending time over and that they belong.

This leads me to a third category of psychological factors. These include insecure attachment to parents in infancy, sexual or physical abuse in childhood, inadequate, neglectful or abusive parenting and being bullied or harassed—in other words, continually feeling unsafe. This is possible even in the workplace, because of one’s own line manager. Bereavement, lack of any close confiding relationships and family breakdown are also factors. I keep promising myself that I shall give a speech in your Lordships’ House in which I do not mention family breakdown. It is getting very difficult to do that because of its myriad, knock-on effects.

There is a strong evidence base about the impact on a child of losing one parent, which sadly goes beyond the financial or emotional and reaches into the heart of this debate. According to Professor Richard Whitfield, for a child to surface, somebody needs to be crazy about them. Morgan and Fearon, researchers at the Institute of Psychiatry, found that family breakdown and early separation from a parent had a clear effect on rates of psychosis in the African-Caribbean population, where there is a higher likelihood of growing up without both birth parents. Insights such as these make it even more imperative that we address family instability, which affects poor communities of whatever ethnicity particularly badly.

Honesty requires us to admit that one’s birth family can be at the root of mental health problems. The first onset of mental health problems is commonly in childhood or adolescence. Half of all lifetime cases have started by the age of 14. A prevention agenda has to make parenting support a major priority. There is a great prize in helping families repair and its members become a resource to each other. Families can also be at the heart of the solution. Recent polling found that more than half the people with mental health difficulties received “a lot” of help and support from their families. This was more than those who cited their GPs and three times as many as those citing psychiatrists. We urgently need better family functioning to be included in the national Public Health Outcomes Framework. This would mean that local authorities had to ensure that couple support and family therapy were offered as standard—for example, in the family hubs for which I am pleased to hear there is growing cross-party support.

There must also be greater recognition of the role that supportive communities can play because not everyone lives in a family. The black-led churches are on the front line of preventing mental ill health. Organisations such as the African Caribbean Community Initiative in Wolverhampton are helping to keep many black people out of hospital by inspiring confidence in mental health professionals that their patients are safe in their hands.

That is what we all need for well-being and good mental health—reliable relationships, whether in families, the workplace, healthcare settings, faith communities or during our retirement years. The Government have a clear role to play by pursuing policies that will strengthen rather than undermine these relationships and the innate desire and ability that people have to look out for one another. I am my brother’s keeper.

15:52

[Lord Addington (LD)]

My Lords, the first and very pleasant duty that falls to me today is to welcome from these Benches—from this part of the coalition—the noble Lord, Lord Suri. A good start has been made and we look forward to what is to follow.

When I put my name down to speak in this debate, it was because of something which is blindingly obvious to somebody such as me who has dealt with disabilities for many years. Somebody who is disabled is likely to undergo slightly more stress than somebody who is not. Stress seems to be one of the key factors, whether it comes from family, or social background. With disability—that is, not being able to function—there is going to be more stress and there are probably going to be slightly more mental health problems there. It is a little bit of a no-brainer.

However, many of the speeches today have touched upon that. I always regard people as being a cocktail of a series of events, circumstances and chance and all these things come together in individual people, making them slightly more likely to go in certain directions or react in certain ways. If you are a person with a disability, who struggles to access certain parts of society or to communicate, or to achieve as your peers would, it is an almost dead cert that you will be slightly more vulnerable and there is a slightly higher probability that mental health problems will occur in your life. Virtually all the reading I have done backs this up, and everyone who has spoken to me has said so.

On the issue of dyslexia—the noble Lord, Lord Farmer, might have said that he always talks about family breakdown; I am trying to find a subject where I cannot find an aspect on dyslexia and my connection to it and I have failed so far—it is well known that dyslexics get slightly more stressed in the classroom and that mental health problems will be that little bit more common among them. However, they are not the only group. When it comes to autism, 70% of young autistics are reckoned to have a mental health problem. That 70% equates to 1% of the population. The on-costs of not dealing with this in the best way are massive. To deal with just those two groups at first, most of those have economic capacity and the capacity to work, but that will be greatly reduced by not giving them support and help throughout. By not taking action, we are effectively creating that little bit more of a burden or drag on society and making people’s lives more unpleasant.

All those whom I have spoken to in this field say that there is one problem that the medical world—and, indeed, the rest of the world—has in dealing with this. When they see a person who has a disability, whether obvious or hidden, they tend to see the disability first rather than think about what might be going on behind it. I remember that we had a long debate in this Chamber about how the deaf, or British Sign Language users, access the health service. How much more difficult is it for a doctor or a professional to establish that mental health provision is required when they cannot understand the person, who has to be translated through somebody else? There are sometimes difficulties there, so how do we address this?

If we are serious about taking this very sensible and good step forward of giving parity to those with mental and physical health problems, the first thing we must do is surely to ensure that all those in the health service are at least aware that this possibility is there. I am talking about everybody not becoming expert and trained but being aware that there might be a problem, which they should assess and move on from. A degree of awareness can be achieved fairly easily, simply by stating, “By the way, in certain groups certain types of conditions are more frequently occurring”. Once again, that is a no-brainer, but what is required to move you on?

Regarding the education sector, my noble friend Lord Storey mentioned how the Department for Education deals with mental health. In education, we have for a long time dealt with special educational needs, but most of the problem that we have is in identifying them and getting the system to recognise them. I do not say that the Department of Health is going to become any worse but without training, without pushing to make sure that it is kept under surveillance to do so, it will not be any better. That is because it will think—and it may be right—that it has enough to do as it is in dealing with the duties in front of it. That will be so unless you place a duty on that department to become aware or find out and make sure that, when it does not, it must report back the reason why. That is both to reinforce the fact that it is a duty and so that the systems are in place to make sure that it does not happen again. If we do not undertake this type of activity, we will reinforce this cycle of people who are underachieving.

We will not address the selfish interest of society properly unless we become aware of this. We will have a whole section of our society who we are encouraging by saying, “You should go out to work and become fully active”. Indeed, we are making that a legal duty; all Governments in the last few years have done this, saying, “You should get out and earn. We don’t want you sitting at home”. But unless we make sure that they are supported the whole way round they are going to fail in this, effectively because they have no option.

If we look at other areas where bad mental health is prevalent and disabilities, often hidden, are common, we could look at prisons. I thought that I might say a few things on that, but I looked at the speakers list, and then across the Chamber, and saw the noble Lord, Lord Ramsbotham. Whether or not he chooses to take a bite out of this particular apple today, I will always defer to him on that issue, but we should look to the examples of how we get such “co-morbidity”, which I think is the correct term here—personally, I think the word means that you are dying twice and quickly, so perhaps we should say “co-occurrence”. For an example of where co-occurrence leads to failure and expense, you need look no further than prisons. This is particularly true of conditions such as autism and other hidden disabilities. In all the cases at which I have looked, not looking at the whole person or beyond the initial aspect will lead you into trouble.

I am in grave danger of reciting all the facts that I have about the problems in these areas, such as that people with a learning disability were traditionally seen as not being worth indulging with a talking cure —because it would not do them any good because you cannot help them anyway. However, they can become more independent and they can get out there. Unless we address the idea that we give all groups in this sector as much help as we can, we will fail. In failing, we pass on costs to society and to those in families who end up looking after these people.

Carers have a high occurrence of mental health problems. They are under stress. We must start to cut this Gordian knot or break the circle—the clichés roll on—and address this by saying that you must look for this problem, think of a strategy and get into the system some awareness of those who are using it. We must also make sure that the medical profession is prepared to take advice on this subject from outside. Unless we do these things we will not ultimately get the full benefits of a very sensible strategy. We must exercise our peripheral vision and think laterally on this, because it will touch every aspect of society. If we do not, the strategy will not work.

16:01

[Lord Ramsbotham (CB)]

My Lords, like other noble Lords, I congratulate the noble Baroness, Lady Tyler, on obtaining this debate and for the way in which she introduced it. I also echo her tributes to the Ministers Paul Burstow and Norman Lamb for their work in the mental health post. I agree entirely with her call for a cross-government mental health and well-being strategy, which has been long needed.

When I saw the list of speakers, I knew that I did not need to say anything about learning difficulties and disabilities, as the noble Lord, Lord Addington, was there. Every time he stands up I realise that we are listening to someone who not only uses his experience wisely, but is worth listening to because of the practical things that he always adds. I also welcome the noble Lord, Lord Suri. I was very glad to hear him concentrate on elements of the criminal justice system, particularly Feltham. Not surprisingly, that is what I propose to do as well: concentrate on the criminal justice system.

Before I do, I declare two interests, first as vice-president of the Centre for Mental Health, which has done a great deal of work in the reissuing, in particular, of carefully researched reports, which have provided everyone with a great deal information on the whole system and the problems within it. Secondly, I am chairman of the Criminal Justice and Acquired Brain Injury Interest Group. This is doing a great deal of practical work, and showing up some of the shortcomings in the criminal justice system in identifying and assessing the problems that people have, and what needs to be done about them.

Echoing the noble Lord, Lord Goodlad, I should explain that I was fortunate enough before becoming Chief Inspector of Prisons to chair the hospital at Hillingdon, which had a very large and extremely well run mental health unit. The director said, “You must train as a lay assessor or otherwise you’re no use to this hospital”. I am extremely glad that he did because he gave me an insight on which I have based all my subsequent experiences.

When I took over as chief inspector in 1995, I was extremely alarmed to find that healthcare in prisons was not the responsibility of the National Health Service. It seemed utterly absurd because people came from the NHS and went to the NHS. The staff were not NHS-trained, and I discovered that only 10% of medical officers in prisons were qualified to act as GPs in the National Health Service. I set out to try to do something about it. That aim was achieved in 2003, eight years later. I was very glad that we had quicker-minded people acting for the country during the Second World War.

Fairly soon after that, in 1998, the Office for National Statistics published psychiatric morbidity figures for all our prisons. It produced the figure that the noble Lord, Lord Addington, cited: 70% of prisoners have one or more identifiable personality disorders. That does not mean that they are certifiable under the Mental Health Act, although at least 500 a year are, but it means that there is something wrong. If you can identify it and do something about it, that could mitigate the bad behaviour or whatever it was that led them to commit their crime. It has always seemed to me that the proper assessment of whatever mental health problems people come in with has been sadly missing. It has always been said that treatment in prisons should be the equivalent of treatment in the NHS, but unless the assessment is right, you will get no treatment that is worth the name. The importance of partnership in that is that time in prison is when various organisations could get to grips with whatever physical or mental health problems a person has and use the time to advantage. That must be a public health benefit when people are released.

An improvement that came from the Health and Social Care Act was placing commissioning for offender services under NHS England. Having heard about it, I looked forward to the development of local health and well-being boards on which I hoped the criminal justice system would be properly represented. However, I am concerned about the inconsistency of these boards, and it worries me that they meet only quarterly. If they are to help the criminal justice system in particular, meetings need to be more frequent and consistency between what happens in one health and well-being board area and another needs to be developed.

Having said that, like the noble Lord, Lord Goodlad, I welcome the foundation of the mental health and well-being task force. It is a healthy development in this area. I particularly welcome its children and young people sub-committee. The five all-party groups that are studying children and young people’s mental health and emotional well-being are going to meet the sub-committee. That is particularly relevant for one of my current concerns, which is that I do not think that all is well within the criminal justice system. I am currently very concerned that due attention is not being paid to the mental health needs of detained children. That is confirmed by the proposal to build a secure college for 320 of them under the age of 18 in which the emphasis is to be on education which, it is alleged, is the key to a reduction in reoffending. What is being proposed is totally at variance with the advice of those who have any experience of the characteristics, problems and needs of the children who will be sent there. The scant acceptance of this advice is reflected in the insistence by the Secretary of State for Justice that educational outcomes are more important than the selection of suitable staff. How wrong he is: staff are absolutely key to anything that is done.

I have two other concerns. One is purely to do with the criminal justice system and the other with the linkage between that system and people outside it with mental health problems. My first concern is probation. There are 200,000 people currently serving community orders. Only 20% of CCGs believe it is their area team’s role to commission healthcare for those on probation. We have just got that figure through the Freedom of Information Act. Only 1% of CCGs are currently directly funding general healthcare in probation; 40% have nothing to do with it; the remainder have some association with it. Only 6% of mental health trusts provide services for probation and the majority of that takes the form of a half-day advice clinic once a week. That is wholly inadequate and something must be done, somehow, to connect the Ministry of Justice and the Department of Health to improve support for those on probation, who have exactly the same characteristics as the Office for National Statistics showed in 1998 for those in prisons.

My second concern is employment, which is absolutely key to the rehabilitation of any offender but is also crucial to the future well-being of people with mental health problems. Last week, I attended the launch of a report by the Mental Illness and Employment Task and Finish Group, which addressed the serious inequality of employment outcomes for people with and without mental health problems. It is a very good report and Norman Lamb spoke extremely well at its launch. I welcome the recent introduction of CCG outcome indicators on employment rates for people with mental illness because this will, at least, draw the facts to people’s attention. I welcome the Commissioning for Quality Innovation targets for supporting adults who are in contact with mental health services. This is an unresearched area and we need to do much more if we are really going to provide mental health services in this country that are worth the name.

16:13

[Baroness Chisholm of Owlpen (Con)]

I thank the noble Baroness, Lady Tyler, for initiating today’s debate and join your Lordships in congratulating my noble friend Lord Suri on his maiden speech.

In my lifetime, mental health services have gone through a radical transformation, perhaps more than any other part of the health system. When I started nursing, people with mental health problems were usually treated in large institutions. Today, as your Lordships know, care is focused mainly in the community. Multidisciplinary teams care for people in their own homes. Admissions are in small specialist units and for those requiring long-term care there are small residential units. This is, of course, the way forward, but unlike most other health complaints, mental health has its own very special problems. When those with mental health issues suffer an episode, they require immediate attention. An appointment one week or even a few days later can be too late and lead to disastrous consequences. Acute in-patient service provision has remained a challenge throughout the country, as has community care. With people being treated mainly in the community, the number of in-care beds has decreased, causing an increased number of out-of-area placements at substantial cost to authorities and with lengthy travel, leading to extra cost to clients and their families. But there is good practice going on that is making a considerable difference in certain areas and I would like to share two of these with your Lordships today.

I am closely involved with a charity called the Nelson Trust which has facilitated two women’s centres, in Gloucester and Swindon, treating clients with substance abuse. As the Corston report stated, more often than not these women have a history of mental health issues. The women whom we are seeing at the centres are those who have suffered trauma in their life, leading to depression, self-harming and personality disorders, and this in turn has led to substance misuse. Many of our clients have served custodial sentences and been in constant trouble with the police. When they are referred to us, the Nelson Trust can be their last chance to avoid a prison sentence.

We have heard from the noble Lord, Lord Ramsbotham, about the importance of looking after people with these problems in our society. In July 2014, Theresa May delivered a speech outlining the importance of ensuring that people with mental health problems are identified and diverted from the criminal justice system into appropriate healthcare and support service providers. The psycho-educational group programme at the Nelson Trust responds to these difficulties along with emotional and practical support not only to the client but, more often than not, treating the whole family. This brings huge financial savings to the community and treats the multiple problems that mental health can bring under one roof. The centres are closely involved with the police, probation and healthcare professionals, magistrates and housing providers.

In Cambridgeshire, our police and crime commissioner, Sir Graham Bright, facilitated a Cambridgeshire and Peterborough mental health crisis care concordat. This landmark agreement sets out how agencies that deal with people suffering from mental health problems will work together to support those experiencing a mental health crisis. Improved information-sharing, prevention and early intervention were just some of the commitments made in the declaration.

Those are just two examples of joined-up thinking which has brought a difference in these communities to both those suffering from mental health problems and the professionals who come into contact with them. Implementing known good practice that already exists provides good integrated mental health care, saves time and money and expedites the care that can be available. The King’s Fund stated in September 2014:

“Cultural change is as important as funding in transforming mental health”.

How true this statement is.

Mental health still carries a stigma, yet one in three of us will come into contact with mental health problems in our lifetime. It can affect people of any age, any socioeconomic group and is hugely destructive not only to those suffering mental health issues but to their families as well. We are at ease discussing other health issues, quite often intimate ones, but will rarely discuss mental health issues. This must change; mental health should be treated as a core public health issue so that it will be as normal for everyone to look after their mental health as it is to look after their physical health. The public health workforce must see mental health as one of its core responsibilities. The voice of the mental health community is finally being listened to and, as we are seeing today, the issues are being debated, but collaboration between commissioners, providers, service users, academics and clinicians and the justice system is still too rare.

Mental health cannot be considered in isolation and can rarely be separated from physical health. Therefore, as with most practices within the NHS, it requires a joined-up approach involving multiple stakeholder groups. A reduction in the number of people across the UK developing mental health disorders is surely the only way that mental health services will adequately cope with future demand. The case for more preventive work is therefore undeniable.

Arguably, the onus today is on GPs to run initial care and give treatment, instead of referring patients on to the appropriate professional. However, as one noble Lord has stated, some GPs have said that they felt out of their depth. Is this partly due to the downplayed role of psychiatric social workers, daycare workers and community psychiatric nurses? Could an acute episode be avoided if respite or suitable community care were more readily available when someone felt an episode building up, thereby saving considerable frustration and a feeling of helplessness for the client, as well as saving the considerable resources required for treating an episode once it reaches crisis proportions?

These are an inadequate few words on a massive subject that affects people from birth to death, leaving in its wake a feeling of helplessness, fear, frustration and loneliness among all those it touches. We must feel confident that, when seeking help for mental health problems, the appropriate healthcare experts will be immediately available to give us the appropriate treatment and care in the appropriate place.

16:21

[Baroness Janke (LD)]

My Lords, I, too, am grateful to the noble Baroness, Lady Tyler, for initiating this debate. I shall focus on the significant numbers of people with multiple and complex needs. They might be street drinkers, homeless people, an aging drug-using population; people with wide-ranging mental health issues, including complex trauma histories; many women trapped in the sex industry with significant multiple needs; and young people, including 16 to 17 year-olds. They might be individuals with serious health-related needs and long-term conditions who have a range of complex needs, some of whom are at the end of their lives, as well as increasing numbers of people who are unable to be housed due to the complexity of their needs and the risks associated with their behaviour.

These people often have at least three of the four needs areas: mental ill heath, homelessness, drug and alcohol misuse, and offending. They are also likely to have other significant factors such as: poor physical health, including long-term conditions; experience of complex trauma in childhood or early years; and experience of domestic abuse. This group is often the farthest away from services or only comes into contact with services when in crisis; they perhaps come into contact with the police, A&E or mental health crisis teams. In addition, gaps in services, or the way that services are provided, can mean that, in the worst cases, help is not available, or that people are passed round the system, having to deal with several different agencies—or, worse still, that they get into the revolving-door syndrome where they are constantly repeating their experiences and not receiving the support to ever move forward.

Mental health needs in this area are often undiagnosed, undisclosed, untreated, masked and compounded by other needs. It is an area where people have problems that are often considered too entrenched or too complex and they have no one to turn to. It is an area where traditional ways of working are simply not working. It is understandable that many of these people feel excluded and without hope. The conventional services are not addressing their needs but are being used in an ineffective and costly way. People with long-standing mental health needs are not well served by repeatedly ending up in A&E or in police custody. As many experts have said, the services provided for those with multiple and complex needs have to change. Indeed, the noble Lord, Lord Patel, said today that it is the services that are hard to reach.

I would like to highlight one project today that is particularly focused on this area of need; it is called the Golden Key project. The idea is that this golden key will unlock services. It consists of a partnership board, resulting from a Big Lottery Fund bid by a consortium of agencies working with Bristol City Council. The project helps people to drive their own recovery by providing support, by reconfiguring services, and by enlisting the help of people who have had the experience of living through similar issues and who have come through it to regain their own lives.

The project is at an early stage. As I said, it is run by a broadly based partnership on which the full range of interested groups are represented, including agencies that provide services, commissioners, clinical commissioning groups, peer mentors who have real experience, business, and city leaders who are championing this project. Key elements include a group of 300 individuals who sign up to the project “walking the journey” with a lead co-ordinator at a pace that is right for them. At the heart of the scheme are the peer mentors, who bring their own lived experience to support, and to inspire hope. Golden Key agencies and services are pledged to work together to make services accessible and sympathetic to needs.

Innovative aspects of this project include small personal budgets that encourage staff and their customers to think carefully about which practical measures might create early successes. There is a “telling your story once” website, with access controlled by the client, so that people do not have to repeat their personal information and story. One symptom of the current service is that an individual seeking support may have to tell his or her story to a range of different agencies. This website tries to bring services together and shape them to the individual who needs them. There will be a psychologically informed environments approach to deliver more effective services through a deeper understanding of clients’ needs. There will also be training and action learning to embed change.

Very many of us are aware of this complex area of need and care about these most deprived and excluded people. It is essential that these people’s acute need is fully recognised and that we look at ways of building on national and international examples of good practice. Through this, we must find ways of unlocking the future for a group of people who often do not believe that they have one.

16:27

[Lord Bradley (Lab)]

My Lords, I also congratulate the noble Baroness, Lady Tyler of Enfield, on securing this very important debate and on her very effective and wide-ranging opening contribution to it. I also congratulate the noble Lord, Lord Suri, on his excellent maiden speech. He will clearly be a very welcome addition to your Lordships’ House.

Mental health has rightly risen up the political agenda significantly in recent years. It is timely to take stock of the current issues and policy developments that have taken place during this Parliament. I declare my interest as a trustee of the excellent Centre for Mental Health, which undertakes superb work in this area.

Let us first consider further some background facts and figures. I make no apologies for repeating what many noble Lords have already mentioned. Mental health problems affect 23% of the population at any one time, the most prevalent of which are depression and anxiety at 17% of the total. As we have heard, the economic and social costs of mental ill health are estimated to be £105 billion annually. As the NHS Five Year Forward View points out, this is roughly the cost of the entire NHS budget. Mental ill health accounts for 23% of all ill health—more than heart disease, cancer and diabetes—and causes as much ill health among working-age people as all physical illness combined. Some 10% of children aged five to 15 have a mental health problem. Three-quarters of people with depression receive no treatment at all. A third of people with a long-term physical illness also have a mental health problem. This costs the NHS an extra £10 billion in extra prescriptions, hospital admissions and more expensive treatments.

As we have heard, nine out of 10 prisoners have a mental health problem, and mental health research funding—as we have heard again—is appallingly low. As the organisation MQ points out, the scale of mental health research is not proportionate to the burden of disease. The spend on mental health research is just 5.5% of the total research spend in the UK, despite the fact that mental health problems, as we have heard, affect around one-quarter of the population in any one year. MQ further points out that a major challenge in the mental health funding landscape is that, in contrast to the other major health conditions, public funding of mental health research is virtually non-existent. For every £1 that the Government spend on cancer research, the general public invest £2.75; for heart and circulatory problems it is £1.35. For mental health research, the figure is 0.003p. I am not arguing against such public investment in other disease groups; I am simply putting mental health research in that broader context. Like the noble Lord, Lord Patel, I look forward to the Minister’s response on that point.

Against that backdrop, what have been some of the key policy pledges made by the Government on behalf of those suffering with mental health problems, and what appears to be the current position on each? First, there are new access standards for mental health, which are clearly welcome. Announced in October 2014, they include, from April 2015, waiting-time standards for improved access to psychological services, and early intervention in psychosis services. The Department of Health’s five-year plan to improve access to mental health care pledged to follow this up with further standards, for example in urgent care and in child and adolescent mental health services. This must be completed to ensure that we have genuine parity of access to mental health care, as we do to urgent and elective care for a range of physical illnesses. There must also be comparable entitlement to NICE-approved interventions to ensure that there is no compromise on quality. Such entitlements are essential to delivering parity of esteem. However, I noted carefully the views of the noble Lord, Lord Patel, on that point.

Secondly, on mental health care funding, data suggest, as we have heard, that NHS spending on mental health services has fallen in real terms each year from 2011 to date. This is putting services under great pressure, leading to disinvestment in effective interventions such as crisis resolution and home treatment, and placing extra pressure on hospital beds. It is even leading to bed closures where there is often already underprovision. Local campaigns, such as those in Waveney and other areas of the country, have been initiated to protect vital local mental health services. I would be grateful for the Minister’s views on that situation, as well as for his view on the Royal College of Nursing’s view that there are now 3,300 fewer posts in mental health nursing and 1,500 fewer beds than in 2010. Planning guidance recently published by NHS England asked CCGs to secure real-terms increases in mental health spending for 2015-16. It is vital that this is implemented and that accurate records are kept of spending on mental health services for adults and children.

Thirdly, on crisis care, the crisis care concordat was published a year ago, as we have heard, and is welcome. It sets out the standards expected in all local areas. The deadline for localities to produce crisis care declarations has now passed. These should be followed up with local action plans to implement agreed measures. The tracking map shows that all areas have now made declarations but that few have action plans to go with them. It is unclear how local organisations will be held accountable for achieving progress and how it will be monitored. I hope the Minister will be able to elaborate on that point.

Next comes liaison and diversion, in which I have a particular interest. NHS England recently announced the expansion of the national programme of liaison and diversion services to cover half the population of England. This is welcomed but we must ensure that it is extended nationwide by the committed-to date of 2017. However, there is also a need for CCGs and other commissioners to commission services to which people can be diverted to make the investment in such services as effective as possible. I hope that the Minister can reassure us on that point as well.

Finally, on employment, the Government have recognised that the Work Programme is not offering adequate help to people with mental health problems, and they have invested in a pilot to trial the adaptation of the individual placement and support approach for people with common mental health problems. This work needs to inform the future of the Work Programme. I also commend the report that has been mentioned, published on Tuesday, on addressing the serious inequality of employment outcomes. It makes very clear recommendations on how to improve employment opportunities for people with severe mental health problems, such as schizophrenia, about which the noble Lord, Lord Goodlad, spoke so eloquently earlier.

In spite of those initiatives, which are clearly welcomed, there remain many weaknesses and concerns. We have already talked about the real-terms reduction in funding and about the fact that people with mental health problems have been adversely affected by continued weaknesses in the work capability assessment and, in some cases, by the use of benefit sanctions. We have heard about schools being given little support in promoting mental health and the removal of well-being from Ofsted inspections. We have also heard of the major concerns in children’s mental health services, which have experienced particularly large cuts. Last year, two-thirds of councils and three-quarters of CCGs cut or froze CAMHS spending. A recent Parliamentary Answer showed that the aggregate PCT/CCG expenditure on CAMHS fell in real terms from £758 million in 2008-09 to £717 million in 2012-13, and I suspect that it has continued to fall. The position is exacerbated by cuts in youth services, many of which have a positive impact on well-being and prevent the emergence of later problems.

Finally, what should be done to ensure that these situations are addressed? This afternoon we have heard many good examples of new initiatives. We must continue to explore ways of making the NHS constitution fairer, including a wider range of access standards and entitlements to NICE-approved interventions. We must consider revising payment systems for all mental health services to put mental and physical health on an equal footing. We must ensure that the NHS, public health and social care outcomes frameworks and the quality and outcomes framework for GPs properly represent mental health priorities. We must invest in cost-effective interventions—which are currently undermined by a postcode lottery—for, for example, perinatal mental health care and parenting programmes, and, crucially, we need early intervention in psychosis and individual placement and support.

My time is almost up but that list is not exhaustive. The quality of this debate shows how many initiatives people understand and want to progress through the development of mental health services. Whether we are talking about adults or children, they need and deserve that support, and I hope that this high-quality debate will help to progress that agenda.

16:39

[Baroness Jolly (LD)]

My Lords, I thank my noble friend Lady Tyler for tabling the Motion for this excellent debate. It has really been a series of mini-debates. We have had experts of all sorts bringing their experience to bear on subjects such as parity of esteem, maternal health, dual diagnosis, children and young people, prisons and public health, to name but a few.

Mental illness can emerge at any age and can have highly significant impacts across much of the life course for the individual, their family and the community. The noble Lords, Lord Goodlad, Lord Farmer and Lord Bradley, among others, have outlined some statistics—and I have some more. We know that at least one in four people will experience a mental health problem at some point in their life. Mental health problems are the single largest cause of disability in the UK, contributing up to 22.8% of the total burden, compared to 15.9% for cancers and 16.2% for cardiovascular diseases. It is estimated that the wider economic costs of mental illness in England are, according to anyone’s figures—and we have heard several this afternoon—enormous.

The noble Lords, Lord Patel and Lord Goodlad, raised the issue of parity of esteem. This has been a game-changing issue. The Government’s commitment to prioritising mental health is encapsulated in the principle of parity of esteem—equal priority for mental and physical health—which was set out in our 2011 mental health strategy, No Health Without Mental Health. This commitment to parity was made explicit in the Health and Social Care Act 2012. Many noble Lords here will remember that vote well and many will be grateful for it.

The 2014-15 mandate to the NHS sets an explicit target for NHS England to make measurable progress to ensure that,

“everyone who needs it has timely access to evidence-based services”.

My noble friend Lady Janke referred to the challenges posed by those who only attend emergency and crisis services. In October 2014, NHS England set out its vision on the future of the NHS in its Five Year Forward View. This recognises that,

“the NHS must drive towards an equal response to mental and physical health, and towards the two being treated together”.

As part of that commitment, for the first time ever, waiting time standards will be introduced in mental health services in 2015-16. My noble friend Lady Tyler referred to these. They will include: 75% of people referred to the Improving Access to Psychological Therapies programme will be treated within six weeks of referral, and 95% will be treated within 18 weeks of referral; and at least 50% of patients experiencing a first episode of psychosis will be treated with a NICE-approved care package within two weeks of referral.

On the subject of child and adolescent mental health services, my noble friend Lord Addington spoke movingly about the fact that, if people are different, mental health problems can follow them. He spoke about dyslexia, dyspraxia and autism. It is estimated that 50% of mental illness in adult life begins before the age of 15 and that 75% of mental illness in adults starts before the age of 18. Early intervention is known to reduce not only the incidence, duration and severity of lifelong mental health problems, but also the cost of mental health problems to the economy. We will invest £30 million a year over the next five years to improve services for young people with mental health problems. We are also investing £54 million over the period 2011 to 2015-16 in the Children and Young People’s IAPT programme, to transform child and adolescent mental health services. In August we set up the Children and Young People’s Mental Health and Wellbeing Taskforce, to focus on innovative solutions to improve outcomes for children and young people’s mental health. It will report to Ministers in spring this year.

My noble friend Lord Storey brought his experience as a head teacher to the debate. I can tell him that I have recently spoken to the Care Minister, Norman Lamb, on the issues that he mentioned, about how things will work and the work that will be going on with the Department of Health to try to nail some of those problems.

Mental health crisis care is crucial. People in mental health crisis need speedy access to safe and compassionate care in the right environment. My noble friend Lady Janke gave us an example of a multidisciplinary, multiagency approach in Bristol—the Golden Key approach. We know that an effective response can often prevent an in-patient admission, which is disruptive to an individual’s life and their well-being, as well as costly to the taxpayer. It can also help to avoid totally unacceptable admissions a long way away from people’s homes. The first national crisis care concordat was published in February 2014 to improve service responses to people in mental health crisis and, in particular, to keep people in mental distress who have committed no crime out of police cells. The concordat—the noble Baroness, Lady Chisholm of Owlpen, spoke about the Cambridge one—is a national commitment for agencies to work together to support people in crisis to find the support that they need.

The 2014-15 mandate to NHS England specifies that NHS England must make rapid progress, working with clinical commissioning groups and other commissioners, to help to deliver on the shared goal to have,

“crisis services that, for an individual, are at all times as accessible, responsive and high quality as other health emergency services”.

That picks up on the question asked by the noble Lord, Lord Patel. I can report that, as of 22 December 2014, every local community now has its own local crisis care declaration in place. Local action plans, most of which are expected in the first quarter of 2015, will make sure that improved crisis care is embedded in services for years to come. I have too many responses to contain in this speech, so I will use this opportunity in answer to the noble Lord’s question on how these will be followed up and monitored to say that that will go out in a letter that I shall send to all Peers.

On offender health, my noble friend Lord Suri brought up the important issue of mental health in prisons. I congratulate him on his maiden speech and look forward greatly to his work in your Lordships’ House. I can assure the noble Lord, Lord Ramsbotham, that the NHS provides treatment and care according to clinical need, so offenders, irrespective of gender, should receive the same range and quality of treatment and services as anyone else. Offenders within the criminal justice system—whether in the community or outside—with mental health needs should have their treatment delivered in the most appropriate setting, whether in prison or in the community. We should listen to his wise words on the issue of young offenders’ mental health. We have committed £25 million to introduce a new standard service specification of liaison and diversion services in England to identify and assess the health issues and vulnerabilities of all offenders when they first enter the criminal justice system. Prison healthcare has improved significantly since the NHS first became responsible for commissioning it in 2006 and it continues to improve. But we should not be complacent. The noble Lord, Lord Ramsbotham, also mentioned health and well-being boards. These were set up locally to meet local needs, so the frequency of their meetings will be determined locally, not nationally.

On mental health information, the lack of mental health data is an issue that goes to the heart of equal priority for services. We do not have the same level of information on mental health services as we do for physical health. Information that has proved so critical in driving improvement and service change in the rest of the NHS is either absent or incomplete for mental health. We are driving forward plans to address gaps in mental health information on prevalence, waiting times and access, outcomes, spend, uses of out-of-area placements and restraint. To further the parity agenda, data from across the health and care system has, for the first time, been brought together on the NHS Choices website. Key in this is the inclusion of a specific mental health section. This level of data will help to facilitate evidence-based decision-making, drive up quality and standards and ensure genuine accountability for the services provided. It will, in time, create the most transparent mental healthcare system in the world.

The noble Lord, Lord Goodlad, raised the issue of schizophrenia and questioned why little progress had been made on schizophrenia research. More than £400 million is being invested over the spending review period to make choices of psychological therapies available for those who need it. We are investing in improving provision, including for those with severe mental health conditions.

Data are also vital to research, helping us to provide the evidence that we need to transform services. Investment in mental health research by the National Institute for Health Research—the NIHR—has nearly doubled in the past four years, from £40 million in 2009-10 to £72 million in 2013-14, and we will continue to support the work of the NIHR and the network of specialist clinical research facilities in the NHS.

From September 2014, more than 800,000 people with the most complex physical and mental healthcare needs are benefiting from the Proactive Care Programme. This is being delivered through an enhanced service to the GP contract. Many of these people will have complex physical and mental health needs and this initiative will ensure that they get personalised, joined-up care and support, tailored to their needs.

NHS England is working with commissioners to make mental health a bigger priority, with better integration of physical and mental healthcare in primary care and, indeed, in all settings. Improving the diagnosis of mental illness is one of four national goals for 2014-15. Providers will be rewarded for better assessing and treating the mental and physical needs of their service users.

The issue of training for GPs was raised. The Royal College of General Practitioners has a programme around training. However, there are two issues: one is the training of new GPs before they go out and practise; the other is the ongoing training of GPs in all the new developments. The noble Lord, Lord Bradley, raised the issue of the mental health workforce. Health Education England has increased training places for mental health nurses by 3.2% for 2015-16.

As for mental health unemployment, getting people back to work is a priority for the Government. Jointly with the Department for Work and Pensions, we commissioned external policy advice from RAND Europe on how we can achieve better outcomes for people with common mental health problems. Based on the recommendations put forward this year, we are taking forward a number of feasibility pilots to explore the most promising and evidence-based approaches.

My noble friend Lord Addington addressed the issue of ensuring awareness among healthcare professionals of potentially vulnerable groups. As the mandate to NHS England makes clear,

“everyone who needs it should have timely access to evidence-based services”,

including people with autism and learning disability. In line with the Equality Act, we expect all service providers to make reasonable adjustments so that disabled people are not placed at a disadvantage compared with non-disabled people.

My noble friend Lady Tyler raised the issue of Time To Change, the country’s largest anti-stigma and anti-discrimination mental health campaign—indeed, several other noble Lords mentioned it—which the department currently funds by up to £4 million a year. Between December 2012 and December 2013, we have seen a 20% decrease in the number of life areas in which people experience discrimination. On discrimination for black and minority ethnic patients, this Government are committed to tackling inequalities in access to mental health services. The commitment to reduce inequalities is in our action plan, Closing the Gap. The 2014-15 mandate to NHS England makes it clear that everyone should have access to the mental health services that they need.

On the issue of mental health and perinatal health for mothers, the mandate to NHS England includes an objective for NHS England to work with partner organisations to reduce the incidence and the impact of post-natal depression through earlier diagnosis and better intervention and support.

On the budget, mental health funding is not ring-fenced. However, we expect commissioners to demonstrate parity of esteem when agreeing financial statements. Aggregate CCG expenditure is not yet available for 2013-14, but NHS England advises that total mental health spending in 2013-14 was £11.3 billion with an estimated £11.6 billion planned for the following year—an increase of £302 million.

There are many other issues that I will write to noble Lords about. I am proud of the Government’s record on mental health, of the role of my honourable friends Paul Burstow and Norman Lamb in the other place and of the commitment and leadership of the DPM. But as the noble Baroness, Lady Tyler, has highlighted, there is still more to be done. I would not want to suggest any complacency on the part of the Government on this vital issue. I feel confident that, whatever May brings us, Members of your Lordships’ House will keep the feet of the new Government well and truly to the fire on issues of mental health. I particularly thank the noble Lord, Lord Farmer, and the noble Baroness, Lady Tyler, for giving us some ideas for the new Government to start with.

16:57

[Baroness Tyler of Enfield]

My Lords, this has been an excellent debate drawing on the wealth of expertise, knowledge and first-hand experience of all the speakers. I thank all noble Lords who spoke and especially commend my noble friend Lord Suri for his excellent maiden speech. I also thank the many local health organisations that provided me with briefing; I particularly thank Mind for its help.

I do not think that anyone who listened to the debate this afternoon could be in any doubt about the strength of feeling on this issue, the importance of mental health to the country’s well-being or indeed the scale of the challenges ahead. Those challenges are for central government, but also for the NHS, local councils, the voluntary sector, communities and, indeed, families.

I leave noble Lords with one thought: many speakers this afternoon, myself included, talked about or implied that the problem was around the issue of institutional bias against mental health within the NHS. I feel that that sort of culture has started to change, given that one quarter of the population in this country experience mental health problems at one time or another, a quarter of all managers in senior leadership positions have a mental health background and a quarter of all the thinking and doing time in the NHS is spent on mental health.

Motion agreed.

Insurance Bill [HL]

Thursday 15th January 2015 Lords Chamber

Third Reading

16:58

Bill passed and sent to the Commons.

Developing World: Maternal and Neonatal Mortality

Thursday 15th January 2015 Lords Chamber

Question for Short Debate

17:00

Asked by

[Baroness Hayman]

To ask Her Majesty’s Government what progress has been made in reducing maternal and neonatal mortality in the developing world; and what plans they have to build on this work post-2015.

[Baroness Hayman (CB)]

My Lords, I am grateful for the opportunity to introduce this debate, and delighted that noble Lords from all Benches of your Lordships’ House are planning to contribute on this important issue. I declare my interests in health and development, particularly my chairmanship of the external advisory group of the Centre for Maternal and Newborn Health at the Liverpool School of Tropical Medicine.

It was in this role that last year I visited Zimbabwe and saw for myself the power of the Making it Happen programme run by the centre in 11 countries, supported by DfID. I saw UK volunteers, an obstetrician and a midwife, together with Zimbabwean master trainers who had been through the course before, supported by the country’s Ministry of Health, running the course for Zimbabwean health workers, giving them the skills to save the lives of mothers and babies and to pass on those skills to their colleagues to ensure sustainability and improved services countrywide.

I will step back from the specific to address the scale of the problem. The statistics are chilling. Some 300,000 women die every year; 800 women die every day in pregnancy and childbirth; 50 will die in the course of this short debate. There are an estimated 2.6 million stillbirths and 3 million neonatal deaths every year; half of those neonatal deaths occur in the first 24 hours of life. A child dies somewhere in the world every five seconds, overwhelmingly of preventable causes.

These maternal and neonatal deaths are not evenly distributed. The maternal mortality ratio shows the highest discrepancy: the greatest gap between high and low income settings of all international health indicators. In the UK, the maternal mortality ratio is eight per 100,000. In Sierra Leone, it is 110 per 100,000. That is the last figure that we have; I hate to think what the figure will be for the last 12 months when the ravages of Ebola have put into abeyance the most basic health services that were available in the past. The average for neonatal mortality in developed countries is 3.7 per 1,000 live births; in southern Africa and south-east Asia it is 10 times that; 99% of all maternal deaths and 98% of all neonatal deaths occur in low or middle-income countries.

Within developing countries there are wide variations, with the poorest, the youngest, the least educated, and rural women most at risk. The deaths are not the end of the story. For every woman who dies in childbirth, it is estimated that 20 to 30 live but suffer lifelong morbidity such as fistula. The health and survival of babies is dependent on the health and survival of mothers, not only in the quality of antenatal, intra-partum and post-partum care, but evidenced by the fact—I have lost the reference for this statistic, but I am sure someone will tell me—that a motherless child is 10 times more likely to die in the first two years of its life than a child who has a mother to care for them.

It was the recognition of this tsunami of suffering and the obstacle to development that the figures represent—because we all know how crucial women are to development—that led to the introduction of millennium development goals 4 and 5, of reducing child deaths by two-thirds and maternal deaths by 75% by 2015. When the Minister comes to answer the question posed in the title of this debate, I am certain that she will outline the considerable progress that has been made since 1990.

I pay tribute to the work that has been done in developing countries by DfID and other international agencies in just about halving those deaths. The figures have been helped of course by the progress in other MDGs, for example in relation to HIV/AIDS and malaria, and perhaps point us again, looking forward, to the importance of joined-up healthcare and healthcare for all.

However, it is disappointing that the progress that has been made has, again, not been evenly distributed, and that some of the countries that have the worst figures, and which need the greatest improvements, are ones that have seen the least change in their statistics. I ask the Minister to address the issue of how, post-2015, we attend to the unfinished business in the millennium development goals and ensure that we do not take our eye off the ball in these hugely important areas where we need to make sustained efforts in order to continue with the progress made so far.

I have not said a lot so far about the causes of maternal and newborn mortality, and how this terrible toll of death and suffering can be reduced. That is partly because when I asked a local expert for help in preparing for this debate and what she thought I ought to stress and what ought to be said, she shrugged her shoulders and said, “There is nothing new to say. We know what the issues are and we know how they can be addressed. What are needed are the resources and the political will to do it”.

You can go through the list of causes of maternal and newborn death: poor nutrition, existing medical conditions—which are often the diseases of the poor, such as malaria—unsafe abortions, infections, eclampsia, haemorrhage and obstruction in labour. The last three of these can be addressed by specific programmes of maternity care, but the first are much wider issues relating to water and sanitation, education for girls, an end to child marriage, immunisation programmes, and access to family planning and antenatal intra-partum and post-partum care from trained and skilled birth attendants. That is where programmes such as Making a Difference can have profound effects: in the first phase of those programmes, maternal death rates in areas where they had been implemented reduced by as much as 50%. The decision we have to make globally is about the priority that we give to the quality of women’s lives and the numbers of women’s deaths.

In the early 17th century, Joseph Hall, who was then Bishop of Exeter, wrote:

“Death borders upon our birth, and our cradle stands in the grave”.

That is no longer true in this country. It need no longer be true in the developing world. But to stop it being the reality for millions in that world, we have to put the resources and the priority into work to reduce maternal and neonatal deaths.

[Lord Bourne of Aberystwyth (Con)]

As the debate gets under way, I respectfully remind noble Lords that this is a time-limited debate.

17:09

[Baroness Hodgson of Abinger (Con)]

My Lords, nearly every minute of every day a woman dies from complications in pregnancy and childbirth. Yesterday 800 women across the world died; 800 will die today and every day until the end of the year and into next. On average, 9,000 babies will die at birth or in the first week of life each day of this year too. In this day and age these are truly shocking figures.

I congratulate the noble Baroness, Lady Hayman, on having secured this debate which encompasses two of the most important millennium development goals—to reduce child mortality and to improve maternal health. Of course, these two goals go hand in hand and I am heartened that the title of this debate recognises it.

There has been improvement. Since 1990, maternal mortality has declined by nearly half. Although progress has been made in all developing regions, as we have already heard, there are vast geographical disparities and it is now estimated that 99% of maternal deaths occur in developing countries. In 2013, the maternal mortality ratio in developing countries was 230 per 100,000 live births, compared to 16 per 100,000 in the developed world. For example, one woman in 30,000 dies as a result of pregnancy and childbirth in Sweden, whereas in Afghanistan it is about one in six. So many of these deaths are preventable. These women will not have had the pain relief and epidurals that we have come to expect here. Many will have had to endure many hours of excruciating and unbearable pain before they die.

Neonatal mortality rates have also declined significantly over the past 20 years, but to have between 3 million and 4 million babies a year currently dying is truly appalling. Cocooned in the Palace of Westminster, we might find these overwhelming impersonal statistics numbing, but we should remember that each and every one of these deaths is a devastating tragedy for those involved. It is a tragedy for the children who lose a mother—and children who have lost their mothers are 10 times more likely to die prematurely—and a tragedy for the mother who loses a baby. In the West these losses are mercifully rare but, having lost a baby at birth myself, I know personally that it is a very hard thing ever to come to terms with.

For every woman who dies, at least 20 more suffer complications which may leave them with lifelong crippling disability and pain. Lack of obstetric care may result in fistula, resulting in them being shunned by their families and the community. Traumatic births can cause postnatal depression—something rarely mentioned in the context of developing countries. Today in the UK, 10% to 20% of women develop a mental illness during pregnancy or within the first year after having a baby. With the right help, women can recover but, without that help, they may never be able to function properly again. For a baby, even slight oxygen deprivation at birth may cause life-changing damage—either physical or mental.

Many of these deaths are avoidable but, to ensure the fundamental well-being and survival of both mothers and babies, every woman needs access to a trained doctor or midwife. In countries such as Afghanistan, only 14% of births are attended by a health worker. Every year, across the world, 46 million babies are delivered without any skilled assistance.

I have seen the challenges from my visits to various countries. For example, I remember visiting the district hospital in Koinadugu in Northern Province, Sierra Leone a few years ago. There was only one doctor in the hospital, who was also the district health administrator. He explained that some of the villages in the district were 100 miles away from the hospital and there were no roads. Although there was a system of outlying clinics, none had doctors and most had no trained nurses either. The radio system to them from the hospital was broken. There are similar tales in many other developing countries. So it is not just about ensuring that there are enough doctors and midwives in these countries; it is also about ensuring that the medical care that is so vitally needed can be reached.

Harmful traditional practices such as FGM and early marriage, all too prevalent in some developing countries, also contribute to maternal and child mortality. Lack of adequate nutrition can also be a cause. Lack of gender equality impacts, too. For example, there are clear connections between women’s lack of access to education and reproductive rights and health. In some countries, girls commonly have to leave school due to pregnancy or for early marriage—that is, if they have attended school at all. I recently visited Mali, which has one of the highest child marriage rates in the world. Half of the girls there will be married before they are 18. In addition to greater vulnerability to domestic violence and the contracting of diseases, these child brides are more likely to bear children before they are physically ready, thus exposing them to extreme risk. Newborn baby deaths are also 50% higher when born to those under 20.

Women need to be empowered in a wider cultural sense by having control over their sexual and reproductive activity. It is estimated that 215 million women in the developing world want to delay or avoid pregnancy, with as many as 50% of pregnancies being unplanned and 25% unwanted. Having to have baby after baby wears a woman out, with each pregnancy multiplying her chance of dying from complications. It is estimated that a third of these deaths could be avoided if women had access to contraception services, which would help avert unintended and closely spaced pregnancies and reduce instances of unsafe abortions. This is because one-quarter of all pregnancies end in abortion and 19 million of those abortions are unsafe, resulting in 68,000 deaths per year and many women suffering complications and infections. So the provision of proper contraception is crucial in improving reproductive health and tackling maternal mortality.

I particularly welcome the debate today, as in spite of the improvement of the last 20 years the situation is still unacceptable. We need to be resolute in tackling the causes in developing countries because we still have a long way to go until every woman and child across the world receives the care that we, in the western world, take for granted.

17:16

[Baroness Kinnock of Holyhead (Lab)]

My Lords, I, too, thank the noble Baroness, Lady Hayman, for introducing this debate and for doing so in such a compelling and expert way.

In large parts of the world, poverty means that great numbers of women die from a lack of family planning, an inability to negotiate the number and spacing of children, the lack of money to pay for skilled birth attendants or emergency obstetric care, and violence. In spite of some welcome progress, it is clear that MDG 5, on reducing maternal mortality and achieving universal access to reproductive health, is far from being fulfilled. However, as affirmed by the UN Commission on the Status of Women, the elimination of preventable maternal mortality is possible in the next decade but it will, clearly, require a major scaling-up of our efforts. Does the Minister agree that sexual and reproductive healthcare for women and girls should be a specific priority, separated from maternal health, so that its allocation and impact can be properly measured? Is the Minister aware that around only 1% of ODA is currently allocated to family planning?

DfID has also committed to,

“enable 10 million more women to access family planning (of which 1 million will be girls aged 15-19)”.

How confident is the Minister that this objective can be met, since only 4,966,000 have been reached to date? Does the Minister agree that, as DfID spending on humanitarian assistance is increasing, it is vital that a comprehensive package is offered in emergency settings, such as conflicts and disasters, and that this should include access to sexual and reproductive health?

The UN high-level panel established to prepare the post-2015 agenda for action estimates that 800 women die every day from complications related to pregnancy and childbirth and, according to the WHO, 99% of those maternal deaths occur in developing countries. In addition, medical experts testify that, globally, every year there are about 80 million unplanned pregnancies and 20 million unsafe abortions with the result that, as Marie Stopes International points out:

“Worldwide, one woman dies every 11 minutes from an unsafe abortion”.

Unsafe abortion is a major cause of maternal mortality and remains a major public health and human rights concern. Being able to make an informed choice and take control of your own reproductive health is surely a basic right. Does the Minister agree with the view that Governments and donors need to prioritise what women want, rather than what they feel most comfortable with doing and providing? Such a change is urgent. I remember talking to Beth outside her home in rural Tanzania. Such were the perils of childbirth that before she went into labour she would say goodbye to her children. Giving life should surely not mean taking such a risk.

A post-2015 assessment says that aiming to reduce newborn mortality by 70% will prevent 2 million child deaths every year. Such evidence highlights the urgent need to provide expectant mothers with nutrients, protection against disease, nursing care, clean water and hygiene facilities. All these initiatives can save precious lives and are taken for granted in the developed world. No girl should die giving birth and no child should die because its mother is too young. Each year around 1 million babies born to adolescent girls die before their first birthday.

These issues go beyond family planning. Campaigns and condom distribution are irrelevant to women and girls who simply do not have the power to make the decisions. A country’s current status and future prospects are clearly illuminated by examining, for instance, the lifetime risk of maternal death, the percentage of women using modern contraceptives, women’s literacy rate, their participation in national growth and the enrolment of girls in school.

The reality is that gender inequality remains a major propellant of poverty and women’s marginalisation, and a basic cause of underdevelopment. Faced with that reality, it is clear that little will change until the underlying root causes of discrimination are plainly and publicly identified as gender inequality and pervasive, discriminatory norms. Religious, cultural and social barriers impose overt discrimination that stands in the way of women’s freedom to choose.

One hundred and ninety-three Governments are currently gearing up for the UN discussion, at September’s annual meeting, on priorities for the next decade and a half. Currently, there are 17 goals and 169 targets. However, we can safely say that there will be a stand-alone goal on gender equality, women’s rights and empowerment. This will include universal access to sexual and reproductive health, and rights to be mainstreamed across all other goals. The task is to prevent an estimated 640,000 newborn deaths and 150,000 maternal deaths each year, which will result in 600,000 children having to grow up without a mother. When motherless children are 10 times more likely to die within two years of their mother’s death, the urgency is graphically obvious.

To achieve such advances we will indeed need political leadership. When fundamental rights are upheld, women, girls and young people can thrive. They can gain education, get better jobs with better wages and therefore reach their full potential. That objective is essential and, I believe, achievable. It will serve every interest. It must gain active support. The British Government have a duty to take the lead in that mission.

17:23

[Lord Patel (CB)]

My Lords, I join the noble Baroness, Lady Hayman, in the tribute that she paid to DfID for the work that it has done and continues to support in areas of reducing maternal and child mortality. I emphasise that in the hope that DfID will not now stop but put extra vigour in joining other partners in delivery until we achieve the goals.

As has already been said, the statistics—which will be cited by others—are horrendous. A woman giving life should neither die nor go through childbirth only to have the heartbreak of losing her child at birth or in infancy. The noble Baroness, Lady Hodgson, described her experiences, which I well understand. Yet for many mothers and their children this is a reality. Three hundred thousand women die every year during pregnancy. For children, the statistics are worse. There are 131 million births a year; of these, 6.3 million children die before the age of five. That is 17,000 deaths of children every day. One million babies are stillborn. Two million die in the first week of life, and for 1 million babies the day of their birth is the day of their death. While progress in reducing maternal and infant deaths has been significant over the past two decades, many millions continue to die, and 223 million children under five died between 1990 and 2013. Four out of five deaths of children aged under five occur in sub-Saharan Africa.

While the number of deaths of children under five has declined, the decline in the number of deaths around birth and in the first month of life is not so striking. Neonatal deaths now account for 44% of deaths of children under five. There has been no noticeable reduction in neonatal deaths. Some interventions focused on the 24 hours after birth hold great potential for reducing maternal and neonatal deaths. We know the causes of death and how to prevent them, but we have not succeeded in delivering health interventions widely and consistently throughout the world or in developing sustainable health systems.

Two-thirds of neonatal deaths occur in 10 countries, and 48%—nearly half—occur in four countries: India, China, Nigeria and Pakistan. Two-thirds occur in only two countries, India and Nigeria, and both of them are capable of developing health systems that would stop them, so what must we do to encourage them to strengthen their health systems?

The causes of neonatal deaths are pre-term births, complications at birth, infections and sepsis and congenital abnormalities. Basic, cost-effective care in the first hour after birth results in significant reductions in maternal and neonatal mortality. For example, breastfeeding in the first hour of life reduces deaths by 40%, yet only 50% of newborns are breastfed in the first hour of life, particularly in vulnerable parts of the world. Skilled attendants at birth and the use of a maternal and neonatal checklist which includes simple tasks, such as cord care, dramatically reduces neonatal mortality, yet 44% of women in some countries do not have skilled attendants, and even when there are attendants at birth, simple interventions are not delivered. For example, only 10% of babies delivered by skilled attendants received seven key neonatal interventions, so we must ask why, even when there are skilled attendants, they do not happen. Hence, we have developed a checklist for maternal and child health at the time of birth to try to make sure that those interventions, including breastfeeding, can be delivered.

The charity, SafeHands, of which I am a patron, as is the noble Baroness, Lady Kennedy of The Shaws, who is not in her place, tries to use education using visual media in rural villages in Ethiopia and other countries to deliver messages about the importance of basic care and attendants at birth, which can have dramatic effects.

What of the future? The world needs to fulfil the promise made to the children of this world in 2000. The MDG 4 target will not be met in 2015. At the current rate, it will not be met until 2026. We need a new commitment, not just the targets of 2015, even if we could meet them in 2026. We need a new commitment to children going beyond MDG 4 that by 2035 every country will see a neonatal death rate of 10 per 1,000 births and a stillbirth rate of 10 per 1,000 births. The challenge could be 20 by 2035, to mothers and their babies underpinned by helping to establish sustainable health systems.

The UK Government have done so much to advance these causes and lead the world. What commitment will they make beyond 2015 towards efforts to reduce maternal and childhood deaths?

17:30

[The Lord Bishop of Derby]

My Lords, I too congratulate the noble Baroness, Lady Hayman, on securing this debate and on introducing it with such expertise and such a challenging sense of the statistics. Millennium development goals 4 and 5 are not being met and, as other speakers have said, the consequences are horrendous. My contribution will be from my own experience working with people at the grass roots, and I will then tease out what the implications of that experience should be.

I work in the diocese of Derby, in England, and we are twinned with the Church of North India, which extends from Calcutta to Mumbai—the whole of north India is twinned with our diocese in an ecumenical link. I work with people in a number of Indian communities where this issue is enormous. In 2012, one-third of global neonatal deaths happened in India. The highest rate of first-day mortality is in India. That is the context in which we are working with our partners, through whose eyes we discern some factors.

The first, as other noble Lords have said, is poverty. People just do not have the means to call medical help and there is no local infrastructure available anyway even if they could. That kind of poverty is a major factor. The second factor is the lack of education about basic hygiene. I visited slums in Calcutta with the Cathedral Relief Service, which trains very young girls of 10 to 12 to wander in and out of people’s houses, giving good advice about hygiene and childcare. This helps families learn good practice in an unthreatening way and will produce a new generation of young mothers with those skills. This is a practical, grass-roots response.

My colleagues in India would say that the third factor is that a lack of respect for women and girls is behind these terrible statistics. The attitude so often is that this is their role—illness is not taken seriously—and their job is to run the household. New mothers are expected just to get up and carry on with things. Fourthly, in the urban areas, the issue is not so much a matter of the infrastructure being hundreds of miles away but that whole families live on pavements and give birth there. I was in Calcutta in December and saw families living in the street with no resources, cutting the cord with an ordinary knife because that was all that was at hand.

That was a snapshot of some of my experiences; what are the responses? I work with ISPCK—the Indian version of the publishing house—and the Cathedral Relief Service in Calcutta. As the noble Baroness, Lady Kinnock, was hinting, they say that the key is to have strong, empowered women. Research by the Cathedral Relief Service in Calcutta shows that 63% of pregnant women in the slums are anaemic. That is an appalling starting place. I visited a slum where they had just invented a green goo to give to people to build up their resources—I had to taste it, and it was a really testing moment in intercultural activity. People have to take this kind of local initiative to build, literally, physically strong women.

Women have to be empowered, too, and many people in development know that it is by building up women that families survive and have structure and leadership. We spend a lot of time in our diocese raising funds to provide sewing machines for women so that the family has a livelihood. This year, we are raising funds to create businesses for recycling in Delhi, where all the waste from industrialising India needs dealing with. It is only by giving women that kind of strength and security that they will be able to deal with some of the issues about family planning and their self-respect and standing in the community.

Other things that we do with our partners include running education and immunisation programmes, as well as doing home visits. We show films in the slums, and some villages have health days, when volunteers go out and gather people around. So what are the implications that I am learning? The key one is partnership. There is a partnership between the people of Derbyshire and people in the slums and rural areas of India around this issue, which provides practical help and tries to empower women and provide infrastructure.

I am privileged to be a trustee of Christian Aid, which specialises in partnership working with local agencies. We work in Kenya, Malawi and Bangalore, in India, and there are lots of stories that I could tell—like the ones from Derbyshire—of partnership working. Most exciting is our partnership at the moment with DfID. The Minister came to the Christian Aid carol service and launched a match funding scheme for a project in Kenya on this very topic. We should congratulate the Government on their approach to partnering with organisations such as Christian Aid, which have a lot of expertise on the ground and grass-roots connections and can deliver real change. I am proud of the way that our Government are investing in that. Clearly, we can always do more and clearly we need millennium development goals that will challenge the Government more, but I record on behalf of Christian Aid our positive experience of working with DfID and what a good job comes out of it.

I finish with two questions for the Minister. If developing countries need encouragement to ensure provision for maternal healthcare, what can the Government do to up their game about partnership with those who have grass-roots contacts? That is where we need to operate—with those who are excluded at grass-roots level. We need to connect with those people. How can the Government up their game, working in partnership and investing their funds, while using their influence with other Governments for grass-roots activities?

Secondly, we all know that a lot of problems in developing countries are caused by the unsatisfactory tax base. So much of what could be raised by taxation to provide money for health and other infrastructure is shifted out of the country by the way that corporations operate financially. Both the Prime Minister and the Chancellor have spoken out against this practice, commendably, and we have had debates in this House about it. I would be interested to know what the Minister thinks about the part that getting a better tax structure in developing countries plays if we are to equip people in their own places to take up this work and meet the challenge.

17:37

[Baroness Tonge (Ind LD)]

My Lords, I, too, thank the noble Baroness, Lady Hayman, for bringing this matter to the attention of the House. As chair of the All-Party Parliamentary Group on Population, Development and Reproductive Health and president of the European forum of the same name, it is a subject that has occupied most of my waking hours in the last few years. Indeed, sexual and reproductive health occupied the whole of my professional life before I was elected to the other place.

I am constantly dismayed when I talk to colleagues about maternal mortality and family sizes. I get back the same old mantra. “Oh”, they say, “we can’t do anything about it—people in developing countries need big families because they have to have people to look after them in their old age and they need people to work in the fields. They’ve got to have big families—you mustn’t prevent them from doing that”. We have all been working hard in this Government, and in DfID in particular, to convince those Members that that is no longer the truth.

We have heard a lot of statistics, and I welcome their repetition; we should have them fixed in our head. But in fact maternal mortality is reducing—there is some good news. It has reduced by some 50% in the past 20 years; now around 250,000 women die per annum. That is still far too many, but it is reducing. With that figure goes the estimate that 2 million neonatal deaths occur per annum—and we know that they are linked.

We must also remember, as all Members have pointed out, that it is not just maternal deaths. They hide the fact that maternal morbidity and terrible conditions after childbirth, such as fistula—of which I know the noble Lord, Lord Patel, has had such experience and on which he has done so much incredible work—are also very important and account for millions of women being unable to take proper part in family life and look after their families properly because of childbirth. All are due to lack of proper medical and obstetric care and to other factors such as too-early marriage, child marriage, forced marriage, violence in marriage—but most of all, in my view, they are due to a lack of family planning, which enables women to control their own bodies and voluntarily space the number of children that they have.

We know that more than 2 million women in developing countries would use birth control entirely voluntarily if they had access to it. That is a fact. It has been disregarded in the past, but thanks to the efforts of parliamentarians here, Governments such as our own, and the Bill and Melinda Gates Foundation, a great effort is now being made to get family planning supplies out to those women who need them.

In 2012, our own Government—and I am very proud to mention and applaud this—held a great family planning summit. Pledges were made from all over the world and progress has been made. Since then, 8.4 million more women are now able to control the number of children that they have: that is in a report from the organisation Family Planning 2020, which was set up to monitor the pledges given at the summit and see that they were being delivered. This is all happening despite tradition, despite their religion, despite all the excuses given in the past—especially the one that we need children to look after us in or old age. I am constantly telling my children that.

I hope that our colleagues in both Houses will take note and realise that maternal health—and family planning in particular—is the way to sustainable develop -ment. The World Bank, no less, has pointed out that sustainable development and a steady rise in a country’s GNP follow a reduction in family size or fertility rate in that country. We know now that it is not the other way around. Sexual and reproductive health and rights, including family planning, are essential for sustainable development. We are pretty sure, too, that fewer people will mean less environmental degradation; my all-party group is doing an investigation into this subject at the moment.

There are other advantages for us, too, when this happens. Less international aid will be required in the long term; there will be bigger markets for our goods, if that interests noble Lords; and—dare I say it—there will be less migration from those countries for a better life in the West. Let us say that loud and clear: if they do not listen to our arguments on maternal health and reproductive health and rights, tell them that; tell that to UKIP and tell those people who disregard the importance of international development.

I am still concerned that this message is not being taken as seriously as it should be by the United Nations body deciding on the action needed after 2015, as was touched upon by the noble Baroness, Lady Kinnock. At that time, the millennium development goals should have been achieved. We know that MDG 5 on maternal mortality will not be achieved: there is not a hope.

The European forum of which I am the president—I want to tell your Lordships about this—has Members of Parliament from 25 countries in Europe and beyond. It includes members from Russia and Turkey; it is not just the European Union. We liaise with, and have encouraged the formation of, similar parliamentary groups to ours and similar forums in Australasia and Africa. All those parliamentarians all over the world are having meetings and making declarations on the very things we have been talking about this afternoon—impressing on their Governments, when they go back home from their meetings, that this is the line that they must take, both in their own country and internationally.

The international parliamentary conference on the implementation of all these declarations, meetings and forums that have taken place among parliamentarians was held in Stockholm earlier this year. Some of us went from our all-party group. This conference agreed that sexual and reproductive health and rights—remember all those elements—should be high on the list for the post-millennium goals agenda. That was only after lobbying the office of the UN Secretary-General after an unsatisfactory interim report was published that did not mention sexual rights or sexual health. It mentioned just reproductive health.

We finally got some movement. We lobbied, and the parliamentarians got together and wrote letters and started making a fuss about this, after all our efforts. I am glad to say that last week we heard from the Secretary-General’s office that the final version of what is called the synthesis report—sorry about the terminology; it is not mine—which was released on Christmas Day, of all days, included the words,

“women’s sexual and reproductive health and reproductive rights”.

That has moved us forward quite a bit: it is mentioned, that is good, they are looking at it. However, the word “rights” still applies only to “reproduction” and not to “sexual”, which means that there is disagreement and concern about a woman’s right to safe abortion, which was mentioned by several speakers. Even after rape, we are still unsure whether women can get a safe abortion. There is no protection against FGM, for example. So we must keep putting on the pressure.

I am sorry, I have nearly finished. I fully understand that these are sensitive issues and I hope that the Minister can tell us that our Government—who have worked so hard on these issues in the last five years and held two special conferences this year alone to deal with FGM and sexual violence in conflict—will insist, at the final conference in September at the UN on the post-MDG agenda, that these issues will be dealt with in full.

Sexual and reproductive health and rights are human rights. We talk about the empowerment of women very glibly, but we cannot ensure that until we allow women to have control over their own bodies. We simply cannot. Women all over the world are depending on us to release them from the position to which they are condemned. We must not let them down.

17:48

[Lord Alton of Liverpool (CB)]

My Lords, we are all greatly indebted to my noble friend Lady Hayman for instigating this debate and for the way that she introduced it. As she told us, my noble friend is chair of the external advisory group of the Liverpool School of Tropical Medicine’s Centre for Maternal and Newborn Health. Her work for the school has given it very great encouragement. For more than 30 years I have been privileged to be associated with the work of the school and serve as an honorary vice-president. The centre designs and implements innovative healthcare packages, and offers unique expertise in research and in developing evaluation frameworks. It works collaboratively and strategically with Governments and global agencies, saving the lives of women in countless countries, along with the lives of their babies.

Professor Nynke van den Broek, who is head of the Centre for Maternal and Newborn Health, graphically sets out the scale of the challenges that face developing countries in reducing maternal and neonatal mortality. She says that an estimated 300,000 women die each year from complications in pregnancy and childbirth and—as the noble Baroness, Lady Tonge, said a few moments ago—this represents a decline. The school says it is about 45% overall since 1990. However, this should not lead us to any kind of complacency because it still equates to a woman dying every 90 seconds, or 800 women a day. There are also at least 2.6 million stillbirths every year and an additional 2.9 million neonatal deaths. At least 43% of deaths in children under five occur in the first month of life.

The World Health Organization says that 99% of all maternal deaths occur in developing countries. Inevitably, this loss of life is at its most acute in rural areas and—as the right reverend Prelate the Bishop of Derby said—in poorer communities. UNICEF reminds us that more than 50% of women still deliver without the assistance of skilled health personnel, with 80% of maternal deaths caused by direct obstetric causes. Pivotal to addressing this shocking and avoidable loss of life is the challenge of improving the health and nutrition of mothers and providing access to good-quality support services for mothers-to-be and newborns, before and after birth.

At a personal level, two decades ago I was struck by what a difference those factors could make. While working in Namibia, my sister gave birth to my niece at 32 weeks’ gestation. My niece weighed less than two pounds and no baby as small as that had previously survived in Namibia. I was told that important to her survival was her mother’s breast milk and the antibodies it contains, but obviously she was too small to be able to suckle. There was no electric breast pump available at the hospital. I was able to buy one and ship it out. How different the outcome would have been if she had been living in the bush or a remote village without access to resources. That is surely the challenge we have to address.

Consider this tale of two countries: 2013 data highlight UK maternal mortality rates as standing at eight deaths in every 100,000, with three neonatal deaths for every 100,000 live births. By contrast, in Zimbabwe—visited by my noble friend—there are 470 maternal deaths in every 100,000 and 39 neonatal deaths for every 100,000. The vast majority of stillbirths, newborn deaths and maternal deaths occur around the time of birth and in developing countries. Ultimately, the health and survival of babies depends on the health and survival of mothers and that requires resources.

It has, of course, been crucial that millennium development goals 4 and 5 have helped to shape the agenda for action to improve these health indicators. That progress has been made is borne out in the report Financing Global Health 2013 from the Institute for Health Metrics and Evaluation. It noted a welcome increase of nearly 18% in development assistance for maternal, newborn and child health. Although I join others in congratulating DfID on the role it has played in this, nevertheless the spending per live birth remained at just £32 per child.

Even where death does not occur, failure to provide resources and care at this crucial moment in a woman’s life can have, as we have heard, long-term consequences. For each maternal death, an estimated 20 to 30 women live but suffer lifelong morbidity including a fistula, which my noble friend Lord Patel has done so much work to tackle and was mentioned by my noble friend Lady Hayman. In addition, there is chronic infection, anaemia and infertility. The Liverpool School of Tropical Medicine is currently working with the World Health Organization to develop new tools to provide more detailed data—something that DfID might want to support.

Improving the availability and quality of data helps to capture and understand the reasons for maternal and neonatal deaths, and to develop the necessary initiatives to prevent deaths. Digging deeper into the currently available statistics, it starts to become clear where we should concentrate our resources and our efforts. Baseline surveys under the Liverpool School-led and DfID-funded Making it Happen programme show that across 11 countries early newborn care packages are simply not consistently available. Out of 749 hospitals and health centres, only 173 were able to provide the required emergency obstetric care package, which is 23.1% or less than one in four. A study of reasons for unavailability of the care package shows that in 17% to 75% of cases there was lack of functioning equipment; in 13% to 17% of cases the reason was lack of a staff cadre—doctors or senior midwives—able to lead the team or provide the more technical aspects of care; and in 2% there was a reported lack of drugs. Not surprisingly, then, sub-Saharan Africa accounts for 62% of all maternal deaths, followed by south Asia with 24%.

As my noble friend Lord Patel reminded us, two countries stand out: Nigeria and India. India accounts for 17% and Nigeria 14% of the total. The right reverend Prelate told us of his experiences in India. It is one of the world’s greatest nations, yet in its treatment of women, from conception to death, India justifies its title as the land of paradoxes. A 2012 report by the United Nations Department of Economic and Social Affairs found that the ratio of boy to girl deaths is severely skewed. Between 2000 and 2010, 100 girls aged one to five died for every 56 boys. Putting that into plain language, an Indian baby girl is almost twice as likely as an Indian boy to die before the age of five, and the problem seems to be getting worse. In 1961, 976 girls were born for every 1,000 boys, and in 2011 that number was 914. The horror stories that have filled Indian papers, describing bodies of baby girls decomposing in heaps by refuse pits or being discovered in their scores in rubbish bins, should rouse our consciences, and I should like to hear from the Minister when we last raised this issue with the Government of India.

Another country that stands out and, because of Ebola, is much on our minds is Sierra Leone. It is estimated to have the highest ratio of maternal deaths, with 1,100 per 100,000 live births. This estimate was made in 2013 and the situation then was bad enough, but obviously, with the inevitable decline in the infrastructure in Sierra Leone today, the situation is getting worse. I hope that the Minister will be able to say something about that.

Are we involved in the formulation of new development goals to ensure continued global advocacy and to ensure that action is under way? A proposed new goal is universal health coverage. Surely a universal gold standard, strengthening health systems worldwide and ensuring that care for mothers and babies is available, accessible and affordable, is one that the United Kingdom should be championing.

As we look at best and worst practice, do we ask what was done well, what was not done well, how care can be improved in the future and how much involvement there is of users and providers? Are we working to see the better development of perinatal audit and cause classification for maternal deaths, and the introduction of an urgently needed system to identify the cause of, and contributing factors to, stillbirth? I hope that my noble friend’s initiative today will help us to achieve some of those life-saving objectives. I am indebted to her for giving us the opportunity to contribute to this debate.

17:57

[Lord Collins of Highbury (Lab)]

My Lords, I, too, thank the noble Baroness, Lady Hayman, for initiating this important debate.

As we have heard, the UN estimates that over the past two decades the under-five mortality rate has almost halved; and the number of deaths of children under five is being reduced faster than at any time in the past two decades, partly due to increased access to vaccination against deadly childhood diseases. As we have heard, the number of women dying in pregnancy and childbirth has also been cut by almost half in the same period.

However, as we heard from the noble Baroness, Lady Hayman, this progress has not been even because women, adolescents and children from poor and marginalised communities are being left behind. Noble Lords have referred to the fact that nearly 800 women die every day in pregnancy and childbirth, and HIV/AIDS remains the leading cause of death for women aged between 15 and 44.

With little control over their lives, millions of adolescent girls are forced into early marriage, putting them at risk of complications from pregnancy and HIV at a young age. Faced with an unintended pregnancy, many women and girls resort to unsafe abortion, which accounts for 13% of all maternal deaths; and for every woman who dies, 20 others suffer illness, injury or disability.

As we have heard, mothers and babies face the greatest risks in sub-Saharan Africa, which accounts for 62% of all maternal deaths, followed by south Asia, with 24%. As the noble Lord, Lord Patel, said, two countries account for one-third of all maternal deaths: India, with 17%, and Nigeria, with 14%. It is worth repeating these statistics, because those are countries that we now consider middle-income countries, which do not need development support. But inequality there is growing rather than diminishing.

The noble Baroness, Lady Hayman, highlighted the maternal mortality ratio, showing the highest discrepancy of all health indicators—the gap between high and low-income settings. Sierra Leone has been mentioned: it is estimated to have the highest MMR, at 1,100 per 100,000 live births—and as we have heard, this estimate is from 2013, before the Ebola epidemic. There is emerging evidence that as a result of the Ebola epidemic more maternal deaths are occurring, both as a result of the virus and as a result of lack of availability of routine care, with the focus on care for patients with Ebola and the collapse of existing health systems—which were, as we have heard, incredibly weak already. I do not know how many noble Lords heard the BBC’s excellent report yesterday highlighting the additional risks to healthcare workers treating pregnant women with Ebola. It was a shocking story.

We have heard about millennium development goal 5a, to reduce maternal mortality by 75% between 1990 and 2015: 11 countries are “on track” to meet it, 63 countries are “making progress”, and 13 are “not on track”. Factors associated with making progress include leadership, working in partnership, using evidence, and being innovative and able to adapt using both long and short-term strategies.

Maternal and newborn health are closely linked. As we have heard, motherless children are up to 10 times more likely to die within two years of their mother’s death. More than 6 million children under five died last year, primarily from complications of prematurity and birth, pneumonia, malaria and diarrhoea, with under-nutrition a major factor. The survival rate of the most vulnerable children—newborns—is improving too slowly: 44% of deaths under the age of five occur in the first month.

As we have heard, nearly all maternal, child and newborn deaths are preventable. Strong health systems, with sufficient skilled health workers and reliable supplies of affordable essential commodities, medicines and vaccines, providing equitable access to universal health care, are critical. Proven strategies to improve maternal and newborn health include increasing access to quality care in pregnancy and childbirth, including emergency obstetric and newborn care, reproductive healthcare and information, family planning services and, most importantly, safe abortion.

Poor nutrition is an underlying factor in almost half of all child deaths under the age of five. The UK Government are a leader in the fight against hunger and under-nutrition, but can the Minister assure the House that all bilateral maternal and child health programmes include a strong nutrition component? The next Labour Government will put universal health coverage at the heart of the global development agenda. Universal health coverage affirms the right of every person to have the opportunity for the highest standard of health, without suffering financial hardship or poverty as a result. It does not just help improve health outcomes, but would help reduce inequality and stop 100 million people a year falling into poverty. Health and economic development are interdependent. Healthy populations are more productive.

It is clear from this and other recent debates in this Chamber that universal healthcare will make countries more resilient to humanitarian disasters and outbreaks of disease. The ability of Nigeria, which has a relatively strong healthcare system, to contain and beat the Ebola virus this year sharply contrasts with the experience of Sierra Leone and Liberia, whose health systems were weak. Universal healthcare is a clear and quantifiable goal. Will the Minister commit the Government to it in considering the language of the health goal in the SDGs when negotiations start in New York next week? What is her department doing to ensure that the next development framework is ambitious and trans- formational to end all preventable, maternal, child and newborn deaths?

As we have heard from my noble friend Lady Kinnock, addressing the underlying causes of ill health and mortality is also critical. As we heard from the right reverend Prelate the Bishop of Derby, this means investing in women’s empowerment, girls’ education, preventing gender-based violence and ensuring access to clean water and sanitation. Will the Minister highlight what the UK Government are planning and doing to address these underlying causes?

18:06

[The Parliamentary Under-Secretary of State, Department for International Development (Baroness Northover) (LD)]

My Lords, like other noble Lords, I pay tribute to the noble Baroness, Lady Hayman, for securing today’s debate, and for her long-standing commitment to maternal and neonatal health. I commend the other contributions we have heard today, which, as ever in your Lordships’ House, have ranged very widely. I also thank noble Lords for their tributes to DfID for our work. We have heard the devastating figures, and as my noble friend Lady Hodgson pointed out, a human face was given to those figures.

The noble Baroness, Lady Hayman, my noble friend Lady Hodgson, the noble Baroness, Lady Kinnock, the right reverend Prelate, the noble Baroness, Lady Tonge and now the noble Lord, Lord Collins, have all pointed out that this relates fundamentally to the rights of women and their unequal status, unequal access to nutrition and education and being forced into early marriage—we have heard the range of challenges. Gender inequality is key.

This is a very timely debate, coming right at the start of 2015, the final year of the millennium development goals and the year in which new goals will be agreed at the UN in September. Globally, as the noble Baronesses, Lady Hayman and Lady Tonge, said, we have made significant progress in reducing maternal mortality. The maternal mortality ratio dropped by 45% between 1990 and 2013. Each region of the world has seen significant improvement, though none, as noble Lords pointed out, has yet reached the goal of a 75% reduction in mortality.

These improvements have been driven largely by more women having access to skilled birth attendants—nearly 70% of births now take place with a skilled attendant. I note what the noble Baroness, Lady Tonge, and the noble Lord, Lord Alton, said about the high level of maternal morbidity. I pay tribute to the All-Party Parliamentary Group on Population, Development and Reproductive Health for its outstanding report, Better off Dead?, as well as to the work on fistula by the noble Lord, Lord Patel. It is not just a matter of physical morbidity. As my noble friend Lady Hodgson pointed out, the mental health of mothers is key. I hope that my noble friend will be pleased to note that mental health is included in the targets for the SDGs proposed by the open working group.

The noble Baroness, Lady Hayman, noted the number of neonatal deaths and that it had not moved in the direction that maternal mortality had. The MDGs did not include targets for newborns; consequently, they received less attention and less progress has been made. The noble Lord, Lord Patel, in particular emphasised how much more we still need to do. Nearly 3 million newborns still die every year, accounting for around 44% of all deaths of children under five, and 1 million of these die on their first day of life, as noble Lords noted. Eighty-five per cent of newborn deaths result from three preventable causes, as the noble Lord, Lord Patel, and other noble Lords pointed out.

The noble Lord, Lord Patel, emphasised the high incidence of neonatal deaths in a few countries, identifying particularly large numbers in the populous countries of India and Nigeria—the noble Lords, Lord Collins and Lord Alton, made reference to that as well. As the noble Lord, Lord Patel, noted, it is shocking to see the proportion of babies not breastfed in the first 24 hours. I was shocked when I visited India early last year to discover that this was indeed widespread. I can assure the noble Lords, Lord Patel and Lord Alton, that prioritising women and girls and seeking to address neonatal health is uppermost in our discussions in India. My right honourable friend Lynne Featherstone has been to India this week as a champion to combat violence against women and girls, so it is very high in the Government’s priorities.

As noble Lords made clear, faster progress in these crucial areas will be achieved only when girls and women are able to access the care and services that they need when they need them. They include better nutrition, access to education and access to clean water and sanitation. The United Kingdom has a strong track record of working to improve maternal and newborn health—and I thank noble Lords again for their tributes. In 2010, we made commitments to save 50,000 maternal lives and 250,000 newborn lives by the end of 2015, and we intend to meet them. We have already exceeded our target for maternal lives saved through a combination of increased investments in family planning, skilled birth attendants and making health systems stronger—all issues that noble Lords addressed. A number of noble Lords emphasised family planning, and we share their view that this is crucial, which is why we emphasised it at the London summit in 2012. A recent report shows that we are broadly on track to meet our commitments. Nevertheless, we are not complacent; we know how extremely important that issue is.

I agree with the noble Baroness, Lady Kinnock, that we need to make sure that we have adequate funding for sexual and reproductive health and that that includes funding from the country Governments themselves. The summit was encouraging, and I hope that the noble Baroness was able to see the commitments that came forward. We need to make sure that those are delivered. We agree that it is vital that girls and women should be able to access comprehensive packages of sexual and reproductive health.

Ensuring that the post-2015 development agenda continues to advance the social, economic and political empowerment and human rights of girls and women remains a top priority for the United Kingdom, and we will continue to work tirelessly to ensure that the final framework advances the needs of girls and women. The noble Baroness, Lady Kinnock, mentioned prioritising what women want in terms of safe abortion. Where girls and women have taken the decision to terminate a pregnancy, our aim is to ensure that they do not put their own lives at risk. Improving access to safe abortion saves maternal lives and reduces maternal ill health; I stress that very strongly.

Beyond international targets, we know what is needed on the ground. We need to see high-quality reproductive midwifery and emergency obstetric services being delivered through well functioning health systems. There is much more that we need to do. Most of these deaths are preventable. We must ensure that clear targets for improved sexual and reproductive health and rights are included to prevent maternal and newborn deaths. They must be secured in a post-2015 framework. We are working extremely hard on this and anything that noble Lords can do working with southern voices in these next crucial months is vital.

My noble friend Lady Tonge mentioned the omission of “sexual rights” from the UN Secretary-General’s recent synthesis report. This report is one of many inputs into the process. We still wish to see the full sexual and reproductive health and rights package reflected in the final framework. We need to ensure that women can access contraceptives if they wish to prevent pregnancy and, if they become pregnant, have access to skilled health workers who have the right drugs and equipment at the right time in the right place to be able to respond to complications during pregnancy and childbirth. I was very moved at the Christian Aid carol service to hear some of the stories from Kenya.

We need health financing systems that mean women do not have to make choices between accessing care and feeding their families. I agree with the right reverend Prelate in terms of finance that a sustainable solution can come only when countries finance their own healthcare adequately. He is absolutely right that tax reform is a key part of that.

We need supporting information systems that tell us whether our efforts are working and how and where to improve them, ideally taking advantage of new technologies, as the noble Lords, Lord Alton, Lord Collins and others mentioned. All this is why universal health coverage must be an important part of the post-2015 agenda. Strong health systems are vital. It is because Sierra Leone and Liberia have fragile health systems as fragile countries that the Ebola epidemic was able to take hold. That is why we are involved in such countries and why such health strengthening has received 20% of DfID’s budget.

We need to continue to work on the social determinants of health, such as poverty, better nutrition, education, and so forth, as I have said. Crucially, as noble Lords have made clear, we need the empowerment of girls and women, to enable them to have voice, choice and control within their households, their wider communities and across their nations. Noble Lords have made a powerful case for that. That means working at every level. I agree with the right reverend Prelate that that clearly involves working at community level and we have our aid-matching system as one of the key mechanisms for that. There are others in our portfolio of support for civil society.

All this is doubly important when we are talking, as noble Lords have, of the hardest-to-reach groups: the youngest, the poorest, the most geographically isolated and those affected by conflict—those left behind by the progress towards the current MDGs. That is why the new set needs to ensure that they leave no one behind. More rapidly declining rates of maternal and newborn deaths will tell us when we are getting this right.

House adjourned at 6.19 pm.