Health Systems (Developing Countries)

Debate between Anas Sarwar and Jeremy Lefroy

Thursday 11th December 2014 Westminster Hall

[Anas Sarwar (Glasgow Central) (Lab)]

It is a pleasure to serve under your chairmanship, Mrs Osborne. I congratulate the Select Committee on International Development on its two fantastic reports, the second of which we will debate in a moment.

I had the great pleasure of serving on the Committee at the start of this Parliament for almost a year and a half. Having worked with many of its current members, I can say that it is full of people who are dedicated to ensuring that we spread the values that we hold dearly in the UK around the world to maximise opportunity in the fight against poverty. Two of my former colleagues on the Committee—the right hon. Member for Gordon (Sir Malcolm Bruce) and my hon. Friend the Member for York Central (Hugh Bayley)—are retiring before the next Parliament. We all wish them both the very best for the future. The fact that both of them have used their last term in office to try to improve the life chances of the poorest and most vulnerable people in the world speaks volumes. The right hon. Member for Gordon has been a member of the International Development Committee since 1997, for which he deserves a special prize. I pay special tribute to the Department for International Development staff and health workers who have gone from the UK and elsewhere to help in the fight against Ebola and have risked their lives to protect the lives of others.

I am particularly pleased to be able to make the case for universal health coverage, as the Committee has done, given that the UK is a global leader on that issue. We should be the strongest global advocate for universal health care because our NHS is the envy of the world. It supports people from the cradle to the grave, and it is based not on people’s ability to pay but on their need. We should spread that health care model around the world.

In the current crisis in Sierra Leone, more than 1,600 people have lost their lives, and every week 200 to 300 people are dying and 400 to 500 people are becoming infected. That is a real and sad example of why sound health care systems are crucial. It also demonstrates why the UK and the Department for International Development are right to emphasise promoting private sector growth. Sustained economic growth, higher employment, strong infrastructure and other good development work can be lost in an instant during such epidemics.

Sierra Leone’s GDP growth has sharply declined, despite its positive growth in recent years. All its post-war achievements in the health, education, justice and employment sectors are in jeopardy. The Committee will know from its visits and from the testimonies it has heard that all the schools in Sierra Leone have been permanently closed, and there is a real risk of losing a generation. A generation of young people in Sierra Leone will never get the education they need to improve their life chances, get into meaningful work, break the cycle of deprivation, create a better life for themselves, their families and their communities, and create a better Sierra Leone in the process.

Let me compare three African countries with varied health systems. Sierra Leone, as my hon. Friend the Member for York Central said, has about 136 doctors and just over 1,000 nurses for 6 million people. That is the equivalent of one doctor for almost every 50,000 members of the population. Sadly, since November, more than 100 health workers, including five doctors, have lost their lives to Ebola. It is even worse in Liberia, which has an estimated 60 doctors and 1,000 nurses for 4.3 million people.

In contrast, Rwanda has more than 55,000 health workers for its population. The president of the World Bank, Jim Yong Kim, said:

“If this had happened in Rwanda we would have had it under control.”

That shows the difference that a meaningful health care system can have. It demonstrates that there is no substitute for adequate local health care cover. If there is no functioning health service, a single outbreak can turn into a global crisis.

[Jeremy Lefroy]

Will the hon. Gentleman also acknowledge Nigeria’s tremendous success in preventing the spread of Ebola? Some attribute that to the health systems built up through, for instance, the polio vaccination campaign.

Housing Benefit and Disabled People

Debate between Anas Sarwar and Jeremy Lefroy

Wednesday 23rd January 2013 Westminster Hall

[Jeremy Lefroy]

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

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

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

[Anas Sarwar (Glasgow Central) (Lab)]

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

[Jeremy Lefroy]

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

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

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

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

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

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

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