Children in Need: Adulthood

Debate between Andrew Selous and Steve McCabe

Thursday 6th September 2018 Westminster Hall

[Steve McCabe (Birmingham, Selly Oak) (Lab)]

I beg to move,

That this House has considered supporting children in need into adulthood.

It is a great pleasure to see you in the Chair, Ms Buck. I am grateful to the Backbench Business Committee for granting this debate on a subject that should matter to us all and definitely needs more attention.

The discussions that resulted in the Staying Put initiative for those in foster care—a decision for which I commend the previous coalition Government—have inevitably opened up a much wider debate about our responsibilities for all children in need and their transition to adulthood. Are the existing obligations placed on local authorities, the NHS and other safeguarding bodies sufficient, or is it time for a rethink? That is the purpose of the debate.

I know that the Government are concerned about mental health and have announced additional resources for that area. Of course we should all be worried about the growing numbers of children and young people needing help with eating disorders, self-harm and a host of other problems. When we raise these matters, we tend to be talking about young people where a problem has been acknowledged and the real issue is waiting times or access to treatment. However, what about all those young people who are being missed? The Children’s Society suggests that there may be as many as 240,000 vulnerable 16 and 17-year-olds in England and Wales, but only about 58,000 have been identified as needing support by local authorities. In fact, 46% of children referred to children’s services are turned away without any form of intervention, and 30% do not even reach the threshold for an assessment.

Where young people are in receipt of support, that often changes on the day they reach 18 as there is no legal obligation to provide continuing assistance and no requirement to help with a transition to adult services. In many forces, even the police marker or flag used to identify youngsters at risk or vulnerable to exploitation automatically expires as soon as a young person reaches 18. Disabled children face particular challenges in moving into adulthood when responsibility for continuing support switches from children’s to adult services.

[Andrew Selous (South West Bedfordshire) (Con)]

I wonder whether the hon. Gentleman shares my concern about a gap on the part of Ofsted, which I think is discriminatory. I understand from Bedfordshire police that there is no Ofsted inspection of children’s homes for 16 and 17-year-olds. The schools of children in mainstream education are inspected by Ofsted. Does he agree that there is a gap, and that we need proper regulation in this area, particularly as bad things are happening?

[Steve McCabe]

I am sure the Minister heard the hon. Gentleman’s point. I certainly agree that any provision of that nature should be subject to proper inspection.

Today there are more than 1 million disabled children in the UK, yet fewer than ever are getting the support they need. We also need to give some thought to healthcare improvements and just how scary it can be for a young person to wake up after surgery on an adult ward for the first time. We have an acute shortage of community paediatricians and much more work is required in the health sector in planning the transition for young people from children’s to adult services.

The Children Act 1989 requires every local authority to take reasonable steps to identify children in need in its area and to publish information on the services available. It places a particular stress on the health and development of children and the needs of the disabled, but cash-strapped local authorities are struggling to provide even the most basic services. The reality is that 15, 16 and 17-year-olds often have to be at crisis point before there is any intervention.

I acknowledge that there has been a big focus on, and in some cases a switch of resources to, child protection issues, yet while child exploitation scandals such as those in Rochdale and Rotherham serve to demonstrate that many teenage children suffer even greater risk outside the home than inside it, support is limited for the vast majority, even if their need involves neglect, abuse or exploitation. The Department for Education’s figures for 2015-16 suggest that perhaps 13,500 16 and 17-year-olds are in need because of “going missing”, and about 1,500 are in need because of trafficking.

It is estimated that each year some 12,000 16 and 17-year-olds approach local authorities because they are homeless, often as a result of a breakdown in relations with a parent or carer, violence in the home or other problems at home. Homelessness is not currently recognised as a risk factor in identifying children in need, and consequently there are no reliable statistics about the scale of the problem. However, most agencies working with teenagers identify it as a real risk factor, likely also to expose young people to a risk of drugs, alcohol problems, violence and sexual abuse.

Electric Vehicles and Bicycles

Debate between Andrew Selous and Steve McCabe

Wednesday 9th May 2018 Westminster Hall

[Steve McCabe (in the Chair)]

We shall look into that. Thank you.

[Andrew Selous (South West Bedfordshire) (Con)]

I beg to move,

That this House has considered take-up of electric vehicles and bicycles.

I am extremely grateful to Members across the House for their support for what I believe to be a very important debate. This is the third time that I have secured a debate in this Chamber on the take-up of electric vehicles. It is such an important issue for many reasons: electric vehicles will help us to reach our carbon commitments; they are the answer to low-cost, pollution-free motoring for our constituents; and, perhaps above all, it is essential for the United Kingdom to grasp global leadership of this key industry of the future, so that a new and up-and-coming industry’s jobs and investment will be here in the United Kingdom.

In the case of conventional vehicles, the UK is passing £5 billion from sales of conventional vehicles on to foreign economies. Partly because of how supply chains work, a country such as Germany has a significant advantage.

--- Later in debate ---

[Steve McCabe (in the Chair)]

You do not have to.

[Andrew Selous]

I will give you one of those minutes.

NHS Fertility Services

Debate between Andrew Selous and Steve McCabe

Thursday 19th January 2017 Westminster Hall

[Steve McCabe (Birmingham, Selly Oak) (Lab)]

I beg to move,

That this House has considered decommissioning of in vitro fertilisation and other NHS fertility services.

It is a pleasure to serve under your chairmanship today, Mrs Gillan.

I am grateful to the Backbench Business Committee for granting this debate; to the right hon. Members for Carshalton and Wallington (Tom Brake), and for Wantage (Mr Vaizey), for their support in securing it; and to the many other Members who are either here today or who have indicated their support for a debate on IVF. Change is urgently needed in this area, and we have broad, cross-party support for such change.

I know that it is not customary, Mrs Gillan, to refer to the Public Gallery during debates such as this one, but perhaps I can just say in passing that I am told that a number of people have travelled here today because of the importance they attach to this issue, and because of their strong feelings that what is going on is not fair and needs to change. It is through listening to their experiences that I have begun to understand the extent to which the present arrangements are not working.

[Andrew Selous (South West Bedfordshire) (Con)]

Does the hon. Gentleman agree that, rather than imposing a postcode lottery on our constituents by withdrawing these services, the areas under financial pressure need to become more efficient and to look at how other areas manage their health systems better to make efficiencies, so that in vitro fertilisation can be provided everywhere?

[Steve McCabe]

I certainly agree with the hon. Gentleman about a postcode lottery; there is a massive variation in service, so we must strive to achieve a cost-efficient system that is genuinely national in the way it is delivered. I agree with that absolutely.

This debate is about IVF and related services. At a time of so much concern about the NHS generally, the debate could easily drift towards becoming a series of questions about other aspects of the NHS, but I am clear that we asked for this debate to raise concerns associated with those who need treatment for infertility issues.

Infertility is a problem that does not get a lot of Government or parliamentary attention; in fact, it was not debated at all in the previous Parliament. Yet we know that it is an issue that affects one in six couples in the UK and is the second most common reason for a woman to visit her GP. The problems of infertility are recognised by the World Health Organisation as a condition for which medical treatment should be provided, but that is not how we approach the matter today in England.

I am immensely grateful to my constituent Louise Jackson for bringing this issue to my attention and for giving me permission to share some of her experience with people today. Louise and her partner have been together for more than 13 years and have been trying for a baby for nearly six years. After tests confirmed that they would need IVF treatment, they were refused it because Louise’s partner already had a child, as a result of a previous relationship in 1975. That child is actually older than Louise herself, who has said:

“Anyone who is experiencing fertility problems will understand the agonising pain and upset it brings on a daily basis. The fact that we have been refused treatment on the NHS just adds to the anguish. We cannot express enough how hard it is to not be able to have children naturally, never mind being faced with the fact we’ve been saving for years for the thousands needed for this treatment. I hope one day these laws will be changed for couples like us and others in the near future.”

My information is that four clinical commissioning groups in England—Mid Essex, North East Essex, Basildon and Brentwood, and South Norfolk—have already decommissioned their assisted conception services, essentially as a cost-saving measure. Also, more than one in 10 CCGs in England are currently consulting on reducing or entirely decommissioning NHS fertility treatment. That means that more than 60 Members of Parliament represent seats where the provision of IVF services is at risk.

The guidelines produced by the National Institute for Health and Care Excellence are fairly clear on the provision of IVF services. NICE recommends that all those women who are eligible for IVF should have access to three full cycles of IVF if the woman is aged under 40, and in 2013 it updated its guidance to recommend further that women aged between 40 and 42, and who meet some additional criteria, should have access to one full cycle.

Fertility Fairness is an umbrella body that has the support of several organisations, including the Royal College of Nursing, the Association of Clinical Embryologists, the British Fertility Society, the National Gamete Donation Trust and the Miscarriage Association. In 2016, it undertook an audit of every CCG in England and found that only 16% of CCGs offer three cycles of IVF, which is the NICE recommendation. That was down from 24% in 2013, while the number of CCGs offering just one cycle of NHS-funded IVF treatment has leapt to 60%. The Minister is on record as saying that she finds the decommissioning of such services “unacceptable”, so she will not be surprised if I ask her what she plans to do in response to these figures.

According to NICE, a full cycle of IVF treatment should include one round of ovarian stimulation and the transfer of all resultant fresh and frozen embryos, but only four out of 209 CCGs comply with the NICE definition of a “full cycle”. As a result, in many parts of England, these efforts to provide IVF on the cheap are—perversely—wasting resources, because this incomplete offer is rarely successful and compromises the cost-effectiveness of IVF as a treatment. It is a bit like giving less than the recommended dosage of any other drug or treatment.

As I have said, NICE offers guidance on age appropriateness for IVF. However, without being required to offer any kind of explanation, some CCGs have lowered the maximum age for IVF to 35; others have introduced non-medical criteria, such as refusing couples treatment if one of them has a child from a previous relationship, as happened in the case of my constituent, Louise Jackson; and apparently even more criteria are applied for same-sex couples, including a requirement to demonstrate that they have already paid privately for six cycles of treatment before they can be considered by the NHS. Those requirements do not look like medical criteria to me; they look like crude, discriminatory rationing, based on pseudo-moralistic prejudices.

In Birmingham, CCGs justify their approach by testing their proposals via public consultation, and in 2014 a consultation covering the criteria for eight CCGs across the west midlands was undertaken. Of the 351 people who responded, 40% were against providing IVF to a couple where one party has a child from a previous relationship; 40% disagreed with that view; and 20% did not know. Nevertheless, those proposals are now the criteria that must be met. I cannot imagine such a crude approach being adopted for determining treatment eligibility for any other medical condition, but that of course is part of the problem.

Too many people think, in defiance of the World Health Organisation, that it is a lifestyle issue and not a medical condition. That is not helped by the fact that the Department of Health merely asks that CCGs “have regard to” the NICE guidelines. This recognised medical condition can have a number of related impacts. If left untreated, it can result in stress, anxiety, depression and the breakdown of relationships. A recent survey of almost 1,000 people with infertility problems conducted by Middlesex University found that 90% of respondents reported feeling depressed and 42% reported feeling suicidal, which was up from 20% when a similar study was conducted in 1997. Some 70% reported a detrimental impact on their relationship, and 15% said that it had led to the break-up of their relationship.

The debate is not about statistics, though; it is about real people and the devastating impact that being denied treatment for infertility problems can have on their lives. On Monday afternoon, I took part in a digital debate with many members of the public, and they helped contribute to our debate today. Hundreds of people shared their experiences. I cannot name them all, but I would like to take this opportunity to thank them for their contributions. I want to briefly share just a few examples that illustrate the kind of problems that mean we need to see some significant change in the delivery of this service.

Kelly Da Silva from south Derbyshire said:

“This is such an important issue for me, the anxiety and depression caused as a direct result of infertility and involuntary childlessness has affected every aspect of my life and caused me to leave a successful 12-year teaching career. The emotional and social impacts are absolutely devastating.”

Becky Thomas is from Hertfordshire, and comes under the direction of a Cambridgeshire CCG. She said:

“My local CCG cut the amount of cycles they offer from three down to one and are considering getting rid altogether. I live in one area that actually offers three full cycles however I come under a completely different CCG. It shouldn’t be a postcode lottery. It’s not a lifestyle choice. It’s a medical condition.”

Erin Nina Desirae from Sheffield said:

“I am in a same-sex marriage. My wife and I have been together for six years and have always talked about having children. We assumed that the law in this country would support us and enable us to try for a family with help from the NHS. Unfortunately, we were surprised and hurt to find that same-sex couples are not offered fertility treatment on the NHS until we have first self-funded at least six cycles ourselves. Whilst a heterosexual couple can receive NHS treatment after two years of trying to conceive. This feels like discrimination. Why should we be treated differently?”

What of the costs? Evidence suggests that many of the decommissioning and service reduction decisions are driven largely by budget considerations. Reports show that the cost to CCGs of commissioning one cycle of IVF can range from £1,300 to £6,000. It varies dramatically across the country. For example, it is much cheaper in Newcastle than it is in Birmingham, without any obvious explanation. What kind of way is that to run a health service and provide a vital treatment? Is it not a classic example of the fragmentation of the NHS that many predicted would follow the Lansley reorganisation?

In England, more than 200 CCGs are responsible for setting their own criteria and commissioning their own IVF services. To make matters worse, research suggests that the high cost of IVF in the private sector is forcing people to travel to such countries as the Czech Republic, where IVF treatment is far cheaper. The problem is that IVF is not anywhere near as well regulated in those countries as it is in the UK. As a direct result of reducing services in the UK, the NHS is being saddled with the high cost of complicated multiple pregnancies and births and other postnatal issues. There is also the additional cost to mental health services, which I touched on earlier. [Interruption.] As you can see, Mrs Gillan, I have successfully transposed a page of my notes. I hope you will bear with me for one second.

Strengthening Couple Relationships

Debate between Andrew Selous and Steve McCabe

Tuesday 14th January 2014 Westminster Hall

[Steve McCabe]

As a divorcé, I do not feel that my divorce has prevented me from being able to have a further solid relationship; nor has it prevented me from having a strong parental role or from being part of a family.

It is interesting that the Government’s most explicit policy to support marriage, the married couple’s tax allowance—we heard quite a lot about that from the hon. Member for Gainsborough (Sir Edward Leigh)—is available only to one third of married couples. The proposals are really designed for the situation in which one partner does not work outside the home or earns very little. It is really a policy for stay-at-home mums, which is perhaps slightly at odds with some of Dr Coleman’s suggestions. Of course, it is available only for married mums, not for widows, cohabiting mums or anyone like that. Perhaps most astonishingly of all, it is available for the love rat who deserts his wife and family and runs off with someone else’s wife. He can remarry and claim the allowance. That strikes me as a slightly perverse way of strengthening couple relationships.

The other thing that is slightly strange about the policy is that it applies to only 4 million of the 12.3 million married couples, and it is not clear what impact it will have on children, given that pensioner families make up more than one third of the beneficiaries. In fact, only 35% of the 30% of families who gain from the policy have children, and only 17% have children under the age of five. It is hardly a well targeted policy if its aim is to support the concerns raised by the hon. Gentleman.

[Andrew Selous]

I want to draw the hon. Gentleman’s attention to the international facts. If we look across the OECD, we see that the UK is very much an exception in not recognising marriage at all in the tax system. In fact, it is really just us and Mexico alone among all the OECD countries that do not recognise it; 80% of the population of OECD countries live under a system in which marriage is recognised.

[Steve McCabe]

I was talking about the efficacy of a particular measure. Despite the doom and gloom, if we accept that not all relationships come in the form that the hon. Member for Aldershot would like to see—I accept that that is his view, and I understand that he holds it sincerely—the Relate survey to which I referred has some interesting observations. Let me pay tribute to the comments by the hon. Member for Mid Derbyshire (Pauline Latham) about Relate. I agree: I think that it is an excellent organisation that we should protect. The Relate survey paints a slightly rosier picture. It found that 93% of people said that, when times were hard, relationships within their family were important. Although the media sometimes presents our society as one in which family relationships have broken down, Relate could not find evidence that that was the case overall. According to its survey, families—albeit sometimes new families or reconstituted families—remain the backbone of our support systems.

Public Confidence in the Media and Police

Debate between Andrew Selous and Steve McCabe

Wednesday 20th July 2011 Commons Chamber

[Steve McCabe (Birmingham, Selly Oak) (Lab)]

A number of Members have said that we all bear some responsibility for our relations with the press, which are sometimes uneasy. That is also true of our relations with the police. At times, Members are anxious about criticising the police lest they appear to be expressing a lack of support. At other times, we are fulsome in our praise when there is a need for criticism.

I think of myself as someone who supports the police, but there are lessons to be learned from what happened at the Met in this unhappy episode. There are serious questions about managerial control at the Met, and that will be a consideration when the next commissioner is appointed. I was struck by the way in which Lord Blair, the former commissioner, wanted immediately to distance himself from the original inquiry, and did not want to have anything to do with it. I accept that he did not have operational control, but he was the guy in charge. I was struck by the way in which Andy Hayman seemed to be in charge of the inquiry, but not remotely in control of what was happening. John Yates did not seem to be at all clear about what Sir Paul Stephenson had asked him to do when he conducted an eight-hour mini-review. Mr Fedorcio seemed to run the public affairs directorate as an odd-job man might recruit customers—it was almost unbelievable.

We need better managerial control at the Met. It is astonishing that no one thought to ask a question about the fact that 10 of the 45 employees in the public affairs directorate were ex-News International. Anywhere else, that would be a question worth asking. The way in which Mr Wallis was awarded a contract worth £1,000 a day is open to question, too. The fact that in the midst of investigations senior officers could have dinners with people who might be directly relevant to their inquiries seems astonishing.

I do not see that the Mayor has played a particularly useful role, with his reference to codswallop and his attempt to roll back. I mention this because the Mayor is the model for police commissioners that the Home Secretary wants to impose on the rest of the country, and the Mayor seems to have played no useful part in terms of accountability during this process. What looks like one of the least accountable forces in the country is set to become the model for the rest of the country. There is an argument that, even at this late stage, the Government should think again about the problem.

[Andrew Selous]

Will the hon. Gentleman explain to the House how he thinks a police force is more accountable to an unelected official than to an elected one?

[Steve McCabe]

That is not really the point. The point that I am making is that in the face of this enormous scandal, the man who was supposed to make the police more accountable did nothing about it.

If Lord Macdonald is right about what he saw in the file, sadly some officers will have to go to jail to restore public confidence. There is no way in which that can be swept under the carpet now.

I echo the points made by the Chairman of the Home Affairs Committee, my right hon. Friend the Member for Leicester East (Keith Vaz), and by my colleague on the Committee, the hon. Member for Hertsmere (Mr Clappison), about victims. At the core of the problem is the way people were treated. Unless additional resources are devoted to identifying the victims and something is done about that, the stench associated with these events will never go away. While there is doubt about whether all the people who have been mistreated have been accounted for, the problem will not go away. There will be no closure until we identify all the victims and they are properly and fairly treated. I urge the Government to think about that aspect.

In criticising the police, we should not forget the pressures they were under at the time, with the incredible terrorist threat that was sweeping the country. We should not underestimate the pressures that ordinary rank and file officers feel they are under because of the cuts and the relentless pace of change that the Government are imposing on them. We need to recognise that wrongdoers must be punished and failure in all its forms in the police must be addressed, but ordinary officers need a break from the relentless attack on honourable policing traditions, which is the problem now afflicting police forces throughout the country.

In the light of what we have experienced in this horrible affair, there is a chance to pause and think again about some of the things that are happening to other forces at this time. It would be a tragedy if we did not learn anything from the experience and went on to create conditions in other forces that mean that the same problems are repeated elsewhere at some point in the future.