World Autism Awareness Week

Julie Cooper Excerpts

Thursday 28th April 2016 Commons Chamber

[Mrs Gillan]

I am doubly grateful to my hon. Friend. He is absolutely right that the achievements of such organisations and programmes should be congratulated by all of us in the House.

Action is needed for the 700,000 people in the UK who are on the autism spectrum and their families. I am aware that the Government have invested £325,000 on autism awareness work, but that is a drop in the ocean if our aim is to ensure, as I believe it should be, that this generation of autistic children grows up in a world that understands them.

At this point, I want to pay tribute to the Minister. Quite honestly, he has attended every autism meeting and function that I have asked him to attend. He shows a great deal of understanding of this area, so I am looking forward to a really meaningful response from him when he winds up the debate at the end of the afternoon. More leadership is definitely needed from the Government.

[Julie Cooper (Burnley) (Lab)]

I am very grateful to the right hon. Lady for the work she does on this really important subject. Does she agree that it is extremely worrying that only 15% of adults suffering with autism are in full-time employment? Would it be right and proper for the Government to support the work of organisations, such as Ambitious about Autism, to help them in the transition into work that could be so crucial for so many?

[Mrs Gillan]

The hon. Lady is absolutely right. I will mention some of the organisations involved at the end of my speech. Ambitious about Autism is just one of the many organisations that are trying to help people with autism into employment. I want to mention that later as well, because it is very important.

To build on the intervention on the criminal justice system by the hon. Member for Cardiff West (Kevin Brennan), I should say that I recently visited Her Majesty’s young offenders institution in Feltham to see at first hand how a deeper understanding of the issues and how some adjustments in the physical environment can help people on the spectrum. The prison recently underwent accreditation from the NAS, and the prison staff’s enthusiasm in, and dedication to, helping the young people in their charge is absolutely admirable and really wonderful to see. I very much hope that members of the all-party group will go there on a visit to see exactly what Feltham has done. Custody can be a really traumatic experience for anyone, but without specific adjustments for those with autism, it is much harder for them to engage in their own rehabilitation. Familiarising staff with autism, allowing prisoners to use communal areas at quieter times, and reducing posters and notices to prevent over-stimulation are just some of the small things that can make a significant difference to the experience of autistic prisoners in custody.

I now want to pay tribute to the Minister for prisons, the Under-Secretary of State for Justice, my hon. Friend the Member for South West Bedfordshire (Andrew Selous), who wrote to every prison in this country asking them to undertake autism accreditation. Currently, over 20 have been in touch with the NAS and its accreditation team and, alongside Feltham, four are going through the process. We want this kind of Government leadership and we want such leadership to be sustained. When I ask the Government to do more on the awareness and understanding of autism, I expect to get this type of response. Far more could be done in the criminal justice system, particular in the Courts Service.

Following the example of Feltham, the public sector can and should do much more to make sure all its services and buildings are more accessible to autistic people, so that they and their families can feel confident that they can visit public buildings and use public services in the same way as everyone else. For example, I was very pleased at the weekend to read that Asda is piloting a “quiet hour” in one of its stores in Manchester, when it will turn off escalators, screens and music for an hour to create a more comfortable shopping experience for those with autism. That is to be commended.

At this point, it would be remiss of me not to mention that Parliament is itself working, under the leadership of Mr Speaker, towards an autism access award and to make sure that autistic visitors to our place of work feel confident that they will be understood and treated well right across the board. In the light of this positive work on the parliamentary estate, I hope the Minister will meet me and representatives from the all-party group and the NAS to discuss how, together, we can build on the early successes of the “Too Much Information” campaign and ensure that all public buildings become accessible to people on the spectrum.

I want to turn to one of the biggest issues facing people with autism and their families, which is the time it takes to get a diagnosis in the first place. I can see from the nods that that rings a bell with everyone in the Chamber. Recent research suggests that, on average, adults have to wait more than two years for a diagnosis. For children, the figure stands at 3.6 years. An autism diagnosis can be life-changing, explain years of feeling different and help to unlock professional advice and support. Government guidelines say that a diagnosis should not be a barrier to putting in place the right support, but 58% of people on the spectrum have told the NAS that a diagnosis led directly to getting new or more support. How can the right support be identified without the clarity of a diagnosis?

Dementia and Alzheimer’s Disease

Julie Cooper Excerpts

Tuesday 12th April 2016 Westminster Hall

[Julie Cooper (Burnley) (Lab)]

I am grateful for the opportunity to serve under your chairmanship, Mr Stringer, and to the hon. Member for Strangford (Jim Shannon) for raising this important subject.

Sadly, there is no cure for dementia, but diagnosis is important for understanding and so that support can be provided. Many welcome supportive initiatives have been developed in the community. For example, in my constituency, the local council has taken the lead in helping to make Burnley a dementia-friendly town and even offers free training to licensed taxi drivers. The initiative is part of a town-wide campaign to encourage residents and businesses to become more dementia-aware, helping Burnley to become a dementia-friendly town.

Raising awareness of dementia among transport services is vital. Some people living with dementia may lose the confidence to drive and become reliant on public transport. Taxi drivers may have friendly, familiar faces for people living with dementia and, if they have gone through a dementia information session, may be better equipped to understand their customers’ needs.

Suffering from dementia is difficult, as is caring for someone with it. It is important to recognise the needs of carers and to give them maximum support. I have seen the problems close up. My grandmother suffered dementia caused by Alzheimer’s disease. She moved from experiencing bouts of mild confusion to a total inability to cope unaided. As my family struggled to care for her, there was little if any specialist support or understanding, and eventually the family were forced to make the hard decision to admit her to residential care.

Things have improved since then: awareness has increased and more support is available. Projects such as the Butterfly project, which many hospitals have adopted and which helps to identify sufferers and to train hospital staff, are welcome developments. Sadly, however, carers are still too often undervalued and under-supported.

Last year, when doing research for my private Member’s Bill in which I tried to introduce free hospital car parking for carers, I talked to many carers, including several who were caring for loved ones suffering from dementia. I was affected by many of the stories I heard. One lady told me she had given up her full-time job to care for her husband who had developed dementia. At home, she fed, dressed and comforted him. When he fell and broke his hip and had to be hospitalised, she continued to provide the same care. She visited him every day, staying long hours, helping with his basic care and bringing calm. If she had not been able and willing to take on that role, it would have fallen to NHS staff.

It is estimated that carers save the NHS billions of pounds every year. At the same time, because caring duties may necessitate them leaving paid employment, many carers suffer financial hardship. I am shocked that the Government chose not to support my Bill, which would have offered some small assistance to carers. It would have sent a strong message of support to carers up and down the country that we value them. The way forward must be to increase awareness and to properly resource support for dementia sufferers and their carers.

Mention has been made of the Prime Minister pumping money into research, which is welcome, but while there is no cure, I would like the Prime Minister to pump money into improving care. That is not only the decent thing to do; it makes sound economic sense.

Oral Answers to Questions

Julie Cooper Excerpts

Tuesday 22nd March 2016 Commons Chamber

[Jane Ellison]

The hon. Lady is absolutely right to draw the attention of the House to the challenge of joining up thinking across the cancer pathway. That is exactly the approach that Cally Palmer and the taskforce implementation team are looking at. I recently had a conversation with her and with NHS England representatives in which we talked about how we get that joined-up approach. That is at the heart of the taskforce’s recommendations, and we will be taking it forward for all the reasons that the hon. Lady has eloquently expressed.

[Julie Cooper (Burnley) (Lab)]

Cancer Research UK has said that cancer waiting targets have been missed so many times that failure has become the norm. Does the Minister agree that failure to tackle that is undoing the good work of the last 15 years on survival rates?

[Jane Ellison]

These days, we are dealing with the fact that a hugely greater number of people are being diagnosed. The increase in the number of people being referred by GPs is extraordinary. For example, last year GPs referred nearly half a million more patients to see a cancer specialist. That is an increase of 51%. When it comes to waiting lists, of course we want to make sure that everyone is seen. The Government have committed more money to diagnostics, for example, but we expect the NHS to look urgently at any local dips in performance and to take action to make sure that all patients get access to treatment as quickly as possible.

End of Life Care

Julie Cooper Excerpts

Wednesday 2nd March 2016 Commons Chamber

[Julie Cooper (Burnley) (Lab)]

I am grateful for the opportunity to speak about such an important issue. Let me begin where the hon. Member for Totnes (Dr Wollaston) left off. I have been very impressed by what I have read. When end-of-life and palliative care in this country is at its very best, it is indeed the best in the world, which makes me proud to be British. However, it saddens me that that is not the case more widely. All the recent reports have demonstrated that access to the very best care varies tremendously, and is very patchy. It is for that reason that end-of-life care has been the subject of recent studies and reports, not least those of the Health Committee.

I understand that a very thorough piece of work was done before I became a member of the Committee last year, and that concerns were raised about this very issue. The “Choice” review body looked into it as well, and came up with various recommendations. I want to focus on one of those recommendations in particular. The review recommended that 24/7 care should be made available for people in a community setting. The point has already been made that it is hard to define the end of life and the timescale involved. Indeed, the British Medical Association makes the point that more funds are needed to train staff to a level at which they can better identify these things. The end of life can be a lengthy process, and people need support at this most important time of their life.

Most people who responded to questionnaires on this subject have said that they would prefer to die in the comfort of their own home, surrounded by their family. In order for that to happen with the maximum dignity and the highest standards, investment is needed in social care above all else. The recent cuts in social care budgets have been a matter of concern for most of us. Lancashire County Council is further reducing its spending on social care, and the elderly and disabled in my constituency and their families are already worried about the impact that this could have on them. However, we still aspire to have the highest possible standards for end of life care, and the two concepts simply do not add up.

I wonder why the Government are delaying their response to the “Choice” review. We desperately need to hear what their plans are, to determine whether they are really listening. The “Choice” review also recommended additional funding of £130 million, because the £8 billion that was allocated for spending in the NHS has already been well and truly spent many times over. County councils’ adult social care budgets are feeling the pinch.

Last year, in the run-up to the introduction of the private Member’s Bill tabled by my hon. Friend the Member for Wolverhampton South West (Rob Marris)—the Assisted Dying (No. 2) Bill—people in my constituency told me of their concerns about dignity at the end of life. Many of them asked me to vote to support the Bill because they were worried that a level of care that afforded them the dignity they wanted would not be available. They were worried about whether they might suffer and what the experience would be like for their families.

This issue is rightly at the top of the agenda, because this is the very least that we can do for the elderly and the sick. We do not like to talk about it, but everyone’s life is going to end and we need to think about this. The fact that we cannot do this better in 21st-century Britain makes me ashamed. We know that we could do it better, so I urge the Minister to read the recommendations put forward last year by the Health Committee and by the “Choice” review. In fact, I am sure that he has already done so. Almost 12 months have gone by, and this is a matter of urgency. It is quite shocking that we have not dealt with it before. I urge the Minister to look at the recommendations and to ensure that those who choose to die in their own homes in the community get the excellent care and support that they rightly deserve.

Junior Doctors’ Contract Negotiations

Julie Cooper Excerpts

Monday 8th February 2016 Commons Chamber

[Ben Gummer]

Yes, and I would add the 2,800 people who have had their operations cancelled. I wonder what answer they would get from the Opposition about whether they support or condemn those cancellations. As soon as we get an answer to that very simple question, it will be easier for us to know the official position of Her Majesty’s Opposition.

[Julie Cooper (Burnley) (Lab)]

Yesterday, the Secretary of State for Health accused the BMA of misleading junior doctors. Today, the Minister comes to the House and accuses the BMA of lying. Is he really asking us to believe that some of the most intelligent people in the country—junior doctors—cannot see for themselves what the Government are proposing? Does he not feel that the continued abuse directed at the junior doctors’ representatives is hindering any possibility of a settlement to this dispute and that that is damaging to patients?

[Ben Gummer]

The hon. Lady is also an intelligent woman, so let me ask her this. If a trusted body, such as the BMA, tells its members that they will have a pay cut of 30% and an increase in hours, but that statement is incorrect, does it constitute a lie? That is the question I would put back to her.

Junior Doctors Contract

Julie Cooper Excerpts

Friday 20th November 2015 Commons Chamber

[Alistair Burt]

Medical studies have demonstrated that there are a number of extra deaths at weekends. The disputes about that are intense, but the medical profession recognises that the absence of facilities, the absence of consultant cover on the level it ought to be at, and the absence of diagnostic tests and other things, make entry into the health service at the weekend less secure than it would be at other times of the week. It is very important to change that. That is what the public voted for at the general election and that is what they expect the Secretary of State to deliver. That that should be held up by an industrial dispute, essentially by a union digging its feet in and not taking the opportunity to negotiate, is unfortunate and bad news for the patients my hon. Friend referred to.

[Julie Cooper (Burnley) (Lab)]

Does the Minister accept that his insistence that junior doctors do not understand the conditions is deeply insulting to some of the most intelligent people in the country? Does he accept that this shabby and patronising treatment has led to a total breakdown in confidence in the Secretary of State, and that the only way forward is through ACAS, an independent body?

[Alistair Burt]

The Secretary of State has gone out of his way to seek to explain to doctors the basis of the contract, partly to deflect what was said about it originally by the BMA during the course of the industrial dispute. He will continue to do that. There is no doubt that we all value the work of junior doctors enormously and fully appreciate that they will be looking very hard at their conditions and everything else. Proper union representation is not delivered by a union that refuses to negotiate after three and a half years and after independent recommendations have been made. I urge the hon. Lady, who also has a valuable role in the NHS in relation to pharmacy and a deep interest in carers, to recognise what will happen for those 50,000 or 60,000 elective admissions that will not be able to take place, to think about those who will be involved and to continue to stress, as I know she will, that negotiations are the answer and that conciliation is available if they are not successful.

Hospital Parking Charges (Exemption for Carers) Bill

Julie Cooper Excerpts

Friday 30th October 2015 Commons Chamber

[Julie Cooper (Burnley) (Lab)]

I beg to move, That the Bill be now read a Second time.

I am pleased to have the opportunity to introduce the Bill and facilitate this debate in the House. I thank Members who have given up their valuable Friday constituency time to take part.

This is an important subject and it is essential at the outset to outline the context. The Bill raises, not for the first time in this place, the controversial subject of hospital car parking charges. Other hon. Members have made the case for free hospital car parking. In 2012, the hon. Member for Kingswood (Chris Skidmore) ran a prominent campaign against hospital car parking charges. In 2014, the right hon. Member for Harlow (Robert Halfon) ran a high-profile campaign on free hospital car parking, arguing that charges represent a “postcode lottery stealth tax”. The hon. Member for Wellingborough (Mr Bone) then chose the abolition of hospital car parking charges as the subject of his private Member’s Bill. I am grateful to them all for their work, which has provided a valuable foundation for my Park the Charges campaign.

No one likes to pay to park, full stop. To pay to park at a hospital, when sickness is involved, seems to add insult to injury. The majority of people in Scotland and Wales enjoy free parking when visiting hospitals and other medical facilities. During the course of my research for the Bill, many people contacted me to express the view that all hospital users in England should enjoy the same privileges as their Scottish and Welsh counterparts and be able to park for free when attending hospitals. That may well be desirable, but it goes beyond the scope of the Bill, which focuses on providing support for carers.

The Bill makes provision for carers who are entitled to carer’s allowance to park free of charge in hospital car parks in England. The duties in the Bill would also apply to walk-in centres, GP practices and private hospitals. The Bill, if passed, will require health authorities to put in place a strategy to exempt a broader range of carers from paying parking charges within one year of the Act coming into force.

I chose this subject for my Bill because about 18 months ago, I had a taste of what it is like to be a carer. My mother was seriously ill in hospital. So serious was her condition that we were not sure what the outcome would be. It was a distressing time. I was, by and large, the only visitor and I visited every day for nine weeks, often staying for long periods to provide comfort and support. I spent a lot of time sitting in hospital corridors, waiting to speak to medical staff; I had read every notice on the walls. Each night when I left, tired and distressed, I queued up to pay for my parking. It was costing me £40 a week, and on one of those days, driving out of the car park, it occurred to me that I was lucky, because I could afford to pay that charge. I reflected on the matter and wondered about those people who could not afford to pay—not those who would rather not pay to park, but those who could not afford to. I was distressed and worried about my mum, but I thought how much more distressing it must be for those in financial hardship that is made worse by hospital car parking charges.

There are currently 5.5 million carers in England providing unpaid care for people who have specific support needs. More than 700,000 of them receive carer’s allowance at a rate of £62.10 a week. A further 400,000 are entitled to the benefit. Those are the carers who will benefit if the Bill is successful.

[Mr Christopher Chope (Christchurch) (Con)]

The hon. Lady makes a compelling case, but do hospitals not have discretion to respond in the way that she wants them to, without the need for the Bill?

[Julie Cooper]

I am grateful to the hon. Gentleman for raising that point, and I will come to it later in my comments, if he will bear with me.

[Mr Chuka Umunna (Streatham) (Lab)]

I congratulate my hon. Friend on bringing forward the Bill. To answer the point made by the hon. Member for Christchurch (Mr Chope), for a carer visiting one of my local hospitals for a couple of hours twice a week to take a relative for treatment, parking costs about £40 a month at St George’s hospital, about £20 a month at King’s hospital and about £48 at Guy’s and St Thomas’s. That is the reality of the situation, and that illustrates how discretion is not being used to help people in the situation we are discussing.

[Julie Cooper]

I am grateful to my hon. Friend for making that important point.

We all need to understand that carer’s allowance is not dished out willy-nilly. To qualify, a person has to devote at least 35 hours a week to caring for a person with substantial care needs, and many carers provide far more hours than that. To fulfil their caring role, they often have no option but to work reduced hours, and some are forced to give up work altogether. They often face a steep drop in income if they have to leave work or reduce their hours in order to care, and there is sometimes a double loss of salary if they are caring for a partner who also has to give up work as a result of their illness or disability. Some 2.3 million people have given up work to care, and that loss of income is often coupled with a steep rise in expenditure as a result of the additional costs of caring and disability, including travel and parking costs as they support the person they care for to attend medical appointments or continue to provide care during stays in hospital.

One carer, Jackie, shared her story with me. She cares full time for her husband David, who has secondary progressive multiple sclerosis and hairy cell leukaemia. She said:

“As David’s wife and sole carer, I was at the hospital every day from 9.30 am until 7 pm. We live 22 miles from the hospital and rely on benefits as our sole income—so the expense of travelling to and from hospital every day and paying the parking charges was huge. We exhausted the little savings we had. Weekly parking tickets were available and cheaper than daily charges, but I never knew how long my husband would be in hospital for. The last thing I needed was to be worrying about car parking charges when I was anxious about whether my husband was going to make it or not. Carers are at such a disadvantage already, car parking charges are one extra penalty they do not need.”

For carers, fulfilling their caring role often involves parking at hospitals for hours on end day after day, week after week. Hospital parking charges place an unfair financial burden on those caring for disabled, seriously ill or older friends or family members. NHS hospital trusts and foundation trusts are responsible for setting their own charging policies and are not currently required under law to provide any exemptions. Some hospitals in England already provide free car parking, and others offer some concessions, although these are few and far between and invariably poorly advertised.

[Julian Knight (Solihull) (Con)]

I congratulate the hon. Lady on bringing forward this interesting Bill. She has just said that some hospitals in England do not charge for parking; surely that shows that there is discretion in the system.

[Julie Cooper]

The fact is that the current system is very hit and miss. Some hospitals provide small concessions, but that is not widespread.

There are no specific exemptions for carers, and hospital car parking charges are particularly onerous for carers who spend long hours on hospital visits on a regular basis. Research by Carers UK found that 48% of carers are struggling to make ends meet, and 45% said that financial worries were affecting their health. The average cost of parking in England is £39 per week, and in London that rises to £130. For those on low or no incomes—as is the case with many carers—charges at any level are a burden they could do without. Dozens of carers have shared their experiences with me over the past few months, and many have said that their entire carer’s allowance is taken up with the cost of hospital car parking and petrol. Many have been forced to get into debt to meet their day-to-day living costs.

I am grateful for the support of Members from across the House, and I know that the Minister shares many of my concerns. In response to some of the issues I have raised, he intends to publish revised guidelines to hospital trusts on parking charges that

“will explicitly include carers in the groups who are eligible for concessions.”

That is new and I welcome it, but it does not go far enough because most hospitals choose to ignore the guidelines. In the past 12 months, more than 100 hospital trusts have increased their car parking charges—recently, the Medway Maritime hospital increased its charges by a staggering 60%—and the trend is not to support the vulnerable. Indeed, Mid Yorkshire Hospitals NHS Trust has gone a step further and introduced charges for disabled parking. The direction of travel is wrong, and more action is needed if we are to effect real change.

It is also important to consider the emotional pressure facing carers, because when someone who has spent hours at the bedside of a person they care about comes out of a hospital, the last thing they want to do is join a queue to pay for parking. They should not need to worry whether the machine is working or whether they have the right change. They are often distressed, and invariably in a hurry. Often they are on their way to pick up clean clothes and supplies, and they are already planning their return journey, which in many cases is on the same day. Some hospitals require payment on entry, which brings its own pressures. Carers who are on limited budgets need to estimate how long each hospital visit will last, and they often have to leave the ward or treatment room to run out and replenish the ever-hungry parking metre.

In the last few months I have encountered many apparently rational arguments against my proposal, and I shall consider them each in turn. The British Parking Association argues that the removal of charges elsewhere has been unhelpful, and that abuses of that have led to a shortage of parking at medical sites. That is easy to deal with, because my proposal does not ask for free car parking for all, but focuses on a specific group of hospital users, each of whom would display a carer’s charge exemption badge in their car, ensuring that only those genuinely entitled would benefit.

Other critics have pointed out that in many areas carers are able to make use of hospital shuttle buses, which are often provided free of charge. They have said that travelling to hospital in a car is in itself a luxury, but they clearly do not understand the issues. Often, carers cannot access services for a variety of reasons, such as other commitments or dependants, which means that they need their own transport. Sometimes hospital transport requires multiple bus changes, and rural communities often have no bus service at all. Sometimes a patient’s condition means that any form of transport is unsuitable. I have spoken to people who are suffering from cancer and who rely on their carer for transport and for support through the regular chemotherapy and radiotherapy sessions. These patients often have impaired immunity, so exposing them to infection on public transport is surely not an option for them.

The main criticism of the proposals in the Bill relate to the perceived loss of income to the NHS. I would make the following points. It is estimated that the contribution made by carers saves the NHS more than £100 billion each year by virtue of the time they spend supporting people in hospital. Sick children, people suffering with mental illness or Alzheimer’s disease, or those with physical and mental disabilities have special needs. They need special care when they are at home and those special needs do not go away when they are admitted to hospital. In fact, they often need more help to cope in an unfamiliar environment.

If carers and parents did not visit and support each day, hospitals would not be able to cope. I spoke to one lady who gave up work three years ago to look after her husband who had developed Alzheimer’s. Her husband had a fall, broke his hip and was admitted to hospital. For three years she had been feeding, dressing and calming her husband, and she continues to perform this role in hospital. The nursing staff already have enough to do attending to the medical needs of all the patients on the ward. They simply do not have the time to provide such intensive caring. Similarly with stroke patients, I have met many carers who go the hospital each day and sit patiently feeding their loved one, leaving nurses free to perform their duties as qualified medical practitioners. Many families are struggling in poverty because their child has an ongoing medical condition. A parent or carer’s presence at the hospital often provides many hours of valuable support that would otherwise have to be provided by the nursing staff—at what cost?

During the preparation for the Bill, I have met parents who have more than one child with multiple health needs, both of whom are constantly in and out of hospital, necessitating multiple journeys to and from hospital. This means little, if any, time for the parents to go to work as they are performing a big support role on the ward, but suffering significant financial hardship. And we want to charge them to park! Torbay and South Devon NHS Foundation Trust proves the point. It has successfully implemented a free parking scheme for carers. It acknowledges that the financial impact has been minimal by comparison with the benefits received. For example, nurses at the hospital report that the scheme means they have more free time, as carers are able to spend longer visiting their loved ones. Carers who use the scheme say they feel valued, that the scheme saves them money and that it removes one of the many stresses in having to visit hospital.

In addition, there is evidence that patients make a faster recovery when they have the continuous support of a known and trusted carer, and are often discharged from hospital earlier, with obvious financial savings to the NHS. Hospital car park charges are a financial punishment for carers for looking after a friend or family member. Without carers, many people would never be able to access the healthcare they need to help them to manage their illness or disability. Carers have so much to cope with, why do we give them one more financial burden?

As a former member of Lancashire’s health and wellbeing board, I know that one of the ways that the Government seek to make savings in the NHS is by reducing the number of hospital stays. Where carers are willing and able to provide ongoing care at home, many patients can now be discharged at an earlier stage than in the past, thus freeing up much needed beds. They go on to return routinely as out-patients, with transportation invariably provided by their carer. The saving to the hospital in those instances is far more than is ever collected in car parking charges. Carers enable people to continue to live in their own home, saving the expense of care homes.

The Minister rightly recognises that if we want to keep people out of hospital we must improve out-of-hospital care. He has also acknowledged that

“Carers do a magnificent job”

and that

“they do not always get the thanks or support that they need.”

I am singling out carers for special attention because they are vulnerable and going through a difficult time, and because they matter and they need our support.

I ask hon. Members to support the Bill to provide free car parking at hospitals for qualifying carers and in the future to consider supporting eligible carers. It will not solve all their problems by any means, but it will help, and just as importantly, it will send a signal to carers around the country that we value their contribution. The Bill would support carers and send a message that Britain cares about carers. Carers are crucial to the future of Britain’s health and wellbeing. Surely the least we can do is allow them to park for free.

--- Later in debate ---

[Philip Davies]

My hon. Friend has made a perfectly valid point. How the hospitals are likely to know who has an underlying claim to carer’s allowance is something that we may explore at greater length as the debate continues.

[Julie Cooper]

May I clarify a point? The only dog’s dinner is the current practice. Some hospitals have a hotch-potch of concessions, while others have none at all. The Bill specifies a clearly defined number of people. As the hon. Gentleman says, it will apply to 700,000 carers and to a further 400,000, so a total of 1.1 million stand to benefit. That is very easy for everyone to understand.

--- Later in debate ---

[Philip Davies]

My hon. Friend is absolutely right. I will say more about Scotland and Wales in due course, because we have seen the impact of this policy in those countries. There is not a never-ending supply of money, and if more is spent on free car parking in the NHS, less will inevitably be spent in other areas. Labour Members seem to think that money grows on trees and that there is a never-ending supply of it, but back in the real world, we have a certain amount of money and we choose how to spend it. If we choose to spend it on one thing, we inevitably have to take it away from somewhere else. The hon. Member for Burnley did not mention the need to make that choice, but it is important that we face that fact.

The hon. Lady has clearly had difficulty in finding evidence to support her Bill, so I thought I would help her out a bit. She has clearly spoken to lots of carers groups, and she has set up the Park the Charges campaign with Carers UK, for which I commend her. For the sake of balance, however, we should not just listen to the views of carers, important though they are. We should also seek the position of the hospitals on this matter, because they would ultimately be the most affected by the proposed changes.

I am not sure what discussions the hon. Lady had with the hospitals, given that her Bill would force them to change their car parking policies. I contacted the East Lancashire Hospitals NHS Trust, which I believe is the hospital trust that covers her constituency. I asked the trust what consultations she had had with it on this policy. I put in a freedom of information request to ask what communication Burnley general hospital had received from the hon. Lady on the issue of carers and hospital car parking charges. I received a response on 25 September, which stated:

“I can now confirm that we have not had an enquiry of this nature from Ms Cooper”.

[Julie Cooper]

For the purpose of clarification, I should like to point out that the majority of people in my constituency who require a hospital stay normally go to Blackburn hospital. It is also part of the East Lancashire Hospitals NHS Trust, and I have discussed these proposals extensively with the chief executive there.

[Philip Davies]

I am pleased to hear that. I am sure that it will be a matter of great reassurance to the East Lancashire Hospitals NHS Trust that the hon. Lady was not interested in its opinion, even though Burnley happens to be her local hospital. I was surprised to find, given that she is trying to make such a fundamental change to hospitals, that the one in her own constituency—Burnley general hospital—had not received a request from her to discuss the impact of her proposals. I would have thought that, as the MP for Burnley, she would have taken an interest in that. I personally believe that the people who tend to know best about things are the people who deal with them every single day of their lives, be they nurses, teachers or checkout operators in supermarkets. When assessing the impact of her Bill on hospitals, I would have thought that Burnley general hospital would have been a good place to start.

We have already discussed who currently decides hospital car parking charges. The hon. Lady is right that such matters are decided locally. We should also note that there are guidelines around hospital car parking charges. NHS services are responsible locally for their own car parking policies for patients, visitors and staff. Back in August 2014, the Government published new guidelines on NHS patient, visitor and staff car parking principles—I hope the Minister will expand on this matter when he responds to the debate. They are guidelines only; they are not mandatory. The car parking guidelines recommend the provision of concessions to groups that need them, such as disabled people—both people with blue badges and people who are temporarily disabled—frequent out-patient attenders and visitors with relatives who are gravely ill. The Government guidelines on car parking charges say:

“Concessions, including free or reduced charges or caps, should be available for the following groups: people with disabilities…frequent outpatient attendees…visitors with relatives who are gravely ill…visitors to relatives who have an extended stay in hospital…staff working shifts that mean public transport cannot be used…Other concessions, e.g. for volunteers or staff who car-share, should be considered locally.”

It was also reiterated in the previous Parliament that relatives of people who are gravely ill or who require a long stay in hospital should also be exempt from car parking charges. The then Health Minister made that clear in an answer to a parliamentary question, in which he set out the people who should be exempt as far as the Government were concerned.

--- Later in debate ---

[Mr Chope]

My hon. Friend is absolutely right. That brings home the point that this Bill has not really been thought through. To what extent has it been discussed with GP practices? I doubt whether it has been discussed with them at all.

If one wanted to bring forward a Bill under the private Members’ Bill procedure and give it a good chance of success, I would have thought that one would ensure that it was very narrowly focused, specific and precise. If the hon. Member for Burnley had discussed her Bill with me before she presented it, I would have given her the same advice that I have given to many other hon. Members from both sides of the House who have aspired to make progress with their Bills: it is better to have a small, modest measure that is carefully thought through than something that is general and easily open to different interpretations, which makes it unlikely to make progress.

On that theme, the inclusion in clause 1(2)(b) of private hospitals is completely absurd. Why do we want to drag private hospitals into the issue of whether to impose car parking charges on carers? I am happy to give way to the promoter of the Bill so that she can explain why she wanted to bring private hospitals into the Bill. Most of the discussion has been about NHS provision. Why does she want to interfere in the private sector? In my experience, most private hospitals do not have any charges for parking.

[Julie Cooper]

To clarify that point, NHS patients have the opportunity to use private hospital services. The carers who transport them there may well still need access to free car parking.

[Mr Chope]

So the hon. Lady is saying that this provision would apply to private hospitals when they were treating NHS patients and that it would only affect the carers of NHS patients, rather than the carers of private patients.

--- Later in debate ---

[Julie Cooper]

indicated assent.

[Mr Chope]

Of course, it does not say that in the Bill. That is a point of detail that I am sure was just overlooked in the drafting. I am grateful to the hon. Lady for making that clearer.

The provision applies to

“car parking spaces provided directly or indirectly, including under contract, by or on behalf of a health care provider…for patients and other users to whom car parking charges would otherwise apply.”

Again, my submission is that that goes far too wide because it drags in contractual provisions in the private sector and could impose directly on hospitals that have contracted out by agreement to private providers. They might have said, “Please build this car park and provide spaces for our patients, and in return we will allow you to charge patients,” and a business plan will have been drawn up accordingly. Clause 1(3) would effectively drive a coach and horses through that contractual arrangement. It could result in a compensation bill being payable by the hospital concerned to the private provider because of a breach of contract. That is another example of why clause 1 is far too wide.

On clause 2, which is about qualification for the parking charge exemption, I am indebted to my hon. Friend the Member for Bury North (Mr Nuttall) for explaining the number of people who have an underlying entitlement to carer’s allowance. In my constituency, where there are a large number of pensioners, a significant number would be subject to the overlapping benefit rule and would therefore be included as carers under the Bill by reason of having an underlying entitlement.

The bigger problem is that the Bill would not help unpaid carers. The vast majority of the 6 million carers in this country do it voluntarily and do not get any help from the state or the taxpayer, yet the Bill would not help them at all. Indeed, it could perversely make them worse off.

--- Later in debate ---

[Alistair Burt]

As I have said, the opportunities for discretion exist, but perhaps the way in which discretion is exercised is something that the carers strategy can look at.

It was this Government who passed the Care Act 2014. For the first time, carers—as well as those they were caring for—were given the right to be assessed by a local authority. We gave an extra £400 million for respite care, to be used by those who needed it during the last Parliament. It is therefore reasonable, given the availability of the carer’s allowance and the other measures I have mentioned, for the Government to indicate that carers are valued in ways that they have not been in the past. There has been an incremental increase in support for and recognition of the carer’s role over the years.

I stand four-square behind what my colleagues have done. The Secretary of State’s determination to devise a new carer strategy, on top of what is already there, is a recognition of the fact that more might well need to be done, but it also recognises the value of carers. Nothing we have heard today on either side of the House, including some graphic examples, has suggested that we do not value carers.

Before I respond to the points on car parking charges, I should like to mention the speeches that have been made today. The hon. Member for Burnley set out her case extremely well, and I shall come back to that in a moment. My hon. Friend the Member for Shipley (Philip Davies) is a necessary piece of grit in the oyster of the workings of Parliament. Mrs Thatcher said that every Government needed a Willy, but in addition, every Parliament needs either an Eric Forth or a Philip Davies. They remind us that, at the end of the day, this is not a game. If we pass a piece of legislation, it has consequences and, accordingly, it has to be right. Occasionally, my hon. Friend will say things that people find uncomfortable, but he is just doing his job.

The process of a private Member’s Bill is not easy. Indeed, as I go on talking for a while this afternoon, there will be plenty who say that these processes should be handled differently, but they are not. This is the way in which some things are examined. My hon. Friend made a good speech. Above all, he talked about the problems of economics that I referred to earlier. There are many things that we would all love to do, but often we cannot. We have to make choices. When the Government of the hon. Member for Worsley and Eccles South were in office, they had to make choices, and so do we.

The hon. Member for Birmingham, Perry Barr (Mr Mahmood) made a strong personal plea for the Bill. He mentioned patients on dialysis, and I would like to reassure him that those patients are already covered in our principles as frequent out-patient attenders. The amendment that we have just made to our provisions will ensure that carers of patients on dialysis will be covered by the guidance.

My hon. Friend the Member for Bury North—God bless it!—(Mr Nuttall) went into forensic detail about the Bill. I ask him to convey my good wishes to all at Fairfield hospital, which I remember very well. Both my children were born there, and my wife still has a plaque up on the wall from when she opened a piece of equipment there. My hon. Friend also went into forensic detail when he described the difficulties that would be created by the Bill. He gave it a necessary examination.

The hon. Member for Heywood and Middleton (Liz McInnes), whom we should thank for her services to the NHS over many years, made it clear how passionate she felt about this issue. In a perfect world, everything would be wonderful, and she finished by saying that it would be great if everyone could park for free at hospitals. They cannot do so, however, because the money would have to be found from somewhere. I will come back to that point in a little while.

My hon. Friend the Member for Solihull (Julian Knight) detailed his own personal campaigning for fairer charges in his constituency. He is a perfect example of how an MP of any party can take up an issue and how, when something is wrong that can be worked through, it can be done in a local capacity. He provided a series of perfect examples of what to do as a local Member.

The hon. Member for Ealing Central and Acton (Dr Huq) made a passionate plea for change. My hon. Friend the Member for Christchurch (Mr Chope) examined the Bill in depth, especially in relation to clause 1. He gave examples of where the present discretionary arrangements could work to people’s advantage, and we will come back to those later. If there was no example anywhere of guidance and of opportunity for discretion being used, then the strictures of the hon. Member for Burnley would be much stronger. The fact is that discretion is used in some areas. Various figures were quoted: some 63% of hospitals do not charge, and some 86% or 87% offer discretion. That allows local areas to take notice of the principles and make their own decisions about what is necessary.

May I just add a word about the phrase “postcode lottery”, which is a favourite of mine? A postcode lottery implies a situation in which there is no chance to do anything about it. Many of the things in modern political life that we term postcode lotteries are not postcode lotteries at all, because they all contain the opportunity for people to make a difference, or to change things. The point of local discretion and of transparency in the delivery of services is precisely that it enables people who represent an area to say, “Why isn’t it as good here as it is next door? What is it they are doing that we are not?” They can then apply pressure locally to get something done. They should not always run to Government to say, “It is your fault. You must standardise everything.” Neither should they throw their hands up in the air and say that there is nothing they can do about it. Therefore, I reject the term postcode lottery on most of the times that it is used. This is an example of where, if discretion is used in some areas, why is it not used in others, and what will people do locally to encourage it? Clearly, it happens in some, but not all, places, and it is not always the responsibility of Government.

My hon. Friend the Member for Shipley said that he longed for the day when Ministers could stand up at the Dispatch Box and say, “It is nothing to do with me.” Actually, local discretion is nothing to do with me. All too often people come running towards Government and demand that something is done, when, actually, the answer lies in their own hands, their own constituents’ hands, their own local decision-makers’ hands and, in this particular case, the hands of those who are making decisions about hospital charges. It is fair that responsibility is very widely spread.

Let me move on and say a little bit about the car parking matter. I will do my best to be quick. Everything that the NHS does is on an epic scale, and that is true even in relation to car parking. At hospitals alone, there are around half a million car parking spaces to finance, manage and maintain, and every day, millions of users need to be seen safely on and off the sites. Parking is an amenity that the NHS has to provide if the service is to function properly—or indeed to function at all. Problems are particularly thorny in large acute hospitals, but they also exist in others. Our aim is always to see that parking provision is sufficient, efficient and fair.

The level of car parking provision required is a reflection of massively increased car ownership. When I was a boy and used to go with my father, a GP, to visit our local hospital, there were no car parking charges and the car park was half empty. I was born and brought up in the late ‘50s and early ‘60s, and life was very different. The more people who use our hospitals, the more car parking spaces we will need. Very recently, I went to the Lister hospital, a local hospital used by my constituents, and saw its new car parking facilities, which make a huge difference, but they have to be paid for.

Car parking, like any other service, is provided at a cost. Owning land costs money, so hospitals have to meet finance costs as well as maintenance, lighting, security and so on. Across the NHS, we now see better and better facilities. It is inevitable that some form of charge needs to be levied to cover those very real costs. From this perspective, it is perhaps remarkable that the average cost of parking across the NHS is only £1.15 an hour—and has fallen slightly this year. Once we accept that there is a real and unavoidable cost associated with parking we have to ask ourselves, “If hospital parking costs are not paid for by drivers, who are they paid by?” Again, that was a hard question asked by Members on the Government Benches.

[Julie Cooper]

I just want to clarify that the Bill is not asking for free car parking for all; it is asking to protect a vulnerable group who suffer great financial hardship from car parking charges. Despite the figure he has just mentioned, I am sure that the Minister will agree that the average car parking cost is £39 a week and significantly higher in some areas. Should the most vulnerable—those on the lowest incomes, who are already providing invaluable support to the NHS—be made to carry that burden?

[Alistair Burt]

As the hon. Lady knows, we have adjusted our principles to ask trusts to consider carers as a particularly special category. I do not think the Bill will work because of the technical issues that colleagues have mentioned and the difficulty of defining carers. I know how the hon. Lady wants to do it, but others would want to stretch it further. There is also the question of whether it is right to pick out particular groups in legislation and not others, a case that has been made very strongly. I entirely accept that she is not asking for free car parking for everyone, although some are, but the question remains that if this group is advantaged in this way, what might others work towards?

The principle remains the same. I do not think that anyone disagrees that if local hospital authorities can provide carers with free car parking within their budget without affecting any of their other costs, that is good and we would like to see it. However, that is not the view that we believe is held by all and, accordingly, we think that it is a matter for local discretion.

Let me briefly mention a couple of issues relating to the provision of car parking. I said that we had changed the principles. The principles, which my hon. Friend the Member for Shipley also mentioned, are delivered by the Government to the NHS and used to read:

“Concessions, including free or reduced charges or caps, should be available for the following groups…disabled people…frequent outpatient attendees…visitors with relatives who are gravely ill…visitors to relatives who have an extended stay in hospital…staff working shifts that mean public transport cannot be used”.

The “Julie Cooper amendments” mean that the reference to visitors with relatives who are gravely ill will now include the words

“or carers of such people”.

Where the principles refer to visitors who have an extended stay in hospital, the words

“or carers of such people”

will be added, and a new line has been inserted reading

“carers of people in the above groups where appropriate”.

The word “carers” has been inserted in the principles for the first time, and that is due to the hon. Member for Burnley. I hope that the examples we have heard of where discretion has been exercised might be used by others.

It is reasonable to suggest that if the NHS as a whole had to find costs upwards of £180 million, perhaps even towards £250 million, they would have to come from somewhere. It is therefore reasonable to ask who else would pay for them and whether that would be done through higher charges for others or at the expense of other parts of the NHS. I think that that is a matter for local discretion.

We heard about Scotland and Wales, and the devolved Administrations have decided what works for them. I also understand, however, that their free car parking policy has brought its own problems. Since charges were abolished at Edinburgh’s Western general hospital, the car park has been constantly full and staff have resorted to parking in nearby residential streets. In the first three months of free car parking on the Western general site, 70 complaints were received whereas before there were no complaints at all. In some areas, residents were complaining that people were parked in front of their driveways and Lothian health board has already had to employ wardens to police the overcrowded car park and is now paying for new car parks to be built.

The question of where car parks are sited was also raised, and the majority of hospital car parks where there are charges are in city centres. It is fanciful to believe that if free car parking was available in a city centre near a station or shopping centre, it would not be used by people who were not going to the hospital. There would have to be another method of policing it. Although the free car parking in Scotland and Wales sounds wonderful, it has its problems and we need to be clear about that. It is not an option for many hospitals in city centres.

The Bill was examined in relation to who might be eligible and who might not. Carers and those with underlying access to carer’s allowance include nearly 1 million people, which raises salient questions about where the costs would be diverted to.

I want to talk a little about the availability of car parking and access to it. A sensible, measured approach to car park charges can dramatically increase the availability of spaces. This matters to people who are looking for a car park space in a busy place at a busy time. It is in no one’s interest for a very small number of people to be able to park for free if everyone else, including, potentially, large numbers of carers, are then denied the chance to park at all. Quite reasonably, people who have cars expect to be able to use them to carry out their daily routine, but the available land for parking is limited and we cannot make it grow at the rate we wish. More people driving means more people competing for space, and hospitals have to find a way to make sure that as many people as possible can have access.

Without fair charges, car parks become congested and there is no turnover of spaces. Patients who arrive at 8.30 am may find that they can park, but those whose appointments are for later in the day are likely to be faced with a long and ultimately fruitless search for somewhere to leave their car. This cannot be fair. The Government take the view that it is not sensible to impose central requirements in relation to car parking. We cannot possibly know what each local situation requires. In city centres the cost of the land may be too high, if land is available at all. We are all familiar with St Thomas’ just across the bridge. It has 900 beds, yet has only 380 parking spaces. Those spaces have to work hard, and to do that they need to be in constant turnover. The situation is repeated again and again across the country. I am sure there is not one of us in the House who has not heard of a friend, colleague or loved one who has struggled to find a place to park at a city-centre hospital.

Hospitals outside the cities might well have more space for parking, but they have increased demand from people who have no viable alternative to driving. My hon. Friend the Member for Solihull, speaking about the importance of local transport provision, again made an important point which will benefit carers, patients and others alike. Some will never be able to travel by public transport—it will not be suitable—but others will, and the car will not always be the most convenient option. NHS organisations must have the autonomy to make their own decisions.

These challenges are not an excuse to ignore the principles which, as I mentioned to the hon. Member for Burnley, now include her amendments. Patients, carers and visitors deserve to have consistent concessions across the NHS. The charges may vary, but we can all agree on the groups of people who should benefit. As I indicated, we have identified five groups for whom we believe concessions can enhance access. By adding carers to those principles, we will have made a valuable contribution, very much as a result of what the hon. Lady has done.

A further area of concern for me is the way that car parks are managed and charges set. One aspect that concerns me is when patients, carers and visitors report unfair charges when appointments overrun, through no fault of their own. A number of colleagues have mentioned the problem faced by people trying to decide how much time they are going to spend at hospital, and the need to make sure that people are not worried about making that decision when they are under stress. That is why our principles support pay-on-exit schemes where drivers pay only for the time that they have used. Too often, patients are forced to guess how long their appointment will take, with the consequence that some of them put too much money in, just to be on the safe side. Others run back and forth between clinic and car park, adding money as their time runs out. How much more reassuring it would be for them to know that the amount to be paid will exactly reflect the time spent at the hospital. Over half of our hospitals currently have pay-on-exit systems and we expect that to increase.

In the time allowed to me, I have tried to indicate our support for the principle of what the hon. Lady has said. That is why we have changed our principles. However, we consider that a national decision is not right. The reason why I am carrying on speaking is that I am not going to leave it to any of my colleagues to do the procedural business of talking the Bill out; that must fall to me. What we have done by changing the principles is to recognise what the hon. Lady has done. I hope that authorities have listened to the examples given by colleagues, showing what their authorities have been able to do, and I hope we see more.

I am sure that the shadow Minister will play a keen part and take a great interest as we work through the carers strategy. I am sure that we will find a strategy that recognises some of the other issues that she mentioned. I hope that in doing so we will be able to keep a cross-party, cross-House sense of the importance and value that we associate with carers, while recognising that the hard economics of the world mean that we cannot provide everything and so must provide the things that are of most advantage.