(9 years, 10 months ago)
Commons ChamberAs I said earlier, we welcome the fact that Labour is now interested in cancer policy. If we look at the reason for those delays, which we are working hard to address, it is because the number of cancer referrals—[Interruption.] Labour left this country with the worst cancer survival rate in western Europe; we are doing something about it. The reason for the delays is that the number of people being referred for cancer tests has gone up by 50% since 2010. We are treating record numbers of people with cancer because we want to do something about that survival rate.
T2. The Public Health Minister is pursuing a long list of nanny state proposals that we might have better expected from the Labour party, including plain packaging of tobacco, outlawing parents smoking in cars and having higher taxes on alcohol. Will she give us a list of which policies, if any, she is pursuing that have a Conservative flavour to them?
Following on from the Secretary of State’s previous answer, tobacco control is an integral part of tackling cancer. I am delighted to let the House know that smoking prevalence among adults in England fell to 18.4% in 2013. This is a record low, which means that the Government have hit their tobacco control plan target for 2015 two years early. I am sure that even my hon. Friend would welcome that news.
(10 years, 1 month ago)
Commons Chamber7. What lessons his Department has learned from the Born in Bradford research study.
By tracking the lives of 13,500 children and their families, the Born in Bradford research study is providing information that will help us to understand the causes of common childhood illnesses, and to explore the mental and social development of a new generation.
In the Born in Bradford study, 63% of Pakistani mothers are married to cousins, and within that group there was a doubling of the risk of a baby being born with a congenital anomaly. The report also found that “a larger number” of children born to cousins
“will have health problems that may lead to death, or long term illness for the baby.”
How much do health issues related to first-cousin marriages cost the NHS, and, given those findings, is it not time that such marriages were outlawed?
We do not have any financial information, but it is important to point out that the Born in Bradford study showed that there was an increase in the risk of birth defects from 3% to 6% in consanguineous marriages. However, that clearly highlights that not all babies born to couples who are related have a genetic problem, and the key issue is to help women to make an informed choice before they get pregnant and to direct them to genetic counselling where that may be required.
(10 years, 4 months ago)
Commons ChamberAs I said, I want to publish the draft regulations alongside the short final consultation to look at any final points people want to make about the wider aspects of the policy. It is important that we do that to move forward in a way that is robust and sensible and that shows that we have considered everything in the round. I want to do that this month; then, if we decide to proceed, we will move to give the House a final decision before the summer recess. There is no reason why the legislation could not be brought before the House before the end of this Parliament.
The Minister’s nanny state instincts do not come as a great surprise. Can she tell us why she set up the review in the first place? Is it because she was not capable of assessing all the evidence herself and making a decision, or because she had already decided what she wanted to do but did not have the guts to announce it and so wanted to use taxpayers’ money to hide behind a review? Whichever it is, it does not inspire confidence. Such decisions should not be farmed out to someone who is unelected and totally unaccountable.
I obviously have an interest in this particular area. May I say to those hon. Members who are protesting that if I could arrange for them to come into an operating theatre and see the damage that oral cancer does to people, they might actually change their mind?
I am ignoring the interruptions. I am particularly pleased by what the Minister has said and I thank her for it. I encourage her to move this nation ahead first, as I hope she will, rather than to wait for the Australians.
(10 years, 6 months ago)
Commons ChamberI am not going to take any more interventions, because many Members have prepared speeches and wish to contribute to the debate.
The proposal has the overwhelming support of royal colleges, health experts and leading authorities on public health from across our country. In the past week alone, 700 doctors have written to the British Medical Journal in support of a ban on smoking in cars with children. YouGov polls have shown that the measure enjoys the support of up to 80% of the public. It also has the support of the Liverpool Schools’ Parliament, which voted for such a ban unanimously. Many colleagues who have visited schools in recent days have encountered similar enthusiasm from young people.
To those who say that this law would be unenforceable, unworkable or a dreadful infringement of civil liberty, let me offer this thought: 38 years ago this month this House debated a law that would make a certain behaviour in a car illegal, and Government Members were granted a free vote. There was general agreement about health and safety, but Members raised concerns about whether it would be enforceable or a step too far. One Member said that it was a mark of the fact that
“as a society we are becoming over-governed and over-regulated.”—[Official Report, 1 March 1976; Vol. 906, c. 1006.]
Despite that, the proposal passed that night with a convincing majority and eventually became law. More than 30 years on, no one is arguing that we should repeal the law that made it compulsory to wear a seat belt. In the same way, few people would argue that we should bring back smoking in enclosed public spaces or on the London underground. In the meantime, the proportion of motorists wearing a seat belt has risen from around 25% to over 90%. It shows just how powerful the effect can be when Parliament unites and sends a signal. We have such an opportunity before us today. This is a matter of child protection, not adult choice.
Members across the House will be familiar with the words of the great liberal philosopher John Stuart Mill. He prized liberty above all else, but even he accepted that a civilized society should exert influence over an individual in order to prevent harm to others. This is a simple and straightforward measure that would make a world of difference to hundreds of thousands of children across our country, reducing the misery inflicted by passive smoking, saving millions of pounds for our NHS and protecting children who do not have a choice and do not have a voice, and who in 20 years’ time, I am sure, will wonder how it was ever allowed in the first place. I sincerely hope that Members on both sides of the House will support the measure today.
I have no quibble at all with the hon. Member for Liverpool, Wavertree (Luciana Berger), who represents the smug, patronising excesses of new Labour. They think that the only reason they came into Parliament was to ban everybody else from doing all the things that they happen not to like. What perturbs me is that Conservative Ministers appear not to have grasped the concept, even though they claim to be Conservatives, that we can disapprove of something without banning it. This is just another in the long line of triumphs for the nanny state.
I will not give way because I want to rattle through what I have to say in order to give other Members an opportunity to speak. I believe that parents are much better placed to decide what is best for their children than the state is. If we want to encourage parents to take responsibility for their children, we have to give them that responsibility. We will never get parents to do that if the Government say, “Don’t worry about taking responsibility for your children, because we will make all the relevant decisions for you. You don’t have to worry about anything.” That is not something we should be encouraging.
The Conservative party used to believe in the rights of private property, and that people could do as they pleased in their own private property. Their private vehicle is their own private property. If people wish to smoke in a car with children, that is a decision for them to take. As Conservatives, we should not interfere with that.
Members have talked about small and confined places and about restricting the proposal to private vehicles, so why not caravans? I know that Labour Members are not going to ask their friends in the Gypsy community to stop smoking in caravans, so we will never have the prospect of that happening. What is the difference between a caravan and a small car? What is the difference between a small, confined flat and an open-top car? Why is it worse for people to smoke in an open-top car than in a confined flat or a caravan? Why is one much more of a danger to health than the other? This in no way reflects the fact that most car journeys are very short. Why do Labour Members think it is an absolute outrage and terribly dangerous for somebody’s child if they smoke in a two-minute car journey but absolutely fine for them to smoke for hour after hour in a caravan that is, in many cases, just as much of a confined space? The whole thing is absolute nonsense.
I have said I am not going to give way. The hon. Gentleman can listen for once.
Moreover, this is totally and utterly unenforceable. What on earth are we doing saying to the police, whose resources are already stretched, that all of a sudden this should be a new priority for them to undertake? Have they got nothing better to do than go up as close as they can to a moving car to see whether there happens to be a small child in the back seat? Of course, this is not just about small children but all children. How on earth does the driver prove that the person in the back of the car is over 18 rather than under 18? What happens when the driver throws the cigarette away and the police have to try to prove whether they were smoking when they were pulled over? The whole thing is completely unenforceable. It is gesture politics of the worst kind, with Ministers and shadow Ministers trying to flex their health zealotry at all these health organisations and saying, “We’re tougher on these matters than the others.”
Standardised packaging—it is not plain packaging, as some people say—is also nonsense. In many cases, the standardised packaging is more colourful than the existing packaging, so this measure will not do anything for the people who say that all the colourful packaging encourages people to smoke. It is already the case that cigarettes cannot be displayed in large shops. What on earth is the point of having plain packaging for products that are already behind a counter and cannot even be seen? Again, the whole thing is complete nonsense.
All these arguments are arguments for banning smoking altogether. If people had the courage of their convictions and said, “We should ban smoking altogether”, I would at least have some respect for them, but they dare not say that that is what they want to do, even though we know it is their real agenda. While cigarettes are a legal product, brands should be free to use their own branding on the packs. Standardised packaging would simply be a triumph of the nanny state that would presumably soon be followed by plain packaging for alcohol, sweets, crisps, and all the foods that supposedly lead to obesity. Once we have gone down this road for one thing, why would we not have plain packaging for everything? We know, particularly given the current Ministers and shadow Ministers, that that is what it would quickly lead to.
I have tabled three amendments to Lords amendment 124 to try to make it more sensible. The Lords amendment states that the Secretary of State can make regulations if he believes that they
“may contribute at any time to reducing the risk of harm to…the health or welfare of”
children—I repeat, “may” contribute. This gives the Secretary of State the authority to make a decision on a whim just because he happens to think that it might make a difference. My first amendment would change “may” to “will” so that he would need to have some evidence for making a change rather than just doing it on a whim.
The second amendment relates to regulations. Under Lords amendment 124, the Government are saying that they can make lots of provisions and as long as some of them are capable of having a positive effect, that is fine. They can propose 10 ridiculous things and two sensible ones, and the regulations allow them to do it as long as some of them are sensible. My amendment says that “each” provision that they want to bring in should be capable of making a difference, not just the odd one or two in a whole series.
The Minister said that it would be a constraint on the Minister’s power to accept my amendments. Well, I make no apology for trying to constrain the Minister’s power. That is what the House of Commons is all about—trying to make sure that sensible decisions are taken based on evidence, not just on the latest whim of the nanny state brigade whom she has listened to. We are supposedly here to try to defend the freedoms of people in this country. This Government want to trample over every single one of those freedoms. It makes me wonder what is the difference between having Labour or this Government in charge. I expect no better from Labour, but I did expect an awful lot better from a supposedly Conservative-led Government.
Listening to this debate, I could have heard the same things said in 2006 when the House came to a decision on smoking in public places. That is public health legislation which the Prime Minister says is good legislation, although he did not vote for it at the time. I hope that Members will bear that in mind.
I hope that Members will also bear in mind, as we always must when considering such legislation, that currently in the UK over 100,000 people a year die prematurely from smoking tobacco. I support the amendment, which will, I hope, further restrict the use of tobacco not just by young people but, in turn, by adults. As the Minister said, two thirds of people who start smoking are young when they do so, and it is addictive.
One of my points relates to what the Minister said about e-cigarettes not being sold to people under the age of 18. Some people argue that e-cigarettes are a gateway to tobacco use, but the organisation that I have worked with on this over many years—Action on Smoking and Health, which the hon. Member for Shipley (Philip Davies) clearly admires—says that there is no firm evidence for that at this stage; it is doing another survey this year. The important thing is that over 2 million people are using e-cigarettes, some of them so that they smoke less tobacco and some so that they smoke no tobacco. I agree with the Minister that we should view them as a medicinal product—as part of the family of nicotine replacement therapies. That should be our approach in stopping these awful deaths from smoking. VAT on nicotine replacement therapy products is currently 5%. If e-cigarettes were also licensed and charged at the same rate, that would benefit everybody.
I support what the Minister said about proxy purchasing. This has not yet been addressed and it should have been. Alcohol and tobacco are harmful, depending on how they are used, although alcohol is not as bad as tobacco.
We have debated standardised packaging many times in the House and heard the arguments about printers being affected, and so on. The hon. Member for Shipley said that standardised packages are very complicated, and of course they are. I hope that we will have better safeguards to stop people engaging in contraband activities. There is no way that this measure will do anything other than stop people advertising on cigarette packets the products that cause all these premature deaths.
I support the Government and the Opposition on banning smoking in cars with children. Enforcement is always an issue, and we accept that. When I first started driving, people had to have seat belts in cars but did not have to wear them, and only one person in four did so. When the law was changed, 90% of people started wearing them practically overnight. This is about changing habits. We could not have a worse situation than somebody in a confined space like a car smoking cigarettes when children are there.
Everybody said that the ban on smoking in public places would never be enforced. I was on the Health Committee when we had that debate and we went to Dublin to look at what had happened in Ireland. A guy there tried to get publicity by saying, “I’m going to be smoking in this pub tonight. Will you come down and get me?” However, there were very few problems with enforcement and the same is true of us now. We have not seen all the details, but, as far as I am concerned, the provision is a further step towards protecting young people and future generations from premature death as a result of ill health, and we should support that.
There is the notion that this amendment on the safety of children in cars is an attack on freedom, but as my hon. Friend the Member for Liverpool, Wavertree (Luciana Berger) rightly said, a model society will always need to put various restrictions on what individuals can and cannot do.
Reference has been made to seat belts, and it so happens that I was in the Chamber during the debates on that. I imagine that if the hon. Member for Shipley (Philip Davies) had been present at the time, he would have argued strongly against compulsory seat belts in cars—of course he would have because when I was listening to him today, I heard the authentic voice of primitive Toryism.
I do not necessarily work on the assumption that whatever the hon. Member for Shipley opposes I should support, Mr Deputy Speaker, but nevertheless that is usually the case.
I was also around when we debated banning smoking in most places, which it was argued at the time was a grave restriction on freedom. Who in the House of Commons today, in 2014, would argue that, apart from the hon. Member for Shipley and a few others? The ban, which was so controversial at the time, has been widely accepted in the country. People said that it would not be accepted and that the law would be broken, but has it been? Where is the evidence that the law on smoking passed in the previous Parliament has been broken?
I accept entirely that it may be difficult to implement the measures that have been suggested on smoking in cars, and I do not underestimate the difficulties. I do, however, say simply that it is worth a try. Every organisation that has been mentioned and is concerned with public health has argued that the amendment should be put into law, as I believe it should be. It provides an opportunity to protect children in the way it describes, and it is likely, however difficult it may be to police, that people will accept that the law has been passed by Parliament, and that there will be a greater desire to ensure that it is observed. This measure is worth a try, and anything that can protect children from the dangers of smoking should certainly be supported tonight.
(10 years, 9 months ago)
Commons ChamberUrgent Questions are proposed each morning by backbench MPs, and up to two may be selected each day by the Speaker. Chosen Urgent Questions are announced 30 minutes before Parliament sits each day.
Each Urgent Question requires a Government Minister to give a response on the debate topic.
This information is provided by Parallel Parliament and does not comprise part of the offical record
Order. We are dealing with an extremely important matter, which I judge as urgent, but we have business questions and two ministerial statements to follow, so the model is what might be called “the Gibraltar model” of Mr Nigel Evans, whereby a good exchange was had, but it was a brief one. I will not be able to accommodate everybody who wants to speak.
Idiotic, nanny state proposals such as the plain packaging of tobacco are what we expect from the Labour party. What we expect from Conservative Ministers is for them to believe in individual freedom and individual responsibility, and to stand up to the health zealots and nanny state brigade who, if they could, would ban everything and have everything in plain packaging. Will the Minister commit to sticking to those Conservative principles and to ignoring the nanny state brigade of Labour Members?
I know my hon. Friend feels strongly about this issue, but nobody is banning anything. Were the Government to proceed following receipt of the review, the proposal would be about packaging, not the ability to purchase tobacco. All the sorts of points that my hon. Friend has often articulated were well made during the consultation, which, as he knows, received an enormous response, and all the responses will be made available to Sir Cyril.
The Minister says that this is a complex matter, but I am a bit puzzled. What exactly is the downside of plain packaging, apart from fewer fags being sold?
The hon. Member for Southport (John Pugh) may be aware that there has been a challenge to the policy in Australia, so it is important to proceed in a measured and evidence-based way.
(11 years, 1 month ago)
Commons ChamberUrgent Questions are proposed each morning by backbench MPs, and up to two may be selected each day by the Speaker. Chosen Urgent Questions are announced 30 minutes before Parliament sits each day.
Each Urgent Question requires a Government Minister to give a response on the debate topic.
This information is provided by Parallel Parliament and does not comprise part of the offical record
Well, I could say that the hon. Lady’s party, when it was in government, had 13 years to introduce such legislation. Indeed, I am more than happy to say that. If it was so simple to introduce standardised packaging, why did Labour not do it? It is not as simple as they now try to make out. Most importantly, I believe, Mr Speaker—and I do speak as a lawyer—you always want good legislation that is evidence-based. That is why I am more than content to support a delay, while we wait to see the evidence as it emerges from Australia.
I congratulate the Government on this decision. The Minister will recall that the last time I raised this subject in the House, she told me that I would see the light, and I am delighted that she and the Government are the ones who have seen the light on this issue. She cherry-picked some numbers of people in favour of and against standardised packaging from the consultation. Could she tell us the figures from the full 688,000 responses? How many of those were in favour and how many against?
Forgive me; I do not have that information at my fingertips. I am more than happy to supply it to my hon. Friend by way of a letter, or any other mechanism.
The position I have set out is what we now need, and if there is a criticism that I would make, it is that we went to consultation first. All good legislation needs a good, healthy debate, followed by, perhaps, wider consultation. We now need to have that debate, and I am very happy to lead it.
(11 years, 2 months ago)
Commons ChamberNo, it certainly is not, and I have given my views. The hon. Gentleman will know that like many decisions on public health, these are complicated matters. Most importantly, it is vital that we take the public with us. I have said before that I welcome a debate, and perhaps he and the hon. Member for Newport West (Paul Flynn) might come to you, Mr Speaker, and ask for a debate in this Chamber or in Westminster Hall. Let us have the debate, because taking the public with us is always important when we make these sorts of difficult and controversial decisions.
Does the Minister agree that some of the proposed standardised packaging is more colourful than the existing packaging, and given that we have a display ban on cigarettes, what on earth is the point of having standard packaging for something that cannot be displayed?
(11 years, 4 months ago)
Westminster HallWestminster Hall is an alternative Chamber for MPs to hold debates, named after the adjoining Westminster Hall.
Each debate is chaired by an MP from the Panel of Chairs, rather than the Speaker or Deputy Speaker. A Government Minister will give the final speech, and no votes may be called on the debate topic.
This information is provided by Parallel Parliament and does not comprise part of the offical record
Before I call Mr Keith Vaz, Members should be aware that although things are quiet at the moment, we have been advised that there is a possibility of lots of noise outside, due to the work being carried out to try and get the visitors’ entrance up and running. If the noise reaches an unacceptable level and people are struggling to hear, we can ask them to stop. Things are all quiet at the moment, but if that happens, please let me know and we can do something about it.
It is a huge pleasure for me both to serve under your chairmanship during this important debate, Mr Davies, and to raise the issue of childhood obesity and type 2 diabetes. In 2007, after a chance testing by my local GP, Professor Azhar Farooqi, who is now the clinical commissioning group lead in Leicester, I was diagnosed with type 2 diabetes. Before I discovered that I had diabetes, it was not really a subject that I was aware of. Since then, it has become my passion inside and outside Parliament.
I begin by paying tribute to the Minister, who has truly revitalised the debate on obesity and diabetes since becoming a Minister. I agree with what she said, in her interview with Total Politics this week, about the public health Minister’s job. I have deleted one or two words, but she said that
“this is not a soft…girly option, it is a…serious job”,
and she is absolutely right. That is why I am delighted to see, on the Opposition Front Bench, the shadow Minister for public health, my hon. Friend the Member for Hackney North and Stoke Newington (Ms Abbott), who entered the House with me in 1987.
I am also delighted to see so many other Members of Parliament who have either raised the issue of diabetes or have been involved in campaigns. There is the hon. Member for Strangford (Jim Shannon), who, like me, is a type 2 diabetes sufferer; the hon. Member for Mid Derbyshire (Pauline Latham), who has raised the matter many times in the House; and my hon. Friend the Member for Inverclyde (Mr McKenzie), who was in the Chamber, but has popped out. There is also the hon. Member for Southport (John Pugh), the hon. Member for Morecambe and Lunesdale (David Morris), who is my next-door neighbour in Norman Shaw North, and last but not least, the hon. Member for Torbay (Mr Sanders), who is the chairman of the all-party parliamentary group on diabetes and who, for many years, has raised the issue with such passion.
Childhood obesity has become an important political issue. The NHS report, “Statistics on Obesity, Physical Activity and Diet”, of February 2012, stated that in 2010, about 30% of boys and girls were classified as either overweight or obese. The study found that 17% of boys and 15% of girls were obese, which is an increase from 11% and 12% respectively in only 15 years. The factors that cause childhood obesity are a major part of the debate. A recent study by University college London found that 30% of the difference between the bodyweight of one child and another can be explained by their genes. However, genes alone cannot explain the rapidly increasing incidence of childhood obesity.
The ever-increasing numbers of overweight children must be addressed, or we will have a generation of obese children growing into obese adults. It will be a generation at risk from the associated dangers of being overweight, including having type 2 diabetes. Unless we do something about that trend now, the twin epidemics of obesity and diabetes will overwhelm the NHS.
Yes, I agree, and I also think that there is no doubt that there is a link between being overweight or obesity and mental health. Which comes first, I do not know, but it is certainly all connected.
The call for action on obesity set out the steps that we are taking to help people to make healthy choices. That is what we aim to do: provide people with the education and knowledge they need, then ensure that they have the opportunities and options to make healthy choices. We have the national child measurement programme; we have change for life. The hon. Member for Strangford may like to know that 1 million families have joined change for life, and 684,000 people have downloaded the “Be food smart” application.
There is much more that we can do, and obesity in children is one of my absolute top priorities. I want to know why we have stopped weighing pregnant women. It seems absolutely bonkers. I am looking at the advice that we give to new mothers on how to feed their babies, and I am also looking at the role of health visitors, midwives and our great NHS workers. As I have said, in Rotherham there is a wonderful project, which anyone who has an interest in this subject really needs to go and see, because one of the things that is happening there is that everything is integrated. The project has been up and running for three to four years, and the NHS, dieticians, GPs, nurses and health visitors all work with schools, teachers and the local authority—in many ways, it is driven by the local authority. It is a wonderful experience, where the project workers do not demonise food, but look with kindness and care at the causes of problems. They help people, not only with their diet through the information that they provide, but by helping them to exercise.
I have completely run out of time. In no way have I completed my speech, and I apologise profusely for that. However, I pay credit and tribute to everybody who has signed up for the responsibility deal. There is much more that we can do; I completely accept that. Nevertheless, I would say that the labelling on packaging is something that we are particularly proud of. We are getting a standardised system that will enable people to make healthy choices and take responsibility. I could talk about schools and the great work that they are doing, but that will have to be the subject of a letter.
(11 years, 10 months ago)
Westminster HallWestminster Hall is an alternative Chamber for MPs to hold debates, named after the adjoining Westminster Hall.
Each debate is chaired by an MP from the Panel of Chairs, rather than the Speaker or Deputy Speaker. A Government Minister will give the final speech, and no votes may be called on the debate topic.
This information is provided by Parallel Parliament and does not comprise part of the offical record
It is a pleasure to serve under your chairmanship, Mr Hollobone. I am grateful to have a further opportunity—you might wonder why we are taking another chance to raise the issue—to discuss the Leeds children’s heart unit. Given that there is a new ministerial team at the Department of Health—I am delighted to welcome the Under-Secretary of State for Health, my hon. Friend the Member for Broxtowe (Anna Soubry) to her new post—and that the decision on the unit has been referred to the Independent Reconfiguration Panel, it is critical that the independent review gets this right. The issues that we have been raising need to be assessed in great detail by the independent panel.
It is important for us to remind ourselves of the key issues. I want to make it crystal clear at the outset that we have always supported the objective of the review. Of course, we all want the best services for our children, and having fewer specialist centres is a principle that we have never doubted. My grave concern is that the review will fail to meet the objectives, particularly in the north of England, subjecting my constituents and those in Yorkshire and Lincolnshire to a worse service than the one that they currently enjoy. That is why I want to outline our concerns.
First, the review has always made it clear that units need to perform 400 operations or more a year. If that is the agreed standard, we must accept that. However, a survey by PricewaterhouseCoopers showed that the majority of patients who live in east, west and south Yorkshire would not travel to Newcastle. Instead they would go to Liverpool, Birmingham, or, in some cases, even to London. Anyone who knows our area knows that that is instinctively the case. Since the decision was made, adverse weather over the past couple of months has caused huge problems on the A1. Would a parent go there or would they choose less problematic routes? The issue is made clear in the analysis. The independent review document states:
“There was more reluctance amongst members of the public to consider travelling to Newcastle as a centre. If the preference of the parents and the public were factored into assumptions of patient flows, they may have implications for projected levels of activity at – in particular – the Newcastle centre.”
What is the review’s answer to the problem? At the decision-making process meeting—a seven-hour meeting to rubber-stamp a decision that clearly had already been made—it was said that patients preferring centres other than Newcastle would be influenced by referring doctors, with the assumption made that they would be pointed to Newcastle. Frankly, the evidence points to the contrary: all 20 referring clinicians in the Leeds network, whose views were never sought by the Safe and Sustainable review, said that they would not refer patients there for treatment.
In addition, the review argued that if 25% of patients from Leeds, Sheffield, Doncaster and Wakefield chose to go to Newcastle, that unit would perform 403 operations a year, conveniently just over the target of 400. That also assumes that 100% of patients in the other remaining postcodes, including Hull and Harrogate, would go to Newcastle. Newcastle can only reach the 400 figure if all the assumptions—that 25% will go from south and west Yorkshire, that clinicians will refer, and that 100% in Harrogate, Hull and elsewhere would use the centre—are correct, but there is no evidence to support such assumptions.
Given the importance of the 400 figure, it is staggering that it has been reached on the basis of assumptions. I know my hon. Friend the Minister was a barrister before entering the House. I wonder how the court would have reacted if she had based her defence or her prosecution on assumptions. That is why I believe the review is flawed. If we are going to change, it must be for a much better service.
That brings me to the issue of co-location. The foundation of the review was the inquiry at Bristol, and ensuring that such events never happen again is crucial. A key recommendation of the inquiry was to have all paediatric services under one roof. The British Congenital Cardiac Association has stated:
“It is important that the centres designated to provide paediatric cardiac surgery must be equipped to deal with all of the needs of increasingly complex patients. For these services at each centre to remain sustainable in the long term, co-location of key clinical services on one site is essential.”
I completely agree with that statement. Indeed, Professor Sir Ian Kennedy, in his report following the Bristol inquiry, stated in recommendation 178:
“Children’s acute hospital services should ideally be located in a children’s hospital, which should be physically as close as possible to an acute general hospital. This should be the preferred model for the future.”
Yet despite Sir Ian’s assessment panel describing the location of key services on a single site as optimal, Sir Ian accepted a watered-down definition of co-location, which allowed Newcastle to be described as a co-located service, and that led to the decision to close Leeds, despite the Paediatric Intensive Care Society’s assertion that it
“would dismiss any suggestion that a service located on another hospital within the same city can be regarded as being equivalent to a service located on the same hospital site.”
What has caused Sir Ian Kennedy to change his mind? Anyone visiting the Leeds unit will know that it is a wonderful, integrated unit. It has all the services that are needed for children with complex and multiple needs. They need paediatricians there with other specialities. On my several visits to that unit, on each occasion I have seen paediatricians coming to help patients with complex needs.
My hon. Friend has led this campaign in Parliament with his customary charm and tenacity. As ever, he is making an excellent case. The national health service is paid for by the public for the benefit of the public. Ultimately, the services that we provide should be the ones that the public want. MPs from our region, from across the parties, are here today, and it is clear that the people in Yorkshire have confidence in the unit, want it to continue and believe it will offer the best possible treatment. Should that not be one of the most important factors that the Government bear in mind?
(11 years, 11 months ago)
Commons ChamberI do, and I will come on to the issue of student carers. The Bill explores student carers for the first time. I do not know why the issue has not been discussed more in the House, but it is vital that we, as constituency Members, take note of it.
Joint strategic needs assessments done at local level do not link care provision with work, and that is why the clause is important. The Department of Health has an upcoming event on developing care markets, the invitation to which we received yesterday. It says:
“the ability to choose from a variety of high-quality services should be available to all people in a local area, regardless of who pays for their care.”
Age UK, in its support for my Bill, commented on that Government aim to give people who need care and support a greater choice. It said:
“this cannot become a reality unless local care markets work effectively to provide people, including those with specialised needs, with appropriate services. Whilst we welcome proposed duties in the draft Care and Support Bill that would require local authorities to take steps to ensure that appropriate services are available this falls a long way short of a requirement to ensure sufficiency. We will certainly be advocating for a Bill or subsequent regulations that will include more specific duties on local authorities.”
I congratulate the hon. Lady on introducing the Bill and bringing the plight of carers to the House. We all owe carers a big debt of gratitude. The Bill is littered with phrases such as “practical steps”, “reasonable steps” and “sufficiency”. What does she consider sufficient and reasonable, because the Bill does not make that clear, and how much would those steps cost?
I will come on to the sufficiency measures, which are similar to a provision in the Childcare Act 2006, which placed a duty on local authorities to report on the sufficiency of child care in their area. The key thing is to ensure, first, that local authorities have a good enough picture. At the moment, the only picture they have is of what they are commissioning and providing, and, as I said, 80% of people who need care are self-funding, and their needs and whether they are being met are not looked at all. We therefore have a huge gap in information on the needs of those people and whether they are being met. There might be a need for nursing home beds for people with certain categories of dementia, and unless they were paying for them, local authorities would have no idea whether those existed. That information does not exist for all the people living in an area who needed that provision. As I said, health bodies and local authorities do joint strategic needs assessments, but they are not taking account of the fact that that can help people to work. We are trying to ensure that, as with child care, there is such provision, so it is similar to that measure.
The Bill does not go into detail because that is usually done in regulations which would be decided after the Bill had been passed. These are matters that can be debated and decided in Committee. However, in placing new duties on local authorities we are aware that we want regulation to be as light touch and low cost as possible. That is why some of the language is hedged around with phrases such as “reasonable steps”. We do not want to put expectations on local authorities that they cannot meet in the present environment.
That was a helpful response. To get to the nub of the issue, does the hon. Lady believe that the House should pass legislation to provide certain duties, at whatever cost, which should be met, or does she accept that only a certain amount of money can be afforded and that the question then is how best that can be allocated?
We are talking about a reporting duty. If local authorities, working with their health partners, do not report on social care provision, no one else will. Those of us interested in these matters ask questions, but we do not get very good information. Sending freedom of information requests to every social care authority in the country is not the best way for national organisations or Members of the House to get such information. We are asking for a picture of the market to be held in each local area. I am not suggesting a move in a direction in which the Government are not already going. The Government now expect local authorities to be what they call “market shaping”, taking action to drive the market. We are saying that they do not even have a picture of what exists now. Until we have such a picture, which is not just gathered by freedom of information requests, the expectation of the Department and the Government of local authorities is perhaps not reasonable. It is not a budgeting duty but a reporting duty.
I was dealing with sufficiency and the reporting duty and saying that organisations such as Age UK believe it is important that local authorities have a view of the sufficiency of their local care services. To expand on a point my hon. Friend the Member for Leicester West has made, the way local authorities are currently cutting back on what they pay in fees for social care beds and nursing home beds is actually creating market distortions, because some providers are simply moving to areas where there are more self-funders. In Greater Manchester, for example, all the nursing home providers might move to Trafford, which is a wealthier borough, and we would not have proper provision in Salford, part of which I represent. What is happening in the market could result in that kind of distortion, and that should be spotted.
I wonder whether the hon. Lady is being unfair to universities by saying that there is a gap in the provision of information for student carers. I do not doubt that she knows more about the subject than I do, but my local university, Bradford, has a very extensive policy on student carers, with lots of information about what help could be provided. In saying that there is a gap, does she think that he might be doing a disservice to universities such as Bradford, which are clearly doing an awful lot to help student carers?
I am very glad to hear that Bradford does that. Professor Luke Clements of Cardiff university, who helped to draft the Bill, says that it depends on having the right sort of vice-chancellor with go-ahead policies. It is not only I who believe that there are gaps; so does the National Union of Students, which understands these things. Particularly in Scotland, the websites of people who are standing for representative positions in the NUS show that they are all campaigning on Fair to Care and asking universities to have a carers strategy. It must therefore be the case that lots of universities, including those in Scotland, do not have a carers strategy. We are asking that a policy be put in place to recognise carers’ needs and tell them where to go for support. I am glad that the Bill would remedy the situation whereby perhaps hundreds of thousands of student carers are left to struggle alone with the difficult demands of juggling their caring responsibilities alongside studying.
The Bill deals with vital issues for carers and for disabled people. I thank Professor Luke Clements and Carers UK for their help in drafting the Bill. Emily Holzhausen and Chloe Wright of Carers UK have provided much extra support in preparing for today’s debate, and I thank them for that. I also thank Kate Emms of the Public Bill Office for her sound advice and help. I thank all the co-sponsors of the Bill for their support for the measures it contains. It has been good to know, as we have worked on this, that the issues involved in social care and the need to identify carers, young carers and student carers generate such great cross-party support.
The provisions in the Bill should be taken forward, and I hope that we will get the chance to discuss and, if necessary, modify them in Committee. Five million carers, including young carers and student carers, depend on our progress on measures that will help them, and I hope that we do not let them down.
It is very rare that an area of public policy, particularly on something as important as carers, can be dealt with by just one Department. I have absolutely no doubt that the Government’s White Paper on social care is the subject of an enormous amount of interdepartmental discussion. One task of the various all-party groups is to highlight to the Department of Health the issues that relate to other Departments, so that it can negotiate with those Departments before bringing forward its Bill. There will be cost implications in different areas, and I am sure there will be a robust debate about money on Second Reading of the Care and Support Bill. We have not yet come to that.
I say to the hon. Lady that the White Paper was published only shortly before the summer Adjournment. There has been little opportunity for any of us to interrogate Ministers in other Departments about policy areas such as those that she rightly identifies. Of course, a number of Ministers, like the one who is here today, have only just taken on new ministerial briefs. I believe that at Minister of State and Parliamentary Under-Secretary of State level, only 11 Ministers will be opening the same red boxes this weekend as they did last weekend. Those of us who have been Ministers know that it takes two or three weeks just to absorb the briefing for incoming Ministers, so we should not be impatient. What is important is to ensure that those of us who are in all-party groups relating to carers, or who are concerned about carers policy, can support the Government’s social care Bill on Second Reading.
I am grateful. I have been trying to decode what my hon. Friend said about me and my hon. Friend the Member for Bury North (Mr Nuttall). I do not know whether he was trying to be insulting, but in his characteristically charming way, or whether he was merely saying that we take a close interest in each private Member’s Bill, which I would say was a compliment, even though perhaps a rather ham-fisted one.
Is my hon. Friend trying to say that if we get the undertakings that I am sure we would all like from the Minister today—he has already made some—it would be helpful if the hon. Member for Worsley and Eccles South (Barbara Keeley) were to withdraw her Bill?
We all have to be grown-up about this. The hon. Member for Worsley and Eccles South has come up in the ballot, and it is a matter for her how she deals with the Bill. She is perfectly entitled to take it forward. I am just concerned to ensure that there is no scintilla of a suggestion that we will get ourselves into a hole. I was in the House when Nick Scott was the Minister responsible for the disabled. We got ourselves into a terrible hole over a private Member’s Bill by giving the impression that we were not interested in policy relating to the disabled, which of course was totally untrue. I do not want there to be any suggestion of that happening in relation to carers. I hope that we have now found a constructive way forward.
That would appear to be the case. If the survey used the wider definition, which I believe it might have, it would indeed indicate that the number of people affected by the Bill would be fewer as a result of its using the statutory definition.
After the Carers Trust’s definition of a carer as
“someone of any age who provides unpaid support to family or friends who could not manage without this help”,
it goes on to state:
“This could be caring for a relative, partner or friend”—
we should note that this definition includes friends as well—
“who is ill, frail, disabled or has mental health or substance misuse problems.”
At this point, we come to what I submit are some of the problems with the interpretation of the Bill. What exactly constitutes a “substantial” amount of care? Who is to be the judge of whether care is substantial or not? One man’s definition of what is “substantial” may not be the same as another’s. Therein lies the first of a number of uncertainties in the Bill.
I am looking at the 1995 Act, too. As my hon. Friend makes clear, it defines a carer as someone who
“provides or intends to provide a substantial amount of care”,
but it also includes the phrase, “on a regular basis”. Does my hon. Friend agree that while there might be a lot of debate about what constitutes “substantial”, there might be quite some debate, too, about what constitutes a “regular” basis of support?
My hon. Friend is quite right that there are two legs to the definition. It is not just a question of whether it is “substantial” but of whether it is “regular”. It could be once a year. If someone visits their elderly granny once a year, that is regular, but it is not the same as going around morning, noon and night to look after an elderly mother who needs care almost constantly. I therefore think there are difficulties with the definition, and I submit that it needs clarification. The Bill is silent on that and I fear that the explanatory notes, which are excellent in many ways, as I shall explain later, are silent on it, too.
On that point, does my hon. Friend agree that the wider definition is more helpful than the one set in statute? There might well be cases—I am sure we have all come across them; I have certainly come across them in my constituency—where people need some kind of care and help, yet the local authority, probably for financial reasons above all else, has decided that it is not going to give them the support they need. Many people are looking after relatives or friends who need care, but who have not passed the test of being assessed as such by a local authority.
My hon. Friend touches on an important point. I fear—I am sure others will, too—that this Bill may unreasonably raise the expectations of that group of carers covered by the wider definition. They may think, “This is me; I’m a carer”, but would they be a carer under the much narrower definition in the Bill? As I say, there is a danger that many carers will feel that this debate is about them, when under the statutory definition in clause 8—it is clear, referring back to section 1 of the Carers (Recognition and Services) Act 1995—they may not be covered.
Before my hon. Friend continues his speech, may I urge him not to be distracted by the tactics of the hon. Member for Kingston upon Hull North (Diana Johnson), who is trying to do something that might be described as rather despicable? She is trying to argue that the fact that someone does not support a particular Bill means that that person is against the whole concept of the aim of the Bill or the subject area. Anyone who knows my hon. Friend will be aware that he is passionate about helping carers and people who need this kind of support. He should not be distracted by those who try to characterise his opposition to certain elements of a piece of legislation as opposition to the welfare of carers as a whole. I urge him to continue in his current vein.
I am grateful to my hon. Friend. I feel that there is a danger that some of the content of the Bill may cause scarce resources to be diverted from front-line services to carers for the purpose of the production of assessments, surveys and strategies, rather than providing real, genuine help for those who need it most.
I have already made my support for carers absolutely clear. My hon. Friend the Member for Banbury (Sir Tony Baldry) has also secured a helpful undertaking from the Minister on ensuring that the Government engage with the Bill’s supporters about the subjects that it deals with in the context of the draft Care and Support Bill.
Has my hon. Friend noted the irony that Labour Members who regularly troop through the Lobby to vote against Government programme motions, because they say that those motions allow insufficient time for debate and effective scrutiny, now take the view that this Bill should go through the House without any scrutiny whatsoever just because it happens to have their support? Our duty in this place is to scrutinise legislation, whether Labour Members like it or not.
There is indeed such an irony. Legislation of all kinds should receive proper scrutiny.
I am certainly not trying to destroy the Bill. I will stick to my point, because I think that we need to look at this—[Interruption.] [Hon. Members: “In Committee.”] It is an important part of the Bill. Existing legislation covers all members of the public, so I do not think that we need to single out a specific group.
Opposition Members talk about these matters being considered in Committee. Given that the Government have published a draft Bill on this very subject, does my hon. Friend not agree that Opposition Members, if their overwhelming priority is to discuss these matters in Committee, will have an amazingly good opportunity to do so at length in relation to the draft Bill? That can be done without this Bill progressing any further.
That is indeed the case. I am sure that it will be possible to consider all these matters in detail when we look at the draft Bill in Committee.
The NHS operating framework for 2012-13 already provides that carers must receive help and support from local NHS organisations. Primary care trusts are required to agree policies, plans and budgets to support carers with local authorities and carers’ organisations and make them available to local people. It states:
“Following a joint assessment of local needs, which should be published with plans, PCT clusters need to agree policies, plans and budgets with local authorities and voluntary groups to support carers, where possible using direct payments or personal budgets. For 2012/13 this means plans should be in line with the Carers Strategy and: be explicitly agreed and signed off by both local authorities and PCT clusters; identify the financial contribution made to support carers by both local authorities and PCT clusters and that any transfer of funds from the NHS to local authorities is through a section 256 agreement; identify how much of the total is being spent on carers’ breaks; identify an indicative number of breaks that should be available within that funding; and be published on the PCT or PCT cluster’s website by 30 September 2012 at the latest.”
So there is already a lot going on within the NHS. Let us not forget that the Department of Health is providing the NHS with £400 million over the four-year period from 2011-15 to support carers in taking breaks from their caring responsibilities. The Department has also funded the national carers strategy demonstrator sites programme, which is focused on three areas of support to improve carers’ health and well-being, carers’ breaks and health checks, with better NHS support. The new idea of national carers strategy demonstrator sites has been independently evaluated by the Centre for International Research on Care, Labour and Equalities at Leeds university, which has prepared an excellent report on how successful it has already been.
Clause 5 seeks to place a duty on a local authority to ensure that within 12 months of Royal Assent
“it takes all reasonable steps”—
again, we have no idea of what “reasonable” may amount to—
“to ensure that in relation to…any school within its area and under its control, and…any functions it discharges…there is in place a policy”
to identify and support young carers. However, the clause makes no mention of academy schools. Perhaps when the hon. Member for Worsley and Eccles South winds up she will be able to explain why academy schools would not be covered, because they are state schools that are independent of local authorities but still funded—
Thank you, Mr Deputy Speaker. I have not been left with much time, but I am conscious of the fact that other people wish to speak. I will therefore try to be as quick as possible, as is customary for me on such occasions. It is a pleasure to have you back in the Chair.
I commend the hon. Member for Washington and Sunderland West (Mrs Hodgson) for her closing remarks, because they got to the nub of the debate. What is important is that today’s debate has raised the issues that are important to all of us. We all want to support carers. Like my hon. Friend the Member for Bury North (Mr Nuttall), I remember my mum acting as a carer for my granddad and her father, Charlie, who had cancer. She dedicated many hours to looking after him and other family members came and helped. I understand from first-hand experience how important it is that we give as much support to carers as possible.
The most important thing about today’s debate, which the hon. Member for Washington and Sunderland West made clear as she summed up, is that we have gone through the issues that we hope will be addressed by the Government. They have produced a draft Bill and presumably legislation will come before the House in the not-too-distant future. All the issues that have been debated today, including the contents of the private Member’s Bill, can be debated during the passage of the Government Bill. Amendments can be made at the Committee and Report stages of that Bill, and far more time than we have been allowed today will be available to scrutinise those measures. We all hope that, at the end of all of that, we will have a measure that we can all agree upon, if that is possible, and that gives the best possible support to the carers who need it. The important thing is not whether this specific Bill gets through to the next stage, but what the overall outcome is. That will be determined by the Government’s draft Bill, and that is where it is best left.
I will move on to discuss the specific issues. It is important to look back at the history. The hon. Member for Worsley and Eccles South (Barbara Keeley), who presented the Bill, said when I intervened on her— I apologise if I get this wrong—that the Bill is about putting reporting responsibilities on local authorities. It goes far beyond that, however. Clause 1 introduces a
“duty to ensure sufficient social care support”.
That goes far beyond the reporting of that support.
As my hon. Friend the Member for Bury North said in dealing with an intervention, the Bill comes after more than a decade of the hon. Lady’s party being in government, and she is now calling for more to be done. It was only in 2008—I seem to remember that the hon. Lady was a Minister at that time, although I could be wrong about that as well—that her Government published an update to the carers strategy that was introduced in 1999. The update stated:
“By March 2011, we will have invested over £1.7 billion for councils to use to support carers in a range of ways through the annual Carers Grant. This includes £25 million a year announced as part of the New Deal for Carers for emergency break provision.
We have also committed a further £22 million to cover the costs of the establishment of information services via a helpline and a training programme for carers and information service, and £3.4 million to directly support young carers through extended Family Pathfinders and support for whole-family working.
We are now investing over £255 million on new commitments as part of this strategy.”
It seems to me that the hon. Lady is asking in the Bill for things that her Government claimed were already happening. Perhaps she will explain why her Government did not do what she seeks.
It is quite clear from all the excellent contributions to the debate that Members understand that this is not just about allocating budgets. It is about having the right processes and about people taking their duties seriously. We can throw any amount of money at carers’ breaks or anything else, but if carers are not identified, if GPs ignore the fact that people are carers or if young carers are not taken seriously at school and are bullied and intimidated, it does not make any difference how much money is sloshing about. That is why the specific reporting and other duties in the Bill are so important. The Bill is mostly about having processes and procedures in place and ensuring that health and other professionals take them seriously.
I could not agree more. I totally and utterly endorse what the hon. Lady says. Joking aside, it is refreshing to hear an Opposition Member say that it is not just spending money but getting results that is important. All too often, spending money was all it was about under the previous Government. It was about input rather than output. I am delighted that she wants to concentrate on output, as I do.
I contend that much of what the hon. Lady seeks to do in the Bill is already happening in one form or another. She might argue that it is not happening as well as it should, and I am sure that it could always be better. She may well argue that it is happening better in some parts of the country than others, and I suspect that will always be true whether or not there is legislation. When she referred to the lack of support for carers at universities, I pointed out the excellent work that Bradford university does to support carers. I believe that the same work is done at Leeds university. I have certainly seen a document from that university about the support that it wants to give to students who are carers. I argue that much of what she wants is happening anyway in various places, and there is certainly nothing to prevent them from happening even without the Bill. I am sure that if all of us, including the Minister and the hon. Lady, contacted universities, showed them best practice from other universities and urged them to follow suit, their vice-chancellors would be happy to do so without the need for further legislation. There are other, more imaginative and perhaps quicker ways of achieving her aims than going through the rigmarole of passing the Bill.
Much of what the hon. Lady seeks is covered in the Government’s draft Bill and White Paper. I take the point made by my hon. Friend the Member for Banbury (Sir Tony Baldry) that the hon. Lady introduced her Bill before any of that was known, so she was absolutely right to do that, but we are where we are. Given that the Government have adopted in the White Paper much of what she wants, we can safely leave the Minister to carry on. We all accept that he is a capable and decent person, and he has given the House assurances today that will have reassured us all about how he intends to proceed. He has said that he wants to involve the hon. Lady in the discussions about the Government’s draft Bill before it proceeds, and I am sure she knows that he means that. We can rely on the Government to introduce the best aspects of her Bill, so we do not need to proceed with it.
My hon. Friend the Member for Bury North made the point, which the Minister reiterated, that some of the duties that the hon. Lady’s Bill would place on local authorities, although well meant and with a positive element to them, could take money away from the front-line resources that we want to go to people who need them. It could instead have to be spent on further reporting, strategies, documents and other things that could eat up a considerable amount of local authorities’ money before we know it. I am not sure whether that approach is desirable. As I said, there might be some desirable ends, but overall it is more likely to take money from carers than to give them support.
Do the hon. Gentleman and his colleague, the hon. Member for Bury North (Mr Nuttall), have a view on the billions of pounds that could remain in the economy if people do not give up work to become carers? If local authorities draw up the local sufficiency picture, it will help carers to stay in work. If carers stay in work, they are earning money, they are not on benefits and they pay tax and national insurance. Does the hon. Gentleman not see that there is a balance to be struck? I am sure that the sufficiency reporting duty will in no way match the billions of pounds that would be lost if 1 million carers give up work to care.
The hon. Lady makes a fair point although I cannot speak for my hon. Friend the Member for Bury North. If he had not been cut short we might have learned his view of the sufficiency measures, but perhaps we will hear it at a later date. I do not want to get bogged down or I will be criticised for trying to talk out a Bill that I have no intention of talking out. On this occasion—one for the record books—I endorse what the Government are doing. I wish the Minister well in developing the strategy, and I hope that we get the outcome we seek. In all honesty, however, we can do that without the Bill, and if the hon. Member for Worsley and Eccles South had known the Government’s plans at the time of the ballot for the private Members’ Bills she might have chosen a different issue. As she must acknowledge, the Government are doing much to go down the route she has advocated today.