Wednesday 17 January 2007
[john cummings in the Chair]
Motion made, and Question proposed, That the sitting be now adjourned.—[Mr. Alan Campbell .]
I am grateful to the Speaker for selecting this debate. It is an extension of the debate that took place in the main Chamber on 7 December when several hon. Members, some of whom are here today, were unable to make contributions. I cannot deny that there are significant housing problems in the heated economies of London and the south-east, but MPs for constituencies in the north and the midlands are experiencing similar housing problems.
I cannot deny that the Government have doubled the amount of money spent on its housing policies, but a significant amount of that new money is not delivering new homes and is being used, for example, to pay increased land costs and to deal with the £19 billion backlog of public sector refurbishment left behind by the previous Administration.
Increased house prices are causing problems too in our regeneration areas. We are paying a lot more in compensation now just to clear the oldest homes. In the north-west, the housing economy bears little relation to the general economy. While the housing market is soaring, the underlying issues of deprivation, poverty and relatively poor economic performance affecting many places in the region are still significant, although much improved since 1997.
The average house price in the north-west in 2005 was £137,804, which is nearly double the average in 2000 and more than 6.4 times the average regional income of £21,541 for that year. House prices in the north-west have grown much faster than for England as a whole during the past five years. England has experienced a 74 per cent. house price increase since 2000, compared with the north-west's rise of 95 per cent. While house prices in the north-west have risen 134 per cent. since 1997, regional incomes have grown by just under 20 per cent. in the same period. As a consequence, the affordability gap for most households in the north-west is becoming much worse. The house price/income ratio has doubled from an affordable 3.3 in 1997 to today's figure of 6.4. The new forecasts from Oxford Economic Forecasting suggest that the region's affordability gap is likely to worsen from now until 2011.
There are huge variations in the north-west housing market. In Eden, Cumbria, for example, the house price/income ratio is 10.5, while in Burnley it is only 3.7, which is more affordable.
That illustrates the point of this debate and I fully sympathise with the people in my hon. Friend’s constituency. The National Housing Federation has produced an interesting booklet entitled “The North-West's Housing Timebomb”. It has also analysed housing waiting lists. Some 560,000 households are waiting for affordable housing across the northern region. That represents 33.4 per cent. of England's housing waiting lists, yet the northern regions receive only 11.4 per cent. of the national affordable housing development allocation.
Shelter is currently conducting a campaign on affordable housing and has conducted some research that shows that, nationally, one in seven, or 1.6 million children, are either homeless or housed badly—170,000 of those are in the north-west region. Shelter believes that we need 20,000 extra affordable homes for rent to be built in addition to existing Government commitments.
I congratulate my hon. Friend on obtaining this important debate. If we travel across the Pennines to Rotherham, there are 30,000 people on the housing waiting lists and 5,000 actively seeking homes with only 30 lets possible every month. Last year, figures from the Ministry showed just 15 socially affordable houses were built in the whole of the south Yorkshire region. We need to get a grip on this issue and I hope that as a result of his debate there will be a movement up a gear in the Ministry’s approach to this grave problem.
I was about to amplify similar problems in Bolton. Before the right-to-buy legislation was introduced more than 25 years ago, Bolton had between 26,000 and 27,000 council houses. Today, it has just over 18,000, which is a loss of one third of its stock as is reflected throughout the northern regions. The overwhelming majority of sales unfortunately have been two or three-bedroom homes, which are the highest demand type of housing. The current high level of private sector house prices has meant that RTB sales have increased rapidly in Bolton, from around 100 per annum ten years’ ago to a peak of 800 in 2004. However, sales have fortunately decreased a little since then.
I have always been against the RTB, especially in high demand areas. In an Adjournment debate on 11 January last year, the Minister told me that 50 per cent. of RTB sales are maintained 15 years after purchase. However, it is the 50 per cent. that are not that concern me most as many of those end up in the hands of private landlords, who charge at least twice the rents of social landlords. That has a consequent impact on the housing benefit bill. Of more concern is the fact that we have not replaced the houses that we have sold in those quantities.
I am also concerned about low valuations of the council-owned homes that are still being sold. The turnover of stock has decreased significantly because people cannot afford to move on. House prices in Bolton rose more than 14 per cent. last year in one year alone, which is more than anywhere else in Greater Manchester, and is certainly above the national average. Terraced houses selling around my home for between £20,000 and £30,000 just a few years’ ago are now fetching an astonishing £100,000—well out of reach of those on low to medium earnings.
Bolton's Homes For You runs a choice-based letting system. In 2003-04, the turnover of stock was 12 per cent. That had reduced to 9.5 per cent. in 2005-06, and is still reducing. In the past three years there has been a 20 per cent. reduction in homes advertised for letting in Bolton and coupled with demographic changes, that is having a marked effect on the housing waiting list. Increasing numbers of elderly people, younger people not getting married, and divorcees, as well as inward migration into the borough, all affect the housing waiting list.
The demand for properties has doubled in the past three years. In the traditionally more sought-after areas the demand rose from 25 per cent. to 48 per cent., but it was a significant 68 per cent. in the traditionally more deprived areas. Homeless statistics for Bolton show increasing levels of homelessness, which peaked in 2004. Bolton has the third highest number of homeless acceptances in the north-west, behind only Manchester and Liverpool.
In my time as chairman of the housing committee for the local council, 1986-1996, the housing waiting list always averaged about 5,000 per annum in Bolton. Today, it has shot up to the current figure of 23,700 and is still rising steeply year-on-year. The Northern Housing Forum, which was formed in the past three years has made a submission to the comprehensive spending review 2007. It proposes that the Government should allow councils across the north-west to release land at less than its market value in order to supply houses for rent at affordable rents. I hope that our Government will listen to that plea.
Does my hon. Friend accept that the picture he has painted of Bolton can be replicated across the north of England and does not just apply to the north-west? Even in Knowsley, where we have experienced decades of a decline in population, we now have an affordable housing waiting list of about 3,000. Previously, there would have been virtually no waiting list. Does he also accept that that means two things? First, initiatives such as building new affordable housing for purchase or for rent in places in Knowsley is now an active policy that needs to be considered. Secondly, initiatives—
I recognise that the problems that I am outlining for Bolton are replicated across the northern arch of authorities. That is why I urgently called for this debate.
Bolton At Home has an arm’s length management organisation that has a very distinguished record. It refurbishes not only homes in the public sector, but homes in the private sector and it will meet the Government’s decent homes target. We are asking the Government to allow us to securitise the assets of the Bolton ALMO, so that we can not only complete the refurbishment of the public sector stock but, more especially, build new stock to meet the housing waiting list requirements that I have explained.
I have three final points. First, community land trusts are catching on throughout Britain as a new way forward, and I am all in favour of them. Those organisations buy land and capture its value indefinitely for the benefit of local communities. Buyers of houses built on that land pay only for the cost of the building, not for the land. In some areas, such as Cornwall, that is halving the cost of purchasing a property, so I ask my hon. Friend the Minister to consider seriously the idea of community land trusts. Perhaps northern authorities can adopt the idea as well.
Secondly, I want to comment briefly on buy to let. There is a belief in some quarters that buy-to-let speculators are fuelling house price rises. In London, they are purchasing two thirds of the new homes. Investing in property is obviously much more attractive today than investing in other areas, such as the stock market. Buy to let is acceptable provided that the let part of the deal is honoured by the speculators. However, there is growing evidence that this phenomenon is significant in the north-west and, unfortunately, not all the homes are let. Many are kept empty, awaiting a quick sale should the market dip suddenly. The charity Crisis believes that those speculators are unbalancing the housing market at a time of severe housing shortage. In Leeds, for example, 50 per cent. of new flats are being left empty. In Salford, the figure is 40 per cent.
Finally, let me comment on shared ownership. The Government are putting a lot of weight on that area of policy, but although the price of a home can be controlled when it is first sold under shared ownership, the problem is that the price of the house soon reaches the market value. Then, unfortunately, the idea of shared ownership is lost.
There is an emerging, or even emerged, housing crisis in most parts of the north and midlands. Each region is different, of course, but selling off much-needed public sector homes at a time when they are very much in demand and the obscene land prices that we are seeing currently are two of the main drivers for the current housing crisis. I look forward to listening to contributions from my parliamentary colleagues.
Before I call the next speaker, I inform hon. Members that a considerable number of hon. Members wish to speak. I appeal to speakers to be brief and to speak for no more than six minutes. Then everyone will be accommodated. I call Mr. David Kidney.
Thank you, Mr. Cummings. I congratulate my hon. Friend the Member for Bolton, South-East (Dr. Iddon) on securing the debate. He is one of the most knowledgeable and consistent champions of the cause of housing in the House, and he will be a great loss to us when he retires from the House. I also congratulate him on making the subject of the debate affordable housing in both the north and the midlands, enabling a west midlands MP such as myself to point out that everything that he said about housing shortages in the north-west applies with equal force in the west midlands.
My hon. Friend mentioned the National Housing Federation and its booklet for the north-west. That is one in a series of regional booklets produced by that excellent organisation. There is an overall one for England. The one for the west midlands, which also talks of a housing time bomb, tells us that house prices are now seven and a half times the average regional incomes; affordable home building is running at less than half the levels needed; and housing waiting lists are rising faster than they are anywhere else in England. Clearly, the need in the region where my constituency is located is just the same as the pressing need that my hon. Friend described for the region where his constituency is located.
I want to consider the basic reason for the overall lack of affordable housing. I know that predict and provide is now old hat but, as the Barker investigation and the two reports, interim and final, showed us, a mismatch between supply and demand still causes a lack of affordable housing. Too many buyers are chasing too few homes. That is why, prompted by Barker, the Government propose a target of building 200,000 new homes a year by 2016. That target was endorsed by the third report of the Select Committee on Communities and Local Government last year, and it is certainly backed by Shelter, which has campaigned consistently and for a long time on the need to increase the supply of affordable housing and especially social housing.
That will cost money to achieve, which is why the Select Committee called for priority for housing in the comprehensive spending review 2007. It is why Shelter calls for priority for housing in the comprehensive spending review this year. It is why I call for priority for housing in the comprehensive spending review. The booklet produced by the National Housing Federation on the west midlands states:
“The Government must deliver on the promised prioritising of housing in the Comprehensive Spending Review 2007 and make sure the West Midlands receives its fair share.”
I entirely endorse that comment.
Will my hon. Friend accept that his remarks about the west midlands extend to the east midlands, where there are 130,000 households on council waiting lists but only 100 council houses were built last year and only 1,200 by registered social landlords? Does my hon. Friend hope that the incoming Prime Minister will relax the embargo that there has been for some years on local authorities building and providing housing that we know can be affordable, accountable and decent housing to the highest standard? That is one of our problems, is it not?
I am grateful to my hon. Friend. I think that the Government have been entirely right to concentrate on the £19-billion backlog of necessary repairs to council housing, but I agree that we should see the various supply models for the housing market and that council housing, where there is a suitable business plan that is robust enough, ought to be an equal player with anything else in trying to meet the need. I am with my hon. Friend on that.
I congratulate the Department on its announcement last year of a £3.9 billion spending plan for the next two years. That is up 15 per cent. and should mean that 33 per cent. more new affordable homes will be built in the next two years than were built in the last two years, including 49,000 social rented homes and 35,000 new low cost home ownership homes. I am still trying to get my head round the three new homebuy options to ensure that my constituents benefit from them wherever they can. That should mean in the north-west 5,150 more social homes, costing £220 million, and in the west midlands 4,900 new affordable homes, costing £195 million.
I thank the Government for that, but I remind my hon. Friend the Minister that Shelter says that parts of the north and the midlands are experiencing chronic shortages of affordable homes every bit as acute as shortages in London and the south-east, which was the point that my hon. Friend the Member for Bolton, South-East made at the start of his speech.
In my constituency, there are particular problems. It is a rural seat and an urban seat. In the rural areas, there are special problems with providing affordable homes. The area has wages that are lower than the national average and house prices that are higher than the national average. There is a lot of green belt in the south of my constituency, so the housing supply is smaller still and prices of houses are even higher. My casework for the constituency involves a higher proportion than I would like of homelessness cases.
As the Select Committee said in its report last year,
“a simple supply and demand model cannot be applied to the housing market.”
The situation is much more complex than that. Yes, we are not building enough houses at the outset, but as well as that there are changes in the market, such as in the buy-to-let market, which my hon. Friend mentioned. There are the changing needs of people in relation to the kind of house that they want to live in and the kind of life that they want to live. There are changing levels of consumer debt, which perhaps makes it dangerous for us to concentrate too heavily on home ownership as the solution to housing shortages. We still need to take more seriously the tackling of empty homes and second homes, whereby we could help to increase the supply using existing property. We need increasing interventions in areas such as fiscal policy and we need changes to planning.
The performance of local authorities in providing affordable homes through the route of section 106 agreements for planning developments has been variable. If we could improve the performance of all the weak local authorities to the level of the best ones, we would massively increase the supply of affordable housing provided by the private developers when they build their estates in the first place. The new planning policy statement 3 should help us to ensure that local authorities realise that they have the powers to do that. I especially want to thank the Government for paying particular attention in PPS3 to the needs of rural areas when considering the exercise by local authorities of section 106 powers.
We should acknowledge that there are great differences in this country from region to region and within regions—from urban areas to rural areas and within constituencies. That will be evident from hon. Members’ contributions. We need not only to increase the total supply of housing, but to be clever enough to have different solutions to meet the differing needs in different areas of the country. We must ensure that there is a supply of affordable housing in every area that meets those differing needs.
I congratulate my hon. Friend the Member for Bolton, South-East (Dr. Iddon) on securing this important debate. York is one of the house price hot spots in the north of England. Seven years ago, in 2000, the average price of a house in my constituency was £80,000, which was lower than the national average. By last year, it had risen to £185,000, which is considerably higher than the national average.
The fastest price rises have been in lower priced housing—the sort of housing that first-time buyers aspire to buy. Overall, in that six-year period, house prices in York rose by 131 per cent., but the prices of the cheaper houses in the lowest quartile rose by 191 per cent. In other words, for first-time buyers the cost of a house in York virtually trebled in six years. What kind of first-time buyer can afford a home costing £131,000? Assuming that they put down a 5 per cent. deposit and obtained a mortgage of three and a half times their salary, they would need to earn £36,000 a year. Half of all residents in York in full-time employment earn less than £22,620. They would need to borrow six times their salary to buy, which is beyond them. That means that half of working households in York are unable to buy a home in their city.
There is an acute shortage of affordable family housing. Some 61 per cent. of the new homes built in York in 2003-04 were flats, because of the Government’s preference for developing brownfield sites. That compares with the 41 per cent. of new homes nationally that are flats. The following year, 75 per cent. of new homes in York were flats. The problem is sharply illustrated by council house sales under the right to buy. In the seven years from 1997 to 2004-05, 1,140 homes in York were sold under the right-to-buy scheme, 88 per cent. of which were family homes. An almost equivalent number of affordable social housing homes were built in the same period, but 70 per cent. of them were flats.
There is a need for changes in policy by national Government at a regional level and by York city council—first, in relation to planning gain. Since 1998, section 106 agreements have provided 600 affordable homes in York on 33 sites. The council sought for 25 per cent. of the homes that were built to be affordable homes and achieved 22 per cent. Two years ago, it increased the percentage of affordable homes that it would expect in larger developments to 50 per cent. I support that bold decision, but it has nevertheless dramatically slowed the number of planning applications coming from developers. The council needs some help from the Government.
The Government should consider taxing banked land in house price hot spots and increasing social housing grant to enable housing associations to partner private developers in areas of great housing need.
There are two major greenfield developments in York at Derwenthorpe and Germany Beck, where planning applications have been called in, which need to be determined one way or the other as soon as possible. Either the development should go ahead and start to provide much-needed housing, or the council’s mind should be refocused on the need to identify alternative sites. The Government office recognises York’s achievements in redeveloping brownfield sites, but it needs to agree on the necessity of greenfield development for family housing in York, as in a number of areas in south-east England.
On the right to buy, I would like the Government to relax the rule that allows councils to spend only 25 per cent. of their receipts on alternative housing investment. I would also like them to impose restrictions on the right to buy in York, as they have done in some local authority areas in the south-east. The Government office for Yorkshire and the Humber should be asked to review all the Government’s landholdings in York, such as those held by the Ministry of Defence, other Government Departments and the national health service, to identify land that could be released for affordable housing.
I welcome the Chancellor’s commitment in the 2007 comprehensive spending review to increase the supply of social housing. There is a pilot homebuy-plus initiative in the York-Harrogate-north-east Leeds so-called golden triangle of house price hot spots. Some £7 million is being invested in that over five years, but that will not produce a significant number of homes. Of course, it is a pilot scheme, but I would like to see a move from the pilot to mainstream provision of homebuy-plus as soon as possible.
The council needs to cut its re-let times. When the Labour party controlled the council, it got the average re-let time for council housing down to two weeks, but that has crept back up to five or six weeks. The council should address that urgently.
I would like the council to provide realistic incentives for tenants to trade down from family-sized homes to release more family housing for rent. I would also like it to allocate a proportion of single-bedroomed properties, of which there is a considerable supply in York, to a rent-and-save scheme to enable young people who cannot afford to get on the housing ladder to build up the deposits and save the money to enable them to do so.
The council should maximise the use of sites that it controls, such as those at Lowfield, St. Barnabas and Shipton street schools, for affordable housing and not simply try to get the largest possible capital receipt from them. It should also use nomination rights with other registered social landlords to their full potential. The council has put great reliance on the so-called tear-drop site—a larger former railway land site next to York station—but it should not put all its eggs in one basket and overdevelop that site.
Thank you, Mr. Cummings, for the opportunity to participate in this long overdue debate about affordable housing. It is incumbent on all parties in the House to raise the profile of this important issue, and I therefore congratulate my good friend the hon. Member for Bolton, South-East (Dr. Iddon) and his colleagues on securing the debate.
We should make no apologies for wanting to speak for longer than our allocated times, Mr. Cummings, because the issue is that important. My hon. Friend the Member for Bolton, South-East set out the requirements of an affordable housing strategy for the north-west, and I wholeheartedly agree with his analysis. I shall therefore concentrate my remarks, in the time allocated to me, on my local authority area. In Salford, we have been aware of the rising problem of affordability for some time. In a city with fantastic economic growth potential, it is vital to have high quality affordable housing if we are to maintain sustainable communities.
The lack of affordable housing has major consequences. Households can be priced out of the market, and people can find themselves living in unacceptable accommodation. Historically, areas such as Salford were perceived as not having an affordable housing problem, because we have traditionally had a plentiful supply of low-cost housing for rent and sale due to the high volume of low-cost terraced housing and council-owned homes. However, housing markets have changed significantly in a short period. During detailed research for Salford’s latest housing strategy, it was noted that some areas in the city were beginning to suffer from the problem of affordability. That prompted the need for further research to understand the demand for affordable housing in Salford.
Using three times household income as a measure of affordability, analysis by Salford city council demonstrates that few areas in the city are affordable for the average household. That indicates a growing need to provide new homes at an affordable price and new financial products to help households access existing or new housing. In Salford, housing needs calculations demonstrate the need for the local authority or a registered social landlord to provide an additional 320 rented homes a year.
The numbers on Salford’s waiting list for affordable social housing rose from 8,000 in 2003 to 12,000 in 2006—a significant increase of 33 per cent. In the Manchester-Salford pathfinder area, the average price of properties increased by 36 per cent. between June 2003 and June 2005. Sales of properties priced below £10,000 dropped from 366 in 2000 to just 23 in 2004. In the same period, sales of properties priced at less than £50,000 dropped from 965 to 521. That indicates that there has been a huge reduction in the availability of affordable properties in the housing market renewal area, in which the average household income is £19,500 per annum.
On a positive note, the market renewal programme in Salford and Manchester is helping us to make real inroads into this growing problem, and there are some significant developments in Higher and Lower Broughton in the city. In my constituency, however, mean house prices rose by between 20 and 27 per cent. between 2003 and 2004. The average house price in the Eccles ward, for example, was £145,000 in 2004, when the average household income was £28,000. If we use three times household income—say £84,000—as the limit for an affordable mortgage, it is clear that average households cannot afford to access homes in their own neighbourhood. Given that incomes have not kept pace with house price rises in the intervening period, that situation has got worse.
If local authorities and their partners are to combat the problem, they must have the certainty that they will receive funding to clear redundant housing and provide new housing. That is why it is important that cities such as Salford, where great progress is being made in transforming housing, have the confidence that central Government will continue to provide support for housing investment. I therefore call on the Minister to provide certainty that the highly successful market renewal programme will continue, allowing councils such as Salford and Manchester to continue regenerating housing markets. We must use the comprehensive spending review to give local housing authorities and market renewal pathfinders certainty about long-term financial planning so that they can make provision for affordable housing. We must ensure that housing investment resources for local authorities are effectively targeted at providing sufficient affordable housing of a decent quality to meet current and planned economic growth.
In conclusion, the widespread perception in the north-west is that there is a serious lack of understanding in Westminster and Whitehall of the problems that we face, and we would welcome any ministerial visit to Salford to see those problems first hand.
I congratulate my hon. Friend the Member for Bolton, South-East (Dr. Iddon) on securing this important debate. At a meeting that was held in my constituency in September to look at the Durham visioning exercise, several local residents mentioned the lack of balance in our communities. In the city centre, student housing has crowded out family housing, and there is simply no affordable housing. What social rented housing was available there was sold off under the right-to-buy scheme and then sold on to student landlords. In recent years, most affordable housing has been made available through low-cost home ownership equity share schemes built in the Durham villages, but little housing has been built under those schemes either. In 10 years, only 500 affordable housing units have been delivered in Durham, which now means that a two-bedroomed terraced house in the city centre can sell for £185,000 or more.
The residential strategy in the recent visioning exercise, which has been led by Liberal Democrat Durham city council, makes no mention whatever of affordable housing or of how to deliver it in the city centre or elsewhere. The council’s only housing strategy seems to be to sell off as much land as possible in the city centre and elsewhere to the highest bidder and to deliver luxury apartment dwellings. That policy has been heavily criticised not only by me, but by local residents and, recently, by a local planning inspector. We had managed to get some inappropriate luxury apartments called in, and the planning inspector refused them. His report backed what several of us had been saying locally, which was that the application of section 106 agreements was the only tool the city council had given itself to deliver any affordable housing. That approach was set out in policy H12 of the local plan that was adopted in 2004. As it happened, however, the Liberal Democrat council had never adopted or applied policy H12, so no section 106 agreements were applied to the delivery of affordable housing. That was picked up in the inspector’s report, which not only criticised the council for not applying policy H12, but made the important point that it had delivered only about 30 social housing units a year and that the district therefore now requires 503 new affordable houses each year just to deal with the backlog.
Interestingly, following all that pressure, the council adopted policy H12 a couple of weeks ago, so I suppose that that is an advance. However, we now have an additional problem in that the regional spatial strategy will not allow Durham to build enough houses each year between now and 2021 to deliver the necessary social housing using policy H12 or other means. I therefore ask the Minister to look again at what the regional spatial strategy says about housing and affordable housing in Durham and, indeed, the north generally. Paragraph 377 of the strategy recognises the need for affordable housing in the region, but then appears to prevent us from delivering it.
I know that time is short, so I shall just say what I think needs to happen. Obviously, we need to have policy H12 not only adopted, but implemented and reflected in the new local development framework for Durham, which, again, makes little mention of affordable housing. The visioning document for Durham also needs to reflect policy H12. We need additional social rented housing and low-cost home ownership, in not only the Durham villages, but the city centre. We and officials in the Department need to think imaginatively about how we turn surplus student housing in the city centre back into family and affordable housing. A group of us in Parliament are thinking about that issue, too, and we need a dialogue. Finally, I welcome planning policy statement 3, and it is really helpful that it talks about family housing and sustainable communities, but we need the tools to deliver those .
I welcome the debate, which was secured by my hon. Friend the Member for Bolton, South-East (Dr. Iddon), because it clearly indicates that the shortage of houses to rent is a chronic problem in the north as well as the south, and that is the message that we must get across. As has been said, the Government were right to give priority to moving the decent homes programme forward in 1997 and to dealing with a chronic backlog of work, which had led to the disrepair and lack of improvement in our houses. At the end of the 1990s, the authority in Sheffield could not let homes in parts of the city; they were standing empty and had to be demolished. Since then, things have changed simply because house prices in Sheffield have trebled. The average house price is now £140,000—double what someone on average earnings in the city can pay for a mortgage. Therefore, people have increasingly turned to social renting as the only option. Unfortunately, that option is often not available for families in housing need. My hon. Friend the Minister will be only too well aware of the chronic housing shortage problems in the south of Sheffield, in particular.
As a member of the Select Committee on Communities and Local Government, I endorsed the national target figures of 200,000 new homes a year and Shelter’s target of 20,000 extra homes for social renting. As I hear more evidence, however, I am led to believe that those targets may be too modest and that even if we were to achieve them we would not deal with the total housing need.
As to the comments about planning policy statement 3, I recognise the Government’s desire to make it easier, and in some cases to try to encourage local authorities, to grant permissions for house building. My only concern about that would be that I should not want to take off the pressure to build the majority of houses on brownfield sites. That has been a successful policy, and is certainly working in Sheffield. I should not want us to revert to more building on greenfield sites when brownfield sites are available. I welcome the fact that the Government are aiming, across the board, for more commonality of approach to section 106 of the Town and Country Planning Act 1990. Some authorities use that well to bring about the building of affordable homes to rent; other authorities hardly use it at all. Certainly, we want more to be done by such authorities.
To focus on local issues in the Yorkshire region, the other day I obtained some figures about 2004-05, the last year for which figures are available, which showed that there were 10 times as many people on housing waiting lists as there were lettings in the region. An even more frightening figure, in some ways, was that for every five houses that were let, two were sold under the right to buy. There is a serious need to deal with that issue, because even if we begin a modest increase in house building—through registered social landlords, local authorities or arm’s-length management organisations—if all that happens is that more are sold off at the end of the process, we shall not tackle the problems of housing need. The Government should think seriously about reducing the discounts in areas of housing need in the north as well as the south, as happened a few years ago. In 2004-05, when, in Yorkshire, there were 10,000 instances of the right to buy, only 270 new homes were built by registered social landlords; none, of course, was built by local authorities or ALMOs.
ALMOs are the major housing provider in Sheffield now. More than 40,000 homes are owned by Sheffield Homes. It is a three-star—excellent—ALMO, and has received that credit two years running. It is a good manager of properties and we should ensure that the good managers are the ones that build, when we finally get round to allowing building in the social rented sector. It let 4,400 houses, or rather homes, in the past year. It was a slip of the tongue when I said “houses” because two thirds of the properties that it lets are flats and maisonettes. There is a chronic shortage of family housing, which is the type that is being sold off, by and large. The problem is not just total numbers, but property type. For some of the family homes there were more than 100 bidders in the choice-based lettings programme for properties that became available. Sheffield’s ALMO wants to build 400 new homes a year, but even that would not replace the homes that are leaving the system under the right to buy. It would not even allow property availability to stand still; but it would be a start.
There are real obstacles. There are problems because of the perversity of the housing revenue account, which means that the ALMO and the local authority lose subsidy together if they build new homes. That is a crazy situation, which we must address. The Government have launched six pilots nationally, one of which is in Sheffield, to consider how that can be resolved. ALMOs have no asset base against which to borrow, and that is a problem when they are minded to try prudential borrowing to raise capital to build new homes. They also have very short-term financial arrangements, under which they do not know from one year to the next what their subsidy position will be, unlike registered social landlords, which can plan much further into the future. Of course they are also on a short-term contract with the council, which means that they cannot plan properly.
I believe that ALMOs have a major role to play in the future in building and providing extra new homes to rent. I am pleased that Sheffield city council and Sheffield Homes are working through the problems. I am also pleased that officials of the Department for Communities and Local Government are engaged in that. Ministers have said that they believe in principle that ALMOs should be able to build new homes. I hope that that principle will be turned into practical achievement before too long.
As other hon. Members have done, I congratulate my hon. Friend the Member for Bolton, South-East (Dr. Iddon) on securing the debate, which is a vital one. I want also to say a word of congratulation to the Government—although I have other kind words to say about them—as the housing issue clearly affects only Labour areas, to judge by the absence of Conservative and Liberal Democrat Members taking part in the debate. The fact that only Labour Members are here for the debate, apart from the other parties’ Front-Bench spokesmen, is a sad indictment.
The reality in areas such as the city of Manchester is that in some ways we are the victim of the Government’s great success. In parts of my present constituency, which I took on at the 1997 general election, there were “For Sale” signs all over the place; houses were in an awful state and people were literally abandoning them. Whole streets were being demolished, unofficially, long before the bulldozers came in. Property prices had dropped so far through the floor that it was possible to obtain a terraced house for as little as £1,000. People wanted to give them away. That will be something familiar to some of my northern and midlands colleagues.
Now, in the same areas, houses have been built, and the “For Sale” signs are up again, but house prices are 100 times what I have stated. It is hard to find many houses priced at less than £100,000. We are now witnessing the opposite end of the process: as there has been large-scale demolition of certain types of housing, such as traditional terraced houses, and as private and social landlords, through housing associations, have given up properties—and sometimes in the period of decline housing associations were very bad landlords—there has been a shrinking of the market for privately rented and affordable housing. That has now become a major issue. As house prices have shot up, and new people have come into parts of my constituency—people who change the area in a positive way and are welcomed almost universally by the existing population—well defined pressures, of the kind that we have already heard about this morning, have begun to be exerted on housing stock.
My particular concern is that it is vital, particularly somewhere with the level of destruction suffered by east Manchester in the past, that regeneration should entail the retention of the existing community, and should build on strong community links. A difficulty in that approach, of course, involves the generations. If the succeeding generation is forced to look outside the area of regeneration for homes—if those people must look for affordable housing outside Manchester, in Tameside, the next local authority along, or further afield, the very communities that should be part of the regeneration process are being broken up. There is a flaw at the centre of what we are trying to do if we cannot begin to wrestle with the question of affordable housing.
As other hon. Members have done, I make a direct plea to my hon. Friend the Minister to consider the need for a massive increase in the amount of social housing—affordable rented accommodation. I have no objection to the private rented sector, which works well in parts of my constituency, although we, like everywhere else, still have problems with the difficult and unpleasant landlords. Nevertheless, we need affordable social housing, and it must be high on the agenda for all of us.
I want to touch briefly on another aspect of housing policy, which my hon. Friend the Member for Bolton, South-East also mentioned—the right to buy. That is of course intimately connected with the question of how we maintain social housing in a proper social housing stock. As my hon. Friend the Member for Sheffield, Attercliffe (Mr. Betts) said, it is ridiculous if in his city, as in mine, more housing is being lost through the right to buy than is being gained through new build or the conversion of property into affordable social housing. We must make sure that the affordable housing stock grows, for those who need it.
The final matter I want to deal with lies beyond the Minister’s Department, so I hope that she will be able to listen to it and report back. This again affects big parts of the north of England. Regeneration is taking place and huge sums of public money are being invested, but one of the problems is that the private contractors are not always respectable partners.
I am sure that I will raise this issue at greater length in future, but I mention it now. In my constituency, Lovell is being used. I recently met residents of an estate where it is the private contractor for a private build new estate. A lot of public money has gone into making this possible. The problem is that Lovell has consistently breached the planning permission that had been given, the contractual agreements that it reached with those to whom it sold properties and all the agreements that ought to have been contractually tied by Government moneys going into that sort of investment.
If we fail to control these large contractors in this generation and we allow them to run rings round local authorities and other public bodies, particularly the new residents moving into an area, we undermine the future viability of those housing estates. We must get a contractual grip and ensure that where public money is invested in large-scale developments, the contractors know that their performance will be measured not simply by those at the bottom end—those who move into the homes—but by those all the way up to central Government, who will insist that there is a contractual price to pay when contractors do not deliver the job and the housing that they have undertaken to build.
I congratulate my hon. Friend the Member for Bolton, South-East (Dr. Iddon) on securing this debate, and I thank my colleagues for being so co-operative on the time available that additional speakers might have a chance to make a contribution.
In an intervention, my hon. Friend the Member for City of Chester (Christine Russell) made a point about house prices in Chester, part of which is included in my constituency. The area of Chester, Ellesmere Port and north-east Wales is the fastest growing economy in the country—a fact that is not always appreciated down in London.
My hon. Friend the Member for Stafford (Mr. Kidney) was right that there is huge diversity within the north-west and his own area, the midlands. The situation creates an enormous number of pressures in the rapidly growing economy around my constituency. Five wards in my constituency are among the poorest in the country, whereas two or three are among the richest. That diversity and the lack of a homogenous housing structure in the region means that we need flexible solutions.
I make a plea to the Minister to examine the evidence that was adduced when our hon. Friend the Minister for Local Government made a visit a few months ago to open a refuge for women suffering from domestic violence. He examined some of the imaginative housing solutions that we have found, but we have been constrained because of the way money is held back from our community. Part of the problem in Cheshire is that its pockets of real need are diluted by its affluent parts, so the flow of money from the Housing Corporation, for example, does not reflect the needs of the community. I urge the Minister to examine closely how moneys are allocated in areas such as mine, and, indeed, in the whole of the region, to see whether a more equitable solution is possible.
My local authority has been very imaginative. Some 15 years ago, our late, good friend Derek Fatchett, came to open the first renovated home—one of the old, concrete stock, Waites homes—that had had a £20,000 makeover to make it good for another lifetime of a house. That was an incredibly good piece of value for money. Interestingly, at the time, the Government office in the north west did not think it was good value for money; it thought that the best idea was to destroy communities and put people in little boxes. We have overcome that one and the work in question has almost come to a conclusion.
However, pockets of such housing still need urgent work. It is being held back simply because the revenue and capital relationships do not work and do not allow our local authority to continue with the work necessary. I visited some women in a house on Eccleston avenue recently and listened to the problems that they were facing as a result of living in properties that still need urgent repairs. The work cannot be undertaken because of the perverse way in which the formula impacts on my community.
I urge the Minister to seek the flexible solutions that will enable local authorities, working with the Housing Corporation, to meet the needs of our local communities. The communities involved are very different. Let us compare my constituency with those of my hon. Friend the Member for City of Chester and my right hon. Friend the Member for Birkenhead (Mr. Field). The Victorian housing stock in Birkenhead and Chester includes a huge number of large properties that have been converted into flats and maisonettes. Such housing simply does not exist in newer communities such as mine. There cannot be a simple, homogenous solution; we must have flexibility. I hope that ideas such as mine can be taken on board in the search for a solution.
New pressures are starting to emerge as a result of the success of the local economy. Some of the demographic information upon which my county council has been working to develop its strategy will prove to be flawed. When all that is taken into account, local residents, particularly those in poorer communities, will be left in a much more difficult situation unless there is active Government intervention.
I find it deeply disappointing that the Opposition parties, which are vying for seats in the north of the country, cannot find a Back Bencher to contribute in this debate. I hope that the media pick that up, because it is a disgrace. It is a reflection on the kind of Opposition who we have got.
I, too, congratulate my hon. Friend the Member for Bolton, South-East (Dr. Iddon) on securing this important debate. The number of my colleagues from northern constituencies who have taken part emphasises the increasing importance of the issue.
I want to make four quick points in the brief time available to me. Most people would consider the Knowsley part of my constituency to be urban—and it largely is—but my constituency contains quite a large rural part in Sefton. It is not uncommon for new houses in Knowsley to cost in excess of £200,000, although that is not an average figure. Such a situation would have been inconceivable a few years ago. That partly reflects the success of the local economy, but it has implications for affordability, which is becoming an increasing problem.
Parts of Sefton—for example, Ince Blundell—in my constituency, probably have average house prices of about £400,000. It is impossible for some people to get a foot on a rung of the housing ladder in such places. Because of those pressures, the housing picture has changed dramatically in the recent past.
I have concerns about private landlords—several hon. Members have mentioned their role. There are some very good private landlords, but a number of private landlords in my constituency are using the system purely to launder drug money. We need stronger controls on private landlords to deal with that serious problem.
It is estimated that 35 per cent. of those on waiting lists are in northern England, yet the area’s Government allocation for affordable housing is only 11.4 per cent. That statistic shows why it is necessary to have this debate, which has been a good one.
I, too, congratulate the hon. Member for Bolton, South-East (Dr. Iddon) on securing this debate, and on framing it so well, highlighting the problems faced by his constituents, and exploring in more detail the wider issues in the north and midlands. He focused on problems with the right to buy, its impact on housing stock and its continuing influence as house prices in the north and midlands begin to catch up with the huge increases in the south.
The hon. Gentleman made a clear case for achieving higher numbers of new units, which is crucial. Many organisations are doing excellent work. As we go into Westminster tube station, we see Shelter’s advertisement. Shelter campaigns tirelessly to make the point that the Government must achieve new units, and I pay tribute to its work on that.
The hon. Gentleman will be aware that housing revenue account rules require local authorities with older housing stock and, therefore, lower historic debt levels, as in York, to transfer resources to areas with higher debt levels—for example, in London and Manchester. Does he agree with City of York council that that is wrong, and would Liberal Democrat councils in areas that benefit from such transfers—for example, Stockport, Islington and Kingston upon Thames—support City of York council and their Liberal Democrat colleagues if they argued for change by putting forward a proposal to the Local Government Association.
The position taken by my Liberal Democrat colleagues in the south is a matter for them, and I would not seek to dictate what they do. The way in which the housing revenue account operates disadvantages some councils, and I shall return to that later. I am grateful to the hon. Gentleman for giving me the opportunity to make that point.
If the hon. Gentleman cannot speak for his council colleagues in York, perhaps he can speak for those in Burnley. I understand that they will propose a move from resettlement grants to loans, without increasing the value available to constituents who are forced to move when their houses are compulsorily purchased, even when the housing price is rising dramatically, I am glad to say, in my constituency, thereby leaving my constituents much worse off. Does the hon. Gentleman support that?
I have not had the opportunity to consider the situation that the hon. Lady describes, but I am grateful to her for bringing it to my attention. I am sure that I shall have the opportunity to raise it with my council colleagues.
The hon. Member for Bolton, South-East referred to community land trusts. We heard how the Conservative party has recently discovered that policy and been converted to it. It has been my party’s policy for many years. The hon. Gentleman also referred to the work in my constituency in Cornwall where the Liberal Democrat-controlled council has been working to deliver the first schemes by that route.
I pay tribute to hon. Members who highlighted the problem of affordable housing throughout the midlands and the north. We must ensure that those regions receive fair support in tackling it. Plain figures do not suggest that problems in the north are as great as those in the south-east and south-west, but, as with all statistics, they hide individual cases and the situation is getting worse in some local communities. I could talk about the rise in the number of second homes in some parts of the north-west, Yorkshire and other areas. I pay tribute to the work of my hon. Friend the Member for Westmorland and Lonsdale (Tim Farron) in drawing that to the attention of the House and the Government.
Does my hon. Friend acknowledge that my constituency has the largest gap in the north and midlands between low average incomes and high average house prices? The percentage of our council property that has been sold off during the past 20 years is the largest in Lancashire and Cumbria. Should those factors not be taken into account when allocating funding for new housing and particularly new social housing?
I certainly agree with my hon. Friend. The situation in his constituency reflects that in mine and those of my hon. Friends in Cornwall, where there is a particular problem with second homes. We were shocked during a recent Adjournment debate on the Barker review when the then Conservative Front-Bench spokesman referred to the great contribution that second homes make to the local economy. I am sure that his constituents would question that assertion.
Local authorities can keep the proceeds of council tax on second homes and spend it locally—for example, on community land trusts—but they must send the proceeds of council tax on empty homes to central Government. Does the hon. Gentleman agree that both should be treated the same?
The hon. Gentleman makes a good point, and I am sure that further work is needed. A great deal of work is going on with empty dwelling management orders, and my party supported the Government when the legislation was introduced. I hope that local councils will take up that opportunity of dealing with the problem of empty homes.
The Government are failing to meet housing needs in the north and midlands. The right to buy has decimated council housing stock. Under the Thatcher Government, 350,000 council houses were built during their first eight years, but during the first eight years of the Labour Government only 3,000 were built.
The right to buy has left councils with far too little stock, but the Government’s framework is forcing councils towards stock transfer. Those who want to deal with the commitment of their tenants to remain within council ownership are facing huge pressure to move away from that. The Government have failed to resolve that problem.
My party’s policy, as hon. Members have mentioned, particularly the hon. Member for Sheffield, Attercliffe (Mr. Betts), is that councils should be given more flexibility to raise the threshold and to lower the discount. In many parts of the north, buying council houses is becoming unaffordable, even with the discount. That is obviously having an effect on the number of right-to-buy applications. We believe that councils should have the opportunity to decrease the discount to help to deal further with that problem.
Numbers on housing waiting lists are rising sharply, and that leads to pressure. The Government are seeking to tackle the problem of temporary accommodation by ensuring that councils can no longer use bed-and-breakfast accommodation, but that gives rise to another problem: where can people go? My hon. Friend the Member for Leeds, North-West (Greg Mulholland) highlighted to me a family who were living in a tent in a friend’s front garden because that was the only accommodation available.
The Government said that they want to give more power to local authorities, but we see little evidence of that happening in practice. Councils must be encouraged to use the planning laws at their disposal to require developers to build more affordable housing in new developments. The hon. Member for Stafford (Mr. Kidney) referred earlier to section 106 agreements. There was a debate in the House earlier this week about the Government’s proposed planning gain supplement. My party does not believe that that is the way to go because centralising the system may reduce local flexibility to deal with such issues.
Great work is being done in Liberal Democrat-led South Shropshire council in the west midlands on affordable housing issues and to ensure that more accommodation is provided in rural areas where incomes are low and house prices are high. In other areas, such as that of my hon. Friend the Member for Harrogate and Knaresborough (Mr. Willis), only one planning application for an affordable home has been successful. That illustrates the size of the problem. We need more support for local councils to be able to deliver the affordable housing that their communities need.
I have had the opportunity to visit Newcastle and to see the Liberal Democrat council’s work on the housing market renewal programme. It has successfully involved the community in delivering that. I was impressed with the quality of some of the new housing.
John Cummings (in the Chair): Order.
I apologise Mr. Cummings. I did say that, but given the time now, I shall write to the hon. Gentleman.
I shall return to the issues. The Liberal Democrats have policies to tackle the second homes issue and to encourage the use of empty dwelling management orders. We want to strengthen planning gain for local communities through a tariff system, and we support strongly the initiatives to use community land trusts and mutual trusts to deliver housing for local people.
Many organisations have pointed out that through the comprehensive spending review, the Government have an opportunity to deliver a step change in social housing investment. We hope that they do so in the next few months.
I, too, congratulate the hon. Member for Bolton, South-East (Dr. Iddon) on raising the issue in his typically knowledgeable, warm and understanding way. He will indeed be a great loss to the House, and it is essential that somebody of great capability and experience fills his shoes. I suggest Mr. Frank White, who having served as a distinguished Member of this House, has just finished a very good spell as mayor of Bolton. He has been an excellent servant of the Labour party and of the wider public. If the hon. Gentleman’s constituency is looking for someone of stature and calibre, which I understand it might be, Frank White would admirably fit the bill.
I thank all Members for their brevity and clarity, which provided a good lesson for all Front-Bench spokespersons. The colleagues who have spoken this morning have a tremendous amount of experience, and I shall briefly run through them, because as the Minister will appreciate, mine will be about the tenth opposing speech she has heard this morning.
The hon. Gentleman spoke about the affordability gap. The hon. Member for Stafford (Mr. Kidney) spoke about the importance, when targets and quotas are set, of greater local involvement over the imposition of national criteria. The hon. Member for City of York (Hugh Bayley) spoke about the problems for first-time buyers. The hon. Member for Eccles (Ian Stewart) spoke about the growing wealth of his constituency and the surrounding area, which I know well from my spell as a Minister dealing with Manchester and Salford, when we were involved with the regeneration project, City Challenge, and the factors that kick-started the tremendous advances in those cities.
I shall, but may I make clear at the beginning my policy on interventions? In Westminster Hall, because of time constraints, one intervention is fine. I am very happy to take an intervention from the hon. Gentleman, and then I shall progress to the end of my speech. I am happy for him to intervene now or later.
I should be grateful if the hon. Gentleman reflected on his own remarks. Will he accept that when I inherited the part of east Manchester about which I spoke earlier, the effects of policies from a Conservative Government of whom he was a member were so devastating that the housing market had collapsed and houses were being sold for £1,000 to get rid of them? That was not part of any regeneration.
The regeneration of Manchester and Salford, which has continued apace, and the good work that the new regeneration company in east Manchester is already doing, are part of a process. One cannot do everything at once, as Government Members have found from their own Government. Many have spent their time covering up their embarrassment at the failure of the Government’s housing policy by explaining how it was right to deal with improvement at the beginning, but how more must be done now. The regeneration that the Conservative Government kick-started in Manchester, Salford and other great northern cities did a tremendous amount of good, laying the foundation for the many good things that have followed.
If the hon. Gentleman will forgive me, there is much to get through in a short period. [Interruption.] I am mentioning everybody’s constituency. The hon. Gentleman mentioned the problems and difficulties that the growing wealth of his area has caused, and I shall agree with him later about some issues.
The hon. Member for City of Durham (Dr. Blackman-Woods) spoke against the regional spatial strategy and described the problems that it was causing in her constituency. The hon. Member for Sheffield, Attercliffe (Mr. Betts) spoke about the failure of social renting and about growing waiting lists. The hon. Member for Manchester, Central spoke, too, about the growing wealth of that area and the problem with keeping control of some ongoing regeneration projects. The hon. Member for Ellesmere Port and Neston (Andrew Miller) called for greater local understanding of what was going on, and the right hon. Member for Knowsley, North and Sefton, East (Mr. Howarth) also spoke from experience about the problems in his constituency.
All speakers, most of whom I have known for many years in this place, would admit in a private moment that had they made their speeches 10 years ago, the logical conclusion would have been a denunciation of the Government in office and a call for it to go, so that a new Government could deal with the problems that they had mentioned. They could not make that conclusion to their speeches, so I shall suggest to the Minister that that was the tenor of their remarks.
The problems are in fact slightly worse than they have stated, although they did so constructively and in an appropriate Back-Bencher way. The problems are difficult to deal with. Ten years ago there was a sense from the Labour party that all we needed to do to solve complex problems was elect them and all would be well. But that is just not true.
The hon. Member for North Cornwall (Mr. Rogerson) spoke about the number of houses being built. In the 1990s the number of social housing completions under every Conservative Housing Minister ran at between 23,000 and 30,000 a year. This Government have managed only between 13,000 and 18,000 a year. Shelter and the Joseph Rowntree Foundation have both made good contributions to the debate about the problems of housing difficulty. Shelter reminds us of the problems of temporary accommodation:
“The average length of time homeless households spend in temporary accommodation before being made a permanent offer of rehousing increased from 98 days in 1997 to 267 days in 2004.”
The problems run deep.
No one this morning has mentioned first-time buyers’ problems, which have increased, as the papers reported overnight, because of increasing costs associated with interest rates and inflation. The Independent this morning says:
“The plight of first-time buyers struggling to get on the housing ladder is worse than ever, according to figures released yesterday.
The Council of Mortgage Lenders said the average person buying their first home takes out a mortgage worth 3.29 times their income - the highest multiple since the survey began in 1974 and up sharply from 2.4 at the start of 2000.”
The article continues:
“In a painful double-whammy, more first-time buyers are also being hit by stamp duty—56 per cent in November compared with 48 per cent a year ago.”
There are costs associated with first-time buying which just did not exist before.
The Government’s grip on the issue is loosening as time goes by. They have made some serious mistakes in housing policy, exemplified by what we have heard this morning, and there have been mistakes in planning and in targets. Regional spatial strategy has already been mentioned. The policy of restricting the number of houses needed in one part of the north, because the Government are trying through pathfinders to deal with problems in some of the biggest cities, is not working. The problem of being unable to build homes where they are needed exists not only in the constituency of the hon. Member for City of Durham.
The other side of the regional spatial strategy is the pathfinder programme. It has its merits in certain places, but I urge the Minister to examine closely what is happening in Liverpool. It is time for an inquiry into the problems that have been caused there, because Liverpool suffers from a series of problems.
Allegations include concerns about how registered social landlords have bought up and kept empty properties, which have then contributed to the dereliction of an area, making it more suitable for demolition than repair; the failure of the Housing Corporation to intervene; the scale of demolitions compared to renovation; the cost to the Exchequer, which includes having now to pay inflated prices for property bought cheaply at the start of the process by speculators anticipating that prices would rise as the market moved, and to which pathfinder could not respond; the subsequent delay to the progress of pathfinder as it ran out of money, condemning some areas of renovation to many more years of blight than they had been promised; and last but by no means least, the cost and abuse of the compulsory purchase order process, bravely halted by Mrs. Elizabeth Pascoe who took on and won in the High Court recently a case involving her concerns about the city’s Edge Lane proposals. It is time for Liverpool’s pathfinder project to be examined seriously.
The answer to some problems is less national targeting, a greater increase in responsibility for local councils, a movement in the planning process from unelected regional assemblies back to elected local authorities, and a lighter regulatory touch from the Government—precisely what they will oppose during the passage of the Sustainable Communities Bill and promote during the passage of the Local Government and Public Involvement in Health Bill. Continuing to consider imaginative approaches, I commend what is happening in Coventry and a scheme in Ealing called Safe Haven London, which effectively securitises housing benefit payments to fund the construction of local housing.
A mixture of measures is needed such as a lighter touch, more local control, innovative schemes and continuing work on shared ownership. Furthermore, we should try to deal with the continued stigma attached to social renting, which should not be there. The Government need to show a little humility over their failures and admit that a rethink is needed to deal with the problems that I have highlighted and which have been so well outlined by members of the Under-Secretary’s party this morning.
First, I, too, congratulate my hon. Friend the Member for Bolton, South-East (Dr. Iddon) on securing this important debate. It is unusual for so many Members to take part in such a discussion. I think that we have had nine full speeches and a significant number of interventions, which shows how much concern there is about this issue in the midlands and the north of England. Not only is the debate marked by the turnout, but, interestingly, the Liberal Democrat Front-Bench spokesman, the hon. Member for North Cornwall (Mr. Rogerson) not unusually took credit for something that the Labour party has done, as too did the Conservative Front-Bench spokesman, the hon. Member for North-East Bedfordshire (Alistair Burt).
Let us consider the reasons for the current situation. Some problems are clearly the result of continued economic success. Let us consider also the demographic situation. Household projections up to 2026 for the midlands and the north, calculated under the 2003-based data, were significantly higher than those calculated under the 2002-based data. That illustrates how the demand for housing has increased across the country. The problems of affordability are no longer restricted to the south.
Draft revisions take account of regional spatial strategies. That important point was raised by my hon. Friend the Member for City of Durham (Dr. Blackman-Woods). Public examinations in Yorkshire and the Humber and the north-east have concluded that housing numbers have increased above those in current plans and are more comparable with household projections, although we have not yet received the panel report on the Yorkshire and the Humber regional spatial strategy. It is important that we look at not only numbers, but where the houses will go. We hear consistently from the Conservative Benches that we need to build more, but not in their backyards.
I shall move on to what we have achieved in housing during our period in Government. We have delivered stability in the housing market and lower long-term interest rates. We have addressed the £19 billion backlog of repairs on affordable housing, to which my hon. Friend the Member for Bolton, South-East referred, so that homes meet basic decency standards. We have addressed decline and abandonment in the housing market renewal pathfinder areas and are tackling homelessness which has fallen to a 23-year low.
May I just say that I endorse everything that my hon. Friends have said about affordability, which is equally relevant in Birmingham? I would like to draw to the Under-Secretary’s attention the situation in Birmingham and ask her to comment on the fact that all Birmingham MPs received a letter recently from the Conservative cabinet member for housing in Birmingham seeking substantial changes to council house subsidies. He might have a point, but will the Under-Secretary ask the Minister for Housing and Planning to meet us in Birmingham? That letter came after a marked failure in communication between us and the Tory-Liberal Democrat administration on housing matters. There are significant worries that their figures do not add up.
I shall convey my hon. Friend’s concerns to the Minister. I cannot respond to all these issues now, however, and shall write to all Members here about the housing revenue subsidies. It is complex and I cannot explain in detail now how those amounts are arrived at.
Our main housing challenge is to build more homes to meet the needs of our ageing and growing population. That includes more market and affordable homes, and social, rented and shared equity in all parts of the country.
I am afraid that I do not have time.
The latest household projections suggest that an additional 209,000 households will form every year until 2026. In 2005, only 168,000 new homes were delivered and the level of new housing actually fell by 50 per cent. between 1970 and 2000. That gap is not sustainable and the result is higher house prices. Just over half of 30-year-old couples can afford to buy based on their earnings. Unless housing supply is increased, only one third will be able to afford their own home in 20 years. Although affordability used to be mainly a southern problem, we accept that every region now experiences it, as I have explained.
Kate Barker's review of housing supply recognised that there had been an under-supply of new housing for many years and called for a significant increase. In response, we set out our ambition a year ago to increase the rate of new housing supply in England to more than 200,000 per year over the next decade. We are making good progress: we announced 29 new growth points, many of which are in the midlands, which have been allocated start-up funding of some £40 million for 2007 to 2008 for capacity building, infrastructure and essential growth-related studies into, for example, flood risk and water supply . Earlier this month, we announced also a new national housing and planning advice unit to provide independent advice to the regions on the steps required to improve housing market affordability. Furthermore, we have been consulting on a housing and planning delivery grant to help local authorities deliver the housing that they need.
Kate Barker also recommended reform of the planning system, to which Members have referred, to improve its responsiveness in delivering housing. In November, as Members have also said, we published planning policy statement 3 requiring planning bodies to take greater account of affordability and pressures within the local housing market when drawing up plans and ensuring a sufficient supply of land for housing where it is needed.
The statement also requires local authorities to ensure that the right mix of affordable and market homes is being delivered to help create mixed sustainable communities. We are increasingly concerned about the mix of homes being built—another matter referred to by some Members. The number of one and two-bedroom flats has rocketed in recent years and we need to ensure also that we provide suitable accommodation for families.
Funding for new affordable housing is another factor to consider. The great majority of our funding goes to the social rented sector, and we are on track to deliver a 50 per cent. increase in new social rented homes over three years between 2005 and 2008—30,000 homes by 2008. There is a wider issue: we must ensure that new social housing meets today's needs, which is why my right hon. Friend the Secretary of State for Communities and Local Government asked John Hills to conduct a review of social housing.
We are already helping thousands of people to get on to the housing ladder through shared ownership, including key public sector workers and social housing tenants. Those are known as homebuy products and will help some 120,000 households by 2010, aiding the recruitment and retention of staff for vital public services and freeing up rented homes for new tenants.
Local authority waiting lists for social housing are unreliable indicators of urgent housing needs—they include those for whom social housing is a preferred option, not a necessity, and so their accuracy varies, which is why they are not used in the formula used to determine regional shares. My hon. Friend the Member for Bolton, South-East mentioned the choice-based letting system, which has been successful for a large number of people. We must remember that it is demoralising for those who actively bid for homes for a long period so those involved in providing that service must be honest with applicants about their realistic prospects of accessing social housing and, where necessary, support them in seeking alternative accommodation.
I agree entirely that community land trusts are an interesting and promising new option and encourage local authorities to consider innovative models. The housing corporation, English Partnerships, is working with community groups to develop pilot trusts. I look forward to the results of those.
On the points raised by my hon. Friend the Member for Eccles (Ian Stewart) about housing market renewal, since the start of the pathfinder programme, more than 30,000 rundown homes have been refurbished and many houses demolished. Again, it is important that we do not just concentrate on houses and that we provide the types of houses that people want, are comfortable in, and will seek to live in and maintain. We have made progress on the number of empty homes.
Education Funding (Middlesbrough)
First, I thank Mr. Speaker for granting me this brief debate. I would also like to say what a pleasure it is to see the Under-Secretary of State for Education and Skills, my hon. Friend the Member for Gloucester (Mr. Dhanda), in his place. I praise him for the good work that he has done in the Department for Education and Skills. He has been in his job for at least six or seven months, and has been doing it with great spirit. However, we shall not carry on our earlier discussion—we chatted about whether “Big Brother” has been racist—because you would rule me out of order, Mr. Cummings. I shall stick to the subject that I want to address.
I wish to focus on some instances of how funding laid down by the DFES impacts adversely on school funding for Middlesbrough local authority in my constituency. Several long-standing issues have been raised many times with senior DFES figures by Middlesbrough councillors and officers, including the lead executive member for education, Councillor Paul Thompson. Despite that, there has been no improvement in the situation, which is why I sought this debate. I am aware that Middlesbrough council has evidence of significant financial losses that have arisen from DFES policy decisions. The DFES needs to address those losses. The key issues are the financial burden placed on Middlesbrough council by the exclusion policies of the two local city academies and the grave impact that having to deal with a high number of excluded pupils has had on the council’s finances.
Middlesbrough was an early supporter of the academy model. The first city academy, Unity city academy, was operational by September 2002, while the second, King’s academy, was operational by 2003. A third academy, Macmillan city technology college, converted to an academy from a CTC in September 2005.
The key issue is that the regulations on financing maintained schools do not cover academies. Those regulations include a provision for the local authority to claw back funding when a school permanently excludes a pupil. Given their freedom from that factor, city academies can therefore exclude as many pupils as they wish, without any financial penalty. Academies will have received funding for those pupils, but the authority is expected to make provision for excluded pupils without that funding being passed on.
In the early stages of the first two academies, there was a high rate of exclusion as compared with that in maintained secondary schools in Middlesbrough. All schools face challenging behaviour from a small minority of pupils. I accept that exclusion is, at times, the only option left to keep order and prevent disruption to other pupils’ education. I have only rarely been approached by the parents of pupils involved in such exclusions, even though King’s academy is in my constituency and Unity academy takes pupils from part of my constituency. However, the fact remains—and can be proved—that the exclusion record of the two academies is far higher than that for the local education authority’s 11-to-16 sector.
In the academic year 2002-03, there were 18 exclusions by the two academies, as compared to five by the LEA’s six maintained secondary schools. In the following year, there were no fewer than 42 exclusions by the two academies, as against 10 by the six secondary schools. In 2004-05, the comparative figures were 17 for the academies and 10 for the six secondary schools, and in the academic year 2005-06, the figures were 18 for the academies and 11 for the six secondary schools. It appears that there is basically a one-way flow.
The academies do not usually admit pupils excluded from other schools. Therefore, the pressure has to be absorbed completely by the LEA, in one of two ways. First, the LEA can place an excluded pupil in a maintained school. That brings a requirement to pay the school the pupil-led funding pro rata for the remaining weeks in the financial year, even though the authority has not received any funding for that pupil from the academy. Alternatively, an excluded pupil can be placed in the pupil referral unit, which is maintained by the LEA. Doing that means that the authority has to increase staffing and other expenditure to make provision for the additional pupils.
The second option bears a much higher unit cost than is the case for a mainstream school, because of the small size of the pupil referral unit and the staffing ratios needed to deliver specialist provision for young people with behavioural difficulties. That can be confirmed by using benchmarking data prepared from the section 52 budget statement that all LEAs send annually to the DFES, which shows expenditure on a per-pupil basis.
The statement for Middlesbrough indicates that it has the highest expenditure per pupil on pupil referral units, at £101 a pupil. Indeed, overall, Middlesbrough has the fourth highest level per pupil in the country, equal with Islington, with only Kensington and Chelsea, Hackney and Blackpool councils having a higher spend per pupil. The all-England average spend on pupil referral units is only £34 a pupil. From that, one can easily assess the impact on the LEA of the two academies’ exclusion policies.
The cash that Middlesbrough council has lost, owing to its being unable to claw back the funding, is estimated at £96,000, up to the end of 2005-06. That, of course, does not include the cost of educating the pupils who are expelled from the academies, which would be higher. That money would have otherwise been spent on improving the quality of the mainstream education provision in the town. To make matters worse, the situation is compounded by the top-slicing of £113 million in 2006-08 from the national dedicated schools grant pot to update academy funding to reflect increases in pupil numbers and to allow for start-up costs for new academies and intervention costs. That has directly reduced the amount per pupil available for Middlesbrough schools.
Despite that, however, Middlesbrough’s schools management forum agreed to an increase in the cash retained by the LEA to spend on provision for pupils, specifically to cover extra cost pressures in the pupil referral unit. In that forum, local head teachers were critical of the inconsistent treatment of academies in respect of the clawback provision for exclusions. As a result, the increase awarded was made conditional upon LEA officers and elected members lobbying the DFES on the matter.
The lobbying promised to the Middlesbrough council community has been carried out. In October 2005, questions were put directly to DFES officers at the northern regional education finance group. In the same month, direct contact was made with the DFES, following receipt of the draft school finance regulations for 2006-07. In reply to both interventions, the DFES response was that there was acknowledgement of the problems, but that a quick solution was not likely to emerge.
In May 2006, Mr. Stephen Bishop, a senior DFES official now in the DFES academies division, attended the Middlesbrough school management forum, where he met head teachers who demanded action on the issue. He replied that consideration could be given to amending the regulations, although he admitted that he thought that unlikely to happen. He also said that the academy funding arrangements could be changed, although he conceded that that would require reciprocal agreement from the academies, making it a remote prospect.
I am aware that the academies programme is expanding across the nation. Given that, I suspect that the issue will increase in importance and that other LEAs will start to press the DFES for a resolution. I could argue that, given Middlesbrough’s early entry to the academy model, my authority is being heavily penalised for being proactive and having responded to policy demands from the centre.
I ask the Minister to study the information in my speech. If he needs extra information, I am sure that the Middlesbrough LEA will be happy to provide it. I hope that he will be prepared to study the issue again so that it can be resolved.
I would like to make one or two helpful suggestions. One way to solve the issue would be for Ministers to consider how they could strengthen inclusion and exclusion policies in the academy sector to stop the problem at source. Alternatively, they could consider amending the regulations to allow money to follow the pupil, regardless of the secondary school sector from which they had been excluded.
I am aware of how important the academy issue is to Ministers and the Government, and I support it wholeheartedly. Removing the financial barrier, in whatever fashion, would allow for more rapid expansion of academies. If we are to build a strong and successful relationship between the LEAs and the academies, problems such as those that I have highlighted need to be arrested. The elected members and officers at Middlesbrough are deeply unhappy about what has been going on for several years. That is why I sought this debate. As a friend, I ask the Minister to respond to the issue. Those people support the Government and were pioneers in supporting the academies. I urge him to respond positively to my concerns.
I congratulate my hon. Friend the Member for Middlesbrough, South and East Cleveland (Dr. Kumar) on securing this debate. I look forward to having a discussion with him later about whether there has been racism in the “Big Brother” house.
This debate is something of a first, in that both speaker and responder are fluent—in my case, fluent-ish—in Punjabi. However, you will be pleased to hear that we will be conducting affairs in the Queen’s English, Mr. Cummings.
I am pleased that my hon. Friend has introduced this debate. He has raised valid concerns, and in a moment I shall explain the point that we have reached in dealing with the issues. Not least from our conversations down the years on education, I know that he has a close interest in schools in Middlesbrough, having been for many years an elected councillor there.
Middlesbrough is an area in which our policy of school diversity can be seen in action. It has three academies among nine secondary schools, including, as my hon. Friend said, two of the first academies in the country, Unity and King’s. The third academy, Macmillan city technology college, has one of the highest contextual value-added scores in England. The academies in Middlesbrough have observer status on the local schools forum, and a range of other ties with authority schools. Those ties are especially important in respect of the issues that particularly affect academies. We want the whole local community of schools in Middlesbrough to prosper through working together.
A flourishing community of schools is one in which all pupils can be properly educated and any behavioural problems can be tackled at root, rather than the pupil being passed from school to school like a hot potato. As my hon. Friend said, for many years funding has been deducted from maintained schools if a permanent exclusion takes place. There is a statutory deduction at a rate fixed nationally. Some authorities make another discretionary deduction at a higher rate to provide a further disincentive to schools that should be trying harder before resorting to the ultimate sanction of exclusion. Such deductions, however effective, are not the complete answer because prevention is much better than cure.
We are promoting local partnerships of secondary schools to improve behaviour and tackle persistent absence. Such work can reduce the need for permanent exclusions. We need to design policies to improve pupil behaviour in the first instance. We have made it clear that we expect all secondary schools, including academies, to join such partnerships by September 2007. That is particularly important in the context of this debate, and early indications from pathfinder partnerships in 19 local authorities have been very encouraging.
Last year, through its schools forum, Middlesbrough drew attention to the implications of the fact that the exclusion rates of two academies were consistently higher than those for the authority’s six secondary schools. In part, that arose from the process of conversion. The schools that precede academies often have considerable problems, so the rate of exclusions from an academy anywhere in the country will often, certainly initially, be higher than that for other schools. I do not say that that is in any way desirable, and I hope that the work to which I have alluded will reduce that effect.
If a pupil is permanently excluded, the authority is responsible for educating them, either at home or in a pupil referral unit, until he or she is admitted to another school. Obviously, that has costs. Middlesbrough has pointed out that its central expenditure on pupil referral units has increased to such an extent that it has had to seek approval from its schools forum to breach the normal limit on central expenditure. My hon. Friend mentioned the figure of £101 per pupil, the fourth highest nationally. Such increases mean correspondingly less money for schools’ delegated budgets.
In turn, that has meant that more attention has been focused on deductions. It is important to point out that the statutory deduction—the only one that Middlesbrough imposes on its schools—can make only a relatively small contribution to the cost of educating the excluded pupils, whether at home or in a pupil referral unit. The key to the problem, from a financial and educational standpoint, is a reduction in the incidence of exclusions in the first place. With that in mind, I am glad to hear that this month Middlesbrough and the academies have been discussing a package of support for the pupils deemed most at risk of exclusion.
Whatever the situation in Middlesbrough, however, we realise that there is unease more generally among local authorities and others about the fact that academies are not participating in the normal deductions regime for permanent exclusions. As always, my hon. Friend effectively makes the case for Middlesbrough, but I am also aware of concerns in other parts of the country, such as Ealing.
The issue raises questions of equity, which is at the core of this debate, especially when our policy for academy funding is firmly that it should be based on equivalence with maintained schools. Unfortunately, the deductions system for maintained schools cannot simply be extended to academies overnight—primary legislation is required—nor can the Department unilaterally change the terms of the funding agreements with academies, as they have the nature of contracts, with all that that entails.
Moreover, changing the funding agreements would not enable academies to receive extra funding for previously excluded pupils whom they then re-admit. They do not have a deduction for pupils who are removed, but neither do they receive money for pupils coming in. However, we propose to undertake a consultation exercise this year in which we shall put the facts to academies and local authorities, and seek views on whether a change should be made and on the best way of achieving it. My hon. Friend has stimulated the debate very well. He explained why the matter is of concern to local authorities, and I am sure that Middlesbrough will play a big role in the consultation.
I do not want to anticipate the contents of the consultation document, but if the exercise suggests that change is necessary, it will be carried through. I hope that my hon. Friend will take heart from that. We will reinforce the message about reducing the need for permanent exclusion, so that the debate is not reduced to one that is simply about shuttling money around the system. It is about real pupils and their lives. I hope that that provides some positive news for my hon. Friend to take to his colleagues in Middlesbrough.
I am aware that my hon. Friend also has concerns about funding generally, and about special educational needs, so in the remaining moments I shall address some of those as well. Since April 2002, the Learning and Skills Council has been responsible for funding school sixth forms. Statutory responsibility for placement and funding decisions for individual post-16 pupils with special educational needs rests with local authorities and schools, which are supported by the LSC through its funding arrangements.
The LSC allocations for SEN are based on 2000-01 expenditure figures, but they are uprated by inflation and by changes in the overall 16-to-18 population of the authority concerned. We are aware that Middlesbrough has expressed concern that its 2007-08 SEN allocation shows a very small increase. In fact, the increase is just 0.42 per cent. It arises because the cash increase of 3.7 per cent. applied to SEN allocations, which is in line with the minimum funding guarantee, is almost cancelled out by a decrease in 16-to-18 numbers in Middlesbrough of 3.28 per cent.
Not unnaturally, authorities have been concerned that the basis for SEN allocations does not take account of changes in provision and local practice. In October 2006, the LSC published its national strategy for learners with learning difficulties and/or disabilities, “Learning for Living and Work”, which included plans to work with local authorities and 14-to-19 partnerships to understand the SEN arrangements and to develop a new approach to funding.
On 5 January, we published jointly with the LSC a consultation document, “Delivering World-class Skills in a Demand-led System”. Again, my hon. Friend may wish to show the consultation to colleagues in Middlesbrough on his return. It includes proposals on a common approach to 16-to-18 funding, including funding for learners with learning difficulties and special educational needs.
We are moving towards a new system from 2008 onwards, and I hope that Middlesbrough will want to help to ensure that it reflects local authority needs. I am sure that my hon. Friend will encourage his local authority to be involved in the process.
Also on grants and funding, the three-year leadership incentive grant, which was worth £135,000 per eligible school in 2005-06, ended in March 2006, as was planned for that three-year grant. To enable schools to plan for sustainability, they were made aware when the grant was introduced that it would end after three years.
From 2006-07, the Government have introduced new funding intended to focus on secondary schools with the most deprived pupil intakes. Secondary schools with at least 20 per cent. of their pupils eligible for free school meals at the time of the January 2006 school census will receive £120,000 in 2006-07 and a further £125,000 in 2007-08. Schools previously receiving the leadership incentive grant that are not eligible for the new money will receive transitional funding. I know that that affects schools in and around my hon. Friend’s constituency.
Seven of the nine secondary schools in Middlesbrough, including the three academies, will get full funding in each year. Two schools will receive transitional funding, as they did not have at least 20 per cent. of their pupils eligible for free school meals at the time of the January 2006 school census. I acknowledge that any school that moves above the 20 per cent. free school meal threshold in January 2007 may feel that it should get £125,000 as well, but to ensure stability the allocations for schools have been announced for 2006-07 and for 2007-08, based on the January 2006 data. I thought that it would be useful to put that information on the record, as I know that it affects Middlesbrough schools.
To adjust the allocations to take account of the January 2007 school census would cause turbulence. Funding is from a fixed pot, so for some schools to gain funding, others would have to lose. That would mean that some schools that receive the full £120,000 in 2006-07 would not be certain whether the funding would continue in 2007-08, and that would undermine the Government’s aim of stability and predictability in school funding. Therefore, we do not intend to revise allocations on the basis of the January 2007 census. School organisations have emphasised to us many times the importance of stability in funding.
I hope that my hon. Friend appreciates from my remarks that we take seriously the issues that he has raised and that we hope to make good progress on them all, not least exclusions. I hope that my contribution to this debate reassures him that we are actively involved with officials in Middlesbrough on these matters. It is an ongoing process. We are very much aware of his concerns and appreciate the fact that he is raising them again in Parliament, and we look forward to working with and consulting him and schools in Middlesbrough in the coming months.
Sitting suspended until half-past Two o’clock.
Residential Care (Public Funding)
It is pleasure to speak in the debate with you in the Chair, Mr. Cummings. I want to raise the issue of Government funding for residential and nursing care because many of my constituents have recently come to see me about it and to voice their concerns. In addition, the Sunday Express has pursued a major campaign, entitled the “Justice for our Elderly” crusade, which I applaud. I hope that it will follow today’s deliberations.
The Express has identified the fact that 70,000 vulnerable people in our country have had to pay for nursing care. A major report, the Wanless report, estimates that £29.5 billion will need to be spent on our ageing society by 2026. That is why the debate is of such interest when we think of the money that will have to be spent on that vital issue over the coming years.
The Government watchdog, the Commission for Social Care Inspection, has warned of a crisis looming for elderly and disabled people. In a damning report, it highlighted how local authorities are cutting back on services for vulnerable older people. That follows similar findings from other influential bodies that include the Government’s health think-tank, the King’s Fund, and the independent charity the Joseph Rowntree Housing Trust.
Age Concern says that it has dealt with increasing numbers of cases in which elderly people have been reassessed as no longer needing care because the local authority eligibility criteria have been tightened to meet only the highest needs. The director general of Age Concern said:
“Those receiving care at home have seen services withdrawn and prices increased, while those in care homes and their families often find themselves subsidising the pitiful amounts local authorities pay for care.”
That brings me to an important issue for my constituents, which is means-testing. Any constituent who has more than £20,000 must now pay for nursing and residential care. I find that an absolute scandal in a country that is the fourth wealthiest in the world, with the fourth largest economy. We are always hearing from the Government about the great economic achievements under the Chancellor of the Exchequer and about the so-called advances, yet my constituents have to pay for care. That is an outrage and another Labour stealth tax for those who are unfortunate enough to have relatives who need long-term care.
Can we be clear for the purposes of the record and the Sunday Express? Income-contingent payments and means-testing have been in place since the social care system was introduced in the late 1940s. When the Conservative Government were in power, social care was provided to citizens on a means-tested basis. Is he now advocating that the state fund social care to 100 per cent. and abolish means-testing?
As a Back Bencher, I can say what I like. I believe that £20,000 is a paltry figure. The Government should strive, if at all possible, to increase that threshold. In Shropshire, many people have more than £20,000 simply because of the huge increase in the value of homes.
So, the hon. Gentleman’s case is that he acknowledges that, as well as a contribution from the state, there will always need to be a contribution from the individual and that under his party the means-testing system would always continue, but that the problem is with the threshold. The campaign is somewhat ambiguous about whether it advocates no charges for citizens. Is he saying that he is after changes in threshold or the abolition of means-testing—
Don’t indeed. It is slightly unfair of the Minister to pose that question. I am merely a Back-Bench Conservative MP and it is not my responsibility to make the policies up. However, it is my responsibility as a constituency MP to draw out my constituents’ concerns to the Minister and to try to tease out what his policies are and how he will strive to increase the threshold if possible, given the fiscal situation.
Mervyn Kohler of Help the Aged said:
“We have a larger population of ageing people than we’ve ever had. Ministers insist there is no new money and we must improve the system through reorganisation. They’re not living in the real world.”
Those words are not mine, but those of a senior director of Help the Aged. I hope that the Minister takes them on board.
I come back to the Minister’s earlier point. I feel that after 10 years of socialism in our country— [Laughter.] It is debateable whether it is real socialism, but I still think of it as socialism. After 10 years of socialism, the elderly should be doing far better than they are. Let me give the Minister another example of my concern.
When the Prime Minister was elected, he said that the priorities of the Labour Government would be “education, education, education”. That is a worrying slogan. It is wonderful theatre and great for getting votes, but how is it possible for a Government to prioritise education over and above the vulnerable elderly and those who need long-term residential and nursing care? The Labour slogans “education, education, education” and “24 hours to save the NHS” took away some of the focus that is so vital in protecting the most vulnerable people who need long-term residential care.
The director of the Wanless report, who used to work for NatWest bank—a senior economist—stated that to provide better care in nursing and residential homes the Government need to come up with an extra £1.7 billion a year. That is the figure necessary significantly to improve and sustain better care in nursing and residential settings. So far, the Government have spent more than £5 billion on the war in Iraq, an illegal war that I opposed and will continue to oppose—
It is no good the Minister shouting at me. I was vehemently opposed to the war in Iraq and made numerous statements about it in my local paper, the Shrewsbury Chronicle. It is a disgrace for a socialist Government to waste £5 billion of taxpayers’ money when my constituents and their relatives are being robbed of their life savings purely to pay for something that should be free on the national health service and should be provided for by the Government.
I turn to the specifics in my constituency of Shrewsbury and Atcham. I hope that the Minister will take note of these points because I want him to remember the problems that we have. The number of people over 74 years of age in my constituency has increased by 27.4 per cent. since 1991. That is a staggering increase.
Shropshire is such a beautiful county, so many elderly people from around England go there to retire. The county therefore has a large population of senior citizens. On top of that, the increase in the number of people over the age of 74 is running at a faster rate in Shropshire than in most other counties of England. Shropshire county council has to grapple with that huge problem. I shall be interested to hear the Minister’s comments on what funding the county council receives in that respect—he doubtless has the figures to hand—but I fear that it is far too little to deal with the problem, given the growth in the number of elderly people in the county needing care. I will highlight some specific examples later.
In preparation for the debate, I met four experts from Shrewsbury who run nursing and residential homes. Mrs. Mandy Thorn, a constituent of mine, operates the Uplands nursing home in Dorrington, a little village just south of Shrewsbury. If the Minister has time, I suggest that he engage in correspondence with Mrs. Thorn, Shropshire’s leading light on nursing and residential care. She is an eminent lady from whom the county council and many others seek advice as she is so involved in running various nursing homes. He would do well to speak to her. I use her as my intellectual stable mate on such matters, and I believe that he could learn a thing or two from her.
Shropshire county council is doing well—of course it is; the county is Conservative controlled—but I praise the council and particularly its chief executive, Mrs. Carolyn Downes, and her team. The community services directorate of Shropshire county council has a three-star rating for its adult social services. Despite the lack of Government funding, it does the best it can to ensure that long-term residential and nursing care are properly fulfilled in the county. However, Government funding is insufficient to provide an equitable service in rural areas. Those are not my comments; they are the words of the men and women who run the residential and nursing homes. If the Minister continues to laugh at such points, as he has already, he will be laughing, or even smirking, at those eminent Shropshire people.
Huge costs are involved in providing care in people’s homes in rural counties such as Shropshire. I was told today by the head of the community services directorate that, in certain cases, the cost of travel to small villages in my constituency such as Snailbeach or Halfway House near the Welsh border is more than the cost of care. Yet the Government, in their great financial models, never take account of the fact that Shropshire is one such rural community, nor of the huge extra costs involved in providing care to the vulnerable in remote villages.
That will obviously be a matter of great concern to the Minister. What do the Government intend to do to help rural areas? Together with an increasing number of frail elderly people, the additional costs incurred in delivering home care services in rural areas is one of the main problems faced by Shropshire.
I am sorry to be party political, but I feel passionate about the matter. Shropshire receives the lowest funding in the country for the police, we are at the bottom of the table for educational provision, and now we are at the bottom of the table for care for the elderly. That smacks of yet another Government policy, which is that the socialists look after their own in the urban areas and in the Labour heartlands, rather than being fair to people in Shropshire and the other rural areas that happen to be represented by the Conservative party.
The increasing costs of service provision have to be passed on to the end user. Those cost pressures include employment costs—we all know how much more expensive it is to employ people—and the huge amount of bureaucracy and regulation emerging from the Government and the European Union. I saw one example of that bureaucracy when I visited the Uplands nursing home. Mrs. Mandy Thorn told me that bedpans have always been washed manually. The home has among the highest health standards in Shropshire, yet the Government have imposed another regulation. The staff are not allowed to wash the bedpans manually, but have to have a special machine to do it—it looks like a dishwasher—at a cost of £7,000. Mrs. Thorn had to buy two machines. That £14,000 goes straight on to the costs of providing care, so either the county council or the relatives of those at the homes will have to stump up the difference.
There is a huge shortage of workers in rural areas, and people such as Mrs. Thorn spend an enormous amount of time trying to find people who can do that work. Better trained and qualified staff obviously require additional pay and better conditions. It is right to have better training. However, it requires additional funds, and the owners of nursing care homes believe that the Government are not taking that into consideration. Although the Government are introducing greater holiday and pension entitlements for those who work in nursing homes—I obviously applaud that—they are not providing the county councils with extra funding to match those increased entitlements.
We are seeing increased fuel costs for home care services, and some of the increases are eye-watering, yet the homes have to take them on board. Inflation stands today at 3 per cent.—a worryingly high figure that will put more pressure on balancing the books. We know also that interest rates are rising. That will contribute to the difficulties faced by people such as Mandy Thorn. Increased inflation and higher interest rates, with more red tape and bureaucracy, will make it more difficult to provide such care.
I turn to some of the solutions that Mrs. Thorn and her colleagues have suggested. They believe that the funding for adult social care services should be ring-fenced. I would like the Minister to consider that. Why not ring-fence that funding to ensure that county councils cannot use it for any other purpose? Residential care is of such importance to the future of our country that Government funding for such provision should be ring-fenced, and county councils should not be able to dip into it to provide other services. Increased funding for out-of-hospital services, too, should go to local authorities.
I turn to the most important point—one that I am particularly keen for the Minister to answer. Mrs. Thorn told me that we need to increase the registered nursing care contribution in line with inflation and backdate it from October 2006, because the last time that that vital funding mechanism was updated was October 2005. Why has the registered nursing care contribution not been increased? Since October 2005, we have had an inflationary increase in costs of at least 3 per cent., huge increases in energy costs and other cost rises. The fact that the registered nursing care contribution has not increased since October 2005 is a scandal and the issue that Mrs. Thorn and her colleagues believe is putting the greatest strain on providing nursing and residential care in Shropshire.
Mrs. Thorn and I believe that we need properly to fund the additional costs of providing domiciliary care in rural areas—I have alluded to that already. Without proper domiciliary care and the other aspects I have spoken about, the NHS will be on its knees in a matter of days. The work done in residential care homes and nursing homes relieves the NHS of an incredible amount of responsibility and work. However, at the same time, the Royal Shrewsbury hospital is £34 million in debt and there is a major restructuring taking place. There are huge potential cuts to services and the Government do not want to have cancer specialists in Shropshire; they want people to go to Wolverhampton and Stoke. The Government are moving away the services that the elderly desperately need because they do not believe that Shropshire, with a population of 500,000, deserves to have those services and that people should go to Stoke, Wolverhampton or beyond.
There are huge pressures in relation to the lack of financing of residential care homes. I have a document that I will give to the Minister at the end of the debate and that I will be making public. The document describes a model that is roughly based on a 95 per cent. occupancy for a residential home and a nursing home. People in my constituency have produced calculations based on all sorts of expenses: wages, uniforms, food, laundry, medical supplies, bed linen replacement, training, patient activities, electricity, water, water disposal, insurance, council tax, repairs and maintenance, hire and leasing, professional fees, and subscriptions. When all those factors are taken into account, it costs approximately £400.30 to provide one individual in Shropshire with care in a residential home. Yet, at the moment, care homes receive a maximum of £292.15. That is a huge difference.
A residential care home provides a marvellous service, but receives £292 when the actual cost is £400. That is a critical situation and the people involved are in a crisis that can only get worse. However, and this is an extremely important point, those people have said to me, “What can we do? We cannot throw the person out.” Can hon. Members imagine the scandal that would be caused by a residential home throwing somebody out? Such a scandal would reverberate around the country. Therefore, care homes are over a barrel. I would like the Minister’s interpretation of how Uplands nursing home can continue to provide a vital service when there is such a huge funding gap.
Lastly, the figure for providing nursing services for a nursing home is £504.62. The maximum that may be received from Shropshire county council is £455.48, which is yet another huge difference. In all candour, I say to the Minister that there is a crisis looming, and I hope he realises that. I would be grateful if he showed some semblance of awareness of the impending crisis that is building up in this area. Can he explain how my nursing and residential care homes can continue to provide their service when there is such a huge disparity in relation to the money that the county council can give them?
I stress that Shropshire county council does a marvellous job, but it does require greater funding from the Government for this vital service.
This is an important area of provision serving some of the most vulnerable people in our communities, and it is indeed under pressure. I congratulate the hon. Member for Shrewsbury and Atcham (Daniel Kawczynski) on securing this debate.
As the hon. Gentleman said, residential care covers a wide range of important needs, and I want to concentrate my remarks on care for elderly people and, in particular, on those suffering dementia. I will also focus on some of the pressures facing high-cost areas such as Oxfordshire.
We should stress that the growing number of older people in our society represents an opportunity, not a burden. It is a wonderful thing that so many people are living longer and it is a testament to the NHS, better housing and higher living standards. The corollary is that increasing numbers of people are living to the point where they need residential care, and more people need close care as dementia afflicts those who in past generations would have died younger through poorer general physical health or disease.
We owe thanks to all those staff in social services and care homes who work hard to provide a good standard of care when it is the failings and unacceptable abuse, as in today’s news reports about Sutton and Merton, that understandably capture the headlines. All of us who have taken up the cases of constituents and their relatives seeking care know that, all too often, families face a difficult struggle to find something suitable and find that there are barriers to the recognition of their needs for NHS continuing care.
I pay tribute to the work of the Alzheimer’s Society which, in addition to its commendable campaigning and briefing—including the briefing provided for this debate—provides invaluable help and advice to carers and their families who are often at their wits’ end in trying to get through the maze to access funding.
The report from the Commission for Social Care Inspection published last month on the state of social care in England was very balanced. It recognised increasing expenditure and progress in areas such as the continued improvement in meeting national minimum standards, better commissioning, and an increased use of direct payments, notably for older people. At the same time, there was real cause for concern in a number of areas. For example, it is appalling that at least a third of homes do not meet standards for managing medication safely and operating safe working practices. It is also alarming that a substantial number of home care services are failing standards on medication, recruitment and supervision of staff. It was also clear that in juggling the increasing demands on them, councils were having to tighten the eligibility criteria. At the same time, there were question marks over the advice and support available to clients and carers excluded from funded care.
The report concluded by highlighting five groups that gave rise for concern: those not using council services but in need of information and support; carers, relatives and friends carrying the costs of ever-tightening eligibility criteria; those who lack choice over services or who comes into their home; those whose service standards are unacceptably low; and those with special complex needs which are not being met.
Does my right hon. Friend accept that a particular problem in this area arises when a home is set up with individuals who may be catered for very well for a number of years but whose needs then become more complex and cannot be met by the home? Often, the result is a real dilemma as to who subsequently picks up the responsibility. That ought to be thought about before such institutions open. Does my right hon. Friend agree?
My hon. Friend makes a very good point. As he says, care homes have to deal with the challenge of the growing numbers of people who are living to the point at which they have what are often very acute needs. That must be part of the care planning, as he said.
The report by the CSCI and other reports confirm what our constituency experience tells us. That is that we are dealing with a crucial and complex area of care, which is modernising and trying to raise standards and to extend choice—I might add that it is doing so in one of the areas in which choice is valued—but which is under enormous pressure because of demand and constraints on resources even as they are increasing. The sector is also feeling some of the backwash from the deficits elsewhere in the NHS to the depressing point at which, as the CSCI report put it:
“A number of councils and primary care trusts are reported to be withdrawing from pooled budget arrangements”
and are “nervous” about embarking on new joint initiatives, so the danger is that things are less joined up at the very time when they all need to be better joined up, not least to address the needs that my hon. Friend raised.
I know—I hope that we all know—that my hon. Friend the Minister brings enormous commitment and real personal experience of this sector to his role. I am confident that he will have been pushing energetically the case for expenditure on the care needs of elderly people, as identified in the Wanless review, both alongside other health priorities and in the wider comprehensive spending review. We all know that not everything can be a priority and that even with our strong economy there is never enough money for everything that the public want the Government to spend money on, but I hope that my hon. Friend and his colleagues will take these remarks as my own very strong support for additional well focused expenditure in this area.
As for the implications of all this in my own constituency, I know that the Minister recognises the importance of prevention, earlier intervention and support to enable people to live independently for longer. Oxfordshire is trying to address big demographic pressures locally by moving services and resources in that direction, but that unavoidably involves a period of extra funding pressure as it tries simultaneously to meet the needs of today and to bring in new preventive initiatives that will help to meet those of tomorrow. If the partnerships for older people projects grant could be rolled out nationally and soon, that would be a significant help to authorities such as Oxfordshire.
I hope that the engagement of my hon. Friend and colleagues in the comprehensive spending review will also address the vexed question of interaction with the revenue support grant and tackle three issues in particular. The first is the need for better provision for the demographic pressures on services for older and disabled people. The hon. Member for Shrewsbury and Atcham referred to that. The county of Oxfordshire predicts a 14 per cent. increase in the number of people over 85 over the next four years, and over the same period a 22 per cent. increase in the number of adults with significant learning disabilities. Those are real pressures that the authority has to try to plan to provide for.
Secondly, on the question of the interaction with the revenue support grant, I hope that the Government will consider the need to reflect adequately the impact of high staff and property costs, which result in very high prices for care homes in our county. I am advised that they are 19 per cent. higher in Oxfordshire than in other county council areas. The third issue is the impact of increased costs in meeting the welcome improvement in the quality of care homes that the national minimum standards are bringing about.
May I underline to the Minister the importance of bringing in a fair, consistent and comprehensible national system for deciding who obtains NHS funding for continuing care? As he knows, the shortcomings of the existing system are totally unacceptable, with carers and relatives, who are often stressed themselves, having to negotiate complicated criteria that obscure eligibility and then find their way through the complaints procedure, and all too often ending up having to take legal action.
As my hon. Friend will be aware, in his written answer on 30 October last year, he said:
“Responses to the consultation”—
the national consultation that took place last year—
“are currently being analysed with a view to publishing the Government’s response to the consultation in late 2006.”—[Official Report, 30 October 2006; Vol. 451, c. 166W.]
In a written answer just last Tuesday, he said that
“we are now considering the responses we received to the consultation.”—[Official Report, 9 January 2007; Vol. 455, c. 462W.]
Will my hon. Friend tell us when he expects to be able to make an announcement and whether it will address the shortcomings that the Alzheimer’s Society has identified, notably on the importance of addressing mental health needs? Those are very acute and important for the people we are talking about.
These vital questions of care for elderly people often do not receive in public debate the attention that they deserve. I think that that is partly because many of the clients, carers and families who are struggling with the system do so in isolation, and because many of the funding questions are so complicated. However, it is crystal clear from the reports of the CSCI, from the Wanless review and other reports and from the experience of our constituents that there are big and vital challenges in this sector and that the pressing care needs of vulnerable elderly people are ones that a civilised society must address as a matter of the highest priority.
It is a pleasure to follow the right hon. Member for Oxford, East (Mr. Smith), who spoke movingly about the needs of people in residential and nursing care homes. It so happens that I have an aunt in a nursing home in his constituency. She will be delighted that her Member of Parliament is concerned about these issues, although that might not be quite enough to persuade her to vote for him at the next election.
I congratulate my hon. Friend the Member for Shrewsbury and Atcham (Daniel Kawczynski) on securing the debate and on how he introduced it. By making a contribution, I am reducing, albeit marginally, the average height of Conservative Members speaking in the debate.
I hope that the right hon. Gentleman and the Minister will not take it amiss if I point out that both have served in the Treasury, and although they moved on to care and spending Departments, they must bear some responsibility for the structure and amount of money being spent in this area.
This is a topical debate because up and down the country social service departments are grappling with next year’s budget against the background of the revenue support grant announced in December. For my county, Hampshire, and, I suspect, others, it was a tough settlement. The formula grant for Hampshire will increase by 2.7 per cent., which does not cover inflation. The consumer prices index, which is relevant to the services that we are talking about, was up 3.8 per cent. in December last year.
This year’s increase follows an increase of 0.2 per cent. last year, once the ring-fenced grants that the Government abolished are stripped out. On top of that, next year’s supporting people grant has been frozen at just below the level for 2006. So far as adult social services are concerned, Hampshire receives the second lowest settlement in the country—even less than Shropshire.
With that as the background, if an authority banks further efficiency savings—Hampshire county council is efficient; it is lit up by beacons that have been bestowed on it by the Government—and then puts up the council tax by the maximum possible without being capped, there is still £10 million to be taken out of services. With education spending largely protected, the spotlight inevitably falls on the services that we are discussing this afternoon.
Expenditure on the elderly is the largest single element within social services, and expenditure on residential care is a significant part of that budget. I listened to what my hon. Friend said about ring-fencing, but the difficulty for the Government is that if they ring-fenced the amount that they think local authorities should spend on services, it would not be enough, and they would have to top it up from other sources. Many social services authorities certainly spent way above the standard spending assessment under the SSA system.
I asked my social services department how it was going to cope with the pressures that I have outlined, and the answer is as yet unclear. It is having to cope with demography, which has been touched on, and the increasing complexity and cost of many care packages, particularly for those with learning disabilities, which the right hon. Member for Oxford, East has just mentioned. My social services department said that there would be a move to help the most critical cases only, with little work done on prevention.
That is bad news for the individuals who will not get the care that they need and who may have to wait until their life really is threatened, they have a serious mental or physical illness or they are unable to carry out the majority of personal care and domestic routines. If the increasing trend of rationing services to deal with insufficient funding continues, all older people will, as early as 2009, receive care only when their needs reach the substantial or critical level. Clearly, that is not a situation that the ageing population deserve, or indeed expect. It might also be bad news for the taxpayer, who might eventually have to pick up a larger bill.
Residential care services face underlying pressures from higher standards and increased costs, both of which were touched on in earlier contributions. Increases in the national minimum wage have been more than twice the rate of inflation for several years. Fee increases have been tightly managed, but there is a real risk that supply will be lost as a result of closures, the refusal to accept social service rates or the inability to meet appropriate standards.
The Government might tell us that they have been putting more resources into social care and, to the extent that they have, I welcome that. However, as the Local Government Association’s autumn statement highlighted, general Government grant support for services such as social care has increased by just 14 per cent. in real terms since 1997-98. Yet, spending increased by 65 per cent. between 1994-95 and 2004-05, so Government funding for social care has clearly not kept pace with the demands of an ageing population.
Overwhelmingly, the extra resources that the Government have found have gone into the health service. With the prospect of insufficient Government investment for social care in the next spending period—I endorse what the right hon. Gentleman said about that—local authorities will clearly face some difficult decisions.
The Minister may tell us that efficiency savings and delivering care in a different way will bridge the gap, but that would be a very optimistic claim. Before Christmas, the leaders of 45 councils wrote to The Guardian, warning that
“services for the elderly are now teetering on the brink. The present situation is unsustainable.”
The pre-Budget report could have brought some good news, but it did not. The Chancellor put all his chips on one number—education. He could have increased education expenditure substantially, but by slightly less, and found some extra money for health and social services. However, he chose not to.
In fairness to the Government, they recognise that there is a problem and they have called for a
“shift in the centre of gravity of spending”,
“care undertaken outside hospitals and in the home”.
If that is their ambition, however, they will have to provide the resources to deliver the outcome.
At the same time as we have this downward pressure on resources, demand is increasing, as we have heard, and the number of those over 85 will double to 1.8 million between now and 2028—the demographic clock is ticking away.
The Joseph Rowntree Foundation has estimated that the number of places needed in residential care homes, nursing homes and hospitals will rise to 1.13 million by 2051, which is roughly double the number now. However, supply has been falling, not rising. If we go back some time, we may find that there are good reasons for that, and people may have been inappropriately placed in residential care—indeed, that was a constant refrain of one of the Minister’s predecessors—but any slack has now been taken up.
Indeed, in Hampshire, the county council and local NHS trusts have joined together to build new nursing homes themselves because of the decline in the private sector. The Hampshire Care Association told me that many independent providers cannot carry on, because local authorities are not covering the cost of care home fees, while others have been unable to cope with the standards. However, care homes are not closing evenly throughout the country, and the problem is at its worst in inner-city areas. Those areas in which residential care has declined the most are not those in which home care services have grown the most, and the Rowntree report sheds some light on that.
There is a further pressure, on which the hon. Member for Stroud (Mr. Drew) touched: NHS deficits have been straining relationships between health trusts and social services, as the NHS is under enormous pressure to cut discretionary spending where there are joint budgets. The pressure on social care also increased after NHS primary care trusts withdrew funding for joint projects from about half of all councils, according to the LGA report “Without a care?”
I do not think that anyone will argue this afternoon that there is enough slack in the system or that there is ample room for economies. Somebody writing in Society Guardian on 10 January said:
“Fees for all but the very top end of the private sector have been forced down to unsustainable levels and many small private sector homes are hanging on by their fingertips. It’s dispiriting to watch this choice, which suited many older people, systematically choked out of existence.”
The Joseph Rowntree Foundation estimates that care homes are underfunded by £1 billion. I will not report again what Dame Denise Platt has said, because the right hon. Member for Oxford, East has just touched on it.
Finally, I want to put some questions to the Minister. First, it is too late to do anything about 2007-08—the die is cast. However, the comprehensive spending review that is under way for the next three years is an opportunity, and we need a fresh start.
Without giving away the negotiating hand, can the Minister reassure us that part of his Department’s bid for the next three years is a step increase in funding to eliminate the underfunding of the sector and provide a realistic baseline from which to move forward for the future?
Secondly, does the Minister really believe that policy for the elderly as a whole is embedded in the work of local and regional government? To take housing, social services and transport as examples, many elderly people could be forgiven for thinking that they are somewhat marginalised.
This problem is smouldering away, and if the Government do not get a grip on it and reach some solutions soon, they will find that it has become much more extensive.
I, too, congratulate my hon. Friend the Member for Shrewsbury and Atcham (Daniel Kawczynski) on securing a debate on this important topic. I do not think that it is going too far to say that my hon. Friend, the right hon. Member for Oxford, East (Mr. Smith) and my right hon. Friend the Member for North-West Hampshire (Sir George Young) have painted a frightening picture of the deterioration in the care of elderly people.
Let me start with the most important point that I want to put to the Minister. Unless Age Concern, all the experts in the field, the Joseph Rowntree Foundation, Members of Parliament and local authorities are all wrong, the current situation is very grave, and there is every likelihood that it will get worse. I therefore ask the Minister please to give us an honest assessment of the position. In my area, in the East Riding of Yorkshire, the number of those over 85 is increasing by more than 500 a year. The impact of that on social care spending is enormous, and I am not sure whether it is factored into any political party’s forward thinking on budgets. I hope that the Minister will address that.
In summing up, I shall certainly give an honest appraisal of the situation. However, can I ask the hon. Gentleman for some honesty too? Does he support the abolition of means-testing for social care? Yes or no? Does he accept that considerable extra investment in social care is likely to require significant increases in taxation? Would he support those increases to justify a significant expansion of investment in social care?
With respect to the Minister, I knew that I would regret giving way to him. Again the narrow partisan approach is being adopted of asking a Back-Bench Member of Parliament about something that there is ample opportunity to debate with those on the Front Bench. I was bringing out the difficulties for any political party—including the Liberal Democrats, who have little likelihood of getting into power but who none the less will, like us, wrestle with such difficulties.
This is a debate, and the Minister’s party is in power. Up to now, no party has been able to find a way to solve what is a really difficult situation. When costs are likely to spiral in coming years—we have talked about numbers and demographics—how is it possible to deal with those costs, without asking people to contribute if they have the resources to do so? If they are asked to contribute, how is that to happen in a way that does not penalise hard-working people with relatively small amounts of wealth built up over a lifetime? How can we avoid creating a disincentive to their saving for the future and a system in which they feel hard done by? The Minister will know that in his constituency, as in mine, people say that they wish they had not saved or put money away, because it is just taken from them. They feel the unfairness.
I do not have an easy, trite solution. I cannot see that we can avoid the requirement for a contribution from those who have assets towards the cost of their care. However, before the general election the Conservative party wrestled with the question and came up with a policy that involved trying to find a form of insurance, so that at least no one would have to pay more than, say, the costs of three years. That was a genuine attempt to cap the requirement and make it reasonable. People are not trying to be unreasonable.
The Minister’s stock-in-trade response, on every occasion on which I have debated with him—which I realise is quite a few now—is to ask Back-Bench MPs about their party’s policy. Perhaps I may take some time now to ask the Minister—as the Conservative party is not in power and neither are the Liberal Democrats, but his party is—not to waste the House’s time in future when we are dealing with a matter of such seriousness and severity. We are not here to make party political points, least of all to a Back Bencher.
The situation is deteriorating. A constituent of mine received a letter from Humberside Independent Care Association, the largest provider of residential care homes in the East Riding of Yorkshire, which told him:
“It is with regret that we are writing to advise you that it is our intention to introduce Third Party Top-ups to all current clients of HICA who are financially supported by their Local Authority. This year we have been faced with major increases in the national minimum wage, gas, electricity, oil and our annual registration requirements for the Commission for Social Care Inspection. We have raised these issues with your Local Authority, however the fee increases we received were significantly below the level required to cover these costs”.
The letter was sent to the son of a lady of 104 who had lived in the Albemarle home for the past 12 years. He is well into his 70s and the request is for top-ups from him and his brother, who does not live in my constituency and whose 65th birthday is coming up this year. We are asking for pensioners to pay top-up fees for pensioner parents. That is the situation that we are getting into, because the moneys coming through into the care home sector do not reflect the costs.
In the East Riding of Yorkshire, the increase in fees this year to both domiciliary care providers and care home providers was 2 per cent. That is with the minimum wage rising, last year, by more than double that, and by more again this year, and with gas and electricity costs, as the letter mentioned, going through the roof. The East Riding of Yorkshire was unable to provide more than a rise of 2 per cent. When I raised that in writing with the leader of the authority last year, and spoke to the officers concerned, I expected them to tell me—because I am used to dealing with Ministers in the House—that what was happening was the best possible solution. They did not; they said that in their view it was unacceptable and did not properly reflect the costs, but they simply did not have the resources to do so.
Perhaps the East Riding is failing to manage its budgets properly, but, as the Minister may know, after being one of the top three local authorities in the country for its financial management last year, it was this year named as the pre-eminent local authority for getting value for money and stewarding its financial resources for the good of local people. I think that that dismisses any suggestion that the Minister might want to make that the local authority is to blame for not passporting on the sums concerned. The truth is that the East Riding of Yorkshire, the council that is the best run, financially, in the country and which I am proud to say is Conservative-led, was unable to put more than 2 per cent. into the sector this year, and problems have ensued.
The situation is such that when the mother of a constituent of mine moved to the East Riding from the Isle of Wight she found that, although her new residential care home in Driffield cost £450 weekly—over £15 more than the cost of her home in the Isle of Wight—the rate set in the East Riding of Yorkshire per week is £328.80, whereas in the Isle of Wight it is £435. It is an extremely serious situation when homes in East Yorkshire have costs similar to those of homes elsewhere, but do not have the money to provide proper support.
I met representatives of the East Riding preferred providers, Verna Community Care and New Concept Care. Their staff are involved in providing support at home for many vulnerable people, so that they can lead independent lives. The care workers whom they employ work split shifts in all weathers, throughout the year, which often involves cycling between clients. Yet those carers, in the main, receive little more than the minimum wage. That is the base situation. The providers are unable to see how they can maintain what they do with the expected deterioration in the situation.
The right hon. Member for Oxford, East mentioned an article in The Guardian about the dropping of fees to unsustainably low levels. As that article said:
“Alternatives to residential care are not in much better shape.”
I wonder whether the Minister will comment on another statement from the article:
“Nonetheless, services for older people remain inadequate, are often unreliable and always done on the cheap.”
Does the Minister deny that? Does he see a rosier situation? Are all the experts and commentators wrong? That is the kind of honesty we could do with. The article comments on the Wanless report and its recommendation of a 1 per cent. shift of spending through GDP. That gives rise to all the issues of taxation, including the fact that the Conservatives, and I personally, believe that if tax rates are set too high the tax take eventually goes down, as opposed to the simplistic economics so often used by Ministers which suggest that reducing the tax rate necessarily means less coming in. It is a tough balance to get right.
I sympathise with the hon. Gentleman’s argument, but should the service be universal, or should it be capped at a certain income level? It always worried me that when we had free social care we had the ridiculous situation in which millionaires in the Cotswolds received free social care. I thought that that was rather an anomaly. Does the hon. Gentleman agree?
I agree entirely. The current situation, however, as the Minister and the hon. Gentleman will know, creates resentment in people who do not have great means, and who feel that they are penalised for the efforts that they have made during their life to live thriftily, as they were brought up to do, and to stand on their own two feet. With respect to my hon. Friend the Member for Shrewsbury and Atcham, the Government are not really a socialist Government. They claim to be as much on the side of striving, hard-working people, who are doing the right thing, as the Conservative party is. Their behaviour often belies that, but philosophically they are, I think, as attached to that view as we are. Therefore we need to consider the provision of decent funding, in the next few years, within the tight financial situation, so that we can at least meet the current costs of care. We also need to examine the thresholds, to create a fairer system that rewards hard-working people—strivers who made sacrifices and decided not to go on holiday so that they could put money away for the future.
For the record my hon. Friend may want to consider—I hope that he will agree—that the difficulty in establishing fairness arises because there are effectively three categories of people: those who do not have the means during their earning lifetime or at any other point to set aside funds for the future, and who need support; those who have had the means to do that and who have made provision, which creates the need for a fair balance; and those who had the chance and chose not to. That is where much of the resentment arises in the debate. As long as we have those three categories in mind we can proceed.
Absolutely. I hope that the Minister will address that because we need a fairer system that provides for those in need. Is there room in the system now? Notwithstanding the long-term difficulties, the wastefulness of this Government is legendary. Never has so much money been spent to so little effect in the history of British government. I imagine that they stand in great comparison with global government. It would be hard to find anyone who has wasted so much—£20 billion on an NHS IT system that does not work.
As for the situation locally, spending on the NHS has doubled—[Interruption.] If the Minister will allow me. Spending on the NHS has doubled, yet in the East Riding of Yorkshire, where there is no funding for domiciliary care or care home provision, NHS beds are being closed. In my constituency, every single NHS bed in community hospitals has been closed. It is proposed that there should be some only in Goole and Bridlington, an hour and a half or two hours’ drive away, which means a round trip of three to four hours. We have a topsy-turvy world in which the Government are not delivering. With efficiency savings and better Ministers, there is ample room within current expenditure to look after older people and provide a better NHS.
I congratulate the hon. Member for Shrewsbury and Atcham (Daniel Kawczynski) on securing the debate on this important subject, which, sadly, is often neglected by the press and sometimes by this House. Older people, particularly those in residential care, are often forgotten people. The sense of abandonment that those people sometimes feel has depressed me greatly in the past when visiting nursing and residential homes, particularly at Christmas. There is a case for families to have more of a responsibility for looking after their elderly. We need to have an honest debate across parties about the ageing population.
I want to pick up on the point made by the right hon. Member for Oxford, East (Mr. Smith) about poor medication management. That really should not happen. We seem to have gone backwards because many pharmacists used to go into nursing homes, and that should have continued under the new pharmacy contract, but because of other pressures, the PCTs do not seem to have commissioned those services. Will the Minister look into that so that we can have a system that is a bit more joined up? That welcome step would make savings in long-term drug budgets.
The right hon. Member for North-West Hampshire (Sir George Young) gave a solid overview of the situation in Hampshire. I, too, represent a constituency in Hampshire, where the pressures are acute. There are about 440,000 care home residents in England and Wales. The Office of Fair Trading study, in May 2005, showed that 35 per cent. of residents have to pay a top-up payment, which varies from county to county. Social service departments fund at different levels in different counties so top-up rates differ between counties. That is counter to the Government’s agenda for choice: many people feel that they do not have a choice as there is little provision available at the price set by local authorities. That is a concern.
Councils have been slow to acknowledge rising costs and to react to the cost burdens on care homes, which means that, on funding, homes are the piggy in the middle between the Government and councils. They face particular problems, some of which have been highlighted. Although nursing homes receive the registered nursing care contributions, they do not always cover the costs. Although the Government’s measures for better training, regulation and protection for older people are welcome—we cannot argue with those measures—the costs of those changes have increasingly fallen on homes and the social care system, which has been underfunded to an extent.
It is not only homes that are caught in the middle. Individuals and families are also caught in the funding battle between health and social care. Nowhere is that more evident than in the prolonged battles that families have to go through about continuing care criteria. It is a disappointment to many of us that there has been a delay in producing national standards. Previously, we had local criteria, which differed. The biggest problem is that the criteria are very subjective. Families have found decisions difficult to understand and many have been open to challenge in the past—there was the Coughlan case, for example. I have supported families in cases in which the description, on paper, of the person being refused continuing care was exactly the same as that of Ms Coughlan. I do not see how we can continue with a system that allows that to happen.
There was a right of appeal to strategic health authorities, which has been moved and is centrally administered. A gentleman—he asked not to be named—who has chaired those appeals came to see me. He told me that people used to be able to exercise their sense of fair play and common sense and take an overview of the situation, but he is concerned that the procedure has been translated to a tick-box exercise and that there is now no flexibility. He felt that perverse decisions were being made. Why has that system been centralised despite the claims that decisions should be taken more locally?
People cannot understand why somebody frail and elderly suddenly becomes part of the social services system, which is means-tested, rather than the health care system, which is free at the point of delivery. As we move care closer to home, which most people welcome, that problem will increase because people who consider themselves to be ill and in need of health services that would usually be provided in hospital will increasingly be means-tested. Although there has been an increasing amount of money available for care packages, because of their complexity the money has gone to fewer people with greater, complex needs.
I want to discuss the Association of Directors of Social Services and Local Government Association review of social services finance in 2005-06. The report goes into some detail about efficiency savings that have been made and the areas that experience the most pressure. The report highlights that
“older people and physical/sensory services are projecting above budget spending of £18 m and £19 m respectively, with other service areas contributing to meet pressures through efficiencies.”
The report goes on to say that the
“financial challenges facing councils and the real difficulty in achieving a shift in emphasis to prevention when there is increasing demand for intensive social care across all adult services”
has led to an increase in fees above the rate of inflation. It also points out that the
“loss of preserved rights income and residential care allowances are presenting significant cost pressures”
in about a third of councils, and that
“an emerging and growing financial burden is being met by authorities in the form of support to other people … without access to funds.”
The report states that
“just under one quarter of authorities are now experiencing a growth in demand for this type of support”,
and, most worryingly, that
“46 per cent. of councils have experienced a reduction in Primary Care Trust funding, or a reduced inflationary uplift.”
As services move from the acute sector to social care, the money is not following. I have asked about this locally. Social services departments feel that their burden has increased but their funding has not.
It would help if we could merge health and social care budgets. Welcome moves have been made in that direction but I was concerned by the comment made by the right hon. Member for Oxford, East that councils were withdrawing from this system. As care is being transferred from the NHS to the social care sector, will the Minister tell us how the money is being tracked? How can there be more public scrutiny of the process so that we know that when services are transferred the funding is also being transferred? The money is not there at present and that is a concern. We all know about the pressures on the NHS. The Secretary of State has said that the books will balance next year, but there is not the same focus on social care. Cynics among us probably think that the situation I have mentioned has had something to do with that.
The pressures are affecting other areas of care. As has been mentioned, eligibility criteria are being affected. I shall draw my comments to a close slowly, but I have spoken for only nine minutes.
Seven out of 10 people now receive support only when their needs are substantial or critical. Are the Government happy with that situation? What will be done to ensure that people can receive support at a lower level? Such an approach may prove to be more cost-effective in the long run.
I congratulate my hon. Friend the Member for Shrewsbury and Atcham (Daniel Kawczynski) on securing this important and topical debate. He is a tireless campaigner on behalf of his constituents. We regularly hear from him in this Chamber, and he has consistently called the Government to account for the state of social care not only in his county, Shropshire, but across the country. He made a useful reference to the challenge that the Wanless review has set for all of us in political life and to the data that it published. This is one of the most challenging and known about issues that our political generation have to deal with.
My hon. Friend made a helpful reference to the Sunday Express campaign. Lucy Johnston, one of the journalists in this area, has been working particularly hard. My hon. Friend also covered the rurality and sparsity factor that can affect the provision of residential care. That aspect is notably illustrated by the hon. Members who are taking part in this debate, although it is important to note that some of the most acute problems are also being experienced in inner-city, urban and suburban areas.
I was taken by the compassionate speech made by the right hon. Member for Oxford, East (Mr. Smith). He made good use of the briefing from the Alzheimer’s Society, for which it is to be congratulated. Equally, the speech by my right hon. Friend the Member for North-West Hampshire (Sir George Young) will be one that many will want to return to as this debate unfolds in the coming months and years. He made a compelling case by reference to the local conditions that he encounters in Hampshire, particularly the supply and demand challenges and what is required for the dignity of older people.
My hon. Friend the Member for Beverley and Holderness (Mr. Stuart) was able, in his customary trenchant style, to challenge the Minister on a number of areas. Whoever the Government were, we would be calling them to account for the big challenges that now face us all.
This is the second time that the Minister and I have met in Westminster Hall to debate this subject in recent months. That is a mark of its closeness to the hearts of all our constituents, which is unaffected by which party we represent. The Minister was trying to tease out of some of my hon. Friends whether they were articulating party policy while they were standing up to represent their constituents. While we go through a fundamental policy review, it is important to note that the speeches of my right hon. and hon. Friends should all be taken as very worthy submissions to the public services improvement group policy review, co-chaired so ably by the former Secretary of State for Health, my right hon. Friend the Member for Charnwood (Mr. Dorrell), and Baroness Perry, a former chief inspector of schools. I shall certainly forward them a copy of the Official Report of this debate for that purpose.
Long-term care funding is one of the greatest challenges. In the previous debate that I mentioned, which was secured by my hon. Friend the Member for St. Albans (Anne Main), the hon. Member for Romsey (Sandra Gidley), who has of course been able to represent her party again today, branded her party’s policy of so-called free personal care as dishonest—that is not a word normally heard in this Chamber—and effectively suggested that those who write the Liberal Democrat manifestos behave in that way. It was one of the most amazing admissions that I have ever heard in Parliament.
The Minister failed to offer any policy on long-term care funding at that time. The issue has been dodged by the Government. As we know, in 1997, the Prime Minister—then Leader of the Opposition—famously bemoaned the fact that people had to sell their homes to fund their long-term care. Yet, in power, Labour has failed to introduce any meaningful policy to combat the problem. Moreover, more people are trapped in the blighted situation that the Prime Minister identified, and the threshold has not remotely kept pace with house price inflation in the intervening period, particularly in the areas that are most adversely affected. The Government have not even given a substantive response to the Wanless review of social care.
At the last election, the Conservative party was the only party to offer a real policy of long-term care funding. Labour brazenly promised to
“continue to provide healthcare free in long-term care establishments.”
Health care is NHS care, as everybody knows, and would remain free under the governance of either of the two parties of government on offer in this country.
Is my hon. Friend aware that the closure of beds and community hospitals means that there is an increasing tendency to send patients who are recovering and in need of health care to nursing homes and care homes, where they have to pay for their own recovery? This Government are not even delivering at that basic level.
The point that my hon. Friend makes only shows the exacerbation of the problem with which we are all seeking to grapple. The Labour manifesto completely failed to address the issues of health and social care costs linked to long-term care. I hope that the Minister will be as candid about those who write his party’s manifesto as the hon. Member for Romsey has been about the people who write her party’s manifesto.
I think that there is already enough on the record from the hon. Lady.
The only foray that the Labour and Liberal Democrats have made into care funding is the increasingly discredited policy of free personal care that their coalition has introduced in Scotland. I hope that the Minister will take the opportunity to comment on the experience in Scotland, where so much of the provision has been disappointing to say the least. Those who are charged with providing it say that they have not got the money that has been passported for that purpose.
The Government’s failure to solve the problem of the division between health and social care is well documented. The right hon. Member for Darlington (Mr. Milburn) pledged to demolish the “Berlin wall” in 1998, but it took until 2005 for the Minister for Immigration, Citizenship and Nationality, who was then at the Department of Health, to announce a joint White Paper
“designed to deliver integrated health and social care systems”.
That was merged with a health White Paper to produce “Our health, our care, our say”, which contains few substantive measures on closing the gap between health and social care funding. The initiatives that it does suggest are now under threat because of the massive NHS deficits. The temptation to shift costs on to local authorities has been too hard to resist for many primary care trusts, and the county councils network has expressed grave concern about this area. The impact on Wiltshire county council of the NHS removing £3 million from its income one day before this financial year started was widely reported. In July, the Local Government Association found that seven out of 10 local authorities in areas with an NHS deficit have been affected. It is fair to suggest that the Labour Government have failed to address—let alone solve—the question of how we fund care.
I move on to continuing care funding. During our previous debate I highlighted the shambles in respect of the attitude to NHS continuing care. A new national framework was pledged by the Minister of State, Department for Transport, in December 2004 when he was at the Department of Health. Despite promises that it was due for publication in early 2006, it did not go out to public consultation until June 2006, and the consultation ended on 22 September 2006.
It is worth noting that the Department of Health has a bad habit of holding consultations over the summer months, when people are away. I am sure that the Minister will wish to deny and dispel any idea that such an approach was intended to bury the consultation.
As the right hon. Member for Oxford, East said, the latest national framework newsletter from the Department states that it is currently analysing the contributions received and will publish the Government’s response in due course. It goes on to say that it aims to publish the Government’s response in late 2006 and will publicise the publication via the website and its usual contacts. As it is now 2007, it must be fair to ask the Minister to tell us when the Government will respond and, more pressingly, when the framework will be published. It is now already two years behind schedule.
I shall bring my comments to a close, Mr. Cummings, at the end of the slightly shortened time available to me.
It is vital that we have a straight response. We should not overlook the fact that many of the issues tie into the palliative care area, which is also a failed promise in the Labour manifesto. I look forward to the Minister’s response to the challenges faced by all our constituents.
I congratulate the hon. Member for Shrewsbury and Atcham (Daniel Kawczynski) on securing this debate on a public policy issue. I notice that the Conservative party is as split as we are on whether this is a socialist Government, but perhaps we could debate that on another occasion.
I pay tribute to my right hon. Friend the Member for Oxford, East (Mr. Smith), the right hon. Member for North-West Hampshire (Sir George Young) and the hon. Members for Beverley and Holderness (Mr. Stuart) and for Romsey (Sandra Gidley) for trying to engage in some of the serious non-party political points that we must address as we deal with the agenda.
The first point is that older people in this country are entitled to be treated with dignity and respect. They are a generation that worked hard to build this country, and a fundamental sign of a civilised society is the way in which it treats older people. That should unite the House.
My right hon. Friend the Member for Oxford, East referred to the disgraceful report on Merton and Sutton primary care trust and the way in which, at the beginning of the 21st century, people with learning difficulties have been treated in some NHS establishments in that area. We will not tolerate such abuse, non-professionalism and exploitation of people with learning disabilities, and we will certainly take firm action as a consequence of that report. Dignity and respect for older people and also for people with disabilities must be at the heart of a civilised society.
I share the view of hon. Members on both sides of the House that social care needs higher status and greater priority in public policy and debates about the future of this country. I make the point to hon. Members, who did not refer to this, that in the pre-Budget report the Treasury identified social care as one of the great challenges facing this country and one that we have an obligation to address. The Government’s recognition that it is a crucial issue that we must face is an important step forward.
I will not give way because I do not have enough time. I will try to give way towards the end if I can.
There have been significant major advances with year-on-year, real-terms increases in resources for local government, and improvement in the performance of many adult social services departments, which is a credit to the staff on the front line and the leadership. It is good news that more people are living longer, and that they continue to live in the community rather than in institutions, and consequently have higher quality and fuller lives. However, as hon. Members said, we must face up to real pressures. Demographic challenges are indisputable and undeniable, and we as a society have a responsibility to face up to them. Older people are living longer, and disabled people are living fuller and longer lives. There are also rising expectations in what the public expect from public services and in quality of life.
We welcome the recommendations of Sir Derek Wanless for a sustainable funding model for social care. We do not agree with every detail of his recommendations, but it makes a major contribution to the debate. Wanless rejected the notion of free social care being a desirable or realistic way forward.
We are arguing forcefully—I shall not reveal the details in this debate—with the Treasury about the importance of a good settlement for social care under the comprehensive spending review. Equally important is the need for all politicians, with the public and charitable sector, to engage in a discussion about what a fair new settlement would be for social care and the responsibilities of the state, family members and citizens. We need a new deal to reflect a new settlement in the demographic realities of the 21st century. We must also be willing to look at reform of social care. It is not just about money. We want more personalised services, and greater control for those who use services and their families, with individual budgets and direct payments. We must do more to raise the status of staff in social care on the front line, and we must look at a greater synergy between the NHS, local government and the voluntary and independent sectors. The hon. Member for Romsey and other hon. Members referred to that.
As my right hon. Friend the Member for Oxford, East said, we must also look at the lessons from the partnerships for older people projects—the POPPS pilots—in which we are focusing resources on preventive, early intervention services in mainstream support for older people to enable them to lead a better quality of life and to make better use of public resources.
I shall not reiterate the points that the hon. Member for Eddisbury (Mr. O'Brien) made about the concession by the hon. Member for Romsey that the Liberal Democrats misled people about free personal care at the general election. That was frankly the most extraordinary admission I have ever heard in the House.
The hon. Member for Shrewsbury and Atcham clearly cares about older people. However, he and his Back-Bench and Front-Bench colleagues are disingenuous about where they stand on the key policy issues concerning older people and their families throughout the country. They are disingenuous because they were the architects of and presided over many of the problems in the current system, and because of the policies that they now advocate in the House. At every opportunity they voted against extra investment for public services and now have an economic policy that would lead to serious cuts in public services.
The hon. Gentleman talked about ring-fencing funding, but the Conservative party says that we should not have ring-fenced pots of money, but should devolve to local level and allow local decision makers to control budgets. He also said that the Government were wrong to prioritise education, and I look forward to him saying that in his election literature at the next general election. Conservative Members want to redirect resources, but they want to redirect them from the poorest and most socially deprived areas to more affluent areas.
The hon. Gentleman said that care services should be free on the NHS, but he knows that much of our debate today was about social care, not NHS care. He said on the one hand that it should be free, and on the other that it is all about thresholds and that he was not advocating free personal care.
The hon. Member for Eddisbury, who speaks for the Conservative party on such issues, questioned the Scottish system and whether it is right. He opposes the Scottish system because it is unrealistically offering free personal care, and it is not working. He is being honest in saying that the Conservative party is not advocating what many commentators and journalists are suggesting—that it should all be free.
Conservative Members oppose service reconfiguration in every community and portray that as cuts, but it is often about redirecting resources from the acute NHS to investment in social care. The Local Government Association, which is Tory-controlled, said before Christmas that there is enough money in the system, but that it is in the wrong place and that what the Government need to do with local delivery mechanisms is to shift resources from acute NHS care to social care.
All I would say to Conservative Members is that they should engage in an adult and mature debate without misleading people that they are on the side of free, personal care, that they would abolish means testing and that they did not create the current system. They should not imply that, nor that they have not consistently voted against sustained public investment.
On continuing care, Conservative Members are right in saying that we need to clarify the issue as soon as possible; we also need to get it right. We have had ombudsmen’s judgments and court judgments, but it is important when we produce guidance that we get it right so that it creates stability in the system. It is true that on occasions local health organisations have not fulfilled their responsibilities to acknowledge that what is being provided is health, not social, care. We need to ensure that the new guidance reflects that.
Public Infrastructure (London)
I am grateful to Mr. Speaker for his courtesy in granting me the debate, and I thank the Minister for taking time out of her busy diary to respond to it.
At the beginning of every day when I travel to London by public transport, being sufficiently green never to have learned to drive, I come in through Victoria railway station and find many hundreds of my constituents and other commuters waiting outside Victoria underground station. The way that one has to queue to get on to the underground system is a sign that that system is under stress. Further, in the summer, one often travels in temperatures higher than those acceptable for the transportation of live animals in the UK.
Many colleagues think that London is treated far too well in resource terms. I have heard a Member comment in the House that London is a junkie when it comes to the amount of public subsidy and support that it receives from the Government for investment in public transport. I am happy to concede that the Government have been generous in recent years, because in real terms they have at least doubled investment in public transport.
It is important to make the case for further and significant increases in investment in public transport and infrastructure in London. I am keen to obtain from the debate an assurance that the Government understand the points that will be made as the comprehensive spending review is undertaken. Transport for London’s budget and projections have a cut-off point of 2010, and it awaits the results of the CSR.
There has already been a lot of input to the debate on investment in London’s public infrastructure. There has been good work from London First and its publication, “Keeping the UK Competitive”; from the report by the Mayor’s office on investing in London; and from the City of London corporation’s annual report produced by Oxford Economics, “London’s Place in the UK Economy 2006-07”. They all offer good reasons why there should be investment in London’s public infrastructure.
The fundamental point is about the high productivity of London’s economy. Any investment of public funds will secure the highest return on the extra jobs created, because they enjoy the highest productivity rate. There is good value in investing in public infrastructure and in transporting people to those jobs with the highest productivity. Greater London is the only part of the European economy that matches productivity in the United States, and because London has a lower participation rate in its employment market, investors would encounter fewer economic bottlenecks, particularly if extra transport were targeted on London’s deprived areas and combined with effective investment in skills training.
Oxford Economics says that London’s productivity is 26 per cent. higher per head than that of the rest of the UK. London produces 17 per cent. of the UK’s gross domestic product from only 12.5 per cent. of its population. In many ways, London is deserving of the additional investment. There are many different means of economic measurement, and there could be a good deal of academic argument about the following figures, but it is possible to argue that while the UK runs a budget deficit of about £40 billion, London’s economy provides a surplus of between £6 billion and £20 billion to the Exchequer.
In part as a result of strong migration, London’s population also enjoys a younger age profile compared with that of the populations of other parts of the UK. That makes our economy more dynamic, outgoing and likely to generate the additional productivity that would benefit from public infrastructure investment. London benefits from its cosmopolitan nature and the migration it receives.
An analysis published last week showed that the value of Greater London’s housing stock rose by 26 per cent. in the past year to £725 billion. With that amount of money invested in Greater London by the public and private sectors, there is a good argument for making the additional investment in public infrastructure to support such a substantial estate. Economic growth varies greatly from one year to another, but GDP in Greater London is growing much faster than in the rest of the UK, at 3.9 per cent. compared with 2.6 per cent. Investment in the winner that is Greater London would be very attractive.
On the detail of the investment in public infrastructure, we must be cognisant of the fact that congestion in Greater London costs at least £1.6 billion every year. An extra 900,000 jobs until 2025 would yield £180 billion in GDP. Employers’ problems will continue if there is no investment beyond that already programmed, but the time that would be saved by the introduction of Crossrail offers businesses the prospect of a further £4.7 billion in savings.
There is a huge amount of migration to London. Last year, about 125,000 people joined the population, but that is not surprising: London is a world city, competing against Tokyo and New York. The latter is already cognisant of how London has run ahead, because Mayor Bloomberg has initiated an investigation of why London is doing so well. Financial services output has increased hugely over the past five years, while the performance of our continental rivals has stalled significantly.
Politicians often talk about how important it is for London and its businesses to reach out to China, India and Russia, and the number of initial public offerings undertaken in London shows that it is best placed to do the job. But if we secure those extra 900,000 jobs, crowding on our public transport system, which is already bad, will become unbearable.
There is also a climate-change element to investment in London as a world city. Hong Kong lost a lot of its attraction for many footloose businesses because of population challenges. Thus, it is important that we can accommodate the extra 2.8 million journeys likely to be taken every day on London’s transport system—a 28 per cent. increase on the current figure of 10 million journeys. That is a reasonable assumption. Investment in Crossrail is important, therefore, and will make a significant contribution through its gearing effect on the economy.
Other types of public transport in Greater London are important as well, particularly cross-suburban transport, and I am grateful to my hon. Friend the Member for Croydon, South (Richard Ottaway) for joining me in this debate. We both know about the problems with commuting across south London—sometimes known as the “banana” owing to the shape of the boroughs that extend from Bexley to Richmond and around outer south London. The lack of proper, effective public transport routes across south London is a problem because it results in too great a reliance on car usage.
Furthermore, I and other representatives of south London note the significant problems resulting from being unable to proceed with Thameslink 2000; I am not sure whether it is still called that, as we are seven years further on. The investment in Thameslink and the provision of extra capacity for south London rail commuters are vital, particularly in dealing with the London bridge bottleneck.
Increased investment in London’s public infrastructure is needed also in housing—house prices in London are very high. Croydon council is very enthusiastic about building more social housing and was very grateful for the recent Government grant for initiating council house building again.
Investment in our water infrastructure is important too. As a member of the London assembly, I chaired an investigation of water provision. I enjoyed my trip down London’s main sewer, although it is fair to say that my colleagues did not find it a funny experience and thought that I should not have imposed it on them. An extra 800,000 or 900,000 people will need water, so it is an important area of investment.
Croydon has also enjoyed important investment in the tram system, which has performed well except, perhaps, financially, although I regret that the only communication between Transport for London and the tram operators goes through the courts. I have been happy to support the Mayor’s provision of additional buses from Croydon, particularly in areas of great deprivation in New Addington in my constituency, where a reduction in transport provision would risk compromising residents’ access to jobs.
The tram system has provided better access to jobs and has had a fantastic regenerative impact, helping to turn Croydon from an area of high unemployment into one of average unemployment—a testament to the value of investing in public transport infrastructure.
I started my speech by referring to the experience of my constituents at the beginning of the commuting day at London’s Victoria underground station. At the end of the day, as a commuter passes through London Bridge station, they will find that the First Capital Connect trains, operating the ex-Thameslink services, are full or overcrowded until 9 o’clock. That is their reward for working late at the office or perhaps having a drink in a City bar at the end of the day.
Investment in Thameslink 2000 is important, and I hope to hear from the Minister that the arguments for such investment in London’s public infrastructure have been heard and understood.
I congratulate the hon. Member for Croydon, Central (Mr. Pelling) on securing this Adjournment debate on spending on London’s transport infrastructure, and also thank him for his generous comments and acknowledgment of the Government’s considerable record of investment for the benefit of Londoners, including his constituents.
The topic of the debate is crucial. London is a dynamic and successful city and key to the UK’s economic, cultural and social success. That point, which the hon. Gentleman raised today, has been made to me constantly and strongly by London First, the London Chamber of Commerce, the Mayor and everybody and anybody concerned with London. They are right to do so. I assure the hon. Gentleman and the Chamber that the Government support fully and recognise the role of transport in London’s growth.
Since 1997, the Government have focused on the two fundamental weaknesses impacting on London’s transport network: the poor governance and accountability of London’s transport networks and the sustained underinvestment in those networks over previous years, which we have been reversing. One of the first steps in this process was passing the Greater London Authority Act 1999, which set up the governance structures necessary to ensure the long-term success of London’s transport system.
Investment decisions are now made by a single, integrated transport body—Transport for London—with oversight of its investment decisions carried out by the Greater London authority, of which the hon. Gentleman is a member. The Government made a decision to increase investment in TFL significantly. Its grant has risen from £700 million between 2000 and 2001 to more than £2.1 billion between 2005 and 2006. In the 2004 spending review, the Government agreed a ground-breaking, five-year deal with TFL, which has allowed it to implement a substantial investment programme through to 2010.
To date, the record investment agreed at the spending reviews in 2000 and 2004 has brought some impressive results. Since 2000, we have seen a 4 per cent. shift from car to public transport in London, despite a rising number of journeys overall. The level and quality of bus provision in London has been transformed. Patronage has increased by 40 per cent. since 2000 and some 1.8 billion passengers were carried between 2005 and 2006—the highest number since 1965.
Furthermore, investment in the bus network has allowed for new routes and much improved frequency and quality levels. Accessibility, too, has improved considerably with nine out of 10 Londoners now living within a five-minute walk of a bus stop. Since December 2005, essentially, the entire fleet has been accessible to wheelchair users and other passengers with mobility difficulties.
The five-year funding deal is helping to facilitate the expansion of the bus network by 4 per cent. over the next three to four years. It is also allowing TFL to introduce the new iBus communications system, which will improve real-time information for the benefit of all passengers.
For London Underground, the Government are committed to continuing to provide long-term and stable investment, reversing decades of neglect, the results of which we still see. The hon. Gentleman rightly described some of the challenges that London Underground faces. However, the huge investment that has been brought about by the public-private partnership since 2003—more than £1 billion of Government money a year, as well as private finance—is addressing the tube’s investment backlog, improving reliability, cutting delays and boosting capacity.
That investment means that London Underground is delivering record service levels and passenger numbers. More than 1 billion passenger journeys are likely to be made during the current financial year, which is more than 30 million more than the previous record, in 2004-05. The PPP will also deliver billions of pounds of extra investment over the next 10 years, resulting in an overall increase in capacity of 25 per cent. by 2016. I hope that that gives an indication of how some of the points that the hon. Gentleman rightly raised will be tackled.
We are also acutely aware that delivery in some areas has slipped, particularly in respect of Metronet, which must raise its game. However, I am satisfied that TFL, using the appropriate contractual means, will ensure that Metronet raises its game and meets its obligations.
Today’s theme is increased investment, so I would like to mention light rail. There have also been extensions and capacity increases in the docklands light railway. By September 2005, the line was used by some 2 million passengers. A series of further improvements is planned on the DLR over the next five years, which will mean a step change in the service provision in east and south-east London, which I very much welcome.
The hon. Gentleman has an interest in schemes that affect his constituency. He referred to Croydon Tramlink, which has brought great benefits to the people of Croydon and Wimbledon, and to the areas of south London that it serves, carrying more than 24 million passengers a year. I am aware of the disagreement between TFL and the operator of Croydon Tramlink, to which he referred, regarding service provision. I regard that as extremely unfortunate, but I hope that the Mayor and TFL will be able to resolve the matter rapidly. In the meantime, I was glad to receive the assurance, which the hon. Gentleman also mentioned, that TFL is providing additional bus services, with the interests of passengers in mind.
Good progress is being made on the east London line extension for heavy rail, which will link Dalston junction with West Croydon and Crystal Palace. Phase 1 is due to open in 2010, opening up an area of London that is in particular need of regeneration.
Commuter services into London have also benefited from investment—for example, the southern region new trains programme has been in service for a couple of years. There has also been significant improvement in new rolling stock, and daily services for many London commuters have continued to improve. Going forward, we shall soon see capacity enhancements as part of the new South Western and Thameslink/Great Northern franchises. There have also been capacity enhancements on the Chiltern route, with extra platforms at Marylebone station. In two years’ time, we shall see high-speed domestic services on the channel tunnel rail link. Meanwhile, the complete link will open this year, with trains going from St. Pancras international station from November.
All the past and planned investment discussed to this point will bring huge benefits to London and Londoners. It has also helped to bring the Olympic games to London, which will generate considerable new investment in east London and leave a lasting legacy for all Londoners.
With regard to the Thameslink project, we are now in receipt of the Transport and Works Act 1992 powers. That decision gives the full legal powers and planning consents for the construction of Thameslink 2000. A final decision on Thameslink and other rail capacity increases will be made this summer, following the conclusions of the Government’s comprehensive spending review and the development of the new high-level output specification for the industry.
My response to the hon. Gentleman would not be complete without mentioning another major rail project to which he referred, Crossrail. As he said, Crossrail will also increase capacity, relieve congestion and overcrowding on the existing networks, and provide support for London’s growth. The Government are committed to Crossrail. Good progress has already been made on the Crossrail Bill, and more than £250 million has been committed to fund work to develop the detailed Crossrail plans.
However, success for rail and all other modes is not just about investment. Management is also crucial. Later this year, we shall hand control over Silverlink Metro to TFL. The new London overground model will help to realise the Government’s more integrated approach to transport delivery in London. The new structure will also allow TFL to invest more effectively in new trains, improvements to stations and increased service frequency.
Investment in London’s roads is also being sustained at high levels, with planned investment of more than £1.3 billion over the next four years, and recent developments such as the Coulsdon bypass in the hon. Gentleman’s constituency. We are also working with TFL to consider demand management solutions on roads, as we do throughout the country. In London, congestion charging is a key part of that approach. It is also a great contributor to tackling climate change and air quality issues, as well as quality of life in London. We gave the Mayor the powers and the funding support to introduce the charge in 2003, and I believe that the majority of Londoners now see the benefits that it has brought to London.
To look ahead, the comprehensive spending review is now under way. It will consider London’s long-term funding requirement to support and enhance its transport networks. The Eddington study, TFL’s “Transport 2025” document and other commentators have all advanced strong cases for continued investment in London’s networks. Those must be considered carefully, alongside the claims of other regions, to ensure that the successes of the past few years can be sustained and developed.
The hon. Gentleman will be disappointed that I did not bring a cheque book today, but I cannot pre-empt the result of those considerations. However, I assure him and the Chamber that the Government remain committed to supporting the growth and prosperity of London and Londoners, and recognise the pivotal role that transport has to play. We shall continue to work hard with TFL to achieve that.
Thank you, Mr. Cummings—you did indeed pronounce co-proxamol correctly. I, too, hope to pronounce the various medical terms correctly.
I am delighted to have secured this debate. I am also delighted that my hon. Friend the Member for Dartford (Dr. Stoate) is here. I hope that he will catch your eye, Mr. Cummings, so that he, too, can contribute. I hope to speak from the perspective of a patient who has taken co-proxamol, but my hon. Friend is a doctor and knows all the fancy medical terms. I would also like to thank Arthritis Care and the British Society for Rheumatology for their help in preparing for this debate. Without their help and detailed knowledge of the subject, I would certainly not be as well informed as I am.
I am glad to see the Minister in her place. She has drawn the short straw, because she was also the Minister who deputised in a similar debate that I secured some 18 months ago, on 13 July 2005. At that time, we discussed the initial recommendation that co-proxamol should be withdrawn from use. I suspected that a follow-up debate such as this might be necessary. In summer 2005, GPs were just beginning to withdraw co-proxamol from their patients. Now, we can see the effect of that withdrawal, and I hope that we can evaluate whether patients have been able to find alternatives.
At the time of the last debate, the Minister and many in the medical profession assured those of us who were taking co-proxamol that equally effective alternatives would be found. For instance, I was told that full-strength paracetamol would be just as effective as an analgesic as co-proxamol. That is simply not true; when my GP contacted me to say that he would no longer repeat my co-proxamol prescription, I, like many, went along with his advice. I stopped taking it and have not gone back to it.
I have not secured this debate for my own sake; I have found alternatives, although the alternative of paracetamol supplemented with dihydrocodeine is probably more powerful than co-proxamol. If I had a free choice, I would go back to co-proxamol, but that obviously also depends on the outcome of today’s debate.
Last summer, there were problems with the supply of the drug—probably because of confusion over its status, which meant that some pharmacists were not reordering it. Stocks diminished as a result. I understand that the problem has been sorted out, certainly in the short term. However, such problems will arise later this year and in the foreseeable future.
As things stand, prescriptions of co-proxamol under existing rules will end in December 2007. Thereafter, it will be prescribed to far fewer people, and only on a named-patient basis. Less of the drug will be required, and the manufacturers will take commercial decisions on that basis.
I have secured this debate to persuade Ministers at the Department of Health that their concerns about the high incidence of suicide among those using co-proxamol can be addressed without a full ban. The action taken during 2005-06 to reduce prescription of co-proxamol has been effective, so it will reduce the number of suicides. The statistic cited for the number of suicides per year among those using co-proxamol dates from 2001. I suspect that in the past two years that number has dropped as a result of the huge reduction in the prescriptions of the drug from 434,250—almost half a million—in January 2005 to just over 70,000 in August 2006. Only 1,350 of those were new prescriptions.
I have a copy of the paper considered by the Committee on Safety of Medicines in reaching its decision; an individual requested one under freedom of information legislation. That paper lists a complete ban as only one of five options. The Medicines and Healthcare products Regulatory Agency said that it decided in favour of a full ban because information and communication programmes had failed to alert prescribers and patients of the dangers of the drug. What the paper presented to the committee actually said was that the programmes had failed at national level as they had
“been piecemeal activities rather than a concerted campaign using several vehicles simultaneously.”
The paper goes further in its conclusions, saying that
“it is possible on pharmacokinetic grounds that co-proxamol may only have a full therapeutic effect with chronic dosing. There may therefore be some justification for co-proxamol remaining a therapeutic option for the management of chronic pain.”
Another conclusion in the paper, on the clinical effectiveness of co-proxamol, was based on the contention that there were no robust data to prove that. Co-proxamol is an old drug that has been around since the 1950s. It has never been subject to testing to find out exactly how it works, as is done on modern drugs. Such testing has not been carried out even today. There are no robust data, because there are no data.
The conclusion drawn could quite easily have been the opposite—that there were no robust data, and that that proved that the drug was not effective. There are no robust data proving that full-strength paracetamol is as effective as co-proxamol either. From my experience, it most certainly is not.
It is difficult for me, as a lay person looking at the papers on which the MHRA based its decision, to find the justification for a full ban. There were alternatives to that. However, it took that decision and created huge confusion. At the time, some GPs assumed that they had to get all their patients off co-proxamol as quickly as possible. Indeed, during my July 2005 debate, the Minister quoted an article in Pulse magazine from May 2005 about a GP who, concerned at the risks of co-proxamol, had managed to reduce the number of patients on the drug from 438 to 20.
However, an article in an issue of Pulse magazine from October last year—a copy of which was thrust under my nose by my brother, who happens to be a GP—had the headline “GPs demand U-turn on co-proxamol ban”. The magazine reported its own survey, which showed that 70 per cent. of GPs and 94 per cent. of rheumatologists demanded that the MHRA revisit its decision. Although the spokesman for the MHRA accepted that there was
“a small group of patients with a clinical need for co-proxamol as alternatives appear not to be effective or suitable”,
he said that the licence for the drug would still be withdrawn in December 2007.
I have asked for this debate so that we can get a sensible solution for that small group of patients—the 20 to whom the GP in the Pulse article of May 2005 still prescribed co-proxamol even after he had tried to remove the drug from all his patients.
I certainly do not argue that we should return to the levels of co-proxamol prescription that preceded the original decision of the MHRA; the drug was too widely available then, and often prescribed for acute pain. My own experience was that it never worked for acute pain. If I had a headache, I always took paracetamol, which worked. Co-proxamol did not. However, co-proxamol has proved effective in dealing with chronic pain, and I can back that up from my own experience. It is not just that co-proxamol is effective; many patients claim that it actually works.
I have received a large number of e-mails supporting my position from all over the country, not only from my constituency. One came from Jonathan Russell, my constituent who instigated my original debate, as a result of which he was able to get his GP to re-prescribe co-proxamol. He writes explaining what a difference that has made. He has a full and active life despite having ankylosing spondylitis.
A correspondent from Ayrshire says that he is “getting a better understanding” of how and why co-proxamol works so well and why pain tests fail to identify that. He says:
“Co-proxamol enables me to cope with more pain but with far fewer side effects than anything else. So physically I am in much better shape and far less prone to despair or depression.”
I have too many e-mails to read them all out, but another correspondent asked me to ask the Ministers concerned
“why they felt that they had to ruin all our lives by withdrawing the medication when they could have made a more humane decision to not prescribe to any new patients.”
There are strong feelings among patients about the effectiveness of the drug.
To achieve an acceptable balance between a significant reduction and availability where there is a clear clinical need, Arthritis Care and the British Society for Rheumatology propose that co-proxamol be made a controlled drug under schedule 3 of the Misuse of Drugs Act 1971, which I hope my hon. Friend the Member for Dartford will explain; that co-proxamol prescriptions should be initiated at specialist level, but that GPs should be able to make repeat prescriptions; that the MHRA should conduct a co-ordinated and comprehensive education campaign, aimed at prescribers, about appropriate and inappropriate use of the drug; that prescriptions be restricted to second-line usage; and that prescriptions be restricted for chronic, rather than acute, pain.
I hope that the Minister has some good news for the hundreds of people who have found co-proxamol the most effective drug in dealing with their chronic pain. They are looking to her to remove worry and to ensure that they continue to have access to the one drug that has made their life bearable.
If only I could cross my fingers, I would. I hope that the Minister has heard my appeal and responds sympathetically.
Thank you, Mr. Cummings, for giving me an opportunity to take part in this debate. I congratulate my hon. Friend the Member for Aberdeen, South (Miss Begg) on securing it and on her excellent speech. She has been a tireless campaigner on this issue, and my colleagues in the medical profession, as well as the 72,000 patients who continue to use co-proxamol, owe her a debt of gratitude for the work that she has done in raising the profile of the subject. I concur with almost everything that she said today, but I shall come back to that later.
I would like to begin by reading a quote from a consultant rheumatologist from Wearside who has been working in the field for more than 20 years and is, therefore, well placed to comment on the merits of the decision of the Medicines and Healthcare products Regulatory Agency to withdraw co-proxamol:
“There is absolutely no doubt that co-proxamol is an invaluable drug for patients with chronic rheumatic pain. Its withdrawal has caused enormous distress for a large number of patients who have found it to be safe, effective and free of the side-effects of other analgesics such as constipation and impaired cognition…Large numbers of rheumatologists and patients have come to the conclusion that co-proxamol is superior to other simple analgesics.”
His is by no means a lone voice. It is apparent from the medical press that the frustration that he feels is shared by hundreds of consultants and general practitioners throughout the country.
Indeed, the poll carried out by the medical magazine Pulse of GPs and consultant rheumatologists in October 2006, to which my hon. Friend referred, found that 70 per cent. of GPs and 94 per cent. of rheumatologists wanted the MHRA to revisit its decision to ban co-proxamol.
Why are clinicians so strongly opposed to the MHRA’s decision? After all, a review by the Committee on Safety of Medicines found that the painkiller is the second most common prescription drug associated with fatal overdoses, with around 300 to 400 people dying each year as a result of accidentally or deliberately taking too many tablets. Similarly, a study published in the British Journal of Clinical Pharmacology in 2005 found that an overdose of co-proxamol was more than 10 times more likely to be fatal than one of co-dydramol or co-codamol.
Perhaps the main reason why GPs and specialists are so unhappy with the MHRA’s decision is co-proxamol’s proven track record as an effective painkiller and the absence of any suitable alternative for certain patients.
A GP who is a prescribing lead in south London stated:
“The problem is that every practice has a number of people who have no alternative analgesic. I’m aware of several patients who tried everything else and nothing works.”
A GP from Hampshire made the following point:
“There is a small but persistent group of patients who are adamant that, for one reason or another, only co-proxamol works for them. It may well be too small a group to be able to pick up in clinical trials comparing efficacy versus other agents, but they are persistent, unchanging and deserve to be heard. I don’t think that they are addicted or lying because none of the ones that I am aware of belong to what you might describe as ‘the usual suspects’.”
One other reason for the continued popularity of co-proxamol is that it has the reputation of being a well-tolerated, low-side-effect drug. For example, an experienced Norfolk GP stated that it is
“a low side effect drug. In twenty years of practice I have seen more side effects from co-dydramol and co-codamol and more lives wrecked by dihydrocodeine addiction.”
Other practitioners have also expressed surprise that the MHRA chose to take such a tough line on co-proxamol when so many other commonly used drugs such as warfarin, digoxin and aspirin are also potentially lethal in an overdose.
However, the thing that disappoints practitioners the most about the MHRA’s decision is that it has taken away the freedom of clinicians to decide for themselves whether the use of co-proxamol is in the best interests of their patients. In effect, the MHRA is saying to practitioners that it does not trust them to make the right decision on behalf of their patients, and that clearly runs counter to the Government’s policy of devolving more power and clinical responsibility to front-line health professionals.
The decision also flies in the face of the Government’s stated policy of giving patients greater opportunity to influence how their treatment is planned and managed, particularly patients with chronic conditions such as arthritis who often have a clear understanding of what they need to do to manage their condition effectively.
Ministers and the MHRA would do well to take heed of what the president of the British Society for Rheumatology, Dr. Andrew Bamji, said on the matter:
“It is unreasonable to withdraw a drug from those who understand the risk.”
That just about sums it up. In other words, as long as the practitioner is satisfied that co-proxamol is the most suitable drug for a patient, and he or she is confident that the patient is fully aware of the potential risks involved in taking it and will follow their advice on how to take it sensibly, they should be free to prescribe it—without, I emphasise, having to walk a legal tightrope to do so.
That is the problem with the compromise solution that has been put forward by the MHRA. Offering doctors the opportunity to prescribe on a named-patient basis what will, in effect, be an unlicensed drug after December 2007 is not viable. Few GPs, if any, will wish to expose themselves to the possible threat of litigation by doing so, however strong the patient’s need for the drug. In practice, the solution amounts to a comprehensive ban.
A more sensible way forward, as my hon. Friend said, is to make co-proxamol a controlled drug under schedule 3 of the Misuse of Drugs Act 1971. The advantage of doing that is that the potential risks involved in prescribing would be flagged up, but GPs could still prescribe the drug when necessary, and it would be clearly acknowledged in doctors’ minds that extra precautions and closer monitoring of patients would be advisable.
Schedule 3 status would also send a clear message that co-proxamol is not a first-line drug and that it should be used only after careful consideration of all the available alternatives. It would also give pharmacists the opportunity to reinforce guidance to patients who are on the drug and to ensure that they fully understand the risks and benefits of taking it.
The MHRA must trust GPs—who are, of course, in dialogue with their patients—to exercise clinical judgment when it comes to the prescription of co-proxamol. In view of the potential risks, the decision will not be easy for GPs to make, but we should not forget that they are highly trained, and well paid, to make decisions on a daily basis that require them to tread the fine line between therapeutic benefits and the disadvantages and side effects of drugs.
The MHRA should have the courage to rethink its decision to withdraw co-proxamol. I hope that, following today’s debate, Ministers will agree to lobby the agency for an immediate review of its position.
I congratulate my hon. Friend the Member for Aberdeen, South (Miss Begg) on securing this debate. I am once again substituting for the Minister who leads in this area. At present, it is my noble Friend Lord Hunt of Kings Heath.
I have had an opportunity to have an informal discussion with my hon. Friend, and I have taken several of her queries to the Department to try to establish what progress has been made since the last Adjournment debate on the matter, and to pick up on some points raised by her and by my hon. Friend the Member for Dartford (Dr. Stoate).
I know that this will not be information for my hon. Friends, but I would like to put on the record, as information for the House, a reminder of why we are where we are today in respect of the withdrawal of co-proxamol.
Co-proxamol is a combination product consisting of paracetamol at a lower than recommended dose and a weak opiate. In 2003, growing concern about the safety of co-proxamol was prompted by UK research showing that it accounted for almost one fifth of drug-related suicides, and that it was second only to tricyclic antidepressants as an agent of fatal drug overdose. Furthermore, co-proxamol is involved in 300 to 400 self-poisoning deaths each year. Many of those deaths involve people taking co-proxamol that has not been prescribed to them; for example, troubled teenagers who come across tablets in their granny’s medicine cabinet.
That leads to an important issue that is not directly about co-proxamol. I spent part of last summer with some community matrons in my constituency. Each of them carried a bag in order to retrieve unused prescribed medicines that were sitting in cabinets in people’s homes. That raises important questions about effective prescribing and the storage in our relatives’ cabinets of drugs that may be dangerous.
Co-proxamol is potentially very toxic, and toxic overdose can occur with only a few tablets more than the recommended daily dose. Unlike paracetamol, with which there is also danger of overdose, there is limited opportunity for the effective treatment of co-proxamol poisoning. Sadly, victims often die before they reach the hospital. The impact, I understand, is rapid. In that sense, it is in a class of its own when compared with something such as paracetamol, without taking away from any of the dangers of overdose from paracetamol.
As a result of the concerns, in 2004 the Committee on Safety of Medicines conducted a rigorous review of the available evidence on the risks and benefits of co-proxamol. It highlighted the lack of evidence that co-proxamol is any more effective than full-dose paracetamol either for short-term use or for chronic conditions. During the review, there was a public call for evidence on the risks and benefits of co-proxamol. The CSM carefully considered the evidence of efficacy for chronic pain and concluded, as I have said, that there was insufficient evidence to justify a marketing authorisation for chronic pain. In particular, there are no robust studies of sufficient duration; I understand that the studies are no greater than 48 hours. In particular, in cases of long-term prescribing there was not the evidence to show why the drug should be prescribed or to demonstrate the efficacy of prescribing it. There is another issue about whether poor efficacy might prompt patients unintentionally to overdose and whether that accounts for a fifth of deaths. I am not taking away from what my hon. Friends have said and from what individuals feel about the efficacy of the drug, but there is a question mark over whether that is tempting people to take more than they are prescribed, which leads to unintentional death.
It is right to take those deaths seriously. They were running at 300 a year, and deaths from paracetamol and co-proxamol combined were between 500 and 600 a year. Those deaths were avoidable. It was right for the MHRA to act, but before any change in policy, and although one sympathises with anyone who can find one drug to offer pain relief and is not satisfied with others, there must be a rigorous examination of whether alternatives are available and what the results of any withdrawal of co-proxamol will have on suicide. As the Minister said, the drugs were widely available and in almost everybody’s medicine cabinet, and people who took two or three over the prescribed limit lost their lives. In other cases, the effects, like those of paracetamol, are irreversible. There was a terrible, regular scourge of deaths, suicides and accidents involving the drugs. The CSM was right to act, but it might well have gone too far.
I know that in the past my hon. Friend has asked questions about the prescription of alternatives to co-proxamol. At that time, the Minister of State, Department of Health, my right hon. Friend the Member for Doncaster, Central (Ms Winterton), said that the guidance provided refers to a number of alternatives that can be used. The chief medical officer has communicated that to health care professionals, too. In particular, we have provided advice on the withdrawal of co-proxamol and the alternatives that should be considered. Despite the withdrawal, we have an inbuilt flexibility to continue to prescribe in certain circumstances for people for whom co-proxamol seems to be the only answer.
The information gathered as part of the review did not provide sufficient evidence on efficacy, in particular, for the continued provision of co-proxamol when that was weighed up against the public health concerns. The review noted that the previous strengthened warnings to doctors and patients about the hazards of co-proxamol had proved ineffective. I note the point made by my hon. Friend the Member for Aberdeen, South about whether the national campaigns are too piecemeal and not effective, but we communicate in part directly with health professionals. Over and above what we do nationally about patients and the public, we have sophisticated methods of communicating directly with health professionals. Even with that direct line of communication, it was felt that those health professionals were not taking the matter as seriously as they should have been through the normal measures. It was believed that the risks of co-proxamol outweighed the benefits of allowing the medicine to remain on the market.
During the review, the CSM considered strengthening warnings on the product information, restricting the pack size, an education and communication programme to alter prescribing behaviours, restricting the indication for the treatment of chronic pain, restricting prescriptions for second-line use, restricting prescriptions to specialist use only and rescheduling co-proxamol as a controlled drug. All the issues that my hon. Friends raised were considered as part of the discussions, but the CSM felt and advised that none of the measures was capable of effectively minimising the risk.
We all take the prevention of suicide seriously: 4,500 people take their own life in England every year—I am sorry that I do not have the figures for Wales for my hon. Friend the Member for Newport, West (Paul Flynn)—and we have a national suicide prevention strategy. It was extremely encouraging to see in April 2006 that progress is being made on our national suicide targets. The third annual report showed that the most recent suicide rate, for the three years from 2002 to 2004, has been reduced by 6.6 per cent. from the 1995 to 1997 base line. The report outlined areas where progress was being made, including in the phased withdrawal of co-proxamol. As I said, it is a cause of accidental as well as deliberate harm. It is estimated that a fifth of the co-proxamol self-poisoning deaths each year were unintentional. On that basis alone, we can assume that more than 100 lives have been saved to date as a result of the action to withdraw co-proxamol.
There are many alternatives to co-proxamol and that is reflected in the steady fall in the prescribing of that medicine. Over the phased withdrawal period, we expected to see prescribing decline. Co-proxamol prescriptions have fallen from more than 7.2 million in 2004 to approximately 1.5 million in 2006—about an 80 per cent. drop in usage over the past two years. Northern Ireland has phased out co-proxamol altogether.
That steady decline in usage has doubtless been supported with pain management guidance from the CSM and the National Prescribing Centre, which demonstrates that health care professionals and patients are making informed choices about appropriate pain relief. However, I recognise that a small group of patients are finding it difficult to change from co-proxamol or that alternatives appear not to be effective or suitable.
Before the CSM review, co-proxamol was widely used. As I have said, there were 7.2 million prescriptions in England in 2004. We received 367 letters during the past two years from patients concerned by the decision. However, that number of letters represents a small minority given the overall benefits that we think will be gained by the withdrawal of co-proxamol. For those patients, the continued provision of co-proxamol through normal prescribing may continue until the end of 2007. We have confirmed with manufacturers that the manufacture of co-proxamol will continue after that date. The main manufacturer has informed us that it is its firm intention to continue to manufacture co-proxamol following the cancellation of the licences, so supplies will be assured.
There will be scope, as always, for the prescription of unlicensed co-proxamol. Clear provision in legislation gives the right to prescribers to prescribe off-label or unlicensed medicines if it is judged to be in the best interests of the patient. If there is clear clinical need, it will still be possible to prescribe co-proxamol, but in a more targeted way with a stronger focus on the risk-benefit judgment for the patient—and the patient will be involved in the decision.
That, I think, is the best way forward. My worry about going down the route suggested by my hon. Friends, which was considered by the CSM in its review, is that it might lead to a regression, prescribing the drug when it might not be necessary rather than prescribing it only for the small minority for whom co-proxamol seems to be the only answer. There is flexibility in the system for it to continue to be prescribed.
It being Five o'clock, the motion for the Adjournment of the sitting lapsed, without Question put.