Wednesday 31 January 2007
[Frank Cook in the Chair]
Health Services (North-East London)
Motion made, and Question proposed, That the sitting be now adjourned.—[Mr. Heppell.]
I thank Mr. Speaker for granting me this debate on the fit for the future programme in north-east London, and how it impacts on Whipps Cross and King George hospitals. Whipps Cross is in my constituency, but the area that it serves is much wider, as my hon. Friend the Member for Walthamstow (Mr. Gerrard), the right hon. Member for Chingford and Woodford Green (Mr. Duncan Smith) and the hon. Member for Ilford, North (Mr. Scott) will testify. The King George is an important hospital for a different population. The populations served by those hospitals have high degrees of deprivation and serious health needs. Indeed, the full functioning of those hospitals is highly relevant to the Government’s policy of tackling health inequalities. If they do not function fully, health inequality will be exacerbated.
The fit for the future programme that covers those hospitals, and the newly built Queen’s hospital in Romford, began last summer. Its alleged purpose is to make the best use of NHS assets, but it came very swiftly in the wake of uncovered serious financial deficits in several local health trusts. I believe that those trusts are the driving the programme, and that the real purpose behind it is to run down either Whipps or the King George.
On 15 February 2001, the then Health Secretary, my right hon. Friend the Member for Darlington (Mr. Milburn), announced on the Floor of the House that there would be a major new investment in a number of hospitals, including Whipps Cross. Some £328 million was promised. That figure fluctuated in subsequent years as the plans were drawn up, but the Government commitment was maintained.
As recently as 22 March last year, my hon. Friend the Member for Walthamstow and I met the then Health Minister, my right hon. Friend the Member for Liverpool, Wavertree (Jane Kennedy), who assured us that
“the commitment to build the new hospital is still there”.
She told us that the hospital modernisation would begin in late 2008 and be fully completed by 2016, with the most important elements of the hospital renewal completed earlier.
The modernisation is necessary, but not because the hospital is bad or the performance of its staff is poor. On the contrary, last October, the Healthcare Commission gave it a “good” score for the quality of its services in the local community. Let me make it clear that only 4 per cent. of NHS hospital trusts scored “excellent”, and only 30 per cent. scored the next category of “good”. So, for the delivery of services, Whipps Cross is among the top 34 per cent. of hospitals in the country.
In the sub-ratings, Whipps Cross got an “excellent” for meeting new Government national targets such as: reducing mortality rates from heart disease, stroke and related disease; achieving year-on-year reductions in MRSA levels; and ensuring that nobody waits more than 18 weeks for hospital treatment from when they were referred by their general practitioner. It also scored an “excellent” for its medicines management, and a “good” for meeting core standards and existing national targets.
I emphasise those scores because I believe that some health officials, in the Department and locally, are prepared to run a campaign of denigration against Whipps and to claim that it is amongst the worst hospitals in the country. That is a lie and the Minister needs to be aware of that. Indeed, he should be. In 2004, the Department of Health described Whipps as
“the most improved NHS trust in the UK with regard to its provision of emergency care”.
The hospital was given a “weak” score on its “use of resources”, but then so were many others—37 per cent. of trusts in the country—including Waltham Forest primary care trust. The hospital trust is addressing that problem, albeit with considerable pain.
Whipps needs to be modernised because it has long Victorian corridors and wards. It could be more efficient and run at a lower cost. That reform is needed, but, instead, we have been presented with a fit for the future process that was born out of panic because of the financial deficit. The firm promise of major investment is being reneged on, and the option of running down Whipps is being mooted. That has led, quite properly, to enormous public protest.
The Waltham Forest Guardian and the Wanstead and Woodford Guardian, collected 18,515 signatures in just six weeks on a petition that my hon. Friend the Member for Walthamstow and I fully backed. My hon. Friend and I have presented further petitions bearing about 2,000 signatures. The London borough of Waltham Forest Labour party has launched an “I Love Whipps Cross” campaign to support the development and maintenance of a modern general hospital at the Whipps Cross site.
The leader of the council, Clyde Loakes, told the Secretary of State in a letter this month that
“the response has been overwhelming”.
The right hon. Member for Chingford and Woodford Green recently presented his own petition, which is reported to contain 21,000 names. The letter handed in by the editors of the local Guardian newspapers stated:
“Our concerns lie in the fact that the Fit for the Future programme for the north east London sector includes the possibility that Whipps Cross could be stripped of many essential services”.
It went on to put succinctly the case against that happening:
“Fears can be summarised as follows: This densely populated area of London, with many social needs and the health problems which are the consequence of poverty, will suffer if services are moved away. Sickness and death rates speak for themselves. The journey to Romford, Goodmayes or elsewhere will put lives at risk, make treatment difficult for people who are made less mobile by age, disability or illness, and deter relatives and friends from visiting patients. Our staff have travelled these routes by both car and public transport and shown that the trips are time-consuming and expensive. While we understand that some treatments for which it was previously necessary to attend hospital can now be delivered in the community, we seriously doubt the capacity of our Primary Care Trusts to cope, given that they too are suffering financially and many staff cuts have been made. We certainly do not believe they are capable of expanding care, either for patients requiring tests and treatment or for people who will leave hospital sooner than they did in the past.”
The letter goes on:
“Whipps Cross University Hospital has received a “good” rating this year for its clinical care, has had many new facilities built in the past few years, is at the centre of a needy community and can be reached easily by the people who live in the areas we have mentioned. In our view it would be criminal to dismantle services which work, either to move them to other hospitals or into new community facilities which would cost a great deal of money to build and equip, probably in duplication, when those facilities already exist at the hospital.”
I support the Government’s policy of increasing the number of medical treatments given in the community, GP’s surgeries and people’s homes, rather than hospital, but the consequent improvements in the locality are decidedly modest, although welcome. Councillor Loakes pointed out in his letter that the number of people attending accident and emergency has increased by 39 per cent. in 10 years, so the extra non-hospital provision has had a negligible impact on that.
GPs have had more money but are limited in the improvements that they can provide. For example, some GPs’ premises cannot fit in the latest equipment. In my deprived area, the workload of GPs remains high, and they do not have the extra time to perform numerous new medical treatments. The Secretary of State rightly says that community nurses can do much, but as the “Save Whipps Cross Hospital” campaign pointed out in its December newsletter,
“the reality is that in Waltham Forest, community nurses have been cut by 8 per cent. through not filling posts and staff are struggling to provide the care patients need now.”
My own survey of local GPs revealed that they are not employing any extra community nurses, and rely instead on the PCT, which is cutting back. The situation certainly does not warrant hospital rundown. The Government’s policy of using more community treatments can be achieved without any local hospital rundown, because of the population growth in north-east London. The indications in relation to Thames Gateway are that the population will be more than 20 per cent. higher in 2016 than in 2001. The planned Stratford city proposal will also add to population growth. As no extra hospitals are planned, it makes sense to maintain the existing ones.
Stratford is also the site of the 2012 Olympics, to which Whipps Cross is the second-nearest hospital. For a successful Olympics, we need a fully functioning Whipps Cross as part of the back-up infrastructure. The recent policy of the Department, which I believe to be simplistic and ill-considered, is that one hospital can be emergency only and the neighbouring one elective only. It is claimed that such a separation reduces waiting lists because emergencies can lead to the cancellation of elective work. Local figures show very few cancellations for that reason.
The policy of separation ignores the reality of where people will present for treatment, and several neighbouring hospitals have said that they could not cope or that they would be adversely affected by it. Worse still, it breaks up the team of medical practitioners—it currently works well, but people would move on. There needs to be collaboration in emergency and elective work. It works well in a district general hospital such as Whipps but may very well not do so under the fragmented system that could be created under this separation policy.
Public anxiety is high and staff morale low as part of this fit for the future process. There is no cause for it to be rushed, ahead of the full-scale review of Londoners’ health needs over the next five to 10 years, which is to be conducted by Professor Sir Ara Darzi of Imperial college and was announced last month. In this context, “Fit for the Future” just amounts to a pre-emptive strike.
There is also no confidence locally in how the health chiefs are conducting the process. They are all in the fit for the future team, but behind that is a turf war with no one taking responsibility for the local NHS overall. That really should be the primary care trusts’ role, but they are intent on the cheapest provision for patients, even if it is a false economy and if the local hospital goes under.
The Government’s choice agenda of four treatment choices for patients risks not including the local hospital, which most local residents want to use. There is also the suspicion that these health chiefs waver with the wind. Whipps has come out top in their initial assessment on non-financial criteria and again on the financial criteria. Public and MP reaction might have had an effect, but now there is similar reaction in the King George hospital area. I remain suspicious that some further criteria may be found or that a decision may be taken against their own assessments in the future. In any case, I resent this being set up as a competition between worthy hospitals and their needy, distinct, populations. I believe that the health chiefs genuinely hope to release cash via hospital rundown for community medical use, but I do not believe that such cash would go, to any significant extent, to such community treatment.
The Government have new pet projects, such as intermediate treatment centres, and the private finance initiative bills for new hospitals, such as Queen’s, to fund. The bills for doctors, drugs and new treatments remain high. Furthermore, the growth period for the NHS is coming to an end. The Government should have ensured that they could fund its core services, such as local hospitals, and change them in a planned way when replacement provision is fully in place. This speed of change, without replacement provision, is leading to crisis. That is a reason why this fit for the future process is not acceptable.
It is unbelievably negligent to think that the people who rely on Whipps could do without its emergency and elective provision. It is understandable that local people are anxious; I, too, think that if Whipps were rundown on this basis, it would lead to unnecessary local deaths, so I urge the abandonment of the process.
I congratulate the hon. Member for Leyton and Wanstead (Harry Cohen) on securing this debate. He knows that all of us bid for it at the same time. We have co-operated fully, regardless of party, on the key issues. I think that we are all united in our rejection of what has been happening. He laid out in detail all the relevant issues, giving specific emphasis to the situation at Whipps Cross hospital. I know that our colleagues representing Ilford constituencies will set out more detail concerning King George hospital.
I should say at the outset that I do not believe in the divide-and-rule policy that health chiefs are undertaking in our local area. I am for retaining Whipps Cross hospital and King George hospital. If either one fails to remain as a district general hospital, it will be for the worse. My comments will focus mainly on Whipps Cross, but I want to make it clear that I am wholly with my Ilford colleagues—and, I believe, with all hon. Members present—in wishing to retain King George hospital.
I want to pick up three points. Why is this process taking place? I agree with the hon. Member for Leyton and Wanstead on this. He outlined why this is happening: a short-term, sudden, snap panic over the idea that the acute trusts have been running particularly strong financial deficits for the past two to three years. When one examines what the deficits are about, one begins to understand that the whole accounting process in the NHS has made this a ludicrous process.
Let us consider the reality of how most of this is run. We are shifting one set of problems from the PCT to the acute hospitals. In the past two to three years, they have told people endlessly about their problems in getting the PCTs to pay for the treatment that they have undertaken in good faith, so they say. I accept that there have been inefficiencies and that there has been poor accounting in some of those acute trusts—particularly, in this case, at Whipps Cross.
The PCT is running a deficit of £1.8 million and trying to claw that back from the acute hospitals by saying that it will not pay for all the treatment that they undertook. In its refusal to pay, the balance of deficit shifts on to the acutes. It is absurd to suggest that we can simply split the two bodies and say, “This lot have bad accounting practice and are not doing very well whereas this lot, who control and run what the acutes do, can decide who will bear the cost.” What has been hidden is a problem for both the PCTs and the acutes. The PCTs, which are running the process, can shift a huge amount of the blame on to the acute trusts.
The second aspect that I want to highlight, which has been raised, is the nonsense about how this process is taking place. The London area is doing its own survey and summary of what needs to be done. I believe that at the same time, running ahead of that, four areas are examining the need for treatments in our areas, driven by the PCTs—how ludicrous. Given that they are running ahead of what London is doing—we are now told that this will dovetail back into London’s review—it beggars belief as to how this can be done. They will arrive at conclusions that might not directly relate to London’s conclusions, unless a nudge and a wink is going on here. We rather suspect that that is the case and that they are clearing the way for London to be able to publish a review that has already assumed certain changes in our area. Either way, this is the wrong way to do things.
Any strategic consideration of what health systems and health care should be in London must examine a London standpoint first and foremost to decide what the needs are. One of the things that would emerge in such a consideration is the peculiar problems of transport—getting from A to B—in parts of London. I shall give hon. Members an example of how little is thought about that.
A meeting with the PCT took place on 9 November as part of the fit for the future programme. MPs were not allowed to attend, but there was a discussion about what would happen if Whipps did not continue as a district general hospital. The answer given by one of the PCT’s members was that plenty of health treatment was on offer in the several acute hospitals that surround our area.
That point has been made to us on many occasions. First, it was said that North Middlesex hospital would be able to take people, but people at the meeting had rung North Middlesex to ask whether it could absorb the demand if Whipps Cross ceased to be a district general hospital in the sense that it is today. The answer given was that it certainly could not do so because for at least the next five years, during which time it will be going through changes—there will not be any spare capacity. The people at North Middlesex were not sure even about what would happen after that.
When that information was presented to the individual whom I mentioned, he turned around and glibly said, “Well, of course there is University College hospital.” That was interesting and it made me wonder about things. UCH is difficult to get to, but of course one would know that only if one had bothered to try to get there by public transport from our borough, particularly from the northern part of it.
I then asked the fit for the future team whether it had corresponded or had discussions with, or drawn in, any of the other acute hospitals in the fit for the future programme going on in our area. By the end of December, it said that it had corresponded with the hospitals. I then decided to write to a number of the hospitals that might be affected. Most interestingly, I asked UCH what correspondence or involvement it had had with the review team. I quote a recent letter:
“As yet we have not been directly involved in discussions concerning these proposals so we have not made any assessment of the likely impact on UCLH. I have asked Whipps Cross Hospital for a copy of the document.”
That was on 18 January, when we were heading towards the conclusion of the report. One of the hospitals, which it was said people from Chingford would magically head off to, knowing that North Middlesex could not take them, was UCH, which did not know anything about it and was not even involved. What a brilliant way to go about it. That proves our point that unless the review is done on a London-wide basis we cannot possibly consider the difficulties in hospitals such as North Middlesex and UCH.
The situation is absurd and indicates what is happening: the review is being done in a last-minute panic, well ahead of the main review, simply because it has been ordered by officials who say that we have to make reductions in the area. There is no consideration of what is going on in our area or the transport difficulties.
That brings out another point that I wish to make. All along, we have all felt that we have not been told the full story by officials. When we ask questions they hide away some elements. That is shown by my correspondence: we were told that the review team was in correspondence with UCH and we now discover that most of that happened directly after the meetings at which the problems were pointed out—not before them, as we thought.
A letter that I received from Sally Gorham at the PCT said that it would be in direct consultation with the hospitals, particularly in early January. The letter that I received from UCH was written in mid-January and UCH had not heard even a word from the PCT. There is always such presentation of things that simply do not take place.
I wish to mention another matter raised by my colleague the hon. Member for Leyton and Wanstead—the Olympic bid. Reading the bid documents, it is fascinating to note that either we lied when we presented our case to host the Olympics here or we had no right to present the fit for the future programme in the way that we did. Whipps Cross hospital is referred to specifically in those documents, as is the investment programme for it. Yes, Whipps is coupled together with two or three other hospitals, but it is in there.
The document states:
“Within the health area that covers the Olympic Park and Olympic Village, there are a number of planned developments for hospitals and primary care premises. These include… the Whipps Cross… University Hospital”
in a total investment of £2.4 billion. It continues:
“The Secretary of State for the Department of Health has provided the guarantee on behalf of the UK Government …Between now and 2012, there is planned capital development on each of these hospital sites”.
The Secretary of State signed that document off. I wonder whether the Olympic committee, if it were to understand what is going on in the fit for the future programme, might have a case to sue Her Majesty’s Government for failing to live up to part of their promise.
We know that a serious terrorist problem is causing the costs of the Olympics to rise, including for access to accident and emergency care in London, part of which is Whipps Cross hospital. King George hospital is part of that as well, although it is not named in the document. The review has completely run across international undertakings. Whipps Cross should never have had its services reduced under fit for the future; that was wrong from the outset.
I turn to what is happening in north-east London. We know that a huge change is about to take place—the Thames Gateway project. The figures in the final Thames Gateway health service assessment make that clear:
“North East London SHA (part of NHS London) will experience a 311,000 population increase”
by 2016. Where do we think those people will go for health care treatment? The situation is absurd. There cannot be a review with that as its cornerstone without having a London-wide review that says where the health care will be for the increased population.
We are engaged in the ludicrous game of people saying that they do not like Whipps Cross hospital or King George because, somehow uniquely, they are bad hospitals. As the hon. Member for Leyton and Wanstead pointed out, both those hospitals scored highly on the quality of their health care. Ironically, the hospital that is held up all the time as the future in our area—Queen’s, which used to be known as Oldchurch—scored low on that measure and has real problems. It will not be able to take any increase in numbers if people have to transfer from either King George or Whipps Cross in the foreseeable future. That does not make any sense either.
This has been a most ill thought through, precipitate review and it should never have taken place. It is wrong in its terms and in the spirit of what we are about. The matter is not party political; it is about what is going on locally. Politicians have got to get a grip on the officials who are running wild in our area and trying to do what they think is the bidding of the strategic health authority and, in turn, the headquarters of the NHS.
The hospitals matter because we in London are unique in having serious transport problems and real difficulty. In our area, we have deprivation figures that leave us with a particularly bad health care problem at both PCT and trust level. Services cannot be removed out to PCTs without prior investment—there is no provision for that. We have set PCT against acute trust because officials are saying, “If we close these or reduce services, we will get more money.” I say that that is unlikely ever to happen. This should stop, and stop right now.
I say at the outset that I support what has been said by my hon. Friend the Member for Leyton and Wanstead (Harry Cohen) and the right hon. Member for Chingford and Woodford Green (Mr. Duncan Smith). I shall try not to repeat too much of it, but there will inevitably be some repetition because the key points are the same for us all.
The first issue to mention is the wider context. Professor Ara Darzi is just starting the London-wide review. I spoke to him recently and he said that he would be examining the clinical context of what is happening across London and that he wanted to speak, among others, to Members of Parliament who might be affected. He obviously regards his work as just starting. How there can be major changes going on in one sector of London in advance of the London-wide review is beyond me.
We are being told by NHS London that it will not let the review go ahead unless it is confident that it fits in with the general pattern of where it wants to go. That suggests one of two things: either it has already made its mind up about the general pattern or, more likely, it has already made its mind up about what it wants to do in north-east London and it does not really matter what comes out of the general review.
The area covered by the review is quite artificial. When one considers patterns of travel and where hospitals are in north and east London, the lines that have been drawn are an artificial boundary. For people in my constituency, Queen’s is a long way away, or they would regard it as such. It might not look very far on the map, but it is when people are trying to get there. Compared with going to Newham, North Middlesex or Homerton, Queen’s is not on the radar for where people would want to go if there were changes at Whipps Cross.
We have asked questions about what will happen to the other hospitals such as North Middlesex, Newham and Homerton, and whether they will have extra capacity. We have been sent copies of the letters from the fit for the future review team to the hospitals. We have also been sent the replies, although I do not see how the hospitals can reply in any sensible way when they do not know what will happen to them in the London-wide review. For instance, a decision that affected Chase Farm hospital in Enfield—we know that there have been discussions about what might happen there—would have an enormous impact on North Middlesex hospital. That, in turn, would affect what North Middlesex could do for areas such as Waltham Forest.
The review is starting with certain givens. One is that Queen’s hospital will remain as a major acute hospital, irrespective of anything else. Of course, that is because it is a new private finance initiative project. The second given is that the independent-sector treatment centre on the King George hospital site is guaranteed a certain number of routine operations every year. We are then told that there is over-capacity in the hospital system, but I do not remember ever being asked whether I wanted an independent treatment centre at King George, and nor does anybody else locally. We therefore face the possibility that established hospitals will be run down, while we are lumbered with an independent treatment centre for which nobody asked and which nobody wants. However, that centre will cream off work from Whipps Cross and King George.
My hon. Friend should be aware that the contract for that independent-sector treatment centre on the King George hospital site is for only five years. Therefore, if elective work is removed from King George, as proposed under fit for the future option 4, there is no guarantee that any operations will be carried out overnight at that site in five years.
That is absolutely right. As has been said, a lot of what is going on is the result of very short-term thinking. We do not know whether the independent treatment centre will be there in 10 years, but we do know that there will be significant population growth in the area over 10 years as a result of work on the Thames Gateway and the Olympics. A significant amount of accommodation will be built as part of the Olympics, and the Olympic village will stay there after the games, but the people who live there permanently will need health care.
My hon. Friend the Member for Leyton and Wanstead mentioned the promises of capital investment at Whipps Cross, and there has been significant capital investment over the past few years. We have a state-of-the-art eye surgery unit, a brand-new high-class endoscopy unit and walk-in centres, and A and E has been refurbished. There is no question but that that investment has led to significant improvements in the quality of care at the hospital. That is reflected in the Healthcare Commission’s comments and in the fact that significantly fewer people get in touch with me to complain about the quality of the care that they have received at the hospital than was the case a few years ago.
What is happening now as regards capital investment? It appears that the fit for the future review started from the assumption that there will be no capital investment at Whipps Cross. If so, it will produce very different answers from those that it would have produced had it assumed that there would be capital investment. Whenever I have met members of the review team and asked them about the assumptions that they have or have not made about capital investment, I simply have not got a straight answer. My suspicion is that the starting assumption was that there would be no major capital investment at Whipps Cross in the next few years. That, in turn, will drive the direction in which the various options go.
The five options that have been looked at have been scored under a system of assessment. The methodology behind the scores is presented as if it were almost a scientific process and allowed us to look at the factors involved. There are several criteria, such as
“improving the quality of health services…ease of access… providing a…flexible physical capacity…supporting a developing and motivated workforce”.
Weighted scores have been attached to those criteria, and we are presented with a table of scores, as if we were dealing with a scientific, rather than a pseudo-scientific, assessment. That, however, is what is going to the seven trust boards in the next month, and I wonder what will happen if they disagree. What will a board do when faced with a paper that says that serious cuts will be made at the trust for which it is responsible? If the board disagrees, who will decide which option is taken? Who will decide what is or is not viable?
We are clearly told that the status quo is not viable and that that option is virtually ruled out. Some of us believe, however, that it is viable, and that is certainly true when it comes to keeping the current pattern of hospitals. When I say that the status quo is viable, I am certainly not suggesting—I do not think that any of us is suggesting—that there should never be any change. I have no problem with seeking greater efficiencies and, for example, improving the length of stay at Whipps Cross after routine operations, because the hospital’s performance on that has not been terribly good and does not compare tremendously well with the national average. We can, therefore, achieve greater efficiencies, and no one has any problem with that.
Nor do I have any problem with the concept that a lot more can be done. GPs can perform operations that have traditionally been performed in hospitals, and community nurses and practice nurses can do more.
The assumption in all the analysis is that primary care is confident that it can take the strain. However, the London borough of Barking and Dagenham has had three top-slices to its primary care budget allocations over the past 12 months. Does that give confidence to those who assume that the primary care sphere will take the strain as the area’s general capacity is run down?
Absolutely not, and I am about to come on to what is happening in primary care. I know that in 20 years hospitals will look different from how they look now, in the same way that hospitals now do not look exactly like they did 30 or 40 years ago. The buildings may look the same, but what is happening in them is quite different. However, whether the community and GP facilities are there is another matter.
Let me quote what some local GPs have told me in recent weeks, because they address the point that my hon. Friend has just made. One GP said that the number of community nurses
“is not only inadequate, but is actually falling…this is an unsustainable situation in the long-run… If this situation is not urgently addressed…we will reach a crisis situation especially if services are suddenly shifted from secondary to primary care”.
Another GP said:
“The number of Community Nurses currently employed by the PCT is insufficient for current needs rather than capable of taking on extra workload in the community.”
In another letter, I was told:
“Community Nurses are already over burdened and my colleagues at our surgery feel that if more and more services are moved into the community without adequate resources…this would not be to the benefit of our patients.”
That is the stated view that we hear again and again when we talk to the people who do the work on the ground.
We cannot expect a hospital to function when all the elective work has been taken away, as is proposed under one option. The consultants tell us that if that happens, they will leave, because the better consultants will not want to work there if they do not have the full range of work. That will affect all the training and teaching that is done at the hospital. In the longer term, it will lead to the hospital gradually declining and running down.
Throughout the process, there has been real resentment about the involvement of local Members of Parliament among some of those who have conducted the review and who will be involved in making some of the recommendations. They do not like our being involved. They do not want to talk to us. When we question what will happen to services that affect every one of our constituents, they seem to resent it.
Can I provoke the hon. Gentleman into relating the story from 15 December, when he asked about consultation, and what was said to him about the reason for embarking on consultation and how little was needed? Will he relate it, so that Mr. Cook can understand?
I will be provoked. When I asked about the consultation process and where it was going—there was the feeling of resentment about us asking the questions, as I have described—a comment was made to me: “We need not have involved you in the first place. We didn’t have to talk to you at all.” That is what came out, and I felt that the view that it is possible not to involve constituency representatives in the process is totally unacceptable. Well, we are involved, and we will stay involved.
We know, and everyone in the area knows, how local people have reacted. Thousands of people in Redbridge and Waltham Forest are deeply unhappy about what is proposed. I share the attitude of other hon. Members who have spoken and who still wish to speak, in that, although I have spoken mainly about Whipps Cross, because it is the hospital in Waltham Forest, I do not mean to say, “Forget about the King George; I don’t care if it is run down instead.”
What happens in the whole area matters, because if either hospital is run down that will inevitably rebound badly on the other, and affect everyone. We are all supporting our constituents in the aim of having local services of good quality that will not disintegrate, but that is where fit for the future is in danger of leading us.
I find my constituency is in a quite unique position. The whole process that we are debating exists, in my view, to set resident against resident and Member of Parliament against Member of Parliament; but my constituency is split so that 50 per cent. of it is served by Whipps Cross and 50 per cent. is served by the King George, so it is an attempt to set me against myself.
It is right to say that thousands of local residents have become involved in the matter. I have received representations from the London borough of Redbridge and its leader, Councillor Alan Weinberg; there has been a resolution of the whole council—across all political parties—to stop this lunacy. Epping Forest district council has not been mentioned yet but its residents are served by Whipps Cross and, at the other extreme, at Buckhurst Hill, by King George’s.
I shall not repeat what has already been said, because I wish to associate myself with the remarks that have been made by other hon. Members. For today, I hope, Mr. Cook, that you will forgive me as a new boy for perhaps not following parliamentary protocol: I think that on this issue we are all friends, not just Members. We are all in total agreement that what is proposed is lunacy.
I shall start by discussing Whipps Cross. At a meeting attended by other friends and colleagues, I asked whether any plans had been made to sell off land at Whipps Cross for housing. As colleagues will remember, I was categorically told no. I can only assume, then, that the former chairman of Barratt Homes, who is now on the Whipps Cross board, is there for his medical expertise, and not his housing expertise.
Yes, that must be it.
I have held two large public meetings and would like to answer some of the questions that have been raised by colleagues. My right hon. Friend the Member for Chingford and Woodford Green (Mr. Duncan Smith) raised the question: what about all the new people coming in from the Thames Gateway? I asked that question of the health services at a public meeting a few weeks ago and was told that the homes being built are obviously for young people, and young people will not be ill or need hospitals. I shall be recommending that anyone who wants to guarantee that they will never be ill should move to our area. It is guaranteed: the health authorities say that they will not be ill if they live in Redbridge. That is lunacy, and unless I am much mistaken, young people get older.
No, I am sorry. Having accidents is not allowed.
Hundreds of people have attended the public meetings that I have been holding, and there are thousands of signatures on a petition that I shall present early in the coming month. At a meeting chaired by the editor of the Ilford Recorder I asked the head of the primary care trust the reason for the proposals and she said that if she did not do it they would sack her and get someone who would. Those were her words, not mine.
I do not want option 1, option 2, option 3 or option 4. I do not want any of the options. The people of Waltham Forest, Barking and Dagenham, Redbridge, Havering and Epping Forest deserve better, and there should be no cuts to any of the services. I agree with the hon. Member for Walthamstow (Mr. Gerrard) that no one is saying that there should not be change or improvement. Of course there should; things should evolve. What we are talking about is not change. The new Queen’s hospital, as a matter of interest, has fewer beds than the old Oldchurch and Harold Wood hospitals that it has replaced, so I am not sure how it will cope with input from Redbridge or Waltham Forest.
I live midway in my constituency and I travelled—not in the rush hour—by car to Queen’s hospital, to see how long it would take. It took me 35 minutes, outside traffic, from my home. Some people are without the use of a car, and need to use three or four buses to get there. People will die. That is not over-dramatic or over-emphatic. People will lose their lives if they have to go to the new Queen’s hospital. The Minister may want to hear—he will not hear it often—that I congratulate the Government on Queen’s hospital, which is wonderful for the people of Romford. However, it will not help my constituents one iota. Taking away our services will not help us.
I want to describe some issues that have arisen during the period of this proposal. No one really wants our input. I have been invited to various meetings and because both hospitals affect my area I have been to meetings with both trusts. Some of them have not involved colleagues; I have been invited on my own to meetings where I have not learned anything different from what other hon. Members have been told, but there has been an attempt to get my support for something that I cannot support in any way. I have made it clear that I will campaign with my colleagues to stop the cuts.
A few weeks ago a reporter took more than 1 hour and 10 minutes to get by bus from the constituency of the hon. Member for Ilford, South (Mike Gapes) to Queen’s hospital. It would have taken even longer by bus from my constituency, because I am a bit further away. We are at a stage in the procedure at which consultation has been pushed further and further back. To echo what we heard earlier, at my last public meeting various heads of different bodies involved with health care provision were asked whether they had been consulted. Every one said no—nothing, not a word. An apology was given for that; it is said that they will be consulted after the final option has gone forward. I think perhaps if we are truly going to consult we should do it in all communities, at the start.
We are sending out a message loud and clear today. Because of time and because of other hon. Members wishing to speak, I shall not go over points that have already been covered, but I want to send a final message, which is, I hope, from us all: we are not going to stand for it. It is not on. All our constituents deserve better. I plead with the Minister to think long and hard before any proposals are put into practice and to consider all the wider issues.
We have heard about the Olympics and pressure on neighbouring hospitals that cannot cope. Before Christmas certain treatment provisions were transferred from the King George to Queen’s hospital. The Minister may be interested to know that they have been transferred back, because Queen’s hospital could not cope. How will it cope with the present proposals?
It is a real pleasure to follow my friends who have made speeches or interventions. We are all on the same side in this debate. I am the Member of Parliament for the constituency with the hospital that will be decimated under the preferred option of those under consideration—option 4. King George hospital is not an old hospital; it is a new hospital in health service terms. It was built in 1993. I was at the official opening of the hospital by the then mayor of the London borough of Redbridge, my friend, former constituency neighbour and predecessor to my friend the hon. Member for Ilford, North (Mr. Scott), Linda Perham. The hospital serves a community and it is incredibly busy. There was a period when it had on average 97 to 98 per cent. bed occupancy. More than half its admissions were to its accident and emergency department, and the hospital has had to put on two so-called temporary wards for some years, because it has not been big enough to cope with the pressure.
About 10 years ago, the acute trusts in north-east London were reorganised, and Barking, Havering and Redbridge were put together. At that time, the then Secretary of State for Health, the right hon. Member for Holborn and St. Pancras (Frank Dobson) assured me that there was no threat to the hospital or to its accident and emergency department as a result of the reorganisation. I believed that promise: I persuaded local trade unionists at a meeting that there was no hidden agenda, and I also attended a public meeting with the then chief executive of the new trust.
On the basis of that assurance, the bureaucrats working on the north-east London proposals are, by subterfuge, undermining the promise made to me by a former Secretary of State for Health, and they are already transferring from King George hospital to Queen’s hospital. Queen’s hospital is a fantastic new building. Some of my constituents think that it looks more like an hotel or an airport than a hospital; nevertheless, they regard it as a fantastic building. However, other constituents have written to me about problems with it. One constituent said:
“I have had the unfortunate experience of having to attend the new Queen’s hospital for an outpatients appointment. When you walk through the doors you are confronted with an enormous almost empty open space with a few shops etc either side and, believe it or not, a grand piano!! Wow that immediately made me feel well again!
I was directed to the outpatients waiting room, a room no larger than my lounge, where all outpatients wait. When a hospital porter tries to get through with a wheelchair or trolley everyone waiting in the queue to book in with one of the two or three receptionists, has to try to disperse to make space. If it wasn’t so pathetic it would be laughable… They have concentrated on design without giving any thought to suitability.”
I received that e-mail from a constituent only yesterday.
I have a fax of a letter that was sent three weeks ago:
“I am Polio Disabled and use a wheelchair. I regularly go to King George’s for check-ups for Breast Cancer and I have had occasion to use Gynaecology and Orthopaedic departments as well as the A and E department. Whereas I can be wheeled to King George for appointments or treatment, I would have to use the car to go to Queen’s and car parking space is at a premium. To go to Whipps Cross does not bear thinking about.”
And I also received the following correspondence:
“Alice is very old and fading fast in KGH, where her care has been excellent. If she was in Whipps X or Queens, she would have had no visitors.”
I said during the Christmas Adjournment debate on 19 December that the problem is the bureaucrats. They have a mindset driven by accountancy and by models of health care that take no account of the poorest people in the poorest communities. Forty per cent. of my constituents in the Loxford, Valentines and Clementswood wards do not have access to a car. My constituency has a large and growing ethnic minority population. It includes refugees and people from the Indian subcontinent, many of whom have young children and do not drive cars. If the accident and emergency department closes at King George hospital, they will expect to go, as the Ilford Recorder reporter did, by two or three buses to get to Romford.
The original proposals in “Fit for the Future” said that it was “addressing health inequalities”. As I told the House on 19 December, it does address them: it makes them worse. The proposals are designed to penalise the poorest and the weakest in the interests of a financially driven model that takes no account of local needs or wishes.
I am not confident that the upcoming consultation exercise has any significance or meaning. The hon. Gentleman referred to Barratt Homes and planning issues. He knows, because it was confirmed at the meeting in December, that North East London Mental Health Trust has had plans for some time to rebuild facilities on the Goodmayes hospital site, which is next to King George hospital. Goodmayes is a 19th-century mental health institution that has been significantly changed over the years. It now has state-of-the-art private finance initiative facilities, but the trust wanted to build new blocks next to it. Those plans, which I was told about a year and a half ago, have been put on hold because the trust now plans to switch facilities to the King George hospital site in buildings that will be vacated by getting rid of elective work and by closing down the accident and emergency department. It is an economic measure, and I want to know about the trust’s long-term plans.
I understand that the Maskells Park site, which is part of the mental health trust will be closed. The trust was going to transfer the work to the Oldchurch hospital site that was vacated as a result of building the new Queen’s hospital. Now, the suggestion in train is that the trust will use the Goodmayes site and concentrate mental health facilities there. It will be able to do so in King George hospital buildings—instead of using them for accident and emergency work to serve my constituents and those of my friend the hon. Member for Ilford, North. I ask questions now, because we were not given that information. There is stuff going on in the health economy, and we are not being given the full facts.
The basis of the exercise is rigged. Reference was made to patient flows. We have just been sent documents by Finnemore Consultants, which is like a company doctor: it closes down departments and hospitals throughout the country. It has included its CV, which shows that it has been involved in Derbyshire, in the west of England and in various other places. It is as though Finnemore is proud of its work; however, it should not be proud of what it proposes in my constituency.
Interestingly, the documents include data about patient flows out of the north-east London health economy. The reason why option 4 is favoured is that because under it, only 7,000 operations will have to be carried out outside the area; whereas under option 2, it is 11,000, under option 3, it is 22,000 and under option 5, it is 26,000. The proposals are not about patient need; they are about stopping patients leaving the local health economy, so that primary care trusts in Barking, Havering, Redbridge, Dagenham and Waltham Forest keep their patients in the local economy.
I wrote to Ruth Carnall, chief executive of NHS London, the day after my speech on 19 December. I sent her a copy of it on 20 December. I received a reply yesterday, dated 22 January, saying that she is not prepared to stop the process, pending Professor Ara Darzi’s London-wide review, because:
“My letter to MPs dated 4 December explained why, as well as commissioning a London-wide review of strategy, we thought it important to continue with some local reconfigurations where there was an urgent clinical and financial case, and where the emerging direction was consistent with national policy.
In North East London the proposals that are being developed are consistent with the policy of shifting care from acute hospitals to community and primary care settings, and concentrating specialist expertise.”
There is nothing there about the needs of patients. It is all about the needs of a model that cannot work unless the investments in primary care referred to by my hon. Friend the Member for Leyton and Wanstead (Harry Cohen) are already in place. They are not and that bodes for total disaster.
I will not accept what is going on and I will do all I can to stop it. I will not allow my constituents to suffer as a result of these bureaucratic, account-driven, false and short-sighted plans. Given the population growth and impact in east London generally, this process cannot go ahead. Please stop it now, so that we can get proper planning of health provision throughout north-east London.
I start by congratulating the hon. Member for Leyton and Wanstead (Harry Cohen) on securing this critical debate. It is worth picking up on a couple of points he made. He set out clearly the level of deprivation in his area and its health needs, but also the progress that is being made by Whipps Cross. One issue that he and other hon. Members touched on was that of independent treatment centres and the impact of their guaranteed business, which ends up sucking business out of hospitals and threatening their viability.
We heard passionate contributions from the right hon. Member for Chingford and Woodford Green (Mr. Duncan Smith) and from others. I was a bit worried that the hon. Member for Ilford, South (Mike Gapes) might need to make use of his hospital, because of the way he was going at the end of his contribution. What hon. Members have done is clearly demonstrate that this is not a party political matter, but a question of ensuring that the needs of the local community are met, and we support that notion.
The debate is not taking place in isolation from what is happening to the NHS nationally. It is worth reminding Members of a couple of points. The NHS, in spite of receiving significant, above-inflation increases, is in deficit. Many trusts are in deficit and although a few months ago the Department of Health was predicting it was going to be in surplus, it is now predicting an overall deficit. There have been in the order of 1,000 or more compulsory redundancies. The Royal College of Nursing’s estimate of the number of jobs lost is far greater: it is quoting a figure of 20,000, including voluntary redundancies, frozen posts and the cancellation of temporary contracts.
The issue of hospital reconfiguration is not only playing out in north-east London, but all over the country. The NHS chief executive announced back in September that there were going to be 60 reconfigurations, which would principally hit the accident and emergency departments, paediatric and maternity services. Hon. Members will be very familiar with the Institute for Public Policy Research report. The IPPR is a think tank that is often quoted by the Government, which has identified that there is an excess—to use its term—of 57 general hospitals in England, and eight too many in London, according to its figures. Those reconfigurations are often taking place without any regard to what is happening in the vicinity or other factors. The Olympics has been mentioned, but there is also the question of population growth, and that of the M11 corridor, in the vicinity of which 11,000 new units will be built. That will clearly have an impact on the Princess Alexandra hospital: the hospital that might have to pick up patients from Whipps Cross. Those factors do not seem to have been taken into account at all.
There is also the matter of the decline of productivity in the NHS. It is against that backdrop that decisions are being taken. The future of Whipps Cross and King George hospitals clearly commands all-party support. The right hon. Member for Chingford and Woodford Green and the hon. Member for Leyton and Wanstead have been prominent campaigners on the issue. I would also like to praise my colleagues on Waltham Forest council. The campaign there has been backed unanimously by councillors at an emergency meeting that was held in November, where a motion was proposed by John Beanse, who is the vice-chairman of the council’s health scrutiny committee. It was adopted by the council, and it called for a range of services currently available in the borough to be maintained. The council then referred the matter to the Secretary of State and I wish it good luck. I hope that it receives a positive response.
Such issues will be familiar to Members both inside and outside London. The situation described by the hon. Member for Leyton and Wanstead is almost a mirror image of the situation in south-west London. The Minister had to respond in a debate about that a week or so ago and he must now be feeling a sense of déjà vu about the issues raised. It was a lot easier for the Minister to respond in that debate by saying that it was simply a matter that Opposition Members were raising for the sake of opposition. Today, he has to address a more significant, all-party issue and will not simply be able to say that the matter has been raised only by Opposition Members.
The process of primary care trusts and acute trusts trying to address deficits is taking place without any democratic accountability, and other hon. Members have referred to that. Decisions are being taken in isolation and not only do they not want to promote democratic accountability and involvement, they want to discourage it, and they do not see a role for Members of Parliament to play in the process. It is the lack of democratic accountability that makes such decisions a lot harder. The primary care trusts and the acute trusts within the NHS in London are not seeking to engage the local community, so when they come up with proposals, they are shot down in flames because no one has been involved in the process or feels party to those decisions. When the local community has input through the overview and scrutiny committees, one sees more and more cases referred to the Secretary of State. However, I am afraid that often their views are not given any particular weight. As of a couple of months ago, only one referral made by an overview and scrutiny committee had been responded to positively by the Secretary of State.
We are not against changes in local services. We are against the way in which they are imposed on local people, without their having a genuine say in shaping things. Will the people of north-east London have a genuine say in what services are provided in their area? Will the consultation be meaningful? I very much doubt it. We believe in greater local democratic accountability. Consultation with local people and clinicians must directly influence local health services and do so at an early stage of the process. That will give local people real ownership of their local health service, while allowing health experts to make difficult decisions on health care delivery.
The Government promised freedom and innovation controlled by local people, but in reality, hospitals are being kept on a short leash and local people have little or no say in how their local trusts are run. It is time to introduce more accountability into the service. Local councils should play a greater role in health so that people can hold them to account for what is happening to local NHS services. We want greater freedom for NHS hospitals through local democratic involvement in the buying and planning of health services. Above all, our local hospitals should have their roots in local communities. That is what the people of north-east London want: they should not be denied that right.
Rarely have I seen such passion or, probably more importantly, consensus in Westminster Hall. The message from right hon. and hon. Members is pretty clear. I hope very much that the Minister is in listening mode and that he will not just trot our his pre-prepared speech, but comment on the many excellent points that have been made.
“Fit for the Future” sounds to me like another corny catchphrase, heralding another reorganisation driven by financial deficits and financial panic. It is not clear to me how the deficits in north-east London have arisen. I suspect that the reason, as in most parts of the UK, is an amalgam of poor financial husbandry, the rustication of the financial debt to other authorities and the funding formula.
Ministers are listening to those who suggest that the funding formula perhaps needs to be revised. They recently met a group from Plymouth, for example. I hope that Ministers will tell us how they will revise the funding formula to ensure in the long term that we are not faced with crippling deficits, which have such perverse and adverse effects on local health care economies and service provision.
The issue needs to be considered in the wider context of what is happening to district general hospitals throughout the country. We heard briefly from the hon. Member for Carshalton and Wallington (Tom Brake) about the Institute for Public Policy Research report. The significance of that report is that the IPPR is close to the Government. What it says about its perception of the need to reduce the number of district general hospitals is important, because Ministers tend to listen to the IPPR.
I think that the IPPR is wrong. The recent reports from the Department, authored by Professors Roger Boyle and Sir George Alberti, are perhaps also wide of the mark on how we should proceed with acute hospital delivery. Professors Alberti and Boyle argue that we perhaps need less A and E provision, with fewer A and E departments in the future, and that services should be concentrated in large tertiary centres. Professor Boyle in particular cites stroke and heart attack in that context. However, Professors Alberti and Boyle are not necessarily typical of doctors who work in either the primary or the secondary sector.
The British Association for Emergency Medicine takes a contrary view. Of the total number of cases that wander through the doors of A and E departments, 97 per cent. have nothing to do with stroke and heart attack, which appear to be driving the agenda forward. We have been in touch with many casualty consultants and others, who are concerned that the general direction of travel on which the Government appear to have embarked will be to the detriment of the 97 per cent. of people who need easy and relatively rapid access to acute services. I hope that the Minister will take a more inclusive view when he consults those who work in the sector before doing anything that is irredeemable.
The changes in doctors’ working hours, such as those under the European working time directive, are also driving a great deal of what is happening in the secondary care sector. As an ex-junior doctor, I can reflect on the one-in-two rotas that I used to work and on whether that was a good thing to be doing. It did not seem to be so at the time, but we have nevertheless moved away from a culture of deep, profound commitment by junior doctors—working day in and day out, through the night, all the hours that God sends—towards more of a workaday approach to duties. That brings with it costs and benefits.
I would criticise the Government in their attitude to the SIMAP and Jaeger judgments by the European courts. We had hoped that the UK would secure a derogation for the specific way in which we tend to work in this country. Unfortunately, we did not do so, and that happened on the Government’s watch. Therefore, rotas have had to be redrawn and re-jigged. Often that results in smaller district general hospitals struggling to offer the same full range of acute services as in the past. In many cases, that has led to district general hospitals facing mergers or closures. We need to understand that.
We also need to understand that, paradoxically, there has not recently been a shift of services from the acute sector into primary and intermediate care—as we understand the Government would wish—but a shift in the other direction. We heard from the hon. Member for Leyton and Wanstead (Harry Cohen) that the changes in primary care had been fairly modest, despite the Government’s intentions. In fact, attendances at casualty departments in his borough and others have increased, so there has been a shift in the other direction. We have also heard that the recruitment of community nurses has been modest, which is certainly the case in my area, as it evidently is in the hon. Gentleman’s area.
We cannot have the Government saying that they will increase provision in the community and close down acute services, without their first planning for those improvements. Those improvements must be up and running before we start contemplating closures in the acute sector. So far, we have seen very little indeed in the way of improvements, and I was interested to hear the hon. Gentleman’s reflections about his borough.
The Secretary of State for Health said last week that she wanted GPs to do more and for more to be done in the community. That is all well and good, but she also said that she felt that GPs’ salaries needed to be restrained or capped. As I know very well, GPs’ remuneration has escalated under this Government. I am sure that GPs are grateful for that. However, I am not sure that it is terribly edifying for the Health Secretary, having supervised that, to say that the Government will have to cap those salaries, particularly if she is saying that GPs must do more.
The Government cannot have it both ways. In general, I would support incentivising primary care to do more and to take more of the burden from the acute sector, because that is what patients want. However, the Government cannot do that on the one hand, but on the other say, “Ah, but we’re going to expect GPs to do more for less”. Things do not work that way and the Minister should know that very well. Ministers need to be clear about the precise direction in which they intend the change to go.
We have spoken a little about consultation, mainly in relation to elected representatives. I have been horrified by what I have heard about the attitude of local health care managers in that respect. However, we should also consider the consultation process in the round. Up and down the country, many consultations are little more than a sham or a tick-box exercise. That is deeply worrying and encourages a culture of cynicism among consultees, who feel that they are not properly listened to, which I suspect is true in the case that we are debating.
The health overview and scrutiny committee and the independent reconfiguration panel process has been mentioned briefly, as have its shortcomings. However, as the hon. Member for Carshalton and Wallington pointed out, the process is important in that there appears to be a democratic deficit. There is indeed a democratic deficit: the Secretary of State is unwilling to assume responsibility for what is happening in the health service for which she is responsible. Time and again, the message that we hear from the Ministers is, “This really has nothing to with us—it’s down to local decision making”. Under the current circumstances that is a sham. I hope very much that the Minister will grip what is happening in north-east London and assume responsibility for it.
I am tempted to say that we are all agreed, but that is not my role in this debate, which must have felt like déjà vu for you, Mr. Cook, given some of your recent experiences with your local health service.
I congratulate my hon. Friend the Member for Leyton and Wanstead (Harry Cohen) on securing this debate, which has been a powerful one. Hon. Members on both sides of the House have made passionate and clear cases about why they feel so strongly about the issues that affect their local communities. In the relatively short period available, I shall try to do justice to the points made. I cannot say that I agree with everything that has been said, but I am sensitive to the fact that many of the concerns expressed have been reasonable and legitimate. I shall try to respond in that spirit.
First, I shall deal gently with the hon. Member for Westbury (Dr. Murrison). He cannot play such games. Tory policy on the national health service is in favour of total operational independence at local level, as stated by the Leader of the Opposition and the shadow Secretary of State for Health. Yet now the hon. Gentleman says that he wants Ministers sat in offices in Westminster and Whitehall to interfere in every difficult, controversial and contentious local issue and to take whatever action suits him at the time. That position is entirely incoherent and disingenuous.
No. The hon. Gentleman talks about looking at the funding formula, but what he means is moving away from a funding formula based on health inequality to redirecting resources to more affluent areas. We will not do that, because that is the policy of the Conservative party, which, furthermore, has voted against every additional investment in the national health service proposed by the Government since 1997. I shall take no lectures from the Conservative Front-Bench spokesman—I emphasise, “Front Bench”—on overall health policy.
The essential difficulty about the arguments is as follows. Hon. Members say in all debates on the health service that they acknowledge the need for change. They say that they acknowledge the comments made, the papers released and the policies developed by people such as Professors Alberti and Boyle—all of which say that more and more treatment needs to take place closer to people’s homes in the community and in primary care settings. Hon. Members acknowledge that that direction of travel is good for patients and reflects many patients’ aspirations and preferences in a modern world. Alongside that, however, hon. Members say that they want the status quo to prevail. They must accept that there is an element of contradiction in that position.
I shall give way to my hon. Friend in a minute; let me develop my argument.
For example, during this debate, hon. Members have talked about the need to invest in primary care and access to transport for their constituents. They are absolutely right to say that it would be nonsense to make changes to acute NHS care in any locality without investing properly in community services and primary health. They are also right to say that it would be nonsense not to consider the very real transport and access problems that constituents experience as services are reconfigured. However, it is unfair to suggest that, if changes were made in any locality, those issues would not be considered holistically, as part of the changes.
I take the Minister’s point, but does he not accept that there is a certain uniqueness to the geographical area that we are discussing? Not only is an increase of 311,000 anticipated in the population of north-east London, but the Government anticipate an extra 750,000 people in east London and across the Thames Gateway in the next 10 years. No one is arguing for the status quo; given those empirical realities, we are all arguing for extra capacity.
I have great respect for my hon. Friend’s work in his constituency, particularly in dealing with the far-right elements that are dividing his community. I agree entirely that any decision made in the context of the reorganisation must take proper and full account not only of the current population but of the direction of travel of population growth. Any failure to do so would be nonsense.
I want to intervene only very briefly; this is important. I know the Minister has little time, but I wish that those on our two Front Benches had not spoken. I have two points to make. First, the Thames Gateway programme talked about 1,000 extra acute beds; it did not say that there would be investment only in primary care. Secondly, we are told endlessly at the meetings that, yes, the PCTs say that there will be more investment, but only when the money is withdrawn from the acute trusts. We are looking way down the road before we even get that facility.
All I say to the right hon. Gentleman is that the future population growth in those communities matters. I would certainly be extremely concerned at any suggestion that young people do not get ill.
To reassure my hon. Friend the Member for Dagenham (Jon Cruddas), I do not think that anybody is saying that Whipps Cross hospital is bad. There is no evidence to prove that: the hospital would not have received a £2.8 million investment in emergency and urgent care, nor a £3.4 million investment in an endoscopy unit only last year if there had been a genuine belief that it was, as a matter of course, a bad hospital. There is no suggestion that that is the case.
Other hon. Members, including the right hon. Member for Chingford and Woodford Green (Mr. Duncan Smith), have talked about the review of London health needs across the piece and the importance of integrating that into the review. They asked why the review was taking place separately. I have two things to say about that. First, it is not for me to instruct NHS London on what it ought to do. Secondly, when NHS London receives the proposals and has to make a decision on whether to consult on them—for that process would be about to take place—it must consider the consequences of going ahead with that consultation outside the overall review of health services in the London area. It is for NHS London to make the judgment on whether that would be an ill-advised direction of travel, but it certainly has a responsibility to take full account of that issue when it receives recommendations and before it decides whether it would be appropriate to allow a stand-alone consultation to go ahead.
I shall make sure that I familiarise myself with that letter.
I say to hon. Members, particularly the right hon. Member for Chingford and Woodford Green, that I do not think that it helps or is appropriate to cast aspersions on the integrity of officials in the local NHS. The right hon. Gentleman may disagree with their judgment. On occasions, he may not be satisfied with their performance, but it is entirely inappropriate to cast aspersions on the integrity of those people, many of whom are genuinely trying to do their best for local patients and the local health economy.
My hon. Friend the Member for Walthamstow (Mr. Gerrard) made some important points. He talked about the knock-on effects on neighbouring hospitals in the context of any London-wide review and the effect of doing things separately from that. He talked about the apparent resentment of MPs’ involvement. Well, I give a clear message to any NHS leader or manager anywhere in the country: engagement with MPs is a priority, although it is not the final part of the process. MPs are democratically elected and represent their local populations and communities for good or bad. They have every right to be those taken most seriously when such decisions are made. That is not the same as saying that hon. Members have the right of veto, which might sometimes lead to anarchy. However, any suggestion that MPs should not be one of the first groups to be consulted is unacceptable.
I nearly called the hon. Member for Ilford, North (Mr. Scott) my hon. Friend. I cannot do so yet, although I am sure that he will see the light one day. He talked about the gentleman from Barratt Homes and his medical expertise. It is a bit rich for the Conservative party to slag off business people sitting on public service boards for being business people, given that it completely transformed the management and accountability of public services and placed business people on boards purely because they were business people—whether they knew about anything else did not seem to matter. That policy was ideologically driven.
However, the hon. Gentleman was good enough to congratulate the Government on Queen’s hospital. I am a bit disappointed that my hon. Friends did not talk positively about the massive investment in that hospital. I say gently to my hon. Friend the Member for Ilford, South (Mike Gapes) that, yes, the hospital has teething problems, but he and we should be very proud of the Government’s £261 million investment. I am also delighted that my hon. Friend the Member for Leyton and Wanstead is a passionate advocate of PFI schemes and the Government’s choice agenda in the national health service. That is a revelation, but I promise not to tell anybody.
The hon. Member for Carshalton and Wallington (Tom Brake) talked about not opposing change for the sake of it. He has clearly not read “Focus” leaflets these days; all the literature is about opposing any politically expedient change. There will be balance in the NHS by the end of the financial year, so the hon. Gentleman is wrong about that.
Northampton Travellers Site
I am grateful to have secured this Adjournment debate, as it provides an opportunity to get my serious concerns about the Northampton Travellers site on the public record and also to get some reassurances from the Minister about how the matter will be progressed. Although the debate will refer to sites in general, the refurbishment of one particular site was part of a national programme of the Department for Communities and Local Government, which is why it is appropriate to bring it to the attention of the House and the Minister.
I am grateful to the Under-Secretary of State for Communities and Local Government, my hon. Friend the Member for Sheffield, Heeley (Meg Munn), who is also Minister for Women and Equality, for the time she provided to talk through the matter with me, and also to officials of the Government office for the east midlands for their time and subsequent actions.
The matter at hand is the Ecton Lane Travellers site and the use of public funds for refurbishing it. The site has 32 utility blocks, which are small brick units with a kitchenette, shower room and toilet. The infrastructure of the site is poor, and the utility blocks themselves are in desperate condition. They are not the kind of facility that is appropriate in this day and age. Frankly, a total rebuild would have been better, but, failing that, refurbishment was desperately needed.
The application for the refurbishment grant was approved in 2005. The Government provided £366,899, and Northampton borough council was to provide £125,000. A company called Westgate managed the site and was involved in drawing up the funding application and then delivering the contract. The contract specifies internal and external improvements to the utility blocks, and also some site improvements and repairs, which were later specified as fencing around the site and floodlighting.
Concerns about the project were first raised with me last spring by a member of staff at the Northamptonshire county Travellers unit, who contacted me because several Travellers’ relatives have settled in my constituency. I should make it clear right at the start that the concerns that were raised with me, and on which I shall focus, involve the delivery of the refurbishment scheme. Separate concerns about the procurement of the contract have been investigated by PricewaterhouseCoopers. I can understand why people would be concerned about the procurement, but those issues were not raised with me, and they have not been the subject of my letters and representations. I ask my hon. Friend to note that my concerns do not involve procurement, and I shall not deal with it in this debate.
My first visit to the site after the matter was raised with me was last May. I spent a couple of hours going from block to block to see the work that had been completed and to talk to the residents, who were concerned and agitated about what had been happening on the site. I then put in a detailed report to Northampton borough council and left the matter for three months to provide time for remedial work to be undertaken.
Since then, I have made two follow-up visits: one last September and one earlier this month, which was meant to have been in conjunction with the council. On each occasion, I made detailed reports, in one case with pictures. That is not something that I would normally do, but it seemed justified in this case, bearing it in mind that we are dealing with the state of repairs. My reports went to the council and to the Department.
What I found has, frankly, horrified me. In particular, there has been a lack of work. On my first visit, few of the units had been completed, although the contract had been running for several months. Not much progress had been made by September, and work had still not started on several units earlier this year. No start had been made on the general improvements—the fencing and floodlighting—at the time of the last visit I made. I know that they were not to be done until February under the revised schedule produced by the council, but I would have expected to see at least some evidence of preparation for those substantial elements of work.
My three visits involved about four or five hours—perhaps a bit longer—on the site, all of it during what should be working time, but only once did I see any builders doing any work: three men working from an unmarked white Transit van were doing repairs to the roof of one of the units.
My second main concern is that the work undertaken has been of incredibly poor quality. I have been told several times that the quality of the work was not specified in the contract, which is indeed the case—the contract is scanty on specifics. However, it would be reasonable to expect the work to be done to a generally acceptable building standard. For example, one would expect that when a kitchen is refurbished, the inside of the boiler cupboard would be redecorated, given that a new boiler was installed. If a shower tray is put in a shower room and a new shower fitted, it would be reasonable to expect that the area around it would be made good—that the space between the shower tray and the floor would be tiled—that windows and doors would fit, and that paintwork would cover the wall and not leave blank patches.
In addition, it is reasonable to expect that refurbished shower rooms and kitchens would be provided with facilities that are reasonably acceptable in the modern day. For example, some rooms had showers that had no trays. The water simply drained out through a hole in the floor. They were not mobility showers, but simply showers that did not have a proper drainage system—they had a hole in the ground. The refurbished shower rooms had new showers fitted, but the water was left to drain away through a hole in the floor, which seems primitive and not what one would normally regard as an acceptable standard of refurbishment.
Thirdly, some work was done to such a poor standard that it has already had to be redone. In one unit, a newly plastered ceiling collapsed, narrowly missing a child. On my first visit, I saw that a piece of plasterboard had been screwed or nailed over the damaged area. On my last visit, nothing had been done about replastering it—there was still just a board fixed to the ceiling. In another unit, the plasterwork in the kitchen had come away completely—there was a large blank patch—and it appeared that plaster had been applied directly to gloss paint. A person could put their hand in the gap between the wall and the rest of the plasterwork, so presumably that will also come down.
My other complaint is that there seems to have been a lack of monitoring of the work. Northampton borough council insists that all the work was inspected, but I find it difficult to understand how all of it could reasonably have been cleared for payment, given the quality and also the quantity of it. I have looked at some of the clearances: e-mails of only a few lines provide clearance for five-figure amounts of public money.
In a file provided by the council under a freedom of information request, I found only one instance in which there was substantial evidence of an inspection. The inspection showed that the invoice submitted by the contractors was not justified by the amount of work done. The company that did the work said that six plots were 100 per cent. completed, whereas the council inspection found that they were, in fact, 60, 98, 90, 70, 95 and 50 per cent. completed.
When I first went to visit the site, it looked like a badly managed public sector building contract—I choose my words carefully. The second time, things looked a bit more serious. The last time, my view was that fraud was likely involved. I focused on a paid invoice for £9,286 for one unit. It appears that only half the work involving that unit was done as part of the contract; the other half was for a mobility bathroom, and I was told that that work was organised and done separately from the contract by occupational therapy. An invoice for another unit was listed as having been paid last summer, but the residents said that that work had been undertaken the day prior to my visit this January, and that it involved only the removal of two internal doors and one cupboard door. It is of some concern to me that some issues were perhaps not picked up on and dealt with firmly enough when they happened.
I was appalled and made to feel that the matter should be brought to the attention of the House due to the lack of action that followed serious complaints. After the first visit, as I said, I left the matter for three months to allow time for remedial work. On my second visit, I had expected at the very least to find that some unfinished, incomplete or inadequate work—some of the more obvious problems—had been made good. One would normally expect that at the very least, if only to stop a person who was complaining and moaning quite as much as I was, but that had not happened.
On my third visit—it was set up in discussion with the borough council, so warning and time had been given to enable people to ensure at least that there would be builders on site or that something was going on—little effort seemed to have been made to address the performance issues.
The contract is due to end in March, by which time all the units are supposed to be finished, the fencing and floodlighting are supposed to be done and all the money should have been spent. My concern is that once we reach that date all the money will indeed have been spent—more than half already has been—but the work will not have been done, or will have been done to such a poor standard that it needs repair. Some units are quite nice, and it is important to say that. Some are well maintained and managed by the residents. However, in a number of those units, the residents have either done some of the work or provided some of the materials. For example, some did extra tiling work in the kitchens, some provided coloured tiles rather than plain white, and some provided coloured paint to supplement the white. When an assessment is made of work done, it will be important to note what work the contractors have done and what the residents have done.
Apart from those units that have been finished, which are well maintained and are nice, we are left with some units of a third-world standard. For example, there has been no effort in any of the units to do such things as refurbish the floors, or in some units to provide skirting boards, which has meant that damp is already creeping up the plaster. Some internal walls are already badly damaged by mould. Residents of one unit complain that raw sewage still comes up the external drain and that they have to repeatedly clean it out with bleach. Fascia boards and guttering have not routinely been refurbished and there are problems with them.
Although this might seem rather a parochial matter, and it does concern only one contract, it is a contract for £500,000 and is part of a national programme to refurbish Gypsy and Traveller sites. That is a large amount of public money, which is providing an important public service on behalf of the DCLG. Some steps have been taken to try to improve matters. As I said earlier, PwC has investigated the procurement and the district auditors have looked into the contract. Also, the Under-Secretary of State for Communities and Local Government my hon. Friend the Member for Sheffield, Heeley met with me to discuss it. I was subsequently informed that a stop had been put to the contract, although the council has since denied that.
It is generally recognised that there is a problem, but the challenge is obviously to put it right. The client group in this instance is not one for which there is a great deal of public sympathy—the Travellers, however, are more complained about than complaining—and it has been made clear to me that that has influenced the approach to the contract. Among the reasons cited to me about the method of procurement and the difficulty in delivering the contract are the “difficulty of the site” and the “difficulties we all know about”.
The fact that a particular community does not normally attract great public sympathy or is associated in the public mind with antisocial behaviour and other problems is not an excuse for wasting public money or doing unacceptably shoddy work. Nor is it an excuse for such intolerable standards of housing in modern day Britain. I do not find it acceptable to go to a site and see disabled children—any children, for that matter—living in a utility unit where the parents complain that raw sewage comes up through the external drain, or to hear parents complain that their children have been sick because of the bad drainage. I have seen such housing and heard such complaints in developing countries, but do not expect to do so in the UK.
Will my hon. Friend the Minister respond with absolute assurances that the site will receive £500,000 of improvements and that if those are not provided by the current contract, additional money will be provided as part of a properly managed contract to ensure that the improvements that the Travellers are supposed to see on their site are provided?
Secondly, I seek an assurance that there will be a full investigation of the contract, including the quality of the work that has been undertaken, to ensure that it provides value for money and that appropriate action will be taken to deal with the failures in it so that they are not repeated.
Thirdly, I seek an assurance that urgent action will be taken, even in the last two months of the contract, to stop the waste of public funds on the site and to ensure that at least during those final two months the work will be properly scheduled and managed and completed to a satisfactory standard, and that the people who are supposed to do the work will turn up.
I have spent a lot of time, before and after becoming an MP, walking around public sector housing schemes in this country and abroad. This contract is probably the worst delivered that I have ever come across. The improvements to the site are desperately needed, and I am most concerned that a large amount of public money is at risk and that one section of the community is not getting the reasonable standard of services that it is paying for and is entitled to. Will my hon. Friend ensure that prompt action is taken, even at this late stage, to protect the public interest?
First, I congratulate my hon. Friend the Member for Northampton, North (Ms Keeble) on securing the debate. This is clearly a matter on which she feels passionately and knows a lot about, and the way that she raised it does her credit.
The Government firmly believe that everybody has the right to a decent home, and it is quite clear that my hon. Friend shares that commitment for all her constituents. Refurbishment works at the Ecton Lane site in Northampton were intended to make that a reality for the residents, so the concerns that she has described on delivery of the works are clearly unacceptable.
My hon. Friend paid tribute to my hon. Friend the Minister for Women and Equality. I hope that their meeting assured my hon. Friend that Government action has been taken. I understand that it was a positive meeting. I hope, too, that she understands from that meeting how seriously the Government take her concerns and the wider issues that she has raised.
The issues raised by my hon. Friend on the performance and management of the contract for the works at the Ecton Lane site are being investigated as a priority by the sub-board for finance that has recently been set up to seek improvements in Northampton borough council’s performance in that area. The contract to which she referred has been suspended while investigations take place.
An independent site condition survey is being commissioned, and we expect that to be available for the next meeting of the sub-board. It will enable the sub-board to compare the quality and extent of the work against the contract that was signed and the issues that have been raised. I hope that that addresses many of my hon. Friend’s concerns. The survey will also inform the sub-board’s decisions on the further action that will need to be taken to get the scheme back on track. I have asked officials to keep my hon. Friend up to date on the progress made by the sub-board in dealing with those issues. She should be kept fully informed.
My hon. Friend expressed her frustration at how long it has taken to act on the issues that she has raised. Officials from my Department have made contact with Northampton borough council and visited the Ecton Lane site. The council has commissioned independent consultants to investigate the issues that have been raised, but my hon. Friend raised concerns about that investigation. My hon. Friend the Minister for Women and Equality wrote to the chief executive of Northampton borough council expressing her concern about the issues that had been raised with her, and asked to be informed of the outcome of that investigation as soon as possible.
My hon. Friend the Member for Northampton, North is aware of the arrangements under which the Gypsy and Traveller site grant is awarded. The Government’s power to intervene is extremely limited. The grant is not ring-fenced, and it is for councils to spend the money on the areas for which it has been given. It is therefore up to the local authorities to resolve any issues arising from that grant. In those circumstances, giving the council the opportunity to investigate and resolve the issues that had been raised was the right thing to do at the time.
It has since become clear that Northampton’s response to the investigation did not adequately address the issues raised today, and we have taken the matter up with the council. We have taken action to ensure that all the issues that have been raised will be dealt with by the sub-board for finance, which has been set up to secure improvements in Northampton’s performance in that area.
My hon. Friend also raised the possibility of fraud in relation to some of those works. That is a serious allegation. I understand that she has taken the matter up with the district auditor and the local police, which was the right course of action. Those concerns should be fully investigated. It is clear that she has undertaken almost a forensic examination, and I hope that it will be considered. I understand that the district auditor is a member of the sub-board investigating the matter.
A number of other steps are being taken to help to ensure that the problems experienced at Ecton Lane are not repeated elsewhere. The Gypsy and Traveller site grant now forms part of the regional housing pot, and recommendations are made by the regional assemblies following a thorough assessment by independent consultants. The fact that regional assemblies are undertaking an assessment—I acknowledge that they have—will help local authorities to deliver schemes that better take account of all the factors involved.
We are also reviewing the information that we ask local authorities and registered social landlords to provide on the progress of schemes to ensure that delivery problems are picked up early and discussed with colleagues in the regions.
My hon. Friend also referred to public concerns over expenditure on site provision. She suggested that in many cases there was not much public sympathy. I believe that there is a wider public interest in ensuring that sufficient sites are provided for Gypsies and Travellers, as that will reduce unauthorised camping and the tensions that can be created among the settled community. It will also reduce the resources that authorities have to spend on costly enforcement action, which is estimated by the Commission for Racial Equality to amount to about £18 million a year. Furthermore, it will make it easier for authorities and the police to take enforcement action on unauthorised camping. That, too, has the support of the wider public.
The opportunity to occupy good-quality sites on a relatively permanent basis will also help to tackle the serious social exclusion experienced by Gypsies and Travellers, and it will help to improve health and education outcomes. There is clearly a wider public interest, and I thank my hon. Friend for raising the matter.
My hon. Friend spoke of the wider issues of the Government grant. We believe that schemes such as the Ecton Lane site are vital in ensuring that Gypsies and Travellers have the opportunity of a decent place to live. That is particularly important, because the shortage of authorised sites means that one in four Gypsy and Traveller caravans are on unauthorised sites, with all the attendant problems.
We have established a framework for increasing site provision and backed it up with additional resources. Coupled with effective enforcement action, that will both ensure that the number of unauthorised sites is reduced and provide additional benefits for local authorities and for Gypsies and Travellers.
I am grateful to my hon. Friend for raising this matter. She clearly feels passionately about it. She has shown her commitment to all her constituents by raising the question of how public money is spent. We want to ensure that it delivers the ends that we intend. I will ensure that she is kept fully up to date on progress. I hope that we can reach a satisfactory conclusion and ensure that the site is brought up to the standard that we all expect.
Sitting suspended until half-past Two o’clock.
I welcome the opportunity to debate what is an important subject. I am glad to see that other hon. Members are here because I did fear that it might be only myself and the three main party spokespeople so I am happy to see other hon. Members.
I have two children and can only begin to imagine what it must be like to want children but to be unable to have them. This is not just a women’s issue, although it is often portrayed as such; it also deeply affects men. Surprisingly, although there is public sympathy for those unable to have children, there is sometimes less sympathy when people are unable to access public funds to solve the problem and have a much-wanted family. The issues involved do not just relate to health as they can also have a wide impact on society at large.
What exactly is infertility? According to the British Fertility Society, it is defined as the failure to conceive after frequent unprotected sexual intercourse for one to two years in couples in the reproductive age group. Obviously, that does not include those with sexual dysfunction. As women start their families at a later age, the problem is becoming more acute. It is estimated that at some time in their reproductive lives at least a quarter of couples experience a period of infertility lasting more than a year. Some continue to be unable to conceive and that leads to approximately one in six couples seeing an infertility specialist at a hospital. Some of those couples will require treatment to assist with conception.
There are many options for treatment, but attention has focused on IVF—in vitro fertilisation. Research published by the National Institute for Health and Clinical Excellence in 2004 shows that England lags behind its European neighbours in providing access to treatment. England provides approximately half the level treatment compared with the European average. A 1998 study revealed that there was a wide variety of provision in the UK. That provision was measured as IVF treatments per 100,000 people and ranged from 21.5 in Scotland to a low of 0.3 in south-west England. Clearly, something strange is happening for there to be such a wide variation—some variation would be expected, but not to such an extent. The best place to live in England to access fertility treatment is the Anglia and Oxford region, which was just behind Scotland with a level of 21.3.
Although public sympathy might not always be readily apparent, a survey in 2002 showed overwhelming support for NHS funded infertility services and a desire for an end to the postcode lottery of provision. That is not a phrase I make a habit of using, but it was used as a result of that report. The then Secretary of State for Health, the right hon. Member for Darlington (Mr. Milburn), acknowledged the distress that infertility caused to thousands of couples and said that it was time to tackle infertility by using some of the new funds being pumped into the NHS. He referred the matter to the National Institute for Health and Clinical Excellence. In the same year, the Prime Minister stated that the same level of high quality service would be available in whatever part of the country a couple live.
NICE published a set of national guidelines in February 2004, which recommended that the national health service should provide three free cycles of IVF treatment for suitable patients in England and Wales. The then Secretary of State responded positively to the guidelines and as an intermediate step stated that all patients meeting the eligibility criteria established by NICE should be offered one cycle of treatment funded by the NHS by April 2005.
The longer-term aim was full implementation of the NICE guidelines that recommended three cycles of treatment for each appropriate patient. In February 2004 the Prime Minister told the House:
“We hope that over the next couple of years we shall see at least very substantial progress towards implementation of the full NICE guidelines, and that they will allow us to end the current postcode lottery”. —[Official Report, 25 February 2004; Vol. 418, c. 278.]
Those were the Prime Minister’s words, not mine.
It is three years since those statements and so it is worth standing back and taking a look at where we are today. I have had a long-term interest in this subject and in 2005 I conducted my own survey by writing to primary care trusts and asking a few fairly simple questions. I had a good response, but unfortunately the results did not provide happy reading. The majority of primary care trusts were, at that time, unconfident about being able to offer more than one cycle of IVF by April 2006. Two thirds of trusts were taking no steps to offer more cycles, and eight out of 10 trusts offered only one cycle. Some 82 per cent. of trusts cited funding as the major barrier to providing more cycles, yet that was despite an increase in the IVF budget in 72 per cent. of primary care trusts. Some 60 per cent. of trusts had a waiting time of more than a year and one in 10 had a waiting time of more than two and a half years. One PCT stated that some couples had been waiting seven years for treatment. It was also clear that many trusts had added their own criteria that further diluted the NICE guidelines. One of the concerns often raised is that criteria are often social criteria, which almost suggests a degree of social engineering that varies around the country.
Anyone who has listened to “The Archers” recently will know that Hayley is being denied the opportunity to have a baby of her own because she has married Roy, who is the father of Kate’s child. I do not intend to go into the relationships of the characters in “The Archers” and who has slept with who over the years, but, basically, Hayley was denied treatment because she is in a relationship where there is a child. It is not her child; it is another woman’s child.
I know the hon. Lady will recall the debate in Westminster Hall initiated by the right hon. Member for Rother Valley (Mr. Barron) in 2005. He asked a good question: why did the then Secretary of State in 2004 add the criterion that priority should be given to couples where there were no living children? That is a social criterion and was not in the NICE guidelines. The Secretary of State added it and many PCTs are now adopting that, including my own. We have never been able to find out why the Department of Health and the Secretary of State chose to put that criterion in.
The hon. Gentleman makes an extremely good point. He is absolutely right; there has been no explanation as to why that was added when it was not in the initial guidelines. I suspect that that has sent the signal to PCTs that they can add further restrictive social criteria. I am sure that all hon. Members would be interested to hear from the Minister why that guideline exists.
I will not labour the point about “The Archers”, but it was interesting that Hayley’s doctor sounded like Lord Winston from the other place. I am glad to see that he is providing NHS services up and down the country. That is what soap operas are made of, but this is a real problem affecting real couples up and down the land.
There are other criterion to the one already mentioned. In Thames valley, doctors only offer treatment to patients who are between the ages of 36 and 40. By that time the fertility of an average woman will usually have declined by half compared with their fertility at the age of 30. Health officials have defended that by claiming that younger women have more options available, for example, they may be able to adopt or they have more time to overcome fertility problems naturally. However, others have said that such a selection process penalises women who may have had a greater chance of success with IVF if treated at a younger age.
For those who doubt the robustness of Lib Dem research, NICE conducted a survey in October 2005, which found that the vast majority of PCTs—94.5 per cent.—had defined their own eligibility criteria . Some 80 per cent. of those responded that their criteria were stricter than those proposed by NICE. Just over 60 per cent. of trusts were offering one cycle. NICE had slightly better results in that it found that a further third were offering two cycles, but not one trust was, at that time, offering three cycles, and one county was not funding any cycles of IVF at all. Since that survey was conducted, some trusts have temporarily put IVF programmes on hold.
NICE also asked about the timetable for implementation of the guidelines. Fewer than 10 per cent. said that that would be within a year. Even more worrying, nearly a quarter of trusts said that there was simply no time line.
The British Fertility Society recently conducted a survey of IVF providers. There was an increase in the number of NHS-funded cycles, but in some areas there is still only a token gesture towards implementation. The society also discovered that there was no clarity over the definition of what constituted a funded cycle. NICE says that that should include ovarian stimulation and the replacement of fresh embryos and the subsequent replacement of frozen-thawed embryos generated by the ovarian stimulation episode. There is no consistency in the application of that definition by funding commissioners.
Although short-term financial pressures are clearly affecting decisions, I also suggest that this could be a time for joined-up government. Research by Professor William Ledger at the university of Sheffield shows that free fertility treatment could boost the economy. He says:
“The costs of IVF are in fact trivial and truly insignificant compared with the huge amount that the child gives back to society, including financially in terms of taxes paid.”
Research by the RAND institute suggests that a case can be made for including fertility treatment as part of a “population policy mix” aimed at increasing fertility rates.
I do not have the advantage of an in-depth cost-benefit analysis, but it would be useful if the Minister, in summing up the debate, informed us whether such work is being undertaken, because if the long-term financial benefits were proved, there would possibly be a case for a separate pot of money, ring-fenced for the prime purpose of boosting fertility. It would not necessarily have to come out of existing health budgets.
The National Infertility Awareness Campaign has been campaigning on these issues for some time. It has raised concerns about a recent recommendation, made by an independent expert group set up by the Human Fertilisation and Embryology Authority, that reducing the number of embryos transferred from two to one for some women could reduce the number of multiple births. That process is known as single embryo transfer. It is true that the increased incidence of multiple births has a long-term impact on the health service, as twins are often born prematurely and with a lower birth weight and are linked to a significant risk of post-natal death. Twins are also at a higher risk of long-term problems such as cerebral palsy. If triplets are put into the equation, the risk is even higher; it is 16 times greater.
The expert group concluded that
“the failure to implement the NICE guideline on fertility (3 cycles) is the major obstacle to the acceptance by NICE and clinicians of introducing Single embryo transfer policies in the UK.”
The National Infertility Awareness Campaign has pointed out that the cost savings that could be achieved in neonatal care as a result of such a move towards the NICE guidelines could be invested in funding more infertility treatment. In other words, single embryo transfer must be introduced at the same time as the number of cycles is increased. Otherwise, if women think that they have only one chance, they will want to maximise their chances.
There are wider issues relating to infertility. Some women are unable to conceive due to blocked fallopian tubes. In some cases, that is a direct result of an infection such as chlamydia. A report by the Select Committee on Health in 2002 highlighted the inadequacies of current sexual health education. More should be done to get some of these messages across to people at a younger age. At a time when women are concerned about preventing a baby, they may take oral contraceptives and not think too much about the possibility of contracting chlamydia or another infection. Chlamydia is often symptomless in women and, despite the availability of testing, is often undetected. When a woman decides that the time is right to start her family, the damage has often been done. I would like to ask the Minister whether she has any plans to ensure that young women are more aware of that potential problem.
Obesity and anorexia also have an impact on fertility. Women with anorexia often find that their menstrual cycles are completely disrupted and sometimes there is a long-term impact. A person with a body mass index outside the range of 19 to 30 is likely to have greater difficulty in conceiving, with or without some form of assisted technology. Again, if more is done to tackle the problem of obesity, there will be benefits in the long term.
The messages are slightly misplaced, although accurate. We often say, for example, “We must tackle the problem of childhood obesity because diabetes is on the increase.” I suggest that most young children who overeat do not really think of themselves as diabetic or not; that is simply not something on their horizon. However, if they thought that their long-term fertility might be affected, that might be a more powerful incentive to try to get their weight under control.
It is not appropriate to highlight individual cases, but as more and more couples are forced to access private care, there is a great need to ensure that the private provision of infertility services is properly regulated. A recent “Panorama” programme attracted attention. I do not want to dwell on that problem, because it centred on a specific clinic and I feel that there is a far bigger scandal than anything that one individual doctor may or may not have been doing.
The scandal is that although this subject was debated in Westminster Hall just over two years ago, there seems to have been little or no progress. It is a scandal that the Government have made no further progress in asking primary care trusts to implement NICE guidelines. It is a scandal that a blind eye is turned to the actions that PCTs take to avoid implementing the guidelines that exist. I hope that the Minister will commit today to ending that scandal here and now by acting to resolve the problems that blight the lives of many.
It is a pleasure to speak under your tutelage again, Mr. Cook. I am delighted to follow the hon. Member for Romsey (Sandra Gidley), who is the major speaker here on this subject. I want to make one or two general comments and then talk about a conference that I went to before Christmas in London—it was the first of its kind—that opened a way up for improvements in IVF treatment and which gives us the chance to do much more to help people to have the children that they obviously desire to have.
I am supported in what I am about to say by Geeta Nargund, who is the head of the reproductive medicine unit at St. George’s hospital and the chief executive of the Health Education Research Trust, which is a women’s health foundation. It is an innovative charity that aims to change the lives of women across the world. It was founded specifically to focus on women’s reproductive health from puberty to menopause. It is empowering, proactive and holistic. I think that this country is leading the way forward in this regard, and I shall say more about that in a moment.
One in six couples in the United Kingdom has fertility problems, so for every 250,000 of population there is a need for about 250 assisted conception cycles per year. There is a true rise in infertility in this country and across the world. That might be about the age of the woman: women are putting off having children until later in life. As an individual ages, the cells and so on change, and there is less propensity for having a child. We have heard about sexually transmitted conditions such as chlamydia and about obesity, but we have not heard about sperm counts, which are going down quite dramatically in parts of the world. We have to realise that environmental factors may be involved in that. All those issues play into difficulties in conceiving. There are other major factors, of course, such as tubal damage. In many instances, we cannot explain infertility. There is also male factor infertility and so on.
I want to make the point early on that the increased demand for IVF in this country is partly due to the fact that we now have more cancer survivors who would like to have children following their medical and surgical treatments for cancer. Cancer is becoming a chronic condition, so young people who are going through chemotherapy and radiotherapy are asking for technology to help them to look after their eggs—I am afraid that we are into the frozen gamete area here—so that later in life, as they recover and become healthy, they are able to have children. That has become quite a common practice in parts of the country, and it will certainly be a demand not only from patients groups but from individuals. The demand for egg donation will increase because ovarian function ceases after certain chemotherapies and radiotherapies for lymphomas and other tumours.
I do not want to say too much about the population decline in this country and the birth rate, but there is concern that the birth rate is a mere 1.66 per woman, which is below that of our European partners. The arguments about the need for future citizens in this country, and about having a young population and work force, loom large in political circles. I shall argue that national initiatives are urgently needed to prevent infertility in men and women, and for fertility protection.
Geeta Nargund and her team called a conference just before Christmas, on 15 and 16 December, at which I spoke. It was held at the Royal College of Obstetricians and Gynaecologists, and was called the First World Congress on Natural Cycle/Minimal Stimulation IVF. Without being too much of a clever dick, I shall keep technical words out of this and explain simply what the conference was all about and how we learned from other countries what they are doing.
The conference was hosted in London by Geeta and others, and some 55 countries were represented. During the two days of the conference, we examined the new research that is going on in IVF and discussed the best way forward for a new regime in the management of IVF. A new society—the International Society of Minimally Assisted Reproduction—was also set up, which will take forward, on a global level, IVF issues such as how to make IVF safer for women and children and affordable to all. IVF is expensive for many, but the new research shows that it is possible to do many more IVF cycles on the NHS than was previously possible.
There are simple treatments for infertility other than IVF. I shall not go into this in detail, but intra-uterine insemination, for example, is still relevant in many cases. We need to ensure that IVF is simple, safer, affordable and successful. We have heard from the hon. Lady about ovarian suppression and stimulation, which were introduced 20 years ago. That process involves blocking ovulation so that more eggs are produced. There are then more embryos for transfer after they have been impregnated with sperm.
We have heard that single embryo transfer is on the agenda again to reduce multiple pregnancies. IVF babies are more likely to have a low birth weight and be premature even when they are singleton babies, so it does not help matters to have twins or triplets, which have an increased risk of having cerebral palsy. It is therefore important to reduce multiple births. The technology that I shall explain simply will enable that to happen. It stems from the interaction at the conference between different countries.
When women are given treatment to produce more eggs, they are often given hormones. The question is whether we are over-treating them with—let me use a few serious words—gonadotrophins and luteinising hormones. Those names will be familiar to some people in the Chamber. Are we overdosing people with those hormones either at that stage or when we fertilise in vitro? It was clear from the conference that experiments that have been conducted around the world show that we are overdoing it. What is the evidence? There is evidence that when there is hormonal stimulation, the early embryos—we can take samples and look at them—sustain chromosomal damage much more frequently than those produced without hormones. Some countries now say that we should minimise the use of hormones, or not use them at all.
In medicine, people get into habits because things have always been done in a certain way, so they think, “Why change it?” There is no doubt that there can be abnormal effects from overdosing with hormones. A lot of work is being done in that area.
I have been in quite close contact with a number of women who have experienced hormone treatment. The effects on women’s lives are horrendous, but they go through the treatment because they are so desperate to have a baby. If, as the hon. Gentleman believes, those women could improve their fertility by some other means, I am sure that that news will be very welcome. For some of them, things have almost got to the stage of breaking up the marriage.
It is true that women can be given minimal stimulation doses. I do not want to go into details about hormone dosages—just a little is needed, or none at all—but there are ways of carrying out the process without using the traditional technique that has been used for years. That knowledge is a result of the conference that was hosted in Britain.
There is agreement on the new process in a number of countries including Holland, Denmark and the USA—I have a list of the countries somewhere. They have been trying it out and have discovered that the conception and embryo transfer rates are just as good as under the old method. That means that we can have more cycles for the same amount of money, so the Treasury need not worry about being asked for more money. We can save a load of money; I shall show in detail how we can get more conceptions within the NHS for the same money.
In something like 40 per cent. of treatments, there is overdosing that need not occur. There are all sorts of side effects, not just headaches. As the hon. Lady said, women have to carry on at work while undergoing the terrible routine of receiving hormone treatment for weeks or months before the necessary oocytes, or eggs, are produced for use.
Women are put under tremendous pressure, but recent evidence shows that there is no justification for that, because the results with conception are just as good without that treatment. I do not place blame on anyone because in medicine old habits die hard. We are trying to change that through good research and showing that embryos produced using the new method are in better condition than those produced when there is over-stimulation using hormones.
It is fair to say that when people from around the world spoke at the conference we felt, not shamefaced, but as though we had missed a trick or two, because they are producing better figures than us. Their conception rates are 50 per cent. better, and they have less recorded problems with side effects. We can argue about data, but it is important that an international organisation has been set up, and that people are looking at new technologies and trying to improve IVF. I am pleased about that, because nothing stays the same for ever. As we learn and experiment, we find things out, and it is nice that we can learn from other countries too. That international aspect really matters.
I return to the savings that can be made. According to the Human Fertilisation and Embryology Authority, there are about 40,000 IVF cycles in this country every year. Some 10,000 of those—25 per cent.—are funded on the NHS. So being able to attempt a conception without having to wait the dreadful lengths of time that many people have to wait is a rich person’s arena.
I understand that the average cost per cycle is £2,500, to which must be added the cost of the drugs, the stimulation, the other effects, and so on. The cost of the drugs is about £800 for women under 35 and £1,000 to £1,200 for those over 38. That is even the case if the drugs are block-purchased in hospital environments. That information was supplied by St. George’s hospital among others. It says that we could adopt low stimulation with a little bit of hormone involved—what is often called the semi-natural approach. Louise Brown was born in 1978 by the natural approach: sperm and eggs in vitro without any hormones being added.
Many people in this country have their babies by IVF and it is not something that one boasts about or talks about. Possibly the figures are not quite as accurate as we think. Others cut the figures all down, but if we were to do all the addition, it is reckoned that we would find that £17 million a year of the current costs of £35 million a year could be saved if the hormones are cut out. I will not go through the details because they have been made available in some of the talks and so on. That means that 30 to 40 per cent. more IVF treatment cycles a year are possible without an extra cash injection, and that is quite reasonable in ball park terms.
We must also add on the over-treatment effects on individuals of hormones; ovarian hyperstimulation is potentially fatal and there are about 1,000 cases a year of it in this country. NHS hospitalisation is a significant part of the resulting cost, which is estimated at about £2 million a year. That does not sound like many cases, but for the individuals concerned it is tragic. Some people might not require hospital admission, but many blood tests and other tests have to be carried out.
Without giving a conclusion, the conference said that we sometimes over-hype the tests that are carried out on women. Tests are carried out for all sorts of reasons. I will not go into the details, but many of them are not necessary. Some are necessary at the beginning of the process, but a year later they are repeated and that is costly to the NHS. We need to examine the evidence on whether some of the blood tests are necessary. The carrying out of such tests might be a habit, because of the way that people have been trained at medical school and the way that things happen in their hospital environment, so I mean no criticism.
My main conclusion is that big savings can be made because of the potential new treatments available. We must examine the evidence carefully and talk to the experts in this country. I am not sure that they worry about NICE; they probably just go ahead and do things without worrying. They say that it would be nice to have some kind of guidelines. We know that people generally behave differently with different drugs, and that tests can be carried out in that regard. It would be nice if there were some guidelines about how much hormone someone needs, bearing in mind the evidence that is being produced in other countries and so on. Such guidelines are not available to us at the moment. We take that approach in many other drug fields but not in this particular one.
The people at NICE are my best friends. They give advice on cycles but someone in the Department of Health needs to examine the evidence and then talk to NICE about it; they need to consider the guidelines process in respect of how all this is carried out. As technology, science and medicine move on, it becomes a continual process. The time is now right for that kind of regime change.
NICE produced guidance in 2004, the short version of which states the following in relation to the side effects of ovarian stimulation:
“Your doctor should use the lowest effective dose and duration for ovulation induction”.
As far as I am aware, unstimulated cycles lead to a lower chance of achieving a successful pregnancy, therefore if the NHS is routinely offering one cycle of IVF, as it does currently, it is difficult to persuade potential parents that they should accept a lower chance of pregnancy on that one cycle. We must think in the wider context of achieving the NICE guidelines in full, including giving access to three cycles. If we did that, we might be able to lower hormone doses, with the possibility of moving to unstimulated cycles to some extent.
It is true that we must give people the best treatment available, so that they have the best chance of conceiving and having a child. Sometimes the evidence runs ahead of the guidelines. In this case, the evidence is saying that we just might not be in tune with other countries on the specific guidelines. It is all right saying what minimal means but we must specify the micrograms per millilitre or use some such terminology to define it. After all, we all have experience in the field of health and safety, where one fibre in a given amount of cubic centimetres of air is a specific target. In medicine, we specify things in most areas relating to drugs, but that has not happened in this one.
Of course, the doctor and the staff have the final decision about the reaction that an individual might have to something, but sometimes we think that overdosing will give a better figure than underdosing. The cost-benefit analysis has to be taken into consideration, so we must think about new guidelines. But, as the evidence suggests, it does not follow naturally that reducing the amount of hormone means that one’s conception rate is less. In fact, in some countries it is better, because the effects of overdosing can suppress the development of the embryo and because chromosome damages occur—more kids have chromosomes missing, things go wrong in the embryonic development process and so on. That concept is not new; it is just that the evidence is coming through now.
The issue of giving treatment to infertile couples is something that we must consider seriously day by day. We must examine the evidence and so on. The evidence for minimal ovarian stimulation in terms of hormone illustrates a way forward. The cost involved is another characteristic. We know that savings can be made in the health service. I am suggesting that the evidence will allow them to be made in this area. The evidence is coming in from different quarters. It is not being promoted by industry. It is being carried out by people who are practising at the coal face. We owe it to infertile couples to give them the best treatment stemming from the evidence and we might not be doing so at the moment.
Order. This is a most absorbing and important topic. I can see that hon. Members are keen to give it full coverage, but I must remind them that the Chair is required at 3.30 pm to give the Floor to the first of the three speakers who will give the winding-up speeches. Two hon. Members are seeking to catch my eye. We have limited time left. I call Martin Horwood.
I shall try to limit my remarks in line with your guidance, Mr. Cook.
I congratulate my hon. Friend the Member for Romsey (Sandra Gidley) on securing the debate. She made a thoughtful and sensitive contribution to this important subject. It takes an effort of memory to think back to the birth of Louise Brown in the 1970s—the hon. Member for Norwich, North (Dr. Gibson) referred to that—to how controversial the idea of test-tube babies was then and to the misguided moral panic that existed about the science involved in IVF at its outset. We are now in a situation where life is given to 8,000 babies a year and joy is given to thousands more parents. That is a moral outcome if ever there was one.
Sadly, the situation in Gloucestershire is rather different. In effect, IVF provision has been withdrawn. Eighty local couples a year, who would have been able to undertake IVF treatment, can no longer obtain it. Twenty or 30 of them could have been expected to have successfully conceived children. Sadly, the reason for this situation is extremely clear, because the Gloucestershire health community laid it out in its service change proposal:
“We are putting forward these proposals because we believe that they will enable us to…Direct funding instead to other areas of greater priority for local NHS resources”
“Assist the health community to return to a sustainable position financially”.
That is despite the fact that Cheltenham and Tewkesbury primary care trust never had a financial deficit. The health community’s proposal was the chaotic overflow from the way in which NHS finances were addressed last year.
The service change proposal went through and resulted in the local NHS ignoring the NICE guidance, which it had followed for only a year. The guidance recommended at least one cycle of treatment for families undertaking IVF, and my hon. Friend the Member for Romsey was right to emphasise its importance in that respect. The guidance asks PCTs to work towards three cycles, not least because the National Infertility Awareness Campaign has said that offering only a single cycle reduces support among potential parents for single embryo transfer, which eliminates the risk of multiple births and the associated health risks. The hon. Member for Norwich, North rightly noted those risks, and the Human Fertilisation and Embryology Authority study supports him, saying:
“the failure to implement the NICE guideline on fertility (3 cycles of IVF for all eligible patients) is the major obstacle to the acceptance by patients and clinicians of introducing eSET policies in the UK”—
eSET being single embryo transfer.
In Gloucestershire, it is possible to see some light at the end of the tunnel. I have pressed the new Gloucestershire PCT, which emerged from the reorganisation, to reintroduce IVF, and it has promised actively to explore the issue. We hope that PCTs such as Gloucestershire—perhaps with the Minister’s support—will be able to reintroduce IVF in the not-too-distant future.
I realise that time is short, so I shall leave the Minister with three thoughts. First, I support my hon. Friend’s emphasis on the wider public health linkages between IVF and issues such as obesity. As we have discussed in a number of ways, that might provide a more natural approach to tackling infertility and allow us to take a wider public health view, rather than always taking the most clinical approach. Given the Minister’s experience in public health and her support for it, I am sure that that will resonate with her.
Secondly, given the accepted NICE guidelines at national level, I hope that the Minister will support PCTs that seek to reintroduce IVF. I also hope that she will lobby hard, so that the ferocious spending round that the Chancellor of the Exchequer has promised us in the next year does not disrupt the provision of local NHS services in the disastrous way that it did last year and does not again disrupt the timetable for reintroducing valuable treatments such as IVF.
Lastly, if new legislation is forthcoming on issues such as the reform of the Human Fertilisation and Embryology Act 1990, I urge the Minister to ensure that it does not curtail the scientific possibilities of infertility treatments. In that respect, the innovations to which the hon. Member for Norwich, North referred are instructive. Clearly, many innovations are being made, including in stem cell technology, and it would be a tragedy—indeed, it would be immoral—if new legislation accidentally, or even intentionally, curtailed the scientific possibilities, which have a very moral outcome, as I said.
Successful IVF has a uniquely wonderful outcome. I certainly have two fantastic, lovely kids, whose current obsessions include diggers and Barbie movies—one cannot have everything. I would not deny the joy of their lives or the joy that my wife and I experience as their parents to any family.
Thank you, Mr. Cook, for calling me. I also thank the hon. Member for Romsey (Sandra Gidley) for securing the debate, and I particularly enjoyed her factual outline of the problem that we are talking about. We are trying to persuade the Minister not only to take that problem as a fact, but to resource solutions more effectively. The hon. Lady’s speech was supplemented by the valuable input of my hon. Friend the Member for Norwich, North (Dr. Gibson), who clearly outlined, from a much more medical perspective than I could, the needs that he believes should inform the way in which we treat infertile couples.
I speak from a very personal perspective. I am infertile and I adopted my baby. Before that, I went through what can only be described as probably the worst five years of my life, when I hoped constantly, but I achieved absolutely nothing at the end. As you know, Mr. Cook, I adopted a little girl, and she is very beautiful. I am so grateful for everything that she has given me. However, the distress that women and couples go through has to be seen.
We talk of one in seven, one in four and one in six people being affected, but the absolute fact is that we just do not know the figures. We must all grapple with the fact that this is invariably an invisible problem, with which couples attempt to cope privately because they feel so embarrassed and shy and do not know quite how to cope. The effects are often devastating, and it is important for us all to understand that, so that we realise the value of each of us, in our different way, banging the drum and making this group’s case to the Government again and again. I was keen to make that statement.
The second statement that I want to make references my belief, which the National Infertility Awareness Campaign supports, that infertility is a disease. This is not about a person’s inability, manhood or womanhood, but about a physiological process or an organ. For those who face infertility, it is crucial that we understand that the last thing we should be saying is, “You have a problem.” Somewhere along the line, there is ambivalence about what that problem is, but infertility is a serious medical problem, which needs to be treated if possible.
I now chair the all-party group on infertility, and when one speaks to infertiles, one quickly becomes aware of their total incomprehension at the fact that they cannot conceive. In addition, there is total hope that modern medicine will deliver for them. Finally, there is total despair when no treatment comes up or works. Those “totals” are often extraordinarily destructive. Infertiles are unable to believe that no one can diagnose their problem or that someone somewhere cannot resolve it. It is important for us all to understand just where people are in this debate.
The House has been very vocal about the issue of infertile couples and very supportive of them. The all-party group was set up by the hon. Members for Romsey and for South Cambridgeshire (Mr. Lansley) and has helped the campaign to educate and inform Ministers, Back Benchers, the public and the medical profession about the issues that they are attempting to handle. It has been incredibly valuable, and it now has 45 members, who are split between the House of Commons and the House of Lords. We have had support not only from Back Benchers and peers, but from Ministers and, indeed, Secretaries of State, who have made clear statements about the desire to see treatments put in place and work, so that people have the opportunity to conceive and to have the family that is so precious to them. Today, however, greater numbers than ever are infertile and they are unable to achieve a conception and deliver that most precious of things that they want—a family.
We have had statements from the Secretary of State for Health, who clearly supported the request from NICE with respect to the full implementation of the guidance on
“equal access for those with an established clinical need to a full range of services for the investigation and treatment of infertility”—
all free on the NHS. A second statement said that, when that investigation has achieved a conclusion, if it is considered appropriate, in vitro fertilisation should be the next step and a full cycle of IVF should be made available to couples. That was a staggeringly valuable and important moment for ordinary people who are desperate for that one thing.
However, PCTs do not or cannot support both statements. Either it is a financial matter, or it is a policy decision that they do not support. When we surveyed PCTs many of them simply did not respond, and we are left to think that that was because infertility is a low priority for them. We wanted to know where their struggles or concern arose, but they did not respond. Also, in discussing this question, PCTs ask what a full cycle means—one embryo implantation or three? There is worrying ambivalence, and not because those involved take the view that one course of action is cheaper and they will choose it; they believe that it is appropriate, and they put the treatment in place. Thus PCTs are not adopting the procedure that the Secretary of State has supported.
PCTs also tell women that they must be over 30—or sometimes over 34 or 36. I do not need to repeat what the hon. Member for Romsey said. The ability to conceive is growing less and less at that age, but a 22-year-old who has undergone all the treatments and diagnosis will be told, “Sorry, you have to wait.” That is not a sensible approach, and I am appalled that, 30 years on from my infertility treatment, I face the same hideous black, blank walls that I faced all those years ago. That is unacceptable. I ask the Minister today to impose compulsion—a regulation—on PCTs to do one easy thing: there should be open and clear evidence of the priorities that they define. We should know their stated priority for their locality. It should be open and unequivocal, so that we can see where their priorities lie. If there is a problem financially, let us hear about it.
In the north, we have the very valuable Centre at Life in Newcastle, with Professor Alison Murdoch. It is an incredible research-based institution that does state-of-the art development work. People in Newcastle and the surrounding area are getting the best of treatments. That is not the case for people in Stockton today.
I am very keen to acknowledge what is being done, but also to point out that what is being done is often ambivalent and unclear. Sometimes decisions are not being implemented. We do not have a national health service that treats infertile couples equally. Some people have that treatment; others receive a minimal service, and some pay through the nose for a service. It is not free; it is certainly not fair, and it is not equal. I ask the Minister to acknowledge that, and to insist that the PCTs should publicise in an open and transparent way which treatments they regard as appropriate when they engage in commissioning and use their funding. I ask her to state clearly—to make a formal regulatory statement—that all PCTs should acknowledge three embryo implantations to be the formal definition of one cycle, so that the ambivalence is removed.
I also ask the Minister to consider the Human Fertilisation and Embryology Authority with great caution. I have great concerns about much that comes out of it, and the White Paper consultation should involve taking note of what the medics in the profession are saying. I hope that that is what will happen.
I argue with passion, and I hope that I have not gone too much over my time. I have been involved in this issue for 30-odd years. I was so pleased when the Labour Government decided that funding should be made more available and that IVF cycles should be clearly defined as appropriate for infertile couples, but I am quite distressed to have to tell the Minister that we need a clearer, more careful examination of the treatments that are offered to our constituents, and we need very firm handling for PCTs when they are defining treatments as appropriate or inappropriate for those people.
It is a pleasure to follow the hon. Member for Stockton, South (Ms Taylor), who made a passionate speech based on her personal experience. She obviously knows the subject well, having followed it through the years. I strongly support what she said about the importance of openness in the setting of priorities by PCTs. At the moment, there is not the transparency that the public need.
I congratulate my hon. Friend the Member for Romsey (Sandra Gidley) on securing the debate. I found the debate fascinating and—as you said earlier, Mr. Cook—hon. Members are clearly well informed. It has been a pleasure to listen to the contributions of all the hon. Members who have spoken. My hon. Friend talked about the great public support for NHS treatment. We might not automatically assume that such support exists, but the evidence so far shows it does. She also referred to two surveys—her own and one by NICE. I am sure that they are both equally authoritative; but both found slow progress in implementing the NICE guidelines. That should be of concern to us all.
My hon. Friend mentioned the possible boost to the economy—and referred to academic support in that context—and discussed whether infertility treatment should be considered as part of a population strategy. I was fascinated by the point that she made about combining single embryo transfer with the introduction of three cycles to give the maximum chance of success.
It was fascinating to hear about the experiences of my hon. Friend—perhaps I may refer to the hon. Member for Norwich, North (Dr. Gibson) in that way—and particularly about the conference that he attended just before Christmas. It seems that we can secure a better success rate and greater safety for women at lower cost to the NHS—a win-win-win situation—if we can follow the guidance that emerged at the conference. It was interesting to hear of the international comparisons, and the overseas evidence that it is possible to achieve a higher success rate with lower hormone use.
The side effects of overdosing on hormone treatment are a matter of real concern, and I ask the Minister if she can respond to the evidence we have heard about that today. Will she explain what the Department is doing to follow best practice from overseas and ensure that we maximise the availability of NHS treatment by reducing the cost as much as possible in that way? I think the hon. Gentleman described that much safer approach as semi-natural, and it is an attractive proposition.
I come to the subject with no great background knowledge, and I was amazed when I realised quite what proportion of couples need help—one in six or one or seven, or possibly one in four, as the hon. Member for Stockton, South mentioned. I am acutely aware of the pain and distress that infertility causes—the hon. Lady referred to the despair that is felt. She described infertility as a disease, which is how it ought be considered so that we overcome the hurdle of it seeming like an optional extra for the NHS. That was an interesting way to describe it.
On international comparisons, I was interested to note that in the UK there are about 580 cycles of fertility treatment each year per million of the population, whereas in most other northern European countries there are about 1,050 per million—getting on for double the rate. In Denmark, 3.7 per cent. of babies are born as a result of IVF treatment, whereas in the UK the figure is just 1 per cent. I shall return to the economic case for at least considering a debate on extending the availability of IVF treatment.
I appreciate that the 2004 NICE guidelines were not mandatory, but were set out as an objective. However, they gave the clear statement that there should be three cycles of stimulated IVF treatment for women between 23 and 39. We all support NICE and see it as a wonderfully independent, objective basis for determining what the NHS should be doing. It seems contradictory, then, effectively to ignore its judgment in practice. It is not ultimately being followed. The Government supported the guidelines and gave a positive response to them, mentioning a phased introduction of the target of three cycles.
My hon. Friend the Member for Cheltenham (Martin Horwood) mentioned the evidence from around the country on the impact of deficits. Before Christmas, in its report on deficits, the Health Committee said that soft targets suffer most when trusts are deep in deficit. Answering a question recently, the Minister said that Gloucestershire, North Lincolnshire and Northamptonshire PCTs had all suspended fertility treatment. I ask her for an update on that: are more PCTs going down that route? I know that many have deep financial difficulties because of historic debt and that it is tempting for PCTs to do that. However, it is not sensible or right. Is the Minister sending PCTs any advice or guidance on the matter?
There has not been central guidance from the Department of Health to strategic health authorities or PCTs on implementing the NICE guidelines. Is such guidance expected and, if so, when? My hon. Friend the Member for Romsey mentioned that there has not yet been guidance on how to prioritise treatment for patients of varying social criteria. We heard earlier that the then Secretary of State introduced a social criterion immediately after the introduction of the guidelines by saying, effectively, that fertility treatment should not be available to families that already had a child, even one born to only one of the parents. Is that where it will end or will there be more objective criteria for determining the social factors to be taken into account?
I wish to mention the value and importance of information for couples. It is critical for couples to be given good-quality information on the optimal age range and matters such as the impact of smoking, alcohol, caffeine consumption and body weight. People ought to be informed about such things so that they can make better judgments and improve their prospects of giving birth.
I turn briefly to economic issues. We are experiencing low birth rates across the developed world. I was fascinated by what the hon. Member for Norwich, North said about the reasons for the decline in birth rates: the impact of sexually transmitted diseases, a reduction in sperm count for whatever reason—
That might be an affliction that the hon. Gentleman suffers from.
Birth rates are now frequently below replacement rates, which poses big questions for Governments in the developed world. At the same time, we have an ageing population. The ratio between the working and retired populations is changing to a disturbing degree. I am not sure whether it has been as a direct result of that, but part of the solution has been immigration. People of working age have come to this country, which has helped to increase the productive work force and to support the retired, ageing population through taxation. However, given current population trends, that is not enough. Any cuts to welfare entitlements will be heavily resisted and the pressure on Governments will be intense, considering the extent of the ageing population and the reduction in the proportion of people in work.
Another consideration is whether one can do anything to raise fertility rates. There should be a debate about whether extending the availability of IVF treatment should be considered in the mix of policy approaches. This is a growing problem for the western developed world. What are the Government doing to research that big policy area and what issues are they considering?
This has been an absolutely fascinating debate and I have learned a lot. There have been impassioned pleas for more to be done to ensure that people get access to treatment, and the chink of light at the end of the tunnel is that it might be possible to do so without inordinate cost to the NHS. That is the potential prize, and I will be interested to hear from the Minister what the Government are doing to ensure that we secure it. Apart from anything else, we should do everything that we can to resolve the personal pain and anguish that couples go through.
I share with others the sense that this has been a good and timely debate. I, too, congratulate the hon. Member for Romsey (Sandra Gidley) on initiating it. We are about two years on from the last time this subject was debated here in Westminster Hall and approaching three years from the point at which the NICE guidelines were promulgated. It is important for us to take stock—I was going to say of the progress, but to some extent it is the lack of progress, that has been made since then.
It has been said a number of times that the Government welcomed the guidelines but, as I said at the time, they welcomed NICE’s production of them and immediately, as it were, removed two of the three stumps. There is no point in asking NICE to produce guidelines and then for the Government—the then Secretary of State himself—to strip away one of their central conclusions. The guidelines stand together.
It has not been mentioned that the reason why three cycles of IVF are recommended is that that maximises the chances of success. Beyond three, the chances of success are subject to a law of diminishing returns. Going down to just one cycle means that there is probably half the chance of success of three cycles, yet the NHS is likely to have invested considerable effort in diagnosis and early investigations, much of which is likely to be wasted. There is a central point there about the NHS and NICE examining what is clinically and cost-effective.
The hon. Gentleman is absolutely right when he cites the financial investment and investigation process that precedes that one cycle. It is much more cost-effective to provide three. However, there is also the family’s emotional investment, which again builds up to just one cycle. It is much more effective for them, too, if there are three cycles.
That is right. Indeed, the hon. Member for Stockton, South (Ms Taylor) reminded us of the sense of distress—of a disease, as it were—that can be occasioned for couples who are infertile. They have a profound sense that the NHS is not there for them. As vice-chair of the all-party infertility group, I am glad that the hon. Lady was present to make those points. We have all discussed surveys, and the group undertook its own survey of primary care trusts in early 2005, producing what I think were authoritative results.
Two years ago, the then Public Health Minister said in this Chamber:
“Where existing provision is greater than one cycle—that is, two, as in the Rother Valley constituency—we expect provision to continue at least at that level.”—[Official Report, Westminster Hall, 26 January 2005; Vol. 430, c. 109WH.]
That is, from April 2005 onwards. One distressing result not mentioned is that, of the results that the all-party group received, 20 of the PCTs that funded more than one cycle intended to reduce their provision to one cycle from April 2005. Unless I am very much mistaken, a number of PCTs are still doing so. If they are not, I hope that the Minister will tell us. However, the concern continues.
Does the hon. Gentleman agree that all that argument might be irrelevant if it were proven that three cycles were no better than one cycle, minus the hormone stimulation received three times, and the fact that the individual’s recovery rate was better and the embryos were in better nick than they would have been after three loads of hormone treatment? Perhaps the evidence shows that once is enough.
I share the sense that the NHS should do what is most clinically and cost-effective. It is NICE’s job to do that. People say that the Department of Health should undertake research, but that is NICE’s job. It routinely revisits its guidelines to take account of the cost-effectiveness of single-embryo transfers—the cost-effectiveness evidence that the hon. Gentleman puts forward on minimally stimulated ovarian cycles. Bourn Hall clinic, where Robert Edwards and Patrick Steptoe began their work on IVF, is in my constituency, and I have seen its success rate with blast-assist transfers. There is a lot of potential, and it must be incorporated in the NICE guidelines.
To return to my central point, what is the point of asking NICE to revisit the guidelines and publish new ones if the Government still say that NICE guidelines will be superseded by statements from the Secretary of State? That is what they have done. Most PCTs have no intention of implementing the NICE guidelines in full and they have no timetable for doing so.
The hon. Member for Cheltenham (Martin Horwood) mentioned Gloucestershire, where IVF has been effectively suspended. As he may recall, the then Cambridge City and South Cambridgeshire PCT did so in the latter part of last year, too. It reinstituted IVF availability, but it is currently rationed. There might be 300 to 400 couples who require IVF each year, but the number has been restricted to 200. People simply go on to a waiting list, and more people are joining it than there are IVF cycles available.
The hon. Member for North Norfolk (Norman Lamb) asked where IVF is not available, and the Minister may know. I know that when I was in Yorkshire two weeks ago, GPs handed me a document dated 22 December from the North Yorkshire and York PCT, which said, among other things:
“With immediate effect, the PCT proposes to suspend the routine commissioning of a range of surgical and other treatments for a range of common non life threatening conditions.”
I did not know that the NHS had arrived at the point where it treated only life threatening conditions, but it seems to be true. IVF is listed under the heading “Suspension of Services”, so it will not be available in North Yorkshire, except
“where the female partner is nearing the upper age limit of 40. Where this is the case the referral should be sent to the PCT Exceptions Panel for consideration. The PCT will work with providers to ensure that eligible patients are still able to receive treatment before they reach the upper age limit.”
Treatment is being deliberately withheld from couples until the woman approaches 40—when the chances of success are reduced. The PCT has instituted an outrageous situation. I know that it has financial problems, but that path is deeply inequitable.
To be fair to the Minister, we have discussed the matter before and she has raised it before. She wrote to PCTs in June last year, when she rightly said that
“persistent inequality of provision is hard to bear, and hard to understand for those affected.”
The question is, what is being done about that? The inequalities persist, and some are being exacerbated by the way that PCTs respond to financial circumstances.
Will the Minister tell us how the Government are to respond? If she says that they are dropping the guidance that the Secretary of State gave in February 2004, that April 2005 meant one cycle of IVF and that in April 2008 the NICE guidelines will be available as intended, it will not cause every PCT to adhere to the guidelines straight away, but it will incorporate into the Healthcare Commission’s scrutiny of PCTs the question whether they comply with NICE guidelines. The enforcement of NICE guidelines is important.
Back in February 2004, the Prime Minister said not only what the hon. Member for Romsey said he said, but added:
“In the longer term, however, we think that we can extend it”—
the availability of IVF—
“even further, but we will release details of that when we are ready to do so.”—[Official Report, 25 February 2004; Vol. 418, c. 278.]
We are three years on. Are the Government ready?
I have two more questions. Sources of infertility are terrifically important, and we have discussed the doubling of chlamydia rates over recent years. The Minister has told us that at the end of June last year, 36 per cent. of PCTs had rolled out chlamydia screening. The target—intention, perhaps I should say—is that by the end of March, 100 per cent. of PCTs should do so. How many have done so now and will the 100 per cent. figure be reached by the end of March?
Another source of the lack of infertility treatment is the lack of availability of egg donors and sperm donors. The National Gamete Donation Trust said in October last year that the average wait throughout the country is two years and that it is very concerned about the lack of donors. The Minister knows that I objected to the removal of anonymity. Will she, even at this stage, accept that we should discuss the subject during the review of the Human Fertilisation and Embryology Act 1990?
I have a final plea. We understand the nature of the distress that we cause couples who are infertile. The NHS should be there for them—we believe in equitable access—but currently access is deeply inequitable throughout the country. Will the Government produce a means to overcome the inequity and the dreadful social criteria that are being introduced? They must do so before a case is brought, as one will be.
Let us take, for example, a couple who have children. The man has children from a previous relationship, but the wife, in her second marriage, has none. She could go to court and seek protection under the European convention on human rights and her right to family life, and I am pretty sure that she would have all the social criteria overturned. Why should we wait until such a case is brought before the Government do what is necessary?
This has been an interesting debate during which many issues have been raised helpfully and constructively. We have heard about what is and is not provided at the moment, and the debate has shown the extent to which the commissioning of such provision is informed by the best possible evidence of the most effective forms of treatment. I shall touch later on the question of how that process is informed by the prevention of problems with fertility—a point made by several hon. Members. Key to all this is how we get the best value for money.
In some small way, I hope that I can reassure hon. Members. Through the three years of work that I commissioned with Infertility Network UK, which began last year, I hope to find out what is happening to primary care trusts and look at the best possible practice—as well as some that is not the best—to try to answer some of their questions or go some way to debating further social criteria, the commissioning of services and the levels of hormones used. I was glad that my hon. Friend the Member for Norwich, North (Dr. Gibson) raised that last issue. My hon. Friend the Member for Mitcham and Morden (Siobhain McDonagh) brought it to my attention when she grabbed me in the Lobby to ask whether I was aware of the conference that has been mentioned.
To follow up this debate, I would like to ensure that my Department is aware of what is being discussed at that conference—I have no reason to suppose that it is not—and I hope that we can share that information with NICE, if that is not happening already. NICE will review the guidelines in 2008, and there are clearly several issues that could be looked at. I want the best possible commissioning process because there is wide variation, which I am sure many hon. Members know already.
There seem to be different levels of expertise in the commissioning of services for infertility and, on the other side of the coin, good examples of PCTs getting together to commission in a wider area, so they can share expertise and strengthen their commissioning. There are clearly very good results in certain parts of the country compared with others.
All those issues are important, and although we are dealing with the here and now, we have a responsibility to take a breath, tackle all the issues and see how they fit in with how fertility treatment can be better provided in the 21st century. It is fair to say, regardless of all the comments made this afternoon, that the NICE guidance was the first of its kind. For too many years, fertility services—how they are commissioned and purchased, and how patients are dealt with—had been left pretty much to their own devices. The NICE guidelines are not the end of the story. In some ways, they were the beginning of the challenge to discuss the issue in as rounded a way as possible.
The hon. Member for Romsey (Sandra Gidley) commented on what the then Secretary of State for Health said about one cycle of IVF, which was reflected by the comments of the hon. Member for South Cambridgeshire (Mr. Lansley). In many respects, that was an attempt by the then Secretary of State to be helpful in a situation where NICE recognised that moving to three cycles was not going to happen overnight, by any stretch, and it was also in recognition of the fact that some PCTs were not even offering one cycle.
Those comments, which may have been taken out of context, were that those PCTs that were not providing any cycles should at least attempt to provide one. In respect of couples living without children being a priority, again, I think that the then Secretary of State was trying to be helpful by not ruling out other couples and their family circumstances from being taken into account.
The hon. Member for Romsey, whom I congratulate on securing the debate, asked about trusts varying their criteria on social questions. That is an interesting point. NICE advises on clinical terms, but we are considering the question through the work that we are doing with Infertility Network UK to see what variation there is in relation to the social questions that are asked. In part, that goes to the heart of the issues raised by my hon. Friend the Member for Norwich, North about the science, the evidence and the most effective fertility interventions.
Should we put all our energy into using three cycles, or is one cycle better and more effective? I do not know the answer to that question, but it is worth exploring further. Due to the nodding that I saw during my hon. Friend’s contribution, I think that it is worth looking into. It could inform us better on how to proceed, and might lead to better consistency in the NHS in the commissioning of services. There remains a question of where social conditions fit into that process, as regards age and other issues.
I do not have to tell hon. Members this, but we have enormously increased the funding available in the NHS. In 2007-08, we shall put in £92 billion, and there has been a real-terms increase of 92.5 per cent. over this Government’s 11 years in office. Are people using that money wisely? I totally understand the comments made by the hon. Member for Cheltenham (Martin Horwood) and the concern in his constituency, where IVF services are suspended while financial deficits are dealt with.
Hon. Members have asked me whether more can be done about prevention. Chlamydia, for example, is a major source of infertility problems, and if we could do something about it, we might reduce the pressure on the waiting list. However, whether we are dealing with fertility services or public health, if we are to find the space and money to devote to those areas, the NHS has to reform how it runs its finances. There is no hope for services such as IVF and public health in other areas—
I am afraid that that is the case. We need a financial balance to create a level playing field, so that we can look at a different way of providing health services for the future.
If I have missed any questions, I am happy to write to hon. Members about them. However, I want to say the following in the short time I have left: what I have done to move the debate forward is fund Infertility Network UK to work with PCTs over a three-year period to identify what is happening on the ground. I recommend all hon. Members, including those who have not been part of the debate, to check that their PCT has answered the questionnaire—a point raised by my hon. Friend the Member for Stockton, South (Ms Taylor). I was happy to meet colleagues from the network recently to talk about how the survey has been going. I have done that with my own PCT, and asked it to copy me in to its response to the network.
We need to look at what is happening to services on the ground, and to social conditions and criteria. Once we have that information, the next step is to feed it back to the NHS and PCTs, and use it to look at where best practice is happening to inform, in a constructive way, those who may not be providing best practice in respect of what they can learn. It would be worth including in that information this afternoon’s debate, particularly the points made by my hon. Friend the Member for Norwich, North, to explore that process further.
Infertility Network UK knows that it is part of the work that will go towards the implementation of the NICE guidelines. The network’s particularly valuable engagement allows the voice of patients to be heard, which is very much part and parcel of what it sees as good practice for the future. Through an agreement with me, it is also considering chlamydia services as part of its survey, so we can take a twin-track approach by considering how important chlamydia screening is in reducing the pressure on services by treating it earlier and by consciousness-raising on the links between chlamydia and fertility to prevent chlamydia in the first place. That is supported by the Department’s sexual health campaigns, too.
We are trying to create an environment, which might not be that well recognised, where the debate can go beyond firefighting to something that is more sustainable for the future, more informed, more effective and more cost-effective.
I start by welcoming you to the Chair, Mr. Cook. Half an hour is too short a time in which to give a detailed examination of the issue in every respect, so I shall try to highlight only a few aspects.
My central thesis is that none of the lessons of Abu Hamza’s stay have been learned. In fact, the entire saga could happen all over again. He, his wife and his family would likely be granted British citizenship, housed by a local authority, assessed as being entitled to thousands of pounds in benefits from the general taxpayer and entitled to buy their home from the local authority.
Furthermore, Abu Hamza would likely neither be brought before a British court for terror offences—unless the Government relented and allowed intercept evidence to be used in court—nor, crucially, be prevented by the Chancellor’s supposedly tough anti-terror measures from transferring assets worth many hundreds of thousands of pounds from a terrorist suspect family member to another family member who had actually been convicted of terrorist offences. The nightmare that has been Abu Hamza’s stay in Britain could happen all over again. In fact, it could happen sooner than we think, because Abu Hamza could be released from prison as early as next year.
I should declare what my interest in the matter has been. I have followed the history of Abu Hamza’s stay in Britain closely since 1999, when, as leader of the Conservative opposition on Labour-controlled Hammersmith and Fulham council, I first became aware of Hamza’s status as a Hammersmith and Fulham council tenant, living in a highly desirable street property on Adie road in the heart of the leafy Brackenbury village in Hammersmith. I called for the council to investigate Hamza’s financial affairs in 2001, and further called for him to be stripped of citizenship and expelled from Britain.
I undertook a great deal of research on the purchase and sale of the Adie road property in Hammersmith and called for resignations on the council when it transpired that Abu Hamza and his family had been housed not just once but twice by the then Labour council. Locally, I called on the council to investigate Hamza’s benefits and his tenancy. In 2003, I called on the Government to investigate his financial affairs in detail. In this debate, I shall set out to correct some of the many instances of misreporting in the press on the Hamza affair and bring some new information into the public domain.
Abu Hamza was a man at the heart of international terrorism. He influenced both the 7/7 and the 21/7 bombers. Two of the 7/7 bombers spent at least two periods living in the Finsbury Park mosque, while a third attended to hear Abu Hamza’s speeches. According to his family in France, the so-called 20th 9/11 bomber, Zacarias Moussaoui, was changed by the Finsbury Park mosque experience from a happy, outgoing young man into a hard-line radical. Richard Reid, the shoe bomber, was also there, as was the police killer and ricin poison plotter, Kamel Bourgass.
The Government failed to act on much, if any, of that, and decided to act only after US authorities made a move for Hamza, seeking his extradition. As it would have been difficult to extradite him to the US for offences for which he might have faced the death penalty, the British authorities took the easier choice of finally putting him on trial here for stirring up racial hatred, various public order offences and one terrorism offence.
Hamza’s views were heinous. There has been much material in the public domain, which I shall not repeat, but I shall repeat material that I downloaded from his website—the website of the Supporters of Sharia—before 9/11. The website was taken down a few days after 9/11, but I shall read a few of its statements that were allowed to go unchallenged by our authorities:
“The Jews have landed to spread corruption. When they come into a land, you will find that corruption begins slowly, then escalates until they are handed over power with others out in front. This is the ways of the Jews, and it has not changed since Rome at the plot to kill Isa”.
Just before 9/11, the Supporters of Sharia published a book entitled “Jihad in America”, which said:
“Many have been asking why doesn’t jihad take place in America. I have been asking myself that question ever since I watched the bombing of Iraq, the Sudan and Afghanistan.”
The first failure by those in authority that I wish to examine concerns Abu Hamza’s right-to-buy purchase of his flat on Adie road, Hammersmith. It was the kind of property that many of the homeless people and those in poor accommodation in my constituency can only dream of—a street property in the heart of the leafy Brackenbury village, home to various media personalities and celebrities. Despite the fact that Hamza was on a wide array of benefits, the Labour council accepted his story that the funds to purchase the flat had come from donations via the mosque. It seems incredible now that the presence of those substantial donations, totalling £75,000, did not trigger the stopping of his benefits.
Just as incredible is the fact that the Charity Commission was at the time investigating the finances of the Finsbury Park mosque—or the North Central London Mosque Trust, to give it its official title—where Hamza had been preaching since 1996 or 1997. Indeed, during the long period between the right-to-buy application being submitted in 1998 and the final purchase on 22 May 2000, Hamza and the Finsbury Park mosque were the subject of a number of Charity Commission investigations. According to the commission, five years of accounts were not submitted by the trustees. To use its own words,
“investigating officers concluded that the internal financial and management controls as exercised by the trustees were inadequate.”
Some years later, in 2002, an order was made by the commission to suspend a Barclays bank account after it emerged that Hamza was a signatory to the account and after the trustees confirmed that they had not been aware of the existence of the account.
The information on the case is not yet complete, but there should be an urgent investigation of whether the £75,000 purchase price for the Adie road property came from diverted funds from the charitable mosque. That investigation should of course have been carried out thoroughly at the time. It seems extraordinary that a man on benefits could pitch up with £75,000, explain it as donations to fund the purchase of a house and not have his benefits stopped, nor have questions asked about the origin of such a large sum of money. It is also worth remembering that Hamza bought the flat for £75,000 and that his son sold it four years later for £228,000.
The second issue that needs urgent investigation is how the Labour council, having sold Hamza the flat on Adie road, managed to house him again, this time in an even bigger and better property—a five-bedroom house on Aldbourne road, Shepherd’s Bush. To give an idea of the desirability of the road, it is home to a Cabinet Minister and another member of the Government. Five-bedroom houses for social rent are in incredibly short supply in Hammersmith and Fulham, and one can imagine how that must appear now.
Order. I am listening carefully and doing my best to acknowledge that the hon. Gentleman is staying within the terms of the debate, which I must remind him is listed in the Order Paper as “Case of Abu Hamza and Government attempts to freeze terrorist assets”. I read that as national Government rather than local government, so I hope that the hon. Gentleman can confine his comments to that issue.
Thank you for your guidance, Mr. Cook. I am coming on to explain how the funds that were raised from the purchase of the property on Adie road include some funds that are at issue in relation to central Government efforts to clamp down on terrorist financing. If you bear with me, I shall try not to test your patience, but there is a point to the information that I have given.
It was not Hamza who was housed on Aldbourne road, but his wife. She had already been living there since December 1994, being supported by all of us, through income support, housing benefit and council tax benefit. The wife was originally housed by the council from 1989, in various properties. The reason for housing her at that time was that she was reportedly fleeing domestic violence at the hands of Abu Hamza. Domestic violence is a serious problem in my constituency, but I draw attention to the fact that after Abu Hamza and his wife were housed separately, they went on to have four further children together, making seven in total.
The Labour council seemed to be in complete denial that Hamza was living in the five-bedroom house on Aldbourne road.
Order. I must point out again that the hon. Gentleman is expecting a ministerial reply, but the Minister cannot be held responsible for the actions of a local council. The one thing that I want to avoid is the hon. Gentleman wasting his debate, so if he would please try to focus on national Government attempts to freeze terrorist assets, rather than on local government attempts to shuffle benefits into Hamza’s pockets, that would makes things much easier for the Chair.
I thank you for that guidance, Mr. Cook, and shall accelerate a little.
The council was in touch with the security services after Hamza was placed on the UN sanctions list in 2002, shortly after a G8 Finance Ministers conference in Washington, I believe. However, according to residents in Aldbourne road, Hamza was constantly watched by plain-clothes detectives, so the reasoning of the Department for Work and Pensions and the council in saying that they were unable to take action because there was no evidence that he was living in that property does not hold water. Everybody knew that he was living there.
As the hon. Gentleman may know, I was tracking Abu Hamza a year before he was. I asked my first questions about Hamza and his associates at about this time in 1998. I certainly agree with some of the hon. Gentleman’s points, but would like to make it clear that Hamza’s citizenship was granted by Mrs. Thatcher’s Government.
The key point is that I was asking questions about Hamza’s finances and benefit position from about that time. The problem was that the answers were always, “We don’t comment on individual cases.” However, the Chancellor wrote to me separately, making it clear that if I had evidence he would be prepared to consider it and take action in respect of any of the individuals concerned, not just Hamza.
Does the hon. Gentleman think that it would be right for the Government to be a little more forthcoming in their answers to hon. Members, even if that was in private? Secondly, has he put any of the evidence that he has produced today before the Chancellor so that it may be followed up in accordance with the UN requirements?
I can confirm that that was absolutely not the case; his assets were not frozen by the Government in 2002. That is accepted wisdom, and I shall come to it.
There is excessive evidence that Hamza was living in that property in Aldbourne road. Everyone accepted it, it seems, except the council and the Department for Work and Pensions, which were housing the family and paying them benefits. The council claimed that his wife was estranged and that describing her as Hamza’s wife
“elicits a negative emotional response”.
The fact that the children whose details were added to the application form all bore the surname Mustafa Kemal—the same as that of Abu Hamza—was, the council said, “of little evidential weight”.
Investigations should have been triggered into the housing benefit, the income support and the council tax benefit. However, in its defence, the council said that the primary duty to investigate Hamza and his family, and to look at past and present benefit claims, lay with the Department for Work and Pensions.
It can be established beyond reasonable doubt that Hamza was living in Aldbourne road. Indeed, the police’s dawn raid to arrest him in May 2004 found him there, and he, and/or his family, was the beneficiary of an expensive flat in Adie road or the proceeds from its sale. Given that Hamza might be released next year, we do not have a moment to lose.
That brings me to the freezing of terrorists’ assets. A year ago, we were told by the Chancellor that
“the Treasury…had to become a department for security…I have found myself immersed in measures designed to cut off the sources of terrorist finance. And I have discovered that this will require an international operation using modern methods of forensic accounting as imaginative and pathbreaking in our times as the…enigma codebreakers at Bletchley Park”.
I hope that his forensic accounting is more effective than that used by the former Labour council or the Department for Work and Pensions.
I am not going to re-rehearse the whole fiasco of the emergence, a few months back, of the fact that Hamza, despite being incarcerated in Belmarsh and despite the Chancellor’s order to freeze his assets in April 2002, managed to transfer the Adie road property to his son, who has himself been convicted of terrorist offences.
I have already established that Hamza needs to be watched carefully when it comes to finances. Indeed, he threw down the gauntlet to the Chancellor when his assets were frozen in 2002, telling The Sunday Times on 21 April 2002:
“I don’t have anything in the bank to freeze. So where are they going to get it from?”
At almost exactly the same time, the Charity Commission suspended Hamza from the mosque, partly because of financial irregularities. The alarm bells should have been ringing, but a year later he was allowed to transfer the Adie road flat to his son—and at nil value, it seems.
This was no ordinary son, but a convicted terrorist. Aged 17, he was jailed in Yemen in 1999 for plotting a bombing campaign against the British consulate, a western-owned hotel and the Anglican church in Aden. After leaving prison, he was deported to Britain. According to the Yemeni court case, Hamza paid for his son’s flight there and gave him £3,000 in cash to help him to carry out the offences. Hamza himself is wanted in Yemen for similar terrorist offences that led indirectly to the death of two Britons. That same son got a job on the tube after 7/7. London Underground said that he was allowed to work as
“he has no criminal convictions in the UK.”
So, despite all the assurances and the fact that Hamza was being watched by a number of agencies, the transfer of the Adie road property was allowed to go ahead. If the Government—
No, I will not. The Economic Secretary will have a chance to answer, and time is short.
If the Government had got their act together, the property could have been frozen as part of a benefits investigation. The Minister has told us that his Department was aware of the transfer at the time, but was powerless to prevent it. That transfer happened in June 2003. Only in October 2006, it seems, was the loophole closed.
On 18 October 2006, the Treasury Committee was told that the transfer could not have been stopped because the assets order affected only funds, not property. The permanent secretary to the Treasury told the Committee that
“the authorities were aware of this transaction”
at the time. Why, then, did it take more than three years to close the loophole?
If we had discovered that we were powerless to prevent terrorist transfers, surely the Treasury’s reaction should have been, “Let’s go get new powers.” It should not have taken three years. Further to that, I put a question to the Economic Secretary: is that loophole now closed? Can an individual subject to an asset-freezing order transfer an asset at nil value to another individual?
Despite all the assurances from the Chancellor, it seems to me that any Abu Hamza of the future, accused of terrorist offences, might not be prevented from transferring large assets at nil value to family members or other third parties. That loophole appears to me to be still open. If it is now closed, it still took more than three years to get there. The Prime Minister calls the Chancellor the “clunking fist”, but in this context he seems to be more of a ham fist.
I have outlined three areas in need of urgent attention: there should be an investigation of the funding of Hamza’s right-to-buy purchase in 1998 to 2000, an urgent investigation of the benefits paid to Abu Hamza and his family for many years, which continue today, and the closing of the terrorist finance loophole, along with the prevention of the transfer of fixed assets at nil value.
Abu Hamza has inflicted 10 years of pain on this country. It should trouble us all greatly that he may be released next year. He is a very dangerous individual, linked to many different terror plots in the past nine years. Moreover, he has been living at our expense, and many of the matters that I have outlined to the House today deserve urgent investigation. I look forward to the Minister’s response.
Mr. Cook, it is a great pleasure to serve under your chairmanship yet again, although for the first time in Westminster Hall.
I congratulate the hon. Member for Hammersmith and Fulham (Mr. Hands) on securing a slot for an Adjournment debate. He was concerned about the many misreportings in the press of the case of Abu Hamza. I fear that people reading the transcript of this debate so far, to the extent that they understand it, will also read a number of misreportings. I shall do my best to put the record straight once again, although I have done so a number of times.
I have answered the questions that the hon. Gentleman has put to me, and the same questions when they have been put to me by the hon. Members for Tatton (Mr. Osborne) and for Chipping Barnet (Mrs. Villiers). In fact, a few weeks ago I had a meeting with those hon. Members and the hon. Member for Hammersmith and Fulham. He put some of those points to me; I answered them at the time and he put the answers on his website. But he asks me the same questions again and again in a way that fundamentally misunderstands both the law and the facts of the case. I shall try to set the record straight.
People listening today or reading this debate probably will have missed some crucial facts. First, Abu Hamza’s assets were, in fact, frozen in April 2002, and he is currently serving a seven-year prison sentence in Belmarsh following his conviction in February last year on six charges of incitement to murder, two charges of stirring up racial hatred and one charge under section 58 of the Terrorism Act 2000 for possessing information
“likely to be useful to a person committing or preparing an act of terrorism”.
He lost his appeal against the conviction and is now seeking to appeal in the House of Lords.
Those wider issues and the many issues that the hon. Member for Hammersmith and Fulham raised about the history of benefit fraud are not really matters for me as a Treasury Minister. They have been widely discussed in the public domain. As I understand it, the case in 2003 of benefit fraud was closed on the advice of the police. Until now, it was not on the agenda in relation to today’s debate.
I would like to set out the facts for the hon. Gentleman and the House. Before I discuss details, I would like to make two general points. First, counter-terrorist financing is an important part of my work at the Treasury. We take our responsibility for asset freezing very seriously. As hon. Members will be aware, this morning eight arrests were made in Birmingham under the 2000 Act. My right hon. Friend the Home Secretary said that that action serves as a reminder of the real and serious nature of the threat that we face. We have acted and legislated decisively and repeatedly in recent years to tighten and toughen the regime for freezing assets and tackling terrorism financing. In the past few months alone, we have passed new orders to deal with al-Qaeda and the Taliban and terrorism. They allow the use for the first time of classified intelligence material in asset-freezing cases and restrict the payment of state benefits to listed terrorism suspects.
Not yet. As a result of those actions, important progress has been made. We have frozen nearly 200 bank accounts holding a total of some £500,000—the frozen money of suspected terrorists. In addition, since 2001 there have been cash seizures under the 2000 Act totalling £469,000, forfeitures by those suspected of involvement in terrorism totalling £126,000, and seizure of £1.4 million of terrorist funds under the Proceeds of Crime Act 2002. My first point is, therefore, that we have been acting decisively, and with substantial results.
My second point, which I have made to the hon. Gentleman and his colleagues several times, is that in the national interest, given that the matter is one of national security, we should be trying to achieve cross-party consensus and not descending into political point scoring and the misrepresentation of information. I am always eager to co-operate with my hon. Friends and Opposition Members in sharing information, but there is a way to do such things, and I do not think that the hon. Gentleman’s conduct in these matters has been consistent with trying, in the national interest, to build consensus about the way forward.
Let me turn now to the matter of Abu Hamza and property transfer. It has been alleged before and again today that he was able to buy and sell properties while he was in custody, thereby contravening our asset-freezing regulations. I will repeat again as firmly as I have in the past, because that is a serious allegation, that Abu Hamza did not buy any property while subject to an asset freeze or during his time in prison.
No, I shall set out the facts first and then I will take an intervention. It will be worthwhile if I recap the facts to prevent further confusion. Abu Hamza already owned a property in Adie road when his assets were frozen. In June 2003, it was transferred for nil value to his son. The police considered whether the transfer constituted a criminal offence under the Terrorism (United Nations Measures) Order 2001 or the Al-Qaeda and Taliban (United Nations Measures) Order 2002. On reviewing the evidence, they concluded that no offence was committed, as the property was transferred for no economic benefit rather than sold and no funds were made available to Abu Hamza. The police reached the same conclusion on the evidence that Abu Hamza’s son sold the property in Hammersmith and purchased a property at Hicks avenue. They decided that no criminal offence had been committed and no funds were made available to terrorists.
The hon. Gentleman claims that the new orders that we introduced last autumn would have meant that those transfers constituted a criminal offence. When I had a meeting with him in December, I set out the position clearly that under the old and new orders, and under UN, EU and UK law, a transfer of property with nil value and therefore no transfer of funds to the designated individual was not, in the judgment of the police and the security services, an illegal act. I set that out in detail to the hon. Gentleman. Six weeks later, the same allegations are still being bandied around.
Today he called for urgency and asked more detailed questions about benefit transfers that go beyond my ministerial remit. After our meeting, he put on his website a report of the meeting and a report about the dealings of a particular designated individual and his family. He complains on his website that I said that I would like to have in writing the details of his concerns so that I can investigate them. The meeting was on 18 December; today is 31 January. I have no evidence of having received a detailed letter from the hon. Gentleman. Indeed, I rang his office this afternoon to ask whether it had been sent, because there was no receipt by my office of such a letter, and I was told that they did not know the answer, that they would have to get back to me, and that they had no evidence of a letter being sent. I have no evidence of a letter being received.
In a moment. The hon. Gentleman lectures me about the importance of urgency. I said to him that he should put down his detailed questions, and that I would give him answers. Some weeks later, I can read about our meeting on the website, but I have yet to receive a letter with the detailed questions.
Instead, we have a repeat of the same allegations. They are a misrepresentation based on a misunderstanding of the law, as I have set out clearly in the House of Commons Chamber and in a written document placed in the Library in reply to the hon. Member for Chipping Barnet. I repeat again: there was no illegal act, there was no illegal transfer of funds. The continued allegation that there was undermines the standing of the police and the security services who are responsible for such matters, and the wider credibility of the British regime against terror. On that basis, I am happy to give way.
I am delighted that the Economic Secretary has finally given way. I should make one thing clear: at no point was there an allegation about buying and selling property. My comments about Hamza buying property and his son selling it were carefully phrased.
Secondly, I did not say that the transaction was an illegal act. The Economic Secretary has missed the point. If it was not an illegal act at the time, why was it not, if the Government are clamping down on the transfer of terrorist assets? A valuable fixed asset was transferred between somebody who was accused of terrorist offences and a son who had been convicted of terrorist offences.
I am happy to answer the question again. Abu Hamza is an individual who is designated under UN law as a terrorist suspect. Therefore, under UN law, under EU law and under UK law, the transfer of resources to him—his receiving revenues—would be an illegal act. There is no evidence, as the hon. Gentleman now acknowledges for the first time, that such a transfer of resources to Abu Hamza occurred. It is true, as I have always accepted, that a property was transferred for nil value to his son, not to Abu Hamza, the designated individual who received no resource. The son is not a designated individual and it is not a criminal offence for him to receive an asset or property.
The hon. Gentleman makes allegations about so-called events that occurred in Yemen. Whether designation occurs is a matter of advice to us from the police and the security services, and at no point has any advice come to us that the son should be designated. Unless the designation is made, the law does not apply. We act not on the basis of hearsay and misrepresentation but on proper evidence from the police and the security services. In this case, it has not arrived—and it certainly has not arrived in this debate. Perhaps when I receive the letter from the hon. Gentleman I will see some evidence, but, as I have yet to receive any correspondence from him six weeks on, I begin to doubt whether I will receive such evidence.
In a classic way, the Economic Secretary is making allegations about allegations that have not been made, but I put a specific question to him: is he happy for people who are charged with terrorist offences to be able to transfer fixed assets at nil value? The implication is that he is.
I am happy that the Economic Secretary is still with us. I shall make a point of sending him the speech that I am about to make. I shall make a number of points about the comprehensive spending review, and I am sure that he would be most interested in pursuing early intervention as an important part of that review.
I am delighted to have secured the debate, not least because it is the latest in a sequence of debates that I have held with Ministers in different Departments, all of which cover the same subject of early intervention. Ensuring that those between the ages of nought and two get the right start in life is the best sort of early intervention that we could make. In my experience as Member of Parliament for Nottingham, North and more recently as chair of One Nottingham—the local strategic partnership—the earlier we intervene the more effective we will be in tackling the symptoms that appear later in life. Those symptoms include the inability to learn and interact at primary school, the disruption of classes at secondary level, antisocial behaviour, petty criminality, drug abuse, failure to get skills and work and, perhaps most crucially, the inability to form effective social and personal relationships.
My constituency sends the fewest young people to university of any in the UK. One in eight young people cannot read the first lesson at secondary school and 58 per cent. of births in Nottingham take place out of wedlock. Breaking the intergenerational replication of those symptoms by early intervention is the key. All those problems can be traced back to the early years if the skills necessary for later social and emotional literacy and empathetic behaviour are not acquired by the youngest in our society from their parent or parents.
The home learning environment is the key to attainment, as the work of Professors Sylva and Sammons at the university of Nottingham has demonstrated and as the Chancellor of the Exchequer has generously acknowledged to them. One Nottingham and our partners will propose a coherent set of programmes to make real our concept of Nottingham as “Early Intervention City”. We will propose 12 important policies, the cornerstone of which will be effective intervention for those aged from nought to two and their parent or parents. That immense social responsibility falls on health visitors and midwives, who do an incredible job in my city. I want to dedicate my speech and our further work to them because of the fantastic work that they do.
I want the Government to understand that heroic personal effort is not the basis of a sustainable strategy. That is why the work of Professor Olds on nurse-family partnerships assumes a massive significance. I congratulate the Government, particularly the Department of Health and the Cabinet Office, on their foresight in pursuing that and putting it at the centre of the social exclusion action plan. The Government have already requested bids for 10 pilot schemes, and I understand that more than 63 organisations have applied, including the primary care trust in Nottingham. As an aside, I should say to the Minister that the project is of such importance to us in Nottingham that, if the PCT bid were to fail, One Nottingham would consider funding an identical project. I hope that, if that eventuality were to come to pass, his Department would offer us its assistance in that difficult task.
Essentially, the scheme ensures that the most deprived families will receive intensive visits from health visitors for two years. However, let us not mistake an effective policy instrument for a strategy. We need to ensure that the pilot schemes do not end their work when the initial funding runs out, but are mainstreamed. That will require appropriate capacity in the health visiting service and the consequent substantial funding that that implies. It will require many other agencies and partners to support that effort. It would be unacceptable for the long-term burden to fall on the PCT alone.
The comprehensive spending review—hence my opportunistic remark to the Economic Secretary as he left the Room—should remake that part of social policy. It is important that the Minister does not answer my questions with the statement that resources are available in the baseline—I am sure that he would not. The point is about additionality and the challenge of Derek Wanless on prevention and on securing good health for all and, remarkably, on being able to reduce the percentage of gross domestic product spent on the NHS. I have today requested a meeting with the Chancellor to discuss that and the need for an ambitious public service agreement target on early intervention.
A proper examination of health visitors’ case loads is also required. In Nottingham, they are between 270 and 435—10 times more than that prescribed for nurse-family partnerships. Nottingham has 54 whole-time equivalent health visitors for the whole city. Does the Department know how many health visitors would be needed to roll out nurse-family partnerships for the whole of Nottingham, or indeed for the UK?
I could try to make a case for health visitors, but the most eloquent expression that I have comes from a health visitor. She told me this week about the problems that need to be resolved: the lack of investment in health visitor training, as the course time was extended, which meant that the numbers of health visitors had to be reduced; the pay structure for health visitors—under “Agenda for Change”, midwives now get a higher salary than health visitors, as do ward sisters—and the fact that many nurses who wish to undertake the health visitor course are experienced nurses and cannot keep their grading if they switch to health visiting, which is already having an impact on those coming forward. It is extraordinary and perverse to drive experienced nurses away from preventive work, and I hope that the Minister can announce an early remedy.
The health visitor continued by saying that health visiting has become a Cinderella service. The work that health visitors do is preventive, and so the service is always cut when financial problems arise. No one understands what they do, and the nature of the job means that they cannot promote themselves in the same way as midwives can. They do wonderful work, but it is hidden and they have not been good at evaluating their work to prove their worth. They are now involved in immunisation clinics, which takes up many hours of their time, and case loads are too high in many areas.
The Government need to come to terms with the harsh reality that the magnitude of the early intervention needed to break the intergenerational cycle in a place such as Nottingham is qualitatively and quantitatively different from our ambitions. To put it bluntly, it has to be part of the bigger vision for society of a new Prime Minister. Patch and mend and the odd short-term pilot here and there just will not do.
All health visitors are qualified nurses or midwives with additional special training and experience in child health and health promotion and education. Every family with children under five has a named health visitor who can advise on everyday difficulties such as teething, sleeping and feeding, as well as immunisation programmes, parenting classes and managing difficult behaviour. Health visitors, properly trained and resourced, could become the means by which we intervene to end intergenerational underachievement.
Alan Sinclair’s excellent report “How Small Children Make a Big Difference” says:
“We screen all pregnant women for factors associated with the child’s health—from a clinical perspective. We ought at the same time to screen for social factors that will adversely affect the journey of the women and children.”
The nurse-family partnership home visiting programme takes that further. It was set up by Professor David Olds from the university of Colorado, and it has three key goals. First, pregnancy outcomes can be improved by helping women to practise sound health-related behaviour such as prenatal care, improving diet and reducing the use of cigarettes, alcohol and incidences of substance abuse. Secondly, children’s health and development can be improved by helping parents provide responsible and competent care for their children. Thirdly, the family’s economic self-sufficiency can be improved by helping parents to develop a vision for their own future, to plan future pregnancies, to continue their education and to find jobs.
Home visitors are highly educated registered nurses. They receive more than 60 hours of professional training from the nurse-family partnership professional development team. Nurse home visitors and families make a 30-month commitment to one another, following which 64 visits are made per family. They begin making visits during pregnancy—no later than 28 weeks after gestation—and continue through the first two years of the child’s life.
Key elements include the targeting of the programme to support at-risk families, specific training aimed at supporting parental behaviour to foster emotional attunement and confident non-violent parenting. An average of 33 visits per family are made, from the onset of pregnancy until the child reaches the age of two. Visits last on average between 75 and 90 minutes. Each nurse has a case load of about 25 families. I should not refer to the Public Gallery, but I see that that objective has raised some smiles. Those figures are a world away from health visitors in the United Kingdom, as they are rarely able to afford more than 20 or 30 minutes per visit, because their case loads are so high.
In addition to helping parents to attune emotionally with their children and to use consistent and more appropriate discipline regimes, the nurses help the mothers to envision a future that is consistent with their own values and aspirations; help them evaluate contraceptive methods, child care options and career choices; and help them develop concrete plans for achieving their goals.
Nurse-family partnership mothers are less likely to abuse or neglect their children, have subsequent unintended pregnancies, or misuse alcohol or drugs, and they are more likely to stop needing welfare support and to maintain stable employment. Among the partnerships’ striking successes are a reduction in child abuse and neglect of 50 per cent. in Elmira and a reduction in Memphis of 75 per cent. in hospitalisations due to non-accidental injuries. That 26-year evidence base cannot be denied. Compared with control group counterparts, families who participated in the Elmira trial exhibited the following successes 13 years after the programme ended. It was not a flash in the pan, and people did not say, “Let’s make it up; we think it is a good scheme.” It is fantastic evidence. There were 69 per cent. fewer arrests of low-income unmarried mothers in the 15 years following the birth of their first child. There was a 44 per cent. reduction in maternal behavioural problems due to substance use—imagine the money clocking up that is being saved. There has been a 32 per cent. reduction in subsequent pregnancies. The interval between the birth of the first and second child is now two or more years. There has been a 30-month reduction in the need for welfare. There has been an increase of 83 per cent. in employment by a child’s fourth birthday. Among the children of low-income unmarried mothers, there have been 56 per cent. fewer emergency room visits where injuries were detected. There has been a 79 per cent. reduction in child maltreatment. There have been 56 per cent. fewer arrests and 81 per cent. fewer convictions among adolescents; and 15-year-old children had 63 per cent. fewer sexual partners.
It is our ambition to give Ministers in many Departments similar outcomes for Nottingham when our nurse-family partnership has taken root. A health visitor told me this week that such a programme would
“get the service back on track again; we did this intensive visiting 28 years ago, and we were told to stop because we were making people dependent on us.”
As a result of its success, the nurse-family partnership is offered in 20 American states, and it serves more than 20,000 families annually. The programme is not cheap—it costs about $8,000 per family for two and a half years’ support. However, economic evaluation by the Rand Corporation shows a payback to the public purse of four times its cost. I believe that that could be a massive underestimate, as the positive benefits of creating happy, healthy and well-adjusted children roll forward into every succeeding generation.
The nurse-family partnership is tested and highly recommended. It topped WAVE’s evaluation system and was recommended by the Sure Start review, the Blueprint programme, Support from the Start and Communities that Care. However, the key question for Nottingham does not concern the viability of nurse-family partnerships or the success of the pilot, but the mainstreaming of the nurse-family partnership once the pilot has proved successful. When I convened a meeting of local health visitors, they all said “This is great and we’ve done it before, but it is never sustained.”
I ask my hon. Friend the Minister to consider these questions. First, what negotiations is he having within his Department and under the comprehensive spending review to prepare for successful nurse-family partnerships to be rolled out that are financially sustainable? Secondly, what measures are in hand to increase the recruitment and retention of health visitors—in particular, to increase their public profile and prestige—and, alongside that, to introduce the concept of early intervention? Thirdly, what measures are in hand to reduce the case loads of health visitors, so that they can make more effective and lasting interventions?
Without effective early intervention, we are condemned to repeat history with our deprivation and underachievement. However, with a package of effective measures, Nottingham can become “Early Intervention City”. Our ambition is not to service the cycle of intergenerational failure but to shatter it, and to give kids in Nottingham—and, we hope, throughout the UK—the life chances that they deserve.
May say what a privilege it is, Mr. Cook, to see you in the Chair again today? I spent the morning with you. I hope that hon. Members do not take that the wrong way, but you know exactly what I mean.
I congratulate my hon. Friend the Member for Nottingham, North (Mr. Allen) not only on securing this Adjournment debate but on the leadership that he is providing in Nottingham. His passion and commitment are focused on ensuring that Nottingham can truly claim the title “Early Intervention City”. That would be a first for the United Kingdom. More significantly, my hon. Friend is working to get us, at the national level, to reflect on what we really need to do to replace intergenerational deprivation with what I described when I had the skills portfolio as intergenerational advance.
Frankly, nothing could be more important than that for a Labour Government. People ask what is our core priority—what do we most want to transform in our society? It would be the greatest legacy for this Government, for as long as we last—and I hope that we will last for a long time to come—if history were to say that the policies that we put in place had genuinely laid the foundations that would help to shatter a society that is still too divided, that still has too much disadvantage and in which far too many people are still denied the economic and social opportunities that hon. Members take for granted.
May I say to my hon. Friend, in all authenticity, that he is doing a great service not only to his city? I believe that we should endorse the concept of the early intervention city, and that Nottingham should be the first such city in the United Kingdom. I hope that that will be seen as trailblazing the concept for other parts of this country.
It also makes an interesting point about the role of politicians in a modern world. Sometimes we are sucked into believing that the only way to make a difference is to attend Committees, sit around tables, and give people titles—some of which may be ministerial. My hon. Friend has demonstrated the power that can be used by a constituency MP who is willing to step up to the mark, provide community leadership and make a difference in a transformational way. My hon. Friend knows, as all politicians do these days, that we will be judged by our actions, not our words, and by the outcomes as a consequence of those actions.
The nurse-family partnership is fascinating because it is almost a missing piece in the jigsaw. The Government’s record on early intervention post-1997 is extraordinary. It is even more extraordinary that this country was so far behind in early intervention by 1997. Frankly, that was a scandal and a disgrace. In terms of our long-term economic and social interests, people often forget that, as a society, we did not even have the infrastructure or the architecture to provide early intervention, which is the most powerful thing that we can do to break the cycle of intergenerational deprivation.
The nurse-family partnerships represent the missing piece of the jigsaw, but let us look at other elements. On maternity services, we are about to produce a significant plan that will demonstrate how we will make a reality of our commitment to choice for every parent all over the country. People forget that antenatal and post-natal maternity services are every bit as important as those relating to the birth itself.
We have developed Sure Start and will be providing children’s centres for every neighbourhood and community. However, what matters is what goes on in those children’s centres; simply having them will not make the transformational difference required. This Government introduced universal nursery provision. Other countries had taken that for granted for decades, but it was this Government who introduced that in this country. Another important piece of the jigsaw is the financial support for individuals and providers. That is needed massively to expand access to quality child care.
Another missing piece of the jigsaw could be what my hon. Friend describes as social education in primary schools. That has begun in his constituency and I know that it is happening in other parts of the country. There is a case for looking at the potential to mainstream that in our education system. As a Health Minister, I am not sure I am supposed to say that so let us hope that no one is listening too closely at the Department for Education and Skills—or maybe we should hope that they are.
On the question of the bid, the number of local authority primary care trust partnerships that have submitted bids for the pilots is reassuring and exciting. It is good news that the number of expressions of interest has been as high as it is. More than 40 per cent. of partnerships have submitted a bid. I agree with my hon. Friend’s point that the purpose of the pilot is not, in this case, to see whether it works—the evidence is overwhelming on that. The purpose of the pilot is to learn the lessons to enable us to mainstream the scheme as effectively as possible.
Obviously, we are about to announce the successful bids and it would be inappropriate for me to go any further than that during this debate. The message from my hon. Friend, which has been delivered privately as well as publicly, is that, irrespective of whether this particular bid from Nottingham is successful, he intends to ensure that the programme is set up in Nottingham. The commitment that I make is that if he is able do that by pulling together the necessary commitment and resources within Nottingham, we will extend to him, and the relevant partners in that city, the maximum possible assistance to enable them to achieve their objectives. Depending on our satisfaction with the design of the programme in Nottingham, we may also—and it is only a “may” at this stage—be willing to extend the evaluation to the project that Nottingham may or may not design. However, we must not prejudge the outcome of the bidding process at this stage.
I will turn to a number of other issues that my hon. Friend raised. He rightly makes an incredibly strong case for health visiting as a profession and for the distinct contribution that health visiting should and does make. We want it to make a more significant contribution in the future. It is true that, to some extent, health visiting is going through a difficult time in many parts of the country. The number of nurses in the NHS has increased by more than 85,000 since 1997 and the number working in the community has increased by 36 per cent. during that time. We can point to a significant overall increase in the number of health visitors. Undoubtedly, all too often, primary care trusts do not regard health visitors and the contribution that they make as being as powerful and important as it is.
As it has not been given much publicity, my hon. Friend is probably not aware that my right hon. Friend the Secretary of State recently announced at the Amicus health visitors conference a fundamental review of the role of the health visitor in a modern society and health service. A big part of the outcome of that review will be the role for health visitors envisaged in these pilots.
There are some difficult issues to resolve; for example, the nature of the universal service that is available to all parents and families from health visitors as opposed to more intensive, targeted support. As the Minister responsible I do not think that the nature of the service is clear. There is much work that needs to be done with the professional bodies, representative organisations and trade unions to tease that out. What is the minimum entitlement that every family has a right to expect from the health visiting service wherever they live? In addition, what is the offer? Will it be focused around the model and the partnerships outlined in the work of Professor Olds? We have to resolve that issue as part of the review.
I reassure my hon. Friend and others that we understand that health visiting is at a crucial point. We need to look at the interface between health visiting and other professions. As completely different professions develop and emerge, we want to encourage much closer working relationships between people irrespective of their professional titles or job descriptions. We need to consider how to get maximum gain from health visitors, midwives, maternity support workers, mentors and the range of professionals who are out there trying to do their best to—as my hon. Friend described it—break the cycle of intergenerational deprivation. How do we bring all of that together in a maximum powerful way? In that context, we must recognise the distinct professional expertise and background that health visiting has to offer every community, and the review will be important in relation to that.
My hon. Friend also asked about mainstreaming the resources and the comprehensive spending review. The Economic Secretary would not forgive me if I gave anything away, but he is absolutely right to say that we must plan ahead—his predecessor would have taken a similar view. The evidence is already there and if these pilots are successful, it would be a shame to have to wait four years before we can expand them. The guidance that we give to commissioners in the health service and local authorities is another vehicle by which we could insist over time that this cross-government outcome on early years prevention and intervention becomes one of their priorities. Therefore there are other levers available.
My hon. Friend also asked about the case load of health visitors. That is part of the review and the consideration in terms of a universal service as opposed to an intensive and targeted service. Clearly, the nature of the service determines what is a realistic case load to take on to add true value and make a real difference, rather than having a superficial relationship with people that is not able to create the changes that we want.
There are many exciting things happening: the pilot, the plan to deliver maternity choice, and the review of health visiting. We need to ensure that that all comes together and contributes towards the missing piece of the jigsaw in terms of early intervention. In the end, it is about breaking that cycle of intergenerational deprivation—
It being Five o’clock, the motion for the Adjournment of the sitting lapsed, without Question put.