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Westminster Hall

Volume 457: debated on Wednesday 21 February 2007

Westminster Hall

Wednesday 21 February 2007

[Mr. David Marshall in the Chair]

Home Care (Elderly People)

Motion made, and Question proposed, That the sitting be now adjourned.—[Liz Blackman.]

I am delighted to have this debate for two reasons: first, because of the importance of home care for the elderly, but particularly, Mr. Marshall, because it gives me the opportunity to participate in a debate under the benign chairmanship for which you are renowned.

I approach the subject of home care for the elderly with some trepidation. Social care policy is a separate world with a language of its own and, in this Chamber, one tends to leave such subjects to the experts. I got involved when I continued to meet elderly constituents or their relatives who were complaining bitterly about the withdrawal of home care support. One case that stood out was that of Mr. Thomas Place, who is not only a war veteran, but a hero with medals for bravery. Thomas is 93, is in a wheelchair and lives alone. When I met him at a Remembrance day ceremony, I was astonished and angered when he told me that his one-hour-a-fortnight home care support had been withdrawn. There was anger throughout Leeds because, quite rightly, the local paper splashed the story on the front page. A number of people rang in to say that they would take care of his home care personally, such was their anger at the plight of that elderly gentleman.

Initially, I thought that a mistake had clearly been made, until I met other elderly residents—all in different circumstances, but at an advanced age and frail and vulnerable enough to justify support. I met ladies in their late 70s, one with recurring mental health problems, who had all been assessed as not being serious enough cases to need support, despite their backgrounds. Although Thomas Place’s case stood out, it was not the worst that I have come across. I know of an elderly couple, both struggling with ill health and living in bad circumstances, where the man struggled to help his wife, despite his medical condition, and often at great physical cost to himself. That is not an isolated event. The whole business of home care would collapse if it were not for the vast army of unofficial carers, unpaid and unsung, who voluntarily put in many hours daily, looking after relatives and neighbours.

Still thinking that this was a local matter, peculiar to east Leeds, or at best, to the city of Leeds, I made further inquiries and it emerged that the local council is carrying out a review of people receiving the service. Of the 2,471 cases reviewed by January last year, 751 were deemed not to require the service and 406 had their hours reduced. Nearly 50 per cent. of the elderly people reviewed so far had their hours taken away or reduced. On questioning that approach, I was assured by the council that it was all being done at Government diktat and was caused by Government cuts in grant. That proved, as the Minister will confirm, not to be the case, but I soon realised that the policy of cuts and reassessment was being replicated throughout the country.

Thanks to the excellent Commission for Social Care Inspection, I discovered that 100 of the 150 main commissioners, who are mainly local authorities, had changed their criteria for home care—that is two thirds of them. As a result, thousands of elderly people had lost their support, and the CSCI gave figures that showed the effect of that. The number of households receiving support fell from 528,000 in 1992 to 354,500 in 2005. My immediate thought was that perhaps the money had been cut after all, but again the CSCI said that the contrary had happened. Although I do not have the figures—I am sure that the Minister will be delighted to produce them at the appropriate time—commentators on the sector accepted that that was the truth, and that resources were actually much higher during the same period.

The agreed explanation seems to be that, as people are living longer in greater numbers, the result is that much more expensive care packages are required by the minority who run into ill health. That is also the result of the effect of the Government’s policy of getting people out of hospital sooner, which is a welcome one, and of trying to keep people independent in their own homes for as long as possible, which is the avenue favoured by most elderly people. The net result is that most councils have more people falling within the substantial and critical categories, and to service those, other categories of need are being ignored. That leaves Thomas Place and those like him bereft of care, and left in what are often difficult and undignified circumstances that cause great distress and can have dangerous consequences, as I shall relate in a moment.

At this point, I should like to break off and talk about a second phenomenon that I have discovered which I thought was a Leeds one: the extent to which the old home help service—now the home care service—has been quietly privatised. Some hon. Members will not complain about that, but to my mind it has been carried out very questionably, and speedily, in an area where customers are vulnerable.

We will put it to a vote.

I am glad that my next-door neighbour, my hon. Friend the Member for Leeds, East (Mr. Mudie), raised the question of home care and privatisation. He has been somewhat reticent about describing the political colour of the council in Leeds. We are weighed down by an unholy alliance of Liberals, Conservatives and Greens. In its most recent move, that coalition began the steps towards privatisation and, as my hon. Friend pointed out, it has been quite a disaster for our constituents. Is he aware that it is now hatching a full push towards privatisation? It is claiming that it will save £1 million, but does he agree, based on our experiences with elderly constituents, that that will be £1 million of misery facing them in the years ahead? Will he deal with that coalition in the more aggressive manner with which we have associated him in the past?

I thank my hon. Friend for that contribution. As his next-door neighbour, I shall be looking to him for the support I am describing when I gain a few more years. By the way, I do think that the hon. Member for Morley and Rothwell is much more attractive.

I will touch on some of the problems of privatisation, although it has been a success in some areas. There must be concern about privatisation when we are dealing with vulnerable people. That is not to say that charities, the independent sector or even the private sector cannot perform certain tasks, but such is the vulnerability of the individuals concerned, one must be very careful. Where profit is involved, people might put that before the required proper treatment of the elderly.

In Leeds, the direct home care service is being run down on what are clearly financial grounds, and direct home helpers employed by the council have been left sitting doing nothing while their long-term customers are directed to private providers. One elderly lady in her 90s required help to bathe. She declined the service, because she was tired of the stream of strangers turning up, oblivious to the sensitivity of the task. The service had been handed to a private sector firm, which had consistently sent different people to bathe the old lady. Such was the indignity that she has gone months without a bath and washes herself standing up. She has been put in that disgraceful position because of the insensitive way in which the private home care provider has dealt with her as an individual.

I am sympathetic to the hon. Gentleman’s argument, as there is an acknowledged problem when there is a change of carer. However, one of my local councils discovered that it was paying a lot more for the council service than for the contracted-out service. Does he think that that is necessarily the best use of public money, as some of the contracted-out services are very good?

I do not challenge the latter point, because it is unchallengeable. My hon. Friend the Member for Elmet (Colin Burgon) mentioned the savings, but one wonders where they come about if the contracted-out providers perform a similar task. We know where the savings come about: at the expense of the person delivering the service. Obviously a good employer, such as a council employer, will have good pension and sickness schemes and a good holiday entitlement, but they are normally absent from the staff conditions for people in the private sector. Contracted-out providers are able to deliver, but at the expense of the individual carrying out the service.

I was describing the treatment of an elderly lady in my constituency. I found it really cruel for her to be treated in that fashion and for the council to accept that. The move to the private sector is confirmed by the CSCI, which pointed out in a recent report that expenditure on home care nearly doubled between 1992 and 2004, but that most of the expansion went to the private sector. I have no principled objection to a varied service, but when it deals with vulnerable people, it needs to be extended carefully. The CSCI report shows that, in 1992, the independent sector had 2 per cent. of the market, but in 2005, it had 73 per cent. of the market.

Most worryingly, the inspectorate also described the home care sector as having

“the characteristics of a ‘cottage industry’”,

and pointed to a large amount of movement in the market. In 2005-06, for example, 415 agencies were deregistered and 905 new agencies were registered. Those figures mean little, until one thinks of the effect on the customer—the elderly person. I was a union official in public service before I first came to this place. I have worked with home helps for 30 years and I know the bond that grows between the elderly person and the home care assistant. They get to know and trust each other. Often the duties that the home care person takes on are far in excess of what would be expected, but a relationship forms and that continuity is important.

As I am sure that hon. Members would agree, one of the greatest complaints that elderly people make about home care—if they ever make a complaint—is about their home care being changed. Such change in the market—being forced into market conditions, or the settling down of a market—is damaging to the care, confidence and comfort of the elderly customer.

When my hon. Friend started his speech, he said that he came to the issue fairly recently, but in his usual humble way, he did himself a disservice. He was an effective and compassionate leader of Leeds city council, of which I was also privileged to be a member, and he presided over a huge increase in expenditure on social services, against a backdrop of Conservative Government cuts in both capital and revenue funding. The services went from strength to strength. As a council, we also used the independent sector at that time, but primarily voluntary organisations in the not-for-profit sector, such as the Pudsey and Horsforth live-at-home schemes in my constituency, and Aireborough voluntary services for elderly and disabled people. There is no objection to the use of the independent sector, but it needs to be used in the effective way that we have used it as a council in Leeds, much of which comes down to the efforts and the management of my hon. Friend.

Those kind words from my hon. Friend are much appreciated—they are kinder than the words that he used when I was carrying out those very compassionate tasks, but that is history.

What is happening is worrying. I recently had a discussion with some elderly people who were being provided a service by a private contractor. They were worried about whether Criminal Records Bureau checks were taking place, given the number of different people arriving and the throughput. Receipts were not being given when carers were asked to do some shopping. Those elderly people were given change without any explanation or receipts. All sorts of issues came through. Also, as one can imagine when a business is being run, if a carer has one hour with one elderly person and another hour with the next customer two miles away, the first elderly person might not get the hour because that individual—not having the public service ethos, but working for a private firm, with private profit as the motive—will have to cut the visit short to get to the next customer on time.

I have been following the hon. Gentleman’s arguments carefully and congratulate him on presenting a compassionate and sympathetic case. We all have live examples in our constituencies that we can think of as he speaks. However, so that I can understand what the debate centres on, I should like some clarification on whether he is arguing that the CSCI regulatory and inspection regime is falling short, irrespective of whether the provision is public or private sector, or whether he is concerned that there is no way that the private sector can provide the service as he would like it to be delivered, because it has a profit motive?

I shall pay tribute to CSCI, which is proving to be an excellent organisation, but I wonder, first, whether individual inspections are CSCI’s responsibility and, secondly, whether whoever is responsible for them—it is probably the local council, as the client—is carrying them out properly. We are all familiar with what has been happening in residential homes, and that is the problem. Where a customer receives a service but is not in a position to articulate his or her complaints, human nature tells us that corners will often be cut. Those corners are cut at the expense of the individual. I am not being critical of CSCI, because it is doing an excellent job—I notice that the hon. Gentleman knows the language and pronounces it as “See-Sky”.

Although it is important to put that point, which is a personal beef, on the record, my main point is the neglect and indifference being shown to so many of our vulnerable elderly. To give hon. Members some idea of the atmosphere among the professionals who know about the sector in more detail, I shall set out what some of the most prominent feel and have said about the current position. The Disability Rights Commission, talking generally about social care, has said that it is

“close to the point of no return”.

The recent CSCI annual report painted a bleak picture of increasing demand for support against the backdrop of ever-tightening criteria for receiving it. That excellent organisation, chaired so admirably by Dame Denise Platt, produced an overview of the problems facing the home care sector in a report called “Time to care?” I am raising one of the main points made in that document, but it also raises a number of other important matters that deserve equal attention.

The Alzheimer’s Society has spelt out social care services’ increasing inability to meet the needs of people in serious need. It points to surveys carried out by the Local Government Association last autumn and Counsel and Care in September last year which show that local councils are tightening eligibility criteria for their social care customers. Both surveys showed in detail that two thirds of councils, as I have mentioned, have criteria in respect of supporting people with substantial or critical needs—that is, two thirds, or 100 of 150 organisations that commission care, have criteria so high that they give care and support only to those with substantial or critical needs. One third have tightened criteria in the past year and 80 per cent. are planning to tighten criteria. Given current trends, nobody with needs defined as lower than substantial or critical will receive support by 2009, two years away.

The Alzheimer’s Society estimates that 680,000 people have dementia and that that will rise to 1 million by 2020. Unless the situation is dealt with, faced up to, funded and resourced—unless the mechanics are worked out—we shall be in a serious situation. The society describes people with dementia being forced into long-term institutionalised care in the absence of good packages of home-based care and carer support services. It claims that people with a lower level of need who would benefit from home care services are not being allowed to access them and that their needs will worsen more quickly and cost more in the long term as a result of subsequent hospital admission, for example. IndependentAge, a national charity, says that there was a 68 per cent. decrease in low-level support from social services departments between 1993 and 2005. However, it states that those are exactly the services that older people say they need to cope and remain living independently.

A grim picture emerges: increased money from the Government is going into the sector, but the majority of the elderly who could benefit are unable to access the resources, which one could rightly say are scarce and needed by the high-risk minority. That minority is cornering those resources and the majority of the elderly who make claims have those denied. It is clear beyond argument that the figures are set to get worse, due to the growing number of people living longer.

Little of that has been contested by the Government; I say that with my fingers crossed, as the Minister is sitting here, although I see little argument about the details. The Minister said on Radio 4 that there needs to be a national debate on the issue, and his Secretary of State has echoed that. In connection with that, welcome and excellent work has been carried out by Derek Wanless on behalf of the King’s Fund. In a year-long project, Mr. Wanless repeated his national health service study with a 20-year look at the problems in trends and resource requirements in social care. He gives options for levels of care and suggests financial mechanisms that would deliver the objectives. The report has been passed to the Government, and it would be interesting to hear whether the Minister has any comment to make on it.

I see that I have one supporter in the Chamber—[Interruption.] I am being asked to put that to a vote.

It would be interesting to see whether that report or a departmental document will be the focus of the national debate and decision. However, Mr. Wanless is considering the 20-year projection, and although that is excellent and necessary, it should not obscure the urgency of the current crisis. The situation that I have briefly outlined is serious and demands urgent action. I find it unacceptable that councils should have raised the threshold for help to such a height that it rules out support to people whose quality of life will suffer, if not disappear. That those people are among the most vulnerable makes the actions of the councils indefensible.

The Government have a similar responsibility. No one can deny that they have put large additional resources into the service, but faced with the declared needs and the vulnerability of the elderly, further and prompt action needs to be taken. Remember that the Alzheimer’s Society expects that no one with lower than critical or substantial needs will be supported after 2009. There is, of course, the national debate along the lines of the recent pension exercise, as the Secretary of State suggests. However, that could appear to some cynical people as a method of avoiding facing up to the current problems and cash shortages. The pension debate could be undertaken at a leisurely pace because the real problems were well in the future; however, the social care problems are with us now and, as the Alzheimer’s Society survey suggests, they will immediately get worse.

I have the following questions for the Minister. If he and the Secretary of State are united in wanting a debate, when will it start? As I asked earlier, will the formidable King’s Fund report by Mr. Wanless be the vehicle of that debate? Very pertinently, where does the Treasury stand on that debate? After all, the inescapable fact coming from any examination of the present crisis is that even more money will be required. Is that the real reason why the Secretary of State has called for a national debate but not taken any obvious steps to programme one?

In the industry, the attention is on the comprehensive spending review. Already the pessimistic view is that in light of their toughness, it is unlikely that social care problems will figure high on the Chancellor’s agenda. In other words, if help is to arrive, it will come after 2010. Given the facts outlined, that would be disgraceful and too late. If that pessimism proves to be correct, there will be real hardship and loss of quality of life for hundreds of thousands of our fellow citizens.

In their 2006 pre-Budget report, the Government state that they will consider proposals relating to the future of social care provision, including

“whether they are affordable, whether they are consistent with progressive universalism”—

whatever that means—

“and whether they promote independence, dignity, well-being”.

I say to the Chancellor, through the Minister, that not taking urgent steps to deal with the current problems in social care will deny so many of the elderly their independence, dignity and well-being. Whether that is affordable is a strange question in the fourth richest country in the world.

I hope that I have succeeded in making clear the urgency of the crisis. The British public need to be aware of how shoddily we are treating so many of our elderly citizens. I hope that the Minister will accept the urgency of the funding crisis and give a real indication of how it will be met in the short term. I hope that we will be given an indication of the Government’s view of the Wanless report and some details of the national debate—when it will start and whether the Wanless report will feature in a major way.

It is a pleasure to follow my hon. Friend the Member for Leeds, East (Mr. Mudie), whom I congratulate on obtaining a debate on such an important subject. He said that he was most conversant with the situation in Leeds, but he added reasonably that the picture across the country is serious and requires urgent attention. I wholly agree with all he said about that.

For many reasons, our starting point should be the NHS funding that has been delivered since 1997. Already there has been a doubling in cash terms of the NHS budget since then; by 2008-09, it will have trebled. That is relevant to the care of the elderly. In general, the older we adults get, the more we rely on having free health care services available when we most need them. It is incredibly reassuring to all older people that a health care service is available to them for free when they need it most.

That is an important starting point, but questions come beyond that. First, is the NHS more than a delivery of hospital services? Of course, it is much more than that; since last year’s White Paper “Our health, our care, our say”, the Government have tried to shape the national health service much more effectively around people’s needs in their communities. Now there are GPs who will see people within two days, and GPs provide a great range of care services, including innovative programmes such as one that I support in my constituency for exercise on referral. GPs can refer their patients to gymnasiums for exercise to keep them healthy. A large range of such innovations has been introduced thanks to the NHS side of the equation.

However, another significant aspect of the great increases in funding for the NHS and the ability to do more is the comparison between the services provided for health care and those provided for social care. The funding gap certainly has grown as there have been big increases in funding for the NHS but much more modest ones for social care, which is creating great problems across the country, as my hon. Friend said and as I shall explain in a moment.

Many people have said that the gap is causing an ever greater problem. As part of the comprehensive spending review process, the Association of Directors of Social Services produced an analysis to show the total gap in funding between what can be provided today and what ought to be provided, and the cost difference. Recently, the Local Government Association chipped in with its own contribution to the debate, and I am pleased to say that, having taken the temperature in my own constituency, I have made a representation to the Treasury about the comprehensive spending review and the need for social care to start catching up and closing the gap with health.

My hon. Friend made several references to Derek Wanless. The Treasury commissioned him to report on future trends in health care in this country, and the final report was published in April 2002. His recommendation in paragraph A.11 of that report stated:

“Health and social care must be considered together.”

Apart from anything else, the hon. Gentleman has a great reputation in this place for championing what is known as the F40 group, of which my local council in Cheshire is a member. He makes an important point about health and social care funding streams. Does he accept that part of the problem that he has been campaigning on, quite rightly, with the F40 group is that the divergence of different funding streams to local authorities makes it difficult to maintain levels of support on the social side, which is, in effect, funded by council taxpayers, because there is no ring-fencing and there is not the same per capita distribution across the country?

Recently there has been a greater focus on how the health spending that I mentioned a moment ago is distributed across the country, and the same issue arises in respect of how social care money is distributed to local authorities. I shall deal briefly with the case of Staffordshire later.

I agree that there will always be arguments about how money should be distributed. It is the difficult task of any Government, of any political colour, to achieve a fair distribution of the available funds, but my basic point—certainly in the case of health—is that this Government could not be better or fairer in the total amount that they distribute.

I want to discuss the gap and how we might narrow it. First, we must look at our daily lives to find measures of how bad the situation is. I always think that a good barometer at local level is the number of delayed discharges from hospitals, because that tends to tell us that there are people in hospital beds who no longer need free health care in a hospital setting but who cannot go home because supports are not in place there or in their community to enable them to leave the hospital. I have seen ups and downs in Staffordshire—there have been good times and bad times for social care services in their ability to respond to their share of the challenges.

The 2002 Wanless report pointed to other measures. It gave as one example the number of older people admitted to hospital in an emergency caused partly by reductions in the availability of appropriate social care. Having reviewed that evidence, Wanless stated:

“In planning the delivery of care, health and social care must be considered together in order to ensure that both provide high quality services”.

As a result, another recommendation was that there should be in the future a greater focus on what he called “whole systems” to cover both sectors.

It was Wanless’s recommendation that, just as he had made a major report on the future trends in health care, there should be a similar investigation and report on future trends in social care. As my hon. Friend the Member for Leeds, East said, that is where the King’s Fund stepped up to the plate, not for the first time, and funded another investigation and report by Derek Wanless.

We have the information and there are arguments about what should be done. As my hon. Friend said, it is now a matter of having the political will to do the right thing. Will my hon. Friend the Minister explain how social care services will keep up with future demand? There are many different ways in which they need to keep up. First, as my hon. Friend the Member for Leeds, East said, demographic change means that a growing proportion of people will live longer and require more services in their homes.

Secondly, there is growing public expectation about standards and quality of care; people expect care to be available when they want it, at their convenience. It is difficult to keep up with such demands. Thirdly, it will also be difficult to keep up with the excellent performance of the NHS as it continues to improve if similar resources are not available alongside in the social care sector. How does the Minister expect that social care services will keep up in such circumstances?

Can the Minister tell us whether the funding shortfall for social care will be addressed in the comprehensive spending review this year? My hon. Friend the Member for Leeds, East said that the soundings that he has taken are pessimistic, but surely, for the reasons that he gave, social care must be a top priority.

I shall illustrate the intensity of the pressures on social care services by explaining the position in Staffordshire, which starts from a slightly out-of-the-ordinary base because, until now, it traditionally retained direct ownership of more residential homes than many other authorities, thereby tying up more of its resources in bricks and buildings, and services delivered in residential homes, than most other comparable local authorities. In addition, Staffordshire is one of those shire counties that always seems to be near the bottom of the funding league table, whether for education, health services or, in this case, social care provision. The hon. Member for Eddisbury (Mr. O’Brien) referred to that.

Furthermore, Staffordshire is experiencing the same demographic changes as the rest of the country. The trends indicate that parts of Staffordshire such as my constituency in the middle of the county—Stafford—tend to have more people living longer who, because of their backgrounds, will be keen to insist on their fair share of services. Such demands on services certainly will not go away in the future—they will get stronger.

Staffordshire social services has found that because of its over-provision of directly provided residential home care, it has not been able to offer the range of services in people’s own homes that my hon. Friend said was available in Leeds when it had a Labour-controlled council. Staffordshire was not quite in that position to begin with, yet it faces the pressures I have described.

Last year, in “Changing Lives”, Staffordshire began to consider the reconfiguration of its social care services, including lessening the reliance on fixed buildings and providing residential care, but extending the range of home help services, such as those that my hon. Friend said used to be available in Leeds. The council proceeded at a good pace. It involved everybody, consulted everybody, explained the path ahead and set out a good timetable—up to 2012—for making the changes.

Suddenly, last Thursday, under a document with the rather innocuous title of “Medium Term Financial Strategy”, the county council—it is still Labour controlled, of which I am proud, but in this case it is mistaken nevertheless—adopted a financial strategy that apparently requires it to close every one of the remaining 22 residential homes within the next 12 months, and to refocus all its finances on services in the community, which I shall describe more positively in a moment. However, I want people in the Chamber to imagine the position last Thursday as hundreds of residents in those homes heard without any previous consultation or notice that their home would close this year and that they could not expect to be there in 12 months’ time, and as thousands of residents’ relatives heard the same news at the same time. Imagine the hundreds of staff who work in all those homes who now have not the faintest idea of whether they will have a job in 12 months’ time. It has been a difficult seven days, as anyone can imagine.

There has been great heartache, anguish and not a little anger at the decision, yet the local authority’s motives are excellent. It wants to reach a position where social care services are available around the clock for anybody any time they need to call on them. It wants to extend respite care services and give greater support to the carers who do such fantastic work, as my hon. Friend the Member for Leeds, East said, out of love rather than for reward, and who save the state billions of pounds of expenditure every year. It wants to develop extra care housing so that there is a middle way, so that people who cannot live any longer in their own home, even with support, but who do not want to be in an institutionalised residential home can have their own home space with support on hand when it is needed. The local authority wants, too, to do more work in partnership with other organisations, especially those in Staffordshire’s splendid voluntary sector—or third sector, as some people like to call it now. Those proposals are all beneficial.

In the past, the range of services has been narrow and the number of clients who can be satisfied has been too few. The local authority wants to be able to say that a wide range of services, including re-ablement services, will be available to all who need them in the future. I support those ambitions and want them to succeed, but if the local authority is saying, as I think that it is, that its finances are suddenly so stretched and so tight that it has to upset thousands of people by instantly closing a lot of residential homes to have the right funding in place at the right time for its new policy, something is wrong. It is not merely a case of my saying to the Minister, “Could you send some more money to Staffordshire to solve our problem?” I have never been one to say, “Let’s throw money at the problem to solve it.”

If there is a problem of timing, and in getting the right sequence of investments and decision making in Staffordshire, and if we need some help from above to plan in a better way so that the finance is more stable and lasts for longer than just 12 months, will the Minister give some attention to Staffordshire? Will he help the concerned Members of Parliament from Staffordshire who are trying to represent thousands of people who are angry and upset? We want them to be satisfied and reassured, and all of us in Staffordshire should have high quality services for the elderly. My hon. Friend the Member for Leeds, East described such services in Leeds in the past; can we get them for the first time in Staffordshire and make them sustainable for the long term?

My general contribution to the debate on the national importance of the subject has turned in the end to a narrow plea of self-interest for Staffordshire, but I hope nobody minds that in the circumstances. The problem is so pressing that I hope the Minister will be able to spare a couple of minutes to give it some attention.

I congratulate the hon. Member for Leeds, East (Mr. Mudie) on securing the debate. He spoke with compassion and concern. It is a shame that there are not more hon. Members in the Chamber. The subject is increasingly being mentioned at MPs’ surgeries and constituents are raising concerns. I am sure that the lack of presence in the Chamber does not reflect the unimportance of the subject, but rather that other things are going on.

The hon. Gentleman was right to highlight the problem of councils restricting their services, in many cases, to those with critical or substantial needs. The depressing trend is that an increasing number of councils over the past couple of years have decided to raise the threshold. They previously provided help for those with moderate and lower needs. Many people believe, and there is evidence to support it, that the provision of lower level care is an investment in the future, because it helps to keep someone slightly more mobile and active in their own home for longer. In many ways, the approach that is being taken makes only a short-term saving. Councils are allowed to do it, because they can take into account their budgetary pressures. Although I accept that a lot more money has gone into council services, far more money has been diverted towards the national health service.

There is a tension in Government policy. I support the principle that people should receive care in their own homes. Often, when an individual goes home an unseemly battle takes place over whether their care is health care, when it stops becoming health care and becomes social care or personal care, and who picks up the tab. Personal care is, of course, the responsibility of the local authority and services are means-tested. In cases of pure health care, the tab is picked up by the NHS. Far too much time and effort is wasted on an unseemly struggle over who will pick up the tab. That is not what older people want when they are probably not feeling at all well and when they are having to adapt to changes in their life circumstances. I would be pretty grumpy, too, if I were not well and could not go out and about and be as active—[Interruption.] I am sure that the Minister is saying something not entirely complimentary from his sedentary position, but I will leave that there.

The problem seems to be that when care is delivered at home sufficient money does not seem to come across from the health service to pick up the costs that it should be picking up. Hampshire county council is increasingly raising that particular problem with me, and it is having to pick up the bill for the provision of services for more acute needs, which it regards not as personal care, but as health care. Ultimately, somebody has to deal with the problem. Many people in local government do not want to see people suffer.

Does the hon. Lady recognise that there might be a deeply counter-productive result if a lot of care is not immediately available or provided in a straightforward way, not only for those who are cared for but for their families and carers? It has an effect on morale, which can have a health-deteriorating effect. For most old people, the last thing they want to do is anything that could constitute a nuisance. They simply want a straightforward approach to being cared for appropriately.

I agree up to a point. I am reminded of my mother, who said, “When I’m old, don’t worry about me. I don’t want to be a bother to anyone, just put me in a care home.” When it comes to it, the reality is not so straightforward. She desperately wants to stay in her own home and is fiercely independent. She does not perceive that as a bother to anybody. It is quite a concern to those who live some distance away and worry about what granny might be up to. That is a problem these days, because families are dispersed. Often, it is easy to say that people should look after their family, but if an older person has friends and relatives in one part of the country they might not necessarily want to relocate to be with their daughter or son or to have to set up new social networks. It is not quite as straightforward as saying that we should all look after our loved ones. In today’s world, that is not always practical, although it is something that most people want to do.

I was intrigued by the exchange between the two Opposition spokespeople. I wonder where we are going with that. The settlement in this country for more than 50 years has been that health care is free when needed, whereas social care possibly needs a contribution to be made. Is the hon. Lady saying that Liberal Democrat policy is different?

The hon. Gentleman is trying to put words in my mouth. I am saying that the borderline between health and social care is muddied. There are increasingly arguments about what falls into which category. I did not say that social care and help should not be means-tested in any shape or form. However, there are clearly situations in which people are having to pay for services that once would have been free under the health service. People are struggling to understand why, given that they have paid taxes all their lives and have saved a little money for their old age, it should suddenly be eroded.

May I ask the hon. Lady to be far more helpful to my hon. Friend the Member for Stafford (Mr. Kidney), who has raised this important issue? It is not true that in this Chamber only a matter of weeks ago—she is a person of integrity—she said that she regretted that her party misled the British people at the last general election in its manifesto by suggesting that personal care could be free? Will the hon. Lady confirm to my hon. Friend that she said that she regretted the fact that her party had misled the people at the last election, when it suggested that personal care could be free?

The Minister is being rather tedious—he seems to raise that question on every occasion. I suggest that Hansard is a matter of public record, and if people are sufficiently interested they can read my previous words. I have different words to say today, and I hope that the Minister appreciates that.

Returning to local councils, one of the problems is that many would like to increase spending in this area because they recognise the problem, but the capping system allows them very little flexibility for keeping within budget the level of service that they would like, not least because staffing costs have rightly increased. It is not something that we should be getting on the cheap. The number of people requiring services, too, has risen, and we must take that into consideration. However, there is a caveat. Many people want to stay at home, but it is not everyone’s choice, so we must not say that everyone must do it. Dame Denise Platt was mentioned earlier. I remember being quite exercised when I heard her talk; she quoted an elderly lady who had said, “This is no longer my home. It’s their workplace.” A stream of people come in; indeed, the hon. Member for Leeds, East said that it could be different people from the care agency every day. People with complex needs may have various people delivering many different services, which can be quite invasive of someone’s privacy.

There is a protection issue. It is a fact that many older people are unwilling or unable to complain. I was pleased that the CSCI has decided to regulate matters. A lot is made of abuse in care homes, but other workers often provide checks and balances—unless there is an institutional problem, I would suggest that there is a greater chance of problems being found out in care homes. However, we should bear it in mind that most abuse takes place in the person’s home, and it is often committed by someone known to them. With individual workers going into people’s homes, it is only right that they should be supervised initially and that spot checks should be made on their work. Because such workers often work alone, it puts people in a vulnerable position. Many surveys show that workers are not supervised in their early days in the job.

I raise the spectre of Criminal Records Bureau checks. I am told that there are still delays, which are often as long as 16 weeks, in getting approval. If the Minister can do anything to speed it up, it would be welcomed. When workers apply to an agency or a care home, they will already have decided to work in the area and cannot afford to wait until the CRB check is completed. Another complication is that the smaller agencies can no longer administer their own applications for CRB checks, unless they do more than 100 a year. That will put an added cost burden on them, and if the Minister can do anything about that, it would help the sector greatly.

The CSCI report, “Time to Care”, highlighted the problem of performance. It concluded:

“There is relatively poor performance in the ‘managers and staff’ domain. Too many organisations fail to achieve satisfactory standards in relation to supervision, support and training for staff. Nearly 39 per cent. are not conforming with basic requirements for the selection and recruitment of staff.”

That is shocking. It would be helpful to know what is being done to address the problem. If we are moving towards more people receiving services in their own homes, it seems fundamental to ensure that the problem is not repeated. It has to be tackled before we increase the number of people receiving such care packages.

I turn briefly to carers and the support of others, which the hon. Member for Eddisbury (Mr. O'Brien) has alluded to briefly. I heard on the radio this morning a welcome announcement of money for respite care. It is much needed, and I am sure that those who receive it will be grateful. However, I hope that the Minister will confirm my understanding that the money is for emergency respite care. Unfortunately, my experience from surgeries and from visiting homes is that people would like to be able to plan such care. If they are able to take an occasional break, be themselves and not have to worry, they feel that they can carry on caring for longer. Making a small investment in regular respite care could result in longer-term savings, as individuals would almost voluntarily be undertaking the caring role. A constituent recently highlighted the problem. She was a bit frustrated that she had to book her respite week several weeks in advance—it was difficult to plan anything, but she accepted that only to find that she was frequently messed around when she had made plans. She accepted that others may have had a more acute need, but it highlights the desperate need for better services.

Having mentioned some of the slight problem areas with home workers, it is only fair to put on record the number of complaints to the CSCI about domiciliary care, of which there were 684 in 2005-06. That is 684 too many, but given the large number of people receiving care, it suggests a relatively high level of satisfaction. Indeed, the CSCI found that most older people speak highly of their own care workers, blaming problems on the system. I quote again from “Time to Care”:

“The vast majority (90 per cent.) felt that they received sufficient visits and three-quarters felt they had the things done that they wanted but, in practice, almost a third felt that at least on occasions less time was spent with them than they were entitled to. Linked to this, over half of the respondents reported that, at least sometimes, care workers were in a rush, and a fifth that care workers were only sometimes or even less often on time, with 5 per cent. never knowing when the care worker was going to arrive.”

Many older people like to plan their lives, because they like a routine. That needs to be considered more carefully.

My final comments are on a key finding, about which I would like to hear the Minister’s comments. The CSCI concluded:

“When the national minimum standards for home care are reviewed by the Department of Health, revisions will be needed to reflect changing priorities and expectations. In particular the standards over-emphasise plans and record-keeping, and under-emphasise the importance of promoting independence and of listening and responding to people’s changing needs and aspirations.”

Given that one in two women and one in three men over the age of 65 will be receiving these services, will the Minister say how he sees the future developing, and whether funding, particularly at council level, will be fairer and more equitable, so that more people can receive the services to which they are entitled?

I congratulate the hon. Member for Leeds, East (Mr. Mudie) on securing this important and timely debate. It is an issue about which he has been exercised over the past few months and has raised a number of times at business questions. He provides an example to us all in the way that he champions his constituents’ interests—in particular, those of Mr. Thomas place, whom we heard about earlier. The hon. Gentleman has been courageous in shining a spotlight on the serious failures in providing health care to the nation that have occurred during the decade of this Government. During a debate on social exclusion on January 11 this year, he said:

“I do not even think that I will read the figures; it makes too hard reading.”—[Official Report, 11 January 2007; Vol. 455, c. 474.]

It is a shame that the Government are not prepared to address this issue on the Floor of the House, despite the hon. Gentleman’s repeated requests for them to do so.

We have heard the wider failures of the Government on social care rehearsed on a number of occasions in this Chamber. Their response to the Derek Wanless review was to produce a zero-based review, about which the hon. Gentleman quite rightly prompted and chided the Government. We have heard nothing since about that. It is right and timely that we should know whether that national debate will start or whether the Government are attempting to let the long grass to grow around the issue for as long as they can get away with it.

Does the hon. Gentleman really believe that, in a democracy, it is the job of the Government or the state to start a debate? The debate about the future of social care is raging and that is good for those of us who care passionately about the issue. As I will say shortly, surely it is the Government’s responsibility to come up with solutions, not to stimulate a debate; the debate is well under way.

The hon. Member for Leeds, East has got his answer from that intervention. Indeed, although the national debate may well be raging, it is important to recognise that the Government have been the architect of suggesting what national debates should be about—for example, new nuclear power. Indeed, the big conversation attempted just that.

Is the hon. Gentleman old enough to remember the Private Eye picture of people snoozing in deck chairs in St. James’s park, under which the heading read, “The great education debate starts”? The lack of Members in the Chamber suggests that that debate is not starting or that no debate is taking place along the lines of that on pension arrangements; the country is waiting. Does he agree that, outside the circles of those closely involved in social care, no one—including myself—was aware of the Wanless report or that a national debate was raging?

There has certainly been a raging debate in the House since Wanless reported. However, the hon. Gentleman raises the serious issue of whether that debate has caught the public imagination in a broader sense or whether it is still a matter discussed only locally, according to local conditions? I suspect that the latter may be true.

This issue also displays the twofold impotence of Department of Health Ministers in the face of the Chancellor’s roadblock to reform. He holds the purse strings, but the double whammy is that the Government are in stasis in terms of policy development until we know whether or not the Chancellor will take prime ministerial office.

The Government’s failure in health and social care extends to home care. I am sure that the Minister will seek to pray in aid the CSCI’s statement that

“the total number of people using home care during 2004-05 rose to 584,000, up by 9,000 compared to 2003-04”

and that

“greater numbers of home care…services are meeting more of the Government’s National Minimum Standards.”

That marks a shift in resource provision away from those with low-level needs towards those with the most intensive needs—a key point made by the hon. Gentleman. In 2005, 98,240 households received intensive home care, which is an increase of 6 per cent. from 2004. In 1990, home care was provided to 500,000 households and last year 584,000 people were using that home care. I accept that the figures are not directly comparable, but they are close enough to draw the conclusion that little has improved in low-level provision since policies before the last decade—indeed, CSCI seems to suggest a regression from those policies.

Although it is undoubtedly right to give people the choice of remaining in their own home and to work to reduce unplanned emergency episodes through better home care, it is wrong that those with lesser needs should suffer because the resources required by those with greater needs are given priority. As I said in an earlier intervention, such cost shifting is not only unacceptable, but short-sighted. Low-level help and care is just as important in supporting older people as other levels of care. It is also important to keep people at home where that is their choice and it is appropriate to do so.

I praise the dedication of home care workers. We have all met those who are selfless and deeply talented at such work. It takes a very special person to do that work well. However, as a number of charities that are active in this sector have highlighted, there are problems. We must take note that the CSCI reports that

“improvement against standards has slowed down”

and that there are pockets of very low standards. That mirrors and is broadly connected to the wider failings of the social and, particularly, the home care market.

The biggest concern about this issue relates to direct payments. Despite having been introduced as far back as 1997 and all the warm words of “Our health, our care, our say”, we must ask whether local authorities have set challenging targets for the take-up of direct payments. What has been the effect of the national awareness campaign that the White Paper said would work

“with a range of external stakeholders to increase awareness and improve understanding of the benefits of direct payments.”?

How can it be that direct payments still account only for about £1 in every £100 of social care expenditure by councils in 2004-05? Individual budgets are also moving painfully slowly.

The CSCI notes in its report, “The state of social care in England”, that social care is being hindered by an underdeveloped care market. Collaboration on commissioning is weak, and I hope that the Government will support our amendments to the Local Government and Public Involvement in Health Bill, which aims to support collaboration. It is beyond me why patient and public involvement should be introduced in a Bill from the Department for Communities and Local Government. Does that show a lack of faith in the Department of Health, or a lack of ability or desire to engage in the issues surrounding the crossover of provision between local government and the NHS? As highlighted during this morning’s comments, I suspect that the latter is the case.

In addition, councils often have immature relationships with home care providers and short-sighted, cost-driven approaches to commissioning. Although in some places blame for that might rest with local council politicians and officials, it is more likely to be the result of national policy drives. The CSCI calls for

“a better understanding of how the availability of one form of service (such as a care home or intermediate care bed) might impact on another part of the health and care system.”

The continuing disjointedness in health and social care lies entirely at the door of the Government. The Wanless review highlights an innovative funding scheme created, as it happens, by Conservative-controlled Kent county council. The council wanted to research—not instigate—the issue of Government subsidies to encourage contributions to long-term care investment. However, as Wanless despondently puts it:

“In the end, Kent county council found there was no appetite from either the Department of Health or the Treasury to fund further modelling on how such a scheme could be implemented, each department wanting the other to sponsor the work.”

As usual, faced with the intransigence of the Government, particularly the Treasury, there was no further chance to consider that innovative scheme for general application. That would have potentially provided a serious answer to some of the issues raised by the hon. Gentleman.

Likewise, short-termism in commissioning is born of a financial climate made extremely uncertain by Labour’s continuing mismanagement of our national health service. The CSCI says that

“councils and other commentators report that the NHS deficit of over £500 million last year is affecting local partnerships between local authorities and the NHS”

and that they are pulling out of pooled budget arrangements and are nervous about re-entering them. The CSCI also notes that people have little control over the services that they use. With such disjunction among users, providers and commissioners, it is unsurprising that the market is having problems. I use the term “market”, as did the hon. Member for Leeds, East, to refer to the overall provision in this area, whosoever may be delivering it.

It is not just those who need care who bear the force of the Government cuts. Where formal care is no longer provided, informal carers often step into the breach. Even with the £33 million that I believe was announced this morning on the “Today” programme—again not in the House, I note—the Government have done too little to support that work force. I am thinking particularly of the point made by the hon. Member for Romsey (Sandra Gidley) about planned respite care, which is probably the most valuable and valued type of respite care for the army of carers in the population. The issue involves not just emergency, plugging-the-gap respite care, although that is unquestionably important. Of course, that funding must be welcomed. This is a very important area, in which policy is being not only rapidly focused on but developed in my party.

I will highlight once more for the record the Government’s failure—the fact that something has not been produced does amount to a failure—to produce the continuing care proposals. When will they be published? Given all that has been debated and even if the Minister can find two minutes to answer the points raised by the hon. Member for Stafford (Mr. Kidney) about his local issues, I hope that the Minister can, if he gives us nothing else in the next 20 minutes, give us at least the long-overdue date for publication of the continuing care proposals

I again congratulate the hon. Member for Leeds, East. He is right to highlight the fact that, as a result of policy, there are a number of areas where the elderly people of this country are being shoddily treated—that was his phrase. It is incumbent on us all—there is a duty on us—to address this live, very important issue of our day. We must get it right; we cannot call ourselves a civilised society if we cannot support and treat with dignity the elderly people of this nation.

I congratulate my hon. Friend the Member for Leeds, East (Mr. Mudie) on securing the debate and on the sensitive, compassionate and well-informed way in which he presented his arguments. I did get a little annoyed and upset a few minutes ago, but he knows that I do not mean it. He talked about social care having a language of its own, and he is right about that. I spent my entire working life before entering Parliament in social care, so for me one of the great things about doing this job in government is now having the opportunity at national level to shape the new policies that are necessary. That is a major privilege. It is a major challenge, too, and I will respond in a moment to the very reasonable and legitimate points that he made.

First, I shall deal with the contributions by Opposition Members. The hon. Member for Eddisbury (Mr. O’Brien) always refers to the “failure” of the present Government. Any debate on support for older people must mention the tripling of investment in the national health service and the very generous improvements that have been made. I am referring to the winter fuel allowance, free TV licences, free bus travel and the various other benefits that pensioners get that they were not getting before 1997. The debate also has to be in the context of the public services that we inherited, which, frankly, were a scandal. Older people and vulnerable people disproportionately depend on the quality and range of, and the investment in, public services. We see that if we reflect on what a civilised society is all about.

Therefore, although I accept some of the comments made by hon. Friends, I find it a little difficult to take lectures from the hon. Gentleman. That said, I share his enthusiasm and support for the dedication of people who work in domiciliary care. They work on the front line—at the sharp end—and make a tremendous difference to the quality of many people’s lives.

On the question of direct payments, individual budgets and the “In Control” programme, I have been a great champion of the notion of people power—transferring power from professionals and organisations to those who use services and their families, so that they have control and can shape the services that are being made available to them. We are on the precipice of a radical revolution in the way in which social care is provided. What has happened in the context of direct payments, individual budgets and “In Control” is that much of that has been dealt with from the bottom up; it has been led by the grass roots. There are pioneers out there who are beginning to make that happen. The challenge in the period ahead is to make it the mainstream way in which social care is provided in this country, and we will produce proposals, based on the individual budget pilots, to see how it might be achieved.

I accept that the Minister recognises that there has been a bit of a slow start on direct payments, but I hope that he will look at the example of West Sussex, which was drawn to my attention recently, as a great example of where he might be able to accelerate the process.

The hon. Gentleman is right to raise West Sussex. I would add to that Oldham, which is not too far away from his constituency and is doing excellent pioneering work in this field.

The hon. Gentleman referred to the Local Government and Public Involvement in Health Bill. A very important point is that in that Bill, for the first time, we are placing a duty of partnership on primary care trusts with local government. Too often at local level, we are told, the missing partner at the table when it comes to local strategic partnerships and health and well-being in a holistic sense is the local health service. What we have managed to achieve in the Bill—I was heavily involved in that—will make a significant difference, although creating legislation to place on people a duty of co-operation and partnership still requires a willingness at local level for leaders and managers in public services to understand that the best way to achieve their objectives in the modern world is by co-operating, breaking down organisational boundaries and putting the needs of the local population first.

The hon. Gentleman asked why the provision was in a local government Bill. Frankly, it is because we wanted to get the legislation on the statute book as quickly as possible. There was an option not to include it in the Local Government and Public Involvement in Health Bill. In fact, there was quite a lot of pressure from civil servants not to include it, but the Minister of State, Department of Health, my right hon. Friend the Member for Doncaster, Central (Ms Winterton), and I wanted to get it on the statute book as a matter of urgency.

The hon. Gentleman must also recognise in the context of the relationship between the NHS and local government that it was only a very short time ago that Christmas pressures were an annual event and bed blocking was normal. That no longer happens in most parts of the country as a result of the relationship between the NHS and local government. In small numbers, it may do, but the notion of an annual crisis and bed blocking as an accepted part of the system has more or less been removed. That is partly a result of the investment that this Government have put in but, to credit people on the ground, it is also a result of much better relationships between local government and the NHS in many areas.

I say gently to the hon. Gentleman that I do not accept the notion of Government cuts. There is a significant debate, to use that term—I shall come to that in a moment—about a shift of resources from hospital-based care to more community-based services. If the Conservative party wishes to go around the country portraying that as cuts, it can, but that is highly irresponsible and disingenuous. In my view, it is extremely misleading for many sections of the population, because any responsible party of government that genuinely believes that more and more people want care closer to home and want to be supported in the community knows that the inevitable consequence of that is a shift of resources from the acute NHS to community-based services. If we are to have debates, let us have mature responsible debates. Let me say very gently to my hon. Friend—or rather the hon. Member for Eddisbury—

If we carry on spending every morning in this Chamber as we have been doing, perhaps we will become honourable friends.

Carers do not like to hear themselves described as a work force, as I think the hon. Gentleman would accept. He referred in his speech to carers as a work force. They are not: they are family members in most cases and sometimes friends. I shall come in a moment to some of the substantive points that he raised about carers.

The hon. Member for Romsey (Sandra Gidley) cares passionately about these issues. She referred to being grumpy in her old age. I think that most Lib Dems will be grumpy in their old age. However, the serious point is that it is all right being decent and honourable, as I believe she is, but politics is about the policies that we put forward and the impression that we give to the public. My hon. Friend the Member for Stafford (Mr. Kidney) hit the nail on the head: we cannot carry on playing this game with the Liberal Democrats. They no longer claim to believe in free personal care. The hon. Lady said—I have never heard this said in the Chamber before—that she regretted her party misleading the public in the last general election that personal care could be provided on a free basis. She can come out with all the comments and policy suggestions that she likes, but when it comes to testing those policies, the electorate will weigh heavily, at the next election, the suggestion from a Liberal Democrat Front-Bench spokesperson that the Liberal Democrats deliberately misled the British people at the last election.

The hon. Lady said that far more money has been diverted into the NHS. I love the use of that word “diverted”. It is as though it happened by accident and was nothing to do with Labour being elected to government in 1997, our unprecedented level of commitment to the NHS and the near tripling of investment to bring us up to the European average. She said that we have diverted money into the NHS. I ask her to be a little more open about the Government’s clear priority decisions and about where the Liberal Democrats want to put resources.

I am proud that we have chosen to rebuild the health service and much of our public service as a priority by using the benefits of economic growth to invest in the public good. Previous Governments chose to use the benefits of economic growth to cut taxes for people who least needed their taxes cutting and, sadly, to fund mass unemployment as a major part of the public bill.

The hon. Lady and the hon. Member for Eddisbury rightly talked about the issues affecting continuing care. I do not have a date for the hon. Gentleman right now, but I promise that we will make an announcement on national guidance in a matter of weeks, not months. I hope that the guidance will clean up the extremely difficult situation with continuing care. We have had ombudsmen’s judgments and court judgments and there is now a lack of clarity about who is responsible for what. In some areas, local primary care trusts have undoubtedly tried to shunt responsibility on to local authorities when they should have been fulfilling that responsibility. The Government will act to create national guidance. Hopefully, that will help to clarify matters.

The hon. Lady was right when she talked about the changing nature of families. We now have families living not just all over the country, but all over the world. What is the implication of that for the level of support that older and disabled people get and what does it mean for the social care system?

My hon. Friend the Member for Leeds, East talked about Thomas Place, the war veteran hero who lives in his constituency. He was extremely concerned about Mr. Place’s experiences and has a been a great champion and advocate of his by saying that what happened to him was wrong.

My hon. Friend also rightly raised the issue of carers. Millions of heroes in our communities look after older and disabled people on a day-to-day basis. We still have a long way to go to recognise and value their contribution, which will be even greater in the future. However, I say to hon. Members, particularly my hon. Friends, that we need to contextualise what we say about these matters. In 1999, we were the first Government to introduce a carers grant. Every local authority, every year, gets a significant amount of money to invest specifically in support for carers. That was part of the 1999 national carers strategy, which was the first time that a Government of any colour in this country introduced such a strategy.

Yesterday, the Chancellor joined me in visiting a family in London. We met Gill, an amazing woman who looks after her severely disabled daughter at home. We were privileged to spend time with that family, including Rowan, an 18-year-old young woman with severe learning disabilities, and her 20-year-old sister, Camilla, who has spent most of her life being an amazing young carer. Yesterday, the Chancellor announced that we are to have a national consultation involving carers and carers’ organisations up and down the country to inform the development of a new strategy for carers.

I shall announce, today, the new deal for carers. The new deal is a combination of the emergency respite care funding that has been mentioned, a national advice and information helpline for carers to ensure that they have easy access to information and practical assistance, and an expert carers programme to help carers with practical tasks for which they need support.

Does the Minister accept that “announcement” is too big a word given that the scheme has already been announced on the “Today” programme?

I shall ignore that.

In addition to today’s announcement, the Chancellor and the Treasury are undertaking, as part of the comprehensive spending review, a fundamental review of the support that we give to children with disabilities and their families. That is an incredibly important area.

My hon. Friend the Member for Leeds, East expressed his concerns about the privatisation of domiciliary care. The Government have introduced the regulation of that sector, through the Commission for Social Care Inspection, so it is regulated in a way that it was not before. Only last week, I announced that the next wave of social care workers to be formally registered will be domiciliary care workers and managers. That should help to raise standards and quality in the sector.

It was the previous Conservative Government who ring-fenced the money that was transferred from the Department of Health and Social Security to local government and who insisted that about 75 to 80 per cent. of it was spent on the independent sector. That triggered the growth of private sector provision of both domiciliary and residential care, and was driven purely by ideology, not quality of services to individuals.

My hon. Friend also talked about dignity and respect and the way in which people are treated. I have launched a national campaign arguing strongly that we need to give much greater priority in every care setting—in hospital wards and residential and nursing homes—to older people’s right to be treated with dignity and respect. That is often not about money, but about sensitivity, compassion and the way that different professionals relate to individual older people.

My hon. Friend the Member for Pudsey (Mr. Truswell) asked about the role of the voluntary sector. He is right to say that it plays an increasingly important role in supporting older and disabled people to live independently and have a good and positive quality of life in the community.

My hon. Friend the Member for Stafford spoke with authority and integrity, as he does in any debate to which he makes in this Chamber. His speech was measured, reasonable and fair. I offer to meet him and any other colleagues to discuss the specific situation with residential care homes in Staffordshire. I do not want to mislead people into believing that I can intervene, or would want to, but I certainly want to engage with him and other hon. Members to consider what is happening there.

The staff at one residential home have expressed an interest in trying to run it themselves. Is there support in the Minister’s Department for setting up social enterprises?

We recently created a new social enterprise unit and several social enterprise pathfinders. I am certainly willing to explore with my hon. Friend the possibility of a social enterprise model, if that is appropriate.

I conclude by talking about the big picture. The Government accept that demographic pressures and rising public expectations mean that we need a new and fresh approach to social care. The Treasury acknowledged for the first time, in the November pre-Budget report, that social care is one of the great challenges that now faces this country. It is essential that it is addressed. We continue to negotiate with the Treasury to secure a fair and reasonable settlement as part of the comprehensive spending review, but it will be a very tight settlement.

I have said repeatedly that what we need is not a debate about social care—it is the charities that have been calling for that—but solutions. We need a new settlement between state, citizen and family to reflect those changing demographics and rising expectations. I said that in my statement at yesterday’s Age Concern conference, which was very well received. We need a new settlement, not a debate, and we need to work out what that settlement should look like.

We also need to use existing resources better, including the money that is available for social care that is funnelled through the health service and other local government departments. The money does not come just from the adult social care budget. If we are talking about securing the health and well-being of older people, that includes all of the resources that are spent in local communities. That means properly commissioning services from the third sector where appropriate.

Regeneration (East Lancashire)

I am grateful for the opportunity to raise this important issue. I am also pleased that my hon. Friends the Members for Rossendale and Darwen (Janet Anderson) and for Burnley (Kitty Ussher) are present in the Chamber, as is the hon. Member for Ribble Valley (Mr. Evans). I hope that they will all have the opportunity to make a brief contribution, because I know that they are as concerned as I am about this important issue.

Given that the hon. Member for Ribble Valley is present, I should say in passing that, by rights, I ought to be the Member of Parliament for that constituency. I contested the seat in the 1987 general election, and I think that it was widely acknowledged that I was unfortunate to lose by 22,000 votes—it rained on polling day and it was hard to get the Labour vote out.

Five or six years ago, I raised in a debate the issue of the housing conditions that some of my constituents had to endure. I told the House that the conditions were a disgrace and that they were a badge of shame for various people—those involved in public life; the council, whichever party ran it; the Government and the previous Administration; and, perhaps most of all, myself, as a Member of Parliament. I had tolerated for too long a situation in which people were living in intolerable conditions.

At that time, more than 2,000 houses had been abandoned in my constituency. They were terraced houses that were unfit for human habitation. People could not sell them and had simply walked away from them. In 2000-01, houses changed hands in public houses for less than the cost of a round. In such an environment, unscrupulous private landlords flourished, because they rushed into towns such as Accrington knowing that they could buy up properties for next to nothing and then make a healthy profit out of the housing benefits system. They did not care what sort of people they had as tenants, which added to the spiral of decline.

It was a housing market that had no base on which to build future prosperity. There was no rising equity in most of the property stock in Hyndburn or in other parts of east Lancashire, which meant that there was little financial incentive for home owners to invest in their properties, although there were obviously other incentives. The housing market at that time was not so much stagnant as in a spiral of complete decline.

My advice surgeries, and, I suspect, those of my hon. Friends, were full of decent and hard-working people. Some of them had perhaps served in the war and had then bought a respectable working-class property, settled down and raised their family. Such people found themselves being the last ones living in a terraced block or street. Imagine what it must be like for an elderly person trapped in that situation. The houses next door would be empty, abandoned, vandalised and burnt out. Damp would be coming through because next door’s roof had been burnt off. The truth is that no matter how well my decent constituents looked after their own properties, they were trapped in that nightmare and could not move. They could not sell their properties, because those properties were essentially valueless. That situation was endemic in the heart of Accrington in my constituency, as well as in Blackburn, Burnley, Nelson, Colne, parts of the Rossendale valley and, I suspect, parts of Ribble Valley. People tend to think of Ribble Valley as being a prosperous area—large parts of it are, but all-too-real pockets of deprivation exist there, too.

I was going to say that what has happened since is that we have been fortunate enough to be part of the housing market renewal programme and to have Elevate East Lancashire as the pathfinder, but we have not been fortunate—those things happened not by chance but as a result of political will. We were not lucky to get the help that the Government gave us, because we deserved it. I am proud of the difference that Elevate is making to the communities that I represent and to those represented by my hon. Friends in east Lancashire.

A few years ago, I took the Minister who had responsibility for housing at that time, Lord Falconer of Thoroton, as he now is, to Lonsdale street in Accrington, in my constituency, to show him the nature of the problem. I think that he was shocked by what he saw and by the conditions in which people were living. Since then, we have had the pathfinder programme, which has made an astonishing difference. Let us consider what has happened in Lonsdale street and its neighbouring streets. Lonsdale street has rightly been demolished. I shall come on to the argument about demolition and refurbishment, but I should say that in some cases demolition is the answer. For example, the conditions on Lonsdale street were dire and needed clearing. We have cleared that street and the neighbouring ones. People who walk along it now can see what we are building in its place: a state-of-the-art health centre in the middle of a ward that has some of the worst public health statistics in the UK. Around that health centre, we will build a mixture of diverse housing that will meet different housing needs in a diverse community. There will not be a one-size-fits-all approach; there will be different types of large and small housing.

This is not just about demolition—or even mainly about it. I must deal with one of the myths that has been put about by lazy journalists who rolled up in places such as Liverpool and east Lancashire and said that we are somehow ripping the hearts out of communities, that we are demolishing our built heritage and that it is all a disaster. If that were the case, neither I nor my hon. Friends would be here—far from it; we would all be signing up to a campaign to oppose what Elevate is doing. That is not what is happening on the ground.

Some demolition is taking place, but the truth is that more than twice as many properties are being refurbished as are being demolished. In 2005-06, which is the last year for which figures are available, Elevate improved 830 houses and demolished 331 houses, mainly older ones that were unfit. The improvement-to-demolition ratio is more than 2.5:1. The reason why I support Elevate so strongly—I believe that this is also the reason why my hon. Friends support it—is that this is about creating sustainable communities. It is about far more than just housing; it is about culture, sport and business. All those things are interwoven.

I congratulate my hon. Friend on securing this debate and agree with everything that he has just said. My own constituency has experienced parallel, if not identical, situations. I support the Elevate programme and want it to grow. He has touched on the subject of broader regeneration. Does he agree that the matter is not only about housing, sport, education and so on, because connectivity is crucial to our constituencies? Will he join me in urging for better links into Manchester, where many jobs are currently available?

My hon. Friend has made a powerful point, and I strongly agree with it. She has been an incredibly good advocate of regeneration in her constituency. She has mentioned links to Manchester, and we could improve the rail link by restoring the Todmorden curve or by doubling the track between Blackburn and Manchester Victoria. Such things are important for cultural, sporting and business links. Improvements would mean that people would be able to travel to work much more easily and that people who live in Manchester could come to see the beautiful scenery in places such as Ribble Valley, thus improving tourism. Those are all powerful points. The important thing is interconnectivity, because, taken together, those are all drivers for economic growth.

I congratulate the hon. Gentleman on securing the debate and on speaking with such passion about the area which I know he loves. As far as the wider business aspects are concerned, will he accept that we also need to see what we can do to ensure that the manufacturing base, for which east Lancashire is well known, does not completely disappear? We must consider how we can regenerate the manufacturing and business lifelines that exist in the whole of east Lancashire. That includes the areas that he has spoken about, which in turn include areas such as Ribble Valley. People think that Ribble Valley is a wealthy area, so sometimes the businesses that operate from it do not get the financial support that they need. People who live in Burnley, Hyndburn, Rossendale and Darwen, and Pendle travel around and work in the other constituencies.

The hon. Gentleman has made an important point. We are not just talking about traditional manufacturing areas such as Accrington—people would think of those areas as having manufacturing—because there are manufacturing companies dotted across Ribble Valley. There are many such companies in Clitheroe, some of which are having a tough time. They need help just as much as companies in my constituency, so I strongly support what he has said.

Returning to housing, five or six years ago, there were streets in my constituency in which house values were essentially nil—I made the point at the beginning of my speech that there was no base to the housing market. I checked some house prices on the internet yesterday in streets in inner-urban areas of towns such as Accrington. To someone living in London, the figures may not sound astonishing, but they are astonishing when house prices in those streets were nil five, six or seven years ago. In China street, Accrington, houses are now for sale for £100,000, and in Aitken street they are £97,000. However, prices in Pendle street show that we still have a problem: houses are for sale at £44,000 because three blocks have been done up, but one block has not. That street is outside the Elevate area, and I hope that the Minister will arrange with Hyndburn council that Pendle street should be the next street to be improved. Only around 200 people live in that block, but they deserve our help in having their case listened to. There are some clouds on the horizon, but we have made a fantastic start.

During the last bidding round for 2006-08, Elevate bid for £104 million and received £94.9 million. We are grateful for that £94.9 million, because it is money that we did not have before. It is great and we are thankful, but if there is to be a £10 million gap every year—it could become wider—we will end up with a funding gap over the period of the project of £150 million or even £200 million. The figures that I have seen go as high as £272 million.

We are in the business of transforming people’s lives with this project, which is making a huge difference to the communities that I represent. We have been blighted by years and years—decades—of under-investment. My plea today is that now is not the time to stop. Now is the time to say that the comprehensive spending review is an opportunity for us. We have a once-in-a-lifetime opportunity to make a real difference to those communities, and I hope that the Minister will press for proper funding for Elevate in the comprehensive spending review.

My hon. Friends and I have asked the Minister for Housing and Planning to visit my constituency and the neighbouring ones to see the work, and I make that request again today through the Under-Secretary of State for Communities and Local Government, my hon. Friend the Member for Basildon (Angela E. Smith). If the Minister for Housing and Planning comes to see what is happening, she will see that it is worth supporting the project and worth campaigning for extra resources.

I thank my hon. Friend the Member for Hyndburn (Mr. Pope) for allowing me to make a brief contribution to the debate.

My constituency is in east Lancashire, and I want to start by paying tribute to Elevate’s valuable work. At the outset, we had a fight to ensure that the borough of Rossendale was included in the scheme, and I am pleased that it was included. Some of the work has made a huge difference to people’s lives, particularly in parts of Bacup and Stacksteads, where there were some very poor living conditions.

I pay tribute to the vision for Pennine Lancashire of Mr. Anthony Wilson and his partner, Yvette. Their plans for an adrenalin gateway in the Rossendale valley would fit in with the spirit of the valley, where we are fond of outdoor activities and sporting events. The proposals are very exciting indeed—I endorse what my hon. Friend said to the Minister—and we hope that they will continue.

As my hon. Friend said, there is a problem because of the increase in house prices, which adds to our concern about the potential funding gap in years to come. In my constituency, we reckon that house prices have risen by a staggering 57 per cent. Houses that were worth £30,000 two years ago are now worth around £70,000. Compensating people for four houses of that value obviously costs a great deal more.

I also endorse what my hon. Friend the Member for Burnley (Kitty Ussher) said about transport links. We want very much to improve transport links into Manchester from Rawtenstall in the Rossendale valley, to cut down on the daily congestion on the M66, and on the Clitheroe to Manchester line, which runs through Darwen, where we are sure a commuter service would be popular. My plea is also intended to try to get things done, and I hope that the Government will consider bridging the funding gap, which we are concerned about, because it will mean that that much-needed project cannot continue.

I want to bring a problem to the Minister’s attention. In Darwen, the Redearth Triangle is due to be demolished. Most of the houses are boarded up and the residents have left. In fact, a former resident of Sudell road came up to me in Sainsbury’s recently, put his arms round me, hugged me, and said, “Janet, I’d just like to say that I have moved to much better house and I am absolutely delighted. Thank you very much for what the Government have done.” I fully endorse what my hon. Friend the Member for Hyndburn said about Elevate. It has transformed people’s lives, and some of the doom and gloom exposure in the media has been far removed from the truth.

We have a particular problem in Darwen because a small group of protestors have managed to hold up the demolition of the area. A planning compulsory purchase order inquiry is due to take place on 12 June. We are concerned about the delay, because the proposal for the site is to build a city academy, which is much needed in Darwen. We have no sixth form in the town, and we have the highest proportion of NEETS—young people not in employment, education or training—in Lancashire, because there is no sixth form in Darwen.

We want to improve education and that is what the academy would do. However, there is a small group of protestors, led by Mr. Simon Hugill—I make no apology for naming him—who does not even live in the area. He does not educate his children in Darwen but chose to move them to Bolton. It does not matter to Mr. Hugill whether the academy is held up, but it matters to the rest of us and to the children in Darwen. Perhaps the Minister would see whether she can do anything to bring forward that inquiry date.

I want to underline what my hon. Friend the Member for Hyndburn said about a ministerial visit. We have written to the Minister for Housing and Planning to ask her to visit. We would very much like her to see for herself the improvements, the way in which many people’s lives in east Lancashire have been transformed, and why it is imperative that that work continues.

I want to add one thing to what the hon. Members for Hyndburn (Mr. Pope) and for Rossendale and Darwen (Janet Anderson) said. If we look at regeneration, we must look at every aspect of it, and that includes business.

We are privileged to have BAE Systems operating in Samlesbury in my patch, and Warton is not far away, so we have two large factories in the area. Constituents of mine and every other hon. Member in the Chamber work there. The importance of that is not just that BAE is there, but that so many smaller industries and firms have grown up around BAE Systems and also employ people. It is important to have the vitality of the aerospace industry in east Lancashire, and that it has a future. That includes projects such as the Eurofighter Typhoon and the joint strike fighter.

I hope that the Minister will say something about industry, and how we can support it to ensure that it flourishes by supporting such projects. The large firms grab the headlines, but the smaller enterprises consist of people who have come in, perhaps remortgaged their homes and properties to start up their own businesses, and give a future to those who live and work in the area.

The Parliamentary Under-Secretary of State for Communities and Local Government
(Angela E. Smith)

I congratulate my hon. Friend the Member for Hyndburn (Mr. Pope) on securing this debate, and on his passion and commitment, which have led the efforts that he and his colleagues have made to secure the improvements in east Lancashire. All MPs from east Lancashire, including my hon. Friend the Member for Rossendale and Darwen (Janet Anderson), the hon. Member for Ribble Valley (Mr. Evans), and my hon. Friends the Members for Burnley (Kitty Ussher) and for Pendle (Mr. Prentice) have shown a wide commitment to the matter.

We recognise that much of east Lancashire had faced deep-seated and long-term housing, social and economic challenges, but the Government’s ongoing sub-regional response is robust, positive and proactive, as my hon. Friend the Member for Hyndburn acknowledged. The Government’s primary role has been to stimulate private investment by tackling particularly challenging blockages to recovery, a number of which my hon. Friend highlighted. Our approach to east Lancashire has focused on investment to address problems in the housing market, and we have invested in capacity-building its people and institutions, where poor performance exists. We have also focused on challenging poor performance to raise aspirations and on stimulating the growth of an entrepreneurial economy, which the hon. Member for Ribble Valley mentioned.

We recognise that, in encouraging sustainable investment, we need to address the many other factors that influence whether people want to live and work in an area. As has been mentioned, such issues include low crime, decent schools and colleges, clean streets and access to leisure facilities. The general issue is whether people want to live in an area and whether they feel safe and secure there and part of the community.

Changes are taking place in respect of all those issues in east Lancashire. It is a particularly beautiful part of Britain, and I say that as a Londoner and an Essex girl. It also offers a great quality of life. I was delighted to hear my hon. Friend the Member for Hyndburn and other hon. Friends refer to our housing market renewal policies there. As a result of those polices, many people are now choosing to live and work in the area.

In December, we were pleased to announce the success of the Pennine Lancashire bid for the local economic growth initiative. The competitive process, which was largely assessed by the private sector, awarded £22.3 million over three years, subject to the comprehensive spending review. That award is the biggest nationally and will benefit the constituencies of Pendle, Burnley, Blackburn and Rossendale and Darwen. I understand my hon. Friend’s comments about funding, and I shall say more about that in a moment. The local economic growth initiative is aligned with, and complemented by, a range of wider strategies because other challenges feed into the housing issue that he mentioned.

Housing formed a large part of my hon. Friend’s speech, and I understand his concerns. Although, as he said, things are slightly different for those of us who live in London, I grew up in an area with very poor housing. I still remember how thrilled I was at the age of 10 when my family got its first house, which was in New Town and had a bathroom and a garden. I am sure that my hon. Friend’s constituents would feel the same. Having somewhere decent to live is one of the most fundamental rights that any person has.

I commend the excellent progress that has been made by the nine housing market renewal pathfinders. More new homes are being built and refurbished to modern standards than are being demolished—my hon. Friend also made that point, and it is worth placing it very strongly on the record. Such initiatives help to improve the quality and choice of housing on offer. The record on that issue is impressive, and I congratulate all those involved. They have had strong support from local MPs and should take enormous pride in the work that they have undertaken.

Since the start of the pathfinder programme, more than 30,000 run-down homes have been refurbished. Since spring 2003, average house prices in the nine pathfinder areas have almost doubled from £40,000 to £79,000. As my hon. Friends the Members for Hyndburn and for Rossendale and Darwen suggested, however, we must recognise that the decades of under-investment in housing and people’s lives mean that there is still much more to be done to restore stability to communities and ensure that they are truly sustainable not only in the longer term, but in the short term, too. In recognition of that, the Government have allocated £1.2 billion to pathfinders for 2008.

I was grateful for the comments that my hon. Friend the Member for Hyndburn made about funding and about the difference that has been made by the money from the Government. We must look at new complementary funding solutions to capitalise on increasing land and property values and draw in as much private sector funding as possible. Value for money is key to making our money work smarter, and we look forward to working with local authorities and pathfinders to identify solutions that bring about even greater private sector investment. We expect the recently announced Communities England to play a significant new role in helping to ensure that that happens. However, we must ensure that partnerships spend money wisely and to best effect. We are talking not only about houses, but about improving people’s way of life in disadvantaged areas and meeting community aspirations.

I was pleased to hear my hon. Friends for Rossendale and Darwen and for Hyndburn give their strong support to Elevate, which the Government, too, strongly support. As we are seeing all over the country, but particularly in Lancashire, the housing market is beginning to turn the corner. Only five years ago, some areas were facing widespread abandonment and market collapse, and my hon. Friend the Member for Hyndburn wisely set out the social costs of that. Now, however, we are seeing the creation of more balanced housing markets that reflect modern communities’ needs and demands. As a result, we are seeing a strengthened housing market.

My hon. Friend referred to the house price increases in his constituency, and I am sure that many Members in other parts of the country would welcome such prices. I was looking at information about the new apartments in Accrington, and they are part of an incredible new development, which would not even have been thought of a few years ago. I understand that there are plans to clear the derelict site on the other side of the lake, which will bring real benefits to the area. It will create a community in which people will want to live and work, of which they will want to be part and where they will feel safe. Hyndburn is therefore an excellent example of how housing market renewal activity is being complemented by other public sector investment.

I was pleased that my hon. Friend mentioned the other issues that must be tackled to bring about real change, and my hon. Friend the Member for Burnley, too, referred to interconnectivity. Unless we deal with transport, employment and business, we will not make truly sustainable communities. Such issues are being taken on board, and we recognise that despite all the work that has been done, considerably more needs to be done. Our aim is to ensure that all housing is decent and attractive. I take the view that if I am not prepared to live somewhere, we should not expect other people to live there either. That should be a strong driving force behind the improvements that we want to make.

Several deep pockets of market failure and weakness remain. Too many houses are still in serious disrepair, and there is insufficient choice and quality for today’s communities. Those problems will not be resolved overnight, but my hon. Friend the Member for Hyndburn clearly highlighted the direction we are taking. We are moving in the right direction and we are in this for the long haul; we will not abandon areas now that we have made a start on making improvements.

There is considerable encouragement to be had from the progress that has been made. I commend Elevate’s partnership work with the private sector and registered social landlords to deliver a much better choice of social housing for people in east Lancashire. I am aware of some of the excellent wider working that Elevate has enabled through programmes such as “Constructing the Future”, which offers residents the opportunity to improve skills and gain qualifications to improve their ability to access good employment opportunities. Elevate has also worked closely with Lancashire county council to develop a new regional economic strategy across the sub-region, and that is directly related to raising the housing offer. It is worth putting on record that unless we deal with the economy and businesses, as the hon. Member for Ribble Valley said, we will not provide sustainable communities.

I pay tribute to the partnership work that has been done in east Lancashire, and local people clearly have a role in determining the future of the places in which they live. I also pay tribute to all those in the sub-region who have risen to the challenges. They have made a personal commitment to, and put effort into, enabling their communities to develop clearer strategies and significantly improve performance. The local strategic partnerships of Pendle, Burnley and Hyndburn have undergone significant change, which has made a real difference to changes in those areas.

Let me say something about liveability, because regeneration is about more than just housing and the economy; it is really about people, although I sometimes think that that gets lost in the debate. My hon. Friends the Members for Hyndburn and for Rossendale and Darwen made it clear, however, that people are the crux of the issue. Regeneration is about raising aspirations, improving the skills of the community, improving the environment and creating places where people really want to live, raise their families, work and spend their leisure time. As my hon. Friend the Member for Hyndburn said, we are seeing improvements in all those issues in east Lancashire. The local area agreements covering the area have been well regarded and have been important in strengthening partnership working, developing proposals for continuous improvement and ensuring a joined-up approach to rationalising and aligning resources to deliver the priorities agreed by the community as a whole.

I assure hon. Members that I will take on board the issues that they have raised and take them back with me. I understand the concern expressed by my hon. Friend the Member for Rossendale and Darwen about the town of Darwen, and my colleagues in the Department will look at the issue. Her commitment is clearly to ensure that people who live and work in the area have the best possible services, and I pay tribute to her for that.

In closing the debate, let me say that we are working, and will continue to work, to support the economic regeneration of the sub-region. I look forward to a day when east Lancashire has re-established the vibrancy that it experienced during the industrial revolution, with the economic diversity providing a varied and sustainable offer for the whole community. I pay tribute to all hon. Members involved for playing their part, and particularly to my hon. Friend the Member for Hyndburn, who raised the issue. He can take some credit for the changes that have been made, as they are due in no small part to his efforts.

Sitting suspended until half-past Two o’clock.

Voluntary Adoption Sector

I am grateful for the opportunity to discuss the triumphs of and, I am afraid, the threats to the voluntary adoption sector. Children in the so-called care of the state, despite the efforts of many fine foster carers, have a miserable and insecure existence, all too often shuttled between carers. That is reflected in appalling outcomes, and I provide just two examples of that: one quarter of girls who go through the care system become pregnant in the process and more than half the inmates of young offenders institutions have been through the care system.

Having children in care adopted by loving families is a noble objective. That is why a small number of MPs established an all-party group in the late 1990s. We welcomed Government announcements that gave priority to improving the miserably low levels of adoption that prevailed then. They have introduced the national register, the Adoption and Children Act 2002 and targets to encourage local authorities to adopt. All those measures have been blessed with some success, and adoption numbers rose from about 2,000 a year to a peak of 3,800 in 2005.

However, when we realise that more than 50,000 children have been in care for six months or more, and when we consider the best performance of a few really good local authorities, we see that the figure should at least double again. Thousands more children could and should be placed in loving homes. In fact, last year the number of adoptions fell, and the rumour going around is that last year’s number will be 2,600. That is the context for the role and the plight of the voluntary adoption sector.

In 2004-05, the last year for which detailed figures are available, voluntary adoption agencies placed almost 500 children, one eighth of the total sector. Most were hard-to-place children: older children, disabled children, children from ethnic minorities and severely damaged children; and more than half of them were in sibling groups. The latest report from the Commission for Social Care Inspection pointed out that 82 per cent. of voluntary adoption agencies reached the required standard on matching, against only 52 per cent. of local authorities. Some 92 per cent. of voluntary adoption agencies reached the standard for adoptive parents, which is so important. Only 55 per cent. of local authorities did so.

The report goes on to say:

“Overall the quality of adoption practice is still very variable across and within local councils, with some aspects of practice falling below the required standard in most places. Voluntary adoption agencies…generally meet or exceed the required standards.”

Only 5.5 per cent. of planned placements break down for voluntary agencies in the period up to the adoption order. The Prime Minister’s report mentioned a figure of about 20 per cent. for local authorities. At a time when an independent report has estimated that of the most recent cohort of children selected for adoption, 40 per cent. are awaiting adoption, such agencies are a precious resource.

However, the agencies are under attack from two separate angles: first, the problems of financial squeeze, exacerbated by delays in the courts, and, secondly, the sexual orientation regulations. Voluntary adoption agencies are reimbursed for each parental group they find, typically at a rate of £19,000, and rather higher in London. Barbara Hutchinson, deputy chief executive of the British Association for Adoption and Fostering commented:

“We have examples where social workers don’t place a child with a family approved by a voluntary adoption agency because they don’t have the money. Fees for using a voluntary adoption agency can be about £6,000 more than using a local authority.”

In fact, some local authorities have free inter-relationships.

The use of the voluntary adoption agencies is sharply declining because of costs. Barnardo’s has written to me to say:

“There are reports that there has been a reduction in placements to voluntary adoption agencies of up to 33 per cent. Barnardo’s has placed 50 children for adoption in the last year, compared to 70 children in each of the previous two years—a 29 per cent drop in placements. We are concerned that if this decline continues the future of the voluntary adoption sector will be unsustainable.”

However, the fees that voluntary agencies charge are often heavily subsidised from fundraising. Delay—let us remember that that means already damaged children waiting months and years for placements—is demoralising for the children and it can sometimes lead to eventual failure in adoption. Stinting on placement fees with voluntary agencies, when children are waiting because a local authority cannot place them, is the economics of the madhouse anyway. Fostering a child costs anything from £12,000 to £25,000 a year, so an up-front fee, even at the upper end of that range, represents in the long run a massive saving to the authority.

That problem is exacerbated by problems in local authorities and the courts concerning the implementation of the Adoption and Children Act 2002, which only recently came into force. There has been a massively disappointing downturn in the numbers of children adopted, from the peak of 3,800 to—the Minister may be able to confirm this figure—2,600 last year. That is the figure doing the rounds, but it has not been published yet. Much of the downturn has been driven by horrendous delays.

The Consortium of Voluntary Adoption Agencies has sent me a string of cases in which the legal process from beginning to end, which is not the whole delay that a child faces, has taken 18 months or longer under the new system. It is extremely damaging for the children, who can no longer be placed temporarily with a couple, and for the agencies because of the delay to their cash flow caused by the delay in payments. Many are on the financial edge.

I call on the Department to publish the report that it commissioned from Deloitte. Perhaps the Minister could explain the delay—I understand that it was finished last autumn—and provide us with a date for publication. More importantly, the Department should impress on local authorities that at a time when they have been provided with extra money for the purpose, the use of voluntary authorities to cut waiting lists of unhappy children is vital to those children. It makes excellent economic sense, even though it means social services departments having to bite their lips and pay out of stretched budgets for out-of-house activity. Equally, local authorities must sharpen up their court work in some parts of the country.

The other main problem is the sexual orientation regulations, the publication of which has been delayed until April. They threaten a number of agencies, especially the 13 branches of the Catholic Children’s Society, which accounts for one third of the voluntary adoption sector. Like the rest of the sector, it takes a very difficult mix of children: almost one quarter of its clients have severe medical problems and well over half are in sibling groups. However, it has the lowest breakdown rate of any agency in the country, with an average of 3.6 per cent. in the latest year’s figures. It is heavily subsidised by the Catholic Church—in fact, the annual collection for the society took place at my church last Sunday. Like all voluntary sector agencies, it provides a full range of activities, from information through to excellent post-adoption care.

It may bring matters alive to provide an actual case. I am grateful to the Salford branch of the society for sending me details of three children with suspected autism. Time allows me to quote the details of just one:

“Jake was three when he was placed for adoption... Jake had waited a long time for a family. He had been placed with a very experienced foster carer who managed his extreme behaviour with difficulty. Jake had insecure attachments and screamed for long periods if he did not have the undivided attention of the foster carer. He had some obsessional behaviour in that he had to have doors closed, he did not like getting wet— even a few drops of rain on his trousers were enough to send him into a panic. His speech was and still is much delayed. The Local Authority…did feel a diagnosis of autism was likely. The LA social workers were so concerned about a family coping with his challenging behaviour that they asked his foster carer to provide a video of him”—

I stress: a video of him—

“to show to prospective adopters. Jake’s adoptive parents accepted him from the start. They were given the option to say no but felt that this little boy needed them.”

Happily all three children have now been adopted, and they are progressing well within their own limitations. However, all that is being put at risk. Nobody is missing out on the opportunity to adopt under the current arrangements. Gay couples form only 4 per cent. of the pool and, as far as the records show, only one gay couple has ever applied to the Catholic Children’s Society. They were courteously and immediately referred to another agency.

The society has for many years accepted single people, provided that they are not engaged in sexual activity, whether heterosexual or homosexual. However, the regulations require that every adoption organisation should have a charter explicitly declaring gay partnerships to be on a par with marriage. Jim Richards, who is, incidentally, a former Labour councillor, is the long-serving director of the largest branch of the Catholic Children’s Society, which is in Westminster. He has commented:

“If we bow to the Government’s Regulations we would, in recruiting adopters, have to state that we accept gay couples, as well as those we accept at present. This would need to be clear in all our published literature and in making public appeals at say, a church. We would not be able to state within the context of adoption, that it is our belief that a married couple is better for children than a gay couple. One needs to imagine the position committed Catholics would face in speaking to a group of sixth formers and extolling the virtues of marriage, with them rightly accusing the speaker of being a hypocrite.”

The problem is not confined to the Catholic Children’s Society. I have received an e-mail from Cornerstone North East Adoption and Fostering Services, a small but highly successful evangelical-based organisation which makes very similar points. Anyway, the strong statement by the Archbishops of Canterbury and York brings a wider dimension to the whole business.

We should surely not be discussing the rights of a small number of prospective adoptive parents, who can approach a range of agencies anyway under the current arrangements. We should be thinking about the welfare of desperately disadvantaged children, who are currently handled by some of the best practitioners in the field working for the Catholic Children’s Society. It is a field where good practitioners are in very short supply.

As a strong supporter of the early and undiluted implementation of the sexual orientation regulations, I put it to my hon. Friend, in all courtesy and sincerity, that people are entitled to their religious views, but they are not, and should not be, entitled to elevate their views above other people’s right to equal treatment. I commend to him the statement of the chief executive of Barnardo’s, Martin Narey, who says that the objective is to find suitable parents to help children:

“Their race, gender, age or sexual orientation does not matter. Their ability to give a child a loving upbringing does.”

Barnardo’s is entitled to that view, and it does an excellent job. The people who work for the Catholic Children’s Society and the bishops who are its trustees take a different view. However, the issue is whether we put the rights of parents or the welfare of individual children first. If the regulations go through in the form suggested—we have not seen their published form yet—the Catholic Children’s Society will have to close when they come into force in two years’ time. The regulations will not provide a single extra place for any child in the country, but they will mean that hundreds of children who are currently being placed will no longer get that opportunity.

Is the hon. Gentleman aware that when legislation went through the Scottish Parliament allowing gay adoption, a guarantee was given by a Minister that it would not affect the work of Catholic adoption agencies? That will now be overridden by the operation of the sexual orientation regulations made in this place.

I was not aware that that was the exact position in Scotland. I had heard conflicting reports from there. I am sure that the hon. Gentleman is right, and it is shameful that that exemption has been abandoned.

There are some wider issues. In future, are we going to say that Christian doctors and nurses must participate in abortions? They have a principled objection to it, so must they participate in it?

I speak as a member of the British Medical Association medical committee. In relation to the hon. Gentleman’s point on doctors, the correct comparison is whether doctors should have the right to conscientiously object to treating gay people. They do not have that right, and they would not be able to maintain their job and their position on the register if they did. The right comparison is whether people are treated without discrimination on the grounds of their sexual orientation, not whether they participate in a certain activity, such as abortion, because, as he said, it is up to Catholics whether to choose to engage in placing children for adoption.

The essential issue with regard to a refusal to treat gay people is whether an individual gets treatment. Ministers themselves have said that the most important issue in this case is the welfare of children. Stopping the activity of the Catholic Children’s Society will not allow a single extra placement, but it will mean losing the hundreds of placements that are handled at the moment by the most successful group of social workers in the country, according to published statistics.

I have nearly finished and other people want to speak. However, I shall give way twice more, but these will be the last two occasions.

In strong support of the marvellous work that my hon. Friend the Member for Canterbury (Mr. Brazier) has done and the speech he has given, and somewhat in reply to my hon. Friend the Member for Buckingham (John Bercow), I want to say that it is not entirely a question of entitling one group of people to have a view that is placed above the views of others. The problem originates from the human rights contained in the European convention on human rights and the universal declaration of the United Nations, in which there are competing principles of equal value. They are the rights of the family and the rights of conscience and religion, and also the question of not discriminating against people on the grounds of gender or race.

It is impossible to say that the argument of my hon. Friend the Member for Canterbury is placing one above the other. He is arguing, quite rightly, for a proper and fair degree of consideration to be given to conscience and religion, and to family.

I was about to cover some of the ground that my hon. Friend mentions, but I shall take the intervention from my hon. Friend the Member for Buckingham first.

I am grateful to my hon. Friend for very generously giving way. In one respect, at least, I would like to endorse the observation of my hon. Friend the Member for Stone (Mr. Cash): my hon. Friend the Member for Canterbury has an exemplary track record in the cause of adopting children, particularly those who are hardest to adopt. I respect that, but it is this particular point on which I strongly disagree with him. I put it to him that there is no question of forcing any agency to close. Agencies will simply be expected to comply with the law. We cannot have a blackmailer’s charter in respect of any piece of legislation.

It is not a question of blackmail; the issue is straightforward. The Catholic Church will not place children with gay couples and has a conscientious objection to doing so, and it cannot continue to do so within the scope of the new law.

A number of wider issues are raised. I mentioned that of abortion, but one that is more immediately topical is that of governors’ appointments of teachers to faith schools. The Catholic Church has a policy, as do the governors of other religious schools, that people who are living in unmarried relationships, whether heterosexual or homosexual, will not be appointed to teaching posts in its schools. Schools have been given an exemption from the legislation by the Government. It seems strange that schools that affect tens of thousands and hundreds of thousands of what I might call ordinary children have been exempted, but no such way forward has so far been found for a very specific arrangement that affects only relatively small numbers of desperately disadvantaged children.

Why should the Government say that Catholic and evangelical social workers cannot continue to carry out a highly professional job unless they agree—bearing it in mind that there has been only one case in all the years that the process has been going on—publicly to proclaim opposition to their deeply held beliefs? The Government have allowed a two-year transition and Ministers have promised that no child already adopted will suffer. That is an ambitious pledge indeed, given the lack of after-care in a high proportion of authorities—45 per cent. have failed the inspectorate’s tests.

David Holmes, the new director of BAAF, has said:

“BAAF campaigned to widen the pool of prospective adopters to ensure as many children as possible have the opportunity to be placed in loving families.”

In other words, BAAF strongly supported the move on gay adoption. However, he continued:

“But we have also been concerned to ensure the expertise of Catholic agencies isn’t lost.

We…believe this package should lead to a sensible solution. We look forward to hearing the detail and offering any assistance that we can.”

I am not quite as optimistic as him, but there is a possibility.

To return to the point that my hon. Friend the Member for Stone made, I have seen a great deal of testimony on the clash of rights between competing groups—Christian rights and gay rights, for instance—but I wonder whether endless arguments about rights are the best way to resolve such increasingly common clashes, in what is becoming a more and more divided, fractured and unhappy country. No child will benefit from the application of the regulations to close successful organisations that help the most damaged children. The Government have allowed themselves two years to find a way of enabling some of the best agencies in a thin field to continue, within their consciences, to serve the most vulnerable members of our community—damaged and disabled children in care.

Order. I intend the winding-up speeches to start at 3.30 pm, giving the three Front Benchers 10 minutes each. Four hon. Members have asked to speak. If they are relatively brief, I shall hope to call them all.

First, I have urgent business in my constituency this evening, so I apologise for the fact that I shall not hear the summation speeches.

I am a Catholic and I am a liberal, and I have agonised over clashing rights. There are issues on both sides. As a Catholic, I have helped my wife, who was formerly chair of a joint Catholic-Anglican adoption agency for six years. As a liberal, I sat with my hon. Friend the Member for Oxford, West and Abingdon (Dr. Harris) on the Committee that considered the Gender Recognition Act 2004, and he knows that I fought for those rights for recognition. I have also stood up for gay rights since I first became involved in politics many years ago. When two sets of rights appear to clash with each other, how do we resolve the matter? With the sexual orientation regulations, it appears that the legislation will ride one set of rights over another, but it does not have to do so. If I thought that there were a prima facie case for that and that some rights had to be subservient, I would accept that argument. However, I do not accept that argument.

Let us consider faith-based rights. Catholics have their views about homosexuality. Not all Christians or even Catholics necessarily share the Church’s view, but let us put that on one side for the moment. People have a right to their faith. We have recognised and extended that right in this country, so that people can give education, and so that other rights, concerning who they allow into their schools, are set to one side. In the past, people have traditionally also done that in the family context of adoption agencies, but we are in danger of cutting off something that is fundamental to adoption agencies—to work within a family context of adopted families. I would argue that that is not necessary to preserve the other set of rights, which are equally important.

I shall come back to the other set of rights at the end of my speech. We have talked about the rights of the parents and the child—they have been well aired—but so far we have not discussed the adoption process and how it works. Given the details and pitfalls of the process, we do not need to impose the SOR across the board, as is proposed, to preserve both sets of rights effectively. Anyone who has gone through the adoption process or worked in a charity will know that potential parents are given the third degree. Some find the process extremely distressing, while others withdraw from it because of the intrusion into their lives by social workers trying to ensure that they are proper and fit people to bring up children.

By and large, social workers get it right. However, there are difficulties in how they relate to different families. It is quite common for adoption agencies working with different ethnic groups to try to employ people from that ethnic background to work with those families, in order to have a better understanding of who those people are. As the hon. Member for Canterbury (Mr. Brazier) has said, there is only one case on record of a gay couple coming to the Catholic adoption agency for approval, and they were referred on. Why would they do so? Would a gay couple really want a local priest to try to judge them and their lifestyle as appropriate to bringing up children?

There are circumstances in which it might be entirely right for a gay couple to bring up a child. An example of that would be a child—particularly a girl, but also a boy—who had been severely abused by men. An entirely female setting might be the best setting for that child. The question is whether we would ask a Roman Catholic, a Muslim or someone else with strong religious views to judge whether that was the right setting, and whether that person would have the right values to judge whether such potential parents were suitable. Could that person ask the pertinent, searching questions without being offensive and in a way that came to the right solution? I suggest that the answer is probably not.

The adoption process as it currently exists is multi-faceted and needs to be so. The danger of the SOR is that it will homogenise the process and that we will return to the bad old days of a politically correct form of adoption that rules certain people out because they do not fit within a narrow definition. We only have to think back to the 1970s, when we had that sort of process. People were compartmentalised according to who could adopt whom, rather than considering individual families on a proper basis.

I am listening respectfully to the hon. Gentleman, because I recognise that he knows something about the subject and that he feels as passionately about his position as I do about mine. May I nevertheless suggest to him that he is developing a most extraordinary argument? It is, namely, that people need to be protected from possibly prejudiced attitudes against their chances of adopting a child, which means, if we follow the logic of the hon. Gentleman’s position, that those with the prejudices are given a uniquely privileged position. That seems to me to be wrong. All we are asking is that Catholic adoption agencies should consider each case on its merits and not be influenced by a doctrinal view about homosexual practice.

The argument that I am trying to develop is not one of prejudice, nor am I saying that we should enshrine prejudice, because I would not wish to do that. I am trying to take forward the idea that we should look at the best way of judging potential adoptive parents. The best way is not to have a one-social-worker-fits-all model, otherwise we will be asking social workers to develop a set of skills that is very broad.

At the moment, we have Catholic adoption agencies—or the evangelicals, the Methodists or whoever—that work within a certain field. To overcome the fears of prejudice, would it not be better to have a model that is close to what we have now, which says that local authorities are the adoption agencies? Local authorities would therefore be responsible for diversity and equality and would be able to contract people within those fields. Although the numbers are small, there is even an argument for saying that a specialist agency might be required to work within the gay community. If we adopted the SOR as proposed, we could not do that, even though it might be beneficial in those cases.

Finally, having worked with and considered Catholic adoption agencies, I can say that they offer “care-plus”—their work goes beyond when the child leaves the adoptive family. If a 40-year-old has problems that relate back to their adoption, those social workers and charities will still be there to help them. That is well beyond anything that local government can do. We are at real risk of undermining some of those very good things to no effect whatever.

As you will be well aware, Mr. Marshall, in Scotland adoption is a devolved matter. I should also like to address the sexual orientation regulations, because there is a particular issue to do with Catholic adoption agencies that affects Scotland.

I stress that I personally support the regulations. I note in passing that although there has been much comment on rights, no couple—gay or heterosexual—has a right to adopt. We should be considering the rights of the child, which seem to be lost in much of the smoke and fury around the issue.

As I have said, I personally do not agree with the stance of the Roman Catholic Church on gay adoption. I see absolutely no reason why gay couples cannot provide a loving and caring environment in which to bring up a child. However, the fact remains that Catholic adoption agencies, of which two operate in Scotland, provide a valuable service. As the hon. Member for Canterbury (Mr. Brazier) has mentioned, they are particularly good at placing children who are otherwise difficult to place. It would be an utter tragedy if such agencies were unable to continue their valuable work because of this dispute.

A specific Scottish dimension applies, because when the Scottish Parliament debated the Adoption and Children (Scotland) Bill, which allowed gay couples to adopt in Scotland, the matter of Catholic adoption agencies was canvassed. Indeed, amendments were introduced to try to ensure that Catholic adoption agencies would be able to continue their work. In his comments on those amendments, Robert Brown, the Liberal Democrat Deputy Minister for Education and Young People, made it clear that the equality law was the responsibility of the UK Parliament in respect of the sexual orientation regulations. He also stated that agencies would be required to comply with it and regulations made under it.

It is also important to set out what Robert Brown said in the debate about the position of Catholic adoption agencies. He said that Peter Peacock, the then Minister for Education and Young People,

“and I made it clear to the Education Committee and the Parliament that the Scottish ministers want faith-based adoption agencies to continue their work, which is a valuable additional service to the services that local authorities and others offer. Indeed, I want faith-based adoption agencies to find more adoptive parents, to provide services to a range of adults and children, and to appeal to their faith-based communities to secure more adoptive parents who can meet all the stringent requirements of the adoption process and can give good homes to children who need them. That is the central point that we should bear in mind. Ministers have consistently made it clear that nothing in the bill will alter the position or practices of Roman Catholic adoption agencies. In practice, if an adoption agency thinks that it is unable to assist a child or prospective adopter, it should refer them to another adoption agency that could provide the necessary service and support. That is the current practice of adoption agencies…Standard 20 of the national care standards for adoption agencies includes a power to refer people who cannot be assessed to another agency, so the amendment”—

which was to protect faith-based agencies—

“will make no difference to what happens in practice. I hope that the Roman Catholic adoption agencies will be reassured by the reassurances that have been given at stage 2 and today on that matter.”

In the light of that, the Scottish Parliament took the view that nothing in the legislation would have impacted on how Catholic adoption agencies were operating and the Bill was enacted. That was right, because the Bill was dealing only with adoption and the right to adopt, not with the question of equality, which is a matter reserved to Westminster.

However, the equality question was canvassed during the passage of the Bill. The Minister—Robert Brown again—specifically said:

“Equalities legislation is UK legislation, and agencies will be required to comply with it and regulations that are made under it. Peter Peacock and officials have engaged with the UK Government on how agencies will be affected. However, I say again that we do not intend to affect the practices of the Roman Catholic adoption agencies; rather, we want them to continue to do their good work.”

Clearly, Ministers at the Scottish Executive were in touch with UK Ministers to try to deal with the situation, because the Scottish Parliament recognised the need for the good work of the Catholic adoption agencies to be protected. It was understood that they would be allowed to continue to pass on people to other agencies. It was a practical compromise, to avoid the situation into which we now seem to have got ourselves. Will the Minister say what approaches were made by the Scottish Executive on the matter and what became of them?

The issue is important in Scotland. As I have said, the understanding was that if a gay couple approached the Catholic agency, they would be passed on to another agency. It is a great shame that that now appears effectively to have been undermined by the actions of the UK Government in refusing to allow the exemption under the sexual orientation regulations. At least we assume that they will refuse to do so, although we have not yet seen the regulations, but given those that have been introduced in Northern Ireland, one presumes that they will.

The reasonable compromise that I have mentioned would not undermine the regulations. Despite some of the more outlandish allegations made in the letters that we receive about the sexual orientation regulations, the regulations already contain exceptions for religious reasons. For example, if I read it correctly, regulation 16—again, I refer to the Northern Ireland regulations—allows religious groups to refuse to rent out their premises to gay groups and others of which they disapprove. The problem is that that applies only when they are operating as a religious organisations. It does not apply to Catholic adoption agencies, which operate outwith the Church and fall under regulation 6, which applies to goods and services.

It is right that we should legislate to prevent discrimination against gay people. However, in legislating, we sometimes need to heed the beliefs of others. Perhaps in this case a small compromise could avoid a serious problem with the adoption agencies.

I am grateful for the opportunity to speak in this debate; I am also grateful, as we all are, to the hon. Member for Canterbury (Mr. Brazier) for raising this matter.

One of the rules of the House is that one gets on personally very well with those with whom one often finds oneself in disagreement, because they are pleasant people. That rule certainly applies to the hon. Gentleman, but I disagree with him on the sexual orientation regulations. I shall concentrate on those regulations, although I recognise that he raised other extremely important issues, some of which my hon. Friend the Member for Mid-Dorset and North Poole (Annette Brooke) will address from the Liberal Democrats’ point of view.

It is right to pay tribute to the record of the hon. Member for Canterbury for his work on adoption across the piece. I am aware of the excellent work of the organisation Parents and Children Together in the Oxfordshire diocese; it has no rule excluding gay couples from adopting, and rightly so. I am a member of the Joint Committee on Human Rights and shall say a word or two about how the European convention on human rights plays on this issue—something that has been raised, not least by the hon. Member for Stone (Mr. Cash).

Several rights are at stake on this issue. The rights of the child, which are paramount in adoption law, although I do not think that they are in competition with the rights of gay people, for reasons that I shall explain. Parents also have rights to be considered fairly and without unreasonable discrimination as prospective adopters by the public authority or the people acting for it in carrying out the public function of the placement of vulnerable children.

There is no contest between the rights of the child and the rights of parents to be considered fairly without unreasonable discrimination. Of course some parents will not qualify for adoption and will be discriminated against. However, the grounds on which that can happen have to result from a professional assessment process and be legitimate. There must be assessments of risk and harm.

Let us be clear: all other things being equal and all the other boxes having been ticked, the House has extensively debated whether gay people should be able to adopt—either individually, as they have for a long time, or as a couple. Although not everyone voted for the provisions, the House overwhelmingly agreed that it was right and proper that gay people should be able to adopt as a couple, just as they could when they were single, and that it was wrong to have unequal parents. Obviously, not everyone accepts that view, but that is the view to which the House came by a large majority.

Yes, but that is not what we are debating now. The hon. Gentleman touched on what we are debating a moment ago: whether the interests of the child—I prefer the word “interests” to the word “rights”, because the rights dialogue gets us further into a muddle—conflict with those of the prospective parents. The practical fact is that only one gay couple has ever approached the Catholic Adoption Society, while hundreds of children have been through its hands. If the regulations go through, thousands of children will be unable to have that opportunity in future. There is therefore a direct conflict between the interests of the children and those of a small group of prospective adopters.

I understand what the hon. Gentleman says, but that is not the only “if”. This is a question not only of whether the sexual orientation regulations go through, but of whether, as a result of the regulations, certain adoption agencies, such as those that he mentioned, choose not to do the valuable work that I accept that they do. That is their decision. It is a question not of whether the law is the law, but of whether people decide—I do not want to use a pejorative term—to take their toys home in response to the House having voted for the regulations. I would urge people not to do that.

I also hope that we can find a way through this problem that does not breach the fundamental principle of non-discrimination in the delivery of public functions on the grounds of sexual orientation. We already accept that principle for other innate human characteristics, such as race and gender, and I shall carefully draw analogies between those forms of discrimination in a moment.

I have mentioned the rights of the child and the rights of parents to be considered fairly and without unreasonable discrimination, but I recognise that people also have the right to hold and express a religious view. That is clearly a right, or an interest, to use the hon. Gentleman’s language. There is, therefore, a balance to be struck between how far people can and cannot express their profound religious beliefs—of course, they might have other, political beliefs—through actions that affect others.

The Joint Committee on Human Rights has not yet produced a report on the issue, but it is in the process of doing so, although I have not seen the legal advice or the draft report, so I can give hon. Members only my view. I believe that the Committee will find that the right, under article 14 of the European convention on human rights, not to be discriminated against in the enjoyment of one’s rights, including the right to privacy and family life, will, on balance, carry more weight, not in respect of people’s right to hold a belief or believe what they believe, but in respect of their right to express that belief outside the strictly religious area in the public sphere and in the delivery of public functions.

No one is arguing for religious people to be forced to do blessings or something else of a religious nature in respect of gay civil partnerships, which is why the Northern Ireland regulations contain exemptions, and we would expect to see such exemptions in the Great Britain regulations. People will not be forced to do such things by law, because such functions are recognised to be directly religious matters and, therefore, direct expressions of people’s beliefs. However, as soon as one becomes a doctor, and is therefore not acting in a religious way, one is not allowed to discriminate against gay people, even if one’s religious views lead one to think that such people are not deserving of the treatment that one might otherwise give. Nor do the regulations allow one, thank goodness, to discriminate against pupils—at least when they are in school—on the basis of their being gay. That is right and proper.

The hon. Gentleman is trying to find a gap where there is none. The bulk of the funding for the Catholic Children’s Society—I said earlier how underfunded voluntary organisations are—comes from collections such as those held at last Sunday’s mass and from leaflets distributed in churches. Under the regulations, there would be a requirement to include a commitment to treat homosexual couples on a par with heterosexual couples, and that intrudes directly and specifically into the religious sphere.

The hon. Gentleman, like a number of other people, may choose to go down the route of saying that there are simply conflicting sets of rights, but there is a direct clash. That is why it would be better to go back to the original point about the interests of the child and to say that the practical fact is that the present arrangement is good for children, while the future arrangement will not be.

I have conceded that there is a balance to be found between the two interests or rights, but I think that case law will show and that it is right in principle that the right not to be unfairly discriminated against in the enjoyment of public functions, whether in the health care system or the adoption service, carries more weight, not in respect of people’s right to hold their belief and to practise it in a religious setting, but in respect of their public function.

The hon. Gentleman raises an important point about whether such public authorities and agencies perform a public function, and there is a lot of case law on that in relation to Leonard Cheshire. However, carrying out a public function does not require bodies to be 100 per cent. publicly funded, and they may carry out such a function without being funded by the state. If that were not the case, bodies could exempt themselves from the race discrimination provisions in the Human Rights Act 1998 by buying their way into being a service provider and not being paid to provide a service.

One cannot base one’s view on how bodies are funded. My view is that adoption is clearly a public function, because it is a welfare function and we are dealing with vulnerable people. That would also apply to voluntary agencies—whether or not they were publicly funded—that provided social services or welfare services co-ordinated by local authorities or the Government. One can therefore draw a line around such provision. Catholic adoption agencies clearly carry out a public function and are therefore constrained by the provisions.

The other good point that has been raised is that Church schools and other faith schools are allowed to discriminate. I do not think that they should be allowed to do that, so I am being 100 per cent. consistent. It is for the Government to tell us why, under section 60 of the Schools Standards and Framework Act 1998, against which my party voted on two occasions, Church schools are, astonishingly, allowed not to employ teachers or to sack them on the basis of their sexual orientation. That has not been tested under Human Rights Act law, although I think that it will be at some point.

The Government gave a concession that, if a teacher does not go to the right church or building on a Sunday or happens to live with someone of the wrong gender, their employer—even if a state school—is allowed not to promote or appoint them. That is disgusting, and it is for the Government to tell us how they can tolerate that, while arguing against the discrimination that we are discussing. That point has been raised by my hon. Friend the Member for Teignbridge (Richard Younger-Ross) and others, and it is fair, but only in so far as the Government are inconsistent on this matter.

Other hon. Members have argued in the debate that deeply held beliefs are at stake, and I do not doubt that. However, there cannot be any more deeply held belief than that people have the right not to be discriminated against on the basis of sexual orientation, because that is humiliating. If the deeply held beliefs to which hon. Members have referred were misogynist or racist, we would not tolerate such discrimination, although we cannot stop people holding their beliefs. The same should apply here.

It is said that not many gay people might approach Catholic agencies, but there is a principle at stake. I served on the Committee that considered the Equality Bill, and part 2 made it clear that gay people would not be allowed to discriminate against Catholics. Religious organisations grabbed that right to non-discrimination, cherished it and said “hurray”, and rightly so. We are just saying that things should be the other way round.

As the hon. Member for Wallasey (Angela Eagle) brilliantly pointed out, saying that people are allowed to discriminate as long as they are allowed to refer someone to another provider is like telling Rosa Parks, when she tried to get on a whites-only bus in the deep south, “You can’t get on this bus, because it’s for whites only. But a mixed bus is coming along, and you’ll be able to get on that.” The humiliation still exists, and it is wrong. We should not turn down anyone on the basis that they are gay.

I am conscious of the time, and I just want to make one more general point. The Labour party has done a good job at keeping the Government on the straight and narrow, and I congratulate those in the Labour party who have lobbied so strongly, but the Government need to sort this out. They could easily say, for the avoidance of doubt, that voluntary agencies, whose work is valuable and valued, are entitled to carry out public functions as long as they do not discriminate against their employees or service users on the basis of sexual orientation or the other strands of discrimination and, indeed, as long as they do not proselytise in the process. On that basis, let them come and help; let them get public funding to do it; but they will do it on the basis of non-discrimination.

I strongly support the arguments that have been put forward by my hon. Friend the Member for Canterbury (Mr. Brazier), as well as the Archbishops of Canterbury and York, Cardinal Murphy-O’Connor and Archbishop Nichols, who is the archbishop of the Birmingham diocese—my diocese, as a Roman Catholic. I am not entirely convinced that we can avoid the question of rights, because the matter is one of law, and is driven by the universal application by the courts of the rights in question. Therefore, first, the question is raised of incompatibility with the European convention, about which a declaration will have to be made on the introduction of any legislation; secondly, the courts will adjudicate.

I suppose I could say, because I happened to be speaking in the human rights debate on Monday, and raised the question then, that we should legislate at Westminster on our own terms, without regard to the European convention or, indeed, the Human Rights Act 1998, identifying in our own Parliament exactly what we as elected representatives want. That is a more general question. By the way, it is open to us to accept, following the adjudication of Lord Hoffmann in the case of Simms and O’Brien, that when legislation that has been passed is express and unambiguous, even if it is inconsistent with the Human Rights Act, it is good law and there is no disputing it; Lord Steyn and many other law lords would agree. However, I am profoundly concerned about the question, which the hon. Member for Oxford, West and Abingdon (Dr. Harris) rather glossed over, of the inconsistency that arises when principles compete and a legal presumption is established, on the tipping point, in favour of one of them.

The way in which the measures were introduced under the Equality Act 2006 gives severe grounds for believing that something not far short of legal or legislative sharp practice by the Government went on. The issue that we are considering now was not raised until a letter was received—there may have been discussions of which I am unaware—from Stonewall. That came shortly before Third Reading in the House of Lords. It was in response to that that the Government, without a Division, or any amendment, put forward the proposals in their own name. When the matter came to the House of Commons—and anyone can read this—although there had been discussion in both the Lords and the Commons, there was no Division and, as far as I am aware, no amendment either. Thus for practical purposes the question has not been tested in the way I should have thought its importance warranted. The problem, as I see it, is that it will not be possible to amend the regulations when they are brought in. Furthermore, section 81 of the Equality Act specifically provides for exceptions without any limitation, so that it would have been entirely possible to make exceptions, although none, as far as we know, is anticipated.

My hon. Friend is making a powerful point from his much more detailed understanding of the legal background, but it seems to me that his point about parliamentary process is at the heart of the matter. As he said, in relation to European law we had the option to go another way, as some of our European partners chose to do. The powerful point that he made was that the matter was not debated in either House of Parliament. It was introduced at the very end of proceedings in the House of Lords and then bounced back here. There has been virtually no discussion.

That worries me enormously, as does the fact that the nature of the regulations means that we shall not effectively be able to amend them. As I mentioned in the debate on the Human Rights Act on Monday there are specific requirements imposed on parliamentary draftsmen, including through the review of human rights by the Government, that, in a nutshell, all our legislation must be drafted to be compatible with the European convention on human rights. I do not believe that it is possible in this context to come up with a declaration as to compatibility when there are competing rights as in this case.

In addition, adoption agencies were not mentioned at all in any discussion of the measure that I know of, except when my hon. Friend the Member for Buckingham (John Bercow) raised it—I invite him to respond, but I presume that he did not just invent the point, and that someone may have suggested to him that it was an important question that needed to be raised. He specified the cases of general practitioners and adoption agencies. I have travailed and trawled through the debates, and I think that last November was the first time the matter was ever raised. In effect, the Government have created a legal presumption in favour of a particular principle, which, by virtue of the Equality Act itself, should be condemned, because there is no such thing as complete equality between any one of the principles concerned. However, the Government have chosen to go down that route—I think against the advice of the Prime Minister and one or two others, including the Secretary of State for Communities and Local Government.

It is true, indeed, although I do not remember the precise date, that I raised the matter with the Minister for Women and Equality during questions in the House at the back end of last year—on my own initiative, as my hon. Friend will understand. Although my hon. Friend is right that there was no Division on the Second Reading of the Equality Bill, it was open to him or any other Member to force a Division. I simply worked on the basis that an Equality Bill should mean equality—not equality on the whole, except in so far as we provided for inequality.

My hon. Friend has raised an important point, because it was not a matter that could have arisen under the Equality Act unless someone had what I should describe as a pretty galactic view of the universality of possibilities. The question of goods and services would not necessarily include adoption agencies. Because of the nature of goods and services and the matters that were encompassed by the Bill as it then was, it was almost impossible to work out what might come out of the woodwork. However, when it came to the specific question that could have been put after Third Reading I was disappointed, on studying the discussion that took place in the House of Commons, that the matters were not given the kind of consideration, by way of amendments, that they could have been given.

That is in the nature of things, but the Government have now specifically, following a Cabinet revolt, decided to create a legal presumption in favour of one principle as compared with another. That is not consistent with the principles of the Equality Bill. That is where I find the internal contradiction; and it is unanswerable. It will raise questions of incompatibility, and it would be far better if we legislated on our own terms to decide such matters. In a pragmatic and practical way we would have arrived at a solution, if we were not bound hand and foot by the application of universal principles that sound very good, like motherhood and apple pie, but which, as I said on Monday, when they are resolved by reference to specific circumstances, give rise to impossible situations. That is pretty well where the Government are now. I shall take all steps necessary to oppose the regulations when they appear, but we have not even seen them yet.

I congratulate the hon. Member for Canterbury (Mr. Brazier) on bringing this timely debate to the Chamber. I think we would all agree with the hon. Member for Stone (Mr. Cash), who said that there has been insufficient scrutiny of this subject. I might disagree with his conclusions, but it is right that the issues should be fully debated.

I shall take a stance that is slightly different from that of previous speakers, because I want to concentrate on the interests of the child and adoption in the broadest sense. I also congratulate the hon. Member for Canterbury on the immense contribution that he has made to the all-party group on adoption and fostering. He will know that although I may differ with him on some things, we broadly agree on most of them.

I start from the premise that every child should be entitled to live in a stable, loving family relationship. It is a tragedy in many ways that 60,000 children are fostered at present, and I welcome the Government’s Green Paper on how we can improve the outcome of looked-after children.

Perhaps one of the worst aspects of the current situation is that many children experience multiple placements, which are so damaging. Several of us have become very interested in attachment theory, which focuses on the importance of vulnerable children—all children—having a strong attachment with one adult figure as early in life as possible. With multiple placements, there is never a chance to unravel the problems of a damaged and vulnerable child.

I also want to think about children’s views on adoption. The November 2006 document on adoption, “Your Rights, Your Say”, included a report on children’s views. Children—of an appropriate age, of course—were asked what was the best thing about being adopted and said that it was joining a new or a real family. They said that the worst thing about being adopted was leaving their old family, that it took too long and that there was too much waiting. Children’s top views on how things could be improved included making the process quicker, involving and supporting them more, and keeping them in touch with what was happening. We certainly should listen to their views.

In 2005, adoption agencies placed 3,100 children for adoption. As we know, the number of adoptions fell last year, so we have to ask some serious questions about the process. I praise the voluntary adoption agencies, which placed a total of 708 children—about 40 per cent.—in 2004-05. That is significant; what is also significant is the quality of those placements. That came out clearly in the Commission for Social Care Inspection report that was published in November 2006, after all 150 local councils and the then 33 voluntary agencies in England were inspected. It stated:

“Overall the quality of adoption practice is still very variable across and within local councils…Voluntary adoption agencies that have a more specific remit generally meet or exceed the required standards.”

In fact, the detailed statistics show that the minimum standards were met by about 54 per cent. of local authorities but by nearly 90 per cent. of voluntary adoption agencies when it came to the all-important post-adoption support. Many lessons could be learned if the two sectors worked closely together.

The report also stated:

“Seven out of ten local councils and nine out of ten voluntary adoption agencies have developed strategies to recruit adoptive parents to meet the needs of children who are waiting.”

Again, a better statistical performance. It went on to say:

“Most councils offered support to birth families but many found it difficult to get it right. It usually works best when it is independent and there is a choice”.

That, of course, is the great contribution of the voluntary sector: independence and choice.

The hon. Member for Canterbury mentioned finances, and I want to touch on that because it is serious. There is a suggestion that local authorities are using the voluntary agencies less because they are too expensive. If we are putting children first, I do not understand how we can use such terms. Barnardo’s was used to place only 50 children last year, compared with 70 in 2005, and that situation seems to cross a number of agencies. I understand that the fees are about £12,000 for a local authority and £19,000 for a voluntary agency such as Barnardo’s, but, if we are concerned about the best interests of the child, there is no comparison to be made if the child remains in foster care for a longer period and there are multiple placements.

On economic grounds, the figures just do not add up because of the cost of foster care. I should add that long-term foster care is the best solution for some children, and it is important to do the right thing for each individual child, but I do not think that cost should be a reason for not placing children through the agencies.

It is also important to consider how costs are calculated. Local authorities may not include all their overhead costs. There needs to be a much more accurate assessment of the cost of adoption placements, and local authorities should be encouraged to work with voluntary agencies to plan the services required. There are also issues around the quality of the local authorities’ commissioning processes.

I have a question for the Minister. He usually says that I ask him lots but, as this is a repeat question, we should definitely get an answer today. The Department for Education and Skills commissioned a review of adoption services—the Deloitte report. Will he give us a date for publication? The leaks that we are getting now cannot be helpful to the overall debate. It would be better to have things out in the open. As this is such an important area, the report should be published and put before us.

Do we want voluntary adoption agencies to become a last resort? That is how things are beginning to look. It is important to secure their financial viability. The issue is much bigger than the sexual orientation question. That is my main point.

I would also like to praise the voluntary agencies for the wide range of services that they provide, which, of course, pull in extra money. Barnardo’s, for example, offers more support to adopters than is usually available from local authorities because it is able to visit the family more often and each of its social workers has a manageable case load. The voluntary sector generally brings a stable staff group. We need to tackle many of those problems in the public sector.

I have asked many parliamentary questions about the situation in the courts but have not had an answer. I am concerned about differentials up and down the country in the time it takes to get a placement order, but the figures are not available. The Minister should undertake an inquiry into how the court process is working following implementation of the Adoption and Children Act 2002.

I apologise, but I will not. I am very short of time.

On the sexual orientation aspect, the National Children’s Homes stated:

“Currently, we have successful placements with people from all walks of life, including single people, gay couples and many families on low incomes. We believe that what matters most is that children are placed in a loving, caring, secure environment and that all potential adoptive parents are fully prepared and supported through the whole process and this support continues as they settle into family life.”

As far as I am concerned, those are the important ingredients. I cannot believe that it is helpful to bring discrimination into our consideration of the best interests of the child.

The British Association of Social Workers says that the Government would not be right to consider exemptions. It states:

“Every social worker in the UK must be registered with one of the 4 regulatory councils and every council’s code of practice states that registrants must not discriminate unlawfully or unjustifiably against service users, carers or colleagues.”

All children need loving and accepting parents who, incidentally, do not display prejudice against other people. I do not question the Catholic agencies’ professionalism, commitment and outstanding record of finding stable and loving homes for some of the most disadvantaged children in society, but we must put things in context, consider the overall situation and look at adoption on a case-by-case basis. I cannot understand how an organisation that is, in effect, operating on behalf of the state can operate a policy that is possibly in conflict with the state’s policy. Overall, we need to think about social workers and the managers of the schemes. We need to recruit sufficient skilled and experienced social workers and to retain them. We need an effective work force across the board.

This is a timely debate. There are challenges to the Government to give leadership to ensure that every child matters by getting the right relationship—the best relationship—between the state and voluntary sector and by working with the Catholic agencies in the months ahead.

I warmly congratulate my good and hon. Friend the Member for Canterbury (Mr. Brazier) on securing the debate. I echo what my hon. Friend the Member for Stone (Mr. Cash) said earlier: it is surprising to learn yet again that the regulations that form the core of the two challenges raised by my hon. Friend the Member for Canterbury will be pushed back by another month and will not be published until April, whereas we had the benefit of the Prime Minister’s view in his statement. The matter was not discussed when the Equality Act (Sexual Orientation) Regulations (Northern Ireland) 2006 were published and adopted, although I am sure that many right hon. and hon. Members received correspondence, because adoption did not form part of the Northern Irish remit.

As my hon. Friend the Member for Stone has pointed out—I am sure that my hon. Friend the Member for Canterbury has been greatly exercised by this, too—we did not have the chance to discuss the subject during the passage of the Equality Act 2006 through both Houses until an amendment was tabled at the latest possible stage on Third Reading in the House of Lords. That cannot be democratic, and it cannot be in the Government’s interests not to allow debate. Perhaps the Minister will confirm my understanding on reading the Library note that the consultation document that formed the basis of the regulations, which we will discuss at a later stage, did not put the question of adoption services provided by either local authorities or voluntary agencies out to consultation. If that was the case, it is regrettable. That is why I warmly welcome the opportunity to debate the matter.

Like so many who have spoken this afternoon, I put the interests of the children at the starting point of every stage of the debate. I want to nail my personal colours to my moral mast: I place particular emphasis on marriage as a special relationship and was delighted to see the Archbishops of Canterbury and of York recognise that so warmly. That is not to say that I do not recognise that there are other relationships and other partnerships, but I believe that children brought up in a traditional marriage have the best of all possible starts in life. We recognise that not every child is fortunate enough to be the heart of that traditional family, and we have all noticed, up and down the country, the disappearance of the extended family. That leaves some 60,000 children in care, some for short periods before they are returned to their natural parents and others for longer periods. There are 61,000 children in care each year.

I recognise and celebrate the work of all adoption agencies, including those which work for local authorities, and especially that of the voluntary adoptive sector. We know that adoption is a challenging and lengthy process, but it brings tremendous happiness and stability to a child, where they are successfully placed. In 2004-05, the voluntary adoption organisations in England and Wales placed 708 children, of whom 227 were placed by the Catholic adoption agencies. For the benefit of the hon. Member for Angus (Mr. Weir), I believe that the figures for the two Catholic adoption agencies in Scotland, where we share a common interest, show that 47 children were placed by them in 2006, of whom only two were disrupted. My hon. Friend the Member for Canterbury has given us a tremendous opportunity to debate the issues.

The Minister faces a difficult situation. Perhaps he has had sight of the regulations that cover the main subject of the debate. In passing, however, I shall refer to the financial squeeze and the problems of delays up and down the country that have been caused by the courts. I want to pause for a moment to refer to an article in The Sunday Telegraph. One of the problems that we face in placing children for adoption is the shortage of adopters. I have been left in no doubt that one of the reasons for that is that parents who put themselves forward, initially as foster parents and ultimately as adoptive parents, often feel that they are on their own. They would certainly welcome more mentoring and training opportunities, and I hope that we can reach a cross-party consensus on that. Another problem is the huge fees faced by local authorities, which The Sunday Telegraph put at up to £26,000 per child. Clearly, if that situation is affecting the number of children who are placed in families for adoption, I hope that we all—and most importantly the Minister—will have regard to it.

There is some good news. I want to pay tribute to the recent work of Kent county council—obviously, North Yorkshire county council is doing good work in this regard, too, but I do not have time to mention every county council. Kent county council has set out a wonderful example of best practice, and last year alone it placed 95 children with adoptive parents, which was a record for that council and for any other county council in the country. The methods that it has used have included family group conferencing and the staying together project. I hope that we can all learn from that and that the Minister will look favourably on those practices.

I wish to focus only on a couple of questions given the time available and the importance of the debate. I believe that when the House comes to consider the sexual orientation regulations, it should not be asked to choose which form of discrimination is higher or lower. We should not be asked to choose whether we are in favour or not; we all oppose any form of discrimination on the grounds of sex, race, religion or any discrimination that came under the human rights umbrella. To force the House to decide in favour of one type of discrimination might create a new form of discrimination on the grounds of religious belief by forcing the former on other agencies, which are predominantly Catholic although, as my hon. Friend the Member for Canterbury has pointed out, other religious voluntary adoption agencies—such as Cornerstone, which operates in the very north-east of England—also do some excellent work.

Why are the Government forcing the House to make that choice? It was never made clear through the passage of the Equality Act 2006 that the matter would have to be faced in such a way. It was not made clear during the passage of the Adoption and Children (Scotland) Act 2007 in Scotland that there would be a threat to the Scottish Catholic adoption agencies, and it was certainly never made clear that it was an issue in the discussions on the Northern Irish sexual orientation regulations.

I hope that the Minister will be able to reassure me that the regulations that his party proposes to put before the House in April will work. Have the Prime Minister and the Department for Education and Skills closed the door on any eventual compromise? Such a compromise would match the mood of those of us in this Chamber and of the House. We would all like to see a compromise, but my fear is that that will not be possible. There is not an umbrella organisation or a gateway process that would work. Who has been tasked with forming such an umbrella organisation to make the regulations work?

Why were the Government reluctant to debate the issues earlier? Why did the consultation document not cover the point that we have discussed? Why have the regulations not been published? How can we have reached a situation where the Minister’s party is considering not allowing a free vote, when such a vote should, by any stretch of democratic values, be allowed on moral judgment?

It has genuinely been an interesting and well-attended debate. It is good to start with areas of common agreement.

I congratulate the hon. Member for Canterbury (Mr. Brazier) on securing the debate. Over the past few months, ever since I took my present role in the Government, which is my first, I have had the pleasure of visiting many parts of the country to take part in events to do with the “Looked after Children” Green Paper, and I wholeheartedly agree with the hon. Gentleman about the positive effects of the stability of placement. He was right in what he said about outcomes for children in the care system; not only do they not attain as well in their GCSEs and other qualifications, but 25 per cent. of those in our adult prisons have come through the care system.

I congratulate the hon. Members for Canterbury and for Mid-Dorset and North Poole (Annette Brooke) on their work with the all-party group on adoption and fostering. I was pleased to attend that group before Christmas, when we had a fruitful discussion.

I shall try to answer as many questions as I can in the eight and a half minutes that remain. There were many good contributions to the debate. I am happy to liaise in writing if necessary, but I shall try to cover as much ground as I can.

The adoption target focused attention on the need to increase the number of adoptions of looked after children. According to the latest figures, about 1,000 more looked after children are now being adopted each year than in 1999. That is excellent news for vulnerable children in need of adoption. For each child, it means being part of the loving, caring environment about which so many Members have spoken. Much of the credit for that must go to prospective adopters, social workers and adoption agencies.

The 30 voluntary adoption agencies in England are an integral part of our adoption provision. They provide a range of services, including finding adoptive families for children, providing adoption support and working with birth parents. As has been mentioned, many VAAs specialise in finding families for children who are disabled or from black and ethnic minority groups, and those who need to live together with their siblings.

According to figures provided by Caritas social action, the Catholic Church's voice on social justice and care, adoptive placements supported by VAAs tend to break down less often than those supported by local authorities. I accept that entirely. In 2004-05, VAAs in the UK approved a total of 543 families, and 708 children were placed as a result of the services provided by those agencies. However, we need to consider how we might sustain and increase the overall capacity of the adoption market and improve the geographical spread of the voluntary adoption agency. Some areas have few, if any, such agencies. We need to ensure that children in need of adoptive placements benefit from improvements in local authority commissioning from VAAs.

We are aware that voluntary adoption agencies consider that the £12,000 fee that local authorities pay other local authorities for finding suitable adoptive families does not represent the full cost. The VAAs consider that the £19,000 fee that local authorities pay the agencies can deter local authority purchasers of VAA-approved prospective adopters. The difference in inter-agency fees is seen by the agencies as a major obstacle to realising their full potential. I accept that, too. They believe that they currently operate at a distinct disadvantage when compared with local authorities.

The hon. Member for Canterbury will know from what I said to the all-party group on adoption and fostering last November that we are considering the issue as part of a scoping study, looking at local authorities’ commissioning of services from voluntary adoption agencies. The report of that study is being finalised. The hon. Member for Mid-Dorset and North Poole asked one question on the subject, so I can tell her and the hon. Gentleman that we expect it to be published in early March. I hope that that is helpful.

I also want to put on record the fact that as a result of our ongoing dialogue with voluntary adoption agencies, we are providing £13,000 to fund independent support in order to help them strengthen their business management and marketing skills. That support will be led by Red Ochre, a social enterprise with expertise in helping organisations to obtain funding and to survive and grow.

A key issue that has recently been under consideration, and which I suspect may in part have prompted today’s debate, is whether faith-based VAAs, when providing publicly funded services, should be exempt from the sexual orientation regulations. That, unsurprisingly, has played a big part in the debate. I was asked a number of questions about the regulations. We are still working on them, but we plan to bring them into force in April.

As hon. Members will know, the issue is not whether civil partners and unmarried couples, whether of the same or the opposite sex, should be eligible to adopt. Such groups have been eligible to do so since the Adoption and Children Act 2002 came into force on 30 December 2005. The problem is the impact that the regulations may have on Catholic and other faith-based VAAs that, for doctrinal reasons, are unwilling to assess unmarried couples of the same or the opposite sex as prospective adopters.

There has been an interesting debate within parties as well. The hon. Member for Buckingham (John Bercow) has strong views on the matter. I sympathise with and relate to many of them, as does the hon. Member for Oxford, West and Abingdon (Dr. Harris), but the latter would disagree with his colleague the hon. Member for Teignbridge (Richard Younger-Ross) on many such matters.

Ministers have considered the matter carefully, and on 29 January the Prime Minister announced that there will be no exemption from the regulations for faith-based VAAs that provide publicly funded services. However, he made clear that there would be a transition period before the regulations come fully into force at the end of 2008. That will give those VAAs time to consider whether they wish to continue to operate when the new regulations come into force.

Leaving aside the merits of the argument—it is already being dealt with and will be dealt with in the big debate in the House—will there be a free vote on the Labour side?

As the hon. Gentleman knows—he has far more experience in such matters than me, as he has been around a lot longer—that is for the Whips to determine. I am not privy to those discussions, but if he wants to know my opinion, I am happy to give it to him.

I will not be supporting an exemption, because I believe that the Government have made the right decision. The hon. Gentleman is well aware of that.

I turn to the questions that I have been asked. The hon. Member for Angus (Mr. Weir) asked where Scotland stands in all this. I understand that negotiations are taking place between the Executive and the powers that be at Westminster on the question of exemption. I cannot give him any more details at present. The hon. Member for Oxford, West and Abingdon made it clear that Catholic adoption agencies can continue to do their work; he also said that he hopes that they will not take the ball away. I agree. I accept that the Catholic agencies do great work, and I hope that they will continue to do so.

Health Services (Rochdale)

I thank the House and the Speaker for the opportunity to initiate this short Adjournment debate on health services in Rochdale. Health services and well-being affect all of us. We are all users of the national health service and hon. Members from whatever political party are proud of and committed to it. I pay tribute to the many health professionals who work in the acute, primary and tertiary health services in Rochdale—be they general practitioners, consultants, nurses, dentists, opticians and health visitors—who do a fantastic job often in difficult circumstances.

My purpose during this debate is to highlight some of the concerns that I and the residents of Rochdale have about the Government’s health agenda and its effect on my constituents. I shall comment on the acute primary and mental health services, but time constraints mean that I shall concentrate on issues of concern rather than on the positive developments that I readily concede the Government have initiated.

Ten years ago, when the Prime Minister was Leader of the Opposition, he declared that there were less than two days to save the NHS. Ask anyone today what that means and most people in Rochdale would consider it a sick joke. Our NHS is in decline. Rochdale is the 25th most deprived borough in the country and contains Central and Falinge ward, in which the Rochdale infirmary is based. That ward has one of the worst morbidity rates in the country, with an average life span of 68 years. None the less, we are faced with the loss of the accident and emergency department and children’s, maternity and other services. Those changes are the result of the “Healthy Futures” and “Making it Better” consultations taking place in the north-west and north-east sectors of Greater Manchester.

I thank the Secretary of State for Health who, a couple of weeks ago, agreed that the “Making it Better” consultation should be referred to the independent review panel following requests received from the overview and scrutiny committees of Rochdale, Bury and Salford councils.

The hon. Gentleman and I have discussed the question of maternity and children’s services in Rochdale and Bury on several occasions. As the Secretary of State has referred the issue to the independent reconfiguration panel, does the hon. Gentleman think it would be useful for the Rochdale infirmary support group—the friends of Rochdale hospital—to meet the parents support group at Fairfield hospital in my constituency to discuss providing a joint response to the independent reconfiguration panel when it comes to Greater Manchester to consider again the proposals for maternity and children’s services?

I thank the hon. Gentleman for that intervention and I agree wholeheartedly. After talking to a consultant at Bury yesterday, I believe that there is much that Bury and Rochdale can do together and I would be happy to facilitate that.

I welcome the reassurance that the Minister, the right hon. Member for Doncaster, Central (Ms Winterton), gave the hon. Member for Manchester, Blackley (Graham Stringer) that all previous promises and commitments are on the table. Such openness is to be welcomed. I am sure that she is aware that the “Healthy Futures” consultation is currently the subject of an application for judicial review from the Fitton family. I pay tribute to their courage following the loss of one of their boys.

I want to place on record, and make the Minister aware of, some of the concerns of the people of Rochdale about the consultations. We are not opposed to change for the better, and we accept that change is inevitable. However, we want a fair review of the options and we want the people of Rochdale to have a fair opportunity to make their proposals.

In the briefing for today's Opposition debate on acute services reconfiguration by the NHS the NHS Confederation says:

“Primary Health Care Trusts have the duty to consult on substantive changes and reconfiguration of services and should present genuine options and not a predetermined programme for reconfiguration in order to be fully accountable to the local community.”

That did not happen in the “Making it Better” consultation, as the only option presented for the Rochdale infirmary was an urgent care centre. Retaining the accident and emergency department at the infirmary was never considered, which is why our application for judicial review has a genuine chance of being accepted: there was no genuine option presented for the infirmary.

Although the “Healthy Futures” consultation agreed to the option of retaining maternity and paediatrics services at Rochdale, and at Fairfield hospital in Bury, when it came to the final decision-making process, totally spurious figures were produced for the cost of the various schemes. For example, there were claims that an extra 1,000 births per year at Rochdale infirmary would cost £43.5 million and that rebuilding the maternity unit and creating a children's service at north Manchester would cost nothing. We know that health bosses are giving figures that support their predetermined agenda and I am determined not to allow that to happen.

I thank the friends of Rochdale hospital, who are ably led by Father Arthur Nearey, together with Councillor Ashley Dearnley—leader of the Conservative group—Councillor Jean Ashworth, and Carol Ashworth-Lord who represents the midwives. My only regret is that the local Labour party has failed to take part in our campaign. I have no doubt that at the appropriate time the Rochdale electorate will bear that in mind.

When the independent review panel is constituted I will ask it to look at the letter written in March last year by the consultants of Bury and Rochdale, which states that we should work together in a shared unit based on both sites. That model, which has the support of clinicians, will be far cheaper than a newly created service at north Manchester and will provide a better geographical balance.

Regarding the consultants’ letter of last year, unless it is different from the one that I received, my recollection was that 17 of the 20 paediatricians working at either Bury or Rochdale signed a letter confirming that they thought a single site would be appropriate, not a shared operation on two sites. Perhaps there is a second letter.

It is true that part of the letter said that, but, from talking to consultants at Rochdale, I know that further discussions were taking place about what joint services could be provided on both sites. If we are to have a genuine chance of providing the geographical coverage needed, facilities must be provided on both sites. That will be a far cheaper option than a newly created service at north Manchester. I hope that the independent review panel will give the proposal serious consideration and that Rochdale and Bury can work together to make it a reality.

The Pennine Acute Hospitals NHS Trust is responsible for the Rochdale infirmary. It is the largest non-teaching trust in the country and was established four years ago. The trust’s management has been heavily criticised by consultants, the unions, and Professor Alberti in his report published last year. It is heavily in debt and the chair and chief executive left under a cloud. Four years ago, I criticised the need for a four-hospital trust and subsequent events have demonstrated that it is too unwieldy. I hope that the Minister will consider alternatives, including splitting the trust into two; one based on the sites in Rochdale and Bury and one based on the sites in Oldham and north Manchester. That solution would be welcomed locally.

Rochdale PCT is a three-star trust and in the top 10 per cent. of PCTs in the country. The merger of Rochdale and Heywood and Middleton PCTs into one unified trust is a welcome move that builds on the strengths of both trusts. The Government say that changes in primary care services will negate the need for continued provision of many acute services based in hospitals. I support that, but the reality on the ground at the moment is rather different.

The LIFT—local improvement finance trust—scheme to provide 10 combined centres throughout the borough of Rochdale is years behind schedule. Only one of the 10 centres has as yet received planning permission—two years late. I am aware, from talking to GPs, that there is real resistance to leaving purpose-built GP centres, which they own, for private finance initiative buildings with increased costs. Of 69 GPs in Rochdale, only one practice, as far as I am aware, has so far agreed to move.

I want an assurance from the Minister that acute services at Rochdale infirmary will not be discontinued until replacement primary care facilities in Rochdale are in place. If she cannot give that assurance, she should not be surprised if we regard the Prime Minister’s pledge on the NHS as hollow rhetoric.

Perhaps of more concern is the development of ICATS—integrated clinical assessment and treatment services—which involves privately run treatment and diagnostic centres. Concern has been expressed elsewhere today to the Prime Minister about the effect of those centres on locally provided, publicly run NHS facilities. Can the Minister tell us where the centre for Rochdale will be sited and what analysis her Department has done of the effects on existing NHS services?

The Minister is aware, from our meetings on the provision of dental services in Rochdale, of my concern in that regard. She has admitted that, between 1997 and 2005, NHS dental registrations in Rochdale, under the old system, fell from 57 to 35 per cent. The new contracts change the way in which patients are counted, but that does not negate the fact that the number of people entitled to an NHS dentist has continued to decline. In an area with Rochdale’s index of deprivation, that is not acceptable. I acknowledge that the PCT has opened an additional dental centre at Castlemere community centre and commissioned an additional two dentists, but that is a drop in the ocean when compared with the number of dentists who have gone to the private sector in the past few years. I would welcome an open debate with the Minister on what we can do to restore an NHS dental service to Rochdale. At the moment, an emergency-only service through the dental access centre is all that is available for the majority of Rochdale residents.

I want to comment briefly on the provision of mental health services in Rochdale—the responsibility of the Pennine Care NHS Trust. Despite additional investment in capital refurbishment at the Birch Hill site, I am concerned that the trust’s current deficit will result in further cuts in community services—a sector that has traditionally been underfunded not only in Rochdale but elsewhere. We need a commitment that there will be more investment, not less, in community mental health services.

The NHS is acknowledged as the only living creation of the 1945 Labour Government. It was the product of a report written by Beveridge, a Liberal MP. We need to see that the words of the present Government are backed by actions and that there is a commitment to a full and free NHS delivered locally in Rochdale in the area of need. I look forward to the Minister’s response.

I congratulate the hon. Member for Rochdale (Paul Rowen) on securing the debate. He has raised concerns on a number of occasions about health service provision in his constituency, including dental services, to which I will return. It is also very good to see my hon. Friend the Member for Bury, North (Mr. Chaytor) here and being allowed to contribute to the debate, because he has been greatly concerned to represent his constituents with regard to the health service provision in his area.

I will return later to some of the details and questions raised by the hon. Member for Rochdale, but I should like to start by reflecting on some of the progress that has been made in his constituency. I was a little disappointed when he talked about the decline of the NHS in his area. I hope that he will join me in celebrating some of the improvements that have been made, not least because many of them are due to the very hard work and commitment of local NHS staff and have led to real changes in the quality of the services that are delivered.

Of course, that hard work and commitment has been backed up by increased investment locally. The Heywood, Middleton and Rochdale PCT—I am glad that the hon. Gentleman welcomed the joining together of the trusts—is benefiting from that investment. In the current financial year, the PCT has received £288 million, which will go up to £316 million next year. We are talking about a real-terms increase of 6.7 per cent. As a result, waiting times have plummeted and there have been major local achievements. The NHS walk-in centre in Rochdale is well established and has made a major contribution to reducing the burden on local accident and emergency departments, but it is also often extremely convenient for the local people who use it.

The PCT, together with Bolton PCT, is developing a new generation of primary care facilities through the LIFT programme. The hon. Gentleman raised concerns about the LIFT scheme, but it is progressing well. We expect financial close in the next three months or so. It is true to say that some GPs prefer to retain their old premises, but I gather that the majority of GPs are backing the improved services that LIFT centres will deliver. We will see real improvements for patients. I can assure the hon. Gentleman that there is no intention of closing existing acute services until the LIFT schemes are operational. The plans for some 13 new health and social care centres will attract investment of some £80 million to the area over the next 10 years.

When talking about changes where services have traditionally been offered in acute hospitals, it is important that we consider the benefits that can be secured through such investment in the community. Across the whole of England, there is a shift from district general hospitals down to community services. That is better for people because the services are closer to home and it leaves the acute hospitals to do what absolutely needs to be done in a hospital setting.

As the hon. Gentleman said, the pattern of future service provision in Rochdale and the wider area has been the subject of much public discussion over the past 18 months, as part of two reviews of health services across Greater Manchester. He mentioned the “Healthy Futures” review that looked at changes to acute hospital services across north-east Manchester. There was good public engagement in that consultation—about 4,000 formal responses were received.

In September, the joint committee of PCTs decided that three of the hospitals covered by the review—Fairfield general hospital, North Manchester general hospital and the Royal Oldham hospital—would provide acute medicine and accident and emergency services. It also decided that Rochdale infirmary would be developed as a local hospital that would provide a range of services including dental, mental health and social services.

I want to touch briefly on dental services because the situation in Rochdale is an example of why it is important to devolve money to local level. Previously, if a dentist left the NHS, there was no money left locally to replace those services. Under the new system, at least there is money locally to provide some of the services that the hon. Gentleman mentioned. That has been happening in Rochdale. There is still some way to go, but at least we are able to retain money locally, so that services can be recommissioned.

The hon. Gentleman talked about mental health services. We have developed new community mental health services, and we have been anxious to ensure that those services do not suffer disproportionately if there are financial constraints or problems. I am glad for his support for mental health services. It is important that they continue to be delivered effectively, because that is the way to ensure that people have access to them not only quickly, but, crucially, in their own communities, so that we can reduce hospital admissions as much as possible.

I welcome the Minister’s comments on this vital issue. One problem that I have been hearing a lot about in my surgeries in the past few months is that of delays in getting people appointments. People are being told that they will have to wait for months. I would be pleased if the Minister looked into that, because that is the real effect of the deficit: people are not getting appointments quickly when they desperately need them.

Of course I will look into that, but I emphasise that, given the shift in the way that mental health services are developing, we are also reaching out to more people. Mental health services are now working much more closely with local authorities to ensure the kind of social care that is so necessary for people with mental health problems.

The hon. Gentleman mentioned a second review—the “Making it Better” review of in-patient maternity, children’s and neo-natal services in Greater Manchester, east Cheshire and High Peak. That was another major review and consultation, which covered some 13 PCTs. The consultation process received more than 50,000 responses, representing the views of about 240,000 individuals. That is a very good indication of the interest that local people took in the development of their services.

On 8 December, the joint committee of PCTs decided that four hospitals—Hope hospital in Salford, Trafford general hospital, Fairfield general hospital in Bury and Rochdale infirmary—would no longer provide in-patient maternity and paediatric services. Hon. Members will know that the decisions on “Healthy Futures” and “Making it Better” were supported by the two relevant joint overview and scrutiny committees. However, the overview and scrutiny committees of Salford city council and Bury metropolitan borough council both referred the “Making it Better” decision to the Secretary of State for Health. Rochdale metropolitan borough council’s overview and scrutiny committee referred the decisions on both “Making it Better” and “Healthy Futures” to the Secretary of State.

I was pleased to tell the hon. Gentleman and other hon. Members during oral questions, so that they had notice, that the Department was asking the independent reconfiguration panel to undertake a review of the issues surrounding the reconfiguration of in-patient services for women, babies, children and young people in Greater Manchester.

I was glad to hear the positive suggestion of my hon. Friend the Member for Bury, North that it would be good to take a joint approach to giving evidence to the independent review panel about the issues that affect both sites. He also made the important point that it is vital to get the support of clinicians when changes are being made and to consult them closely.

My right hon. Friend the Secretary of State for Health has asked the IRP to review the decisions related to the “Healthy Futures” decision in light of the referral from the Rochdale overview and scrutiny committee. We are now working with the IRP to establish the terms of reference for the two reviews and a timetable for their completion.

I hope that hon. Members understand that the IRP’s involvement in reviewing the “Making it Better” and “Healthy Futures” decisions makes it inappropriate for me to comment in detail on the concerns that have been raised today. I can, however, make some more general points about health inequalities that the hon. Gentleman talked about and deprivation in those areas. We are trying—this is particularly important in addressing health inequalities—to ensure that services are accessible. That is why the NHS walk-in centre in Rochdale and the primary care centres that I mentioned are extremely important.

The hon. Gentleman talked about journey times. The north-west has a top-performing ambulance service, which has provided very good and efficient services. Indeed, it made the point in the consultation that it could provide them with the new reconfiguration. It is important that that is considered in the review.

I understand what the Minister is saying, but I ask her to talk to the ambulance drivers who use those roads. During peak hours, it is impossible to get from Rochdale to Fairfield or Oldham in the times stated.

I am sure that all hon. Members will want to raise such issues with the IRP, whether or not they agree with that statement. We have made the referral to the IRP, and I assure the hon. Gentleman and my hon. Friends that we have high-quality services not only in Rochdale, but across the whole of Greater Manchester.

Therapeutic Services (Abused Children)

I am delighted to have secured this debate on the important issue of therapeutic support services for children who have suffered abuse. My personal interest stems from my role as a parliamentary ambassador for the National Society for the Prevention of Cruelty to Children, my work as an MP in Dewsbury, and my being someone who has supported ChildLine for many years.

It is a fact that many children who have been abused are not receiving therapeutic services and that such services will help them to overcome the effects of abuse. That situation surely cannot continue, because it devastates children’s lives and damages their life chances.

Last year, I tabled an early-day motion supporting the NSPCC’s campaign to encourage children to speak out about sexual abuse. It recognised that many abused children do not receive the support that they need to deal with the serious and lasting damage caused by abuse and it called for access to therapeutic services. It was only tabled in May of the last Session, and in just two months it received 247 signatures from MPs of all parties. Despite the late tabling, it was the 23rd most signed early-day motion out of 3,158. That clearly demonstrates the importance attached to this issue by Members of Parliament from all political parties.

Before I focus on the problem, I want to acknowledge this Government’s outstanding record. They have rightly made it a priority to improve educational standards for all and to reduce social exclusion, antisocial behaviour and the number of young offenders. I know that my concerns about offences against children are shared, and that Ministers at the Department for Education and Skills, which has primary responsibility for the safeguarding of children, have done a huge amount of work on prevention. A great deal of work has been done between the Department of Health, the DFES and the Home Office on the subject, including the Safeguarding Vulnerable Groups Act 2006. This Government have done more than any previous Government to attempt to prevent abuse and safeguard children from it, so I commend them.

Where abuse occurs, our objective must be clear: to have a society in which all abused children are provided with the support and care they need to enable them to come to terms with their experiences and to rebuild their childhoods and lives. Although I fully acknowledge the work that the Government have done through the victims of violence and abuse prevention programme and the development of sexual assault referral centres for children in London and Manchester, many children still do not receive the help they need.

I should outline the scale of the problem in this country. The NSPCC’s study of the prevalence of child maltreatment found that 16 per cent. of children had experienced some form of sexual abuse, a quarter of children had experienced one or more forms of physical violence during childhood and 6 per cent. of children had experienced frequent and severe emotional maltreatment during childhood. Today, there are more than 30,000 children on child protection registers because they are at risk of abuse, and, on average, nearly 700 children are added to those registers in the UK each week.

Although some children are at risk from strangers, it is often those closest to them, be that a carer, relative or family friend, who pose a significant threat. Some 1 per cent. of children experienced abuse by a parent or carer, 3 per cent. were abused by another relative during childhood and 11 per cent. were abused by people known but unrelated to them. Those statistics are shocking, but they do not give the full picture. Three quarters of sexually abused children did not tell anyone about the abuse at the time, 27 per cent. told someone later, and about a third still had not told anyone about their experiences by early adulthood.

It is difficult to gauge the numbers of children and young people who currently receive therapeutic services to help them overcome abuse. Different forms of abuse co-exist—all forms of abuse involve emotional abuse, while sexual abuse often involves physical abuse, and so on. One detailed study in 2001 on the provision of therapeutic services for sexually abused children estimated that 90 per cent. of children who had experienced sexual abuse had received no substantial support.

Research into the effects of child abuse shows serious and lasting harm to those affected. For them, the horror of abuse does not stop when the abuse stops—it continues into adulthood, often seriously impairing their life chances. According to a recent study by Hammersley and Read, two thirds of people with schizophrenia have been physically or sexually abused as children.

I congratulate the hon. Gentleman on securing this debate on such an important subject. He is probably aware that I have raised the issue many times. I fully endorse his plea for all children who have been abused to receive therapeutic services, but will he join me in asking the Minister about a further group: the children and young people who themselves display sexually harmful behaviour? If they could receive treatment at the earliest possible time, there is a chance that we will tackle the whole problem in a greater way.

The hon. Lady raises an important but sometimes forgotten issue. I endorse her position, and I am sure that the Minister will take her point on board.

An older but extensive five-year study by Martin reported that slightly more than half of the 58 physically abused children that he studied had some type of neurological impairment, and approximately one third had an impairment that was significant enough to handicap everyday functioning. Similar neurological, sensory, and/or psychomotor problems have been identified by other researchers investigating the consequences of physical abuse, while very recent research by Andreas Danese confirms that childhood physical or sexual abuse may also have an impact on adult physical health and well-being, particularly in relation to diabetes and heart disease.

Anxiety and depression, anger and guilt, poor self-image, difficulties in functioning at school and, later, at work, problems with personal relationships and parenting, sexual problems and physical effects are increasingly recognised as the long-term consequences of abuse. Maltreated children are also at risk of a range of psychiatric conditions that may contribute to their reduced ability to function successfully. They include: cognitive distortions; depression and anxiety; dissociation; a decreased sense of self and others; low self-esteem; and altered sexuality. Such people are at greater risk of becoming alcohol and drug abusers and of engaging in tension-reducing behaviours, such as self-mutilation, compulsive sexual behaviour and eating disorders. They are also at greater risk of suicide.

The consequences of abuse speak for themselves, but what of the pecuniary costs? Recent research by the NSPCC on the cost of investigation, protection, prosecution and care estimated the short-term cost of child abuse to be £20,000 per case. Where a child is taken into residential care, a conservative estimate of the cost is £3,500 per week, or £182,000 per child per year. The long-term consequences of abuse include criminality, unemployment, mental health problems and drug abuse, to name but a few.

What is the cost of the NSPCC’s therapeutic work? It is an average of £3,759 per child. It is not rocket science to do the sums, but this is not a quick fix. The Government will have to be prepared to invest to save, and to accept that shifting the pattern of expenditure will take years, not months.

Will the Minister acknowledge that investing money in therapeutic services for these children when they need it would greatly improve the life chances of many thousands of children? This is particularly true of children in care—another priority for the Government. Some 63 per cent. of children and young people entering care do so for reasons of abuse or neglect, yet few of them receive the therapeutic support they need to overcome the effects of this abuse.

I have demonstrated the support that this issue has in Parliament. The Minister will not be surprised to learn that it also has great support among the public at large. During a campaign last year that received little publicity, more than 17,000 people contacted the Secretary of State for Health, backing the need for support services for abused children.

Since this debate was selected, I have been contacted by the Children’s Commissioner for England, Professor Sir Albert Aynsley-Green, who believes that the shortage of therapeutic services for abused children is a cause for great concern. He believes that every child who has suffered abuse should be treated under child protection arrangements and, following a proper assessment, should be given the required therapeutic support. He also believes that it is imperative that victims of sexual abuse are not stigmatised and regarded as inevitable future abusers. The majority of young people who have been abused do not go on to become abusers.

The Government are, rightly, committed to ensuring that comprehensive child and adolescent mental health services are available to all who need them. However, experience of those services is that they are rarely delivered in the longer term to children who have been abused. Despite the acknowledged increase in funding for those services, resources at all tiers of provision remain stretched, and the thresholds for assessment are too high. Children in the care system do not, typically, have access to therapeutic help unless they are diagnosed with a mental health disorder. That is not necessarily an appropriate measurement when assessing a child’s need for therapeutic support, as is demonstrated by the following quote from a foster carer:

“He destroys everything in his sight. He self-harms, doesn’t sleep, doesn’t get on with other members of the family, isolates himself, needs 24 hours of supervision, he pulls his hair out, pulls his finger nails off”.

These services

“won't work with him as he is not in a permanent placement. They see him to monitor his medication but do no one-to-one work”.

Will the Minister consider the following questions? First, is his Department aware of the level of unmet need in this sector? Secondly, will he acknowledge that if the Government’s social exclusion action plan, which I commend, is to be successful, particularly for children in care, therapeutic services must be available to all abused children? Thirdly, what negotiations is he having in his Department and under the comprehensive spending review to ensure that all children who have been abused have access to therapeutic services? Fourthly, will he consider the proposal to fund comprehensive, inter-agency, post-abuse therapeutic provision in three pilot areas to demonstrate the effectiveness and impact of such provision, and to create a model for a national roll-out of comprehensive services?

Before the Minister responds, I want to share with him some quotes from real-life case studies. David, aged 10, told his ChildLine counsellor:

“My dad sometimes takes me out after school. Mum doesn’t know but he always comes with another man and they touch me. It hurts, but I can’t stop them. Dad said he will kill mum if I tell anyone.”

Tracey, aged 14, said:

“I’m calling about my dad.”

There was a long pause, and then she said:

“My dad does things to me. I don’t like it. It’s been going on for a year when my mum goes out to work. It makes me feel dirty.”

She had not told anyone about it before. Emma, aged 16, said:

“My mum and dad make me have sex with men for money. My dad takes my clothes off and then the men jump on me. I tried to get away once but my dad dragged me back by my hair.”

Marie, aged 14, had run away from home, and called ChildLine about her dad, who had been sexually abusing her since she was 11. Every time it happened he said:

“if you tell anyone I'm going to kill you”.

She wanted to tell her mum what was happening but was afraid of what her mum might do. Marie had run away from home several times, but always went back because

“I've got no money and I don’t know where to go anyway.”

Marie agreed that the police could pick her up from the phone box.

I do not underestimate the Government’s commitment to this work. Only this month, the Prime Minister, speaking at the NSPCC’s full stop campaign event, said that

“each one of those statistics in their thousands represents a young person that has been through probably a deeply traumatic experience where if they are not given that help that experience can stay with them and possibly change and warp their lives for the rest of their lives, then each one of those numbers is a young person with a life that can be rebuilt rather than a life that is destroyed as a result of the experience that they have been through.”

I know that the Minister will agree that expenditure in this area today saves substantially greater expenditure in the medium to longer term, and that, far from it being a cost, it is an investment in our children and our future.

I congratulate my hon. Friend the Member for Dewsbury (Mr. Malik) on securing this Adjournment debate on an issue that should be of supreme importance to every Member of the House and every person in our society.

The sexual abuse of children is not new in our generation, but perhaps it is more spoken about and more open than ever before. The more it is spoken about and the more open it is, the more society begins to realise the devastating consequences for children and young people who go through the experience. The reality of the impact on the child or young person should be outrageous enough for us to believe that we need to act. However, we should remember that the impact is often lasting for the child or young person’s future life. We should also remember that those children and young people often become parents, and that that damaging experience as a child can affect their experience of parenting and bringing up their own families. That is not the only horrendous impact on children and young people. There is also an impact inter-generationally, and on our community and society in a variety of ways.

As my hon. Friend has said, there is strong evidence to suggest that if we can intervene quickly and early and ensure that such children and young people have access to appropriate professional and therapeutic services, the economic and financial gains are indisputable. Failure to do that will lead not only to many more members of society being incredibly damaged, but to a knock-on effect on the social fabric and economic success of our country. Early intervention, and understanding the importance and power of the issue is incredibly important.

We must still ensure that in the context of any debate about the sexual abuse of children we must first do everything in our power to use all the resources at our disposal to minimise for every child the risk of being sexually abused. We still have responsibilities to ensure that the social and health care system works properly in an integrated way to safeguard children to maximum effect. We all know of the horrendous cases that are highlighted in the media, and we also know that 99 per cent. of the function that social workers fulfil leads to the protection of many children at risk. In debates such as this, we should pay tribute to the professionals on the front line who battle every day to support some of our most vulnerable children. No Member of this House, however hard we work, can totally understand the emotional experience of being a professional social worker in child care, perhaps with a case load of 20, 30 or more children and young people who are at risk of being or have been abused.

The system has grotesquely let down children in some circumstances, and those circumstances have been brought to the attention of this House and our society over the years. The everyday heroes who protect children in a most remarkable way are rarely given credit in such debates. We must consider the progress that has been made in recent times. Having reflected on that progress, we must consider how we can do even better in the future. I shall spend a couple of minutes articulating some of the positive action that has been taken to try to improve the situation for children who have been sexually abused.

The Department of Health, together with the Mental Health Foundation, has funded a study into psychotherapy for girls aged six to 14 who have been sexually abused. It will not come as any surprise to my hon. Friend or to other Members that the study found high rates of depression, anxiety and post-traumatic stress disorder. For those children psychotherapy was an effective treatment, and in those circumstances it had lasting benefits.

In my days as Minister with responsibility for young people, which seem like a long time ago, I spent a lot of time during 2001-02 just talking to young people. One experience that shocked me were conversations with young girls, who frequently told me that self-harm was a major issue among themselves and their friends. We, as a society, have not even begun to highlight or to focus on that issue or on what is happening in the real world. However, I do not want to be misquoted: I am not saying that self-harm is always related to sexual abuse, because that would be entirely misleading and inappropriate. There is, none the less, evidence that some self-harm is directly related to children and young people who are being sexually abused. I wanted to use the debate to flag up the issue of self-harm among youngsters, and to say that throughout the Government, we have a responsibility to take it seriously.

I shall move on to other developments. In November 2006, our Department and the Department for Education and Skills published a report that considered the progress made in promoting the mental health and psychological well-being of children and young people. It highlighted that although Child and adolescent mental health services have made enormous strides in recent years in helping more children and families, and in doing so more promptly, there is still a need for substantial improvements to services.

Information from the CAMHS mapping exercise for 2005 shows that in the last three years the number of CAMHS staff has increased by more than 40 per cent., and that the number of cases seen also increased by more than 40 per cent. During the same period, recorded annual expenditure on CAMHS increased from £283 million to more than £500 million. I remain committed to ensuring that we continue that progress.

We will report very soon not only on the target that we set for the development of CAMHS services throughout the country, but on how I intend to maintain the pressure in the system, particularly in the health service, to ensure that once the target period is over we keep our eye on the ball to maintain investment and to focus on the importance of CAMHS services. It simply will not be enough to say, “Here is the target and here is our report on how we have done against it.” The prioritisation of CAMHS services in the national health service is equally important.

We work closely with the Department for Education and Skills on those issues. We also work with other organisations. For example, with the National Institute for Health and Clinical Excellence we are working on guidance on the identification and recognition of all forms of child abuse. Guidelines are expected in late 2008.

We are working with the Home Office, the DFES, the National Society for the Prevention of Cruelty to Children and other voluntary sector organisations, providing services for sexually abused children through the joint Department of Health and National Institute for Mental Health in England victims of violence and abuse prevention programme. The objective is to equip professionals and services to identify and respond to the needs of children and adolescents who have been sexually abused, raped or sexually assaulted, or of victims of sexual exploitation through prostitution, pornography and trafficking. I look forward to seeing the national service guidelines that the programme will publish later this year on therapeutic and preventive interventions with sexually abused and exploited children.

With the Home Office, the Department of Health has been supporting the establishment of sexual assault referral centres, a joint service for victims of rape and sexual assault provided locally by health and police services and the voluntary sector. St. Mary’s hospital in Manchester and The Havens in London, as my hon. Friend has said, have piloted children’s services, and they are being evaluated.

We are also working with the Home Office on behalf of young people who sexually abuse, a point made by the hon. Member for Mid-Dorset and North Poole (Annette Brooke). Many were victims of abuse in their childhoods. We have recently published two research reports: one provides evidence that interventions can be effective in preventing new or continued abuse; the other studies links between sexually abusive behaviour and emerging severe personality disorder traits in childhood. That makes it all the more important to provide early and effective interventions.

To support that work, a national strategy is nearing completion, and with it we will publish guidelines on therapeutic and preventive interventions. That directly responds to a point that the hon. Lady—to her credit—has raised time and again in this House.

It is not often that I credit a Liberal Democrat Member with anything in this House.

My hon. Friend the Member for Dewsbury knows that I have met the NSPCC formally to discuss the issues before us. I also want to pay tribute to his role more generally as an ambassador for the NSPCC in this House. He does a tremendous job in ensuring that the voice of children is heard loudly.

Reflecting on last week’s report about our international standing on children and young people’s well-being, I was concerned about the way in which it was presented, because it did not make any reference whatever to the Government’s every child matters programme, children’s centres, Sure Start, universal nursery provision, massively expanded child care or the beginning of work on emotional and social behaviour in primary schools. None of that work will feed through for a generation.

This Government are often accused of going in for short-term initiatives and for headlines, but there are no short-term political benefits in investing in such early years prevention. No other Government in the history of this country have done as much as this Government to create an architecture in which such early intervention is offered to families during the earliest years, when the greatest difference is made.

Although I am not complacent about that international study, on which we must reflect, we must balance the coverage of the issue before us. None of the findings has reflected on the new approach to early intervention and to early years provision that this Government have created for the first time in the history of this country. It was sadly lacking from the debate that rightly took place about the way in which we should react to the fact that our children and young people are regarded as not being as well and as happy as we would all want them to be.

Currently, a child who is sexually abused does not automatically need access to mental health services, and universal health services may be adequate for addressing some needs of those children and young people. However, we have agreed that later this year there will be a scoping event to bring together all people with an interest in the provision of services for sexually abused children. That will take place in direct response to my meeting with the NSPCC and to my conversation with Mary Marsh, who does a wonderful job.

We must reflect on whether the policy is right. Should we as a country say that a child who is sexually abused ought to have automatic priority access to child and adolescent mental health services? That is not the current position, but the NSPCC has a strong case when it argues that it ought to be the presumption for children in such circumstances. My hon. Friend has raised an important issue, and I promise him that the Government and I take it exceptionally seriously. I expect to see some real progress in the months ahead.

Question put and agreed to.

Adjourned accordingly at Five o’clock.