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Westminster Hall

Volume 459: debated on Tuesday 17 April 2007

Westminster Hall

Tuesday 17 April 2007

[Mr. Bill Olner in the Chair]

Mental Health

Motion made, and Question proposed, That the sitting be now adjourned.—[Mr. Michael Foster.]

I appreciate the opportunity to introduce this debate for several reasons, the first being that it is national depression awareness week. I do not know whether Government managers were aware of that when they scheduled the Second Reading of the Mental Health Bill, or whether the Speaker’s Office was aware of it when my name was drawn out of the hat for today’s debate, but I learned of it in the course of preparing for this debate. The event is organised by SANE, the mental health charity, and by the Depression Alliance. Sadly, I suspect that not many hon. Members or anybody else is aware of it. One of the underlying problems with mental health as a political issue is that it does not have a high profile, so I am doing all I can to raise it.

The second reason that I welcome today’s opportunity is more personal. Like other Members of Parliament, I am struck by the number of people who come to me for help with problems arising from mental illness. Large numbers of people come to my surgery for advice on problems with incapacity benefit that are linked to mental illness; many neighbourhood disputes or episodes of antisocial behaviour have at their root someone in a community who is unable to contain the symptoms of their mental illness. I have heard some heart-rending personal stories. I give the following examples because I undertook to the families involved that I would try to raise the profile of their cases.

One lady, Mrs. Knox, whose daughter committed suicide, wrote to the Minister of State, Department of Health, the right hon. Member for Doncaster, Central (Ms Winterton), and to the Secretary of State for Health stating:

“I can assure you that I am not looking for either an enquiry or compensation—just ACTION.”

Mrs. Knox wrote to Ministers and to me in the hope that somebody in the Department of Health would take notice. Her case is not untypical. Her daughter was schizophrenic and was well dealt with by clinicians, but she was then released into the community. Mrs. Knox believes that her daughter would still be alive if the sheltered accommodation that is available to elderly people as a matter of course were available to people with mental illness.

I congratulate the hon. Gentleman on obtaining this debate. I have an interest to declare: I am a patron of a befriending scheme for mental health patients in North-West Leicestershire.

Does the hon. Gentleman agree that schizophrenia is one of three conditions—anxiety and depression are the other two—whose sufferers benefit greatly when given psychological therapy within the NHS? A report published some time ago, “We Need to Talk”, urged greater resources and targeting of waiting times for access to such treatment. I do not know whether his constituent was waiting for access to support or psychological therapy, but it would be helpful if the Chancellor and the Minister were to announce a higher priority for such treatments today, to add to what is a good record on mental health over the past 10 years.

As it happens, the case to which I referred was more acute and therapy would probably not have been beneficial, but the hon. Gentleman is absolutely correct. I shall devote a substantial chunk of my comments to what has become known as the Layard plan, which is designed to build psychotherapy up to be a more central part of mental health treatment. The hon. Gentleman is right to emphasise its importance.

The second case I wish to mention to illustrate the importance of the subject involves some long-standing personal friends whose children went to school with mine. As their son grew up, it was discovered that he had serious mental health problems that were later compounded by alcoholism. Not untypically, when he approached mental health services, they would not deal with him because of his alcohol problem; he went to alcoholism services, but they could not deal with him because he had a mental health problem. He finished up in prison and, like many others in our overcrowded prisons, he should not be there. He should be dealt with by mental health services, but they are not structured to help him.

The examples that my hon. Friend has given are of individuals with mental health illness within families. Does he agree that in many cases severe mental health illness impacts on a whole family, not only on the individual with the clinical problem? Is he aware that, since a ruling by the Law Lords a year ago, the courts have been unable to refer families whose members are suffering severe mental health disorders for treatment at specialist centres such as the Cassel hospital in my constituency? As a consequence of the ruling, the Cassel and other hospitals report that a significant number of children are now being placed in local authority care or are being put up for adoption, because their families are not receiving support and treatment.

That is clearly an important point. I was not aware of the specifics of the case that my hon. Friend mentioned, but I am grateful that she has brought it to our attention. I shall refer later to the Cassel hospital, which is one of the institutions that are under financial pressure.

The final personal point relates to my own family. One of the difficulties that people have with mental health is that they are coy about discussing it because it carries a stigma. However, one in three families are touched by mental illness in some way. I still remember a particular day from my own childhood. I was 10 years old when my mother was taken off in an ambulance to what all my friends called the loony bin because she had what is now called post-natal depression. At that time the condition was not described in such sympathetic terms; people were described as “mad” or “loony” and that was it: one was stigmatised. The tradition of not wanting to talk about such conditions has remained, and so their prevalence is not properly understood. A further reason for the debate, therefore, is to bring out such personal experiences.

A third reason is to draw attention to some of the financial pressures in the system. The Minister will be very well aware of them and I shall address them in more detail later. Unfortunately they are also well hidden. Often the cuts that are currently necessitated are occurring through commissioning bodies rather than directly through providers, and those bodies are in turn shunting costs on to local authorities. Much of the pain and the impact is therefore not publicly displayed but exists nevertheless, and I shall describe the effects in my local area.

The final reason why I welcome the opportunity for the debate is because I am my party’s economics spokesman. It might seem odd to link economics and mental health, but the link is a strong one. That was highlighted by a fellow economist, Lord Layard, who drew attention to the enormous economic costs of incapacity benefit, the impact on the prison system, and so on. Throughout the debate I shall inquire as to the Government’s progress in implementing his recommendations.

One way to come to that topic is by stressing the sheer scale of the problem. My understanding of the professional data is that approximately 30 per cent. of all recorded illness now relates to a mental condition of some kind. One in every six adults has experienced clinical depression or chronic anxiety, and among those very large numbers only one in four is ever treated, so the problem is largely concealed. Moreover, the scale of the problem is not static, but growing. The Institute for Public Policy Research recently produced an interesting report which pointed out that in a 30-year period the number of young people and children with mental conditions has increased by some 70 per cent. The problem is extensive and is increasing in its share of the sick population.

There are massive economic implications. A good illustration of that is in a parliamentary answer given to my hon. Friend the Member for Inverness, Nairn, Badenoch and Strathspey (Danny Alexander), who asked a few weeks ago for data from the Department for Work and Pensions on incapacity benefit claimants. Various points emerged from the data, including the fact that now almost 1 million people are on incapacity benefit because of mental illness, and 30 per cent. of all new applicants are people with mental illness. Even more striking was the statistical breakdown of that large number. Some three quarters—755,000—are people who have been out of work for more than a year. Yet more striking was the nature of their conditions. Approximately 377,000—about half of those on long-term incapacity benefit—were people with depression, and about a quarter, or 160,000, suffered from anxiety and neurotic conditions. The mental illnesses with which we are more familiar, and which are perhaps more dramatic, such as schizophrenia, were way down the list. There were about 36,000 schizophrenics.

The vast majority of people who are out of work, on benefit and unable to enter the labour market are suffering from conditions that are normally regarded as treatable—depression and neurotic conditions. Lord Layard, who did an analysis of the economic aspects of the problem, concluded that the direct cost to the Government of the number of people currently out of work and on benefit with treatable conditions was probably of the order of £9 billion, and that the cost to the economy as a whole indirectly was probably £25 billion, because of course many people are working but suffer high rates of sickness and therefore lower productivity. Therefore high economic costs are associated with mental illness.

As an economics spokesman I am naturally attracted to the idea that there may be ways of spending more money through the NHS to get savings rather than simply additional outlays. On the basis of that explanation, I want to develop further the arguments that Lord Layard put forward, and to pursue with the Minister how far the Government have got in taking the recommendations on board and implementing them.

I am not as familiar with the problem as my hon. Friend, but there is a distinction between those who are depressed and therefore unemployed and those who are unemployed and depressed as a result. Did Professor Layard offer an analysis of the difference?

I think that he did, and that he recognised a circular process. However, the key point was that the conditions are potentially treatable. Although Lord Layard is not a clinician—he is an economist, like me—he drew on the professional literature to demonstrate that psychotherapy in particular can be used to good effect with many of the people concerned.

There is obviously a need to take care in using such arguments; there are cases in which psychotherapy does not work and where drugs may be more appropriate. Evidence and clinical advice should provide guidance on that; it is not a subject for amateurs. However, the key point, which research by the National Institute for Health and Clinical Excellence has reinforced, is that there are many cases of depressive conditions that are best dealt with by psychotherapy, which takes us back to the intervention by the hon. Member for North-West Leicestershire (David Taylor). There are two reasons for emphasising psychotherapy. One reason is economic: Layard’s figures suggested that the cost of a 16-session course, which was regarded as about right for many people, would be about £750. The cost of remaining on invalidity benefit is about £750 a month, so the cost-benefit position is clear. The second reason is that patients greatly prefer psychotherapy to drugs. There is little doubt about that, thanks to the many surveys about choice and about patients’ attitude to mental health treatment. Indeed, one of the reasons why so few people are treated is fear of drug treatment. If patients are offered psychotherapy they are much more likely to come forward.

The problem arises when that basic and apparently sensible argument is contrasted with the reality, which is that there are very long waiting lists for psychotherapy; on average they are six to nine months, but they can be as long as two years. Surveys of GPs show that nine out of 10 doctors prescribe drug treatments, even though they are aware that psychotherapy would be more effective. Only one in 10 mentally ill patients sees a psychiatrist within a year, and one in 20 sees a psychologist within a year. There is an enormous gap between our understanding of best practice and what actually happens. To remedy that, Layard produced a programme, which he recommended to the Government through the Cabinet Office, involving the training of 8,000 extra therapists and establishing evidence-based psychotherapy units in each primary care trust to develop the programme at local level.

The Government responded positively. At the beginning of last year, the Secretary of State indicated that the Government had taken the recommendations on board, wanted to see them carried through and had commissioned two pilot studies. What has happened and where are we going? I asked that of my local mental health trust and its members simply rolled their eyes and said that they did not know what was going on. It would be helpful if the Minister explained where the pilot studies have got to, whether they will be rolled out, where the training programme has got to, what is a realistic objective for the 8,000 therapists—if that is the number that the Government are working towards—and when people in the field can expect the new approach to bear fruit.

There is a link between that specific issue and the more general question of how financial cuts in the NHS impact on mental health. Clearly, if mental illness is increasing proportionately, relative to other illnesses, one would have thought that it should take a larger share of the NHS budget, which would reflect the Government’s general philosophy of shifting to preventive treatments. However, since 1997—I am sure that the Minister will confirm this—the proportion of NHS spending given to mental health has shrunk from 14 per cent. to 11 per cent. today.

There is a lot of evidence of financial stress in mental health services. The Minister has acknowledged that 11 our of 84 mental health trusts are under financial pressure, and I hope that in view of all the evidence presented to her she acknowledges that the problem is, in fact, much more widespread. SANE pointed out that in May 2006 it was calculated that deficits had resulted in £30 million of cuts across mental health services, which have now doubled to £60 million. In July 2006, a report revealed that 68 per cent. of finance directors of mental health trusts believed that cash was being diverted to bail out primary care trusts that had overspent. At the end of July 2006, David Nicholson, who was then head of the London strategic health authority, outlined savage cuts to mental health services throughout the capital.

The hon. Gentleman is recognised throughout the House as being fair and objective. He referred to 14 per cent. of the 1997 spend going to mental health services. Does he acknowledge that that spend has now doubled in real terms and that 11 per cent. of it is still an increase of more than half in real terms? I accept the hon. Gentleman’s general thesis that the proportion should be higher, but to attribute stress and pressure to budgetary problems when the budget has increased by almost 60 per cent. in real terms is a bit harsh.

I do not entirely share the hon. Gentleman’s optimistic interpretation. We know that the cost of clinicians in particular has risen substantially and has absorbed much of the real-terms increase, and it is not clear that the increase has fed through into service provision. In fact, the opposite is probably the case.

The Government’s response has often not been satisfactory. At Prime Minister’s questions some months ago I asked about the impact on my local area and drew attention to the fact that mental health provision and provision for people with learning disabilities were being cut back. The Prime Minister’s response was that there are many more doctors and many more hospitals. However, there has been contraction in the specific area of mental health. The trust in my area—Richmond—was not included among the 11 trusts that the Minister acknowledged. The mechanism by which it is happening is real.

I am grateful to the hon. Gentleman and agree with the points that he is making, particularly on financing. It can only add to the stigma attached to mental illness if the funding for mental illness is advanced disproportionately relative to the funding for physical illness. Does he acknowledge that the number of completed episodes of mental illness treatment and patients has been falling too? A lot of money has gone into the extra costs of employing agency staff because of the disproportionately higher number of vacancies among qualified mental health professionals. Therefore, disproportionately less money is being spread more thinly on fewer patients.

I was not aware of the precise details, but the hon. Gentleman has made the point well. In addition, demand is increasing rapidly at a time when the number of treatment episodes has been declining, so the gap is widening.

I imagine that the process in my area is common throughout the country. The primary care trust, which is well managed and runs surpluses, has found that the surpluses are being top-sliced and transferred to other parts of the NHS. That has been covered by a substantial chunk of the deficit having been offloaded on to the mental health trust, which has had £800,000 taken out of its £21 million budget. The mental health trust has dealt with this in two ways. First, it has shunted the costs on to the local council, which is not in a position to absorb them. The main consequence of that is a decline in the services for the elderly chronically mentally ill, such as people with advanced dementia who were given continuing care. The second way in which the cuts manifest themselves is that the requirements under the national health service framework to create outreach and support for people in their home, which is a positive initiative, are operating at a skeletal level. Local mental health trusts do not have the resources to improve that.

In practice, cuts are taking place, but they are neither visible nor dramatic, so they will not lead to banners in the streets. They are not like hospital closures. The elderly mentally ill will not be marching down the high street. Indeed, perhaps those are the reasons for what is happening. They are largely invisible, but they are very painful and real cuts in service provision.

I wish to round off my remarks with some specific questions about the Layard proposals and general financing. In their analysis to follow up depression awareness week, SANE and the Depression Alliance deal with how general practitioners operate. Most diagnosis is carried out at GP level and there are many deficiencies. SANE is asking whether the Government are looking again at the GP contract to ensure that doctors have a maximum incentive to produce prompt and efficient diagnoses of mental illness to get around at least some of the delays within the system. Is the Minister looking at the GP contract in the light of the professional criticisms that have been made?

I do not think that anyone argues now for institutional care on a substantial scale, but we acknowledge that care in the community has often not worked because of the lack of back-up. My constituent, Mrs. Knox, has asked whether there has been a concerted attempt to provide more sheltered accommodation for people with mental illness who have left institutional care and who need much more support than is provided traditionally by the mental health teams that visit someone’s house once or twice a month. Do the Government monitor such matters? Are they encouraging action in any way?

A third issue relates to co-ordination. The Minister has a role not only in the NHS itself, but in co-ordination with other Departments. How does the right hon. Lady approach the linkages with the Department for Work and Pensions? We know that pathways to work is working well for many long-term unemployed, but it does not seem to work for the mentally ill. Has that approach to employment been revisited? Does the Minister have any proposals for revising it?

As a result of the problems with financing the mental health sector, we are discovering the difficulties arising out of the localisation of decision making. We are now operating in a more decentralised mode, which is very welcome. There is greater emphasis on primary care trusts making their own decisions locally. However, the problem is that some local providers such as councils, which are democratically and locally accountable, and mental health trusts and primary care trusts acting as commissioning bodies, which are not, are shunting costs and responsibilities between themselves to avoid accepting the responsibility for the difficult choices that have to be made. How far is the Minister helping to produce greater coherence at a local level to ensure that mental health budgets are properly managed between local authorities and primary care trusts, and that there is an overarching local accountability through local authorities? What we are seeing at a local level is simply a shifting of responsibility from one body to another, with the elected bodies being landed with the worst of the difficult choices that have to be made.

Mental health is a vital part of NHS provision, and it does not always get the public or parliamentary attention that it warrants. I congratulate the hon. Member for Twickenham (Dr. Cable) on securing the debate and, together with Government business managers, making this week something of an exception.

I want to take the opportunity to thank the staff working in the mental health services in my constituency, in the Oxfordshire and Buckinghamshire Mental Health Partnership NHS Trust, and to draw particular attention to areas of work locally that are topical and relevant as the House moves to consider the Mental Health Bill, which received its unopposed Second Reading last night.

As the hon. Gentleman said, there are huge humanitarian and economic consequences of mental ill health. I would also urge that in the difficult choices facing the NHS in managing its budgets, even expanding budgets, full weight is given to the needs of mental health patients who, because of continuing stigma—that must be challenged at every opportunity—and their own situation, are not in a position to mobilise the sort of public pressure that is often brought to bear in other areas of NHS services and funding. In the past, I have spoken out against damaging pressures and unfair cuts in our local mental health budget. My right hon. Friend the Minister will recall responding to one such debate on the Floor of the House last year.

Let me also say, and I am sure that the hon. Member for Twickenham will accept this point, that there is an important distinction to be drawn between mental health trusts having to cut back to meet deficits elsewhere in the NHS that are not of their making and service reorganisation within the mental health care sector which, although often controversial, can be justified because it enables service improvements to be made ensuring that more care is available to more people more quickly and more appropriately for their needs. Examples of this in our own mental health care trusts are the much-needed extension of crisis services, and the development of early intervention services which allow more people to be treated outside hospital. Both improvements were funded by cost savings last year.

The Oxfordshire and Buckinghamshire trust is also able to look forward to the opening of a women-only forensic unit at Littlemore later this year, which will provide a dedicated and much-needed service for women across the Thames valley who are currently being looked after in mixed-sex wards or in distant secure units. Other local innovations that are improving provision include the bridge-builders service operating from the acute day hospital at the Warneford. It helps people to make that crucial move back towards independent living and employment which benefits their health, their family and the wider community. There is no doubt that if we are to help more people either get off incapacity benefit—that has been referred to—or avoid getting on to it in the first place, mental health support, advice and counselling have to be right up there with other rehabilitation services and work much more closely with Jobcentre Plus and other employment providers than they have in the past.

I want to focus particular attention on an especially important innovation that has been piloted in Oxfordshire and a number of other trust areas. I commend it to the Minister as appropriate for extension across the country. I refer to the complex needs service, started four years ago, which meets the needs of people with a range of personality disorders and with tendencies towards self-harm, attempted suicide, chronic relationship problems and drug and alcohol abuse. The service operates in close partnership with the voluntary sector—in our case, with Mind—and works to treat personality disorders through a therapeutic community of members.

The results of the service, which operates from a dedicated centre in my constituency, are encouraging. I have met patients who have greatly benefited from the service’s approach. Indeed, their personal testimony, as they literally put their lives and personalities back together and rebuild their self-esteem, gives an inspiring picture of what modern mental health services and their dedicated staff at all levels can achieve. The evidence is that people using the service spend less time having in-patient treatment, can be discharged faster from their community health team and make 65 per cent. fewer visits to their GP than prior to their treatment. That is also an important consideration when we bear in mind that as many as 40 per cent. of visits to GPs are directly or indirectly related to mental health.

The service shows an important way forward. My understanding is that although it has been funded as a pilot, there is still uncertainty over its longer term funding. I hope that the Minister will be able to tell me in her closing remarks that she recognises the benefits of that approach and that she can reassure the complex needs teams, in our area and elsewhere, that the success and benefits that they are bringing to patients will be matched with longer term funding.

I dare say that as part of her answer the Minister will say that the money is there in PCT baselines, but I am told locally that that money is hard to identify and find—and, of course, it can all too easily be subject to other pressures. I urge the Minister to highlight the funding available, supplement it when necessary and do anything else that she can to push forward that important and valuable approach. As I am sure she recognises, such services will be very important in making a success of the provisions in the Mental Health Bill, demonstrating that real and effective help can be provided to people who in the past have risked being seen as untreatable, or who have not had the treatment most effective for their needs.

On a related issue, I congratulate our mental health care trust and Oxford university on having been awarded a £500,000 research grant to enable them to examine how community treatment works out in practice. That was announced last month by Professor Louis Appleby, the national director for mental health. The study will consider who gets community treatment orders and what the benefits are. That research is very important, because supervised community treatment—part of the Mental Health Bill that will be subject to much more discussion as the Bill proceeds—needs to work properly. It must ensure not only that the community has proper protection from the minority of patients who present a risk, but that people with mental health problems are given the chance to rebuild their lives, for which family, social contact and employment are vital.

I am following closely what the right hon. Gentleman is saying; the project in his area sounds very interesting. However, does he not agree that the Government have now commissioned research into the effectiveness of community treatment orders on the back of international research that has not been able to give any empirical evidence for their efficacy? Would the Government not do better to wait until that research has come up with positive results before going ahead with legislation that would enforce the orders, which may have a detrimental effect on some patients with personality disorders who at the moment are benefiting because they are treatable?

The Government would be vulnerable to criticism from another direction were they to embark on legislative innovation in this area without properly monitoring and learning from the experience of such work as it progresses. The hon. Gentleman is right to say that lessons must be drawn from research elsewhere in this area and from international experience. This dedicated research project is invaluable because, like mental health services themselves, research into mental health issues has often been a poor relation when comparisons are made with other areas of medicine. The new funding is all the more welcome for that.

My final point relates to a national concern. This is not a particular issue in my area, because it has a specialist adolescent unit. I understand that as many as 1,000 children and adolescents with severe mental health care problems are placed on adult psychiatric wards each year. We all agree that that is unsatisfactory. Those young people need to be able to be referred to specialist provision. Again, that will be debated further elsewhere as the Mental Health Bill proceeds, but will the Minister tell us what progress is being made in tackling that pressing matter? Mental health services need to cater properly for the needs of the whole community and we all agree that children and adolescents are a high priority in terms of our fulfilling that responsibility.

The Government have made good progress in mental health policy generally. I note what the hon. Member for Twickenham said about the share of the budget, and I shall always be to the fore in arguing that mental health services need to be given proper priority, as, I am sure, will the Minister. Equally, as my hon. Friend the Member for North-West Leicestershire (David Taylor) pointed out, we should recognise just how big a funding increase has taken place under this Government—£1 billion in real terms since 2001. In many areas, mental health provision is being transformed beyond all recognition for the better, notwithstanding the pressing concerns and pressures that have arisen from tackling deficits.

I commend the innovations that are taking place locally, and congratulate the staff who are working in mental health. All too often they fail to get the public recognition that they deserve, partly because of the stigma in this area. In a minority of cases, staff face the risk of abuse, and their contribution should be properly recognised.

My right hon. Friend is right to pay tribute to staff in the mental health sector of the NHS, but will he also pay tribute to the role of volunteers? He talked about social contacts. Good numbers of befriending groups and others play a huge part in the recovery of patients who are emerging from periods of mental ill health. Will he acknowledge that such an approach is often an effective way forward and that it does not cost a great deal to train volunteers to have that type of role?

I strongly agree with my hon. Friend. I should include the work of the voluntary sector in the praise that I have been giving to staff. I referred to the importance of Mind’s contribution to the complex needs service that I was advocating. My constituency has an excellent initiative called Restore, which helps people to move forward through training programmes and work experience. It has dedicated employment advisers who help people, often those with acute conditions, to rebuild their lives, their social contacts and their family involvement and, in many cases, to move forward to employment. Progress is being made, although there is lots more to do.

I thank my hon. Friend the Member for Twickenham (Dr. Cable) for securing the debate. He has a long and distinguished interest and expertise in this area, which was fully on display in his articulate exposition. I should like to raise two matters. The first has not been mentioned but is of enormous national interest—the provision, or lack of it, of mental health services in prisons. Secondly, I should like to dwell on the experience of the changes and cuts being introduced into mental health service provision in Sheffield, as an example of some of the knock-on pressures that have been mentioned.

It is difficult to see much of a silver lining in the increased public attention on the state of our prisons in view of the burgeoning overcrowding crisis in the prison system, but if there is a silver lining, it is that more public and press attention has been focused on conditions in prisons. One fact that has finally been given a little more exposure—it deserves still more, in my view—is that there is a huge number of people in prison with acute mental health conditions who are simply not receiving the treatment they require. It is reliably estimated that one in 10 of the prison population are identified as functionally psychotic. Prisoners are seven times more likely to commit suicide than the general public. As the Corston report on women’s prisons highlighted last month, 80 per cent. of women in prison are diagnosed with mental health problems. The scale of the problem is enormous. On that, we can all agree.

I want to press the Minister to expand on what I thought was an extremely encouraging break with Government rhetoric and policy in a paper on the criminal justice system as a whole. Forgive me: I do not have the precise title of the document to hand. It was published, I think, two or three weeks ago by No. 10, and the Lord Chancellor was active in the press, expounding its virtues. In that paper, which was a fairly wide-ranging and somewhat motley gathering of different observations on the criminal justice system, there was an extremely significant allusion to the need to develop what the document called hybrid prisons.

If I understand it correctly, the purpose of hybrid prisons would be to relocate offenders with acute mental health problems from the closed prison estate to specialised hybrid prisons, where of course incarceration could continue but treatment could be effectively provided. That seems to me to be a very important and promising, although extremely vague, new direction of travel in the Government’s utterances on this major issue. I urge the Minister to explain whether she is aware of quite what the Government have in mind when talking about hybrid prisons, what plans are in place to develop hybrid prisons and what resources would be found to do so.

At the moment, £1.7 billion has been earmarked to expand the prison population by about 8,000 places—places, incidentally, that will not come on-stream until about 2011-12, by which time, judging by current rates, the prison population will have well surpassed that increase of 8,000 places anyway. In common with the conclusions of the Corston report, it would make a great deal of sense to reflect on whether it would be more sensible to spend that money on specialised hybrid prisons and secure and semi-secure mental health treatment facilities, so that the very significant number of offenders in prison with acute mental health conditions could be moved from the closed prison estate into facilities more suited to their needs.

My hon. Friend has introduced a very important and much overlooked theme. I think that we all accept that prison is not conducive to mental health and well-being in any sense whatever and particularly in the case of women. Has he any statistics that reflect the difference between the people who arrive in prison with a mental health problem and those who develop a mental health problem in prison?

No, in short, I do not—the statistics on this issue are quite patchy. Similarly, little empirical work is being done, for instance, on the link between the failure to treat mental health conditions in prison and rates of reoffending, which have increased dramatically in recent years, as we know. Quite a lot of empirical work therefore needs to be done to complete the picture.

Time is short, so let me move on to my second point. The right hon. Member for Oxford, East (Mr. Smith) rightly alluded to the fact that all sorts of controversies and debates may arise if changes are required to the provision of mental health services. Such changes can take place within the parameters of competing judgments about the best way in which to provide mental health services. Things become altogether more fraught, however, when changes appear to be forced through because of the knock-on effect of financial pressures, particularly on primary care trusts.

The primary care trust in Sheffield has mooted several extremely controversial changes, although it has at least been open enough to say that they are almost entirely driven by the financial pressures on its own account. None the less, that may have a dramatic and disruptive knock-on effect on the mental health service in Sheffield, which has been a Cinderella service for some time. It is widely recognised among practitioners and patients in Sheffield that mental health in the city has not been given the priority that it deserves. It is all the more incomprehensible to them, therefore, that extremely controversial changes are being rushed through as a result of financial pressures that have nothing to do with the mental health care trust.

The manner in which the changes have been floated and introduced is a model of how not to persuade the public, political stakeholders and workers in the mental health sector that changes are required. In substance, the consultation document, which I have in my hand, amounts to no more than two and a half pages of sweeping recommendations, which is clearly insufficient to explain the wide range of proposed changes. The consultation period has also been somewhat rushed, while the consultation document is vague to the point of being vacuous. It makes several claims about a renewed reliance on GPs, community-based services and social day care and on reducing acute in-patient beds. In other words, it pursues the general drift away from hospital-based treatment and towards various forms of what might euphemistically be called community-based treatment. It also fails to explain how the money will be saved, in what time scale and to what end.

Unsurprisingly, the reaction in Sheffield has been universally hostile, and the Minister may be aware that Labour Members from other Sheffield constituencies have, like me, been active in asking the primary care trust to withdraw the consultation document altogether. Last Friday, all Sheffield Members were informed by letter that the consultation document would not be withdrawn. Ironically, we received another letter at the same time telling us that the PCT’s financial position would be wonderfully restored to good health in the next few months, which raises the question why it needs to impose this set of disruptive proposals on the mental health sector in Sheffield.

I appreciate that—

Order. May I ask the hon. Gentleman to bring his remarks to a close? Some very good questions have been posed to the Minister, and I want to ensure that she has time adequately to respond to them.

I will indeed bring my remarks to a close, Mr. Olner. I realise that the Minister cannot comment on the specific local circumstances that gave rise to the situation in Sheffield, but I hope that she will agree that it is difficult for the public or, indeed, political stakeholders in places such as Sheffield to feel that their voice is being heard if, as in Sheffield, the primary care trust is impervious to the most elementary forms of public and political accountability. In Sheffield, that is reflected in its extremely poor, thin and rushed consultation document, which will have very disruptive effects on mental health service provision in the city.

I congratulate my hon. Friend the Member for Twickenham (Dr. Cable) on opening up a huge and important debate. As he said, mental health issues affect nearly everyone, and I was reminded of that acutely the other day. I was on the phone in my surgery discussing amendments to the Mental Health Bill with my hon. Friend the Member for Romsey (Sandra Gidley) when a regular client who has mild paranoia appeared at the counter. He believes that a member of the House of Lords is out to get him by perpetually sending thugs to his area and he renders himself homeless on a fairly systematic basis. He writes three letters a week to me and has seen every Member in the north-west, including the Leader of the House. He also thinks that his phone calls are being intercepted and that the legal profession is corrupt. Not all of his views are necessarily delusions, but they certainly make a prima facie case for further inspection. His doctor referred him to the psychiatric service, which reported that he was an interesting man with no particular problems, which somewhat disappointed me because he is an elderly man and at some point his behaviour is likely to have adverse effects on his physical health as well as leading to a further deterioration in his mental health.

Mental illness is not exactly the same as, or simply a sub-group of, physical illness. Although it is often politically correct to say otherwise, that is not actually true. However, like physical illness, it covers a huge spectrum of conditions that can be chronic or acute, or chronic and acute, as is obviously the case with schizophrenia. Mental illness is socially disabling to a varying extent and affects personal autonomy, capacity, insight and behaviour to different degrees depending on the ailment. Sometimes the causes are known and sometimes they remain hidden and await further research. Equally, cures in the mental health field are sometimes quite well established, sometimes utterly absent and sometimes quite uncertain. Therapies are mixed and varied, and include the chemical, behavioural, personal and family based. There are few quick fixes and few long-term guarantees.

What is universally true is that there is a stigma associated with mental health and a questioning of the competency, reliability, and predictability of the behaviour of those suffering from mental health problems. As many hon. Members have said, that results in the clamour for better services and complaints about poor services being somewhat muted. Obviously, those who are, in many respects, the most troubled will complain the least, which means that mental health is a relatively soft target for underfunding, for cuts—although of a fairly covert nature—or for virement to other services where people clamour with greater force.

It has quite accurately been pointed out in this debate that the share of NHS funding for mental health has fallen, although it must be admitted, as the Minister will no doubt say, that total funding has appreciably risen. It is still the case that raids from the regional authorities are relatively common, and the fact that it is easy for trusts to maintain a balance shows how easy it is to adjust their costs and to cut services where financial need arises. That often results in a slow response and long wait for psychiatric services, which is one of the most prevalent and pervasive complaints that I receive about mental health services. When there is an issue and people need help it is difficult to get past first base and there is a long wait to receive regular attention from a consultant psychiatrist.

I have received complaints in my constituency about service reductions, but I will not expand on those now. As the Minster has acknowledged, there have also been justified complaints about treatment taking place in inappropriate settings; for example, when adolescents and children have been seen in adult environments. There is, of course, the unspoken difficulty that people are sometimes over-medicated in circumstances where medication is not the sole or even the best answer to their problems. Although that may be the quickest way of dealing with such problems, it may not always be the best.

As my hon. Friend the Member for Twickenham pointed out with his economic hat on, the social effects are even worse. Billions of pounds are paid out in disability benefits and the Sainsbury Centre for Mental Health has said that 91 million working days are lost because of mental health problems. One third of all new claims for disability allowance are on the grounds of depression and anxiety. In the past, when the care model was the mental hospital, there were heavy, fixed and immovable costs that could not easily or covertly be adjusted. Now, in the community, it is far easier to adjust costs and, if necessary, reduce them.

It is good that there is more money—we must all admit that—but that money must be spent within a framework, monitored and assessed under performance management. That is the goal to which I think everybody aspires. We have not got there yet, and it is hard to see how payment by results will benefit. Obviously, we call for the performance of PCTs and mental health trusts to be better monitored, but their delivery on mental health services is somewhat hard to measure because some conditions are not curable, only manageable. The social background of different areas makes an appreciable difference. Clearly, if there is a lot of unemployment in the area, we expect a high rate of depression and anxiety to go with it.

Mental health is an area in which the voluntary sector can perform in different ways and places. The sector has a key and beneficial role to play in mental health, a field where imagination and innovation pay off. We are all familiar with some exciting and worthwhile projects involving mental health users and art. I also mention the increasing use of IT and software therapies. Years ago, a chap called Weizenbaum designed a programme called Eliza, which was supposed to act as a substitute for psychotherapy. One can download it and try it oneself. An odd feature of Eliza was that some people preferred the software to their own consultant psychiatrist. The computer never looked away and always gave a response, and it was always a remarkably tolerant and interested response. There are better examples, as much development has taken place in the field, but it indicates that innovation in mental health can make a substantial difference. However, it is often difficult to monitor and assess.

Professor Layard calls for concentration on the less acute sector, bearing it in mind that only one in two depressed people receive treatment and that only 8 per cent. see a psychiatrist, yet where pathways to work pilots have concentrated on the issue, substantial effects have been recorded. Therefore, he calls for an extra 5,000 psychological therapists and double the number of consultant psychiatrists. I think that we would all go for that, but the therapies must be tested—NICE has a key role there—and the services must be validated.

We are all aware of a number of counselling services of various kinds and qualities springing up in our constituencies. They are mushrooming. Some are very good, some are not so good and some are a waste of time. It is important when services are offered that they are properly validated and assessed. The Department for Work and Pensions also needs to offer a more holistic service, particularly to the unemployed, because one thing people need before they can get back into employment is a boost in morale and maybe to address underlying psychological problems. There is some evidence that it is doing so. I went to my DWP office recently and found that that is precisely what is going on to get people off disability benefit and back into work.

Another Layard theme is that mental health should be seen as a social goal for the Government—what might be called the happiness agenda, whereby the Government are charged with the positive promotion and encouragement of a good and mentally whole life in the workplace, family and community. It is a tough task for the Government, I must say, though I record in passing that Plato regarded it as a fundamental chore of the state. As my hon. Friend the Member for Twickenham might know, Plato regarded the economy as something that the state would do better to butt out of and leave to the merchants, and the promotion of the good life as its fundamental aim.

Unlike my hon. Friend, however, Plato was a totalitarian. We must acknowledge that any liberal state allows for diverse concepts of the good life, and that many of those concepts will be contestable. However, it seems self-evident that where social conditions identifiably lead to unhappiness, removing those obstacles is a fairly important and uncontentious task for the state. That is the modest aim of a liberal state.

Apart from the wider goal of generating social happiness, which I have no doubt every Government have tried to achieve in some way, there is the more pressing need to improve existing mental health services. As my hon. Friend indicated in his introduction to the debate, there is an awful lot of work still to be done.

We have had a very interesting debate. I add my congratulations to the hon. Member for Twickenham (Dr. Cable). The timing of the debate is fortuitous. We shall be mental healthed-out by the end of the week: debate on the Mental Health Bill started yesterday, and as he mentioned, this is national depression awareness week, which is an initiative of SANE and the Depression Alliance.

The hon. Gentleman raised some good points and introduced a wide-ranging debate on the subject, unlike the limited one that we had yesterday on the Mental Health Bill. I am pleased that this debate is part of a profile-raising exercise for mental health, which is not a fashionable subject. As he rightly said, many people who suffer from mental illness will not be the first to admit their own problems, let alone demonstrate in the street, so it is incumbent on us as legislators and the representatives of those most vulnerable people to speak up for them. This debate is another good opportunity to do that.

All hon. Members in this Chamber and, I am sure, across the House know from their surgeries and constituency post of distressing cases of people who suffer from mental illness but are unable to access services. I refer to two cases in my constituency. One constituent recently had a psychotic incident that involved the police. He was arrested and kept in the cells for five days before he was assessed by a mental health professional and then able to be sectioned to the Maudsley hospital. That is no way to deal with somebody with a disturbing illness.

Secondly, I had a very distressing case a couple of years ago of a father who had killed his own daughter. She had asked him to kill her because of her mental illnesses. She had just been thrown out of a local mental hospital. The help that she needed was not there, and the system failed her. That was a deeply tragic case, and the trouble is that there are too many such cases all over the country.

Whatever the Minister and the Government may say, mental health services remain the Cinderella service of the NHS. I was pleased that the hon. Member for Twickenham gave the figures. We know that extra money has gone into the NHS across the board in large portions, quite rightly, and that extra money has gone into mental health services, but the percentage of NHS funding going to mental health services has fallen during the past 10 years—it has not increased. That can only help to compound the stigma that is attached to mental illness.

I believe that every Member mentioned problems with deficits. Mental health was last in the queue to benefit from the Chancellor’s largesse, and now it is first in the queue when services are being asked to hand money back to pay for deficits in other parts of the health service. Mental health is suffering a double whammy: mental health trusts had to tighten their belts because of the present funding crisis, and they have to tighten them a second time to bail out other parts of the NHS. That really is not fair. Louis Appleby, the mental health tsar, said that acute trusts should be ashamed for taking money from underfunded mental health services. The Government have admitted that that is happening, but they must do something to ensure that it does not happen even more in the future.

As I said earlier, vacancy rates among mental health professionals are much higher than for the rest of the NHS, and there is a postcode lottery for services, particularly in talking therapies. Several Members mentioned the lack of availability of talking therapies such as cognitive behavioural therapy. The hon. Member for Twickenham was absolutely right to mention the depression report and the excellent work of Lord Layard. From an economic perspective, funding such services makes sense—the numbers add up. More than 1 million people are on incapacity benefit for a mental illness-related problem. A relatively short course of treatment, which would involve a relatively small amount of money, would have a success rate of around 50 per cent., as calculated by Lord Layard. We could get those people back into the economy and into employment, at great personal benefit to themselves and to the state and the NHS budget, so it has to make enormous economic sense.

We heard some interesting contributions in addition to those made by the hon. Member for Twickenham, who opened the debate. The hon. Member for Richmond Park (Susan Kramer), who is no longer in the Chamber, spoke in an intervention about the Cassel hospital. It is unfortunate that she did not elaborate on that. I visited the Cassel hospital a little while ago. It is worrying that that excellent institution is facing a funding squeeze at the moment, particularly for the work that it does with mothers facing mental health problems—often being able to keep them with their babies. One in six women will suffer from depression around the time of a pregnancy. That is a largely unseen mental health problem, but it has enormous consequences. Four out of five women with babies are admitted to psychiatric hospitals without them. That can only engender greater distress in those women. The Cassel hospital has made great strides in being able to keep families together.

I reiterate the praise that the right hon. Member for Oxford, East (Mr. Smith) gave to staff and volunteers. There are enormous challenges and pressures for the staff working in mental health trusts around the country. We have some excellent mental health voluntary organisations, such as Rethink, SANE and MIND, which do fantastic work for the sufferers of mental illness.

Hon. Members were right to say that there is a continuing stigma attached to mental illness. I was interested in a local project in Oxford that the right hon. Member for Oxford, East mentioned, particularly as it deals with treating personality disorders, with therapeutic benefit, on, I would guess, a voluntary admission basis in many cases. However, the proposals in the Mental Health Bill for people with personality disorders would regard those people as largely untreatable. It is for that class of patients that the Government are now introducing community treatment orders, with no empirical evidence to underline their efficacy. There is no research internationally to suggest that such things work. The right hon. Gentleman’s constituents who are benefiting at the moment from the great advances and innovation in mental health treatment, particularly for personality disorder, could be subject to those community treatment orders. Nothing would deter them more from presenting in the first place for therapeutic treatment than the fear that they may be subject to some degree of compulsion. After last night’s debate, we face the bizarre prospect of Ministers saying, “We must have more compulsory treatment to guarantee treatment for those patients”. However, the compulsion is on the patient to receive the treatment, not on the mental health trust or the providing authority to provide it. The Government have got their priorities wrong.

I am worried about the sort of projects that the right hon. Member for Oxford, East mentioned, which are doing great work on a pilot basis, although funding is not guaranteed. For those projects, the prospect of people turning up in future could be greatly imperilled by coercive measures, which this Government seem hellbent on pushing through the House, that are having great ramifications outside.

The hon. Member for Sheffield, Hallam (Mr. Clegg) mentioned problems in his constituency with the deficit crisis. I know Sheffield well and I know the problems with the health service there. Too much is being done in the name of reconfiguration. In Sheffield there is a rather vague reconfiguration to save money, which is really what it is all about. The hon. Gentleman mentioned prisons and he was right to do so, because the state of mental health in our prisons is an absolute scandal and is highly counter-productive. There are large numbers of prisoners suffering from mental health problems and there is a lack of integration to get them sorted out mentally before they can be properly rehabilitated and not reoffend. It is worse in young offenders institutions. I visited the young offenders institution in Feltham just a couple of months ago, where a lot of impressive work is going on. Again, though, it is a deeply depressing place. A lot of work is being done to try to address the mental health needs of young offenders there. The recidivism rate for young offenders who are sentenced to jail terms of less than 12 months is 92 per cent. A lot of that is due to not dealing with the underlying problems that may have led them to get into crime in the first place.

The hon. Member for Twickenham mentioned the problems of dual diagnosis. It is ridiculous that we do not have better inter-agency working, so that while we may be able to deal with a person’s mental illness we cannot deal contemporaneously with their alcohol or drug misuse problem. The two things are closely linked and we need far better progress on dual diagnosis. Whether the hybrid prisons will do anything about that I do not know; it sounds to me like another soundbite from No. 10, which the Prime Minister may hope will form part of his legacy, but which will not amount to much.

Mr. Olner, you are right to say that hon. Members have raised many questions about mental illness, which the Minister needs to answer. I ask her in particular to give detailed indications of what will happen to the CBT pilot projects in Newham, which I visited recently, and in Doncaster. There are fears that those will not carry on, despite the fact that they do great work. I should like her also to comment on the lack of progress in dealing with the black and minority ethnic community given that Matilda MacAttram, director of Black Mental Health UK, said recently:

“Absolutely nothing has changed for black people over the last 12 months”.

She also commented:

“The 2006 Bill as it is currently drafted will make this situation a lot worse. This calls into question the Government’s commitment to address race issues within mental health services.”

Many people in the black and minority ethnic community suffer disproportionately from mental illness. They suffer particularly from being disproportionately subject to sectioning and other coercive treatment, and the Government need to take that far more seriously.

There are many other things that we could say in a mental illness debate. I am glad of the opportunity to air problems within the mental health community and I shall not recount again the problems affecting young people and children, one in 10 of whom will now suffer some form of mental illness, with one a day in the past few years being admitted to highly inappropriate and intimidating adult mental health wards. As the Children’s Commissioner for England said recently:

“It wouldn’t surprise me if children leave adult wards worse than when they went in. Putting children in an age-appropriate and developmentally appropriate environment can only be better for them.”

Mental health needs to be a far greater priority than it currently is in the NHS and the Department of Health. It is a false economy not to make it a greater priority. It is one of the most challenging ticking health timebombs that we face in westernised countries. It is a particularly false economy not to take the subject of young people with mental illness more seriously. I hope that at last the Minister will treat that as a priority. She might start by guaranteeing that the Government will restore mental health funding in the NHS to the level that she inherited in 1997, which was much higher, in percentage terms, than it is now.

I congratulate the hon. Member for Twickenham (Dr. Cable) on securing the debate. As he said, it is particularly relevant this week, and it provides a good opportunity to raise awareness of mental health issues in the House. Debates in the past couple of days have suggested how many Members of Parliament have relevant constituency cases: carers, families and patients are all very much affected when, as we know, about one in six adults at any one time report having a mental disorder, and one in every four GP consultations are directly related to mental health.

I shall deal, as other right hon. and hon. Members did, with some of the specific issues that the hon. Gentleman raised about Lord Layard’s report, but I want to deal with some wider issues first. It is important to start with the question of finance. There has been a consensus that extra money has gone into our mental health services. An extra £1.5 billion is now being spent on mental health services. According to the European Commission, and despite what the hon. Member for East Worthing and Shoreham (Tim Loughton) says, the proportion of the overall health budget devoted to mental health in the UK is among the highest in any EU member state. That extra investment has led to some great improvements, and I join my right hon. Friend the Member for Oxford, East (Mr. Smith) in paying tribute to the many staff in the mental health service who have made them possible.

The way in which some of the 700 new community teams work is completely different from the traditional delivery of mental health services. Teams work with people in their own homes and communities, reducing some of the stigma that many right hon. and hon. Members have mentioned. If we can treat people in their home environment, they will not have to be removed for the whole time to an in-patient setting, where it can be more difficult for them to make a recovery and where things can be more difficult for carers and families. There are also 14,000 extra staff working in mental health services, which, again, has made a difference.

It is also true, however, that mental health services in some areas have been asked to make a contribution to ensure that the overall NHS budget is put on an even keel. However, I should say two things about that. First, I have been absolutely clear that mental health services should not be asked to make a higher contribution than any other services in an area. For example, if other trusts or primary care trusts have been asked to make a top slice of 3 or 5 per cent., mental health services should not be asked to do anything disproportionate, unless they, for example, contributed to the deficit in the first place. I am more than happy to take up any cases in which people think that mental health services have made a disproportionate contribution, and we have pursued every case that hon. Members have brought to my attention.

Let me add, however, that we have raised the profile of mental health services in recent years. They are no longer a Cinderella service, although they can be prey to raids on budgets if the NHS is not in overall financial balance. Many people who work in mental health services tell me that it is important for the NHS in their local health economy to be in financial balance because mental health services might suffer otherwise. Overall, therefore, mental health services staff want us to ensure that budgets are properly balanced so that they can plan services properly in the longer term.

Let me move on to some of the specific questions raised by the hon. Member for Twickenham. On GP contracts, we are developing quality and outcomes framework standards so that GPs can recognise and refer cases of depression and anxiety to the new services as they become available. Therefore, we are looking at issues relating to GPs, who play an important role. The new graduate workers who have been working out of GP surgeries have also been extremely important in delivering some of the psychological therapies that everybody has mentioned.

The hon. Gentleman also talked about the importance of multi-agency working and of looking at issues such as sheltered housing and social services support. The Government have tried to ensure that provisions such as local area agreements assist in that process and enable mental health care services and local authorities to pool budgets and staff in certain instances. In that way, they can provide the necessary support, which, as he rightly says, is extremely important for securing co-ordination at local level.

I pay particular tribute to my right hon. Friend the Member for Oxford, East, because it was his personal commitment that made some of the pathways to work projects so successful. There was a great breakthrough in considering the link between employment and mental health. There are too many instances in which, even if people did not start their unemployment because of a mental health problem, a mental health problem develops because of the stigma, discrimination and low self-esteem that accompany unemployment. Pathways to work projects have been important in that regard, as has consideration of how to get better links with jobcentres.

People in the DWP have told me that, when they are successful in getting people off disability benefit and back into work, the savings for the Department revert to the Treasury and are not reprocessed into doing more of the same—not even a proportion of them. Is it worth investigating ways to incentivise those parts of the DWP that get people back into work after mental health problems, so that they do more?

One of the triumphs of our current work is the adoption of a cross-Government approach—an approach that was taken in the case of the work of the social exclusion unit, which reported last year, and which applies to the close relationship between the DWP and the Department of Health. One can certainly extol the benefits of that approach.

My right hon. Friend the Member for Oxford, East made a point about the complex needs service in his constituency. I hope that benefits are being seen at the local level as a result of in-patient stays being reduced through development of services. The new services whereby people can be prevented from entering patient care are both cost-effective and effective in their own right, and I hope that they will receive appropriate local consideration.

The hon. Member for East Worthing and Shoreham seemed to confuse the issues of treatability and supervised community treatment. We want to get rid of the treatability test in mental health legislation because people with personality disorders have for too long been told that they are untreatable. That has meant that services have not been set up, and people have been turned away.

Supervised community treatment is an entirely different issue. The hon. Gentleman seemed to suggest that certain people in my right hon. Friend’s constituency might somehow be placed on supervised community treatment because of a personality disorder. People enter supervised community treatment if they have had an in-patient stay and if their clinician feels that it is appropriate. We do not want people to be in-patients for any longer than necessary. If it is more effective to return them to their home environment under supervision, that course is known to lead to better recovery and prevent relapse. That is the point of the proposals in the Mental Health Bill.

My right hon. Friend referred also to supervised community treatment in the context of the funding that has been put into research. The research by the Institute of Psychiatry said that existing research was not definitive. The Government have stated their intention to adopt the path of supervised community treatment, which is already used in many other countries and has been implemented in Scotland. The existing legislation in this country does not permit implementation of a programme that would benefit patients. We shall ensure that we monitor the work that is done so that it is effective as possible.

I want to address the issue of mental health in prisons, which was raised by the hon. Member for Sheffield, Hallam (Mr. Clegg). He was right to refer to the Corston report. Jean Corston said that she supported the Mental Health Bill provisions on treatability, because there were too many women in prison who had ended up there because they had a personality disorder and, because of the way the Mental Health Act 1983 is phrased, did not receive help.

The hon. Gentleman made the important point that we need to ensure that good court diversion schemes are in place, so that people can get a hospital disposal early if that will be effective, and that there are proper transfers of people from prison to the acute setting if that is appropriate for them. We also need to ensure, as we are doing through the prison in-reach teams, that there is good help for people in a prison setting. Not everybody wants to be transferred to a hospital, because of some of the implications of that, which is why we need to ensure that there is good support in prisons for people who need it. On the hon. Gentleman’s point about the consultation document, I agree that it is important to get consultation right.

The hon. Member for Southport (Dr. Pugh) rightly pointed out how important the relationship with the voluntary sector can be. We need to do more work with the voluntary sector, which is making very good progress in providing services that people sometimes access more readily than they do some of the statutory agencies. It is right to have that relationship.

With regard to Lord Layard’s ideas, we made a commitment in our manifesto that we would increase access to psychological therapies. That is because it is very important that people with mental health problems have the choices that people have in other areas of health care. It is right to say that such therapies are not necessarily the answer to everything. Sometimes people need drug treatment as well, but what we are doing at the pilot sites, which have seen about 4,000 people, is examining the effectiveness of the demonstration sites. We are expanding those this year—there will be about another 10 sites during 2007—so that we can demonstrate the benefits and show that that system can be delivered across the country. We can consider the new commissioning strengths of primary care trusts to ensure that they develop those services locally.

As well as rolling out not only 10 sites this year but more than that the year after, we are considering how there can be proper accreditation not only of the types of therapy that are available, but of the practitioners who work in those fields. This is important. Not everybody needs to be a full-blown psychologist. Other people can provide important counselling services, but we need to ensure that there is proper accreditation, and we are doing that.

I turn now to group therapy sessions and computerised CBT. Last month we issued implementation guidance for computerised CBT, which means that PCTs should now be in a position to offer that technology to patients with mild to moderate depression. That represents real progress in ensuring that the NHS understands that alternative therapies, particularly talking therapies, are available and we need to make them much more widely available.

We can take away from the debate the fact that there is consensus that extra funding has gone into mental health services and that services have improved quite significantly. We also all agree that mental health care still has some way to go. New therapies are available and there are new changes that we need to make and improvements that I think we all agree are necessary. I assure right hon. and hon. Members that better mental health services remain a priority and we will continue to support people who need care and help at what are some of the most difficult times of their lives.

Integration and Cohesion

It is a pleasure to see you in the Chair, Mr. Olner. I am grateful for the opportunity to introduce this debate on integration and cohesion in Britain.

I am sure we all agree that public discussion about integration and cohesion has travelled a long way in recent years—from Lord Parekh’s commission for the future of multi-ethnic Britain, to Ted Cantle’s report on the 2001 riots, to the Government’s new, or fairly new, Commission on Integration and Cohesion. The discussion has not ended up where one might have expected at the beginning of 2001. There has been an unmistakable new interest in integration among opinion formers such as the BBC journalist George Alagiah, the Pakistan-born Bishop of Rochester Michael Nazir Ali and Trevor Phillips, who is to head the commission for equality and human rights.

This debate allows the House an opportunity to explore all aspects of that developing public discussion. I want to concentrate on an important part of it—relations between Muslims and non-Muslims in Britain—before asking whether there is merit in Cantle’s main recommendation, which the Government have not to date taken up: the development of a statement of allegiance that would follow what Cantle described in his report as

“an honest and open national debate”.

The events of 9/11 and their consequences have had an unmistakable impact on relations between Muslims and non-Muslims in Britain since 2001. In Britain, they have included the Dhiren Barot conviction, Richard Reid’s attempted shoe bomb atrocity, the Abu Hamza affair—and, of course, the horror of 7/7 as well as the events of 21/7. I am the Conservative Member with the largest number of Muslim constituents and my constituency also felt those consequences last summer in the form of the alleged aeroplane bomb plot; two of my constituents currently face serious charges in respect of that.

Last autumn, I offered the House my analysis of barriers to integration as they affect British Muslims. They include racism and Islamophobia, lower life chances, intergenerational conflict, the failure of the multiculturalist consensus, foreign policy and, perhaps above all, the impact of ideology. In its most stark form, that ideology is one of terror—hence 9/11 and 7/7. In its less brutal form, it rejects terror in Britain but embraces separation. Separation, of course, inevitably leads to a lack of integration and cohesion and the “parallel lives” of which Cantle warned.

A common term for the ideology is “Islamism”, a term sometimes used by Ministers. It is worth noting that some separatist Islamic groups in the tradition of al-Banna or Mawdudi use the term to describe themselves. However, many Muslims are unhappy about it and argue, understandably enough, that the use of the term tends to conflate that ideology with Islam itself. It is perhaps necessary to reiterate that the two are not the same. Islam is an ancient religion, whose history and practice seem to me just as various, complex and multifaceted as Christianity’s. The separatism that I have mentioned is in essence a modern political ideology, and I want to give the House a flavour of it.

Earlier this year, I discovered from a Channel Four “Dispatches” programme, “Undercover Mosque”, that a DVD featuring a preacher called Abu Usamah was being distributed from my constituency. In the programme, Abu Usamah was quoted as saying:

“No one loves the kuffar”—

that is, the non-Muslim—

“not a single person here from the Muslims loves the kuffar, whether those kuffar are from the UK or the US. We love the people of Islam and we hate the people of kuffar, we hate the kuffar”.

Abu Usamah also said:

“God has created the woman, even if she gets a PhD, deficient. Her intellect is incomplete, deficient. She may be suffering from hormones that will make her emotional. It takes two witnesses of a woman to equal one witness of a man.”

He went on to say:

“Do you practise homosexuality with men? Take that homosexual man and throw him off the mountain.”

I shall not weary the House with any further quotations, but it is important to demonstrate what this ideology of separation is like. It favours an ultimate political settlement in Britain in which the barrier between the sacred and the secular is torn down and different people are governed by different laws. As Dame Pauline Neville-Jones wrote in her recent report “Uniting the Country”, even those ideologues

“who eschew violence advocate...a social order…not compatible with modern western ideas of individual freedom, the equality of men and women, fundamental human rights and democratic government under the rule of law”.

I stress, of course, that this ideology is rejected by the majority of British Muslims.

When I last had the chance to address the House on these issues, I said that it is important to diagnose the cause of an illness—in this case, the to-some-degree poisoned relations between Muslims and non-Muslims—before attempting to treat it. Today, I want to set out some ideas that might help to find a cure.

I am delighted to see the Minister in her place, because I want to ask her some questions, and my hon. Friend the Member for Surrey Heath (Michael Gove) in his, because he is an acknowledged expert in this field. I am also grateful for the presence of my hon. Friends the Members for Cities of London and Westminster (Mr. Field), for Beaconsfield (Mr. Grieve) and for Newark (Patrick Mercer), and the hon. Member for Hazel Grove (Andrew Stunell), who is a spokesman for the Liberal Democrats. It is a pity that there is not greater representation on the Labour Benches.

In my view, the origin of such a cure lies in strengthening the unwritten social contract that exists between Muslims and non-Muslims in Britain. Under that contract, non-Muslims are obliged to recognise that Islam is now a permanent presence in Britain, that British Muslims have lower life chances than the non-Muslim majority as a whole, and that those life chances must be raised as part of any programme of social justice. In turn, Muslims are obliged to face up to the fact that Dhiren Barot, Richard Reid and the perpetrators of 7/7 claimed to act in the name of Islam, however unjustified that claim is, and recognise that the separatist ideology that I described earlier must not merely be condemned—it must be actively challenged, confronted and rooted out.

First, I want to deal with ways of raising Muslim life chances. According to the Office for National Statistics, Muslims are more likely to be lower paid than Christians, but the relevant figure, like others that point to Muslim disadvantage, must be read carefully. According to a study called “Religion and economic activity in the South Asian population”, 41 per cent. of Indian-originated Muslim adults are in full-time work, compared with 26 per cent. of Pakistani-originated Muslim adults and 23 per cent. of Bangladeshi-originated Muslim adults.

Those figures help to put some of the statistics about Muslim disadvantage in context. Indian-originated Muslims often come from a more prosperous background than Bangladeshi-originated, Pakistani-originated or Kashmiri-originated Muslims, so the figures suggest a hierarchy of disadvantage. As Munira Mirza wrote in her “Living apart together” report for the think-tank Policy Exchange—in my view, the leading think-tank on Islam and Muslim-related matters—

“Policy-makers talk about helping ‘Muslims’, but levels of social disadvantage actually relate more closely to ethnicity than religious grouping, and even more importantly, to socio-economic class.”

In other words, it is only common sense to recognise that Muslims who speak English as a second language, or not at all, and who come from more deprived backgrounds are less likely to enjoy good life chances than Muslims who speak fluent English and come from more prosperous backgrounds. Homes and schools are therefore vital locations for the levering up of life chances, especially given that no fewer than a third of British Muslims are under 16.

Some questions need to be addressed. Do parents who can speak English always encourage their children to do so at home? Do parents champion the value of education as a source of opportunity and not seek to discourage young women from entering the labour market should they wish? Are the expectations that some schools have for Muslim pupils too low? Is enough done to encourage parents to enter the teaching profession or to come forward as governors? How can integration possibly be helped by the planned reduction of support—although I understand that that is being reviewed—for the teaching of English to new migrants?

So, raising Muslim life chances, especially the life chances of Muslims from poorer backgrounds, is necessary if the unwritten social contract between non-Muslims and Muslims in Britain is to be strengthened. However, although improving life chances is necessary for that to happen, it is not sufficient. Marc Sageman’s study of 172 al-Qaeda operatives around the world suggests that there is no simple link between lower life chances and separatist ideology. Indeed, he found that many operatives were from relatively wealthy backgrounds. The horror of 7/7 helps to prove that point: Mohammed Siddique Khan was, after all, a qualified teacher and a graduate of Leeds Metropolitan university.

Therefore, in the interests of integration, I turn to ways of rooting out the separatist ideology that I described earlier. The Government alone cannot do so, but ministerial leadership is crucial. According to recent reports issued over the Easter break, the Minister’s Department will lose its lead role in relation to British Muslims to the new office for security and counter-terrorism. The Minister is shaking her head, but it is important that she clears that matter up today. After all, her Department has only been in charge of this matter for about a year and placing relations with British Muslims in a security context will obviously have big implications.

Mention of the Department leads me to reflect on Government policy as a whole since 7/7. It is fair to say that the entire political and media establishment was caught off-balance by the horrendous events of that day. The Government’s initial reaction was to set up the “preventing extremism together” project, but there is some controversy about how many of its recommendations have been implemented. That approach has clearly been superseded by the new Commission on Integration and Cohesion. There have been reports that Ministers want to raise the age at which spouses can enter Britain from 18 to 21. Will the commission consider that matter and report on it in June as part of its findings?

The Government’s approach to preventing extremism needs to be synoptic, but it is hard to see such an approach at the moment. For example, the Department for Education and Skills—partly in reaction to a legal case involving a girls’ school in my constituency—has recently issued guidance on school uniforms, which makes it clear that schools are entitled to bar the niqab or veil if they wish. However, the Department of Health refuses to issue similar guidance. I asked about that matter after the Royal Preston hospital was reported last year to be modelling a gown for patients based on the burqa, which, as hon. Members know, is not worn by most Muslim women in Britain. The answer that I received was that national guidance was inappropriate. Perhaps the Minister will explain why guidance appropriate for schools and teaching staff is not appropriate for hospitals and medical staff.

Terror groups are reported to be targeting universities and prisons. What guidance is issued to prison governors on the receipt of extremist literature by prisoners and is enough being done to encourage college principals to follow the example of universities such as Birmingham, which checks visiting speakers’ credentials in advance? More broadly, many of our constituents will ask why it took so long for the Danish embassy protesters who shouted support for terror to be charged, and why the loophole that allowed Abu Hamza to pass on property from prison is still unplugged.

I turn from preventing extremism to its flip side, which, of course, is supporting moderation. Having tried to give a flavour of what extremism is like, I shall now provide a flavour of what moderation is like by citing an event that took place at the Palace of Westminster before the Easter recess when I was privileged to co-host a reception for the Sufi Muslim Council. The SMC is unambiguously moderate and campaigns against extremism. It wants to see citizens from all backgrounds living together under one common law. It believes that British Muslims can live privately under sharia law in the same way that Jews, for example, can live privately under their own religious law. It rejects placing entire areas of Britain under state-run sharia law, which extremists such as Abu Izzadeen advocate. Just as importantly, it also rejects permitting different religious groups to live under different state laws—the system that operated in India under the empire, and which is championed by such Islamists abroad as Sheikh Yusuf Al-Qaradawi. I believe that organisations such as the British Muslim Forum, to which the three main mosques in my constituency are listed as affiliates, broadly take the same moderate view.

In the light of that, can the Minister confirm that the Muslim Council of Britain is no longer being treated as the main representative voice of British Muslims? According to Dr. Mirza's research, only 6 per cent. of British Muslims believe that the MCB speaks for them, and only 1 per cent. believe that the Muslim Association of Britain, which is usually regarded as the British arm of Hamas, speaks for them. Can the Minister explain, therefore, why the MAB was given the same status as the MCB, which at least has a large number of representative organisations affiliated to it, and the BMF on the steering group of the Mosques and Imams National Advisory Body project, which is looking at the future of British mosques?

Indeed, can the Minister confirm whether the Government would like the MCB, the MAB, the BMF and the SMC—I apologise for all these acronyms—to be rolled into one representative body for British Muslims? If so, is the amalgamation of such divergent organisations really practical, and do Ministers believe that a single organisation can provide a reliable link to all British Muslims—the highest figure is 1.8 million—a proportion of whom do not attend mosques regularly, if at all?

Before Easter, the Secretary of State announced details of a £6 million pathfinder fund to prevent violent extremism which, as the Minister knows, was described as a hearts-and-minds drive. There is a case for using public funds for that purpose, but it is essential that non-Muslims do not feel that they are losing out, and that the use of that money is closely monitored. What safeguards have been put in place to guarantee that the regional forums against extremism, which are part of that drive, cannot themselves be taken over by extremists?

Ultimately, building moderation and cohesion is not the responsibility only of the Government. For example, public broadcasters have a responsibility, by interviewing extremists with the same curiosity and rigour that they traditionally bring to bear on democratic politicians. Mosques have a role to play by opening themselves up to outside visitors, as the main mosque in High Wycombe has a history of doing. The mainstream Islam taught in those mosques has an indispensable role to play in the fight against separatism and extremism. A significant feature of the study of al-Qaeda operatives to which I referred earlier is that most of them were not raised in religious homes where such mainstream Islam was practised. Indeed, Dhiren Barot is a convert to Islam from Hinduism. Wahabi publishing houses produce a mass of books, tapes and DVDs both here and abroad, but Britain's Sufi mosques do not usually have access to the same resources. I am not suggesting that the state should chip in, but many British Muslim business people are active in community and charity fundraising, and there is no reason why more effort should not go into a publishing drive by moderates. I should be interested to know whether the Minister is doing anything to encourage that.

I have attempted to set out some ideas to help to prevent extremism and to support moderation. There is no perfect means of doing that and no perfect solution; indeed, there is no inevitability about finding solutions to these problems. If enough non-Muslims embrace race separatism, the doctrine of the British National party, and enough Muslims embrace religious separatism, the obviously repellent doctrine of Bin Laden and Ahmadinejad and, in a more subtle form, of Qaradawi, then—to borrow a figure of speech from Yeats—things will indeed fall apart.

None the less, like the Minister I am sure, I remain an optimist as politicians must. It can all too easily be forgotten, amid all those difficulties, that in each day of every year in the communities that we represent British Muslims and non-Muslims live alongside each other peacefully. What is certain among all the uncertainties is that fashion changes. During the first half of my adult life, the fashion in the mainly Muslim world was for Arab nationalism and socialism. In the second half, it has been for religious separatist political ideologies that distort and pervert Islam. Perhaps the best course that British citizens can take, whether they are Muslims or non-Muslims, is to wait for the fashion to change—as it will sooner or later—and in the meantime persistently and patiently make the case for our common inheritance: individual freedom, the equality of men and women, fundamental justice, and democratic government under the rule of law. I believe that the role of Muslim women, in particular, will be crucial to making that change.

I said earlier that I would come to Cantle’s proposed statement of allegiance. It perhaps illustrates a way of thinking that holds that Britain is now so diverse as to require the replacement of our unwritten constitution with written contracts. Since 1997, constitutional change has brought us to a halfway house somewhere between our old constitutional settlement and a new future that has yet to be revealed. Looking at recent election turnouts, it is fair to say that that halfway house is not particularly popular. One of two routes is now open to the recovery of ownership of the political system by the people.

The first route is via a fully fledged written constitution that is endorsed ultimately by a referendum, of which Cantle’s statement of allegiance could be a part. The second is via direct democracy, by giving more power to the people rather than to unelected judges through the greater use of referendums. Discussion about integration and cohesion in relation to Muslims and non-Muslims in Britain turns out to be part of a wider discussion about the future of faith communities, which the recent debates about faith schools and gay adoption have touched on, and indeed about relations between us all. I look forward to hearing from my hon. Friends and to the Minister’s reply.

I congratulate my hon. Friend the Member for Wycombe (Mr. Goodman) on obtaining this important debate. He has a great interest in such matters. As he rightly said, his is the Conservative-held seat with the largest number of Muslims, and in that as in so many other ways I am second to him, as I have a large and diverse Muslim population in my constituency. I am keen to move away in my remarks from dealing exclusively with Islam and Muslim matters, but inevitably they will form part of our discussions both today and in the future.

My hon. Friend made an extremely interesting speech and a 90-minute debate is by no means long enough to address the whole range of issues. However, I wish to touch on some of the aspects that have been mentioned. In addition to my 73,000 residential constituents, some 40,000 non-UK nationals live in my constituency. They range from the wealthiest of business men to some of the most vulnerable asylum seekers—both ends of the spectrum to which my hon. Friend referred. We must also bear in mind the 1 million or so people who visit central London daily either to work or as tourists.

In the borough of Westminster, which also encompasses part of the constituency of the hon. Member for Regent's Park and Kensington, North (Ms Buck), some 56 per cent. of residents were born in the UK, compared with an English average of some 91 per cent. and a London mean of 73 per cent. I fall within the minority, as I was born in a British military hospital outside the UK.

New folk arrive in the area daily, and issues of cohesion and integration are at the forefront of everyone’s mind. People come to this country looking for work, homes and a better life than they would have had from whence they came. Much of the more recent influx has come from eastern Europe. Over the past six months I have had the opportunity on several occasions to speak in and, in fact, lead debates in Westminster Hall on aspects of A8 and A2 nationals coming from eastern and central Europe. Many others have been resident in the area for some time and are now making their way out to homes in other parts of London and the nation at large. I maintain that neighbourliness is alive and well in my part of London. Part of the secret has been the continuation of community identities along the lines that my hon. Friend the Member for Wycombe pointed out.

This time last year, the leader of Westminster city council, Simon Milton, launched a one-city vision to create excellent services and stronger communities. He emphasised the importance of taking action over the next five years to ensure that Westminster remains an open and tolerant city. I appreciate that the Government have done much along similar lines and have helped to finance some local initiatives. The Minister will discuss that in her contribution later. My hon. Friend referred to a dichotomy. My view is that initiatives must be community-based. They cannot simply be the result of an ex cathedra judgment of a local or national government but must be very localised if we are to make progress.

We must create a city in which people are linked together by more than geography, and we must stress the importance of building on shared values and aspirations. Elements of that include the importance of English language tuition, which my hon. Friend the Member for Surrey Heath (Michael Gove) will discuss later. I have always taken the view that public money should not be spent on tuition in other languages but that, as far as possible, an almost limitless fund should be available so that people who come to this country can learn English at the earliest opportunity. A lack of English is the most important potential barrier for those who come to this country. They can make a full contribution, not simply economically but in every other way, if they are able to learn English, and we must encourage that at the earliest opportunity.

We are also keen to engage residents from overseas in the democratic process as a whole, to create a common set of aspirations and to develop representative resident and business associations. I heartily endorse all those local considerations, and I believe that there have been improvements in the social behaviour and tolerance of people living in central London and thus, ultimately, in the integration and cohesion of all those who live in the area that I represent.

I am blessed by having in my constituency a very large Chinese community, which is based mainly in Soho and its surrounds. London’s Chinatown is the traditional heart of the Chinese community in Great Britain. There is also a very large Bangladeshi community in my constituency. In the week of Bangladesh’s national day, I salute the contribution of Bangladeshis to the local communities in south Westminster and in the City of London square mile.

After a few years of residency, many of my constituents feel that they belong to small central London villages. For example, there are no fewer than 30 active residents associations scattered within the seven square miles that make up my constituency. I am convinced that one of the great charms of this part of central London is the fact that so many of its residents care deeply about the neighbourhoods in which they live, and the frenetic activity of many residents associations plays an important role in ensuring that, by and large, we enjoy a high quality of cohesion and integration in our civic life.

However, those same communities feel under attack from the remorseless tales of street violence in London and the seemingly never-ending anxiety about terrorist attacks in the central area. Two of the 7/7 bombs went off at Edgware Road and Aldgate stations, two geographical extremes of my constituency. In the aftermath of the July 2005 terrorist atrocities on and under the streets of London, much national soul-searching has rightly taken place. The question that remains unanswered is how and why modern Britain has bred from its home-grown ranks so many anti-British fanatics. I believe that the notion of multiculturalism that has been promoted in our country in recent decades has been largely discredited. We need to assert the core values of identity, integration and cohesion more strongly. That will be possible only if we embrace this nation’s laws and customs.

My hon. Friend the Member for Wycombe rightly pointed out some of those issues, and I would like to discuss them in more detail. I recognise that other hon. Members wish to speak in this important debate, but I would like to talk about our core values, and about how they have been shaped over centuries to allow us to be a nation of freedom and respect for others.

I take as my starting point Martin Luther’s defiance of the all-powerful Roman Catholic Church, which took place as long ago as 1517 and heralded the Reformation. The importance of those events to the intellectual development of what we may regard as western society and ideas cannot be overstated. Up until that fateful year almost 500 years ago, there had been a universal, established Christian Church that was, like traditional Islam today, intolerant of any dissent to its power. The threat of excommunication was in no way conducive to independent thinking, scepticism or a broad range of academic and artistic speculation. By chance, within two decades, under King Henry VIII, England had also struck out, so burgeoning intellectual freedom formed the basis of the British state that we understand today. I believe that that freedom has been at the forefront of the vast array of developments in science, the arts, philosophy and political thinking which has moulded western European and global civilisation ever since.

The passion for secular democracy, individual liberty, freedom and equality before the law, religious toleration and pluralism is, I believe, at the heart of what it is to be British. It might be depressing to think this way, but let us make no mistake: those values are not compatible with much of the Islamic teaching that we hear about today. I do not dispute what my hon. Friend had to say about ensuring that the more moderate aspects of Muslim and Islamic thinking are also put across, but it is, I fear, a stark reality that much of that religion’s teaching is incompatible with the values that have grown up in the past 500 years.

Collectively, we in Britain seem to have lost the confidence to assert our sense of identity. Ironically enough, the first wave of post second world war immigrants were in very little doubt as to what Britain stood for. Many of those people were products of British colonial rule and came to settle in what was then regarded as the mother country.

I fundamentally agree with my hon. Friend that it is un-British of us to simply codify our values in law, but we are in a state of flux, not least because of the halfway house of constitutional reform brought about by the Government in the past decade. One reason why we have never had a written constitution in this country and why the Conservatives are instinctively opposed to signing up to one via the European Union is that the English way—we are different from the Scots in some respects—has been for a slow, piecemeal evolution of laws and customs. English law has never been formulated as a coherent set of rules by a body of technical experts. Despite all of the centralising pressures coming from an established Church, academia and an ever more powerful state, our law—the common law—has evolved gradually over time, as have the core values that make us what we are. Unlike other countries, we have not sought to oblige our people to speak the national language, although I appreciate that that is changing; we have not looked at the idea of making a vow of allegiance or of showing some respect to the flag, which is the norm in the United States. Our infinite flexibility is in many ways a wonderful strength. Our customs and values are practical and are based on an ongoing reality so when circumstances change, so too can laws and customs.

Order. May I ask the hon. Gentleman to realise that two of his colleagues hope to speak and that I want to allow plenty of time for the Minister and the official Opposition spokesman to answer?

I believed that only one other hon. Member wished to speak and that the winding-up speeches would start at 12 o’clock. Have no fear, Mr. Olner: I do not wish to hog a further 90 minutes, but I take on board what you said.

As I was saying, the rule of law is a particularly British concept. Our society is based on the notion that we all abide by the same rules whatever our wealth or standing. The rule of law is an attractive concept to those from abroad who settle here. Often it stands in stark contrast to what many people from far afield, and indeed many closer to Britain, are accustomed. As my hon. Friend the Member for Wycombe is aware, my mother comes from a part of Germany that is now in Poland. In the first 15 years of her life she lived first under Nazi dictatorship and then under Communist rule before coming to the west and being able to appreciate those values.

Our legal system, however, is very confrontational, and determined to give the defendant a fair trial. I know that we all have concerns about that in relation to terrorism matters, but it is a fundamental truism in terms of what the British legal system exists to achieve, in comparison with many continental systems, which are designed to reveal the truth, and therefore concern themselves with the interests of the state rather than those of the individual.

We are also a secular society, in that our sovereignty resides in the Queen as a constitutional monarch, with Parliament. The British way has never been to appeal to some higher spiritual jurisdiction. Our laws are made exclusively by the Houses of Commons and Lords and interpreted by an independent judiciary. For historical reasons we have an established Church, but no one should make the mistake of thinking that that indicates anything approximating to a theocracy. Pluralism and religious tolerance have been part of the British constitutional settlement since the Glorious Revolution of 1688.

I must confess that as an Englishman from birth and a Londoner all my adult life I believe that many of my opportunities and dreams have no limit. I recognise fully that that is a stark contrast to countless thousands and millions of people in Britain, some of whom are of course in my constituency. Like my hon. Friend I am an optimist and excited by the challenges facing me and our country in a fast-changing global economy. As a man in early middle age I confess that I sometimes envy those half my age and younger. Their dreams and imaginations will be even more expansive than mine. With vision, leadership and a passion for all that the future holds, we live in a world that holds the most exciting of opportunities, which, only a decade or two ago, no one would have imagined. Global travel has become commonplace. In our debates on aircraft and pollution it is important to realise that global travel is one of the most important ways of enabling people to see different cultures and consider the issues of cohesion and integration that we are debating. The opportunity to travel so far abroad is now within the grasp of many people in this country.

Rather than obsessing in debate about multiculturalism we need without delay to counteract the sense of humiliation and grievance, and the culture of victimhood, that has beset so much of the Muslim world and so many young disaffected people growing up in our inner cities. That growing band of disaffected people, who feel that they have in some way been brought up unfairly, and want to strike back angrily at the society that has borne them and nurtured them, has developed its own sense of victimhood and is independent of much else in society. The new Britons who rail against the society in which they grew up and were educated compare remarkably unfavourably with many immigrants to these shores in the past century, many of whom were escaping horrors in their erstwhile societies. Much of the Arab world has failed to give its young people the political and intellectual leadership that would encourage them to take a more positive path. Meanwhile, we in the west, who have problems among our own young people, should not play up to that culture of historical grievance.

Many parts of the world remain backward, economically and politically, and many of our young people will identify with those failing countries, whether they are in the Arab world, Africa or parts of the Caribbean. I can only imagine how some young people feel now, as perhaps second or third generation British citizens, in a country whose institutions constantly play up to their feelings of discrimination, whether real or imagined. The sense of alienation and humiliation makes, I believe, for a most unstable mix, and for a breeding ground for some of the extreme violence to which my hon. Friend referred.

I believe, as ever, that much hinges on education. I suspect that there will be agreement in the Chamber about that. All our young people need to embrace the history and development of the culture of this country. They need to learn that freedom and fair play have been won after many centuries of pain and railing against a fundamental authority. We must stop apologising for past ills and encourage all our citizens to look forward and rejoice in this country’s lack of restrictions and its ability to give its people self-determination and self-responsibility.

It is a pleasure to follow my hon. Friend the Member for Cities of London and Westminster (Mr. Field). I do not think that my speech will be as wide ranging, and I hope that it will be a bit shorter—with respect. It is a pleasure to serve under your chairmanship, Mr. Olner, and to be opposite the Minister, for whom I have great respect. I congratulate my hon. Friend the Member for Wycombe (Mr. Goodman) on having gained this incredibly important debate. Unlike my two hon. Friends who have spoken, I have only a small Muslim community—and indeed only a small ethnic community—in my constituency, but it is amazingly influential.

I pay tribute to the Al-Karam school, and in particular to Pirzada Sahib, who runs it. He has been instrumental in so much Sufi thinking in this country and in the British Muslim Forum. I spend a lot of time with Pirzada Sahib, and I hope that I have learned much from him. He has certainly attempted to teach me a great deal; whether it has succeeded is of course another matter.

I was pleased to hear the Secretary of State for International Development, in his speech a few days ago, eschew the whole concept of a war on terror. That is an important statement for him to make. I fear that the media tried to make some sort of political point out of it. I do not know whether that is what the right hon. Gentleman intended. To stop Islamist fundamentalists spreading throughout this country and the world, it is crucial that we cease to consider the campaign—even that is not a good word—to counter terrorism as some sort of war. It is not. Such ideology must be countered by another form of ideology, based essentially on tolerance, understanding and above all else—to echo the words of my hon. Friend the Member for Cities of London and Westminster—on education. To continue thinking of it as some sort of military campaign is quite wrong.

I was very impressed in some ways and horrified in others—I shall come to the horrific bit in a moment—by the Government’s counter-terrorist design, the plan or strategy Project Contest. Project Contest has been around for several years. As everybody in this room should know but probably does not, it depends on four different strands of thought and action, the so-called four Ps: prevent, prepare, protect and pursue. Intellectually—I am sure that the Minister will agree—I can find no fault with that. The rigour that has gone into designing the strategy is pretty good, and it is difficult to criticise, but I fear that the implementation has been woefully lacking.

This is not a new theme of mine, but it needs to be brought into the public domain yet again. After the 7/7 attacks, the Prime Minister’s delivery unit was asked to carry out a rolling audit of Project Contest. It was a secret process, or certainly a discreet one. It started, I believe, soon after the July attacks and reported, I think, sometime in September 2005. We got to know about it only because a leaked document appeared a few weeks later. It was published in October.

The Prime Minister’s delivery unit—the Prime Minister’s own audit body, which had been unleashed on Project Contest—reached the following conclusions at the end of 2005, which I paraphrase. The strategy is immature. Forward planning is disjointed or has yet to occur. Accountability for delivery is weak, activity is not connected or coherent and—here is the rub—who is in charge? We measure meetings and reports, not real-world impact. In other words, the Government condemned their own strategy in September 2005.

The breath was knocked out of me just a few weeks ago when the Home Secretary, while discussing the Home Office’s evolutions, changes and new organisation, seemed to suggest that Project Contest would remain in force unchanged. Indeed, he went on to say that the first strand, which we are discussing today—the “prevent” strand—would continue to be the responsibility of the Minister’s Department. I know that she agrees with and understands that, but is it not like sending a car in for an MOT test, being told, “I’m sorry, your car has failed to come up to scratch to run on the road,” and saying, “Okay, give me the keys and I’ll carry on driving it”? Nothing has been done about Project Contest since September 2005 when it was roundly condemned. Yet here we are with the Home Secretary saying that the “prevent” strand of this moribund strategy continues to be the responsibility of the Minister and her Department. I would be fascinated to hear the Minister’s comments on that.

I note the comments that have already been made about the pathfinder fund and other initiatives, which I will not go into in any more detail because they have been properly made already. However, let me continue to expand on the theme of cohesion and integration. I do not know how many others inside this Chamber were stunned by a comment made by the Prime Minister a couple of days after the 7/7 attacks. He came to the House and, for the most part, made a very good speech, but one particular comment struck me as being completely remarkable. He said that in the light of the bombings, we had to start a programme for Muslim outreach. Start a programme for Muslim outreach in July 2005? I wonder what sort of debate we would be having today if the aircraft plots of last summer had come to fruition and 3,000 or 4,000 people had been killed. Aircraft from this country would have exploded over the American mainland not only killing people, but fracturing the relationship between the United Kingdom and the US. In what climate would we now be debating? Would we not be asking about the Prime Minister’s 12-point plan—one of the products that came out of the 7/7 bombings?

I will not bore the Chamber by going through the plan point by point, but will the Minister comment on two specific points? First, can she expand on the points that have already been made about a commission to advise on better integration of those parts of the Muslim community that are less integrated than others? Exactly how far has that work got as part of the Prime Minister’s much vaunted 12-point plan? Secondly, could she explain the point about the ban on Hizb ut-Tahrir and its successor organisation Al-Muhajiroun? I was under the impression that the Prime Minister was the Prime Minister and that his word was law. Why has Hizb ut-Tahrir not been banned? Surely the Minister fully understands what an insidious organisation it is, what it does to cohesion and integration inside this country, and how it nurtures so much of the divisive and dangerous thinking that has already been described.

I have detained the House long enough. However, I find it extraordinary that in the light of the July 2005 plots—let us not forget that there was one successful attack and a planned attack that could have killed many more people—and in the light of several other failed attempts and the brilliantly intercepted but none the less deeply dangerous plan to attack aircraft last summer, many of the perpetrators of which came from the constituency of my hon. Friend the Member for Wycombe and all of whom were British born, and in the light of the full and comprehensive understanding of the Government that we must try to prevent such atrocities, I am appalled and surprised by the fact that Project Contest continues to be in force, by the paucity of thinking that has gone into the Home Office reforms and by the fact that there has not been an appointment of a single Minister for security. It leaves me completely aghast and I should be grateful for an answer from the Minister.

I congratulate the hon. Member for Wycombe (Mr. Goodman) on the very thoughtful and comprehensive view that he has brought to the debate. In preparing for the debate, I had the opportunity to review what he said in the Queen’s Speech debate last autumn. He has covered much of the same ground today, and very felicitously if I may say so. He has left the Minister with some questions that I hope she will have the opportunity to answer. I certainly do not want to eat into her time.

I should like to underline the hon. Gentleman’s point that there is no one-shot solution to this issue. When he spoke about the Queen’s Speech, he said that we needed to get the analysis, the prescription and the treatment right. That is exactly right. I should like to take that medical analogy a little bit further and remind the Minister and the House that curing illness is two thirds about happiness and well-being and only one third about the pills and the treatment that people get. As far as our society is concerned, I think that we sometimes concentrate a little bit too much on the action points and not quite enough on the happiness and well-being point, which is what will come to our rescue in this complex situation.

It is a complex situation. The situation in Wycombe is different from that in Westminster and the situation in Burnley is different from that in Brixton. We make a mistake if we think that there is one national prescription or one national analysis that will deal with all the complexities that we face in all those different situations. Although the focus of our debate has been Muslims and social cohesion, we need to recognise not just that there is complexity between the different faith communities of those of different ethnic backgrounds. To focus solely on one solution in one area, then presume that we can apply it everywhere else, will almost certainly not be successful.

It was interesting to hear the speech by the hon. Member for Cities of London and Westminster (Mr. Field). I agree with him that a lot of it has to be about community initiatives, not centrally imposed top-down solutions. I was less comfortable with his visit to the constitutional never-never land of Britain in the olden days, which I want to comment on in a minute or two.

The hon. Member for Newark (Patrick Mercer), who has suffered a little bit of turbulence recently, made a strong point in saying that we should get away from the language of the military: wars and campaigns and so on. Again, we need to understand that we are in a complex situation. We have friends, a few enemies and a large number of people who are neutral or agnostic. The language that we use will be of great importance in coming to a successful conclusion.

I want to spend a minute or two dealing with the historical realities versus the British myth, because a lot of the conversation that I hear in this building and in the media has a patronising tone about how Muslims need to shape up and fit in with British society, with an underlying assumption of some golden model of British society that has a historic inevitability about it that is wholly admirable and wholly desirable. I remind the House that 500 years ago, the Catholics were trying to blow this building up, but of course we do not think about it quite in those terms; we think of Guy Fawkes. A consequence of their attempt was a purge of Catholics in this country that exceeds anything that we have contemplated in the debate so far. Much more recently there was another attempt to blow up this House, which killed the then hon. Member for Eastbourne. On that occasion we did not have a purge against Catholics, which shows that in 500 years we have learned something in this society about understanding the difference between terrorism and an ideological belief or a religious conviction.

I remind hon. Members that we recently celebrated the fact that 200 years ago an Act was passed in this place for the abolition of slavery. We were all happy to celebrate that. William Wilberforce has of course been held as a champion of that cause, and he was an Anglican. It might be wondered why non-conformists, for instance, played no part in that parliamentary victory, and the answer is simple: they, like Catholics, were excluded from the House, which was open only to members of the Church of England. Any impression, therefore, that there was a golden age of integration and cohesion in England is completely inaccurate. Furthermore, although this is perhaps of marginal significance now, we cannot have a Catholic king, let alone an Islamic one.

You might wonder, Mr. Olner, which direction I am coming from, so let me say that I am a Baptist—a non-conformist. The Baptists were the first religious group in western Europe to argue for religious toleration—even for Catholics—and that was at a time when this country’s laws forced them to worship in Holland. When we talk to our Muslim colleagues, therefore, who have a very multifaceted faith just as Christians do, we need to be a little more sensitive and just a little less arrogant in what we say and presume.

I thank the hon. Gentleman for giving way and I take on board what he has said. The point that several Conservative Members have been trying to make is not that everything has been perfect in Britain for the past 500 years, but that integration and cohesion require a sense of common purpose, common values and common aspirations. Those values evolve with time and with each wave of immigration, and large waves of Muslim immigration, for example, will inevitably have an impact on them going forward.

I entirely agree. Indeed, in the second part of my comments, I want to address the fact that things have changed and developed exactly as the hon. Gentleman says. We have learned the lessons, and one of those lessons, which is reflected in the different way in which this country reacted when Guy Fawkes tried to blow this place up and when the IRA successfully blew up part of this place and killed an hon. Member, is not to conflate Muslims or Catholics with terrorism. At a time when it is commonplace to say that we want immigrants to know more about British history and to understand our background, we have actually forgotten our history and our background, and I sometimes wish that the Government would pick up on points such as those that I have just made.

As regards the action that the Government have taken, I very much welcome the Commission on Integration and Cohesion, which was a sensible mechanism to put in place and which has the opportunity to explore the issues and introduce recommendations and possibly remedies. Indeed, the Liberal Democrats have made a submission to it and we look forward to its output in due course.

I am less impressed, however, with some of the other things that the Government have done. The Secretary of State’s recent six-point plan is a case in point—good intentions, but poor analysis. To return to my earlier analogy, the idea that the solution to the bomb that killed Airey Neave was closer supervision of Catholic churches would be seen as totally absurd, and the idea that the correct response to bombs on buses in London is to supervise mosques is similarly totally absurd. Of course, if supervision is introduced and is successful—I do not know what that means, and nobody can actually tell me what it is supposed to mean—those who do not like it will do exactly what the Baptists did 400 years ago: go to prison or go overseas. The state may therefore attempt to control the way in which people practise their beliefs, but that route will lead to failure.

That brings me to a point raised by the hon. Member for Wycombe. He apologised for producing a long string of acronyms—I must say that I lost my way as he went through them—but there are many different representative organisations for different parts of the Muslim faith. If the idea is that we can have an automatic, state-imposed council of Churches for the Muslim faith in this country, I have to say that that is as absurd as suggesting that the Government could impose a council-of-Churches model on the Christian Churches of this country. The diversity is enormous and of course the membership and the commitment of people from a Muslim background to any one or, indeed, any at all of the different branches of the Muslim faith is not by any means assured.

That brings me to the point on which I wanted to conclude. There has been much discussion of separatism and parallelism and whether that is a good or a bad thing. I think we should accept that it is a neutral thing. The Government do not propose to take action against the Plymouth Brethren, who keep themselves completely separate in this country. They do not participate in the political process, they do not intermarry with other groups and so on. I am sure that I shall be told that that is an absurd point because the Plymouth Brethren pose no threat; they have not been blowing up buses. Of course all that is true, but then why do we think that the right approach is to bring mosques into some kind of pro forma way of relating to this country and our society? Are Muslims not permitted to have an equivalent of the Plymouth Brethren when that is permitted for Christians?

I ask that question because sometimes the discussions that I hear seem to be leading people into a quagmire that cuts absolutely across what the hon. Member for Cities of London and Westminster said about this country, its unwritten constitution and its capacity to accept diversity, to take on board different values and to recognise and have mutual recognition for them. We need to be clear about what we are trying to achieve and not allow ourselves to be overcome by discussion of particular mechanisms for achieving it, which might be more costly.

Of course, there is the point about the dress code. I wanted to hear in the Tea Room what the hon. Members for Wycombe and for London and Cities—I cannot get that right; let us call him the hon. Member for London—wanted to have as the dress code option. In Britain, do we want a written constitution? I do not think so. If we do want a written constitution, should it say something about our dress code?

When I was in the third year in secondary school, boys were sent home for wearing trousers without turn-ups because that was not permitted. By the time I got to the sixth form, they were being sent home for wearing turn-ups, because that was not permitted, so I have some difficulty with an authoritarian system that dictates what people should wear. Of course people have to wear clothes that permit them to carry out their public functions, but please let us not get carried away by an outward symbol that we presume means something else. Let us look at what the something else is.

The last part of the evidence that the Liberal Democrats submitted to the Commission on Integration and Cohesion said that

“we would simply add…the importance of one intangible and inexpensive ingredient—talking. Informally, socially, casually. Learning that the other person is human, has shared aspirations and an interesting family and cultural background. Seeing past the collective myth to the personal reality.

Acts of Parliament and large sums of money may well be needed to make progress, but it will all be wasted if that informal and personal dialogue does not take place thousands of times a day right across the country.”

It is a pleasure to serve under your chairmanship, Mr. Olner.

I congratulate my hon. Friend the Member for Wycombe (Mr. Goodman) on securing the debate. As the hon. Member for Hazel Grove (Andrew Stunell) pointed out, my hon. Friend made a brilliant speech in the debate on the Queen’s Speech, in which he outlined the scale of the challenge that our society faces. That challenge is not one of religious separatism, but one of ideological division, and here I must take issue with what the hon. Member for Hazel Grove said in his fascinating, wide-ranging, but in some respects misconceived remarks. He was right to stress the importance of community initiatives. He was, as ever, right to stress the importance of pluralism and to recognise that one size does not fit all when we are dealing with the various problems that we have all had an opportunity to analyse in the debate. However, he was wrong to suggest that the problem is an explicitly religious one, and to draw the historical comparisons that he did.

I should point out that, when the hon. Gentleman said that we no longer believed in one version of British history that saw us moving towards a golden future, he was disavowing a grand Liberal tradition. That version of history, which saw us moving towards a more liberal future, which used to be known as Whig history, and was the product of Macaulay and Trevelyan, used to be the guiding light of his party. It is a pity that it is no longer. One of the insights of Macaulay, Trevelyan and other Whig historians is that what has made Britain great is not just our respect for pluralism and tolerance, but a belief in liberty, rooted in our historic institutions. Those institutions are challenged by the specific ideology outlined by my hon. Friend the Member for Wycombe.

Islamism is distinct from Islam. Islam is a great faith that has nourished millions for hundreds of years. To this day it contributes intellectually and spiritually across the globe to enriching the lives of a great many people. No one on the Conservative Benches would want to criticise Islam as a faith. Indeed, it has enriched this country. Islamic scholars and tens of thousands of British Muslim citizens make Britain a better and more tolerant place today, but the best of those—in fact, the majority of them—also recognise that those who call themselves, sometimes, Islamists or jihadists, or who use another name, such as Salafists, and who follow the specific Islamist ideology are following a 20th-century totalitarian aberration that is intended to undermine the very tolerance that makes Britain both a safe and a warm house not just for its Muslim citizens but for all citizens. If we are to ensure that toleration will survive in this country, and protect pluralism and liberty, we need to be aware of the precise nature of the threat. That is why my hon. Friend the Member for Wycombe deserves praise for drawing attention to that challenge in this House and elsewhere.

The hon. Gentleman was kind enough to address his remarks to me, and of course I acknowledge the points that he was making about the hon. Member for Wycombe, who has rightly set out his stall on the matter. I hope that I conveyed the point that I wanted to make, which is that confronting the extremists is not the major job that we have. We must address the society.

Both go hand in hand, and we cannot effectively champion the interests of moderate Muslims and of our pluralist, tolerant and liberal society, unless we show a determination to tackle extremism. It is the extremists who, in the past, have crowded out from the debate the moderate voices in the Muslim world. I am thinking particularly of the voices of female British Muslim citizens, which have been stilled and silenced as a result of extremists operating not just in mosques but more broadly in our society.

I want to say a word of appreciation about my hon. Friend the Member for Newark (Patrick Mercer) and congratulate him on his speech. He brings huge expertise and great integrity to the debate. In his professional career before he joined us in this House he spent many distinguished years serving this country and defending its interests. While he has been in the House he has proved himself a dedicated public servant, and whenever he speaks on such issues it behoves all of us to pay close attention to the expertise and integrity that he brings to bear on them, as he did so effectively today.

I also congratulate my hon. Friend the Member for Cities of London and Westminster (Mr. Field) on his speech. Rather than inhabiting a constitutional Never Land, all that he did was stick up for those Enlightenment values that are the best protection for all minorities. In that respect I am delighted that his comments found a ready answering call in all my hon. Friends’ speeches.

When we are talking about integration and cohesion it is important for all of us to choose our words carefully and to tread with care. With your permission, Mr. Olner, I want to make a brief apology to the House. On a previous occasion, in December 2005, I had an opportunity to question the Home Secretary about his strategy for preventing extremism. I believe that several individuals whom the Government had asked to work with them on preventing extremism were themselves linked to extremist groups. I took the opportunity to raise in the House the names of some of those individuals. One of them, a gentleman called Ahmad Thomson, is a Muslim convert who was involved in holocaust denial, and I believe that it was right to draw attention to his involvement and that of several others whose enlistment by the Government in their fight against extremism seemed to be mistaken.

However, even as I was pointing out that the Government had made a mistake, I myself made a mistake. One of the individuals to whom I drew attention was Mr. Khurshid Ahmed. I remind the House that the gentleman to whom I drew attention has exactly the same name as another Khurshid Ahmed who is indeed linked with extremist activity, and who operates primarily in Pakistani politics but also has a link with institutions in this country. The Khurshid Ahmed who served on the preventing extremism together group is an admirable individual. I have now had the opportunity of meeting and working with him on several occasions.

When I discovered my mistake, I immediately wrote to Mr. Ahmed and to the Home Secretary to apologise and to put the record straight, but I have received representations from Mr. Ahmed’s Member of Parliament, the hon. Member for Dudley, North (Mr. Austin), who asked me to use any opportunity to place on the record in Hansard an acknowledgment of my mistake and to underline what I said in my letter, which was that Mr. Ahmed has done considerable work to further integration and cohesion in our society, and that he deserves nothing but the highest praise for his many years in public life. I am happy to use this opportunity to state on the record, for the benefit of Hansard and those outside, my appreciation of Mr. Ahmed’s work and of the calm, diligent way in which the mistake was brought to my attention by the hon. Member for Dudley, North, whose own contribution to fighting extremism in his area of the west midlands also deserves to be noted with credit by the House. I placed copies of the letters that I wrote in December 2005 to the Home Secretary and to Mr. Khurshid Ahmed in the Library earlier today.

I mentioned that it is important to acknowledge our mistakes, and I believe that the Secretary of State for Communities and Local Government, in her conduct since taking on responsibility for integration and cohesion matters, has acknowledged that the Government made errors in the past. She did that not in a breast-beating way, but in an appropriately respectful fashion. Before sitting down and allowing the Minister to reply to the many questions that have been put by my hon. Friends, I would like to acknowledge that the Government have moved but also to indicate that there is still some way to go.

I believe that the Government have accepted that, before the fateful events of 7 July 2005, they had fallen down on the job when it came to questions of integration and cohesion, and of extremism, specifically within the Muslim community. They have acknowledged that the principle of the covenant of security—that unless someone is actively engaged in violence against the state, their activities would be tolerated, no matter how extreme their preaching—was a mistake. More than that, I believe that the Government have acknowledged that some of their chosen partners in the Muslim community and elsewhere were not as well chosen as they might have been.

The Secretary of State was absolutely right to point out recently that Muslim organisations that boycott holocaust memorial day should no longer receive public money. I also note with approval that recently she has been showing a willingness to work with the Sufi Muslim Council, the British Muslim Forum and especially the Fatima Women’s Network, all of which are more moderate Muslim organisations.

The Government’s greater openness to working with moderate, mainstream organisations is to be welcomed, but it provokes a couple of questions. First, as my hon. Friend the Member for Wycombe pointed out, the Government still seem to be taking a disjointed and far from synoptic approach. I mention one area that he did not, which comes under the rubric of the Department for Education and Skills. Why is it that the Government’s adviser on the teaching of Islam in higher and further education, Dr. Ataullah Siddiqui, is linked with the Islamic Foundation and the Markfield Institute of Higher Education, both of which are institutions that were set up by the Jamaat-e-Islami party, an explicitly Islamist organisation, and its supporters? In other words, why is the man who is charged with checking extremism on Britain’s campuses in fact linked with a body that was set up by a separatist Islamist organisation?

Secondly and more broadly, I welcome again what the Secretary of State said about seeking to encourage mosques to register with the Charity Commission and, as a result, receive not only help with fundraising, but a higher level of oversight and help with governance. What, however, do we do with mosques that explicitly reject that kind offer because they wish to carry on with extremist preaching and teaching? How do we ensure, as my hon. Friend the Member for Wycombe said, that the flood of extremist Wahabi literature and, indeed, Saudi money into certain mosques is effectively checked so that the process of indoctrination in an extremist ideology is scrutinised and we deal effectively with teaching that might encourage a new generation of people who believe in separatism and division?

In that regard, I am very interested in my hon. Friend’s question about the Mosques and Imams National Advisory Board. Why is the Muslim Association of Britain—the UK branch of the Muslim Brotherhood, an Islamist organisation—on an equal footing with the British Muslim Forum and the Muslim Council of Britain? Why is Finsbury Park mosque, which used to be the haunt of Abu Hamza, now run by the Muslim Association of Britain’s Dr. Azzam Tamimi? Why, having got rid of one extremist, do we have another version of extremism in control?

I have a final request for the Minister. I appreciate that time is pressing and that she has a limited amount of time in which to answer all our questions, but can she prevail on the Secretary of State and the Cabinet to ensure that we have a full-day debate on this issue in Government time? Given the setting-up of the commission, the Secretary of State’s announcements and, crucially, the prospect of significant changes in the Government machinery for dealing with this most sensitive of issues, as well as the Government’s fitful record of implementation, to which my hon. Friend the Member for Newark referred, we need the Government to give a clear statement in their own time on precisely what the new strategy is. That will give those Opposition Members who wish to see them and our multi-ethnic society succeed an opportunity to make an effective contribution to this ongoing process.

I congratulate the hon. Member for Wycombe (Mr. Goodman) on securing this important debate. In direct response to the final point made by the hon. Member for Surrey Heath (Michael Gove), let me say that the hon. Member for Wycombe raised the issue of a future debate with the Leader of the House during business questions, who said that it was under consideration. This debate, too, will bring the issue to my right hon. Friend’s attention.

I am pleased to have this opportunity to debate issues of integration and cohesion in the UK and to outline the significant work that is under way to build integrated and cohesive communities in which all are welcome and able to flourish. The debate also gives me the opportunity to dispel some of the myths that exist and which hon. Members present have, unfortunately, reiterated. I am therefore grateful to be able to put the record straight.

I doubt that I shall be able to answer all the many questions that hon. Members have raised, but before I seek to do so, I want to set out what the Government are doing. I give a commitment, however, that I shall write to hon. Members if I do not have time to respond to the issues that they have raised, and hon. Members may wish to prompt me on various issues following the debate.

First, we need to recognise the enormous progress that has been made on this issue. Equality between individuals and good relations between communities are much better than they were in the 1950s and 1960s. Immigration has brought huge economic and other benefits to our country, and our cultural life has been enriched beyond measure by people who have made their home here. However, we also know that diversity can bring tensions and that big challenges remain, particularly as new pressures, brought about by increasing globalisation and EU expansion, are felt in our neighbourhoods. Such pressures can be exploited in extremist thinking and rhetoric, whether by radical Islamic groups or far right parties.

In the face of such challenges, integration and cohesion are fundamentally about a simple question: how can we live together in all our diversity, with our different backgrounds and beliefs? That simple question encompasses a set of more challenging issues for us to think about as we consider the kind of society in which we want to live: one that is at ease with itself, confident and united in diversity; and one in which we continue to respect difference, but at the same time ensure security and a sense of solidarity.

To get to that place, it is crucial that all sectors of our society—private, public and voluntary—as well as communities themselves, continue to work together towards a common goal of integrated and cohesive communities. I appreciate the comments made by hon. Members today that this is not just a matter for Government. Although the Government clearly have an enormously important role to play, it is essentially also a matter for communities.

I start by stating that one of our core principles regarding cohesion is that the focus on local communities should be critical. The integration of new communities and the promotion of cohesion between existing groups, although driven by national events and changes, is largely experienced at a local level. The global changes that shape our lives are often best met with local solutions and on that point, I entirely agree with the hon. Member for Hazel Grove (Andrew Stunell). What happens in one community is not the same as what happens in another and we need to have responses that work at a local level.

The machinery of government changes that took place in May last year, which the hon. Member for Newark (Patrick Mercer) conveniently seems to have ignored, were critical for creating a stronger focus on cohesion at a local level because responsibility for community cohesion was transferred to the Department for Communities and Local Government. Clearly, that took place some time after the report of September 2005 from which he read. That transfer of responsibility is why the DCLG is helping to develop the local infrastructure to support our partners in their effort to build cohesion, first, by making cohesion an integral part of local government’s role as the leading strategic body in the local area, which is a role emphasised in the White Paper “Strong and Prosperous Communities” published last October. The White Paper recognises that local authorities are best placed to understand the particular challenges that their areas face, and to work with communities and local partners to decide how to respond.

Secondly, the Department wishes to ensure that we understand what works at a local level, and I endorse the comments rightly made by the hon. Member for Surrey Heath about Khurshid Ahmed from Dudley, who I know personally. One of the aspects of the work that he has done with the Government is to demonstrate what works at a local level. There are some good examples of work taking place in areas such as Dudley from which we can learn.

The Commission on Integration and Cohesion, about which I hope to say more later, has the role of examining how to develop a local and practical approach. The commission will make recommendations in June on how, six years on from the disturbances in the northern mill towns and two years on from 7/7, we can build resilience to tensions and conflict in our communities.

Finally, we are looking across Whitehall to identify what other structures have a role. For example, we are considering the role of schools in promoting community cohesion through a curriculum and ethos that supports diversity and promotes a sense of common identity. By showing pupils how different communities share common experiences and values we hope to make them feel part of a broader regional and national community. The Education and Inspections Act 2006 places a duty on governing bodies of schools in England to promote community cohesion, and for Ofsted to report on the contribution made by each school. That legislation will come into force in September this year and I hope that it will build on the good work that many schools are already engaged in. I endorse the comments of the hon. Member for Wycombe about the importance of people having influence by becoming school governors in their communities.

Infrastructure is only part of the story. Those involved in building cohesion on the ground also have a vital role. For example, people working in the voluntary and community sectors are critical in building social capital and forging bridges between communities. Local charities, youth volunteering groups, and sports teams all have a role to play in bringing communities together and promoting the sustained and meaningful interaction that is at the heart of strong, cohesive communities.

Faith communities also contribute to social and community cohesion through the values and activities that underpin good citizenship, such as, altruism, respect for others, ethical behaviour and community solidarity, alongside strong examples of inter-faith work and outward-facing activities. The work of those organisations is taking place within a broader framework set from the centre, which includes a robust commitment to equal opportunities for all. As hon. Members will know, from October this year the new commission for equality and human rights will be in place. That is a fundamental part of saying that equality is an issue for everyone and that we must eliminate racism from our society.

The Government have, in recent years, strengthened our legislative framework, and—this has not been discussed today but is of concern to hon. Members—welcomed the recent all-party parliamentary inquiry’s constructive and comprehensive report on anti-Semitism in particular.

Continued support for those organisations taking a stand against Islamist extremism is important. Cohesive communities can help in our efforts against extremism of all varieties, but our work on preventing violent extremism in the name of Islam requires something else as well. We know from our experience of 7/7 that even in the most apparently cohesive communities pockets of extremists can be operating. That is why my Department launched its “preventing violent extremism” action plan earlier this month, which is first and foremost about winning the struggle for hearts and minds, and supporting Muslim communities in building their resilience to extremists’ messages. It will effect a significant change in the Government’s work to tackle radicalisation, including a £6 million fund to support local community-based projects.

I shall respond to some of the issues that the hon. Member for Wycombe raised about the “preventing extremism together” project, which has been misrepresented. The project was put together in September 2005, and the report that only a few of its recommendations have been implemented is simply not correct. The working groups came together—I was part of them in my ministerial role—and the first steps were taken at that point to put together a set of practical recommendations to build a partnership between the Government and Muslim communities.

I shall respond to a question from the hon. Gentleman about a matter that the hon. Member for Surrey Heath also raised. The Government are not seeking to have one Muslim organisation to talk to. The reality of all groupings—we have been into the history of a number of other religious organisations—is that every community has many facets, and the Secretary of State has made it clear that it is important to work with organisations that support us in our role, that want to ensure that we actively tackle extremism and that are part of the drive to deal with the issues that concern us all. The truth is that the latest stage of our work and the action plan that the Secretary of State presented recently is supported by a whole range of Muslim organisations and scholars who see it as an enormously important step that we must take in our further work on the matter.

May I continue, because I fear that I may not be able to deal with some of the important issues that have been raised?

I shall deal with the points that the hon. Member for Newark unfortunately set out incorrectly. Let us be clear about Project Contest. The Home Secretary held a review of the counter-terrorism strategy in autumn 2006, and the result was cross-Government agreement that the DCLG was best placed to lead on “prevent” in building resilient communities. The creation of a new office dealing with sectarianism and terrorism has again been confirmed in the House, and the DCLG will continue to have that role, which was first put in place in May 2006. It will have an important role in working with other Departments on the whole Project Contest strategy, of which “prevent” is one part.

Unlike the Conservatives, whose view is that the issue could be dealt with by just one Minister and one Department, we recognise that it is hugely complex. It is important that not just the changes to the machinery of government in 2006, but those that are now coming forward mean that Departments will continue to act and to work in the roles that best suit those Departments and their overall brief.

Finally, the Commission on Integration and Cohesion is enormously important and we must be clear that it will look at a range of issues, including shared civic value, but there is no intention at this point—

Military Procurement

I am indebted to the House for giving me the opportunity to raise this matter yet again; such debates have almost become an annual event. The hon. Member for Chorley (Mr. Hoyle) is in his place, and I am indebted to him for starting this debate long before I became the Member for Bridgwater.

An important munitions factory is based in the heart of my constituency, and as the Minister is aware, BAE Systems is also responsible for equipping some of the ageing fleet of Nimrod reconnaissance aircraft. Unfortunately, as this House and the public know, one of those planes dropped out of the sky in Afghanistan last September, tragically killing the entire crew, including an RAF sergeant from Bridgwater. My local munitions factory in Bridgwater is due to be closed imminently—that could happen at the end of the year—and suffice it to say that a very powerful British company is unfortunately not the flavour of the month in my constituency.

Procuring contracts for sensitive defence products always depends on the attitude of the Ministry of Defence, its Ministers and, unfortunately, the Treasury. That is why I am pleased to see the Minister of State in his place across this Chamber. I want to tell him a few home truths in a nice way, and although I shall sometimes be blunt, I know that he listens to what hon. Members have to say.

Defence is a genuine interest of mine. I used to be an adviser at Land Command headquarters and I maintain the rank of major. I am also still on the reserve list, so the Minister could doubtless get his revenge by sending me to places far and foreign should he wish.

I am also indebted to the Minister’s staff for correcting a typo when I managed to get the wrong country.

I am nearing the end of a privileged spell of service with the RAF, which has taken me to the very front line in Afghanistan twice in the past few months with the armed forces parliamentary scheme. It is a remarkable scheme, and many of us are indebted to the professionalism and superb ability of our armed forces. I am always struck by the enormous enthusiasm and resilience of our soldiers and airmen. They make it their business to get the job done in some of the most hostile terrain in the world, even though they are unfortunately often without the proper kit. Our people are performing daily miracles in these places and they deserve the united applause and support of this House—I know that they get it.

They also deserve the Government’s support in all shapes and forms, especially through procurement. That means providing more than the bare minimum. I have no doubt that the Minister will respond, as we all sometimes do, by reeling off huge, impressive-sounding figures to show how much has been spent and what has happened. We all accept that defence is always expensive; everybody is aware that even the bare minimum does not come cheap. My argument is that we are in danger of cutting too many corners and of procuring nothing but danger for the very people who courageously carry the flag for this country.

My first trip to Afghanistan was a grim reminder of just how dangerous the place is; the wreckage of the RAF Nimrod that came down last September was still in the desert. The plan was to lay a wreath there for those killed in the accident, but the last resting place of this huge aircraft was slap bang in the middle of an effective Taliban firing range. So I had the great honour of laying a wreath at the memorial in the Kandahar base on behalf of the Knight family. I got to know some of the brave airmen, and they told me harrowing stories about the conditions in which they are working and the equipment that they are expected to use.

Everything that I have read about the battle of Britain inspired me to believe in the imagination and single-mindedness of our flyers, and that has not changed one jot; they are incredibly gifted people with true grit and humour. The difference is that in 1940 they were flying state-of-the-art Spitfires that were the envy of even the Luftwaffe, whereas in 2007 they are flying 30-year-old Nimrods. Usually, more Nimrods are sitting on tarmac with the bonnet up than are doing what they were built for, but that is hardly surprising as the Nimrod is based on the airframe of the Comet airliner—they stopped flying Comets when I was in short trousers. No arm of the military cares to admit that its toys are falling to bits, and that damages troop morale.

The morale of aircrews on Nimrods is pretty close to rock bottom these days. If he has not already done so, I invite the Minister to take a look at the Professional Pilots Rumour Network at I would not normally suggest that a Minister should look at a rumour-mongering site, but that one is interesting, because it involves the airmen themselves. It cannot, of course, be relied on to tell the whole truth, but the airmen are using it as a valve for internal grumbles. I should like to quote from a pilot’s entry of a few weeks back:

“I’ve served 6 months away each year in the Sand, every year for the last 4 years. But that didn’t knock my morale anywhere near as much as crewing in at 0400 but not getting flying until 1700.”

The Nimrod is becoming the RAF’s Skoda. The men want to fly, but I am afraid that the plane is clapped out. I should like to bring another entry to the Chamber’s attention:

“A serving crew member told me of a recent sortie in search of a submarine, the radar was not working on the Nimrod…When he asked how he was supposed to find a submarine without radar he was told to look out of the window and use his eyes!”

Even if only a small proportion of those stories are true, there is a major problem to which I hope the Minister and the Government will own up and say, “We need to cough up.” We must not and should not put aircrews at risk because the kites that they are flying are beyond their sell-by dates. We should never put anything into the air that does not have the proper equipment inside it.

I believe that the bulk of the work on the aircraft is the responsibility of BAE Systems, and guess who is building the replacement to Nimrod. The new plane was conceived in the mid ‘90s, when 21 were ordered. That fell to 18 under the Labour Government, and I believe that the number is now 12. However—hold on to your hats—Nimrod’s replacement should be in service by 2011. Three prototypes have been tested already. They look remarkably like the old Nimrods, but then they are based on the same old airframe. Basically, BAE Systems has been squeezed by the MOD, which has in turn been squeezed by the Treasury. I put it bluntly to the Minister: I am afraid that son of Nimrod is a cheap facelift.

I represent a constituency with a proud history of providing our Army, Navy and Air Force with the means to do the job. In Bridgwater, we make bombs and explosives and have done so efficiently, economically and successfully for more than 50 years. Some of my constituents are the best legal bomb makers in the business. They are true specialists, and, as the Minister is well aware, dedicated to their work. However, in a month or so there may be no more work for them to do. BAE Systems runs the old Royal Ordnance factory just outside Puriton and, as the Minister is aware, it intends to close the place. It and, dare I say it, the MOD believe that they can buy what Britain needs elsewhere in the world—and, unfortunately, cheaper. I think that they are misguided, and I am not alone. Some 136 skilled people agree with me—as does Lord King, my parliamentary predecessor and former Secretary of State for Defence, as do many people with a real understanding of ordnance supplies. To shut the plant would be more than a local blow. It would be a national disgrace and could put the very defence of the realm at risk.

We started making armaments in Bridgwater during the last war; it was a question of genuine necessity. Germany was stretching our military capabilities to the limits and we needed more weapons. Over the years, the discreet little plant has churned out munitions for every theatre of war in which we have taken part since the second world war, as has Chorley.

In my local Royal Ordnance factory, the famous bouncing bombs that destroyed the Ruhr dams were designed and built. I dare say that Sir Barnes Wallis, their inventor, would rotate in his grave if he thought that the factory was doomed. The bombs that we aimed successfully at Saddam Hussein’s bunkers were primed in Puriton and the explosives, the final charges, for Trident missiles are also made there.

The work force were, and remain, very special. Originally, they—experts with cool heads—were recruited from all over Britain, and the Royal Ordnance factory maintained an enviable reputation for safety. When the factory became part of BAE Systems, the employees faced the change with their typical can-do attitude; they really felt that they could make it work for the future. Even when the plant was under threat of closure a couple of years ago, everybody volunteered for extra productivity without any problems. I know that because I worked alongside the trade unions and local management to keep the factory in business, and I will continue to do so.

Now, unfortunately, crude economies are beating sound common sense. BAE is rationalising—I have no problems with that—but for hard commercial reasons. The official line is that there is nothing to worry about and BAE is confident that there is no supply risk. The Government have told me so as well through Lord Drayson, but recently at Glascoed, where packaging takes place, 3,000 rounds of artillery were made of which only 150 were workable. There are major production problems.

The Government should never, and I hope will never, treat defence as a matter of commerce. BAE Systems obviously does not think that a little bomb factory in Bridgwater that ticks over nicely and makes a mint will be at the heart of its business; it will not. BAE Systems keeps telling me that Britain can buy munitions without Bridgwater, but the evidence is against that.

I am told that the US navy is seriously worried about its future supplies, because the Puriton factory produces a type of explosive hard to obtain. Rumour has it that the Pentagon tried to persuade my local plant to make more of the stuff so that the Americans can stockpile it when they do not have Puriton. BAE Systems has marked one factory in Tennessee as the future source of the explosive RDX, but, as we know, it has suffered a catastrophic explosion and cannot produce it at the moment.

The Minister is aware that the cost of replacing the plant would be £50 million. That equates to £2 million a year for the 25-year lifespan of the factory. The same would go for Chorley. Surely £2 million a year between the Government and BAE Systems is nothing to pay for the security of supply for our nation’s well-being. I ask him to urge the MOD to rethink. Of course it is possible to buy anything in this world, but we want it to go bang, not fizz, when we need it most. A few years ago, the British Army tried to buy bullets from the far east, but they did not work. Millions were dumped at sea, and the factory, along with Chorley, had to make up the shortfall.

Rumour also has it that France could become a new source of supplies for BAE Systems. The French make good cheese and wine, but I do not think that they do explosives. A container of explosives was recently shipped from France to Bridgwater so that Puriton could have a look at it. The product was OK, but it was not of the quality that we expect in this country.

This is not the time or place for complacency. If Somerset were the only ordnance factory of many to be closed, that would be fine, but it is the only one that we have. It is a sad saga of price not peace. Making weapons is far too important to leave to the marketplace. Closing our arms factory would be a bitter blow to Bridgwater and Chorley and is a steep price for our national security. I appeal to the Minister and the MOD to intervene and use their considerable muscles before it is too late.

I thank the hon. Member for Bridgwater (Mr. Liddell-Grainger) for securing this debate. It is important that we put on record the failings of Royal Ordnance. It has cheated the workers of Chorley and Bridgwater. Those people gave everything whenever there was a need, whether in the Gulf, the second world war or Korea. Their loyalty and expertise were second to none, and their reward was closure. That is a sad indictment of the RO.

The RO is a disgrace. It tells lies, misleads people and makes empty promises. We were told that engineering offices would remain at Chorley, and what happened after it settled closure at Chorley? It removed that promise. It cannot be trusted as an organisation. This is about money and nothing else. It ought to be ashamed of what it has done to the workers.

There is still time to protect Bridgwater and Chorley. We in this country will be naked—we will not be able to make explosives without them. Nowhere else in this country can they be replicated. BAE is failing our national interests, and it ought to be ashamed of itself. What did it leave in Chorley? A storage facility of explosives. That is how good BAE is to the people of Chorley—not one job will remain, but everybody’s bombs and explosives will be stored in Chorley. There will be no jobs and no security. It is unacceptable.

What did we ask BAE for? We said, “Why not put up a memorial to this factory? Although Sir Barnes Wallis used Bridgwater, the casings were made at Chorley. We have a great history that ought not to be lost.” What was the BAE bosses’ reply? “No, we are not going to provide anything.” They ought to be ashamed of themselves as a company. It is a total disgrace that they are willing to use overseas workers at the expense of British jobs. It is not good enough. They ought to come back to the table, go back to the MOD and ensure that the workers of Chorley and Bridgwater will be truly represented. It is unacceptable. I say once again that they should be ashamed of the lies that they tell.

I congratulate the hon. Member for Bridgwater (Mr. Liddell-Grainger) on securing the debate on the procurement of BAE Systems products by the UK armed forces and on providing an opportunity to discuss that important issue. I am also grateful to him for providing his thoughts in advance, allowing me the opportunity to provide a fuller response to his points.

I have listened carefully to the hon. Gentleman’s speech and would like to start by correcting a number of the points that he has made. He mentioned a time when bullets were procured from a source in the far east that were subsequently found not to be of the required standard and were removed from use. That is true, but I am advised that it happened in 1976 and I do not think that I can be held responsible for that. Subsequent Governments obviously learned their lessons relating to that.

The hon. Gentleman mentioned an explosion at the US Holston factory. He raised that matter during a debate on 6 June 2006, which is in Hansard at column 66WH. However, we can find no such evidence for what he refers to. He was written to by the then Under-Secretary of State, my hon. Friend the Member for West Bromwich, East (Mr. Watson), on 19 June 2006 asking for more details, but none were forthcoming. To repeat the accusation today is slightly disingenuous: it is more a whimper than a bang. If there is evidence, he should give it to us. But we cannot find any source for it at all.

The hon. Gentleman mentioned rumours concerning the US navy. I am sure that he will understand that I cannot respond to rumours. I need hard facts. If he can give me more details about what he has been advised of, I will certainly look into that and respond to him in detail.

The hon. Gentleman also mentioned the 105mm artillery round, termed the L50, which is a new round, using new production processes and facilities. The company is working hard to deliver that new capability. Meanwhile, I assure him that operational delivery to the front line is not being compromised as a consequence of that new development work, because we are continuing to use the current 105mm high explosive round successfully on operations. There is an issue and both the Ministry of Defence and the company are actively engaged in finding a solution to it, which I am confident will be found.

Let me now turn to the more general aspects of the hon. Gentleman’s speech. The MOD sources its matériel from a wide range of companies at home and abroad. However, I accept that BAE Systems is the largest supplier of equipment to the MOD. BAE Systems provides up to £4.5 billion of equipment a year to the MOD and employs 30,000 people in the UK, with another 60,000 worldwide. That is a major contribution to defence acquisition and support. We aim to work effectively and closely with the company to improve its performance and ensure that complex programmes meet operational, programme and budget imperatives. We are currently working closely to implement the defence industrial strategy, which was published in 2005, the aim of which is a competitive, lean industrial base that provides security of supply of critical capabilities to the armed forces while delivering long-term value for money.

BAE Systems’ position as the largest supplier of equipment to the MOD places it in an important position as part of that equation. The DIS is widely supported across industry, Government and the trade unions. I believe, and I hope that my hon. Friend the Member for Chorley (Mr. Hoyle) believes, that that is the way forward and gives the best arrangements for partnerships with industry, including BAE Systems. We have made much progress in implementing the strategy, which has been needed for a long time. We have now defined it and are making progress on it.

One aspect of the DIS was to recognise the military importance of munitions. There are critical capabilities that we want to retain and to develop. We also want to retain the ability to design and to produce munitions, to support them throughout their lifetime and to test them safely, which is also highly critical.

That is why we have a general munitions industrial strategy to take those commitments forward. It is in that context that the munitions acquisition supply solution project operates. Project MASS is charged with delivering future arrangements for the supply of general munitions beyond 2010. It is part of the overall analysis and strategy.

Operational sovereignty, security of supply and value for money are crucial factors in determining the way forward for project MASS. The result will be that industry will have a better understanding of the opportunities to provide safe and effective munitions. We are working to ensure continued security of supply, both now and on operations in the future.

As part of such efforts to improve efficiency and value for money for the taxpayer, BAE Systems has made the commercial decision to close the munitions sites at both Chorley and Bridgwater. Both sites are due to be closed in their entirety by early 2008, as my hon. Friend and the hon. Gentleman will be aware.

The closure of the sites is not a sign of disrespect to those who have worked there—on previous occasions I have abundantly praised all that has been delivered by those people. As decisions have been made on site or base closures, both within the MOD and between the MOD and industry, I have paid genuine tribute to those who have provided service in the past. However, change is required, and clearly there are those who are adversely affected by it. The employees of both sites have worked hard and delivered a quality service over a number of years—that is not in question. However, at the end of the day, the decision is one that BAE Systems must make on the basis of its best commercial judgment.

We at the MOD must take the impact of that decision into account and assess its effect on military capability. I am satisfied that capability will not be compromised by the decision to close the sites in Bridgwater and Chorley. We have worked closely with the contractor and we are satisfied with the assurances provided by that company that the supply of material will be safeguarded.

I do not have time to go into all the details, but I will write to the hon. Gentleman and to my hon. Friend at length and set out the various bilateral relationships that we have with our allies on supply security—the memorandums of understanding that exist. I will place a copy of the letter in the Library. The issue has been raised by both the hon. Gentleman and my hon. Friend, and it is a critical one.

On wider acquisition issues, I believe that we have a good story to tell. It is not a case of throwing big numbers around and saying, “Doesn’t that sound good?” I do not accept that we are cutting corners. Equipment valued at more than £10 billion has been delivered to the armed forces in the last three years alone, which is an astonishing record. Equipment now successfully deployed in Afghanistan includes Apache helicopters, upgraded armoured vehicles, Bowman communications kit, new light machine guns, under-slung grenade launchers, weapon sights, a wide range of night-vision aids, and other infantry equipment such as body armour.

I hear the stories on equipment failures—it is part of my job to be out in the territory, to be visiting Afghanistan, Iraq and other places where we have people deployed, and to hear the concerns of those people. We pick up some concerns, but we no longer get complaints about personal equipment from those in the front line; they are well served, and if a shortfall is found it is immediately rectified. That is why we have spent nearly £700 million on urgent operational requirements for both Iraq and Afghanistan in recent years. That was to meet the defined requirements, including shortfalls and past failures, which have been addressed, but it is an ongoing process as well.

The loss of the Nimrod XV230 in Afghanistan with the loss of life of the 14 military personnel on board was unquestionably a tragic incident. Such incidents serve to remind us of the risks that our servicemen and women take across the world every day. The loss of an airframe inevitably means that it is more difficult to meet front-line requirements—that is the nature and the hard logic of the matter. However, the Nimrod personnel and aircraft are meeting their operational commitments and continue to do an excellent job. Of a fleet of 15 aircraft, nine are typically available to the front line. The remainder are being modified or in deep servicing. Four are deployed on operations overseas, and five are available in the UK to be used at short notice.

The depth contract with BAE Systems and its subcontractor Flight Refuelling Aviation Services is proving to be a great success. Nimrod commanders are positive about the support that they receive from the company, which is meeting aircraft maintenance schedules, with aircraft entering and leaving servicing on time and to standard. That is the hard test that we have to set those who supply the equipment to us. They have to meet the time demands and the high quality that we demand of them.

There is no question but that the Nimrod is a unique asset. It is in great demand at home and overseas and is providing vital direct support to our troops on the ground in Iraq and Afghanistan. That inevitably means that front-line Nimrod squadrons are very busy. I have met members of the squadrons in both those theatres. As a consequence, personnel are committed over the level that we would desire and over the harmony guidelines. We cannot hide from that, but to address it in the short term the RAF is rebalancing its engineering manpower to put additional resources at the front line. We have a study under way to identify longer-term solutions. Again, we have identified an issue and are seeking to address it. Simply to take those aircraft out of that situation would put at risk all the people operating on the ground.

It is important to recognise that pressures on retention do not come just from service issues. This is not just about what is happening in relation to harmony guidelines or other such issues. There is a tremendous pull from industry, because the people that we train in the armed forces and, in this case, in the RAF are a highly prized asset. There is no question about that. There is active recruiting by industry among our personnel, but we have not found that there is a haemorrhaging of our people. That is because of what the hon. Gentleman described. They have a high level of commitment. They joined the RAF for a purpose. They are carrying out their duty to a very high extent and many of them are therefore prepared to carry on in that role, but at all times we must continue to monitor the situation and to ensure that we are getting things right. Part of the role of the Armed Forces Pay Review Body is to ensure, if there is a retention issue, that remedies are sought that can address that—of course with ministerial engagement and involvement in all that.

Let me now deal with the aircraft’s replacement, because the hon. Gentleman referred to the age of the fleet and it is an old aircraft. We should be clear about what we will get from the new aircraft. It can fly at Mach 0.77, has a range of more than 6,000 miles and can loiter on station for more than 14 hours. Its engines produce 25 per cent. more thrust than those in the current aircraft and are 30 per cent. more fuel efficient. Its Searchwater 2000 radar can sweep an area the size of the UK every 10 seconds. The MRA4 will provide a step-increase in capability. Precisely because it will be such a capable aircraft, which includes having superior availability, it will be able to achieve its taskings with fewer airframes. That was the judgment that was taken.

The MRA4 contract, which has not had a good history, was placed in 1996—again, that is something for which I do not have responsibility. There have been delays and cost increases. I could say that part of the reason why we have had to develop the defence industrial strategy is the failings of past procurement processes. I am referring to 1996, a date before the present Government came into office.

The programme is technically complex and demanding, but we have got it back on track. We restructured the programme with BAE Systems in 2003. Design costs have remained stable. We signed a £1.1 billion production contract last July for 12 aircraft. All three pre-production aircraft are now flying, with trials going well, so although the hon. Gentleman set out quite a stark picture, I think that the opposite is in fact the case.

I do not believe that the defence of the realm has been compromised by the decision to close the facilities at Bridgwater and Chorley. I am not saying that there are not issues that we must address. Clearly there are, and that is what we are trying to do with the company. Our new procurement processes are about identifying the partnership between industry and the MOD, so that we can meet the heavy demands of the front line. We owe it to our people on the front line to get it right, and I think that we are now on course to achieve that. Sadly, some lose out in all this, and again I pay tribute to those who have provided such sterling service over the years at Bridgwater and Chorley.

Comprehensive Spending Review

The public expenditure consequences of failure to invest early are immense. Further expenditure will be needed to fund disrupted classes, missed opportunities to get qualifications or work, antisocial behaviour, expensive interaction with the criminal justice system, drug rehabilitation, or a lifetime dependency on benefits. I am delighted to have secured this debate to explore two questions that are central to the policies that we are pursuing in Nottingham to develop a policy of early intervention that can be sustained in the long term. Those questions are how to transform successful local pilots into public services, and how to save the taxpayer and Government billions in public expenditure on the costs of failure through immediate investment in early intervention.

Our local and national partners are working with One Nottingham, the local strategic partnership, which I chair, and are exploring how we can take forward the concept of the “early intervention city”. Having developed the first stage—a vision of an “early intervention city” and a package of evidence-based measures—the next stage is to develop the package of policies that will give the vision shape and direction. Local and national partners are committed to doing that in the next few months. However, in today’s debate I shall look still further ahead to the third stage, by asking how the measures can be funded in the long term.

In the short term, many of the components of an early intervention package are already being funded by local partners, or can be assisted by One Nottingham’s £15 million neighbourhood renewal fund. Equally, the medium-term effort covering, say, year three or four, could be sustained by mainstreaming by local partners including the police, primary care trust, city council and so on. However, maintaining pilots by local mainstreamed funds is different from the long-term requirement to roll out successful pilots over a wider area. That cannot possibly be done purely from local funding, particularly in an era when public sector settlements are likely to be tougher than in the past few years.

For example, funding the nurse-family partnerships as part of One Nottingham’s early intervention package would cost a manageable £700,000 over two years. When the pilot has reached the end of the two years, our expectation might be that the primary care trust and other local partners fund it. However, rolling out a successful nurse-family partnership over the whole city of Nottingham could take as much as 10 times the expenditure that was required to sustain the pilot. Clearly, that would be an unacceptable burden on local partners. We therefore need to examine the wider context of public expenditure—when we transform a local pilot into a public service, we must also make the transition from local finance to public spending. Remarkably little has been done to address that. It requires a cultural shift to take place through the medium of the comprehensive spending review.

Public expenditure should be rebalanced to favour early intervention to tackle the causes of problems, and consequently to reduce the need to spend ever larger amounts of public money on containing the symptoms. The nurse-family partnership again provides a useful example. We can pay a few thousand pounds for a health visitor to assist a single mother to develop effective parenting skills so that her newborn can be given social, communication and emotional competences to ensure that the child is school-ready, or we can continue to allow children to go to school unable to speak in sentences or to recognise letters and numbers, as many in my constituency do according to local Ofsted reports. I estimate that leaving speech and language problems unaddressed in this year’s cohort in reception classes will cost nearly £4 billion over their lifetimes. I am not talking about picking off tiny groups—it is a problem of volume in my constituency, not one of an isolated or small group. Frighteningly from the financial viewpoint, it needs mainstream service reorientation and not one-off special measures. However, the savings are enormous.

As James Heckman demonstrated in his Nobel prize-winning work in 2000, intervening early and giving children the wherewithal and the social skill set to learn and interact is cheaper than the lengthy tail of public expenditure that comes with failure. He shows that the economic payback of such investment is three to six times higher pre-school than post-school. Figures from the Department for Education and Skills show that more than three times as much is being spent per head on higher education than on pre-school. That is a complete reversal of the optimal pattern of expenditure.

Similarly, Dr. Bruce Perry's work shows that spending on programmes intended to change the brain are eight times higher at the age of 20 than at the age of three. Yet the same study shows the human brain to be more than five times more malleable at the age of three than at 20. Early intervention means more brains per buck. It is a switch from mis-spending, which is driven by inertia and short-termism. We want to see strategic thinking aspired to and achieved in the CSR.

One of the most stunning financial pay-offs in the UK recently has been the Government’s measures to get people back into work, converting the enormous pool of unemployed who are a massive drain on public funds into taxpayers making a positive net contribution. That same philosophy now has to be applied to those who are socially excluded generation after generation. Breaking that cycle will release massive amounts of money for expenditure in other areas. That argument has to be accepted at the political level.

At the moment, as part of the CSR, the Treasury and DFES are undertaking a policy review. They issued an excellent interim report in January. The CSR provides the vehicle to ensure the prevention of problems rather than merely servicing the consequences. The strategy needs to be co-ordinated across Departments. The current system of allocating CSR spend separately to each Department means that the DFES or Department of Health, for example, have no interest in investing in early intervention that will reduce crime and therefore benefit the Home Office's budget, but not their own. Their spending is influenced solely by their own immediate public service agreement targets. We should consider top-slicing those separate budgets to create a national early intervention fund, or create cross-cutting PSA targets aimed at reducing the effects of social disadvantage. Only the Treasury has the interest in savings to the public purse that transcends narrow departmental ambitions.

A good example of decision making is the Treasury's recent announcement in the pre-Budget report that the Government will pick up funding for one early intervention initiative that is close to my heart, namely the “Every Child a Reader” project, which provides one-to-one reading recovery teaching to disadvantaged six-year-olds who are struggling to learn to read and write. That was a bold step, with a clear spend-to-save purpose. It was influenced by the economic analysis of the return on investment provided by the scheme. However, welcome initiatives need to become part of a coherent strategy to identify the key barriers that disadvantaged children experience in their early years and to put in place a systematic plan to address those barriers through robust evidence-based interventions, not just in one city but nationwide.

One area that we would be keen to explore with the Government from Nottingham's point of view is revitalising the concept of invest to save. I was excited to see that £100 million was spent on the benefit service as one of the first invest-to-save projects. Minister, we could build an early intervention city in Nottingham for that, save £1 billion in public expenditure, end educational under-attainment and social and emotional deskilling in our city, and give back some change as well.

Page 6 of the CSR policy review paper concedes that

“estimating the costs of poor outcomes is difficult.”

None the less, it estimates a £6 billion saving if

“children with poor education could be raised to the average.”

It also says that the additional costs of those not currently engaged in employment, education or training is at least £8.1 billion. Similar stories can be told in health, skills, law and order, and benefits—all in billion pound denominations—so that pretty soon we are talking serious money. All that can be reflected locally on Nottingham’s 940 NEETS—young people not in education, employment or training—which is one in 10 youngsters. I joked about the sum being £100 million for Nottingham, but that alone costs my city £216 million over their lifetime according to recent figures from the reform group.

Will the Minister undertake today to commission more work from the Treasury to discover several things? First, what money could be saved on all the public services that have to be deployed around an individual who has not attained at average levels? Secondly, what amount of investment would be needed to ensure early attainment to provide the foundation for that individual and therefore remove the costs of a lifetime of remedial public expenditure? Thirdly, what robust financial tools will we need to enable early intervention investment to be discounted against later savings?

Will some serious modelling and analysis of the matter be commissioned inside or outside the Treasury? If we are to invest in early intervention, pre-emption and prevention, we need to devise tough financial tools to enable organisations such as our local strategic partnership to borrow against future savings, perhaps using venture capital, bond issues or public works loans. That might best be considered on an individual account basis. If a potentially under-achieving person is allocated, say, £1 million of public expenditure over their lifetime, can that be front-loaded to save some of that £1 million? One Nottingham would be more than happy to pilot such a project if the Treasury team felt that it would be useful.

Another area where we would be keen to partner the Treasury is performance management. That applies at national level where a light-touch public service agreement on early intervention should be agreed with all the relevant Departments if public expenditure is genuinely to become less reactive, but refocused on a metaphorically healthy diet rather than ever larger dollops of comfort food in respect of public expenditure. When the Government impose statutory duties on localities, they need to be affirming not confining, and a spur not a break to activity.

At local level, incredibly able local partners drown under middle England targets as well as inspection and accountability regimes that suffocate local talent and hand-crafted solutions in favour—in the case of my local strategic partnership—of 1,000 local area agreement, floor target action plan, community strategy boxes that we must tick. I am privileged that I can—and do—fight back on such issues. However, no local career public servants have that luxury. Indeed, until innovative and creative thinking on early intervention is sanctioned officially by the PSA and performance management regimes, it can be seen even by the best local chief officers as a threat to be controlled rather than an opportunity of which to be taken advantage.

I shall leave for another debate an excursion into the vital local issues where most public services are increasingly administered with little or no real democratic governance. However, cultural and democratic evolution need to lie alongside financial creativity if our efforts are to be sustainable.

Nottingham is pioneering the vision of early intervention city through a package of measures comparable to those found at Greater Littleton in Denver. Some are already under way in Nottingham, including the teaching of social behaviour at primary schools based on the foundation of the social and emotional literacy programme that the Government are rolling out; the nurse-family partnership to which I referred earlier; intensive family support for the 50 most difficult families; and an effective parenting skills programme.

In addition, local and national partners could consider other locally led but evidence-based programmes, including pre-parenting skills for teenagers so that they understand the responsibility of raising a child and how to build and maintain personal and family relationships, and an effective mentoring scheme, perhaps like the successful big brother, big sister scheme in the USA. Other possibilities include the roots of empathy scheme, under which a class adopts a baby to develop empathetic behaviour, and the teens and toddlers scheme, which is favoured by the Cabinet Office. Finally, health services, the police and children’s services could share data so that we can catch people at the earliest possible stage. Whatever package is agreed, it will focus relentlessly on the causes of problems and will be driven by local and national partners working together.

We will deliver every aspect of the partnership locally, and Departments are committed to doing so nationally. We now need the Treasury to come to the party—we need to move from schemes to services. The prize is to finish servicing the endless stream of problems and to break the intergenerational cycle of underachievement through early intervention. All that I ask the Minister to do today is to commit to engage in a serious continuing dialogue with me and the steering group of local and national partners—our kids deserve nothing less. If the Treasury can give that commitment, we will be able to do some extremely good work together, with tremendous positive consequences not only for youngsters, but for their parents and our society.

I congratulate my hon. Friend the Member for Nottingham, North (Mr. Allen) on securing the debate; he has been generous in the amount of time that he has given me to respond. It is a great relief to be able to have this debate today, because it had to be rescheduled on a previous occasion, when the House finished its business early. My hon. Friend was unable to be here for that debate, because he was in Nottingham in his role as chair of One Nottingham, the local strategic partnership. He was meeting a team of Ministers who had gone up to see the work that he was leading in Nottingham on these very issues. I am happy to give him the assurance for which he asked and to say that the Treasury, like the other parts of the Government with which he has discussed the issue and which have visited Nottingham, is happy to engage with the detail of these matters.

As my hon. Friend says, the key issue is to ensure that decision making and spending are properly co-ordinated not only across Departments at the centre in Whitehall, but at local level. I have always been a champion—as a Minister, and before that as an adviser—of the role that local strategic partnerships can play in bringing together different agencies locally to make policy work more effectively. Over the years, however, we have all learned that partnerships work only if there is strong and effective local leadership to bring that co-ordination about, and my hon. Friend is demonstrating effective leadership at a local level. As somebody who grew up in Nottingham, I am pleased to see it prosper, but I understand that it still faces very real challenges, inequalities and divides in terms of income and opportunity. I am therefore pleased to see my hon. Friend providing leadership in Nottingham, to hear and understand details of the concept of Nottingham as an early intervention city and to have the opportunity to respond to some of my hon. Friend’s points in this debate.

As my hon. Friend says, each child deserves a secure, safe and happy childhood and upbringing, and that is the best way to support later development and to allow children to fulfil their potential as they become adults. As my hon. Friend says, without a good start young people can enter a vicious cycle of poor outcomes, which they pass on to the next generation. Although we have done a lot since 1997 to support parents and communities and to make significant improvements in the lives of all children, it is still the case that not all children are benefiting equally. Children from disadvantaged backgrounds, including from a number of wards in my hon. Friend’s constituency, continue to face greater barriers to realising their potential than children from other, often more affluent families. As a Government who care about opportunity for all and about every child having the best start in life, we have a responsibility to address those issues.

In the 2005 pre-Budget report, the Government commissioned a review of children and young people to consider what more we could do to improve outcomes. The report set out three principles to underpin our approach. First, there should be rights and responsibilities—we needed to do more to support parents, but they had to meet their responsibilities to their children. Secondly, we would pursue an approach based on progressive universalism: support for all, but targeting greater support to where there is greatest need. Thirdly, we would operate on the principle of prevention—working to prevent poor outcomes for children, young people and their parents from developing in the first place.

In January, we produced a discussion document on the interim findings of our review on children and young people. Our aim is to ensure that those principles are effectively incorporated into the comprehensive spending review that we are currently conducting, and to build on the emerging success of the “Every Child Matters” strategy for local co-ordination. We want to make sure that those principles—in particular the preventive strand that my hon. Friend highlights—are incorporated into our spending decisions.

I should like to respond to some of my hon. Friend’s particular points. I agree that one of the important steps in moving to a more preventive approach is to understand properly the size of costs and benefits and to be able to make the case credibly that by investing to save, we can deliver long-term cost savings for local providers. One of the things that has struck me as I have conducted the work has been how often the evidence base is not satisfactory or good enough to make those judgments.

I give my hon. Friend one example of an issue on which I have worked closely—services for disabled children to promote their life chances; they are one subset of the issues that he has raised today. The evidence base is weak, patchy and often incomplete. However, when we have been able to collect better knowledge and information about the cost savings available from early intervention, the case has been made. To give one example, the early support pilots have shown that better outcomes are gained from giving better information to families with a disabled child and providing support for them and professionals to work out a plan of care early in life. In the long term, that—rather than waiting until things go wrong and difficult and much more costly care outside the home becomes necessary—saves money.

That is one example, but it is small; we need to accumulate such evidence bases much more widely. I am interested in the idea of Nottingham as an early intervention city and in how my hon. Friend seeks to improve the evidence base at a local level to make the case for spend to save. We would like to learn more of Nottingham’s progress on such issues, and I will be happy for the Treasury to come to Nottingham to see that emerging evidence and help in the work that my hon. Friend is leading.

My hon. Friend also suggested that with a better evidence base we could do more to shift the focus of policy and spending on to prevention and early intervention. The local government White Paper has committed to giving local areas more freedom to set local priorities, reducing the amount of central direction and allowing more freedom to shape spending to meet priorities—including, when the case can be demonstrated, more emphasis on prevention.

I am also interested in my hon. Friend’s suggestion to allow local areas to borrow funds in anticipation of future savings. Although as a Treasury Minister I can see potential pitfalls in that approach, it is right that we should consider the idea further and give it due attention to ascertain whether it is a way to strengthen the ability of local leadership to promote early intervention. As my hon. Friend acknowledged, we have produced funds to facilitate pump-priming—for example, the £780 million invested in the children’s fund in the past four to five years; one of that fund’s key aims is to deliver better preventive services. In addition, over the past seven years the invest to save budget has invested £420 million in projects, a number of which have been in the field of preventive support for children and families. By the end of next year, nearly a third of local authorities will have received support from the DFES to identify how to create service efficiencies that allow a move to prevention.

Case studies have been done by the DFES: in north Lincolnshire, a more preventive approach reduced re-registrations on the child protection register from 18 to 11.5 per cent.; and in Blackpool, the identification of cashable efficiency savings in children’s residential care released resources for prevention. I am keen to see what more can also be done in Nottingham to benefit from that kind of flexibility.

As my hon. Friend knows, in the Budget’s spending review we announced a significant investment in the capacity of children’s services for supporting prevention and early intervention as part of an overall increase in the education budget. It will rise by 2.5 per cent a year in real terms on average between 2007-08 and 2010-11. The review will build on the progress made against the “Every Child Matters” agenda by building resilience, providing greater responsiveness and personalisation of services, and offering proactive and preventive support for families who are facing severe difficulties caused by complex needs.

We recognise the need for early intervention and there will be implementation in respect of taking forward the ideas in our discussion paper—I am thinking in particular of the strands on high-risk, high-harm families, disabled children and their families, and youth services. We must ensure that spending on the early years is sustained through the primary school years and into the teenage years. Educational attainment is not enough, because this is about developing wider social and emotional skills to improve life chances and build resilience. That can be done only by ensuring that services are even more responsive and that we can engage children, young people and families in decisions about what is made available to support their own efforts and ambitions. That involves all the local services, the professionals in those areas, from head teachers to general practitioners, and others more widely.

My hon. Friend mentioned support for early intervention in Nottingham, and in particular support for health visiting and the nurse-family partnership scheme. The evaluations of nurse-family partnerships in the US suggest significant short-term and long-term benefits to mothers, children and wider society from intensive support to first-time parents with the highest levels of need. He cited that research in detail. It encouraged us to introduce Sure Start in the early years of this Government. It deliberately brings together education and health services for first-time parents in more deprived communities.

That research also shows why the Government announced last September that they would establish 10 projects to demonstrate models of health-led parenting support for parents of children from pre-birth to their teenage years. The work will build on the experience of the US and will involve a structured programme of home visits by trained health visitors and community midwives to test how the model is best applied in the UK. In particular, it will try to evaluate and quantify the long-term cost savings, including the wider, downstream costs to society, such as those associated with antisocial behaviour and criminality. My hon. Friend cited those in his speech.

We want to work with Nottingham to help build its capacity, so that it can be considered as a site for nurse-family partnerships in the future.

Will the Minister consider the possibility of the Treasury commissioning more work in this area? I am pleased that Treasury officials will come to Nottingham, but will he consider doing so in order to see the work that we are doing?

I would be happy to return to the city in which I grew up to meet my hon. Friend and his local strategic partnership. One thing that we could do would be to examine how this model of nurse-family partnerships in Nottingham could be part of the wider early intervention strategy that he is taking forward and leading. As I have said, local leadership makes change happen. It is only through local leadership that we can have effective early intervention. The kind of local leadership that is benefiting Nottingham is something that we want to learn from in the Treasury and the Government, so that we can spread best practice around the rest of the country, and I could learn from it by taking up the invitation to visit my home city as soon as possible.

Macular Degeneration

This debate follows neatly on from the earlier one. I heard the Economic Secretary speak about prevention and early intervention and I hope that those sentiments will inspire the Minister of State, whom I welcome.

I welcome the opportunity for a brief debate on age-related macular degeneration, which causes a progressive and irreversible loss of central vision in older people, and accounts for more than half of all registrations for blindness or partial sight. The Macular Disease Society is based in my constituency and I am grateful to its chief executive, Tom Bremridge, the Royal National Institute of the Blind and Simon Kelly, a consultant ophthalmic surgeon in Bolton, for a briefing for this debate. A number of colleagues share my interest, and I am pleased to see my hon. Friends the Members for Reading, East (Mr. Wilson) and for Weston-super-Mare (John Penrose) in their place. The Macular Disease Society brought to my attention a case from the constituency of the hon. Member for North Norfolk (Norman Lamb), who may catch your eye, Mr. Amess, after I conclude.

There are two types of AMD—dry AMD, which is caused by the slow deterioration of cells on the retina at the back of the eye, which is incurable and untreatable, and wet AMD, which is the most aggressive type. It is caused by the leakage of blood and fluid on to the retina. The macula, which processes detailed central vision, becomes obscured, and a healthy eye can then become blind and useless in three months, unless it is treated. People with AMD, who are usually otherwise healthy people and fully functioning citizens, suffer a diminished quality of life. They become unable to read, drive, recognise friends, tell the time or carry out many other everyday tasks. They run a higher risk of falls, hip fractures and depression, and are, of course, higher users of health care and community-supported services.

In 2004, the RNIB published an estimate of the costs of blindness. It showed that the annual total cost of sight loss was in the region of £4.9 billion. That figure makes it clear that treatments that can halt, or even reverse, sight loss will not only help people who suffer from AMD to avoid the distressing consequences, but will significantly reduce the consequential cost. Thus, rationing treatment to save PCT costs is short-sighted. Allowing any individual to go blind when there is a cure is indefensible. It is also extremely expensive for the taxpayer.

Happily, there are now two new licensed treatments for wet AMD. They stabilise sight loss, prevent blindness and in many cases restore lost vision, as long as diagnosis and treatment are relatively swift. They are Macugen, which was licensed for use last May, and Lucentis, which was licensed in January this year. The treatments have dramatically improved the prospects for sufferers, and the medical and public health professions are understandably lobbying for them to be made more widely available. Less happily, most patients—about 26,000 present themselves with the disease each year—cannot benefit from the new treatments because of the NICE review process, which started in September last year and is not due to complete until October; that is a period of 13 months. Yet in the meantime the drugs are in widespread use in the USA, Australia, France and Germany, and Macugen has been licensed for use by a similar process in Scotland, where it has approval. In the case of many other new therapies that NICE examines, an alternative treatment may be available in the meantime, but the new drugs for wet AMD are unique and there is no alternative.

The Department of Health—I welcome the Minister, although I may say some unkind things about his Department—has said that the NICE review process should not be a barrier to the use of new treatments, but it has in effect opted out and delegated the decision on whether funding should be authorised to the 152 primary care trusts in England. Many are overspent, and do not have the resources to conduct the effective reviews of the treatment that they are obliged to carry out. The RNIB and the Macular Disease Society have told me that many primary care trusts hide behind the absence of NICE guidance and simply refuse treatment point blank. In Oxford, a consultant’s application for permission to treat was referred to the PCT’s exceptional circumstances committee, which takes a month. It turned down the application because going blind was not regarded as an exceptional circumstance. Consultants in Bristol have been told not even to apply for funding. Therefore, in effect, there is a blanket ban on using those treatments for patients. Many of my hon. Friends will know that their own PCTs are under enormous financial pressure and unless they have to provide a treatment, many decide not to.

I congratulate my right hon. Friend on the way in which he is making his case. I shall strengthen his argument by citing the example of North Somerset primary care trust in my constituency, which effectively runs the system that he is describing. Basically, if something is not mandatory under NICE guidelines, because there is a double deficit situation—both the PCT and the hospital are in deficit—the treatment is simply not available.

I am grateful to my hon. Friend for reinforcing the case that I am making. I shall move on in a moment to what I think that we should do about that.

At Health questions, the Secretary of State for Health said:

“No patient should be refused Lucentis or Macugen simply because NICE guidance does not yet exist”. —[Official Report, 6 February 2007; Vol. 456, c. 692.]

But that is exactly what is happening. The treatments are not being prescribed because the NICE guidance does not exist.

It is not all bad. Some enlightened PCTs and commissioners of services have authorised the new treatments. If someone lives in Salford they are all right, but if someone lives in Wigan, they are not. Other PCTs have mitigated the cost by authorising the use of the unlicensed treatment Avastin, which is having good results. The Secretary of State has suggested a head-to-head trial between Avastin and Lucentis and I want to press the Minister on the progress of those trials. I understand that Professor Usha Chakravarthy in Belfast and Professor Simon Harding in Liverpool are leading such a trial with funding from the Health Development Agency. If it goes ahead, the trial will provide good evidence that would allow regulators such as NICE to recommend the use of Avastin over Lucentis and save the NHS a considerable amount of money. I am interested to find out today whether it would be possible to refer people who live in PCT areas, such as those of my hon. Friends, to whatever centres the trials take place in, so that they can have the treatment offered under the trials. That would effectively create a way through the current bottleneck and postcode lottery.

The consultant ophthalmic surgeon Michael Lavin from Manchester Royal eye hospital said:

“If all patients with wet AMD in the UK were treated with standard dose Lucentis, costs to the NHS by year two would be approximately £1,008m a year; if Avastin were used the cost would be about £4m a year.”

That sounds a good argument for a trial. Even if one uses the lower current figures for Lucentis, at £782 million there would still be a substantial saving.

Putting to one side for a moment those PCTs that are prescribing Macugen or Lucentis and those that are using Avastin off-licence, for the most part, PCTs are simply saying no to the use of the treatments because they are not under any compulsion from the Department of Health to provide them. For example, Mrs. Beeby has been refused treatment in Southampton. She is already blind in one eye and her consultant said that apart from going to him privately—private treatment varies from £1,000 to £1,750 per injection and up to eight injections may be needed in the first year—the only option was for him to ask her GP to apply for treatment in another area. That does not strike me as a good advertisement for a national health service.

What should the Minister do? Only a tiny minority of people know that smoking causes blindness as well as lung cancer and heart disease. More teenagers said that they would quit smoking if they had early signs of blindness compared with lung or heart disease. Does the Minister think that it is time to warn the public of that risk and perhaps to have the message “smoking causes blindness” on tobacco products as well as the more conventional warnings?

I have already said that there is a role for the Government in the head-to-head trials between Avastin and Lucentis and I want to find out whether there is enough funding available for those trials to take on board the constituents of my hon. Friend the Member for Weston-super-Mare and, indeed, the constituents of other hon. Members who find that they are blocked by the current funding policy of their PCT. I hope that the Minister can assure me that the centres at which the trials are taking place will have enough capacity to deal with those people who I am particularly concerned about.

More should be done now. As I said, 26,000 people a year present themselves with this disease and treatment is available now, so it should be provided now. The Government should tell those PCTs that hide behind the absence of NICE guidance that it is unacceptable not to provide the treatment, and that all applications for treatment by consultants should be processed promptly with a presumption that treatment will be given unless there are clinical reasons for that being inappropriate. Ministers should reaffirm that we have a national health service, not a collection of independent trusts, and that the current postcode lottery for treatment must come to an end.

Wet AMD eyes do not wait for the NICE review, for PCTs, for exceptional circumstances, for committees to convene and come to a decision, for patients to appeal against local decisions, or for lobbying to MPs. Such eyes do their own thing and to leave people to go blind within three months is unacceptable, so I ask the Minister to prescribe some humanity now and to provide the service that I am sure he would want for his mother or father.

May I first congratulate the right hon. Member for North-West Hampshire (Sir George Young) on securing this important debate? I am grateful to him for enabling me to speak in it.

I want to highlight the cases of two constituents. First, Jack Strange hit the headlines last week. He is elderly and has had to spend most of his life savings to pay for Avastin. His family tell me that it had an immediate and dramatic effect on his quality of life, and has halted his developing condition. That very rapid improvement has come only because he could pay for it, but he has used all his life savings in doing so.

The second case is a 56-year-old who is in work as a self-employed gardener. He has not yet had a decision, so he is waiting as he loses his sight in one eye. He has been told that he could lose his sight in both eyes within five years. That will ruin his quality of life, but he will also become completely dependent on the state. For reasons of quality of life and the overall cost equation for the country, it is ludicrous for people who could benefit from the treatment not to have access to it.

I want to reinforce the fact that time is of the essence because the disease is time-sensitive. I understand that it involves the formation of unstable new blood vessels in the macula, right at the heart of the eye, under the retina, and that scarring occurs with irreversible loss of sight. The drugs work only when that process is occurring. When it has occurred, it is too late and nothing can be achieved. For those who need help now, time is slipping away, and it is so important for them that a speedy decision be made.

It is interesting that the Norfolk and Norwich hospital has proposed to Norfolk primary care trust that it should use Avastin. As the right hon. Gentleman pointed out, it seems that it works effectively in many patients. However, Norfolk primary care trust has a deficit of around £47 million, so it is caught between a rock and a hard place. It is unfair and unacceptable that people are paying the price. They need their sight to be saved, and it is crazy for the rest of us to have to pay for the care of someone who becomes blind when their sight could have been saved.

I am grateful to the right hon. Gentleman for giving me the opportunity to make those points.

I begin by paying tribute to the right hon. Member for North-West Hampshire (Sir George Young) for bringing us here today to discuss what he rightly said is a crucial matter. We have all had constituents who have been in this position. It is of huge significance to them and their families. The hon. Gentleman is right to say that there are approximately 26,000 new cases of wet age-related macular degeneration every year and that it is the most common cause of sight loss in people over 60.

I, too, congratulate my right hon. Friend the Member for North-West Hampshire (Sir George Young) on bringing this important matter before the House today. May I tell him briefly about the case of Les Dean, which was covered recently in the Reading Evening Post? He woke up one morning with bloodshot eyes and was quickly diagnosed with wet AMD. He was refused the drug Lucentis soon after. He is a 79-year-old man and he has had to spend his entire life savings on buying the drugs himself. He was forced to choose between going blind and spending his life savings. Does the Minister agree that it is not morally right that any Government or local organisation should force someone into that position?

I am afraid that I do not have the details of that case. I hope that the hon. Gentleman will allow me to say that the issues are complex. We will get into some of the complexities that face decision makers in the public sector later in the debate. We have to recognise the important and difficult job that they do on behalf of all patients in their local communities.

I should like at the outset to pay tribute to the Macular Disease Society, which is based in the constituency of the right hon. Member for North-West Hampshire, for the important work that it is doing to raise public awareness of these issues and to the RNIB. I worked very closely with the RNIB as a Back Bencher on issues related to age-related macular degeneration, particularly around the time when photodynamic therapy was being introduced. It ran an excellent campaign across the country to look at areas where, with greater focus, the services could be introduced more quickly. I co-operated with it on a scheme in Wrightington, Wigan and Leigh hospital.

I wanted to assure the right hon. Gentleman that I understand the importance of the issues he raises. If he will permit me, I will just give some background on the Government’s commitment to eye care services. In 1999, the Government reinstated free sight tests for everyone aged 60 or over, recognising the increased risk of eye disease as people age. The eye test remains one of the main, if not the primary means by which age-related macular degeneration can be detected.

The national cataracts programme has helped to reduce maximum waiting times for cataract operations to just three months, which is four years ahead of the original target in the NHS plan. The Department of Health has only recently launched a toolkit to help primary care trusts commission a greater range of community-based eye care services to improve patient convenience and choice. However, we need to ensure that we continue to support the NHS in delivering improved eye care services for patients in line with the improvements that medical technology and science allow.

I fully understand that there is a great deal of interest in this area, with the development of new treatments potentially offering hope to more patients than it has been possible to treat in the past. As the right hon. Gentleman said, there are two main types of macular degeneration, usually referred to as dry AMD and wet AMD. The dry type of AMD is the more common form. The onset of this condition tends to be slow, with the vision deteriorating gradually. People are often not aware of the loss of vision, if initially only one eye is affected, and these cases are often picked up at an eye examination carried out by an optometrist as part of an NHS sight test.

It remains a sobering fact that dry AMD is not treatable. However, there is a great deal that can be done to support people with visual impairment, partly through vision aids but also through rehabilitation and training services. In that context the effective collaboration of relevant agencies across health, social care and the voluntary sector is vital.

Our debate focuses on the other type of macular degeneration, known as wet AMD. It is less common but tends to be more severe, with a rapid effect on the central area of vision. Blood vessels form under the retina at the back of the eye and may leak, causing a rapid and significant reduction in central vision. In 2003, the National Institute for Health and Clinical Excellence recommended the use of photodynamic therapy for treating wet age-related macular degeneration in some patients. All PCTs are now funding photodynamic therapy in accordance with NICE’s guidance. That is an important point of context for this debate—NICE has already recommended a treatment that all PCTs are funding.

However, NICE is currently appraising two drug treatments that have been developed, Macugen and Lucentis. The new treatments offer the scope to treat a greater range of patients than with photodynamic therapy. NICE is expected to publish guidance on Macugen and Lucentis this October, following a public consultation on draft guidance in the summer.

I stress to the right hon. Gentleman that NICE plays an important role in appraising those and other new treatments. He claimed that the Department had opted out of the process and simply left the decision to the 152 primary care trusts. The NICE process invests in that independent body the capacity to advise the national health service about new treatments, and I think that he and others would be the first to complain if the Department intervened on every similar issue to take decisions based on levels of public concern or anxiety. It must be a clinical decision. It is also right that it is a clinical decision at local level whether funding is made available for NICE.

I am sure that the right hon. Gentleman would accept that the NICE process is incredibly thorough and detailed. Because of that, it inevitably takes some time to complete. NICE has developed a reputation around the world for producing the gold standard of advice on new drugs and technologies, such is the quality of its work.

I refer again to my guidance to the national health service on 14 December last year on precisely what happens in the interim when a treatment is being considered by NICE. I say categorically for the record that it is not appropriate for PCTs to refuse treatment simply on the basis that NICE guidance has not yet been issued. I cannot be any clearer than that. Neither is it appropriate for such decisions to be taken in Whitehall, bypassing the system established to ensure that national clinical guidance is of the highest quality and based on a robust and independent assessment of the evidence, which is exactly what is happening at the moment. I fully appreciate people’s frustrations as that process takes its time, but I repeat what the Secretary of State said a few weeks ago: no PCT should deny patients Lucentis or Macugen on the basis that NICE has not yet finalised its deliberations.

I appreciate what the Minister says about the guidance that he issued. Does he have any evidence either way that it is actually being followed? Anecdotally—around the country and, I suspect, in many hon. Members’ surgeries—there is abundant comment from patients and others that decisions are being taken locally on the basis of finance. The decisions have to be taken on that basis because the money is not there to pay for this stuff. I am concerned that the Minister’s guidelines may, generally, not be being followed as he thinks they are.

It is for PCTs to determine those questions. In many cases they will set clinical criteria, whereby cases will be considered on an exceptional basis and a clinically led decision will be taken locally. That is the right way for them to proceed. Opposition Members often say, “Trust the professionals. Trust the NHS. Don’t interfere in all the decisions that the system makes.” At the same time, however, we get another request to do differently. In this case, the guidance from the centre could not be clearer: PCTs should consider the best available international evidence, and other clinical evidence, available today on those treatments and make their decisions on the back of that. However, like all health commissioners, they have to balance available resources with the clinical evidence. That is the job that NICE has to do, too.

No. I have given way a couple of times to Opposition Members.

I want to take up some of the particular cases picked up in the debate. The right hon. Member for North-West Hampshire mentioned Bristol, but he was incorrect. I understand that Bristol teaching primary care trust has not advised consultants that its patients cannot apply through the exceptional funding panels for funding for this treatment. All cases will be considered on individual merit. In such cases it is crucial to be precise with the information, because this matters a great deal to people in those areas and it is important that that clarification is put on the record.

The hon. Member for North Norfolk (Norman Lamb) mentioned two cases in his constituency. Like anybody, I could not help being moved by the instance that he put forward. Norfolk primary care trust will be reviewing its policy on funding treatments for AMD in May and a decision will be taken at the board meeting on 22 May. I think that the hon. Gentleman said that Norfolk and Norwich University Hospital NHS Trust has put a specific proposal to the PCT about Avastin and a different way of doing things. Again, those decisions are to be taken locally. It is not for me to intervene in those decisions. I hope that the hon. Gentleman feels that there is some comfort in that time scale and that these issues are being addressed quite speedily.

The right hon. Member for North-West Hampshire mentioned Mrs. Beeby from Southampton. I am advised that until recently there was no formal process for managing the authorisation and treatment of patients with Lucentis or Macugen within Hampshire PCT and, as there was no clear procedure, the consultant at Southampton eye clinic was not able to correctly refer the patient in question. However, the PCT identified that problem. It recently met Southampton University Hospitals NHS Trust and agreed a process for managing the authorisation and treatment of patients on a case-by-case basis. There should now be no barriers to cases being advanced for consideration by clinicians.

The right hon. Gentleman mentioned the head-to-head trial, which is important and is, perhaps, an area where we can find some good measure of agreement. He asked about progress. I am pleased to advise that the National Institute for Health Research health technology assessment programme has agreed to fund a head-to-head trial of Avastin and Lucentis over a 42-month period. We hope that the project will start on 1 May 2007. The right hon. Gentleman made an interesting suggestion about whether people could be referred to that trial from different parts of the country. I can tell him that contracts are yet to be signed. Details will follow about whether that is possible. However, the Department will feed that proposal into the process. It would be too early for me to promise anything, but it is a point well made. I will take that away and I will, if I may, come back to him in due course.

These are important issues. I am not oblivious to the cases raised or the passion felt by Opposition Members. I hope that by working together we can get to the right solution for our constituents.

It being Two o’clock, the motion for the Adjournment of the sitting lapsed, without Question put.