Wednesday 2 May 2007
[Mrs. Janet Dean in the Chair]
Motion made, and Question proposed, That the sitting be now adjourned.—[Huw Irranca-Davies.]
What a pleasure it is to see you in the Chair, Mrs. Dean, not least because we are fellow Staffordshire Members, but also because in this debate I shall draw in particular on the work of a Staffordshire organisation that you will know about. I begin by saying how much I appreciate, and pay tribute to, the work of many hon. Members on the issue of care and facilities for disabled children. Those hon. Members have given much time and energy to the issue, and a real head of steam is building up to say that something must be done.
I pay tribute in particular to my right hon. Friend the Member for Coatbridge, Chryston and Bellshill (Mr. Clarke), who led the parliamentary hearings on the issue last year, to my hon. Friend the Member for Blackpool, North and Fleetwood (Mrs. Humble), who was the vice-chair of those hearings, and to my hon. Friend the Member for Normanton (Ed Balls), who is now happily ensconced as Economic Secretary to the Treasury and who, we hope, can do something about these matters. I could mention many more hon. Members. I refer to this only because it should be recorded that Parliament and Members of Parliament have taken a considerable interest in the needs of disabled children in recent times and have sought to advance their cause. I simply want to add my own little bit to that today.
My involvement in the issue has been prompted almost entirely by the fact that there is a rather remarkable organisation in my constituency: the Birth Defects Foundation, now known as BDF Newlife. It is presided over by a formidable—I hope that she will not mind me calling her formidable—woman called Sheila Brown, who, since creating that organisation in 1991 to campaign for the needs of children born with disabilities and to offer them and their families support and assistance, has created an absolutely extraordinary organisation. She has warehouses of goods supplied by major clothing retailers. People come from miles around to buy the garments from Marks and Spencer, Laura Ashley and all the other retailers at heavily discounted prices, and it has become one of our major local industries. It is a tremendous tribute to Sheila Brown’s energy and imagination and those of the team that she has assembled around her that we now have the privilege of having such an organisation based in the constituency. In my remarks, I shall refer in particular to a report that the organisation has just produced; indeed, it was launched at a reception in the House last week.
Until I had contact with BDF Newlife on this issue, I had assumed, as I suppose most people in our society had assumed, that for children who were born with severe disabilities and needed special equipment simply to function, whether that was a wheelchair, a special buggy, a special bed, a hoist or a walker—just the things required for normal life—there was a system out there that provided them. It would have seemed to me some years ago inconceivable that we might have an arrangement in our society whereby children who were born with such disabilities and needed very basic equipment to function should not be able to get it, but that is the situation.
BDF Newlife discovered in the course of its normal work of providing support and help to the families of children with disability that it was increasingly being asked for help with items of basic equipment. Those were the requests coming in from the nurse helpline that it has as one of its functions. The organisation, being what it is, decided that it ought to try to do something about that. It set up a specific grant scheme so that it could fund some of the basic equipment for which it was receiving an increasing number of requests, and it has been doing that for the past three years.
In the first year, BDF Newlife provided £37,000-worth of equipment; the following year, it provided £500,000-worth of equipment; and, in the last financial year, it provided £750,000-worth of essential equipment. The organisation provided the equipment in a way that obviously was a lifeline to the families who approached it. By having an extremely fast turnaround system, sometimes the organisation was even able to provide the equipment on the same day on which it was asked for. It was able to give the grant, acquire the equipment and deliver it all at the same time. Obviously, the organisation could offer a hugely positive service to families who were turning to it.
BDF Newlife discovered also that many of the requests were coming from professionals—people working in health and social services. They were themselves approaching the charity directly to ask for the equipment that they knew the families they were dealing with needed but which they could not supply. That led the good people at BDF Newlife to think, “It’s not enough that we provide this service ourselves. We need to know what’s going on out there. We need to know why people are turning to us in these numbers for the kind of equipment that they are asking for.” They concluded that the system of public provision of essential equipment for disabled children was crumbling. The effect of that was that people were turning to charities.
What did the people at BDF Newlife do? They asked the families who approached them why they were having to approach them. They asked the professionals who were coming to them with requests why they were coming to them, so that they could find out what they were saying. Very imaginatively, they wrote to every Member of Parliament who had in their constituency a family to whom they had given a grant, telling the Members of Parliament why it, as a charity, had had to give a grant for basic equipment for a child or for a family in those constituencies. The effect of that was that many hon. Members were able to intervene with their local primary care trusts or local authorities to try to ensure—indeed, they succeeded in ensuring in some cases—that provision was made.
Then BDF Newlife decided—this is the initiative that has produced the report that I want to draw to the House’s attention—to ask every PCT and local authority in the country about the amount of money that they were spending on basic equipment for disabled children. The people at BDF Newlife found that that information was not available: it was not available from the Government; it was not available from normal sources. They had to go out and find it and they did that by using the Freedom of Information Act 2000. I have to confess that that was not my suggestion to them; it was their own idea. They therefore made a freedom of information request to every PCT and local authority. Let me say in the margin that if anybody needed persuading of the value of introducing freedom of information legislation and the need not to restrict access to information, as is proposed in some quarters, the details that BDF accumulated, put in the report and brought to the attention of the House under freedom of information legislation stands as a glowing and obvious testimony to the value of that legislation.
What did BDF find? It found that many organisations did not know how much they spent. Of the PCTs that responded, 35 per cent. could not provide the necessary information. Of the local authorities that responded, only 30 per cent. could provide a figure, and 56 per cent. claimed to have no responsibility for provision. There were huge variations. Of those PCTs that reported spending money on equipment for disabled children, the lowest placed spent £504, while the highest placed spent £442,000. The lowest-placed local authority spent £850 on equipment, while the highest placed spent £302,000. Four PCTs in England reported spending nothing at all on equipment. On average, PCTs spent only £45,000 on equipment for disabled and terminally ill children, while local authorities spent only £58,000 on average on equipment. On average, therefore, PCTs and local authorities spend as little as £30.42 on equipment for each disabled and terminally ill child. One has only to compare that figure with the cost of some of the equipment—a special wheelchair can cost several thousand pounds, a special bed can cost more than £2,000 and a special car seat can cost many hundreds of pounds—to know that such spending figures, although not inadequate, bear no relationship to the need that we are talking about.
If that is the position that the report documents, the question is what happens and who takes up the slack. I raise that question because, as we know, about 30 per cent. of families with a disabled child live at or near the poverty line. The answer is that several things happen. Charities take up the slack, and BDF itself spends more than any PCT or local authority on equipment. The report shows that all the charities together spend more than £4 million on basic equipment, which is a quarter of all statutory spending—an extraordinarily high figure. As we know from comments by professionals in the report, those who provide statutory services in some areas have a policy of applying to charities for equipment, because they know that it is needed, but they cannot provide it themselves, and they do not want it to be the first claim on their budget. They know that the charitable sector exists and they draw on it.
What happens beyond that? When they can, families pay for equipment themselves, and some run up considerable debts. If a child needs equipment, what parent would not try to get the money from whatever source they can, even if that means accumulating a debt that will last for many years. In many cases, that means going without, which has consequences for the child’s health and well-being. We all know about that, and if we do not, it is documented in the report, in which hundreds of families tell their stories and describe what it means for the lives of their children to acquire essential equipment or to have no access to it.
How can such things happen? They happen because there is not enough money, because not enough priority is given to disabled children and because of overlapping responsibilities—all things that those who have looked at the issue have discussed endlessly. The result is frustration on the part of professionals working in the field and frustration, anger and distress on the part of families who have to cope with the situation. Other factors include long waiting lists, the inability to turn assessments into equipment in a timely way and the fact that it is the wrong time of the financial year, that budgets have run out and that people with complex needs that require a range of equipment can have only one item.
Provision for children also seems to be inferior to provision for adults. I was interested to read the legal advice that BDF Newlife took for its report. It asked leading counsel to go through the range of the provisions that might explain why it is so difficult to get the necessary equipment and to look at the framework of current provisions that it might be suitable to use. In her legal opinion, the barrister draws attention to the difference between the provisions made for adult services, where there is an attempt to draw up eligibility criteria, with banded assessments that have consequences in terms of services, and children’s services, where there is a lack of equivalent provision. Speaking of the system for adult services, she says:
“It follows that, if a service user was assessed as being eligible for community care services, it would not be acceptable then to:
a. State that ‘there is no budget’, or that the ‘budget has run out’, or that…equipment cannot be provided until the next financial year;
b. Place a person on a lengthy waiting list that had the effect of further restricting access to equipment or rationing provision—this is a disguised form of (a). The service must be provided within a reasonable time; or
c. Offer unsuitable equipment or vouchers which will not cover the cost of the equipment which is needed;
d. Limit the numbers of pieces of equipment which will be provided to a fixed number, eg one or two.”
“As far as I am aware, there is no central guidance on eligibility criteria for children’s services which mirrors ‘Fair Access to [Adult] Care Services’. However, the standards set by that guidance are relevant, and there is no rational reason why eligibility criteria for children’s services could or should be more restrictive than those for adults (there are arguments that they should be less restrictive).”
That brings me back to the context of my argument: I have been working my way through this issue recently.
There is no shortage of law, guidance, commissions or reviews relating to almost the entire issue. There has been a national service framework, the strategy unit has done a report and there have been comprehensive reviews of wheelchair services. It is not as though the subject has not been visited; it has been endlessly visited by people who have endeavoured to make improvements and have described what best practice would involve. In the end, however, we are still in the situation set out in the report, which builds, of course, on reports by Whizz-Kidz, Barnardo’s and others. Evidence still accumulates about the lack of provision, and every study has recognised the position.
I have concentrated on equipment, because of the work done by BDF Newlife, but what I say on the subject exemplifies the general problems of providing services for all disabled children. A report on services for disabled children produced in 2003, not by a campaigning group but by the Audit Commission, said:
“We found a lottery of provision. The services that disabled children, young people and their families are offered depend largely on where they live, and on how hard parents are able to push... We found too little provided, too late. Service provision is rarely based on the priorities and needs of individual families. What is provided is often too little and too late to make the best possible improvement to their everyday lives... We found a jigsaw puzzle of services. Families have to struggle through a maze of services to track down essential information. They then have to jump through a series of hoops to try and gain access to support. When they manage to be considered for help, families are asked to repeat their painful stories over again to a series of different staff. Services tend to work to their own priorities rather than plan jointly, so families fall through the gaps between services.”
As I have said, it is as not as though we have not been told, many times, about the inadequacies of service provision for disabled children and their families. The detailed information that BDF Newlife has now produced about the equipment side of things underpins that general point.
What are we to do? That is the question that we want to engage with. Everyone who has looked at the question says the same kind of thing—that we need clear responsibility. We need to know who is responsible for providing services. Families should not get bogged down in the network of divided and overlapping responsibilities. We could at least achieve that. There should be some kind of standardised assessment procedure, so that wherever people lived, they would be assessed against a standard on which everyone would agree. We must ensure that funding actually follows the assessment and does not enter a black hole from which nothing can emerge. There seems, also, to be complete agreement—it seems to me essential—that families must have a single person who can work with them to negotiate the maze of provision that the Audit Commission describes. People’s testimony shows how important that help can be, whether we call the person providing it a key worker or a co-ordinator.
A broader point arises from that, about public services as a whole: the more complicated, disaggregated and fragmented public services become, often for good administrative reasons, the more impenetrable they become for the people who have to use them and the more important it becomes to try to build in the access routes to those services for people who do not, and should not have to, understand the complexities of provision. I increasingly take the view that we should specify what people are entitled to, in as many areas as possible, and that we could well include the provision of equipment for disabled children in that approach. Using a standardised assessment we could decide what basic equipment a disabled child and their family were entitled to. We could then ensure that that entitlement would be delivered. They would carry the entitlement with them. We could discuss the methods by which it could be delivered. As we know from wheelchair schemes, in principle, there is a variety of delivery routes. The key point is that, if people had rights and entitlements, whether to equipment or to short breaks or other things, it would transform the relationship between the provider and the person using the services. In public services generally, and particularly in the sphere that we are discussing, we should explore that route.
We may—this is my view rather than anyone else’s—need to think seriously about how to involve the third sector in doing some of the work, so that we do not simply bleat about the inadequacies of public provision but find a more dynamic system, built on entitlements, that will deliver in a way that the families and children in question need. When we launched the report last week, I raised in passing with the families who were present the question of whether it would be a good idea for organisations such as BDF Newlife to be involved in delivering services, and a great cheer went up. Those people’s experience of dealing with such an organisation has been wholly different from their experience of trying to extract things from statutory providers. I hope that that approach can be explored.
I am extremely grateful to the Minister for taking the trouble to come to the launch of the report in the House last week. It meant a great deal to me, to BDF and to the families who were there that he came along and said what he did. I am grateful for the fact that the Treasury is undertaking a serious review of children’s services, with a focus on disabled children. We shall shortly see the fruits of that in the comprehensive spending review. I am grateful, too, that my hon. Friend the Minister is also conducting a review, with particular reference to equipment, thus leading to the expectation that, finally, the analysis will convert into action and the problems that have been identified will be remedied.
We know, in detail, what the problem is and we now need to know, in detail, what the solution is. BDF believes that one in three of the 750,000 children who have disabilities has difficulty accessing basic equipment—250,000 children who speak for themselves or whose families speak for them in the report. Every day, another 125 children with inborn disabilities arrive to be cared for. The report is called, “It’s Not Too Much to Ask” and contains examples of good things that are happening and of good people on the ground making real efforts to make the system work better. However, the system should not be a patchwork. How people are treated should not depend on whether they live in an area where a certain person works their socks off to help people to access the system. The families of children with disabilities should be entitled to get the basic equipment that they need, wherever they live. That is not too much to ask.
Getting the right equipment of all kinds for disabled children is crucial, and I congratulate my hon. Friend the Member for Cannock Chase (Dr. Wright) on securing the debate. He was absolutely right to praise other right hon. and hon. Members for their commitment to this issue, and I congratulate him on his work with the BDF Newlife campaign and on his excellent speech.
I am pleased to join my hon. Friend and others in campaigning for the thousands of children and their families across the country for whom getting the equipment that they need is a real struggle, with much avoidable misery. As we have heard, they often need to have recourse to charitable support. In my constituency, we are fortunate to have at least two centres of excellence: the Oxford Centre for Enablement, which is part of the Nuffield Orthopaedic Centre, and the Aiding Communication in Education Centre —the ACE Centre—which, with its sister centre in Oldham, provides support, research and advice on the specialist needs of communication-impaired children. I take this opportunity to thank the staff and volunteers at both centres for their work, which is greatly valued by the children who benefit and by their families.
Those staff and volunteers demonstrate two especially important requirements for successful service delivery: flexibility and teamwork. Flexibility is needed to respond simultaneously to the needs of the child and the wider needs of their family, and to ensure that equipment is changed as the child grows, so that it can cater for their wide range of needs, including play, education, transport, sport and leisure. Teamwork and effective co-ordination are also crucial. Joint working, often across a number of agencies, and working with parents, therapists and teachers to try to achieve the best provision for all the different environments in which their children live and receive care or education is important. Given the range of needs and the rate at which demand has increased, excellent work is done.
Advances in technology can yield liberating changes for such children and their families, but we have to ask how adequate provision is. I get the impression that it is barely adequate for most people in my area. As my hon. Friend has told us, it is often much worse than that across the country; some real horror stories have been reported in the excellent BDF Newlife campaign report that was published last week.
Some of the pressures that are felt particularly in my area have been drawn to my attention, one of which is keeping up with the reviews that are needed to ensure that children do not outgrow their wheelchairs. I was told that wheelchairs are to a disabled child what shoes are to a non-disabled child: they need to be fitted and checked regularly. Priority for assessment tends to go to new referrals and those with acute problems, which can cause delays for routine follow-ups, especially if a budget needs to be stretched out across the year. Another local pressure arises with residential schools. The costs of the ongoing supply and maintenance of equipment falls on services in the school’s area, rather than on the placing primary care trusts, and the money does not transfer to support them. I hope that the Minister will look into that anomalous situation.
My hon. Friend has already covered some of the other important, more general, concerns across the country, such as those about the inadequacy of equipment. There are also concerns about affordability and health services having to demonstrate a health benefit, about manufacturers raising the expectations of families and therapists when they cannot meet those expectations and about the criteria on what may or may not be provided being down to local agreements and decisions and therefore varying enormously.
Funding mechanisms are subject to general NHS efficiency savings and are largely historical, whereas the number of children with severe disabilities who survive and who live longer is, thankfully, increasing. The BDF Newlife report shows that variability in funding is huge. Given that local authority spending varies from £850 to £302,000 and that PCT spending varies from £504 to £441,000, there is bound to be huge inconsistency in provision.
There is a shortage of suitably trained therapists, especially in wheelchair and seating provision, which it is crucial to get right. Funding arrangements for equipment are often complex and may depend on whether something is needed for daily living and basic mobility needs, for education or for social needs, with provision for social interaction often falling to the voluntary sector.
The variability of provision is well illustrated by the provision of communication aids, for which there has never been a properly defined funding stream, perhaps because their introduction has taken off only in the past 25 years. There is extraordinary variability. In some places, the education service will fund voice output communication, but usually only for children who have statements. The devolution of funding to schools has also brought problems, because there is not always enough in school budgets for large pieces of equipment.
In some parts of the country, health authorities will fund some voice output communication aids. I understand that that is the case in Birmingham, parts of London and around Bristol. In other parts of the country, there is no earmarked funding at all. In that sense, the need for funding has never been as comprehensively acknowledged as it is for wheelchairs, even with all the problems that we have heard about, but the difference that communication aids can make in the development of a child’s potential is every bit as great, especially because computers open up such exciting new opportunities to give virtual voices to those who never could have had them before.
Under the communication aids project, which ran from 2002 to 2006, £20 million was spent on assisting children with communication needs at school. More than 2,200 children were provided with communication aids and a further 2,300—mainly students with dyslexia—were given laptops to help with written recording. The project was heavily over-subscribed and many children missed out. Before it came along, some local authorities would not purchase voice output communication aids, which can cost anything from £100 to £9,500, unless they were taken to tribunal. Now that the project has finished, I am told that variability in provision is on the increase again.
The ring-fenced funding that the ACE centres used to receive from the Department for Education and Skills was removed last April on the basis that local authorities should be buying ACE services directly. That is all very well in theory, but in practice, it is a long slow job getting local authorities to buy into those services, so the funding that was lost has not yet been replaced. Furthermore, the Gatsby Charitable Foundation, which has always funded ACE research, will stop doing so in three years’ time, as the centres are having to use its money for core costs—that is not what it was intended for.
We all understand that local authorities have many and competing demands on their resources, but I hope that the Minister will agree that they ought to be given every encouragement and guidance informed by best practice, so that every child with communication needs can benefit from the enormous help that such support can provide.
In a written answer to my hon. Friend the Member for Cannock Chase, the Minister referred to what he called the
“radical review of community equipment and wheelchair services”.—[Official Report, 12 March 2007; Vol. 458, c. 122W.]
May I ask him whether that review includes communication aids, when it is to report and whether it will be able to inform the comprehensive spending review that is due later this year?
I hope that it is clear to everybody that many vital issues need to be addressed. They are crucial to getting the best equipment and support to the disabled children who need it most. Despite the progress that has been made in some areas, the pattern of provision and the funding mechanisms simply are not up to what the public expect of a civilised and caring society. Remarkable progress in disability rights and the legislation that supports them has been made in the past 10 years, but if children are to grow up to make a reality of those rights and to enjoy the entitlements that we legislate to say that they should have to make the most of their potential, they need the right equipment. If there were ever an area that needed a root-and-branch overhaul, so that responsibility, entitlement and funding are clear, this is it, and I hope that the Minister, who has a real personal commitment to this issue, will be able to tell us that we are going to get it.
I congratulate my hon. Friend the Member for Cannock Chase (Dr. Wright) on securing this debate on an issue that is of enormous importance to many Members of Parliament because it vitally affects a number of our constituents. Parliament is fulfilling one of its many roles in giving a voice to the debate and helping to move it up the political agenda. Provision for disabled children is not a party-political issue, so perhaps our predecessors in all parties in Parliament have not given sufficient attention to it, but it is moving up the political agenda. I hope that hon. Members from all parties will work to ensure that we give it the attention that it deserves.
I welcome the fact that the Government are involved in a series of reviews of provision for disabled children, because it is important that we ensure that the public money spent to support disabled children and their parents is used in the most effective way. Part of the problem is that there are many different streams of funding and responsibility is spread across a number of Departments. It might well be possible to achieve an improvement in services simply by spending the existing money more effectively, although I think that more money will probably need to be made available. Given that the two hon. Members who have spoken have outlined most of the issues, I simply want to make a few points about my constituency and then to use the experience of two of my constituents who have written to me in the past few months to illustrate the effect of the deficiencies and problems in the present arrangements on real people—parents of disabled children—in my constituency.
I am grateful for BDF Newlife’s report, which informed me that Milton Keynes council, which is a unitary authority that serves the population of the whole of Milton Keynes, spends only £68,000 on provision for disabled children. I note that that is more than the average but it is still a relatively small sum to address the need in my constituency. My primary care trust, which fortunately covers exactly the same area, spends only £30,000, which makes a total of £98,000 being spent to fulfil this need in Milton Keynes. That sum is clearly inadequate, because, as everyone knows, Milton Keynes is a growing city that has a relatively high proportion of children compared with other places in the UK. We ought to spend more than other places on supporting services for disabled children because we undoubtedly have greater need, but we are clearly not doing so. I welcome the fact that increasingly my primary care trust and council are jointly commissioning services. That is a positive move across the piece, because at least it means that locally there is much more effective working than before between the national health service and the local authority in this area, as in many others.
As I said, I want to try to relate the debate to the experience of real people. I shall not use any names, but I should mention a family who wrote to me in January. Their son has severe myoclonic epilepsy and global development delay, although their older son is not handicapped in any way. They described the difficulties that they were having in funding the adaptations and equipment that they need to install within their home to be able to provide the care that their son needs and to be able to have the normal sort of family life that any family has the right to expect.
The family were entitled to a grant of £25,000 to make the adaptations, but found that that sum was inadequate. They needed £7,700 of the grant simply to deal with the health and safety issues involved in getting their child up stairs. They needed £1,750 for a hoist system and £15,550 for building works. A specialist bed cost £3,500, which occupational therapy could not provide, and they were going to have to find another £3,000 of their own money to have a vehicle adapted to take their son’s wheelchair.
We need to keep stressing the point that the family made, which is that in order to cope at all the mother had had to give up work to become a full-time carer. That put enormous pressure on her husband, who then had to work particularly hard to ensure that the family income was kept up, as it was only he who was able to contribute to it. In common with many other parents in similar situations, they suggested that given the hard choices that they had made—they were not thinking of reconsidering their choices, because they thought that they were the right ones for their family—they were not being given the support from the state that they ought to receive.
The family felt that the existing support systems tend not to help parents who try to help themselves, so in addition to the specific issues that have been raised in this debate, we must think about the way in which all the support that is given through the benefits system and other channels to families in that situation might not be helping sufficiently those families who are doing their level best to provide for their disabled children themselves. Such families simply ask that the state should help them in that work.
The other family wrote to me even more recently—just a few weeks ago. They have a severely disabled daughter. She is eight and has suffered since birth from severe developmental delay, which means that she is more like a six-month-old baby and requires round-the-clock care. She has recently had a major hip operation and needs intensive physiotherapy both at home and at school. She now needs bulky additional equipment, including a standing frame, a special chair because her spine is beginning to bend, a pushchair and a wheelchair.
Again, the mother has given up work to be a full-time carer, and both she and her husband have suffered ill health from the effects of lifting and carrying their daughter. They too are looking to make the necessary adaptations to their home and, they too are finding that the money that is available to help them is inadequate to enable the necessary work to be carried out. They are being offered a way out, which is a sensible way forward for the local authority to advise them of, which is to raise the additional sum by putting a charge on the property. At least the work would be done and they would be given the additional money, but they would have to pay it back when they eventually sell their house.
The disabled facilities grant, which is currently limited to £25,000, is under review, which indicates the need for a comprehensive review of support to parents of children with disabilities. The different grants interact one with another, so if one part of the grant system is made more generous, to a certain extent that simply takes up the slack from other parts of the system. Although I wholly support the specific points that my hon. Friends have made thus far on equipment for disabled children and its funding, I urge the Minister to ensure that the various reviews take an holistic view of all the necessary support and the different routes of funding.
I wholeheartedly support the point that although, inevitably, support will be required from a variety of departments at both national and local level, the system should be made as simple as possible for the parents of disabled children. Those parents should have a single point that they can go to locally to enable them to access all the streams of funding, help and support. They should not have to navigate their way around the system. That should be the job of the local authority, the NHS locally and the Government nationally.
I start by congratulating the hon. Member for Cannock Chase (Dr. Wright) on securing this debate, on making an excellent speech, and on his work to highlight the Birth Defects Foundation’s work.
It has been a useful debate. The hon. Gentleman referred to last year’s initiative, in which the right hon. Member for Coatbridge, Chryston and Bellshill (Mr. Clarke) and Members from all parties, including my hon. Friend the Member for Mid-Dorset and North Poole (Annette Brooke) were involved, of conducting an inquiry into the development of children’s services. That provided an important and useful model of how we in this place can reach out to, involve, listen to and, hopefully, respond to parents, disabled children, non-governmental organisations and the public more generally. The litmus test of that and the useful review over the past year will be whether they result in some traction in respect of the Treasury’s comprehensive spending review; in the more holistic approach to the delivery and design of services that the hon. Member for Milton Keynes, South-West (Dr. Starkey) mentioned; and in comprehensive support, with everyone working together. We must all hope for those outcomes.
The hon. Member for Cannock Chase talked a lot about the excellent work of the BDF and the lifeline that it provides, which is an excellent model of services, not least in terms of the rapidity with which it is able to meet the needs of disabled children and their families. He was also right to identify the grey area between statutory provision and entitlement and what is provided by the charitable sector. I hope that the Minister will indicate how that grey area can become less grey and more black and white, so that both sectors can co-operate when appropriate and ensure that the statutory sector is picking up and shouldering its appropriate burden on behalf of society. The BDF’s evidence is a significantly damning indictment and requires a response from the Government.
Reference has been made to the wider issue of poverty and how it impacts on a family’s ability to meet the costs of providing for a child with complex needs and disabilities. Trying to respond to those needs may cause families to fall into debt. It is clear from my constituency mailbag and discussions with colleagues that a lot remains to be done to raise awareness of the take-up of disability living allowance and other benefits. I agree with what the hon. Member for Milton Keynes, South-West said about that.
Three threads have run through the three contributions so far. None is rocket science. The first is mindset, the second is planning, and the third is delivery. In terms of mindset, the starting point must be a social conception of disability and a presumption that a range of services and support will be put in place that promotes and enables independence first and foremost. We must try to ensure that children lead as normal a life as possible and that ultimately they can have fun, which is part of childhood. That is sometimes lost because provision of fun is not a statutory requirement, but it is critical to children’s development.
On planning, I was struck by the dearth of data—the BDF’s work underlines that—on available spending even within local authorities and primary care trusts. Some PCTs do not know how much they are spending, which is surely a scandal. How on earth can they commission such services if they do not have the data? There is a lack of data on the number, location and needs of families with disabled children, which cannot support good local commissioning. I echo the comments about how essential joint commissioning between PCTs, local education authorities and children’s trusts is. Third sector and independent sector organisations should also be at the table when services are commissioned and developed. That is essential because of the complex range of needs—clinical, educational, developmental and social—that must be met. If services are to be built that are fit for purpose, disabled children and their families should be involved in planning and commissioning, in the way sought by the parliamentary hearings. It is critical to better services that they are tailored to individuals and fit into the lives of the child and the family, rather than being shoehorned into meeting the needs of the service. They must also recognise the transitions between childhood, teenage and adulthood; perhaps more flexibility is needed in that respect.
On delivery, I agree with the right hon. Member for Oxford, East (Mr. Smith) that there should be access to timely assessment—not just the first assessment, but a regular programme of reassessment. Otherwise, equipment ceases to be fit for purpose and children’s development may be stunted because they do not have access to the right equipment at the right time. There should be access to appropriate equipment following assessment, without a long wait and negotiations on how to put together the funding between competing agencies that are scrabbling to avoid their responsibilities because of budget pressures. I agree with that point entirely.
I hope that the Minister will say more about the way in which access to one point that helps with navigation around the whole system can be made the norm. I hope also that the Minister will say something about portage. From my experience of my local children’s trust, I know that portage has played an important part in helping families to navigate their way around the system and, indeed, to lead their lives. Parents have been able to go back to work, when previously, as the person booking the appointments and making the arrangements, they were not able to work full-time.
The right hon. Member for Oxford, East talked about communication aids. The ability to explain and articulate ideas, discuss choices and express oneself lies at the centre of a person’s quality of life. We in this place take that for granted, but some people, trapped in their own mind, feel like they are in prison because they are unable to express themselves. Although there has been good progress with the national service framework, communication aids projects and integrated community equipment services, there has been a consistent pattern to them all: they have all been pilots. There has not been enough evaluation or learning, and the necessary follow-through of resources and mainstreaming has not taken place to enable such projects to develop a consistent pattern of delivery throughout the country.
I should particularly like to know precisely how a further review of the transformation of integrated equipment services will bear down on the absence of consistency. Others have asked the Minister about that today. In opening the debate, the hon. Member for Cannock Chase made a point about the lottery that still exists in such services. I should like the Minister to explain how the review will provide us not only with yet another insight into what must be done, but with the triggers that will make it happen on the ground, and particularly in respect of communication services. That is what all constituents would like more than anything else.
Will the Minister say something about the funding of equipment services? I am struck by the fact that funding through the scheme for communication aids stopped in 2005. Where is the funding stream to meet communication needs? If a disabled child lacks access to equipment, that is a prison sentence not only for the child, but for their family. Access to equipment may not be the panacea, but it can liberate. After 10 years, some foundations have been laid, which have been referred to in the debate, but there is still work to be done on designing the structure that has yet to be built.
The hon. Member for Cannock Chase rightly said that studies and reviews come and go, and he documented many of them in his contribution. Surely now is the time to resource and mainstream such learning so that we do not return to the debate in 10 years’ time to find that there is still a lottery and that people still cannot access services.
I, too, congratulate the hon. Member for Cannock Chase (Dr. Wright) on securing the debate, and I congratulate him on the moving way in which he opened it. The way in which he has taken hold of the issue based on something that he discovered in his constituency and thanks to the work of BDF Newlife is a good example of the way in which the House works at its best when Members learn about important issues through situations that arise on their own patch. He has done so admirably.
I also thank BDF Newlife for its important work on the issue, particularly in publishing the report before us. Organisations such as BDF Newlife and Whizz-Kidz, the largest supplier of mobility equipment for children outside the national health service, do an enormous amount of important work campaigning on such issues. We must listen to what they say, because it is grounded in their experience of helping families with disabled children, and it gives their messages credibility.
The report by BDF Newlife said that our failure to provide for families of disabled children was a national disgrace. Its phrase echoes the words that the Children’s Commissioner for England, Sir Al Aynsley-Green, used when he said that the services for disabled children and their families were a national scandal. Despite those strong words, it is worth saying, as the hon. Members for Milton Keynes, South-West (Dr. Starkey) and for Cannock Chase said, that the problem is not due to a lack of good intentions from all parts of the House. It is not a party political issue.
Over the past 10 to 15 years, a huge amount of legislation—starting with the Carers (Recognition and Services) Act 1995, followed by the Carers and Disabled Children Act 2000 and the Carers (Equal Opportunities) Act 2004—has sought to address the issues. However, the blunt truth is that it has not worked. When one asks why, one finds that there are structural reasons going right back to the founding of the welfare state. When the welfare state was conceived, in the Beveridge report, it was not designed to deal with the needs of disabled children and their families.
All today’s speeches have touched on the point that disabled children and their families need a co-ordinated approach that cuts across agencies, Departments and organisations. However, the welfare state has not been designed to do that. The result is that Mencap, for example, said in a report that it published a few years ago that 37 per cent. of families with disabled children are dealing with eight or more different professionals. In the recent parliamentary hearings on services for disabled children, one mother of a disabled child said that having to juggle 11 different professionals all wanting access to her child had driven her family to the point of breakdown.
The hon. Member for Milton Keynes, South-West pointed out that it is not only the social care system that is a nightmare, but the benefits system. I totted up the number of questions that a family with a disabled child would have to answer to apply for the eight different benefits for which they are eligible: they would have to answer a total of 1,118 questions spread out over 273 pages. Some 80 per cent. of those questions are repeated, so there is a huge amount of duplication in the benefits system, which is critical to such families, and in the social care system, because of the multiplicity of assessments.
The welfare system has not been designed with that group of vulnerable people in mind, but there has been a huge growth in the number of disabled children. The official figures show that their number has increased from 476,000 in 1975 to 772,000 in 2002. We urgently need to address the problem, because all the demographic indicators suggest that the trend will continue and, indeed, accelerate: by 2029, it is expected that there will be another 500,000 disabled children, but that the total number of children will decrease. There will be 500,000 fewer children and 500,000 more disabled children. Of course, it is wonderful that some disabled children now survive when they would not have done so before, but we must be careful about doing nothing to address the serious crisis that will emerge.
Owing to the growth in the numbers of disabled children, there has been a crisis in social services funding, which has already been alluded to. I am pleased that my local authority, Surrey, is one of the top 10 providers in the country. However, elsewhere in the south-east, a special educational needs co-ordinator who was quoted in the BDF Newlife report said about a disabled girl who needed specialist seating:
“Unfortunately in order to fund the buying of this, we would have to look at reducing her hours of (educational) support.”
The choice for that child was to get to sit down or to be taught, but not both. There are other heartbreaking stories in the report. One that particularly stuck in my mind was of the disabled boy who loses his dignity every day because he has to be washed in a garage by his mother, as she can no longer carry him up the stairs. There was also the quotation by a disabled boy, Nathan Giles, who said:
“Waiting for new equipment is like being starved of something, especially when you are not sure if you will ever have it”.
The problem has been compounded recently by the NHS budgetary crisis, which has resulted in a lot of PCTs having to cut right back on funding. We just hope that the situation will improve now that the overall financial position in the NHS seems to be closer to achieving balance.
As the hon. Member for Sutton and Cheam (Mr. Burstow) mentioned, the issue is also important to the Government’s poverty agenda. We know that one in three disabled children grow up in poverty. Having to borrow between £3,000 and £20,000 for a wheelchair can tip a family further into poverty at the precise moment when they should not have to be contending with interest payments on the purchase on top of all their other outgoings.
I want to suggest to the Minister a couple of areas where I think solutions to the problems can be found. One suggestion from Whizz-Kidz is to look at the NHS purchasing systems, to see whether it is possible to get much better economies of scale in the purchasing of equipment. Another suggestion is to introduce a much more fundamental reform of the assessment and commissioning process for services. The Minister will be aware of the £4.75 billion that we spend in supporting disabled children and their families, 26 per cent. of which—£1.25 billion—is used up in the assessment and commissioning process.
I should like to mention the “In Control” pilots, of which I know the Minister is a great supporter. They are taking place in 85 councils throughout the country, including Oldham, which seems to be pioneering the programme, as well as West Sussex and others. Councils have been able to reduce the amount of money spent on commissioning by putting sums of money into the hands of the families. That is incredibly relevant to today’s debate, because the satisfaction level with the amount of money that families receive to help them has increased in those areas from 45 per cent. to 90 per cent. Similarly, satisfaction levels with the services that families receive in those areas have increased from 42 per cent. to 97 per cent. If adopted, that model could transform the lives of many hundreds of thousands of families with disabled children.
In March, the Minister said that there was going to be a radical review. I understand from his website that that review is now complete. Implementation was going to take place later this year, but apparently now it is to happen in 2008. I, too, would like the Minister to say exactly what is happening with the review and its implementation. I know that he is personally committed to change. However, what we want to hear today is not only an expression of sympathy with the plight of so many families, but a determination to ensure that fine words are turned into fine actions, so that all those families can look forward to decent levels of services, which we all agree should never have sunk to such a sorry state.
I congratulate my hon. Friend the Member for Cannock Chase (Dr. Wright) on securing this Adjournment debate and on comprehensively explaining the challenges that we face. My job, partially, is to express empathy for children with disabilities and their families when the system lets them down; but a bigger part of my job is to begin to sort out some of those problems with colleagues across government, so that people’s daily experiences of the system change as rapidly as we can make that happen.
The mother of a young man with autism came to see me recently in my constituency. She said two things to me, as she explained the frustration with the system that she had experienced over a number of years. The first thing that she said, very passionately, as she looked me in the eye, was, “I am the expert on my son”—a clear message to professionals as much as to politicians. The other thing that she said was, “Why do I have to shout before anybody listens?” Those are common feelings and experiences among parents of disabled children in our society. That cannot be acceptable to any political party or to anybody committed to building the kind of society that has at its root the notion of social justice, and the belief that every disabled child matters and has the right genuinely to fulfil their potential.
In recent times hon. Members have—for the first time, and in my view it has been long overdue—taken significant responsibility for raising the profile and status of the issue, and brought the voices of disabled children and their families to the House. Like my hon. Friend, I pay tribute to my right hon. Friend the Member for Coatbridge, Chryston and Bellshill (Mr. Clarke) and my hon. Friends the Members for Blackpool, North and Fleetwood (Mrs. Humble) and for Normanton (Ed Balls) for ensuring that the issue is much higher up the political and public policy agenda than ever before. The level of engagement on the issue by political parties in all parts of the House also demonstrates how important it is to parliamentarians as well as to the Government.
I join my hon. Friend the Member for Cannock Chase in paying tribute to the work of BDF Newlife and, in particular, to the passionate and effective leadership of Sheila Brown. BDF Newlife has brought to our attention, in a stark and transparent way, some of the difficulties in the system that have to be tackled and resolved. We have heard about the extreme variability in spend in the health economy and social care services in different parts of the country. However, because of the lack of the transparency, using clear figures as comparators could be misleading. With the complexity of budgets, one of the problems is that it is sometimes quite difficult to unpick what level of resources is actually being spent on the service.
My hon. Friend identified a number of other issues. He talked about inadequate resources, insufficient prioritisation and a lack of clarity about responsibility and accountability. I shall return to those issues towards the end of my contribution.
Unless I am being paranoid, my right hon. Friend the Member for Oxford, East (Mr. Smith) seems to be following me round Adjournment debates, although I am sure—or at least I hope—that he follows other Ministers round Adjournment debates, too. His contributions are always constructive and, for obvious reasons, incredibly well informed. He talked about the two centres of excellence in Oldham and Oxford. He referred to their flexibility and teamwork, and their recognition that the needs of disabled children and their families are constantly changing as people grow up. One of the challenges for the system—but also one of the great successes of a modern society—is the demographic reality, which is that disabled children now have full and long lives. That is something that we all ought to celebrate; but equally, we should ask new questions of the system, which, as the hon. Member for South-West Surrey (Mr. Hunt) said, was not built for that demographic reality.
My right hon. Friend talked about the importance of joint working across agencies, as did other hon. Members. From the perspective of the parent—or indeed the adult with disabilities, if we were talking about them—the nature of the organisation or professional providing the service does not matter much. People requiring the services want easy access, support and a single door through which they can walk and know that they will end up in the right place with support. “One-stop shop” is the fashionable term; I prefer “first-stop shop”. If hon. Members reflect, they will find it difficult to believe that we could create a one-stop shop for the myriad of services involved. However, a first-stop shop—one door through which people could walk with a guarantee of being taken to the right place and being supported in getting there—is incredibly important.
My right hon. Friend talked about technological advances. Every day, such advances provide us with new opportunities to improve the life chances and quality of life of children with disabilities. If we are able to harness those technological advances to their full effect, those children will be able to experience those improvements. My right hon. Friend also referred to the difficulties of children at residential schools whose funders are in another locality. As we seek to fix the system, we need to consider the reality for those children.
Like the hon. Member for Sutton and Cheam (Mr. Burstow), my right hon. Friend referred to communication aids; I reassure hon. Members that the review includes them. The ability to communicate to maximum effect is fundamental. If children with disabilities are to achieve their full potential—whether through education, social interaction, or, as the hon. Gentleman said, fun and having positive relationships with peers—communication is surely not a luxury or add-on, but absolutely integral to disabled children’s life chances and quality of life.
Communication aids feature in the review and I am in discussions with the Department for Education and Skills. As was always the understanding, the ring-fenced funding came to an end; it was always to have been made available to build capacity in the system, after which local commissioners were to take on responsibility. Clearly, that has not always happened, so with the Department for Education and Skills, we need to reflect on how we make sure that communication aids are a key priority as part of an integrated approach.
My hon. Friend the Member for Milton Keynes, South-West (Dr. Starkey) made a powerful speech and brought to life what the obstacles and barriers mean for families with disabled children. They are tiring and mean that such families are not easily able to support their child as every parent would want to if given the opportunity. She also said that although within the system there is an opportunity to argue for more resources for disabled children and their families, as hon. Members should, existing resources are not being used to best effect. There is no doubt of that in my mind, and I shall turn to that issue in a moment.
My hon. Friend also talked about the centrality of achieving a genuinely holistic view, whether about social and health care or the relationship between statutory agencies and the voluntary sector. We should harness all the resources and expertise in local communities to ensure that we create a child-centred and streamlined system that is simple to access.
The hon. Member for Sutton and Cheam also referred to the importance of the statutory voluntary agency partnership. When debating the compact principles, we must close the rhetorical reality gap on the relationship between statutory agencies and the third sector across a range of services, including those for disabled children, and on our expectation about how such bodies need to work together to secure holistically the health and well-being of their local communities.
The hon. Gentleman referred to mindset in the context of maximum normality for a disabled child growing up. I entirely agree, and say to the hon. Member for South-West Surrey that my only reservation about some of his party’s rhetoric on such issues is about its presentation of special schools as being the panacea in all circumstances. Some parents want special provision and special education, and their voices must be heard. However, many parents want integration for their children, and we need to get the balance right.
The hon. Member for Sutton and Cheam also talked about a dearth of data on the issue. He is absolutely right that we need to do something about that. He also mentioned transition, which is one of my great areas of focus. Parents tell us time and again that the transition from child or young person to young adult involves a cliff edge; the move from children’s to adults’ services is difficult, and planning has to be at the centre of changing that.
The hon. Member for South-West Surrey rightly praised the work of Whizz-Kidz and Barnardo’s. I share in that support; they are actively helping us with our reviews. He rightly drew attention to the consequences of changing demographics and rising expectations and made the link between the needs of disabled children and our ambition to eradicate child poverty. He is right; there is a direct correlation between the two. On the issue of streamlining questions in applications and assessments for benefits, I say gently to him that that is one of the reasons why his party should be a little more progressive on electronic records and sharing information, which are two of the ways to streamline assessment and reduce the number of questions that people are asked.
As we speak, the Government are identifying the issues, then the solutions, then—most important of all—making sure that we see real and tangible changes on the ground in the near future and not at some distant point. The Treasury is leading the review of support for disabled children and their families as part of the comprehensive spending review. That is a major advance towards elevating the needs of disabled children and their families to being one of the great public policy imperatives for the Government. That review will address many of the issues raised in the Chamber today.
An independent review of palliative care services for children has been reporting to me and will be published in the near future. The review of community equipment has been concluded and the implementation stage is under way. It will lead to a new model of providing community equipment in every community. That will take effect from the beginning of the financial year 2008. There has been preparatory work on that new model, which includes streamlined assessment, an enhanced role for the voluntary sector, shifting resources from the entirely inefficient and very costly-to-run equipment stores and logistical operations towards the direct provision of equipment to disabled children and their families.
The third sector should have a much greater involvement and partnership role alongside local authorities and primary care trusts in every community. There is the concept of a key or lead professional to consider the holistic needs of disabled children and their families. Local government and the voluntary and private sectors have worked with that model in building the market, and it will transform how families in this country experience access to community equipment services.
Ultimately, we shall be judged on families’ everyday experience of whether the system improves. I believe that we are finally on track to make a real difference, but I expect hon. Members on both sides of the House to hold us to account as we continue to listen to the experiences and voices of the families of disabled children.
Gershon Review (Great Yarmouth)
It is a pleasure to serve under your chairmanship, Mrs. Dean. It must be unique for me to follow the other Tony Wright—my hon. Friend the Member for Cannock Chase (Dr. Wright)—but this one is slightly younger.
I am pleased to have secured this debate. I have been putting in for it for a long time, and the procedure of the House means that Members have to take pot luck. Clearly, the day after the strike in the public sector about the job cuts is a timely occasion. It was difficult to secure this debate because it covered different Departments, from the Inland Revenue to the Department for Work and Pensions and the criminal justice unit. It was difficult to find who could respond to my questions and the issues that I want to raise. I am pleased that my hon. Friend the Financial Secretary will respond to the debate on behalf of the Treasury.
I want to set the scene and to explain why the issue concerns me. Great Yarmouth is, unfortunately, a place with higher than average unemployment. In 1989, it reached 19.7 per cent. unemployment—one in five people. Since 1997, 10 years ago, the number of people unemployed has fallen from the heady heights of 4,850 down to 2,934—a massive drop of some 40 per cent. However, we have to move on and it is clearly not good enough that we are still in the top 50 unemployment blackspots in the UK. That makes uncomfortable reading when we consider the views of departments when they consider relocating civil service jobs from Great Yarmouth to an area that has relatively low unemployment. In Norwich and other areas, unemployment stands in the region of 3.5 per cent.
In December 2003, the Chancellor of the Exchequer made a statement on the pre-Budget report. In respect of the Lyons review, which we were considering at the time, he said that
“we will relocate out of London and the south-east 20,000 civil service jobs—to the benefit of the regions and nations of the UK.”—[Official Report, 10 December 2003; Vol. 415, c. 1065.]
Clearly, that came on the back of the announcement that we had to reduce the number of civil service posts across the scheme of things, and there might well have been reasons for that. However, it gave us hope for the future that a place such as Great Yarmouth, with offices at lower than average costs and space in its departments, would be ripe for the move from London and the south-east and that some of the civil service jobs in and around Great Yarmouth would be reinvigorated. Unfortunately, the reverse has happened.
Since the announcement, part of the review has considered the number of civil service jobs across certain clusters. We are in cluster 11 for Her Majesty’s Revenue and Customs, which takes into account Dereham, Norwich and Great Yarmouth. I can understand the need to consider such matters, but I cannot square that with the fact that jobs are being moved away from the most deprived area in East Anglia, with the highest unemployment in the region, to a fairly affluent area. We need to take that on board. I am sure that when Gordon made his announcement on the Lyons review and on the Gershon review, he did not anticipate that we would lose jobs from already deprived areas.
We can do a number of things about the situation. About 18 months ago, I held a debate in this Chamber to talk about Jobcentre Plus and the difficulties with the roll-out of the new system. The Minister who responded to the debate made it clear that
“As we take forward our plans to centralise benefit processes, some buildings, including Yarmouth house”—
in my constituency—
“will no longer form part of our network.”—[Official Report, Westminster Hall, 23 November 2005; Vol. 439, c. 447WH.]
That was the end of one of the Government’s properties. Fewer than a dozen people now work for that office, and we know that its end will come soon.
That takes us on to the question of HMRC. There are huge concerns in Havenbridge house about the proposed reduction in the number of jobs and the relocation of a number of them. It has been quite an education to consider the jobs at Yarmouth house that we might lose, because we have to consider what the effect will be on the families of those who are employed in those departments; on my constituents, who have many difficulties; and on the economy. Since I secured the debate, I have received a number of letters from my constituents who work in those departments, which shows the strength of feeling.
When the staff surveys were carried out, the most startling thing was that the vast majority of people who were asked for their views were given the option:
“Considering everything I am satisfied with my job”.
A large proportion—more than 50 per cent.—said that they were satisfied with their job. Another question was:
“Considering everything, I am satisfied with this department at the present time”.
That was agreed with by 32 per cent., while 44 per cent. disagreed. Overall, there was relative satisfaction with the job.
However, since the decision was made about the reduction—I know that there have been guarantees and consultation, that everything will be reviewed and that there are no plans to close the department—staff have felt that the situation is somewhat different. I can understand why they would assume that decisions are already in the pipeline and that it is a fait accompli. Clearly, if the estate has to be reduced—bearing in mind that we have Yarmouth house and Havenbridge house—that will cost an awful lot of money. If it is reduced to such a level by outsourcing the jobs to Norwich, Lowestoft, Peterborough and other areas, it will clearly no longer be viable for the department to maintain the office, so it would be closed for cost reasons.
I want to concentrate on HMRC, as the staff have put forward their views. Although the changes to the benefits office have had a devastating effect in Great Yarmouth, on my constituents and on the staff, HMRC is relatively new. The building houses 130 to 140 staff, a number of whom have been told that they will be moved. I want to read one or two notes from members of staff about their concerns. Somebody who works in the business support team says:
“I have been involved with educating employers and the self-employed, our evaluation sheets prove that employers who receive education are much more confident—the evaluation sheets of customers I have educated myself show 97 per cent. are more or much more confident. If staffing and locations are reduced this will affect employers and the self-employed living in rural areas—they will have to travel greater distances for education so more cost to them in travelling and time, that’s if the education is still available.”
That is the advice that they would give the business community, bearing in mind that we always try to attract new businesses to the area and the department needs to give them help and advice. That is just one example.
As for flexible working, one of the big issues raised with me is how many parents work in the department. Sometimes both parents work there. The Government’s desire—a right one in many cases—to get mothers back into work is one that I certainly support, but here we are going against the grain. One of the benefits of working for the department is its flexible working patterns. Staff can work around their lifestyle, their children’s schooling or any difficulties they might face if they have an elderly parent at home.
I have a letter that provides a picture of a number of the letters that I have received on the issue:
“The effects on my family will be fairly devastating, as both myself and my partner work for HMRC in Great Yarmouth; also, we both use part-time flexible working to look after our three children. There are not other jobs in this area that offer the flexibility to enable us both to work and look after our children. Working in another location is not feasible, as the next nearest office is in Norwich, and in our rural location this can mean up to an hour’s travel each way.”
The job cuts will mean taking away a family’s flexibility to work. The possibility of getting another job for both parents is probably negligible. Even though one of the household might well be able to relocate to Norwich, it will prove extremely difficult for them to continue. We are already taking away money from that household.
The other issue, of course, is what will happen to the local economy. Another letter says that
“my family income will be reduced by half if I lose my job. My husband is also a civil servant and facing a job cut… My daughter’s life will be affected, as we will have no income to do things, get books, help her at school or buy clothes… I shop locally, go regularly to swimming and take my daughter…to a local dance class.”
There are other ongoing issues of the knock-on effect on the local economy. If we take away an individual’s earning capabilities, they can no longer spend money locally. That has a knock-on effect throughout the system.
As I said, it can take people up to an hour to travel to Norwich and an hour to come back, so it will add time to the working day. One thing that people are saying to me is that, at a time when we are considering environmental problems, we are going to add to our carbon footprint. Asking people to travel to work and back, rather than working in their locality, is certainly a consideration, albeit one that has been raised on a couple of occasions.
Staff morale is pretty low in some respects, due to uncertainty about what is happening. Somewhere along the line, we must balance what is considered acceptable in today’s society and what needs to be done for the economy. Although I can accept that we need to move jobs around, our inability to do so without affecting families who already find it difficult at times to balance their lives will remove their ability to earn over time.
The other question is cost. People who must travel to and from Norwich for work could incur a burden of up to £50 in costs. In a low-wage economy, it is proving difficult for people to balance the books at the end of the day, so that would have an extreme impact on what we consider acceptable.
I began by talking about the economy and the problems that we face in Great Yarmouth. We are talking about losing 250 positions, as another 50 jobs were cut from criminal justice when the local police station moved to Norwich, again because of the need to cut back on costs. Although I met with the managers, it became clear that that was an irreversible decision based on cost-cutting. The total job cut of 250 is totally unacceptable. When the Chancellor announced that he was moving jobs from the south-east to other regions, I fully expected us to benefit; I certainly did not expect us to lose positions. Perhaps the Minister will suggest that decisions have not been taken to close particular offices, and certainly not the HMRC office, but when we consider it, the fact is that the costs of keeping open an office with very few people in Great Yarmouth could lead to it closing altogether. That would certainly set us back.
I set the scene earlier by speaking about the Government’s tremendous work in reducing unemployment and increasing employment opportunities. We have seen the benefits in Great Yarmouth, and the loss to our economy of those jobs would send out the wrong message. Indeed, the other side of the coin is that the offices of HMRC and the Department for Work and Pensions are often used by schools for work experience, to encourage youngsters to go on to further education and to get good jobs in the economy. That is another part of the equation that we are removing in Great Yarmouth.
It is sad that we are in this position, especially bearing in mind that it affects an economy that has struggled for years. We are on the way up, and it will be a kick in the teeth if both the DWP and HMRC join the criminal justice board in removing their offices for good. We will probably not get them back again. I ask the Minister to consider seriously not only what can be done to ensure the security of departmental offices in Great Yarmouth, but what else could be transferred from London and the south-east to replace some of those jobs. Perhaps people could be given the opportunity to transfer from one civil service job to another. That would secure the economic future of Great Yarmouth. The staff are very professional. The tragedy is that staff with more than 20 years’ experience are being moved away from their jobs—they have taken redundancy and their jobs have been given to lower-salaried individuals. Unfortunately, once such experience is lost, it will never return.
Service delivery to the public will be affected over time as well. I have anecdotal evidence of the time delays that result from such job cuts. People calling for crisis loan applications can stay on the phone for hours. I have a worksheet for 10 to 13 April that says of people calling for crisis loans:
“Been ringing since 9.00 am yesterday… Unable to get through… Has tried for almost two weeks, one day tried for three hours constantly on the redial button—line engaged”.
The system is not working, and my constituents—both customers and staff—are bearing the brunt of it. I should like the Minister to consider the matter seriously, not only taking on board what the Gershon review said about relocating jobs, but looking at the benefits if some jobs were relocated out of London and the south-east into the Great Yarmouth area. I ask him to stop the movement of any more jobs from Great Yarmouth to Norwich and to secure the future of HMRC in Great Yarmouth.
Thank you, Mrs. Dean. It is a pleasure to respond to this debate, which my hon. Friend the Member for Great Yarmouth (Mr. Wright) has successfully secured, with you in the Chair. He is an MP who is incredibly proud of his home town, and he has spoken strongly and consistently in the House for its people and its interests in the 10 years since he was elected to represent them.
My hon. Friend said that he was looking for someone to respond to his Gershon-wide interests, and it falls to me to do so, though he concentrated particularly on Her Majesty’s Revenue and Customs. I will do so as well, as it is clearly the Department for which my colleagues and I, as Treasury Ministers, have direct responsibility.
My hon. Friend set out powerful arguments that picked up on the concerns of staff, and his concerns about the improving but still underperforming economy of Great Yarmouth. He rightly paid tribute to the dedication of the staff in the Department and to the job that they do for HMRC and for the tax paying public in general.
I begin by assuring my hon. Friend that there is no fait accompli. There is a review of HMRC’s jobs and office arrangements, but, in somewhat characteristic fashion, he has secured this debate before the review has even begun. I shall ensure that the comments and points that he has made today are included in the review, and that he has the opportunity to play an active part at each stage of the process.
There will be a clear process. My right hon. Friend the Paymaster General has ensured that we approach the questions in an open, systematic way and that we take great care to incorporate the views of local communities, staff, HMRC unions and MPs. Let me emphasise that no decisions have been made on the future of Great Yarmouth or, for that matter, any other HMRC office in the eastern region. The Paymaster General and I, particularly because of this debate, will examine any recommendations that reach Ministers through the process.
For my hon. Friend’s benefit, let me spell out what the process is and how it may relate to Great Yarmouth. In November, HMRC explained to MPs and to staff how the review process will work. Basically, it will have three phases. The first phase is the initial analytical or diagnostic work. In essence, it will develop options and proposals for rationalisation and more efficient working—which are, of course, expected of us—and the potential closure of offices. That normally takes about two months, and work will begin in about August this year on the cluster of Norwich, East Dereham and Great Yarmouth offices.
The second phase, which we term the feasibility phase, stretches over about three months and includes an eight-week consultation period. Specifically, we will seek the views of MPs and staff on the proposals that have been developed. I suspect that we will aim to start that phase for Great Yarmouth, Norwich and East Dereham some time in the autumn. Then there is the publication of the consultation findings, recommendations to Ministers for decision and, finally, an implementation phase that in some cases could take up to two or three years depending on the nature of the changes.
I shall go on in a moment to give my hon. Friend what assurances I feel I can give him at this stage. I hope that they will be useful to him, to his constituents and to some of the staff in the HMRC office, particularly those at Havenbridge house in Great Yarmouth. We understand the concerns that he expressed, and we know that they are shared by the staff who work in the Great Yarmouth office. Staff members are concerned about the extra travel time that may be involved and the availability of transport links to other centres. He also made a point about the environmental impact of greater commuting distances.
My hon. Friend mentioned Yarmouth house. I am aware of the decisions that the Department for Work and Pensions has taken. In speaking up for HMRC, I might say that perhaps those decisions were not taken as part of a systematic and open review process such as the one that my Department is determined to follow. Throughout the process, Ministers and senior managers in HMRC have been and will be committed to being as open as possible with staff. We will explain the options available to individuals and explore how their expectations and concerns may be matched with the central and essential need to make our operations more effective.
I shall briefly give the background to the review before I go on to the reassurances that I can offer at this point. It is clear, following the merger of Customs and Excise and Inland Revenue, that there is more office accommodation than the new unified tax department needs. We estimate that we probably have 40 per cent. more than we actually need. When that is combined with significant changes to what is expected of a tax agency and authority these days in relation to developments in the taxation system, changes in the economy and changes in customer demands—more online filing, for instance—it is clear that we are facing a period of change. Also, like all parts of government, we are required to make efficiencies and to conduct our operations as efficiently as possible to reduce unnecessary cost—taxpayers expect us to do that. A combination of factors underlie the review process that we will undertake later in the year.
I thank my hon. Friend for that response to my queries. Will he also guarantee that he will compare the cost of office space in Great Yarmouth with that of other department estates such as those in Norwich, Peterborough and Lowestoft? I believe that the Great Yarmouth costs are substantially lower, which would result in a lower cost base should the building be used for other civil service positions.
I can indeed give my hon. Friend that assurance. Obviously, that will be an essential aspect of the early analysis that will be required. The comparative cost and size of the office space that is available at the three sites in Norwich, Great Yarmouth and East Dereham will be part of the calculations.
In the short time that I have remaining, I shall try to give my hon. Friend one or two other assurances. First, in conducting the reviews to reduce office accommodation, the board plans to focus on back-office functions, not on public inquiry facilities. As the departmental Minister, the Paymaster General has made it clear that the network of inquiry centres must be maintained. If an inquiry centre needs to close—for example, because a lease cannot be renewed—she has asked the board to re-provision a facility as near to it as possible.
My hon. Friend quoted from correspondence that he has received from staff members. They are particularly concerned about flexibility of working patterns and family life. May I give him an example? HMRC will shortly announce decisions on its review of urban centres in the south-east. As part of the staff support process, managers will meet their staff to discuss whether the moves that result from the decisions are reasonable in the light of their circumstances and, if not, HMRC will provide work for them in a location that is within a reasonable daily travel distance or it will consider other arrangements such as alternative hours or home working. Staff will not be made redundant as a result of the announcements; that is entirely in line with the current no-redundancy agreement with the trade unions.
My hon. Friend is also rightly concerned about the economic and job situations in Great Yarmouth. I have reviewed the figures. Great Yarmouth has an unemployment rate three times the regional average, and twice the level of Norwich—a stark contrast. I shall ensure that the fullest analysis of the situation is part of the diagnostic phase of the review. I shall also ensure that it figures in the consultation, and that we take account of developments and the decisions of other Government Departments—the Court Service, the DWP and the probation service—that are located in Great Yarmouth.
I welcome this debate. It is very much part of the work in progress that the Department would wish to do with my hon. Friend, as the local MP, throughout the review process. It is an important contribution to the work that we will do as we prepare for the review. I offer him the opportunity at an early stage to meet the senior managers who are responsible for the review process. Their briefing would be of benefit to him, but such a meeting would also allow them at the earliest stage to hear the points and concerns that he is anxious for the review to take into account. If he wishes to do that, I will be happy to set up such a meeting at his convenience.
Sitting suspended until half-past Two o’clock.
Maternity and Midwifery Services
I am particularly pleased to have secured this debate this week because it is the international week of the midwife, which, I am sure the Minister knows, culminates in the international day of the midwife on Saturday 5 May.
Being a reasonable chap, I will start with some sugar for the Minister before the pill arrives. I congratulate the Government on their record on investment in the NHS, which is most welcome. [Interruption.] As I think the Minister has just acknowledged, the Liberal Democrats have supported that investment and some, although not all, of the activities of his Department during the past 10 years. I am sure that to a far greater extent today than 10 years ago many consultants and GPs are happy with their personal circumstances, with the rewards that they have received and the conditions of service under which they operate. One would expect such investment to result in an improvement in outcomes and I am pleased that the Government have a record of some improvements, although not perhaps to the level that many of us would have liked. None the less, there has been an improvement in outcomes. I hope that the congratulations I have given to the Minister will dissuade him from filling too much of his response congratulating himself and the Government.
I have spoken to the makers of “Panorama” and, as the Minister is no doubt aware, they will be broadcasting a programme tomorrow evening that will demonstrate that there are matters of concern within maternity and midwifery services—obstetrics—across the country. I will refer to the national context, but I have spoken to and am well aware of the issues facing those involved in front-line maternity and midwifery services in Cornwall and the Isles of Scilly, as that is the patch that I represent. The “Panorama” programme shows some worrying and, one assumes, not necessarily exceptional cases from St. Mary’s hospital in Manchester and a hospital in Barnet that demonstrate the consequences of having an overstretched service that is supported by an insufficient number of midwives and insufficient resources for front-line patient care. In addition, the Minister needs to address some serious questions about safety.
On a more general point, the culture of good and wise Government requires transparency, clarity and a capacity to see the benefits of robust scrutiny as a contribution to service improvement and good governance itself. I shall be constructive in my comments, but I have recently asked the Minister and his colleagues a number of written questions about midwifery and maternity services, and many of the answers that his Department has provided reflect a climate of cynicism. Those responses would provoke even a normally calm person such as myself into raising stakes and using hyperbole and colourful adjectives that could otherwise have been avoided. That is not true only of the Department of Health; the climate is similar in other Departments. I will give examples of some of the literal interpretations and minimalist responses that I have received from Ministers in a moment.
There is not only a climate of cynicism, but a climate of secrecy. Would it surprise the hon. Gentleman to know that the Oxford Radcliffe Hospitals NHS Trust is refusing to publish the names of the clinical working parties that are determining the future of maternity and children’s services in my constituency and the Horton general hospital? Can the hon. Gentleman think of any possible justification for the names of those on a working party that is determining the future of hospital services not being a matter of public record?
I cannot. No doubt the Minister will have heard that intervention; he will have an opportunity to reflect on it and consult his colleagues before he responds to the debate. Perhaps the hon. Gentleman will receive an answer or explanation of why he has not been given that information.
I will give an example of the type of response that I have received by referring to a written question tabled on Wednesday 7 March, which received an answer on 23 March. The question was
“To ask the Secretary of State for Health (1) how many maternity-related compensation claims there were in each year since 1995; (2) how much her Department paid in compensation to patients in each year since 1995; and what proportion of such payments were for maternity-related claims.”—[Official Report, 23 March 2007; Vol. 458, c. 1196W.]
In response, the Government provided a table of claims and payments made on the basis of the date that the claim refers to. Therefore, it provides us not only with an impression that obstetric and maternity-related claims are reducing over time, but that the total number of claims is as well. We all know that many claims are still waiting to be resolved after the initial occurrence—for 20 years, in some cases. It would have been helpful if the Government had presented that information in the correct context.
Another question asked on 7 March was responded to on 23 March. The question related to hospital births:
“To ask the Secretary of State for Health, what the (a) minimum and (b) average period was that (i) primagravida”—
and (ii) all other mothers spent in hospital after delivery in each year since 1995.” —[Official Report, 23 March 2007; Vol. 458, c. 1189W.]
The answer provided by the Minister of State, Department of Health, the hon. Member for Leigh (Andy Burnham), was:
“information is not available in the form requested and it is not obtainable without disproportionate cost.”
Given one of the basic tenets of the Government’s health reforms is to keep copious records and capture hospital episode statistics, why would that information not be available and why would the Government not know how long a patient spends in hospital? Frankly, I find it beyond comprehension that the Government have provided me with such a response when it is clear that they have based their business case for health care reforms and payment by results on the application of tariffs that relate to the amount of time that patients spend in hospital.
The deliberate diversionary avoidance tactics used in many of the answers that I have received do not aid the process of constructive engagement with the issue. That does not set us off very well, so I urge the Minister to look again at the nature of the responses provided by his Department.
Does the hon. Gentleman accept that one of the advantages of payment by results—there are disadvantages—is that it can clarify how smaller maternity units can prove their business case, which is to be welcomed? I remember evidence from Torbay seen by the all-party group on maternity that showed clearly that a smaller unit is viable. Does he agree that that, at least, should be welcomed?
The hon. Gentleman makes a reasonable point, although an entirely different one from mine. Certainly, smaller units do not have the same high level of complex interventions—including obstetrics, clinical and anaesthetics—as tertiary centres. Certain accounting mechanisms can demonstrate a cost-effective service for relatively low-risk—one hopes—patients.
We welcome the policy statement on the future of maternity services set out in “Maternity Matters”, published on 3 April. Having spoken to those in the profession, I think that it has been universally welcomed as a statement on how the Government intend to improve services by 2009. One hopes that the Government can achieve a first-class NHS maternity service in that period.
I congratulate the hon. Gentleman on securing this debate. Although I am sure that the aims set out in “Maternity Matters” are welcomed by everyone, does he agree that too few people are training as midwives in the first place and that those who qualify often cannot find jobs? Although we can all support the aspirations in “Maternity Matters”, they are highly unlikely to come into practice.
I was about to come on to the hon. Gentleman’s point about dealing with the core services that the Government need to provide safely now.
Having investigated the problem with training posts, I think that the picture is mixed and variable. Evidence from some parts of the country suggests that midwife graduates have had difficulty getting jobs, particularly last year, when many posts were frozen owing to budget difficulties in many trusts. I hope that the Minister is listening to the general point: adequate work force planning is needed to maintain experienced midwives, who are crucial to the provision of a safe service, and to ensure that the training available—training in this country is excellent—is adequate and provides the required midwives.
Although it is desirable to improve services so that patients have the luxury of genuine choice, it is important that core services are in place first. That is the theme of my comments to the Minister today. The Royal College of Midwives provided a useful analysis of the policy statement in “Maternity Matters”. As I am sure that he knows, it has undertaken a rigorous analysis of the numbers of midwives required on the basis of actuarial predictions of births, which very often underestimate what actually happens. However, those predictions showed that England needs the equivalent of at least 22,000 midwives. The latest figures that I have show that we are some 3,000 full-time equivalent midwives short of that figure.
I congratulate the hon. Gentleman on his balanced and responsible argument. I welcome the RCM’s extremely fair assessment of “Maternity Matters”, but is he aware that, only a few weeks ago, its position was that there was a shortage of 10,000 midwives? Week after week, that figure was being repeated in the media. He just acknowledged that its assessment now—I shall explain in my speech our position on work force development—is that only 3,000 midwives are needed. Is it not curious that it went from 10,000 to 3,000, and yet still we see the former figure used in press reports week after week?
I am dealing with the situation as I see it now and with the briefing that the RCM provided me with. I shall not attempt to referee a spat between the Minister and the RCM over estimates that might have been made. Having looked at the basis on which the RCM’s calculation was made, I consider it to be a conservative—with a very small “c”—estimate. I think that the figure of 22,000 is an underestimate and that the RCM took a very conservative line. As I interpret the assessment, it is saying that we need at least that many.
I wish to draw out another point demonstrated in chapter 4 of the document, regarding roles and responsibilities—it has fallen open nicely at the right page. Acres of space on responsibilities are given to foundation, delivery, acute, ambulance and primary care trusts. A significant number of bullet points list those with responsibilities: general practices, local authorities, mental health trusts, maternity service liaison committees and so on—right down to 16th place and the smallest sentence of all, on the roles and responsibilities of the Department of Health.
According to the document, the Department’s responsibility is to develop
“national policy and guidance to support and enable local implementation”.
That is interesting. It demonstrates a culture of pushing away responsibility from the Government. In fact, that is in line with parliamentary answers that I have received in recent weeks. On 22 March, I received an answer providing a table on obstetrics and gynaecology figures. It was good to see that, between 1995 and 2005, the number of midwives increased from 3,406 to 4,580—a significant increase, owing largely to the working time directive.
According to the same answer, between 1995 and 2005, the number of registered midwives increased from 18,034 to 18,949, although I understand that the figure has gone down since. However, the figures fail to recognise a relative plateauing—proportionately there are fewer midwives in comparison with the overall NHS work force. Over those 10 years, the role of midwives has increased tremendously. They are now responsible for clinical governance, child protection and public health roles, dealing with, for example, teenage pregnancy, smoking, infant feeding, antenatal screening and the provision of information on choice and continuity of care. They are the overall professional leads for mothers. All those roles come on top of their role in the past, but that is not reflected in the figures.
On 22 March, I received answers to another four questions about average case loads, particularly of community midwives, and about other related matters. Once again, I had the following answer:
“This information is not collected centrally and we have not carried out an assessment of, or provided advice about, the size of case loads. It is for primary care trusts in partnership with local stakeholders to commission midwifery services in order to meet local needs.”—[Official Report, 22 March 2007; Vol. 458, c. 1141W.]
How can the Government publish a document such as “Maternity Matters”, which talks bravely about choices available at grass-roots level, when they do not collect the data and do not make an assessment of the case loads that community midwives are supposed to take on?
The Minister gave a similar answer when I asked what estimates the Department had made of the numbers of midwives needed by the NHS now and in the next five years. He said:
“It is for local planners with support from the workforce review team to determine their future requirement for midwives to meet local service needs.”—[Official Report, 14 March 2007; Vol. 458, c. 441W.]
How can the promises be made in a document such as “Maternity Matters” when it is clear that the Department takes no responsibility for making any estimate of the needs in the service?
Similarly, when I asked what factors were taken into account in estimating the average case load of community midwives, the Minister answered:
“Decisions about the size of community midwives’ case loads are made locally. It is for primary care trusts…in partnership with local stakeholders to commission services”.—[Official Report, 20 March 2007; Vol. 458, c. 863W.]
It is the same answer. How can the Government make the brave guarantees, the statements and the recommendations in a document such as “Maternity Matters” if they are clearly making no assessment and are not even providing any advice?
I thank the hon. Gentleman for giving way again. Can he explain how he squares his ambition for a command-and-control direction of the health service from Richmond house with his party’s rhetoric about localism, devolution and responsibilities being placed at the front line of people in local communities and in local public services? How can he square the rhetoric in his speech on that issue and his party’s underlying philosophy and policies on local devolution and freedom to make decisions related to local need?
The Minister’s statement exposes the problem. The written questions to which I have referred are about information and assessment. Yes, I agree that we should all aspire to achieve minimum levels of guarantee nationally. I see no difficulty at all with a Government taking a view that we should have aspirations to a minimum level of expectation of care at the front line. However, we would have democratically elected authorities delivering that on the front line, rather than those appointed by the Secretary of State to do her bidding, yet the Minister is now saying, “No. Once they are out in the field, on the front line, making decisions, it is their responsibility.” She and he take no responsibility. What is worse—this is the point of exposing the barrenness of those written answers—they make no assessment and they provide no information. There is no monitoring of the situation at all if that is what the Government are saying.
The Minister’s party believes in a more centrally controlled system, it seems. At least, they appoint the trust members to run—
Well, whether it is directly or indirectly, they are certainly not elected by the local populace to represent local people in the community and to defend local services. This is clearly an area of strong argument between the Minister and me. I query the capacity of the Government to talk about a choice agenda in 2009, when it appears that they make no assessment. They are not monitoring; they are not collecting the information that is clearly crucial to them in even talking about rolling out the services in the future.
The primary focus of this debate should be the role of the midwife. [Interruption.] I am trying to explain the main issue to the Minister. At least he understands that the Royal College of Midwives, which he is clearly listening to—at least, I hope that he is—has come up with a recommendation to the effect that 3,000 full-time equivalent additional midwives are required. There is serious pressure on the service.
The “Panorama” programme tomorrow evening will clearly show that in one case—I do not think that it is exceptional; certainly the anecdotes that I hear from front-line staff bear this out—one qualified midwife was responsible for 24 antenatal and post-natal mothers on an acute ward. There are occasions when that happens. The programme will also show that there are serious equipment shortages with regard to CTGs—cardiotocographs.
I hope that the Minister pays attention to the consequences of the resource constraints with which midwives are operating on the front line. Those out in the community tell me that they have been given new computer systems, but they argue that the Government and the consultants whom they use to roll out the information technology programmes need to consult the front line before rolling them out. They are finding that, even though they put all the information into the IT systems, they have to keep paper records, because they cannot get the information out again.
Of course, pay is an issue. It is interesting that, when speaking to midwives, one is aware that they are continually and clearly demonstrating their commitment to and support for the service and their professionalism. Hardly any of them mention, as their first concern, their quite justifiable gripe about the way in which the pay review body’s recommendation of a 2.5 per cent. pay rise for this year will be phased in. The Government have been tackled on that issue a number of times already, but midwives are caught in that conundrum. In effect, this year, they will receive a pay cut, which is poor reward when they are being asked to have ambitions for the future with regard to the rolling out of a policy proposal that is, of course, very welcome—although if it is to be rolled out, we have to get midwives on board.
The professionalism of the service is excellent. The Minister will acknowledge that. However, in this respect we need to consider, for example, the National Institute for Health and Clinical Excellence guidelines with regard to post-natal visits to mothers. The advice is to visit on day one, day five and day 10. If it is part of the Government’s assessment that that is when the community midwife will visit, it may be the professional judgment of many midwives that they should visit on more occasions than that, and that is important. Leaving a newborn baby without a midwife’s visit for the number of days that is proposed in the guidance concerns many professionals.
The Government have claimed that the UK is among the safest places to have a baby, yet following another written question that I tabled, answered on 16 April by the Financial Secretary to the Treasury, I received an answer from the Office for National Statistics that shows that it is almost impossible to make any international comparisons when assessing perinatal statistics, because perinatal information is recorded in different ways in different countries. Even then, however, if we look at the number of maternal deaths per 100,000 live births, we see that the UK does not perform terribly well at all. Yes, the figure is roundabout the European average, but the expanded European Union has many poor countries, as the Minister knows, and certainly the UK is behind Ireland and Italy in respect of maternal deaths.
My hon. Friend may not be aware that, in 2003, the EuroNatal working group reviewed, as an alternative to those difficult perinatal mortality and maternal mortality statistics, the statistics on sub-optimal care that may have led to deaths in maternity units. In a survey of 10 countries, it found that England had the highest risk.
The numbers are so small that a statistical blip can greatly change the statistics. The unfortunate and tragic circumstances at Northwick Park might well be one cause of the difficulties with the UK statistics on maternity deaths. Even so, we in this country should not necessarily be content with the overall figure. I hope that the Minister takes that point on board.
“Maternity Matters” is a welcome statement as far as ambitions for the future are concerned, but I urge the Minister to ensure that the Government can at least crawl before they try to run. Before anything else, they must get front-line and core services in place and ensure that they know how to assess and monitor those services so that they are properly assessed. They must also put safety first and ensure that health inequalities are addressed before they move on to the luxury of choice, which is what the document is primarily about.
Maternity services should be clinically audited to establish how mothers are being treated and where the inequalities are and to monitor how effective interventions are. At the moment, we monitor only mishaps, and stillbirths are recorded as being unexplained. I have spoken to Professor Jason Gardosi of the Perinatal Institute in Birmingham about this matter a few times—I believe that the Minister knows of his work. The professor proposes five basic performance indicators, which I urge the Minister to consider, particularly in relation to early booking and groups such as less well-off, young teenage mothers and other women who do not refer to a midwife early on.
I urge the Minister to address also continuity of care and, perhaps most importantly, the detection of foetal growth restriction, which is a clear indicator of later problems both at the point of childbirth and later in life. Will he consider carefully those proposals and the need for the Government to address issues of safety and the inequalities of health? Will he also consider whether there could be better central monitoring of the way in which the service is managed? We need to get the number of midwives right, to ensure that safety is put first and to get health inequalities right before we have the luxury of choice.
It is a pleasure to have you in the Chair, Mrs. Dean. I hope that this debate is more constructive than the last one to which I contributed when you were in the Chair.
The debate is particularly timely for two reasons, one of which is close to home. Our sixth child was born two weeks ago at Chase Farm hospital, so I have a particular interest in, and some experience of, maternity services in Enfield. I shall focus my comments on those services, particularly the ones with which we had contact during the birth, and the challenges that they face. I shall not go through all six of our children’s births, given the time constraints. I expect also that my wife would prefer not to read blow-by-blow accounts of them in Hansard. I shall therefore focus on just two of them, which provide an example of the challenges that maternity services face.
The debate is also timely because Sir George Alberti’s report on the reconfiguration plans for health services in Enfield and Barnet was published today. The plans include the downgrading and effective removal of the Chase Farm accident and emergency services, and the transfer of consultant-led maternity services from Chase Farm to Barnet hospital. I commend the hard work of my colleague Nick de Bois in Enfield, North, who is campaigning hard on those services.
A little closer to home, our son Toby was born two weeks ago. We ticked all the boxes to qualify for a midwifery-led service—it was a low-risk pregnancy, and we chose to go ahead with that service at Ridgeway birth centre. Similarly, with our third child Dougal, we ticked the boxes and had a midwifery-led service. Those two births, indeed all six, had unique challenges. That is the first point that I want to make: each birth is unique and cannot be fully planned, strategised and targeted. Unexpected complications may arise midway through births or at any time during labour, and it is important when we look at such issues with the mantra of choice in mind that we realise that choice may be taken away unexpectedly during labour.
For Dougal’s birth, we took advantage of the midwifery-led service at Chase Farm and everything was going smoothly until the later stages, when worrying complications meant that we had to be transferred down to the labour ward. Happily, we currently have a labour ward and consultant-led service at Chase Farm, so they were literally just down the stairs. We went down in the lift, but the lift took some time and those seconds were absolutely crucial to me, as a father, and to my wife, who was in the throes of labour. Every second mattered during that transfer.
Toby’s birth, a few weeks ago, was similar. Everything was progressing normally and we were motivated. There was an interview of our leader on television with Andrew Marr, but that did not motivate Toby enough. Neither did the “Match of the Day” highlights. Eventually, he came, but only in his own time and, as he was on his way, there were again complications. If the birth had not happened within the hour, we would again have had to be transferred to the consultant-led service. Happily we had a safety net. We appreciated the fantastic care that the midwives provided, but we were happy to have the safety net of the labour ward just downstairs.
If the reconfiguration plans go through as advised by Sir George Alberti and others, that labour ward will be transferred to Barnet and we will not have that safety net. That is of great concern and might jeopardise children’s lives. We would have been profoundly concerned if we had had to be transferred by ambulance during those births when there were potential complications. We would have had to go to Barnet, but Enfield routinely calls Barnet at night and finds that it is full, and people then have to be transferred to Whittington or to another hospital that has space. Those practical realities must be borne in mind when we talk about choice.
The Ridgeway birth centre, which is a fine centre and which was opened not long ago in 2003, is at risk of being relocated to another area. It has the space and environment to encourage safe and healthy births, and it has one midwife at night—there should be more, but we have already heard about the lack of midwives nationally. The location of that centre is key, because the labour ward is there on hand, and there is no need for transfers further afield. That is important, and we and other parents in Enfield are concerned that the birth centre will be undermined by the loss of the safety net of the consultant-led labour ward that is planned as part of the reconfiguration.
We and other residents feel that the reconfiguration will break up Chase Farm’s maternity services, which have paediatrics and children’s services all under one roof. It will also fragment the midwifery training at Chase Farm. Midwives there tell me that they are very concerned about the plans to move the consultant-led service away from them. That change will also affect people’s confidence in the care that they will receive. Currently, they can be confident of the fine care that they will get at Ridgeway birth centre and confident in the security that if there is an emergency or unexpected circumstance, they will have the benefit of the service downstairs.
The case made by the hospital and, indeed, by Sir George Alberti, who seeks to garner the royal college’s support, is based on numbers. They say that 4,000 births are needed to cover the presence of consultants and that we can have only two consultant-led services in the wider area rather than three. That is one of my concerns, and perhaps the Minister can draw out some of the arguments. Why is the figure specifically 4,000? Is it a fixed figure? Is there flexibility? Should we take proper account of local circumstances? Should proper account be taken not only of the historical figures in Barnet and Enfield, which, it must be conceded, show that there were just about 3,000 births at Chase Farm last year, with just over 3,000 at Barnet and 3,500 at the North Middlesex, but of present demand? Perhaps my family is doing its bit to encourage the demographic trend, but one hears that there is an increase in demand for services. Should we really be hidebound by the 4,000 figure, when that might lead us to do a disservice to many parents who want an all-round choice? Should we look properly at local choice?
The Government have a national strategy of putting mothers and babies first and they talk about giving mothers choice over where to give birth, but the Minister must concede that the reality in Enfield is that choice will be limited once we lose the safety net of the labour ward downstairs. Indeed, the project director for the reconfiguration plans said that
“choice will be limited for those mothers who have been advised that there may be risks to themselves or their baby”.
However, the problem goes further, because life is not that straightforward, and birth certainly is not. As the cases of two of my children illustrate, complications can occur mid-birth, and one needs to be able to choose to have a consultant-led service on hand. Choice should not be limited at such a crucial time. My wife and I relied, happily, on Chase Farm hospital to help care for our new baby and cover for such unexpected emergencies. I am therefore resolved to continue the fight, despite Sir George Alberti and, indeed, the Government’s national strategy, because the same choice should be available to future parents and children at Chase Farm.
I rise to take part, albeit briefly, in this important debate. I congratulate the hon. Member for St. Ives (Andrew George) on bringing the issue before us once more—several of us have debated it regularly. If nothing else, the Government will hear our opinions and, I hope, act on them.
I have a vested interest in this issue, because the Stroud maternity unit has been reviewed more times than virtually anywhere in the western world. Reviews are a daunting prospect, and I feel for the staff every time they are reviewed. Sometimes reviews have a purpose, but sometimes they seem to take place without a purpose, almost as a way of escaping taking inevitable decisions that may not be palatable.
We have had another review, and the hon. Member for Cheltenham (Martin Horwood) will no doubt speak in due course about the implications of the proposals because they take in Cheltenham general hospital as well as Stroud maternity hospital and the Gloucestershire Royal hospital. All those institutions maintained some semblance of their maternity services, but it was a difficult process, and I thank the Minister for talking to me about it personally. It is fair to say the decision was a local one, although the Government did look at it because it sets precedents. Stroud maternity was and, I believe, still is the third biggest independent unit left in the country, so if it were to close, that would set important precedents for independent units elsewhere in the country. I therefore pay tribute to Michelle Poole and all the team at Stroud maternity.
I want to concentrate now on a couple of national issues. The first, to which the hon. Member for St. Ives alluded, is the relationship between the “Maternity Matters” Green Paper and the reviews that are being carried out by the King’s Fund and the National Perinatal Epidemiology Unit. Having been somewhat involved with those giving evidence to the various reviews, I am confused about the relationship between the different elements in the evolution of the Government’s policy. The Government have made their views clear in the Green Paper, and one hopes that it will be a good staging post.
There is also, however, the issue of the two independent reviews, which I totally support. One would think that safety was paramount in this area, but it is interesting that there is a lack of information nationally and internationally about what we mean by safety and what we would accept as the parameters of safety and about other elements involved in childbirth, such as the early take-up of breastfeeding and post-natal depression. There may be a lot of statistics about, but there is not much interpretation of them and there are not many comparisons of different units and different sizes of unit. I therefore welcome the two reviews. I just want the Minister to clarify what we expect the outcome to be. What is the timetable for the two reviews? How will they impact on Government policy, notwithstanding the fact that we cannot prejudge their recommendations?
Having taken part in the review in Stroud, I know that any reconfiguration, to use that dreadful term, is subject to the national picture, and local people certainly feel somewhat hamstrung because they know that things might happen locally as a result of the national driver. The Minister is looking a bit quizzical, but if he could say something about what we expect the two reviews to say, that would help me.
Suzanne Tyler did some good work on Stroud, which I hope will feed into the process. She made a quite devastating analysis of the arguments against shutting the unit and in favour of keeping it open. I hope that that work by an independent consultant and reputed expert in the field will be listened to.
My second national point relates to insurance, and it is the one about which I am really worried; indeed, I am a bit surprised that it has not come up yet. In the debate on Stroud, we got into the nitty-gritty of which unit should be the preferred one and what we meant by choice, but the backcloth to that debate was the issue of insurance. That issue has come up in relation to independent midwives, and I am unclear about what the Government are saying. What help might they offer independent midwives, who play an important role, not least because they can bolster the numbers in some of our units?
If I understand the picture clearly, it is a sad fact that more than half of litigation cases involve maternity incidents. That, of course, is a strong reason for people to have some form of indemnification against being sued. However, we cannot have it both ways. I very much support the choice agenda, and people want low intervention, starting with home births all the way through to midwife-led units, with consultant-led provision at the other end of the continuum. If people are offered choice, however, we must know that it is real choice. If deaths result because units cannot be kept open and midwives cannot keep operating because they cannot get insurance, that is not choice, and we need some clarity on the issue.
I have talked to midwives, I worry that they are beginning to practise very defensive medicine. That may be what any sensible practitioner should do, but if that is the only way in which people operate in their chosen profession, we will not have future generations of midwives, because they will be driven out of the profession. We need to know where we stand and we need to give a clear purpose to people who are doing a difficult job and offering choice. The choice should not entail their being held personally liable if things go wrong. As the hon. Member for Enfield, Southgate (Mr. Burrowes), whom I congratulate, made clear, we need to understand that these things happen and we cannot rule them out.
Recruitment is a key factor in the pressure that midwives are under. There is a dearth of people coming into the profession. I know—I hope that the Minister will say something about this—that more training places are being made available and that we are bringing people into the profession through training, but that is for the future. I am concerned about immediate problems.
We need some transparency. When people are offered a choice, it should be a real one and they should understand the risks. That can happen only through greater transparency. I hope that the Minister will attend carefully to my questions, and, even if we cannot have the answers now, I hope that we shall get some later, because midwives in general want such reassurance. If they do not get it, I fear for the profession.
I congratulate the hon. Member for St. Ives (Andrew George) on introducing the debate, and my hon. Friend the Member for Enfield, Southgate (Mr. Burrowes) on the birth of his child—although I hope that someone has explained to him that babies grow into teenagers. That has been my experience.
As the hon. Member for Stroud (Mr. Drew) said, what is important in the debate is choice. The Secretary of State says that as a consequence of “Maternity Matters”, every mother will have the choice of a home delivery or delivery in a midwife-led unit or a consultant-led unit. Although that sounds very good, behind it there will be the potential for considerable downgrading of services in various parts of the country.
The Horton general hospital in Banbury has served for more than a century a significant area of the United Kingdom—north Oxfordshire, south Northamptonshire and south Warwickshire. We have for a long time—decades, centuries, generations—had a consultant-led unit at the Horton, but that is now threatened with being downgraded to a midwife-led unit. We already have an excellent midwife-led unit at Chipping Norton hospital. Any mother who wants a midwife-led birth can go there.
When the proposals were made, local GPs responded as part of the consultation to the Oxford Radcliffe Hospitals NHS Trust. I think that what they said is worth repeating:
“We remain opposed to the proposals on the grounds of safety, sustainability and the reduction in access to basic health care and choice for our patients, which will affect especially the most vulnerable.”
They continued by discussing maternity services specifically:
“Under the proposed model mothers who may fail to progress or show signs of foetal distress in the second stage of labour, or who have prolapsed cord or haemorrhage, would require very rapid transfer to Oxford. Given the numbers involved this would carry significant risk and would be inhumane.”
That is a strong word. Their submission continues:
“There would be an increase in the burden of responsibility on midwives and ambulance crews. Legal claims”—
the comments of the hon. Member for Stroud are relevant here—
“following incidents where there was harm to the mother or baby might be very costly to settle.
Babies born in need of immediate resuscitation would incur a transit time of approximately one hour. The idea that paediatric cover could be provided safely from Oxford in these circumstances is false and dangerous.”
The submission states:
“We submit the opinion of Professor James Drife who wrote in the BMJ...about the shortfalls of midwife led units...It accords with recent publications by NICE on the safety of such units”
“We are not reassured and maintain that a midwife led unit with a delivery rate of 450+ per annum, which is 25 miles away from the nearest obstetrician and paediatrician, is not safe. Through no fault of the midwives working in such a unit, GPs would have to consider the wisdom of recommending mothers to this service, numbers would drop further and the service soon become non viable”.
“A midwife led maternity unit, possibly lacking the confidence of local GPs, may well wither. Kidderminster had to close its unit due to excessive neonatal mortality (6 avoidable deaths in under 2 years). Increasing concern about such units is being expressed by RCOG and NICE.”
RCOG is the Royal College of Obstetricians and Gynaecologists. The GPs’ submission continues:
The existing serious congestion at peak times and lack of parking facilities at the JRH site will be worsened by 1,000 to 1,600 extra deliveries per year. All emergency surgery and major gynaecology currently managed in North Oxfordshire will need to be absorbed by the JRH as will all paediatric cases requiring overnight assessment or admission.”
The GPs said:
“We conclude that the current proposals...will result in services which are unsafe and unsustainable into the future”
“are not in the best interest of our patients who will be faced with serious obstacles in both accessing services and visiting sick children or relatives. The most vulnerable will be hardest hit.”
They believe that the proposals
“will increase demands on the ambulance services and its crews and on already overstretched departments at the JRH...will have consequences both in medico-legal and human terms that are far reaching and expensive...adhere to an outmoded model of centralisation that ignores more modern trends to bring services closer to patients...ignore the clear recommendations of the Davidson Inquiry and the prerequisites of the agreement to merge into a single trust”
and that they
“are overly influenced by a small group of medical specialists in Oxford who have plans for centralisation that ignore the expressed and documented needs of this community.”
The GPs end their submission:
“These proposals offer neither a better deal for children nor security for a range of other services vital to our local community”.
Those views were in a document signed by 85 local family GPs from north Oxfordshire, south Northamptonshire and south Warwickshire. As a consequence, not surprisingly, the trust took its proposals off the table and set up two clinically led working parties on paediatrics and children’s services to see whether they could find an approach that GPs would find acceptable. They are still deliberating.
I have one concern and one question to put to the Minister in that respect. I can see no justification for keeping the membership of the working parties confidential. I understand why they might want to deliberate in private; however, I walk into the Court of Appeal every day, where the lords justices of appeal deliberate in private, but I know who they are and they are accountable. It cannot be right, as a matter of public policy, that clinicians should decide whether their participation in the working parties should be made a matter of public record. It undermines confidence in the system and the process if my constituents are told that they cannot know the membership of the bodies that will determine the future of services at their general hospital.
At the end of the process the working parties will, I imagine, make proposals, which will vary to some extent from those that were originally on the table. GPs will have to decide whether they think the amendments make the changes safe. They consider the existing proposals unsafe and inhumane. Unless there is overwhelming support from GPs for the changes, given their total opposition to the changes to date and given that the Horton will no longer have consultant-led midwifery services, I want to ask that, if in those circumstances the matter is referred to the Department, the Secretary of State look favourably on the idea of the proposals being considered by the independent reconfiguration panel.
I share the concern that was put to me by a GP, who said that he and his colleagues felt constantly worn down by academic professional pressure to accept as the least worst option something that they were not happy with but thought they would end up with. GPs have been put in an intolerable position in all of this, and I still have a very unhappy impression of the situation. We want to continue to have a general hospital in Banbury that provides the full range of services of a general hospital, including consultant-led midwifery.
Taking away the consultant-led unit from the huge catchment area that has had such a unit for as long as anyone can remember because there is a midwife-led unit down the road, or another consultant-led unit an hour away, does not enhance choice, but undermines it. It means that there is a worse service, and nothing that the Minister or anyone else does will persuade my constituents that a service that they see as worse than the present one is an improvement to the NHS. If the Minister believes otherwise, he is welcome to come to Banbury at any time and meet people from the “Keep the Horton General” campaign, which has been ably led by George Parish, a local Labour councillor. I do not believe that it is possible to get that message across because people realise when their services are being downgraded, and services are being downgraded in Banbury.
I join others in congratulating my hon. Friend the Member for St. Ives (Andrew George) on securing this debate. Given the subject, it is slightly bizarre that it is being conducted entirely among male MPs. That is yet another example of why Parliament needs more women. As my hon. Friend pointed out, it is appropriate that the debate is taking place during midwifery week, which celebrates the role of midwives and enables us all to congratulate them on the role that they so often play in making childbirth a healthy, happy and fulfilling experience for all concerned.
This year in particular, midwifery week is drawing attention to the fact that childbirth is not only a physical experience, but a social and emotional one. The hon. Member for Enfield, Southgate (Mr. Burrowes), who spoke about his personal experiences, illustrated that well. That means that where childbirth takes place and the nature of the experience are just as important as the physical outcome of the process, or at least important alongside the physical outcome. An increasingly important part of the philosophy of patient care is paying attention not only to the physical needs of patients but to their wants.
The Government’s national director for patients and the public, Harry Cayton, who is a brilliant man with whom I have had the pleasure of working, said that
“it is essential that we put the needs and preferences of patients and service users at the centre of all we do.”
In this respect, it is right that the words that emerge from Government policy are more often than not words with which we can agree. The trouble is that the practice is often very different, as hon. Members have pointed out.
Let us review the evidence on the policy itself. Going back as far as 2003, positive policy statements were made. “Keeping the NHS Local—A New Direction of Travel”, which was published in February 2003, contained the general aim of retaining good local services. It clearly stated:
“The mindset that ‘biggest is best’ that has underpinned many of the changes in the NHS in the last few decades, needs to change. The continued concentration of acute hospital services without sustaining local access to acute care runs the danger of making services increasingly remote from many local communities.”
I would certainly agree with that. The document pointed out clearly, as the hon. Member for Banbury (Tony Baldry) has done, that we should not be concentrating services in certain regional or other centres at the cost of providing a lesser service somewhere else. It said that the focus should be
“on redesign not relocate. Redesign can offer a high quality alternative to relocating services, extending the range of options for developing new configurations that meet local needs and expectations”.
Again, the emphasis was on what local people want. I have experienced a campaign in which 10,000 people marched through the streets of Cheltenham trying to get not just what they needed, but what they wanted. Many hon. Members have had similar experiences.
The document also specifically addressed maternity services, stating:
“The challenge facing maternity services is the need to identify EWTD-compliant models of care in the middle ground between large consultant obstetric units and midwife-led units.”
That was one of the clouds already looming on the horizon, because the European working time directive was clearly going to pose a challenge to the delivery of the existing model of maternity care. The Government were rightly thinking about how to respond, but in that 2003 document they were not thinking in terms of the large-scale centralisation of services, let alone of reductions in the number of midwives or of midwife training places. They were talking about developing the middle ground between very large units, of which we have an increasing number in this country, and midwife-led units. That sounds great: it sounds just like Cheltenham general hospital’s St. Paul’s wing. Its 2,500 deliveries a year makes it quite big for the rest of Europe, but in the middle to small end of delivery units in this country, where the trend is increasingly towards giant maternity units.
Other policy documents have been published. In July 2004, the wonderfully named “The Configuring Hospitals Evidence File: Part One” was published. One of the sections was specifically on maternity, where it was stated:
“Recent research shows that childbirth in such centres”
—midwife-led maternity units—
“is as safe as in consultant-led units, provided that a) admission is restricted to low-risk women or b) if the midwife unit is not located near a consultant unit, there are efficient escalation protocols for transferring the woman to an acute hospital.”
Other hon. Members have alluded to the need for proper escalation protocols, but that should reassure those hon. Members who were expressing concerns about the risks inherent in midwife-led units, as the hon. Member for Banbury seemed to be doing at times. I hope that the reviews that we know about will conclude that, when properly managed, and with proper escalation protocols, midwife-led units can be a safe and positive alternative. Certainly, the National Childbirth Trust believes that they offer the best outcome for those in low-risk categories, and often offer better continuity of care for women.
In 2005, the latest Labour manifesto was published. It contained the very positive statement:
“By 2009 all women will have choice over where and how they have their baby and what pain relief to use. We want every woman to be supported by the same midwife throughout her pregnancy. Support will be linked closely to other services that will be provided in Children’s Centres.”
I congratulate the Government on the approach based on children’s centres and on the use of Sure Start to support antenatal classes; those are positive things. I also support the words in that statement. As we have all said, choice is important and the way in which it is delivered is important. There is no reference in any of those documents to reduction in the number of midwives or to the centralisation of services.
Does my hon. Friend acknowledge that in many parts of the country antenatal classes are declining or closing? That is having a direct impact on the welfare of mothers, particularly as they need to build up social networks of other parents post-natally. That is important for their mental welfare after their child is born.
I am grateful to my hon. Friend for saving me time, because I was going to point that out later. Antenatal classes, by their nature, also help to reduce complications, so they are even a cost-saving device as well.
As I was saying, there is no reference in any of those documents to a reduction in the number of midwives or to the centralisation of services. The clear of thrust of stated policy was in the opposite direction, towards localism and more choice. That was reinforced in a health White Paper that supported the concept of care closer to home and more choice in maternity.
In February, Sheila Shribman, the Government’s maternity tsar, set out the choices that women should have:
“a home birth supported by a midwife, or…birth in a local facility under the care of a midwife such as a designated midwifery unit”
or—this was carefully phrased—
“birth supported by a local maternity care team that includes a consultant obstetrician. For some women, this type of care may be the only safe option.”
This is where we start to get to the nub of the problem with the concept of choice, because once the number of consultant-led units in an area is restricted, as we have heard is happening in Oxfordshire and may happen in Gloucestershire, there is the risk that for many women for whom such care is the only safe option, there is much less choice.
There were subtle differences in the phraseology used in “Maternity Matters”, which was published last month, because the parallel statement in that Green Paper was
“birth supported by a maternity team in a hospital.”
The word “local” was conveniently dropped. It continued:
“For some women, this type of care will be the safest option”.
That is not what Sheila Shribman said. She said clearly, and more realistically, that for some women such care may be the “only safe option”. The impression of choice is being given, but the reality is different when maternity units start to close.
I shall illustrate that with an example that might be close to a Minister’s heart. I gather that the Prime Minister might be moving house soon and that he may have a little more time to spend with his family. He will find that within nine miles of his new home in Connaught square, there will be 19 obstetrician-led maternity units. By contrast, the residents of Clyde crescent, which is one of the poorest areas in my constituency, will, if the planned changes go through, have a choice of just one obstetrician-led maternity unit within 20 miles—twice that distance. Their journey distance will change from just over a mile to Cheltenham general hospital to more than nine miles to Gloucestershire Royal hospital along the congested A40 into an unfamiliar city.
The hon. Gentleman keeps referring to a reduction in the number of midwives. Will he correct the record because that is entirely inaccurate?
How on earth can we pore over locally based geographic decision making from an office in Richmond house in Whitehall, Westminster and make the right judgments and the right calls, locality by locality in this country? Why mislead people into believing that that is possible or desirable?
Thank you, Mrs. Dean. I shall draw my remarks to a close by quoting the Royal College of Midwives, which makes it clear that the number of midwives is falling and not rising—[Interruption.] The Minister does not believe me, but in 1997, there were the equivalent of 18,000 full-time midwives. By 2006 that had risen to 18,862, but it has now fallen. That is so whether measured by full-time equivalents, head count numbers or even training places. In a recent survey, two thirds of heads of maternity reported that their unit was understaffed, and more than one in five reported that their midwifery staffing establishment had been cut. The general secretary of the royal college says:
“With this situation women are not going to get the choices they’ve been promised. Some areas are struggling to provide even basic services. Vulnerable and disadvantaged women who need the most intensive support will suffer the most."
I, too, congratulate the hon. Member for St. Ives (Andrew George) on introducing the debate and other hon. Members on contributing to it. The topic is important. It is vital that NHS services are both safe and accessible, and we thank midwives throughout the country for all that they do, often in difficult circumstances.
As we know, this is midwifery week. It was organised by the Royal College of Midwives, which does an excellent job of representing its members and highlighting the important issues for discussion.
There is no doubt that the Government have set out an ambitious programme to give women more choice and better maternity support, and they should be congratulated on that. However, there can be no substance to those proposals while the NHS continues to suffer a shortage of midwives and the closure of maternity units. Those problems cannot be denied and I shall be interested to hear the Minister’s response. Those two themes run through all the issues facing maternity and midwifery services.
Let us start with the number of registered midwives working in the NHS. I agree with the Minister that the Royal College of Midwives has estimated that an extra 3,000 midwives are needed if the Government are to deliver their promises in the document, “Maternity Matters”. However, what do we find? We find that overall the number of midwives has fallen for the second year running, having fallen during the last year in question by 339. The number of full-time equivalents—in our opinion the best measure of the availability of a midwife at any time—has risen by 4.5 per cent. since 1997 according to Government statistics, but that has failed to keep pace with the birth rate, which has increased by 9 per cent. since 2001. If the number does not keep pace with demand, it puts increasing strain on midwives.
In this place, we often bandy figures about in the hope that they illustrate our arguments and so on, but I propose to the Minister that the situation is even worse than the figures suggest because midwives not only work shorter hours than 10 years ago, but the maternity case load is even more complicated, with more mothers giving birth earlier and later in their lives. That is complicating the casework.
At a result, understaffed maternity units are overstretched. According to a survey by the RCM, an estimated two thirds of department heads thought that their units were understaffed, with posts being cut and too much reliance being placed on maternity care assistants. As we have heard from a number of hon. Members, a BBC “Panorama” programme tomorrow will confirm that picture, with overworked midwives afraid that they do not have enough time to give patients the right level of care.
On top of that, vacancy freezes brought about by financial deficits will only make matters worse. Figures confirmed by the Government show that by November 2006, a third of all midwives who had completed training since May 2006 had not found their first job in the NHS—a total of more than 4,200. Apart from the consequences for the NHS generally, the cost of training those professionals for unemployment was around £230 million. That money could be better spent on patient care.
Perhaps most disheartening is the impact of understaffing on the Government's own pledge to provide women with one-to-one continuity of care by a named midwife by 2009. That is an important aspiration—the gold standard in maternity care—yet it cannot be achieved without a substantial increase in the number of midwives. In view of all those concerns, will the Minister take this opportunity to state clearly and for the record what estimate he has made of the number of additional midwives needed to meet the challenges set out in “Maternity Matters”?
It is doubly worrying that the fall in the number of midwives is taking place against the backdrop of maternity units being closed throughout the country, as a number of hon. Members have said. Last December, we identified up to 21 midwife-led units under threat. Those centres are often based in the community rather than in hospitals, and they offer women a less medicalised birthing experience. They tend to be well loved resources and should be protected. I suggest that without local midwife-led units, the Government cannot realistically offer women alternatives to giving birth in a highly medicalised environment in hospital. Only by making those options more widely available can we enable women to question the received wisdom that medical intervention is the preferred option.
The only other alternative to hospital is home birth, but only 2 per cent. of women giving birth do so at home, although many more would like to. Again, the shortage of midwives impacts on that. There is already a striking north-south divide for women who are helped to give birth at home, with women in Devon seven times more likely to secure a home birth than women in Merseyside. The Government say that they want to make home births more widely available, but plans to reconfigure consultant and emergency services around fewer and larger regional centres works against that objective. As many as 15 per cent. of planned home births result in a transfer to hospital and those transfer times and distances are likely to be longer in future because of the Government’s plans to centralise services. That policy could put lives at risk.
Conservative Members are very concerned about the Government’s proposals to concentrate consultant services. First, there is still no clear evidence base or clinical model for the move towards fewer, larger maternity units, yet the Government seem to be hellbent on encouraging mothers-to-be to give birth in ever larger units. We are increasingly being told that larger, consultant-led units with more than 3,000 live births a year are safer for women, but the National Perinatal Epidemiology Unit is not due to report on the topic until 2009, so on what basis can those assertions be made?
Meanwhile, the move to larger units goes against the grain of maternity provision on the continent. The largest unit in Germany has only a little more than 3,000 live births a year and the largest in France has 4,000. In contrast, English maternity units, such as the one that is being investigated by the BBC at St. Mary’s hospital in Manchester, often deliver more than 5,000 babies a year. That is not to say that all larger units are worse, but the clinical case for ever larger units has not been made, and the Government should recognise that before they continue down the line of encouraging mothers to give birth in ever larger units.
I know that the Minister has taken issue with the Greater Manchester reconfiguration in his own backyard, but the problem is that the Prime Minister and the Secretary of State for Health have both endorsed the principle of larger, fewer units. Some people would argue that there is an element of hypocrisy in that state of affairs: the Minister who is present argues one thing in his own backyard while he peddles a national policy that goes against that local argument.
In the time allowed, I must mention independent midwives. The Government seem determined to ensure that independent midwives take out professional indemnity insurance, despite the fact that they are unable to obtain it because of the high premiums that reflect the potentially huge payouts involved. There is no clear evidence of a link between possessing insurance and being a safer midwife; if anything, the intuitive link runs the other way, because midwives stand to lose everything in cases of negligence. Their services are especially valued by women who are either fearful of highly medicalised interventions during childbirth, or have had a bad experience in the NHS.
Will the Minister explain why the Government seem hellbent on pursuing that argument and policy on insurance without at least granting a consultation? We have requested one, but we have not received an answer from the Government. I raised the issue in a letter to the Secretary of State on 29 March, but so far, I have not had the courtesy of a response. Will the Minister now respond by promising the House and all independent midwives that the Government will consult on their proposal?
In conclusion, the principles of one-to-one care and choice in maternity are the principles on which the future of maternity and midwifery services ought to be based. However, the Minister must right now start explaining how we can deliver the Government’s pledges without the appropriate increase in midwife numbers, and while the Government pursue the policy of closing midwife-led units.
In terms of equal distribution, the hon. Member for Billericay (Mr. Baron) has left me with less time than I should have had to answer what has been a substantive debate. However, I do not think that he did so on purpose.
I congratulate the hon. Member for St. Ives (Andrew George) on securing this important debate during the international week of the midwife. I pay tribute to the tremendous work that midwives do every day on the front line of maternity services in this country, to the contribution that the Royal College of Midwives makes to these debates and to raising the profile of such issues in Parliament, and to the leadership of Dame Karlene Davis. The RCM has been consistently supportive of the vision and the plan that was outlined in “Maternity Matters”, despite expressing genuine concerns about some of the issues that have been raised during the debate.
We have heard from hon. Members that, during maternity, women and parents will experience arguably one of the most important periods in their life, and all that I ask for is balance in the debate about the state of maternity services. It is the height of irresponsibility to suggest that somehow, the majority or even a significant number of women will have a poor maternity experience in our hospitals.
The balance of the debate has suggested it, but it is not supported by one jot of evidence.
Let us hear some statistics. We invested a total of £1.67 billion in maternity services in 2005-06. Between 1997 and September 2006, the number of midwives employed in the NHS increased by 9 per cent.—a whole-time equivalent increase of 5 per cent. The number of students entering the profession rose by 44 per cent. between 1996-97 and 2005, and the projection is that 1,000 additional midwives will qualify by 2009. How anyone in this debate can suggest that that represents a reduction in the number of midwives—
I have no time to give way.
The number of consultants in obstetrics and gynaecology in England has increased from 1,032 to 1,506—an increase of 46 per cent. In summer 2005, when women were last asked, 80 per cent. of those surveyed said that they were satisfied with the maternity services that they had received. In 2001, we committed £100 million additional capital investment to improve maternity facilities, and we are still spending that money. So let us be clear: there has been a tremendous amount of investment and tremendous advances in maternity services. Do we still have many challenges ahead of us to achieve the gold standard in maternity services? Most definitely, we do.
To achieve the vision in “Maternity Matters”, we have made it clear that, in addition to the introduction of those 1,000 midwives, other measures will have to be taken in local health economies where the work force is not at the appropriate level to deliver that guarantee of choice to women. We have made it absolutely clear to primary care trusts in local health economies that they will have to commission additional midwives if they do not have a sufficient baseline number of midwives; they will have to consider all the professionals who contribute to the maternity experience and get them working together; and they will have to entice back to the NHS some of the midwives who have left.
The hon. Member for St. Ives and other hon. Members talked about the roles and responsibilities of the Department vis-à-vis the local NHS. I find it staggering that, time and again, we hear rhetoric from both main Opposition parties about maximum devolution, localism, local determination and being in the best place to respond to the needs of local communities, but that we are then criticised for not commanding and controlling every decision from offices in Westminster and Whitehall. It is a complete intellectual contradiction.
From the centre, we can make resources available, specify the outcomes that we expect, put maternity high up the NHS annual performance assessment framework, give the Healthcare Commission the power to inspect to ensure that maternity services are adequate and ensure that the local health service leadership understands that maternity must have a new priority and that strategic health authorities commission and develop services to deliver “Maternity Matters”.
The hon. Member for St. Ives says that the Government appoint people to run health organisations. Does he not realise that the independent NHS Appointments Commission is a source of great angst to many Government Members?
The hon. Member for Enfield, Southgate (Mr. Burrowes) made a very personal contribution, and I congratulate him. The slogan that comes to mind is, “Cameron fails to deliver, Labour ends triumphantly,” but perhaps the hon. Gentleman would not necessarily accept that.
During the debate, hon. Members made several points about reconfiguration, but let us be clear that, whatever decisions are made locally, every woman must have access—through real choice—to a consultant-led service, a midwife-led service or a home birth. Wherever they live, in whatever part of England, such access is absolutely central to the “Maternity Matters” guarantee that will be in place by the end of 2009. Any decision about reconfiguration in Banbury or anywhere else must lead to a scenario in which any woman has access to such choice.
I say to the hon. Member for Banbury (Tony Baldry) that if the scrutiny Committee refers the decision—I do not think that it has been made, by the way—to the Secretary of State, she would of course consider the weight of evidence from a variety of sources in her determination about whether to send it to the independent configuration panel. I shall write to the hon. Gentleman about the membership of the working party and why there is no transparency in that respect.
I say to the hon. Member for Cheltenham (Martin Horwood) that change in some areas—in many areas—may be necessary for safety, quality and choice. Politicians should be frank and honest about that. However, not all proposed changes are right, and frequently, local communities do not like the proposals, which is why Parliament has laid down clear processes, so that local communities and commissioners have the right to say, “A proposal in our area does not best meet our needs.”
I say to my hon. Friend the Member for Stroud (Mr. Drew) and the hon. Member for Billericay that we are working with independent midwives to resolve the insurance issue.
Education Funding (F40 Group)
It is a great pleasure to have this opportunity to address Westminster Hall and the Minister for Schools on an issue of such importance to my constituents. I am going to talk about the state of education in the East Riding of Yorkshire and the funding of that education system. I shall then discuss the F40 model, which is a mechanism by which the Government can better target funding towards those most in need. Finally, I shall touch on the school early years and 14-to-16 funding consultation that the Department for Education and Skills is currently conducting.
The structure of my remarks will be remarkably similar to that of a speech that I gave on a similar subject in March 2006. As the Minister knows from personal experience in his constituency, however, the problems do not go away easily. I am delighted to see a Minister here who led a delegation to meet the Secretary of State for Education and Skills in 2002, precisely to challenge what he described as the unfair distribution of funding among education authorities throughout the country. Although he has been the Minister now for a year, we have high hopes that he will eventually lead the transformation of the system and bring about the greater fairness that we want.
The East Riding of Yorkshire is an improving education authority. It is above the national average at key stage 2 and key stage 3. At GCSE, 62.2 per cent. of pupils gained five or more A to C grades, as compared with a national average of just 59.2 per cent. I want to highlight the performance of two schools in my constituency. First, Longcroft school and performing arts college in Beverley had serious weaknesses just three years ago, but it is now ranked as the country’s fifth most improved school, with more than 60 per cent. of its pupils achieving five or more A to C grades, including in maths and English. Secondly, Beverley high school for girls is, once again, the top performing comprehensive in the East Riding at GCSE, with 78 per cent. of pupils achieving five A to C grades. Even with the inclusion of English and maths, 71 per cent. of its pupils achieved five good GCSE grades.
I pay tribute to the pupils, staff and head teachers in the East Riding, as well as to the local authority, which does an exceptional job in challenging circumstances. When I met the Minister to discuss the issue last year, he accepted that low-funded authorities had made Olympian strides to improve standards in some cases. However, that does not change the unfairness of the funding formula, which he rightly identified back in 2002.
East Riding schools receive funding well below the national average. Last year, the East Riding received a guaranteed unit of funding per pupil of £3,322, through the dedicated schools grant, and it will receive £3,535 this year. That compares with nearby Hull, which will receive £3,999 per pupil, and with Tower Hamlets, which will receive £6,028. The national average, meanwhile, stands at £3,888—I do not know what a numerologist would make of the repetition.
If the East Riding were to receive the same amount of funding as Hull, an additional £21 million would be available to share among the schools. How does that affect schools in my constituency? In 2005-06, Bilton primary school in Holderness received £2,458 per pupil, whereas Wansbeck primary school received £2,922 per pupil, yet those schools are less than a mile apart. Despite its rurality and areas of deprivation, the East Riding is the fourth-worst funded education authority in the country.
The East Riding’s allocation for this year represents an increase of 6.4 per cent. That sounds generous, and I am sure that the Minister will rehearse comments about increases in funding over the years—regardless of any pleas not to. However, that increase is below the national and regional average, as he knows. The national increase in 2007-08 will be 6.7 per cent., while the increase in Hull will be 7 per cent.
The cash gap between the highest and lowest funded authorities is therefore widening. Since 1997, although there has been a substantial increase in education funding, that gap has increased by more than £600. Even over the comparatively short period of the new funding arrangements, from the base year of 2005-06 to 2007-08, which the Under-Secretary of State for Education and Skills, the hon. Member for Corby (Phil Hope) mentioned last year, the gap between the funding per pupil in the East Riding and the national average has increased by a further £59 per pupil. That gap equates to £2.84 million missing from my constituents’ schools.
The Conservative-led local education authority has worked hard to make up for central Government’s inequitable distributions. It has maximised spending on schools, largely by reducing central costs, particularly on strategic management. Last year, for example, the proportion of the dedicated schools grant delegated to school budgets was more than £2.7 million above the average for similar-sized authorities. That was achieved by reducing spending on strategic management to £61 per pupil, as compared with the national average of £87 per pupil, which represents a saving of £1.3 million.
Using its excellence fund, the authority put £1 million extra into schools above the Government’s spending guidance.
The authority has managed to find the extra money to put into schools and demonstrated that it can be converted into improvement and genuine delivery for pupils throughout the area. However, there is no getting away from the shortages in funding, which are having a devastating impact on the ground. I have spoken to many head teachers in the East Riding, almost all of whom have told me that they will be forced to make substantial cutbacks in the near future.
Beverley grammar school, which I have visited, is currently £160,000 in the red. It has been hit with increased costs of £420,000, including a £51,000 rise in exam fees and a £28,000 increase in energy costs. The head teacher, Chris Goodwin, recently said:
“I will make cuts. They will have a big impact. Hull schools are swilling with money compared with us. We are in a funding crisis and morale and energy are being sapped. I despair because I can’t see how it is possible to raise standards in such circumstances.”
Beverley high school is more than £100,000 in the red, despite making cutbacks. The head teacher, Ruth Vincent, whom I have also visited, has said:
“Beverley High School will be facing a £400,000 deficit in 2008-09. It is becoming increasingly difficult to maintain standards.”
Roy Cooke, the East Riding secondary heads convenor and head teacher of Wolfreton School, has said that he expects to cut five teaching posts by September. He added:
“We are having to look at making savings, which means spending less on teaching and learning.”
Overall, 24 of the East Riding’s 159 primary and secondary schools are in the red. That shows the impact on the ground of the Government’s current funding formula and the above-inflation increases in costs with which schools are having to contend. The rising cost of energy, for example, has had an adverse effect on the budgets of many schools. Energy costs increased by 54.72 per cent. in 2005-06, compared with the previous year. The cost of exam fees for East Riding schools, meanwhile, increased by 16.74 per cent. between 2004-05 and 2005-06. As overheads increase, the budget for other resources becomes increasingly squeezed. Coupled with falling rolls, resources, such as extra classroom support, are therefore often forfeited to balance the books. The East Riding’s low funding base restricts the opportunity to accommodate falling rolls.
The area’s rurality has also had an impact. The East Riding of Yorkshire is the largest unitary authority in the country, spread ever 930 square miles and with a population of 327,000. The 2001 census showed that 51 per cent. of the population lived in rural areas, compared with an average of 20 per cent. for the Yorkshire and Humber region as a whole. The East Riding has a number of small village schools, which have financial and rural isolation issues. A recent report by TeacherNet showed that primary schools with between 80 and 100 pupils cost 16 per cent. more per pupil to run. If the school has fewer than 50 pupils, the cost per pupil increases substantially. The Under-Secretary told me last year that the formula recognises rural circumstances. I am sure that the Minister knows that it does so, but insufficiently.
The allocation of funding according to where people live, rather than where they are educated, compounds the injustice. More than 2,000 pupils who live in other local authorities are currently at schools in the East Riding. As John Mager, the former director of education in the East Riding, has said:
“One secondary school in the East Riding of Yorkshire receives 30 per cent. of its intake from one of the most deprived and disadvantaged estates in Hull. They will be expected to provide the personalised learning which many of these children will require but the proposals for deprivation funding will not provide the East Riding with the funds to support the school.”
The East Riding does not discriminate against incoming pupils, but the cost of providing the additional support needed is met by pupils across the area. That is clearly inequitable, given that pupils in Hull receive £464 more in funding than those in the East Riding. It is not as though places such as Withernsea in my constituency do not have deprivation issues; the January 2004 Ofsted report on the local education authority stated:
“Pockets of social deprivation, the steadily rising inward migration from neighbouring urban districts, the remoteness of some parts of the region and relatively low funding levels all pose a challenge.”
As I told this Chamber last year, Bridlington South, Bridlington Old Town, Bridlington North, Goole and South-East Holderness are among the 33 per cent. most deprived wards in the country. Household income is below the national average. The effect of the Government’s funding model is that children who live in rural areas, some of whom are relatively poor, can receive absolutely nothing that recognises the deprivation that they suffer. The application of that aspect of schools funding is crude in the extreme.
The main result of the inequalities is that East Riding pupils are now being forced to make do. Activities involving off-site provision—trips, co-operative activities with other institutions or off-site course provision—are simply out of the question. The breadth of curriculum provision is increasingly limited to what can be provided on site. Specialist teachers of shortage subjects, such as physics and maths, are becoming more and more difficult to recruit, and they are easily persuaded to accept posts in better-funded areas. Moreover, the majority of East Riding secondary schools run some classes in which the week’s teaching is split between two or more teachers. In a worrying number of cases, non-specialist staff regularly carry a share of the teaching.
What can be done? It is great that the Minister is here today, because the current review into the school funding system for 2008-09 and beyond is timely. He will know all about the F40 group of poorly funded local education authorities, of which the East Riding is a member. Those authorities represent almost 16 million people and more than 200 parliamentary constituencies. Through East Riding council, the group devised the F40 pupil entitlement model, which is used to determine the needs of individual education authorities and schools, based on the needs of the individual pupil and what it costs to run a school.
The model shows that, by using an index of multiple-deprivation data and education data, it is possible, within the education management system, to attach a deprivation score to each child using a home postcode. That formula would better reflect the social and educational needs of every child in the country.
Under the “Every Child Matters” programme, the Government are obliged to provide young people, wherever they live, with the same life opportunities. All children, no matter where they live, should have the same level of access to well managed and serviced schools. They should also have access to inspirational teachers and up-to-date resources and equipment. That way, children of all ages will have the best opportunity to fulfil their potential—an aspiration that I know the Minister will share.
Last year, the Secretary of State said:
“All we have to do is raise the bar and close the gap.”
If we could close the gap in the current funding formula, standards of teaching and learning would almost certainly improve and the five outcomes of “Every Child Matters” would become a reality. The Department’s consultation paper acknowledges that the basis for the current formula is inequitable, that it is not based on social and educational needs and that it generates a very large and increasing gap between the best and worst-funded councils. I hope that the Minister, having accepted that, will give a firm guarantee today that he will work with his colleagues to put that right for the betterment of children throughout the country—from my point of view, particularly those in East Riding.
I congratulate the hon. Member for Beverley and Holderness (Mr. Stuart) on securing this important and topical debate and welcome the opportunity to bring the issue of the current review of school funding to the House. However, as he is aware, the consultation does not close until the end of this month, and that constrains the extent to which I can comment on some of the specifics. I do not want to prejudge the consultation.
As the hon. Gentleman did, I congratulate the teachers and pupils in his constituency and the whole area of the East Riding of Yorkshire for their continuing hard work and achievements. Last year, 78 per cent. of East Riding pupils reached the required standard in science at key stage 2, three percentage points up on 2005, and six points above the national average. Meanwhile, the number of East Riding 15-year-olds achieving five good GCSE passes or the equivalent increased last year to 62 per cent.—again, above the national average. If English and maths are included in the calculation, young people in the East Riding achieved 4.4 percentage points above the national average at GCSE, and 9.5 points above the regional average. All were excellent achievements and all staff and pupils associated with those results should be warmly congratulated.
You will pleased to hear, Mrs. Dean, that I shall now turn to education funding, the subject of this debate. It is important to remember that all local authorities have seen substantial increases in funding under this Government; I should put that on the record even though the hon. Gentleman anticipated that I would. Total revenue funding per pupil in the East Riding went up by £1,090 in real terms between 1997 and 2005, an increase of almost 40 per cent. It puzzles me that that increase is more than ours in Dorset, where the real-terms increase was only—“only”, he says—£980, an increase of 34 per cent. The increase for the East Riding is virtually the national average increase, differing by 0.2 percentage points. From 2006, we introduced the dedicated schools grant and a two-year school funding settlement. As the hon. Gentleman said, that gave the East Riding increases in core funding for schools of 6.6 per cent. per pupil last year compared with their spending the year before, and a further 6.4 per cent. per pupil this year.
What has the increased investment bought? Obviously, talking only about money becomes fairly meaningless without a sense of what it can deliver. Since 1997, East Riding schools have been able to employ 360 more teachers, 610 more teaching assistants and 450 more other support staff. Spending on school buildings has also increased dramatically. Ten years ago, the allocation for East Riding was just £1.3 million. For the years 2005-06 to 2007-08, we plan to allocate £58 million to East Riding council and schools in its area. That includes more than £14 million of targeted capital funding; I congratulate the council on having successfully bid for that to support two major capital projects. I have already talked about the results that investment in people and buildings has produced. Looking ahead, investment in education will continue to build on the increases of the past decade. The most recent Budget contained the settlement for education, skills and children’s services until 2010. Overall investment will continue to increase by 2.7 per cent. per year in real terms.
In 1997—at the moment, it is fashionable to look back 10 years, Mrs. Dean—education spending was £29 billion per year. This year, it is £64 billion; by 2010, it will be £74 billion. With my colleagues in the Department for Education and Skills, I am now considering how that settlement can be most effectively spent. We hope to announce specific details before the summer break. I recognise the challenges that schools can face, particularly when the number of pupils on roll is falling, which is a particular problem in the part of the country that the hon. Gentleman represents. However, multi-year budgets help schools to plan ahead and manage their resources so that they are better placed to deal with such challenges. Local authorities should, of course, work with schools with particular difficulties to help them to restore a balanced budget; I know that that process is very active in the East Riding at the moment.
I have been speaking about the national picture, but, as we have heard, there are some concerns about funding for schools in the East Riding and in some other local authorities, particularly when compared with the funding that other areas receive.
The hon. Gentleman and the F40 group would like to see a higher basic entitlement in the distribution of school funding, with rather less emphasis on funding for deprivation. However, other local authorities in areas with high levels of deprivation might argue that the funding that they receive for deprivation is not enough. London receives more funding than anywhere else, but the hon. Gentleman will be delighted to know that his Conservative colleague who led the delegation on London funding continued to press his case for receiving what the hon. Gentleman would consider to be large sums for places such as Tower Hamlets and Kensington and Chelsea—where his colleague came from—as he thought that they were still not large enough. That is the balance that we have to weigh up.
We need to ensure that we have an appropriate balance between basic funding and funding that recognises the different needs of each area of the country. Some areas, particularly London and other inner-city areas, receive additional funding in recognition of the fact that it costs more to recruit and retain teachers and other members of staff. Other areas, including the East Riding, my county of Dorset and Gloucestershire—I see that my hon. Friend the Member for Stroud (Mr. Drew) is in the Chamber—receive additional funding as they are sparsely populated, with many small, rural primary schools that are more expensive to run. The hon. Member for Beverley and Holderness made a reasonable point about that.
A couple of days ago, I visited Burstwick primary school, which the Minister would be pleased to see. It has changed its facilities under the head teacher over the past six or seven years. It has improved its performance. I visited each classroom and saw a fantastic range of learning opportunities and an improved estate. However, does he accept that there is a strong case that the formula does not properly recognise the costs of providing education in rural areas? The school is a good one in a rural area, and the head teacher faces the problem of falling rolls. He is acutely aware of the difference in funding between his school and those not far away in other authorities and feels that if that gap were closed the school would be able to maintain the excellence that it delivers.
I shall try to address that point, because relative fairness for authorities was the central point of the hon. Gentleman’s speech. When we consider the responses to the consultation next month, if we decide that we want to make any significant change or redistribution, we will have to accept that the minimum funding guarantee per pupil will have to be lower to create the financial room to allow that redistribution. Hon. Members need to be aware that if we were to choose to do that, it would create a higher risk of instability in the school funding system. We must weigh up that balance as we make those considerations.
My hon. Friend is aware that the F40 is a cross-party group, ably led by my hon. Friend the Member for Stafford (Mr. Kidney). I want to put on the record our thanks to the Department for ensuring that civil servants were present at our annual meeting. It is important that we consider the facts, and it was a good opportunity to enter into dialogue. Notwithstanding the consultation, I hope that the Department will keep that dialogue going.
I am determined to keep the dialogue going. I was going to pay tribute to my hon. Friend the Member for Stafford (Mr. Kidney), Members from all parties and the F40 group of authorities for the constructive way in which they have engaged with the Department. As well as being determined to keep that engagement with F40 and the other lobbying groups, I have renewed the sense of purpose behind the rural schools group that meets me to advise me on rural issues in the Department, so we are confident that officials across the schools directorate hear the concerns of rural areas.
The main reason for differences in funding levels is the emphasis we place on targeting deprivation through the funding system. The areas that we fund at a higher level have significantly higher levels of deprivation than average. For example, the comparison can be made between the East Riding and its neighbour, Kingston upon Hull, by considering the proportion of pupils from families in receipt of income support. That was the most significant factor for recognising additional educational needs in the funding formula that we used until 2005. More than one third of Hull pupils were from families receiving income support, whereas the proportion for the East Riding was just over one in 10. The national average was almost one in five.
The hon. Member for Beverley and Holderness made a much-repeated point—I do not want to devalue it by describing it in that way—about the cross-border movement of pupils between Kingston upon Hull and the East Riding. I am advised that the flow of pupils into the East Riding has little effect on the total of the authority’s overall level of deprivation: 8 per cent. of the pupils living in the authority are on free school meals, another measure of deprivation, and 8 per cent. of the pupils coming into the authority are also on free school meals. I accept that there can be an impact on individual schools near the boundary, and local authorities can make an allowance for that in their local funding formulas.
We include a significant weighting towards deprivation in some of the grants paid to schools outside their core funding. Some are specifically targeted at raising attainment in deprived, inner-city areas, where tackling under-achievement is most challenging. Closing gaps in attainment between different groups is critical to our aim of promoting a fair, prosperous and inclusive society.
There have been improvements in attainment at all levels of education in recent years, and schools in the most disadvantaged areas have improved most of all. However, there is still a major gap between the outcomes of children from disadvantaged backgrounds and those of their peers. That is why the Secretary of State is clear that closing those gaps is a continued target and that funding needs to reflect that. In 2006, fewer than a third of young people who received free school meals achieved five good GCSE passes, compared with more than 60 per cent. of their peers. Reducing that gap in attainment is critical and we believe it is right and just to invest our resources where they will make the most difference.
We will therefore continue to target resources through local authorities to schools that serve deprived communities. However, we want to ensure that we do so as effectively as possible. The review of the school funding arrangements therefore has a strong focus on identifying the most effective means of providing funding for deprivation to local authorities. It focuses, too, on how they distribute that funding to schools to ensure that pockets of deprivation, in rural areas for example, have that deprivation recognised in the educational needs of pupils in their schools.
As I said, I am grateful to the F40 group and other interest groups for their input into the process and their continuing input into the consultation process. I thank them for the way in which they constructed the meeting with me earlier this year.
In March, we issued specific proposals for consultation. It might be helpful to describe some of the key proposals that will be discussed. The first will be how we should distribute the dedicated schools grant from 2008-09—the choice is between the “spend plus” methodology used this year and last and a return to a single formula that would have greater degrees of redistribution from the status quo. The second will be how funding for deprivation is best recognised in the distribution of the dedicated schools grant, and the third will be what the level of the minimum funding guarantee for schools should be over the next three years. I mentioned that earlier. On the second proposal, we are seeking views on which of the most up-to-date and fine-grained indicators of deprivation we might use in the dedicated schools grant distribution and whether and how we could target funding in a more sophisticated way, reaching pockets of deprivation in areas that are not deprived overall. I am confident that the F40 group will have some constructive views on that.
We also make proposals in the consultation to support some of our most important education reforms, giving support to schools to deliver “Every Child Matters”; delivering the extended free entitlement to early-years education for three and four-year-olds; and introducing diplomas for 14 to 19-year-olds. I congratulate Beverley high school and Beverley grammar school, two schools mentioned by the hon. Gentleman. They are part of the East Riding central consortium that has applied successfully to deliver the new creative and media diploma from 2009 and will receive extra funding to deliver that.
The school funding consultation closes on 1 June and I am sure that the hon. Gentleman will take the opportunity to raise his concerns. I reassure him that we will listen to the views of all interested parties and consider them carefully before we announce our decisions this summer. I know that he shares my ambition to see even greater improvements in standards over the coming years. The spending review settlement and the options in the school funding consultation will enable us to raise standards for all and to close the attainment gap.
Question put and agreed to.
Adjourned accordingly at twenty-nine minutes past Four o’clock.