Tuesday 15 May 2007
[Mr. Bill Olner in the Chair]
Alcohol Harm Reduction Strategy
Motion made, and Question proposed, That the sitting be now adjourned.—[Kevin Brennan.]
It is a pleasure to have secured the debate under your chairmanship, Mr. Olner. It is timely and important. When the Government published the alcohol harm reduction strategy they also promised a review of the strategy in 2007, during which they would “take stock” against “clearly defined indicators”. The Department of Health and the Home Office will soon publish a revised draft. This is, then, an important opportunity to engage with the Government directly, before publication. However, that opportunity has not been afforded properly to interested groups and individuals, by way of a formal consultation.
The answer to my parliamentary question about consultation, which I tabled on 30 April, reveals the different ways in which the Government deal with their drug and alcohol strategies. The response on the drug strategy was:
“A consultation document is planned to be issued alongside details of the consultation process in May/June 2007. The intention is to consult interested groups and individuals, including service providers and those affected by drugs—users, families and local communities. Subject to cross-Government agreement, the new strategy is likely to be published in late 2007.”
Moving on to the question of alcohol, the response was:
“A series of detailed discussions have been held with key stakeholders from the health, police, young people’s sectors and the alcohol industry to inform the development of the new Alcohol Strategy. The new strategy is due to be launched in summer 2007. A formal consultation is not planned prior to launch, but consultation is likely to be required on implementation of key aspects of the strategy.”
—[Official Report, 2 May 2007; Vol. 459, c. 1771W.]
Why is there no intention formally to consult in the same manner on alcohol and drugs? Does the Minister recognise the concern from different interest groups, including Alcohol Concern and the Wine and Spirit Trade Association, that the Government
“needs to be much more proactive and confident in consulting”?
Have the detailed discussions with key stakeholders included service providers, alcohol addicts and their families, and the local communities that are most affected by alcohol misuse? Even before the launch of the new strategy, a fundamental criticism of the Government’s approach is exposed in its process of review. That is the fact that alcohol is the poor relation in drug and alcohol policy.
The debate is important because alcohol consumption and the harm arising from alcohol misuse affect all our constituencies. The debate is less about the millions of people who enjoy drinking responsibly than about the millions who do not do that, and who devastate many lives and relationships around them. It is a debate about binge and chronic drinkers; but such drinkers should not be the only focus of debate. The Government strategy is too limited. It fails to tackle the need to reduce overall consumption and alcohol harms. Indeed, that attitude is supported in many ways by the media, which play to our voyeuristic tendency to be entertained by the antics of binge drinkers. Mr. Olner, you may have seen recent television productions of that kind. We can too easily stereotype the problem of alcohol misuse, and comfort ourselves that it is someone else’s problem. However, increased consumption and harm are everyone’s problem.
Alcohol consumption has grown and spread. Consumption has doubled in the past 50 years, and it is up 15 per cent. in the past five recorded years. It is estimated that 8.2 million adults have an alcohol use disorder and that up to 3 million are alcohol dependent. Young women have doubled their consumption in the past 10 years, and children have doubled consumption in the past 15 years. Six million under-25s binge drink and 60 per cent. of 15-year-old boys binge drink monthly.
Many of the figures relating to alcohol harm will be familiar to hon. Members who are present for the debate, but it is important to explain the harms at the outset. Alcohol damages the economy. The total loss to the economy from alcohol misuse is estimated to be some £6.4 billion a year. Alcohol damages mental health: 65 per cent. of suicides are linked to alcohol misuse. Anxiety and depression are very common among heavy drinkers. Alcohol damages health: 22,000 people are estimated to have died each year as a direct or indirect result of alcohol—more than the combined number of deaths from breast and cervical cancer and MRSA, which often make the headlines. Deaths from alcohol-related liver disease have doubled in the past 10 years.
Alcohol damages through violence. At least one in three reported instances of domestic violence are known to be linked to alcohol. The British crime survey’s figures show that 44 per cent. of victims of violent crime believe that their attackers were drunk or under the influence of alcohol at the time of their attack. Alcohol damages public services. Hospital admissions resulting from alcohol abuse have increased steadily between 1997 and 2004 from more than 19,000 to more than 25,000. More than 3,000 of those admissions were of children. At peak times seven out of 10 accident and emergency admissions stem from alcohol abuse and the Department of Health estimates that about £1 in every £3 spent in A and E is alcohol-related.
Alcohol damages the young. Home Office figures state that among 16 to 24-year-olds 63 per cent. of males and females who admitted to criminal and/or disorderly behaviour were drunk during or after the event. Alcohol and drug misuse is the cause of permanent exclusion from school for more than one in 16 children. More than three out of 100 babies born could have been damaged by their mothers’ drinking during pregnancy. Alcohol fundamentally damages families. It is estimated that 920,000 children in the United Kingdom currently live in a home where one or both parents misuse alcohol. Marriages in which one or both partners have a drink problem are twice as likely to end in divorce as those that are not affected by alcohol. The list could go on.
The Government need to be more open about what they want to achieve by their strategy for alcohol. Do they seriously want to reduce overall consumption and alcohol harms? If so, a more strategic approach is needed, recognising the impact of price, regulation and availability; alcohol misuse should have the same public health status that tobacco and obesity currently have. The 2004 strategy, like many strategies emanating from the Prime Minister’s strategy unit, is strong on fine-sounding words but weak on delivery. To take one aim—improving health and treatment services—it is estimated that alcohol-related harm is at least six times worse than the harm related to drugs, but alcohol services continue to receive far less than drugs services.
It is extraordinary that the Government have developed a treatment policy with a pooled treatment budget, targets, monitoring and all the paraphernalia of bureaucracy that go hand in hand with the Government’s top-down initiatives, but that they have failed to include alcohol in that treatment policy, leaving it as the almost exclusive preserve of drugs. For a Government who pride themselves on their target-led approach to health and asserting their key health priorities, it is significant that the alcohol strategy discussed the importance of
“Setting goals and monitoring progress”
but also stated:
“There is no comprehensive target for reducing the harms caused by alcohol misuse”.
Guidance notes for primary care trusts have been published, including on programmes of improvements and models of care for alcohol misusers. The result of the strategy is much paperwork, but the impact in increased access to treatment has so far been limited, as local commissioners have determined their actions without national targets to guide them. The lack of dedicated funding and the absence of alcohol monitoring in the quality outcomes framework have meant that alcohol issues have not been prioritised by many PCTs. The alcohol strategy has failed to set out a framework of national, regional or local targets, or drivers to increase access to treatment for problem drinkers. That has left 17 out of 18 problem drinkers, on average, without access to the specialist support that they require. The Prime Minister’s constituency of Sedgefield suffers from being in the region with the highest incidence of problem drinkers and the lowest access to treatment, with barely one in 100 able to find any kind of treatment. I doubt that the other 99 would agree with the Prime Minister’s foreword to the strategy, in which he said that it would
“in time, bring benefits to us all in the form of a healthier and happier relationship with alcohol.”
In stark contrast to the 2002 drug strategy, there are no targets to increase the number of problem drinkers in treatment, or reduce alcohol misuse in general. Also, no funding is ring-fenced for alcohol treatment services, and it is unclear how much money goes to alcohol services. There are no centrally held figures beyond the global figures that the Minister gives in parliamentary answers, so I have conducted my own survey of primary care trusts across the country. It is significant that of the 66 PCTs that have so far responded, only 39 know how much is spent on alcohol rather than being absorbed by the drugs budget. Most have responded that only a small proportion is given to alcohol treatment and that they do not think that the amount allocated to alcohol is sufficient.
In 2006-07, of the 39 PCTs that supplied separate figures for alcohol and drugs services, the average spent on alcohol was £424,500, compared with the average of £3,832,000 that is spent on drug treatment. So, alcohol treatment receives about 11 per cent. of the amount that is allocated to drug treatment. The survey shows that the 20 PCTs that were able to provide the relevant data for 2006-07 will spend an average of 0.72 per cent. of their total annual budget on drugs and 0.15 per cent. on alcohol.
The situation in Enfield illustrates the reality: the strategy has not made tackling alcohol misuse a priority. The answer to a parliamentary question in March revealed that £1.5 million had been identified
“to support various ‘Choosing Health’ White Paper initiatives including alcohol treatment services.”
But there was, as always, a caveat. The answer goes on:
“It is for PCTs to determine how to use the funding allocated to them to commission services to meet the healthcare needs of their local populations.”—[Official Report, 5 March 2007; Vol. 457, c. 1681W.]
The Minister might, in her response, be quick to extol the virtues of PCTs having self-determination, but managers at the cash-strapped and top-sliced Enfield PCT would say that they do not have a choice. It has a £13.1 million deficit and a priority to meet other central targets, which means that alcohol services inevitably lose out. There is no funding for any specialist alcohol treatment services in Enfield to support the good work that is being carried out by Rugby house and the service providers at Central and North West London NHS Foundation Trust mental health and substance abuse services.
Enfield has squeezed out of its drugs budget some support for alcohol addicts. Its focus on excluded and disadvantaged sections of our community is welcome and chimes with the words on page 5 of the alcohol harm reduction strategy, where it proposes
“better help for the most vulnerable—such as homeless people, drug addicts, the mentally ill, and young people. They…need clear pathways for treatment”.
However, that is not happening in Enfield or in many other places. It is madness that although patients might be addicted to both illicit substances and alcohol, there is a division between those services. One service might not treat illicit drug abuse until the patient is detoxed from alcohol, and the alcohol services might not detox a patient whilst they are addicted to illicit drugs, hence the patient does not get access to appropriate treatment. Drug action teams are encouraged to take the lead with alcohol strategy, but they refuse to do so in Enfield because they do not receive the funding.
The strategy speaks about piloting schemes to find out whether the earlier identification and treatment of people with alcohol problems can improve health and lead to longer-term savings. That all sounds good on paper, but the PCT in Enfield has cut the £82,000 allocation that was intended for alcohol screening in the accident and emergency department. Will the Minister tell us how that decision fits in with the strategy?
The situation in Enfield is not due to a lack of effort on the ground. The alcohol strategy manager there is doing a fine job, and Enfield is one of only six London boroughs that has such a strategy management consultant. There have been significant results with crime and disorder in Enfield as a result of the dedicated support of a co-ordinator pushing up the alcohol agenda across services in Enfield and because of joint working with the police and probation, particularly on domestic violence. Despite the strong multidisciplinary approach and partnership to tackle alcohol misuse, however, the PCT is unable to allocate funds to plug the funding gap, especially with tier 3 alcohol treatment.
The lack of a serious and resourced strategy to deliver real progress on the ground means that alcohol treatment is left predominantly to small voluntary sector organisations such as local Alcoholics Anonymous groups and 1NE Beulah road, which are beacons in the desert of treatment. There is a highly effective and cost-effective abstinence-structured day care programme for alcohol at 1NE Beulah road, which has no direct or reliable source of funding despite the fact that most of the people who use the service there are referred from the statutory sector.
An area that the 2004 strategy avoids, which I would like the Minister to consider, is the control of supply and availability. Government policy has been to liberalise the main drivers of consumption—regulation and taxation—but where does that policy fit in with the strategy to reduce harm? The rising levels of alcohol misuse in recent years, the state’s power to sanction the manufacture and sale of alcohol and its potential power to control the availability and price of alcohol all inevitably give the Government the lead responsibility to minimise the harm that alcohol causes, not least because of the cost to the public purse. However, the 2004 strategy rejected tax as a means of tackling harm. In so doing, it rejected substantial scientific evidence that the price of alcohol is one of the principal influences on levels of alcohol consumption and harm, whether we like it or not. Will the Minister review the evidence that supports the idea that duties should be based on the alcohol content of the drink and should be used as a means of controlling alcohol problems?
I am not sure what the Minister’s career prospects will be in seven weeks’ time or whether she is feeling demob happy, but I invite her to boldly go where no Minister of Health has gone before in terms of alcohol policy. Professor Chris Cook, who is a consultant psychiatrist in alcohol misuse, has said:
“The enormous popularity of alcohol—our ‘favourite drug’ can make wise evidence based policies politically unattractive…It is not enough that debate about matters of production, distribution and consumption are conducted simply in terms of scientific opinion, political expediency and consumer choice. Alcohol policy should also be based on soundly reasoned ethical principles.”
I invite hon. Members and my hon. Friends to debate this matter, and urge the Minister that we should have an alcohol strategy based on such principles.
I am pleased to take part in the debate, and I congratulate the hon. Member for Enfield, Southgate (Mr. Burrowes) on securing it and on raising serious issues of alcohol abuse.
A minority of people misuse alcohol, and most people enjoy it responsibly. Burton-on-Trent is the capital of brewing, so alcohol is important in my constituency for jobs in the brewing industry and pub companies present in the town. Like the industry, I believe that it is important that people drink responsibly. We can tackle the misuse of alcohol only if we all work together. That includes local and central Government, the industry and the police, where necessary. Of course, individuals must also be involved—they must be responsible for their own drinking habits.
We have made progress in the past few years. One example of progress is the “Challenge 21” initiative to tackle under-age sales. I do not know whether other hon. Members have been into retail establishments in their areas to promote “Challenge 21”, and encourage vendors not to sell alcohol to young people unless they appear to be over 21. That approach gives more leeway and makes it easy to identify people who should be challenged to produce proof of age cards if they do not look over 21. All sectors of the industry—both on-trade and off-trade—have been responsible in developing that policy.
The on-trade self-regulatory regime has been developed to eradicate irresponsible retailing, and there has been a great deal of progress there. Pubs, in general—this is certainly true of responsible pubs—try not to have happy hours or two-for-the-price-of-one offers, and do not encourage people to drink as much as possible in the first hour that they are in the pub. There has been movement on this, and we should thank the industry for developing and working with the on-trade.
Recently, the Drinkaware Trust was established. It is supported by the alcohol industry: producers and both the on-trade and the off-trade. I am trying to give credit to all those who have been involved. It is early days for the Drinkaware Trust, but I am sure that it will help to promote sensible drinking and to educate young people, in particular, about the importance of not abusing alcohol.
Ongoing discussions are taking place about labelling alcohol in respect of its strength. That is particularly important, because much stronger wines are now available and because although cider may not seem to be strong, it is tremendously strong. We need to know the exact strength of the alcohol that is on sale.
The changes in the licensing hours have not had the dire consequences that many predicted. In fact, there is evidence that staggered hours are helping to change the culture, but that process will take time and it is still early days. The all-party group on beer held an inquiry in the late 1990s into what should be done about licensing hours, and there was general agreement that changing them and having a more relaxed system would help to change the culture. Just before the changes were introduced, the media were saying that every pub was going to be open 24 hours a day. We know that that is not the case, and that such pubs are the exceptions. One pub may be open until 11 pm whereas another may be open until 1 am, thus staggering the leaving times from the establishments.
Coors, which is the biggest brewer in Burton-on-Trent, has been supportive of two organisations in my constituency: the Burton addiction centre, which has an abstinence-based approach and deals with people with both drug and alcohol problems; and ADSiS—Alcohol and Drug Services in Staffordshire—which prevents and minimises harm. One of the good things that has come from ADSiS is its development of a commercial arm. That involves going into businesses and developing workplace policies on alcohol and drugs with local industries, so that they can best advise, and deal with, their work force in a helpful way where they think people have alcohol and drug problems. That is another way forward, and we should use it. The help needs to be in place when people develop the problems, because we are talking about how we deal not just with binge drinking, but long-term alcohol abuse. Just giving somebody the sack will not help them to deal with their problem, but keeping them in work and trying to help them within work can help them to overcome it.
We have made a start, but we need to do more. I have mentioned the responsible behaviour of the on-trade, and I should like to draw hon. Members’ attention to early-day motion 495, which was tabled by my hon. Friend the Member for Selby (Mr. Grogan) and secured 193 signatures. It states:
“That this House believes that the substantial price differential between alcohol sold in pubs and that sold in the off-trade is exacerbating the problem of binge drinking; continues to support the pub trade’s efforts to curb irresponsible drinking and promotions; and urges supermarkets and off-licences to follow the example of pubs and act to end irresponsible drinks promotions and agree not to use alcohol as a loss leader on their premises.”
There is considerable feeling in the House about that issue. The all-party group on beer recently met representatives of supermarkets and we questioned them on their policies regarding the sale of alcohol. There seemed to be a reluctance to recognise the difference between the price promotion of alcohol and that of tins of beans, and there seemed to be the idea, “If we can get people in to buy alcohol cheaply, we can sell other food.” The point was put to them that they could encourage people to come in for other goods, which do not have the detrimental effect that cans of beer can have in the wrong hands. If the on-trade can do it, so too should the off-trade. This is not just about supermarkets selling at prices at which it is hard to believe that they do not loss lead and the health dangers of that; it is also important that prices in the off-trade are fair to producers and customers, and do not promote the irresponsible use of alcohol.
Following on from that point, there is evidence that young people drink cans of beer at home before they go out to pubs. I know that the evidence is anecdotal, but there is a feeling that they drink the cheap stuff at home and then go out, which leads to pubs taking the blame for people drinking too much when they have already had their share before they even get to a pub. We should make parents more aware of the dangers of allowing young people to take alcohol out from the home to drink with their mates. One of the worst dangers involves young people and alcohol on the streets—they drink in parks and so on with their mates. It is possible that alcohol bought in bulk from supermarkets is the source of some of the alcohol drunk on our streets.
We ought to consider charging those who attempt to buy alcohol when under age, as opposed to charging merely those who sell it. That would send out the strong message that those who are under age should not even attempt to buy alcohol. We rightly concentrate on the seller of alcohol, but perhaps we should, on occasion, also examine those who buy it illegally.
Perhaps the hon. Lady would like to moderate her sensible suggestion by saying that we should prosecute those who buy alcohol to provide subsequently to younger people, rather than charging young people themselves—they have enough ways of getting into trouble at the moment.
Most young people are great; too often, we hear in the media about when they do things wrong rather than about the vast majority who do not do things wrong. It is sometimes difficult to pinpoint when people deliberately buy alcohol for young people, but where it is clear that they have done so, they should be charged. I do not want to lock all young people up or any such thing, but if people realised that they could be charged with buying alcohol under age, it might, on the odd occasion, deter a few.
I urge the Minister to consider changing all drug action teams to drug and alcohol action teams. Some areas already have such teams—I understand that Stoke-on-Trent has a drug and alcohol action team whereas the rest of Staffordshire has drug action teams. It would be helpful if they could all become drug and alcohol action teams so as to equalise the emphasis. It is also important that we ensure that primary care trusts give priority to funding both treatment and prevention and that a key message from the Government to PCTs is that they should do so.
Overall, this is about treating alcohol with respect. I want to end on a light note by commending the Coors brewery in my constituency, which has recently reopened its brewery tap bar and is linking food with alcohol. One way of ensuring that we treat alcohol with respect is for that connection to be made. There is a recommendation in that tap bar’s restaurant of what beer to have with what food. The museum has just gained the anchor point of the European route of industrial heritage, which is recognition of the part that brewing has played in our heritage. It produces Worthington White Shield in the museum brewery, so it is well worth a visit.
It is also important to encourage people to recognise quality in alcohol rather than quantity. Burton has the quality of Marston’s pedigree, and ales produced by microbreweries, such as Burton Bridge brewery, which has just had its silver anniversary.
It is a pleasure to follow the hon. Member for Burton (Mrs. Dean), who was right to represent the interests of the Burton brewing industry, which is a traditional, well known and responsible industry in that area.
I congratulate my hon. Friend the Member for Enfield, Southgate (Mr. Burrowes) on securing this important and timely debate. He is the epitome of a decent, hard-working and caring MP.
I also congratulate the Government on their alcohol reduction strategy, which is delivering some successes, not least, as I freely admit, that binge drinking is no longer rising. The Minister is a bright lady, so she will acknowledge that there is much still to be done, especially on alcohol-driven yob behaviour, which is one of the many areas in which party politics does not play well. We should all work together to make our communities safer places.
I agree with my hon. Friend that the reply from the Under-Secretary of State for the Home Department, the hon. Member for Gedling (Mr. Coaker), in response to his parliamentary question was a little surprising. The Under-Secretary said:
“The new strategy is due to be launched in summer 2007. A formal consultation is not planned prior to launch, but consultation is likely to be required on implementation of key aspects of the strategy.”—[Official Report, 2 May 2007; Vol. 459, c. 1771W.]
I await the Minister’s explanation of why she has decided that consultation is not appropriate, because this is an area in which the public have strong opinions.
There is a clear and unequivocal cause-and-effect association between alcohol and risky and bad behaviour by young people in particular, but not exclusively. I shall focus this morning on young people. Alcohol causes aggression and loutish conduct. More than 90 per cent. of young people’s first use of drugs occurs when they are under the influence of alcohol. That problem affects every constituency, and I recommend the most used non-traffic law as the basis for control action. The Confiscation of Alcohol (Young Persons) Act 1997 has a number of excellent characteristics. One is that we empowered the police to act, but did not criminalise young people for possession or consumption of alcohol—they have enough ways of getting into trouble without us creating gratuitous new ones. Another good characteristic is that the police should always inform and involve parents when they catch a youngster consuming alcohol and remove it from them.
I want parents to be clearly involved in the alcohol harm reduction strategy. I do not want a strategy that takes responsibility away from them.
Yes, I think I said that it was not exclusively a problem involving youngsters, but the vast majority of parents want what is best for their children. They have a responsible attitude to bringing up their children and want to set a good example for them. I will return to the hon. Gentleman’s point.
A binge drinker is like an elephant: difficult to describe, but we know one when we see one. The definition of binge drinking is a problem. The Government use twice the recommended limit in any 24-hour period as a definition, even if no alcohol has been consumed on all the other days of that week. I know that you rarely imbibe, Mr. Olner, but if you consumed six or eight units in 24 hours, or if Mrs. Olner consumed four or six units, the Department of Health would officially consider you to be binge drinkers. That definition is too tight—if you will excuse my pun, Mr. Olner—to be acceptable to the majority of the public. If a target is believed to be wrong, it becomes totally ineffective.
During a hot barbecue lunch, and an afternoon and evening with friends in my garden, I can consume six or even eight units—that is three or four pints to you and me, Mr. Olner—without getting the least bit squiffy. If we adopt unreasonable targets and limits, we lose the argument and fail to change behaviour. The public believe that binge drinking occurs when someone becomes drunk in a few hours, and loses control and inhibition.
Let me suggest a definition of binge drinkers. They are people who consume, for argument’s sake—we certainly need professional guidance on a new definition—double the daily limit within two or three hours, or who consume four times the limit in a single day. With reasonable limits, we have a chance of changing behaviour, but if we do not get the definition right and win public credibility and acceptance for the definition, we will miss our chance to change behaviour.
Some associated issues include alcohol-related attacks on NHS staff. I declare an interest because my son works in the NHS and, like many doctors and nurses, he has been attacked a number of times by drunks in accident and emergency. Such attacks are too frequent, and should receive zero tolerance from the police and the courts. We owe it to our nurses and doctors, who try to help people who are ill or who have had accidents, to give them maximum protection.
On a different but topical note, we should not get carried away with silly politically correct calls to make criminals of parents who introduce their children to alcohol. Moderation and reasonableness by parents are, of course, necessary. French parents introduce their children to wine responsibly and that prevents binge drinking problems in the so-called Kevin teenage years. Let us use common sense and moderation. We should persecute not the parents, but the PC pedlars. Parents who want to prepare their children for the real world should be congratulated. Children should sit with the wider family at important meals throughout the year in a civilised way, and if parents wish to introduce a little alcohol responsibly, that may be rational and a good thing to do.
Another issue is that of tackling unhelpful advertising of alcohol, especially when it is targeted at or designed to impress youngsters. The Government’s 2004 strategy started good work to tackle that, and Ofcom and the Advertising Standards Authority moved it forward with the 2005 code. However, action is needed to police advertisements more effectively. Perhaps I could gently hint that this is an area where the Government should show a little more leadership. They are trying to stay out of the matter and leaving it to the various regulatory bodies. A little leadership from the Government would be welcomed.
I shall move on to an issue that the hon. Member for Burton raised. Some retailers are flouting the purchase age limit of 18 years old. There are good and bad retailers in all our constituencies, of course, but in Castle Point, Shopright on Benfleet high road is excellent. The owner, Mark Baddeley, is fierce in protecting youngsters from alcohol, and he therefore saves the rest of our community from loutish behaviour. Other retailers are sometimes less scrupulous, and we need more aggressive checks on trading. It may even be right in certain circumstances to use young, set-up children to trap the culprits. We should then take very tough action against those culprits.
Let me put the issue into local and national perspectives, as the hon. Lady sought to do. She rightly said that alcohol abuse is a minority problem, which is especially true with youngsters. We have excellent, hard-working youngsters of the highest integrity, and their reputation is spoiled in all our constituencies by just a few yobs. Youngsters have more money, and sadly, more pressure than we had when we were growing up, but they are generally reasonable and sensible with drink. In response to the intervention from the hon. Member for Bedford (Patrick Hall), I should say that they are proportionally more reasonable and sensible than adults. I may receive slight criticism for saying that in the local pubs and clubs where I can often be found, but if the truth hurts, what can I do?
Let me address the defining issue of the price and availability of alcohol. Price and availability have changed in recent years, and they control the market and consumption levels of our youngsters in particular. The supply of alcohol, which is bought cheaply and illicitly resold, largely drives the issues of harm to our youngsters and of bad behaviour on our streets, from which we all suffer and for which we all pay the price. The key villain in the piece is the European Union, which has swamped us with cheap alcohol and made it readily available to our British kids through nefarious supply chains, circumventing parental control and the use of our mostly decent and carefully controlled retail outlets and pubs.
If we got out of the EU, there would be a number of important and very helpful consequences. One of the smaller but significant benefits of our exit would be to help our responsible and excellent traditional brewing industry, the retail trade and pubs and clubs. It would help cut youth binge drinking, tackle antisocial behaviour, give the police and parents more control and help protect our kids.
Does the hon. Gentleman accept that the problems a few years ago of the white van trade were mainly eliminated, and that the illegal importation of alcohol was tackled through better controls at our ports? Perhaps he was referring to those problems when he talked about the European Union and activity on our streets. I hope that he would recognise that the issue has been tackled. I am a member of the all-party group on beer, and we went to Calais to analyse the problem, which I understand has now diminished.
I am grateful for that intervention. Perhaps my view of the situation is coloured by the proximity of my constituency to the ports. In Kent, Essex and other areas of the south-east, the uncontrolled supply and resale of cheap EU booze is still a major problem that affects trade badly. In the industry, it is still a factor that drives the massive growth in street disorder and problems for our children. My hon. Friend the Member for Enfield, Southgate provided statistics on the number of young children who are binge drinking, and we all know where much of that booze comes from, at least in that area of the country.
I am delighted that some Members agree with the vast majority of the sensible British public, who say that we would be better off out of the EU. I wish more Members would stand up to the vested interests of their parties, listen to the people and provide leadership on that issue. We should return to the original trading relationship and take control of our laws, taxes, borders and imports. It would, in a small but significant way, help our alcohol harm reduction efforts as well as our economy. It is sad that the Prime Minister is so obsessed with his legacy that he is currently trying to row us in the opposite direction.
Yes, Mr. Olner, I accept your advice. However, taxes, VAT, and import and border controls affect in a small way the supply of alcohol to our kids on the streets, and that is the point that I was making. I accept your ruling so perhaps I had better call time on my speech. However, the Labour and Conservative Front-Bench spokespeople must realise that the subject will not go away for the British people.
I congratulate the hon. Member for Enfield, Southgate (Mr. Burrowes) on his success in having his name picked out of the hat. He knows that, on an all-party basis, a number of us were seeking to secure the debate, and I congratulate him on being the one to do so.
I shall not get distracted—tempted though I am—by the entertainment that we have just had from the hon. Member for Castle Point (Bob Spink); perhaps others will have time to refer to that. The hon. Member for Enfield, Southgate set the national scene ably, so I intend to concentrate on the situation in Bedfordshire, where some of the most valuable work on the treatment, awareness and prevention of alcohol abuse is carried out by the non-statutory body Alcohol Services for the Community, a charity that was set up in 1979 as a treatment and prevention organisation. It started in Luton, but it has expanded to cover the whole of Bedfordshire, including Bedford and, indeed, Kempton, which is in the constituency that I represent.
Under the umbrella of ASC, there are four services. First, there is a preview prevention service, which seeks to raise knowledge and understanding of alcohol through the media, community events and groups, and which provides training and resources. Secondly, ASC delivers a licensees’ course to help them to prepare for the national certificate for licensees exam. Thirdly, the James Kingham project, which is based in Luton and Bedford, is a rehabilitation service that supports people and families who want to resolve an alcohol-related problem. It also operates an outreach service throughout the community, helps to build self-esteem and encourages people to retrain and re-skill.
The fourth project, which is aimed at young people and children, is called prevention, understanding, knowledge and education—better known as PUKE. It is linked to the James Kingham project, and mainly through schools, it provides an outreach information and support service to young people and children throughout Bedfordshire. Some have a drink problem themselves, but many live in households where adults and parents have a drink problem.
Over the years following the creation of ASC, the resources, including the number of staff and, therefore, the range of activities, initiatives and innovations, have grown. Within the Luton unitary council area, Luton borough council has consistently supported the project, but unfortunately, the situation in the rest of the county of Bedfordshire, including Bedford, has been very different.
A few years ago, the James Kingham project employed five full-time-equivalent staff in Bedford, and from Bedford, 6.5 full-time-equivalent PUKE workers. Owing to funding reductions, the numbers have gone down to 2.5 full-time-equivalent staff in Bedford, and 2.5 full-time-equivalent PUKE workers. However, the work load has increased both in Luton, where the borough council has maintained the funding, and in Bedford.
The work load has increased at a price, of course, because one cannot get something for nothing. The price has been a considerable reduction in the essential one-to-one work in Bedford and wider Bedfordshire, and an increase in group work. Many more volunteers are being employed—if I can use the word “employed”—in Bedford and wider Bedfordshire. The volunteers do a good job, and I am not criticising them, because they are well trained. However, there is a difference between the likelihood of volunteers and the likelihood of paid staff remaining in such activity. Therefore, things are changing, but not necessarily for the better.
The second cost that is being borne owing to reductions in funding is that waiting lists have been introduced by ASC in Bedford and Bedfordshire. That is absolutely the last thing that somebody who feels ready to face up to their problem or to work with members of their family with a problem needs to hear. People screw up the courage to ask for help, but are then told to come back in six months. That is a worrying development, but that is what ASC has had to do.
Despite those pressures, I congratulate ASC on handling 1,100 referrals to the James Kingham project last year, 900 of whom have gone on to the active list—not everybody maintains their wish to be helped. The PUKE project has engaged 6,000 young people in Bedfordshire, 150 of whom have received much more intensive help. Therefore, despite the increasing pressure, good work is still being done.
The hon. Member for Enfield, Southgate made the point, which I now want to make, too, that there seems to be a serious mismatch between the resources directed at tackling drugs and those dealing with alcohol abuse. The boost in Government funding through the Home Office for drug treatment and prevention in Bedfordshire and nationally has been very impressive indeed. I understand that the increase in resources for drug treatment in Bedfordshire was around 18 per cent. in 2005-06 and 56 per cent. in 2006-07, although those might in fact be national figures, so perhaps my hon. Friend the Minister could clarify that. However, at the same time as those considerable increases in resources for drug treatment, ASC’s budget for the last financial year was cut by 5 per cent. That is a clear mismatch, and ASC still does not know what its funding situation will be in the current financial year.
In December 2003, I was privileged to be asked formally to launch the Bedfordshire drug action team, which is based in Bedford. Since then, it has changed its name to the Bedfordshire drug and alcohol action team, which relates to the point that my hon. Friend the Member for Burton (Mrs. Dean) made, although I have a different take on that. From the evidence of what is going on in Bedfordshire, it seems that putting the two issues on an official level playing field and in an equal position of recognition is a good way of proceeding.
The Bedfordshire drug and alcohol action team commissioned a report last autumn on alcohol use and the availability of alcohol treatment services in Bedfordshire. However, despite the official interest in alcohol, which is suggested by having that word in the organisation’s title, I have been categorically assured by ASC that senior staff at BDAAT say that it does not fund alcohol services and that its increased resources are entirely directed at drug treatment and prevention. From my detailed local knowledge of the attitude of councillors, it seems that officers are telling councillors in Bedford, at both the county and district level, that BDAAT is dealing with all alcohol matters, as well as all drug matters. That is the message that Bedfordshire primary care trust seems to have been given, too. Therefore, when there are resources, whatever they are, they go to BDAAT, not to the organisation that has such a good track record and is still doing such good work.
There is confusion. The situation is unsatisfactory and should be resolved locally. However, perhaps the Government can intervene and assist, too. The national review of the strategy is an opportunity for that to take place, and could propose clearer advice to PCTs and drug action teams. I ask my hon. Friend the Minister to comment on that, if she has time.
Alcohol abuse is a serious problem. It is a national issue, and it is not good enough to leave it to be dealt with primarily by the voluntary sector. The Government are understandably reluctant to impose targets. Whenever they do, they are pilloried, sometimes by the same people who might ask them to impose targets for alcohol. However, there will need to be a stronger lead and a clearer message. Alcohol-induced harm to individuals and society is on a far greater scale than that caused by illegal drugs. Massive resources have been allocated to drug treatment and prevention, but more people die from, and are harmed by, alcohol misuse. I therefore ask the Minister to respond to the proposal that more of the revenue collected from the sale of alcohol be invested in the prevention and treatment of alcohol-related harm.
Certainly, Mr. Olner. In fact, you will have heard from the way I was speaking that I was seeking to convey the message that I was indeed bringing my comments to an early conclusion.
We need the balanced picture that alcohol can be pleasurable, and even preventive in health terms, and has been part of our culture for centuries. However, part of that balance is to admit that there is a serious problem that cannot be ignored, and that must not play second fiddle to acknowledging the serious problems associated with illegal drugs. We look to the Government to strike the right balance through the review promised this year. In doing that, I hope that the problems faced in Bedfordshire will be resolved, but also that we achieve a much better balance, which will help us all in this country.
I congratulate the hon. Member for Enfield, Southgate (Mr. Burrowes) on securing this debate. The problem of alcohol abuse has had a raised profile recently, which is a good thing, although I still believe that it is not discussed enough, so I thank him for successfully raising it today.
As a relatively fresh MP a few years ago, I made a round of visits to police stations. I would ask the local police officers what their biggest problem was. I was also quite interested in the drugs problems, because they were high profile at the time. This was probably not a politically correct comment to make, but the police would invariably say in informal feedback, “Drugs? No problem. In fact, we quite like them when they’ve been smoking spliffs, because they’re quite mellow and they don’t cause that much harm”—let us put aside the longer-term harm of drugs for a moment. “Alcohol’s the real problem we have to deal with, but nobody’s doing anything about it”. Seven years on, it is difficult to see what has been done to address those problems practically, because they have got much worse.
Hon. Members have mentioned that there is a problem in recognising alcohol abuse, and also highlighted the fact that the availability of treatment varies. “A Glass Half Empty?” by Alcohol Concern calculated that £400 million had been spent on 18,390 drugs service users, which is equivalent to just over £21,000 a head, but that only £217 million had been spent on the 1.1 million people who are dependent drinkers, which is equivalent to about £197 a head. There is clearly a great disparity in how the different problems are funded and perceived.
I know from talking to my local drug and alcohol treatment centre that it feels that it has a relatively large amount of funding for drugs, but that it struggles to find adequate funding to treat alcohol problems. It is only because more and more people are coming through with joint problems that the centre can tackle some of the problems, such as the long waiting list. Figures show that an average of only about one in 18 people who need treatment for alcohol abuse can receive it. The regional disparities are even starker; in the north-east of England, only one in 102 people requiring access to such treatment can receive it. If people who have an incident that prompts a desire to tackle their alcohol problem cannot get help there and then, things become difficult. The necessity of waiting weeks or months to access services is one of the urgent problems that needs to be tackled.
I am surprised that little mention has been made in this debate of Alcoholics Anonymous, which provides a very useful service, although the style may not be for everyone. Last year, I was invited to attend an open AA local meeting, which I found illuminating. I was particularly struck that some people with an alcohol problem had been attending Alcoholics Anonymous for 15 or 20 years. They felt that it was important to keep the link and realised that they were no better, if you like, than the tramp in the gutter with a bottle of cheap plonk.
The hon. Member for Castle Point (Bob Spink) highlighted the problems in respect of children. Recent surveys have all pretty much confirmed that alcohol consumption among children is increasing. There are mixed reports about whether allowing children to consume alcohol at home eases or worsens the problem. We are probably taking too broad and simplistic a view of the issue. As was hinted at in an earlier intervention, there is a range of parental attitudes towards alcohol. Some parents introduce it in a controlled setting and supervise their children’s exposure to it. However, I remember being absolutely horrified when I watched a programme called “Wife Swap”—one has to de-stress somehow—in which a couple were knowingly giving their quite young children quite large amounts of alcohol. The parents thought it fine if their children, totally unsupervised, drank large amounts at parties. So there is a range of parents, and they can have completely different attitudes to alcohol. We have to take that into account when we analyse such surveys.
Binge drinking among children is on the increase, and that is a concern. The European school survey project on alcohol and other drugs found that drinking levels among 15 to 16-year-olds in the UK were at 27 per cent., exceeded only by two other countries in Europe. Ireland tops the poll at 32 per cent. Clearly, there is a problem. Recently, I tabled a parliamentary question about end-stage liver disease among the under-18s. I did not expect any sort of answer at all, and some people were pleased that only three under-18s had been diagnosed with the problem. However, given the lead-up time to developing end-stage liver disease, the figure means that children are drinking large amounts at a younger and younger age. A bulge in the figures indicates such a shift and indicates the growing problem, which is not being tackled.
Obviously, the problem will impact on the health service, but there are other impacts too. My hon. Friend the Member for Bath (Mr. Foster) asked for figures on alcohol-related accident and emergency admissions since 1997. In 1997-98, there were 75,863 such admissions; by 2005-06, that had almost doubled to 148,477. Earlier, we heard evidence that when such people access A and E, they can be abusive and a threat to our NHS staff. That is another aspect of the problem that we cannot afford to ignore. There is also a large alcohol-related component in domestic violence figures; about half of domestic violence incidents are fuelled by alcohol.
Another health-related link is with teenage pregnancy and it should not be ignored. In 2002, when I was one of its members, the Health Committee wrote a report on sexual health. We invited young people to talk to us and they were clear that the pressures of drink—or the pressure to drink—added to the problem of the pressure to indulge in sexual activity. The two are not unrelated. Alcohol Concern’s “A Glass Half Empty?” points out that evidence suggests a strong link between alcohol consumption and the neglect of contraceptive use during sexual intercourse among the young. However, that issue was completely ignored by the alcohol strategy. It would be helpful if the Minister said whether anything was planned to tackle the issue.
The hon. Member for Burton (Mrs. Dean) claimed that things had not worsened under the new licensing hours. However, there is no evidence that matters have improved either. Recorded alcohol-related crime between 11 pm and 2 am has not decreased as a result of extended opening hours. However, I—and many other hon. Members as well, I suspect—have probably had an increase in our postbags as a result of those hours. People now go home from the pub during a longer time span, in which minor criminal damage—silly things, such as damage to cars and property, that are a real irritant to people—can take place. Having spent my teenage years on the continent, I always felt that introducing those hours would be a good thing. However, that is not necessarily the case.
In my last couple of minutes, I should like to talk about advertising.
I take your point, Mr. Olner.
I am fairly sure that it is too late for a sensible-drinking message, because there are confusing and conflicting messages about alcohol—those who drink in moderation, for example, live longer than teetotallers. People do not have a strong idea of what moderation is; glasses are bigger and alcohol is stronger. We really need a hard-hitting advertising campaign and to consider a ban on alcohol advertising. The UK budget for alcohol promotion is estimated at £600 million to £800 million, but that for alcohol awareness is £7 million. The figures do not stack up, and all the evidence shows that increased exposure to advertising increases the incidence of drinking among the young and the not-so-young. It would also be helpful if the Minister outlined how that issue will be tackled. Advertising before the watershed is also a big problem that needs to be sorted.
I congratulate my hon. Friend the Member for Enfield, Southgate (Mr. Burrowes) on securing this debate and on the measured and thoughtful way in which he introduced it. It is about an important subject; alcohol-related deaths went up by 18 per cent. between 2002 and 2005, and that is a worrying statistic. I am sure that the Minister will tell us about the importance that she attaches to the apparently deteriorating position in respect of illness and lawlessness related to alcohol, and what she intends to do about it as part of phase 2 of the alcohol harm reduction strategy for England, or AHRSE.
According to that strategy, alcohol abuse costs £20 billion a year. I am afraid that we tend to dismiss such statistics: £1 billion, £20 billion—what’s the difference? The sum is massive, however, and it impacts on all our public services as it is money lost to them. It is extraordinary that such a relatively trivial sum should have been spent on alcohol harm reduction, given the enormous figures, in cold economic terms, that alcohol abuse causes.
The alcohol harm reduction strategy has, I am afraid, been characterised by something of a lack of direction and rather indistinct leadership from the start. The Minister without Portfolio, the right hon. Member for Salford (Hazel Blears), set it up when she was in the Department of Health, and she appeared to take it with her when she was translated to the Home Office. Of course, cross-cutting and interdepartmental work is important with such initiatives, but they need ownership and it is not clear where that has been during the strategy’s short history. In short, no one appears to have been in charge for much of the time.
The Prime Minister’s strategy unit’s website, which comes complete with typing errors, tells us that the first alcohol harm reduction strategy aimed to
“tackle alcohol-related disorder in town and city centres”.
Clearly, it failed to do so. It aimed to
“improve treatment and support for people with alcohol problems”.
I represent East Knoyle, and the Minister will know that in East Knoyle are the premises of Clouds, a charity that deals with alcohol problems and has recently been reformed as Action on Addiction. I doubt whether those at Clouds feel that things have improved over the past three or four years.
The strategy unit tells us that the strategy aimed to
“clamp down on irresponsible promotions by the industry”.
We have heard today about how there may be shortcomings in that respect, and I would be particularly interested to hear what the Minister feels about supermarkets’ attitudes to that. The strategy aimed to provide
“better information to consumers about the dangers of alcohol misuse”.
Baroness Andrews spoke about that in 2004 in connection with foetal alcohol syndrome, and said that she would work with the industry on labelling. Not much has transpired since then. Will the Minister update us on where she is with that?
In March 2004, the alcohol harm reduction strategy said that Government would “take stock” in 2007, and that they would
“measure progress regularly against clearly defined indicators”.
We have reached the point of taking stock. What are those clearly defined indicators and how has the strategy measured up to them? We understand from those who have been consulted, briefly, that there has been some effort to inquire widely as to how the first alcohol harm reduction strategy has gone. As we have heard from others today, in no way has that taken the form of a consultation. That is remarkable as Ministers come to set up the second part of the alcohol harm reduction strategy, which we expect to be launched next month. As my hon. Friend the Member for Enfield, Southgate pointed out, it is timely to review what has gone right and what has gone wrong in order to inform phase 2 of the strategy. It is worrying that it has not been more obvious that that process is under way.
It would be interesting to know whether the Minister intends to publish any sort of review to inform and educate the rest of us. It would be nice if that were the case, but so far we have seen no evidence of it. Back in 2004, the alcohol harm reduction strategy called for a national audit of the demand for alcohol treatment services and their provision. I have not seen that, and it would be interesting to know where it is. The alcohol harm reduction strategy called for, among other things, greater use of exclusion orders to ban the troublesome, more fixed penalty fines, work with licensees to ensure better enforcement of under-age drinking rules and the licensing of door supervisors by March 2004. I do not make any comment about the relative value of any of that, but it would be interesting to know where the Minister has reached.
The alcohol harm reduction strategy states somewhat tautologically:
“Effective treatment requires that…appropriate treatment is available”.
I would have thought that that was fairly obvious, but clearly it is not, as the strategy’s call for an audit of treatment facilities ought to have shown us. We know from providers—I have mentioned Clouds house—that primary care trusts are reluctant commissioners of services that mainly fall outwith the NHS. Other hon. Members have discussed that this morning. I know from alcoholics who have been to see me in my advice surgery that they have problems accessing residential treatment in particular.
Three times as many people die from alcohol as die from drugs, yet the National Treatment Agency for Substance Misuse focuses almost exclusively on drugs. Drug action teams, according to the strategy, were to be encouraged to become drug and alcohol action teams by the second quarter of 2004. To what extent has that happened? We know that £946 a head is spent on those who are dependent on drugs, but only £197 on people who have problems with alcohol abuse. Why does alcohol appear to be the poor relation, despite the fact that in public health terms it is clearly the more important issue?
The Food Standards Agency is exercised about identifying foods that are high in fat, sugar and salt, but alcohol seems to be the elephant in the room. The proper identification of units surely eclipses complex nutrient profiling, on which the FSA appears to be focused completely. I hope that the Minister will tell us how she will update information on units better to inform the public, who appear to have a lamentable understanding of what a unit actually is.
The first alcohol harm reduction strategy stated that the experience in the US was that there was no significant change in drinking behaviour as a result of labelling alcohol. Is that still the Government’s position? Despite the lack of evidence, we were told in 2004 that the UK permanent representative to the EU, no less, would thrash out a compulsory labelling scheme for alcohol. Has he done so? Does it involve the rather crude pregnant woman logo that I believe that the French are keen to put on their bottles of alcohol? If anything similar is contemplated in the UK, it is important for the Minister to establish the evidence base that she will use to require such an initiative.
There is a link between the cost of alcohol and consumption, but the Chancellor has resisted putting up the price of alcohol dramatically, presumably because he is worried about smuggling, among other things. Has the Minister given any thought to the British Medical Association’s suggestion that alcohol content should be taxed rather than the product? Presumably that would apply rather more to wines and beers than to spirits. Does the Minister think that it might be used as a lever to cut alcohol content?
I will wind up with much pleasure. The Minister has a lot to answer for and I shall certainly leave her time to do that.
As the Minister takes stock at the end of the first alcohol harm reduction strategy, perhaps she will agree that given the fact that ill health and lawlessness attributable to alcohol have worsened since its start, much needs to be done. I hope that the second alcohol harm reduction strategy will be a great deal more successful than the first.
I am sure that the hon. Member for Westbury (Dr. Murrison) will forgive me if I prioritise the questions of the hon. Member for Enfield, Southgate (Mr. Burrowes), who secured the debate, and other colleagues on the Back Benches. The hon. Member for Westbury probably gets more than his fair share of opportunities to ask questions of the Front Bench.
First, I congratulate the hon. Member for Enfield, Southgate on securing the debate. It is timely, because we are reviewing the alcohol harm reduction strategy for England that was published in 2004. Although we have not carried out a formal consultation as part of that process, I can assure hon. Members that we have had a series of detailed discussions that have informed our thoughts and views on how to take the strategy forward. Those discussions have included stakeholders from health, non-governmental organisations, the police, young people’s services and industry.
Once the strategy is published, there will be further opportunities to consult on different aspects of it. It is a cross-Government approach to tackling the multi-faceted problems of some for whom drinking has become a problem in their daily lives to varying degrees, but it is also for the majority who keep within the sensible drinking limits but for whom excessive drinking spills over into their lives. That might be because they want to go for an enjoyable night out without having to face the prospect of disorder in their communities or, as we have heard, because of matters such as domestic violence in which alcohol plays a part. Hon. Members have commented on the difficulties for children living in homes where alcohol is a common feature and contributes to a lack of support for them. There will be on ongoing discussion, and we will look for opportunities to consult on the various aspects of it.
We are determined to reduce the harm caused by alcohol misuse, and without being at all complacent I think that we have made some progress. It is becoming clear that the mechanisms that the Government have put in place since 2004 are becoming established and beginning, in spite of comments made today, to have a positive effect in tackling the range of harm that results from alcohol misuse. Most of the commitments in the Government’s strategy have been delivered—on under-age sales of alcohol and on violent crime and offences involving alcohol, which have fallen. That is not to say that we should be satisfied by where we are, but the indications are that such offences have fallen.
I pay due respect to those in local communities who are enforcing operations on under-age sales, which have been extremely successful. The partnership involved has been very good. I visited two small supermarket outlets, which I shall not name, and in both asked about alcohol sales. Both those supermarkets were on a final warning after two operations in which, I am afraid, they had been found wanting. In the staff room there was information up for all staff to further get across the point that they really had to take responsibility for checking on age. Schemes such as those mentioned by my hon. Friend the Member for Burton (Mrs. Dean) are, I am sure, common to many other hon. Members’ constituencies and tackle under-age drink sales. That is vital if we are to change some of the worst aspects of where drink is provided in our communities and the consequences of that.
We need to challenge the belief that drunkenness and antisocial behaviour are an accepted part of English drinking culture. There is sometimes a perception that it is our drinking culture, but the reality is that a minority indulge in such a way. Most people drink within the Government’s sensible drinking guidelines or exceed them only occasionally. Even among 18 to 24-year-olds, the group most often associated with drunkenness, more than two-thirds of young men and three-quarters of young women drink within the guidelines. Of those who drink at levels above them, only a quarter become involved in antisocial behaviour or disorder.
The renewed strategy needs to build on what has been achieved and where we are now, and set out how to embed the strategy further—it is not about starting afresh—and take it forward. Total recorded alcohol consumption in the UK is estimated to have doubled between 1960 and 2002, which is a trend over a long period. That is important in dealing with the cases of cirrhosis of the liver that appear in our hospitals, and I agree with the hon. Member for Romsey (Sandra Gidley) that we need to consider future health and what we can do to prepare for the number of people who might still have problems with cirrhosis of the liver or other health conditions linked to alcohol. We must look further down the road at how we can stem that flow in the future, but consumption has doubled in 40 years.
The average weekly consumption of alcohol increased from 5.3 units in 1990 to 10.4 units in 2000, and it has since remained at about that level. That decade was significant in that respect. Heavy drinking remains high, but levels have decreased significantly among men and there are indications—I use that word carefully; we cannot be complacent—that it may have peaked among 16 to 24-year-old women. It is too early to say whether that represents the start of a consistent downward trend in consumption levels, but it is at least helpful for an informed debate.
In 2000, between 15,000 and 22,000 deaths in England and Wales were related to alcohol misuse. Since 2003 the number of alcohol-related deaths has slowed and flattened out. I use those figures not to over-hype that as a sign of success, but something seems to be happening. I am not suggesting that it is all down to the Government; maybe it is because of greater awareness or maybe the headlines in our papers are beginning to make people take stock of their drinking and the impact that it has.
Through the strategy we undertook the first national assessment of the need and availability of alcohol treatment, which was published in November 2005. We allocated £3.2 million last October to establish three major identification and brief advice trailblazer trials, which are taking place on 57 sites, to identify and support harmful drinkers. That initiative is important because it is about trying to address people who are not defined as chronic alcohol dependants but whose drinking is regularly proving hazardous to their health and could result down the road in severe health conditions for them to face up to.
We are trying to examine the matter differently—maybe in accident and emergency settings or maybe in other environments such as a local police station if someone has been picked up for antisocial behaviour—to engage with a person’s drinking and its relationship to why they have turned up there. They might have turned up at A and E because they have fallen over and cracked their head open and require stitches, or at a police station because of disorder. I know that they are examining the matter in Enfield and are in discussion with their trust about staffing in the A and E department to support such work. I congratulate them on that.
The hon. Member for Enfield, Southgate, my hon. Friend the Member for Bedford (Patrick Hall), and the hon. Members for Romsey and for Westbury talked about drugs and why they are given such a priority compared with alcohol. We could have a whole debate about that, but I have a few comments. Action on alcohol is at a much earlier stage than that on drugs. It is also, as I think we all agree, a complex issue in that it is not of itself illegal. The drugs strategy was combined with dealing with illegal drugs and their link to crime. Unlike tobacco consumption, low alcohol consumption may be beneficial for health for certain population groups, and moderate consumption is not harmful. Alcohol therefore poses a different range of problems and issues to be resolved.
The alcohol harm reduction strategy for England was the first comprehensive Government-wide strategy to establish different ways to approach this complex issue. We may compare that with drugs, for which the Government have had a strategy in place since 1998 and for which there were predecessor strategies before that under other Governments. We are now encouraging drug and alcohol action teams, and many people involved in drug addiction through illicit drugs, a number of whom I have met, also have alcohol problems. There is an opportunity for dual diagnosis and dual treatment to go hand-in-hand.
I say to my hon. Friend the Member for Bedford that there is an opportunity to use the young people’s grant to address both alcohol and drugs. I am happy to talk to him about the situation in Bedford and why that might not be happening in his area. We work with the NTA and discuss such issues regularly, and we are considering how we can improve the situation. I hope that I shall not be corrected on this by officials, but I understand that if an area has met its targets on drug treatment numbers there is flexibility to use resources for alcohol services.
Of course, a number of our providers are both alcohol and drug treatment providers and will have benefited, for example, from the capital funding that we have provided for those services. Many of them are in the voluntary sector, such as Clouds, which was mentioned. I was happy to go to the launch yesterday of the merger of Clouds, Action on Addiction and The Chemical Dependency Centre. Quite cleverly they are going to use the same name—Action on Addiction.
We are absolutely serious about focusing on the area in question. I commend the comments of my hon. Friend the Member for Burton about how we can work with the industry. We cannot work with the illegal drug industry, but we can work with the alcohol industry in different ways to tackle irresponsible retailing. I have heard the points made about on-trade/off-trade promotions. We are examining advertising, and the authorities are going to review the code that they tightened up only a short while ago to see whether it is working. We are also working on labelling, and through self-regulation that is one way in which we have made some progress.
Higher Education (Funding)
It is a pleasure to appear under your care and control this morning, Mr. Olner, and to have the company of such a star-studded cast of Members of Parliament, in particular my hon. Friend the Minister for Higher Education and Lifelong Learning, with whom I had the pleasure of working for a considerable period. We still speak intimately as well as publicly.
I am delighted to have the opportunity to speak on the important issue of funding systems for higher education in the United Kingdom, an issue that has been neglected somewhat since our intensive discussions on the subject during the passage of the Higher Education Act 2004. The area that particularly concerns me and which I want to explore is the existence of different funding systems in the UK. I proceed from the premise that education should always broaden the mind, and that individuals from the different member countries of the UK should be encouraged to go to university in other member countries of the UK. The present system is making that more and more difficult.
I am reaching the time of life when my own children are considering going to university. That pleases me greatly but the situation brings pressures and concerns. I recently picked up a rather good edition of The Guardian that included a helpful university guide. An interesting article headed, “Want to study in a different part of the UK? What you need to know” contained 16 paragraphs setting out the different arrangements that exist for individuals who want to apply to go to universities in different parts of the UK, depending on where they live and where they want to study. That is a real concern for the student. I have a simple approach: I believe that students should apply to study on the course that suits them best as an individual and that will take them the furthest academically and in terms of their future career. At present, financial factors differ depending on where they are from and where they go to university, and that is unfortunate.
I have a strong constituency interest in the matter because I represent a border constituency; Wrexham constituency is on the border with Cheshire. I represent an area of the country, north-east Wales, that has been extremely successful economically in recent years. Indeed, the area that includes west Cheshire and north-east Wales has been one of the most successful in the UK. Recent studies have shown that that geographical area, which is known as the Deeside hub, is one of the areas of the UK with the most intensive economic growth.
There are many multinational companies in the area, including, most famously perhaps, Airbus in Flintshire, General Motors, Sharp UK and JCB, all of which are large multinationals. It is interesting that, until very recently, that area did not have within it a university. I am pleased to say that a couple of years ago university status was secured for what is now the university of Chester, and, at present, the North East Wales Institute of Higher Education in my constituency of Wrexham is going through the arduous process of securing degree-awarding powers.
Yesterday, I attended the launch of NEWI’s annual review. I have nothing but praise for the work that is being done by the institute’s staff, particularly the principal, Professor Michael Scott, who has taken the institute forward enormously. We hope that there will indeed be a university based in Wrexham within the next year.
NEWI is a particular type of higher education institution. It is entitled to boast that 67 per cent. of its graduates come from households earning less than £17,000 per annum. That is an extremely impressive statistic, and even more impressive is the fact that 91 per cent. of its students are in work within 12 months of graduation.
The institute works hard to engage with powerful companies in the economic area. Along with a further education college, Deeside college in the constituency of my hon. Friend the Member for Alyn and Deeside (Mark Tami), it has developed a foundation degree with Airbus, which is the type of degree that I understand is on the Government’s agenda and what we want for delivering higher education throughout life.
The institute takes individuals from non-traditional university backgrounds through education, and provides the education and skills that we all want for our children—and, indeed, for adults. Many of the students at NEWI are part-time students who secure entry to university, often through their employers and often through an aggressive marketing campaign that the institute runs in the area, which convinces people from non-university backgrounds that university is for them and that it will take them forward.
A problem for the geographical area known as the Deeside hub, which is an integrated area, is that it spans both sides of the England-Wales border. The financial regime for students from Wrexham is completely different from the one for students from, for example, Cheshire, which is literally across a brook some 5 yd wide. That creates enormous complications for the institutions that have to deal with the process. As I said, The Guardian set out in 16 paragraphs the process for any student who wants to attend university in the UK. I believe that there are actually seven different funding systems for UK students.
I have always been concerned about the issue. Indeed, that concern was one of the major reasons why I voted against implementation of the 2004 Act. One of the most unfortunate aspects of the Act, as far as I am concerned, is that it has created a situation in which it is cheaper for Welsh students to attend university in Wales than in England. As a Unionist—I do not hesitate to use the term—I think that that is extremely unfortunate. I would like a situation where that is not an issue for someone from my constituency who chooses to go to university. The key consideration should be whether the course is right for them academically, not whether it is cheaper to attend a university closer to home.
There are different conditions in England and Wales. There is also the situation of someone from Wales who wishes to study veterinary science but cannot attend a university in Wales because the course is not available in any of the higher education institutions. They would have to go across the border into England, and in that case the funding system for them would be the same as for a student from England.
The complexities of the present system in the UK are legion, but we are not having any real discussion about them. We have had recent elections in Wales and Scotland, and Governments are yet to be formed in those constituent parts of the United Kingdom. Therefore, it is an appropriate time for us to step back and to examine the overall higher education system and the way in which students choose to go to university in the United Kingdom. The constituent parts of the United Kingdom should begin to talk to each other to a greater extent about how the higher education system should progress.
There is a common agenda for UK higher education and we all recognise that the sector is a competitive environment. We all know of universities that are competing hard for international business and trade. The difficulties of the different funding systems do not just affect students; they also affect higher education institutions. When I secured this debate late last week, I quickly found out that there is an active higher education system in operation for briefing MPs. I am grateful to those bodies that forwarded interesting information to me about their particular areas of interest.
It is clear that there is real concern about the future of university funding and the different sources of funding that exist. I have always accepted that, at a time when, on leaving school, 43 per cent. of individuals go into higher education, it is appropriate for students to make a contribution to their higher education. However, I favour a graduate tax, rather than the variable fees introduced by the Government in 2004.
The hon. Gentleman makes an interesting case against the disparity between charging systems in England and Wales. Does he wish to roll back the devolutionary settlement whereby Wales can have separate arrangements for university finance?
I do not want to roll back the devolutionary settlement, although I am certain that some of my colleagues will be surprised at my gentle approach to that matter. I would like to facilitate much closer dialogue between the constituent parts of the UK, and between Ministers in the devolved bodies and the UK Government. We should not simply go back to the system that existed before the Higher Education Act 2004 because there are benefits from having closer links between universities and the local community as a result of a devolved system. However, there must be better recognition that we are operating in a competitive world market and not simply a UK market.
I am sorry that I missed the start of my hon. Friend’s speech. He speaks with feeling about the complexities affecting students, particularly in his own area. On the funding of higher education as a whole, does he agree that there is a strength in diversifying sources of funding and that, as well as a contribution from the taxpayer and students, there is an increasing role for endowments and other sources of funding? That would allow us to strengthen the independence and long-term stability of our universities and colleges in what is, as he said, a competitive global situation.
That is certainly the case. It is extremely important that we diversify the sources of funding in higher education. There are difficulties in the approach to endowments recently announced by the Prime Minister because the scheme tends to benefit those universities with a more traditional background, more alumni and more affluent alumni; smaller and newer universities do not have that same support. We must look for new sources of funding by developing links with previous students and with industry. The most competitive economies in the world have extremely high levels of contribution from the private sector. For example, in the higher education sector in the United States, levels of private sector funding are higher than we currently have. That is something that we need to develop. The foundation degree scheme that I mentioned in relation to Airbus in my own area must be extended in order for universities to progress.
There are concerns about the disparity of funding in the UK, which was recently expressed in evidence that was given by the Higher Education Funding Council for Wales to the inquiry on globalisation by the Select Committee on Welsh Affairs. Even now, under devolution, there is a dual-support system for higher education in Wales. The Welsh Assembly Government provide funding through the Higher Education Funding Council for Wales and funding is also provided by the Department of Trade and Industry and UK research councils to important universities in Wales, such as Cardiff and Bangor. Therefore, even under the devolved system, contributions are made by the UK Government.
The higher education sector in Wales has expressed concerns that it is not adequately funded by the Welsh Assembly Government. When a Government have been formed, I will ask them to look at that issue. The Higher Education Funding Council for Wales observed in its evidence to the Welsh Affairs Committee:
“Levels of overall public investment in HE in Wales lag well behind England, Scotland and some of our key international competitors. HEFCW estimates a £41 m funding gap exists between the HE sectors of Wales and England.”
Anecdotally, vice-chancellors in Wales have told me that that is their perception of the issue. I am not sure whether the Minister should take that as a pat on the back from England or not, but I am sure that he will take it that way if he can.
Welsh institutions are in a small higher education environment and must compete with higher education institutions in England. It is increasingly difficult for Welsh institutions to secure the appropriate level of investment to finance high-quality higher education for students. In the modern economy that we are developing, which is supported by universities, it is important that progress is made on that issue. I want to see a university in Wrexham, in my own constituency, that works closely with the successful private industry in north-east Wales and provides support for the research that companies undertake. I have met companies in my constituency that have told me about their research and that they use universities from across the United Kingdom and, in certain cases, from other parts of the world. There is a gap in the market and a missed opportunity for the local education sector as it could provide companies with the support that they need to progress.
The link between industry and universities must be taken forward and competitive universities should be able to offer the appropriate support to business. However, that is complicated by the current arrangements and the disparity in funding regimes for students and institutions in the UK. This matter has not been on the political agenda for a long time, which may be because of the elections to the Welsh Assembly and Scottish Parliament. The issue presents some political difficulty and should be discussed not just within one political party, but among all parties. We all agree that we need a competitive and high-quality higher education sector, which at the present time is very complex. We had a full debate about different funding systems for students at the time of the 2004 Act, but things have moved on since then. We are beginning to see evidence of changes in student behaviour, and that evidence will, of course, increase as time passes.
This is the appropriate time for the UK Government to engage closely with the devolved Governments and institutions to discuss how we can codify and bring together the funding systems within the United Kingdom. It is also time that we had detailed proposals from all political parties, not only from the Conservatives and Liberal Democrats in the House of Commons, but from nationalist parties in Wales and Scotland, so that we can hear what they have to say on the subject and how they believe that higher education can be taken forward.
Make no mistake: the higher education sector is vital to the continued success of the UK economy and to the UK as a cultural centre that other countries respect. We have built that up over many years, and further in recent years, and I am pleased to see the increased number of students accessing higher education through different means—not just through school, but through the workplace, institutions such as the North East Wales Institute and other non-traditional means. It is important that we make the system work as well as possible. In order to improve the current position, we need much greater dialogue between the UK Government and the devolved institutions.
I congratulate the hon. Member for Wrexham (Ian Lucas) on securing this debate. He is quite right to say that this issue needs more discussion. The level of public debate seems to have gone down since the one on the Higher Education Act 2004. I add also that, as a parent, I appear to be in a similar position to him. My other interest, perhaps formal, is that I am a university academic, and I shall come back to a point arising from that in a moment.
The hon. Gentleman raised an important point about differences between funding opportunities for students across the boundaries between Scotland and England, and Wales and England. However, in many ways, that comes back to the fundamental point made by the hon. Member for Henley (Mr. Johnson), that this flows from the very idea of devolution and of devolving student support as part of the devolutional settlement. That relates also, as he said, to the devolution of some parts of university funding. What he said about one part of university funding—the research councils—remaining on a UK basis is true.
There is an interesting question about whether that should be devolved further to Scotland and Wales, or whether there is an important benefit from maintaining a UK basis for research council funding. The amount of money available to universities from the research councils might be stabilised, because the complication of devolution makes it more difficult for the Government to shift resources about. I gather that there is a question about whether the research councils will continue to come under the auspices of the DTI, which may not be long for this world. If that is the case, the question arises of where the research council funding should go. Should it go to education or perhaps to the Cabinet Office? That is a difficult decision, but academics can take some comfort from one thing at least: because of the complications of devolution, the Government’s possibilities for raiding the research councils’ overall budget might be less in mainly England Departments than in United Kingdom ones.
On fairness and the opportunities for students on different sides of the boundaries, it strikes me that this is very similar to what used to happen when county councils and local education authorities could give discretionary grants for particular postgraduate courses, for example. Funding depended on where a person lived, but that was a political decision by that local authority, just as it is a political decision by the Scottish Parliament to spend the money available to it on effectively paying the fees of Scottish students in Scottish universities. It seems to me that if devolution means anything at all, it means allowing different layers of government to make different political decisions about spending priorities. That is the Scottish Parliament’s decision, and we have to respect it.
The second point from the hon. Member for Wrexham that I want to comment on was about the breadth of sources of funding in higher education. He is quite right that we should be looking for a broad range of funding sources. During our discussions on education funding at the end of the last decade and the start of this one—with the Dearing report and so on—a number of ideas arose that have not been taken forward. Most obviously, the point was made that students, the economy, employers and the Government all benefit from higher education, but in the debate since then, we have concentrated exclusively on the balance between the individual student and their family on the one side, and the taxpayer on the other. The one source of funding originally mooted, but no longer in the debate—it ought to be brought back—is employers. What place should they have in the funding of higher education? I would be interested to hear the Minister’s views on that.
Does the hon. Gentleman accept that one way in which employers could help would be to assist those they recruit with meeting their outstanding student debts? He might care to elaborate on that. Does he accept also that it is not quite true to say that other sources of funding have disappeared from the picture? Does he welcome the £200 million announced by the Government earlier this year as match funding for universities and colleges able to raise money from other sources, thereby expanding the endowment foundation, which, as I said earlier, has an important role to play in offering stability, security and independence for universities?
Yes, on those two points, certainly I welcome the money offered by the Government to universities to encourage fundraising. There are limitations on it and difficulties with the amount offered, but the principle is none the less a good one: higher education institutions should be looking for as much independence as possible, and financial independence is one of the foundations of academic freedom. It is often said that the older institutions have more opportunity to fundraise on that basis than new ones, but experience in the United States, to which the hon. Member for Wrexham referred, shows that even quite new state universities can raise a lot of money from the private sector in that way.
On the other point that the right hon. Member for Oxford, East (Mr. Smith) mentioned about employers effectively paying off the debts of those they recruit, that is one way in which employers can contribute, but of course it is voluntary: some do it, but others do not. There is a problem with free-riding by some employers. Furthermore, in America—part of my education was at a law school in the United States—I noticed that that was one of the ways in which the very well-off commercial law firms in New York and Wall street attracted bright students to their firms, as opposed to their going into perhaps more socially useful areas of the law. The number of my contemporaries who went into New York legal aid was, I think, one, and the number of my contemporaries who went into very large commercial firms in New York was very large. That is part of the problem with doing things in that way.
My main reason for speaking today, though, is to put a particular point to the Minister, to which I hope he will respond. Much of the debate on fees has been about the financial attractions or otherwise of taking a university course. As an academic, my point of view is probably slightly different from that of most people, in that for me, the most important thing about university is the content of the course and the effects of higher education more broadly on our culture. There is evidence, for example, that people who go through university courses tend to be more tolerant and liberal in their outlook, which I think is a very important aspect of our education.
Nevertheless, the question of the financial return to the student from taking a higher education course is important. I want to bring the Minister back to his comment in a debate in the main Chamber not so long ago that, on average, the financial benefit for students of taking a degree, over and above what they would obtain on the basis of A-levels, was about £100,000. Does that figure take into account taxation and the amount of income forgone by a full-time student on a three-year course? I ask that because those amounts can be quite considerable.
There are estimates that the amount of tax that someone would pay on an extra lifetime income of £100,000 would be about £42,000. Turning to the income forgone, let us say that someone worked for, say, 30 weeks a year extra by not taking a course and they worked full-time at about minimum wage level. On those figures, a student would lose, over the period of a three-year degree, some £20,000. Obviously, that figure would be much higher if the alternative employment was more lucrative, as it probably would be.
Let us consider how much per year a student will gain over a 40-year working lifetime and how much they lose by not working for the three years of the course—they never get that back, and in effect they lose the interest that they could have earned by putting the money in the bank. If we also take into account the tax, the overall calculation as to whether it is worth while, purely in financial terms—for me, that would not be the most important factor—for a student to take on a university course turns out to be very close. Indeed, it is so close that the question whether there are fees, and especially whether there are £3,000 fees, would make a difference to a large number of students.
I ask the Minister to consider that, because if the calculation is correct, we will see a shift in the student population away from students who are from what one might call risk-averse backgrounds. People who are not sure what the rewards will be may be less confident than others that those rewards will come their way, which will discourage them from going into higher education. Perhaps just as important, there will be a shifting of students on to courses on which they think they will get a higher financial return than the present average.
That might be part of what the Government intend to achieve through their higher education policy, but we need to consider whether it is right to encourage students to think about lucrative careers—in the City, perhaps—and to think less about less lucrative careers, which might be highly socially useful, such as careers in social work or in teaching. For me, the crux of the argument about fees is what we are trying to get students to do and whether we think that the only plausible incentive to give people who go into higher education is financial. If it is financial, will it work and what effects will it have?
My final point about the fees system applies also to the proposal made by the hon. Member for Wrexham when he talked about a graduate tax; it is a problem with that system as well. If it is true, which I think it is, that higher education is desirable for the whole of society—it is something that we want to see more of—does it make sense to tax it? Increasingly in the debate about green taxes or environmental taxes, for example, it is accepted broadly across the political spectrum that taxation should be used as far as possible to discourage activity or behaviour that we disapprove of and to encourage behaviour that we do approve of. If that applies to higher education, what we are doing now is completely wrong.
I was not expecting to speak so soon: I thought that the right hon. Member for Oxford, East (Mr. Smith) might be about to speak, so that we would have an Oxbridge contribution across the Floor of the Chamber.
I congratulate the hon. Member for Wrexham (Ian Lucas) on securing the debate. I listened with interest to his description of North East Wales institute of higher education. He may not know that I come from south-east Wales originally. I am sure that he has followed the fortunes of what was in my day Caerleon institute of higher education, which has become the university of Wales, Newport. Newport has become a city; perhaps Wrexham will go along the same path in the near future.
I also had some empathy with what the hon. Gentleman said about Airbus. From the point of view of my own constituency across the border in Bristol, Airbus is crucial to the west country economy as well as to the economy of north-east Wales and Cheshire, and co-operation between higher education institutions and industry is vital in that area.
Going back 20 years, I was a cross-border student myself, but it was a rather simple thing for me to decide to go from a south Wales valleys comprehensive school to an English university. There was no difference at all for me between doing that, going to Scotland or going to Cardiff or Swansea, which were my two nearest home institutions. Now, of course, students face a considerably more complicated application procedure and have financial choices to weigh up. The Campaign for Mainstream Universities has sent through a most useful briefing, to which I think the hon. Member for Wrexham would also have had access, which says that there are seven scenarios as to whether someone is an English, Welsh, Scottish or Northern Ireland student, depending on where they apply. Universities UK has also sent a very useful summary, which sets out the financial difference that students now face.
Let us take the example of students who originate from Wales or are going to study in Wales. A Welsh-domiciled student studying in Wales will receive from the Welsh Assembly Government £1,845 towards their £3,000 tuition fee, whereas someone going from Wales to study in an English university, as I did 20 years ago, will not receive that support: they will have to pay the full £3,000, albeit on a deferred basis under the new arrangement. A Welsh student from my background will now have to weigh that up.
An English student studying in Wales is subject to exactly the same regime as if they were studying in an English university. Someone who is from Wales but studying in Scotland has a completely different arrangement, and a Scottish student studying in Wales has a completely different arrangement as well. I will not go into the arrangements in Northern Ireland, because that would complicate things even further.
As someone who believes profoundly in devolution, I suspect from what the hon. Member for Wrexham said that I have rather more enthusiasm for it than he has. Indeed, my first political act as a schoolboy in the late 1970s was to deliver leaflets for the yes campaign in the dying days of the Callaghan Labour Government, so I have a long-term interest in devolution, and some of the things that he described and that I am summarising are an inevitable consequence of the devolved arrangements. I am sure that those complexities will evolve even more. If we believe in devolution, we cannot complain too much about that, because just as is the case for different health treatments on different sides of the English and Welsh border, or for bus travel and all the other anomalies that have sprung up since devolution, it is a natural consequence. For a 17 or 18-year-old in school who is contemplating where to study, the state none the less has a role in ensuring that they have access to the best advice and information, so that they can make an informed choice.
The hon. Member for Wrexham alluded to the funding gap between Welsh and English universities as institutions. Again, I can express concern about that as my party’s spokesman on higher education in England, but it is for the Welsh Assembly Government to decide how to spend the block grant that it receives from the UK Treasury, and the choices that it makes in the Cardiff Welsh Assembly are fundamentally a matter for politicians there. Perhaps the hon. Gentleman should influence his Labour colleagues in Wales—if they are still in government—to invest rather more in higher education than they have over the past eight years of devolution.
At many events in this place, I have anecdotal conversations with Welsh vice-chancellors and principals, and many of them have told me that the Welsh Assembly Government are not giving higher education in Wales due attention. Historically speaking, that is rather peculiar, because investment and belief in education have always been fundamental in Wales, and there has always been enthusiasm for investment in education. I did a history degree at Bristol university, and my dissertation was partly about the foundation of the university of Wales and the Welsh people’s huge enthusiasm for providing the initial funds to set up Aberystwyth, Bangor and Cardiff. It is a pity that that enthusiasm is perhaps no longer felt with enough fervour by politicians in Cardiff.
The investment is happening in higher education in Wales, but as the hon. Gentleman said, the Welsh Assembly Government have chosen to invest in providing support for the student fee contribution—the £1,800 that he mentioned. Welsh institutions are spending the money, but money cannot be spent twice—there is not a bottomless pit. That might be why the funding that the Government give directly to higher education institutions in Wales is lower. The difficulty for the Liberal Democrats is that, yet again, we have no suggestion of where the money they talk about will come from.
I am happy to be bound by your ruling, Mr. Olner, and I have no intention of going down that road anyway.
Of course, students, whatever their nationality, face further complexities, and bursaries are a good example. The financial section at the back of different universities’ prospectuses now needs to be ever larger. There are complex tables about what sort of bursary students might expect to receive, covering funding from the university’s own endowment-giving or alumni sources, which is fine, and the £300 minimum bursary that all universities must now offer as a result of the Higher Education Act 2004. Following that Act, it was expected that a market would eventually develop in fees, but that has not happened, because most institutions, with the exception of one or two, such as Leeds Metropolitan, have charged right up to the cap. However, a market has developed in bursaries, and it is now hideously complicated for a student to weigh up what subject they might do at what institution and what support they might get from that institution.
The situation is also not very egalitarian around the country. One reason why institutions such as Oxford and Cambridge, where my hon. Friend the Member for Cambridge (David Howarth) and I spent most of yesterday, can award generous bursaries to students from disadvantaged backgrounds is that relatively few apply and are accepted for places. However, a post-1992 university, which might take in a lot of students from its locality, which has done a great deal of work in widening participation and which draws in many students from poorer social and economic backgrounds, will have the same pot of money available to it and will therefore be unable to offer such a generous bursary, even though its students will clearly have the same need as those at other universities. I therefore wonder whether the bursary market that has developed is delivering equity for students from different family backgrounds at different institutions.
My hon. Friend the Member for Cambridge rightly mentioned the role of employers in university funding. It is now 10 years since the Dearing report, which recommended a tripartite approach to university funding. Lord Dearing recommended that money come from the state, and that funding has continued. He also recommended that the student or graduate should contribute, and that contribution has increased over the eight years since tuition fees were introduced. Finally, he recommended that employers step up to the plate and make a contribution, but that part of the report has not received sufficient policy attention from the Government. I therefore invite the Minister to expand on the Secretary of State’s comments in his funding letter of 11 January 2007 to the Higher Education Funding Council, which is reproduced as a final appendix on page 41 of the Library debate pack. In paragraph six of his letter, the Secretary of State invites HEFC
“to develop a new model for funding higher education that is co-financed with Employers”
“achieves sustained growth in employer based student places”.
Will the Minister expand on what the Government are alluding to? Are we really starting to ask employers to make a greater contribution to higher education?
My hon. Friend the Member for Cambridge rightly said that the undoubted salary benefit to graduates of accessing education is now more in the balance given that the debt that they will incur is now augmented by increased fees. The Government’s evidence for drawing firm conclusions about the policies that they have implemented and those that they might be contemplating is still rather flimsy. We do not yet know for certain which of the shifts in behaviour that my hon. Friend mentioned might be taking place. We do not know whether students are deciding to do business studies rather than classics because they think that such courses will be more commercial and more attractive to employers when they graduate. I saw the hon. Member for Henley (Mr. Johnson) rushing to meet the Roman soldiers who were outside Parliament yesterday to stand up for ancient history, and I agree with him that it is important to preserve such things. Merchant banks and firms of chartered accountants, such as the one that I worked for, want to employ people with trained minds who can think critically for themselves and argue a case, and students are better able to get those skills from a history, classics or law degree. However, students are now thinking about the commercial viability of their courses and might take courses that they might not otherwise have taken because of the financial arrangements.
The hon. Gentleman makes a good point about the necessity to make it clear to students that the humanities also offer lucrative prospects. However, is it not also our duty to make it clear to students that science—the numbers have gone down in the past, although the Minister will no doubt correct me and say that they are booming—is also a lucrative path for them to take?
Absolutely. My hon. Friend the Member for Cambridge and I heard anecdotally from an admissions tutor at Cambridge about a conversation with a parent who wondered whether their daughter should take physics or business studies. She was scheduled to get four As, including physics, and was an ideal candidate for a physics degree, but she thought that business studies might be more appropriate because of the debt and everything else.
Shifts are therefore taking place in subject choices, which is bad enough, but there are also likely to be shifts in location. It is a question not only of the cross-border issues at the heart of this debate but of whether the pattern of access to higher education, from which all of us here probably benefited—with people going away to study—will become completely different.
I went to Bristol from south Wales. It was a completely different environment from that of the mining village in which I grew up, and my life is completely different now. I have even largely lost my Welsh accent. Will students from more disadvantaged backgrounds now study closer to home, because that will reduce their subsequent debt? Increased fees, which augment the debt, might lead to that shift in behaviour.
Looking to the future, I am sure that the Minister hears from many vice-chancellors of their desire for the cap on the £3,000 fees to be lifted. I know that the Government will hold a full review in 2009. Of course, if the cap is lifted in England, the chances are that there will be even greater financial pressures affecting the ability of the Welsh Assembly Government and the Scottish Executive to maintain the differential, and that investment in those universities will change as a consequence.
My hon. Friend the Member for Cambridge also mentioned research. Of course, the Department of Trade and Industry made an extremely short-sighted decision to lop £68 million from the research councils’ budgeted income—income for which they had already budgeted, which they had allocated to research projects, and which they will now have to claw back. That decision cuts investment in tomorrow to finance the industrial mistakes of the past. At present we have a UK-based research funding council system, which is, at least, able to invest in Scottish and Welsh universities. I hope that that will continue.
I thank the hon. Member for Wrexham for introducing the debate. He rightly said that not enough attention has been given to the anomalies that are now arising between the three nations and one Province of the United Kingdom. Those issues need to be teased out much more in the future.
I, too, congratulate the hon. Member for Wrexham (Ian Lucas) on calling the debate and on putting his finger on a difficult political problem, which will not get easier, and which will start to come up the political agenda as we move towards a further reform of higher education finance, for reasons that I shall go into in a minute. He has only scratched the surface of the problem, but he is right to draw attention, first and foremost, to the need for strong and stable public finance for higher education. That is certainly something to which my party is firmly committed. Higher education is good for the country. Universities UK says that it generates £45 billion a year, and I do not quibble with that. It is a wonderful thing. It is a great motor of social mobility and, as the hon. Members for Cambridge (David Howarth) and for Bristol, West (Stephen Williams) both said, it is a great thing in itself. We thoroughly support the expansion of higher education and we want to ensure that it is funded properly.
Higher education is not, however, being funded properly at present, in the sense that the unit of resource has gone down considerably. As the Minister will confirm, anyone who goes to universities and talks to students about what kind of deal they are getting will sometimes encounter a good satisfaction rating—the students are happy—but will often meet students who say they are not getting a fair suck of the sauce bottle: they do not get enough teaching, class sizes are too big, and the student learning experience is not what they have come to expect. Particularly now that we are asking students to pay their fees, they are becoming more and more consumerist, and they deserve a better deal.
We need to think creatively. I welcome the cross-party note that the hon. Member for Wrexham struck. He is right, because the issue is so sensitive politically that there is a risk that it can become acrimonious. We all need to think creatively about ways of getting more money into higher education. The right hon. Member for Oxford, East (Mr. Smith) is of course right to say that endowments offer great hope. I welcome the recent proposals by the outgoing Prime Minister; I hope that the incoming Prime Minister will develop them. The Minister nods, which is all to the good, and we should support that idea.
I do not necessarily agree with the slightly defeatist note that is sometimes struck, although it is a valid point that some universities do not have the alumni base that others do, and therefore find it difficult to raise funds in the same way. That does not mean that we should discourage that route. Let us remember what American universities have achieved in a short space of time. They have fantastically increased the amount of money that they pull in, and we should think—in a revenue-neutral way, as I am not allowed to make any spending commitments—about the possibilities. For example, it might be possible to adjust the gift aid arrangements to make them more like the American system, where the giver has more of a direct sensation of giving. In America people can write out a cheque with more noughts on it than they can using the British system. It is a cosmetic change, admittedly, but I wonder whether it has a role in the psychology of giving that seems to be so prevalent in America.
I wonder, also—and I know that the Minister has thought about this and that the Higher Education Funding Council is already working on it—whether it is possible to be more relaxed with universities about how they spend the money that they get. Might it be helpful in some cases to break down some of the barriers between the various budget lines that HEFC sets out? Is it possible to smash some of the jam jars so that vice-chancellors just get more of their money in a single wodge, rather than having to bid constantly for this or that penny packet of money? There are arguments both ways, and different vice-chancellors would give different answers about it, but that seems superficially an attractive way to go, because it would involve trusting universities more and allowing them to get on with developing their operations as they see fit.
We should also, of course, develop funding for part-time students. If we could get the holy grail of some kind of income-contingent, revenue-neutral system of funding part-time students, which did not discourage business from contributing, we should go that way. We also need to think—as we are doing—about getting money from the beneficiaries of higher education. That was the importance of the 2004 reform, against which the hon. Member for Wrexham voted; and we should look honestly at the results of the reform. I do not think that the gloomsters have been proved right. It is perfectly obvious that numbers going into higher education—certainly in England—have gone up. I know that the Liberal Democrats sometimes dispute that, but the figures are 7.2 per cent. up this year in England. I think that I am right in saying that that effect is happening in the lower socio-economic groups.
I am sure that the Minister will be pleased at the hon. Gentleman’s helpful points, but does he acknowledge that the largest group of applicants to the Universities and Colleges Admissions Service is those defined as unknown? That group is growing, because students do not say what background they come from. The evidence that the number of students from lower socio-economic groups is growing is flimsy.
I would say that I am grateful for the intervention, but I am not really. The hon. Gentleman is clutching at straws to vindicate a point that was convincingly demolished by the increase—surge—in applications this year. He should execute a complete U-turn and drop his opposition.
To come directly to the point, the position in England is not replicated in Scotland, where, admittedly from a higher base, the number of applications has gone down by 1.2 per cent.
Would not it be fairer to look at figures across two or three years, since in England there was a great decline in applications and then a great increase? There were two factors: the introduction of a new system, which always causes uncertainty, and underlying demographic changes. People’s chances of becoming a student are still pretty much what they were before the change happened.
One could not call the 2006 figures a sharp decline, as they were substantially up on the 2004 figures. The Liberal Democrats must move on from this point. They have lost the rubber; they should give up the argument, move across and start supporting a constructive, creative and socially progressive way of getting more money into universities.
This issue is particularly relevant in Scotland, where numbers have gone down. The Scottish did not go for the English solution and they have something approaching a crisis in their university system. There is a brain drain of academics going down to England, and there are considerable redundancies in the faculties of Scottish universities—I hope that we are allowed to talk about Scotland even though it is a devolved Administration. Dundee has had to lay off 100 lecturers, Strathclyde is laying off 250 and Glasgow 230.
If one reads the Scottish papers, as I do, one will know that Scottish academics are looking longingly at the alternative English system that was created as a result of the devolution arrangements. They are urging Scottish politicians to go down the English route, and are becoming more and more vociferous in saying that their competitive position is not sustainable and that they want to replicate the situation here. Unfortunately, something terrible has happened in Scotland: they voted for the hon. Member for Banff and Buchan (Mr. Salmond), who takes an even more regressive position than that which was taken by the previous Administration. He says that he will get rid of all kinds of repayment and will reinstitute the grant, which will further increase the disparity between the English and Scottish systems.
Does the hon. Gentleman agree that one advantage of devolution is that it enables us to compare different systems and see which works best? We can look at the evidence and then follow a particular route as a consequence. It will be to the advantage of the devolved Administrations to work towards a single UK model by consensus.
One might just as easily gain the same advantage by looking at many different countries. However, I see the hon. Gentleman’s point. This is a difficult problem and it is going to get sharply worse. Some time this summer, the Government will appoint a commission. The word on the street is that the person who will run it has already been designated by the Minister. I do not know whether that is true; there is a studied blankness on the Labour Benches. One way or another, a commission will be appointed this summer to look forward to 2009 and to begin work on a review of higher education financing in England.
I do not want to prejudge the review in any way, but I will say that we all want an equitable system that allows universities as much freedom as is compatible with widening access and ensuring that people from poorer, non-traditional backgrounds are not deterred from going to university. We want progressive reform that gives universities more freedom to make their own financial arrangements, within reason, if that is possible. One imagines that at some stage in the next Parliament, a Bill will come before Parliament, as it did in 2004, setting out the arrangements by which that might happen in England. The background to such a Bill will be very different from that in 2004, because by then the disparity between the funding arrangements in England and Scotland will be even worse, and Scottish academics will be looking with ever more longing eyes at the English system and worrying that their competitive position is being further eroded.
I cannot let the hon. Gentleman move on without putting to him the obvious, Scottish academic, point of view. Funding for research in Scotland is considerably more generous than it is on this side of the border, so the academics who are looking longingly across the border might be looking the other way.
The hon. Gentleman makes a fine point about research, but if he were to read the Scottish papers and look at the redundancies in Scottish faculties, he would not speak quite so glibly.
Given the widening competitiveness gap between Scottish and English universities, one has to wonder whether the 59 Scottish MPs should be allowed to vote on these issues in this Parliament. English MPs have no corresponding say over those questions in Scotland, and the motives of those Scottish MPs will be mixed, to say the least. Will they vote for a system that allows English universities to have a yet greater competitive advantage and so disadvantage universities in their own constituencies? Should we allow a Bill to be drawn up that will take account of those Scottish motives, when it will affect only English universities in English constituencies. I do not think so.
It is all very well to have two or three different systems of university funding in this country, but it is not right to have one group voting on another group’s system if the other group is not allowed to vote on the first group’s system. That fundamental injustice is going to move up the political agenda, and it will be extremely difficult to solve unless the Government move towards the system that the Opposition advocate, of having English votes for English laws. Under no circumstances would a Scottish Conservative MP vote on a higher education funding Bill that did not affect his constituents. The most elegant, logical and natural solution is for the Minister to pledge now that no Scottish MPs shall vote on the future financing arrangements of English universities.
The problem is not insoluble, and the hon. Member for Wrexham was right to raise this issue. His comments are timely and prescient, and he is right to point out the difficulties of having several university finance systems in a united kingdom. I look forward to joining his cross-party effort to sort the problem out.
It is a pleasure to respond to my hon. Friend the Member for Wrexham (Ian Lucas), whom I congratulate on securing the debate. It is not often that a Minister has the opportunity publicly to thank his former Parliamentary Private Secretary for his work. My hon. Friend worked very well on my and the Government’s behalf, and he knows that I was disappointed when he left that position. I thank him for his excellent work.
I have some personal understanding of this important and interesting issue, as I went to university in Cardiff, and I well understand that there will inevitably be a flow of students across borders. I recognise my hon. Friend’s concerns about the different higher education funding systems in each of the devolved Administrations, particularly the different systems of financial support for students. There is no point in denying that the nature of those differences can cause complexity, but while I recognise the strength of his views on the merits of giving responsibility for higher education to the devolved Administrations, I must tell him that there is no prospect of turning the clock back in terms of the devolved settlement.
Fundamentally we must recognise that the differences arise from different, but legitimate, democratic decisions: those of people in Scotland and Wales to support devolution, and those on student finance and universities taken by elected Ministers. Sometimes the exercise of that democratic choice gives rise to complications and rough edges. The task for all of us, whether in Westminster, Cardiff, Edinburgh or, indeed, Belfast is to do what we can to make sense of the complexities. We neither can nor should wish away the democratic process that has led to them. This is not something dramatically new, because there have always been differences in the education systems in the different parts of the United Kingdom. Devolution naturally empowers each country to do things differently for its people when compared with the prevailing systems elsewhere in the UK.
It is important to make it clear that each Administration carried out a thorough review of their own higher education systems before implementing the current systems of student financial support. Each system has helped, importantly, to maintain the upward trend in higher education application figures. The systems, in effect, provide different ways of achieving important and common objectives: they encourage all students to participate, and they support those from lower-income backgrounds, who would not be able to access higher education without additional support.
The other feature that the systems all share, which I want to emphasise, is that nobody affected by the new arrangements should, or does, pay up-front tuition fees anywhere in the United Kingdom. We have rightly recognised that it was a mistake in 1998 to introduce the concept of the up-front payment of tuition fees, and the new system across the UK rectifies it.
I can also reassure my hon. Friend that we are actively monitoring what is happening in each part of the UK. My officials from the Department for Education and Skills talk regularly to their colleagues at the Scottish Executive, the Department for Education, Lifelong Learning and Skills in Wales and the Department for Employment and Learning in Northern Ireland, to encourage the effective and efficient delivery of student finance across the UK and to sort out any cross-border issues. That is overseen by regular contact at ministerial level.
We are not going back to a one-size-fits-all model, but we all accept that students need proper information and advice on the choices that they face. Such information is put out for students and parents, and on the web, setting out clearly the full details of the student financial package in England as well as information on what students can expect should they choose to study at a university in Scotland, Wales or Northern Ireland. We make it clear what applies to England, and a section directs people from Wales, Scotland and Northern Ireland to the appropriate information sources in the devolved Administrations.
In all this debate, we should not forget that the benefit of this apparent complexity is that much more money is now available in higher education than was the case under the previous Government and that the systems are better and fairer. They are helping more students to participate in higher education, which is good both for them personally and for the country.
It is worth underlining the scale of the change that has taken place. Let us consider the situation just 10 years ago. Between 1989 and 1997, funding per student fell by 36 per cent., and that at a time of great expansion in higher education, as our economy changed from mass production to high skills. The result of that funding squeeze was that universities were seriously underfunded in comparison with their international competitors.
In contrast, since 1997, this Government have invested heavily in higher education. Our spending has increased by 23 per cent. in real terms since we took office, and we now spend more than £10 billion a year on higher education, with more to come in real terms in each of the next three years.
It is important to point out—this is an issue to which I shall return—that increasingly the responsibility for the future funding of higher education needs to be shared between the Government, the individual and employers. The changes that we have made, certainly those in England to the student finance system and the fees system, are proving beneficial. Not only are they bringing in additional money, but the most recent set of university application figures—those for courses next year—are a strong pointer in the right direction. Applications have increased by about 6 per cent. and the proportion from lower socio-economic backgrounds has increased too.
We have made progressive changes to the system of student financial support: we introduced the return of non-repayable grants; we provided for additional bursaries from universities; and we raised the threshold for loan repayments from £10,000 to £15,000. All of that has been positive. We have also had to focus on communicating those messages effectively to students and potential students. I pay tribute to the work that the Government have done with Universities UK, the National Union of Students, the Student Loans Company and the Universities and Colleges Admissions Service—UCAS—to name but four, to ensure that students can access the information that they need.
I should like to respond directly to a number of the points that have been made.
That is an interesting question. Although there has not generally been a market in fees, there has—this is where I agree with the hon. Member for Bristol, West (Stephen Williams)—been a market in bursaries. In that sense, a competitive situation exists in which universities rightly have to examine not only their student financial support package, but the quality of delivery. Let us consider the new mechanisms to ensure positive performance, for example the national student survey. Universities rightly will increasingly have to justify the work that they do and the service that they provide to students.
Does the Minister agree that as we approach the review of the fee cap, it is crucial that a good, thorough, comprehensive and trusted evidence base exists about the impact of the fees, the bursary arrangements and so on, both in overall terms and in terms of the performance of each individual institution? We need to have an informed debate at that stage, and the empirical evidence that underpins the debate will be crucial.
My right hon. Friend is right, and I shall return to the point. To all the people who say that we should pre-empt the decisions of the independent commission in 2009, I must say that it is right that we see the proper, full evidence from the first three years’ full operation of the new system and that we, the Office for Fair Access, UCAS and others work together to ensure that as much information as possible is available to inform whatever judgment is made after 2009.
To return to some of the points that my right hon. Friend raised, I agree that one of the strengths of our university system is the diversity of funding streams. He is right to focus on our recent announcement of the £200 million to incentivise the giving of endowments to universities. The way in which we have structured the initiative means that it moves significantly beyond the top five or 10 universities in terms of research income; we envisage that about 75 institutions will be able to benefit from that matched funding scheme. We also need a greater contribution from employers, and I shall return to that.
This week, we are hosting a major international conference in London—the Bologna conference—on comparability and the mobility of students across the broader European higher education area. As I talk to my counterparts, I find, privately at least, that a number of them are envious of the broader funding streams that we have in our higher education system.
The hon. Member for Cambridge (David Howarth) talked about raiding the research budget. This Government and I will take many criticisms, but if he were to look in detail at this Government’s commitment to, and record of, financial support for research over the past 10 years, he would see that it is one of the most positive in generations. There has been a 70 per cent. increase since 1997. We are talking about more than £2 billion a year, combining the DFES and Department of Trade and Industry contributions.
The hon. Gentleman raised the issue of employer contributions. As I have said many times in the past couple of years, the big future expansion in higher education will be in the field of employment-based higher education. Part of the way that that needs to go forward involves developing a co-financing model, whereby employers contribute to the costs of driving up the skills base and the qualifications of their employees.
The hon. Gentleman also raised some questions about the financial return to students. I want to make it clear to him that the figure that I am quoting, which is based on detailed research, is an average net £100,000 graduate earnings premium of a student over the course of their working life, compared with someone who has just two A-levels. That is on top of tax and on top of forgone income during students’ three years of study. Indeed, the financial returns for graduates in the UK are among the highest in the world.
I must say gently and charitably that I take some the Liberal Democrats’ concerns with a pinch of salt. People ultimately judge politicians not on what they say at the hustings or in opposition, but on what they do when they have their hands on the lever of power. The Liberal Democrats, in coalition in Scotland, have supported a system of postgraduate repayment, which is no different in principle from the variable fee system that we have in England. It is important to register that point.
The basis of this debate, called by the hon. Member for Wrexham, is that the systems are different. The system in Scotland is plainly different from that in England, because the first principle of the Scottish system is that the Scottish Executive pay Scottish students’ fees.
Yes, and the hon. Gentleman will be aware that although there is less to pay in fees, the student must find more for living costs. In England, low-income students have much more support per year for living costs. Better-off Scottish students also have the fees advantage, but receive significantly less maintenance support because income thresholds are lower and the non-means-tested part of the loan is much smaller than the 75 per cent. in England.
Let us have a proper debate on the facts, and let us stop sloganising about higher education. When people look long and hard at what the Liberal Democrats have done when in power, it is very different from what they say in speeches on university campuses throughout the country.
The hon. Member for Bristol, West (Stephen Williams), who leads for the Liberal Democrats on this issue, chided my hon. Friend the Member for Wrexham to encourage the Welsh Assembly to invest more in higher education. Again, the Liberal Democrats have not been part of the Assembly’s government. If he is handing out advice, he can give it to my colleagues in the Welsh Assembly, but he must also give it to his own colleagues.
The hon. Gentleman said that we are not doing enough to encourage employers to contribute to the cost of higher education. That is not true. For example, the Government have developed foundation degrees, co-designed with employers. At the moment, there are around 61,000 foundation degrees throughout the country, and we are moving towards 100,000. The hon. Gentleman referred to the Secretary of State’s letter to the Higher Education Funding Council. We have told the Higher Education Funding Council in England to provide at least 5,000 co-funded places a year, working with universities that are keen to expand this area. We have initiated three regional pilot schemes under the training-to-gain banner, to add a higher education dimension to that programme of encouraging and helping employers to move their employees up to the highest level.
The hon. Gentleman also asked about the cap. Let me make it clear that the Government have said all along that we need an independent commission in 2009. I believe it would be premature to pre-empt its deliberations and decisions, and I say that to some vice-chancellors who urge me to lift the cap now, and to the National Union of Students which urges me to scrap tuition fees. I also said it recently to the Liberal Democrats’ think tank, which urged me to lift the cap now to £5,000 a year. Across the board, it is important to await the full three years’ figures, and then make the judgments.
The hon. Member for Henley (Mr. Johnson), who leads for the Conservatives on these issues, raised some important points. He started by questioning what was happening to the number of science applications in our universities. I dispute his accusation, which he and I have discussed on a number of occasions. There has been a three-year trend of a turnaround in applications for STEM subjects—science, technology, engineering and mathematics. The application figures for the coming autumn show significant advances of 10 per cent. plus for physics, chemistry, maths and engineering. One reason is that we are now more successful in convincing students of the additional graduate earnings premium for STEM subjects, which is about a third more than for students of non-STEM subjects. Indeed, I shall make a major speech and an announcement tomorrow on what more we must do to get the facts across to young people about the benefits of studying science at university in this country.
The hon. Gentleman then went on to decry the fact that the unit of resource had fallen considerably in our universities. That was certainly the case under the Conservative Government, and between 1989 and 1997 it fell by around 36 per cent. However, during the current three-year comprehensive spending review we have, for the first time in a generation, maintained the unit of resource. In the Budget announcement this year, we made it clear that for the next three-year period we will again maintain the unit of resource, so for six years in a row, after a generation of moves in the opposite direction, we are maintaining that unit of resource in higher education.
On top of that, we have additional fee income, the endowment initiative, and the extra research funding commitment to universities. As I go round the country talking to academics, university staff and vice-chancellors, although there are, rightly, questions and challenges, they acknowledge, virtually universally, the real step change in support and funding that we have delivered to our higher education institutions during the past 10 years.
The hon. Gentleman also asked about part-time students. It is to the credit of this Government—I would say so, wouldn’t I?—that we are the first ever to have introduced a part-time student grant. Not only that, last year we increased it by some 27 per cent. We have also increased the access to learning fund from £3 million to £12 million across the country.
I make no apology for saying—I think the hon. Gentleman and I agree on this—that it would be wrong to replicate the full-time student support package for part-timers because the evidence shows that around 41 per cent. of part-timers have their costs met by their employers. Given that we must collectively incentivise more employers to make a greater contribution, I would not want to do something that simply substitutes state funding for employer contributions. Our changes have been beneficial. We must monitor the impact on part-time students, but we should not do things that might have an unwelcome consequence.
The hon. Member for Bristol, West intervened on the hon. Member for Henley and made an accusation that it was difficult to claim that the proportion of students from lower socio-economic groups was being maintained and increased, given that an increasing number of students do not designate their social class identification in the UCAS application process. It is certainly true that there has been a reduction in the number who do that, but the hon. Member for Bristol, West has no basis in fact for suggesting that that would disproportionately impact on students from lower socio-economic groups.
I say this charitably, but there is a need for real care in this debate. I respect the fact that the Liberal Democrats claim to have a different position on student finance, but there is a slippery slope from that position of integrity and moving to misrepresentation and scaremongering, which will put off the very students from the poorest backgrounds for whom the system of student financial support is immensely better than in the past.
In the final minute of his speech, will the Minister address my central question: does he think it right, with the current university financial crisis in Scotland, that Scottish MPs should be able to vote on further reform of university finance in England?
People have voted for a devolved settlement, and it is right and proper that that is taken forward. It enables people throughout the United Kingdom to exercise their choice and judgment.
In conclusion, we have had an extensive debate. I congratulate my hon. Friend the Member for Wrexham on raising the issues, and pointing to some of the important work that local institutions near his constituency are undertaking, which he and I have talked about. They are doing absolutely the right thing, particularly in respect of foundation degrees.
St. Helier Hospital
I am very grateful for the opportunity to raise the issue of patient care in this debate. I also put on the record my thanks to the Minister for the generosity that he showed to a constituent of mine, Mrs. Donoghue, who visited him with a representative from Headway. I hope that, during the debate, my hon. Friend the Member for Sutton and Cheam (Mr. Burstow) will also be able to catch your eye, Mr. Taylor, as he would like to make a few important points, and I am happy to facilitate that.
The St. Helier hospital and the Epsom and St. Helier University Hospitals NHS Trust have not escaped media attention in the past few months, following the trust’s decision to remove one out of every three light bulbs from its communal areas. However, in today’s debate, I shall raise a much more serious matter: the quality of patient care generally in the trust, and specifically at St. Helier hospital. I shall ask whether it is affected by the trust’s need to balance its books and to hit its efficiency savings targets, which amount to at least £24 million over the next two years.
It is always dangerous to draw conclusions from anecdotal evidence, so I acknowledge that the two patient cases to which I shall draw the Minister’s attention—the cases of a man whom I shall call Douglas, and a Mr. Kent—do not amount to a pattern of neglect. The many constituents who have contacted me recently to express their gratitude for the care that they have received at St. Helier hospital would, I am sure, want me to make that point.
However, the two cases require the trust and the Minister to set out what the trust and the Government are doing to ensure that the quality of patient care is acceptable and is not affected by the trust’s cutbacks. In my view, the trust has in those two cases failed to achieve that standard of acceptability. The debate is not about high-tech equipment or the availability of expensive drugs; it is about the washing and feeding of patients, communication with relatives, respecting patients’ dignity and keeping their loved ones as well informed as possible at a time of great stress.
In those two cases, and others, which had time allowed, I could have raised, the source of patients’ and relatives’ complaints has been problems concerning poor communications with relatives, medication not being administered, soiled bedding not being changed, inadequate levels of hydration, strict diets not being implemented in a timely manner, and relatives having to clean up their loved ones. The issue is not about a postcode lottery for the latest wonder-drug.
I shall first relate some of the details about Mr. Leonard Kent. In September, he went for a total hip replacement in Epsom. After the operation, he was discharged with a weeping wound. The wound was discharging clear liquid, but I understand that it is normal practice to discharge a patient in that condition. In October, he was admitted to St. Helier hospital with signs of jaundice, and there then ensued a number of incidents. For instance, his CT scan was delayed, because the portable oxygen bottle that he needed to take with him for the scan was not available. He was also put in B4 ward. From the letter that the trust’s chief executive, Graham Smith, sent to the Kents, I understand that B4 had recently moved, and that there were more bank staff on the ward than was usual.
Mr. Kent suffered the indignity of soiling his bed because he was not attended to, and his wife had to clean him. Water, which he needed, was not always available, and cannula changes were not carried out promptly. Charts relating to his strict diet were completed three days late. It is not clear whether it was simply a case of the charts not being completed, or whether the diet was not adhered to in those first three days. The trust’s letter does not make it clear. Fortunately for Mr. Kent and his family, none of the errors or delays proved life-threatening. However, they left him and his family with the feeling that he had been neglected. I am pleased that in that particular case, the trust has issued a full apology.
The second case is that of a patient, Douglas, who very regrettably has since died. His family are still recovering from that loss. He was admitted in January for a broken hip and transferred to B4 ward, the ward where Mr. Kent was placed. Douglas was transferred to the ward three months after its reorganisation, so any issues about the ward’s move and reorganisation three months previously should have gone away. However, I am disappointed to note that his and his family’s experience of patient care was very similar to Mr Kent’s.
Douglas was left with an unsupported broken hip when in bed, his bed was wet from urine on at least a couple of occasions when his family visited him, his mouth was not hydrated, medication was apparently left half dissolved on his tongue with a second tablet on the floor, and his family felt that they were not kept informed about what was happening to him or about the care that he was receiving. Now, his family are struggling with their loss and with the knowledge that the care that he received in the final stages of his life was not acceptable.
The experience of the local health service for the two patients and their families was not only very sad, but perplexing given that there has been a large increase in the number of nurses working in the NHS. The Government intended ward housekeepers to take responsibility for the quality of the cleaning and food on the wards, thus freeing up nurses’ time to enable them to focus on patient care. The Government introduced that initiative in 2000, with £50,000 start-up costs for each trust, and I assume that the Epsom and St. Helier University Hospitals NHS Trust was a beneficiary of that sum. At the time of the launch, the Government set a target whereby half of all trusts would have housekeeping services in place by 2004.
The document, “A First Guide to New, Modern and Dependable Ward Housekeeping Services in the NHS”, was published in 2001. Describing the role of ward housekeeper, it says:
“A ward housekeeper’s main tasks will focus on cleaning services, food services and maintaining the environment… Ward housekeepers will work together with the ward sister to ‘get the basics right’, so that: patients feel...cared for; patients’ individual needs are met; hospital wards are clean; food is enjoyable”.
The guide also says:
“There must be commitment from trust management”
to make it work. Such care was exactly what Douglas and Mr. Kent needed but did not receive.
The trust is abolishing the existing housekeeper posts. Their abolition is the most concrete example of a measure that will, inevitably, impact on patient care. In the trust’s proposal for removing the housekeeping service, it specifically says in its conclusion:
“There is a risk that the standard of support services, and the ability to respond to immediate requirements of the ward, will reduce, but”—
it goes on to say—
“be consistent with other wards in the Trust.”
The conclusion implies that the trust is reducing services to the lowest common denominator. The higher standards that applied to the wards with housekeepers will no longer apply; standards will simply be consistent with those that apply to the trust’s other wards, because housekeepers have not been available on all its wards. I could cite other examples, such as the freeze on staff vacancies, which will have an impact on patient care.
Like my hon. Friend the Member for Sutton and Cheam, I hope that the better healthcare closer to home project will continue to proceed smoothly. We have debated it many times in this place and it could facilitate the rebuilding of St Helier hospital. However, it is not the subject of today’s debate. In the meantime, I urge the trust not to lose sight of the necessity to provide patients with standards of care that we would all feel comfortable with were they applied to our own families.
I congratulate my hon. Friend the Member for Carshalton and Wallington (Tom Brake) on securing today’s debate, which is one in a series of debates that we have had about the future of St. Helier hospital and the Epsom and St. Helier University Hospitals NHS Trust. Over the past 18 months or more, many people in my constituency have rallied to the flag to give their full-hearted support to St. Helier, through protest marches, petition signing and letter writing. However, amid the publicity, the expressions of support for the trust and the high-profile campaigning to secure its future, people have also said, “I cannot support St. Helier, because of the experience that I and my family have had there.” I acknowledge, as my hon. Friend did, that they are probably a minority of those who have experienced care in the hospital. The vast bulk of people who have been cared for there do not write to me as a Member of Parliament, because they have had a good experience. However, that should not be an excuse for ignoring those who do not have a good experience.
I should like to a refer to one particular case and to a conversation that I had recently with the Sutton Association for the Blind, which has drawn together a compendium of evidence relating to its concerns about the experience of blind or partially sighted people at the trust.
The case that I want to cite is that of my constituent Mr. Bedford, which was drawn to my attention by his daughter Mrs. Eaton. He was admitted to St. Helier hospital in September 2006. During five weeks in the Barrington Brooke ward he went from being a mobile individual, able to potter around the ward, as my constituent put it, to one who was bedridden, incontinent and unable to feed himself. He suffers from Parkinson’s disease and appears also to have had a change in prescription of the drugs used to manage his condition, which has produced some violent reactions and a change in his condition generally. My constituent also tells me that Mr. Bedford had not been bathed for 10 weeks and that when he was transferred to St. George’s hospital, it was discovered that his hair was dirty and matted, evidence of a lack of attention to personal hygiene on the ward.
Mrs. Eaton felt that the decision making about her father’s care was more about managing the work pressures of the staff than about choosing the appropriate level of care for the individual. She cites the fact that it appeared to have been decided to treat him as though he were incontinent rather than providing a bedpan, to put him on a drip rather than providing him with fluids orally, and to leave him wet in a bed until lunch was served rather than changing him before then. It was only when the family’s lobbying and my contribution to it led to a transfer to St. George’s that things got a little better. Indeed, some of the comments and reactions at St. George’s that Mrs. Eaton passed to me were disturbing in themselves. I mention that case because it is one of a number of examples that constituents have raised with me recently.
Sutton Association for the Blind has cited three repeated concerns of visually impaired constituents of mine and my hon. Friend’s, which go to the heart of the initiatives that the Minister is likely to tell us about in a minute. First, there is a concern about the lack of awareness and sensitivity on the part of staff about feeding, particularly of people with disabilities or a visual impairment. Placing food in front of someone who is blind, but then not guiding them to the knife and fork or the plate, is a sure-fire way of not providing them with a nutritious meal. Secondly, there is a concern about medication not being properly provided in a capsule that can be readily accessed and about patients not being talked through the process. As a consequence, patients on wards have taken the wrong combination of medication or incorrect quantities.
The third concern, which is almost always at the centre of the cases that constituents bring to me, is about communication. That includes communication with the relatives, at what is often the most emotionally charged point in the care of their loved ones, when they need staff who are most able to communicate effectively and understand their needs, communication between staff, the effective handover between teams and effective record keeping. The lack of audit in all those respects is a concern.
That is why I agree with my hon. Friend that what is required is a fresh start. We do need that new hospital that he talked about. But, well before that, we need the kind of cultural change in the organisation that the Government want to see in the NHS and which is essential if the care that relatives and patients need is to be delivered in the right way.
It is always a pleasure to serve under your chairmanship, Mr. Taylor. I congratulate the hon. Member for Carshalton and Wallington (Tom Brake) on securing this Adjournment debate. It is perhaps important that we as parliamentarians occasionally bring individual real-life stories to this surreal world of ours. I congratulate him on bringing to our attention some of those cases, which I shall deal with, as much as I can directly, in a moment.
I am also delighted that my hon. Friend the Member for Mitcham and Morden (Siobhain McDonagh) has joined us in this debate. She more than anybody has been passionate in her support for St. Helier hospital and in making the case, privately and publicly, for the site to remain a district general hospital, serving the local community. There has been a tremendous all-party commitment to that campaign, which we welcome, although it is interesting to note that no Conservative Members at all, either Front Benchers or Back Benchers, have been present during this debate. I do not quite know what that says about their interest in the health service or some of the issues locally.
The hon. Gentleman recently brought Mrs. Donoghue, one of his constituents, and the organisation Headway to see me, to talk about the impact of her husband’s condition on her and her family’s life. She is a remarkable woman, of tremendous courage and insight, and she gave a most powerful presentation. The hon. Gentleman will be pleased to know that we are having a summit tomorrow on the specific issue of long-term neurological conditions. As promised, we will begin that summit with a presentation on Mr. Donoghue’s case given by Jean Donoghue. Talking about the real-life impact that those debilitating and challenging conditions can have on people is an innovative and important way to begin such a meeting, so I thank the hon. Gentleman for giving me the opportunity of meeting Mrs. Donoghue. We shall be using her and her husband’s personal experience tomorrow to influence, I hope, the development of some of our policy on neurological conditions.
The hon. Gentleman referred to two cases: that of Mr. Leonard Kent and that of Mr. Douglas. The first thing that I would say, through the hon. Gentleman, to the families of those individuals is that we cannot underestimate the reality, which they have articulated, of their experiences of the health care that they have received. It is important to send them the clear message today that not only do we have empathy and sympathy with their experiences, but we redouble our efforts to ensure that every day we minimise the number of people who have a negative experience of the national health service. We would never want to belittle or devalue the experiences that people have had. I should like in particular to extend my condolences to the family of Mr. Douglas, who tragically passed away, having, from his family’s point of view, not received the kind of care that they would have wanted and had a right to expect.
It is also important to say, however, that the vast majority of people, when asked about their experiences of acute national health service care, speak about it incredibly positively, whether at St. Helier or in different national health service organisations up and down the country. There is a great disparity between the way the NHS is reported and people’s general or abstract sense of optimism about the state of the NHS, as well as the real-life experiences of those who access NHS services day in, day out.
It is important to make that point, and not only for political reasons—clearly the Government are very proud of the additional investment, nearly tripled by next year, that has been put into the NHS. We are also proud of the fact that by the end of 2008 we shall have achieved the historic target of a maximum wait of 18 weeks from the point a patient visits their GP to reaching the door of the operating theatre, for the vast majority of conditions. That is a remarkable story for waiting times in the NHS, compared with 10, 15 or 20 years ago.
It is important to make the point that the extra investment has made a difference and that waiting times are coming down. However, the point is also important for the morale of the people who work on the front line of the service—the doctors, the nurses, the support staff and the ancillary staff. On the whole they do a tremendous job, not always in the easiest circumstances, to ensure that patients and their families get access to the highest-quality treatment. However, health services are about not only treatment but emotional support and understanding what emotional impact a serious illness can have on a patient and their family. On the whole, those health care professionals are still passionate and idealistic about working in the national health service and still, by and large, do their best to be as professional as possible. In debates such as this we must always pay tribute to those front-line workers.
However, we must also make it clear that dignity and respect in how we treat patients, particularly older people, have to be at the heart of the health care that we provide. About a year ago, not long into this job, I launched a national campaign to place dignity and respect at the heart of services for older people—whether delivered in hospitals or nursing and residential care settings, or as part of day care services or of the support that people receive at home. We launched the campaign because people and their families told us time and again about some of their unsatisfactory experiences. Those were not so much to do with surgery or medical attention, but were about the sense that becoming a patient should not mean ceasing to be a human being. When we become more frail and dependent and lose control of many elements of our personal needs, perhaps for the first time, we want to hang on to our dignity and respect more than ever. It is crucial that the health care system—indeed, the social care system—should place dignity and respect at the heart of everything that they do.
The hon. Member for Sutton and Cheam (Mr. Burstow) mentioned the experiences of the Sutton Association for the Blind and his constituent Mr. Bedford. I say to Mr. Bedford’s family that obviously I regret some of the experiences that they appear to have had. It is not for me to make judgments; there is a formal and proper complaints process that families and patients have the right to use. However, I obviously regret that Mr. Bedford and his family feel that they were let down.
The Sutton Association for the Blind raises issues that are right at the heart of our national dignity and respect campaign. First, at a basic level, if somebody does not eat properly when they have a health problem, that will undermine their capacity to recover and will affect their general well-being. Too often, we hear from patients and relatives stories of food being left in places clearly inaccessible to the person who wants to eat. The direct impact will be that the person will not have the balanced, nutritious diet that they require and that will have a direct impact on their health care. A major part of our dignity and respect campaign is the question of nutrition. Often an assumption is made that somebody’s deterioration is due to their condition, when it may well be because they are not getting the balanced and appropriate diet that they require.
There are other factors. My hon. Friend the Member for Don Valley (Caroline Flint), the Minister with responsibility for public health, may not thank me for saying this on the record, but if an older person of 85 or 90 is used to eating steak and kidney pudding, trying to persuade them to eat salads regularly is a little pointless. There is also the question of appropriate food, listening to people’s definitions of a balanced diet and offering them a choice so that the food is as attractive as possible.
There are also cultural and faith-based sensitivities about food. That applies particularly to older people. For most of their lives, they have been in control, have made choices, and have been proud of their independence and clear about what they want. Suddenly, because of a health issue, they find themselves dependent on others in a way that they would not have chosen. Even in such circumstances, it is crucial that we respect their right to retain maximum control.
Will the Minister confirm that one of our concerns should be about how staff are sometimes too informal in how they address people, particularly seniors? Sometimes staff drop patients’ titles and use first names very familiarly. Should there not be further encouragement to staff to respect the patients’ wishes and use the name that the patient wants?
I can think of occasions on which we Members of Parliament would like to be called names different from those that are used.
Of course what the hon. Gentleman mentions is an issue. Some time ago, the Daily Mail attacked me for making that point and asked whether that was the only problem that existed in the system and whether it really mattered. However, it is a person’s fundamental right to be addressed in the way that they feel comfortable with. We should not take that for granted. Sometimes first names are used when older people would prefer more formality; on the other hand, some older people will feel more comfortable and relaxed if addressed by their first name. The issue is about establishing what the person feels is appropriate and respectful and what makes them feel as comfortable as possible. It is not about launching some ideological politically correct campaign, but about the rights of individuals to be treated with respect.
Does the Minister agree that in most cases, constituents’ letters in MPs’ postbags are not about waiting times or people being on trolleys at the weekend or overnight, but about care? They are rarely about brain surgery, but often about the human care that people get. Do we need to consider how we train nurses, and the qualifications that they require?
My hon. Friend makes an important point. All the evidence is that personalisation, individual attention and treating each person differently according to their needs, experiences and preferences are the future challenges that face the health service and all public services in this country. That is why the reform of public services is important and giving maximum control as well as choice to those who use services really matters. Of course there are implications for the nature of the training experience—initial and entry training and also continuing professional development—in respect of the things that we focus on.
I also have a strong view on the role of senior managers in the health service. To inform their management decisions about what matters in their organisation, they should be on the front line, regularly engaging with staff and patients. I do not believe that that happens anything like enough. Chief executives and senior managers should spend time and be visible on the wards to experience for themselves the everyday realities for staff and patients.
It is not for me to second-guess decisions, trust by trust and hospital by hospital; such judgments and decisions are for others. However, it is true that when we consider the responsibilities and priorities of a modern health care system, the personal, emotional and practical needs of the patient and family are incredibly important. They should not be given Cinderella status in comparison to other aspects of the health care provided—particularly, although not exclusively, when we are talking about older people. Recently, we have heard pretty horrendous stories about how people with learning disabilities have been treated by the mainstream health care system. Frankly, that is unacceptable in a modern society.
To conclude, I again congratulate the hon. Member for Carshalton and Wallington on raising some really important issues on behalf of individual constituents. The vast majority of people speak positively about the NHS and the vast majority of staff do an excellent job. However, we have to reflect and listen when people tell us, from their everyday experience, that the service is not as good as it needs to be.
HIV/AIDS (International Development)
We are all aware of the tragedy of HIV/AIDS and the impact of that pandemic throughout the world. The damage being done is particularly serious in a number of developing countries. We are looking forward to the launch of the Government’s consultation on a new strategy for HIV/AIDS later this week. The Minister will not be able to anticipate the content of that document, but I hope that he will see the debate as an opportunity to set out the Government’s assessment of the problem.
Some 40 million people now live with HIV. Last year alone, 3 million people died of AIDS and more than 4 million were newly infected. Two thirds of people with HIV live in sub-Saharan Africa and three quarters of all AIDS deaths occur in that region. In recent years, the most dramatic increases in the spread of HIV have been elsewhere. In east Asia, the number of people living with HIV rose by 17 per cent. in the last three years. In eastern Europe and central Asia, the number of new infections rose by almost 70 per cent. in the last two years.
HIV/AIDS in the developing world is predominantly a young person’s disease. The leading causes of death in the UK tend to affect people as they get older; HIV/AIDS tends to strike young people. Life expectancies in many countries have plummeted and many of the people killed by AIDS are at an age when they would contribute most to the development of the country that they live in. So it is that in many developing countries, HIV/AIDS corrodes the economies, the services and the infrastructure. Vital sectors—health, education and agriculture—are put under intolerable strain as the work force are removed by AIDS.
The world has responded to the pandemic, but slowly. The $10 billion estimated to be available for HIV in low and middle-income countries this year is a significant increase on the $8.9 billion provided last year. However, that $10 billion is just over half of what is needed. Estimates of global resource needs for this year stand at $18 billion, and $22 billion will be needed next year.
One landmark development in the effort to combat HIV/AIDS has been the establishment of the Global Fund to Fight AIDS, Tuberculosis and Malaria, which has approved a total of $7 billion for more than 450 grants in 136 countries. A report on the first five years of the work of the global fund was published in February, and the fund has made a good start.
The focus has rightly been on expanding access to treatment. Until a few years ago, to become infected with HIV was in practice a death sentence. The question was not whether one would die of an AIDS-related condition, but when. That is no longer the case thanks to the development of antiretroviral drugs. With access to proper treatment and care, people with HIV can now live fairly normal lives. However, millions of people have died of AIDS despite the emergence of antiretroviral treatment because those drugs have been unavailable to much of the developing world.
In recent years, the international community has accepted the principle of universal access: as far as possible, everybody who needs antiretroviral drugs should receive them. Under the presidency of the UK in 2005, the G8 agreed the aim of universal access by 2010, which was taken up in the political declaration by the world’s Governments at the UN last June.
There have been improvements in access to antiretroviral drugs. UNAIDS—the Joint UN Programme on HIV/AIDS—estimates that since 2002, some 2 million life years have been gained through expanded access to antiretroviral treatment. In December 2006, the number of people on treatment in low and middle-income countries was 54 per cent. higher than in the previous year.
Treatment still reaches only a small proportion of the people in need. The World Health Organisation estimates that just over a quarter of people in low and middle-income countries who need treatment receive it. There is a particular problem with children. Despite a 50 per cent. increase in the number of children receiving treatment in the past year, still only 15 per cent. of those in need get access to HIV treatment. The World Health Organisation and UNAIDS have called for urgent action to develop appropriate diagnostics and paediatric drugs.
A report published last month by the World Health Organisation, UNAIDS and UNICEF made it clear that universal access by 2010 will require a steep increase in the number of people who receive treatment each year. The UN Secretary-General has reported that many countries are struggling to scale up their work sufficiently to be on course for the 2010 commitment. If we continue at this pace, the UN estimates that less than half of those in urgent need of treatment will receive it by 2010. My hon. Friend the Minister will be aware of the campaign calling for a G8 funding plan to be put in place to achieve universal access, and I would be grateful for his thoughts on that.
Will my hon. Friend set out what is being done to enable developing countries to find their way through the legal complexities of TRIPS—the agreement on trade-related aspects of intellectual property? There are particular concerns about access to newer drugs, including second and third-line treatments. Since 2003, the price of most first-line antiretroviral treatments has decreased by at least 50 per cent. in low and middle-income countries. However, the World Health Organisation has found that the prices paid for second-line treatment tend to be unaffordably high in countries that lack generic alternatives.
In the years to come, more people will need access to second and third-line therapies as the first-line treatments will cease to be effective. UNITAID, the international drug purchasing facility of which the UK Government is a sponsor, is working to lower prices of second-line medicines and I was pleased to see the price reductions that the Clinton Foundation was able to announce last week. However, as patenting restrictions are tighter on newer drugs, a lot needs to be done before we can expect to see adequate reductions for second and third-line treatments.
On 30 August 2003, a decision was taken with the aim of allowing certain countries to import generic drugs. However, my hon. Friend is probably aware of the conclusions of Médecins sans Frontières that the mechanism is unworkable. The Government have made clear their support for the right of developing countries to use TRIPS flexibilities to ensure affordable access to drugs, including the use of compulsory licensing provisions. My right hon. Friend the Secretary of State and his G8 counterparts agreed at their meeting in March that more needs to be done to help to lower the cost of some drugs
“including the use of TRIPS flexibilities to the fullest extent”.
My hon. Friend will be well aware of the calls from non-governmental organisations in the field for the G8 urgently to review the effectiveness of the TRIPS flexibilities and to identify and resolve all obstacles to their use. I would be most grateful for his perspective on the progress that has been made.
Perhaps my hon. Friend can also take the opportunity to update us on the new independent advisory body that was announced by his Department last month to help get more drugs to the world’s poorest people. The Secretary of State has also expressed an interest in patent pooling, and I should be grateful if my hon. Friend would tell me the Government’s thinking on that point.
In order for antiretroviral treatment to be successful there must be a medical infrastructure in the country that ensures that people have regular access to their medication, and are properly instructed and supported in adhering to their regime. The UN Secretary-General has remarked that we must move from an emergency footing to a longer-term effort, laying the groundwork for sustainable progress and strengthening health and social service systems. Far greater investment is required in the infrastructure of health systems.
When we talk about getting drugs to people, there is a tendency to assume that Governments and Government services alone can deliver, but in many countries projects run by employers or the voluntary sector are equally important. Professor Richard Feachem, the previous executive director of the global fund, and the Secretary of State himself have singled out faith groups as being particularly important because of the work that they do in that area.
It is right that we focus tremendous effort on expanding access to treatment. It is a matter of international shame that so many have died and continue to die of a treatable disease. At the same time, we must dramatically step up our efforts to prevent the spread of HIV/AIDS. Work on a vaccine continues, and it seems that every few years we are told that a vaccine is 10 years away. I know that that work is supported by the UK Government. A vaccine would of course be a huge breakthrough, but in the meantime we need to improve prevention efforts dramatically. If we do not, meeting the commitments to universal access to treatment will be well-nigh impossible.
The rate of new infections far outstrips the expansion of HIV treatment. While 700,000 additional people got on to treatment last year, 4 million became infected with HIV. Treatment and prevention services must be scaled up in parallel. The World Health Organisation has called urgently for far more effective outreach work with at-risk populations and for prevention work to be done with people living with HIV/AIDS.
UNAIDS has identified three main problems with the current prevention effort: insufficient funding, inadequate access for populations with higher rates and risks of infection, and a lack of action against the social, economic and cultural factors that drive the spread of HIV, such as stigma, poverty and gender inequality. Access to prevention services for at-risk populations in low and middle-income countries remains generally very low. In 2005 it was less than 20 per cent.
Still only about 11 per cent. of pregnant women with HIV are given treatment to prevent mother-to-child transmission. That is a particularly depressing statistic when one bears in mind the fact that the treatment available for pregnant women with HIV is so effective that it virtually eliminates the possibility of the child being born with HIV. I presume that it is very different if no treatment is provided. I would have thought that most reasonable people would see it as a priority to get a lot more pregnant women on the treatment so that their children are not born HIV-positive. Just last year my hon. Friend’s Department cited an estimate that a comprehensive HIV prevention package costing $4.2 billion annually could avert 29 million of the 45 million new infections expected by 2010.
I cannot end my consideration of prevention work without mention of a recent development relating to male circumcision. As colleagues may well be aware, the World Health Organisation and UNAIDS have stated:
“Male circumcision services should be recognized as an important intervention to reduce the risk of HIV infection”.
That followed clinical trial data that demonstrated a significant reduction in the risk of heterosexually acquired HIV infection among circumcised men.
This summer marks the halfway point in the work to achieve the millennium development goals. As one of those goals, the international community made a commitment to have halted and begun to reverse the spread of HIV/AIDS by 2015. A massively increased prevention programme is required if we are to meet that commitment. We must also consider the important role that diagnostic testing must play, as the availability of testing is vital for progress in prevention and access to treatment. The global coverage of HIV testing and counselling remains low. Available information is limited, but surveys done in a small number of countries in sub-Saharan Africa indicate that at most one quarter of people living with HIV were aware of their status. Late diagnosis not only impedes prevention work that can be done with people living with HIV but means that treatment for an individual is less likely to be successful.
The Government are playing an important role in the councils of the world. They have ensured that HIV/AIDS is on the agenda at the UN, the EU and the G8. They are also putting their money where their mouths are by increasing the amount that Britain spends on overseas aid. Will my hon. Friend give us his view of the prospects for progress at the G8? The Finance Ministers meet this Friday and the G8 summit is just more than three weeks away. I am sure that we all hope for progress.
I am pleased that we have had the opportunity to have this debate in the week when my hon. Friend the Minister will be launching a consultation on a new strategy along with the interim evaluation of the current strategy. I look forward to hearing his comments.
I begin by saying, and particularly this time genuinely meaning, that I am grateful to my right hon. Friend the Member for Edinburgh, East (Dr. Strang) for persuading Mr. Speaker to allow us to debate this topic. As he said, the debate is timely, not least because of the launch on Thursday of a consultation on how we can step up our work on HIV/AIDS as a country and particularly as a Department, but also because we are a matter of weeks away from the G8. There will be considerable international attention on what else the G8 can do to focus attention on the terrifying growth in the incidence of HIV/AIDS across the world. I shall not repeat the statistics that he rightly reminded the House of.
My right hon. Friend ended his comments by drawing attention to the lead that the Government have taken on HIV and AIDS. It is perhaps worth noting that, in 2005, when we held the G8 and EU presidencies, we took the opportunity to use them to secure important commitments to universal access to HIV treatment and prevention. As he and the House will know, through the UN General Assembly we managed to secure a commitment to a broader definition of universal access, including prevention, treatment, care and support. I know that he supports that.
A year earlier, in July 2004, we attempted to prepare the ground for such a discussion at the UN by setting out an ambitious and, I hope the House will agree, progressive UK policy on tackling AIDS in the developing world in the document that we published called “Taking Action”. We shall have a chance to discuss on Thursday a review of that document and an assessment of where we have got to in implementing the commitments that we made in it. It set, for the first time, a spending target for funding through my Department of some £1.5 billion to support our response to AIDS, making us the world’s second largest bilateral donor. It took a strong stance on the importance of meeting the needs of vulnerable groups, including by committing to spend some £150 million on support for children affected by AIDS.
My right hon. Friend rightly sought to remind the UK and the international community of the need to follow through on the commitments made at that G8 summit and the UN millennium review summit. That is why we have sought to do our part by commissioning an independent interim evaluation of the “Taking Action” document to enable us to assess our performance at the midway point in the drive to make progress towards universal access, and to enable us to take any corrective action needed. Again, Thursday will offer the opportunity to review in more detail where we have got to.
It is also why we pushed to set ambitious targets in-country, led by the developing countries themselves, including interim targets for 2008, in the UN General Assembly’s political declaration on AIDS in June 2006 to help us to review progress towards the goal of universal access. It is also why we pressed the G8 at St. Petersburg—and will press again at the summit in just a matter of weeks—to report against the AIDS commitments that were made at Gleneagles.
On progress, it is clear from the UN and from civil society reports that there are areas where the AIDS response has progressed. We can be proud of that response, but it is also true, as my right hon. Friend said, that there is a considerable amount that we still need to do if we want to achieve our ambition of an AIDS-free generation.
On treatment, there have been huge increases in the number of people taking antiretroviral drugs, as my right hon. Friend said. According to UNAIDS, the World Health Organisation and UNICEF, more than 2 million people were receiving treatment at the end of 2006, a 54 per cent. increase in just one year. Of that number, more than 1.3 million people in sub-Saharan Africa were receiving treatment in December 2006, compared with just 100,000 in 2003.
However, the sad truth of those impressive statistics is that only 28 per cent. of those who need treatment actually have access to the drugs that they need. We must do more to boost access to treatment and diagnostics, in particular for children. We must take steps to reduce the cost of second-line AIDS drugs, which, as my right hon. Friend clearly knows, can cost as much as 10 times more than other treatments, and we must take more steps to tackle the stigma and discrimination that block people’s access to services, including treatment.
I am delighted that the UK played its part in tackling those issues by helping to set up UNITAID, the new international drug purchase facility. It has already approved, among other things, programmes of nearly $62 million for treatments for children and nearly $70 million for those second-line therapies that cost so much.
This week, UNITAID and the Clinton Foundation announced a major cut in the price of 16 AIDS treatments that will be available to 66 developing countries. That clearly is positive progress and an endorsement of the approach that mechanisms such as UNITAID allow. I am pleased, and I hope that my right hon. Friend is as well, that through the Medicines Transparency Alliance we can begin to tackle some of the fraud and other inefficiencies that can on occasion lead to a 300 per cent. mark-up in the price of medicines in developing countries.
My right hon. Friend drew attention to funding, and rightly said that we need to do more to ensure that the necessary resources are available to finance universal access. He said that an estimated $10 billion will be available in 2007 for HIV-related programmes in low and middle-income countries. As he said, that is a huge increase, but, as he also said, it is just over half of the $18 billion that UNAIDS estimates is needed in 2007, so the international community needs to do more work together to meet that funding gap.
We are committed to playing our part, not least through the Global Fund. I take this opportunity to put on the record my appreciation of the considerable effort made by Richard Feachem, the first head of the fund, and of the excellent job that he has done. We have pledged some £359 million to date to support the fund, making us the fifth largest donor, and we recently supported the decision to triple the size of the fund so that it has the potential to reach $6 billion to $8 billion in 2010.
I touched on UNITAID. We pledged some $20 million for UNITAID as part of a 20-year commitment potentially increasing to some $60 million by 2010, subject to the performance of the organisation. We also pushed hard at the UN General Assembly in June to ensure that the international community in general made a commitment that no credible, costed national AIDS plan should go unfunded. That important commitment should play a central role in helping to get all donors working on the goal of achieving universal access in each developing country.
The AIDS response must support and strengthen health systems—we must not undermine them. In short, that is the only way to achieve universal access and better all-round health outcomes. We must do more collectively to strengthen health systems, not least because of the need to address the global shortage of 4.3 million health care workers, as estimated by the Global Health Workforce Alliance. People are not likely to stay on antiretroviral drugs without health care workers to support them as they take the drugs, and, potentially, the virus could become more resistant to drugs. I have no doubt that that issue will be of particular importance in the discussions that will take place at the G8 coming soon.
The UK is playing its part on that issue. In Malawi, for example, we are helping with a £100 million emergency programme over six years that seeks to double the number of nurses and to treble the number of doctors. The programme helps to do that by increasing salaries by some 50 per cent. We are considering options to extend that approach to other countries, and we are seeking to have discussions with other donors about how we can better pool our funding to make that happen more effectively in developing countries. I personally have had discussions with key people in the US Government about how we could do that.
My right hon. Friend touched on the importance of prevention. We are supporting ongoing research to develop new microbicides, which potentially offer the most appropriate technology most quickly to help women to protect themselves from HIV infection. We continue to put money into the international AIDS vaccines initiative to help to make progress there.
I know that my right hon. Friend shares our concerns about stigma and discrimination. I hope that he will be able to attend the launch tonight with England and West Indies cricketers of a stigma unit to promote our work in the Caribbean, which has the second fastest rising epidemic rates in the world. Discrimination is the single biggest blockage to making progress on that issue.
My right hon. Friend also asked about our position on trade-related aspects of intellectual property rights. We remain a strong supporter of the right of developing countries, including Thailand and Brazil, to implement the TRIPS agreement, as is appropriate for their circumstances. We understand the concerns of Médecins sans Frontières and several others about the complexity of the agreement, which is why we are working in Kenya and Botswana to fund legal research and assistance that will help those countries to implement the flexibilities that are available under the TRIPS process.
We initiated an access to medicines conference just a matter of weeks ago because of concerns about TRIPS, about whether enough diagnostics are available, about whether we need new treatments and about how to cut through some of the other blockages to making drugs available to fight HIV/AIDS. The conference brought together experts in health systems and drug programmes from developing countries, people from the non-governmental organisation world, international pharmaceutical companies and generic drug companies. From those who came to that meeting, we are seeking to establish a small group to work with us, on a continuing basis, on the key blockages internationally to making progress on delivering more HIV/AIDS drugs and more drugs to help to fight other developing-country diseases.
I am grateful for the considerable effort that was put in by the many different stakeholders who turned up at the conference. As my right hon. Friend will know, access to medicines is often a politically contentious issue, but the constructive nature of the dialogue at that conference offers hope that we will be able to make faster progress. I know that he will be pleased in particular by the announcement by UNITAID and the Clinton Foundation.
Again, I welcome the opportunity for this debate. It is timely, with the G8 approaching so soon, with our launch on Thursday of a consultation on what we can do next about HIV/AIDS and with the launch of the stigma unit tonight. My right hon. Friend takes a considerable interest in the issue and has done so for a long time. I hope that he will continue to pursue that interest and to put pressure on us to do more.
Local Health Funding
I am delighted to have secured a debate on local health funding after having the good fortune to initiate a debate on midwifery and maternity services only a fortnight ago, to which the Under-Secretary of State for Health, the hon. Member for Bury, South (Mr. Lewis), responded. I am pleased to see that the Minister of State will be responding to this debate. I will consider the Government’s national policy and the way in which it affects local health funding, considering the local circumstances in my area—Cornwall and the Isles of Scilly—and, as I am sure the Minister expects, I will look constructively at potential solutions to local problems.
I have always welcomed, strongly supported and voted for investment in the NHS. I appreciate that the Government were fearful that some of the money would go into a black hole and that they have therefore engaged in a number of reforms, but I fear that the Government have created some black holes of their own, particularly regarding the pursuit of the so-called choice agenda. Sadly, I believe that that agenda has swallowed up billions of pounds in IT systems and bureaucracy. Choice is desirable, but for many people it is a luxury to be considered after basic services are in place and are sure to be intact.
The theme of my speech is that I am worried about a lot of the changes to the NHS. I have seen some of the proposals for health reform and they seem to be promoted by PowerPoint-wielding management consultants who have too much say in how services are run. Instead, we should concentrate on running front-line services properly and effectively. Those are the issues that I want to consider.
When considering the national policy context, the Minister may wish to look at the British Medical Association document that was published last week, “A rational way forward for the NHS”. It puts the issue in context and provides some good, helpful and constructive comments, on which I am sure the Department has reflected. At the BMA conference in 2006, alarm was expressed at the incoherence of Government NHS policies. The letter that was attached to the BMA document and was circulated to MPs—I am sure it was also sent to the Government—states:
“Thanks to the government's injection of funds and the hard work of NHS staff, patients have seen considerable improvements in the health service.”
The letter goes on to state:
“However, there has been a failure to engage either the public or health professionals in the early stages of policy developments which undermine the long-term future of the NHS.”
The BMA document states:
“Progress…is under threat due to a constant wave of poorly integrated initiatives from the centre”,
“The NHS is suffering from reorganisation fatigue”.
I am sure that those are themes that the Minister has heard many times before from critics of the system. Indeed, at the weekend, the former Secretary of State for Health, the right hon. Member for Holborn and St. Pancras (Frank Dobson), said on “The World This Weekend” on Radio 4:
“We started losing advantage when we started saying choice was the great thing and that the choice that people want is the choice between 5 competing hospitals. Every bit of polling evidence and common sense suggests that that's not the case. The first choice for most people is that the hospital down the road will do a first class job for them and do it promptly. That should've been the Government's task. It started going wrong there.”
I agree with that.
If the Government want to offer choice, in my area the choice of an NHS dentist would be nice. Those who get the opportunity of once in a while joining an NHS dentist seem to have that opportunity for only a short time before being presented with the ultimate choice of staying with the practice and going private or having no dentist at all. Sadly, that is the type of choice offered to the patient—the consumers—on the ground.
The national programme for IT underpins the choice agenda and the “choose and book” system, which has been re-branded “connecting for health”. The system is immensely expensive, and the BMA News of 27 May last year states:
“Connecting for health management has now admitted that it will cost at least £15 billion and final figures in excess of £30 billion have not convincingly been denied.”
Perhaps the Minister will reflect on that. I have asked many parliamentary questions about the cost of the “choose and book” system and the nature of its assessment and costs locally. In March, I received an answer to a written question that I had asked about what measures the Secretary of State had put in place to assess the change in the overall administrative burden of the “choose and book” system. The answer provided was:
“None. The choose and book system should reduce the overall administrative burden of managing referrals.”—[Official Report, 12 March 2007; Vol. 458, c. 142W.]
Yet we know that because of the creation of private sector contracts, which primary care trusts were forced into, the Government has had to encourage PCTs to establish referral management centres to intervene in the referral process. That has added a further administrative and cost burden, which has not been part of or factored into the overall budget of the service.
Indeed, the movement towards a greater emphasis on the private sector has concerned many people. The BMA document that I referred to earlier, which was published last week, states:
“There is no evidence that the private sector offers improved services or better value for money than the NHS”
and that the role of the private sector is to
“support the NHS rather than supplant it”.
I know that my hon. Friend the Member for North Cornwall (Mr. Rogerson) has been assiduous on that matter, particularly regarding the movement of a contract to a private sector hospital in his area in Bodmin. He shares my concern about that issue and I have asked parliamentary questions on the nature of the contracts and the basis on which PCTs were forced into them. In particular, I asked about the widely understood target of contracting 15 per cent. of all elective procedures, and in an answer that I received last July, the Minister said:
“The figure of 15 per cent. is not a target but a level of service that the independent sector might be providing by 2008.”—[Official Report, 18 July 2006; Vol. 458, c. 381W.]
On the same day, in answer to another question, the Under-Secretary of State for Health, the hon. Member for Bury, South, said:
“Individual contracts’ performances are monitored to ensure facilities are utilised.”—[Official Report, 18 July 2006; Vol. 458, c. 376W.]
On the same day, in the very next column, the same Minister said:
“Capio and national health service sponsors are working to ensure that the full value of activity is delivered over the contract period.”
I have also asked Ministers questions about the extent to which the Government are ensuring that contracts would add value to services locally, rather than denude funding from the local community.
In February, the Minister of State, Department of Health, the hon. Member for Don Valley (Caroline Flint), said in answer to a question in the Chamber:
“I am pleased to say that the Plymouth and Bodmin treatment centres are on target for up to 100 per cent. capacity.”—[Official Report, 6 February 2007; Vol. 456, c. 703.]
Freedom of information figures showed, however, that the company met only 19 per cent. of its contracted activity in the first quarter up to April 2006; 45 per cent. in the six months between April and September, and only 65 per cent. in the final period to the end of March. Any yet it will be paid fully for the services that clearly are not being rendered to the local community.
On 7 March, in a debate that we had here, I raised another point with the Minister about the impact of European competition law, which he did not address that day. Indeed, I raised subsequent questions in the House and wrote to the Secretary of State to ask what assessment the Government had made of the impact that that significant move in trend will have on increasing the amount of work contracted through the private sector, and whether it will open a Pandora’s box. On 5 April, in reply to a letter that I had written her, the Secretary of State for Health stated:
“National Health Service bodies have generally fallen outside the scope of EU competition rules”.
Generally that might be the case, but given the contractual and tendering processes, and the ability to alter, reconfigure or intervene, the NHS will be open to very complex challenges. In fact, the European Court is likely to deem the service a market and not a public service. I am sure that local health services will be most concerned about that.
On the local situation, as the Minister knows, at the end of the last financial year, the Royal Cornwall Hospitals trust ended up with a deficit of £45 million, and is currently one of 18 financially-challenged trusts undergoing a review. Obviously, it aims to balance its budget, but wants an agreement on how to repay the deficit. It believes that that can be done provided that it is given a reasonable time in which to repay. It is now in the second year of a three-year period, but it would be helpful to have the Minister’s advice on whether it is possible to consider a five-year period in which to achieve the kind of balance that a trust such as Royal Cornwall Hospitals needs.
I have another point to make that I really would like the Minister to address: unlike other trusts with severe deficits, for some reason, the strategic health authority, rather than the Department made the adjustment for the resource account budgeting arrangement for the Royal Cornwall Hospitals trust. As a result, it appears to have lost out significantly.
I am sure that my hon. Friend would want also to reiterate to the Minister the fact that prior to the switch in health authority, the hospital never had a deficit. It inherited one that has built up subsequently and which it has struggled to overcome, primarily owing to the low levels of funding that it receives. Its cost per patient is low, and its outcomes good, but under the financial formula that ties its funding to low local wages, it will struggle ever to balance the books.
I am very grateful to my hon. Friend for making that point. I was due to come on to the income that the Royal Cornwall Hospitals trust and indeed the health community in Cornwall receives. He made the point very well.
I would appreciate it, however, if the Minister could answer this point: in order to help lift the burden we must address the purely administrative question of who adjusted the RAB for the Royal Cornwall Hospitals trust. If it had been the Department of Health, as in the case of many other trusts around the country, it would have been better off by a significant number of millions of pounds.
The Minister responded to me on 17 July last year regarding the market forces factor. I am sure that he would be surprised if I did not raise this issue, given that Cornwall is at the bottom of the league table for the income it will receive under that element of the funding formula. He said:
“The advisory committee on resource allocation (ACRA) is carrying out a review of the approach to calculating the staff market forces factor”.
“It is expected that the work will be completed by autumn this year. The publication of the findings will be considered later.”—[Official Report, 17 July 2006; Vol. 449, c. 245-46W.]
We know that that work is completed and we are awaiting its outcome; it would be very helpful if the Minister could indicate when it is likely to be published and give us a timetable for making adjustments. Were the Royal Cornwall Hospitals trust to approach at least average funding and parity under the market forces factor, it could net at least £6 million to £8 million —that is just for that trust, let alone others in Cornwall and the health community generally.
On positive proposals, I would like the Minister to consider the fact that under local government reform proposals in Cornwall we are looking closely at the possibility of bringing the health and social community far closer together. I know that the Minister would welcome that. I received a parliamentary answer that stated:
“Local partnerships…under section 31 of the Health Act 1999”
can be used
“to deliver seamless services and develop close co-operative working.”—[Official Report, 10 May 2007; Vol. 460, c. 406W.]
A week earlier, I was advised that powers exist for single pooled budgets to be established
“under section 75 of the NHS Act 2006 and for an application to be made to the Secretary of State to establish a care trust as permitted under section 45 of the Health and Social Care Act 2001.”—[Official Report, 3 May 2007; Vol. 459, c. 1842W.]
We seem to have quite a bit of potentially conflicting legislation to achieve such pooled arrangements. The BMA’s proposals for a new NHS framework stated that it wants a great deal more democracy introduced into the decision-making process for the future of that service. When considering bringing the two budgets together, I hope that the Minister will bear in mind the fact that health is free at the point of delivery, whereas social care is means-tested. It would be helpful to give some advice to the local community on how to ensure that those two budgets are brought together seamlessly and not fractured, which is the danger with the means-testing of certain activities but not others.
That is particularly important with regard to, for example, the many cases in which an elderly person might end up in hospital, when really they require care at home, which cannot be provided. Providing that service in hospital might be much more expensive that providing it at home, which might also be more appropriate. I hope that the Minister will consider those elements when answering my questions.
I congratulate the hon. Member for St. Ives (Andrew George) on securing this debate. I know that he takes a close interest in these matters and I pay tribute to him for the diligent way in which he seeks to improve health services in his area. I wanted to acknowledge that at the beginning.
At the same time, however, I would have hoped perhaps to have heard more acknowledgment from him of some of the major progress being made in the health services in the south west and in Cornwall specifically. It is an interesting day on which to have a debate on local health funding, because the Department published today a detailed breakdown of how the extra £8 billion that the NHS will receive this year will be spent in communities up and down the country.
At times, we can become complacent about the numbers, but by any reckoning, £8 billion extra for the NHS is a major increase and will produce tangible benefits on the ground in constituencies throughout the country, including those of the hon. Members for St. Ives and for Truro and St. Austell (Matthew Taylor). In the south-west, it means an extra £590 million a year for that health economy, and it will, among other things, make possible rapid progress towards achievement of the target of 18 weeks from GP referral to hospital treatment.
I hope that the hon. Member for St. Ives would acknowledge that significant and substantial improvements can be expected in all parts of the country this year. It is important, while we rightly address concerns, that those things are accepted and explained to the public, because it is the public’s money and they are entitled to know what it is paying for.
The transformation of services that I am talking about has been possible because of the extra funding that we have made available. Every primary care trust received an above-inflation increase in funding in 2006-07 and will do so again in 2007-08—an average of 9.4 per cent. across the NHS. The hon. Gentleman’s local PCT, Cornwall and Isles of Scilly PCT, received allocations of £646 million in 2006-07 and £711 million in the current financial year, which together represent an increase of £119 million over the two years, which in turn equates to a 20.1 per cent. increase in funding over the two years. Notwithstanding the issues that he put before me today, which I shall come to in a moment, that compares favourably with the England average for all PCTs of 19.5 per cent. growth in funding over the two years.
In addition, we have adopted a faster pace of change policy for the 2006-08 revenue allocations period. PCTs such as the one in the hon. Gentleman’s area have been moved more quickly towards their fair share of funding. In 2003-04, the most under-target PCT was 22 per cent. under its fair share allocation; by the end of 2007-08, no PCT will be more than 3.5 per cent. under target. Cornwall and Isles of Scilly PCT will be only—I say “only”—3.3 per cent. under its weighted capitation target by the end of this year. The hon. Gentleman would rightly say to me, “Come on. Let’s see further progress towards that target funding.” I, too, represent an area where the PCT is under its target allocation. Although it remains the Government’s intention to move PCTs towards their target allocation, we of course have to do that at a pace that is fair to the rest of the NHS.
Let me deal with some of the specific issues that the hon. Gentleman raised. He asked me to comment on the BMA document. I agree that it makes some very important points about how we take forward the debate about the future of health care and the NHS specifically, but he did not comment on one of the central points in that report, which was the call for, as I understand it, more rationing of services and more openness about where services may need to be rationed. We have shown in the past 10 years that a comprehensive NHS and universal service can be provided free at the point of use, and that certainly remains our intention. I hope—in fact, I expect—to continue to have the Liberal Democrats’ support in making the political case for such a service as the NHS approaches its 60th anniversary.
The hon. Gentleman spent some time attacking the notion of choice and quoted others in aid of that point. He needs to think: in this day and age, on what basis can we say that people cannot have the right to choose what is best for them and their families? I ask him to think about his own constituents. There may be a family with a young child who has a rare condition. I am sure that his constituents are like mine: they want full rights to go to wherever in the health service may be able to help them. I do not think that it is right to say that that is a political construct or a fad that is being imposed unnecessarily.
It is true that people want a good local service, but what if they do not have one? What if they live in a part of the world like mine, where a number of reasonably large district general hospitals are within easy reach? For my constituents, Warrington, Wigan, Bolton and even Hope hospital in Salford are within pretty easy reach of one another. Why should people not be able to look at the service provided by those organisations and choose which one suits them best? It is true to say that providing choice is not an end in itself, but if it can help to achieve the goal of better local services for patients in areas where they are not good enough, surely it is a justifiable policy. It is not the be-all and end-all, but it is an important part of improving the system from the bottom up.
I do not want to detain the Minister on choice—I would rather that he moved on to the local questions—but just to clarify the position, of course choice is desirable, and I think that I acknowledged that, but the point is that it is important that the Government recognise that local health services need to walk before they run. Routine services need to be in place and to be reliable and local. By all means, once we have achieved that, the desirability and luxury of choice is something that I think we can all applaud.
I accept that point; it is one on which we can agree. I have to say to the hon. Gentleman, though, that we cannot will the end without willing the means. He mentioned “choose and book”. Last week, 40 per cent. of appointments were dealt with through that system, and some 68,000 patients received their appointment in that way. It is important that people do not just cast aspersions, as they tend to, on these projects. Just think about the benefits for those 68,000 patients: they got their appointment immediately; straight away they knew their time, so they could then start making plans. The alternative would be people waiting for the hospital to contact them with an appointment that might not suit them. There are direct benefits to the individual from these systems, and it is important to recognise them.
On the use of the private sector, the hon. Gentleman raised concerns about the utilisation rate of Bodmin independent sector treatment centre. I can tell him that utilisation is building month by month. In May the rate was 85 per cent. and in April it was 80 per cent., so I hope that he can see that there is a build-up. The point of the policy is that, as services become established, they will work towards the full utilisation rate. It is very important, if his constituents are to benefit from the 18-week target, as I expect all people in the country to be able to, that that capacity be made available to the NHS.
In many ways, what we are describing is a different relationship with the private sector. It is not one in which the private sector trades on the back of failings by the NHS and the really awful notion of choice that applied under the previous, Conservative Administration: “You can wait two years or the feller down the road will deal with you in two days.” That was utterly appalling. Now, the private sector puts its capacity into the NHS for the benefit of NHS patients, which I think most people in this country would celebrate.
On European law, I understand the point that the hon. Gentleman makes, but I think that perhaps he is overstating the issue. Within the European settlement, as I understand it, it is possible for domestic Governments to manage and control health services as they see fit, but I take his point that these things need to be carefully watched.
The Royal Cornwall Hospitals NHS trust has particular financial challenges. We are looking case by case at each of these trusts in this particular period, in which they would struggle to repay at the same time as keeping services stable. I can assure the hon. Gentleman that we will inform both him and the hon. Member for Truro and St. Austell about any decisions taken in relation to recovering that trust’s financial position, but it is making improvements this year through its turnaround process, and I hope that we can see a clear way forward in the not-too-distant future.
On the market forces factor, a review is going on that will inform this year’s allocations—the allocations to be made later this year for all PCTs. That is the timetable. The hon. Member for St. Ives asked me about that. The representations that he has made over a period and that others have made about the issue will be listened to, but obviously I cannot prejudge the outcome of that review of the market forces factor.
Let us finish on a positive note. I completely agree with and support the notion of a greater partnership between local government and the health service. I would welcome progress in the hon. Gentleman’s county on that issue, so—
It being Two o’clock, the motion for the Adjournment of the sitting lapsed, without Question put.