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Westminster Hall

Volume 462: debated on Tuesday 3 July 2007

Westminster Hall

Tuesday 3 July 2007

[Mr. Bill Olner in the Chair]

Parenting and Child Care

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

I am delighted to be granted a debate on this important issue. Parenting and child care are the most important lifetime activities for both parents and, of course, children. I say that as a man—new or otherwise. To quote “Every Child Matters”:

“Parents, carers and families are the most important influence on outcomes for children and young people.”

First, I want to acknowledge and celebrate the effort, vigour and substantial amounts of money that the Government have put into developing child care and parenting initiatives. Sure Start, tax credits, children’s centres and the parenting academy are all significant strides forward. However, there is a saying in Welsh—“Nid da lle gellir gwell”—which means, “Not good enough where there could be better”. A great deal still needs to be done.

I want to refer also to the visit that the all-party group on Sweden undertook to that country to consider parenting and child care. I want to pay tribute to colleagues from the all-party group who undertook that visit—all men, I noted at the time—some of whom are here today. The hon. Member for Luton, North (Kelvin Hopkins) has already told me that he is tied up with a constituency engagement, or else he would certainly be here this morning. I want to pay tribute to our Swedish colleagues and the people at the embassy in Stockholm, who made the visit such an interesting and worthwhile experience. I intend to refer to the situation in Wales as well as that in Sweden. I know a good deal more about Wales than I do about Sweden, and no doubt colleagues who also visited Sweden will make up for any deficiencies on my part in referring to our visit.

I accept that child care policy in Wales is the responsibility of the Welsh Assembly Government, but I argue that the provision of formal child care in Wales is intimately bound up with the available resources, which are a Westminster matter, particularly in respect of child care tax credits. I shall refer to those later. On a positive note, I shall argue that others can learn from the Welsh experience in child care and parenting, particularly because of my interest in language issues. I am mindful of the Prime Minister’s new emphasis on the role of language in defining and symbolising identity. That is a pertinent aspect of our visit and of the situation in Wales.

Finally, I shall refer to the role of extended families and grandmothers in particular. I draw attention to research that I commissioned from a colleague called Natalie Jones, which was published as a pamphlet some three and a half years ago: “Gofal o Fath Gwahanol”, or “A Different Kind of Care”. It specifically considered the role of extended families, particularly grandmothers.

There is a huge demand for child care in Wales, as in the rest of the UK. In Wales, bilingual child care provision of all sorts is especially scarce. That is particularly so in the south and east, where we have seen the most marked growth in the Welsh language in the past three decades, especially among young people, who are today’s and tomorrow’s parents. One parent from Cardiff recently remarked to me—in desperation, not in jest—“Welsh medium child care? It would be easier to get your child into Eton.” Why on earth any one should want to go to Eton is another matter.

I congratulate the hon. Gentleman on securing the debate. Is he aware that in my constituency the local authority has had to start up four Welsh medium starter classes because there is no room in the schools for those children to start? There is enormous support for Welsh language classes in Cardiff.

I acknowledge that. There is enormous support, but also an enormous demand. I am sure that we will see a growth in that in the near future.

It is not only bilingual child care that is scarce in Wales and all over the UK. Provision of child care throughout the UK is, at best, patchy, particularly the extended and flexible care that parents are now looking for. The Daycare Trust reported in January 2007:

“Sixty-seven per cent. of Children’s Information Services (CIS) said that parents had reported a lack of affordable childcare in their area in the last 12 months”,

and that

“finding suitable childcare is even more difficult for parents of disabled children.”

That is a particular issue.

We can contrast those facts with the provision in Sweden. As I understand it, all parents are guaranteed a child care place within three months of asking, which produces a certainty of provision and the resultant confidence among parents that they can re-enter the work force and go back to work with the guarantee of a place. That contrasts with the uncertainty in much of the UK for some potential returnees—perhaps even the majority—and the great problems that they face in returning to work.

In Sweden, there is a high level of income replacement over an extended period for new parents. In the UK, improvements have been made to the provision and more are on the way. I particularly welcome the provisions that are on their way for fathers, but the provision is still far from Scandinavian levels, which we observed during our visit. Child care in Sweden is affordable—we were told that it costs about £100 a month, with adjustments down for lower-income families and adjustments when the family has more than one child who receives child care. In many areas of the UK, child care is either scarce or expensive and scarce, particularly in inner-city areas.

My experience is of rural areas, and that was why I commissioned the report, “A Different Kind of Care”. In rural areas, whatever child care provision that is available might be 10 or 20 miles in one direction, and the parents might work 10 or 20 miles in the other direction. There are huge practical difficulties in accessing the proper standard of flexible child care. The encouragement—I say encouragement; others might use a stronger term—to new parents to return to work is the same in the city as in rural areas, regardless of the level of child care that is available locally. No account is taken of the local circumstances.

One reason that provision is so patchy, particularly in rural areas, is the over-reliance on the market. In many places, parents have no alternative but to rely on the market to provide the sort of flexible child care needed to enable them to return to work. Public sector provision is insufficient, or insufficiently flexible, if it is available at all. In certain areas, perhaps in many areas, the market has failed.

The child tax credit system provides an element for child care, of course, but clearly it is not enough to pay the actual cost, particularly in inner-city areas. In some areas, it has failed to generate sufficient demand for the private sector to provide services. Private nurseries report that there is insufficient demand despite the level of support. In some rural areas there will possibly—probably—never be a sufficient level of demand to provide the sort of child care that we would all like in those areas.

In my recent experience of casework in my rural constituency, I have seen a small but growing reluctance to claim tax credits—there is a perception of a disincentive. I do not want to stray into discussing tax credits in general, or to overstate the case, but every surgery brings more cases of people who are in thousands of pounds of debt to the Revenue. They might be a small minority in the broader scheme of things, but an impression is abroad of the difficulty and danger of debt. There is a disincentive to claim the tax credit, particularly the child care element of it.

Child poverty is falling, although it has stalled in Wales at 28 per cent. According to the latest figures, for 2004-05, from Save the Children, 180,000 children live in poverty in Wales. The Government have an ambitious and essential target of eliminating child poverty by 2020, and enabling parents to return to work is a vital step in reaching it. Some 15 per cent. of Welsh children live in workless households—almost by definition, in poverty. That figure is also from Save the Children. In areas where the market has failed to provide, can we really afford to rely so heavily on the child care tax credit? That is not the route taken in Sweden. We need to foster alternative provision both in the public sector and, crucially, through parents’ co-ops.

I can imagine that it will not be easy for the Minister to respond to the debate. Child care covers all aspects of life, and I have gone in several directions already and intend to go in others. Perhaps she can tell us what percentage of qualifying parents do not claim the child care element of the tax credit and how much money for child care is therefore lying unclaimed. We might ask why that money should not be deployed in other ways to the same end. If the Government are making money available, why should it not be used in other ways to provide more child care?

In Sweden, the state provides child care. I should also say that it taxes heavily, but it either provides child care or enables others to do so. When we were in Stockholm we saw a pre-school and were told about the involvement of parents, particularly through parents’ co-ops, which are an interesting idea and might be taken further.

Setting up a co-op in Wales and the UK in general is no small matter. There is a successful child care co-op in my constituency called Dwylo Da, which means “capable hands”. It is in Dyffryn Nantlle, which is a former slate-quarrying area and one of the most deprived communities in Wales. People there managed to set up a child care co-op, but it was a truly Herculean task and took them more than three years. Mudiad Ysgolion Meithrin, the Welsh-language pre-school playgroups association, told me the other day that three years would be the minimum time period for setting up such a parents’ co-op, with no certainty of success, even if the difficulties could be overcome. Most communities do not have the resources for sustained work over three years, although Dyffryn Nantlle is slightly different. That is particularly true because grant aid is so often awarded on a year-by-year basis, which is the bane of the voluntary sector in general.

I am sorry that I was not able to accompany the hon. Gentleman, the hon. Member for Battersea (Martin Linton) and others on the visit to Sweden. Looking at the supply side of the equation, does he think that there are continuing rigidities in the planning system that prevent the emergence of sufficient supply in local areas, perhaps because of nimbyist objections? What view does he take of the scope for further encouragement of a supply of workplace nurseries so that they become the norm rather than the exception in medium and large enterprises?

I thank the hon. Gentleman. Dwylo Da, which I mentioned, is in a new build. That was part of the problem that it faced—there was not a suitable place for the nursery. That was a major difficulty there, but in other places people might be able to deploy redundant buildings. I am sure that there is scope for that. There might be nimbyism, but I cannot imagine why.

On the provision of workplace nurseries, there was an excellent employer in Bala, in the constituency neighbouring mine. It was a clothing company and, being of sufficient size, provided a workplace nursery. The economy in rural areas is often a series of small enterprises of one or two people that are not in a position to do the same, but the enterprise in Bala provided a nursery. It has recently closed, with the work going, I think, to China. With it, of course, went the workplace nursery. The size of enterprises can be a problem, particularly in rural areas, but there might be an opportunity for small companies to club together and provide jointly for their workers. That is the best standard—it is good practice, not general practice.

I referred a moment ago to Mudiad Ysgolion Meithrin, the Welsh-language pre-school playgroups association, and I now turn to bilingual childcare provision. The importance of language has been highlighted, not least by the Prime Minister. There are other providers in Wales such as Wales Pre-school Playgroups Association, but I focus on MYM because of the language issue. I should confess that I used to be the chair of the local MYM group and have a long-standing interest in its work. It provides traditional playgroups, full-time child care and, interestingly, what it calls ti a fi groups, which means “you and me”. There are about 1,000 groups throughout Wales, providing a service variously from birth to school age, with an emphasis on interactive, creative learning and playing to a purpose. We saw that in Sweden, where children follow such a curriculum up to the age of seven. The educational results at the end are excellent, no different from those of the more traditional methods of teaching employed in the UK.

MYM uses methods consistent with the groundbreaking curriculum that is being brought in by the Welsh Assembly Government and will be in all schools in Wales by 2008. The ti a fi groups might appear a little different from mother and child groups or, perhaps more accurately in some circumstances, grandmother and grandchild groups, which are an increasingly common pattern. Given the Prime Minister’s emphasis on language learning, I wish to say that 70 per cent. of the children and parents attending the ti a fi groups have English as their home language but attend Welsh-medium provision. Through those groups, MYM works with non-Welsh-speaking parents and grandparents, and with children, to introduce the language. That is a ready-made model; it perhaps does not quite fit circumstances elsewhere, but it is none the less interesting.

The groups teach simple words and pronunciation to adults so that they can use them for bedtime reading to children from simple books. There is not enough emphasis on reading to children, which I used to enjoy enormously with my three daughters. The grandparents and parents are taught songs that they can sing with their children, although perhaps they do not understand them fully. The pay-off is that children learn in a participative, creative way and become bilingual at an early age. By default, the adults also learn elements of the language.

I should contextualise that example by referring to broader trends in Welsh society, such as the growth in the number of adults learning Welsh and the availability and use of the language in education, television, newspapers and so on. In particular there is a project called “twf”, which means “growth”. It targets Welsh-speaking new parents and encourages them to pass the language on to their children. Broad tendencies are developing, and in ti a fi groups we have a successful model of how to pass on a language, which should be of interest.

The later value of becoming bilingual, the better development of cognitive ability, is now clear and uncontested. Bilingual people have the edge—perhaps not this bilingual person, but there we are. I need not emphasise the importance of such techniques of second-language acquisition in apparently monoglot England. I say “apparently monoglot” because there is a huge, little-regarded richness of language. There is a great deal to learn on our own doorstep as well as from Scandinavia.

I wish to mention parenting and promoting the involvement of extended families. It is important for us not to be too starry-eyed and stigmatise parents, particularly lone parents, who do a great job under difficult circumstances. I have no intention of looking back on some imagined, wholly unproblematic past when families cared for themselves, thank you very much, without the help of the nanny state. I have no doubt that the hon. Member for Nottingham, North (Mr. Allen) will refer to issues around parenting later, rightly putting the emphasis on the value of early intervention and parental involvement. As the report, “Every Parent Matters”, states—perhaps it is stating the obvious—

“Parental involvement has a significant effect on pupil achievement”.

A famous rugby coach—famous in Wales, at least—called Carwyn James used to say “get your retaliation in first”, so before the hon. Gentleman gets to his feet, I shall briefly refer to parenting and a project in my area.

Throughout north Wales we now have the incredible years programme, which is fostered and promoted by colleagues at the university of Bangor. It works with children and parents and provides training and guidance to cope with problems in behaviour early on, with clear success. The person behind it is Judy Hutchins, who is a former colleague of mine from my time at Bangor. She has worked with a range of local agencies including my local authority, Cyngor Gwynedd, and with particular community initiatives such as a children’s centre in my constituency called Plas Pawb. The parenting programme has been implemented in deprived housing estates, and, as a result, parents have been attracted to all sorts of other courses offered, such as cooking, financial management and so on.

I should confess to a small part in the programme: I handed out parenting course completion certificates to proud parents who recently completed the course, and, as we are talking about Wales, the local course was run by my sister, Bethan Hughes.

Using carefully controlled scientific methods, the project has demonstrated that early intervention can be hugely successful in improving children’s behaviour and, indeed, the relationship between parents and children. Such initiatives are not cheap. Cyngor Gwynedd won a grant to the tune of £800,000 to take the work forward after 2008. We are talking about real money. It is a large amount, of course, but such programmes are hugely valuable. The dividend down the line is that young people’s behaviour will be much improved and, as they may one day be parents, we are storing up a great deal of good for the future. A colleague involved in the project told me that in Norway the parenting part of the initiative is compulsory for all new parents and, interestingly, is available free of charge.

My final point concerns informal care, mainly by grandparents. Again, I refer to the report, which highlighted some interesting conclusions. Care by near relatives was valued highly by parents as being flexible and trusted. It is their first choice, and it is low cost or even no cost—hugely valuable. Grandmothers in the study did not want to be registered, inspected or paid. They did not want to be child minders; they were providing out of love. There is a quote in the report along the lines of, “we are the grannies, this is what we do”. God help anyone who stands in their way.

However, the grandparents did point to some of the costs of caring, and we must take account of those, particularly in respect of grandparents who might be on disability benefits or pensions and who may themselves be low-income people. It is problematic to think of paying people for doing what they would do anyway out of love, but provision of care by relatives in other contexts—disability, for instance—is acknowledged financially by the benefits system. This morning, I say only that the issue needs to be considered. The grandparents whom we talked to were not looking for vast amounts of money but some recognition of the costs of caring for children, particularly over the summer holidays when they might be taking children to the swimming pool and so on.

The issue needs to be considered because the number of available grandparents is likely to fall in the near future because of demography, substantially, but also because some grandparents will stay in work longer and simply will not be available. Through more flexible working and other provisions, the contribution of relatives will need to be recognised or possibly replaced if parents are to be enabled to work.

In that respect, proper child care is vital not only for families but for the economic development of deprived areas such as my constituency, where the rate of economic engagement is damagingly low. A very low proportion of my constituents are engaged in productive work. We need to look at the issue again. Child care and parenting are not only important for families and children; they are central to economic policy.

Order. Before I call the next speaker, I would appreciate it if Members would keep their comments brief, brisk and to the point, because I want to give each of the Opposition spokesmen 10 minutes to sum up, and the Minister 15 minutes at the end. This is an extremely important subject, and the Minister should be given that time to make her points.

Thank you, Mr. Olner. I congratulate the hon. Member for Caernarfon (Hywel Williams), whom I call my hon. Friend, on securing this debate on behalf of several of us who went to Sweden. As I am in a congratulatory mood, I also congratulate the Minister on her job. I believe that it is similar to her previous one, but I hope that it will include even wider responsibilities, not least because the Prime Minister has replicated at national level what we have had at local level—a children and young people’s Department, in effect. I hope that the Minister will attend many Cabinet meetings to fight the corner for children, schools and families.

It is important that such a structure is in place. We are talking about a central difficulty that we as policy makers must resolve if we are to make progress in our society. Members of Parliament have probably seen that many of the problems that we encounter—whether antisocial behaviour, failure at school, disruption in classes, criminality, drug abuse or a lifetime on benefits—stem directly from the failure to raise children in the right way, and that is a follow-on from parents not having the right parenting skills.

To resolve some of those problems, our main strategy must be early intervention. We can spend billions chasing after problems once they are part of a human being and part of their personality, or we can intervene early and spend a little bit of money on children and mothers, so that both can fulfil their human potential. Early intervention should be the key strategic objective in Government policy making in this area.

Two years ago, I could not get anyone to talk about early intervention. Now everybody talks about it, and they are throwing in everything. On every policy, we are talking the talk on early intervention, but we must be careful. We need to define what early intervention is. To me, it is a policy that makes an impact on the inter-generational nature of problems, that seeks to break inter-generational cycles. I am sure every Member has had this experience. I have been in the House for quite a long time. I am now getting not the 16-year-old who came to my first surgeries in 1987, with a little babe in arms, but the babe in arms herself, bringing her child to my surgery to get advice on problems. That inter-generational cycle must be broken.

That is not to say that we should not continue with our remedial policies—of course we should. We should be helping out at the sharp end. We should be helping to find remedies for those people who suffer because of neglect in the early years, but let us not confuse a package of early intervention measures with the continuing necessity for remedial policies.

Early intervention is necessary because in so many areas we have lost the skill—the art—of parenting. I say that because in many senses we are a child-illiterate society. We have lost the trans-generational transmission of child-rearing practices. Parenting has never just been about one poor little 16–year-old girl on a tough estate in my constituency struggling to raise a child on her own. Parenting was traditionally something in which a whole group, or family, engaged. Work has been done on that by Bruce Perry who, by tracking back the family group size to the year 1850, has made it clear that it was typical to have 12 people in the family unit. If we go back further to 1,000 years ago, there were sometimes up to 50 people in a family unit—thus there was always a stimulus around, the ability to learn was developed and interaction took place. In a sense, we are trying to find a substitute for that in modern society, and we certainly do need to find a substitute because this problem will not get better.

According the work of the Child Trauma Academy, the number of young people who we can say are generally at risk is around 10 per cent. but, because of differential birth rates and the fact that mums in those situations have their children earlier, in six generations, it will not be a 10 per cent. problem, but a 25 per cent. problem. Let us imagine the feral nature of our society if one in four children do not have opportunities in society and have all those terrible risks. This matter is not one of choice or of asking whether we do or do not take action; it is a matter of how fast we seek to act.

The policy task is to provide early intervention and to reinvent and relearn effective parenting and child rearing. We also need to spread as standard the best parenting practices that are around. To do that, we must make the best use of the natural—biological—gifts that we have, which we are not doing at the moment. For example, we must make best use of the power of relationships and the ability of a mother to transmit empathetic parts of behaviour to a baby—the ability to care, to understand, to interact and to relate to others. Doing so will act like body-building for the brain. We must focus on the ability of the brain to interact, understand and mirror development, so that youngsters can develop to their fullest potential.

The other biological gift is the brain’s malleability, particularly in the early years. Oddly, a graph of expenditure on education would start quite low and build up to a massive amount of expenditure on those who go to university. That direction is obverse to the brain’s development and its capacity to move quickly, which is very high in the first three years, but for most of us in this room has now tailed off to a level plateau.

Child rearing at home by parents and socially through interaction at school and elsewhere is the bedrock of our society, and we neglect it at our peril. The issue is that important; it is the choice between a healthy or unhealthy society. I could provide examples from education, health or employment, but I will give just one example in relation to crime. I am talking to people in the Home Office and to Ministers in the Cabinet Office and the new Department of Children, Schools and Families about the issue. If empathy can be developed in children, it becomes the greatest inhibitor to crime—particularly violent crime. If someone is raised with an understanding of how other people feel—for example, how someone feels if they are hit—it is a great inhibitor to violent crime. We are creating large numbers of people who do not have that inhibition and who think nothing of using violence to further their ends, whether when they are in the playground at four years old, when stealing a mobile phone from a child when they are a teenager, or in relation to other even worse activities.

Research has been done by George Hosking at the World Alternatives to Violence Trust on helping parents to introduce empathy and interaction and to resolve arguments without violence. We are trying to do that in my city by extending the “social, emotional aspects of learning” programme. If we can develop such qualities in people and, above all, do so early, we will put money in the bank in terms of crime prevention. In effect, ensuring that people act reasonably is the glue of our society, whether that relates to the awful extreme that we heard of yesterday where a family member raped and murdered a two-year-old girl or to the other trivial, superficial end of the spectrum where “I’m not bothered” culture is prevalent in society.

We can do better, and to do so makes social and economic sense. The economic sense is an area on which I hope the Government always feel vulnerable. It is useful to demonstrate that early intervention saves masses of public money. Investment made in intensive health visiting and mother care centres before the birth is tiny relative to what it costs to get a youngster on to a drug rehab programme. It costs the taxpayer £250,000 to keep a 16-year-old at a secure unit. However, Place2Be—a voluntary sector scheme that helps young people under the age of 10 talk about their problems, get their anxieties out and get the help that they need—costs my city £100,000. We have a choice: £100,000 to put dozens and dozens of young people on the right track or £250,000 to pointlessly bang up a 16-year-old for a year. I know where my money would go.

The hon. Gentleman is making a truly outstanding speech. He referred to the waste entailed by a young person who is incarcerated in jail. At the last reckoning, 60 per cent. of approximately 12,000 people in our young offender institutions suffered from speech, language and communication difficulties that prevent them from accessing education courses. Would the hon. Gentleman care to guess how many of those young people would not be in young offender institutions today if they had benefited from early intervention?

The figures bear out the hon. Gentleman’s point. There is a tremendous correlation between the under-achievement that results from poor parenting and people’s backgrounds, and criminality. Where people do not learn language skills, they invariably do not learn other skills, so the hon. Gentleman has hit the nail on the head.

One of the problems in getting such a strategic view over to the Government is that they fear the public expenditure consequences. The Government often talk about the 3 or 4 per cent. that we need to help. In a constituency such as mine in Nottingham, North, which is possibly one of the most educationally deprived constituencies in the UK, it is not a 3 or 4 per cent. problem; it is probably a 30 per cent. problem. It is a volume problem; not a small slither problem. To tackle that and put it right, we cannot just have schemes, pilots and little projects—although, of course, they will pioneer where we need to go. Ultimately, we need a complete reorientation of public services and to move away from the massive expense of failure towards intervening early and inexpensively to ensure that youngsters benefit and reach their full potential.

The hon. Member for Caernarfon also mentioned long-termism, which has been raised time and again. Whenever I take part in such a debate, I e-mail people locally, let them know what I am doing and ask them whether they have any bright ideas. I have been inundated with responses from people saying, “Please tell them about long-termism. I am fighting now to save my job, which runs out in six months’ time. I am getting a little bit of grant from somewhere, am begging money from the lottery and am trying to get some neighbourhood renewal funding to keep this work going”, and, as the hon. Gentleman pointed out, that is particularly the case in the voluntary sector.

In Sweden, there has been a long-term approach, over 50 or 60 years, involving both parties—there has been an all-party consensus—which is the answer for us, too. We must do it long term. As the chair of the local strategic partnership, I am looking to create in Nottingham a 20-year prevention package, but I do not know whether there will be a local strategic partnership next April, or whether it will have any money to spend, because the comprehensive spending review has been delayed for so long.

Very briefly, Mr. Olner—I am conscious of your words earlier—I shall finish by mentioning three specifics from Sweden. First, on maternity leave and pay, in Sweden a person is allowed 18 months of child-rearing leave, for 13 months of which they are entitled to 80 per cent. of their work salary. That time can be split between the partners. In the UK, maternity leave is for one year. Mothers and mothers-to-be can receive statutory maternity pay for up to 39 weeks, but the employer, not the state, pays 90 per cent. of the individual’s average weekly earnings for the first six weeks, and then a mere £112 for the remaining 33 weeks. How would one of us like to raise our children? Clearly, we would choose to do so in the system that allows us those 18 months, to keep body and soul together.

Secondly, prenatal services—another facet of the Swedish system—are provided to pregnant mothers who register with a mother care centre, which allows the earliest possible contact, which continues throughout pregnancy, and early intervention for those who need it most. Again, that compares favourably with our own system. In Sweden, everyone is entitled to take time off from work for antenatal classes at their mother care centre, whereas here we need an absolute right for pregnant women to have antenatal classes and care. That should be specified in legislation. It should be a right, and there should be a duty to promote it within primary care trusts and local councils. That is not a matter of middle-class choice; it is essential that we get help to pregnant mums at the earliest possible moment and start them on that trail, so that they can access the necessary assistance as and when they need it. We need a more systematic effort to get to people at the earliest possible moment.

Finally, I understand that my hon. Friend the Member for Battersea (Martin Linton) will talk about child care provision. However, we need to ensure also that that is comprehensive. This is the most important aspect of our social policy. We need to learn the lessons from Sweden, which has been doing this for a long time. We need to do the same and ensure that our comprehensive spending review recognises that early intervention is good not just for society, but for our economy as well. If we do that, we will end up reducing the proportion of at-risk children from 10 per cent., but if we do not, we had better be ready to reap the whirlwind that will result if 25 per cent. of our children behave in a way that most of us do not feel is appropriate in a civilised society.

I shall calibrate my remarks to the timetable that you set out, Mr. Olner.

I thank the hon. Member for Caernarfon (Hywel Williams), who is certainly a friend, for asking for this debate, and I congratulate the Minister, who has long been a champion of better parenting and child care. I am glad that her voice on these matters will now be heard in the Cabinet.

Over the past 10 years, we have made immense progress on parenting and child care, but as everyone acknowledges, we started a long way behind the Scandinavian countries, and we are still catching up. I am sure that the Minister is aware of the situation in Sweden. The focus of the visit made under the auspices of the all-party group on Sweden was on comparing benefits to parents in the two countries. My hon. Friend the Member for Nottingham, North (Mr. Allen) took a very thoughtful and broad approach. I shall try to concentrate more on the details.

The trip was organised by Christina Winroth, Anna Komheden, and others at the British embassy in Stockholm, and it was very helpful in giving us the background to the situation there. I shall go through chronologically the years from nought to six, starting before birth, because Sweden provides for mothers in physically strenuous jobs pregnancy benefits amounting to 80 per cent. of their salary for up to 50 days before the birth. I do not know whether we have an equivalent. When the child is born, the first issue is statutory maternity pay; as my hon. Friend the Member for Nottingham, North said, it applies for 13 months in Sweden at 80 per cent. of salary. In the UK, it is available for nine months, starting at 90 per cent. but falling rather abruptly to £212.75 a week. Sweden’s 80 per cent. is not for unlimited salaries, but for those up to £35,000, which still means that mothers can be paid up to £28,250 a year, plus for another three months at £105 a week. For most of the 18 months on statutory leave, therefore, they will receive a reasonable income.

Another issue is what happens to fathers. In Sweden, they are entitled to 10 days on 80 per cent. of pay. I am glad to say that in the UK fathers can now take up to two weeks at £112 a week. In a written answer, however, the Minister told my hon. Friend the Member for Nottingham, North that the then Department for Education and Skills was

“developing a new entitlement for fathers”.—[Official Report, 20 June 2007; Vol. 461, c. 1875W.]

I look forward to hearing about that.

Probably the most important issue is statutory maternity leave, which is for up to 18 months in Sweden and is now 12 months in the UK, although before April, it was dependent on being with an employer for six months. I am glad that that condition has now been dropped. Another issue is whether a father can take parental leave. As I understand it, in Sweden, parental benefit can be taken by either parent, but the other parent must take at least two months. A single mother can take 13 months, but any other parent can take a maximum of 11 months, with the other parent having to take the other two. In the UK, however—I hope to be corrected if am wrong—parental leave is an individual right and cannot be transferred between parents.

Another issue is whether a parent has to take the whole parental leave period in one stretch. In Sweden, it can be taken at the full rate for one year, at a half rate for two years, a quarter rate for four years or even at an eighth rate for eight years. Given that the leave has to be taken by the time that the child is eight, it is possible for parents to take the whole of the period off, electing to draw their parental benefit at a much lower level. More commonly, it is taken in bits, in the form of a shorter working week or working day—a six-hour day, for instance—at any time up to the child’s ninth birthday. It is true that most parents take it in the first year, but many stretch it out over two or three. Some hold it back until later. Typically, Swedish parents take a two-month summer holiday when the child is four, five and six, using up their parental leave.

Another issue is what to do when a child is sick. Often that is overlooked, but it is very important for parents of young children. In Sweden, if a child is sick, the parents want to take a child to the doctor or the child minder is sick, up to 120 days—roughly 17 weeks—of temporary parental benefit can be taken. That extends to when the child is 12. During such periods, the parent gets 80 per cent. of their salary, up to a lower ceiling of £22,000, which still is much more than in this country. As I understand it, in the UK, we get up to 13 weeks of unpaid parental leave to take care of a child, but only until that child is five.

There is a question about the age at which a parent can enrol their child in a nursery school. In Sweden, it is a legal entitlement to take children from the age of one. However, most local authorities refuse to take children before the age of one; that happens very often in this country. However, nursery provision is almost universal by the ages of four and five; 96 per cent. of Swedish children are in nurseries at that age.

How much do people pay for nursery provision? Again, the comparison is interesting. Nursery school fees are much lower in Sweden than in this country. They are related to income. People pay 3 per cent. of their income for the first child, 2 per cent. for the second and 1 per cent. for the third, but all that is subject to the incredibly low maximum charge of £92 a month, or £23 a week. Many people in my constituency pay more than £200 a week for one child—nearly 10 times the Swedish figure. Furthermore, the maximum charge for a second child is only £15 a week; for a third child it is £8 a week; and a fourth, fifth or sixth child goes to nursery free.

The Social Democrats fought the last election in Sweden on a platform that included a promise to reduce the maximum charge from £23 to £17.50, which seems almost like never-never land to us—we would be happy with either sum. The Social Democrats lost the election and the charge remains at £23, but either way it is much lower than ours.

In the United Kingdom, as I am sure hon. Members know, the maximum available help with child care costs has gone up enormously in the past two years. People on working tax credit can now claim 80 per cent. of nursery costs up to £175 a week. That increase was introduced explicitly to help families in constituencies such as mine in London, where nursery charges can be extremely high. In the 10 years since 1997, there has been a fifteenfold increase in help with nursery charges, but many parents in my constituency still feel that they cannot afford to have their children looked after.

In Sweden, nursery places are so heavily subsidised that the average parent pays only 8 per cent. of the true cost. That has a clear implication for the system of taxation, which has to be much higher than in other places, but it means that no parent feels that they cannot afford to put their child in a nursery. In this country, even a couple with two children on maximum support will pay 16 per cent. of the true cost. That is the case even with the combined effect of the child care element and free nursery places.

Another big difference is that, at the age of three, children in this country qualify for 12.5 hours of free nursery provision, whereas in Sweden it is 15 hours—which we will soon go to, but only for four and five-year-olds. In the UK, children start nursery school at three and have to go to primary school at five, although sadly many local authorities start them at four. Sadly, many children—I speak as someone who has been the governor of a nursery school for the past 20 years—stay in nursery school for only a year or even two terms because they are starting school, in some cases only a few days after their fourth birthday.

In England, many people think that the earlier a child starts school, the better that child will do, but the truth is the complete reverse. In all Scandinavian countries, children learn through play and discovery until they start primary school, and the legal age for primary school is seven, although in practice most start at six. Children in those countries spend four or five years in nursery education learning through play and do not start formal education until they are seven, yet all four Scandinavian countries are in the top 10 for reading standards. Studies by the Organisation for Economic Co-operation and Development have shown that six-year-olds in England are ahead of their contemporaries in Finland in relation to the three Rs—they can read, count and all the rest of it better than Finnish children—but by the time those children are 15, the Finns are at the top of the league, far ahead of British children. As a nursery governor, I have spent a long time campaigning, along with the Early Childhood Forum and others, on the importance of extending nursery education further into school careers.

There is a tale of underachievement in this country and it is no coincidence, in my view, that that underachievement is found among precisely those two groups that, for developmental reasons, do not take well to an early start to formal education—that is, boys generally and children from deprived backgrounds. The fundamental issue is that we need to help children to spend time with their parents and with other children. If we want children to have a better childhood, the first step is to give parents a better parenthood. If we give them a better parenthood, we create the right conditions for a better childhood, and a better childhood will, in time, lead to a better parenthood.

I, too, congratulate the hon. Member for Caernarfon (Hywel Williams) on securing this debate and on his contribution, which was very interesting, particularly given the Welsh dimension; that was new information for many of us. I also congratulate the Minister on her enhanced role, and the Government on putting the word “Children” first in the name of the new Department. That has to be good. With great regret, I was unable to take part in the recent visit to Sweden, but fortunately I had been on an earlier visit and had at least visited one nursery school there.

As we reflect on the debate today, we can think about the recent UNICEF report that ranked the United Kingdom 21st out of that number of industrialised countries for children’s general well-being. We cannot escape the fact that the countries that were ranked much higher included the Scandinavian countries. I suggest that the excellent child care provision and very good provision for maternity and paternity leave in those countries must have made some contribution to that ranking. I agree with the hon. Member for Battersea (Martin Linton) that we ought to be thinking seriously in this country about the education of children up to the age of seven. Are we putting them in that hothouse too soon, turning them off education and alienating them? There are some good questions to be answered in that regard.

I am sorry, but I shall not do so, because of the time.

Without a doubt, I congratulate the current Government on their commitment and the enormous increase in public expenditure on early years services. It has to be a cause for celebration when we look back to 1997 and look at the situation now, but oh how we wish we could have the Scandinavian situation. Even with the massive increase in investment by the Government, we are spending 0.5 per cent. of our gross domestic product on early years provision, whereas in Scandinavian countries the figure is more than 2 per cent. That means that we must have a long-term policy, because it would require an enormous switch in resources to achieve that figure. That is why, having started with all my congratulations to the Government, I shall now be slightly challenging. As we are spending a lot of money and we need to spend a lot more, it is very important that we are spending that money well.

We face conflicting challenges with child care provision: sustainability, quality, quantity and affordability. Those issues are very difficult to juggle within our budgetary framework. We also have to think of the different motivations. Good child care provision provides an opportunity for early identification of some of the issues that have been mentioned. That has to be good. Early years support and a choice of provision has to give many children a very good start in life. There should be an element of choice—we must not be too prescriptive—but it is a way of breaking the vicious spiral of poverty if we can give children a good start in their early years. Rather more directly, we can lift families out of poverty by making it easier for parents to return to work.

The National Audit Office report published at the end of 2006, “Sure Start Children’s Centres”, questioned whether there was value for money throughout children’s centres. The point was made that much more monitoring had to be done and that local authorities needed better information to determine their priorities. We must bear this in mind. Huge sums of money are being invested, but are we getting it right? More recently, the same issue was raised in the June 2007 Sure Start evaluation; that, too, questioned whether we were getting value for money.

We must also think about whether we are reaching disadvantaged families. Again, the NAO report clearly picks up the fact that there are difficulties, and that was strongly reinforced by the Sure Start report in June 2007, which said:

“Providers found barriers to attracting ‘hard to reach’ families difficult to overcome.”

The challenges ahead are enormous.

We must consider how complex the child care element of the working tax credit is for families to claim and how inflexible it is in terms of support. That is another reason why it is difficult for the disadvantaged to access good child care, and I hope that the Minister, with her wider brief and portfolio, will look at how the situation can be improved. I am also particularly concerned that children from workless families, as well as those from families where the parents are seeking work, should be given the same important early opportunities.

Given where we started, it is inevitable that we have mixed child care provision. In my area, it was important to achieve a good partnership with the voluntary and private sectors because there was so little state provision. More recently, however, there have been questions about how well some local partnerships are working. There is certainly great anxiety, particularly in the private sector, about whether there is enough money in the system to enable providers not only to offer the entitlement, which is important to all children, but to maintain quality and, indeed, to survive. Inevitably, when we use a market-based system, we will have surplus places from time to time, but we need a level playing field, as outlined in the Childcare Act 2006. However, the NAO report suggests that children’s centres have been providing child care in areas where there were private providers. Given that we are so dependent on a mix of providers, we must ensure that there is enough money in the system and that there is a genuinely even playing field.

I have met my local private providers, who said that the partnership has diminished since early years partnerships disappeared and were replaced by children’s trusts. They do not feel that they have the voice that they used to have in the local authority, and that is giving rise to some of the problems. The Minister recently issued the response to the consultation, which mentions sitting around the table more in the context of the school forum. It will be really important to get that right for all child care providers, who feel that they have been left out in the cold. As a result, we have a big conflict, which is not good for the situation generally.

Quality is all important, because poor quality child care can be damaging in certain circumstances. We must get quality right, and it will be essential to put even more money into the pot to train the work force. Skimming through the briefing provided by the Library, I noticed that the average wage of a child care worker is £6.40 an hour. We are talking about the most important years of a child’s life, and we really have to professionalise and to raise esteem. How does that affect affordability? That is a difficult conundrum.

We have mentioned the generous maternity and paternity leave in Scandinavia, and we must move to a more Scandinavian model over time, because parents need to have a choice. I visited a playgroup yesterday and sat having coffee with the mums. One mother was near to tears when she said, “I’ve just got to go back to work, but I don’t want to. I want to stay at home with my child for longer, but the mortgage is such that I can’t.” I really want parents to have the choice of a longer period, but the question is how we build up the investment over time. My party has made a proposal that would at least provide the minimum wage over a longer period, which would benefit those on a low salary—it would not particularly benefit those on a high salary—and give them more choice.

Let me quickly—

I would like very quickly—in one minute—to mention parenting. I am particularly concerned about the future role of health visitors. We have had the survey from the Family and Parenting Institute, and I have read “Facing the Future”, which suggests that there are two ways for health visitors to go: the universal service or the concentrated service. The early Sure Start centres that I have visited have really good health visitors and many of them, but the numbers of health visitors are declining. I therefore make a special plea to the Minister to bear it in mind, as the current review is being looked at, that health visitors are crucial in all the things that Members have mentioned this morning.

Finally—I will keep to my time—we need choices as regards child care and choices for mum and dad. We also need early intervention, although there is a balance to be achieved between the nanny state and early intervention. Overall, the nature of society today means that we must put back in place structures that are no longer where they used to be.

I congratulate the hon. Member for Caernarfon (Hywel Williams) on calling the debate; this is the second attempt by those who were in Sweden to call one. This is also an opportune moment to congratulate the Minister on securing her reappointment and enhanced role, which sends a positive message to all the children’s groups that wanted children and parenting to be placed right at the heart of policy making. How, however, will she square this morning’s calls for increased spending with the Prime Minister’s strict spending commitments and with an impending comprehensive spending review? She will not do the debate justice if she does not respond to that point.

As regards the calls for parental choice, Conservatives want to see sustainable, affordable child care of the highest quality. I look with some concern at what the Government are doing, because they are limiting, not extending, parental choice. On the issue of midwives and pre-birth care, there have been two consultations on the maternity hospital in the constituency of hon. Friend the Member for Ryedale (Mr. Greenway), which is adjacent to my constituency. One, which was entitled “Maternity Matters”, was initiated by the Government, while the other, which was a more local consultation, was initiated by the Scarborough general hospital, where the maternity unit is situated. The primary care trust now proposes to close the maternity unit. How will that increase mothers’ choice of where to give birth? Equally, there is a lack of health visitors. Surely, we must have good access to health visitors, particularly in deprived areas, if the Sure Start children’s centres are to be rolled out successfully.

I should like to challenge the Minister to say definitively today that the Government recognise the mixed economy in nursery care provision. There is every indication that they are ideologically opposed—from the new Prime Minister down to the Minister and her new Department—to private nurseries and are seeking to put them out of business.

The Minister of State, Department for Children, Schools and Families
(Beverley Hughes)

Will the hon. Lady tell us what evidence she has for the claim that we do not support the private sector? As far as I am aware, the evidence points in completely the opposite direction, and that includes my recent comments directly to local authorities about their role in supporting the development of the private sector.

The Minister is in a very weak position, because she and her Department do not actually know where the money is going. I do not think that any hon. Member in the room disputes the fact that a large amount of money—£3 billion a year—is going into early years provision, and she said that there was an extra £3 billion for the Sure Start programme. However, in her reply to me of 14 June, we learn that the Government do not actually know where the money is going. People say that imitation is the greatest form of flattery. It is odd and very gratifying that, after I had sent out a questionnaire on behalf of the Conservatives, the Government should send out an almost identical one to exactly the same people.

Yesterday, I chaired a meeting of private, voluntary and independent providers, and I should be very happy if the right hon. Lady would join me—she has been invited several times—in meeting a delegation. If she would respond to the invitation, we could take the matter forward.

I was very taken by the remarks about parenting made by the hon. Member for Nottingham, North (Mr. Allen). It is something that we take for granted—that parenting has cascaded down the generations. I am concerned about what happens when children are seen to be misbehaving. The hon. Gentleman’s idea of early intervention is positive and timely. With “Breakdown Britain”, we have seen that families are breaking up, perhaps fewer couples than before are marrying and there are more multiple relationships and more children coming from disjointed relationships. We are considering that aspect of the matter carefully. We would be doing the present generation of children a great service if we could intervene through schools, police and parents when children truant, and perhaps put less emphasis on putting them in custody. I think that the right hon. Lady will confirm that there are now more children in custody than there were 10 or 15 years ago. In that regard, prison orders have cut down on education, but that is a matter for a separate debate.

As for parenting, obviously two parents are better than one. We would like greater access to fathers, with greater involvement and more shared parenting, but, for children who are not living in their natural home, will the Government recognise that children will flourish through access to the wider family? I am taken by the fact that, in this country, one in every 100 children lives with a grandparent. That is an average of 2.4 children in every primary school. Denmark has run with the idea of grandparenting, and in two municipalities, funding is received from the Ministry of the Family—the matter has also been allocated to the relevant consumer organisation—for the creation of a network of substitute grandparents when there are no real ones.

We—and I expect the Minister, too—have received strong representations to the effect that children in care, and children at risk of a breakdown in a relationship and the possibility of entering the protection of the state, benefit from access to their wider family, such as grandparents, older siblings, aunts and uncles. I wonder what plans the Government have to consider the role of family conferencing.

Like the hon. Member for Mid-Dorset and North Poole (Annette Brooke), we are concerned that, although the original concept of Sure Start children’s centres was inherently good, we have heard from the National Audit Office that, of 30 centres that were visited, only nine were reaching out to the families most in need. Furthermore, it was never, in my understanding, intended that Sure Start children’s centres would compete in the same neighbourhoods as existing private and voluntary nursery providers. That is the nub of the representations that are being received by hon. Members who have excellent private nurseries in their constituencies. We know that Sure Start children’s centres are offering good quality early learning, combined with full care provision for children, for a minimum of 10 hours a day, five days a week, 48 weeks a year. Does the Minister accept that that is forcing some private nurseries to look carefully at their books?

I am delighted that the Minister is looking to local authorities and introducing the questionnaire that has been mentioned. Will she make the results available to hon. Members through the Library? In response to my question last week, at the Question Time of her previous Department, she replied to National Audit Office criticisms:

“We have made it clear in subsequent guidance that outreach must remain a fundamental element of the children’s centre programme”.—[Official Report, 28 June 2007; Vol. 462, c. 467.]

Where is that guidance? Is it in publishable form, and can we have access to it? Many people are asking for it. Will the Minister confirm that she accepts a mixed economy provision and that no Government could roll out the child care programme that we would all like without input from private and voluntary associations? Will she also attend to the issue of strengthening the family? The family is the institution that, first and foremost, contributes to good behaviour, morals and manners.

I want to conclude by referring to the emphasis on emotional well-being and social mobility in the responses to a YouGov poll commissioned by the children’s charity NHC, which included the finding that

“adults were of the view that emotional wellbeing is twice as important as social class in their own social mobility; and that emotional wellbeing is seen as more important than family income, physical health and IQ.”

We therefore welcome the role of the family in providing the most natural form of child care, but we also want an enhanced role for the extended family.

The Minister of State, Department for Children, Schools and Families
(Beverley Hughes)

This has been an excellent debate. I congratulate those who sought such a debate, because it is a welcome opportunity for me to air important issues with hon. Members who are as passionate about them as I am. I hope that hon. Members will agree that there has never been such a strong spotlight on children and young people at the heart of Government policy as in the past 10 years. I welcome the support that hon. Members from all parties have given to that approach.

It is important to understand the reasons for what we have done. It is not just a good thing to support children and families: doing so must be at the heart of the social and economic priorities for any progressive Government, in relation to the social objectives of reducing child poverty and inequality and ensuring that every child reaches their potential and to the economic objectives of ensuring that we can call on the talents of all our people, so that our economy will be well placed and so that families prosper. In addition, it is the job of a progressive Government to give strong support to families. They are the engine of our economy and the place where the next generation is raised.

I am very pleased at hon. Members’ comments about the restructuring of the Department in the recent governmental changes and its renaming, which deliberately puts children firmly first, as was noted by the hon. Member for Mid-Dorset and North Poole (Annette Brooke). We all welcome that. Several hon. Members make the point, with which I entirely agree, that the way in which we support parents is critical. For Government, it is important always to stay on the right side of the line, by which I mean that we do not tell parents what to do. We should never diminish what ultimately must be parents’ responsibility for their children. However, we have the job of providing the widest possible support for parents and making sure that, routinely, our big public services—health services, schools and children’s services—see it as a core part of their job to involve parents closely in what is being provided for their children.

Clearly, the trip to Sweden had a big impact on hon. Members, and to judge from their comments today, it influenced what further progress they would like here. There is no doubt that the investment in and commitment to children and young people in Sweden is a major reason for its deserved reputation as one of the most equal and mobile societies in the world. That is where we, too, are coming from, and why we want to invest in children and young people. However, I am grateful to hon. Members for their recognition that Sweden’s achievement did not happen overnight. It took about 150 years. The first creche was opened, I am told, in 1854, and since then there has been investment on a huge scale over a long period.

It is also salutary, in making the comparison with Sweden, to recall the starting point in this country in 1997, when there was little support for families. My hon. Friend the Member for Battersea (Martin Linton) mentioned that. Paid maternity leave was just 14 weeks, and there was no paternity leave. There was no right to flexible working, no right to time off for domestic emergencies and no help whatever for adoptive parents. Provision for young children was very limited, patchy and unco-ordinated and there were no children’s centres. There was no minimum wage, no protection against discrimination for part-time workers and single mothers were vilified. My first child was born in 1979, and my third in 1984, so my children grew up in that period, and I know from personal experience how difficult it was then for both parents to manage their work and bring up their children together.

It is important to recognise how things have changed in a relatively short time compared with Sweden—we are learning from progress there—because of the huge investment that we have made. We are building many positive elements of the Swedish system into the changes that we have made, such as providing, for the first time, free nursery and early education for all three and four-year- olds. At the moment, there is an entitlement to 12 and a half hours, but that will, as my hon. Friend the Member for Nottingham, North (Mr. Allen) said, increase to 15 hours and, we hope, beyond. Those changes have increased almost threefold the number of three-year-olds who access such places from 34 per cent. to 96 per cent. We are now piloting free child care and early education for two-year-olds, particularly to disadvantaged two-year-olds, because we know that that is how we can make the biggest difference.

We are doubling the number of available child care places and are providing £3 million a day to make child care more affordable through the tax credit system. There has been more than £21 billion of investment over that period to establish an apparatus and level of service for children, particularly young children, and their families that was not there before.

I do not think that we dispute the figures, but it is difficult, because there is no transparency to allow providers to see where that money has gone. The Minister must accept that local authorities take different amounts for administration. When the Conservatives left government, our nursery voucher was quite popular. It was a bit more difficult to apply, administratively, but it was more transparent. How does she plan to introduce transparency, so that providers can see that there is a level playing field between different local authorities, as well as absolute transparency and accountability in the financing?

I shall get to that point, and I am grateful to the hon. Lady for raising it. However, I will say now that the one note of discord in this debate has been the Conservative party’s position on several issues, not least that of inequality. We removed inequality with the Childcare Act 2006, which the Conservatives voted against. On this issue, they are wedded to the idea of a top-up fee or voucher system, which would create a two-tier system, because it would allow well-off parents to buy the best nursery education, while leaving more disadvantaged families unable to do so. We are completely opposed to that, and we will not allow top-up fees. However, I am certainly committed to having transparency in the system, and I will go on to say how we will introduce it.

The Conservatives have not pledged to have top-up fees, but we do accept that they are currently being used for that extra half hour between two-and-a-half and three hours. However, we can discuss that issue outside the Chamber today.

As far as I am concerned, the Conservatives have been supporting providers who are calling for top-up fees to be allowed. That was the reason for my comments.

I return to the comparison between the UK and Sweden. Care and education in the early years are now being integrally linked, as they already have been in Sweden. The early years foundation stage, which is based on play but moves towards quality and consistency for parents, very much mirrors the approach taken in Sweden with the pre-school curriculum.

The emphasis on training and qualifications in the Swedish work force, which is so important to quality, is something that we, too, are concerned about. We want to ensure that leadership in children’s centres is graduate-led. As in Sweden, local authorities in the UK now play the central role in providing child care, as a result of the Childcare Act 2006. Indeed, that role is expanding in both countries. The 2006 Act placed on local authorities, for the first time, the duty to ensure that there is sufficient child care. I shall now deal with some of the points that have been raised on that issue.

The 2006 Act placed on local authorities the duty to consult parents to establish where there are gaps in child care and to move towards providing higher quality and flexibility. The duty is not to provide for any shortfall that is identified, but to work with private and voluntary providers. Local authorities are charged by law—I do not know whether the hon. Member for Vale of York (Miss McIntosh) is familiar with the Act, but some of her colleagues are—with being a provider of last resort only when the private and voluntary sectors cannot provide services at a reasonable cost. The example that we discussed in Committee was that of a severely disabled child. It is enshrined in legislation that, while local authorities are rightly charged with meeting local need, they must also encourage diversity in the market and ensure quality and sustainability. That is an entirely appropriate role for elected bodies to take locally. That approach underpins our commitment to maintaining, supporting and raising the quality of a mixed economy, which is how parents will get higher quality and more choice. I hope that that answers the hon. Lady’s concerns about our commitments on that issue.

I understand completely why hon. Members present have called for more, better and faster, as I share those feelings. I point out, however, that there is another comparison to make between the UK and Sweden—issues of affordability come into play. Yes, the proportion of child care costs paid by parents is 10 to 15 per cent. in Sweden and averages about 45 per cent. here, but that difference must be seen in the context of the higher taxation there.

I do not know whether the hon. Member for Mid-Dorset and North Poole is committing her party to the further spending that she asked for, but Sweden has the highest tax quota, as a percentage of gross domestic product, in the industrialised world, with rates of 50 to 55 per cent. income tax for those with salaries above only £22,000. It also has VAT rates as high as 25 per cent. on some commodities. So there might be differences between our child care provision, but there are also differences between how it is paid for. Those are the different contexts that we are dealing with.

My hon. Friends raised important points about maternity and paternity leave. My hon. Friend the Member for Battersea asked about progression of paternity leave. We are currently consulting on that, with a view to extending provision for fathers. At the end of the consultation, in August, we will bring forward detailed proposals. I know that there is concern about tax credits—as an MP, I meet some of the people who have such concerns—but more than 400,000 families now benefit from the child care element of tax credits. That is twice the number who benefited from the child care tax credit at its peak. I know that there are problems for a minority of people, which we must get right, but many more people benefit from that provision.

My hon. Friend the Member for Nottingham, North made an incredibly powerful speech on early intervention, with which I agreed entirely. He has shown incredible leadership in his area to progress these issues and to address the need for services to do more for disadvantaged children in particular. He will know about early learning partnerships, which will take the lead on this issue, and the nurse-led family partnerships through which a new role for health visitors is being developed. They will not only help disadvantaged children, but will bring about another model for health visiting, which will be enthusiastically adopted by the profession, whose members are very keen. If the hon. Member for Mid-Dorset and North Poole is not aware of the detail of those partnerships, I will send her some information on them, because it is great stuff.

The hon. Member for Mid-Dorset and North Poole mentioned the UNICEF report. I recognise completely that, although most children and young people are doing better and say that they are happier, we must do more for important minority groups, but I do not accept the results of that research. It was methodologically invalid and produced conclusions that do not withstand reasonable scrutiny, so it is a shame that it has been so widely accepted.

Before the Minister sits down, will she say a few words about pre-birth services? Does she think that they should be offered more universally as a way of starting the data-tracking of families?

Yes, I do. That is something that will be addressed by the nurse-led partnerships. They will start by doing pre-birth work, and carry on for two years to demonstrate how we can go forward on that.

There are challenges with quality and reaching disadvantaged families, and in relation to fathers, giving further choice to parents, affordability and flexibility, all of which have been raised today. I will strain every sinew to ensure that we make as much progress as possible as fast as possible. With the support and commitment of Members present today and beyond, we will do so.

NHS Procurement and Purchasing

First, I should say something on the subject of the debate. Its title is slightly different from the one that I wanted, which would have included mention of the practices used for prescribing. Perhaps that is a debate for another day, so I have narrowed it down to how things are acquired and how they are valued in general.

To give a bit of background, the issue stems from the privatisation of what were the procurement services for the national health service in England and the establishment of a new structure. This price-driven model has tried to reduce costs in order to save £1 billion for the NHS in England. It has involved the use of a commercial contract with DHL—I am talking about the German parcel-delivery company—and its subsidiary, which I believe is based in New Jersey.

As someone will ask why I, a Member of Parliament from Wales, came to this issue, we should deal with the West Lothian question first. I came to it because I have been doing a lot of work on wound care and considering how we can introduce innovative processes into health in general, the standards that are applied, how the National Institute for Health and Clinical Excellence—NICE—works and how it evaluates things.

A factory in my constituency manufactures the basic elements of wound dressings. People might think that that involves just knitting together bits of lint or something from the past. It is anything but that; it is a high-technology operation, because silver-based dressings, honey-based dressings and all sorts of new technologies, gels and so on exist. The process is interesting. That factory is an employer in my constituency, so the question of how it gets its goods to market interests me too.

Wales has continued a process of buying in a different way. I need to see what the incidental effects of England’s changing that process dramatically are, because, in terms of the UK, what England’s NHS does has a huge incidental effect—it probably has a direct effect too—on the market and on how things are applied.

I am also interested in how we drive the quality of care forward and in protecting my party, because politics is also involved. I am interested in the politics: I do not want the leafy suburbs of England leaving us at the next election, because I have a direct interest in the continuation of a Labour Government. I hide none of those things, but they are the reasons for my coming to this matter.

I asked some basic questions about how the market process is meant to work, and because the answers that I received from the NHS merely stimulated my concern, I secured the debate. Irrespective of what one thinks about the idea of privatising the process in England and the debate on the question of whether or not it could or should be renationalised in some way in the future, this process will now operate, because there is a contract that will run for 10 years. I need to see what the health of that process will be.

Does my hon. Friend agree that it is perverse that in parallel with the alleged attempt to save £1 billion by outsourcing, we are seeing things such as the NHS Connecting for Health IT programme, which involves £12.5 billion, and the rampant private finance initiative, whose costs into the middle distance will far outweigh the savings that might be made? Does he hope that the Minister, whom I am pleased to see in his new role, will discuss the pharmaceutical price regulation system, which awards substantial and excessive profits to pharmaceutical companies, given that we are apparently moving towards a price-driven regime?

This is part of a broader discussion of issues, be they PFI contracts for physical buildings or the price regimes that my hon. Friend mentioned. We need to assess what constitutes long-term value as opposed to short-term price. In terms of how we deal with medications and drugs, I agree that similar issues need to be carefully monitored. In such areas, proper controls and transparency are needed.

One of the first things that I discovered in respect of this process was the lack of transparency. We started to get some of that through NICE in terms of evaluations of particular medical procedures, drugs and so on. That is becoming inconsistent. If we are to have the sensible debate about the rationing process in the NHS that is necessary, all those elements must be included. Today, I must concentrate on this particular issue, because otherwise you would discipline me, Mr. Olner. This is illustrative of a broader discussion that we need to have.

I examined what was said about what the controls and transparency would be in this new process and what the architecture would be to achieve those things. There is a hangover from the privatisation of the original system. I might get some of the titles wrong, because the NHS is like the British Army, in that everything involves initials.

The Purchasing and Supply Agency has a residual remit in relation to all this. I understand that its role was to set up procurement hubs, on a seemingly largely English regional basis, and to set up the Centre for Evidence-based Purchasing, which will be a central element in all this, and to examine compliance to some degree. From what I can see, that means compliance in the NHS or some way of finding a method of consensus, but it is not compliance in its general sense. One of the major elements of the body’s intended role is to help to establish the Centre for Evidence-based Purchasing, which relates to evidence-based medicine. Apparently, that is supposed to establish what are described as nationally agreed protocols.

That sounds all very well, but I thought that I would test the health and efficiency of it. The trouble that I have is that even if all those things were in place, what would the status of the protocols be, how would they come about and who would be involved in them? I understand that there are to be 12 dedicated evaluation centres in trusts and universities. Descriptively, it all sounds nice, but when the practice is examined, it starts to fall down. In order to achieve all those things, product councils are to be established. I asked further questions about that. Who will be involved? What will their deliberations be? What will the transparency be? The answer came back, “There won’t be any.” These will not be open processes.

The Medical Technology Group met Roger West, the procurement director of the NHS supply chain, on 27 June. He talked about all these things. He said that these bodies will be set up, but their composition will not be public. There may be additional product taskforces. He was unable to give any more information about that. There are seemingly no mechanisms to consult either with patient groups or with clinicians.

I am unclear about the situation. What seems to be being said to me is that patients and patient groups will in some way be represented by clinicians through the collaborative hubs or in the product councils. I examined how the product councils are to be set up. People could not really tell me how they are to be set up, but I have now seen the advert for the first one, which relates to nursing. That one is important to me, because it is where wound care and training comes in.

I am told that the trusts will in some way be represented by the individual nurses who will be appointed through a system of self-nomination. Who will choose them? They will be chosen by the NHS supply chain. The NHS supply chain is DHL. I am not quite sure about that. The company running the contract seems to be choosing the people who are going to be on the product councils to do the evaluation of the evidence-based medicine. That did not appear to be a healthy, open or transparent process, so I continued my investigations.

The hon. Gentleman is making an excellent analysis of and case about so many of the difficulties that a lot of us have encountered in trying to understand the new process. It all comes back to individual examples. Advanced Medical Solutions in Winsford in my constituency has, like the companies in his constituency, been developing a new dressing. It is seaweed-based and very effective, but the company has had the biggest nightmare possible trying to get anybody to recognise that it is worth while for patient care in England. In the end, we had to go to the Department of Trade and Industry to show that our country was losing a genuinely innovative opportunity. That was a better way than going through any Department of Health process.

I agree with the hon. Gentleman in that respect. One of the big issues that concerns me is the stifling of innovation. The new structure’s very aims include promoting innovation. It is also meant to promote the involvement of small and medium-sized enterprises—SMEs, to use the jargon—in supplying the NHS, yet what I see is a process that seems to exclude more people than it will include. There will be a smaller number of larger fixed-term contracts. There is huge tension between fixed-term contracts and opportunities for innovation as well as for involving SMEs. I shall address those questions a bit further later.

There is also the question of what is meant by the evaluations. I fail to understand how self-nominated people chosen by the company can represent NHS institutions such as trusts. That is unfair to the individuals chosen, who will be motivated by good reasons, such as wanting to make a contribution to the evidence-based process and to innovation. What will they be asked to evaluate? How will they evaluate it?

Those individuals will be asked to evaluate on the basis of this driver—whether it costs less. That is what they will really be asked to do. The description says that they will do a lot more than that, taking into account all the various considerations, including the non-financial aspects of any evaluation required. However, my difficulty is that that will be done, one way or another, by the company, using the product councils and liaising with the Centre for Evidence-based Purchasing. What are their formal relationships? How will the guidance, and the remit that we decided elsewhere in terms of clinically-based evaluations, figure in that?

I am told that all the non-financial aspects—quality of care, and issues such as assessing whether a treatment will save nursing time or keep people from having to go back to hospital again and again—can of course be overridden. The problem is that I am being told that the process of NICE guidance—a whole different architecture that we established for the very good reason that we needed to evaluate new and existing processes properly—will still run alongside that programme.

I am told that once NICE decides that a treatment is safe and efficient—that includes both the health aspect and cost-effectiveness—it will accredit it and clinicians will want to prescribe it. However, another architecture will now evaluate it again to decide whether the NHS will buy it. The guidelines from NICE will be only guidelines. They will not run the structure.

I am told that as far as NHS commissioning authorities are concerned, the money should follow the argument. If the treatment is agreed by NICE and prescribed by a doctor, the patient should get it, and it should be paid for. Well, they will order it, and the authorities will say, “We’re not going to buy it,” because they will be able to override NICE. There will be no obligation for the authorities to have any consistent relationship to NICE advice, because it is only a guideline and the authorities’ remit will be to consider only price. To be polite about it, other factors seem extremely incidental. The NICE technology appraisals—this will not apply just to drugs—can be overridden.

How such non-governmental bodies will be established and run is crucial, as is their interrelationship. Ultimately, they might delay the introduction of good things. They might not destroy innovation, but they will not exactly stimulate or facilitate it. Maybe some people will get the right treatment, but they will get it later. Frankly, that is not good enough. It is inimical to the whole attempt to drive greater efficiency in the NHS. When the Prime Minister says to me, “I want ideas about how to do it,” I will say to him, “One of the ideas that you have established in England is potentially deficient—this one. It needs re-examining.” The Minister needs to establish some sort of ombudsman for that process in England. That is just a bit of advice from a boy from the valleys, but he ought to take it. It will have incidental effects on me, but it will also have direct effects on him.

I have some quotes on the matter from industry representatives who have written to me. The company Bardex says:

“There is still a large gap between the aspirations of DH procurement policy and their practical delivery.”

That is nice and diplomatic. In particular,

“there is a continuing failure to distinguish between cheapest price and best value”—

I think that that is at the guts of the whole issue—

“in the devices sector and prevarication about innovation resulting in slow uptake of new technology.”

Sir Christopher O’Donnell is apparently the retiring chief executive of Smith and Nephew and a man who has been running a large company in the sector. He has said:

“the company’s investment is now going into America, Germany and Japan”.

Why? Because

“the NHS is a slow adopter of innovation”.

The new structure will only stimulate that.

Another industry source says:

“Manufacturers have been forced to make drastic price cuts in order to be listed suppliers. As a result, valuable back up training and support which was previously provided free of charge has, in many cases, been withdrawn.”

That is crucial. When things are bought, they do not just come in a box. They come with support and training—training that the NHS cannot and does not offer. Perhaps the issue of how training in the NHS works is a debate for another day. I do not think that we have got it right at the moment. In 2006, ConvaTec, a company in my constituency, trained 10,500 nurses in the new wound care technology. If we are not careful, we will screw the manufacturer on price until he says, “Okay, we’ll meet your price by cutting the so-called incidentals.” That will create another cost that we will have to meet in a different way. The Minister should be careful. He might appear to save £1 billion, but he will end up spending not only that £1 billion but a lot more in another way—the least efficient way.

My hon. Friend has spoken about the impact on companies and on the health service, but will there not also be an impact on ordinary people? A gentleman in my constituency is desperate for the drug Alimta, which can hold back the ravages of asbestos-related diseases. If what is being said today is true, there might be yet another block to people’s access to such drugs. Surely that is not what our Prime Minister means when he says that we should listen to the voices of the people using the NHS.

My hon. Friend makes a point that we all understand. We all have people coming to us saying, “I want the best treatment. There is one available to me, but I have a difficulty in acquiring it.”

That is the whole point. That is exactly why we established NICE. That is why we decided to have a process to evaluate treatments. NICE was slow in the products area, and I have had previous debates about that. It was faster in the drugs area than in the technology area, but patients often require both. They do not come in boxes or live their lives in compartments. The NHS may work in its little silos and compartments, but the world does not. The difficulty is how to make a value assessment that gives the true and total value of something, rather than the separate price or cost of an individual item.

I referred to the excess profits being made by pharmaceutical companies, which the Office of Fair Trading highlighted in its report in February and to which the Government will respond later in the summer. Does my hon. Friend agree that we must give pharmaceutical companies, one of which is a major employer in my constituency, stronger incentives to invest in drugs for those who have medical conditions with the greatest need, not where there is the greatest profit?

As a general proposition, I could not possibly disagree with that. The short answer is yes. The business about how modern processes can drive us towards being up there with European standards—we have made that declaration—is important, but we must discuss how to get products on to a list.

There is another debate to be had about how to get old stuff off a list. The problem is that we have a way of adding to the list, but not of taking things away. I know clinicians who, for a combination of many reasons, prescribe older technologies. I do not want to traduce them, but it may be partly because they just do not know about new treatments and partly because of the way in which new treatments are presented financially. A new treatment may seem to be terribly expensive, but evaluation is deficient if it does not show the real value over time. The truth of the matter is that some diseases and processes, such as cancer, are ceasing to be acute and are becoming chronic, and we are keeping people alive, but they will continue to be patients for a long time. The new technologies may save costs because patients may not need to return to hospital if they are receiving medication. It seems that the NHS is incapable of seeing that. The point about the process is that it seems that the non-financial aspects can effectively be disregarded on the basis of price.

Is the hon. Gentleman claiming that if something is not supplied by the NHS supply chain but is approved by NICE, it cannot be obtained by a hospital, clinic and so on? I do not believe that that is so; I believe that it can be obtained from elsewhere.

The hon. Gentleman asks an interesting question, and I do not know the answer. I cannot say whether it is yes or no, because it would be different in different places. That is another aspect. The Minister will say that in England there are GP commissioning processes and so on. Who does the ordering is an interesting question, and the hon. Gentleman may be correct. If a GP orders something, he may get it because it comes through a different process, whereas the same doctor working in the trust might have to order it through the procurement process and might not get it.

NICE was set up to address postcode prescribing and to provide consistency, but not uniformity, in the process with rules that everyone understands and works to, but it seems that the guidelines have no force. Something may be excluded if it is ordered through one process, but may be available through another process. That does not help us to square the circles relating to different practice and best practice across the piece. It seems that guidelines for specialist medical equipment will not be published, so how will we know what is best? Either there should be a structure—I would not have started from the present position, but as it exists the Minister should examine it—to provide consistency and to allow a contribution to the broader discussion, or there will be a contradiction, people will be excluded, and there will be no stimulation to prescribe and develop new products. That is the guts of the issue.

I may be ranging widely, Mr. Olner, but the matter must be seen in context. Either the Government want to reduce the number of suppliers, and to drive down prices, as Tesco does with baked beans, or they want to do something else. Descriptively, it looks very good, but when we drill into the process to see how it functions, it stops looking good.

I received a worrying answer from the previous Minister when I asked how the procurement process will produce long-term savings for patient bed days, nursing time and repeat procedures in the NHS. The answer cometh back:

“The contract…will measure savings based on the reduction to buy price”.—[Official Report, 16 April 2007; Vol. 459, c. 373W.]

I do not know whether that means, “I don’t know” or “It won’t”, but I think it probably means “It won’t.” It is only part of something that needs to do all those things. Currently, however, it is deficient. That is extremely worrying because it cuts into other processes that we are trying to establish to introduce better practice into the NHS.

The process will undervalue something that the NHS has taken for granted—the training and incidentals that come with contracts—and England will rue the day. At Currys, one can by cheap products from Taiwan. They come in a box, look similar to other products and will do the job immediately, but there will be no product support or training. The relative quality over time will be worse, and that must be considered.

I have asked the Minister questions, and he should consider value versus price. A decision should not be made nakedly on price. There will be inconsistencies, and I fear the consequences, such as lack of innovation and the effects in my constituency. For the Minister, however, the consequence will be litigation, and if I were a lawyer, I would be licking my lips. We have seen with NICE that when it makes a decision and there is a problem with the application, people resort to law.

There will be inconsistencies. NICE will agree something, someone will try to buy it, but it will not turn up because they will be told that they cannot have it—the rules do not have to be abided by—so people will go to law, which is not the best place to resolve such issues.

The hon. Gentleman may be right about the increase in litigation, but I am afraid that it is highly likely that that will be the preserve of bigger, established companies that can afford to take the risk of litigating to find an opening for a product that is complementary to a current product line. That will continue to bear down, and to crush innovation and the entrance of the small and medium-sized enterprises that we want to encourage.

It has all that potential, and I share that fear to some extent from the industry’s point of view, but I also think that individual patients will have to resort to the law. Clinicians and trusts will have to test where they are because they will be told that they are outside the law. There will be legal opinions from half a dozen people. If someone asks six lawyers for a legal opinion, they may end up with seven if they are prepared to pay. Those opinions will have to be tested, and they will be tested in the courts. That is a recipe for nonsensical and unnecessary litigation.

There is also a question of how the matter relates to the UK. The Welsh Assembly has announced a whole new process of transparency so that patients can have an easier way of raising grievances and addressing problems in the NHS, to try to avoid the need for them to go to law and claim compensation. Wales has a very transparent process. There is an individual for people to phone. They can ask her how the process works and who is assessing what, and the process is completely open.

I am not sure about the situation in Scotland, but I know that there is no need for secrecy, and every need for less of it. The more information, evidence and consistency there is in the process of understanding what is good, how value is really achieved, how standards can be driven up and how we get the industry working on the issue, the better things will be. The Minister will not achieve all those aims through the new process; it needs some sort of remediation.

Transparency is at the guts of the matter. It is not acceptable in any way for organisations—private contracted companies in particular—to argue that the processes cannot be both open and seen to be open. That argument will not run, and the Minister will be tested on it. The way to achieve openness might be to have an ombudsman process, because there is no current right of appeal except through litigation. There are huge contradictions between the processes that NICE and other evaluating bodies undertake, the guidelines that are to be established, and whose writ runs where. The hon. Member for Southport (Dr. Pugh) asked earlier what happens when somebody prescribes and about whether we go down one route or another. Innovation is another important point, and it will be delayed if not destroyed by the new process in many cases. Neither does the new arrangement do anything for SMEs.

The Minister has only been in his job for about 48 hours, so it is a little unfair to make requests of him today, but I am tackling the man with the ball, and he has it. Therefore, if he is willing to give it to me, I would like a commitment from him at least to consider re-examining the process. It is still in its early stages and is only partly formed, and I do not want to see its formation go badly. It would probably be unrealistic to argue politically to the Minister that he should scrap it and go another way. However, it is not unrealistic to consider a re-examination of the type that I have described, and to put in place processes that will avoid what I think is predictable damage—in relation not only to a particular organisation and patients in England but to patients across the United Kingdom generally, potential supplier companies that we all have in our constituencies, and all the people who do such a great job working in the NHS. Let us help them do that job, rather than adopting a process that effectively makes it more difficult for them to perform.

I congratulate the hon. Member for Merthyr Tydfil and Rhymney (Mr. Havard) on having secured a debate on a very important subject. I must admit that he has put his case extremely well. I welcome the Minister, who must surely have been on a crash course in NHS procurement in the past few days. I hope that his new responsibilities make a pleasant change from landfill and saving the planet.

NHS procurement is an enormous issue. It is not just about supplies but about buildings, staff services, drugs and medicines, and entire treatments. There is a huge volume of business and a huge number of transactions. There is a kind of urban myth that the NHS once spent without regard to anything—budgets were considered elastic, everything was affordable, the taxpayer was compliant, and success and cost were limited only by mortality and low expectations. According to the myth, the system spent funds without regard to cost. I am sure that such stories about the bad old days abound.

Change in the NHS came when medicine became more successful, when longevity increased, and when expectations rose and the wages of people servicing the NHS rose with them. The ratio between the working population and the ailing population changed for the worse. Procurement then became a live issue, value for money became a big issue, and counting the pennies became an important issue. There has since been downward pressure on procurement costs in many areas.

Value for money has not been the only factor at play, however: other variables have contributed. For example, in the case of PFI, which was mentioned earlier, there was a need to keep capital expenditure off the balance sheet. There has been recognition also of the need to sustain a profitable British pharmaceutical industry with a big research base in this country. Furthermore, the NHS needs to retain highly qualified staff and requires cutting-edge equipment.

Not surprisingly, the result is that a variety of procurement solutions has been used in the NHS, depending on whether supplies, staff, buildings, drugs and medicines, or IT were being talked about. However, every NHS cost centre must now deal seriously in some way or another with procurement, and become—in current jargon—a smart procurer.

There are across-the-board opportunities in each field. One that I am sure the Minister will mention is e-procurement, which involves the electronic inspection of the supply base. Everybody is now looking also at the possibility of shared services and commissioning. Outside that, every single area of NHS procurement has its own distinctive profile, most of which have been examined in some depth by the Public Accounts Committee, whose reports I have with me—although now is not the time to read them out.

Supplies were the main thrust of the hon. Gentleman’s speech. They cover everything from simple bandaging to complex imaging machines. There has been an essentially two-pronged attack in that area. One approach is to have customer clusters or procurement hubs, as I think they are called, and the other is to have DHL and the NHS supply chain, which is essentially catalogue shopping. Those are traditional solutions that have been used also in local government. The distinctive feature of the NHS variant is that it is linked to a sophisticated delivery network in the form of DHL.

There are serious problems that the hon. Gentleman signposted well. First, the listing must be fair and open; at present there is no certainty that that is the case. Secondly, in whatever way the listing is done, there must at the end of the day remain a variety of suppliers. It is not obvious that that will be an effect of the new system. Some suppliers that are not listed and some of the smaller firms might simply be driven out of business, in which case we shall become dependent on the remaining core of firms.

The system should not stifle local initiative. There must surely be some cases in which people might wish to venture outside the limits of NHS supplies and use a local supplier with whom they have a good relationship. The system should allow also for legitimate clinical discrimination—that is a genuine concern. If doctors prefer something that is not on the catalogue for which they can make a reasonable case, they should be able to get it. The hon. Gentleman highlighted a further crucial point: the system should allow for fair access to drugs right across the country that does not depend on the contractual arrangements that exist with the main supplier of the hospital or clinic.

None of that can be achieved by concentrating just on the magic figure of £1 billion savings. There is a need to build in safeguards, appeals and genuine transparency, and it is fairly self-evident that the so-called product councils do not currently provide those elements.

There are similar wrinkles that need to be ironed out in other areas of procurement. There are appreciable savings to be made by the NHS on staff services.

Let me ask something before the hon. Gentleman progresses down a different route. I do not know whether he is a medical doctor by training.

Patient choice is very much a matter of discussion. The hon. Gentleman mentioned that doctors should be able to make different choices. I raised the question about evaluations of the best and most modern treatments by, for example, organisations such as NICE. What does he think about where the choices to be made by all the stakeholders—including patients—might rest?

Choice is not one of my major themes when I talk about the NHS in general. One thing that could be said is that certain choices that people believe themselves to have even within the NHS are not genuine choices. That is the case to some extent in relation to drugs, for example. They are choices between scarcely distinguishable alternatives. We must not build into the system a false choice whereby the preference of a GP for a particular brand—because someone has sent him the latest brochure—becomes more dominant than clinical effect. However, if people are being denied products that are genuinely clinically different and make a difference to how their treatment goes, the choice should exist, and it should not be precluded by any supply contract that is put in place simply to save money.

I am interested in how the hon. Gentleman envisages that situation happening under the new process. There are product councils, and, it would appear, an evaluation-based process is being established. However, as I tried to illustrate earlier, the non-financial aspects of quality of care and choice could be avoided in the process to drive the situation simply by price.

The hon. Gentleman made a very good case during his speech, and I share his scepticism about product councils and the extent to which they can be neutral arbiters of what ought to go into the brochure. However, it is for the Minister rather than me to answer those questions.

On the subject of staff procurement savings, the National Audit Office has conducted some trailblazing work on the extent to which agency costs can be reduced. It supports and advocates the idea of a national bank of NHS professionals, as the Department of Health does. As in the case of supplies, there is still a desire to apply local solutions where effective, and if a centrally driven alternative neither drives down costs nor produces the £38 million of staff services savings that the NAO believes can be found, it ought not to be used.

On buildings, the Government have recommended PFIs, but they are not a solution for keeping down costs or for reducing procurement. Often, they lock people in to high, long-term maintenance costs. There are only partial solutions to the problem, and there is a clear link between hospitals with PFIs and hospitals with substantial debts. The partial solutions include cutting tendering costs so that more people become involved in the game, because one great problem with central solutions is that they tend to drive down the number of players in a market. Market-testing clauses are being included in PFI contracts, recognising that they do not provide value for money on procurement. Benchmarking clauses are being included, too.

Drugs are another key area in which procurement can make a substantial difference. We must recognise that the Government have been successful in their drive to make more use of generic medicines, which is wholly good. They have been relatively successful in securing a better deal on branded goods, although they are still covered by the price regulation scheme, which results in some of the highest-priced drugs in Europe. The same drug can cost much more in the UK than anywhere else.

The invention of NICE and better ethical guidelines have done something to drive down procurement costs, but the NAO still estimates that there is £200 million to be saved. Even when considering that global figure, however, one must take into account the fact that clinical quality is an issue, and that genuinely different drugs must be made available. Professional discretion is crucial, and generally speaking cost is not the only imperative.

IT procurement is a favourite topic of mine. The NHS used to specialise in piecemeal procurement, and a variety of schemes emerged, but it has been replaced by “Connecting for Health”, about which the hon. Member for Eddisbury (Mr. O’Brien) and I know a good deal. It is a very aggressive model of procurement. Richard Granger, the man who ran the procurement programme, specified that his attitude towards his suppliers is the same as a husky driver’s towards his huskies: when one of them fails, he kills them and feeds them to the others. That procurement model has not been totally successful, and it has led to a limited number of regional suppliers, because some have been toppled and only the cash rich remain. There is no evidence of a more competitive market, and some fear that we will get a proprietorial lock-in to the certain limited number of suppliers that are still running.

Does the hon. Gentleman agree that the common thread in what he says about the NHS IT procurement programme and the subject of this debate is the absence—be it in the product groups, or in the various systems within the NHS IT system—of genuine participation, consultation and action, as a result of listening neither to patients nor to users at the bottom end? Such action would make the system organic, adopted and owned by users, rather than being imposed on them from the top, which most people say they do not want.

I could not agree more. We are picking on a central flaw of all centrally driven systems of this scale. There has been a failure to recognise the transition costs to individual hospitals, primary care trusts and so on, but there has also been huge legitimate professional protests by people who are supposed to use the equipment with which they will be endowed, as the hon. Gentleman just emphasised. Those are not just the selective concerns of a few disgruntled people, but genuine concerns about the way in which the system will operate. To be fair to the Government, they are getting the message, and a concession that there should be local flexibility, which is defined around open standards, to ensure that there are a larger number of suppliers and a better market to deal with small IT issues, is creeping in.

I really do not think that the hon. Gentleman needs to be fair to the Government, because they were warned up front, and the consequences have all been intended, not unintended. We have now come full circle, and if the Government are listening, they should have got matters right first time. They should be criticised for all the wasted time and money in between.

It is a congenital vice of mine to try to be fair, but whether I should be fair in this case, I shall leave for others to judge. In all honesty, the people who are endeavouring to run the project are receiving the message, because they see the system running into the ground. If they have non-compliant users who are appalled by what is happening, the system will become a catastrophic disaster of immense proportions.

In sum, the NHS and every NHS cost centre must mind its costs. They should be and I think are motivated to be smart procurers. However, in the field that the hon. Member for Merthyr Tydfil and Rhymney laid out, and in all the other fields about which I have spoken, there is a sharp learning curve for individual hospitals, clinics and PCTs, and they have not always been assisted by the Government’s advice, so in the situation before us, there will be a substantial and sharp learning curve for the Government, too.

May I congratulate the hon. Member for Merthyr Tydfil and Rhymney (Mr. Havard) on securing this incredibly important debate? He has done much to make the Government accountable for the privatisation of NHS purchasing and supply, and by my rough calculation, between us, we are responsible for having tabled about 90 per cent. of all parliamentary questions on the issue. We have been right to identify it as an area in which the Government owe us answers. I am glad that, as a result of his successful application, we have the opportunity today to debate the issue—an opportunity that has been denied the House, despite considerable pressure from Opposition Members. I was very interested in his effective speech. It covered themes, which I hope to develop, about price versus value, transparency, and the effect on innovation and small and medium-sized enterprises He raised the issue about whether there should be an ombudsman process. I shall not cover that issue; I shall leave it to the Minister to respond to him directly.

With that in mind, I welcome the Minister to his new role. He is very welcome to the world of health policy and practice. This is the first of two meetings that he and I will have today, the other being on the Floor of the House at the close of the first Opposition day debate, which is about access to NHS services. As a result of the absence of parliamentary debate, it has been interesting to hear how the hon. Member for Merthyr Tydfil and Rhymney has been supported by some effective interventions from his colleagues, who have now left their places, and by the hon. Member for Southport (Dr. Pugh).

The outsourcing of the NHS Logistics Authority and the NHS Purchasing and Supply Agency was last touched on on 5 July 2005. I do not say debated, as it was only the outsourcing of NHS Logistics that was debated here in Westminster Hall. The then Health Minister, now Financial Secretary to the Treasury, said:

“Three options are under consideration. The first is what we have been debating today—the option to outsource NHS Logistics only. However, there are two other options. One is to integrate NHS Logistics and the NHS Purchasing and Supply Agency into one organisation; that is the recommendation of the arm’s-length bodies review. A third option is to market test the whole supply and procurement chain. We are not considering that option now”.—[Official Report, Westminster Hall, 5 July 2005; Vol. 436, c. 20WH.]

In the absence of any such market testing, that statement was later clarified. We might feel that “clarification” is a somewhat generous word in such a context, because in a letter that was sent only to the hon. Member for Amber Valley (Judy Mallaber), who secured that debate, and not to any other participant, the then Minister revealed that the market testing of NHS Logistics

“also involves the consumables procurement activities that are currently managed by NHS PASA.”

That is the point that could have done with clarification—indeed, correction—but there was no joy there.

After considerable effort on my part throughout the last summer recess, when I fear that Ministers and some of their advisers were sunning themselves on beaches in various parts of the world, the letter was made available only in October 2006, more than a full year later and, most significantly, a month after the contract with DHL was signed, notwithstanding the questions that had been raised, and just before we came back after the recess. When I complained about that to the then Leader of the House, now Secretary of State for Justice, he had the temerity to claim that the delay was due to an oversight. I have not yet had an explanation, despite repeated questions, of how that oversight came to be. The former Leader of House wrote to me at great length, having carried out a full and formal investigation, to try to explain, but the note that he gave me from the Department states

“a copy should have been placed in the Library, but [David Nicholson’s private office to complete]”.

Unfortunately, it never did. Perhaps the Minister will enlighten us today. The Department of Health gets bad marks for that.

I am well aware that there was more than a little discussion about the establishment of this organisation and the dissolution of the previous organisations. The trade unions—Unison, the GMB and so on—and my hon. Friend the Member for Amber Valley, who cannot be here today because she is away from the House, have sent me a lot of information. Does the hon. Gentleman agree that a spotlight trained on exactly what would be established in the first place would have helped the health of the process to be established and avoided some of the discussions that we are having today?

The hon. Gentleman makes one of the conclusions that I shall draw later. That is absolutely right.

It is worth noting the magnitude of the difference. The initial Official Journal of the European Communities procurement notice stated that the contract would cover procurement and delivery in respect of goods the value of which, in 2005, was projected to be £715 million. Under the contract as it stands, DHL is managing non-pay spend in the NHS worth an estimated £3.7 billion per annum. An explanation that has been given for the difference, which the Minister will no doubt repeat later, is that the £715 million is the value of goods and services that went through the NHS Logistics Authority in 2005, whereas £3.7 billion is the value of the market in those goods and services in the UK health sector and so marks the possibility of expansion for an enterprising supply chain contractor. Will the Minister now reveal what share of the market DHL has, and what percentage share he expects it to take by the end of the contract?

A number of concerns were expressed at the time about the involvement of the US company that has already been mentioned, Novation. It was certainly suspicious that it went from being in a consortium with DHL, and was therefore named up front as a prime party to the bid, to being relegated to a contractor when stories arose of the group purchasing organisation inquiries in the United States of America. Have the American investigations into Novation concluded, and have the results been communicated to the British Government, as the issues about the inquiry were communicated to Ministers at the time that the matter was considered? What decisions have been made in the United States and what decisions have our Ministers made as a result of the information that has come their way? If we do not have any news, when will we?

When will the product councils be established, and when will their terms of reference be published? Obviously, I make that point to reinforce those made by the hon. Member for Merthyr Tydfil and Rhymney. On 27 June this year, Roger West, the procurement director of the NHS supply chain, stated that the composition of the product councils will not be made public. Why? How can the Minister suggest that that does not impede accountability in procurement decisions, particularly because the lack of transparency—a theme that has been clear throughout the debate—does not meet the Nolan principle? Under the new Prime Minister—never mind the last one—surely that is something on which a Minister would want to keep an extremely close and careful eye. In “Transforming government procurement”, the Office of Government Commerce states that

“each procurement should have a clear, fair and transparent process and evaluation criteria”.

Will that be fulfilled?

Let me make one more point about a subject that is often prayed in aid—I would not be surprised if the Minister were receiving a quick note to that effect at this moment—namely, commercial confidentiality. We are dealing with the private sector, and there must always be commercial confidentiality. The Cabinet does not contain one person with even an ounce of commercial experience—I do not know whether the Minister has a commercial background—and, of all the Members in this House, I have done commercial. The Minister knows that; everybody knows that. It has nothing to do with commercial confidentiality. It has to do with accountability and transparency to get a fair price that considers value as much as commoditisation. I fear and suspect that the words “commercial confidentiality” are used as a Harry Potter invisibility cloak to hide Ministers’ embarrassment and ineptitude at every opportunity.

I share some of the hon. Gentleman’s concern. I asked the Minister direct questions about the contract and was told that it was commercially sensitive, and so I could not be told. It seems that the argument is about the price caps that have been established and the fact that a certain amount of savings are made and then the profits are capped. We cannot be told what that cap is because, apparently, it is commercially sensitive. As he rightly says, there are other aspects, too, and I do not understand why those elements cannot be made public when they do not seem to be commercially sensitive.

The hon. Gentleman makes a fair point. The reason why I am sure that there are no commercial confidentiality issues is that it is not commercially sensitive and confidential to expose why someone is most competitive. Above all, someone would certainly not want that to be confidential—unless they had something to hide that showed that they were not the most competitive and that the system was failing the taxpayer and the care of patients, who are the end users.

If the Minister intends to persist in describing all that the NHS supply chain is purchasing for the NHS as commodities—we have had all sorts of examples, such as syringes and toilet paper, and various things can be thought of as commodities—what is the remit for a product council? Surely the only question is price, not quality—other than a minimum assurance.

If, however, NHS supply chain is to procure unique medical supplies—perhaps the product that the hon. Gentleman mentioned from his constituency experience—is there not a role for a body akin to NICE, as was argued earlier, if not NICE itself? What do the product councils add to the cost-benefit mechanisms already available in the NHS?

The point has been made repeatedly that there are no mechanisms in NHS supply chain to consult patient groups and include their views and needs or those of the public in product councils and taskforce evaluations. Does the Minister support that, or does he regard his new appointment as a grand opportunity to have a jolly good, thorough review to ensure that we do not go down another cul-de-sac? We would thoroughly support him in that.

In December 2003 the chief medical officer announced the establishment of the rapid review panel to assess new technologies in the fight against hospital-acquired infections. In August 2004 the panel was set up, following criticism of the delay from the National Audit Office. In December 2004 the panel announced its first set of results, including a top-level recommendation 1 for Bardex IC, which was mentioned earlier. Nevertheless, despite a favourable cost-benefit analysis from a departmental economist, the product was not even listed by the NHS Purchasing and Supply Agency until September 2005. Two and a half years after the panel’s recommendation 1, the net effect has been modest uptake of technology. I am putting that as generously as I can. It is patients who suffer from the delay.

Will the Minister tell us why NHS supply chain is not required to comply with the evaluative decisions of NICE, the Medicines and Healthcare products Regulatory Agency and the Centre for Evidence-based Purchasing to ensure that clinicians have access to the best equipment and medical technology and that patients are empowered to choose the treatment that benefits them most?

On savings and benchmarks, the Department of Health has given NHS supply chain a clear remit to make £1 billion of savings in NHS procurement. That is the basis on which its success will be measured, and all of us will be thinking about it. What year-on-year targets has the Department set—goodness knows, it likes targets—and what savings has DHL delivered thus far?

Is the Minister, although new to his brief, in a position to deny the widely held understanding, which I share and which makes sense to me from my commercial experience, that the Department of Health signed up to all this in a rush, just before we all came back, to avoid our being in session? The vast majority of the £1 billion that is promised over a 10-year period is projected to be saved only in the last two to three years of the contract. Who will be accountable? Will the Minister still be in position? His predecessor who made the original claim is not. If Parliament is to have genuine accountability, we need to ensure that we have benchmarks and milestones along the way. Otherwise, it will always be a promise for the future and never delivered.

Consistency across time is absolutely vital. As the hon. Gentleman says, the individuals who are making promises and are involved in the process now will be well gone, I suspect, in 10 years’ time. The Ministers involved will doubtless have rotated, if no one else. Given his commercial experience—I find it interesting that, as a member of the Conservative party, he knows the difference between price and value, and I suspect that he is one of the few—how does he think the contracts should be structured, and what processes should be run to ensure consistency over time?

I am grateful to the hon. Gentleman, who shows that my speech must at least have a thread of logic to it. The very next words in my prepared script are to ask the Minister whether he agrees that a counterbalance that measures both value and the competitive strength of the market is needed to make savings sustainable, and whether the performance of DHL is being measured in that way. To gain something just in price does not give sustainable supply for the future, nor necessarily best value for patients.

I shall give an example from way back that we can all remember. When Freddie Laker set up his airline, my goodness it was the cheapest price, but where did he get his pilots? From among those who had been through the expense of being trained by what was then British Overseas Airways Corporation and British European Airways. They were trained at those companies’ expense and then poached by Laker. It was not sustainable, because over time a business owner must fuel the business and reinvest in it. Value requires the recognition that price cannot simply mean the cheapest contribution to the margin at the time of supply; the full lifetime costs must be recognised.

Would the hon. Gentleman apply the same logic to the further privatisation of the NHS, which I understand his party might want to do if it ever got back into government?

At this point, the hon. Gentleman and I completely part company—he has obviously not been listening. Even if there had been any credible suggestion that there was any wish to do that on the part of anybody in the Conservative party, which I deny, the dropping and scrapping of the so-called patients passport policy, which some suggested would mix the sources of funding, should give him all the assurance that he wants that he has nothing to fear from the arrival of a Conservative Government, within, I hope, the next couple of years. The health service will be much safer in our hands, as the public polls have been telling us in the past 18 months.

I wish to mention a couple of botched procurements. It is always helpful to see what has gone wrong to ensure that one knows how to do things right. The Department’s commercial directorate issued its original consultation on the revision of part IX of the drug tariff in the autumn of 2005. It covers items such as incontinence appliances that cost the NHS about £631 million a year. Various consultations are yet to report, but in the meantime, product prices are frozen and will remain so until 2008.

The procurement of new oxygen supplies in 2005-06 was another gross failure by the Government in which I got deeply involved. They failed to procure efficiently and effectively, leaving many users extremely worried about the security of their domiciliary oxygen supplies. It was only the great good will of community pharmacists like Ian Littler of the Tarvin pharmacy in my constituency, who were prepared to go out in the middle of the night to supply oxygen, despite having just been kicked in the teeth, that enabled many patients to proceed with their treatment.

The recent Association of British Healthcare Industry and Ernst and Young survey of small and medium enterprises in the medical device sector revealed that their UK sales growth was 2.2 per cent. in 2005-06, compared with export growth of 10 per cent. That has resulted in a fall in UK revenues as a percentage of total revenues from 66.9 per cent. to 65.2 per cent.—a significant fall. Of course that partly reflects the difference in health service needs between the UK and other countries, but it raises concerns about the continued appetite or ability of medical device manufacturers to continue to invest in the UK market. Losing our highly innovative SME base will damage the UK economy.

Sir Chris O’Donnell, whom I have not met, was quoted in The Sunday Times the day before yesterday as saying that his company’s investment is now going to America, Germany and Japan

“because the NHS is a slow adopter of innovation.”

It is not for the Government to interfere unduly in the health procurement market, which is an oligopsony, to use the technical term, but the NHS is by far the major buyer, rather than supplier. The Government must therefore take into account the future viability of the market. What appraisal has the Minister made of the impact on that market of NHS supply chain, as it is currently construed?

If the Government had had more respect for Parliament as they were putting together the outsourcing of NHS supply chain, the questions raised here today might have been settled before it took place. I submit that the process would have been the better for it. I believe that the Government were too embarrassed by the word “privatisation” and under too much pressure from many on their Back Benches and from the unions. They have been effective in keeping the matter away from Parliament—at times suspiciously effective—and in keeping manufacturing organisations roughly within their “big tent.”

The arguments are on the record, and I dare say that such a report will now be considered. It would be a useful and helpful addition to the debate.

Perhaps the Minister, fresh from ducking badger problems and dealing with bovine TB in my constituency, could stamp his mark on his new job by being the first Health Minister with whom I deal who is open and transparent, not defensive, and who does not hide behind the false pretence of commercial confidentiality. On 23 January just this year, Her Majesty’s Treasury published “Transforming government procurement”, which explicitly recognises that good procurement is not just about driving down contract costs, but about championing the need for transparent processes that encourage innovation and take account of whole-life value for money.

The major question is around the lack of balance between value and price in the NHS supply chain set-up, which, of course, must be addressed. I hope that the new Minister will do so. I also hope that he has taken many clues from what I hope he will regard as constructive criticisms in this debate and that he takes account of the fact that perhaps a Government without any commercial experience should buy some in to ensure that the interests of NHS patients are properly and truly served.

I thank my hon. Friend the Member for Merthyr Tydfil and Rhymney (Mr. Havard) for securing this debate and apologise to him and hon. Members in advance that they have a Minister who is so fresh in the job. Clearly, a lot has gone on in the past, and I undertake to look into it. I have discarded the speech that my officials prepared for me because my hon. Friend and the other hon. Members who contributed clearly have followed the issue closely and know much about the process that has brought us to where we are now.

I shall endeavour in a moment to respond to as many of the points and questions as it has been physically possible for my officials to give me advice on in the course of this sitting, but perhaps I could suggest a helpful way forward. Hon. Members who have not already availed themselves of the opportunity could come to the Department and get a detailed briefing from one of my officials at the appropriate level who has followed the process through from the start. If they then felt that there were still unresolved and unanswered questions, or if they still had criticisms of the process, they could come back and have a meeting with me in which I would try to address the issues.

I should like to say just one thing about the criticism that the hon. Member for Eddisbury (Mr. O'Brien) made about the parliamentary process. As he well knows, the Government do not control it. If hon. Members feel that there has been insufficient scrutiny and questioning on the subject, that is a matter of regret; but of course, the parliamentary process and the timing and selection of debates is a matter for Mr. Speaker, quite rightly. It is my understanding that there have been many debates, including several in Opposition time, on the health service in general, and they would have provided an opportunity for hon. Members on both sides of the House to scrutinise and question the decisions that were made. I should like gently to rebut his criticism.

I shall try to deal with as many of the questions that were raised as possible. As I said, I will look again at the process that has taken place, and if hon. Members remain dissatisfied after meeting with my officials to sort through the matter, I will endeavour to meet them and/or write to them and respond to their points.

The hon. Member for Eddisbury suggested that the inclusion of purchasing and supply in outsourcing was not made clear at the time of the outsourcing. My understanding is that the original advertisement in the Official Journal of the European Union that invited suppliers to bid for the service clearly included purchasing and supply. What was not clear was the scale, which became clear only in the negotiations that happened subsequently.

The hon. Gentleman asked what our current estimate of the DHL market share is. I am advised by officials that the national health service spends £17 billion a year on goods and services. Initially, DHL took on £800 million of consumables listed in the old NHS Logistics Authority catalogue, plus £800 million of direct delivery contracts previously managed by the NHS Purchasing and Supply Agency, so that amounts to £1.6 billion. The intention is to grow that to £3.7 billion by the end of the 10-year period.

The hon. Gentleman also asked how much the DHL contract has saved. The estimates are £6 million so far this year. He said that it was a year after the Bardex catheter device was given a recommendation 1 by the rapid review panel that it was listed in the catalogues. My understanding is that, although the RRP gave the product a recommendation 1 for clinical evidence, it was not clear whether it was cost-effective. The new centre for evidence-based purchasing has been working with the NHS to undertake further research studies to establish the evidence. It has become clear from that episode that the industry itself is not always as good as it might be in providing good evidence to support innovative products. It is important that we are convinced by the evidence before a product gets widespread adoption by the NHS.

I shall give way, but I very much doubt that I will be able to give the hon. Gentleman any more information than I already have.

I ask the Minister to give way because it is helpful to get some figures, and perhaps his officials will be able to pass him a note to confirm whether this is correct. As I understand it, the £6 million saving so far appears to have come from one contract, which is for the NHS antenatal foetal anomaly ultrasound screening programme. The savings relate to only one programme.

I cannot give that clarification, but I undertake to write to the hon. Gentleman after this debate.

The hon. Gentleman also asked about part IX of the drug tariff. My understanding is that it has not been reviewed for more than 25 years, but a review is being undertaken with full consultation. On home oxygen, it is true that there was an underestimate of demand for it in the early days of the contract—we accept that.

My hon. Friend the Member for Merthyr Tydfil and Rhymney asked about accountability. Members of Parliament will be able to monitor performance in very much the same way that they can monitor the performance of the current service providers: the logistics division of NHS Business Service Authority, or BSA, and the NHS Purchasing and Supply Agency, or PASA. Like now, both PASA and the BSA and their divisions will be subject to an annual audit by the National Audit Office.

Senior officials in my Department sponsor the BSA and PASA. The officials report ultimately to the permanent secretary and to Ministers. Both PASA and the BSA will lay their respective reports and accounts before the House of Commons each year, and the Department of Health, BSA and PASA will continue to answer parliamentary questions. I hope that that reassures my hon. Friend somewhat. I shall reflect on his request for an ombudsman process. Unfortunately, on my second day on the job I cannot give him the assurance that he seeks—I hope he will accept that that is reasonable—but I shall certainly reflect on the issue and discuss it with my officials and ministerial colleagues.

My hon. Friend also raised questions about the accountability of DHL and the contract. The contract sets out clear key performance indicators, and the BSA will be responsible for managing the contract and reporting on the performance to my Department. Financial penalties will be charged to DHL if it falls short of the minimum service levels required, and the contract between DHL and the NHS has built-in failsafes, particularly for any action that could be deemed to be in breach of contract. A sustained breach of contract could result in the operations being brought back in-house.

I was asked by my hon. Friend and by the hon. Member for Eddisbury about the progress that is being made on setting up the product councils, and exactly how transparent the process will be. My information is that the first two councils are expected to be established in the autumn. They are intended to provide a forum through which DHL can interface with the NHS.

It is intended that such councils will be open and transparent in several ways. First, DHL will arrange contracts using public sector processes and will be subject to normal EU public procurement rules and probity. Secondly, the councils will engage key customers in the NHS to ensure that decisions are based on what the NHS needs and wants. Thirdly, it is my understanding, contrary to what was suggested during the debate—I cannot remember by whom—that the names of council members will be in the public domain.

I am grateful to the Minister for explaining that there will be accountability through the usual processes of scrutiny in the House and that no one will act outside the law. Frankly, I would not expect anything different. The latest information that I have is that the advertisement has gone out for one of the first of the product councils in relation to nursing. In the advertisement, there is no description of how the stakeholders that he mentions will be actively involved. As I explained earlier, it seems that there is an open self-nomination process, yet the advertisement states that the nurses who will be appointed through that process by the supply chain, not by anyone else,

“will represent the views and interests of the NHS by acting as a reference, resource and sounding board to the NHS supply chain”.

Frankly, I do not know what that means—other than what it says on the paper as a piece of English. I fail to understand how someone who is self-nominated and has been chosen by the supply chain can represent the NHS.

I will write to my hon. Friend to try to reassure him on that point. I have not seen the advertisement myself and have not had a chance to discuss the details of it with my officials, but I will do so and if he is not satisfied with the reply that he receives, I invite him to come back to me.

My hon. Friend also raised concerns about product availability.

Can the Minister confirm what the proceedings of the product councils will be? Presumably, they will have meetings, debates and input from a variety of sources. Will there be public documents in any shape or form that we can access?

I am afraid that I do not know, but I will find out and let hon. Members, including the hon. Gentleman, know.

On product availability, the contract with DHL enables the Department of Health to instruct DHL to list specific products in the catalogue and evaluated products will be made available. On range, because the catalogue will need to expand to achieve targets, more rather than fewer products will be available to the NHS. I hope that that will be of some comfort to my hon. Friend as he mentioned a company in his constituency that manufactures dressings for wound care. The question was asked whether, if a product is not listed in the supply chain catalogue, the NHS will still be able to obtain it. The answer was helpfully given by the hon. Member for Southport (Dr. Pugh): yes, people will still be able to obtain it because trusts are not mandated to use DHL and can purchase direct if they chose to do so. The second point is that it will not be in DHL’s interest to limit products, as it is driven by volume and growth, so it will work with the NHS to secure what clinicians want and need.

My hon. Friend the Member for Merthyr Tydfil and Rhymney and the hon. Member for Eddisbury raised the issue of value versus price and whether there is an inherent conflict between a price-driven approach and what real value is considered to be in a health context. We accept that there have generally been problems with public sector procurement in relation to that because it tends to be price focused. That is exactly why we established the health care industry task force, where we have been working with industry to do two things. The first aim is to create a centre for evidence-based purchasing to devise a common definition of value and to assess products from a value perspective, not simply a price perspective. Secondly, we will create a new integrated procurement framework that will ensure that value, rather than price, is properly assessed in the procurement process. Part of that framework is the development of a new benefits framework that will look at broader value issues, rather than simply price.

On the relationship between the DHL and the NHS, the DHL must partner trust to deliver the contracted service. It has recognised that clinical engagement is essential to that process. The contract is only nine months old and, as I have mentioned, product councils will build on existing consultation mechanisms, such as the clinical nurse specialist group that already exists.

It is perfectly reasonable that we should not expect the Minister to give us definitive answers, but it is, at last, very helpful for us to put these issues in his inbox. Perhaps he would like to reflect on why there was such a rush to get the whole thing going before the product councils were established, whether that was entirely wise and whether there might have been a more useful way to ensure that the process was kicked off in the right way.

I hope the hon. Gentleman will forgive me, but I have only been in this job in working terms for less then 48 hours and have not yet become an expert in what has gone on with this issue in the past two years. I have done my best to grasp the bare essentials of this subject in the last day and a half and to do all the other things that one has to do in the first day and a half in a new job. I will endeavour to come back to this issue, and I offer an invitation to him, my hon. Friend the Member for Merthyr Tydfil and Rhymney and the hon. Member for Southport to come and have an in-depth briefing in my Department. If they still have outstanding concerns, they are welcome to come back and talk to me about them.

I thank the Minister for that invitation, and I am sure that we will find a way to take it up, because this important issue will roll forward over some time and will need monitoring; it does not just relate to a single incident. He mentioned the process of how the supply chain will involve itself with the NHS, and I will remind him of something that I said that he may have missed. As I understand it, the director of procurement of the supply chain says that he will be under no obligation to take notice of the guidance and technology appraisals of the National Institute for Health and Clinical Excellence or the recommendations that come from CEP, which is the organisation that he says has been established to do that.

Again, if my hon. Friend is not satisfied that his questions have been dealt with, I will have to clarify the issues that he has raised in writing, following a briefing in the Department. I apologise to hon. Members for being unable to answer all their questions. I have endeavoured to answer as many as I possibly can, but it would helpful—not least for my own knowledge of this subject—if they were to have a full briefing with officials in my Department. They are welcome to bring any further questions to me for clarification.

Sitting suspended.

Public Services (Gloucestershire)

It is pleasure to serve under your chairmanship, Mr. Hood. Before I start, I would like to welcome the new Minister in what I believe is her first parliamentary outing. I am sure that she will do very well and, hopefully—from her point of view—follow in the path of her predecessor’s meteoric rise.

The subject of my debate is the funding of public services in Gloucestershire and the comprehensive spending review. My objective is straightforward. A number of the public services in Gloucestershire, ranging through local government, health, policing, education and transport, are funded either directly or indirectly by central Government. Gloucestershire tends to appear at the bottom of funding league tables in most cases. In some cases, one would expect it to be towards the bottom, owing to the nature of the area relative to others, but in some cases one would not. I wanted the opportunity, therefore, to put my constituents’ concerns on the record prior to the Government’s conclusion of the comprehensive spending review in the autumn, in the hope that they will be addressed, at least in part, and that the disparities between Gloucestershire and other authorities will not get worse, even if we do not expect rapid improvement.

It is not always clear to people locally exactly what the Government spend in particular areas. If the Sustainable Communities Bill, which is currently in another place, gets through Parliament, central Government will be required to make clear how much they spend on local services in each area and, as my right hon. Friend the Leader of the Opposition said, it would

“significantly alter the balance of power in favour of local councils and local communities”

because the amount of money spent by central Government in each area would be much clearer. People would be able to see exactly how much of their tax was coming back to their local area.

Given that that Bill has not passed into law yet, it is difficult to assemble all the data. However, I shall put some figures on the record and hope that the Minister can respond. I shall deal, first, with health, which I know is a matter close to her heart; in her constituency of Burnley, she has been involved in a number of local campaigns, as I have, to save local hospitals, and busloads of her constituents have come down to Westminster to protest about cuts in local services, which indeed has happened in my constituency. As a constituency Member, as well as a member of the Government, she will know how much such matters concern local people.

Gloucestershire receives about 90 per cent. of the national average for health care funding, which, were we to receive it, would amount to an extra £66 million. Over the last few years, we have been facing cuts in services at community-hospital level—I am pleased to say that we saved the hospitals at Dilk and Lydney in my constituency—and currently are trying to fight off cuts to mental health services. In part that is down to deficits and a lack of funding that does not represent properly the health needs in my constituency and Gloucestershire more widely.

In this debate and the comprehensive spending review, I hope that the Government will address the health allocation formula, which divides health spending around the country. One of the reasons that Gloucestershire does rather poorly is that the current formula focuses more on deprivation than on rurality or the age profile of areas. However, I noticed a piece of good news in the constituency health profiles just published: given that, in the Forest of Dean, female life expectancy, as well as that for males, has risen, women now live longer there than in England as a whole. Although those two pieces of news are very welcome, they mean that the population is ageing, and older people use more health care than younger people. The overall prevalence of disease in my constituency and Gloucestershire will rise with that higher age profile, which will push up the cost of health care. The current formula does not represent that adequately, which will give us a problem in the future.

On policing, again, the bulk of funding for our local force, the Gloucestershire constabulary, comes from central Government. This year, the Government grant will give our police force the equivalent of £97 per head of population, whereas across the country, that figure is £122. That difference would equate to an extra £14 million for our county’s police. Even if we exclude the large metropolitan forces from that equation, we are still being underfunded to the tune of about £7 million, which means in Gloucestershire that the police authority has had to put up the council tax precept rather higher than the rate of inflation.

Most members of the public in my constituency will remember that, a few years ago, in 2003-04, there was a 51 per cent. rise in the police precept in order to create a large number of detective posts and firearms officers for the level 2 policing that the Government talked about in their review of the attempted mergers of police authorities. That was tackled locally in Gloucestershire. However, that huge increase was driven largely by the lack of funding from the centre. Dr. Timothy Brain, our chief constable, who is also the finance spokesman for the Association of Chief Police Officers, has been warning, both nationally and locally, that there will be a squeeze on the number of police officers in the coming years as costs rise ahead of Government grants. That will be a particular problem in Gloucestershire because of our relative lack of funding compared with other parts of the country.

The Conservative county council that gained control in 2005 promised broadly in its manifesto an extra police officer in each electoral division, which is being paid for by the council tax part of the overall council tax, rather than by the police precept. There are now a significant number of officers. In fact, all the increases in the number of police officers since 1997 have been funded, not by central Government, but either by the county council or the local precepts. We have more police officers, but the credit needs to go to the police authorities and local taxpayers, rather than central Government.

I shall move on to education. It is extremely well known, in Gloucestershire and elsewhere, that our county is in the F40 group of education authorities, which are the worst funded in the country—Gloucestershire is the 11th worst funded. Our children get about £315 less per head than the national average, which equates to £25 million over the year, or about £750,000 for a large secondary school. Clearly, governing bodies and head teachers in those schools would see the tremendous difference that they could make, if that funding were applied more evenly.

On transport, there is a small specific issue, of which I gave the Minister prior notice, concerning the changes to taxi licensing in the Road Safety Act 2006, which will lead to higher costs for the county council in providing public transport. In Gloucestershire, there is a great deal of use of private hire vehicles on long-term contracts to transport children to school, particularly those with special educational needs. Drivers working on those long-term contracts used to be exempt from the licensing regime, but that is no longer the case. That will drop a cost straight on to the council that will not be covered by central Government funding. Again, that is just another example of how financial pressures hit constituents in my area and the county as a whole.

It would also be helpful if the Minister could address the amount that local government is expected to get. For example, this year, Gloucestershire received an increase in its grant of only 2.7 per cent. when inflation was running at 4.2 per cent. The county council’s allocation from central Government is £163 per head, compared with the national average of £170—a difference of £4 million. If the county council got the national average grant, no rise in council tax would have been needed this year, which would have been very welcome, particularly for pensioners and hard-pressed families who find the council tax a real burden.

The Government’s changes to supported borrowing have hit the county council’s funding as well. As the Minister will know, supported borrowing is a method whereby councils can borrow money to build and refurbish schools and to repair and develop roads, for example. The Government used to give the council a grant to cover the interest and repayment charges, and the charges therefore did not hit council tax payers. That grant has now been cut on future borrowing, meaning that councils will have to spend less capital, or they can continue borrowing the money but will have to meet the full cost of the interest payments, which will push up council tax, hitting local council tax payers. That is of particular concern to those in the community who have the most difficulty in paying the council tax.

Despite all those financial pressures, the county council in Gloucestershire should be praised for its efforts in keeping the council tax down. That was the top priority in its 2005 manifesto and it kept the increase down to 3.4 per cent., which was excellent news for those on low incomes and pensioners, but it required a huge focus on efficiency savings, which are obviously easier to achieve in the initial stages and cannot be carried on for ever.

It is worth noting that in the current year the Government have cut the funding for flood protection in the midlands. For the purposes of flood protection, my constituency is in the midlands, although it is in the south-west for all other purposes. Given the events of the past few weeks and the fact that my area and areas like it are very vulnerable to flooding, I hope that when the Treasury is examining flood protection in the future, it will ensure that those short-term cuts—frankly, they are short-sighted cuts—do not take place again.

I touched on rurality—rural areas and the cost of delivering public services in those areas. Few of the funding formulas that are used to dish money out across the country take adequate account of that. Delivering services in a rural area is more expensive due to the costs of transport, a dispersed population and the time, and number of people, needed to deliver the services. That is not reflected adequately in those formulas, particularly for health. It is worth noting that the formulas used by certain devolved nations in the United Kingdom for distributing that money take more account of rurality and the difficulties of delivering services in rural areas than the formulas do in England. Perhaps the UK Government could, on devolved matters such as health and education, more adequately recognise that.

Something that, to be fair, the Conservatives did to some extent when we were in government, but which the present Government have become past masters at, is loading extra responsibilities and costs on to local government and not adequately meeting those through central funding. The admittedly small example of taxi funding was an example nevertheless of a change in legislation leading to a direct cost on local government with no change in local government grant.

I hope that in the comprehensive spending review the Minister will note the points that I have laid out and that action will be taken on some of the formulas that allocate funding across the whole range of public services. One does not realistically expect them all to be changed hugely overnight, but it would be helpful if the Government said what work they were doing on them, explained the extent to which the rurality of an area—the difficulty of delivering public services in rural areas—will be taken into account, and assured us that all the factors that drive cost, such as the age profile of the population, will be better taken into account in the future. If the Minister does that, the people of Gloucestershire and the Forest of Dean will have much more confidence when the Government finally announce their public spending proposals for the next three years when they publish the comprehensive spending review in the autumn.

It is an honour to make my Commons ministerial debut under your chairmanship, Mr. Hood.

I congratulate the hon. Member for Forest of Dean (Mr. Harper) on securing the debate and representing so eloquently the views of many of his constituents and, indeed, the wider interests of the local authority. He raised some interesting issues, not all of which, I am delighted to say, are my ministerial responsibility, but the manner in which he raised them has shone a spotlight on the need for the Government to think in a cross-cutting, cross-departmental way when considering such issues. I am grateful to him for that and for the constructive way in which he approached the debate, which has allowed my officials time to provide some answers that I hope his constituents will find useful. I should like to make a couple of observations as a general response to the points that he raised. I shall then deal with the specific points, and if I have any time remaining, I shall perhaps make some observations about how this debate fits into the comprehensive spending review.

The hon. Gentleman was right to say that many of the issues are perhaps best discussed in the debate taking place on the Sustainable Communities Bill, which is going through Parliament. One of its provisions would place a duty on the Secretary of State to provide a local spending report, which would consider the net effect on a certain geographical area of the various spending decisions that are taking place. That may not lead to a change in those decisions, but it will shine a spotlight on whether there are any anomalies that local communities may want to lobby about or may consider unfair. The hon. Gentleman raised a valid point, and it is interesting to consider the effect of a number of different decisions on a particular geographical area.

A number of points that the hon. Gentleman rightly raised will be considered as part of the routine negotiations that take place between every local authority and the Department for Communities and Local Government in relation to the always intense and strongly argued representations that are made as each annual funding process is gone through. Like every other MP, in acting as a constituency MP I have made strong representations. It almost seems to me that we get into more trouble if we do not. MPs who do not make representations may be subject to a cut, as opposed to those who do make representations being subject to something favourable. The hon. Gentleman is right to raise these issues, but they will be considered as part of that routine process.

As part of the CSR, my Department and other Departments in Whitehall are engaged in more blue-sky, root-and-branch consideration of the demands that currently apply to local authorities due to pressures that have arisen from elsewhere, and the implications for local government finance of the way in which Government policy has evolved elsewhere. I am thinking, for example, of the new obligations that we are taking on in respect of waste. The Government are considering that and I urge the hon. Gentleman’s council and others to make their views known strongly as part of that process, because our intention is certainly to listen.

It may be helpful if I outline the basis for determining the level of local government grants. Perhaps the difference between us is that the hon. Gentleman emphasised, rightly, the level of funding in terms of input—I disagree with some of his numbers—but the process that the Government go through involves considering the effect of that spending. The amount allocated to Gloucestershire is not determined arbitrarily; the amounts are determined through a clear and rational process based on the needs of each local authority. I shall not bore the House by explaining the funding formula in all its detail, not least because, thankfully, it is not my responsibility. If there were a great clamour, I could try, but I am not sure that there is. However, it is important to realise that it takes account of a large number of characteristics of each authority, including demand for key service areas, such as adult social services and children’s services. That is calculated on the basis of the area’s population: the number of people employed and unemployed, the number of children and so on.

After establishing demand, the formula considers the capacity of a local authority to generate revenue from council tax, before determining a total allocation for each authority. The allocation is then subject to damping, which I am sure Gloucestershire is feeling a little sensitive about, as it is a process that is right for the country as a whole, but there are winners and losers each year, because it guarantees all local authorities a minimum increase in grant—known as the floor—by scaling back the allocation of authorities above the floor. The advantage of that system is that all authorities, including Gloucestershire, know that if factors external to them or beyond their control mean that in one year the formula means that the allocation is below the floor, they can rest assured that that will not suddenly result in an enormous drop in funding. I hope that the hon. Gentleman will recognise that this is a well-established system, which is necessary to ensure stability in local government finance settlements and avoid large fluctuations that make it even harder for local authorities to plan effectively.

The hon. Gentleman also mentioned supported borrowing, which I am told is the local government finance term for a central Government promise to make available a revenue stream to finance borrowing from capital. Like the damping system, supported borrowing is clearly established, and there are regular discussions on it between central Government and local authorities, which gives those with concerns the chance to have their say. We understand that the interaction between damping and supported borrowing can lead to difficulties in some cases, but such difficulties tend to be short term, and the system is fair when considered over a longer period. As I said, we would support both procedures as part of an overall policy. If we moved away from supported borrowing—some local authorities are asking for direct cash payments—responsibility for debt finance would effectively pass to central Government. That cannot be done in a completely cost-neutral way, and central Government would have to remove revenue from the local government finance system. There is, therefore, no win-win option out there for local authorities.

Another specific issue raised by the hon. Gentleman was taxi licensing. At present, private hire vehicles—vehicles with fewer than nine passenger seats that are made available for hire with a driver—are exempt from the need to be licensed if they are involved in long-term contracts. As a result, unlicensed operators can be involved in contracts without having gone through criminal record and other checks, which is of particular concern given that they may be involved in transporting vulnerable people and children, as the hon. Gentleman mentioned. For public safety reasons, therefore, the Road Safety Act 2006 will repeal that exemption, and we intend that to apply from January 2008. That will level the playing field between licensed and unlicensed operators and save those engaging private hire vehicles from having to make checks themselves.

We recognise, of course, that that will mean extra costs, and that is exactly the type of issue that local authorities should routinely raise with the Department for Communities and Local Government in their annual budget negotiations. Our estimate is that the national cost will be about £1 million, although the hon. Gentleman implied that the cost for Gloucestershire county council would be quite substantial. Perhaps we can bottom that out outside this place, but the effect on Gloucestershire does not seem to be enormous, although he may correct us if we are wrong on that. Like all legislative changes with such an impact, however, the present policy has been carefully considered through the various processes and by means of the regulatory impact assessment. The public safety concerns outweigh the national cost, which will be spread over a number of operators, and I am sure that hon. Members will agree that we need to take measures to ensure the safety of vulnerable and young people.

The Minister is outlining very clearly the need for the change introduced by the Act, and I did not suggest that it was not necessary. My point was that local authorities transport children in different ways—in rural areas, the reliance on taxi provision is much higher than in other areas—and that the differential financial impact of the change should therefore be recognised so that the cost does not fall disproportionately on Gloucestershire. I was not suggesting that we should not take the necessary measures; I was thinking of the measure’s financial effect, rather than its rightness.

I am grateful for that clarification, and I urge the hon. Gentleman and his local authority to make that point clearly to the appropriate Department.

To return to the overall level of Gloucestershire’s funding, the grant allocation that each local authority receives is the outcome of a clear process, which is based on an area’s needs and population and on the need to ensure funding stability for local authorities. Gloucestershire receives £164 per head in grant, which our analysis says is exactly the average for shire counties with fire responsibilities. We should also remember that, despite damping, Gloucestershire still received a 3.8 per cent. increase in last year’s grant settlement. The hon. Gentleman mentioned a figure of 2.3 per cent., but that was the allocation for 2006-07; the allocation for 2007-08 is 3.8 per cent. Gloucestershire’s allocation is therefore going up, and the county has received above-average rises for three of the past four years. Given that four-year evidence base, I would perhaps gently question the concept that Gloucestershire is being completely unfairly treated.

The hon. Gentleman also said that Gloucestershire receives a below-average grant generally, compared with the national situation. He is right to argue his case, but he is perhaps not comparing like with like, given the average for similar areas—other shire counties with fire responsibilities. Gloucestershire is apparently just a little £3 per head above the average. We must make sure that we are in the same ball park when discussing these figures.

When talking about funding, we should also remember that Gloucestershire, like the rest of the country, has benefited from substantial investment over the past 10 years. When we launched our first CSR ten years ago, Britain needed modernising—as we all know, it suffered from a historic backlog of under-investment—and standards in public services were well short of what people rightly expected. In the past 10 years, we have successfully addressed that historic backlog, and I am delighted to say that Gloucestershire, like the rest of the country, has seen improvements.

On education, there are 610 more teachers in the county than in 1998, average funding per pupil is up by more than £1,000 in real terms and more than £250 million of capital investment has been allocated to Gloucestershire local education authority since 1998-99. We have talked about the difference between inputs and outputs, and that investment has led to improved results, which is the most important thing. Some 83 per cent. of 11-year-olds now achieve the required standard in English, while 80 per cent. achieve the required standard in maths, compared with 68 per cent and 60 per cent. respectively 10 years ago. That is a direct result of the improvement in public investment.

The hon. Gentleman started by mentioning health, and I congratulate him on saving his own hospital—ours has been saved, although perhaps not as much as one would have initially liked. I was delighted that he said that female life expectancy, in particular, is much increased. That rather makes the point that allocation is made according to need and outcome, although that is in no way to say that Gloucestershire is not deserving. In fact, I am told that Gloucestershire Royal hospital is, as he will know, in the early stages of a £32 million redevelopment, with a new accident and emergency department—Burnley will be jealous—diagnostic and treatment centres, a children’s centre, a coronary care unit and an extended X-ray department. The services that are available will therefore be improved, and I hope that the life expectancy of males and females will rise even faster.

We have also seen investment in transport. The final section of the Gloucester south-west bypass was opened to traffic in May and a new bus and train interchange and parkway scheme is under consideration for Elmbridge Court. I hope that the hon. Gentleman will join hon. Members on both sides of the House in celebrating that.

The hon. Gentleman also mentioned crime. There are now 203 more police officers in Gloucestershire than in 1997, but the important thing is the output: domestic burglary has fallen by more than 28 per cent., robberies have fallen by almost 13 per cent. and theft of and from vehicles has fallen by more than 47 per cent. It is always boring when a politician comes out with statistics, but they make the point that public services are improving as a result of our sustained investment.

The hon. Gentleman mentioned that the increased police numbers are funded from the precept rather than central Government funding, but I understand—thankfully, this is not my direct area of responsibility—that the issue is subject to negotiation between central Government and local police authorities. It is not as if people have gone off on their own and done something; as far as I understand, what has happened has been done by agreement. If that is wrong, however, we will let him know later.

I am extremely grateful to the hon. Gentleman for raising the issue of the level of funding in Gloucestershire, and he is right to do so. We will reflect on the issues that he has raised, but I hope that he will agree that Gloucestershire, like the rest of Britain, has benefited from the increases that have taken place in public spending. Indeed, the grant continues to increase, and I hope that his constituents will be glad of that.

I have one minute remaining and I want to come back to Treasury core areas. Notwithstanding previous improvements, we are not the slightest bit complacent about the need to invest in public services. The end of the current comprehensive spending review process is in sight, and there will be no slowdown in the rate of public service improvements over the CSR period. I hope that that will be of some reassurance not only to the hon. Gentleman’s constituents, but to people in other constituencies.

Let me finish by congratulating the hon. Gentleman on raising issues of such importance and by reaffirming my delight at being able to respond to them under your chairmanship, Mr. Hood.

Safer Hastings (Crime Reduction Partnership)

I am grateful for the opportunity today to debate the excellence of the Safer Hastings partnership, but also, unfortunately, to raise a concern about a recent decision to reduce the funding for the partnership in-year. The Safer Hastings partnership is the local crime reduction partnership serving the borough of Hastings and St. Leonards, and, in common with other CRPs, it has achieved the Government’s objectives on reducing crime and, importantly, the perception of crime. All that good work has been possible because of the Government’s wisdom, in 1998, in deciding to fund crime reduction partnerships.

Does my hon. Friend agree with me that it is not only in Hastings where there have been advances in combating crime, but that across Sussex generally there has, for instance, been a 55 per cent. drop in the number of burglaries since 1997? In Brighton and Hove, part of which I represent, we now have the sixth lowest burglary rate in the country. Does the hon. Gentleman agree, however, that consistent rates of funding to help that work to continue to combat crime are important, not only in Hastings but across East Sussex and West Sussex?

Indeed, my hon. Friend is right. Government investment has meant falling crime rates not just in Hastings but across the nation. However, there is another problem in many places, and that is the rising perception of crime. I know that that perception is not increasing in Brighton and Hastings. Why should that be so? The crime reduction programme, combined with communication initiatives, has meant that the percentage of people who now feel safe walking alone in their neighbourhood, certainly in my area, has gone up to 55 per cent., even at night, and 92 per cent. in the day. The percentage of people who feel safe in the town centre when they are alone at night has gone up to 31 per cent.—an increase of 13 per cent. The equivalent daytime figure has jumped to 95 per cent. That is an excellent record. Indeed, under the community strategy put in place by Hastings borough council, which is set to run until 2013, a target was set that 50 per cent. of people should feel safe at night alone in their neighbourhoods by 2008-09. Already—two years ahead of schedule—the figure is 55 per cent. The importance of a perceived fall in crime rates cannot be underestimated, economically or socially. When people have confidence in the safety of their environment, they are more willing to engage in their communities, and they can go about their daily lives with a more positive attitude.

Perhaps I can explain a little more about how the success that I have described has been achieved. Several streams of funding were provided by Government, and gratefully received. It has been a massive investment. However, an essential stream has been the one known as the safer and stronger communities fund. It relates in particular to the building of safer communities and the combating of antisocial behaviour, and to drug support partnerships. Those are key components in the fight against crime and the perception of crime, and that is why I am concerned today at the Government decision not just to impose a reduction on the budget, but to impose a reduction in-year, after the budget was fixed.

The problem that my hon. Friend is speaking about has, of course, been imposed across the whole south-east. Funding to my own crime and safety partnership has been cut by £42,000. Does he agree that, apart from the effect of the cut itself, there is an impact from the fact that it has been imposed in-year, with no notice from the Government office for the south-east?

My hon. Friend is right. It is that which causes me to raise the concern today. Not only were cuts made; hon. Members were not involved in the process, or even told what was going to happen. They learned only after the event. That is what has been so damaging—it is not just that the amount of cash has been reduced, but that there has been an effect on the well-being of the partnership, and its confidence about what can happen, particularly given the Government’s proud record of giving forward funding in all sorts of other areas.

Examples of what has been done with the funding include the restorative justice scheme for teenagers, which introduces first-time offenders to their victims and takes them on prison visits, highlighting the consequences of their continued actions. Reoffending among those participants has gone down, according to some checks that have been made in my area, to 5 per cent. That is an amazing success story. Another example is the LIFE project, in which fire and rescue personnel, over a five-day course, train offending youngsters in fire-fighting skills, and challenge the reasons for antisocial behaviour. That has proved highly effective in instilling a new sense of personal values.

An aspect of the Safer Hastings partnership’s work on the perception of crime has been its innovative approach in providing a network of 11 community televisions in public places across the town, such as McDonald’s, Tesco and doctors’ surgeries—you cannot get away from it—telling residents that life is much better than they might have thought. That innovative approach has been credited with the achievement of a 20 per cent. increase in the number of people who believe that crime is falling. Of course, that figure should be 100 per cent., because crime is falling, but an increase of 20 per cent. is pretty good.

The community television scheme that I mentioned was showcased in the House of Commons exhibition earlier in the year, when my noble Friend Baroness Scotland, who was at the time a Home Office Minister, and is now the Attorney-General, referred to the scheme as an exemplar, and one that she would want to spread wider. It has been so effective that not only has it achieved ministerial approval: Roger Fisher, the former head of the Home Office fear of crime team said that the Home Office currently views community partnership television as an example of best practice as a method of communicating with the public.

The plaudits for the Safer Hastings partnership and other crime reduction partnerships go on and on. They are a real success story. For example, the Government Office for the south-east communications conference awarded the SHP the award for best new media initiative, as part of the community partnership television scheme. Just recently the partnership achieved international acclaim as a result of its varied programmes, funded by the Government’s safer communities fund. Hastings has now been recognised by the Italian Association of Language Consultants as one of the best destinations for foreign students. In fact, later this year, in this very place, the managers of the SHP, David Furness and Mike Fagan, will receive an award from the Italian authorities recognising their success in achieving a safe town. To conclude the list of awards, the SHP has been shortlisted for the Tilley Award, which is a prestigious Home Office award for the most intelligent, courageous and effective approaches to the relevant problems.

The reason I have told the House all this is because I want hon. Members to appreciate that the Safer Hastings partnership, and the crime reduction partnerships in my hon. Friends’ constituencies, have been a huge success in helping to achieve the twin objectives of the Government—the right objectives of reducing crime and reducing the perception of crime, which is so debilitating. It is in that context that I am bewildered and puzzled to learn of a cut in funding for the current year, 2007-08. It is not a matter of future plans, but of the here and now—something that happened after the budgets had been fixed. Funding reviews will always need to reassess priorities, but in this case, without any consultation or warning, the funding has been cut after the financial year has begun. I also regret that, as I have mentioned already, Members of Parliament whose constituencies were affected by the cuts were not informed of the decision by the Department. It all came out by rumour; in my case an outraged police inspector called me on the telephone to say, “What is this all about?” Sadly, at the time, I was unable to tell him.

In East Sussex the building safer community’s budget has now been cut by £102,000, or 14 per cent., and the Safer Hastings partnership takes its share of that. Having spoken with SHP officials I understand that that means that this year there will be cuts to initiatives targeted at reducing hate crime, domestic abuse and street crime. That is dreadful. Public reassurance initiatives will also suffer, and that could have a hugely detrimental impact on public confidence in our crime reduction programmes.

I am told that the reason for the changes is that the Home Office needs extra money for prisons and the prevention of terrorism. Obviously, those are both important programmes, especially in light of recent events, but there will always be competing demands, and it is short-sighted to address in that way issues that are priorities for people, namely street crime, local crime and local confidence that they are being dealt with. To do so means simply that many of our objectives, such as not having overcrowded prisons, will be lost if we do not also reduce the crime that leads to people being put in prison.

There might even be a legal impediment to such late notification—I would welcome the Minister’s comments on that—because the deal was done and the grant was agreed, but then withdrawn. I suspect that that is something for local authorities to consider, but the purpose of this debate is to ask the Home Office to reconsider. The decision was clearly made under the old regime, and I invite my hon. Friend to return to his colleagues, including the new Home Secretary, and ask whether it can be reconsidered. These are relatively small sums of money in the great scheme of things, but the cuts will have an effect on local crime reduction partnerships, both on the programmes that cannot be continued and on the morale of people who will be removed from their posts part-way through the year, after contracts have been entered into.

The Government have made it clear, in their dealings with local authorities, that they will not simply say what next year’s budget will be, but will try to give three-year funding projections. They are the first Government who have ever been prepared to do that, and that decision is to be applauded. In contrast, this in-year cut is contrary to all that the Government say is their intention and to what they are doing in all other respects.

I have corresponded with the Treasury team about this matter, and have here a letter dated 3 May from the then Chief Secretary to the Treasury—now the Minister of State, Department for Business, Enterprise and Regulatory Reform—telling me that the budget for the Home Office between 2005-06 and 2007-08 provided £2.1 billion of extra resources, which is equivalent to an average real-terms growth of 2.7 per cent. for the period, so extra money has been provided. He also said in the letter that the Government’s priority is to have a “safe and secure society”, and stated:

“By the end of the current financial year Home Office spending will have risen by 75 per cent. in real terms since 1997”,

which is to be applauded.

The Home Office has had reasonable settlements. Of course, it has enormous obligations, but it has the cash to avoid this lurching of cuts part-way through the year. I therefore ask that the in-year cuts be restored and that should changes be necessary in future, we do not adopt the across-the-board approach, but consider what works best. Clearly, the Safer Hastings partnership works well—I have given examples of its success—as do the schemes in Milton Keynes and Brighton, but schemes in other areas might work less well. Perhaps some objective assessment should be made as to where, if anywhere, reductions should be made.

If reductions are made in the constituencies that have been mentioned today, services will be affected. The Minister might say that funding could be filled from other sources or could be dealt with differently, but that is not possible because it is ring fenced, so a reduction in the funding for particular projects means a reduction in those programmes. I regret that it has been necessary to raise this issue, and I am grateful for the opportunity to do so. I hope that the Minister will reassure my colleagues and me that he will reconsider.

I congratulate my hon. Friend the Member for Hastings and Rye (Michael Jabez Foster) on securing the debate. He spoke with passion about all that has gone on in Hastings with policing, community safety and Home Office matters, and about developments throughout the public sector to do with the Safer Hastings partnership. I do not doubt that the partnership has, as he described, had a significant impact on improving the quality of people’s lives in Hastings and St. Leonards.

Let me give the detail of the main Home Office funding for the partnership’s work, although that funding is not paid directly to the partnership by the Department. Key elements for 2007-08 are the safer and stronger communities fund, the drug interventions programme grant and the basic command unit fund. The SSCF is a pooled budget comprising funding from the Home Office and the Department for Communities and Local Government, which is paid to upper-tier local authorities under the local area agreement process.

My hon. Friend will know that, for this year at least, the SSCF for East Sussex is £2,301,332 in revenue and £702,451 in capital, compared with £1.69 million in revenue and £190,000 in capital last year. That is an advertent point, which he did not seek to make, but the overall SSCF has not been cut; its pooled budget has grown. I shall come to his specific point about the Home Office, but people should not run away with the notion that the overall SSCF, and all that it does with such success throughout East Sussex, including Hastings, has been cut in the way that he described, because it has not.

Given the pressures that my hon. Friend described, which I understand are not priorities from his perspective, tough choices had to be made across the Home Office, both before and after its split from the Ministry of Justice, to enable us to live within our budgets and to meet our public protection obligations. As a result, the Home Office contribution to the SSCF is less than it was in the indicative figures that were offered in December, but that does not mean that we are any less committed to local delivery through LAAs—local area agreements—and partnerships, or to having a localised, neighbourhood focus on all that we do in policing and community safety. He will know that the overall pot for neighbourhood policing in England and Wales has increased by 41 per cent. this year, and he will be as committed as I am to ensuring that neighbourhood policing, in all its forms, works alongside crime and disorder reduction partnerships and other partnerships to bed in the success that he discussed.

The East Sussex upper-tier authority, in which Hastings sits, received over £3 million from the SSCF for 2007-08. Under its LAA, East Sussex and its partners enjoy greater freedom and flexibility to decide how best to use the SSCF grant to deliver an agreed range of outcomes. The intention is clearly that local areas should be able to prioritise pooled resources as they see fit to meet the needs of local communities. That flexibility is at the core of the new relationship between central and local government and is the basis of the LAA development that we want to see, not least in holding local police forces accountable more readily, particularly at BCU level.

I acknowledge that local authority systems should determine priorities locally, but perhaps I did not make my point very well. How can a local authority do that if it has fixed its budget and made its decisions for this year, and then a reduction is made after that budget has been agreed and determined?

In the strictest sense, it was not agreed. It was not until mid-May or June that Home Office contributions to LAA budgets were confirmed. That was quite wrong, and I assure my hon. Friend that that cannot and should not happen again. Previously, from December onwards, any figure about the Home Office contribution to LAAs was indicative, so the notion that the deal was done by December simply is not accurate. I understand why my hon. Friend is frustrated, and I accept, as I had to on a range of other issues last year, that it is not appropriate to wait until after the start of a financial year to wait for confirmation of decisions or subsequent reductions before making such decisions. I shall do all that I can to ensure that that does not happen again.

My hon. Friend will also know that Hastings is within the East Sussex BCU, which received £190,000 from the Home Office for 2007-08, as it has for the past four years. In any partnership, partners bring some of their own funding and resources to the table, and funding streams feed into the Safer Hastings partnership to meet local priorities. I was pleased to hear, for example, that it is being awarded funding from the neighbourhood renewal fund to progress its already considerable efforts in tackling town centre violence and disorder. If my hon. Friend could tell me how he unlocks NRF money, I would be enormously grateful, because my constituency has not received a penny from it in the past 10 years, despite containing significant pockets of deprivation.

The overall allocations of the SSCF grant were given to upper-tier areas, including East Sussex, and, given the nature of the pooled pot for LAAs, that allowed areas at that stage to plan their spend. I agree with the core element of my hon. Friend’s point: it is unfortunate that the detail of the Home Office element of SSCF allocations came later than usual. I fully understand that that may have caused some local planning difficulties, and the Home Office is committed to ensuring that it is not repeated in future years. The reasons for the delay were complex, but we will learn from this experience.

Collectively, £10 million accrued to the Home Office in terms of its contribution. Rather like the £27,000 lost in Hastings, that could, in the scheme of things, be conceived as being rather small beer in the Home Office’s budget of billions. I take with a gentle pinch of salt the letter that my hon. Friend received from the Treasury saying how wonderfully generous it has been and that everything is fine because it gave 2.7 per cent. None the less, I appreciate and would not deprecate the notion that £27,000 is huge in terms of Hastings’s funding. The loss of such a sum would have a potentially significant impact if forewarned and planned for; it would have even more impact if not planned for.

In the scheme of things, £10 million does not help matters much in the Home Office’s budget, but I have had to take £10 million from one place, £20 million from another and £10 million from another to get funding for the key priorities at the time— prisons and the counter-terrorism budget—and we in Government must take such decisions.

I also take my hon. Friend’s point about the notion of using needs-based assessment, rather than universality, if these things are reduced in future. It is no comfort to him, or to my hon. Friends the Members for Milton Keynes, South-West (Dr. Starkey) and for Brighton, Pavilion (David Lepper), that they have all been hit by 14 per cent. cuts. The fact that they share the pain does not make it all okay.

My hon. Friend the Member for Hastings and Rye made the fair point that, if we were to recalibrate and lessen the moneys—I have no intention of doing this—that the Home Office puts into the LAA and SSCF pots as a matter of policy, it should be done more readily on either a success and performance-reward basis or a needs basis. I am entirely sympathetic to the challenges that the funding reduction causes and to the point that the Home Office elements were determined late and should have been done more readily—hopefully prior to the start of the financial year—so that people could have gone about their business.

Hon. Members would expect this, but I should say that we would still expect areas to meet their agreed target on reducing crime and disorder and the harm caused by drugs. I hope for the continuation of the substantive success that has occurred across East Sussex broadly and certainly in Hastings, as my hon. Friend outlined.

It is easy to talk about tough choices, appropriate priorities and targeting resources where they can have the most impact as things flatten out, rather than be reduced more generally, in terms of the Home Office. I am afraid that I cannot give my hon. Friend any satisfaction on restoring those elements that were reduced this year. However, I assure him that whatever the news, good or bad, for SSCF, LAAs, the BCU and all the key Home Office funding elements, it is incumbent on the Home Office to ensure that people know sooner rather than later what budgetary elements are coming from it. Such an approach would allow them to plan accordingly and to sustain—this is true in the case of Hastings—the good works that have been done through the partnership.

I applaud not only the commitment, but the innovations, substance and evidence of results of the Safer Hastings partnership. Although I might deprecate and decry the manner of the process, largely because I was involved in it, given that I know what the £10 million is being spent on elsewhere in the Home Office, I would defend the fact that cuts were made. My hon. Friend’s anger and frustration at it being mid-May or June—well after the start of the financial year—before the funding was finally announced is entirely fair.

I applaud what is happening in Hastings. East Sussex is wedded to the neighbourhood policing model that I see very much as the other part of the equation in terms of what people are achieving in partnerships such as Safer Hastings. I wish my hon. Friend and his colleagues in the partnership well in continuing the process, albeit, however temporarily, handicapped by the late confirmation of Home Office funding, for which I apologise. I shall seek to ensure, through him and my other colleagues, that that will not happen again. I therefore hope that we can maintain the good news and good success in crime and community safety, rather than discussing the unfortunate oversight of presenting the funding after the financial year has started.

Sitting suspended.

Dental Services (Sutton and Merton)

I welcome the Minister to her new post. I am pleased to have been able to secure this debate. I am sure that it will be non-confrontational, so I hope that it will be a gentle easing into the process for her.

I welcome the opportunity for this debate. I highlighted my reason for seeking it in health questions last week, when I mentioned the responses I had received to a health survey in my constituency that is almost complete. We sent out 70,000 survey forms, one to every elector in the constituency, and so far we have received about 7,000 back, quite a representative sample of residents. A certain amount of self-selection may have gone on in the response—perhaps it is true that people who are happy generally tend not to respond to surveys, whereas those who are unhappy do—but 7,000 residents is still a significant proportion of my constituency.

The biggest issue that leapt out of the health survey responses was access to NHS dentists. No fewer than 71 per cent. of those who responded said that they had had problems registering with a dentist. That prompted me to launch a campaign called, snappily, “Desperate for Dentists”. I secured a skeleton—it was loaned by local Carshalton college—and arm-twisted my dentist into allowing us to set the skeleton in her chair to illustrate how long people were having to wait for access to an NHS dentist, although fortunately it is not normally quite as long as that.

The campaign addressed securing free check-ups, ensuring a contract renewal process engaging both patients and professionals properly so that contracts are drawn up with full co-operation by both parties, placing greater emphasis on preventive treatment and establishing individual dental plans tailored to patients’ needs. I understand that the National Institute for Health and Clinical Excellence supports the latter idea, as different patients might require more or less dental treatment. Some people whose teeth are in stable condition might not need a check-up every year, but some people clearly need much more frequent check-ups and different treatment.

I suppose that I should not have been surprised at the amount of concern expressed about access to NHS dentists. We know that the national picture is that a significant percentage of dentists are not taking NHS patients. Indeed, within three months of the introduction of the new contract, 1,500 dentists had opted out of the NHS, representing 8 per cent. of NHS dentists. That is a worrying position.

Although 28 million patients seen by NHS dentists in 24 months, according to national statistics, is a large figure, that figure had not changed since the previous period. Despite the new contract and the expectation that it would lead to more people being seen, in practice there has been relatively little movement during the 12 months between 31 March 2006 and 31 March 2007.

London also has issues, particularly for children. Only 65.3 per cent. of London children were seen in the past 24 months, compared with nearly three quarters of children in the south west strategic health authority. There are regional discrepancies. Unfortunately for my constituents, the local discrepancy within the London region points to particular issues in Sutton and Merton.

Let us compare what has happened in London with what has happened in Sutton and Merton primary care trust. In London as a whole, the number of patients seen from 30 June 2006 to 31 March 2007 dropped from 51.7 per cent. to 51.2 per cent. That is a relatively small percentage, although a large number of people were affected, but in Sutton and Merton the number has dropped much more substantially, from 52 per cent. to 49.7 per cent., at a time when the average across England as a whole has not changed for the past four quarters. The same percentage of patients have been seen throughout those periods, whereas in London the number is beginning to drop and in Sutton and Merton it is dropping more substantially.

On the face of it, that is hard to understand. The number of dentists per 100,000 people is quite good in Sutton and Merton—it has 53, compared with 42 in other parts of England. Still, a smaller percentage of the population in Sutton and Merton are seen by dentists—only 45 per cent., compared with 51.5 per cent. in England as a whole. Clearly, there are local issues, highlighted by my survey and borne out by publicly available statistics.

I sought the view of a local dentist and met a couple of weeks ago with an orthodontist. His name is Tim Pollard, and he is happy to put on record his view of the new dental contract:

“It’s bad for dentists and bad for patients. It was designed solely to cap expenditure. It was about money”

rather than improving

“patient care or encouraging dentists to stay in the NHS…The contract was based on an arbitrary year (Oct. 2004 to Sept. 2005)”,

and for some practices,

“that year may not have been a typical year.”

The practices might have been starting up, or had maternity or sickness leave that made the year atypical.

The contract

“caps the amount of NHS work a dentist can carry out in any one year”,

so dentists cannot grow their practices. It may also mean that once the dentist has done all the work that he has contracted to do, he may end up with staff unable to work except in the private sector. Patients have the frustration of knowing that dentists and staff are available to do NHS work, but because the financial input from the PCT for that year has been spent and all the work has been done, the dentist cannot do any additional NHS work.

Importantly, dentists are at financial risk because they have lost control of their business. An interesting question, which I hope the Minister can clarify, is what position dentists who have built up their practices using private money will be in when they attempt to sell on those practices. My understanding is that given that there appear to be no funding guarantees from the PCT, dentists will be left with a practice in which perhaps half the work is not guaranteed—the other half, if it is private work, will be—and uncertainty about the practice’s future income will make it almost unsaleable. For dentists who have invested heavily in their practices, that is a huge problem.

The biggest problem is what will happen after 2009 when the contracts come to an end. I raised that issue in health questions last week, so I hope that the Minister’s officials will have done their homework and perhaps secured a detailed response. It was interesting that, in response to the hon. Member for Chorley (Mr. Hoyle), the then Minister said that under the present contracts PCTs are not allowed to spend the money allocated to dentistry on anything else: they cannot switch it to other services. I understand, as do the orthodontists, that there will be no such guarantees after 2009, and that it will be for PCTs to determine what level of funding they want to put into dentistry. I understand that they will have to provide “reasonable services” and, if so, I hope that the Minister will explain precisely what that means.

If orthodontists and dentists are thinking about increasing their practices and want, for example, to extend their premises because they will be doing more business, they need to invest now. They need certainty now so that they can make planning applications, design extensions and put together investment plans for the future. However, because of uncertainty about what will happen beyond 2009, they are not in a position to do so.

Last week, I hoped to obtain an indication from the then Minister—perhaps the present Minister can provide it now—of the point at which PCTs should enter into discussions with dentists and orthodontists about what will happen beyond 2009. Clearly, if PCTs leave that until January 2009, dentists will not have made the necessary investment, and they are worried that big corporate organisations might come into the sector after 2009 and put them out of business, or that they might invest in anticipation of securing renewal of their contract but find that a big corporate takes over a block of work. Both dentists and, more significantly, patients need clarity on what will happen. We do not want patients turned away, which may, unfortunately, happen under the present contractual arrangements, and we certainly do not want services collapsing or investment not being made because dentists do not know what will be over the horizon in 2009.

I do not want to give a solely negative view of what is happening with my local primary care trusts. I am pleased that they have chosen to re-establish an oral health advisory group, and I hope that that group will be truly representative of patients and professionals. If it is not, the claims that are being made about PCTs being representative of the local community will simply not stack up. At the moment, I am afraid that the view of PCTs is that their democratic accountability is sorely lacking. Only through organisations such as the oral health advisory group, with real representatives, real power and a real say in local services, will the local community begin to believe that primary care trusts are genuinely accountable to local people in a way that I do not believe they are now, although they are working on it. The level of scrutiny that they are under is welcome, but democratic accountability has still not been achieved.

I hope that the Minister will clarify whether, before the present round of contracts, there was a requirement for primary care trusts to have an oral health advisory group. I understand that under the new contractual arrangements there is now such a requirement. I am confused as to why my local primary care trust disbanded its oral health advisory group. There was a period of abeyance and inactivity with no such organisation, but it has now been re-established. That is welcome, but I wonder why it was abolished and why there was an interim period without such a group.

I hope that the Minister will tell me, in writing if not now, whether the advisory bodies, such as the oral health advisory groups, have any statutory powers or responsibilities, or whether the Government expect them simply to be advisory groups to help the PCT, but with the PCT ultimately able to decide to go forward in whatever way it chooses.

I hope that the Minister will give me the important news that there will be an improvement in access to dentistry in Sutton and Merton, because there seems to be a gentle decline at the moment. In London, the decline may be even gentler, but there is a deterioration in access to services, and I would like confirmation that that will improve. Finally and most importantly, I would like clarification from the Minister as to what will happen beyond 2009 so that dentists can make the necessary investment and patients know that NHS dentists will be available to treat them.

I congratulate the hon. Member for Carshalton and Wallington (Tom Brake) on securing this debate on dental services, and I thank him for his kind and supportive comments at the beginning of his speech. I also congratulate him on the imaginative use of his website, the pictures with his local dentist, and his survey of his constituents. It is certainly the way forward to consult all stakeholders and the PCT.

I want to respond to the specific issues raised by the hon. Gentleman, but I want to begin by describing the main steps taken by the Government in the past two years to help to expand access to NHS dental services.

For some 15 years, following problems that arose from a new contract in 1990, dentists had been drifting away from the NHS. Under that old system, dentists could set up practice where they wished and choose how much NHS work they wanted to do. That was an inherently unstable system. In April 2006, the Government took decisive steps to bring the situation under control. They devolved more than £1.7 billion of resources to primary care trusts, which now use that money to agree with local dentists the services that they will provide for the NHS. If a dentist stops providing those services for any reason, the local NHS now keeps the funding and can use it to agree new services with other dentists.

Those changes build on a major programme of Government investment in dental services. Overall expenditure this year, including revenue raised from patient charges, is likely to be at least £2.4 billion, a real terms increase of more than £400 million since 2003-04. Another key change introduced last year was to abolish an outdated system of dentists' pay, which had created a drill-and-fill treadmill. The new remuneration system supports dentists in carrying out less complex courses of treatment in line with modern clinical practice.

I ask the hon. Gentleman to remember that we are only just over a year into the new arrangements and, inevitably, some aspects are still bedding down and need further discussion, but there are already excellent examples of how PCTs have worked with their dental services—for example, in Leicester and Norfolk, an inner city and a more rural area.

The hon. Gentleman’s concern today is his constituency. Sutton and Merton PCT is now commissioning more services than in April 2006, and its primary care support service can place patients with NHS dental practices in the area. I am sure that the hon. Gentleman’s consultation work, and the active interest that he takes in his PCT, are helping with that.

The volume of dentistry now being commissioned by primary care trusts is greater than it was before last year’s reforms. Primary care trusts are finding also that, when they commission new services, significant numbers of dentists are interested in taking on more NHS patients. That follows a major recruitment programme in the two years leading up to the reforms, in which more than 1,400 new whole-time dentists joined the workforce. The Government have also provided £100 million of capital funds to allow NHS dentists to invest in premises and equipment. That all takes place against the background of dramatic improvements in oral health, with 12-year-old children in England now having the best oral health in Europe.

I agree that more progress needs to be made. There are still difficulties in obtaining access to services in some areas of the country, and the hon. Gentleman has drawn attention to problems in his constituency. I will be talking to patient groups, dentists and the NHS to consider how we can achieve further progress. However, primary care trusts are now in a much stronger position to develop dental services in ways that improve access and reflect the needs of their local populations.

The first factor is financial investment. The Government have increased investment by over £400 million in the past four years. In 2009, which the hon. Gentleman mentioned, those resources are due to become part of primary care trusts’ overall health budgets. That will strengthen still further the responsibility of the local NHS for dental services in its area. In making decisions on investment, PCTs will have to take into account the new statutory duty given to them last year, which requires them to provide dental services in their area that reflect local needs. Primary care trusts will need to continue to build up investment where it is necessary to meet those local needs.

The second issue is the work force. In 2005, the Government increased the number of dental undergraduate places by 25 per cent., which means that 170 extra students now enter training each year. The first students from the expanded training programme will graduate in 2009, and new dental schools are opening in the south-west peninsula and in Preston later this year. Another positive development is that dental therapists, hygienists, technicians and nurses are increasingly playing an enhanced role within the dental team. That is much to be welcomed.

The third factor is how primary care trusts and dental practices use the £2 billion or so that is invested in NHS dental services in ways that deliver the best outcomes for patients. Local responsibility for dental services forces primary care trusts to focus not just on how much they are spending, but on what that investment is delivering in relation to patient care, such as the number of patients who are able to access services, as well as clinical quality, patient experience and health outcomes. The Department of Health works closely with the NHS to help drive improvements in all those areas.

The final factors that I will touch on are professional and public engagement, to which the hon. Gentleman has already shown his commitment. If NHS dental services are to prosper, there has to be a strong local relationship between PCTs and dentists. It is important in that context to debunk the myth that general dental services contracts, which the hon. Gentleman mentioned, will expire in 2009. That is simply not the case; the contracts are ongoing. There are greater flexibilities for PCTs and for dentists to review the precise terms of contracts after 2009. However, if a local practice is delivering high-quality services that are valued by local NHS patients, it is hard to see why the PCT or the practice would want to propose any significant changes. There is a smaller category of contracts that have fixed terms. It is good practice for PCTs and practices to review and, where appropriate, extend those contracts on a rolling basis to promote continuity.

PCTs are also increasingly engaging the local public in helping to review how services should develop. For instance, some PCTs have used their new powers to establish dental services in areas of historically poor access—both in response to local public demand and to recognise the greater oral health needs of those areas. I am sure that the hon. Gentleman would agree that it is important to the future oral health of our constituents that there be close co-operation with PCTs in areas where people have not always had access to dental treatment. The Department is working with the NHS to spread that good practice, and the hon. Gentleman might wish to encourage constituents who have experienced difficulty in obtaining access to services to get involved via the patient advice and liaison service.

I want to press the Minister on one issue before she finishes. She has clarified that there is a statutory duty to provide local dental services and to reflect local needs, and she has also said that the dental budget will be incorporated in the overall PCT budget. That gives rise to the concern that, when the dental budget competes with cancer services budgets, it might lose out. What guarantee, if any, can she therefore give that PCTs will maintain broadly the same spending profile for dental services?

My experience is that when a contract is working well in the NHS, and when we are building on a good relationship with PCTs and dental services, it is obviously wrong to go back on it. We should build on the success of NHS dentistry and PCT involvement. The system of the 1990s and before did not work but, since 2006, the new contract has led to proven improvements in oral health and in NHS services to patients. PCTs would do well to consider that and to continue the progress that has been made.

There have been solid achievements in the first year of the new system. There is, of course, still much work to do, including building up trust in the contracts and in working relationships. Nevertheless, investment is growing, the local NHS is commissioning a steadily increasing volume of dentistry, and the numbers of NHS dentists are back on an upward track. The Government are committed to working with the NHS and the profession to build further on that progress. I am confident that there will be co-operation, and I will always welcome the opinion and comments of the hon. Gentleman on what is an important issue.

Question put and agreed to.

Adjourned accordingly at three minutes to Two o’clock.