Tuesday 9 October 2007
[Mr. Eric Illsley in the Chair]
Speech, Language and Communication
Motion made, and Question proposed, That the sitting be now adjourned.—[Mark Tami.]
Good morning, Mr. Illsley. In welcoming you to the Chair for what is the first Adjournment debate in Westminster Hall since before the summer recess, I confidently look forward to your firm, fair and wise stewardship of our proceedings.
On 3 September this year, I was pleased to accept the invitation extended to me by the Secretary of State for Children, Schools and Families, supported by the Secretary of State for Health, to lead a review of services for children and young people with speech, language and communication needs. The review is charged with advising the Government of the day on the range and composition of the universal and specialist services that will be required to meet, in an affordable manner, the diversity of needs that exist. It will also consider how planning, performance management and effective co-operation nationally and locally can spur beneficial early intervention with the effect of securing improved services. Furthermore, it will look at those examples of best practice in the commissioning and delivery of services that could usefully be regarded as benchmarks for the wider development of services across the country.
That is quite a broad remit, and within it fall a large number of issues, on which I do not have the time, and I do not intend today, to focus, although I should like to address some of them. That, however, is the background to the events that are likely to unfold over a period of months. It is also probably as well to say that when this Adjournment debate was secured on 25 July, courtesy of the ballot undertaken in Mr. Speaker’s office, I had it in mind, as a result not least of discussions with a range of interested parties, to highlight a series of quite specific issues, and it is on those that I shall concentrate the thrust of my remarks.
It is probably a good idea to set out the background to our consideration of these important issues. In other words, what is the problem? Approximately, 5 to 8 per cent. of pre-school children suffer speech, language and communication problems, and the figure rises to 10 per cent. for children of school age. About one in 500 children suffers a severe and intractable communication impairment. That is the context that right hon. and hon. Members need to address in considering these issues.
I want to focus specifically on three main areas and then listen intently to the contributions from colleagues on both sides and the Minister’s response. I want to say something about training and co-operation in the delivery of services, and about the statementing process. I have agreed with the Secretary of State that the review is not intended to reopen the question of Government policy on statementing, although I confess that the Government have not quite got it right at the moment. The Secretary of State has agreed, however, that I certainly am entitled to look, and should look, if the review is to be complete and full functioning, at the impact of statementing on children with speech, language and communication impairments, because that is fundamental. I want to look at language units, which are often a proper source of provision for the affected category of children. There are a number of issues relating to language units on which we need to focus and which should be proper matters for consideration in the review.
What is to be said about training and co-operation? Good work is being done out there; there are some excellent professionals and there are examples of good practice. I say that at the outset for the avoidance of doubt, lest anybody think that I am seeking to create an impression of doom and gloom. I am not seeking to do that, because that would not be justified, but there are legitimate concerns about public policy and current practice, and the Government must take those into account if they are to build on the work that they have done in recent years.
I have been struck by the survey evidence that I have seen and by two pieces of evidence in particular. A YouGov survey undertaken for the Communication Trust showed that 73 per cent. of adults in contact with children in schools did not believe that they had had any training that would equip them adequately to cope with children who suffered speech, language and communication impairments. That is a significant deficit, which we need to address. The second piece of opinion polling evidence that struck me as relevant was the finding in the poll undertaken by the National Union of Teachers, which showed that only 32 per cent. of respondents felt confident in accommodating and dealing with children who suffered speech, language and communication impairments. A large number of professionals therefore say that they have not had the necessary training and only a small proportion of teachers—less than a third—feel comfortable enough to deal with the client group with which I am concerned.
That evidence seems to highlight the importance of the inclusion development programme. I am conscious that that programme is now to be unveiled and rolled out—relatively widely, I hope, across the country—but there are issues that the Government need to consider. First, there is the perennial issue of funding. Have we got the wherewithal to make this a meaningful commitment? Secondly, will the Government, in upskilling the entire work force, as the evidence that I have adduced demonstrates is necessary, take proper account of the need to make a greater priority of ensuring that there are sufficient specialists who will be able to address the needs of children with more severe impairments? In other words, we can upskill the general work force to deal with the relatively widespread but modest impairments from which children suffer—that is one issue—but we must also ensure that we have sufficient skilled specialists to provide the expertise and intensity of care that the more serious sufferer requires.
Finally, I ask the Minister not to discount the likelihood that, as a consequence of unveiling the programme and, as I hope right hon. and hon. Members will understand, raising expectations, he will generate an increase in demand for the very services on which my review must focus. It is a question, therefore, not only of whether there are sufficient resources today, but of whether the resources are likely to be adequate as events unfold in the months ahead.
I congratulate the hon. Gentleman on raising this subject and endeavouring to move things forward, and I am sure that we shall all play our part in supporting and helping him. I just wanted to point out that the title of the next debate suggests that health funding can lead to inequalities in the system. I am very interested, as I know the Government are, in inequity and inequalities in this country. Will the hon. Gentleman address that problem and realise that somebody such as Stephen Hawking, who is very creative, can access equipment that people in other parts of the country find difficult to access or to get support or continuing funding for? There is an inequity problem that I hope the hon. Gentleman will address in his review.
That is a fair point—the short answer to the hon. Gentleman’s question is yes, I will. In the terms of reference agreed with the Department for Children, Schools and Families and the Department of Health, we have factored in the requirement to look at the circumstances of people from lower socio-economic backgrounds and those from areas of significant deprivation because problems in those communities can be intense. I accept the salience of the hon. Gentleman’s point. As in so many other walks of life, people who have means or who have contacts and therefore access to means are able better to cope with their significant difficulties than those who do not have such means or access to contacts who could provide means. I hope that, I have reassured the hon. Gentleman that although his concern will not be the only or prime focus of the review, it must be part of the equation.
I spoke about training and co-operation and I shall now say something about the need for that co-operation. In acknowledging that important work has been undertaken and that good examples of effective practice can and will be identified, we cannot shy away from the fact that there are significant challenges, to put it fairly and dispassionately, which are represented not least by some of the critical reports that have been issued in recent months. The Minister may recall that we last debated these matters on 28 November 2006. Since then, there have been no fewer than four reports that, in one form or another, posed a significant challenge or raised a pertinent question.
A report from the National Audit Office focused specifically on the subject of the Sure Start children’s centres. It perturbs me that the report said that, of 27 centres surveyed, only five demonstrated a close working relationship with a local primary care trust. That is not good enough. I accept that the children’s centres, which are a welcome development, are of recent origin, so I am not saying that they should be damned for ever or seriously lambasted, but there is a policy failure and the NAO properly drew attention to it. The Audit Commission has also produced a report, which lamented the lack of multidisciplinary support services at local level. An Ofsted report said that standards in communication in schools were lower than expected. Finally, a report from the Public Accounts Committee explicitly said that more had to be done to meet specific needs such as the requirement for speech and language therapy.
I hope that the Minister will take note of those reports in a constructive spirit and agree with the general proposition that they underline, perhaps most strikingly of all, the need for co-operation at all levels—among practitioners on the ground who are charged with the delivery of services, between schools and local authorities and, critically, between local authorities and PCTs. The issue of joint protocols or concordats from PCTs and local authorities would perhaps be a portent of better things to come. It would be a sign that they accepted a responsibility to translate the theory of joined-up working into demonstrable practice—demonstrable not only to service providers and those responsible for strategic management, but to the recipients of services. Such co-operation, joint working and a sense that we have an obligation to seek to provide so far as possible a seamless service is of the essence.
I should emphasise how incredibly important joint working and a seamless service are as far as children are concerned. Specialists in the field generally conclude that one of the best predictors of, or guides to, the outcome for the child is whether the agencies concerned come together early and meet as necessary relatively often, both to plan what to provide to the child and to monitor how those provisions work, and to improvise as necessary. I say that in the context of what I believe Members on both sides of the House will accept as the basic fact of the enormous benefit of early intervention and the huge danger of its absence. Simply stated, the benefit of early intervention is that children can have teething problems addressed, as it were, and they will then be in a position to access the national curriculum and to fulfil their potential.
The Government have signed up to the principle of early intervention. The downside of its absence is difficult to overstate. I do not in any sense seek to be melodramatic about it and I am working simply on the basis of what I understand, as an interested lay person, to be the evidence. If there is no early intervention, there is a risk of emotional and psychological difficulties, behavioural problems, lower educational attainment, poorer employment prospects, persistent communication handicap, challenges to mental health and, indeed, in the worst-case scenarios, a descent into criminality. If we are to avoid that grisly scenario, we must ensure that agencies come together early, regularly and effectively to translate the aspiration of good policy into practical effect at local level.
Does the hon. Gentleman agree that another important aspect of agencies working together is that parents and other non-educational sector interested parties make maximum use of the time that the children affected spend outside their educational establishments? Co-ordination within the educational setting would mean that maximum use is made of the time that a child spends outside it.
That is certainly true, in which respect the hon. Gentleman prompts me to make an additional and, I hope, valid observation about the incredibly important role of parents. They must be a part of the delivery of the best possible care for their children, but information and support for parents is sometimes not what it might be. Parents ought to have some sort of toolkit, the better to enable them to play their part in helping children. That would require effective planning within an educational setting with a view not only to that environment, but to the time that a child spends outside school.
I apologise for being a few minutes late. I should like to invite the hon. Gentleman to follow up on the issue of early intervention. A lot of work has been done on early intervention concerning what does and does not work. Actually, we must be clear about the form that early intervention takes. Some programmes are successful. The incredible years programme—aficionados call it the Webster-Stratton programme—has been rolled out in all Sure Start centres in Wales, and their performance has outstripped that of centres in both Scotland and England. The programme is dedicated and committed and is centred around parents, but it does some important work with children. While looking at early intervention and working with parents, I hope that the hon. Gentleman takes on board work that has shown that we must be clear about which programme is being followed, and that we must monitor programmes carefully to produce particular outcomes.
The right hon. Lady makes the point that it is not good enough simply to sign up to the principle of early intervention, but that one must be clear about what form it should take. I do not claim to be an expert, or seek to prescribe a precise blueprint for application across the whole country. That said, she is right that there are examples of obviously good practice that follow a particular model and that could perhaps be benchmarks, as I mentioned at the beginning of my speech, for the development of services across the country. I am not sure that it is for me to invite myself to the project that the right hon. Lady describes, but if she, through her good offices, felt able to weed out an invitation, it is perfectly possible that my colleagues and I might find the time to go there to see for ourselves what good work it is doing.
That is exactly what we want to see—good practice. Actually, we should like to see some examples of bad practice, but not with a view to playing the blame game or because we want to point the finger or to apportion responsibility between one individual and another. At the risk of sounding pious, which I do not intend or want to do, the issue is bigger than that. We are trying to arrive at constructive solutions, so I am very happy to look at what the right hon. Lady suggested. There are of course examples of I CAN programmes, among others, that work very well, but there is a range of different provision, and we should be open-minded in looking at what is effective.
I said that I should like to say something about the statementing process, specifically as it relates to children with speech, language and communication impairments. I hope that the Minister will understand when I say that one of the difficulties that parents have is that there is not always that much material on paper that can be easily viewed and presented to Ministers. It is therefore necessary to some extent to work on the basis of examples heard from reputable pressure groups, and to reach a view about whether those are isolated instances of malpractice, inefficiency or lack of forethought, or whether they are emblematic of a wider trend about which we should be concerned. I am not saying that the statementing process misfires in every local authority in the country, but I believe that the evidence of inadequacy, poor practice and grounds for concern is sufficiently extensive—if not prevalent—for us to need to address the subject.
I have some specific considerations for the Minister and colleagues. I know from the contact that I have had with campaigning organisations and charities in the field—including AFASIC, I CAN, the Royal College of Speech and Language Therapists, the National Autistic Society, and Treehouse, which I had the privilege of visiting earlier this year, to name but a few—that there are anxieties among parents. For example, a lot of parents are actively discouraged from pursuing a statement for their children, or are not even told of the existence of the statementing process. If they come to know about it they are told, “It is very unlikely that you would get a statement; it is not worth trying. There is a Government preference for their reduction and it simply is not the right route to follow. You should go about things in a different way.” That can happen justifiably, but it can happen when manifestly the child would benefit from a statement of special educational needs.
I think that we know—and the Minister can testify from personal experience, I am sure—that in a vast number of cases, if a child does not have a statement of special educational needs, he or she is unlikely to receive speech therapy on any sort of regular basis at all. The argument concerning such a child is that he or she is not the most seriously affected, and that school action—or school action plus a bit of monitoring, waiting for the developmental process to happen and an assessment in due course—will do. However, that is the danger; very often if the intervention does not take place, and if nothing is provided by way of speech and language therapy, the problems of those children will be significantly exacerbated, necessitating a greater investment, and more extensive intervention later, or, failing that, leading to the virtual certainty of seriously aggravated difficulties for the individual and probably for the economy and society as a whole.
Some children who do have statements of special educational needs—this is not a party political point; I found examples of good practice in authorities with different political labels around the country, and I found that some local authorities run by my own party were good, while others were very bad—get very little speech and language therapy. It might, for example, amount to a termly assessment and a brief session with a therapist. I put it to hon. Members that when someone has been deemed sufficiently needy to warrant a statement of special educational needs, to get simply a termly session, or a couple of sessions a term, is palpably insufficient.
There are examples of children having to wait a long time between agreement to the statement and implementation of the requirement to provide speech and language therapy. I know of a case—other hon. Members may be able to invoke still worse and more serious cases—in which a child’s parents had to wait seven months from the time when the statement was agreed to the time when provision was put on the table for the child in the educational setting. There are many instances in which the speech and language therapy is unquantified in the statement—very likely in violation of the letter, and certainly of the spirit, of special educational needs legislation in general and the code of practice in particular—and in which that unquantified commitment is then undelivered. The requirement is unquantified and undelivered and, therefore, the need is unmet. That suggests to me that we should at least consider in the statementing process some sort of scrutiny by an external source of the content of statements, and monitoring of implementation of statements. That failsafe would guarantee to parents that what was in a statement was translated into practice. Parents need that safety valve or reassurance, which is I think lacking at the moment for many children. Let those issues be debated in the course of the review, the visits that we make and the evidence that we receive.
The final issue on which I want briefly to focus is language units. I mentioned that they are often very suitable sources of assistance to affected children. I have declared an interest in this matter before, Mr. Illsley, but for the avoidance of doubt may I declare that interest again, as the father of a child approaching the age of four? My son, Oliver, is in a language unit at a mainstream primary school in Pimlico, and he is getting fantastic help. It is a brilliant unit. He is very fortunate. The unit does not appear to be threatened. Although my interest in the subject of speech, language and communication was, as I have openly and honestly stated, initially founded on and driven by my personal experience, I am not complaining about what my child is getting. We have been very fortunate. Many people have not been as fortunate, and we all have a responsibility to try to do something to better their prospects and improve their care and provision.
What is it about language units that concerns me at the moment? In at least five cases—this is the only point at which I shall name names, of organisations, at any rate—it would be very difficult to ascertain that the local authority provided such units at all. In the cases of Bristol, Durham, Norfolk, Salford and Wandsworth, it is difficult to see from my research and from looking at websites that such a facility is available. The question that I want to ask is, how can parents ask for a place in a language unit if they are not aware of the existence of the unit? The truth is that they cannot.
It seems to me that the wider issue of data collection—having a store of information that is kept locally and perhaps transmitted to the national level—is worth considering in the months ahead. I know of several cases in which people have said, “There is a cut in the number of placements in the units, brought about by the drive to reduce the incidence of statements.” If the cut in the number of places were the consequence of a declining need objectively identified, I should not be wasting colleagues’ time and yours, Mr. Illsley, complaining about the situation. If, however, the reduction is the result of arbitrary and capricious decisions taken to meet some wider and separate but not necessarily justified public policy, it is a source of concern.
People have reported to me through pressure groups and parents’ organisations that a language unit may be gradually run down, and the authority will then say that there is no demand for it. Parents in such authorities have come to me or to colleagues and said, “We were told simply that we had to place our child in a mainstream class”—not in a language unit within a mainstream school—“and we were not informed of the unit’s existence as an option at all.” That seems to constitute an arbitrary run-down of provision.
I know of instances in which such units have come to house children who are on the autistic spectrum and who perhaps have behavioural, emotional and social difficulties. Although some units can cater to such children’s needs, if a child’s primary need is not speech and language therapy, one must at least ask whether a language unit is the proper or best place for that child. We must be careful not simply to push children into a particular facility without reference to their objectively identifiable primary need.
The challenges are considerable. The Government have at least three sources of guidance on the stocks, which I think have been publicly released, that are supposed to inform the consultation process on the future of such units. I have raised the matter with the Secretary of State for Children, Schools and Families, and I should like to be clear in my mind that authorities know clearly what those sources of guidance are, that we can establish what mechanism exists for monitoring their enforcement, and whether Ministers are satisfied that the rules are being followed in both letter and spirit.
I raise the issue in such terms because I am not saying categorically that there is a rampant or majority abuse of the procedures. I should not go so far as to suggest anything of the sort, but the evidence that has come to me is more than merely anecdotal. I hope that colleagues will forgive me if I say that the special needs community, although it is gradually becoming more demanding, articulate and vociferous, and rightly so—I am looking at the right hon. Member for North-West Durham (Hilary Armstrong), who had responsibility for social exclusion for a considerable period—is still not particularly powerful.
I have sometimes cavilled when Ministers, or representatives of any party, have said, “Well, of course these matters must all be determined locally. Local education authorities are elected bodies. They must make their dispositions in these matters, and if parents are dissatisfied they can kick out the authority at the ballot box.” To that piece of institutionalised cant, I tend to reply, “Get real.” For the most part, such parents are few and far between and thinly spread, and they often do not know each other. The idea that by objecting to a particular decision on a given institution in an individual locality they will be able to drive the local authority from office is for the birds. In dealing with vulnerable children, we need protective mechanisms. The Government have a special responsibility, which I am confident they will accept, to monitor what is occurring with a view to securing improvements and redressing bad practice wherever it proves necessary.
The House has indulged me so far, for which I am grateful. I do not think that the issues are ideological at heart. I have reflected on them long and hard. There are differences of emphasis—sometimes quite important ones—between the advocates of inclusion and those who are absolutely and indomitably opposed to it, but my sense, having mixed with a wide variety of people in the field during the past 18 months, is that most people do not subscribe to either position in its extreme form. Most are fairly pragmatic. They can see the benefit of an eclectic mix of provision tailored to the particular circumstances of individual children, and most are prepared to depend on and be guided by what the evidence proves.
In most cases, it is not an ideological matter or the source of a great philosophical tension between the political parties; it is a question of pragmatics and of trying to bring the big issues to the fore. If the Minister will forgive me—I would say this whomever the Government in power were—it is a question of ensuring that, while we are, very properly, preoccupied with our big battles about the future of the health service, education provision and social care, we do not forget those important services that are needed admittedly only by a minority, although a significant minority, and that require uplifting in political priority and public consciousness.
It is worth trying to co-operate across the parties. It is much easier to walk away into one’s hole and avoid any criticism by saying, “Never the twain shall meet; we can’t possibly work with people of another party.” That judgment probably makes for a quiet life, but it is the wrong judgment to make. I am proud to be a Conservative Member of Parliament. I happen to think that such issues are important, and I believe that this place is, on the whole, pretty tribal. Most politicians are too tribal, as are most commentators, but I think on the whole that the public are not very tribal. They rejoice in instances of politicians across the spectrum coming together and considering how to put aside our party differences and work together to better the public provision, especially when the beneficiaries are a group of children who are often very needy, frightened and vulnerable.
I remind colleagues that children with speech, language and communication impairments are disabled children. That is often not recognised. The hidden disability of an incapacity to communicate can be a source of great problems for the individual, for his or her wider social network and—ultimately, if those problems are not tackled—for the country. It would say something positive about this country’s political DNA if we came up during the next nine months with a set of constructive and practical proposals, the implementation of which would alleviate some of the difficulties, improve the quality of provision and raise the life chances of some concerned and frightened children who need our help sooner, rather than later.
I welcome the debate that the hon. Member for Buckingham (John Bercow) has secured, and I enjoyed his excellent speech. I know that he will be busy later today, as he is sponsoring a reception for the Children’s Services Development Group, underlining his point that we owe so much to the many organisations involved in the field. They are right to seize the moment and focus on the issues that he raised, and which hon. Members from all parties have raised in the Chamber and in the various Committees and Departments with which we are associated.
When I saw just before the recess that the hon. Gentleman had secured this important debate, I welcomed it, as I am sure did hon. Members from all parties. During the recess, when I had the opportunity to visit schools in my own constituency, I saw the meaning of many of the things that he said. I welcome the fact that he did not paint a picture of doom and gloom, because there have been many achievements, and we are entitled to acknowledge that. Nevertheless, challenges remain. In my constituency, I have visited excellent schools such Drumpark school in Bargeddie, which deals with special needs children, and Portland school in Coatbridge, which deals with children with behavioural problems. What stood out principally was the dedication of the outstanding people working day in and day out for solutions to many problems and trying to ensure that their children achieve their absolute potential. I realised that this debate would give us the opportunity to offer support and to push things forward a little more urgently, as the voluntary organisations would wish.
I was also encouraged to listen to the hon. Gentleman and to follow his speech, in common with my hon. Friend the Member for Norwich, North (Dr. Gibson), the hon. Member for Mid-Dorset and North Poole (Annette Brooke) and others, because I was delighted to have had the opportunity to chair the all-party review on the needs of disabled children, a review that received outstanding support from the consortium and which campaigned under the slogan “Every Disabled Child Matters”. Indeed, the right hon. Member for Normanton (Ed Balls), now the Secretary of State for Children, Schools and Families, was very encouraging and proactive, and we were able to produce a report that was inevitably much more general than the specific issues that the hon. Gentleman is dealing with this morning but which led to a very positive response.
I can tell the Minister for Schools and Learners, who will reply to the debate, of the very considered response to the work of the all-party group. It listened to those organisations that wanted to be heard, and even to some disabled children—for example, young people who were concerned about that period of transition. When considering the response to the all-party report, we saw that the Treasury and the then Department for Education and Skills was allocating an additional £340 million to deal with those issues. My Scottish colleagues will be delighted to know that under the Barnett formula we received £34 million—something that I hope the hon. Gentleman will remember in his review.
The all-party group made steady progress, but it would not have been right then to sit on our laurels and say “That’s fine. We’ve done a good job. End of story.” Our constituents would have told us that, as would parents, because our experience of visiting schools and working in education—I know that this debate is largely to do with education—shows that there are problems of poor provision and low attainment.
Speech, language and communication are extremely important. The challenge is to ensure that the policies of Government and Parliament, in their respective roles, have a clear influence to ensure that progress is made.
Like the hon. Gentleman, I welcome the contribution of the organisation I CAN. It has shown through projects such as Make Chatter Matter and initiatives such as the Chatterbox Challenge that, in many ways, the voluntary sector is leading the field. I doubt whether anyone would want to dispute the important role of the voluntary sector and the charities in this important matter because, in truth, they are addressing some serious problems, such as those of early identification—something that many local authorities have yet to address.
It is often said, although it is regarded as trite to say so, that to some extent there is a postcode lottery, and I am afraid that the facts indicate that that is so. Some local authorities appear to have other priorities. I do not criticise those priorities, but on the evidence and based on our experience it is absolutely right that we should address those issues this morning. For example, 1.2 million children in the United Kingdom have a communications problem that requires special help. On average, that is three children in every classroom. We are told that children are arriving at school without the skills to achieve their full potential. That is the principal challenge. In some areas, particularly in those with heavy unemployment and housing that is below acceptable standards—in other words, areas of deprivation— 80 per cent. of those children are being doubly penalised because we are not addressing, as we want to, the issue of speech and language services.
The hon. Gentleman rightly referred to the question of training, which is hugely important. He also mentioned the Communications Trust survey; and the trust is doing a first-class job. However, another finding of the YouGov survey was that preparation and training for serving children with special needs, who have speech and language difficulties, is that such preparations are often falling apart in some local authority areas. It showed that 61 per cent. of staff over the age of 45 had SLC training, yet only 37 per cent. of staff aged under 35 had it. That is extremely worrying, and obviously unacceptable. It is important, therefore, to underline training—as the hon. Gentleman did. Communications problems can occur in isolation and as a result of other disabilities such as autism or Down’s syndrome, or even hearing impairments. We should have a proper collection of data. In other words, we should find out what the problems are so that we can compare and evaluate achievement and try to encourage a rise in standards; but that is not the case, and I think that they were doing a fine job in seeking to achieve the objectives upon which I think we can all agree.
I underline the excellent points made by the hon. Gentleman about early intervention. It is absolutely crucial. We hear of tackling the difficulties of children with behavioural problems, but who knows what lies behind those problems? Who knows what family influences there were as the children left for school in the morning? In some cases, I wonder whether attainment in speech and language is not influenced also by those other problems. If so, we must take it on board.
I welcome the debate. I know that the Minister takes these matters seriously, and I hope that he has the opportunity to respond to all the points raised this morning. I hope that there may be a closer working relationship—the Minister’s body language is interesting—between Departments. We want to see them working together, and the Department of Health looms large in that. We want to ensure appropriate local authority responses, and we want to know that the Government will respond effectively to them and others in commissioning speech and language services.
I welcome the opportunity to speak on this important issue. I wish the hon. Gentleman well—particularly on the important review in which he is so heavily involved—and congratulate him on introducing the debate.
Thank you. I was confused by the time.
I congratulate the hon. Member for Buckingham (John Bercow) on securing the debate, on his speech and on his new role in leading a major review for the Government on the provision of services for children and young people with speech, language and communication needs. Since our last debate in Westminster Hall on the issue, which was almost a year ago, not only has a major review been announced, but the communication trust has been set up.
Those announcements were preceded, however, by the various reports that have been mentioned. For example, the Pubic Accounts Committee report concluded that
“more needs to be done to meet specific needs such as speech and language therapy to provide the early intervention that is critical to child development.”
The Ofsted report on the foundation stage said that
“standards in communication, language and literacy were lower than expected and children’s speaking and listening skills were weak in a third of the settings visited”.
If we were writing a report for the Government on progress on the issue during the past year, we would judge that they can and must do better. Although there are examples of excellent practice, progress has been patchy overall and the new initiatives face challenges. I am absolutely committed to the fact that children’s communication skills must be at the core of the Government’s development of children’s policy. However, it is not just a matter of policy; there must be real changes on the ground.
We have talked this morning about early intervention, and I agree that we need to understand exactly what we are talking about and to identify good and not-so-good practice. We know that about 50 per cent. of five-year-olds arrive at school without the speech and language that they need to fully participate and achieve their full potential. That figure rises to 80 per cent in areas of high unemployment and poor housing.
The Ofsted report to which I referred identified a widening gap between boys and girls. We must consider the significance of that gap in respect of future educational attainment. Much is made of attainment at age 11 and of the fact that a quarter of children do not achieve satisfactory standards in literacy and numeracy. How much of that problem stems from a lack of early intervention and a failure to deal with the issue when it needed to be dealt with? We know that poor language and communication skills have a knock-on effect on behaviour. Not surprisingly, when a child becomes socially isolated and does not have the tools to integrate with his or her peers, behavioural problems develop. We know that many young people who end up in young offenders institutions have poor language and literacy sills. It is vital that we put more emphasis on a holistic approach to the issue.
I would like to emphasise that speech and language needs are complex. We are talking about a whole spectrum of needs, and I worry about the suggestion that one solution fits all. Transient problems can be sorted out with sufficient speech therapy and with back-up in the home. Such transient language difficulties are probably caused by our lifestyle—watching too much television, not sitting down for meals together and a lack of communication in the home. However, there are also very severe and highly specialist needs that may or may not be accompanied by another disability. We must be very clear about what approach we need to deal with this issue.
I shall refer to a case study that I have been dealing with this summer, but I will of course also discuss more general points. A grandmother came to see me whose grandson was aged four and did not speak a word, which was quite alarming. I raised the case separately—I could not get to talk to one person—with the primary care trust and the head of children’s services. That process started reasonably well because Tyler was first referred to the speech and language therapy service by his health visitor—my first point of call. The provision of health visitors across the country has become patchy, and although I support the intensive help given by family nurses to vulnerable families, basic health visitor provision is vital because that is how these issues are most likely to be picked up. The Family and Parenting Institute study has clearly shown that there are deficiencies in health visitor provision.
Returning to the case study, that first referral was the good news, and Tyler was seen in June 2006. Unfortunately, staff shortages meant that Tyler was not seen again until 7 December 2006—six months on at a critical time in the child’s life. Treatment then improved as speech therapy was given and it was recommended that Tyler receive specialist nursery provision. However, the provision was in another authority and a lone parent could not get the child there. There was no offer of transport or other help. I then wrote to children’s services and asked why such specialist provision was not in our authority. The reply said that the
“development of daily ‘drills’ by the therapist passed on by the pre-school staff are in the view of many professionals preferable to occasional attendance at group sessions.”
That proves the point that we need the whole spectrum of provision to match the whole spectrum of needs. Some children will benefit from projects such as I CAN and from intensive provision in a pre-school setting. Other children will benefit from speech therapy that is backed up with support from home. It must be the right mix for the right child, and I do not apologise for talking about an individual case, because the crux of the matter is that we are talking about individual children for whom we must get the best support. I am greatly concerned that a child would have fallen through the net if it was not for their grandmother raising the issue. It is difficult for parents who do not know their way around the system to access what they need.
We have repeatedly said this morning that training is critical for nursery school teachers. I had a parliamentary answer in July saying that only £37 million of the children’s transformation fund for training had been spent. Surely we should be spending the money to put the essential training in place. We must use the early years foundation stage, which becomes statutory in 2008, as an opportunity to ensure that staff are trained and that we do not have the rigid curriculum that some of us fear. We must take the opportunity to ensure that we have early identification and intervention, and most of all that we foster language and communication skills for every child.
As good as we as a society—not me personally—may be at information and communication technology, we have a problem with basic communication. We need to know how big the problem is, as the right hon. Member for Coatbridge, Chryston and Bellshill (Mr. Clarke) said. Considering the range of communication and language difficulties, do our local authorities know the extent of the problem? We have discussed statementing this morning. The Government must not bury their head in the sand and pretend that all is well. As MPs, we know that that is not the case. There is much more to be done to ensure that children can access the support that they need, that the finance is there and that we have qualified professionals who are trained to deliver that support. Joint working between health and education services locally and nationally is vital. For a long time I have been concerned about a situation with Dorset county council. However, we should congratulate it this morning because it has employed a full-time health worker in its children’s services whom I have met and spoken to at great length. It is such a pity that I have so many different authorities in my constituency; I can always find problems.
Finally, I want to mention some of the important points Scope made to us about—I shall have to read this bit in full—the availability of appropriate additional augmentative communication aids; now I can say AAC. Scope has been raising those issues for some time, and its conclusions were really interesting, as they are the same as those that we are making on other points. It referred to:
“Better training on AAC for Speech and Language Therapists and teachers…joined-up services across all ages”
and the need to establish who is responsible for the provision of the equipment. That is another dimension that I hope will be covered in the review of the hon. Member for Buckingham.
First, the answer to that is yes. That is an important issue; I did not address it because I wanted to focus on other subjects today, but the question of assistive and augmentative technology is important. It will certainly fall within the terms of the review, and we will consider it very seriously. Secondly, the hon. Lady might be interested to see a quite informative article in the education section of The Guardian today that focuses, among other topics, on that point.
I thank the hon. Gentleman.
In conclusion, I want to re-emphasise that we are looking for the right provision for each individual child, whether that is in mainstream education with proper support or in a specialist unit. Whatever comes out of our debate today, it is about ensuring that our children are able fully to access a curriculum at school and to have a rich lifestyle. They cannot have that if they have those language and speech impairments.
First, I declare my interest, as in the Register of Members’ Interests, as the chairman of a company involved in educational support services.
I add my congratulations to my hon. Friend the Member for Buckingham (John Bercow), who made a typically well-informed and robust oration, all without notes—another 30 minutes and he would have equalled the achievement of my right hon. Friend the Leader of the Opposition at the party conference last week. It was a particularly impressive, detailed and heart-felt contribution, but then my hon. Friend has form in this area. He mentioned the debate that he instituted in this Chamber almost a year ago, his role as the chairman of the all-party group on speech and language difficulties and, of course, his close personal interest because of his son. That interest is shared by my right hon. Friend the Leader of the Opposition through his personal experience, which is why he has concentrated for much of his time during his years in this place on the subject of special educational needs. The subject is close to many of our hearts, and all hon. Members will have a personal interest or will have been approached by many constituents. It is right that that should be mentioned.
My hon. Friend the Member for Buckingham made a number of points, and I do not need to repeat them, but I was particularly interested by his undertaking that he is interested in seeking out best practice, because the experience is patchy up and down the country. I was encouraged by his reference to the role of parents, because it is the parents who have the 24-hour, day in day out responsibility and care and often do not get the support that they need. He also mentioned the great dedication of some of the people involved in the lobby, but it is a fairly disparate lobby and so it is right that this place should speak up for a minority that desperately needs support.
We hear an awful lot about the numbers of doctors, nurses and teachers, the number of heart operations that take place, improvements in cancer treatment, the number of GCSE passes in schools and so on. We hear very little about the problems connected to speech, language and communications, and virtually nothing about the number of practitioners and therapists available up and down the country—I fear that there are woefully few. Communication is vital to social and educational development and, as the right hon. Member for North-West Durham (Hilary Armstrong) said, the right sort of early intervention is the right investment to make as early and as appropriately as possible, and it is a false economy not to do that. It is also right that early intervention should involve a joined-up approach between schools, pre-schools, Sure Start—that is why I am so pleased about the I CAN pilot projects in Sure Start children’s centres—and the health service, too, so that a seamless support operation can be put in place.
We need more specialists and a greater understanding among teachers and other professionals in health and education. Apparently, an estimated 7,000 SLC therapists are on the books in this country. It is estimated that we need at least some 2,300 more and there is a question about the training places available for many of those coming out of university who want to go into that area.
A survey by the Royal College of Speech and Language Therapists recently found that 78 per cent. of managers questioned said that their budgets were being frozen, and 50 per cent. said that they would be obliged to provide an inferior service or to conclude that the service was altogether non-viable. The area has not had the attention or investment given to other areas of education and health.
Does the hon. Gentleman accept that although we will always need more specialists, if we have more effective intervention at an early age, new parents learn how to communicate with their children and do so much more effectively? Does he agree that that is the way to ensure that many of the most disadvantaged children, rather than those with a specific disability, get through their speech and language difficulties?
The right hon. Lady’s point is self-evidently right, and hence my point that it is a false economy not to make that early investment and to work with parents and everybody else.
We will all recall that the Select Committee report published last year made some concerning comments about the SEN system in this country. Many hon. Members have mentioned the statistics about the six in 100 children who will at some stage have a speech, language or communications difficulty. The hon. Member for Mid-Dorset and North Poole (Annette Brooke) mentioned the high number of children who arrive at school without the basic speech and language abilities that they need. My hon. Friend the Member for Buckingham mentioned the 73 per cent. of staff who have not had proper SEN training. The right hon. Member for Coatbridge, Chryston and Bellshill (Mr. Clarke) made a good point about the demographics, too. The expertise is with older staff who are coming up to retirement and less with younger staff. There is a potential demographic time bomb that we seriously need to deal with.
I CAN’s “Cost to the Nation” report noted that impoverished language is an emerging 21st century problem that results in lower academic outcomes in children with persistent language difficulties. We obviously need to tackle it young. As we know, there has also been a reduction in specialist provision. There are 146 fewer maintained special schools than in 1997. The number of places in state special schools has fallen by more than 5,000 since 1997. Although it is appropriate in some cases for children to be able to go through the mainstream school sector, in many cases that can be viable only if the support is available in those schools, often on a one-to-one basis. I am afraid that that level of support has not been matched in too many cases.
I want to praise the work of I CAN and many of the other organisations involved in this area. I CAN operated a school in my constituency that unfortunately had to close a few years ago but had an excellent reputation. I CAN commented on the Ofsted report on the foundation stage, which came out in March of this year, and made the point that
“it is clear that more should be done from top to bottom to identify and then support young children with SLC difficulties.”
It identified this fact:
“Workforce reform is something that is critical to this process and the government and Local Authorities must do more to up-skill the workforce in this area.”
It also said:
“I CAN wants to see more being done to support all staff who work with children, with particular consideration to be given in ensuring that additional speech, language and communication support is made available in areas of high deprivation where the links to impoverished language are clear.”
I CAN also commented, as did my hon. Friend the Member for Buckingham, on the relationship with health and the need for greater joined-up working between education and health, and on the joint working and ownership of the work force, because speech and language therapists might be employed by health services, local authorities, schools, charities or social enterprises, or might be working privately. A vicious triangle is operating here. Often, those who bring cases to me requiring speech therapy support have gone already to their education authority, which has said, “Oh, that is not for us. It is health.” They then go to their PCT or hospital and are told again, “Oh that is not for us, but for children’s or social services”. That is a vicious triangle. The problem does not go away if we pass the buck. The longer that that buck is passed, the bigger the problem with that child might become. We need much better joined-up working.
Although I welcome the greater joined-up working in Sure Start children’s centres, I fear that because of budget constraints, PCTs have too often been retrenching on some of their joint funding arrangements and that a bigger burden of the bill has therefore fallen into the lap of local authorities, which is putting particular strains on the provision of some services through Sure Start children’s centres. There are reports from around the country that some language units are being closed without proper consultation or risk assessments, often for the very reasons that my hon. Friend mentioned. It is very important that we have integrated working across health and education for the benefit of children with speech, language and communication needs. Surely, that is a crucial part of the “Every Child Matters” agenda as well. The fact that only five of the 27 children’s centres surveyed by the National Audit Office work closely with their PCTs shows that such joint working has a lot further to go.
I want to make two other brief points. As I said, the Conservative party has taken this matter very seriously. Earlier this year, a commission headed by Sir Robert Balchin reported on the question of special educational needs and made this recommendation:
“Statements should be replaced by Special Needs Profiles (SNP) drawn up by Profile Assessors, who would be educational psychologists and others, possibly operating in consortia.
These Profiles would be cumulative and subject to regular review to ensure that the continued provision is as dynamic as the child’s needs. As early intervention is crucially important. Special Needs Profiles should be created as early in a child’s life as possible.”
My hon. Friend touched on the problem with statements: there is a reluctance to refer people to get a statement, and ignorance about the availability or mechanism for getting one. However, if a person does not get one, they are very unlikely to get the services that go with it. That is a Catch-22 situation, which is absolutely intolerable and serves only to worsen the situation and the concerns and angst of parents having to deal with very complex problems with their children.
Does my hon. Friend agree that when we get people writing or coming to our surgeries seeking a statement for their children and it transpires that their need is demonstrable, we as Members of Parliament often end up thinking, “Thank goodness that we have been able to help them, but what about all of those who did not know that they could come to us”? I know that that is emblematic of many other features of public policy across the piece, but I put it to him that there is a gulf between people who are educated, articulate, broadly middle class and not completely empty-pocketed, who on the whole are used to jousting with authority, and who can write letters and fight a battle, and those who are uneducated, inarticulate, hard-pressed, possibly in very difficult family circumstances and who cannot cope. We have an obligation to them.
My hon. Friend is absolutely right. Those whom he mentioned at the end are most usually in the greatest need of support, but perhaps it is the most articulate and tenacious whom we see and who then take up the cudgels.
What impresses itself on me more than anything in this respect is the battle that such people have with local authorities, or whatever agency. If the money that is wasted on rejecting claims and on the appeals process—the number of appeals has increased enormously—were targeted at providing the services, rather than on trying in too many cases to deny parents what is a right, the system might work rather better. We should be putting every piece of support and help at the disposal of those parents, rather than seeking to put obstacles in their way, as appears to be the case so often.
Finally, may I leave the Minister with a few questions, to add to the great list that I think he has already? His Department has said that it will be making speech, language and communication a key issue, so we would like to know exactly what it intends to do to improve the situation for children with communication difficulties. Will he commit to working more closely with the Department of Health at a senior level to explore what more can be done between agencies and to provide joined-up political leadership? What will the Government do to ensure that all members of the educational work force are trained to identify and support children with a communication disability? What will he do to ensure the appropriate local assessment and provision for children with SLC difficulties? How will the Government support local authorities and PCTs to effectively commission speech and language services?
I know the Government’s commitment on that matter. The work that the Minister’s colleague, the Secretary of State for Children, Schools and Families, did earlier in the year was excellent, with the support and great energy of the right hon. Member for Coatbridge, Chryston and Bellshill. However, we need action and to see how this will happen. We need to ensure that suitable resources are targeted in the right place, so that we can have serious results for those whom we all see in our constituencies, whose case was so well articulated by my hon. Friend.
It is a pleasure to respond to what has been an excellent debate with well-informed and interesting contributions from all right hon. and hon. Members. In particular, I commend the hon. Member for Buckingham (John Bercow) on securing this debate and on being, as always, such an eloquent and persuasive advocate for children and young people experiencing communication difficulties.
I also take the opportunity to congratulate the hon. Gentleman on his appointment to lead the recently announced review of services for children and young people with speech, language and communication needs. That has left me in an interesting position in responding to him, because, clearly, we have acknowledged not only that we want to improve such services further—we would not have commissioned a review otherwise—but his expertise. It was tempting to ask him to write my wind-up speech for me. However, it is important to acknowledge that the fact that he is doing this review does not mean that he does not remain an independent and staunch advocate for the children about whom he has been talking today.
The hon. Gentleman’s appointment to head the review is a signal of the need for us to co-operate across parties, as he talked about towards the end of his remarks, and of the need to move away from tribalism when dealing with such vulnerable young people. I shall not fall prey to the temptation to reel off statistics about how, although 166 special schools have closed in the last 10 years, it is not as many as the 234 in the previous 10 years, and all that kind of stuff, which bores everybody.
We have heard well-informed and insightful observations during the debate. I tried to listen carefully and shall respond to as many of them as I can in the time that I have. The hon. Gentleman raised substantial points about training and co-operation. An informed and confident work force are essential if children with special educational needs are to receive the support that they need. I think that it is right that he is concerned and that other right hon. and hon. Members echoed his points.
To help early years practitioners, we have issued Communicating Matters training material and are working in partnership with I CAN—a children’s communication charity—to pilot its early talk training programme in 200 children’s centres. Similarly, all schools staff need to have the skills and confidence to support appropriately children with special educational needs, including those with speech, language and communication needs. To help raise teacher confidence, we are launching, in one week’s time, through our national strategies work, a major programme of professional development for teachers and other staff in the form of the inclusion development programme, which the hon. Gentleman mentioned.
The IDP is funded with £2 million to support the first body of work that is attached to it, and local authorities will also have the school development grant to support the training and development of teachers. I am sure that the hon. Gentleman will consider that issue. However, we have told the IDP to begin by focusing on speech, language and communication needs and on dyslexia, which demonstrates the importance that we attach to children’s ability to communicate.
The newly formed Communication Trust will build on the IDP by guiding teaching staff to more specialised training and sources of information and assistance. My Department has committed £900,000 in support of the trust, which is a collaborative venture between the communication charities I CAN, AFASIC and the Council for Disabled Children.
The hon. Gentleman also discussed specialists and supply therapists, but before I move on to that issue, I shall touch on the issue of early intervention, which he raised, as did my right hon. Friends the Members for North-West Durham (Hilary Armstrong) and for Coatbridge, Chryston and Bellshill (Mr. Clarke), and the hon. Member for Mid-Dorset and North Poole (Annette Brooke).
Early identification is the key to supporting special educational needs effectively, ensuring that all the right support measures are in place as soon as possible. From September 2008, all settings offering early years provision will be required to deliver the early years foundation stage, which supports all settings in their planning of activities and experiences that can help all children to make progress in their development and learning. It stresses the importance of practitioners being alert to the early signs of needs that could lead to later difficulties, and it provides a framework to enable early years practitioners to respond quickly and appropriately, involving other agencies as necessary.
Collaboration between services is essential to the provision of good speech and language support. Sure Start children’s centres that are aimed at the youngest children have a critical role to play, as our practice guidance for centres acknowledges. We are ensuring that all children’s centres promote language acquisition and identify speech and language difficulties as part of their universal provision. All children’s centre staff should be trained in language development by a speech and language therapist to help develop a centre-wide strategy and approach, and to ensure consistency among all staff. Through Children’s Trust arrangements, local authorities and health services should jointly commission speech and language services to ensure that children’s centres offer easy access to those services.
However, we recognise that, as the hon. Gentleman said, not all centres currently provide services of the quality that we would like. That is why the children’s centres practice guidance that was issued in November 2006 gave details of the best practice that we want all children’s centres to develop. We are also working in partnership with I CAN to pilot its early talk training programme in 200 children’s centres.
As far as I understand, the guidance will not be mandatory, but I shall look at that issue, and if we need to give the hon. Gentleman more information about it, naturally, we will do so.
During the debate, we heard important points about the involvement of, and information for, parents. Local authorities have a clear legal duty to make available to parents information about the SEN provision in their area, including specialist speech and language resource provision or units. Local authorities must make that information available on their websites and provide a written copy on request. The statutory SEN code of practice, by which local authorities must be guided, advises authorities that they must ensure that information is available and accessible for all parents, and that they should work with the local parent partnership service to secure that outcome. The parent partnership services work to minimum standards that are also set out in the code. The standards state that partnerships should ensure that parents are provided with accurate and neutral information on their rights and on the wide range of options that are available for their children’s education, including specialist speech and language provision.
In our response to the report by the Select Committee on Education and Skills about SEN last year, we undertook to exemplify the minimum standards in the SEN code. We set clear expectations for parent partnership services in every area to increase parental confidence in their impartiality and the quality of information and advice that they provide. That work is well under way, and it will be issued later this term. That issue is about more than information, however. It is something on which I shall reflect, and I look forward to the comments in the review that the hon. Gentleman is leading, so that I can reflect a little more on the way in which we encourage better involvement, particularly from that broadest range of parents whom he described during his intervention on the hon. Member for East Worthing and Shoreham (Tim Loughton).
I accept that there is a certain amount of anxiety among parents about statementing. Parents have a right under the Education Act 1996 to request that local authorities assess their children’s special educational needs with a view to the children being given statements. If the local authority declines the request for an assessment, the parents can appeal to the SEN and disability tribunal, whose decisions are binding on local authorities; and as I have said, in each local authority, the parent partnership service should give practical, unbiased advice about special educational needs, including statementing. Local authorities cannot have blanket policies not to assess certain groups of children. The Secretary of State will investigate any complaints against authorities, and if there is evidence of such policies, he will issue directions to the authorities to remedy the situation.
The SEN regulations also set out statutory time limits for completing statements, which amount to 26 weeks from the initial request for an assessment. Figures collected by the Audit Commission show that in 2005-06, 95 per cent. of draft statements were completed in the statutory 18 weeks, when none of the allowable exemptions, such as health or social services being late with their advice, came into play; and that almost 80 per cent. were completed when they did. We are introducing a new indicator to monitor how many statements are completed within the statutory 26 weeks, and we hope that it will improve matters.
I do not sniff at the fact that the speed with which statements are completed is an important subject; I know that the Government have a target for it, and that they are pleased that there has been some progress. However, may I put it to the Minister that it is not necessarily either the only or the best target and that what is incredibly important is that, once the content of the statement is agreed, the lead-in time to its implementation should be as short as possible? Does he agree that delays of several months and more are simply unacceptable?
I certainly agree that such delays are unacceptable. As soon as a statement is finalised, a local authority has a statutory duty to arrange the educational provision set out in the statement, including any speech and language therapy that is specified as necessary educational provision. In practice, there may be some delay—for example, with the local authority having to arrange speech and language provision with the health service; but in cases in which there is an unnecessary and lengthy delay in putting the educational support in place, parents can complain to the Secretary of State on the ground that the local authority is failing to carry out a statutory duty. Naturally, we would consider such situations seriously, because some delays that we hear about anecdotally are unacceptable.
I shall return to the issue of the supply of speech and language therapists. It is important that we bring services together through such measures as extended schools and children’s centres, which I have discussed. The number of qualified speech and language therapists has increased by more than one third since 1997, but we must do more. We must ensure that we match up affordable demand and supply in the NHS work force, and we must focus on strengthening front-line capacity through increases in productivity and the skill mix. I am sure that we will hear more about that from the hon. Gentleman in due course.
The hon. Gentleman also referred to concerns about unit closures. He has raised those concerns in the House, most recently at oral questions on 26 July. Since May 2006, local authorities have had to apply a statutory SEN improvement test when they plan to close a dedicated language unit or to remove resource provision. To obtain a clearer picture about the situation regarding language units, our national strategies SEN advisers have been asked to identify the number of existing units in each local authority and any plans to change the number in 2008. The review that the hon. Gentleman is leading will—I am sure—consider the merits of going further on data collection, with due regard to the need to minimise burdens on schools and local authorities. I look forward to seeing what his review suggests.
Supporting children and young people with speech, language and communication needs and their families is a key priority for the Government, but no political party can or should claim any monopoly of concern about this subject. Much is already being done to help improve services and provision, but more must be done to ensure that everyone gets the type of support that they need, when and where they need it. We are committed to improvements in the system and better collaboration between health and education.
The review that the hon. Gentleman is leading will—I am sure—cast new light on those elements that are working well and on those elements that need improvement and change. We await with interest its outcome.
It is a great pleasure to be under your eagle eye today, Mr. Illsley, while we discuss this important issue.
It is well recognised that inequalities exist in all advanced countries, but it is equally sure that where the extremes are closer, the societies are better. The issue is not just a moral one but one of self-interest for everybody in the country. The Labour party exists to lessen such inequalities. That was why it was formed, and it is why many Labour Members joined it.
Inequalities in health are stark. The life expectancy gap between those in the poorest and richest parts of the country is often 10 years or even more. Morbidity—the way that people feel about their health—follows the same path. Labour recognised that in our 2001 manifesto, in which we stated:
“There has been a growing health gap between rich and poor. Beyond other commitments to combat child poverty and poor housing, we will tackle the long-standing causes of ill-health and health inequality”.
In our 2005 manifesto, we stated:
“By 2010…we plan to reduce the health inequalities that exist between rich and poor.”
That aim was exemplified in the policy document that went to all Labour candidates for that election, in which we stated:
“It is simply unacceptable to us that the opportunity for a long and healthy life today is still linked to social circumstances, childhood poverty, where you live, how much your parents earned, how much you earn yourself, your race and your gender…Though health inequalities remain, we are determined to use a third term in office to reduce them further.”
That is clearly recognised. Indeed, in his first speech on taking office, the new Secretary of State concentrated on health inequalities. There is no difference between ourselves and the Government on what we want to achieve.
I shall not take any lectures or strictures from the Conservative party on the issue. In all the time that it was in office, it refused to allow it to be discussed. The recent Joseph Rowntree Foundation report indicated clearly that, in the years between the 1980s and 2000, health and social inequalities widened dramatically. Rather than any strictures, an apology would be in order.
To tackle health inequalities, we must first identify them. Two headline figure indicators have been identified: infant mortality and life expectancy. In November 2004, spearhead authorities were identified to tackle health inequalities. They were classified as those in the worst 20 per cent. of authorities in England in three of the following five areas: cardiovascular mortality; cancer mortality; life expectancy at birth for both males and females, and the index of multiple deprivation. Wigan is in the worst 20 per cent. in all five categories.
Health inequalities are recognised as an issue and identified as a geographical problem. So what about the means and resources of tackling them? The Government have a formula whereby they distribute 75 per cent. of their health budget to primary care trusts. That formula measures health needs by taking account of age, sex, mortality, morbidity, the cost of living and economic deprivation, and it produces a target for each PCT. I should emphasise that it is a Department of Health formula—it is the Department’s assessment of the health needs of each area. However, the actual funding does not follow the targets set by that formula. It is guided by them, but does not follow them. The guidance is not particularly well followed, as I shall show shortly.
Prior to the 2005-08 comprehensive spending review round, a group of Members pushed the then Secretary of State, the right hon. Member for Airdrie and Shotts (John Reid), to speed up the pace of change and the rate at which PCTs get closer to their targets. I wish to pay tribute to him, because we were reasonably successful, particularly in the areas that were seriously below their target funding allocations. For instance, in 2005 Easington PCT was £25.5 million below its target funding. It is now £6.5 million below—a shift from 16.2 per cent. to 3.5 per cent. below. That was replicated in many other areas that were seriously below target in 2005, and we should pay tribute to the then Secretary of State for making those massive improvements, which laid a firm foundation upon which we can build for our next comprehensive spending review round. This debate is essentially about making further progress on that.
Despite the efforts of the then Secretary of State in the 2005-08 round, primary care trusts still do not receive the share of funding that the Department says they need to tackle the health needs of their populations. The differences are stark, and many of them are inexplicable, especially when set against the Government’s stated aim of reducing health inequalities. Ashton Leigh and Wigan PCT is £11 million—2.4 per cent.—below its funding target. Westminster PCT is £41 million, or 11.6 per cent., over its target. Newham is £15 million, or 3.2 per cent., below; Richmond is £28 million, or 13 per cent., above. Bradford is £20 million, or 3.5 per cent., below; Brent is £20 million, or 4.8 per cent., above. Liverpool is £25 million, or 3.2 per cent., below; Lambeth is £56 million, or 12.6 per cent., over its target. Incidentally, that last example shows a totally inexplicable increase, because in three years Lambeth has moved from being £25 million over target—6.4 per cent.—to being £56 million, or 12.6 per cent., over. Rather than moving in the right direction, some PCTs are moving in totally the wrong direction.
I emphasise that the issue is not one of north versus south. It is about deprived areas throughout the country, and deprived boroughs in London are as underfunded as many of the areas in the north and the midlands. Newham is £15 million below its target, Barking and Dagenham £10 million below, Tower Hamlets £14 million below and Hackney £15 million below. The matter is not north versus south, it is about health inequalities, deprivation, health need and funding PCTs to address their health needs and reduce inequalities.
I represent the poorest region of the UK, Cornwall and the Isles of Scilly, which is below its target for the funding available to the PCT. Does the hon. Gentleman agree that it is inappropriate that, in such circumstances, PCTs with appointed, not elected, members, were forced by the Department of Health to spend 15 per cent. of their limited resources within the acute sector in private hospitals, rather than support struggling NHS hospitals? Does the hon. Gentleman agree that such decisions should be made locally, not enforced on PCTs by the Department of Health?
I do agree, and that is an issue that we have addressed previously. Indeed, the Department has made changes to the second and third round of independent sector treatment centre procurement, and those changes will address the problem. While I understand the hon. Gentleman’s point, it is not fundamental to the issue that we are discussing, which is about overall health funding rather than how the funding is spent in particular areas. However, I take his point.
I shall give an example with which my hon. Friend may not be familiar, from my own area of Wolverhampton. Infant mortality improvement has completely stalled in recent years, and male life expectancy is rising at a much slower rate than national male life expectancy. That may well be related to Wolverhampton City PCT’s having been under formula for many years.
My hon. Friend is absolutely right and raises an important issue. We have not merely been underfunded for the past three years; the underfunding is historical and goes right back to 1948, when the NHS was formed. The number of GPs that our PCTs are able to employ and the number of interventions that we can make in our areas are seriously lower than in the areas that I have identified as being over target. That is not only because of the funding of the past three years, but because of the nature of the funding, historically. All that impacts on health inequalities. Whatever happens in this comprehensive spending round and whatever Ministers are able to do about the problem, the impact will not be immediate or dramatic—it will be a long haul. We must recognise that it will take a long time to reduce the health inequalities in our country, and we must make a start now.
In August 2007, guidance was given to spearhead PCTs on reducing standard mortality ratios in a range of areas. In Wigan, although cancer mortality rates are down, they are not down as much as for the country as a whole, so the gap is widening. Life expectancy in Wigan is improving, but only at the national rate—the gap is staying the same. With cardiovascular diseases such as heart attack and stroke, our standardised mortality ratios are consistently 40 per cent. higher than those for the UK, nationally. Those PCTs that have been identified as spearhead trusts have been given no extra funding to tackle those issues. Where specific funding has been given—for smoking cessation services, for example—and practice nurses have been used in GP surgeries to screen for cancers, there have been dramatic improvements. The lesson that we can learn from that is that additional resources bring improved results.
In 1997, in a reversal of the disgraceful attitude of the previous Tory Government, Labour commissioned Sir Donald Acheson, the then chief medical officer, to review health inequalities. His report made 39 recommendations, only three of which were directly related to the NHS. Inequalities in health indicate that there is wider deprivation and have an impact on that deprivation. This is an important point. We are not just talking about inequalities of health as a result of deprivation: inequalities of health and in the way in which people are unable to contribute to the local economy help to create deprivation in those areas.
Other agencies, particularly our local authorities, will have to tackle areas of multiple deprivation. That point was recognised in the 2002 Wanless report, in which Wanless drew particular attention to personal social services. Many local authorities and PCTs, including my own in Wigan, now have joint commissioning and pool the funding for those services. But there we hit yet another difficulty—many of the local authorities covering the areas in which PCTs have below-target funding are themselves inadequately funded. Just as the Department of Health has a formula to calculate health needs and allocate funding accordingly, so does the Department for Communities and Local Government. Just as that formula is not followed by the DOH, it is not followed by the DCLG. Almost inevitably, the local authorities that are underfunded in health are also underfunded in local government. Wigan is £10 million underfunded in local government, while Westminster is £18 million overfunded. Bradford is £12.5 million under, while Brent is £21.5 million over; Newham is £15 million under and Barking and Dagenham is £14 million under, while Richmond is £13.5 million over and Wandsworth is £49 million over.
Will my hon. Friend allow me to add the figures for Sunderland to that list? My local authority, which also represents one of the more deprived catchment areas, estimates that it was down just under £7 million in 2006-07 and £6.4 million in the current financial year.
I think that all Labour Members present could give figures for our areas and show that we are underfunded not only with our health allocation, but in local government. That is important because of the way in which they interact and affect each other. If we are to tackle health inequalities, we must also tackle other areas of deprivation.
I appreciate that it is not in the purview of the DOH to review local government funding, but, as Sir Donald Acheson made clear and as Wanless has re-emphasised, we will not reduce health inequalities through the NHS alone. The two Departments must tackle the problem jointly. To continue the double whammy of underfunding PCTs and local authorities serving the same local population will mean that those populations will continue to suffer health and social inequalities.
The debate is timely because this afternoon the Chancellor of the Exchequer will announce the comprehensive spending review for 2008-11, which will allocate health and local government resources nationally. In his 1998 report, Sir Donald Acheson said that only three of his 39 recommendations related directly to the NHS. The most important of those three was the need for a
“more equitable allocation of resources”
within the NHS.
I totally support my hon. Friend’s comments, but does he accept that there is also a problem within areas? A problem with semi-rural constituencies is that people living in the more rural areas who do not have income to support them are often very disadvantaged in health terms. It is important that we drill down—I suppose that is the in term—to look below the macro picture at what is happening on the ground. Does he agree?
I do agree. In my borough, the best ward is at around the national average, whereas six or seven wards are in the bottom 3 per cent. of deprivation in the country. Within each of our areas will be areas that are relatively well off and healthy, and areas that are significantly unhealthy and significantly worse off.
The debate is vital for all our constituents who die before their time or who suffer debilitating illnesses and grow old before their time. The size of the national health cake has been decided, and we will hear an announcement on that this afternoon. A more equitable distribution of that cake will allow PCTs such as Wigan to contribute to achieving the Government’s aim of making serious inroads into the health inequalities in this country.
I shall be brief, to allow others to speak. I congratulate my hon. Friend the Member for Wigan (Mr. Turner) on securing this timely debate. I also congratulate the Secretary of State; it gladdened my heart that he gave a speech to the Socialist Health Association at Toynbee hall. Inequality was mentioned all through that speech, which should be bedtime reading for every chair of every PCT and every chief executive officer who thinks that they know something about health.
I want to speak briefly about my role as chair of the powerful all-party group on cancer. We have very much played our part in developing a programme with the Government. The first cancer reform strategy, cancer plan one, has come out and we are now looking at a cancer plan two—although we call it our cancer reform strategy—with patient groups and others. I hope that money will be put into that strategy. It is partly about addressing inequalities related to gender, race and sexuality, but other issues also need to be addressed. I am told that many homeless people do not get health service support, such as the identification and diagnosis of early-stage diseases such as cancer in their environment. The St. Mungo’s Trust in London, which looks after the homeless, has really accentuated that point.
People who have rarer and less-talked about cancers do not get the same kind of support as those who have breast cancer and prostate cancer. Incidentally, there is not as much support for prostate cancer, as for breast cancer, but identification levels are on their way up. People with ovarian, pancreatic, liver and brain cancers do not get the same support, which is necessary to repair their lives and cure those cancers.
The lack of information does not help and inequality exists, particularly in black and minority ethnic communities. My PCT in Norfolk—I am glad to see my hon. Friend the Member for Great Yarmouth (Mr. Wright) here—has suddenly decided that it is worth putting out some documents in different languages. It has suddenly decided that Portuguese migrant workers, Lithuanian policemen and others deserve to have something written in their languages. It has taken it 10 years to see that, but it has a long way to go. I hope that the PCT is embarrassed, and that that fact is reported if anybody is listening. The problem is growing. Minority groups exist and do not get the whack of support from the health services that they need.
There was a report in The Lancet Oncology this summer about inequalities on another level—between us in the UK and other European countries. The report dealt particularly with two children’s cancers: a rare brain cancer called neuroblastoma and Wilms tumour, which is a kidney tumour. On looking at the survival rates, we see that we are lagging behind. There are many arguments about early identification and so on, but the situation has gone on a long time and we should be worried about it. Our first cancer plan is at an early stage of development and perhaps the data will improve as time goes by, but we should not sit back and expect that to happen. We have much more to do.
The answer is not always just to shovel money into the system willy-nilly; it is about directing money to the right places. I was on the Science and Technology Committee when the first cancer plan was set up. We investigated where the extra £640 million had gone, but it was difficult to find out from the PCTs at that time—a few years ago—what they had done with the money. Was it ring-fenced for cancer or did it go elsewhere? Was it used for car parks, and so on? We did not get to the bottom of that, but our questions precipitated a further investigation by the Department of Health. Funding for cancer research, treatments and cures was meant to be spread across the country, but it was unequal.
Cancer has been the doyenne of the health service, given what we have achieved in the past 10 years. It is a paradigm for many other illnesses such as diabetes, mental ill health and so on. Patient support groups have worked together and with the Government to improve services. Stimulating charities to join together is important.
I mentioned children earlier, but we must also think about the carers in the process. In some places in this country, carers are respected and given support. For example, if a child has to get treatment at the local hospital or clinic, a parent must go with them. If the parent works, they have to get time off work and lose pay. Things are not fair in this country—some people are not allowed time off. A managing director or football club manager, for example, presumably can take time off—unless they are managing Norwich City, when they need as much time as possible to achieve anything. However, I am sure that Members will take my point that it is easier for some people to get time off work. We must consider whether funding has been fairly adjusted in this country. Many young people are not getting that kind of support from their carers.
More men die of cancer than do women, particularly older men. I have mentioned ethnic minorities, particularly the women in them. The all-party group on cancer runs the Britain Against Cancer conference. Last year’s conference was attended by more than 300 people, with a waiting list just as long. Patient groups and other information groups speak about the issues and inspire us to do things. Some young women spoke about outreach projects that they were involved with in parts of London and elsewhere in the country, through which small groups of people address the big cultural differences in understanding the treatments that can be applied in various situations. Their problem—a real problem that I hope the Government will address—is that they set up a project that achieves greatness in year one and more greatness in year two, but then the money falls. When voluntary groups do such things, we must ensure that they are able to continue in office and to support the people out there.
I finish on this note. One of the Ministers and I will be attending a dinner tonight, and I point out that there are people lurking in the background who want to privatise the health service. Such people are pushing the idea that they can deliver better cancer services than the NHS. We should beware of the fact that they will be waiting in the wings with their American supporters if the Government do not precipitate action through the new reform strategy.
Ever since my election to this House in 1997, health inequalities has been one of my major campaigns. I therefore congratulate my hon. Friend the Member for Wigan (Mr. Turner) on securing this important debate.
Regrettably, Bolton is included in a list of the 15 per cent. most deprived boroughs in the country, with 37 per cent. of its population living in the 20 per cent. most deprived wards. Of the three Bolton parliamentary constituencies, mine demonstrates the most deprivation, followed by Bolton, North-East, then Bolton, West. The Royal Bolton hospital, which has the second busiest accident and emergency department in Greater Manchester, is situated in the heart of my constituency.
Several diverse ethnic minority communities, mainly from south-east Asia, live in Bolton, particularly in my constituency. They present special challenges to the national health service, such as different diseases, cultures and styles of living. For example, 23 different languages are spoken in one of my primary schools. Such a situation is a challenge to the NHS.
Bolton is a low-wage economy. The median pay is only £317.60 per week, compared with the England average of £369.40 and the north-west average, which stands at £344.20. Worklessness, as represented by those receiving jobseeker’s allowance, incapacity benefit or severe disablement allowance, is high at 12.9 per cent. The figure reaches 49 per cent. in the most deprived wards in Bolton.
In the past, the principal industries in the town were mining and cotton textiles, supported by heavy engineering. They have caused considerable incapacity and disablement, particularly in our older population. That is a feature of all the old industrial towns. In some Bolton wards, life expectancy today is under 67, with a 15-year gap between the rich and poor areas of the town.
In 1997, the Wigan and Bolton health authority was considerably underfunded; I believe that the figure was about £14 million at that time. I compliment the Government on introducing the pace of change policy, which has brought more money to constituencies such as mine. Unfortunately, as my hon. Friend pointed out, the pace of that policy has been rather slow, and in some cases we have actually gone backwards, as I shall demonstrate.
There are just not enough doctors or dentists in Bolton. That is particularly true of the most deprived areas of the town. Bolton’s primary care trust, which is coterminous with the borough boundary, is currently just over 2 per cent. away from target in the three-year allocation leading up to 2007-08. That equates to a shortfall of £8 million. Compare that with affluent Richmond and Twickenham PCT, which receives 12 per cent., or £27 million, above target. As my hon. Friend said, such discrepancies simply cannot be right.
In November 2004, the Government defined spearhead local authorities as those rated in the worst 20 per cent. in the country in three out of five categories, which my hon. Friend defined. Bolton qualifies in four of those categories. The average spearhead PCT was 1.1 per cent. or, on average, £2.6 million under target in 2006-07—Bolton is at 2 per cent.—while the non-spearhead PCTs received, on average, 0.5 per cent. or £1 million over target. The differential is reducing. Bolton PCT’s figure has reduced, but only from 2.0975 per cent. to 2.035 per cent. Not surprisingly, especially in view of Bolton’s health legacy, which I described, I would support accelerating a reduction in the health inequalities that have existed not only in my constituency but in others for far too long.
A recent analysis of cancer mortality rates in the north-west for spearhead versus non-spearhead PCTs has shown an actual worsening of the position by 4.4 per cent. for men and 19.7 per cent. for women. Instead of the 6 per cent. absolute reduction required by the Government’s public sector agreement targets to reduce health inequalities between the fifth most deprived areas and the rest by 2010, the gap has increased in the north-west. Stomach, cervical, lung, and bladder cancers are of greatest concern, especially among women.
I assure the Minister that Bolton is doing everything possible within its financial capabilities to reduce the health inequalities in our town, even by using non-health pots of money such as neighbourhood renewal funding to pump-prime interventions, but we need more help than we are currently getting. That is what this debate is about.
We are discussing health, and I am afraid that my health is not particularly good today, so I shall not speak for long because my voice might not last. I want to speak because this debate is important, and I congratulate my hon. Friend the Member for Wigan (Mr. Turner) on securing it, and on speaking so strongly on this important subject.
I speak for Luton, which is seriously and consistently underfunded, and has been for many years. It is the most underfunded health area in the relatively prosperous eastern region, yet we have the greatest health inequalities, enormous levels of heart disease and diabetes, and serious mental health problems, which are not being addressed as they should be because we are underfunded.
I was recently called to a meeting by Amicus, which is now part of Unite, because its members include health visitors and there are not enough health visitors. Luton has a large young population with many children and a high birth rate, so we need health visitors and we do not have enough.
I have recently been informed that Luton has the longest waiting times for musculoskeletal treatments. Again, that is simply because of underfunding. Some non-statutory funding areas have been cut—for example, foyers for people with mental health problems—and there are funding squeezes all around. There was a health funding freeze two years ago, when Luton should have been treated rather better than some other areas, but it was treated worse and had the worst health funding cuts of any primary care trust in the region. Others in the more prosperous leafy shires and relatively middle class areas were allowed to increase their spending when we were forced to cut ours. That was gross inequity by any standard.
More recently, in the past year or so, we have had a savage cut in our walk-in centre. Walk-in centres were recently trumpeted by the Prime Minister, and the then Secretary of State for Health opened our walk-in centre with a great fanfare, but its hours were later cut to a quarter of what they had been. It was a wonderful facility that took pressure off GPs and the local accident and emergency department, and enabled people who might not have gone to their doctor to drop in. Some people with health problems, particularly middle-aged men, do not go to their doctor when they should, and walk-in centres pick up on conditions.
I do not blame the health professionals, who do their best in difficult circumstances, and I commend my local patient and public involvement forum, which has done a tremendous job in lobbying on behalf of local patients. Some months ago it called a special meeting to discuss the walk-in centre and other matters with representatives of the primary care trust and the strategic health authority. The PCT officers, to their credit, turned up at that meeting. They had a hard time, but they turned up. The SHA officer did not turn up and there was a vacant seat. I understand that a few days later, the SHA called the PCT officers to an early-morning meeting elsewhere in the region and told them to get the PPI in line. The SHA’s behaviour was outrageous. Not only did it impose unfair spending cuts; it lambasted its own officers in the PCT for not keeping local patient representatives in line.
Luton has serious problems, which must be addressed. I have written many times and at length to successive Secretaries of State for Health about our funding problems. I want Luton to be treated fairly in future, and I urge my right hon. Friend the Minister to look carefully at Luton’s funding and at other areas that are similarly poorly treated, to ensure that we have fair funding levels in future.
Thank you, Mr. Illsley, for giving me the opportunity to participate in this important Adjournment debate. There is no doubt that social care funding has had great difficulty in keeping pace with demand. The pressure on social care services from rising demand is well rehearsed and reflects the experience of Doncaster and Barnsley, which are my home authorities. People are living longer with improvements in health care from birth to old age, so more people have complex dependency needs. They have greater expectations for more and higher quality services. The situation has been compounded by recent developments in the NHS—for example, long-stay hospital closures. Treating more people more quickly with earlier discharge requires more intensive care in the community and places an extra burden on social care services.
Within social services, better assessment and early intervention, rather than reducing long-term costs, is creating pressure to offer more in the way of early, targeted support. More investment is needed for the shift from spending on intensive care services to prevention and individualised support.
The Government face a difficult scenario, but it is compounded by the inequalities in the health funding system, as all hon. Members who have spoken have said. This debate is not just about health funding inequalities; more importantly, it is about health inequalities in general.
You will be familiar with the health profile of my constituency, Mr. Illsley, where more than one in three households has at least one disabled person. It has the highest number of individual claims—more than 12,500—for chronic bronchitis and emphysema from former miners. Former miners in my constituency have received more than £100 million from the Labour Government. They would not have received that if we had had a Conservative Government, and those claims are a legacy of the mining industry.
The latest figures that I have for mortality rates for cancer are for 2005-06 and are based on 100,000 people of all ages. The average rate in England is 177; in Barnsley it is 204.35 and in Doncaster it is 207.68. Turning to the mortality rate for chronic heart disease, the average rate in England is 101.8; in Doncaster it is 115.8 and in Barnsley it is 145.02. That is 40 per cent. higher than the national average, and provides a snapshot of the sort of picture that we face in Barnsley and Doncaster. Yet overall Government funding bears little relationship to assessed needs, with current grant differing from some 130 per cent. over target to some 23 per cent. below target. Doncaster is 6.8 per cent. below target and Barnsley is 9.3 per cent. below target. Around 95 local authorities nationally are below target funding by some £686 million. Of those, 37 are part of the special interest group of municipal authorities outside London—SIGOMA—and are losing £239 million this year. Both Barnsley and Doncaster are members of SIGOMA.
I have a confession to make. I was one of the three founding fathers of SIGOMA when I was leader of Barnsley council. The other two gentlemen in the frame were Councillor Peter Smith from Wigan and Councillor George Gill from Gateshead. That was one of my greatest achievements as leader of the council. [Hon. Members: “One of many.”] Yes, one of the many achievements. It is important that the Government revisit the issue, so that resources can be more effectively targeted at areas of greatest need.
The efficiency of local authorities has been widely acknowledged in recent weeks, and the Local Government Association lobbying of Ministers to switch 0.5 per cent. of the NHS’s expected budget of £100 billion—that is £500 million—to social care should be widely welcomed and supported, because there is evidence that such a switch would deliver better value for money.
In conclusion, the issue is one of fairness and equity, and I would like the Minister to answer this specific question when she responds. How can it be right that Barnsley, where the death rate from chronic heart disease is 45 per cent. higher than the average, is underfunded to the tune of 9.5 per cent. below target? The Barnsleys and Doncasters of this world do not want more than other areas. We would be more than happy with our fair share.
I thank my hon. Friend the Member for Wigan (Mr. Turner) not only for securing the debate, but for the careful way in which he put forward his arguments and also for mentioning Newham many times. I thank him too for characterising the debate not as one between north and south, but as one about health inequalities. I am really grateful to him for framing the debate in that way.
This debate is very important for my constituency, which is the eleventh poorest part of England and Wales. In the distance of the short journey on the Jubilee line from here in Westminster to my home in Newham, life expectancy for children decreases by six years. Put simply, my local authority does not have the money that it needs to deal with health inequalities. In the year 2007, the locality where people live should not determine lifespan, but the reality is that it does.
I acknowledge, as have other hon. Members, the findings of the Black and Acheson reports that health inequality has its determinants in poverty, low income, poor housing, lack of education, lack of security and high levels of stress. It is therefore clear that any redress in health inequality needs to engage more players than the NHS alone. My hon. Friend the Member for Wigan mentioned that we need a partnership with the Department for Communities and Local Government in dealing with these issues, and he is absolutely right.
There is no need to be an expert in Maslow’s hierarchy of needs to understand that living on a low income in a high-cost capital has an impact on healthy choices—food, leisure and education choices—and therefore on the stress levels of families struggling to make ends meet while living cheek by jowl with the enormous wealth of the City. It does not take a genius to understand that it is very difficult for families in temporary accommodation, living in the private sector in homes that they can barely afford, and moving every few months or years while they wait the 13 years that it takes to get a house in the public sector, to have a lifestyle that maintains good health.
Newham has a housing waiting list of 30,000 families—families that are moved from place to place while they wait, often unable to put down roots in an area, and are therefore unable to find their way on to doctors’ waiting lists. If they are successful in registering on the very full lists, they are often then subject to another move and another search for the most basic of health requirements—access to a doctor. Is it any surprise, therefore, that such families access their health care erratically, through the accident and emergency services of the local hospital, too late for there to be an impact on their health? That results in a shorter lifespan and means that such people live longer in ill health than those in better circumstances.
The continued inequalities experienced by my constituents are exemplified by the infant mortality rate, which in Newham fell by 4 per cent. between 1998-2000 and 2003-05, although it fell by more than 10 per cent. in London as a whole. Obviously, all improvements in health are welcome, but the worrying growth in inequality simply cannot be ignored. There are clear inequalities in outcomes, but also great disparities in inputs, such as funding per person. North-east London contains several deprived boroughs with some of the lowest life expectancies in England. In 2004-05, the average expenditure per weighted head of the population was £1,090, compared with the north-west London figure of £1,311. Indeed, according to the Government’s own weighted capitation calculations, and as my hon. Friend kindly stated, Newham Primary Care Trust currently receives £15 million less than it should each year. Such underfunding in an area such as mine is frankly immoral.
Last year, I was forced to have a meeting with the then Secretary of State for Health to express my deep concern at the requirement made by NHS London that Newham PCT contribute 3 per cent. of its 2006-07 budget to a financial risk pool for London. The risk pool was required to ensure that the NHS in London as a whole was in financial balance. Although I understand that requirement from the wider perspective of getting the NHS on budget, it is hard to stomach given the local circumstances. Newham PCT has a consistent record of hitting its financial targets. The deficit in London had been run up by other PCTs, many of which have been, and continue to be, overfunded according to weighted capitation targets. My hon. Friend referred to that too. Along with other demands, such as that for a 15 per cent. saving on management and administration costs by 2008 as a consequence of commissioning a patient-led NHS, the requirements mean that the PCT is facing significant financial pressures while attempting to make real progress towards narrowing health inequalities.
I am confident that this Labour Government are facing up to the enormous challenge of inequalities in health care—something that the previous Government failed to do. However, while there is much to praise, good intentions will be carried through only if constituencies such as West Ham and the other constituencies mentioned here this morning receive better and more appropriate funding and health care—health care designed around the needs and realities of living in a borough such as my own.
It is incumbent on each of us to thank my hon. and good Friend the Member for Wigan (Mr. Turner) for securing such an important debate. Each of my Labour colleagues who has spoken previously has covered the general issues adequately, so I shall keep my comments specific to my own city of Salford and to the north-west.
For Salford, health inequalities are not just about quality of life, important though that is; they are about the actual lengths of people’s lives. They are important to the SIGOMA organisation, which was mentioned earlier, because Salford is an active member of that group. As to the more general comments made by my hon. Friends, let me just say that if we are to deliver the joined-up services for which we strive, and improve the health of our citizens and successfully tackle social problems in our neighbourhoods, the Government need to move swiftly towards full implementation of their own funding targets.
In Salford, the evidence is stark. Despite huge improvements in the general health, housing, employment, income and education of Salford residents, the relative inequalities in health in parts of the city remain as great as they were 100 years ago, if not greater. In parts of Salford, male life expectancy based on 2003-05 figures is 73.8 years, compared with 76.9 years for England as a whole. The equivalent figures for women are 78.4 years in Salford, compared with 81.1 years elsewhere. That means that male life expectancy in Salford is the sixth lowest in England, and female life expectancy is the fifth lowest. Life expectancy in Salford has improved in recent years, year on year, but the gap for male life expectancy between Salford and England as a whole—3.1 years—is the same now as it was eight years ago. For women, it has widened from 2.3 years to 2.7 years.
The death rate from smoking in Salford is higher than the north-west and England averages and is the fifth highest in England. Smoking accounts for 505 deaths in Salford every year—deaths that are avoidable. The early death rate from heart disease and strokes is higher than the north-west and England averages and is the fifth highest in England.
The number of people claiming sickness benefit in Salford because of mental health problems is higher than the north-west and England averages and is the sixth highest in England. The rate of hospital admissions for alcohol-specific conditions is also above the north-west and England averages and is the tenth highest in England. Reducing health inequalities and improving well-being therefore remains one of the key challenges across agencies in Salford and requires an active and co-ordinated approach.
After taking weighting factors into account, Salford PCT’s GPs have more patients to care for than the national average. The PCT estimates that we would need an additional 17 full-time GPs over and above the current 132 GP full-time equivalents to bring the average weighted GP list size down to the national average. Extra doctors would result in greater specialisation, and most practices could, for example, have GPs specialising in areas such as diabetes and heart disease. That, in turn, could lead to reduced mortality rates.
On the plus side, I should say that the number of road injuries and road deaths in Salford is relatively low and that significantly more older people are helped to live at home than the national average.
If you have not visited Salford, Mr. Illsley, you might be surprised to hear, given what I have said, that a recent Royal Bank of Scotland survey, which developed an index of lifestyle indicators and how much they cost, found that Salford is one of the best places in Britain to live—in fact, it is No. 5. Given that Salford has such good facilities, I want residents to be around and in good health for as long as possible to enjoy them and I want them to have better-than-average life expectancies.
The problem before us is complex, and we need action on a number of fronts. For example, economic and regeneration policies have a role to play, as my colleagues have said. I applaud the north-west food and health action plan, which was published at the beginning of the year. It looks at how regional agriculture and food industries can help local people to make food choices for healthier lifestyles. I was also pleased to see a recent report from NHS North West and others, which championed the role that local parks can play in improving our physical fitness and general well-being. It does not help, however, that we will lose our excellent maternity services, and we will continue campaigning to retain those services so that mothers can continue having their babies safely in Salford.
Today’s debate is more focused on health funding, however, and it is clearly about not only quality of life, but length of life. I therefore urge the Government to deliver health funding based on need, and the same goes for local authority social services. Our public and voluntary authorities will continue to work together to deliver the best for local people. If we in Salford are given additional resources, we will use them wisely and effectively. We now need to ensure that the tremendous social, environmental and economic progress that has been made in Salford is matched by progress in the health of Salford people.
I, too, congratulate my hon. Friend the Member for Wigan (Mr. Turner) on securing this important debate and enabling me to draw attention to health inequalities and health needs in Knowsley, which I represent.
Of the 26 indicators in Knowsley’s health profile, 18 are worse than the national average and one is better—it happens to relate to deaths in road accidents, although that might be connected to the low incidence of car ownership, which in turn might be connected to the fact that 29 per cent. of residents are dependent on health-related benefits, against a national average of 13 per cent. Knowsley’s figures for smoking are above the national and north-west averages. According to the statistics, we also have the worst record in England for the number of adults who eat healthily. Our male life expectancy is seventh lowest in the country and female life expectancy is fifth lowest. The main reasons for that gap in life expectancy are coronary heart disease and cancer, although we have had a proud record in that respect over the past decade, given that deaths from coronary heart disease have fallen by 19 per cent. and those from cancer have fallen by 5 per cent.
As regards the provision of funding to meet Knowsley’s health needs, I must acknowledge that the Government have recognised the problem and provided significant uplifts in funding over the past three years, and we are grateful for that. That money has been spent wisely, with sound budgeting, efficient organisation and proactive health improvement measures. Generally, our record has been good. For example, Knowsley PCT has managed the implementation of the new GP and dental contracts better than many other PCTs, and I have had little problem solving my constituents’ difficulties in that respect with the PCT’s help.
However, Knowsley is still 3 per cent. off the expected target for an area with its health profile, and that amounts to £9 million per annum. The financial strategy for the next two years assumes that we will have a 6 per cent. uplift, given Knowsley’s under-target position. If that turns out to be over-optimistic, planned investments to make a real difference to the health inequalities suffered by the people of Knowsley might have to be reduced or delayed.
Much of Knowsley PCT’s undoubted success in managing its resources is due to the synergy of its working arrangements with those of the local council. The two bodies pioneered the joint appointment of the PCT’s chief executive and the council’s director of health and social care. That has allowed for an integrated approach to health and social care and joint working to address the health inequalities agenda. That has been made possible through section 31 arrangements with the local authority, the pooling of budgets, the sweating of assets and, generally, by working together to achieve efficiencies across a wide range of services.
Although such working arrangements have contributed to the PCT’s undoubted success in addressing the health inequality agenda, its future success is vulnerable to the outcome of the comprehensive spending review. The local government formula has less weighting for social deprivation, and the local authority fears that there will be a standstill in uplift because its population is not increasing at the same rate as elsewhere in England, where there are higher levels of immigration. Clearly, that will have an impact on health care in Knowsley, as the council will have less money to invest in initiatives to help improve the health profile of the people of Knowsley.
As in many other respects, Knowsley, which is typical of the Liverpool area, has a story to tell about its attempts to address the health inequality agenda, and it can be justly proud of it. At the heart of that success story is the close working between the PCT and Knowsley council. Like other PCTs, Knowsley PCT is therefore highly dependent on the outcome of the CSR. I therefore urge the Minister to give due and particular attention to that and to ensure that Knowsley council and Knowsley PCT can continue to address health inequalities in Knowsley as well as they have in recent times.
I will be very quick, because everything has been said. Clearly, this is a major issue for Labour Members, and it is significant that the Opposition Benches are empty; either Opposition Members have no health issues to raise or their areas are well funded by the Government.
All too often, we can be critical of the health service, but there has been significant investment in my constituency in the past 10 years, which has significantly improved the health of my constituents. However, there are problems with the way in which the formula is worked out. Significantly, the formula for Great Yarmouth means that we are now 3.5 per cent. below the average, but that does not tell the complete picture. Although we are underfunded, we were on target last year, but we were penalised because money was clawed back from the SHA as a result of shortfalls in other areas. In fact, our formula works out at about 6.9 per cent. below the average, which is a considerable amount of money—around £21 million—and it is something that we need to look at.
I am aware that the Government are looking at and will probably change how the formula is calculated. I do not think that there is anything wrong with the formula per se, but the funding is not coming. I would like an assurance from the Minister that there will not be changes to the formula that would change PCT funding procedures overnight.
I, too, congratulate the hon. Member for Wigan (Mr. Turner) on securing this important debate. Although at times it has seemed like a competition to decide which of the many eloquent speakers has the worst life expectancies or funding in their constituencies, I recognise the passion with which all who have spoken put their case. The title of the debate on the Order Paper is “Impact of health funding on health inequalities”. Although there is a geographical aspect to such inequalities—not, as others have demonstrated, a north-south divide—I should like to talk about gender and race inequalities.
The hon. Member for Wigan said that there is no doubt that a person’s life expectancy and health outcomes are affected by their social class at birth and by where they live, and a powerful case has been made for increased funding for areas that have the greatest need. I acknowledge that money has been spent, but we must ask whether it has been spent in the most effective way, because much of the extra Government funding has been diverted to secondary care. If we are to tackle inequality problems in the long term, we must ensure that more money is spent on the preventive health agenda and that more people have good access to primary care.
The Government recognised the inequality problem and announced that there would be 88 spearhead PCTs in 70 of the local authorities with the poorest health outcomes according to many of the indicators. The aim, which we might all agree was a worthy one, was to tackle inequalities in the long term, focus on improving life expectancy and reduce more quickly rates of premature deaths from cancer and heart disease. We might have expected to see those PCTs increase spending on public health if they were truly to address their aim, but the Liberal Democrats have analysed the public health spend in all PCTs, and unfortunately, we found absolutely no correlation between spending and the extent of need.
For example, in 2005 Lewisham was designated to receive proportionately more Government money than other PCTs to compensate for its position in the one fifth of areas with the worst health and the largest gaps between rich and poor. In fact, there was a drop in public health spending by that PCT far in excess of any other trust—14 per cent. of total PCT spending used to go on public health but the figure has dropped in recent years to 1.7 per cent. We must ask ourselves why there was such a dramatic reduction and whether it was to do with other financial pressures. Why was Lewisham PCT allowed to take its eye off the important goal of reducing health inequalities in the long term?
We also discovered that a quarter of all spearhead PCTs spent less on public health in 2005-06 compared to 2003-04, and that 26 received an increase in public health spending of less than £1,000. Will the Minister explain why that happened and why it was allowed to happen, and say something about whether we can stop it happening in future?
The hon. Member for Norwich, North (Dr. Gibson) spoke about directing money toward different budgets, and that needs to be looked at closely, because there are huge variations between trusts. The King’s Fund has analysed the national programme budget project—the NPBP—and the Government have collected data since 2003 on 21 different disease areas. There are now sufficient data to allow comparison between PCTs and to enable us to ask questions about whether they are putting funds to their best available use.
Analysis shows that the three largest shares of increase in overall PCT spend have gone to mental health, heart disease and cancer. That reflects Government priorities and no one should have a problem with it. However, the analysis also shows that there are large variations in the amounts and proportions of total budgets spent on individual disease areas by PCTs. For example, Islington PCT spends £406 per head on mental health compared to the £56 per head spent by Bracknell Forest PCT. We can argue all we like about whether people who live in Islington are any saner than people who live in Bracknell Forest, but there is also a fourfold difference in spending on cancer, a threefold difference on circulatory system diseases and an eightfold difference on musculoskeletal problems. It might be argued that the differences can be accounted for by relative needs, and there may be an evidence base for them. However, even when we adjust for those factors, we can see that the sevenfold spending gap between Islington and Bracknell Forest reduces only to a fourfold gap, which is still a huge difference in the amount spent.
The same pattern occurs around the country in relation to spending on cancer. After taking into account known population differences, the proportion of budget spent on cancer ranges from 3 to 10 per cent. of a trust’s overall budget. Local decision making cannot account for such a wide discrepancy. In-depth research ought to be undertaken so that we can compare amounts spent to outcomes, to see where money is most effectively spent and to learn lessons from that.
I shall briefly talk about gender. On average, women live five years longer, but there is a wider gap in the most deprived areas. The situation is even worse than that suggests, because general health outcomes are worse for men. For example, women contract skin cancer much more frequently, but men have a higher death rate from the disease. We are not serving men well if we allow such things to happen. Again, bettering men’s health is not necessarily down to spend; it is down to taking different approaches to tackling their problems. Men between the ages of 16 and 34 consult a GP half as frequently as women, and the outcomes are there for all to see. Asian men have a high rate of diabetes, but funding formulae do not account for ethnic mixes.
Finally, I shall comment on the Institute for Public Policy Research report that was published yesterday. It claimed that focus on choice has helped the better-off, but that to help the poorest, public services need to be personalised. Research has shown that the more affluent and better educated a person, the greater the health benefits they receive from the NHS. Care for such people is planned, but the less affluent tend to present themselves as emergencies. People in poorer areas have 20 per cent. fewer GPs per 100,000 people than in the most affluent areas in the country. Cancer death rates are 29 per cent. higher in the poorest fifth of the population.
In summary, money is important, but some of my examples show that we perhaps need to aim at other targets. We need to look at access to health services in the most deprived areas. People will not access a GP if they cannot get to one via a good travel network, and they may not be able to afford a car. All such things are relevant. Furthermore, do we have enough health visitors going into deprived areas to try to encourage families to adopt healthy living styles from the outset?
I have a final query: the Darzi review recommended polyclinics. If we centralise our health services, will that mean that in the poorest areas the poorest people, who are least likely to access existing services, will be even less likely to access them in future? There is much food for thought in what is happening, but much potential for improvement as well.
I congratulate the hon. Member for Wigan (Mr. Turner) on bringing forward this vital debate. He has long campaigned for those of his constituents who have been adversely affected by health inequalities under the present Government. I note also his work chairing the special interest group of municipal authorities within the Local Government Association, particularly with reference to its report of last month, “Caring for All: balancing fairness and stability in the funding of local services”. He slightly spoilt his introduction by, of course, attempting some party political point scoring. Perhaps I can help him. I do not know where he has been in the past few days, but recent events suggest that he may need to catch up—that in fact the Prime Minister has bottled it and ignominiously retreated from facing the electorate, having marched him and all his colleagues up the hill.
I am grateful. I am sure that the hon. Member for Wigan will agree with me that the fact that this debate is being held 10 years into the rule of a party that pledged from the outset to stand against such inequalities says something about the impact that his party has had—or rather has not had—on the country. I represent a constituency in the north-west, which is particularly well represented in the debate this morning, and that fact is important.
I also want to thank the hon. Gentleman, who is a well-known Wigan rugby league club supporter, for ceding Jason Robinson into union, without whom England might not have succeeded so well at the weekend.
Under the present Government, the relative gap in life expectancy for men has increased by nearly 2 per cent, and for women it has increased by 5 per cent. The latest figures on infant mortality confirm the previously reported trend. Despite overall improvements, the relative gap between the routine and manual groups and the population as a whole has widened over recent years, since the target baseline; and the number of sexually transmitted infections has doubled over recent years.
I will not, because we are very short of time, and the hon. Gentleman had his own chance.
We have had a wide-ranging debate in which many good points were covered. Many effectively amounted to bids, which I am sure the Minister will deal with individually when she replies.
The hon. Member for Wigan may remember a supplementary question on health inequalities that he put to the then Health Secretary, the right hon. Member for Darlington (Mr. Milburn), in 2002. The response was
“we are now in the process of reviewing the whole way in which NHS cash is distributed to local communities.”—[Official Report, 26 March 2002; Vol. 382, c. 688.]
Sadly, the current Administration, particularly as regards health policy, has rarely moved beyond the review as a piece of ongoing politicking. Last week brought us Lord Darzi’s interim report. Its release just before the end of the recess served not only to deepen the electoral chasm left by the Prime Minister’s fear of the electorate, but also to avoid Lord Darzi’s having to come to the other place. Notwithstanding the claim with which he opens his report—
“I’m a doctor not a politician”—
can the Minister tell us when the noble Lord—whose main job now, whether he likes it or not, is as an accountable politician and a Minister, and who is paid by the electorate and who accepted the job—will make his maiden speech in the House of Lords?
In his interim report, the noble Lord twice made the point that
“the Secretary of State has announced a comprehensive strategy for reducing health inequalities”.
It is true that in his statement to the House on 4 July, the Secretary of State for Health said that the matter of health inequalities is “crucial to the Government” and, referring to the Darzi review, that it was
“too important for us to wait for that review”.
He gave an assurance that the Government would
“crack on with that as an absolute priority.” —[Official Report, 4 July 2007; Vol. 462, c. 969.]
However, the Secretary of State seems to have made the announcement neither to the House nor, even more surprisingly, to the press. True, the Minister of State, the right hon. Member for Bristol, South (Dawn Primarolo) announced a web-based health inequalities intervention tool on 23 August. As far as I can see, all it does is tell spearhead primary care trusts whether to focus on smoking cessation, reducing infant deaths or preventive prescribing for cardiovascular disease. Undeniably that is of some use, but it is a far cry from a strategy. Indeed, the biggest claim that the Government made of it was that it could
“be used as part of a comprehensive local strategy to reduce health inequalities.”
Will the Minister tell us when the Secretary of State will make good on his promise of a comprehensive strategy for health inequalities?
Another review that the hon. Gentleman will be familiar with is that relating to the market forces factor, to which his constituency neighbour, the then Health Minister, and now Chief Secretary to the Treasury, the right hon. Member for Leigh (Andy Burnham) made reference in a Westminster Hall debate secured by the hon. Gentleman on 6 June. The hon. Gentleman may be interested to know that his comments in that debate were well reported by the Revolutionary Communist Party of Britain (Marxist-Leninist) on its website.
The first review referred to by the then Minister was
“an overall funding formula review that will examine the make-up of the market forces factor”,
being undertaken by the independent Advisory Committee on Resource Allocation, to be published before the allocations were made. The second was a
“specific review of the technical aspects of the MFF, which is different from the general funding formula review that ACRA has undertaken.”—[Official Report, Westminster Hall, 6 June 2007; Vol. 461, c. 138WH.]
The hon. Member for Falmouth and Camborne (Julia Goldsworthy), who was also present at that debate, said that she was informed at Christmas that the latter report was on the desk of the then Minister, Lord Warner. The Minister also made reference to the departmental consultation on payment by results, confessing that the market forces factor had been left out of the public consultation, but included in the independent, but ultimately internal, review.
Resource allocation is still being decided across the country on the basis of assumed and aggregated data in respect of deprivation and age. We increasingly have data that would allow known morbidity in a community to be the basis on which NHS resources are allocated. Can the Minister tell us, first, when ACRA’s overall funding formula review will be published; secondly, when ACRA’s specific review of the technical aspects of the marked forces factor will be published—and why it has lain so long on Ministers’ desks; and, thirdly, when the results of the departmental payment by results consultation will be published? Can she also confirm that ACRA will take account of morbidity data in its review and reflect them in the funding formula? Will the funding formula be changed to reflect local pay variation as has been done with the area cost adjustment in the local government formula?
It was the Government’s intention to publish an annual status report on health inequalities, but the first report took two years. They said in July 2003 that the Department of Health would publish an annual report on health inequality indicators, related to the health inequality targets. The first was published in August 2005 just as we were in recess. Will the Minister tell us whether she plans to reinstate that? Any Government who want properly to address the issue of health inequalities will focus not on absolute reductions, but on the relative gap between the most and the least healthy, and between the richest and the poorest. I have no doubt that the Minister will tell us all the statistics on how many cancer and coronary heart disease deaths have been prevented in the last 10 years, but will she admit that they are on a trend that was pretty well established in the latter part of the 1970s for coronary heart disease and in the early 1980s for cancer? What plans do the Government have to switch to meaningful metrics?
In “The Road to Wigan Pier” George Orwell said
“a man who drinks a bottle of whisky a day does not actually intend to get cirrhosis of the liver”.
Admittedly, that was a metaphor illustrating Orwell’s luddite attack on mechanisation, but it is a moot point for today’s debate. Only last month the Department of Health announced an increase in consumption among school-aged pupils who drink. On current trends obesity will overtake smoking within three or four years as the principal cause of avoidable death in this country, bringing concomitant diseases in its wake. The story is similar with rising alcohol consumption, drug abuse and a rise in sexually transmitted infections. Yet the Government were all too happy to watch public health budgets being plundered as PCTs tried to rake in cash to pay off a deficit of the Government’s making. A Conservative Government would give PCTs dedicated public health resources. When will the Minister show that she really cares about combating health inequalities and do that?
One issue that is not often addressed under the heading of this debate is long-term care: it is right, however, that any debate on health inequalities should look at inequity across the age range. In fairness, several hon. Members, not least among whom was the hon. Gentleman, conceded that point. Today we anticipate something of a damp squib with the comprehensive spending review, with the Government failing once more to address the scandal of people selling their houses to fund their long-term care, something that was deplored by the former Prime Minister and Member for Sedgefield in 1997. I suspect another dodge by the present somewhat enfeebled Prime Minister. That could be the only thing to trump the brazenness of the Liberal Democrats, who are still running with the headline—it is on their website if anyone wants to look—about a free personal care policy, despite their health spokesman’s confession in this very Chamber that it is a dishonest policy.
I look forward to hearing what the Minister has to say. I hope that she will give firm dates for the publication of the various reviews that I mentioned and that she will use the opportunity radically to overhaul the Government’s public health strategy, to begin combating the growth in health inequality of the past 10 years.
I congratulate my hon. Friend the Member for Wigan (Mr. Turner) and the 10 Labour MPs who have spoken so eloquently in this debate. It is timely in the parliamentary agenda.
Since the creation of the national health service, we have seen impressive social, economic and health improvements in this country. People in all regions and from every social group are healthier and living longer than ever before, and we should celebrate that, but—it is a big “but”—despite those tremendous achievements, health inequalities remain. The Government recognise the great challenge that they pose and have established the most comprehensive programme ever seen in this country to address that deep social injustice—as opposed to the previous Tory Government, who buried the Black report and ignored it.
Health inequalities are proving stubborn, persistent and resistant to change, and we are disappointed with the progress made. We have set national targets to narrow the gap in infant mortality across socio-economic groups and in life expectancy across geographic areas, but we have not seen the narrowing that we want. We knew that it would take time; we are the first Government in a generation to recognise it as a priority and choose to highlight it. We must acknowledge that every major country in the world, with the possible exception of Sweden, is struggling to resolve this intransigent problem.
There are some early signs of progress. Some 60 per cent. of the areas with the worst health and deprivation, referred to as spearhead areas, are making progress to narrow their share of the life expectancy gap by 10 per cent. by 2010. We have already seen a 27.9 per cent. reduction in the heart disease absolute inequality gap and a 12.7 per cent. reduction in the cancer absolute inequality gap between the spearhead authorities and England, but as my hon. Friend the Member for Norwich, North (Dr. Gibson) said, we must do more. The cancer reform strategy to get individuals to GPs early and the additional help in spearhead authorities are addressing the challenges.
The number of children living in absolute poverty has been halved. The number of homeless families living in bed and breakfasts has been reduced sharply, and the number of teenage pregnancies is down. We have proved that with a concentrated effort it is possible to close the gap between the affluent and the disadvantaged. If the problem is stubborn and persistent, we as a Government must be so too. We are determined to see change on inequalities.
The Secretary of State has said that tackling health inequalities will be central to the work of the Department of Health and is his priority for the NHS. He has announced that we will publish a comprehensive strategy next year for reducing health inequalities. In his interim report, published last week, my noble Friend Lord Darzi described the aims of the comprehensive strategy: to ensure that the NHS and other health services close unjustifiable gaps in health status between individuals, whatever their background, to ensure fair access for everyone to the NHS and to treat all patients fairly with high quality and good outcomes of care for all.
Will my hon. Friend give way?
If my hon. Friend will allow me, there is so much to answer from those who have already spoken. I shall make progress, but I am happy to speak to him at the end.
My noble Friend emphasised in his report the need to help all members of our diverse population live longer, healthier lives, especially those least able to help themselves. What that will mean for areas with poor primary care provision is clear from that interim report. There is a strong correlation between underdoctored areas and deprivation: many such primary care trusts are also spearhead areas. A new package will provide 100 new GP practices, including up to 900 GPs, nurses and health assistants, in the 25 per cent. of PCTs with the poorest provision.
I am grateful to my hon. Friend. I exempt her from my earlier comments about no socialist being a member of our Government. The Minister has read out a series of points, all of which are self-evident and have been so for many years, yet I understand that we are spending millions more on yet another review. I urge her to lead from the front in a good socialist way and implement it without further delay.
I am always grateful to my hon. Friend for his support and encouragement. I am sure that he agrees that change must be put in context. I challenge the picture that the Opposition parties wish to paint—that nothing has been done. We are the first Government to do so, and we are making progress, but more must be done.
My hon. Friend the Member for Wigan focused particularly on resource allocation. Investment in the NHS has trebled since 1997 and now stands at £90 billion of public money. To ensure that the money reaches those in most need, the PCTs’ revenue allocation fairer funding formula takes account of deprivation, need and unmet need. We are tackling health inequalities through mainstream core funding, but my hon. Friends have quite rightly questioned some of the provision. They know that we inherited a situation in which some PCTs were getting more than they should, and it takes time to adjust that.
I give credit to my hon. Friend for the pressure under which he has kept the Government, ensuring particularly that the pace of change policy closed the gap. ACRA, the independent body overseeing the development of weighted capitation, is considering a review of how that formula works and whether it delivers the outcome that we expect. I can give my hon. Friend the Member for Great Yarmouth (Mr. Wright) the reassurance he seeks. We have not yet received ACRA’s recommendations. When we do, we will consider carefully before deciding whether, when and how the formula should be changed, for the reasons that he mentioned.
Under the fair funding formula, Ashton, Leigh and Wigan PCT received an allocation of £449.1 million. During the two-year period 2006-08, it has benefited from a total resource increase of £74 million, or 19.7 per cent., which is greater than the average national increase. It has also received £4.8 million in additional funding through allocations from the £553 million. Under the pace of change process, we have continued to reduce the gap.
To follow the comments made by my hon. Friends, we as a Government have faced up to the problems of health inequalities, but we must now act. Improving the health of the nation means ensuring that those with the poorest health improve the fastest. I congratulate my hon. Friend on securing the debate. I listened carefully to the comments and representations made, and I shall take them back with me to the Department of Health.
Government IT and Software Procurement
IT procurement within Government is thought to be an unmitigated disaster, but that is not true. There is good and bad procurement in Government, just as there is in the private sector, and mistakes made in the private sector are sometimes similar to those made in the public sector. Nevertheless, Governments have wasted a lot of money on IT over the years, with a number large of projects being overspent or overrun, and from time to time stuff has been bought that is not fit for purpose.
A consensus is now emerging about what good procurement is, which is supported by the Office of Government Commerce among others. The view is that good procurement should be competitive and should result in an effective partnership; software should be adjusted to the needs of the users—those who, at the end of the day, have to operate it—and it should be capable of being updated and adjusted economically.
Four things ought to be avoided. The first is a lock-in, an indefinite commitment to a single proprietary solution—endless licensing renewal that the Government simply cannot get out of. Secondly, there must obviously be interoperability; its absence will always be a problem, because it limits the growth and integration of whatever software has been bought, as well as one’s choice of supplier. Thirdly, it is preferable to have access to the source code, so that if necessary people can understand what they have. Finally, it is extraordinarily helpful to have a good skills base on the client side, so that people know what they are dealing with.
On that basis, one would expect the Government to have made use of the growing British open-source software industry, which is by and large highly successful, although there are exceptions. It is successful in a number of operations known to all, such as eBay, Amazon, banks and stock exchanges and so on. However, apropos of such technology, we have a rather peculiar position. There is a lot of tokenism and talk about what benefits it may have, and there are policies aplenty, and I do not think that anyone would argue with the policies per se. However, there is relatively little pick-up of and involvement with open source by the Government compared to the private sector and other EU Governments. That is somewhat peculiar, because it is alleged that substantial savings can be made through the wider application of open-source and non-proprietary software. The hon. Member for Tatton (Mr. Osborne) made something of that some time ago, and I agreed with him—indeed, I might have thought it before him—when he said on behalf of the Conservative party that a 5 per cent. reduction in the Government IT bill could be arranged if only open source were seriously considered.
The alternative, which applies across many Departments, is the tendency to have memorandums of understanding with big companies, often foreign and usually American. There is a close association between that side of the industry and the Government—an association that is personal, consultative and advisory. The House will be aware that the former Prime Minister launched the Labour business manifesto at Microsoft. Hon. Members will also be aware that, on the International Business Advisory Council formed by the current Prime Minister, there sits the owner and founder of Microsoft. However, that is not the only problem. Tendering processes and thresholds for the submission of tenders applied by the Government actually exclude many companies—not only open-source companies but many smaller companies and small and medium-sized enterprises. For example, one thinks of the British Educational Communication and Technology Agency agreement for educational software.
The crucial and damning aspect of the Government’s treatment of certain sectors of the industry is that many of the applications chosen by Departments are locked into and tilted towards well-known proprietary solutions. I shall give some examples. The Driving Standards Agency driving theory CD-ROM can be used only on Windows computers. The Revenue website has limited functionality for the Firefox web browser, the most popular alternative to Internet Explorer and one that some would argue is more secure. The Department for Work and Pensions online benefits system can be accessed only by those who have a Windows computer. Those who have Unix or Linux computers or who use Mac computers should simply not bother. Technically, the Government gateway is owned by Microsoft, and there is a certain amount of co-advertising of products between the Government’s chosen solutions and the providers of those solutions that, at times, is close to being product placement.
I believe that things are worse than that, however. We accept that, like many industries, the software industry is a free market, and that the free market has various desirable outcomes and can bestow great benefits. However, free markets do not prevent monopolies. Worse still, they do not prevent the misuse of monopoly or quasi-monopoly power. They do not prevent predatory pricing or the stifling of real competition; nor do they provide absolute protection for consumers, so that they can have long-standing alternative choices. That is why the Government regulate, as do other bodies throughout the world. The United States has its anti-trust laws, and the European Union has its competition regulations. The Minister will be aware that the US Department of Justice and the attorney generals of 20 states sued Microsoft in order that they became what I might call a more open partner in the free economy. Classically, the Court of First Instance in the EU fined Microsoft for non-competitive or anti-competitive behaviour.
The hon. Gentleman makes an interesting case, which I am following in detail. Would it not help in the quest for openness if the British Standards Institution were to follow the lead in other parts of the world and make open source XML one of the standards to be applied throughout the world? It would mean that people working outside the Microsoft sphere could have access to the code, and it would help the world in future-proofing big projects such as the British Library archives.
I agree. The hon. Gentleman makes a fair point, and the more we converge around open standards, the fewer arguments—arguments of the sort that I am involved in now—there will be.
In fact, Microsoft is not the only villain of the piece. The BBC was forced to withdraw its net learning project—at least in part, the BBC is a Government agency—because it was judged by the EU to be anti-competitive. The point is that the Government have a huge impact in the market as purchaser. They can use that power partially or fairly. They have the capacity to distort the market, and they can render it less open and less competitive. It seems to me that the Government are, in part, in breach of EU regulations. A prima facie case can be made that here we have illegal state aid—a similar case to that made with regard to the BBC iPlayer. The public sector is the biggest procurer in the UK. If the public sector skews the market to favour certain companies and if the Government distort the market by their actions as a prime purchaser, it is not the same as a private company doing so; in a sense a private company is free to do so. The Government are spending public money, and in doing so, it is difficult to see how they are not also breaching state aid rules and providing illegal state aid. If someone cannot access benefits online without using a Windows-based computer, as is currently the case, I do not see how the Government can be doing anything other than involving themselves in illegal state aid. They simply do not need to do that as it would be technically possible to access the system some other way.
Personally, I put up with the fact that inside the Palace of Westminster I can no longer use an Apple Mac computer to surf the internet, which the Parliamentary Information and Communications Technology department has said is because of security, although it has never actually explained how. Why should benefit clients have to purchase Windows Vista, which costs a few hundred pounds, when technically, if the Government allowed them, those clients could do the same thing for free on an operating system such as Linux? Why are the Government making people do that?
I exonerate the Government on that point and turn my accusation against the members of that Committee. I made my representations and will continue to do so. This issue is as clear a case of illegal state aid as, for example, the BBC iPlayer—a case that will go to the EU—and Jam, the internet resource. Other organisations, such as BECTA, also have cases pending in the EU court. Why are schools advised on upgrades to Windows, but not on upgrades to OS X, for example, which is used by a couple of schools near me?
I have every respect for Microsoft’s technology and enterprise and for its founder. However, during the court case against Microsoft, Judge Jackson in the US Department of Justice said—I would not have put it in such a way, as he said things that are quite damning—that Microsoft’s executives had
“proved time and time again to be inaccurate, misleading, evasive, and transparently false…Microsoft is a company with an institutional disdain for both the truth and for rules of law that lesser entities must respect. It is also a company whose senior management is not averse to offering specious testimony to support spurious defenses to claims of its wrongdoing.”
I think that that is harsh. I might choose to believe Microsoft when it tells me that the Office suite and other products provided for the NHS Connecting for Health programme are thoroughly interoperable and replaceable if they are not cost competitive—it has told me as much. I would like to believe the Government when they tell me that they have an efficient deal with Microsoft in relation to Connecting to Health, but I am less than happy that the details of the deal are subject to a confidentiality clause. Microsoft executives tell me that they have changed and that interoperability is the name of the game. Apple, Oracle and some of the other bigger firms are scarcely blameless, but my key point is that the institutional bias of the Government for this particular firm seems to be an open and shut case of illegal state aid.
I choose to have a Windows computer at home and in my office. I am obliged by the Government—until I get my P45—to use a Windows computer if I want to apply online for benefits. If the problem did not concern software and I was forced to buy a Vauxhall car to use the roads, it would be a simply intolerable situation. The fact that this issue concerns a new industry makes the point less obvious, but none the less equally damning.
Fundamentally this debate is about neither Microsoft nor open source; it is about eradicating the suspicion and certainly the prospect—indeed, I believe it is the reality—of illegal state aid being given to any software enterprise through the use of public resources.
I congratulate the hon. Member for Southport (Dr. Pugh) on securing the debate and thank him for raising the issue. In general, Government IT and software procurement are important matters. He is right to say that, through their decisions on procurement, the Government can have some influence on the way in which the market develops. However, the Government must also provide software that is relevant to the computers that most people in the UK have and, as he admitted, Microsoft Windows is one of the dominant operating systems.
That is the type of canard that comes up every time—that we must use a particular supplier because everybody uses it. If the Government are obliging people to use a supplier, that becomes a self-fulfilling prophesy, as I am sure the Minister will acknowledge.
I caution the hon. Gentleman to allow me to develop the theme of my speech before he leaps up hyperventilating and continues talking about the great Microsoft dominance. The Government are neutral about the types of software systems that they wish to be used. I accept that the Government spend taxpayer’s money and need to get the best possible value and effective procurement.
The hon. Gentleman is right that there are examples where new technology has made a real difference and transformed the way in which Government services are made available to citizens. On health, 37 million prescriptions have been transmitted electronically; nearly 350 million images—X-rays and scans—have been digitally stored; and more than 5 million hospital appointments have been booked online through Choose and Book, which gives patients more choice and improves value for money. As part of our overall strategy for transformational Government, it is extremely important that new ways of delivering services are robust, available to all and of benefit to citizens.
I know that the hon. Gentleman does not want lock-in and wants to get rid of proprietary dominance in software procurement, and he is right that we need to avoid the risks of lock-in with particular suppliers—whether that is Microsoft or anyone else. For that very reason, I am keen to explore the benefits of open source software solutions. There can sometimes be a danger of lock-in with some proprietary providers, and we must avoid developing an over-reliance on individual suppliers. The Government, via the Office of Government Commerce, work hard to avoid that by using open standards to ensure that different suppliers’ software can be used interchangeably. However, I agree that open source software, which philosophically speaking everyone in this room would be in favour of, can be another option. I agree that open source software and different operating system platforms can help to ensure the healthy competition that we want in the software market. Competition policy is another of my ministerial responsibilities, so I am anxious to see that flourish in the procurement market.
We have been considering open source software for a number of years and both the Office of Government Commerce and the British Educational Communication and Technology Agency, which the hon. Gentleman mentioned, have published reports on open source software in the past few years. We set out the Government’s policy on such software in 2004. Government policy makes it clear that, as a procurement agency, we do not favour either open source or proprietary providers. The best provider in each case, based on ability to meet our requirements and the value for money that can be provided, is our aim in government, and that is what the OGC strives to make available as an approach for all Departments and local authorities that seek to procure.
The Government want to see a level playing field for all suppliers, so that each individual procurement can be judged in a decision on its merits. That is effectively what happens. Since setting out that policy, we have made increasing use of open source software, which is now playing a key role in the delivery of some of our most high-profile IT projects. Our key online portal, Directgov, successfully uses open source products, so its 6.5 million users every month already benefit from the Government’s use of open source, whether they realise that it is open source or not. A significant part of the Driver and Vehicle Licensing Agency’s electronic vehicle licensing system, which provides a more convenient service at lower cost to the taxpayer than before, is delivered through open source components. In the past year, more than 75,000 people have used it to buy a driving licence.
As well as procuring open source software, the Government have supported it. We backed the Open Source Academy, for example, which brought together local authorities to encourage and support the adoption of open source technology. Some of them, like Bristol city council, have embraced open source solutions. The Government are even providing open source solutions to the public. The National Archive has released its file format identification system, which is called DROID, based on an open source licence, and that has been downloaded 1,600 times in the past year. We are using open source software, and we realise that there can be benefits from doing so.
I personally like the philosophy of open source, the idea of users collaborating and working together to improve the product, and the fact that open source software can encourage competition in the market, which I want to see and am committed to. It is for the Government to get the best software and IT possible for each procurement, so that we can give people the best service and the best value. If open source software can help to achieve that, I want to see the Government use more of it. We have shown that we are willing to encourage that, but we will only do it where open source options can provide the quality, reliability and security that we need and if they can offer the best value for money. That is in the nature, as the hon. Gentleman must appreciate, of procurement.
It is often suggested that open source solutions offer better value because they are cheaper to buy. In fact, the total cost of ownership is considered in procurement, and it is not always the case that the open source solutions are the cheapest. Although they are free of licence charges, because they can involve high levels of support and training costs, they sometimes do not provide the best value for money. External studies have not shown a consistent cost advantage to open source solutions over proprietary solutions. It is often bandied about when such issues are debated that proprietary solutions are necessarily more expensive than open source solutions, but we have yet to prove that. Some of the figures of potential Government savings from the wholesale adoption of open source that are being bandied about are not taking into account the extra support costs over the lifetime of the project.
Some open source projects cannot meet our needs for quality or security, and we are not prepared to compromise on those. Sometimes—I particularly wanted to get this message out today—we are just not offered open source solutions, although the Government are looking for them because we want the level playing field that we have tried to establish to be effective in practice as well as in principle. When the Cabinet Office and the Office for National Statistics wanted to procure desktop and other infrastructure earlier this year, for example, the specification was deliberately designed to permit open source as well as proprietary solutions. None of the 10 initial solutions that we received based their designs around a full or largely open source approach, although we have since worked with the successful supplier to ensure that open source options are available where that is cost effective. We are trying to shape this debate, but when contracts are put out to tender we are reliant on what comes back as an offer from the industry. If the industry is not offering us open source options, the hon. Gentleman cannot blame the Government for not taking them up. I want open source options in as many cases as possible that can compete on good value for money.
Today, I want to challenge the open source industry. We will not favour open source because, while it can be the best option and can offer the best value, it will not always. However, as I have said, we offer a level playing field, and I want to make that a reality. We will procure the solution that can offer the best value for money and that can best meet our requirements: high quality, reliability, security and more specific criteria in each case as the contracts are designed. If that solution is open source, we will use open source.
I am grateful for what the Minister is saying; it is a useful background and encouraging to hear in some respects. The point that I was making, which she has not dealt with, was not about whether some of the tenders are open and above board and give everybody a chance to bid, but about what is being tendered for—in this case, it involved the DWP website. When that produces a product and solution that favours the further use of a company’s products, that is quite different from the company’s winning the original tender. Microsoft might not have had any part in designing the DWP website; I am simply suggesting that the DWP website, in so far as it influences and provokes other consumers, because they have to get a Windows computer—
I understand the nature of ongoing contractual relationships. All that I can say is that because we do not want lock-in or citizens to be left with sub-optimal solutions, it is up to the people contracting to ensure that that does not happen. I think that we are far more sophisticated about that than we used to be. Our absolute insistence on open standards makes it far less likely that we will end up in a situation like the one the hon. Gentleman attempted to describe in his intervention.
I go back to my challenge to open source providers to work with IT services firms, so that they can integrate open source into the solutions they supply when they contract with the Government. That is already happening in many cases, and we are using open source—I have given examples of that—but I would like it to happen more. On our side, John Suffolk, the Government’s chief information officer, will work with the industry and with departmental CIOs to help ensure that our open source policy is innovatively applied throughout the supply chain and in the future.
I thank the hon. Gentleman for his contribution to today’s debate, for securing the debate and for his interest in the subject. I think that we share the same goal of ensuring that we have the best possible and healthiest mix of competition and innovation in the UK Government’s procurement of IT software in an increasingly sophisticated environment, to ensure that services to citizens are modernised in the way that I have described. I hope that I have explained that we are committed to exploring the ways in which open source software can help us to achieve that and to using such software where it is appropriate to do so. We are committed to offering a level playing field, and we will make case-by-case decisions about which of the solutions presented to us in any procurement win. I want to challenge open source software providers to show us what they have to offer and what they can do, so that we can ensure a far greater mix of solutions, far greater competition and more innovation in the way in which we procure software, to give citizens modernised access to Government services.
Child Location Services
It is a pleasure to serve under your chairmanship, Mr. Taylor, for the first time in an Adjournment debate.
This is the third time that I have raised in Parliament the need for the regulation and licensing of the burgeoning new industry in electronic location services, which are used particularly to locate children. In introducing this debate, I thank in particular John Carr—I thank him for my previous interventions as well—who is the secretary of the Children’s Charities’ Coalition for Internet Safety. This time, I hope that the Minister can assure me that the matter will be discussed seriously in the Department and followed up.
To recap on previous discussions on the matter, the internet kicked around for the best part of 20 years without anyone taking any real notice of it. In the beginning, it was principally the plaything of a small number of boffins working mainly in defence research establishments, essentially swapping test results with one another. Nobody really cared about this obscure technological development. How wrong we were. It was only when the internet started to penetrate the mass consumer market that a whole raft of social and political issues started to emerge, catching Governments and the policy-making community on the hop.
Today, we seem to be engaged in a seemingly endless game of technological and regulatory catch-up. We could now be at one of those historic moments with mobile phones and, above all, satellite-based technologies, which are facilitating the steady emergence of an array of cheap and easy-to-use surveillance tools that soon will enable every Tom, Dick and Harriet to become their own 007—for the first time in history, we all have it in our powers to be James Bond, or to be like the police and track another person 24 hours a day, seven days a week, 365 days a year. The mass consumer market is being targeted with cheap and easy-to-use tracking devices. We have not yet got a hold of the industry.
Just before I walked into the Chamber, about half an hour ago, I was sent an e-mail by Action on Rights for Children telling me about another new development in which the school uniforms manufacturer, Trutex, has mooted the idea of embedding global positioning systems in school uniforms. ARCH did not take that seriously. It thought that it was a silly season story, but it contacted Trutex’s public relations company only to find out that it was true. Trutex is actively seeking ways in which to take that forward. At the moment, there is apparently no way for any Government Department to ask whether there are any safety or other issues that ought to be pursued with that company.
I first raised this matter at a time when I had seen a number of cases of journalists being able to track people without their knowledge. Also at the time I had just seen, on CNN, a piece about the CeBIT hi-tech trade fair in Hanover. One exhibiter said that he was amazed that more parents had not yet invested in his child location product. “Just pop it in your kid’s backpack and get peace of mind,” as he said. But the problem is: what if someone else pops that tracker into a kid’s backpack in order to trace them? That exhibiter on that television programme advertising his wares did not say whether he checked whether his product was sold to parents or paedophiles. Those surveillance technologies that are getting going have indeed made their first appearance in the child protection market. That is where we need to be particularly concerned, although I think that there is a general issue about surveillance and such products coming forward without any real controls.
I made a speech during the ten-minute Bill that I introduced last year that called for a licensing regime. I have a copy of that Bill, which the Minister can use if he so wishes. It sought to establish
“a licensing regime for the sale or promotion of any service providing data on the location of children where these data have been derived from any mobile telephone network, satellite system or other electronic or communications medium.”
At the time, I referred particularly to the example of the Teddyfone—it is not hard to guess what it looks like. It is a very attractive little phone in nice blue and white livery that the hungry eyes of a little child would jump on. They would be only too pleased to take it away with them. Indeed, that company is targeting that very young market. The Teddyfone would fit easily into tiny hands, pockets or backpacks.
As I said, however, who checks to whom that product has been sold? Obviously, the phone does what any phone does. It lets someone talk to whoever is carrying it at the time. It also restricts who someone can call from it. However, just by sending a text message, it automatically and silently converts the phone into a listening device. When a colleague of mine contacted Teddyfone, it confirmed that the listening device was turned on without any audible warning. It said, “Well, if the child knew that you were listening, it would defeat the point of it.”
One wonders not just about child safety issues. One might think that people know where that tracker is, but how do they know whether it is with their child, and how do they know that their child has not been given a tracker by somebody wanting to track them without a legitimate reason? Furthermore, is it good to be able to listen into a child’s conversations without them knowing? I am not sure that that necessarily is the best way in which to move forward with social relationships and to ensure that parents’ relationships with their children are the best that they could be. Do parents want their children to carry a phone into which a teacher or somebody else could listen?
Of course, however, the Teddyfone also turns into a tracking device and provides information on the physical whereabouts of the person carrying that phone. Obviously, that can bring wonderful peace of mind. A parent can feel safe because their child is carrying such a device. However, what peace of mind can it give if that service remains unregulated and open to misuse by strangers who might be very clever at grooming a child? We are sleepwalking into a surveillance society without having made sure that it is properly regulated.
Whenever a mobile phone is switched on, it is transmitting and receiving signals from individual, geographically-specific radio cells on the owner’s mobile phone network. Therefore, the network knows where the owner is, possibly to within a matter of metres. If the phone is turned off, the operator will know where they were at the last connected moment. That has been very valuable. On the production of a warrant, that location information has always been available to the police who increasingly use it when investigating all kinds of crimes.
If I fell down a ravine and had one of those devices, I would be only too pleased that an ambulance could track me. If I was going up a mountain, I might well want one so that a mountain rescue team could find me if I got lost. They have many valuable uses. However, they are potentially very dangerous as well. At the moment, the UK’s mobile phone networks have put that location information on sale to the public, and so far about 30 companies, of which Teddyfone is one, are packaging and selling it. Many of them are doing that in the name of child safety. If a person has a Teddyfone, without going to the trouble of talking to their child, they can go to a website and see where they are, or they can ask for a map to be sent to their mobile phone showing the same information. As I said, they can also decide whether to listen in to their conversations.
Devices are coming on to the market that do not depend on mobile phone networks. We have gone beyond a situation involving just mobile phones and on to global positioning system technologies, with which we are familiar in relation to satellite navigation and the ability to find a person’s car. However, that tells a person where they are; it does not tell other people where they are. If they want road location information or to find out about traffic, they can plug it in and use it. That is very useful. At the moment, however, the combination of those two technologies—mobile phone networks and satellites—is much more potent than either technology used alone. That is likely to be the model for the future.
In theory, the child being tracked, if they have one of those tracking machines, has to give consent. However, it is a little absurd to think of a four-year-old giving their consent—and four-year-olds are part of Teddyfone’s target market. How do we ensure that those systems are controlled, because clearly the four-year-old cannot agree to be tracked?
This is becoming very widespread. John Carr went into a company called Spymaster which sells equipment that spies on people. It is based off London’s Oxford street. When he asked the sales assistant if there were any problems, for example, in buying an electric plug or a seemingly-normal fountain pen that doubled as a microphone or transmitter, she said, “No, because in the UK there is not a basic law of privacy”. Of course, if someone heard anything from using a hidden microphone, it could not be produced as evidence in a court of law, but most of its customers are not interested in going to court. They are simply trying to collect intelligence.
From Spymaster’s website, it is obvious who would want to use its products: perhaps overseas Governments or the super-rich. But it could just as easily be private investigators, who I am sure use such equipment. The danger of that equipment spreading far and wide without any proper regulation is clear. I shall focus on children, because that is our primary area of concern. However, I wanted to make the point that we now have a society in which those products are on the market and widely available to everybody.
I shall return to the issue of children’s location products. The Home Office, the police and children’s charities negotiated with the UK’s six largest networks, and they agreed a voluntary code of practice governing the deployment of child location services and location services generally. The code existed when my ten-minute Bill was debated, so one may ask why I felt that we still needed regulation when a voluntary code was there to be used. At that time, there had been the examples of a Guardian journalist, who had managed to track his girlfriend without her knowing—I hope it did not damage their relationship—and a Mail on Sunday journalist, who had tracked various people, including a 14-year-old girl. I have her account with me, although I am not sure whether it ever appeared in the paper. There was another example, too.
I met representatives of some of the mobile phone companies last week, and they told me that they have ironed out some of those glitches and that some of the ways in which those incidents occurred have been brought under control. They have a code of practice, whereby, for example, the system cannot be turned on until the person who has the device on them has registered a response to a call asking whether they are happy for that to happen. That does not apply very well if the device is on a four-year-old child. In one of those examples of tracking, the journalist had himself responded to the call before his girlfriend got the phone back. The mobile phone companies tell me that they have sorted that issue out and that there is now a time lag before the response can be made. Having spoken to them, I know that they take their responsibilities seriously. The companies sell their services and allow people with their products to use their mobile phone network to locate people, but if the companies see that something is going wrong, they have the power to switch the service off. There is a control mechanism, but they can control it only by trying to issue guidelines to people who buy the products, or by undertaking mystery shopping.
The jury is still out on whether the voluntary code for using the mobile phone network will stand the test of time, but one of my reasons for pursuing the issue is that what I predicted when I introduced my ten-minute Bill last year has come to pass: tracking devices are becoming available through GPS systems and other technologies. When I read about the launch of a product called Buddy, I thought that it was based solely on GPS, but I understand from the company behind it that it uses a mix of GPS and mobile phone technology. That is because a mobile phone network will not work if the user is underground; they need the mix of the two technologies to make the product work effectively.
Systems that use solely GPS technology are being sold, however, and they fall outside the voluntary code that governs mobile phone networks. In any case, it is only a voluntary code, and it is hard to see how we can ensure that there is any control over the use of that technology and its potential dangers without licensing or regulating those who sell the product.
I have met the managing director of Buddy. The company seeks to use its system to track pets, which might be popular; to track people’s parents who suffer from dementia and tend to wander off; and to use it with autistic children in particular. It has been working with the National Autistic Society. The company is aware of the potential dangers, and it seeks voluntarily to follow the same sort of code as that which the mobile phone networks have set down. Although we did not agree about the exact form of any safeguards, the managing director said that safeguards are needed.
I do not want to introduce a difficult regulatory regime with a huge licensing bureaucracy that is going to be a problem for people, but we need safeguards and a licensing scheme for those who sell such products. That area must be looked at seriously. The people who are responsible within the industry clearly believe in some form of regulation. The mobile phone companies have their voluntary code, the managing director of Buddy agrees that some safeguards are needed and other people wrote to me after my ten-minute Bill debate last year.
I have a letter from an organisation called MindMe. It does not undertake child location services; it supplies industry and individuals with a portable security device for lone workers. Understandably, if one operates in an area by oneself, for example as a security guard for a company, it is helpful to have one of those devices in case one gets into trouble. MindMe wrote to me, saying:
“We are very interested in your proposals because we would welcome a licensing body for all forms of location services to cover both adults and children.”
It went on to set out its concerns about its industry. I had similar responses from other organisations in the industry, so the idea does not provoke shock and horror among those in the industry, because they see the potential dangers.
If the system works, that is fine; if the voluntary code works, that is fine; if a company such as Buddy acts responsibly, as it seems to be doing from my discussions with its managing director, that is also fine. What happens, however, if something goes wrong? With a burgeoning industry, that scenario is increasingly likely, and Departments must get a grip on the issue.
After I raised the issue in my ten-minute Bill, I tabled an amendment to the Safeguarding Vulnerable Groups Bill. I subsequently withdrew it, but it would have introduced some safeguards to the legislation. I have not pursued the issue vigorously with Departments, but I cannot just sit back and let it happen any more. Appeals to the Home Office and the Department of Trade and Industry have drawn a blank in the past, and one letter in particular to those Departments did not elicit a very forthcoming reply.
The Department of Trade and Industry, which is now—really—the Minister’s predecessor Department, provided financial assistance to a company that was developing a child tracking product. When the DTI was asked whether it had considered the possible criminal or other misuses of such technology, it said in effect that such questions were none of its business. What is more, it even gave the firm in question a prize for innovation. I appeal to the new Department for Business, Enterprise and Regulatory Reform not only to analyse child location services and tracking services, but to realise that it has a responsibility in that area. It must talk to children’s charities and to the Home Office. They take a serious and deep interest in the ways in which technology can be used to endanger people.
When the DTI was asked whether it thought it should have consulted child protection specialists before agreeing to fund the development of a child detection product, the DTI officials just said no, so I ask the Minister to make his colleagues and officials aware that that attitude must change. I urge him to raise in the Department the issues that I put forward in my Bill, and to enter into discussions about the safeguards that might be introduced—preferably a licensing system, as I have put forward, although there may be other ways. The Department should take serious account of the safety of any product that comes before it—in any area.
We are sleepwalking into a situation in which anybody can come under surveillance. One example that worries me is somebody who is in a refuge because they fear violence from a partner. Commonly, those partners seek to find out where the refuge is, and it usually has a PO box number. If that partner wishes to chase them, what could be simpler than to put a tracking device in a phone, post it to the PO box number, and—subject to there not being a strike at the time—find out when it gets there where the machine, and therefore their partner, is? I discussed that issue with the managing director of Buddy yesterday, and she came up with some ideas about how to deal with that problem.
I hesitate to call for a great debate about the surveillance industry, but we cannot let the issue get out of hand. We have seen the dangers of other technologies only after they have been introduced: for example, the internet and the mushrooming number of child abuse images; video nasties and their effect on people—a subject that is being debated in the Criminal Justice and Immigration Bill currently before Parliament; and the Jane Longwith case. As with all such areas of technology, we need to get a grip on it before it has a grip on us and before we find that it has appalling and horrifying consequences for our society. Those consequences may be few and far between but, just as we talk about how MySpace and all those other technologies can be used indiscriminately to track children and provide information leading to someone’s house being burgled, we need to get a grip on the technology before it creates such problems.
It is important that we consider a licensing regime and safeguards on the burgeoning industry, so that we can ensure that our children, in particular, are kept safe and that there are some safeguards and licensing, as I would like to see, on the industry in total. I am particularly concerned today about the safety of our children and ensuring that devices are properly used and regulated so that they meet the reasons for which people seek to buy them and are not put to uses that will bring harm and danger to our children. I hope that my hon. Friend the Minister will give me a positive response about taking forward the issue.
I thank my hon. Friend the Member for Amber Valley (Judy Mallaber) for raising the issue and for the opportunity to debate child location-based services. She is absolutely right that child safety is a critical issue for the country, and she made a point of both general and specific relevance. I shall come to the specifics shortly, but the general question raised is, when technological advances can be used for good purposes or ill, how should the Government respond?
We may consider, for example, electricity, which is an essential good of modern life. We could not imagine modern life without it, yet a badly wired house can be a danger to life. My hon. Friend mentioned the internet, which is certainly one of the most amazing inventions of my lifetime. It has opened up a vast, unimaginable array of information to people and enables families and friends to stay in touch, if they live in different countries, far more easily than before. Yet, as she said, through social networking sites and so on, which are mostly beneficial, it can also be used in a manner that could place people in danger or, as we have seen, to help promote political extremism. Each technological advance opens up new opportunities and horizons but can also pose new risks.
I turn to some of the specifics. My hon. Friend mentioned surveillance, which is a topic of considerable political interest. Is more surveillance good or not? Speaking from my own constituency experience, the demand from my constituents is often for more surveillance of their streets—more cameras, more of a presence of the state by way of the police force and more control over what happens on their streets. Yet some people, of course, have concerns about that.
Child location services, enabled by the kind of technologies that my hon. Friend mentioned, can offer an important comfort to parents who want to know where their children are, conscious, as parents are, that their children are growing up in a world of probably far greater opportunities than ever before, but also of risks that we did not have to worry about in the past. She rightly said that the issues she raised were of relevance not just to child safety, although that is her principal concern today, but in cases of domestic violence, for example. She is right that the victims of domestic violence quite rightly want to keep their locations secret from abusive former partners.
Perhaps it would be helpful if I set out the regulations that are in place, because the area is not unregulated. The technology is new and developing, and in setting out the position I am not saying that we could never go further. However, I hope that my hon. Friend will understand that I will not be promising her today more regulation in the field. At the moment, the Privacy and Electronic Communications (EU Directive) Regulations 2003 apply a number of privacy safeguards to services based on traffic and location data, including a requirement of informed consent from subscribers to, or users of, the services involved. For services involving children, consent must be given by a child’s parents or guardian.
The code to which my hon. Friend referred calls for checks to confirm the identity of those applying. I could go into detail, but given the time perhaps it will suffice if I say that that involves the sending of e-mails, the supplying of PIN numbers, PIN numbers being returned and so on. Subscribers or users must be able at any time to withdraw their consent. That can be done temporarily in relation to each connection to the network, or on a permanent basis. The processing of personal data is regulated by the Data Protection Act 1998.
Enforcement lies with the Information Commissioner’s Office, which to date has not needed to take enforcement action against any company operating a location-based service. It has rightly had considerable input into location-based services, out of a general concern about surveillance conducted through mobile phone technology. It works closely with the industry and with child safety experts on an ongoing basis.
As far as the Government are concerned, the legislation is supplemented by a self-regulatory framework developed by the Home Office in partnership with the industry. In 2004, the voluntary code of practice called the “Code of Practice for the use of passive location services in the UK” was developed by a working group comprising UK location service providers, five mobile phone network operators and children’s charities.
Does the Minister accept, first, that that code is voluntary, and secondly that it was developed with those using mobile phone technology, not new technology? As I understand it, there are no particular legal controls requiring someone selling a product, for example, to check up on who is being tracked and how.
My hon. Friend is right that the code is voluntary and applies to mobile phone technology. I shall come to the issue of global positioning systems in a moment.
The code is subject to regular review so that it remains relevant to the needs of consumers and the industry and is compliant with applicable law. All location service providers using location data supplied by mobile network operators in the UK should, as a minimum, observe that code of practice. It states that child location services should not be marketed in any way that exploits parents’ concern or fear that their children may become victims of crime, and that services should take account of the fact that someone knowing where their child’s phone is does not necessarily tell them where their child is. It is taken seriously because of the implications for child safety.
My hon. Friend asked about GPS technology. It is a valid question, and we understand the concerns expressed that it might be possible to overcome some of the security and privacy protections laid down in legislation and in the code. The Home Office has set up a location-based services group consisting of the representatives whom I have mentioned. It was established to oversee and monitor the working of the code, and I am happy to tell her today that that group is examining developments in relation to GPS and the potential for misuse arising from it.
Will the Minister undertake to meet me and people from the children’s charities, or ask one of his colleagues to do so, to discuss the gaps that we see? Will he also undertake to ensure that, where child safety issues fall within the purview of his Department, rather than the Home Office, they are taken into account and that the appropriate charities are consulted before decisions are taken that simply relate to an industrial interest?
I am certainly happy to say that I or my officials will meet my hon. Friend when we consider such issues. We are not convinced that a system of licensing is necessarily the way forward, but we have certainly heard what she has said and I am sure that my officials will take seriously the points that she has made today.
General Practice (Northamptonshire)
I am sure that you have had a busy and productive morning, Mr. Taylor, but I suggest that this debate will be the highlight of your entertaining morning. I thank Mr. Speaker for granting me permission to hold the debate, and I also thank general practitioners throughout Northamptonshire and all their staff for the wonderful job that they do for people in Kettering and across the county.
One of my reasons for seeking today’s debate is that when we talk about the national health service, all too often we talk about hospitals and do not spend enough time talking about GPs. Yet most people’s most frequent contact with the NHS is through their local family doctor. Having talked to GPs in Northamptonshire, I know that their impression is that they are an overlooked part of the NHS. When the Government talk about schools and hospitals, they should not forget that GPs provide an extremely important part of our NHS.
The hon. Gentleman has rightly said that we should value GPs, that they ought to have more priority and that there is too much emphasis on hospitals. How does he feel that ripping up GPs’ contracts will enhance morale amongst GPs in his community?
May I say gently to the hon. Gentleman that at his party’s conference, the shadow Secretary of State for Health announced his intention to rip up GPs’ contracts and start again. I assume that the hon. Gentleman is bound by the policy of those on his own Front Bench.
The purpose of today’s debate is not, from my perspective, a party political one. I am a Back-Bench Member of Parliament, I speak my own mind on these issues and I am disappointed, to be blunt, with the Minister’s tone in these opening exchanges. For me, the purpose of this debate is to draw his attention, as a Minister of the Crown, to the future of general practice in Northamptonshire. I suggest that whether I am a Conservative or Labour Member, many of the things that I shall say today are comments that any MP would want to put to him.
One of the biggest and most important issues affecting GPs in Northamptonshire is the fact that it is a designated growth area. The population of the county is due to increase by between one third and one half in the next 15 to 20 years. I should like the Minister to clarify how PCTs are funded in that respect. It is certainly the impression of local GPs that PCT funding is determined by the number of patients who are registered with GPs rather than the actual number of people resident in the area. One statistic that I have been given is that there are an estimated 20,000 unregistered patients in the county town of Northampton alone. Such people tend to make extensive and often inappropriate use of accident and emergency facilities at a cost to the PCT under the payment by results plan, which means that resources that could be provided to local GP practices are not being provided. The Government’s own statistics, given in answer to one of my parliamentary written questions, told me that the average practice list size of a GP practice in Northamptonshire is 8,000 patients, which is 30 per cent. above the national average of 6,000. Even before the very rapid increase in population that the Government have planned for Northamptonshire, general practice list sizes in the county are already one third above the national average.
I congratulate my hon. Friend on securing what is an important debate for Northamptonshire. Is he aware that in many areas in my constituency it is almost impossible to get on to the list of a GP practice? I had a case in which an 80-year-old who came to the town could not get on to a list. She had to apply and was put on a list elsewhere in the town. That has occurred before the growth has taken place.
I know that my hon. Friend attaches great importance to health service issues as part of his “Listening to Wellingborough and Rushden” campaign, and I am delighted that he has taken this opportunity to highlight what is a real problem for many vulnerable people in Wellingborough and Kettering. Often, several members of the same family will find themselves being registered with different local GPs, which cannot be the best outcome.
An increasingly important issue in Kettering and Northamptonshire is the number of people arriving from eastern Europe and seeking GP services. That is causing problems for GPs with language—many such people are unable to speak proper English, especially when it comes to medical terms—and with gaining access to previous medical records. Every GP to whom I spoke in the summer recess said that they had new arrivals from eastern Europe on their books and that it is a genuine problem for them. Many GPs feel that it is inappropriate to include translation services, which are paid for by the PCT, in the enhanced services budget, because the PCT can then claim that it spends more than the indicative sum on enhanced services. That effectively deletes the money that is available for the development of medical GP services. Will the Minister be kind enough to look into that important issue?
GPs are also concerned about the recent NHS reorganisation in the county. The PCTs that existed two years ago have been merged into one PCT that covers the whole county. My hon. Friend the Member for Wellingborough (Mr. Bone) and I opposed that reorganisation, as I understand Labour Members in the county did, but the Government nevertheless went ahead with it. The problem is that part of the big overspend in the south of Northamptonshire has effectively been transferred to the north, where the overspend was not nearly as great, putting budgetary pressures that did not previously exist on GP practices in the north. As a result, GPs are prescribing cheaper drugs than they would otherwise prescribe because of the budgetary pressures from the PCT and the strategic health authority.
Another big concern that local GPs have brought to my attention is the state of children’s mental health services in the county. One GP wrote to tell me:
“I think the most significant aspect of healthcare in the Shire is the poor service available in Mental Health and particularly Children’s Mental Health. Only this week…we have a 13-year-old girl with…an Eating Disorder who has been dismissed as “depressed” by the Service and she is too young to access alternative services so her (not well-heeled parents) are referring her privately.”
The letter goes on:
“If young people’s mental health problems are not properly addressed, they are at best emotionally scarred for life and grow up to be emotional cripples, unable to sustain healthy relationships, and at worst end up in crime”
or on drugs. All the GPs to whom I spoke highlighted that as being an issue—patients requiring services that, all too often, simply are not available.
It has been brought to my attention that computerised cognitive behaviour therapy has been proposed by the National Institute for Health and Clinical Excellence as an effective tool for many patients. It was announced some six months ago that CCBT would be available. It is due to become available in Northamptonshire this month, but the responsible PCT team has only just been appointed. To add further insult, access to the therapy is being restricted to patients with severe depression, whereas NICE recommends it for mild depression and neuroses such as obsessive-compulsive behaviour. Again, there is a real concern that GPs are not able to access the services that they would want to access from the local mental health team.
GPs are also concerned that they are required to spend a growing amount of time on collecting and producing data under the quality and outcomes framework. They rightly say to me that, all too often, they spend far too much time on data processing instead of patient care, particularly as they have to deal with lists that are 30 per cent. above the national average.
Unfortunately, there are also problems with the choose and book scheme. One example that I can put before the Minister is from a local GP who referred a patient through choose and book for orthopaedics. The GP phoned the number, and someone took the details and said that the patient should phone the office where orthopaedic referrals were triaged. The GP phoned the number, but an answerphone said that staff were on holiday for two weeks and to phone another number. The GP phoned the other and was told that the office was not taking bookings like that but that it would wait for a GP letter and then write back. Two weeks later, a letter was received advising that the patient needed to see an orthopaedic consultant and to phone yet another number. The GP phoned the number six times, each time being cut off when the phone was answered. The GP finally got through and was told that the phone “is always doing that”. Those are frustrating circumstances for hard-pressed GPs. They made a particular point of wanting me to highlight the fact that choose and book is not working as it should.
Now we come to the issue of GP contracts. In good faith, the Government negotiated contracts with GPs. Reference was made to out-of-hours services. NHS survey data published in July show that 85 per cent. of patients in Northamptonshire are satisfied with GP surgery opening hours. Only 7 per cent. of patients said that they would like GP surgeries to open at weekends. There may be demand for surgeries to open in the evenings and at weekends, but having asked my constituents and having spoken to GPs, I can detect no such surge of opinion in Kettering or Northamptonshire.
GPs rightly say that they would expect few people to take advantage of the service if they were to open for weekend surgeries. They also point out that although the Government may be pressing the issue because they are embarrassed that, in their view, they are paying GPs more than they should get, there would be extra costs outside the GPs’ remuneration for paying for staff and building occupancy at weekends.
Local GPs provide an out-of-hours service through the Keydoc service. It is provided on a rota basis, and I can tell the Minister that it does a better job than NHS Direct, and at a far lower cost. In many cases, phone callers find themselves speaking with the Keydoc service because NHS Direct is unable to cope with the volume of calls that it gets. I am not saying that Keydoc is perfect. I have had complaints about it, but I have also had complaints about NHS Direct. I draw the Minister’s attention to the concerns of a constituent who e-mailed me. He stated:
“I today had occasion to contact the NHS Direct service. I needed medical advice after swallowing an object…I tried to call for over 4 hours and constantly received an engaged tone. In the end I contacted my GP surgery who were able to reassure me. A quick straw poll of work associates shows this is typical and generally they call the out of hours GP service because NHS Direct is either busy or is so general in advice that it is not sufficient for purpose.”
That unsolicited e-mail was from a constituent in Rothwell. Local GPs are concerned about the amount of money that the Government put into NHS Direct, particularly when they compare its cost-effectiveness with that of Keydoc.
Overall, the message from Northamptonshire is that GPs are extremely hard-working. In general, the system is working well, but GPs are beginning to feel unappreciated by the present Government, particularly in respect of the unnecessary pressure to extend opening times outside the weekday appointments system. There is growing concern about the amount of data that they have to collect, and they feel that the Government ought to reprioritise GP care rather than concentrate only on hospitals when they talk about the NHS.
I close by placing on the record three surgeries in the Kettering constituency that in a recent NHS survey achieved levels of satisfaction that were higher than the national average. The Guilsborough, Dryland and Mawsley surgeries are setting an extremely good example for local GP surgeries throughout Northamptonshire.
It is always a pleasure to serve under your chairmanship, Mr. Taylor. I congratulate the hon. Member for Kettering (Mr. Hollobone) on securing this Adjournment debate. The intervention of the hon. Member for Wellingborough (Mr. Bone) was obviously important from his constituents’ point of view. I have to say, as a Manchester City supporter, that he would be greeted in a positive way if he were to venture into Manchester these days, in view of his well-known likeness to a certain high-profile football manager.
Seriously, this is an important debate, and the hon. Member for Kettering raised some valid, legitimate issues on behalf of his constituents. I do not wish to be churlish, but the emphasis and focus of his speech were disingenuous. I shall explain why it is fair to say that.
First, the hon. Gentleman said to GPs in his community that he and his party are on their side and that the Government are doing things to the national health service that are getting in the way of their doing their job. That was his main message. He used anecdotes about individuals to prove a point. I always think that it is unfair to try to talk down the NHS by doing that, as 99 per cent. of anecdotes would demonstrate that people receive a wonderful service.
I suspect that the hon. Gentleman wrote his speech before the announcement at his party’s conference about ripping up the contract that GPs and the Government recently signed. That is now the position of the Conservative party. It has gone down incredibly badly with GPs at a time when the Government’s message is that, yes, we need to make significant changes to primary care, but that we intend to do that in partnership with the profession, building on the contract rather than simply ripping it up and starting all over again. The Conservative policy is putting his party into conflict with GPs who are working hard every day of the week to improve the NHS.
I shall make some progress and then give way to the hon. Gentleman. Major progress has been made in Northamptonshire. All Northamptonshire patients are able to see a GP or a nurse for a routine appointment within 48 hours; Northamptonshire practices achieved an average of 960.1 quality points out of a possible 1,000 in the quality and outcomes framework, and 74 per cent. of the population aged 65 and above have been vaccinated for influenza. Across Northamptonshire, all practices have open lists and are accepting new patients—the hon. Gentleman disputes that—and several practices employ highly skilled nurse practitioners who provide a range of services from the management of long-term conditions to diagnosis and treatment of minor ailments.
The performance of the health service in the hon. Gentleman’s constituency has advanced massively in the past 10 years. He will not like my saying this, but a significant reason for that is the near tripling of investment in the NHS that the Government chose to make. The NHS had been starved of resources in the previous 20 years, which meant that the baseline of NHS funding was a scandal when compared with other countries around the world.
The hon. Gentleman is right about growth. The Northamptonshire PCT received growth area adjustment in its 2006-08 revenue allocation to take account of the demographic issues that he properly raised.
I will give way in a moment. I shall provide some recent information, which is not made up, about what is happening in the hon. Gentleman’s health economy area. Six large extensions opened in 2007—three in Northampton, two in Corby and one in Daventry—and a new surgery has opened in Higham Ferrers in east Northamptonshire. Two large new medical centres will open within the next nine months in Rothwell and Kettering, and an extension is due for completion in December in Northampton. There are plans to develop health facilities in Kettering, Thrapston, Raunds, Corby and Northampton, and the south midlands LIFT project will see the development of new facilities in Corby, Wellingborough and Northampton.
A new approach to service delivery will involve a series of health hubs providing a wide range of services along the lines of polyclinics. Willowbrook community hospital polyclinic in Corby will have investment of £27 million, and the integrated care centre polyclinic in west Northampton will have investment of £21 million.
My point is that there is now massive, unprecedented and sustained investment in primary care in the constituencies of the hon. Members for Kettering and for Wellingborough. That recognises that patient expectations, technology and science means that health care must be incredibly different if we are to make best use of the new technology and new drugs being created almost daily, and if we are to respond to patient expectations.
I understand the Minister’s case, but unfortunately it falls flat when it comes to Northamptonshire PCT because under the national capitation formula, which the Government set up to decide how many millions of pounds each PCT receives, Northamptonshire has received less than 100 per cent. in each and every year since that formula was implemented. Over the past few years, that has equated to £110 million. If the Government implemented their own programme, we would not have a problem, but they do not do so in Northamptonshire.
I shall deal with that accusation head-on. In 2006-07, the allocation to the PCT increased to £730 million—a cash increase of 12.7 per cent. In 2007-08, it received £870 million, which is a further cash increase of 12 per cent. That is a cash increase of 26.3 per cent. over the two years 2006-07 and 2007-08, compared with a national average of 19.5 per cent. The funding formula and the funding system recognise that the hon. Gentlemen’s constituencies have particular issues and challenges that must be addressed.
No. It is exceptionally disingenuous for hon. Members who represent a political party that slashed NHS spending in every part of the country to come here and undermine the massive additional, above-average investment in their communities. We should remember that during the past seven or eight years, that party has repeatedly opposed the additional investment that the Government have chosen to put into the national health service.
It is important that we do not mix up the debate about out-of-hours and emergency services provided by GPs with extended hours in terms of evening and weekend opening. Under the previous system, GPs often worked until midnight or 1, 2 or 3 o’clock in the morning, and then went back to their practices at 8 am to see patients. That was an unreasonable set of expectations and did not necessarily lead to the best possible, safe patient care. Under the new contracts, GPs were given the option of saying that they no longer wanted to provide emergency or out-of-hours cover, and the PCTs were given responsibility for securing that out-of-hours cover.
The argument about extended hours is that because of labour market realities, choice and preference, many patients would like to be able to see their GPs in the evenings or at weekends. That would be more convenient for patients and a more personalised service. That is the next stage in the NHS transformation that the Prime Minister, Lord Darzi and the Secretary of State have spoken about. Having fixed the NHS and rebuilt its foundations, we must now move to a highly personalised service. I find it astonishing that any Member would stand up here and say that patients are not entitled to that and do not want that. Surely we should create an NHS that continues to be increasingly responsive as society changes. Let us not mix up emergency out-of-hours cover with extended hours and more convenience for patients.
This is the 10th debate on local issues that I have managed to secure, with the permission of Mr. Speaker, in the past two years, and this is the most inappropriate party political response that I have had from any Minister. This Chamber should be a genuine forum for Back-Bench Members to raise genuine constituency cases. I was not making any political points whatever. Will the Minister confirm that NHS spending in Northamptonshire is based on registered patients at GP practices, and not on the population? On extra opening times for GP surgeries, I was simply quoting to the Minister his Department’s survey data, which show that 85 per cent. of patients in Northamptonshire are satisfied with the current opening hours of GP surgeries.
The tone of the hon. Gentleman’s presentation was to talk down the NHS and its performance, and to use anecdotes to say that the Government’s desire to respond to patient preference and choice is misguided. He did not refer to the fact that at his party’s conference, the shadow Secretary of State waged war on the GP profession by saying that the Tory party’s position is to rip up GPs’ contracts.
The hon. Gentleman rightly referred to access to children’s mental health services. The Government have begun to rebuild child and adolescent mental health services—CAMHS—and have put a lot more money into them, but there is a long way to go because, as you are aware, Mr. Taylor, such services were practically non-existent in many parts of the country back in 1997-98. We have two trailblazers and another 11 are starting now. Access to talking therapies through primary care in every community is something that I am proud of, and later today there will be further announcements about health spend over the next three or four years. It is important that, in future, there will be greater emphasis on investing in talking therapies, which can make a massive difference to people’s quality of life and mental health. There was no access to talking therapies in this country when we came into government, and people waited months and years for an operation. By next year, people will wait a maximum of 18 weeks.
The hon. Gentleman’s community should respond positively to the Darzi interim review proposals. There will be more than 100 new GP practices, including up to 900 GPs, nurses and health care assistants in the 25 per cent. of PCTs with the poorest provision. It may well be that the hon. Gentleman’s constituency could benefit from that. New resources will enable PCTs to develop some 150 GP-run health centres, with up to 1,750 GPs and nurses situated in easily accessible locations and offering a range of services to all members of their local population. As a result of last week’s interim review announcement by Lord Darzi and the Secretary of State, the hon. Gentleman may be able to secure even more resources for primary care for his constituents.
The hon. Gentleman raised valid and legitimate issues, but it is important that we do not allow people to suggest that the health service has not advanced massively. In our vision for transformation, personalisation is the next stage, and the Government will match that with continued and sustained record levels of investment.
Question put and agreed to.
Adjourned accordingly at Two o’clock.