Wednesday 2 April 2008
[Mrs. Janet Dean in the Chair]
Pulmonary Arterial Hypertension
Motion made, and Question proposed, That the sitting be now adjourned.—[Siobhain McDonagh.]
I wish to declare an interest—I am a trustee of the Pulmonary Hypertension Association UK—which is listed in the Register of Members’ Interests. I am grateful for the opportunity to bring to the House’s attention the grave concerns of expert clinicians, patients and their advocates about the preliminary recommendations in the National Institute for Health and Clinical Excellence appraisal consultation document, “Pulmonary arterial hypertension (adults)”. The NICE appraisal committee is meeting today to consider the submissions to its consultation, which ended on 20 March, and I hope that it will take account of our deliberations.
Pulmonary arterial hypertension is a condition that causes high blood pressure in the pulmonary arteries, which carry blood from the heart to the lungs. The condition causes those arteries to thicken and narrow, restricting blood flow in the lungs. As a result, the right side of the heart must pump much harder. The symptoms are breathlessness, chest pain, angina, fatigue and fainting spells. So far, it is not curable, and if not treated, it leads to premature death. Treatment aims to improve patients’ quality of life and extend life, enabling lung or heart and lung transplants to be made in suitable cases. Pulmonary arterial hypertension affects children and adults. It is a rare condition: NICE estimates its prevalence to be between 15 and 50 cases per million, which means that, at the top end of the range, 2,165 adults in England and Wales may have the condition. Approximately 1,500 patients are currently being treated.
The vast majority of PAH patients are treated in specialist centres, of which there are six in England and one in Scotland. The centres were designated by the Department of Health in 2001, are recognised internationally as centres of excellence and are world leaders in the development of PAH treatments. As a result of the expertise developed in the specialist centres, PAH patients’ quality of life and life expectancy have improved significantly. Many patients who had to give up work have been able to resume their careers. Women with PAH have been supported successfully through pregnancy, which might have proved fatal a decade ago. Other patients have lived long enough to have transplants. Those life-transforming effects have been achieved through the skill and dedication of expert doctors and nurses working in specialist treatment centres and developing drug therapies that are effective in tackling this life-threatening condition.
Last year, the Department of Health asked NICE to appraise the main drug therapies for adults in specialist centres: epoprostenol, iloprost, bosentan, sitaxentan and sildenafil. The NICE appraisal committee published its preliminary recommendations and asked for comments by 20 March 2008. NICE recommends sildenafil for the treatment of PAH in adults. Where sildenafil is not effective or causes side effects, bosentan and sitaxentan may be used. Epoprostenol and iloprost, known as prostacyclins, are specifically not recommended for the treatment of PAH. Patients currently using prostacyclins may continue to use them, but the recommendation prevents new or existing patients from moving to those proven and successful treatments or using the drugs in combination with other authorised drugs proven to be effective. The recommendations do not apply to children.
Patients and clinicians have reacted to the preliminary recommendations with shock and disbelief. According to NICE, its recommendations that the use of prostacyclins be stopped are based purely on grounds of cost-effectiveness. The NICE appraisal committee states in its report:
“The Committee reviewed the clinical effectiveness of each of the technologies under consideration. It agreed that studies had demonstrated the efficacy of intravenous epoprostenol, inhaled iloprost and oral bosentan, sitaxentan and sildenafil in improving exercise and functional capacity and symptoms of PAH relative to supportive care alone.”
NICE does not question the clinical effectiveness of the drugs; the problem is the cost of prostacyclins. They are expensive drugs. Even though the price has fallen somewhat, annual drug costs for some patients may exceed £100,000. In NICE’s opinion, because quality-adjusted life year costs exceed its recommended £20,000 to £30,000 threshold, the treatment is not cost-effective.
I congratulate my hon. Friend on securing this debate. Like many people, I have been contacted by constituents, including Anna Baker, with pulmonary arterial hypertension, even though the number of PAH patients in my constituency is small. They make the point that for a relatively rare disease—although PAH is probably under-diagnosed due to its non-specific symptoms—it is not appropriate to use the £30,000 threshold. If the number of diagnoses were higher, the unit cost of treatment would no doubt fall to a level that NICE might find acceptable. Does my hon. Friend agree?
My hon. Friend will recall that at a meeting held in the House a few years ago, the manufacturer of the main beneficial drug justified its price not according to the costs of production but according to the drug company’s problems—I believe that some of its other major drugs had failed and, in order to stay solvent, it had to charge an extraordinarily high price for the drug. Is it not true that, in many cases in which NICE must attempt to set a limit, the problem is not with the drugs’ efficacy but with their excessive cost, which is intended to provide solvency to drug companies? Would it not be better if the patents were handed out to other companies so the drugs could be sold for a price closer to the cost of production?
That is an interesting way of looking at it, but we must remember that drugs cost many millions of pounds to develop. I shall touch on ultra-orphan drugs, which include the drugs that we are discussing. NICE and the Department of Health should consider such drugs differently, and perhaps even support their production, so that people with rare conditions such as PAH are not prevented by the cost of the drugs and the scarcity of patients from getting a life-saving treatment.
I welcome you to the Chair, Mrs. Dean. I congratulate the hon. Member for Carmarthen, West and South Pembrokeshire (Nick Ainger) on securing this debate. In relation to drugs and the treatment of PAH, does he know which of the drugs considered by NICE are used regularly in the United States and other countries?
I am well aware, as I am sure NICE is, that the drugs are used universally for the treatment of PAH. I am also aware that the cost of prostacyclins in the United States eight years ago was between one eighth and one tenth of the price in this country. There was a huge difference in price. Epoprostenol—its brand name is Flolan—which is manufactured in GlaxoSmithKline’s plant in Dartford in Kent, was exported to the United States, where it was one eighth to one tenth of the price charged in this country. The situation has improved, but, as my hon. Friend the Member for Newport, West (Paul Flynn) said, the unit price of such drugs is an important matter, to which I shall return later.
On 10 March, the Pulmonary Hypertension Association UK organised a hearing in the House of Commons that took evidence from patients, clinicians, patients’ advocates and a health economist. I am sure that hon. Members who attended that hearing will wish to catch your eye later, Mrs. Dean. The patients and clinicians who gave evidence explained that, for patients with advanced PAH, prostacyclins are the only effective treatment and that without them they would die—there is no alternative.
Ms Sam Kahn, who is a PAH patient, described the history of her diagnosis and treatment, illustrating how she started with relatively inexpensive treatments, but how, as her condition worsened, those early treatments became ineffective. She now uses inhaled iloprost, which NICE recommends should not be used. However, thanks to that treatment, she has managed to keep working and has a good quality of life. Professor Andrew Peacock, of the Western infirmary in Glasgow, which is one of the designated specialist treatment centres, told us:
“We are concerned that if you take away the best drug, the patient still has to be treated—they will be in hospital very sick, having other sorts of therapies but not the one that they need. The cost will still be large, it may be even larger.”
Ian Armstrong—he is here today, listening to our debate—is chairman of the Pulmonary Hypertension Association UK, and a specialist nurse at the Royal Hallamshire hospital in Sheffield, which is also a specialist treatment centre. He told us:
“If we are not careful, the NICE proposals will allow any clinician anywhere in the country to say, ‘All we can do is give you a cheaper medication, Sildenafil, and if that does not work then there is nothing else we can do’”.
He also quoted a survey of PAH patients in which 83 per cent. of respondents said that their symptoms and quality of life had improved since being treated with prostacyclin.
Lisa Needham, an NHS manager at the Royal Hallamshire hospital, said:
“If we are not going to keep that specialist expertise, why have we invested for 12 years or 14 years in developing the world renowned care that we…in the UK”
have delivered in our specialist treatment centres? Finally, Adam Lloyd, a health economist, told the hearing:
“NICE has recommended withdrawing the prostacyclins, which have been the treatment of choice for almost 15 years and there is no recognition that this is not a case of preventing a new therapy or of preventing a new drug from coming into use, we are actually withdrawing something that has been the standard of care.”
I am not here to attack NICE, which does a very difficult and important job, but the recommendation is wrong. I am sure that all Members agree that NICE should appraise the cost-effectiveness of treatments—no one would dispute that it should do so—but when there is no alternative to a proven, clinically-effective drug used to treat a very rare condition, different criteria should apply. Such drugs are known as ultra-orphan drugs. Indeed, the principle that such drugs should be appraised differently was accepted by NICE, but it has not been applied in the appraisal that we are discussing.
Paragraph 4.9 of a NICE paper dated 16 March 2006 and entitled, “Appraising Orphan Drugs”—it is still available on the NICE website—states:
“If the Institute is to appraise ultra-orphan drugs, and be prepared to accept substantially higher ICERs [incremental cost effectiveness ratios] than those hitherto considered to be cost effective, then separate decision rules (ie the range of ICERs considered ‘cost effective’) will need to be developed and adopted for these products. The Institute proposes that these ultra-orphan drug decision rules are based in the ICERs of those ultra-orphan drugs currently on the UK market.”
“The further work would determine a rationale for a new ultra orphan-drug threshold. However, it appears that at current prices indicative ICERs for ultra-orphan products are in the range of £200,000 to £300,000”—
not £20,000 to £30,000—
“per QUALY [quality adjusted life year] (ie a ten-fold increase on the decision rules currently applied in conventional appraisals).”
I have three concerns about the appraisal committee. First, inexplicably, it made no mention of the ultra-orphan status of PAH prostacyclins. Under NICE’s own criteria, prostacyclins are orphan drugs, and its March 2006 draft report would permit their continued use. The use of the £20,000 to £30,000 threshold for common diseases such as diabetes is understandable, as millions of patients are involved, as my hon. Friend the Member for North-West Leicestershire (David Taylor) said. However, it is not right to do so when only 1,500 patients receive treatment for PAH, fewer than 400 of whom use prostacyclins either as a monotherapy or in combination with other drugs.
My second concern about the report relates to the way in which the appraisal covers the clinical use of the two drugs. Specialist centres assess what is the right therapy for the individual patient. In the majority of cases, particularly where there has been an early diagnosis of the condition, other therapies are used. Prostacyclins are not the first drug therapy to be used, unless the patient’s PAH is well advanced, and cheaper therapies are used until they are no longer effective. However, the appraisal evaluates the prostacyclins as first-line treatments and compares them with the cost-effectiveness of other therapies. However, that is wrong. The treatment of PAH changes as the condition changes, and according to the patient’s reaction to the treatment. The appraisal does not take that into account.
My third major criticism of the appraisal is that prostacyclins have been used in the treatment of PAH for 15 years. It is the main weapon used by clinicians to tackle the disease in its later stages. Clinicians are genuinely shocked that NICE is removing an effective treatment from their armoury, and they are not aware of any other decision that removes drugs that NICE accepts as being clinically effective and for which there is no alternative.
It is estimated that the cost of using all available treatments, including prostacyclins, is £20 million to £25 million a year. All that clinicians and patients are asking is that the best available treatments be used. They want to be able to use all the tools in their toolbox, as my hon. Friend the Member for Stockton, North (Frank Cook) put it at the hearing on the 10 March. Prostacyclin’s effectiveness was shown in a withdrawal trial. Clinicians do not like withdrawing treatment, but in that trial, all patients who had their prostacyclin withdrawn showed a significant deterioration in their condition before the treatment was restored.
I recognise that NICE is independent—it should remain so—but I ask the Minister to raise with it a number of issues: first, why were those drugs not treated as ultra-orphan drugs in the appraisal? Secondly, will she ask it to reconsider how prostacyclins are used in the progress of the disease? Thirdly, will she ask it to explain what effective alternative there is to this treatment? I also urge her to raise with NICE the fact that every expert clinician in our treatment centres is appalled at the prospect of ending the use of prostacyclins. They are the acknowledged experts, and only use prostacyclins when that is in the patient’s best interests. They are well aware of the costs involved and do not prescribe them unless they are effective and there is no alternative. They are saying, quite simply, that if the preliminary recommendation is confirmed, not only will patients’ quality of life suffer, but their lives will shorten substantially.
One worry that I have is about the knock-on effect in the care sector. A friend of mine does not get all the care that she deserves, but if we downgrade the condition, people will need additional care. I worry about whether the care agencies will recognise that fact or further downgrade the condition.
I do not know whether my hon. Friend’s friend uses prostacyclin, but if prostacyclins are not available to clinicians to prescribe, there is no question but that the quality of life and the condition of PAH patients will decline dramatically. Their care, whether it is delivered at home or in hospital, will increase substantially, so there will be an enormous increase in the resources needed to care for them. It is a serious issue, and it is a cost that the NHS and social services have to bear. I do not think that the appraisal committee has taken that factor into account.
That is the dramatic difference that the treatment can make to people’s lives. Not only does it improve the quality of their life, but it keeps them alive. That is what has shocked those expert clinicians, who are world leaders in the treatment of the condition: NICE, without proposing an alternative, has suggested that the drugs be withdrawn.
I wonder whether the hon. Gentleman is aware of the Raynaud’s and Scleroderma Association, which was founded in my constituency and based there. Only a very small group of people suffers from those conditions—scleroderma in particular—and the drugs to which he refers are the only ones that can give any relief at all. The alternative is death. Will he ask the Minister to explain when she makes her winding-up speech why, on that one and only occasion, NICE has denied patients a life-saving drug when it has not done so for any other condition?
Indeed. I think that I have already made that point to the Minister. I have great sympathy with her in this case, however, because so far, it has nothing to do with the Department of Health; it is purely a preliminary recommendation by the NICE appraisal committee.
The Minister must be aware that if the decision is confirmed, it may well—returning to the point that I made to my hon. Friend the Member for Newport, West—discourage the pharmaceutical industry from investing in research to find treatments for rare conditions such as PAH. If that is the climate in which orphan drugs are treated and NICE does not take account of the far higher costs of treating rare conditions such as PAH, what incentive is there for the industry? My hon. Friend the Minister should consider asking her officials to open negotiations with the two drug companies, GlaxoSmithKline and Bayer Schering Pharma, to see whether the price of the drugs can be reduced.
I became involved with the Pulmonary Hypertension Association because of a constituency case. One of my constituents, the father of a seven-year-old patient, wrote to me saying that he was very worried that the funding for epoprostenol, the drug that was keeping his son alive, would stop. That was in 1999, and he said in his letter that the drug cost £120,000 a year. I wrote to my friend, Jon Owen Jones, who was the Wales Office Minister with responsibility for health, and I put a PS at the bottom, saying, “I’m sure he’s got it wrong. It must be only £12,000.” Jon Owen Jones wrote back to me, saying, “No, the figure is correct, and with the likely increase in dosage, next year the price for the drug will be £165,000.”
I took up the case and discovered, as I said to my hon. Friend the Member for Newport, West, that the price of that drug in north America was between one eighth and one tenth of its price in the United Kingdom. I made an arrangement with the pharmacist at Withybush hospital in my constituency, and we started to import drugs from north America at one eighth of the price that was quoted in this country. There is room for serious negotiation. I know that the price has come down; I do not dispute that. I know also that, because they are ultra-orphan drugs, they are extremely expensive. However, the price that is quoted in the NICE appraisal must be examined to check that it is the actual price, because the appraisal committee’s report refers to the fact that prices are negotiated locally. I cannot see why we should not have national negotiations for an ultra-orphan drug. We do not leave it up to individual pharmacists or hospitals to negotiate a separate deal, so surely, with only 400 patients, we should be able to negotiate a far lower price with those two companies, and perhaps compensate them by putting a penny on the price of aspirin or on something else.
I congratulate my hon. Friend on securing the debate and on his sterling work over the years on this important issue. He makes the eminently sensible suggestion that we should negotiate a national price, but would he consider negotiating an international price—perhaps throughout the European Union—and using EU buying capacity to reduce the cost of the drugs?
I do not care whether negotiations are national, international, universal or whatever. The important thing is that they are ultra-orphan drugs that are used on a very small number of patients. That is the only difference. The things work. There is no question about the clinical efficacy of the drugs; it is purely about their unit costs. If that is the issue, we need to address it nationally, and ideally, internationally.
I am fascinated by my hon. Friend’s enterprise as a drug importer, and I should like to know how successful it was. My hon. Friend the Member for Vale of Clwyd (Chris Ruane) points out that there is an international market in drugs, which are accessible through the internet and other sources internationally. Is it not possible to get around the extraordinary difference in the price that GlaxoSmithKline charges in this country and in America? Is it possible to do so by investing in the enterprise to which my hon. Friend the Member for Carmarthen, West and South Pembrokeshire (Nick Ainger) referred? If so, I shall buy shares in it first thing tomorrow.
Circumstances have changed since 1999-2000. Nevertheless, there is no question but that at the time the arrangement saved the national health service about £120,000 on that one patient, compared with the price that it would have paid the following year. The situation illustrates that throughout the world, different prices are charged for the same product. The irony was that we imported from the United States something that had been produced 250 miles away in Dartford, Kent.
That was nonsense. It was obscene that a system could operate whereby in the United States, which is not a developing country by any stretch of the imagination, the cost was one eighth to one tenth of the price in this country, because of the arrangements that were made there. I also learned that, for individuals who are on Medicaid in the US, once their Medicaid ended, the deal was that the drug supplier would give the hospital the prostacyclins free of charge, which was a very generous arrangement. Perhaps that arrangement is indicative of the different deals that can be done with the drug companies.
For 15 years, prostacyclins have significantly improved quality of life and extended the lives of PAH patients. If the drugs are withdrawn, patients will die unnecessarily. To withdraw prostacyclins on the basis of a flawed appraisal and prevent their future use is medically unsupportable, and I trust that NICE will take on board all the submissions that are made today and reverse its preliminary recommendations.
May I congratulate the hon. Member for Carmarthen, West and South Pembrokeshire (Nick Ainger) on securing this debate and on the very balanced and reasonable way in which he has advanced his case? I attended the meeting to which he referred in his speech and I am a sponsoring signatory of the early-day motion that he has tabled.
This is a very important debate. The Minister, with her nursing and medical experience, will take what is said today very seriously and I hope that she will ensure that NICE is made well aware of the strong feelings on this subject in the House of Commons.
As the hon. Member for Carmarthen, West and South Pembrokeshire said, there is understandably great concern among the health community and the pulmonary arterial hypertension community in this country about future treatment in the United Kingdom for this rare—he was right to describe it as such—but deadly disease. Patient organisations are not only disappointed but extremely concerned for their members about NICE’s preliminary recommendations on the treatment of PAH.
To take up another point made by the hon. Gentleman, it would appear that there has been a complete lack of understanding of the implications for patients, particularly those with connective tissue disease-related PAH, such as Raynaud’s and scleroderma, to which my hon. Friend the Member for Congleton (Ann Winterton) drew attention in her intervention.
PAH is the greatest single cause of death in people with connective tissue diseases, of which scleroderma is perhaps the most deadly. It causes a most distressing form of death. Until approximately 10 years ago, the only standard treatment was parental prostanoids. As the hon. Member for Carmarthen, West and South Pembrokeshire said, intravenous prostacyclin still remains the accepted therapy for very advanced cases of PAH in all treatment centres, not only in the UK but in the United States of America, Canada and many European countries.
Hope, in the form of oral therapies, has made a tremendous difference to a patient’s quality of life. Therefore, endothelin receptor antagonists, or ERA, should be the first line of treatment for use in cases of connective tissue diseases associated with PAH, for which it is considered to be the best treatment option. When patients deteriorate despite oral therapy, they should have the choice of using intravenous prostanoids or possibly combinations of oral therapies, as evidence of their success increases.
The hon. Member for Carmarthen, West and South Pembrokeshire has already stated this, but let us be clear that we are only considering a very small number of patients—approximately 1,500—of which a third have connective tissue disease. Without the option of prostacyclin, patients will have no option other than palliative care when their condition deteriorates. They will then be condemned to six to 10 months of what one can only describe as a miserable existence: being breathless; suffering progressive right heart failure; and experiencing recurrent prolonged hospital admission, with all the costs that the hon. Gentleman outlined in his speech.
That would not be the case if the treatments shown to be effective in other countries were standard in the United Kingdom in future. NICE has accepted that the therapies are effective; again, I take up a point made by the hon. Member for Carmarthen, West and South Pembrokeshire. The problems arise from the assertion that there is no difference between scleroderma and idiopathic PAH in terms of individual drug efficacy or modelling of cost-efficacy and that the appropriate cost comparator should be palliation. The standard therapy is intravenous prostanoids, which was proven more than 10 years ago to be effective, and which all guidelines accept is the gold standard therapy for the condition—I highlight that to the Minister.
As the hon. Gentleman also said, the model developed by NICE to determine cost-efficacy is not fit for purpose; I stress that to the Minister. The NICE appraisal acknowledged that the model failed to predict the actual outcome in the treated population. In fact, the national survey shows a 6 per cent. mortality rate every 12 weeks for patients with class 3 scleroderma-associated pulmonary hypertension on treatment. Surely it is totally irrational to choose to ignore real data and to determine the treatment of the condition on the basis of a model that is acknowledged to fail to accord with reality.
The PAH centres in the UK are the envy of the world, as was stated at the well-attended and well-informed meeting organised recently by the hon. Gentleman. However, should the NICE recommendation be implemented, very sick people will continue to die unnecessarily. Surely the Minister must accept that message and take it to NICE.
How can NICE even consider taking away the only hope from this small group of patients, who, through no fault of their own, have developed a highly lethal condition? It is tantamount to condemning them to a death sentence. That is a very harsh thing to say, and I am sure that that outcome is not what NICE wants, but if its recommendation is acted on that is precisely what it will be doing; it will be condemning a small number of people to a death sentence.
With that small patient population, it is estimated that appropriate access to all available treatments would cost the NHS between £20 million and £25 million per year; again, I quote the figures given by the hon. Gentleman. Surely that is a very small sum. Moreover, patient outcomes are vital. The importance of getting people back to work, with their subsequent financial contribution to the economy as a whole and the reduced costs for the NHS, together with the patient’s improved quality of life, are factors that do not appear to have been taken into account at all. That is an oversight, and a very sad one.
NICE must be urged to review its provisional guidance to ensure that patients continue to receive life-saving treatments and to maintain the UK service record as the envy of the world in this area of health care; that status was highlighted at the meeting to which the hon. Gentleman referred in his speech. I trust that NICE will reconsider this unbelievable and extremely serious recommendation and make patients, not just money, its main priority in its considerations on this critical matter.
This is the first time that I have had the opportunity to speak under your authority, Mrs. Dean, and I promise to do my utmost not to attract your displeasure.
I, too, offer the customary congratulation to my hon. Friend the Member for Carmarthen, West and South Pembrokeshire (Nick Ainger) on securing the debate, and I couple that congratulation with a commendation for his determination, because it is not easy to acquire these opportunities. Sometimes, one has to try and try again, and he has been an exemplar in that regard. I commend him heartily for that.
My hon. Friend said that he did not want to attack NICE, but I cannot promise to maintain the same degree of passivity. I have tangled with NICE before, when it issued its diktat that drug-eluting stents should not be used any more. As I have three of them in my left anterior descending artery, I felt a bit peeved about that decision. They might need replacing in the future, but the fact that they are drug-eluting has made their replacement less likely. I also thought that everyone, including me, should be able to have the same degree of comfort. Having taken issue with NICE, I looked at its systems of econometric assessment and found them to be somewhat lacking. The issue that we are discussing today is a similar example of accountants having gone mad. We have heard from my hon. Friend the Member for North-West Leicestershire (David Taylor), who is a well qualified accountant, but who is different from all the other accountants whom I have met in that he has a degree of compassion. Most accountants do not, so I think that we should put him in charge of NICE or in a similar position.
There is a mega weakness in NICE’s attitude to assessment. I am sure that it approaches its medical analyses in a professional way, but perhaps it gets so bogged down with them that it forgets other aspects. It is our job, in this place, to fight for individuals in our constituencies and throughout the nation, and it is with that intention that my hon. Friend the Member for Carmarthen, West and South Pembrokeshire secured the debate. I am pleased to join him in seeking to push the issue forward.
Thomas Woolley is 13 and a half years old, and he lives in my constituency on the Wynyard estate. His parents wrote to me and asked me to attend a meeting, which was convened by my hon. Friend. I had to struggle to get there; we always have lots of petitioners and people who are lobbying on this, that and the other, and it is not always possible to find out how important a matter is until one gets there. Had I not received a letter from Mr. and Mrs. Woolley, I probably would not have arrived at the meeting, but when I got there, I was stunned by the presentation, which was remarkably controlled. It had a great impact on me that people who live with such a problem could relate their difficulties in such a measured manner and with such politeness. That is why I have committed to give every kind of support that I can summon, meagre though it be.
I got another letter from Mr. and Mrs. Woolley, but it was not addressed to me. It was addressed to the hon. Member for Romford (Andrew Rosindell), who kindly passed it on. With your leave, Mrs. Dean, I shall read it out. It says:
“Dear Andrew, we came to ask for your help some time ago with regards to the Pulmonary Hypertension Association. At the time, we were living at 25 Albert Road, Romford, and our son Thomas had Pulmonary Hypertension. Since we last saw you we have moved home and on October 26th 2007, Thomas had a double lung transplant at Great Ormond Street Hospital. He has made an excellent recovery and is living a full and active life now. Once again we are asking for your support. If preliminary recommendations by the National Institute of Health and Clinical Excellence (NICE) are implemented, then drugs like Epoprostenol will not be available. As you know, this drug allowed Thomas to live a good quality of life for four years up to his transplant”—
I reiterate that point: the drug allowed him to live a good quality of life up to his transplant—
“and it would be a dreadful thing if other patients were not given this opportunity because of the expense of the drug. We hope this letter finds you well”.
If NICE had taken its decision five years ago, Thomas Woolley would be dead now. Is that the kind of health service that we display such pride about? Is it the kind of decision that NICE ought to be capable of? Are we going to remove tools from the toolbox that consultants normally have available, and say, “You can’t do that. There’s a life there, but you can’t save it”? How can we justify that?
The chief of the NHS gave evidence to the Select Committee on Health on 22 November 2007, which is not long ago—just three or four months. He said:
“I am trying to manage the resources of the NHS against a vote that Parliament gave me, and that is what we are trying to do in the most effective and efficient way. What I can say is that…decisions…can now be taken wholly on clinical grounds, not on the basis of whether we have the resource.”
If you will permit me, Mrs. Dean, I shall repeat that:
“What I can say is that…decisions…can now be taken wholly on clinical grounds, not on the basis of whether we have the resource.”
Our independent colleague, the hon. Member for Wyre Forest (Dr. Taylor), who is a professor of medicine, immediately piped up with the reply:
“Because there is enough money to do it on clinical grounds.”
Mr. Nicholson’s response was:
“The NHS, by its good management and organisation, has created a healthy financial position for most of the country.”
That is a pretty firm statement, in my catalogue—a healthy financial position for most of the country.
So, what are we about? We have heard some interesting suggestions about taking up drug trafficking, which has apparently been done very successfully. I wish that I could have bought a few shares in that. My hon. Friend the Member for Newport, West (Paul Flynn) made the even more effective suggestion that we should take more effective measures in that direction. We must certainly question NICE’s assessment. The response that I eventually got from the Minister—not this Minister but a different one at the time, although it was not so long ago—after a fairly long delay was that the evidence that NICE had examined when it came up with the drug-eluting stent decision and restriction was being re-examined. I hope that NICE has learned from that lesson and in future will check every kind of evidence that is placed before it with a view to arriving at decisions that are sustainable afterwards. The drug-eluting stent decision was not sustainable, and the recommendations on epoprostenol and similar drugs are equally unsustainable. I hope that NICE thinks again about its decision and that the Minister insistently recommends that it does so.
I did not intend to speak, but some balancing comments should be made about the National Institute for Health and Clinical Excellence. The debate seems to involve another attack on NICE for making a decision that none of us would like to make. We have set up NICE to shift away from politicians the impossible choices that have to be made under a limited health budget. It always is limited, but we do not want to believe that. It is unfair to put all the blame on NICE, or to suggest that it does not put patients first. I am sure that it does, but it must put itself in a position where it can challenge the pharmaceutical companies.
My hon. Friend the Member for Carmarthen, West and South Pembrokeshire (Nick Ainger) mentioned the usual story from pharmaceutical companies that they have to charge large amounts for some drugs because few clients use them, it is a small market, and they have to pay for the cost of research. That argument might be convincing if they, particularly GlaxoSmithKline, did not spend a great deal more on marketing drugs than they do on researching them. They spend a large amount on research for drugs for stomach pains, headaches and those ailments that involve huge demand but very little on research into drugs for ailments that affect a small number of people.
There can be no justification for blaming NICE if it asks the pharmaceutical company, “How on earth can you justify this life-saving drug”—which can offer so much, as we heard today in moving stories—“which is made in Britain, costing 10 times as much outside the factory gate as it costs on the other side of the world?” That cannot make sense, except for commercial reasons.
I repeat what I said in my intervention, because I remember the meeting held by my hon. Friend, who has been persistent and campaigned on this matter for years. I was shocked when we cross-questioned the lady who was running the drug company and she told us the cost. Twenty years ago, many of us would have thought that it was impossible for anyone to have a course of drugs that cost more than £10,000. One would not have believed that possible, but now we hear that the drug companies charge £165,000. What if they were to charge £1 million or £2 million per patient? Would we tell NICE to pay, regardless of the cost?
If children or someone in our constituency were about to be deprived of drugs, we would all say as constituency MPs what my hon. Friend the Member for Stockton, North (Frank Cook) said: “Pay it. It is only £20 million. It is nothing in the context of the health service budget,” but we must take some responsibility for the policy that NICE has to implement on our behalf—a thankless task—and acknowledge that NICE is not the problem. We beg NICE to pay for the drugs—I do not think that it has any choice—but, ultimately, the answer is not to ask NICE to pay whatever is demanded by greedy pharmaceutical companies that need to get their balance sheets right.
I repeat that I support the campaign of my hon. Friend the Member for Carmarthen, West and South Pembrokeshire, which is of long standing. I acknowledge what the hon. Lady says, but we have to take on what has been happening since NICE was formed. Pharmaceutical companies set up cynical campaigns to boost drugs and exaggerate the effects of drugs—not this one, but others.
I investigated a drug on behalf of a constituent who was suffering from a particular form of cancer. The drug was recommended as the cure for it. I said to her, “Go along and see your physician.” I was approached not by the drug company but by a group of its lobbyists who put forward a case for the drug that was wholly dishonest and optimistic. Having made inquiries, I learned that the cost was £16,000 for each patient, that the drug increased life expectancy for cancer sufferers by 12 days, and that it had adverse side effects, including death, in 10 per cent. of cases. The balanced judgment was that the drug, in the state that it was in then, was a poor gamble and certainly not worth investing £16,000.
We are being subjected to marketing and lobbying campaigns by pharmaceutical companies that are likely to destabilise NICE decisions altogether. We cannot constantly say to NICE, “Whatever the drug companies ask, you must pay.” I support this specific case entirely, but I cannot go along with many of the things that have been suggested today about a blanket condemnation of the decisions that NICE has to take. Thank goodness we as politicians do not have to take them.
I congratulate the hon. Member for Carmarthen, West and South Pembrokeshire (Nick Ainger) on leading this debate and on his persistence in the matter.
I cannot rival the hon. Gentleman’s knowledge, but I do know that pulmonary arterial hypertension, whether in the secondary or primary form, is dangerous, debilitating and difficult to treat. It is dangerous because it is often fatal. Life expectancy is not good: the death rate is high. It is debilitating because it destroys ordinary life. We heard some touching stories of heroic endurance. One wonders how people put up with the situation and do so with such apparent cheerfulness at times. The condition is also difficult to treat, because there is no cure, some of the treatment is invasive and good treatment is hard to access. In my constituency, people have to travel as far as Newcastle to get specialist treatment.
It has been suggested that NICE has added to the woes of poor, suffering patients by recommending no further use of prostacyclins, intravenous epoprostenol or inhaled iloprost, which are regarded as gold standard treatments. It is suggested that that adversely affects 25 per cent. of sufferers, particularly those who are most severely or terminally ill.
As has been said, all arguments about NICE tend to follow a familiar pattern. Incidentally, I must put on record the recent welcome change in NICE’s decision about Lucentis. That shows that NICE does occasionally listen to arguments and have second thoughts. However, what usually happens is that a cheaper alternative is held up by NICE and set against an expensive proprietary drug. The reasons that the drug is expensive have been explored in some depth already.
On one side, we have NICE and the primary care trusts, and, on the other side, we have patients, patient groups and the drug companies. NICE will normally claim that cheap alternatives are available—in this case, sildenafil—and that they are as efficacious as the more expensive alternatives. The drug companies and patient groups will argue, with some plausibility, that the more expensive alternatives have special benefits or—this is important—special benefits to particular patients, if not the whole patient group.
No one per se is against NICE, which is a necessary evil. We all must acknowledge that health care is, if not rationed, at least finite, but people will argue with decisions if NICE has not followed its own guidelines and procedures sufficiently rigorously, or if guidelines have been inappropriately applied. That, I understand, is the argument proposed by the hon. Gentleman in favour of ultra-orphan drugs, notwithstanding the cost. In layman’s terms, he suggests that the principles applicable to common complaints should be applied to this cruel and rare disease and its therapies, which is against NICE’s guidelines. On the face of it, he appears to be correct, and his case was extraordinarily well made.
However, I sound a general caution against assuming two things: first, NICE’s infallibility; and, secondly, the total objectivity of its procedures. NICE assessments are undeniably rigorous, and its inspection of evidence is thorough. I have attended sessions at which it inspected drugs, and there was a huge amount of documentation; they were long sessions, during which patients groups were consulted. It seems to be an impressive procedure, but at the end of the day I would say that it is a judgment call. That call is based on the assessment of this strange unit called the QALY—the quality adjusted life year.
The QALY reminds me of the great utilitarian 19th century philosopher Jeremy Bentham, who invented the hedon—a unit of happiness and pleasure. He suggested that all legislative and moral dilemmas could be solved by counting hedons, using what he called a hedonic calculus. One could work out units of happiness in order to discover whether proposed laws would increase or decrease the overall level of happiness. As a method, it has some advantages over parliamentary democracy. However, Bentham’s method led to interminable debates about how to count hedons.
Today, we have the same debate—how to assess the QALY. It is not simple arithmetic; indeed, it is not arithmetic at all. However, NICE and the QALY is the best that we have, provided always that NICE guidance is mediated and offset by patient experience, which is not always the case. Patient experience needs to be judged over time, and it needs to take account of proper clinical caution and casework experience. That is especially important for diseases that are rare and not understood, such as the one that we are debating today. We do not understand pulmonary arterial hypertension as well as we might. We know the symptoms, but we do not know its cause. Caution should be applied to removing therapies that are not obviously redundant or otiose in the light of patient experience and that of the clinicians who care for them.
When we do not understand the cause of a disease, we often do not know why a drug works for some individuals, but not all—or not with a control group. That is why the voice of the patient group must be heard. Thanks to the hon. Gentleman, it will be heard even more loudly. In this case, cautious wisdom genuinely has a place.
May I say what a pleasure it is, Mrs. Dean, to serve under your chairmanship?
I congratulate the hon. Member for Carmarthen, West and South Pembrokeshire (Nick Ainger), as have many other hon. Members, on securing this debate. I was touched by the passion that he displayed on the subject and the enormous amount of work that he has done on it. The debate is not about a new drug, or another NICE problem—something that we often face—but about an existing and established treatment that has been available for about 15 years. As many hon. Members said, the treatment is considered to be the gold standard.
Pulmonary arterial hypertension is one of five sub-types of pulmonary hypertension. It is rare; as the hon. Member for Carmarthen, West and South Pembrokeshire said, it is the result of an increase in pressure in the pulmonary artery. We have not focused much on the symptoms or how it might feel to be a patient with the disease, but it is characterised by fatigue, shortness of breath, chest pains, fainting, swollen ankles and legs and a swollen stomach. Patients often tell of extreme breathlessness and exhaustion.
It is important to remember that rare diseases are often difficult to diagnose. Of particular note with this disease is the fact that people might have been attending their GPs for some time before a diagnosis is made. Before treatment starts, they may have suffered a year or more with symptoms not being affected by the treatments offered. They will see a diminution in their quality life; and, as with any complex and incurable disease, the poor survival rate will be associated with depression. The disease has a profound effect on the family, which is another subject that has not been touched on today.
The debate is about whether NICE is operating within its guidelines. The hon. Member for Upper Bann (David Simpson) spoke of the cost of drugs in the US—an interesting point—and highlighted the much higher price that we pay for prostacylins, and I hope that the Minister will address that point.
My hon. Friend the Member for Congleton (Ann Winterton) mentioned another important group of patients—those who suffer similar disorders such as Raynaud’s and scleroderma. She said that NICE appears to be ignoring its own rules.
My hon. Friend the Member for Macclesfield (Sir Nicholas Winterton) spoke with his usual clarity about the subject. I was, as always, flabbergasted by his expert medical knowledge on such matters, especially as I used to be a nurse. He raised concerns about the preliminary recommendation and emphasised that we are considering a very small number of patients for whom there is no alternative. If NICE’s recommendation goes through, there will be no alternative.
My hon. Friend said that there is no argument about the efficacy of the drugs—NICE does not disagree—but he raised concerns about the modelling that is used by NICE. Although most hon. Members would support much of the work done by NICE, the debate has highlighted and drawn out concerns about the treatment of those with pulmonary hypertension. I hope that the Minister will take that point.
The hon. Member for Stockton, North (Frank Cook) spoke about his tangle with the NHS over stents. I am pleased to hear that his stents appear to be serving him well, enabling him to contribute with clarity and some passion to today’s debate. He reminded us—especially those on the Front Benches, who sometimes forget—that we are here to fight for individuals. He mentioned the case of one of his constituents, and we all appreciate it when Members quote from letters, as it brings home to us the fact that we are fighting for individuals. He said that epoprostenol and iloprost are part of a toolbox, which is a point that no other Member mentioned today. Clinicians have a range of drugs at their disposal, and if we remove some of those from their toolbox they will be less able to deal with symptoms.
The hon. Member for Newport, West (Paul Flynn) raised an extremely important issue, about which I feel strongly. It was good to hear someone speaking up for NICE, which does a good and difficult job. But he also raised the important question of the huge amount of money that drug companies put into marketing and selling their drugs. All Members have at some time been caught up with drug companies pushing particular treatments. Much more work needs to be done with drug companies, which often fund patient groups and work behind the scenes in ways that are not clear. I appreciate that they put a huge amount of money into research and development, but it is notable how much they put into marketing. To some extent, that is one of the challenges facing the NHS. Part of the money that, in fairness, the Government have put into the NHS has gone into drugs budgets.
The hon. Member for Southport (Dr. Pugh) said that, ultimately, however much evidence NICE has, it must make a judgment, which must be offset against patient experience and clinical expertise. Although that patient experience should not overrule its judgment, it is important, especially in relation to rare conditions for which robust evidence of what works is difficult to find. Conservative Members respect NICE’s independence, and it is important that calls on health service budgets are made by experts and not by politicians, who should not interfere. The criteria for assessing not only drugs, but treatments in the NHS, should be their clinical effectiveness and cost-effectiveness. It is also important that NICE conducts its work quickly, openly and transparently, and has the public’s confidence.
The current use of QALYs, which has come up again today, has often been criticised as inflexible. The Conservative party is considering whether larger societal costs should be taken into account. I go back to where I started, and to the impact that such diseases can have on families. The hon. Member for Carmarthen, West and South Pembrokeshire said that if alternative drugs are not available, withdrawal of a drug may incur considerable extra costs in hospital care, the patient losing their job and family members having to give up work to care for the person who is unwell.
Pulmonary arterial hypertension is not the only illness or disease in relation to which effective treatment could save society considerable costs in the long term. Investment up front will sometimes produce a saving further down the line. Therefore, removing some of NICE’s inflexibility is important. It is a shame that we do not always have the opportunity to consider the emotional and humane cost of treating diseases. Sadly, in this day and age, we are fixed on budgets. They are important, but it is also important to put on record that we recognise the profound emotional cost for families who are battling this illness.
We would like NICE’s role to be extended. Although it is not the subject of the debate, it is important to mention that NICE has a wider role in producing evidence and setting guidelines on standards of care that encourage best practice and achieve outcome objectives.
On NICE’s relationship with the drug companies, we want a better dialogue with the pharmaceutical industry, and the hon. Member for Carmarthen, West and South Pembrokeshire referred to that. NICE needs to be aware of what is being developed, what treatment regimes are available and what regimes are being trialled. It should work with drug companies to try to reduce prices. We must understand—I hope that the Minister will address this—why there are huge variations in the cost of drugs. That would help not only us in developing our ideas of where NICE should go, but clinicians and patient groups better to understand why its decisions are made.
We cannot turn the clock back on NICE’s preliminary report on PAH, but it will have caused considerable concern to those who are reliant on the drugs. Life is difficult enough for people who have a rare disease; it is difficult enough if they have an incurable disease; it is difficult enough if the symptoms interfere with daily activities, so that perhaps making a cup of tea is almost impossible. But this preliminary report is a huge added burden for them, given the concern about whether treatments will continue to be available, and, for clinicians, whether they will be available for new patients.
I urge the Minister to keep an open mind about NICE. This has been a non-partisan debate, and I always welcome such debates, but I would like to hear what she is doing and what steps she will take to ensure that NICE remains flexible and is encouraged to work more closely with drugs companies. I would also like to hear her response to the more general concerns about how NICE operates, and to understand why it seems to have ignored the ultra-orphan status of the group of drugs involved. I hope that she will address those matters.
It is brilliant to be here under your chairmanship, Mrs. Dean.
I congratulate my hon. Friend the Member for Carmarthen, West and South Pembrokeshire (Nick Ainger) on securing this debate. I know, as do all hon. Members, that for many years he has been a strong and persistent advocate of behalf of sufferers of pulmonary hypertension. He has actively engaged many of my predecessors, and rightly so, in helping to advance the case for improvements in treatment and to promote awareness of the disease throughout the United Kingdom, together with the Pulmonary Hypertension Association UK. I thank him, too, for sharing the transcript of the recent House of Commons stakeholder investigation, to which many patients, carers, professional staff and MPs contributed. Many of those MPs are present for this debate.
I agree that this has been an emotional and educative debate. Hon. Members who have taken part are senior and experienced, with a track record of standing up not only for their constituents, but on health issues. The hon. Member for Macclesfield (Sir Nicholas Winterton) has apologised for having to leave early to attend another meeting. Serious attention must be paid to what he, the hon. Member for Congleton (Ann Winterton) and all hon. Members who have made a contribution said. One could not help but be moved by the contribution of my hon. Friend the Member for Stockton, North (Frank Cook) about the little boy. I, too, have constituents with the disease. One little girl who had a transplant, sadly did not make it, but had often attended fund-raising events.
Hon. Members have described the effects of pulmonary hypertension, which is a rare and potentially fatal condition that affects the heart and lungs. It requires expert care, expensive drug treatment and sometimes specialised surgery if life is to be prolonged. There has been considerable progress in treatment over the years, and I hope that hon. Members will allow me to explain current services: what we have achieved, how services are organised, how the commissioning of specialised services for the condition has developed and changed over the past few years, and the role of guidance on clinical care. I shall also address the issues concerning NICE.
There are six centres for the treatment of adults with pulmonary hypertension in England, in Newcastle, Sheffield, Papworth, Hammersmith and the Royal Free and Royal Brompton hospitals. Several of those centres run outreach clinics at other hospitals to ensure that patients do not have to travel too far. Those centres offer a high-quality service and are run by dedicated, highly professional clinicians. It is to their credit that more patients are being treated and that outcomes are improving.
The six centres have been nationally designated by the National Specialist Commissioning Advisory Group, which became the National Commissioning Group in 2001, to ensure that highly specialised services are restricted to a small number of expert centres allowing the development and long-term maintenance of expertise in treating rare conditions. Commissioning responsibility has remained with local primary care trusts and specialised commissioning groups. The number of patients at the six centres has doubled over the past five years for two reasons. First, local hospitals are more aware of the condition and refer pulmonary hypertension patients to the centres at an earlier stage in the disease. The diagnosis is improving—I am aware that much more work must be done on that—and we should congratulate professionals and clinicians on the progress that has been made. The Pulmonary Hypertension Association can take great credit for that.
Secondly, patients who are treated at PH centres are surviving longer. I understand the concerns of my hon. Friend the Member for Carmarthen, West and South Pembrokeshire about delays in recognising the signs of pulmonary hypertension and obtaining an initial diagnosis. However, as I have said, I encourage pulmonary hypertension clinicians and the association to continue their efforts in raising awareness across professional boundaries, perhaps through the royal colleges. If my hon. Friend believes that I, as Minister, and the Department can do more to raise awareness, it is our duty to do so.
I am grateful to the Minister for her kind words, which were totally justified, about the effectiveness of the specialist treatment centres. She referred to my persistence in meeting her predecessors. The main issue that I raised with them was the fact that designated specialist treatment centres are still dependent on commissioners to provide the funding for the patients who are treated there. The argument that I put to her predecessors is that Great Ormond Street hospital, which treats child patients with PH, is now centrally—directly—funded. Will she meet members of the Pulmonary Hypertension Association and me to reconsider the possibility of funding those excellent treatment centres centrally?
Of course I will meet my hon. Friend and the people he would like to bring. The more I can learn about this subject, the better I can help.
On the care and treatment of children with pulmonary hypertension, as my hon. Friend has just said, the national network is organised on a hub-and-spoke principle. The hub is Great Ormond Street hospital for children and the spokes for follow-up care are seven centres of paediatric cardiology at Leeds General infirmary, Bristol Royal hospital for children, Freeman hospital in Newcastle, Birmingham children’s hospital, the Royal hospital for sick children in Yorkhill, Glasgow and the Royal Belfast hospital for sick children. I believe that Southampton has just joined that arrangement.
Since April 2007, pulmonary hypertension services for children have been nationally commissioned, and performance has been managed by the National Commissioning Group on behalf on the NHS. The centre at Great Ormond Street has enjoyed considerable success. Published studies show that treatment through the children’s pulmonary hypertension centre at Great Ormond Street has significantly improved survival rates for children with that serious condition. Studies have also reported improvements in psychosocial well-being and return to school. I pay tribute to that excellent service and the leadership of its outgoing lead clinician, Professor Haworth. Nearly all patients are investigated, diagnosed, receive treatment and have their care package organised by a multi-disciplinary team on site. All the services essential to the care of pulmonary hypertensive children are consultant-led and delivered at Great Ormond Street.
The centre at Great Ormond Street expects to treat 80 new cases in 2007-08, compared with the 20 new cases that were treated in 2001-02. Its caseload in 2007-08 is forecast to be 418 patients, compared with 60 patients in 2001-02. The Great Ormond Street service reports survival as 96 per cent., 91 per cent., and 83 per cent. at one, two and three years respectively for children. Those results compare favourably with other studies. I do not have the time to discuss the Carter review because I want to spend time talking about NICE. However, hon. Members, particularly my hon. Friend the Member for Carmarthen, West and South Pembrokeshire, will be aware of Sir David Carter’s report and the way in which it has changed commissioning.
On the consensus of clinical guidance, with the encouragement of my hon. Friend and many of my predecessor Ministers for health, lead clinicians agreed to work together to produce a consensus statement for the management of pulmonary hypertension in clinical practice. That has taken longer than originally anticipated, and I am sure that that reflects the complex and difficult nature of weighing evidence and capturing and describing best practice. I was pleased to note that the consensus statement was launched three weeks ago at the House of Commons, and I welcome its publication as a significant step forward in raising standards of clinical practice and ensuring that the best available evidence is taken into account. All the clinicians involved are to be congratulated on their efforts.
Many hon. Members rightly raised the issue of NICE, and I thank my hon. Friends for their praise of NICE and for acknowledging the complexities of the organisation. Today, the main focus has been on NICE’s appraisal of the cost and clinical effectiveness of drugs for the treatment of pulmonary arterial hypertension. The initial conclusions were recently issued with an appraisal consultation document, and stakeholders had until 20 March to submit comments. I learned from my hon. Friend that today is yet another deciding day. The Pulmonary Hypertension Association and clinical colleagues have made submissions to NICE, which should be fully considered by NICE in the next stage of formulating final guidance. Some people welcome NICE guidance and some do not. As has been well highlighted today, we recognise that the institute’s decisions have serious implications for patients and their carers. Such decisions are difficult, but they are made on the basis of the clinical evidence that has been submitted to NICE. Today’s decision is critical.
We ensured that NICE was independent, and it was right to do so. Health Ministers have always maintained that independence is important, and I would welcome Opposition Members’ agreement that that should be the case. At the end of the day, I am in an awkward position, because if that independence is to be retained, with the best will in the world, I can only continue to urge hon. Members to do all that they can, and I will continue to do all that I can.
My hon. Friend may not remember that one of our first conversations in the House was about a patient of mine who required the drug, and he told me about the purchase of drugs from the United States. I have an interest to declare because the headquarters of GlaxoSmithKline is in my constituency—I apologise for declaring that at the end, rather than the beginning, of my speech. I tried to undertake negotiations with GlaxoSmithKline, and with the help of my hon. Friend I was successful in looking at how such things could be negotiated. I do not come to this debate as a Minister who is simply reading a speech; I come to the debate as a former nurse and someone who is well aware of what quality of life is really about, as the hon. Member for Guildford (Anne Milton) and others have described so well.
This year, we are celebrating 60 years of the health service. In the Darzi review, we are looking at long-term and rare conditions, which have been included in the patient pathway. I give hon. Members my word that I will raise the issue of long-term conditions, particularly rare conditions, with Lord Darzi as part of his review. I hope that NICE brings us good news today.
Wirral Metropolitan College
I am delighted to have secured this debate on Carlett Park, which is one of three campuses under the auspices of Wirral Metropolitan college. That is a further education college offering both degree courses and higher-level qualifications. The college has announced that it is to pursue a two-site option, both in the north Wirral area, which would result in the closure of Carlett Park. I told the principal before the decision was taken that I believed that such a decision was flawed and did not take adequate account of the history of Carlett Park or the needs of the people of Eastham or south Wirral. People in Eastham and elsewhere share my disappointment that the site’s future is again in question, and it is for those reasons that I wish to voice my concerns and to urge all those involved to reconsider the decision.
Carlett Park, in one form or another, goes back a long way. The chapel, which is still on-site, was built in 1884 as a family chapel. It is the only remaining part of the original house and is listed in the diocese records as the Chapel of the Good Shepherd. A listed building, it was built originally for family worship by Canon Torr.
The history of Carlett Park as an educational institution goes back to the 1940s, and it has played a key role in south Wirral since then. In 1948, the county authority—we were then part of Cheshire—decided to buy Carlett Park to use it for a further education college serving Bebington, Ellesmere Port and Deeside. The college was known as West Cheshire central college of technology. Courses commenced in 1952, and in the 1950s and ’60s, Carlett was one of the top six colleges training people to the level of graduateship of the Royal Institute of Chemistry, which is a professional qualification equivalent to a university degree.
From October 1964, the college was known as the central college of further education, Carlett Park. Computing became a strong subject there, with lessons beginning in the 1970s. Its reputation for sciences was developed when state-of-the-art science and chemistry laboratories were built in 1978. At its peak in the ’70s, Carlett Park offered a full range of courses, specialising in engineering and the sciences. From the 1960s onwards, a very large number of students came from overseas, from as far away as Iran, Bahrain, Kuwait and elsewhere, to learn skills relevant to, among other things, the oil and aluminium industries. There is a considerable history and a considerable substance to Carlett Park.
In 1982, the central college of further education at Carlett Park amalgamated with Birkenhead technical college and Wallasey college of further education to form Wirral Metropolitan college. By that time, our area had become part of Merseyside rather than part of Cheshire—the local government boundaries had altered—and the official title adopted for all the campuses was Wirral Metropolitan college.
Over Carlett Park’s long history, many Wirralians have been educated there. They include, for example, Ray Stubbs, who is a sports presenter, particularly on football among other things, and has been a crooner in his time; Paul O’Grady, another TV personality; and Brian Fleet, a senior vice-president of Airbus UK. Many others were also educated there. Christian Furr, an artist who studied at Carlett Park relatively recently, became, at 28, the youngest artist officially to paint the Queen.
Despite its success over the years, Carlett Park has not secured a position of stability and permanence, to my regret. It was threatened with closure in 1999, as it was then thought by senior management that the relocation of programmes to other sites would overall increase the number of students. I campaigned against that and presented, among other things, a petition with 7,000 signatures calling on the then Further Education Funding Council to reconsider the decision by the board of the college. The campaign was long and hard. I think that the campaign was the catalyst for the departure of the then principal and the board of governors. I am not hoping or anticipating that the same will be true in this instance, but it does highlight how strongly people feel about the site. Subsequently, the college was given a fresh start with a new board of governors. I had a modest part in all that, and it is frustrating and disappointing to observe that Carlett Park’s future is again in jeopardy. Surely the opposition to its closure both then and now suggests that the site should be allowed to continue.
The site is occupied by various buildings making up the present campus, but part of it was sold in 2001, with outline planning permission, as the location of a housing development to be built by Westbury Homes—an issue to which I shall return later. That helped to alleviate considerably the serious indebtedness of the college at the time, but the housing has, if anything, become a hindrance to development of the site, because once people move in, they tend to resist development next-door. That is the nature of the human condition, and there is some suggestion that it has hindered development on the site. Obviously, the campus is now more compact than it was in the past. None the less, it is still a valuable part of Wirral Met, as we know it.
As well as the housing side, the main administrative functions of the college are at Carlett Park. Various courses are also taught there, including leisure, tourism and travel, occupational studies, public services, sport, computing and IT, entry to employment, music and media, and some health and safety, science and teacher education courses. It is, in a sense, a shadow of its former self, but it is still substantial.
In 2002, Carlett Park’s 50th anniversary was celebrated. The celebrations included an exhibition at the site showing the contribution to education made by the college over the 50 years. Robin Cook came with me to see that exhibition and to visit the site.
The campus has been upgraded relatively recently and money has been spent on refurbishment, with a view, it is said, to a new focus on equipping students with the skills to enter local business and industry. Again, I shall return to that. In January 2007, planning permission was granted for phase 1 of the construction of a purpose-built sports hall. I think that I am right in saying that construction commenced at the end of March 2007, but the project was shelved due to lack of funding. In its place, a temporary fitness studio was installed at the same location.
In addition to the proposed sports hall, there has been the possibility of a long-term phased replacement of the current facilities with new buildings. Therefore, the potential for Carlett Park’s continued development has recently been, and is currently, evident to senior management at Wirral Met. That makes the sudden closure decision all the more surprising. In my view, it is misguided. I should stress that this is the only campus in south Wirral. In the borough of Wirral, the next nearest is in Birkenhead. Carlett Park has, in that respect, what one might call a captive market, if it is allowed to be accessed. The reasons for the proposed closure are shrouded in a degree of unnecessary mystery. We have a press release on the plans to close Carlett Park, which says:
“The Board of Governors had commissioned analysis on exploring the range of options and, following analysis of educational needs and demands, they agreed that the college should now proceed to explore a two-site option in the north Wirral area and develop a business case for maintaining a presence in the south Wirral area.”
Words mean what they say. When the board says that it will develop a business case, it does not mean that it will make use of that case. The case will also only be developed with a view to maintaining a presence in the south Wirral area, and a presence is not necessarily a campus.
The college says that the analysis cannot be made available either to me or to the general public for reasons of confidentiality. The only information that I have is from a recent meeting with senior management at the college at which I was told that other options included refurbishment of all the sites, a complete rebuild of Carlett Park, replacing Carlett Park with a new site—possibly in the south of the borough—and the building of a super-site college on a single site serving the whole of Wirral.
The board decided to go for the two-site option. I maintain that the research commissioned by the board to inform its decision should have been made available so that we could understand and analyse the reasons behind the proposed closure. Understandably, the board is not keen to duplicate facilities between campuses, but Carlett Park is the only campus in the south. It cannot be right for the college to be based only in the north. In the press release it states that the college is
“aware of the educational needs and potential opportunities for those who live in the more deprived parts of Wirral.”
“We understand that the Government has made a significant amount of money available to help FE colleges improve their buildings.”
That is very welcome.
“To get a share of this money for Wirral, the college would have to show that it meets the needs of the whole Wirral community.”
How can that be achieved if the south is left out?
I believe that there are numerous ways in which Carlett Park’s resourcing facilities could be made to meet the needs of the whole Wirral community. More importantly, there are strong arguments regarding maintaining the current location of such resources.
According to Wirral Met’s Ofsted inspection report from May 2007, the college has been effective at reaching its goal of enrolling a high number of students who were previously not in education, employment or training, otherwise known as NEET learners. The college has also increased the percentage of learners from wards with high widening participation factors—from 27 per cent. in 1998 to 1999, to 48 per cent. in 2006 to 2007. In order to further those goals, the new principal—he took up position in 2006 with a proactive agenda to address local community learning needs—is working on those issues. To maintain such an increase in learning participation, it is imperative that Carlett Park remains open and available as an option to all those who wish to enter further education.
We are now told that only some 2,300 students study at Carlett Park. That is a large number, but admittedly small in relation to those in the north. However, it has, to a large extent, become a self-fulfilling prophecy and there have been sins of commission as well as omission. Relatively few courses are now taught at Carlett Park. Opportunities to serve business needs have been tragically ignored. The science laboratories and engineering departments that once made Carlett Park a thriving college have long been taken away.
According to Wirral, South’s indices of mass deprivation 2004, in which Wirral’s super output areas are ranked against each other, most of Eastham—the ward in which Carlett Park is located—and neighbouring Clatterbridge and Bromborough are ranked highly. That relative deprivation is not always identified on broader-scale deprivation rankings. The current opportunity to develop skills and employability that Carlett Park affords should not be taken away from the people of south Wirral, who generally feel that they are treated with scant attention compared with those in the north of the borough.
Child poverty statistics for Wirral, South from 2007 also demonstrate that some children living in wards adjacent to that in which Carlett Park is based are ranked higher than average. It does not make sense that Carlett Park, which caters for local students who are evidently in need of opportunities to learn a variety of skills and optimise their chance of success in life, should close.
On Carlett Park’s doorstep is the centre of gravity of Wirral’s industry and commerce. It houses the largest concentration of businesses and commerce in that part of Merseyside. Statistics show that 17 per cent. of employees in Wirral, South work in the manufacturing sector, compared with just 11 per cent. nationally. That is not surprising given that Wirral, South is home to organisations such as Unilever, which alone employs nearly 2,000 workers, and the Wirral international business park, which is seen as a strategic site by the Northwest Regional Development Agency. Many thousands of people are employed on that site. It houses, among other things, 15 major international companies.
There is also a major retail site known as the Croft retail park. One employer, Asda, currently employs 540 people—that is not extraordinary for the site or the national picture—and, if it gets planning permission, could recruit a further 80. Vauxhall Motors is located close by. Such organisations and businesses should be considered as a catchment for Carlett Park. Its southern boundary falls into Wirral’s employment corridor, which runs along the Mersey side of the peninsula. The location represents a major economic opportunity for Wirral as a whole, but also exhibits serious deprivation. The so-called employment corridor is identified as the location with the greatest potential for securing European funding. There is also enormous scope for training in skills relating to those areas of industry and commerce.
The college has already capitalised on the construction industry of the north-west, but has failed to serve the needs of local industry to an adequate degree. With the Government’s renewed emphasis on investment in apprenticeships, it seems that Carlett Park could facilitate the transition from a low-income, unskilled work force to one that masters and embraces the skills of contemporary and future industry, thanks to local work experience and partnership opportunities. I think that it is shameful that Carlett Park’s proximity to south Wirral’s industrial and managerial sector has not been exploited. The board and management should hang their heads in that regard.
I am taking up too much time, Mrs. Dean, and I will conclude shortly. On the issue of land and money, the size of Carlett Park previously made it a target for developers, and as I mentioned, some of it was sold off in 2001. Such short-term ways of acquiring money are often a driver in the wrong direction. Perhaps that feature of financing is behind the decision to close Carlett Park. It is good news that the Government, through the authorities, are making a large amount of money available. The college has an opportunity to secure a multi-million pound investment and, in order to do so, it has committed to create a world-class FE college, which does not include Carlett Park. That suggests that the long-term approach for Wirral Met college, in which the vision is to take into account the current and future needs of students across the peninsula, is not being adopted. To some extent, it appears that the college is hastening to pursue a policy of chasing the money that is available. I endorse the idea that the college should seek additional funds and grants, and that it should seek excellence, but it should not be at the cost of sacrificing such a valuable site to satisfy funding criteria. It is an upside-down approach.
It has been recognised by the management that considerable sums of money are needed to refurbish the older buildings on the Carlett Park site. Yet surely that kind of investment should be preferred over knocking down valuable older sites and building new ones, which will eventually also need refurbishment and additional investment.
Eastham is a nice and historic place in which to live. The village is in the Domesday Book, but it is not strong on facilities. Admittedly, it has a golf course, a rugby club and a country park, but it does not have a great deal of employment and facilities. We are in danger of tearing the heart out of it. There is overwhelming evidence that the campus is part of the fabric of Eastham and that it serves a crucial role in the local community; with the right direction, it could play a key role in south Wirral’s future economic development. I urge the college and the Minister to reconsider the proposal. I know that a consultation will take place, and I urge people to participate in it. The most effective way in which to cover the whole area and ensure easy access to further education would be to maintain Carlett Park.
I congratulate my hon. Friend the Member for Wirral, South (Ben Chapman) on securing the debate. He is a powerful advocate, both publicly and privately, for his constituents. Indeed, he raised this specific issue with me on the Floor of the House at oral questions last week. In the Wirral and throughout the country, we need to face up to the skills challenge and we see our further education colleges as crucial drivers. That is critical.
My hon. Friend referred to the fact that in the recent past, hundreds of thousands in communities throughout England have benefited from the Government’s investment in the college infrastructure. Colleges such as Wirral Metropolitan have taken the opportunity given by our investment of more than £2 billion in the past 10 years to develop world-class learning buildings and facilities. That is in stark contrast to the situation 11 years ago, when there was not one penny of capital funding in the mainstream FE capital budget. In the past 10 years, the Government’s investment of more than £2 billion has ensured that learners have access to the state-of-the-art buildings and facilities that are essential if we are to meet our skills ambitions and the needs of our local communities.
We have recently announced in our “Building Colleges for the Future” capital strategy that a further £2.3 billion will be invested in the college estate in the next three years. I have seen examples up and down the country of the transformation of college buildings, facilities and opportunities. That gives the lie to those who claim that investment and money do not make a difference—manifestly, they do make a difference. That investment will benefit generations of learners to come, help to meet the skills needs of employers and act as a genuine catalyst for community regeneration. Capital investment plays a crucial role in the Government’s implementation of our priorities for young people and adults as set out in the 14-to-19 reform programme and our response to the Leitch review.
Modernisation of the FE estate is about not only bricks and mortar but creating the best possible learning environments that are accessible to all learners; ensuring that young people are excited by learning, so that they stay on in education and training; creating greater specialisation, so that businesses have access to a wider range of industry-specific skills development opportunities for their current and future employees; and creating community-owned facilities that meet local needs and can provide the important kick start for local regeneration. Ensuring that such facilities are accessible to those who most need them is critical, as my hon. Friend said; it is absolutely necessary if we are to maximise the public benefit of our investment.
Before talking about the specifics of the Wirral Metropolitan college, I should like to talk about the process for capital applications. It is crucial that any investment plans by colleges underpin their core mission of reflecting and responding to the diversity of their local communities, to provide high-quality learning opportunities for people in all parts of society who need to further their knowledge and improve their skills. That is a requirement for all the areas that a college covers, not just some of them. It means that a college must engage with all sections of the community when it is starting to plan any redevelopment project, to take into account the needs of the population that it serves. To be considered for public funding support, colleges are required by the Learning and Skills Council to demonstrate that their proposals will serve the educational needs of people in their local area. That is a genuine test through which local colleges must pass. Colleges must go through a robust, multi-stage process, whereby the educational and business cases are scrutinised. Public consultation is rightly an important part of that process and is required even before the plans can be approved in principle. Further widespread consultation will take place before planning permission can be granted.
On the heart of the argument that my hon. Friend made, Wirral Metropolitan college has begun the journey—it is at the start and not the end of a process. It is a medium-sized general FE college which, currently, as he made clear, occupies three campuses: Conway Park and 12 Quays in Birkenhead, and Carlett Park in Eastham in the south of the borough. In January last year, the college was considering a new sports facility at Carlett Park. In the subsequent months, the thinking of the college management and board broadened, and the college board of governors agreed to defer any decisions until a full range of options for redeveloping the college estate has been considered.
Following considerable research and analysis commissioned by the board of governors, a number of options have been investigated to ensure that there is an educational case to underpin them. As part of that process, the options were discussed with other interested parties such as the local authority director of children services, local councillors, and the principal of Birkenhead sixth form college. On 5 March, the college governors reached their preferred option, which is to consolidate the colleges on the two sites in Birkenhead in north Wirral at the same time as developing the business case for maintaining a presence in south Wirral. The devil, as always, is in the detail, and I acknowledge that, as the consultation process goes forward, it is incumbent on the college and its governing body to explain clearly and precisely, locally, what is meant by “a presence in south Wirral”, which is the very point that my hon. Friend made.
I should be clear that the college is at the earlier stage of the consultation process and no sites have been identified. The college’s three recognised trade unions are supportive of the concentration option, which includes looking at the business case for “a presence in south Wirral”. Since that in-principle decision, the college has begun to consult with current students and stakeholders, contacted Wirral’s MPs, including my hon. Friend, and conducted a meeting with local councillors for Eastham. That is the minimum that needs to happen, and I urge that a fully comprehensive consultation process takes place.
The next stage is for the formal submission of the application in principle in June. It would be considered by the Learning and Skills Council’s national property, local partnership, and regional finance teams. After that, it would require approval by the LSC north-west regional council and the LSC national capital committee. A full proposal is not anticipated until early 2009. I say that to communicate the point that an awful lot of water will flow under the bridge before a fully-fledged proposal comes forward. Within that, there must be genuine opportunities for the local community, local stakeholders and, importantly, local MPs to make their voices heard. The director of the LSC for Greater Merseyside recently said that to be considered for funding support, the college must demonstrate that its proposal provides further education opportunities that meet the needs and demands of the Wirral to support education and training for the next 30 to 40 years.
A comprehensive prospectus for the whole of the Wirral community must be put forward. Clearly, the issue of access will need to be addressed. At the moment, 85 per cent. of learners at Carlett Park travel more than 3 miles in contrast to northern campuses, where more than half of learners live within 3 miles. The issue of access and transport must be addressed.
It is ultimately a matter for local decision and for the governing body of the college as an independent institution. It would be inappropriate for me to intervene directly—I am actually prohibited by legislation from doing so. Nevertheless, I strongly urge my hon. Friend to continue to engage on behalf of his constituents with the college governing body and the LSC to ensure that the college’s plans meet the needs of all learners in the Wirral; in the whole of the community rather than just parts of it. Knowing my hon. Friend, I am sure that he will continue to make the case.
Sitting suspended until half-past Two o’clock.
Scotland Act 1998
I welcome you to the Chair, Mrs. Dean. I am sure that you have heard that these excursions into Scottish politics are usually cosy, consensual affairs, and I expect that we shall see some of that. I have been looking forward immensely to the debate and cannot wait to hear some of the contributions of Labour Members. They did not have an opportunity to discuss this issue and their commission at their Aviemore conference, so I thought that I would helpfully oblige by supplying the debate today.
Is it not great that we are where we are now? Who would have believed that, in one short year, we would be where we are? Everyone agreed that devolution is a process, not an event. Everyone in this Chamber agreed that more powers are required for the Scottish Parliament. Who would have believed that the Conservative, Liberal, Scottish National and Labour parties would now demand more powers for the Scottish Parliament? It is remarkable, and we should take a moment to appreciate its full significance and importance. Of course, it was all started by the Scottish Government’s national conversation. Now everyone is talking. We cannot shut them up any more.
In the past few days we have had significant contributions to that national debate. Sir Tom Hunter, Scotland’s top businessman and entrepreneur, said that a referendum is required immediately.
Did not Sir Tom Hunter say that the referendum should consist of only one question—yes or no to Scottish independence?
It took all of two minutes, so I am grateful for that intervention. Yes, of course it should be a one-option referendum—a yes or no. That is the Scottish National party’s favoured position. If the hon. Lady had been paying attention she would know that that is exactly what we want. I shall come back to the issue of referendums.
At what stage may we expect the SNP to take its national conversation to the Scottish Parliament?
The national conversation will go to the Scottish Parliament. Already we have had many significant and notable contributions: a succession of Labour former Ministers, Labour Members of the European Parliament and current Labour Members of Parliament have added to the national conversation in the past few days. The hon. Member for Midlothian (Mr. Hamilton), who is in his place now, said:
“We should have a referendum sooner, rather than later.”
The hon. Member for Glasgow, North-West (John Robertson) said:
“We should go for it now, get this out of the way and then focus on the issues that matter.”
The hon. Member for Linlithgow and East Falkirk (Michael Connarty), who wanted to attend the debate, but could not, said Labour
“should not be afraid of a referendum”
“the independence option should have been put to the people at the time of the devolution referendum”.
I could not agree more. Welcome to the club. The national conversation has got everybody speaking.
A conversation occurs when people talk about things, and they may even happen to agree. The most notable contribution was from the abominable no-man himself, former Scotland Office Minister Brian Wilson, who said in his usual robust way,
“I’d rather have a referendum rather than this incremental nonsense of fiddling about with powers as if that’s what politics depended on.”
It is incredible that we are where we are. Of course, Mr. Wilson was referring to the Scottish Constitutional Commission that has been put together by all the Opposition parties in the Scottish Parliament, independently chaired, we are led to presume, by Sir Kenneth Calman. It is an uneasy alliance of the three Opposition parties in the Holyrood Parliament, but an even more uneasy alliance between those parties in Holyrood and the parties here in Westminster.
The motion in the Scottish Parliament deals with increased fiscal powers, but it does not deal with returning powers from Holyrood to Westminster. I am looking forward to hearing the Liberals’ position on that in the debate: I am sure that we shall have it. [Interruption.]
I know that the hon. Gentleman cannot wait for his opportunity to have his say in the national conversation—and for his colleagues in the Scottish Parliament to do the same. It will come to the Scottish Parliament when it comes to the Scottish Parliament.
To deal with the constitution, I know that the Minister will say that the national commission is still in its early stages; it has still to report, and some of the membership is still outstanding. Nevertheless, we must hear from the House today, especially if the commission is not to have a democratic mandate from the Scottish people. The House has responsibility for the constitution and the hon. Members present will have the final say. We need to hear from Labour Members whether they have bought into the process. Are they enthusiastic champions of the commission? We must hear that from them.
The hon. Gentleman will take it under false pretences, then. I welcome the national conversation, but I should like it better if we could have it in Westminster. Will the hon. Gentleman explain why his former Westminster leader—perhaps his present Westminster leader will tell us—did a deal with the Government not to have Scottish Grand Committees, in which we could discuss Scottish issues a lot more than we can in this forum? If he wants a conversation, will he explain that?
I shall leave the hon. Gentleman to conduct his one-man crusade to resurrect the Scottish Grand Committee, but I welcome his contribution to the national debate. I look forward to the first intervention from a Labour Member wholeheartedly and enthusiastically backing the commission set up by the Scottish Parliament.
If the SNP did any such deal with the Government, I certainly never heard of it. If the hon. Gentleman wants to continue his campaign to resurrect the Scottish Grand Committee he is more than entitled, and is welcome, to do so. However, I am still waiting to hear one intervention in support of the commission and enthusiastically championing the idea.
I enthusiastically support the commission because it will develop the Scottish Parliament in a very positive manner. Is it not the hon. Gentleman’s intention to destroy the Scottish Parliament at the end of the day? That is his real agenda.
That is one of the most ridiculous interventions that I have heard so far, but I am sure that we shall get some more like it in the debate. We want to make our Parliament a normal Parliament, with the same powers as the Parliaments of every small nation in Europe. There is nothing wrong with that. I respect the hon. Lady’s position on independence, and I have my position. Those are the things that we agree on. We should be putting our positions to the Scottish people and then conducting the debate and the argument. The hon. Member for Midlothian thinks that that is the right thing to do. I do not know the hon. Lady’s position, but I suggest that she possibly does not think that.
I want to support the commission that is under way—for one good reason. It allows us to review the whole gamut of the Scotland Act 1998, which allows powers to be taken back from the irresponsible Administration that currently exists in the Scottish Parliament. The relevant powers, quite clearly, are on energy policy and energy security, which is vital to all of us. I do not want my country to have a gap in energy provision in the years ahead because of policies that have been adopted. Does the hon. Gentleman want that?
I was waiting for the first point about taking powers back. There is support for independence in the Scottish Parliament—I am sure that the right hon. Gentleman accepts and appreciates that—and for more powers for the Scottish Parliament, but there is no support whatever for taking powers from the Scottish Parliament to the Westminster Parliament. If he pursues that agenda on the commission, he will have the same discussion with the Liberals. They have made it abundantly and absolutely clear, as the hon. Member for Orkney and Shetland (Mr. Carmichael) said, that there will be no clawback of powers. The Liberals must be clear that, if they do not get an assurance from the Minister that a clawback is a non-starter, they should walk from the commission today. If they are going to be sincere about their intention—
Before my hon. Friend moves on—[Hon. Members: “No!”] How many interventions from Labour Members has my hon. Friend taken? He has been very generous.
The right hon. Member for East Kilbride, Strathaven and Lesmahagow (Mr. Ingram) spoke about an irresponsible Administration. The UK Government have a £581 billion cumulative deficit, £44 billion net debt, £87 billion deficit in trading goods and £189 billion liability on private finance initiative projects. The Government’s economic irresponsibility logically insists that economic powers should be immediately handed over to Holyrood.
As always, my hon. Friend makes a very powerful point and I can see blank faces on the Labour Benches in response to it.
How did we have arrive at this very satisfactory situation? Has there been a Damascus-like conversion from Labour Members? Did they wake up one morning and, all of a sudden, think that the Scottish Parliament needs fiscal powers and autonomy to do its job properly, better to represent the people of Scotland? Alternatively, maybe—just maybe—it was something to do with a certain day in May when an SNP Government were elected and the Labour party lost power for the first time in a generation. Perhaps it had something to do with that.
I have imagined the scene in the Scottish Parliament when the commission idea was first suggested and mooted. I can imagine the Labour Members of the Scottish Parliament sitting in their weekly meeting, despondent and depressed. They have been completely shattered by their Scottish leader getting involved and embroiled in the donations scandal; bruised by the continued popularity of an SNP Government riding high in opinion polls; and monstered on a weekly basis at First Minister’s questions. I can see the former, sacked, disgraced, over-refreshed adviser going to the meeting and saying, “I’ve got an idea to get one over on the Nats. Let’s take the whole issue of the constitution to the SNP.” One can imagine all the back-slapping following such a suggestion.
However, Labour MSPs did not account for hon. Members here in Westminster. I can imagine the steam coming out of the ears of the hon. Member for Lanark and Hamilton, East (Mr. Hood) and others when they heard the plan for more powers for the Scottish Parliament. I can imagine mutterings of “Over my dead body” from the right hon. Member for East Kilbride, Strathaven and Lesmahagow and the state of apoplexy induced in the hon. Member for Livingston (Mr. Devine). The call would have been met less than enthusiastically, and I understand why those people are less than enthusiastic about powers being transferred from Holyrood to Westminster—Labour Members are not intervening to support the idea, so I am looking forward to their speeches. They once ruled the roost and had powers absolute in Scotland.
Is it not a sign of the times? We want all powers transferred from Westminster to Holyrood, and Labour are coming along with us. They want some powers to be transferred—they do not yet know which ones—but they are on our territory.
I should like to make some progress if that is all right. I have a lot to get through. I shall give way to the hon. Lady later.
We are where we are and we are trying to move forward. After the Scottish group meeting, the hapless Minister was dispatched. His call was to inform the Scottish press. In his best Kelvin MacKenzie-speak, the Minister said that no one was interested in further constitutional change other than the “McChattering classes”—an odious and offensive term. Had it been used by the metropolitan press—
The hon. Lady says, “Hear hear!”, but had the phrase been used by the metropolitan press, it would have been subject to a number of complaints.
Unbeknown to the hapless, unfortunate Minister the McChattering classes were just about to recruit their most notable and significant member—his boss, the Prime Minister. I would not like to have been the Minister on the day when he found that his boss, the Prime Minister, was a member of the McChattering classes.
The hon. Gentleman said that increasing the powers of the Scottish Parliament is a priority. Never in one of my surgeries, or when I have walked around on the streets, or at community and public meetings, has one single constituent of mine come up to me and said: “The No. 1 priority is more powers for the Scottish Parliament”. It would be helpful if someone gave the hon. Gentleman some advice. Has he met such people?
It is the hon. Gentleman’s No. 1 priority. Labour have set up a commission to look at what powers should be moved. He is looking at the process of transferring powers from Holyrood to Westminster. If it is not an issue of interest to the Scottish people, why has a commission been set up? I find the hon. Gentleman’s remarks bizarre.
To placate hon. Members, the idea of two-way traffic—the prospect of some powers being taken from Holyrood and repatriated to Westminster—began to emerge. For about three weeks, they could not even bring themselves to call the body a commission. Only at the last possible moment, grudgingly, did they decide to call it a commission, which is remarkable. Two-way traffic has absolutely no support. It exists only in the fevered imagination of Labour Members. Nobody has mentioned the issue and there is no public support for it—if it were put to the people, it would be overwhelmingly defeated. I say to Labour Members: it will not happen.
The hon. Gentleman spoke about parties’ support for different positions, but he has not referred to the result of last May that overwhelmingly rejected the cause of independence. The independence parties could not get a majority in the Scottish Parliament.
I remember the SNP taking seats from the Liberals in practically every part of Scotland—[Interruption.] As comments from a sedentary position suggest, that has particularly been the case in Argyll and Gordon. I shall take no lessons from the Liberals about who did best in last year’s Scottish parliamentary elections.
Exactly what powers would Labour seek to return to Westminster? The right hon. Member for East Kilbride, Strathaven and Lesmahagow mentioned some. Powers in relation to terrorism, foot and mouth and, I believe, bird flu have been mentioned by one Minister or another. However, terrorism is already a reserved matter for Westminster. I am sure that Scottish farmers would not thank the Labour party for taking powers over the management of foot and mouth from the Holyrood Parliament to Westminster when the Department for Environment, Food and Rural Affairs, which is a Westminster Department, initiated the last foot and mouth outbreak and never properly compensated farmers.
In that case, I am desperately trying to understand what that point was about. In a debate yesterday on counter-terrorism, I made the point that the only terror power that the Scottish Parliament has available to it is the right to try terror suspects. I am beginning to believe that that has now been caught up in the talk about the transfer of powers from Holyrood to Westminster. I do not know what is being referred to—the Gentlemen has further confused the issue—in the talk about transferring powers over terrorism. Certainly, Scottish farmers will not thank Westminster for taking responsibility for foot and mouth and bird flu, for example. I have no idea what Ministers are talking about.
Perhaps I could help the hon. Gentleman by clarifying what the hon. Member for Dumfries and Galloway (Mr. Brown) said. The counter-terrorism legislation says, in response to the Association of Chief Police Officers Scotland, and the most senior counter-terrorism policeman in Scotland, that it is for the safety of the island—the British Isles—that suspects are tried, when appropriate, where specialist prosecutors and investigators are best suited to get a conviction to keep our island safe. If the SNP objects to that, it should say that it is prepared to put politics before the safety of this island.
I find the hon. Gentleman’s intervention curious. He and I were both at the debate yesterday and heard considered arguments being put forward. We have no problem with terrorist suspects being tried in the most appropriate places. Indeed, the Glasgow terrorist suspects were transferred to English jurisdiction last year. What we will not do is sacrifice the independence of the Scottish courts in order to achieve that. We will stand up to ensure that that is maintained.
I return to the transfer of powers. The Liberal party must make it abundantly clear to Labour Members that it is not prepared to go through with the process unless it gets a cast-iron commitment and guarantee that there will be no taking away of powers from the Scottish Parliament to Westminster. We all look forward to hearing that from the hon. Member for Argyll and Bute (Mr. Reid), who will be speaking for the Liberal party. No one believes that there is any requirement for a return of powers to Westminster: it exists only in the fevered imagination.
The biggest problem with the commission—there are many—is what I would call the democratic deficit. The only thing that it will not consider is independence. If it is to consider Scotland’s constitutional options, it is absurd and inconceivable that independence should be left out of a review of further powers for the Scottish Parliament. What are Labour Members afraid of?
We do not know. The hon. Member for Midlothian would certainly like to test that proposition. We look forward to ensuring that there is a referendum. If Members believe that the chairman was right, why do they not want a referendum on independence—especially if they believe that they would win it?
In response to the hon. Member for Cumbernauld, Kilsyth and Kirkintilloch, East (Rosemary McKenna), our preference would be for a yes-no referendum. That is the position of Brian Wilson, as it is of MEPs, former Ministers and hon. Members. That is what we want—a yes-no referendum. If the commission can come forward with a constructive and viable proposal, why cannot it be tested? Why should the Scottish people not have a say? If Labour Members do not want a yes-no referendum on independence, why not have a referendum on all available constitutional options? We are democrats. I believe that Labour Members are democrats. Why will they not let the Scottish people decide?
I do not know whether the hon. Gentleman saw his party leader being interviewed by Andrew Marr on Sunday, but he unequivocally said that it should be done under the single transferable voting system—that voters should have three choices. Did the hon. Gentleman not hear that? Is there no significance in the fact that his party leader said that?
Absolutely. Our preference is for a yes-no referendum, but if it is to be a multi-option referendum, that is what we shall have. A multi-option referendum has previously been supported by the Labour party. An early-day motion from 1992, signed by 12 Labour Members, said that a multi-option referendum was necessary to secure Scotland’s constitutional future. The Prime Minister agrees that a multi-option referendum would be the most appropriate way to settle Scotland’s constitutional future for ever. Donald Dewar believed that a multi-option would be required to settle the matter. If it was good enough for them, it should be good enough for Labour Members—and it should be good enough for the House.
Does that not show the difference between the approach of the Scottish National party and that of the Labour party? We include all points of view, but the aim of the Labour party is to seek to exclude other points of view and other voices, not letting the people of Scotland tell us what they want. Labour is a self-selecting bunch of politicians who think that they know better than the people of Scotland. It is shameful.
I could not agree more. My hon. Friend makes a powerful point. It is we who believe in letting the Scottish people choose. It is Labour Members who seek to exclude the Scottish public. They are not prepared to engage with them, and they are not prepared to consider all options.
On three occasions, the hon. Gentleman has said that I, the hon. Member for Midlothian, am involved in the conversation. Is that the national conversation that he and his party are promoting, saying that they take all views into consideration? However, the hon. Gentleman says that he will not consider moving powers from Scotland to Westminster. How can it be open dialogue if he is refusing that? He was better as an organ player than he is as a politician.
I know that the hon. Gentleman has all my albums, so I am grateful for that. Does he not realise that it has never been suggested that there should be a movement back to Holyrood? No one supports that position. No one has raised that as a serious proposition. It exists only in the fevered imaginations of Labour Members. That has never been raised before as an issue, and it is a deal-breaker with the Liberals.
I said that I would not give way again. I want to ensure that everyone else has time to contribute to the debate.
We believe that the Scottish people have the right to choose on this important question. It is unfortunate that Labour Members do not feel the same way. The Scottish people will have a choice. They will have their say. Neither time nor the Minister will stem that tide.
The tradition is to thank the hon. Member who initiates such debates. Indeed, I do thank the hon. Member for Perth and North Perthshire (Pete Wishart) because he has given us the chance to explore some of the myths and falsehoods being perpetrated about what the Scottish people want.
If what the hon. Gentleman says is true—that everyone in Scotland wants this national conversation and that they all want the chance to vote in a referendum, multi-question or not—why does his party not put that position to the democratically elected body of the Scottish people, the Scottish Parliament? There is nothing to stop his party from doing that. He may say that it is legislated for here in Westminster, but surely the first step that anyone who wants a referendum should take is to get the principled agreement of the legislative body that will carry it through. I challenge him to say why his party not only does not put the national conversation to the Scottish Parliament but will not put forward the idea of a referendum to it.
Does the hon. Lady not agree, having endured so many lectures from the SNP over the years about the Government ignoring Parliament and concentrating on the powers of the Executive, that it is curious that the SNP is not prepared to put its own core principle and belief to the very Parliament that it always accused other parties of side-lining?
I am struck by the impatience of the Labour and Liberal Democrat parties to get on with a referendum, which is welcome. They must know, of course, that the matter will come to the Scottish Parliament, in the terms of the Scottish Parliament, but I thank them for their impatience. Its importance to them is witnessed by the number of Labour Members who have come here today to join in the conversation.
Before anyone thinks that the hon. Gentleman’s interpretation of what I said is correct, I have just said that it is for the SNP, if what it is saying is correct, to come to the Scottish Parliament with its idea. I did not say whether anyone would support it. It is the SNP’s contention, and no one else’s, that that is what the Scottish people desperately want—that it is their No. 1 priority. As with most politicians in the Chamber today, that is not what I hear on the doorstep, through the mail or in the constituency surgery.
In fact, I am overwhelmed by the incompetence of the SNP on Aberdeen city council. It has managed to find a black hole of £27 million, which it cut from the budget in one financial year. As a result, the council is shutting swimming pools, ice rinks and sheltered workshops for the blind, and taking away day centres and day care from vulnerable adults. All that is at the hands of the SNP administration in Aberdeen. The hon. Member for Dundee, East (Stewart Hosie) spoke of irresponsible administration. I can tell him where to find an irresponsible administration; it is to be found in Aberdeen and the SNP and Lib-Dem city council. It is a shower. If anyone thinks that the SNP can run a Government, they should consider what is happening in Aberdeen. The party is in power, and what it is doing is appalling.
I am sure that, for the sake of completeness, the hon. Lady will want to advise the House that in the past four years, under the previous administration in Aberdeen, the council reserves were raided to the tune of £7 million, £9 million, £11 million and £12 million. A total of £39 million was taken, leaving a closing balance in deficit last year for the first time since 1999. It is no wonder that there are difficulties, given the shambles of the Aberdeen administration and the £39 million raid on reserves over the past four years.
I am so happy to answer that, because when Labour left office five years ago in Aberdeen, we left a surplus of £23 million. We had a large amount in reserve as well, although I admit that that surplus has disappeared into a black hole. Since the SNP administration took over in May last year, its financial cuts have hit the most vulnerable. It has not done a disability impact study; it has merely taken lines through the budget without realising the consequences of its decisions. It has not necessarily had to deal with a difficult budget, but most of us object to how it has dealt with that budget.
I have no idea what that has to do with the renewal of the Scotland Act 1998 but, when it comes to Aberdeen council, where was the Labour budget this year? Why was one not produced? What would the hon. Lady cut? How much would she increase council tax to address the problem? Every opposition party has produced a budget—
I take what you say, Mrs. Dean. In Aberdeen and elsewhere, when my colleagues and I and the Liberals were discussing the Scotland Act before the 1997 election, we worked together as part of the constitutional convention and Civic Scotland. We brought together lots of people’s ideas. It was not just a matter of going it alone, as the national conversation is doing, and it was certainly not one-sided like the conversation happening now. The SNP has no history of any kind of compromise or of working with others. In fact, its members become defensive if anyone suggests that their view of Scotland is anything less than perfect. They believe that their view is shared by everyone. If that were true, perhaps they would not find themselves in a minority Administration in the Scottish Parliament. That is why they will not put their ideas to the Scottish Parliament: they know that they will lose.
The hon. Member for Perth and North Perthshire began his speech by saying that it is accepted everywhere that devolution is a process, not an event. Again, we can argue whether that is accepted everywhere, but it is his interpretation of the word “process” with which I have a problem. I have always understood a process to involve moving forward and perhaps changing something, not necessarily taking more powers. I do not think that any dictionary definition of “process” includes an assumption of more power. Sometimes it involves putting things together, as in the case of a process worker, but I do not know of any definition that necessarily involves adding, taking back or taking more powers.
Even if Donald Dewar said that devolution was a process and not an event—it is still open to doubt—that does not necessarily imply the interpretation made by the hon. Gentleman. What is clear—this is why we are having this debate and why the commission has been set up—is that after 10 years of devolution, it is perhaps time to take stock of how things are working, what is working well and what is not working so well. I do not think that anyone in this Chamber has a problem with that except SNP Members. They have one view and one view only, and if no one else shares that view, they are somehow unpatriotic or un-Scottish. The SNP does not hold the flag for everyone in Scotland, nor are its views shared by the majority of Scots.
Unlike the hon. Gentleman, I was involved in a lot of the discussion leading up to the Act. I campaigned on it for most of my political career; it is what brought me into politics. Ironically, the reason why I ended up joining the Labour party in 1983 was that I went along to SNP hustings meetings and discovered that I could not vote SNP even to get rid of the Tories—I apologise to the hon. Member for Lancaster and Wyre (Mr. Wallace)—although I believed in Scottish self-determination. Why not? Because I did not agree with the SNP’s hard-line, single and one-dimensional view of Scotland.
That is when I joined the Labour party and became involved in the debate. Unlike some Members, I was there. The Labour party and I were part of it, and we think that we created something to be proud of. It is up for review. We have not even started the process yet, but that is where the hon. Member for Perth and North Perthshire wants the decision to be made— [Interruption.] He has his mind made up before we have started any conversation. That is what makes a conversation one-way.
Indeed. The reason for pride in Scotland and Scottish values is that we listen to and engage with others. We are part of a wider civic Scotland, and we do not have the single view held by the SNP. It is a no-compromise and go-it-alone organisation that does not want to engage with others. That is why its only response is to mock those of us who genuinely want a debate.
As the hon. Lady speaks about engaging with others, I am sure that she will welcome the fact that last Wednesday in Edinburgh, at the second part of the national conversation led by the First Minister, representatives of the Scottish Trades Union Congress were present.
On the issue of the STUC and the trade union movement in Scotland, is my hon. Friend aware that, when a modernisation fund was being promoted by this Government, the Scottish National party was not there for the trade union movement to vote or support it?
On the subject of engaging with various organisations, my hon. Friend may be aware that the Select Committee on Scottish Affairs visited Glasgow this week, and the shipbuilding yards in Govan and Scotstoun, as part of our inquiry into employment in the defence industry. The SNP is represented on the Scottish Affairs Committee, but unfortunately no one from the SNP was present on our visit. However, it was made crystal clear to us that the shipbuilding industry, particularly in Scotland, depends almost entirely on UK Ministry of Defence contracts. Does my hon. Friend agree that it is deplorable that the SNP seeks to put thousands of jobs in jeopardy by taking Scotland out of the UK?
One of the main reasons why Scotland is a stronger part of the United Kingdom has to do with those defence jobs. We are also stronger because we do well out of welfare spending. There would be an £800 million black hole if Scotland were to go independent with regard to welfare spending.
I would normally take an intervention from the hon. Gentleman, but I have used all my time.
To sum up, when the SNP does not know what to do with its power—this is absolutely clear from everything that it has done in the Scottish Parliament and in Aberdeen—it calls for more. Labour Members should have a sensible conversation, rather than being part of a trumped-up, one-sided conversation in which only the SNP Administration in Holyrood are interested in taking part.
John Smith referred to devolution as unfinished business, and he was right. As we have heard, my neighbour, the hon. Member for Perth and North Perthshire (Pete Wishart), supports devolution. However, we come at the issue of Scotland’s devolved settlement from different points of view. The position that I take is overwhelmingly supported by the Scottish people, by two thirds of the Members of the Scottish Parliament—indeed, it has been voted on and supported by the Scottish Parliament, which is funding it—and by the UK Government. The hon. Gentleman and the SNP approach the matter somewhat in isolation: they have minority support in the Scottish Parliament and from the Scottish people, and authoritative polls show that support for separation, at 23 per cent., is falling.
The point is not only that we approach this matter from two different points of view, but that the issue of Scotland’s governance is being discussed by two different entities. One—the Calman commission, to which I alluded—is approved by the Scottish Parliament; it is independent, it has cross-border support and its findings will be consulted on by the Scottish Parliament and the UK Government. Let us compare that with the alternative that we have heard about today—the nationalist conversation. The conversation document was produced with taxpayers’ money, but without the approval of taxpayers’ representatives. It was launched during the summer recess to avoid the headlines, and it approaches the governance of Scotland from the isolated position of separation.
I do not know whether the hon. Gentleman has actually read the national conversation, but it would be nice if he had. It puts the case for more powers for the Scottish Parliament—we want to debate that. We did not think that the Labour party would actually get around to producing anything or doing anything significant, so my party had to do the job for it. We outlined the case for more powers, and that is set out in the national conversation, which includes all options. Why can the hon. Gentleman not include all options in his commission?
I will come to my involvement with the national conversation in a moment, so I hope that the hon. Gentleman will bide his time.
The national conversation on which the SNP has embarked has been carried out largely in cyberspace and in the early hours of the morning for some strange reason. Perhaps the nationalists are up pounding their computer keyboards because they are too worried about all the manifesto promises that they are breaking to sleep. Perhaps the consultation process will tell us the reason, but perhaps it is because some of the contributions to the national conversation do not deserve to see the light of day. There have been comments about burning the Union Jack and about Union liars, as well as comments that could incite hatred and divide people, such as those about Asians, Swedish, Danish, Belgian, Norwegian and English business men owning land in Scotland. I want the SNP as a party, and certainly Ministers in the Scottish Executive who represent me, to dissociate themselves from such aggressively confrontational comments. I hope that SNP Members will take the opportunity of this debate to do just that.
I will take this opportunity to dissociate myself—as I am sure that my party would—from anybody who behaves in that way. We do not know who is doing this. It could be agents provocateurs—we do not know. However, will the hon. Gentleman answer the question that the hon. Member for Aberdeen, South (Miss Begg) failed to answer? Does he support more powers and further independence for the Scottish Parliament? That is one of a series of questions that we could ask Scottish Labour MPs.
My hon. Friend gave a very interesting list of the rhetoric that is used. I draw his attention to the fact that, not very long ago, an SNP MSP called the Union flag the butcher’s apron. That comment has never been repudiated. Will my hon. Friend give way to an intervention by an SNP Member to see whether they will repudiate it?
I am certainly willing to sit down if there are any takers for another intervention—no, I did not think so. Perhaps the SNP should look in greater depth at some of the tawdry comments on its website. Incidentally, it got one more hit from me last night, but I urge SNP Members not to read anything into that, because I did not engage in the conversation.
Perhaps SNP Members should look at some of the other comments on its website, such as that by Alistair from Stirling. In his posting, he said that few things made him want to get involved in politics, but that having
“my country—the United Kingdom—destroyed by a minority government is something that cannot be ignored”.
I am very impressed by the hon. Gentleman’s knowledge of the national conversation website—I have seen the hard copy, but I have not seen it in electronic form. I just wonder what Gordon from Ochil is saying about the issue of more powers for the Scottish Parliament.
I have already asked the hon. Gentleman to be patient. He will hear what Gordon from Ochil—and South Perthshire, I hasten to add—feels about more powers for the Scottish Parliament.
However, perhaps the hon. Gentleman should listen to John Stuart from Edinburgh, who considers the national conversation “a Nationalist rant” and who questions who is paying for it. Let me take this opportunity to tell John Stuart who is paying for this nationalist rant—it is Scottish taxpayers. The hon. Gentleman should also listen to Alan from Midlothian, who
“would much rather we didn’t change as I believe Scotland is better the way it is”.
The second round of the conversation, which we have heard a little about today, has met with equal derision, and no wonder. The First Minster has used the hastily convened opportunity for a relaunch to announce that a referendum on separatism—despite what the hon. Member for Perth and North Perthshire said—could be on the basis of multi-option preferential voting. That is an attempt to get separation at any cost. Perhaps the First Minister would be better spending his time listening to the advice given to him by CBI Scotland and getting on with the job that he is charged to do.
I invite the SNP to engage in the official review of how devolution is working. At the same time, the party could show a maturity that has been lacking to date and engage constructively with the UK Government on a range of issues. We must get away from the peddled myths that Scotland is being bullied by the UK Government, the BBC and the Treasury. At the same time, we must squash the myth, as one of my colleagues has said, that for someone to be patriotic to Scotland, they must be a nationalist—they do not. We must rise above the persecuted, Braveheart image of politics in Scotland or, indeed, its “alter image”, as described on the national conversation website—the politics of the White Heather club. Both are equally unfitting for Scotland in the 21st century.
In response to the question from the hon. Member for Na h-Eileanan an Iar (Mr. MacNeil), let me say that I would not support that call. That is because I am still looking for answers to the question of where the £34 million for disabled children and their families has gone. I have had three replies on the issue from Executive Ministers, but they make no sense. If that money has not come to local authorities and health boards in Scotland when I get to the end of my investigation, the SNP Administration can hang their heads in shame.
My hon. Friend makes extremely good sense, and I think that the whole of Scotland wants to know what happened to that £34 million.
The Calman commission provides an opportunity to grasp all of the issues that I have paraded before the Chamber. It will explore the success of devolution and consider how the devolution settlement can be better developed to work for the people of Scotland within the UK. The chair of the commission stated clearly that he
“would not have accepted this if I felt this was something being driven from elsewhere”.
We have a real opportunity for Scottish progress, on a particularly Scottish matter, in a way that will include a wide range of expertise from Scottish business, law, public life and civic Scotland. Although it is fundamentally important not to prejudge the outcome of the commission—unlike what the SNP wants us to do—the flexibility that the Scotland Act gave us must be retained in any new agreement. Since 1999, the flexibility under the Act has delivered 164 orders with more to come later this year. That flexibility reflects good governance in the interests of the Scottish people.
Where there has been a clear case for devolving further powers, the UK Government have agreed to do so. For the sake of clarity, no matter has ever moved the other way—from devolved back to reserved control. That balance must be a matter for consideration by the commission and for it to make recommendations on. How can it be independent if we do not allow it to reach its own conclusions?
The Calman commission allows for a review of the devolution settlement, which has been in place for 10 years, for the position approved by the democratically-elected Scottish Parliament to be considered and for cross-border and non-partisan discussion. Will the SNP abandon its late-night cyberspace conversations, see the light and embrace it?
This has been a rather cathartic experience. Often it is only every five weeks that we get to debate such matters in the House. Unfortunately, however, this debate has been characterised by hyperbole and spin and has not given us the opportunity to discuss and consider matters of detail, which should form part of the discussion about the creation of new powers for the Scottish Parliament. The Liberal Democrats have set down a marker—we do not want more powers repatriated back to Westminster. That is an important issue for us. However, we want to discuss such matters with the other parties. We recognise that the Labour and Conservative parties have moved, and have come on to our agenda, as set out by the Steel commission, led by Lord Steel of Aikwood, who considered those matters in considerable detail. We welcome the opportunity to have this discussion today.
I was rather surprised that this debate was scheduled to take place in the Chamber, because, as has been mentioned, such a debate has not been held in the Scottish Parliament. I went to the Scottish Government’s website to see where this national conversation had taken place. It has been conducted in various places, including Estonia, Dublin, Harvard university, Stolt salmon farm on Harris and even the Moonlight Tandoori in Turriff, but it still has not taken place in the Scottish Parliament—[Interruption.] Perhaps the hon. Member for Na h-Eileanan an Iar (Mr. MacNeil) will stand up again and give us his view on whether it should take place in the Scottish Parliament. Or does he recognise that, if it did go to the Scottish Parliament, the matter would be killed off and that there would be no mandate for the national conversation, either in the Scotland or in the tandoori in Turriff. He is frightened of exposing the question to the will of the Scottish Parliament, as expressed in last May’s elections.
No, because I only have two minutes.
It should be recognised that the pro-independence parties—Tommy Sheridan’s Scottish Socialist party, the Scottish Green party and the SNP—formed a minority in the last year’s elections and did not secure a majority of Scottish opinion in their favour. Last May’s election was the referendum. We do not need another one, because the single issue party—the SNP—put their manifesto to the electorate and it was soundly beaten. The pro-Unionist parties—we are now the pro-reform parties—were in favour of the Union and therefore secured a majority of opinion on our side. We must recognise that the will of the people has been expressed, and we must now have a serious look at the issues at the heart of the debate, such as fiscal federalism, the abolition of the Scottish Affairs Select Committee, broadcasting and so on. Those are the issues of substance that should be considered.
I congratulate the hon. Member for Perth and North Perthshire (Pete Wishart) on securing this debate. I shall make three very quick points. First, I surveyed 10,000 households in my constituency and asked various questions about issues that were important to them—issues of the day—and discovered nothing of great surprise. The things that are important to people—health, education, the economy, the environment and so on—are the same across the UK and Scotland. As the hon. Member for Dunfermline and West Fife (Willie Rennie) said, those matters of substance are rarely mentioned by the SNP and were not mentioned by the hon. Member for Perth and North Perthshire. They are the issues that we should be debating, because they concern people the most.
No, because I only have two minutes.
Secondly, the way in which the nationalist conversation is being conducted seems to encourage the posting of bigoted, racist comments on the Government website, which is funded totally by the taxpayer. The Scottish Administration needs to consider very carefully what they are encouraging. My third point concerns the issue about which the hon. Member for Na h-Eileanan an Iar (Mr. MacNeil) has been jumping up and down and chuntering away. He wants all powers devolved to Scotland and full independence. My hon. Friend the Member for Dundee, West (Mr. McGovern) mentioned defence. I was perusing the Scotland on Sunday and noticed a letter from a chap called Jeff Duncan who runs a campaign to reinstate all six former Scottish regiments, which I understand is also the SNP’s policy—that demonstrates how little concern it has about defence. However, I also noticed that Mr. Duncan describes himself as the webmaster for the Black Watch. Among other things, he consistently criticises troops’ commitment to the course in Afghanistan, which does profound damage to morale in the Black Watch. I am deeply depressed that this man, who describes himself as webmaster for the Black Watch website—indeed, he appears to be so—also describes himself as being close to Alex Salmond, by whom he is supposedly extremely well supported. I hope that SNP Members will take this opportunity to dissociate themselves from Jeff Duncan’s disgraceful comments, if he is, as I believe he is, the Black Watch webmaster.
Need we say more? Perhaps the hon. Gentleman will ask the leader of his party whether he will dissociate himself from Jeff Duncan’s comments because, until now, he has been a big fan of his. To answer the hon. Gentleman’s question, I am entirely relaxed about an intelligent discussion on the powers of the Scottish Parliament. That is the purpose of the Calman commission, and I look forward to seeing its proposals.
I understand that the Front-Bench spokespersons have kindly agreed to give up a couple of minutes, thus allowing me to speak.
I did not originally intend to contribute to this debate, but I was moved by the contribution of the House’s favourite rock star, the hon. Member for Perth and North Perthshire (Pete Wishart), whom I congratulate on securing this debate. He said one thing that really struck home: that the commission does not have a democratic mandate. That is a misrepresentation that cannot be allowed to remain on the record unchallenged.
That is exactly what the hon. Gentleman said, and he can check it tomorrow morning. The commission has a democratic mandate. It has been endorsed by the Scottish Parliament, which is impressive and stands in stark contrast with the website offered by the Scottish Government. That is very important. That democratic mandate emphasises and reinforces the fact that the work of the Calman commission is in accord with the mainstream view, which is where the centre of gravity lies in Scottish public opinion. We want a Scottish Parliament and we can see that, after 10 years, the time has come to consider giving it extra powers. To my mind, that is a very important position. After eight years of the Scottish Parliament, it is time to look at giving it the power to raise more of its own budget.
I am sorry, Mrs. Dean. I think that you were quite right to castigate the hon. Member for Na h-Eileanan an Iar (Mr. MacNeil) in the way that you did.
As usual, of course, the SNP chooses not to be part of this process. That is nothing new. In the early 1990s, we had the Scottish Constitutional Convention. Mainstream Scottish civic opinion was concerned with that convention and engaged in debate, but where was the SNP? Its members did not want to know. They took their ball away and did not want to play. All we are seeing today—and on their website—is a repeat of history. They have nothing to offer and for that reason they do not want to be part of our commission. [Interruption.]
I congratulate the hon. Member for Perth and North Perthshire (Pete Wishart) on securing the debate. That is a heartfelt congratulation, not just a courtesy, because the debate is timely and interesting. It is certainly timely, coming the week after the appointment of Sir Kenneth Calman as chair of the constitutional commission, which is examining the powers of the Scottish Parliament.
There is widespread support throughout Scotland for the long-held position of Liberal Democrats that there should be more powers for the Scottish Parliament within the United Kingdom. We are therefore pleased to be working with the Labour and Conservative parties within the constitutional commission, and we are disappointed that the SNP has opted out of the commission, just as it opted out of the constitutional convention in the 1990s.
The present state of affairs, in which the Scottish Parliament’s sole financial responsibility is to receive a block grant for £30 billion from Westminster and then decide how to spend it, is not sustainable. That situation has meant that, since 1999, the debate in the Scottish Parliament has been about how to spend that block grant and not about how to raise money. I do not believe that that situation is healthy for our politics, and it has to change.
We need to modernise the relationship between Scotland and the rest of the United Kingdom through a new federal settlement for the whole of the UK, which delivers new powers for the Scottish Parliament through a written constitution for the UK. In the matter of finance, the Scottish Government should raise as much of their own budget as is practical, and there should be absolutely no question of powers being returned from the Scottish Parliament to Westminster. In fact, there should be a new written constitution for the UK, which entrenches the rights of Scotland and other nations and regions of the UK within a constitutional framework, rather then the present situation, in which the Scottish Parliament’s powers are determined simply by an Act of Parliament, as those powers could be removed simply by another Act of Parliament.
I will be as quick as I can. The hon. Gentleman said that there should be no return of powers to Westminster, but I think that I am correct in saying that the Liberal Democrats have said that, whatever the Calman commission proposes, we should support it. As far as I can see, they have abdicated responsibility; I believe that that is the position in Scotland.
I am afraid the hon. Gentleman is labouring under a misunderstanding. We have never given that commitment. We have our own views, and we will argue for them within the Calman commission. Furthermore, such is the strength of our views, we are confident that other parties within the commission will agree with them.
My understanding is that the hon. Gentleman supports the presence of Faslane in his constituency. Does he agree that, under the existing Act, it is possible that the powers resting with the minority Administration in Holyrood could frustrate or delay much-needed developments at Faslane? If that is the case, would it not be better if some of those powers came back to the centre, so that there could be better control of national security?
No, I disagree with the right hon. Gentleman. I believe in democracy and the decentralisation of power, just as I support the presence of the Navy at Faslane in my constituency. However, we must persuade the people of Scotland that that situation should continue, and I am confident that the people of Scotland will support the presence of the Navy at Faslane.
This all seems to be quite a bit of a shambles; hon. Members cannot agree among themselves about these sorts of issues. What we need to hear from the hon. Gentleman is an answer to this question: if the Labour party persists with the idea of taking powers back from Holyrood, at what point will the Liberal Democrats leave the commission and have nothing whatsoever to do with that particular objective?
Does my hon. Friend recall that, at the start of the constitutional convention process in the 1990s, we found ourselves in very similar territory, as a lot of senior people in the Labour party said that under no circumstances would they ever countenance a Scottish Parliament elected by proportional representation? Does he also recall that we argued the case for that Parliament within the Scottish constitutional convention, and eventually Labour produced a blueprint that included proportional representation in elections? Finally, does he recall that we did that on our own, because the SNP could not stand the heat of constructive engagement?
Yes, my hon. Friend is quite correct. I remember the process that the constitutional convention underwent. Initially, there were to be 112 seats, which would have meant that the Scottish Parliament would not be proportional. It was through our arguments that we persuaded the Labour party to add another 17 seats, which allowed the Parliament to be proportional.
If it had not been for the Liberal Democrats insisting on proportional representation, the result of the Scottish Parliament elections would be very unfair, and we would have a Labour Government with an overall majority despite the fact that Labour won less than a third of the votes. I hope that the hon. Gentleman is not arguing that we should go back to that situation.
The hon. Gentleman shows that he obviously does not believe in democracy. However, I must press on.
The Liberal Democrats set up the Steel commission three years ago to make recommendations on constitutional changes. Chaired by Lord Steel, it reported in March 2006, and I certainly suggest to all hon. Members that they read its recommendations, because it made excellent recommendations about how we should take the debate forward. The commission found that, compared with many Parliaments that operate in a federal system, the Scottish Parliament has considerable legislative power, but very limited control over taxation. That situation certainly has to change. We need a written constitution that sets out the limits of power of the various partners within the Union; sets out the powers that are the exclusive domain of the UK Parliament; introduces a new category of formal partnership working in specific areas; and confirms that all other areas are within the competence of the Scottish Parliament. In particular, tax-raising powers must be transferred to the Scottish Parliament, so that it raises the bulk of its own funds. I certainly look forward to the constitutional commission taking this debate forward and the Liberal Democrats, unlike the SNP, will enthusiastically participate in the coming debate on Scotland’s future within the United Kingdom.
I welcome you to the Chair, Mrs. Dean, and I congratulate the hon. Member for Perth and North Perthshire (Pete Wishart) on securing the debate. Having listened from the sidelines as a Member of Parliament who represents an English constituency, the debate has reminded me of what I have missed, having moved south. Now I know what the Conservatives missed while not on Renfrewshire council for all those years, in the days of Hugh Henry and the like.
The debate is a missed opportunity. It could have been about the opportunities and challenges facing Scotland, but instead it has pretty much followed the line of the SNP since it was elected in May 2007, which is all about gloating. The party’s justification for everything is, “We got more votes than you; we got rid of a few Liberal Democrat MSPs,” and that is about it. I went to the Scottish Parliament and saw First Minister’s questions last week, and that was the only answer that the First Minister, the right hon. Member for Banff and Buchan (Mr. Salmond), gave to any of the questions asked by the Opposition. He was saying, “Well, it doesn’t matter, because we are more popular at the moment.” However, we all know that popularity lasts only so long in grown-up politics. Real decisions have to come home to roost, and we have to stand by them.
We could have taken this opportunity to address UK issues that affect Scotland, such as defence. However, I am not surprised that the SNP did not want to address such issues, because it has no coherent defence policy whatsoever. I have a long memory and, as an ex-member of the Scots Guards, I follow closely pledges to save regiments, as well as marches through Dundee. The Black Watch is going to be saved by the SNP, but for what purpose, as the party has no defence policy whatsoever? The Scottish nationalists rushed to save RAF Leuchars and the base in Moray, but what are they going to fly in an independent Scotland? Who could forget Lieutenant-Colonel Crawford, the Scottish nationalist military adviser who said in a policy pamphlet for the SNP, in 1999, that we could replace Scotland’s nuclear deterrent with chemical and biological weapon stocks? We cannot forget that. I am not sure what he is doing now, but no doubt he will make a surprise return to the SNP fold at some stage.
Unsurprisingly, this debate is about peddling the myth that the SNP speaks for Scotland and that it is building momentum. It is vital that the party has momentum, because without it people will realise that smart Alec is just that and nothing else. The SNP is absolutely determined that this referendum—it is trying sneakily to divide us on the commission—is all about building momentum. However, the facts speak for themselves, and show that that is a myth: 17 per cent. of people who were eligible to vote in May 2007 voted for the SNP. That is hardly a ringing democratic endorsement of proposed independence. In every one of the past few polls, less than 30 per cent. of respondents wanted independence. Interestingly, 12 per cent. wanted to abolish the Scottish Parliament—a mere 5 per cent. less than the percentage of eligible voters who wanted independence. Let us not get carried away with the myth.
We have failed to elicit a reasonable or understandable response from the Labour party on whether it wants the Scottish Parliament to have more powers. Does the hon. Gentleman favour giving greater powers to the Scottish Parliament and greater independent control to the Government in Edinburgh?
I am a Scot and a Unionist, and I will do anything that helps Scotland to become more prosperous and more economically successful and to enjoy the security that the United Kingdom gives it. We can argue about Committees and the commission, but that is what I favour. If the ideas that come from the commission, whether from the Labour party, the Liberal Democrats or the Conservatives, make sense and help Scotland to do well, I will support them. However, my party and I will not support an outdated, destructive break-up of the United Kingdom for some pathetic doctrine that does nothing to help the country’s poorer people other than to give them a pipe dream.
Does the hon. Gentleman agree that the SNP consistently tries to pick fights with Westminster, and that fostering grievances is its speciality? Does he agree that today’s debate fulfils the predictions that an SNP Administration would mean years of constitutional wrangling instead of them getting on with ensuring that Scotland prospers?
I agree. The tragedy is that it is a two-part strategy. The first part is to upset the English and other members of the UK, and create a logjam so that people such as the entrepreneurs whom we saw in Scotland at the weekend say, “Let’s get this over with.” The second part is to say that the party will keep the momentum going because it speaks for Scotland. That is a wicked trick to play on the electorate and on the UK.
We could have had some answers on the referendum. We could have been told whom the Scottish nationalists define as Scottish citizens. Will Scots who live in England or abroad get a vote? What about the English who live in Edinburgh, and those in the financial sector—will they get a vote? We do not get any answers to those questions, because, as we know, even if they answer those questions and say that Scottish-born people or people who have Scottish parents will have a vote, more Scots are against independence.
There we are; there is the answer. The hundreds of thousands of Scots who live in England because their jobs have sent them there, and the soldiers who have been sent there, do not get a vote. That is exclusion, not inclusion—on the record. We know the game, and people will soon see that this is not about citizenship; it is about political manipulation.
My party and I are Unionist. I believe that we are stronger together than we would be if we were independent. I do not believe in every man for himself, and I believe that we share our security, our opportunities and our potential. However, the Scottish people might be given the alternative of destroying what we have built up over hundreds of years for some pipe dream that we could be better. I do not believe that many Scottish nationalist politicians go around trying to pretend that the Scots want to be independent because they dislike the English. Indeed, I do not think the Scots do so. However, my English and Welsh colleagues in the House could make that mistake if they thought that that was the case.
The SNP predominantly thinks that Scotland could be made better by destroying what we have, but I think that we could be better without destroying it. However, the Unionist parties in the House face some challenges from our colleagues. Our party has colleagues in all parts of the UK, because we are big enough to take differences of opinion, as opposed to the position of some former SNP members, who are now independents in Edinburgh. We accept dissension in our party. The real myth that we have to scotch is that the SNP speaks for Scotland, because it has never done so. Finally, none of the facts, including the SNP polls at the last election, opinion polls and the political make-up of the Scottish Parliament, shows that the SNP speaks for Scotland.
I trust that you have enjoyed the debate, Mrs. Dean. The nation that gave the world the enlightenment and the rebirth of intellectualism continues to pioneer the way in profound political thought.
I congratulate the hon. Member for Perth and North Perthshire (Pete Wishart) on securing the debate, and congratulate all hon. Members who have taken part either by giving a speech or by way of intervention. However, there is a profound irony at the heart of the debate. The hon. Gentleman broke the land speed record to get a debate in the House on the work of the Calman commission before it has even started work. The commission so far consists of one member—the chairman, Sir Kenneth Calman—as the other members have not been appointed yet. The commission has not drawn up a work schedule or taken evidence from anyone yet, but the hon. Gentleman has rushed here to have a debate about it.
At the same time, his party’s nationalist conversation, which has only one aim—to break up the United Kingdom—has not been within a country mile of the Scottish Parliament. Not only has it not been there, but the SNP brought out the national conversation in August, when the Parliament was in recess. Hon. Members on both sides of the House will recall that, for the past eight years, every time a sparrow died in Scotland in the summer, Nicola Sturgeon demanded a recall of Parliament so that it could be debated. Yet, here we have the most profound change imaginable to the governance of Scotland and the United Kingdom being debated without any recourse to the Scottish Parliament.
Why is that? The hon. Member for Perth and North Perthshire was given five chances during his speech to tell us when the national conversation was to be brought before the Scottish Parliament, but he failed on every occasion. Is it not ironic that a party that purports to want to give more and more powers to the Scottish Parliament does not trust it with the powers that it already has, or trust it to debate the national conversation? It would bring a finance motion to the Scottish Parliament to help to fund the party’s version of an independence constitution. What absolute cowardice his party has demonstrated. It will not trust the elected representatives of the people of Scotland to debate the national conversation.
In the three years that I have been a Minister, I have delivered more powers for the Scottish Parliament, enhanced the powers of Ministers and MSPs, and overseen the transfer of powers from this place to the Scottish Parliament, so I have no fear of what Sir Kenneth Calman and his commission bring forward. Unlike other hon. Members, I will not make any judgments in advance of it.
I am proud to support my party and this Government. We created the Scottish Parliament and ensured that it has the powers that it needs to address the big issues that face the people of Scotland. When we were devising that Parliament, where was the SNP? It was nowhere to be seen.
My hon. Friend the Minister is making an excellent speech. I served on the Cabinet sub-committee that drew up the Bill which subsequently became the Scotland Act 1998. It is fair to say that that sub-committee would have been astonished if, after 10 years, we did not feel confident about supporting the kind of commission that the Minister is commending to the House.
May I briefly refer the Minister to the point made by my hon. Friend the Member for Dumfries and Galloway (Mr. Brown)? I believe that the Cabinet sub-committee would also have been astounded if it had been told that the Treasury serving the United Kingdom Parliament had allocated £34 million for disabled children and their families, including vital national health services, with absolutely no idea where the money has gone.
My right hon. Friend is a great champion of the rights of disabled people and children, and he makes his point well. I would ally his point with the one made by my hon. Friend the Member for Ochil and South Perthshire (Gordon Banks). When Donald Dewar was First Minister, he had £14 billion to spend. Alex Salmond has £30 billion to spend, and the fact that he will not allocate £34 million to help disabled children speaks volumes about his party’s priorities. [Interruption.] The priorities are to spend money on a national conversation, to support a website that is a forum for every swivel-eyed, bigoted, anti-English lunatic in Scotland and beyond to spew forth hate-mongering and obscenities and to cast aspersions on the United Kingdom and its flag. It is a matter of profound shame that those are his party’s spending priorities. This Government’s spending priority is to ensure that money goes to disabled children and those who care for them.
Actually, I had in mind the people who write opinion columns in the Sunday Herald and Scotland on Sunday. In fact, the newspapers could save money on those who write those columns. They could send an office boy around to St. Andrews house to collect press releases rather than have Ian McWhirter write them.
Those are the people who I had in mind. One individual wrote a column in which he said that antisocial behaviour did not really exist, that it was something that Labour politicians invented in order to stigmatise young people. I said to that gentleman, “Come to Inverclyde any day. Don’t tell me when you are coming, just come. We will open a map together, and you can pick any street you want. We will go to it together and ask the people of Inverclyde whether antisocial behaviour is something that Labour politicians invented.” Those who are endlessly obsessed with the constitution, with balances of power and with grudge and grievance going back 300 years are not prepared to address the real concerns of the people of Scotland. That is why I have nothing to fear from a commission that will look at how the Scotland Act has worked.
So we are to have a yes-or-no referendum. That is interesting back-tracking, as my hon. Friend the Member for Falkirk (Mr. Joyce) said, on the position that applied this past weekend. I was looking forward to hearing about that position. One has to hand it to the Scottish National party: one thing it does really well is come up with slogans that rhyme. Who can forget “Scotland free by ‘93”, or “Scotland free by 2003”? Now we are to have “Scotland free by STV”—or single transferable vote.
To advance seriously a way of deciding the future of our nation that could result in its becoming independent through a first preference of 26 per cent. of voters is taking the Scottish people for granted. The arrogance that has been displayed by the present Administration for the past year was encapsulated magnificently in a half-hour speech by the hon. Member for Perth and North Perthshire. The arrogance that they have demonstrated shows that, in the end, they will be seen to be out of touch with the ordinary people of Scotland, whose concerns are different.
It has been 10 years since the Scotland Act was passed. We remember what things were like before the Act, when a handful of Ministers in Dover house took all the decisions that affected health, education and transport in Scotland. We remember that that was wrong, and we remember how hard we worked to change the situation, and to have democratic accountability so that decisions on the big day in, day out issues—health, transport, crime—could be taken by Scottish politicians in Scotland who are closer to the people who they represent.
That is why when Tony Blair came to office in 1997 the Labour Government put devolution at the heart of what they did: we now have a Parliament in Scotland, an Assembly in Wales, an Assembly in London with a directly elected Mayor, and an Assembly in Northern Ireland. We have put devolving power throughout the United Kingdom at the heart of what we do, because letting the people exercise power at a level that is closer to them is part of our core principles as a party.
Devolution was an enormous event. Those who say that it was not are missing the most astonishing change in more than 300 years in the way in which this country governs itself. Of course, it was an event, but it was an event that contained within it a process.
No, the hon. Gentleman can sit down. He made a hames of his one shot at intervening. He has just woken up to the fact that, since devolution, since 1999, there have been 165 Scotland Act orders, 14 of them transferring significant powers directly to Holyrood Ministers, and 34 of them changing UK laws as a result of Acts of the Scottish Parliament.
This Government created the Scottish Parliament and protected it. The SNP wants to destroy devolution because it is obsessed with a dogmatic proposition to break up the United Kingdom. We are proud Scots. We are proud of our country, our history, and what we have achieved. We are confident about the future. It is because we are proud Scots that we have confidence to stand with our friends and colleagues in England and Wales and remain part of a united kingdom. That is the will of the majority of the people in Scotland, and no amount of bluster from Alex Salmond or manufactured grievance and fights with Westminster will change that.
Small Pharmacies (Chelmsford)
I am delighted to have secured this debate on the important subject of applications determining whether businesses can establish pharmacies. I start by thanking the Minister, who over the past few weeks has been extremely helpful in meetings and conversations and in looking into the problems that I have raised with her. I am grateful for her attitude and the co-operation and help that she has given me.
There is a problem up and down the country. There is certainly a problem in my constituency, and I do not think that it is unique. Constituencies up and down the country have a first-class network of pharmacies. They are mostly small pharmacies and many of them are family-owned and family-run businesses that have blended well with the larger contemporary high-street pharmacies such as Boots. My constituents and others know the pharmacist in their local area. They are familiar with the business, and the people serving in the pharmacy know their customers and can give them personal advice and help, not only when they go there to have their prescriptions fulfilled but when they are buying other medication over the counter. A pharmacy is a vital part of a local community.
Until recently, if any business, be it large or small, wished to open another pharmacy in an area, the criteria that had to be considered before a decision was taken on an application included whether it was necessary and whether it was desirable. Unfortunately, the National Health Service (Pharmaceutical Services) Regulations 2005 changed that level playing field, regardless of whether a small or large operator was making the application.
Let me refer to regulation 13. For obvious reasons, this will apply mostly to larger operators—supermarkets, Boots and so on. Under regulation 13, provided that applicants fill in the application form 100 per cent. accurately and completely and provided that they promise to open for 100 hours a week, the primary care trusts have no power other than to approve the application, regardless of whether that is necessary or desirable. The hands of the PCTs are tied.
Ironically, when an application is submitted, there is a 45-day consultation process whereby members of the public and other interested parties can make their views on an application known. The downside is that the consultation process is utterly meaningless, because 100 per cent. of the responses could be against the granting of an application by, for example, a large supermarket, but the PCT would in no circumstances be able to refuse the application, provided that it met the criteria that the form had been accurately and completely filled in and the applicant was promising that the pharmacy would be open for 100 hours a week.
That is unfair. It creates an unfair, unlevel playing field for considering applications. I do not want to distort a market. One should not automatically say on every occasion that pharmacy services should be provided only by a small outlet. In certain circumstances, there is a role for supermarkets to provide pharmacy services, but let the decision-making process for the applications take place on a level playing field where everyone has to compete in the same conditions without the system being loaded in favour of the big operators, which, for a variety of reasons, can promise 100-hour opening.
The reason that I raise this issue is that there are two particular problems in my constituency. There is a problem involving the small family-run Waldman pharmacy in Chelmer village, next-door to Asda the supermarket—its front door is 50 ft away from the entrance to Asda. Ironically, Asda owns the property that the family run their business from and is their landlord. They have been providing the local Chelmer village community with pharmaceutical services for the past 25 years. They are well known and well liked in the local community, and they provide a first-class service. They know their customers and they can give advice as well as fulfilling the prescriptions presented to them.
In almost 21 years as a Member of Parliament, I have never had a single letter from anyone in my constituency complaining that they have not been able to obtain prescription drugs or non-prescription drugs in Chelmsford out of hours. That is because the pharmacies have a system in Chelmsford: they will be open on a Sunday and late in the evenings to meet the needs of the local population. No one has complained to me about the current situation, but Asda has made an application to open a pharmacy on its site, with 100 hours being promised. If that application is granted, it will almost certainly put out of business the family-run pharmacy next-door, for no other reason than that the application has been granted on an unlevel playing field and a small pharmacy cannot compete in the same way as a large supermarket. That is unfair.
If there were a series of complaints about the service that the pharmacy provided, it would be justifiable to say, “Let’s look at what’s going on and see whether there’s a way to improve the current system and the service being provided, or perhaps we will have to change the supplier,” but there never has been a complaint. People are happy with the service that they receive. For that reason, what is happening seems unfair.
It now emerges that, further round the northern arch of my constituency, in the town of Chelmsford, the Pharmacy, in Clematis Tye in Springfield, faces a threat from Sainsbury’s, which is located in that part of the town and is making its third application, under regulation 13, with a promise of 100 hours of pharmacy opening time. That small community pharmacy will be put out of business if the application is granted. Again, that is wrong. We are talking about ruining the livelihoods of individuals who are very dedicated and have worked extremely hard, in the public interest, to provide a first-class service that is welcomed by customers and the local community that they serve. They will be put out of business at a stroke simply because of the bulk-buying and market power of a large faceless supermarket.
In addition, the supermarkets will not be able to build up the same relationship with their customers, because of the sheer nature of their business. Their business is determined by turnover and getting customers in and out swiftly, while ensuring that they buy the maximum amount of goods. Why are they putting in a pharmacy service? I am not sure that their wanting to provide prescription and non-prescription drugs for their customers is totally altruistic—of course, supermarkets already provide a range of non-prescription drugs. The motive is to get more people into their premises so that when they come in to change their prescriptions they will almost certainly, on the law of averages, purchase foods and other goods, which will increase and enhance the supermarkets’ ability to make a larger profit. My argument is that such a change is not necessary and not in the interests of the local communities.
I also have one or two problems with what happens when the applications are granted. I understand that Penny Beck of Tesco recently came to the House to address an all-party group. She said that many supermarkets were putting in applications for pharmacies on the basis of the 100-hour rule because they felt that it was a dead cert that they would be successful if they completed the forms accurately. However, once the supermarkets are successful in their application, they then seek to reduce the commitment that they have given to open for 100 hours and try to change the terms and conditions to 80 hours or 60 hours. I can see one of the Minister’s officials looking rather sceptical. I do not want to cross swords with them because they are far more knowledgeable than I am. Perhaps I could give them some evidence of where this is happening to substantiate my case.
I understand that Sainsbury’s in Chafford Hundred in southern Essex has had a 100-hour application granted, and it has not delivered on those hours. It is not a question of seeking to get the terms changed; it has just not delivered the 100 hours even though the application was granted solely on that basis. Will the Minister tell me what action she, the Department of Health or the local PCT will take against those supermarkets or applicants that make an application on such a false pretence?
In south Essex, another pharmacy has been granted an application for a 100-hour pharmacy, but it is trying to reduce the conditions to 40 hours. If applications based on 100 hours are granted in good faith, and small pharmacies in the immediate area have been put out of business, it is a bit rich for the applicant to try to reduce the hours they have to open to 40, which is what the small pharmacies were already doing. We cannot then bring back the small pharmacies that have gone out of business. Will the Minister tell us what action can be taken against pharmacies that have been granted an application based on 100 hours but are not keeping to those hours, and how we can stop larger applicants, which have been granted an application solely on the commitment of 100 hours, from reducing their hours?
At some point in the not-too-distant future, the Government will publish a White Paper on pharmacy services. I have heard on the grapevine that the publication date is tomorrow. I do not know whether that is true, and I do not know whether the Minister is in a position to confirm it. However, when that White Paper is published, I hope that it contains some recommendations on the system of applications for running a pharmacy service. I assume, as is normal with many White Papers, that the Government will have a view about the direction that they want to take, but they may want a consultation process to hear other people’s ideas.
If the Government accept my argument that there is something inherently unfair with the existing system and agree to change it and redress the imbalance between the larger and smaller providers, would the Minister be prepared to suspend the 2005 rules until she has made the necessary changes? That would save a number of pharmacies—not least the two in my constituency. They might be caught up in a situation in which the Government were minded to make the system fairer but were unable to make the changes for some time because of other parliamentary business—unless the Government used secondary legislation. It would be tragic if the smaller pharmacies then went out of business knowing that help was on the way, but time was not in their favour.
For those reasons, I hope that the Government will accept that the situation is unfair, and that it is morally wrong to weight a system in such a way that it affects people’s livelihoods and businesses. I hope that the Minister will do something to help the smaller pharmacies that have played such a vital role within our local communities. In the majority of cases, they have provided a first-class service. Customers are, by and large, happy with the personal service that they receive and do not want it replaced by a highly impersonal service from a larger provider that, in other areas of the retail sector, is taking over more and more of our small shops and high streets.
May I congratulate the hon. Member for West Chelmsford (Mr. Burns) on securing this debate? I know that this is a matter that has caused him great concern and he has again highlighted the main issues that he seeks to bring to my attention and the attention of the House. I am also aware from the Department’s postbag that other hon. Members from other parts of the country share his concerns. I will briefly outline the current position and respond to the points that the hon. Gentleman has raised.
As I am sure that the hon. Gentleman will agree, pharmacies are businesses, and the Department of Health did not address the question of fairness of competition. To give some background, in 2003, a report from the Office of Fair Trading recommended total deregulation of the retail pharmacy services in the United Kingdom, with the abolition of the regulatory restrictions on NHS pharmacy applications, known as the controlled entry. The Government responded to that substantial report, which called for total deregulation, with a cautious move in the directions recommended, but announced a balanced package of reforms for England in July 2003. They recognised many of the points that the hon. Gentleman has raised and stopped quite a long way short of the original recommendations. The measures were largely introduced from April 2005. The hon. Gentleman has again asked me—as he has in private—whether I have the power to suspend the 2005 regulations. I have to tell him that a simple suspension is beyond my powers.
The reforms had a number of aims. They were designed to open up the NHS pharmacy market to greater contestability to improve patient choice and access to pharmacy-led services and to drive up the quality of the services in tandem with the new contractual framework for community pharmacy. The hon. Gentleman would accept all those principles.
The reforms included four specific exemptions to the controlled entry system, one of which was for pharmacies prepared to open for at least 100 hours a week. When introducing those reforms, the Department made it clear that pharmacies that benefited from those new regulatory freedoms would also have to meet obligations and safeguards. The hon. Gentleman touched on that point, and I want to answer him.
Pharmacies that commit themselves to opening more than 100 hours a week must stick to that commitment. They must also agree to provide the services that the PCTs require them to provide locally—for instance, helping people to stop smoking, or providing emergency hormonal contraception. We have also ensured that PCTs have the power to remove contractors from their pharmaceutical list that consistently fail to meet those terms with no good reason.
The hon. Gentleman asked me for information about those pharmacies that, in his view, do not stick to their commitment. They will be monitored by the PCT, which will require regular returns on opening hours, monitor complaints and take action under the regulations to impose further conditions. Ultimately, notice of removal to a contractor can be given; if default occurs, it can be removed from the list.
The hon. Gentleman also asked whether companies that committed themselves to 100 hours were automatically given agreement. It is not automatic; in the two years since March 2007 about one fifth of applications for 100-hour pharmacies have been refused by the PCT or withdrawn. I know that the hon. Gentleman’s PCT will be considering the application that concerns him at its May meeting. He may want to make further representations on the issue. The PCTs have the necessary powers.
The Minister said that PCTs have the powers necessary to refuse an application. I have had meetings with the Mid Essex PCT, and I am assured that if the form is completed 100 per cent. correctly and a commitment given to opening for 100 hours, its hands are tied. On what other grounds can it refuse an application?
It is difficult for me to deal with that specific application, as I have not seen the details. However, I am happy to go back further with my officials to find out; we have that option before May. I make two points. First, there is the power to refuse applications. Secondly, there is the power to monitor for a failure to deliver; if necessary, that can result in the removal of the agreed contract.
On the second point, the removal of the contract would be too late. If the application was granted and the small pharmacy went out of business, it would no longer be in business. On the first point, I would be extremely grateful if the Minister were to let me know as soon as possible on what grounds Mid Essex PCT might be able to refuse an application. I would be pleased to pass on that information.
I undertake to get that information to the hon. Gentleman.
I know that the hon. Gentleman is committed to patient choice, so I remind him that the Department undertook a complete review, which was published in January 2007. It specifically considered patient choice. With respect, I say gently to the hon. Gentleman that, if the pharmacy of the patient’s choice was providing all the services, the patient could continue to use it regardless of whether a 100-hour service was provided nearby. That is certainly my personal practice when using a pharmacy; I use the local community pharmacy in return for services that I value.
There was no evidence of a detrimental impact on access to pharmaceutical services. I remind the hon. Gentleman that we are talking about what is legitimate for businesses in competition. None the less, the service is valuable and it is important to take matters forward. The review of the 100-hour pharmacy contract showed that through their extended opening hours they can and do make an important contribution to expanding access to NHS services. They are certainly popular with patients, as is the community pharmacy.
The national data produced by the NHS information centre show that pharmacies exempt from the control of entry requirements provide proportionately more locally commissioned services, such as the minor ailment schemes, nicotine replacement therapy and emergency hormonal contraception, than existing pharmacies. I agree with the hon. Gentleman’s focus on those issues with regard to pharmacies that are already flourishing, but such pharmacies should not need to worry.
However, our report also drew attention to some drawbacks. The impact of the reforms was found to be uneven, with pockets of greatest activity in certain parts of the country. The NHS found the new system difficult to administer, and exempt applications sometimes hampered their efforts to plan strategically and to commission more clinical services. As the hon. Gentleman eloquently said, business reaction was mixed, with many being concerned about the operation of the exemptions and the 100-hour provision alongside community pharmacies.
I said earlier and in previous weeks that the application that the hon. Gentleman raises today is to be decided by the PCT’s pharmaceutical services committee at its May meeting. If the application were to be approved—it can be approved only if the PCT thinks that the specified services will be provided—there will be up to nine months before the pharmacy opens and the monitoring process starts.
I assure the hon. Gentleman that we are continuing to keep the provision under scrutiny. It is popular, and it can increase access to services both generally and out of hours. Despite his eloquent arguments, there is insufficient evidence to support the withdrawal or amendment of the exemption. However, I have listened closely to what he had to say. Although I cannot tell him what is in the White Paper—it will be published tomorrow—I can say that the strength of feeling that he expressed today will be noted. The White Paper will touch on some of those issues, and the debate about the benefits and the drawbacks will continue, so that we can find a sensible solution. I hope, in time, to deal with the issues raised by the hon. Gentleman in relation to his local pharmacy.
Mr. Michael Burke
It is a pleasure to speak under your chairmanship, Mrs. Dean. I wish to present the case that my constituent Michael Burke and his family have been making since December about problems with his trial and imprisonment in Italy.
Michael Burke, a Manchester United supporter, travelled to Italy to watch his team play Roma in the champions league on 12 December 2007. On that day, violent clashes involving fans and the Italian police occurred before the game. Mr. Burke and three other men—Kyle Dillon, Nicholas Lukacs and Richard Wimmer—were arrested by the Italian police. After an abbreviated trial and court hearing, the four men were convicted of resisting arrest and assault, and all were handed custodial sentences. Michael Burke was sentenced to two years and four months in prison. Appeal on his conviction and those of the other three men will be heard on 2 May.
My hon. Friend the Minister will recall that I contacted him about the case on 24 December. He was helpful in obtaining some comment about the case from consular staff in Rome, but some of the information that he received appears not to match the statements made by my constituent and other men since then. At the time, there was a feeling in the UK that the violence in Rome should be condemned. English fans travelling abroad have earned a poor reputation over the years, and what happened with some Manchester United fans last December seemed to underline that.
It was initially reported in the media that the Italian police officers who arrested the four were helped by spotters from the Greater Manchester police who identified the men as known troublemakers. That was not the case. I have it in writing from the late chief constable of Greater Manchester police, Michael Todd, that no GMP officers were involved in the arrest. The Greater Manchester police also confirmed that they have not provided any evidence to the Italian legal system, and that the Italian authorities never requested any. Michael Burke has said in a statement that he was actually at the receiving end of a violent attack rather than having caused one. It seems clear that Michael Burke and the other fans were in the wrong place at the wrong time.
I turn to my concerns about legal representation and the trial of Mr. Burke. The right to a competent interpreter for anyone who does not understand the language of the court is considered a fundamental rule of justice, and one of my chief concerns about the trial is that Mr. Burke was not offered effective or competent interpreting or translation services. That also affected the quality of legal assistance. The court-allocated lawyer did not speak English, and Mr. Burke and the other fans do not speak or understand Italian. Mr. Burke and the other men met the court-appointed lawyer in the holding cell immediately before their first hearing, and no interpreter was present. Mr. Burke has commented that he had no idea what was happening or what he was being charged with.
My hon. Friend is making a strong case on behalf of her constituent and of mine, Nicholas Lukacs. I apologise that I will not be able to stay for the full debate. Will she raise with the Minister the conditions in which the four men were held in prison, particularly during the first two weeks after the events that she has described? They were denied access to towels, toiletries and a change of clothes. They were confined for 23 hours at a time without breaks and at no time during those two weeks were they given access in English to the information that she mentioned.
Indeed I will. I thank my hon. Friend for making that point. I shall return to it later, although I know that he will not be able to be here.
Article 6 of the European convention on human rights states:
“Everyone charged with a criminal offence has the following minimum rights:
(a) to be informed promptly, in a language which he or she understands and in detail, of the nature and cause of the accusation against him…(c) to defend himself in person or through legal assistance of his own choosing…(e) to have the free assistance of an interpreter if he cannot understand or speak the language used in court.”
Language translation and a court interpreter are clearly of the utmost importance to British citizens arrested abroad.
Further difficulties in the case relate to differences in the legal systems. The Italian legal system is inquisitorial and allows for abbreviated trials, which are unfamiliar to those here in the UK. My constituent and the other defendants accepted an abbreviated trial without understanding the consequences. Mr. Burke has written since then that the men were told only that an abbreviated trial represented their best chance of being released and that, if they agreed to one, they would be home quickly. Given that it happened only a few days before Christmas, it was understandable that they accepted. Indeed, they do not appear to have been given another option. My constituent has learned since then that agreeing to an abbreviated trial implies a guilty plea, but he has never admitted guilt and says that he would not do so. I feel that he accepted an abbreviated trial only because its implications were not properly explained to him.
My constituent and the other three men were first given access to an interpreter only when they entered the court for their first hearing. Mr. Burke has written that the interpreter did not communicate any of the exchanges between the judge and the prosecution. In fact, when Mr. Burke asked to be told what was happening, the interpreter told him to be quiet. Mr. Burke has also written that he had no confidence that his statement was represented fairly in court, and that the interpreter spoke in quite broken English that he and the other men found difficult to understand.
Before the trial, Mr. Burke and his fellow defendants requested a more competent interpreter. Their lawyer apparently agreed to it, yet when they returned to court for the trial hearing, the original interpreter was again present. My constituent says that they again asked the interpreter to explain what was happening in court and that the interpreter again refused to interpret the proceedings, saying, “I’m not here to tell you about the trial, only to tell you whether you’re going to prison or not.” In fact, the next time the interpreter spoke to them was to tell Mr. Burke and Mr. Lukacs that they had been sentenced to more than two years in prison.
The trial process appears to contravene article 6 of the European convention on human rights. How can my constituent have received a fair trial if he did not understand a word of what was being said and if his interpreter refused to interpret the court proceedings for him? Case law of the European convention on human rights makes it clear that the obligation towards the defendant also extends to ensuring that he has translations of all the relevant documents in the proceedings in order for the trial to be fair within the meaning of article 6.
In March 2003, Stephen Jakobi, a lawyer and the founder and former director of Fair Trials Abroad, told the European Scrutiny Committee:
“I am hoping that resources will be found in Europe to have an efficient, European level justice system that works. We have not got one in the European Court of Human Rights, I am afraid.”
Referring to a landmark judgment in Kamasinski v. Austria 1989, which is seen to have set the standard for court interpretation, Stephen Jakobi said that
“about three countries actually made the effort to get the standard of interpretation and translation right, including, I am glad to say, the United Kingdom. As for the rest, nobody is anywhere near it. It is no good having a court of last resort that supposedly is setting standards for the whole of Europe if nobody listens to it.”
A duty is placed on the court to provide defendants with effective interpretation and translation, but Fair Trials Abroad feels that that duty is not being taken seriously in much of the EU.
Of the first hearing, Michael Burke writes:
“The interpreter asked me to tell the court my account of what happened. I did this. It took me about five minutes or so. The interpreter then translated this in about 30 seconds.”
Even allowing for differences in language and speed of delivery, it seems unlikely that the interpreter provided the court with an accurate interpretation of Mr. Burke’s words. Summarising Mr. Burke’s statement to that extent must have resulted in the court hearing only a truncated version of what he said.
The European convention on human rights also states that the accused has the right to full knowledge of the charges against him. As I have mentioned, my constituent writes that he did not know the charges against him until after the first court hearing. By that time, Mr. Burke had made a statement to the court about what happened without knowing the charges against which he was defending himself. Also, the four men did not meet their court-appointed lawyer until minutes before the first hearing, and the lawyer was unable to offer them competent legal assistance because of the language barrier. I understand that Mr. Dillon requested that the four men have the use of a private lawyer, but the request was refused, so the men were represented by a lawyer who did not provide them with sufficient information to understand that accepting the abbreviated form of trial meant effectively pleading guilty.
Although the solution to the problems lies in the Italian justice system, I hope that my hon. Friend the Minister will take any steps that he can to ensure that my constituent and the other men receive a fair hearing when their appeal comes to court on 2 May. We need to think about the problems created for the families of Michael Burke and the other fans arrested who will be missing their loved ones and suffering financially: the appeal lawyer is costing the families many thousands of pounds each; each visit to Italy costs many hundreds of pounds in flights and accommodation; and the four men are not, of course, working or earning. Together, that causes great distress and worry to the families.
I would like to thank my hon. Friend the Minister for his involvement in the case and for keeping in touch with me over it. To some extent, consular visits have helped to ensure that my constituent’s welfare is adequate, although it is worth returning to the comments of my hon. Friend the Member for High Peak (Tom Levitt) about the fact that standards in Italian prisons are nothing like even those that people complain about in this country. Food, exercise and finding things to do are all issues. Straight after the trial and conviction, the four fans were together in one prison, but disturbingly they have now been dispersed across different prisons, some quite a distance from Rome, which again makes travelling for the families very difficult. Given that none of those fans speaks Italian, they are now stuck with nobody to talk to, which is a very difficult situation to be in. Standards in those prisons fall short of what we would expect to find in prisons in the UK. Michael Burke and the other three men are to be in Italian prisons for up to two and half years, because they got caught up in violence not of their own making.
I ask the Minister whether he can take his involvement in the case further and make important interventions before the appeal on 2 May. Will he write to the Italian authorities urging them to provide my constituent and the other defendants with translations of court documents and an effective court interpreter? They did not have those during their first case, but given everything that I have said today, there is no reason why they should not have them at their appeal hearing.
Mr. Burke’s partner has booked flights and accommodation to visit him on 1 May—the day before the appeal hearing—but the families have just been told that 1 May is a public national holiday in Italy and that, as a consequence, prisons are closed to visitors. It is a pity that they have made all their arrangements already, because clearly it is key for the families to visit before this vital appeal and it is, of course, very difficult to change those arrangements. Will the Minister urge the prison to allow Mr. Burke’s partner to visit? I should add that, when I ask him to make the case for Mr. Burke, I mean him to include the constituents of other hon. Members, including of my hon. Friend the Member for High Peak.
More broadly, will the Minister look into this case as a matter of urgency to see whether anything else can be done to ensure that my constituent and the other three British citizens get a fair hearing, particularly at the appeal? If the appeal fails—none of us wants to think that way, or hopes that we will need this solution—can anything be done to allow my constituent and the other fans to be repatriated to the UK, so that they can be closer to their families? That would at least release them from some of the financial distress being experienced from travelling to Italy. We understand that that is done from time to time, but that very often there is a delay of something approaching 12 to 18 months. We realise that that could not be considered until after the appeal. However, it could be considered then—but not if it will take 12 to 18 months and involve all that financial distress.
I am delighted to have the opportunity to respond to this debate under your chairmanship, Mrs. Dean, and to say that I am pleased that my hon. Friend the Member for Worsley (Barbara Keeley) was successful in securing this debate on such an important subject. Right from the beginning, she has taken a tenacious and personal interest in this matter. She wrote to the Foreign Secretary the very day that her constituent visited her to explain Mr. Burke’s predicament. She has also contacted me personally on numerous occasions, here in the House, and on Christmas eve, when I was pleased to have the opportunity to talk to her and to put additional energy into the process.
My hon. Friend raised a wider point about the right of British, and all citizens, following football teams across the European Union, to do so safely, although that can never be guaranteed, and with the full protection of domestic law, and of European law as a residual protection. As somebody who has travelled as a football supporter—not a Minister—of Glasgow Celtic, I know that that is a live conversation among the many thousands of supporters who increasingly travel across the continent to support their football team. That includes the four gentlemen who are the subject of this debate.
I shall respond to some of the points raised by my hon. Friend who secured this debate and by my hon. Friend the Member for High Peak (Tom Levitt), who made particular reference to Mr. Lukacs. She raised a number of important issues and shared with the Chamber some details about the timeline of the case. As Minister, however, it is incumbent on me to put on public record those specifics, particularly in relation to Mr. Burke’s case. As she said, Mr. Burke was arrested prior to the Roma versus Manchester United match in Rome on 12 December 2007 and subsequently charged with assault and resisting arrest, along with three other Manchester United followers. Consular staff present at the match made contact with Mr. Burke to check on his welfare. He asked that we did not notify anyone of his arrest, but subsequently asked that we contact his partner in the UK, Ms Carmon Ducker, which we did on 14 December.
As my hon. Friend alluded to, on 14 December, Mr. Burke appeared before the magistrate and at that hearing his court-appointed lawyer, avvocato Lupino, requested that the hearing be adjourned to allow more time to prepare for the case. The magistrate rescheduled the hearing for 21 December and in the meantime remanded Mr. Burke at Regina Coeli prison. During this time, consular staff provided Mr. Burke with our prisoner’s information pack, which included details of English-speaking private lawyers in the Rome area, should Mr. Burke not wish to be represented by the court-appointed lawyer.
My hon. Friends both raised wider points about the welfare of all the gentlemen, but particularly about that of Mr. Burke and Mr. Lukacs, during that first period. During those first days, the men raised a number of concerns identified by my hon. Friends, such as the lack of toiletries and reading material, the cold and some medical concerns. My understanding is that British authorities provided toiletries and reading materials to all four and a warm jumper to the one who only had a T-shirt. We raised the medical concerns with the Italian prison authorities, as is standard practice in such cases. If hon. Members representing any of the men in question have further welfare concerns, on top of the residual and continuing ones before the appeal, I invite them to bring them to my atte