Tuesday 20 May 2008
[Mr. Peter Atkinson in the Chair]
Motion made, and Question proposed, That the sitting be now adjourned.—[Liz Blackman.]
It is a great pleasure to serve under your chairmanship, Mr. Atkinson. I am most grateful to Mr. Speaker for giving me the opportunity to call this debate. As I shall be entering territory that is highly charged with controversy and emotion, it might be helpful if I begin by saying where I come from. I do not have and never have had any personal, family or business connections with the state of Israel, any Palestinian community or institution, or any Arab country. It is meaningless to call any individual human being objective—that would be a misuse of the language—but it is fair to say that I come from as neutral a background as can readily be conceived.
I have visited Israel three times: once in my 20s, privately; once at the invitation of the Conservative Friends of Israel—I hope that they do not regret their kind hospitality to me on that occasion; and once as a member of the International Development Committee. I have also visited on one occasion each of Israel’s Arab neighbours—in fact, I have been to Egypt three times. That is my background.
I had originally asked for a debate to commemorate the 60th anniversary of the foundation of the state of Israel, but I gather that, for technical reasons, it is not possible to make that the subject of a debate. The foundation of the state of Israel, which took place 60 years ago last week, was an event of extraordinary consequence in the middle east. It took place in extremely dramatic and, indeed, desperate circumstances. I remind the House that in May 1948, there had been open warfare between Jewish and Arab-Palestinian communities in Palestine for a long time. The mandate was about to end: the British were withdrawing to the last ports and would leave for the last time the next day or the day after. The very next day, on 15 May 1948, all four of Israel’s Arab neighbours—Lebanon, Syria, the Hashemite Kingdom of Jordan and Egypt—together with Iraq invaded Israel. Few people gave Israel any great chance of surviving.
Israel did survive, of course. It won that war and three subsequent wars with its Arab neighbours. Today, it is a remarkably successful country with an extremely high standard of living. Its per capita income is the highest in the middle east, except for the oil and gas-rich countries of the Gulf, and actually it is not so far removed from them as one might imagine. I checked the figures last night: the latest World Bank figures show that Israel has a per capita income of $18,000 a year, and Saudi Arabia, with all its oil, has a per capita income of only $23,000 a year. That is the measure of Israel’s economic achievement.
Israel is a stable democracy and the only country in the region that can be described as such. It is famed for its universities and its scientific and entrepreneurial achievements. I believe that it is the third country in the world in terms of the rate of business creation per head of population, and the first for the rate of business creation by women and those aged over 55.
I am well aware that many people in this country and in the world are willing to pay tribute to the achievements of Israel but will then immediately say there is a dark side—that all those achievements have been made at the expense of the Palestinian people whose land has been seized and whose heritage has been robbed by alien immigrants and occupiers. It is because that view is so widespread that I want to address it explicitly this morning.
Three things must be said in response to that view. First, Palestine has never had a homogeneous population: there have always been some Jewish communities there. Some Jews remained after 70 AD, when Vespasian put down the Jewish revolt, dispersed the population and destroyed the temple except for the famous western wall. Some Jewish communities remained through the rest of the Roman-Byzantine period, through the Arab invasions in the 7th century, through the arrival of the Seljuks, through the period of the Christian kingdoms—the Crusader kingdoms of the 12th and 13th centuries—and through the arrival of the Ottomans in the early 16th century. Indeed, in the later Ottoman period there was increasing immigration of Jews into Israel, notably from eastern Europe.
As a result, by the time that political Zionism and any sort of co-ordinated immigration into Israel began—I date that as roughly from 1896, the publication date of Theodor Herzl’s famous book on the Jewish state, “Der Judenstaat”, or 1897, the time of the first Zionist Congress—the majority of the population of Jerusalem was Jewish. There were 25,000 Jews living in Jerusalem, as against 14,000 Arabs. Anybody who says that the Jews should never have been there, that they were taking down the Palestinians, must start off by saying when the Jews should have ceased to be there, or from what point they should not have been allowed to arrive.
The second thing that needs to be said is that there was absolutely no expropriation or involuntary expulsion of Arab communities by Jews whatsoever during the Ottoman and mandate periods. The mandate authority would occasionally requisition land for the purposes of building public infrastructure, but it never expelled Arabs to give land to the Jews. There was, of course, an enormous expansion of the Jewish population from roughly 90,000 to 600,000 between the beginning of the mandate in 1920 and 1948. Those people were largely refugees from Nazi Europe, but they installed themselves on unclaimed land, or on land that had been purchased perfectly legally at market prices from the local inhabitants or proprietors.
Indeed, some of the land that was bought resulted in people doubting the good sense of the Jewish purchasers. When Menachim Ussishkin, for example, bought 40 square kilometres of the Jervaal valley in 1920 on behalf of the Jewish National Fund, it was simply a malarial swamp. He was much criticised, including by the next Zionist Congress, for having extravagantly wasted money. The Jervaal valley is now the centre of one of the most fertile and productive agricultural areas in the whole of the middle east, but one can hardly say that its value was created at the expense of the Palestinian people.
Many Members will know Tel Aviv—a booming and, indeed, swinging city. Its mixture of entrepreneurialism and hedonism reminds me of Los Angeles, and it has the same climate as that city. One hundred years ago, Tel Aviv did not exist—it was not even a small settlement, which Los Angeles was 200 years ago. It was nothing at all, just sand dunes and a beach—the beach is still there, by the way. No one can fairly say that Tel Aviv’s enormous value was created at the expense of the Palestinian people or stolen from them.
My third point is that a determinant of the very sad history of the middle east during the past 70 or 80 years—a history with which we are all familiar—was a decision taken by the Palestinian leadership right from the beginning of the mandate. In my view, that decision was taken at the expense of individual Palestinians. I do not wish to criticise the members of that leadership, which was dominated and personified by Haj Amin al-Husseini, known to history as the Grand Mufti of Jerusalem, but the policy that they adopted was one of violent opposition to Jewish communities in Palestine. Undoubtedly, the violence came from one side—the Palestinian side.
Some people say that the Zionist project was an exclusive project and that, ultimately, the Palestinians had no choice. In all fairness, that thesis, if it was a thesis at the time, was never put to the test, because the Zionist leaders of the day—Chaim Weissman, David Ben-Gurion and so on—made it absolutely clear on every possible occasion that they wanted to deal peacefully with the Arabs, to respect their rights and to have good, harmonious relationships with them. They were never allowed to do so. The violence began right at the beginning of the mandate, with the Arab riots in 1920; they were followed by Arab riots in 1921 and in 1929, when 133 Jews were killed. It was in response to these riots that the Jewish community set up the Haganah—the origin of the Jewish defence forces—because the mandate authorities were incapable of defending Jewish communities through the length and breadth of the mandated territory of Palestine. It is hard to blame the Jews for that.
There is no question that in 1948 there were expulsions of Arabs from areas of Palestine. Most of the Arabs who left their homes in 1948 did so of their own accord— sensibly and understandably, they wanted to get out of a war zone. Some of them may have left because Arab leaders told them to do so. A number of them may have left because of the fear engendered by the appalling atrocity perpetrated by Jewish terrorist organisations—the Stern gang and the Irgun—at Deir Yassin, where more than 200 Arabs were killed. Although Arabs may have left for other reasons, some undoubtedly left because individual Israeli units expelled them from villages that they were occupying. There is no doubt about that at all. However, people cannot read back into history from the expulsions in 1948 and say that that justified the violence of the 1920s and 1930s, because there had been no expulsions and no expropriations at that point: that is the key historical fact. The war, the fighting and the expulsions of 1948 were the consequence of a series of violent episodes that, unfortunately, were started by the Arab riots of 1920.
If the Arab leaders—the Grand Mufti and his colleagues—rejected any kind of negotiation or deal with the Jewish community, or any kind of integration, they also rejected partition when it was first proposed in the Peel report in 1936 and, with much more devastating consequences for the Palestinian people, when the United Nations decided that that was the solution in the 1947 resolution. That had enormous consequences. It can be proved mathematically what a bad decision that was for the Palestinian people, simply by calculating the surface of the territory that UN partition resolution—which was accepted by the Jews but rejected by the Arabs—would have accorded to the Palestinian Arabs and comparing that with the frontiers that were demarcated by the ceasefire lines of 1949. I am sorry to say that, at that stage in their history, the Palestinians chose the path of violence and lost. That is a sad fact for them. There is no doubt that, as a result, for 60 years the Palestinian people have had a miserable history, but I am not sure that it is possible simply to say that it is all the fault of Israel or of the precursor Jewish communities in Palestine.
From 1948 to 1967, the Palestinian leadership adopted a policy of non-recognition, which we would call, using the modern phrase, being in denial—pretending that Israel did not exist and rejecting the idea of negotiation, including direct negotiation, or a final settlement. What happened in 1967? I read the other day in The Guardian that Israel conquered the west bank. With due respect to The Guardian, that was an extraordinarily disingenuous use of language. I have seen that word used before. “Conquered” implies Julius Caesar conquering Gaul or William the Conqueror conquering England or the British conquering Zululand or Ashantiland: it implies a prior decision to go out and swipe somebody else’s territory and therefore to plan an invasion with the effect of doing so. Nothing could have been further from the truth in 1967. In fact, in 1967, Israel went out of its way to make desperate efforts to persuade King Hussein not to attack it in the rear while it was involved in the war in the west that had been provoked by President Nasser. But King Hussein of Jordan found that he was under such pressure—blackmail, really—from Nasser and the Palestinian leader at the time, Ahmad Al-Shukairy, that the future of his own kingdom would be threatened if he did not join in the war and attack Israel. So he attacked Israel in that war and, as we all know, he was defeated, the Arab Legion retreated and the Israelis found themselves on the banks of the Jordan river. Again, it is difficult to blame the Israelis for that. Once they were there, what were they to do?
Once again, and for 25 further years, the Palestinian leadership refused to deal with Israel, refused any kind of settlement and decided instead, first, under Ahmad Al-Shukairy and then under his successor, Yasser Arafat, to invest in international terrorism—those were the terrible days of the Achille Lauro and the murder of the Israeli athletes and so forth—as if that were going to solve the problems of the Palestinian people. So the Palestinian people were condemned, for another 25 years, to a continuation of the purgatory of statelessness, the lack of any sense of future and the inability to enjoy any kind of compensation, as they should have had and, I hope, still will have. All of those who left in 1948 should have had compensation a long time ago for the land that they left behind. That is a sad story.
The story has become slightly happier in the past 15 years. Right hon. and hon. Members will be familiar with the events of the past 15 years: the famous Rabin-Arafat meeting at the White House in 1993, and the Oslo I and Oslo II meetings in 1995, which were followed rapidly thereafter by the murder of Rabin by a Jewish fanatic who accused him of giving away Israeli land. Those deals and agreements—Oslo I and Oslo II—were, of course, interim arrangements that involved the extension of successive slices of Palestinian territory to be administered by a Palestinian authority: they were not a final settlement and did not represent a two-state solution.
The big imaginative leap forward came with Ehud Barak’s Government’s proposal in 2000 at the Camp David conference, which would have involved transferring to Palestine 98 per cent. of the territories, including the Haram al-Sharif in Jerusalem. As we know, the then Palestinian leader declined that offer and declined even to negotiate on it, to the consternation of President Clinton and the other Americans present. That was an extraordinary decision: it was a decision to invest in violence, as we found, rather than invest in peace. We now know that Yasser Arafat was planning the second intifada all along, which, as we recall all too well, involved the obscenity of suicide bombing, sometimes involving impressionable adolescents and people with mental illnesses. For a third time, the Palestinian leadership decided, when given the choice, to go down the route of violence and, again, that did not work. Fortunately, largely as a result of the construction of the security fence or wall in the west bank, that campaign of violence did not succeed.
There have been peoples who have had worse leaders than the Palestinian leadership—the Russians had Stalin and the Germans had Hitler—but throughout human history I cannot think of any people who have been cursed with three leaders of the quality of the Grand Mufti, Haj Amin al-Husseini, the friend of Hitler, Ahmad Al-Shukairy and Yasser Arafat, who is now dead and is generally despised by Palestinian militants of all hues because of the massive evidence of corruption that has emerged since his death.
In many ways, the story of the Palestinian people is a sad one and there is no doubt that they are the victims, but they are not the victims of any wicked Zionist conspiracy to uproot them and remove them from their land. I am sure that all hon. Members in this Chamber, and all those who wish the Palestinian and Israeli people well, are united in hoping that we shall see in our time in politics a genuine long-term settlement and a genuine two-state solution. We hope that Mahmoud Abbas is the Barak or the Rabin of Palestine—the man who is prepared to invest in peace and take the risks of peace, rather than invest in war and take the risks associated with that. We hope that he may be in a position to speak for Gaza and deliver it as well as the west bank, although I cannot see how that can be achieved in the immediately foreseeable future. Some other leader might have to do that.
We can all see the way forward and we are all aware of the need to recognise the claims of and to compensate the 1948 refugees. We all recognise the need to deal with the Haram el-Sharif and the holy sites of Jerusalem. We all recognise the need to deal with the fact that, as a result of the events that I have described, 400,000 Israelis are living in areas beyond the 1948 boundaries. There is no great mystery about the task ahead of us, and we all hope and pray that, well before its 70th anniversary, Israel will be able to add to its list of magnificent achievements the conclusion of a final peace settlement with its neighbours.
I congratulate the state of Israel on reaching her 60th birthday, and I salute her remarkable achievements. Israel has achieved a remarkable amount, and I want to talk about some of her achievements, particularly in science and technology. I shall be as brief as I can because I am conscious that other hon. Members wish to speak.
Israel is a country that is low in natural resources, and to succeed she has had to depend on the inventiveness of her people. Indeed, her people are her greatest asset. Israel has done well not because she has vast mineral wealth, oil or huge natural resources, but because her people are enterprising, extremely innovative and able to apply high technology. Israel has attracted enormous foreign investment in new high-tech companies, and ranks second only to the United States in her research and development achievements in recent years.
Israel has more companies listed on American exchanges than any other foreign country bar Canada. Her high-tech products have found their way into most homes and offices throughout the world. Israeli inventions and high-technology have found their way into computers, telephones, cars and satellite television stations. Israel is no longer—if she ever was—merely a land of citrus groves and kibbutzim. She is a major global player in high-tech R and D. A vast number of the world’s multi national giants and companies seek to participate and to have a presence in Israel. It is a remarkable achievement that both Microsoft and Cisco Systems developed their first R and D facilities outside the US in Israel. In addition, companies such as IBM, Motorola, Unilever, Sony and Hewlett Packard all have a major presence in Israel. Major financial houses and venture capital companies also have a big presence in Israel, including Morgan Stanley, Goldman Sachs and Merrill Lynch. Israel’s astonishing success at integrating into the global market has been facilitated by an enormous number of free trade agreements with the US, Europe and other countries, including Canada, Mexico and so on. In fact, Israel’s approach to free trade is one that we in this country could learn from.
I shall draw my remarks to a conclusion by saying that I hope that the Government will continue to do all that they can to forge close economic ties with Israel. We can learn an enormous amount from Israel, and it is important that we do all that we can to try to help Israel to prosper and to benefit from close economic ties.
On Israel’s 60th anniversary, she has an enormous amount that she should be proud of. Few countries in the world can claim to have matched her ability to generate high-tech ideas, to translate those ideas into reality, and successfully to integrate them into the global marketplace for all of us to benefit from. Happy birthday, Israel.
I congratulate my hon. Friend the Member for Grantham and Stamford (Mr. Davies) on securing this debate. He referred to some of his visits to the region, and I was with him on his last visit with the Select Committee on International Development.
Just over two weeks ago, I visited Auschwitz with the Holocaust Educational Trust. For anyone who goes there, it is a chilling experience to see where 1.5 million people were clinically and brutally murdered. That left me with two salutary reminders of things I already knew. The first is the obvious one: the message that we must never, ever let anything like that happen again. The second is that the experience of the holocaust is ingrained in the collective memory of every Jew in this country and throughout the world, and a large proportion of the population of the state of Israel. It is there as Israel marks its 60th anniversary.
I am not suggesting that the Zionist dream of Israel came from the holocaust, because it did not. My hon. Friend talked about some of Israel’s history and criticised some of the selective versions of history from the other side—one could say that there was some selectivity in his description too, but I will not go into that. I simply want to say that if the search for peace in the middle east today is to be successful, we all need to understand the sense of identity of those involved. Their hopes and fears today are conditioned by, informed by and, to some extent, a product of those collective memories. The holocaust must be part of that, and it is essential to understand that. For anyone who is more associated with the Palestinian and Arab perspectives of the current situation—as I consider myself to be—an understanding of that collective memory of the holocaust is vital.
I say candidly to my hon. Friend that there are other collective memories that are different in scale and nature from the holocaust, but are just as real and just as painful for the people concerned. For all Palestinians, the collective memory of what they call the Nakba or catastrophe, which was also 60 years ago, is one. Seven hundred thousand Palestinians lost their homes. As my hon. Friend said, some were driven out by threats of violence, some were driven out by actual violence, and some fled because they were in a war zone. The point is that, however they left, they were never allowed to return.
Today, 4 million Palestinian refugees are registered, and refugees form a big part of the 1.5 million people who are imprisoned in Gaza with the appalling humanitarian crisis there. I do not want to go into the details of that today, because it is not the time, but to understand the Palestinians we must realise that the collective memory of the Nakba is a daily reality in Gaza and for those who, in the west bank, face closures, checkpoints and the separation wall.
That is also the reality and in the consciousness of the Palestinian minority who live in Israel. During my recent visits to the region, what perhaps struck me most is that it is not just those Palestinians who live under occupation in the west bank and Gaza who feel that. There is a massive and growing sense of grievance among Palestinians living in Israel, partly because in practice the laws discriminate against them, although in theory they do not, partly because in practice there is inequality in access to jobs, health care and education, and partly because of the way in which thousands of Bedouin homes in the Negev are demolished while the number of homes for Jewish families expand. That has been amply documented by groups such as Human Rights Watch. There is a feeling that Palestinians may be tolerated as citizens of Israel, but are not welcome in the area. It seems to me that if Israel wants to live at peace with itself, it must address that.
I pay tribute to the New Israel Fund and Sir Jeremy Beecham for bringing such matters to broader attention. Finding some sort of accommodation and recognition that Israel needs to deal with the reality of the Nakba and of the refugees must be part of that. I hear people say that Palestinian refugees cannot be allowed the practical implementation of the UN resolutions that apply to them because that would destroy the Jewish character of Israel. Actually, I believe that there are ways of recognising the rights of refugees without some of the problems that Israel believes there would be. However, what message does it send to the 1.3 million Palestinian citizens of Israel if they get the impression that their presence is tolerated only if there are not too many of them and that they do not become a majority in the area? That feeling is not new. Golda Meir was progressive in many ways compared with some of the Israeli leaders who followed her, but in 1969 she was quoted as saying:
“We must ask ourselves: ‘What sort of Israel do we want?’ I say: a Jewish Israel, with no question marks or doubts. A Jewish Israel, without the daily fear whether the minority now constitutes fifty per cent or not”.
What would we say if somebody said that about a racial or religious minority in the UK? Indeed, what would we say if that logic was applied to Jewish rather than Arab people?
If Israel is to have the bright future that my hon. Friend and all of us want, it must ask itself some serious questions. Israel must ask whether—not just in theory but in reality—it wants equal rights for its citizens. If the answer to that is no—quite apart from the impact that would have on Israel’s continuing relations with its neighbours—I do not think, as a state, it will be able to live at ease with itself, whether in relation to its Jewish or non-Jewish citizens. If the answer to the question I have posed is yes—and Israel means it—the refugee issue might not be as difficult to sort out as Israel thinks. Also, the search for peace, real equality and real co-existence between Palestinians and Israelis, and between the Israeli state and its neighbours, will not be as difficult as those involved think and the issue of occupation can be brought to an end. Israel needs to think about those issues and seriously ask itself those questions.
In conclusion, I ask the Minister whether he talks about those matters in the many discussions he has with his counterparts in Israel. If so, what do they say?
It is a pleasure to serve under your chairmanship, Mr. Atkinson. There remain 30 or so minutes for eight or nine two or three-minute snapshots of Israel, which should be enlightening. Certainly, if the contributions follow the lead of the hon. Member for Grantham and Stamford (Mr. Davies), who opened the debate in such a measured and interesting manner, we are in for an interesting few minutes.
I begin from an unchanged position: as a friend of Israel and as someone who visited it as a student. I carry many memories of that land from a number of visits over the past years. However, like all friends of Israel, I do not take an uncritical position. At this stage, I do not want to labour the contemporary difficulties—I will come on to those. However, as my hon. Friend the Member for Harwich (Mr. Carswell) mentioned, a number of things should be put on the record about Israel. In paying tribute to Israel’s 60 years, such things should not be forgotten. For example, it has an extraordinary free press and a sense of religious freedom that is not shared throughout the middle east. Israel has shown commitment to other nations through humanitarian and international aid. In addition, it has good health care facilities, and has worked on climate change issues, on combating desertification and on environmental innovation. Those are all things of which the Israeli people can be proud.
In Israel itself, there is co-operation across faiths. The Christian Allies Caucus has been established through the Knesset and throughout the world to cement the strong relationship between Christians and Jews. The Center for Jewish-Arab Economic Development has done much work and economic efforts have been made to improve the circumstances of those in the Arab community. The centre’s recent newsletter provides details about small shops, small enterprises and the technological advances achieved through the co-operation of Israeli Jews and Israeli Arabs. That is a remarkable testament to what goes on under the surface of a country, about which we often hear only the difficult things and world shattering events, rather than the things that mark the everyday lives of people.
Of course, we do not think of Israel in those terms; we think of it in terms of its strategic world position, and I shall say a couple of things about that. History and memory are both a blessing and a curse. For most people, history and memory sit lightly upon us. In fact, there is a medical condition that leads to people being overcome because they remember everything that has ever happened to them. They cannot move or function because everything they do is affected by the slights and hurts that they felt in the past. Most nations do not have such a condition: they wear their history relatively lightly, gently erase what they want to forget and keep the things that they need to allow them to move on. The middle east is too often stuck because of problems related to memory—things are never forgotten and that prevents people from moving on. It is essential that people are able to move on.
Israel’s friends are candid with it. No state is perfect. The way in which it reacts to the unique circumstances that affect and threaten it has weaknesses, which could damage Israel in the eyes of world opinion. No discussion of Israel’s reaction to its difficulties can avoid recognition of those threats themselves. One of Israel’s neighbouring nations is working on potential nuclear weapons with the declared aim from its President of wiping Israel from the map. Hostile undemocratic forces on its borders are unprepared to acknowledge its right of existence and will not work within the realities of modern politics to find accommodations that will ultimately benefit those whom they claim to represent, if memory can, to some extent, be put to one side. Its enemies hide weapons in the clothes of children and rockets in the households of the humble. They appear to glory in the privations of their people—using them in campaigns of hatred and rejoicing when a suicide bombing kills the innocent of all ages.
Yet, Israel survives—as I trust it always will. It remains an oasis of democracy and freedom in a troubled region. Israel’s friends salute its jubilee and wish it many more, but most of all they wish it to have peace among its neighbours and pray for a change of heart among those who hold back those opportunities—those who perhaps hold to memory on both sides. Some of that memory must now be put to one side to take the nations concerned forward and provide the peace that those in the middle east so earnestly deserve.
Often debates on Israel focus on the peace process and the failures of the Israeli and Palestinian political establishment to reach a comprehensive settlement when so much time has already been dedicated to talking about that. There is plenty to say on that matter and I am sure that colleagues have and will expand further and at great length on the problems and the solutions.
However, given the broad title of the debate, I wanted to take the opportunity to look at aspects of the state of Israel that are not related to peace and security and to focus on some of Israel’s remarkable achievements in the fields of education and health. Both areas are of particular interest to me and I am committed to trying to reduce health inequalities in the UK. My constituency suffers from particularly high rates of heart disease and cancer and I am keen to learn wherever possible of ways to reduce those rates in the north-east. As a member of the Select Committee on Children, Schools and Families, I have been lucky enough to have had opportunities to consider what other countries are doing in terms of education. Much can be learned from some of Israel’s achievements and best practices.
When the state of Israel was founded in 1948, a fully functioning education system already existed. It was developed and maintained by the pre-state Jewish community. The modern Hebrew language—an updated version of biblical Hebrew—was used as the language of instruction, which had been revived for daily speech at the end of the 19th century. However, since shortly after the establishment of the state, the education system has faced the enormous challenge of absorbing large numbers of immigrant children from more than 70 countries. Some children arrived with their parents, and others came alone. The UK can learn a range of lessons from Israel’s massive success in integrating such a vast number of children into an evolving school system. We are constantly developing our own education system to deal with a changing demographic and it is hugely important that we take lessons from other countries who have successfully dealt with similar situations, although in differing circumstances.
In the newly established state of Israel, the mass immigration of the 1950s—mainly from post-war Europe and Arab countries—was followed by a large influx of Jews from north Africa in the 1960s. In the 1970s, the first sizeable immigration of Jews from the Soviet Union arrived. Since the beginning of the 1990s, more than 1 million Jews from the former Soviet Union have arrived in Israel, and tens of thousands more still arrive each year. In two mass movements—in 1984 and 1991—almost the entire Jewish community of Ethiopia was brought to the country. In addition to meeting urgent demands for more classrooms and teachers, special tools and methods had to be developed to help absorb youngsters from many cultural backgrounds into the school population. Programmes designed specifically to meet the needs of newcomers include preparation of appropriate curricular aids and short-term classes to introduce immigrant pupils to subjects with which they were not familiar, such as the Hebrew language and Jewish history. Special courses were initiated to train teachers to deal with immigrant youngsters, and retraining courses for immigrant teachers have helped them to find jobs in the Israeli education system.
Israel takes the provision of education seriously and, since 1990, national expenditure on education as a percentage of gross domestic product has averaged above 8 per cent. That compares with UK education expenditure of 5.6 per cent. of GDP in 2007. School attendance is mandatory from the age of five and is free until the age of 18. Almost all three and four-year-olds attend a pre-school programme.
Higher education plays a pivotal role in developing the country. In the academic year 2004-05, 257,000 students were enrolled in Israel’s higher education institutions, with 48 per cent. attending universities, some 30 per cent. studying at various colleges and 21 per cent. participating in courses through the Open university. A wide range of programmes, from bachelor degrees to courses at post-doctoral level, are available at Israel’s eight universities, while colleges offer academic courses as well as specialised training in fields such as primary school teaching, music, fashion design and physical education.
Israel has recognised its lack of natural resources and compensated by investing heavily in higher education and scientific research and development and in the application of R and D. Some 24 per cent. of the Israeli work force hold a university degree. In that respect, Israel ranks third in the industrialised world after the United States and Holland. The statistics speak for themselves. With so many of Israel’s youngsters reaching university, their level of production in science and technology is remarkable. While we consider innovative and creative means of encouraging our youth to enter university in the UK, we should take the time to examine how Israel has achieved that and whether we can learn from it.
The other area that I wanted to talk about was health, but I am aware of the time and that many other hon. Members wish to speak. I will therefore cut my comments short. I will just highlight Hadassah hospital in Jerusalem, which is a beacon of integration. Its mission statement includes a pledge to forge links between patients of all nationalities, races and religions who come to its doors for healing. As well as being at the forefront of medical research and pioneering technologies, Hadassah is a tremendous example of equality and medical care that transcends all political divisions.
I hope that I have given an insight into the contributions and achievements of Israel and that I have highlighted work that we might be able to learn from in the UK. No doubt Israel will continue to stride forward over the next 60 years. I wish Israel the best of luck in all its fine work.
I congratulate my hon. Friend the Member for Grantham and Stamford (Mr. Davies) on securing this very important debate and on his tour de force of historical analysis. That said, I would like to mention one or two points of particular relevance to the UK. First, it was, of course, the UK that created the Balfour declaration, which led to the state of Israel. That was the positive. The negative was how very soon afterwards, under the British mandate, we made every effort that we could to limit immigration by Jewish people into Israel. The most appalling decision was made in May 1939. I am referring to the White Paper that limited immigration, on the eve of the holocaust, to 75,000 people over five years.
When considering the history, we should remember, not as a side note but as an important point, that hundreds of British service people and civilians gave their lives during the period of the British mandate, trying to fulfil what was an impossible task given to them by the British Government and the League of Nations in the mandate. The graves of those people are often forgotten.
When talking about the problems of the Palestinian refugees, we overlook the Jewish refugees from Arab lands. In 1945, some 800,000 Jewish people were living in Arab countries; today, there are fewer than 7,000. I am thinking of the Jews from Iraq and Yemen, who had to flee the pogroms there. The net result was what can only be described as an exchange of populations, because of the number of Palestinians who left and the number of Jewish people who went to Israel, having been expelled from Arab lands. Now, of the population of Israel— 7.2 million—some 20 per cent. are Arab, yet there is still immigration not just from Russia and Ethiopia, but from Europe. Of course, there are people from my constituency who like to carry out aliyah—to return to what they consider their homeland of Israel. We also see, in the rest of Europe, people fleeing to Israel from the fear of anti-Semitism, which has been growing dramatically.
In the short time available, I would like to remind hon. Members of the founding principles of Israel. The declaration of independence stressed the values of liberty, justice, peace and equality—traditional values. Israel has been able to maintain that democracy against all the threats with a vibrant Supreme Court, which challenges its own Government in the same way that our courts challenge our Government, of whichever political hue—often to the regret of the politicians involved.
Although Israel has won the wars that it always has to fight against threats that exist—I am thinking of the events of 1948, 1956, 1967 and 1973—unfortunately it has lost the battle for public opinion. When we compare how people perceived Israel in 1967 with how they perceive it now, we need to ask why the perception has changed. It is partly because Israel has not gone out to court world opinion. Also, people forget that Israel is surrounded by an enormous population of people who are hostile to it. That has fed anti-Semitism around the world. It has led to terrorism, hostage-taking, the missing Israeli service personnel, from Ron Arad to Gilad Shalit, and now we see for the first time threats to Israel’s existence from Iran and the nuclear programme of President Ahmadinejad, who refuses to negotiate about that. Although the threat to Israel’s existence—though not to its population—through terrorism has declined, a very different world is now developing. We will perhaps see some realignment as Arab states, too, are threatened by the growth of Iran’s armoury.
There is little time left in the debate, so I will simply say this. If there is to be progress and a peace agreement, the three international conditions of an end to terrorism, recognition of international agreements and recognition of Israel by Hamas must be met.
I welcome the debate and the historical analysis provided by my hon. Friends the Members for Grantham and Stamford (Mr. Davies) and for Birmingham, Northfield (Richard Burden). Obviously, the creation of the state of Israel is a product of history and of the Zionist movement, but also of the holocaust before and during the second world war. Like my hon. Friend the Member for Birmingham, Northfield, I visited Auschwitz earlier this year, and one can only be moved by the sheer horror of what happened and the violence that was used to try to exterminate a large number of people.
We are now dealing with the existence of the state of Israel and, with all the hullabaloo surrounding the 60th anniversary, I would just advise Members to look at page 2172 of today’s Order Paper, which states that the Select Committee on International Development is taking evidence on:
“The Humanitarian and Development Situation in the Occupied Palestinian Territories”.
Who is occupying the Palestinian territories other than the state of Israel? If Israel wishes to live in peace and prosperity in the future, it has to start reckoning both with its own immediate past in terms of the expulsion of large numbers of people from what is now Israel into Palestinian lands and refusal of their right of return, and with the destruction of 530 Palestinian villages.
Does the hon. Gentleman agree that the future security of Israel very much depends on a two-state solution and that if that is to be the case, there must be a viable second state, and at present Israel appears to be doing a great deal to ensure that that does not exist?
I agree. I will be brief because I know that other hon. Members wish to speak. While all the celebrations are going on in Tel Aviv and Jerusalem, not far away—in fact, probably less than an hour’s drive away if the roads were normal—one has in Gaza the most densely populated place in the world, with 80 per cent. unemployment, desperate poverty, food shortages, water supply shortages and sanitation problems.
The Gaza mental health organisation has informed me that 70 per cent. of the population are seriously medically depressed by the situation. Gaza is nothing more than a vast prison surrounded by barbed wire and roadblocks, and there is an inability to travel. Imagine what it is like for a young person growing up in Gaza, knowing that the only future they have is to stay living in that prison and that the possibility of travel is about zero.
Young people growing up in Gaza and on the west bank live their lives vicariously through television and the internet. The possibility of travel and experiencing the rest of the world is zero, and the poverty that they experience is terrible. I want peace in the middle east. I want recognition of a Palestinian state. Imprisoning the people of Gaza and, to some extent, the west bank does not achieve that.
Does my hon. Friend think that it will help the people of Gaza, and normalise their existence, endlessly to fire rockets and mortars from Gaza into Israel? I believe that 7,000 such firings have taken place since 2002.
As my hon. Friend knows, I am on record many times as being very critical of anybody firing rockets from Gaza into Israel—and, indeed, of the bombing of Gaza by Israeli jets. I remind him that 21 children were killed in April alone by Israeli bombardment. The death rate in Gaza from Israeli bombardment is high. I remind him of what was described by the United Nations as the collective punishment of the people of Gaza and the raids that take place on the west bank. That collective punishment involves roadblocks, imprisonment and the wall. Israel presents itself as a democracy; perhaps it should give some thought to the 70 Palestinian parliamentarians still being held in Israeli prisons.
I want peace in the middle east. I want people to be able to live in peace and security, and enjoy each other’s company. Israel is not creating security in the Palestinian territories; it is making the situation much worse by its refusal to negotiate, particularly with Hamas; by its continued construction of the wall; and by the grabbing of Palestinian lands.
The sense of anger and outrage among ordinary Palestinian people is so great that it will boil over at some point. The way to deal with that is not by continuing the oppression and the occupation, but by engaging—by replacing conflict with politics. That, surely, has to be the way forward. Israel, on its 60th anniversary, might think about those things a little more and recognise that keeping people in poverty is not a good way to ensure its security.
I, too, congratulate my hon. Friend the Member for Grantham and Stamford (Mr. Davies) on securing this important debate.
Despite Israel’s unprecedented situation—it has always faced hostility from states that do not recognise its existence—it has over the past 60 years created a vibrant, progressive and multi-racial society. It has recreated the Jewish national home and revived the Hebrew language, and it has provided a haven for victims of persecution. They include victims of the holocaust, and victims of persecution in Arab and Muslim countries. Indeed, half Israel’s population are Jews descended from people who lived in Arab countries. Today, Israel welcomes refugees from Darfur who had been rejected and often attacked in Egypt.
The threat against Israel’s existence has sadly not been removed. I draw the House’s attention to the continuing threat from Iran. Its president attempts to build a nuclear bomb, threatens to wipe Israel off the map, calls Jews “filthy bacteria” who should be eliminated, and trains and funds groups such as Hamas and Hezbollah that are dedicated to preventing a two-state solution.
Israel’s achievements are many. They include the socialist kibbutz movement, which has inspired millions over the years; the co-operative values of the moshavim; and the strength of the Histadrut trade union movement, which sets a model for such movements internationally and which now works with the Palestinian trade unions. Israel’s economy is highly successful. Its innovations are world renowned, and they include software and voicemail technology. It may be a mark of Israeli society that book sales per capita are the highest in the world.
Mention has been made of Israel’s democracy. It is important to point out that 25 per cent. of Israeli citizens are not Jewish, that 12 of the 120 Members of the Knesset are Israeli Arabs, and that Israeli Arabs in Israeli society include Ministers, diplomats and a justice of its Supreme Court, the independent court that often overrules Government decisions.
Israel is a progressive society. While Iran hangs gay people from cranes in the street, Israel welcomes civil partnerships. Israel’s hospitals and universities are models of co-existence. The remarkable world-class Hadassah hospital in Jerusalem, Poriya hospital in Tiberias and Soroka hospital in Beersheba have doctors and nurses from all backgrounds, religions and ethnicities helping patients from all backgrounds. Only last year, I visited Hadassah hospital as a member of a delegation from Labour Friends of Israel, and I saw a tiny baby from Gaza, the victim of a domestic fire, being given dedicated care by a team of Israeli medics. Organisations such as Givat Haviva bring Israelis and Palestinians together.
The tragedy of the situation is the failure to find peaceful co-existence between Israel and the Palestinians. Although Israel can be criticised in some respects, the overwhelming responsibility for that failure lies on the Palestinian side, and the battles fought by those rejectionist elements that prefer the cult of death and the suicide bomber to negotiated peace. The best success that Israel can achieve is co-existence with its neighbours. That would bring peace throughout the region and, I hope, achieve the dream of Shimon Peres of a federation of countries of the middle east working together for peace in that area and beyond.
I congratulate my hon. Friend the Member for Grantham and Stamford (Mr. Davies) on securing the debate.
I intended to speak about the role that Israel has played in the field of international development. It is an altruistic, innovative, outward looking actor on the world stage, but it gets little international recognition because the state is generally viewed through ideological eyes. I do not have the time to speak in depth about the work that Israel does globally, albeit on a small scale, in water resource management and irrigation, desert agriculture, early childhood education, community development, emergency and disaster medicine, refugee absorption, employment programmes and so on. All that is built on Israel’s experience as a struggling nation in an inimical climate, and the nation offers advice, expertise and support globally.
More important than developing those points in the short time available is, I feel, responding to my hon. Friend—he is a friend—the Member for Birmingham, Northfield (Richard Burden), who represents a seat on the other side of Birmingham from mine. I do not think that it is on to come here and conclude, as he did, with what effectively amounts to a denial of the state of Israel as a Jewish state, having begun those remarks with a reference to Auschwitz. My message to him today is that he cannot have it both ways. He cannot end his speech by referring to a state that is wonderfully and purely democratic but not Jewish after choosing to start, 10 minutes, earlier with Auschwitz.
It is not that easy and it is not that simple. If the holocaust means what it does to a lot of people here and if the history of persecution over centuries and millenniums is relevant, a state that is definitively, absolutely and unconditionally Jewish is part of the deal. My hon. Friend cannot have it both ways.
I, too, congratulate the hon. Member for Grantham and Stamford (Mr. Davies) on securing the debate. He spoke authoritatively and gave us a good base of Israel’s history.
The debate has been incredibly positive. The number of people attending and speaking today is testament to the importance of the state of Israel and its place in the region and on the world stage. It is good to have had a debate that has touched on many aspects of Israel that often are not covered because, understandably, we usually focus on the peace process. We heard about a wide range of topics—economics, our grave remembrance of the holocaust, the political situation, education, anti-Semitism, culture, health care, international development and the challenges with neighbouring countries such as Iran.
The timing of the debate is obviously appropriate, coming as it does just after the 60th anniversary of the founding of the state of Israel, and it is important that we celebrate that milestone and the country’s many successes, which have been covered in the debate. We should recognise what it has achieved in its fairly short history. The anniversary is also an opportunity to look forward to the next 60 years and beyond, and it is important to take a sober look at the prospects.
The future of Israel must lie in finding peace with its neighbours. Sadly, the prospects for that look increasingly fragile. I visited Israel in 2000, which is some years ago. Such a visit is essential if one is to understand properly the climate of fear surrounding the security situation in the country—the tension is palpable. I was also struck on my visit by the beauty of the country and how varied it is, despite its small size, from the mountainous north and the Golan Heights to the wonder of the Dead sea, the beautiful golden beaches next to the bustling city of Tel Aviv, which were mentioned, and Jerusalem, which is, frankly, stunning, with history around every corner.
Having visited only once, I did not notice the change in the Dead sea, but I have read of the problems arising from lack of water. Indeed, I had not necessarily clocked the politics of water in the area generally—it is vital and underlies many of the political tensions. With climate change, those are likely only to increase.
Obviously, my visit was a few years ago, so I thought it would be good to hear from people who have visited more recently. I spoke yesterday to my hon. Friend the Member for Brent, East (Sarah Teather), who last month was on a cross-party delegation to Israel to see the situation. She was struck by the problems and difficulties, from the Israeli town of Sderot, which is under daily mortar fire—indeed, the delegation of MPs narrowly missed being hit by a Qassam rocket at the Gaza checkpoint—to Gaza, which she described as an appalling horror. Lakes of raw sewage surround it and there is a lack of basic medical supplies, such that there is a life-or-death lottery based on whether a person can get a pass to visit better medical facilities—some Palestinians receive treatment in those facilities, as the hon. Member for Liverpool, Riverside (Mrs. Ellman) mentioned.
That is the backdrop, but, equally, there is agreement in the House on the need for two separate states—Israel and Palestine—with secure borders, and on the need to rid the area of the scourge of violence that has blighted so many lives on both sides and that has created an atmosphere in which people live day to day in a state of fear.
The re-launch of efforts for the peace process at Annapolis was viewed by many as slightly optimistic, given its timetable for conclusion by the end of 2008, but it must be remembered that there is no better way than dialogue. The current situation and the violence will not bring a solution, so despite the many barriers and obstacles to success, dialogue must be the path that we pursue. The Quartet has some flaws. It is widely seen as US driven, but the US is not necessarily seen as an honest broker in the process, and given our former Prime Minister’s history in Iraq and the region, he was not necessarily the most obvious choice as a representative to bring peace, although we wish him well in that difficult job. The Quartet has much dialogue with Arab countries, but its lack of an Arab representative is a problem. It would be better if it was driven by the UN instead of the US and if it was chaired by the Secretary-General.
Obviously, the daily violence will be a huge barrier. Until that violence is renounced, progress is not likely, and the history of suspicion and mistrust on both sides, which we have heard about today, will be difficult to overcome. The injustice of Gaza and the humanitarian problems are pressing—until there are basic humanitarian standards, it will be incredibly hard to see a way forward.
On the other hand, only a couple of weeks ago the Quartet expressed deep concerns about the settlements issue. Indeed, as my hon. Friend the Member for Edinburgh, West (John Barrett) said, the number of settlements could reduce the viability of a Palestinian state. If we want a two-state solution, that thorny issue needs to be tackled, as does the political situation, including the election of Hamas and the historically weak leadership on both sides in relation to acting and taking the risk for peace—I do not recall who said that, but it was a good way of putting it. It is a risk, but it needs to be taken. The prize is worth it.
Although the situation can seem hopeless, we can see chinks of light if we choose to look for them. The citizens of Palestine and Israel want to live in peace, like most people—it is a basic aspiration. That is a good starting position, and we need to focus on getting the parties talking. We need to recognise that if we wait until we meet the three conditions that were outlined—the renunciation of violence, accepting previous peace agreements and recognising Israel—before talking to Hamas, we might leave it too late. There needs to be no doubt that renunciation of violence is essential, but if Hamas makes positive moves, they should be rewarded, working towards the other two conditions being met. The dialogue process is essential if we are to find peace in the region.
I recently met Waza Fahoum, an Israeli-Arab, who was on a trip to the UK. An incredibly inspiring person, she is the chair of an Arab-Jewish centre in Haifa called Beit Hagefen. At grass-roots level, the centre organises meetings, cultural activities that celebrate both Arab and Israeli culture, educational classes and festivals, and provides lots of opportunities for Arabs and Jews to work together. To me, it seemed that at least at the grass roots some people are getting it right and finding a way to live together in harmony, learn, and share time and culture. We should focus on those things as points of light and optimism for a future settlement.
The politicians in the region would do well to learn from some people at the grass roots who are making those things happen and working together in peace and harmony. Only when politicians learn to engage in dialogue and follow such examples will we see peace in that troubled region.
I congratulate the hon. Member for Grantham and Stamford (Mr. Davies) on securing this timely debate, even if he was not able to introduce it under the precise title that he wanted. He and many other Members have rightly paid tribute to the achievements of the state of Israel in the past 60 years.
More than anything else, an episode from my first visit to Israel some years ago sticks in my memory. I visited an immersion centre to see the work to induct Falashas from Ethiopia, and Russians who spoke no other language and who had lived only in the Soviet Union, into Israeli life, language and culture. One of the defining characteristics of Israel is the conscious and successful efforts to forge a nation from people who come from disparate cultural and linguistic backgrounds. That is a remarkable achievement in its own right.
Hon. Members have spoken of Israel’s achievements in different spheres of life over the past six decades. My hon. Friend the Member for Harwich (Mr. Carswell) spoke about Israel’s achievements in medicine. Several hon. Members spoke about the quality of Israeli universities and the country’s commitment to high educational standards. We could talk about Israel’s scientific and technological achievements; and, as the hon. Member for Liverpool, Riverside (Mrs. Ellman) did, about the way in which Hebrew has once again been developed as a living language. We could talk about the flowering of Jewish art in Israel, or about the work of Israeli historians and archaeologists. We could talk about the way in which Jewish musical traditions have been fostered, or the fact that Israeli musicians are among the foremost players and conductors of classical works in the western tradition. There is a great deal to celebrate in Israel’s culture and its economic achievements.
There is also a great deal to celebrate in Israel’s political and constitutional achievements. Israel is a state that abides by the rule of law. As the hon. Member for Liverpool, Riverside said, the courts do find against the Government and, crucially, the Government then obey what the courts have said. Israel is also a vigorous democracy.
I am interested in the hon. Gentleman’s point about Israel abiding by laws. Israel has flouted a large number of UN resolutions, and as I said in my speech—perhaps he will comment on this—70 Palestinian parliamentarians who were democratically elected in internationally recognised elections are still in Israeli jails.
The hon. Gentleman will know from other debates that I am not uncritical of the decisions that have been taken by Israeli Governments and authorities over the years. There are also fierce critics of Israeli Government decisions in Israel itself. However, it is fair that we describe and celebrate the fact that we have a vigorous democracy in the middle east. One will find as many opinions in Israel as there are Israelis—indeed, the fiercest critics of Israeli Governments are often sitting in the Knesset or writing for Israeli newspapers. That is a sign of strength. In which other country in the middle east has there been the same level of public scrutiny as there has been, for example, of the conduct of the 2007 war in Lebanon?
When I went to Israel at the end of last year, I wanted to see the effects of the barrier around east Jerusalem. It was an Israeli non-governmental organisation or pressure group—B’Tselem—that took me around and explained the harm that it believed Israeli policy was doing to Palestinian political aspirations and economic prospects. If one is looking for people who are demonstrating and lobbying for Palestinian rights—I have heard the hon. Member for Islington, North (Jeremy Corbyn) make this point himself on the Floor of the House—one will find them in Tel Aviv and other Israeli cities. Again, that pluralism is a source of great strength.
It is right, however, that we also recognise that there is a great missing ingredient in the Israeli achievement. The situation was summed up quite well by a columnist in the Financial Times, who said:
“As long as Palestinians are in despair the Israeli miracle will remain, like Schubert's eighth symphony, unfinished.”
Last year, the Israeli Prime Minister, Mr. Olmert, openly said that without a settlement based on a two-state solution—an Israel that is recognised by her neighbours and that lives within secure boundaries alongside a viable, independent Palestinian state—the existence of the Israeli state will be at risk.
I therefore passionately hope that the Annapolis process, for all its imperfections, will succeed. We have debated many times in the House what needs to happen if we are to see that success. We need the rockets to cease being fired from Gaza at Sderot and other cities. We need improvements to security on the west bank, so that not only politicians but ordinary Israeli citizens can feel confident that their security against suicide bombers will be maintained. I am happy to repeat that we need action to stop the growth of settlements and remove the outposts because that, more than anything else, will send a message to those Palestinians who are committed to negotiation and the path of peace that there are real gains to be had from engagement in the process of negotiation and peacemaking.
I hope that we hear from more and more Arab leaders throughout the middle east a public and repeated commitment that if and when Israel and the Palestinians reach a settlement, that settlement will embrace the entire region. King Abdullah of Jordan has spoken out along those lines. The invitation to Foreign Minister Livni to speak to a conference in Qatar a few weeks ago was a further encouraging sign. Prince Turki al-Faisal said that if there was peace between Israel and the Palestinians, he—one assumes that he was speaking for many in the leadership of Saudi Arabia—would regard the Israelis as their brothers in the region. Those moves are all welcome.
When I went to Sderot last December, I noted that a square in the city was named after the late King Hassan II of Morocco. It was King Hassan who said that if the Israelis and the Arabs could live in peace and work together, they could turn their region into the garden of Eden. That is the vision that should inspire us, despite all the difficulties. That goal is profoundly in the interests of our country and of Israelis and Arabs in the region.
As ever, it is a pleasure to serve under your chairmanship, Mr. Atkinson. I congratulate my hon. Friend the Member for Grantham and Stamford (Mr. Davies) on securing the debate, which marks the foundation of the state of Israel. Although we might agree or disagree with parts of his speech, we all recognise that it was a tour de force as a short history of the conflict and the process of state building. I also congratulate all the hon. Members who have taken part: the debate has been not only interesting, but incredibly disciplined, and I know how strongly they feel about the ongoing conflict.
Like the Prime Minister and the Foreign Secretary, who have both recently spoken on this subject, I am happy to celebrate this historic anniversary. As we have heard, the establishment in 1948 of a homeland for the Jewish people followed centuries of discrimination and persecution. As hon. Members have said, the holocaust was persecution at its most chillingly murderous, and the Jewish people had long suffered such hatred. In trying to describe the uniqueness of Israel, my hon. Friend the Member for Birmingham, Erdington (Mr. Simon) reminded us that the country was created out of that crucible of horror and in a maelstrom of further violence. It is a tribute to the tenacity and imagination of the Israelis that their country has, in just 60 years, developed from a fragile political novelty into the vibrant, economically dynamic and technologically advanced country it is today. No one mentioned it but, from a mere 650,000, Israel’s population has grown to 7 million, which includes immigrants from 96 countries, speaking 66 different languages.
My hon. Friend the Member for Grantham and Stamford reminded us that Israel’s gross domestic product per capita is comparable to that of some of the Gulf states, which is remarkable. It does not have coal, oil or gas—or only a little: perhaps some will be found offshore—so those figures are a great achievement. We have heard from hon. Members some of the details of Israel’s turbulent history. The hon. Member for Harwich (Mr. Carswell) reminded us of its great economic and scientific achievements, which were created and recorded in the teeth of wars. I am old enough to remember listening to what I think was the first account I ever heard of a war—the 1967 war, which was broadcast almost live. I doubt whether there had been a war, certainly since the second world war, with such a commentary. Yet at the same time the great achievements that the hon. Gentleman outlined were under way.
My hon. Friend the Member for Birmingham, Northfield (Richard Burden) is a doughty contributor to debates on Israel and he cares enormously about the region. He reminded us of the collective memory of not only the Israelis but the Palestinians. He told us that the Palestinians must be not only tolerated but welcomed as citizens of Israel. I have met many Palestinians in Israel who feel that they are welcomed, but I know what he means. The debate about the place of Palestinians is as active now as it was 60 years ago in the state of Israel, and it cannot be ignored. The day after Israel’s birthday party, none of the issues, such as the religious settler divide and the place of minorities—especially Israeli Arabs—appears any easier. They must be made easier—a way through must be found.
The hon. Member for North-East Bedfordshire (Alistair Burt) reminded us in a wonderfully apposite way of the military and terrorist threats that poison relations between Israel and its neighbours and affect the debate about what kind of state Israel should be. That problem has never gone away.
My hon. Friend the Member for Gateshead, East and Washington, West (Mrs. Hodgson) listed some of the Israeli state’s social, health care and educational achievements and the lessons that we might learn from them—especially those achievements generated by mass immigration of sometimes poor and poorly educated people into a small, crowded country. That involves recognition of what a great potential asset they are to the state, as the hon. Members for Harwich and for Aylesbury (Mr. Lidington) and my hon. Friend the Member for Liverpool, Riverside (Mrs. Ellman) said.
My hon. Friend the Member for Hendon (Mr. Dismore) highlighted the numbers of Jewish refugees who, in the early days, returned to what they considered to be their homeland. The story is not a simple one of the displacement of one people because another people moved in. It was a complicated time and, as I have said before, there were great hopes that people could live in one state or in a federation of nations in the region. The present situation is a consequence of a litany of war and hostility, enunciated so well by my hon. Friend the Member for Grantham and Stamford.
My hon. Friend the Member for Hendon said that Israel may have won the military wars but it has largely lost the war of public opinion, and I think that he is right in many ways. The war continues. There should not be a war; what is happening should be about information, and some of the tremendous achievements that we have heard about today should weigh in on the side of acceptance that a state exists that should be living in peace with its neighbours. My hon. Friend told us, as others did, of the threat to Israel and to other, Arab, states posed by Iran with its expansionist rhetoric, if not actions.
My hon. Friend the Member for Islington, North (Jeremy Corbyn) always takes part in debates on Israel. He reminded us that there will be a Select Committee hearing this afternoon on the occupied Palestinian territories and aid from this country, which is very extensive, as is aid from the EU. He reminded us of the destruction of villages and, most vividly, of the dreadful humanitarian situation in Gaza. He is right to bring that to the debate, because there will not be peace in the area until the problems are solved. The humanitarian situation in Gaza is shocking, and I know that my hon. Friend understands full well the tensions generated not just by what he describes as the fence of barbed wire and blockades around Gaza, but by rockets being fired out of Gaza and bombs hitting it. That is an intolerable situation, which must be resolved.
My hon. Friend the Member for Grantham and Stamford reminded us of one of the reasons for what is happening. I, too, can think of very few peoples who have been as badly served by their leaders as the Palestinians. It is dreadful. I remember when I began to hear the first stories of the corruption of the Arafat regime. I suspect that that corruption continues to this day, and it has done no good to the reputation of the Palestinian leadership.
I was going to come on to that, because I wanted to answer some of the comments made by the hon. Member for East Dunbartonshire (Jo Swinson).
My hon. Friend the Member for Islington, North is right to highlight the matter of the 71 Palestinian parliamentarians who remain in jail. They should be either charged and tried, or released. It is as simple as that. It does Israel’s reputation no good when that story circulates continuously through the Arab streets.
My hon. Friend the Member for Liverpool, Riverside enunciated some great achievements and contrasted them well and sharply with the cult of death and the absurdity of wallowing in the notion that suicide bombing is somehow a redemption of what has happened to the Palestinian people. Suicide bombings are obscenity, and that philosophy should be resisted at all times.
The hon. Member for East Dunbartonshire spoke of Israel’s remarkable achievements, but I do not agree with her that the Quartet is driven by the US. I have had the privilege of taking part in Quartet meetings and the US is one player, along with the UN, the EU and Russia. Those representative bodies are not easily pushed to one side. I have had the privilege of travelling extensively across the region and speaking to Arab leaders and ordinary citizens, and I believe that Tony Blair was a good choice as an envoy. He is capable of making a difference in helping to mobilise the economic potential of the region. I remind the hon. Lady that the Quartet met the United Arab Emirates, Egypt, Saudi Arabia and Jordan in London on 2 May. Those were useful talks and, like the hon. Member for Aylesbury, I hope that, as part of the Annapolis process, they succeed.
NHS (Elderly People)
It is a pleasure to be under your watchful eye, Mr. Atkinson. I recognise that I must approach this important subject with a degree of caution. If my remarks are not balanced, it will diminish the arguments that I seek to make. I shall therefore start by putting on record the fact that millions of elderly people are treated successfully every year in the national health service. Staff across the NHS do heroic work to care for people whatever their age, and we owe those dedicated professionals our profound thanks. My family and I have received superb care from the NHS, and while spending a day as a porter at my local hospital, the Royal Berkshire hospital, I witnessed superb care being given to elderly patients.
However, I would not want that glowing accolade to cover up the key point of this debate, which is to show that there are problems with care for the elderly in the NHS. I aim to draw to the House’s attention the plight of a minority for whom hospital is a frightening and often unpleasant place. I am sure that I am not alone in finding in my postbag and hearing in my surgeries increasing concern about the negative experiences of elderly patients in hospital. That does not necessarily apply only to my local hospitals; people come to us to talk about the treatment of relatives all over the country.
The moving force behind my application for this debate was a well-known constituent of mine who contacted me. The name Jenny Pitman will be familiar to anybody who has been involved or has an interest in racing, but her name has gone further. She is not just a successful trainer of grand national winners; she is a woman of huge strength of character and forthright views. Having recovered from cancer herself, she knows all about how the NHS works. Her elderly but hitherto healthy father died of clostridium difficile in a local hospital. That tragedy prompted her to make some remarks that hit the national press. After that, she was deluged with letters and e-mails from around the country detailing horrific cases of appalling care standards and neglect. She has shared that correspondence with me. I have some of it with me today, and I intend during this debate to give voice to the many families who have experienced the distress of witnessing a loved one die through neglect or receive treatment that falls short of the standards that we all expect. I shall detail some of those tragic cases in order to highlight the range of ways in which elderly patients are being failed by the NHS, outlining problems with hygiene, a lack of basic care and respect for patients, poor nutrition and, perhaps most importantly, a lack of specialist training in dealing with the elderly, particularly those with dementia.
It is important to note that older people are the main adult users of most NHS services. However, it is clear that the NHS is not organised with older people’s needs at the forefront. That is not just my view; it is also the view of Age Concern. Recent research by the British Medical Association showed that doctors believe that health care services for elderly people are simply not good enough. The research found that eight in 10 doctors believe that health care services for older people are not up to scratch, and only one in 10 believes that enough money is being spent on care for the elderly in the NHS.
I congratulate my near neighbour on securing this debate on an important issue. He referred to the level of resourcing; we are all aware of the challenge presented by an ageing population. Does he agree that many instances of inappropriate care or lack of adequate nutrition—constituents have certainly drawn to my attention cases of people not being fed properly in hospital—have less to do with the level of resourcing than with the need to improve training and supervision in hospitals on day-to-day care, such as actually feeding people rather than just putting a tray in front of them? That is something that we all want to see.
I agree entirely. The right hon. Gentleman makes a good point. Nobody in this House would deny that enormous resources have been put into the NHS. I am simply voicing doctors’ opinions on resources as expressed through the British Medical Association. He is absolutely right: the problem is often not financial but cultural, the result of individual, fairly low-level managerial decisions, and it can be rectified without any great call for new resources. However, I shall come to that in a minute.
On 13 March in this Chamber, Members debated the 2007 report of the Joint Committee on Human Rights on the human rights of older people in health care. The report—this is the point that the right hon. Gentleman alluded to—found that a complete change of culture is needed to protect the human rights and dignity of older people in the NHS. Health care professionals as well as patients are speaking out, and it is important that the Government not only listen but act.
Our ageing population is arguably a product of the NHS’s success in other areas. There are just under 5 million Britons aged 75 and over, and the number of people over 85 will double nationally in the next 20 years. In my constituency, and possibly that of the right hon. Gentleman as well, it will double in the next 10 years. Unless we address the problems now, we face a demographic time bomb that will cause huge problems for future health care provision. With more elderly people in the UK relying on the NHS for treatment, it has never been more important that the problems with standards of care for the elderly are addressed.
I should like to extend this debate to the issue of care for those with learning difficulties, but I recognise that an important inquiry is going on in the Department of Health involving six cases, one of which occurred in my constituency. We await the report, which is the product of important work by Mencap, but it is vital to recognise that too many cases of unforgivable neglect occur because staff have not had the time, training or ability to attend to their patients’ most basic needs. That must change.
It is clear from reading just a few of the letters that Jenny Pitman and I have received from people whose elderly relatives have had unpleasant or upsetting experiences in our hospitals that the problem—when it occurs; it is important to make that point—lies in an absence of the most basic care. Nursing staff are clearly overstretched. There are far too many patients per nurse. As a result, the most fundamental aspects of care, such as feeding, changing and bathing, are being overlooked.
I spoke this weekend to a nurse who discussed the shortage of nurses going into geriatric care. She told me how an average shift is structured. It is not unusual for half of it to be taken up with—I shall choose my words carefully—bodily functions: bedpans, soiled bed linen and so on. It is not glamorous work. It can take about 45 minutes to feed a patient. While doing their best to keep the ward clean, cater for new admissions and handle patient crises, NHS staff just do not have the time to give the level of care that most of them would like to give.
One constituent told me of the experience of his father, Mr. Albert Unwin, who died earlier this year. Mr. Unwin went into hospital for treatment for a knee injury. He was left in a side room, unable to get out of bed and with his urine bottle and emergency alarm out of reach, for long periods. On one occasion, Mr. Unwin grew desperate and, hearing voices outside the room, started shouting to get a nurse’s attention. Twenty minutes later, and growing increasingly desperate, he was forced to use a Marmite jar left beside his bed to bang on his metal rails to draw someone’s attention. Another 20 minutes later, a nurse came in and chastised him for making such a racket. Where is the dignity and, more worryingly, the care, in that?
All too often, it seems that older people are being made to feel invisible in our hospitals and driven to “misbehaving”—that was the word that the nurse used in that case—to get the attention of staff when in urgent need of assistance. Cases such as Mr. Unwin’s prove that simple elements of care, such as ensuring that a patient’s emergency alarm is within reach, are not being carried out, resulting in unnecessary distress to patients. Just last month, the Department of Health released figures on its website revealing that despite massive investment in the NHS, the patient experience is actually getting worse. Hospital standards have slipped on cleanliness, friendliness and comfort from last year.
A student nurse wrote to Jenny Pitman outlining her own experience working in a hospital. She exposed massive understaffing resulting in the gross neglect of elderly patients, and recorded incidents of patients being left sitting in their own faeces and ending up with severe bed sores, of rough and disrespectful treatment of patients while washing and of a shocking lack of attention to cleanliness, whereby wash bowls were not changed or properly cleaned between patients—that means patients having their faces washed in a bowl that had cleaned previous patients’ bodies. Nobody can read that e-mail without being profoundly shocked. I recognise that it is an exception, but even with that caveat it is absolutely disgraceful that such things happen in this day and age.
Unfortunately, such reports of a lack of attention to hygiene are a recurring theme in letters that I receive. As we know, hospital cleanliness is of the utmost importance, particularly for elderly patients, who are known to be the most vulnerable to superbugs such as clostridium difficile and MRSA. According to the Health Protection Agency, in 2007, there were an estimated 49,785 record cases of C. diff across the UK in patients aged 64 and older, and 6,383 reports of MRSA between 2006-07. Professor Brendan Wren, from the London School of Hygiene and Tropical Medicine, claims that 6,500 people die of C. diff in UK hospitals every year, which is the equivalent of one person dying every hour in our hospitals. In 2003-04, there were 7,700 reported cases of MRSA, which means that there would have to have been a total of 3,850 or fewer cases of MRSA last year to meet the Government’s target. However, HPA figures released in April showed that there were 3,471 cases in the first three quarters, meaning that we really must question whether the Government are meeting their target for controlling such hospital-borne infections.
Frankly, infection control in hospitals needs improving, and the lack of management of infection control in some hospitals, wards, and hospital facilities needs to change. Although it is encouraging that work is being done by PCTs and trusts to tackle the issue of cleanliness in hospitals, more needs to be done. I accept that we are deep cleaning our hospitals, but there is no evidence that this is a long-term solution. What really needs to be addressed is the attitude of staff to hygiene through managerial support and appropriate training, so that cleaning wash bowls, for example, becomes a priority, rather than something that can be overlooked owing to lack of time. Regular hygiene control must become a habit, rather than a one-off.
I have tabled some written questions on venous thromboembolism, which is known as the silent killer, cases of which have increased dramatically—in fact, my predecessor but one as the Member for Newbury, died of just that condition. I feel very strongly about it, and we are starting to see an increasingly huge number of claims against the NHS. It is an area of concern that will mirror concern about MRSA and C. diff in coming years.
An issue that seems disproportionately to affect older people in hospitals is the lack of dignity that they are afforded. The fact that grown adults, who have worked all their lives, brought up and supported families and even fought for their country are being left in their own faeces for hours on end, or told off for trying to draw someone’s attention to the problem, is a national disgrace. Unfortunately, however, that is not the only way in which an older patient’s dignity can be taken away. There are more subtle, but always equally upsetting, ways in which older people are being degraded while in hospital.
The Healthcare Commission reports that the three most common causes of complaint in relation to dignity were patients being addressed in an inappropriate manner, being spoken about as if they were not there and not being given proper information. Those seemingly small things combine to make the experience for vulnerable, older patients not only degrading but often frightening and upsetting. One case of best practice that I particularly liked, which I heard about from the same nurse at the weekend, was the displaying of photographs of patients by their beds, showing them in younger years. She described someone near to the end of her life—a husk of a body—next to whom was a photo of her, in earlier years, as a head teacher of a much-respected local school. All around the ward, there were pictures of patients as soldiers, parents and pillars of the local community. That brought home to the staff working there that they were dealing with real human beings who deserved the respect that they were giving them.
Mixed sex wards also continue to be an issue—my hon. Friend the Member for South Cambridgeshire (Mr. Lansley), the shadow Secretary of State for Health, has been talking about this today—affecting older patients’ sense of dignity. Despite the Government’s repeated promises to abolish mixed sex wards, there has been a disappointing lack of progress, with targets being missed and many elderly patients being inappropriately placed in mixed sex wards. The Healthcare Commission’s 2007 annual inpatient report showed that one in four patients had to share a sleeping area with the opposite sex when first admitted to a hospital ward. In his reply, I hope that the Minister will talk about that and say, in particular, what defines a mixed sex ward. For example, we know that elderly people are concerned about walking past other wards containing people of the opposite gender on their way to use the lavatory. This needs to be looked at through the eyes of the patient. I am aware that Lord Darzi has started to retract the pledge given on mixed sex wards, but this remains a matter of great concern to elderly people.
Older patients are more likely to have health issues additional to those for which they are being treated in hospital, of which dementia is a leading example. The lack of training and knowledge in our hospitals for dealing with patients suffering from dementia is of very great concern.
I thank the hon. Gentleman for securing this debate and for allowing my intervention. The all-party group on dementia, of which I am a member, produced a report on the use of antipsychotic drugs in the care of dementia entitled “Always a Last Resort”, and last Wednesday, I introduced a ten-minute Bill on the same subject. One in three of over-65s—that includes us in this Chamber—will face dementia towards the end of their lives. Does he agree that his description of the inadequacies in training should include the inadequate training for dealing with dementia? Half of patients in private care homes being prescribed antipsychotic drugs had their prescription started in hospital. Too frequently, antipsychotic drugs are used because staff do not have the time or training to deal with some of the distressing symptoms associated with dementia. That is a really crucial issue that I hope will be addressed in the national dementia strategy, which will be published later this year. Does he agree with that?
I certainly do; and I hope that the Minister will touch on the national dementia strategy and training.
I shall come on to the transfer of responsibility for the patient from the hospital to social services. The control of drug use by a patient with dementia is very important. That is particularly relevant to me, because someone in my community found themselves in that situation recently. The hon. Gentleman was absolutely right when he said that the work of the all-party group was vital. He will be much missed in the House when he hangs up his boots because he has great experience in issues such as this. It is vital that the Government listen to such views.
I was told about a patient who was suffering from dementia. She was left unfed for long periods of time, and often had full plates of food taken away because no one would help to feed her. Even if she had been able to feed herself, it would not have helped because the food was often left out of reach. The patient’s daughter was forced to go into hospital at meal times. That is not a one-off case. Patients’ families often have to make the time to go into hospital to feed a relative because no one else is doing it. When the daughter asked a member of staff why they would not feed her mother she was told that the “demented”—she actually used that word—had a choice to eat or not and that it was not the job of the staff to feed them. That was in a hospital in Kent. Again, with my caveat that such examples are the exception rather than the rule and that much wonderful work is being done, the fact that that happens once in this country is something that many of us find deeply shocking.
Dementia sufferers need a completely different level of care from other patients. The fact that our hospitals often cannot provide such care is a matter of deep concern. The right hon. Member for Islwyn (Mr. Touhig) made a very good contribution in the debate on the Public Accounts Committee report last week. He said that
“between half and two thirds of people with dementia never receive a formal diagnosis at all, let alone an early diagnosis. Absurdly, many dementia sufferers are not diagnosed unless they go into hospital with another illness or an injury.”—[Official Report, 15 May 2008; Vol. 475, c. 1599.]
The PAC report said that the main obstacle that prevented correct and early diagnosis is GPs’ poor knowledge and lack of training. It said that compulsory training on dementia or older people’s health is not a statutory part of GPs’ training and there is no requirement in their continuing professional development to study older people’s mental health.
Would the hon. Gentleman further agree with me that in cases in which there has been best practice in the treatment of dementia in its early to middle stages—both in private care homes and in the NHS—non-pharmacological approaches are often much more successful because they do not damage the quality of life, shorten life or increase the risk of stroke and all the attendant problems that are associated with the use of antipsychotics?
The hon. Gentleman makes a very good point. As a layman, I would like to understand why drugs are being prescribed in a different way in different parts of the country. For example, I would like to know why, in some places, treatments other than antipsychotic drugs are being prescribed. The fear is that a dementia patient can be put in a state so that they will not be any trouble in a busy ward. In 2008, in the fifth richest country in the world, that is a matter of massive concern.
The situation on training is no better for nurses. The Royal College of Nursing told the National Audit Office that student nurses have between two to five hours’ teaching on older people’s mental health. I know that anyone who wants to go far in politics should not criticise nurses. However, I am not criticising the nurses, but the system that allows only two to five hours’ training on older people’s mental health. The NHS should insist on dementia training for health care professionals; it should be a clear requirement in the NHS that all trainee doctors and nurses learn about dementia.
I have gone on for longer than I intended, but I want to cover two very quick points. The issue of nutrition in hospitals is very important. Some 97 per cent. of trusts claim compliance with standards regarding help with eating in hospital, yet, according to Age Concern, only 58 per cent. of patients say that they always get the help that they need. A recent editorial published in the British Medical Journal found that about 20 per cent. of patients in general hospitals are malnourished, thin or losing weight. Up to 80 per cent. of those patients enter and leave hospital without any action being taken to treat their malnutrition because screening tools are underused and poorly enforced.
The National Institute for Health and Clinical Excellence recommends that all patients are screened for nutritional risk on admission to hospital. However, NICE estimates that fewer than one in three patients is screened on admission to hospital. One case that was brought to my attention was that of a stroke patient who was left for some 15 hours on a trolley without being given any fluids, despite severe vomiting the previous night. He was in such a state of dehydration that he was unable to talk due to the lack of saliva to lubricate his tongue. His family had to ask staff two or three times to provide intravenous fluids before anything was done to ease his discomfort.
I know that my hon. Friends have repeatedly urged the Government to do more to tackle nutrition. The amendments that they tabled to the Health and Social Care Bill would have created a statutory requirement for the proposed health regulator, the Care Quality Commission, to issue nutrition guidelines and to enforce them through new inspection powers and penalties. It was a great pity that those amendments were rejected.
I mentioned to the hon. Gentleman the handover from hospitals to social care. I believe that that process needs improving so that patients who need long-term care are given the best standard of service possible. It was very interesting to see the impact that a case, such as the one that I am about to mention, had on the community in which I live. An elderly person, whom I have known nearly all my life, was released from hospital and sent home without a proper statement of her needs being carried out. She was left in an entirely inappropriate way. She has no family and so had to rely on her neighbours, who have been quite exceptional in their care of her. They eventually got her readmitted to hospital, and she is still there today. The effect on the individuals around her was profound and it has stretched throughout the whole community. I cannot overstate the collateral damage that such a case does to the reputation of the NHS. Most people in my community, who have had a good experience of the NHS, were shocked when they heard of such an awful case. The damage done to the NHS, both locally and nationally, was profound. The Government must recognise that.
Help the Aged has reported a vast number of cases of inhumane discharge due to a desire to get rid of bed-blocking patients. The problems that occur in the transition between hospitals and social services seem to stem from a lack of consultation, lack of vital information, lack of clarity about options and a lack of choice for older patients. In the case that I just quoted, there was a complete misunderstanding of what drugs were prescribed and how that individual was supposed to understand when she was to take them.
There needs to be a change in the ethos of the NHS management so that nursing staff can provide the standard of care that they wish to give and that their patients deserve. Our nurses, health care assistants and carers do an extremely difficult job in incredibly tough circumstances. The job is made harder by bad management and a lack of specific training in how to care for the elderly. Understaffing and a lack of strong management on a hospital ward inevitably lead to low morale among already overworked staff. That contributes to the low standards of care that some elderly patients are reporting.
In conclusion, poor management and a diminished culture of care are allowing the NHS to fail in its duty of care for too many elderly patients. There needs to be a change in the culture of the NHS so that those who are most vulnerable—whether that be temporary or permanent—are given the standard of care that they deserve. I am aware, as we all are, that a number of Government initiatives have recently been announced that will go some way to addressing care for the elderly within the NHS. I look forward to hearing the Minister refer to them. I welcome the initiatives but I would like to emphasise the need to take active steps in applying wide-scale reform to the culture and ethos of the management of the NHS so that treatment of the elderly is changed for the good. The Government need to recognise that there is a problem for that key group, and that they have an obligation to ensure that the elderly are treated with dignity and respect while in the care of the NHS.
I congratulate the hon. Member for Newbury (Mr. Benyon) on securing this important debate on a topic that is close to a lot of our hearts and which we all take seriously.
As we all know, the elderly are often the most vulnerable in our society and among those most in need of care. They are also the most likely to have the most complicated care and treatment needs. I think that we would all agree that how those needs are met in our health service must be a key indicator of how the NHS is fulfilling its role in society.
Like the hon. Gentleman, I acknowledge that there are many wonderful examples of care for the elderly in our health service. Unfortunately, as he said, there are still far too many examples not only of their needs not being met, but of people being subjected to treatment that is completely unacceptable and in some cases, such as those that he highlighted, absolutely scandalous and possibly criminal. Again, we would probably all agree that the societal attitude in this country still seems not to put as much value on older people as on younger people in all sectors of society. The Government cannot necessarily address that, but we all need to take it seriously and try to change it.
Turning to current developments in health, I say to the Minister that although the health agenda is changing fast, with a lot of initiatives and a lot of positive things happening, the debate brings into focus the fact that such things must not be pursued at the expense of the basics of care, which have been mentioned this morning. All health organisations must focus on simple things such as hygiene, nutrition and, particularly in the case of older people, dignity. Those values need to come to the fore a little more when NHS trusts release their mission statements, for example.
It is extremely worrying that 18 of the 23 hospital trusts studied in the report that the hon. Gentleman mentioned, “Caring for dignity”, were deemed to be failing to care properly for the elderly. That is a damning indictment of health care provision in NHS trusts. Doctors, GP consultants and staff grade physicians responding to a British Medical Association survey, the results of which were released earlier this month, believe that health care services for elderly people are simply not good enough. For example, 68 per cent. of doctors believe that staffing levels are inadequate, and three in five believe that the necessary continuity in health and social services does not exist.
Not surprisingly, older people account for the highest use of acute hospital services. The NHS spends 45 per cent. of its expenditure on them, but that is not necessarily reflected in the priorities given by health trusts. I say to the Minister that that can be addressed at the grass-roots, organisational level of the NHS. That needs to be the focus. There have been positive developments such as the national dementia strategy, but I hope that the Minister will acknowledge that there still appears to be a disconnect between the positive policy initiatives that we all support and what is happening on the ground.
Older people’s organisations, older people themselves and their relatives, families and carers highlight dignity in particular. As we know, older people are particularly vulnerable because they are often in positions of reduced control over their health and well-being. Help the Aged states:
“Stories of older people left in pain, ignored, or distressed by a lack of privacy in health and social care settings emerge at such a frequency that they cannot be dismissed as isolated cases.”
It also states that that is in spite of policy guidance. Again, things are not happening on the ground. The Healthcare Commission reports that the three most common causes of complaint in relation to dignity are patients being addressed in an inappropriate manner, being spoken about as though they were not there and not being given proper information.
The hon. Member for Newbury highlighted the problem of mixed sex wards and mentioned the figure in “Caring for dignity” showing that almost a quarter of elderly patients have had to share a room or bay with someone of the opposite sex at some time during their treatment. That is simply not acceptable. I echo his comments and ask the Minister when that figure will come down and when people will be put in mixed sex wards only in situations of emergency or absolute necessity. That is one of the major concerns for older people and their families.
The hon. Member for Newbury mentioned some particularly terrible cases of people not being taken to the toilet when they asked. In some of the worst cases, people have been allowed, or even told, to go to the toilet in their bed. He was right to highlight the knock-on effect of that on hygiene and health care associated infections. I chaired a Westminster health forum conference on that subject this morning.
We are not making the connection as we should, as is clear from the Healthcare Commission report on the appalling incident at Maidstone and Tunbridge Wells, which says that the families of patients
“told us that when patients rang the call bell because they were in pain or needed to go to the toilet, their call often wasn’t answered, or not in time. Particularly distressing, nurses had told patients to ‘go in the bed’, presumably because this was less time consuming than helping a patient to the bathroom. Some patients were left, sometimes for hours, in wet or soiled sheets.”
I accept that that was a particularly awful and, I hope, isolated situation, but if we do not address the key issues of people’s dignity, we will open a can of worms in relation to health care acquired infections.
I wish to highlight a couple more areas of concern. The hon. Member for North-West Leicestershire (David Taylor) rightly mentioned dementia. The wider issue of older people’s mental health is of particular concern. Age discrimination is explicit in the health service in the case of people with mental health conditions. Someone over 65 is subject to a different service regime from someone under 65.
The difference between the services can be seen most starkly among those who experience a transition from adult mental health services to older adult mental health services when they turn 65. Many of them find that vital services on which they rely are no longer available to them. That is simply wrong, and I ask the Minister to look into it. I have said that the national dementia strategy is a good thing and that the focus on that distressing condition is welcome, yet age discrimination is inherent in the system. That is not acceptable.
The hon. Member for Newbury mentioned the need for training and I reiterate that there must be far more training for staff in the area of mental health. I also agree with him that the provision in this area within nursing training is not acceptable.
The final point that I want to make is about the worst problem in this whole area, which is elder abuse. In this country, elder abuse still goes on far more often than it should. It is often undetected and it still does not seem to be taken as seriously as it needs to be by the authorities. Help the Aged has estimated that at any one time about 500,000 older people are being abused in the United Kingdom. The Community and District Nursing Association told the Health Committee that 88 per cent. of district nurses report having seen cases of elder abuse. We know that the majority of elder abuse happens within the family, which makes it a difficult and distressing problem to deal with. Nevertheless, a considerable proportion of elder abuse is down to care workers and that must be clamped down on.
I ask the Minister this question: when will we start looking at providing more training in prevention and recognition of elder abuse? Surely, such training should be a mandatory element of all staff training for all front-line staff in the health and social care sector. Furthermore, to widen the debate, when will we see adult protection becoming a compulsory part of police training and would it not be a good thing for such training to be placed on a statutory footing?
I ask those questions because I am very focused on the human rights agenda and I know that the Government are also committed to that agenda. However, it still appears that the human rights of older people are simply not recognised in the same way as those of younger people. That is a situation we simply cannot accept.
In conclusion, I echo the point made by the hon. Member for Newbury, who said that in many years’ time we will have considerably more older people in our society, so this issue will come into even greater focus. In 20 years, a quarter of the UK’s population will be over 65 and the number of people over 85—that is the particular age group where a lot of these problems occur—will have doubled. So, this is something that we must tackle and an issue that we must address now, as a society; it is not just about Government.
As I said at the start of my speech, there are some positive policy initiatives, but we now must ensure that they are carried through on the ground and that we have a change of culture in the NHS, so that the dignity and care of older people are paramount. I hope that the Minister shares those sentiments, and I look forward to him addressing some of the points that have been raised by the hon. Member for Newbury and by me.
I appreciate that the right hon. Member for Oxford, East (Mr. Smith) has changed his mind about speaking. I also appreciate that it is somewhat unusual for a Back-Bench contribution to come after the winding-up speeches have started—the hon. Member for Leeds, North-West (Greg Mulholland) will not have the opportunity to comment on the right hon. Gentleman’s speech—but I gather that there is no objection to that and, as we have plenty of time, I call Mr. Andrew Smith.
Thank you, Mr. Atkinson. I was taking account of the time available. I thought that I would take the opportunity to make a few points, and I am sorry that the hon. Member for Leeds, North-West (Greg Mulholland) has already given his winding-up speech.
I congratulate the hon. Member for Newbury (Mr. Benyon) on raising this vital subject. It is crucial that elderly people receive the best treatment, whether in hospital or elsewhere in society, and none of us can be anything but very unhappy when that treatment is not provided.
I want to set my remarks in a wider context. Across the NHS, I believe that a fantastic job is being done by staff, including nurses and doctors. Indeed, I receive many more positive messages and letters, including from elderly people, about the treatment that they are receiving in the NHS than I do complaints. However, that in no way diminishes the importance of the points that the hon. Gentleman and other hon. Members have made in the debate.
Although incidents of poor treatment of the elderly are in the minority, when there are instances of people’s dignity not being respected they are enormously concerning to us all. For example, I received a complaint from the daughter of one patient, who, on visiting her mother, saw that she had not been eating properly, her bed gown was dirty and she did not seem to be receiving proper care.
I feel sure that there would be common ground for the view that, although professional development, training, inspection and all those types of work are, of course, really important, what is also important is the daily entrenchment of a culture of sensitive caring on the part of everybody who is managing the treatment and care of elderly people. It is shocking when such good treatment is not provided and when there are these cases of neglect, including people being left in their own faeces or not being fed. We think, “Well, somebody is seeing them and somebody is responsible for that ward, so why is the treatment not being provided?” The Department of Health—together with trusts, matrons and managers, and working with the nursing professionals, who will be fully signed up to the highest aspirations for standards of care—must make a concerted effort to root out totally unacceptable practices.
I take the points that were made about the importance of the national dementia strategy. There is a particularly poignant dimension to the position of people suffering from dementia. Often, they are not in a position to signal their needs and feelings, other than sometimes through what is seen as aggressive and inappropriate behaviour.
Furthermore, the idea that such aggressive or inappropriate behaviour should be controlled inappropriately by anti-psychotic drugs is utterly abhorrent. The Alzheimer’s Society has estimated that more than 100,000 elderly people with dementia are being prescribed anti-psychotic drugs and that, in two thirds of cases, those drugs are unnecessary.
There clearly must be a thoroughgoing revision of the prescription policy on the use of those drugs. As was mentioned earlier, alternative therapies and ways of managing people’s conditions should be used instead. No one pretends that the situation is easy, but this is a critical challenge that we all must face up to, in partnership with those in the NHS.
On nutrition, I do not think that it is just a question of monitoring, measuring and inspecting, although all that work has a role to play. I believe that there is also a common-sense issue of putting wholesome food, which people want to eat, in front of patients. I know that there have been pilot schemes in the west country—I dare say that the Minister will refer to them—using locally sourced produce, rather than the prepared meals that travel a long distance, are reheated and sometimes stuck on a tray that is out of reach of patients. Getting food that is nutritious and good to eat must be a common-sense part of the solution to those problems. Furthermore, the amount of food that is thrown away in the NHS is, in itself, an indictment of the inadequacy of the food supply system.
I hope that the right hon. Gentleman may move on and take the opportunity to bend the Minister’s ear on the question of specialist orthopaedic hospitals. I mentioned hospital-borne infections. It is worth noting that the level of infections is far lower in those specialist hospitals, yet they are suffering the difficulty of financing themselves, due to the question of the tariff.
I hope that the right hon. Gentleman, who is a very able chairman of the all-party group on specialist orthopaedic services and hospitals, will raise that point with the Minister.
The hon. Gentleman has done it for me. I can also assure him that barely a week goes by without my bending the Minister’s ear on the position of orthopaedic hospitals in general and Nuffield Orthopaedic Centre in particular.
The hon. Gentleman is quite right: there are very low infection and cross-infection rates in the orthopaedic sector. Indeed, I hear enormous praise for the treatment that people receive at the Nuffield. That reinforces the powerful case for resolving the tariff problems that affect that sector, and in a meeting with the Minister a couple of weeks ago, I urged him to do that. This debate gives him the opportunity to discuss that important issue as well.
The point that I was making about food is that the predominant existing sourcing of food for the NHS clearly is not working that well in many instances, as judged by the colossal amounts that are thrown away. That is a dreadful waste. I presume that the amount ordered is thought to be the amount that patients might need to eat, but the fact that so much is thrown away is in itself an indicator of nutrition not being what it should be.
I look forward to the Minister telling us about the experience gained from efforts that have been made to give people wholesome and attractive food. The fact is not only that the general hospital experience benefits, but that there are direct health benefits, which aid recovery. Again, that is common sense and not at all surprising.
The hon. Member for Newbury mentioned the important matters of care after leaving hospital and social care. I certainly urge a continuing drive to maintain and enhance standards of care in social care homes. There are many examples of good practice as well as bad. I visited a St. John Care Trust home in my constituency a couple of weeks ago, and I was very impressed with the ambience of the place, the caring attitude of the staff, the positive feedback that I had from residents and the extra efforts being made. The aromatherapist who comes in happens to be blind, and she brings her dog so that the elderly people have something to pet. There was a warm and caring atmosphere.
The social care sector is often spoken about as a sort of Cinderella, but it is important to signal that very good work is done in it. There are issues around the training of social care staff, but I believe that many of them, through their caring attitude and day-to-day supportive work, bring an enormous amount that perhaps compensates for the lack of formal professional qualifications. It is important to enhance people’s wish to care for elderly people and to attract and retain such people in the service, including the many migrants who have come to this country and done a good job. That should be praised, but it is clear that we need to learn from best practice and apply it more generally.
I close with a bit of lateral thinking, which was drawn to my attention just last week. The Ridgeway Partnership, which is the learning disability trust in Oxfordshire, is an excellent provider. The hon. Member for Newbury said that the treatment and care of learning disabled people are relevant to this debate. The partnership does a wonderful job with homes in the community and support for learning disabled people. It is one of the best performing trusts in the country. At a reception, it voiced to me the potential that there might be for applying the expertise that it has developed in domiciliary care precisely to the needs of elderly people, including the vulnerable elderly. In other words, it would support the third option. Many people would like to be not in hospital or a social care home, but in their own home.
I look forward to the Minister’s response as to whether we might look at that example of best practice and run pilots whereby we could explore whether the service of such a trust, which has a track record of excellent service to the learning disabled, might be diversified to elderly people who may have higher-level needs and would like to stay in their own home.
This is a vital area. It is important that our criticisms are couched in an overall context of recognition of the terrific amount of valuable and successful work that is done through the NHS. However, there is no doubt that there is a formidable challenge in ensuring that the dignity of elderly people is properly respected, that they get the standards of care that we would all want for our own loved ones, and that unacceptable practice is driven out and, equally importantly, good practice is learned from and applied more generally.
I begin by congratulating my hon. Friend the Member for Newbury (Mr. Benyon) on introducing this debate and highlighting the very real problems of caring for the elderly in the national health service. In my speech, I shall pick up on some of the points made by the right hon. Member for Oxford, East (Mr. Smith). It is important to have balance in a debate such as this one. We realise that some very good practice is being followed, and it is important to pay tribute not only to the nurses and doctors but to all the care staff involved in looking after elderly people who are doing an excellent job; on the other side, however, there is no doubt that there are problems and areas of concern.
I gather that my hon. Friend was inspired to introduce this debate because of the experiences of Jenny Pitman, who felt that standards in the NHS had fallen well short of that which she expected. He highlighted cleanliness and dignity, and in all the issues that he raised he stressed the importance of the detail. The hon. Member for Leeds, North-West (Greg Mulholland) spoke about the basics. This debate is about the basics and the detail. It is about getting things right and setting the bar high for standards in the care of elderly people.
[Mr. Eric Martlew in the Chair]
When discussing cleanliness, my hon. Friend obviously had to raise the matter of some 6,500 people dying every year from C. difficile. Many agencies say that the problems with C. difficile and MRSA are down to standards and about nurses having the time to carry out procedures properly. I shall return to that later.
My hon. Friend also raised an interesting idea of having photos of people above their bed. I will refer to that when I close, but it is terribly important to remember that elderly people were young once and that some had terribly important jobs—perhaps more important than those of us in this House feel we have. We sometimes lose sight of that when we see in front of us someone who is, perhaps, incontinent, or who cannot feed themselves. People who have had a stroke at a young age tell us that the problem is particularly acute for them because they are treated as though they are elderly, when, in fact, they might be 45, and only the day before had responsibility for a full-time job and a family at home.
My hon. Friend discussed the care of people with dementia or mental health problems. There is no doubt that our concern about older people and the care that they receive should increase 100 per cent. when we consider the care of older people who have dementia or mental health problems. It is not easy to care for people who have dementia, who are confused, or who are older. It is triply difficult to care for people who have all those problems. The dignity with which we treat them is extremely important.
Speaking of dignity, I make no apology for the fact that much of what I say today relates to my experiences as a nurse in general hospitals and as a district nurse in the community. I am sure that the hon. Member for Crawley (Laura Moffatt), who is now not in her place, would agree with my comments, as she was a nurse. I remember somebody once saying to me that when a person goes into hospital they hang up their dignity as they go into the ward and pick it up when they leave. That was said to me many years ago, but it probably remains true today.
There is much talk about human rights and the human rights of patients. I always feel slightly despondent when I hear people talking in such terms, because things really should not get to that point. We should not need to demand that people’s human rights be respected. This is a matter of courtesy, respect and being civil to people. It is not about patients, but about treating people. Somehow, it seems, people hang up their dignity and become a patient and a different being, and we are entitled to treat them differently and not with the same respect. We need to remember that we are treating people. People are being cared for by the state, so we have a duty of care to them that we should feel acutely. It is a long time since a radio programme called “Does he take sugar?” was broadcast, but a lot of what has been said today echoes what we heard in that programme. We often forget the person sitting in front of us.
Mixed-sex wards have been mentioned. I understand that the most recent Healthcare Commission survey reported that 30 per cent. of people are still sharing bathroom areas. The Government are trying to deal with this, but that is not good enough. Male and female patients having separate facilities is fundamental to respect and dignity. Generally, in all wards, there are curtains around a bed, but even if people are sharing a same-sex ward, that is not enough to afford them privacy when intimate procedures are being carried out. Everybody can hear what is going on and what is said behind the curtains, and often the curtains do not meet. Mixed-sex wards in any form are not acceptable. I should like the Minister to tell us what progress the Government feel they are making on this problem, which has been hanging around for much too long.
The British Medical Association recently reported that 20 per cent. of people in hospital are malnourished, thin or losing weight and that 80 per cent. enter and leave hospital without any action being taken to address their nutritional needs. Some studies have found that the number of malnourished people leaving NHS hospitals in England has risen by 85 per cent. in the past 10 years. During the Committee stage of the Health and Social Care Bill, the Minister and I discussed weighing and measuring children. If my memory serves me correctly, I mentioned that we are keen to do something about childhood obesity, but said that, at the other end of the scale, we should also be keen to do something about older people’s nutrition. Poor nutrition can lead to older people getting thin and frail and can lead to confusion, mental health problems, dementia and depression. I should like the Minister to reassure us that the Government are taking malnutrition in elderly people seriously. It is not only what happens to elderly people when they go into hospital that matters: often, they are malnourished before they enter.
The right hon. Member for Oxford, East mentioned wholesome, locally sourced food. All hon. Members would go along with that. However, I think he missed the point. The problem in respect of much malnutrition in hospital is not that the food is not getting to the person’s bedside, but that it is not getting into their mouths. A lot of people cannot feed themselves.
I do not think for one minute that the right hon. Gentleman does not consider that to be a problem, but it needs emphasis. How many times have hon. Members been on a ward or in any sort of care setting and heard a patient say, “Can you hand me my drink?” or, “Can you pass me the tray of food?” What is important is individual care, paying attention to people’s nutritional needs and what food they like to eat and providing them with the ability to eat the food that is put in front of them. Although I am not one to rush into monitoring, staff need to be given clearer guidelines and we need to raise this matter as a priority. The danger is always that nutrition slips down the list of priorities and other things get attention first. I said to somebody the other day that the danger with oppressive targets in health care settings is that they become the priority. If nurses in hospitals that are short of staff are rushing around washing their hands, which we commend, they simply may not have the time to feed people. I would not like to see any issue gain importance above another.
My hon. Friend the Member for Newbury mentioned resourcing, which is an issue, along with training, support and nurses having the time to nurse and care. One of the most common problems that nurses contact me about is their feeling that they do not have the time to care for people in the manner in which they were trained and hoped to be able to practise, or in a way that maintains people’s dignity and privacy and gives them the care that the nurses themselves would expect to receive.
I have to return to how managers treat their staff. To some extent, if we want people to care for others, they have to be shown the same amount of dignity, respect and courtesy and have to be treated with the professionalism with which they are expected to treat their patients. I am concerned that sometimes the management styles in the NHS do not necessarily engender that. The hon. Member for Leeds, North-West mentioned some of the problems experienced in Maidstone and Tunbridge Wells NHS Trust. Whether or not it is in the Health Commission report, there is a lot of anecdotal evidence suggesting that the management styles in that trust were poor, staff were not treated well or with respect, and staff had no way to complain to their line managers about what was going on in the wards. That is important. Although such feelings are subtle and hard to put one’s finger on and cannot be measured, a lot of NHS staff feel that they are oppressed by targets and the need to produce figures and numbers, and that not enough time and attention are given to their concerns about the quality of care that they need to give. Quality takes time, and it means that people need more resources.
Hon. Members mentioned discharge from care—not only from care in hospitals, but from nursing homes and other settings. At every step, people’s dignity must be maintained. We sometimes forget the fear following, for example, a fractured neck or femur or a stroke and the imminent prospect of discharge. I heard recently about an elderly gentleman who is frail and has been admitted to hospital with a stroke. He is in a fantastic stroke unit that is an example of the best practice that we have talked about. His discharge home is being planned: the man’s wife is having a stair lift installed and is employing a carer to look after him. However, she and her husband have considerable fears. At the moment staff are on hand to help him to the lavatory, but he is concerned that, when he gets home, he will not make it to the lavatory. Those are the sorts of things that people are concerned about. Many people would prefer to be looked after in their own home, but there are some big buts for those people and their families. They want to be looked after at home, but only if they have help to get to the lavatory, only if their wife has somebody to help with the shopping and only if their wife has the time to feed them.
There are also complicated issues to do with people’s feeling that they are a burden on others. The language used in respect of discharging people from hospital has been most unfortunate at times. People are referred to as bed-blocking, as though they were staying in hospital on purpose or as if it were their fault. It is not their fault; there is no doubt about that. I make no party political points about this matter. I hope that we will have a joint approach to the concerns about the huge number of elderly people for whom we will have to care and offer support in the years ahead. When I was training to be a district nurse a very long time ago—probably well over 20 years ago—I did a project on discharge home from hospital, and I read some research that pointed out that being in hospital is very brief interlude in someone’s life. It is a brief spell out of their home, and at every step we must consider what people’s needs would be in their own home.
The hon. Member for Crawley was not in her place when I mentioned her earlier, but I am sure that she shares my feelings about the care of the elderly in the NHS, because I know that she trained as a nurse. I am also sure that, like me, she was taught to provide the highest standards of care for the people she looked after. I continue to be proud of the fact that I trained at St. Bartholomew’s hospital and of the training that I received there. All that I learned at that time stands me in good stead: it guides me as a politician. It is extraordinary how useful such training is for a politician—to some extent, that training and experience on the front line took me into politics.
Barts was a challenging place, and some senior nursing officers could have come straight from the “Carry On” films. They had buxom figures and were terrifying, but they reminded us that nurses in charge of a ward were in charge of a place that was someone’s home for the time being and that we should treat everyone as if they were in their own home. The bar was extremely high on standards: nothing less than the best would do. I hope that the Government will continue to engender those feelings.
Hon. Members do not often recite poetry in this Chamber, but a poem that appeared in a textbook, “An Ageing Population”, in 1981 has become famous. It refers back to the point made by my hon. Friend the Member for Newbury about photos above people’s beds. It was found in the locker of a lady who had died and who had been unable to speak, and I shall read the beginning and the end.
What do you see nurses
What do you see?
Are you thinking
When you are looking at me
A crabbit old woman
Not very wise,
Uncertain of habit
With far-away eyes,
Who dribbles her food
And makes no reply,
When you say in a loud voice
‘I do wish you’d try’
Who seems not to notice
The things that you do,
And forever is losing
A stocking or shoe,
Who unresisting or not
Lets you do as you will
With bathing and feeding
The long day to fill,
Is that what you’re thinking,
Is that what you see?
Then open your eyes nurse,
You’re not looking at me…
I remember the joys,
I remember the pain,
And I’m loving and living
Life over again,
I think of the years
All too few—gone too fast,
And accept the stark fact
That nothing can last.
So open your eyes nurses,
Open and see,
Not a crabbit old woman,
Look closer—see ME.
The Minister may introduce strategies and policies, but when thinking about how to address the dignity of older people, will he take himself out of his shoes, turn himself around, put himself in another pair of shoes, and see himself in 20 years, 30 years, 35 years, or even 40 years on? Will he think of himself having to be cared for and saying, “Once, in 2008, I was a Government Minister.”?
How does one follow such poetry? With reference to the final remarks made by the hon. Member for Guildford (Anne Milton), as a teenager I nursed my mother through Alzheimer’s to death, so I know a little about looking after elderly patients and caring for them, their needs and their dignity.
I congratulate the hon. Member for Newbury (Mr. Benyon) on securing this debate on such an important issue, and apologise to him and other hon. Members that the Under-Secretary of State for Health, my hon. Friend the Member for Bury, South (Mr. Lewis), who is responsible for this policy area, is not here to respond to the debate. He is absent from the Chamber for very good reasons, which I shall come to later.
We all agree that how we treat the most vulnerable in society, including the elderly, is a measure of our civilisation. We have a growing elderly population, who are healthier, longer lived and more materially comfortable than any previous generation. We also have a society in which people have higher expectations of their health and social care, and their quality of life. People not only expect that for themselves, but we in the Government expect the private and public sectors to provide it.
Although many elderly people are living longer and healthier lives, many need care in hospital or a care home, and stays may be more frequent or longer than previously. As the hon. Member for Leeds, North-West (Greg Mulholland) acknowledged, all parts of the Government, but not just the Government, have a responsibility to ensure that people enjoy dignity in old age. I shall outline some of the matters for which my Department is responsible.
First, statutory guidance in both the health service and social care places a legal obligation on all staff to ensure that people are treated with dignity. It provides a complete definition of abuse and a framework for public bodies to work with the police, the NHS and regulators to tackle abuse and prevent it from happening in the first place. It also sets out the framework for partnership working throughout Government and other agencies to deal with and prevent abuse of vulnerable adults. As well as that, we have a new local performance framework for the NHS, which builds on that and means that every nurse and every health care professional has a responsibility to safeguard and respect an individual’s dignity.
Subject to parliamentary approval, the Health and Social Care Bill will create a new, integrated, independent health and social care regulator—the Care Quality Commission. The hon. Gentleman is aware that we are seeking to amend the Bill to reinstate the Government’s original intention when passing the Human Rights Act 1998, which is that the independent care home sector should be directly subject to duties under that Act for the publicly arranged residential care that they provide.
Whatever the care setting, the Care Quality Commission will provide assurance that services are safe, people are not put at risk of harm and essential levels of service quality are maintained. The requirements that providers will have to meet will be set by the Government in secondary legislation—we debated that at length in Committee—and monitored and enforced by the Care Quality Commission. They will replace the existing core standards for better health in the NHS and the national minimum standards and regulations that apply to social care and independent sector care providers.
The independent Healthcare Commission’s most recent survey, of 14 May, states that overall satisfaction with care remains high and is increasing with 92 per cent. of patients saying that their care is either good, very good or excellent. The same survey shows that only 3 per cent. of patients say that they have been treated in an undignified way. The survey also shows improvements on some other issues that hon. Members raised, such as food quality. I shall come to some specific matters in a moment and explain how we hope to do better.
The national health service operating framework is basically the orders that go out to the service from the chief executive of the NHS, David Nicholson, setting its priorities in every year. For the last year, it has contained for the first time a core strategic requirement for a good user experience so that users of the health service feel that their dignity is respected. Health and social care providers will be measured against that standard.
A number of hon. Members talked about the importance of investment in nursing and the quality of nurse training, including issues of dignity. I am sure that they are aware that we have invested considerable extra resources in the number of nurses and in nurse training. There are 80,000 more nurses in the NHS than in 1997, 51 per cent. more students entered training to become nurses or midwives during the same period, and there are more senior nurses to help to drive up standards, including 831 nurse consultants and a commitment to increase the number of matrons to 5,000 to improve the quality of nursing.
I assure the hon. Member for Leeds, North-West that dignity is a core part of nurse training. The issue is not that it is not there and needs to be introduced. No nurse has ever been educated to say to anyone, “Go in the bed.” That was one of the appalling findings that came out of the Tunbridge Wells and Maidstone inquiry.
I hope the hon. Gentleman will forgive me if I misunderstood, but I thought he implied that he would like dignity to be a core part of nurse training. It already is. However, it is also a core part of what is required from health providers. He can check the record on that if he wishes.
I suggest that the hon. Gentleman check the record.
The hon. Member for Newbury mentioned the case of one of his constituents, Jenny Pitman, who had a terrible experience in relation to a parent who was in hospital. My information is that the trust concerned is working closely with Jenny Pitman. She has quarterly meetings with the director of nursing to monitor progress on infection control; I think she has such a meeting next week.
On the general issue of infection control and health care-associated infections, I am sure that the hon. Gentleman will be pleased to note that the latest Health Protection Agency figures show a 30 per cent. decrease in MRSA—methicillin-resistant Staphylococcus aureus—to December 2007, for the last 12 months for which figures are available. There has been a decrease in C. difficile of 23 per cent. during the same period.
The hon. Gentleman’s local hospital, which I imagine is the Royal Berkshire in Newbury, has had an encouraging 60 per cent. decrease in MRSA in just six months between April and December 2007. That is a tremendous tribute to the hard work of the staff and management of that hospital, which also had a 15 per cent. reduction in C-difficile in the same period. I hope that he welcomes those great strides forward by his local hospital.
The hon. Gentleman was kind enough to acknowledge that overall the NHS does an excellent job, that heroic work is done and that millions of people get excellent treatment—indeed, the hon. Member for Guildford (Anne Milton) said the same from the Conservative Front Bench—but he gave a number of specific examples of the service that people received not coming up to scratch.
The examples used by the hon. Gentleman related to unacceptably poor treatment. It is important that if a patient—an elderly patient or, indeed, the relative of an elderly patient—experiences what they believe to be unacceptable treatment, they use the robust and independent complaints process that is now in place to put those matters right. I have seen a number of cases involving people who have gone to the newspapers or come to my surgery to make such complaints. People need to have more confidence in the independent complaints process.
We have an independent Healthcare Commission to deal with such matters and an ombudsman, which is the second tier for complaints. It is important that people use that system because in the annual reports of the Healthcare Commission trusts are judged by the number of complaints made and how they dealt with them. If people do not bother to complain, the danger is that there will not be an incentive for the service to get better.
Is the Minister aware that last year a report by Which? stated that people are concerned about what to do when an elderly relative is already in a care setting? There is huge concern—I have felt it myself—that if a complaint is made, it will be taken out on the relative who is still in the care setting.
Yes, I am aware of that report. As politicians, it is important that we all encourage people to have faith in what most of us accept is a sound and robust independent complaints structure. It would be completely unacceptable for any organisation or trust to take it out on anyone who complained, as the hon. Lady mentioned. In my experience, only by using the complaints process are some of the problems uncovered and therefore resolved.
Incidentally, I also encourage staff to complain. I think the hon. Lady said that staff are often nervous of complaining when they see substandard behaviour in their own hospitals. We have a culture of encouraging whistleblowing in the health service and it is important that staff feel confident to complain—anonymously if they prefer to do so—to ensure that problems are dealt with firmly and robustly.
A couple of surveys on mixed-sex wards have been published in the past few weeks. One was from Ipsos MORI and the other was included in the annual Healthcare Commission patient survey. Both found a welcome decrease in the number of patients who reported sharing a sleeping area with a patient of the opposite sex. We welcome that. However, we also acknowledge that there remains some way to go for us to deliver on our commitment to reduce mixed-sex accommodation to a minimum.
Although occasionally the need to treat and admit a patient has to take precedence over complete gender separation, everything possible should be done to maximise privacy and dignity in those situations. We do not think it desirable to turn patients away just because the right bed is not immediately available.
This year’s NHS operating framework states that, at local level, primary care trusts should assess the situation in all trusts in their area and agree, publish and implement stretching local targets for improvement. Given that, we hope and expect to see significant improvement in the Healthcare Commission survey scores for next year.
As I mentioned, my hon. Friend the Member for Bury, South normally speaks on this issue, but he cannot be with us today because he is launching the latest strand of the dignity campaign, which he established in 2006. As a number of hon. Members are, I am sure, aware, the purpose of the campaign is to create a health and social care system in which there is zero tolerance of abuse and disrespect for older people. That includes simple things that many hon. Members have mentioned, such as respecting privacy, helping people to use the bathroom, addressing people in the way that they prefer, listening to people, helping people to eat food if necessary, and ensuring that food is placed where it can be reached. All those small things can make a huge difference to an older person who is staying in hospital.
The hon. Member for Newbury and his Front-Bench colleague, the hon. Member for Guildford, mentioned nutrition. We had a long discussion about that in the Health and Social Care Bill Committee. I wish to correct the hon. Gentleman: the issue was not that the Government were not interested in doing anything on nutrition, as he implied. As my right hon. Friend the Member for Oxford, East (Mr. Smith) made clear, we are doing a lot in relation to nutrition and nutritional standards are improving all the time, although they are improving more quickly in some hospitals than in others.
The Government resisted an amendment tabled by the hon. Gentleman’s party to include a requirement in the Bill for nutrition to be part of the new system that the Healthcare Commission will police, alongside health care-associated infections, which are fatal in many cases, as he rightly outlined. However, we have made it clear—we are consulting on this—that, under the new auspices of the Care Quality Commission, nutrition and nutritional quality should be part of the registration standards. Therefore, in extremis, if a hospital was not providing adequate nutrition or adequately helping patients with eating and feeding, it could lose its registration and therefore its licence to operate.
We also had a long debate on the issue of people who come into and go out of hospital suffering from malnutrition. If the hon. Gentleman is interested in the matter, he may want to check the record. Without going over the matter in great detail, one has to be careful about taking the statistics at face value. If someone goes into hospital with an underlying malnutritional problem, that will often not be the first episode for which they are treated, so they will be registered as being treated for something else apart from malnutrition. Only after they have been in hospital for a while and when the initial superficial condition for which they are being treated or operated on is dealt with will malnutrition be registered as an episode. That can often be the last episode, which is why, when one considers the stark figures, it looks as if more people leave hospital malnourished than enter hospital malnourished. That is not the case, and it is important that we bear that in mind when we make such claims.
On the dignity campaign, we now have a network of more than 1,800 dignity champions who are out in the community, improving dignity in their local areas, putting dignity on the local agenda and tackling bad practice when they see it. They are unpaid volunteers who are often managers, councillors, health and social care staff and ordinary members of the public. They are making a difference.
As Nursing Times has pointed out, the number of cases of abuse of older people coming before the nursing regulator has halved in the last year alone. In addition to the dignity champions, to whom I have already referred, thousands of people in care homes and hospices have benefited from the—
BBC World News
It gives me great pleasure to introduce this short debate on the future of BBC World News. In our roles as Members of Parliament or Ministers, occasionally we have the great privilege of going abroad to represent Parliament or the Government. For example, I note from yesterday’s press conference involving the press officers to my right hon. Friend the Prime Minister that my hon. Friend the Minister for Sport is, quite rightly, going to the European cup final tomorrow in Moscow, accompanied by my right hon. Friend the Secretary of State for Culture, Media and Sport. The press spokesman for the Prime Minister said that that would be the only occasion on which the Secretary of State, who is an Everton supporter, would ever get to such a European final. The Minister for Sport, as well as being a Bradford City supporter, is a Manchester United supporter, so he is in a happier position.
I am preparing for my sixth visit to Mongolia in my role as chair of the all-party group on Mongolia. I will be representing Parliament and the all-party group. Why do I mention that? I do so because as MPs or Ministers, we find ourselves in hotel rooms around the world, and what do people do when they go into a hotel room for the first time? I stress that I am talking about when they are on official business. They might look at the view. They might look at how big the bathroom is or see how comfortable the bed is. They might even be tempted to look at what is in the mini-bar. However, when I go into a hotel room abroad, I look straight away at the list of channels on the TV. If I am in a region of the world for some days, it is with great relief that I see that there is not only CNN on the news channels but BBC World News and that there will not just be an American perspective while I am there.
BBC World News is increasingly successful at getting its coverage into hotel rooms. It is in 1.3 million hotel rooms around the world, which represents a 25 per cent. increase over the past two years. In China, a very important market, BBC World News is in 250,000 hotel rooms—a 40 per cent. increase in the past two years. BBC World News is now available in 281 million homes around the world and 1.3 million hotel rooms, as I said, and on 48 cruise ships, 37 airlines and 29 mobile phone platforms. With 76 million viewers a week, it is the most watched BBC television channel.
I have initiated the debate for several reasons: first, to consider the financial model of BBC World News, which is a success; secondly, to consider the quality of programming; and thirdly, to consider the future of BBC World News. It is an example of what I understand is commonly known in diplomatic circles these days as soft power. The British Council, the BBC World Service on the radio and online and BBC World News represent a great influence for our nation among key decision makers. I would put the BBC on a level with other things that Britain is known for—premier league football and popular music from the Beatles onwards. The BBC stands in that trinity of things with which Britain is seen to make its mark in the world.
However, BBC World News, in comparison with the World Service, has not been examined sufficiently in the House. The World Service is often praised. World leaders such as President Gorbachev and President Mandela have said how much they were influenced by the World Service. However, BBC World News is now becoming a symbol of modernity, and I shall recount two stories of my own to illustrate that. Once when I was in Syria on parliamentary business, I went to a local bar, and two things were noticeable about that bar. One was that people were playing snooker in the corner. The second was that on the television was BBC World News. Just as in Britain a bar would have Sky Sports News on the TV to show how fashionable it was, there was BBC World News on a TV in the middle of Damascus. With that and the snooker, the pub was clearly making a statement that it was looking outwards to the world.
Equally, I was in Belgrade and went to see representatives of the one political party that accepts the independence of Kosovo, which is called the Liberal Democrats. Again, to show how modern they were, they had a picture of our former Prime Minister, Tony Blair, on the wall, and in the corner, very ostentatiously, was BBC World News on the TV. That was an unspoken statement on their part of modernity and contact with the world outside.
BBC World News competes in a fierce market, and its financial model is successful. It shows that a public service can be enterprising, make money and act in a very entrepreneurial way, because BBC World News, unlike the World Service, is not subsidised by one penny of taxpayers’ money. It started in 1991 as BBC World Service Television. In 1995, the right hon. Member for Charnwood (Mr. Dorrell), when he was Secretary of State for National Heritage, gave it permission to operate under the name BBC World, which has recently been changed to BBC World News. However, the financial model whereby no licence fee payers’ money goes towards it has continued throughout that period.
We can compare BBC World News with the French news channel, France 24, which was launched in 2006. The Independent reported at the time that France 24 was to take on “‘le rosbif’ TV”, which was BBC World News. The French channel has a very heavy taxpayers’ subsidy. The French Government allocated €100 million for the launch of the project, and its annual budget is €80 million, most of which comes, I understand, from the French state.
Another competitor of BBC World News, al-Jazeera, received a start-up grant of $150 million from the Emir of Qatar. He aimed to make it self-sufficient through advertising by 2001. When that failed to occur, the Emir agreed to continue subsidising it on a year-to-year basis, with $30 million having been given in the last recorded year. Equally, NHK in Japan is launching an international news service that is heavily subsidised.
It is therefore a success story that BBC World News is on target to break even in 2010-11. That would be a remarkable achievement. Advertising sales are up by 20 per cent. per annum over the past six years. Over the past five years, BBC World News has doubled its total revenue and halved the deficit. To cover the deficit, BBC World News takes out loans, but it is now within sight of being able to break even. It is worthy of note and some celebration that that has been achieved.
The quality of programming has significantly increased in recent years. BBC World News produces 26-minute bulletins on the hour, pretty well every hour. It has more magazine programmes, such as “World News Today”, transmitted three times during the day. It has big-name BBC presenters such as George Alagiah and Zeinab Badawi, and its popularity is spreading in America. In the aftermath of the Iraq war, it is possible that people in America are increasingly looking for more balanced news, and that has given the BBC its first chance to get a foothold, with BBC America and BBC World News, in the States. Matt Frei presents BBC World News America, which is available on BBC News 24 as well. That has been a big breakthrough. There are programmes such as “Have Your Say”, a weekly programme that allows viewers to share their thoughts and questions with guests. That is also on BBC World Service radio. Other programmes such as the “Doha Debates” come from the middle east. The “Doha Debates” are done in Doha in Qatar; the Emir’s Qatar Foundation provides some of the money, but the programmes maintain the BBC’s news values of unbiased coverage. Those debates, broadcast on BBC World News, cover many controversial issues in a format that would not normally occur in the middle east. For example, the subject of a recent debate was “This House believes that the Sunni Shi’a conflict is damaging Islam’s reputation as a religion of peace”. The subject was fiercely debated, and the programme was transmitted around the world.
BBC World News also broadcasts a series of world debates. Last weekend, it considered the role of business and how accountable it is. Again, the debate confronted key issues such as the future of the planet, and well-known guests gave their views. Because of the BBC’s power and reputation, it attracted guests who would possibly not be attracted by other formats.
The programming has definitely improved. The eternal dilemma of BBC World News is that it is a world news channel; the question is how much should it reflect what is happening in Britain? The big criticism of CNN is that it is biased and focuses too much on America. However, there have been some developments in recent months on BBC World News. For example, “Football Focus” can now be seen on BBC World News, as can “Final Score”, which means that people who are travelling abroad can at least see the latest football scores; and a compendium of “Newsnight” is broadcast for half an hour each week.
Looking ahead, the managers of BBC World News will have to get that balance right. There is probably a debate, particularly among British citizens who travel around the world, as to whether more should be broadcast about what is happening in Britain, but on the other hand the channel has to keep its reputation as a world news channel to the forefront.
Access to the channel is a key issue. All MPs can watch BBC World News in their offices. If the Minister travels on the Heathrow Express tomorrow en route to the European final in Moscow, he will be able to see a shortened version of BBC World News. If you, Mr. Martlew, find it difficult to sleep tonight, you will be able to watch it because BBC News 24 and BBC World News merge in the early hours—between about 1 am and 4 o’clock. If you watch BBC 4 at about 7 o'clock tonight, you will see exactly the same news for half an hour as can be seen on BBC World News.
BBC World News is about in the United Kingdom, and it can be seen from time to time. However, under the original document that allowed BBC World News to be broadcast, it is not officially available in the UK. One can direct a satellite at the Astra 1, Hotbird or Astra 4 satellites and pick it up. It is not illegal and it can be done, but the BBC is constrained from advertising the service.
Will the Minister say whether, under the new charter, it will be a decision for the Department for Culture, Media and Sport, as it was in the past; or can the BBC Trust decide to allow a wider audience in the UK to have sight of BBC World News? My understanding is that if the BBC management wanted to put a proposal to the BBC Trust it could do so; however, the proposal would have to be judged on whether it would have an adverse commercial impact on other broadcasters of world news broadcasting in the UK, and various other factors. Is it a decision for Government or for the BBC Trust?
One of the principal reasons for this debate was my wish to clarify the matter. There was a time when the BBC World Service radio service was not available in the United Kingdom. It then became available in the middle of the night, when Radio 4 was not broadcasting, and insomniacs could listen to it. Then, very sensibly, a couple of years ago came the expansion of digital TV and so on, and one can now listen happily to the World Service.
My central contention is that if one can listen to the World Service, is there a substantive reason why one should not be able to view BBC World News? Why should it not be available on platforms like Freesat? After all, it is part of the BBC; it is something of which we should be proud. It gives a more international flavour to the news. Its wider availability in Britain would not seriously damage other international broadcasters such as al-Jazeera, Sky News and so on. It would provide a little more competition in the market, and a little more choice for viewers.
Good afternoon, Mr. Martlew. I start by congratulating my hon. Friend the Member for Selby (Mr. Grogan) on securing this debate. I confirm that I shall be travelling on the Heathrow Express tomorrow morning, and I shall watch BBC World News, as I regularly do. I shall be going to Moscow to support Manchester United; I hope that the game is without incident and that everyone enjoys a successful time in Moscow watching British football.
My hon. Friend is a hero. Not only is he a renowned Bradford City supporter and a hero in Selby, but he is a hero in Mongolia. He has visited Mongolia on a number of occasions, and I know that he is held in high esteem there. He is also a champion of other causes about which people care passionately—not least as chairman of the all-party beer group. Indeed, his interest in broadcasting is well known—not only on such issues as BBC World News but television issues in general, not least the listing of sporting events on terrestrial TV.
I am grateful to my hon. Friend for taking such a positive outlook about BBC World News. I confirm much of what he said about the channel, which was known as BBC World until last month. It is a commercial channel, funded through subscription and advertising. It broadcasts international news, sport, weather, business, current affairs and documentary programmes in English to more than 20 countries and territories. It has a total distribution of 276 million households worldwide, including some who watch the channel part-time—for example, some bulletins are available on public service broadcast stations in the United States.
As my hon. Friend said, 159 million households are able to view the channel 24/7; that figure increased by 14 per cent. over the last two years and by 50 per cent. over the last five years. The channel is available in nearly 1.6 million hotels rooms worldwide—an increase of 25 per cent. over the last two years. A major growth area is China. BBC World News is available in nearly 250,000 hotel rooms there, an increase of more than 40 per cent. over the last two years. As my hon. Friend said, the channel is available also on 57 cruise ships, 42 airlines and 34 mobile phone platforms.
BBC World News has a weekly audience of 78 million people. It is the BBC’s most watched television channel. Its weekly audience has grown by 20 per cent. over the last two years. Based on research surveys regularly conducted in the key European and Asia-Pacific markets, its weekly audience has grown over the last five years by 50 per cent. in Europe and by 25 per cent. in the Asia-Pacific market. As my hon. Friend said, a media brand value survey published in April and conducted on three continents revealed that it had high trust and influence among some of the world’s most influential business professionals. Respondents placed BBC World News ahead of competitors Bloomberg, CNBC Europe and CNN in the brand value categories of trust and influence. That is clearly impressive.
As my hon. Friend said, BBC World News is a loss-making organisation, but its financial position is improving. Over the last four years it has halved its losses, and over the last five years it has tripled its advertising revenues and doubled its total revenue. As my hon. Friend said, it receives no public funding or subsidy from the licence fee.
The House will doubtless be aware that the BBC has for many years been allowed to operate commercial services, which generate income and return value to licence fee payers, thereby reducing pressure on the licence fee. The firm conclusion of the BBC charter review, backed up by consultation and research, was that it is right to maintain that principle. The BBC should seek to maximise commercial revenue in appropriate areas and reinvest it in programming and talent to the benefit of licence fee payers. BBC commercial activity must be based on four principles. First, the activity must fit the BBC’s public purposes and, secondly, display commercial efficiency—in the case of BBC World, that assessment must be made against the financial targets set in the business plan that was agreed by previous BBC governors. Thirdly, the BBC brand must be protected and, fourthly, market distortion must be avoided.
BBC World News is owned and operated by BBC World Ltd, which is a member of the BBC’s commercial group of companies. Under the terms of the BBC royal charter and its agreement with the Government, the BBC executive board is responsible for overseeing the activities of the BBC’s commercial arm. The BBC Trust is responsible for setting the rules that relate to the approval of changes to the BBC’s commercial services and it must hold the executive board to account for ensuring that commercial services comply with those rules.
The trust is responsible for holding the executive to account for complying with the criteria for commercial services. Parts of the assessment may well go against the individual criteria objectively and quantifiably, but the overall decision is inevitably a matter of judgment. The trust needs to assure itself that systems are in place to cover the interpretation and application of the criteria. For example, when assessing whether individual magazine titles fit the BBC’s public purposes, the trust might consider the extent to which editorial content aligns with a programme’s output. In assessing whether an activity displays commercial efficiency, the trust will need to consider whether better value for money could be obtained by selling individual commercial services or by closing them down.
The trust requires the executive to demonstrate how a particular service delivers the best possible return for the licence fee payer with reference to comparable operators in the individual market. It is the trust’s responsibility to challenge the targets set by the executive. The latter is required to submit a full and open assessment of the performance of the commercial services, including a statement of compliance to the four criteria.
It is a fundamental principle—it is written into the agreement—that there should be no cross-subsidy from the BBC’s public services to its commercial activities. In other words, commercial services must not be underwritten by the licence fee payer. The trust is responsible for ensuring that appropriate safeguards are in place, including fully separate accounts and clear terms on which transactions are conducted between public services and commercial activities.
My hon. Friend asked why BBC World News does not broadcast in the UK in areas other than those he mentioned. The reason arises from the terms of the original approval for the services granted in 1994, as he said, by the previous Government. Under those terms, the BBC was required to operate the service on the basis that it was for reception in mainland Europe and not the UK. As I understand it, that was to alleviate concerns about the competitive effects of a commercial channel on domestic channels. As I said, under the BBC charter and agreement, responsibility for approval of, and changes to, the service now rests ultimately with the BBC Trust. I understand that when it approved the service, the trust wanted to preserve the terms of the original approval, meaning that the service cannot be broadcast in the UK. I hope that that answers his question.
Broadcasting a service to the UK would now amount to a change to the BBC’s commercial services. That would require approval because it would be a change to the strategy for the commercial services set by BBC Commercial Holdings Ltd and the executive board. Any change would also be subject to approval by the trust under the requirements of the commercial services protocol, which requires trust approval for changes that fall outside the strategy for commercial services approved by the trust. I understand that the BBC has no plans to propose that the service is broadcast in the UK and, under the terms of the charter and agreement, there is no provision for the Government to intervene. However, my hon. Friend has raised the matter in the debate and I am sure that the BBC will hear of his remarks. I am sure that he will continue to press for changes in his usual combative manner to ensure that his voice is heard.
I was interested to hear my hon. Friend talk about the many visits that he rightly makes on behalf of his constituents and the many bodies in the House to which he belongs. However, he is perhaps limited if all he does is look at the TV screens when he stays in hotels or, indeed, visits the bars of the world. I know that he will continue to put forward the positive aspects of the BBC. He has made some good points in the debate and I hope that it listens to what he has to say.
Strategic Framework (FCO)
I am delighted to have secured this debate and to serve under your chairmanship for what I believe is the first time, Mr. Martlew.
I do not intend to do the Minister’s job, but I thought it would be helpful to outline exactly what we are talking about, because I imagine that various documents are called “Strategic Framework for the Foreign and Commonwealth Office”. I wish to talk about the framework launched by the Foreign Secretary in a written ministerial statement on 23 January. It has since been published on the Foreign and Commonwealth Office website and informs its departmental report. I believe that it took effect on 1 April.
The written statement is of great interest—it is right that the Foreign Office reviews its overall strategic direction, priorities and so on from time to time. I strongly applaud various aspects of the framework, including counter-terrorism, counter-proliferation, climate change and conflict zones such as Afghanistan. To digress slightly, the Foreign Office has done particularly well on counter-terrorism in the past six years—in many ways, it sets global standards. I saw for myself in Kano, Nigeria, some of the helpful work that it does to match British Muslims with Muslims in other countries to exchange best practice on community cohesion and the softer counter-terrorism work.
On the set of goals in the strategic framework, I regret that the promotion of democracy has been transferred to the Department for International Development. I think that it more properly belongs with the FCO, but adding goals and objectives to the strategic framework is not the main purpose of my remarks; rather, they are less about what is in the document than what is not, and the resources that the Foreign Office has or does not have to meet the objectives of the framework—the issue is more the Foreign Office’s capacity and infrastructure to deliver the framework.
The FCO’s overall budget is projected to be £1.7 billion by 2010-11, which is not an awful lot. It is significant, but compared with the £2.7 billion of extra borrowing announced last week, it is not that great an amount. We can also compare it with the newly-nationalised Northern Rock bank, which has more than £100 billion in assets. Overall, we get good value for money from the £1.7 billion given to the FCO, but it represents a reduction in the budget. The Foreign Affairs Committee calls it
“an average real annual reduction of 0.2 per cent.”
It also says in its annual report published on 19 November 2007 that the amount
“compares poorly to the settlements of other departments”,
“risks jeopardising the FCO’s important work”
“if the FCO’s settlement is compared against its expenditure plans for 2007-08 as set out in Public Expenditure Statistical Analyses, we calculate the change in budget as an average real reduction to be…5.1 per cent. per annum”.
I have some doubts about whether the strategic framework document is deliverable on such a budget. Doubtless the FCO will manage—it always has—but overall Government expenditure is riddled with waste and there is not much on the FCO’s bones to take off, as it were, if we wish to achieve the overall goals.
I want shortly to compare our budget with the budgets of some of our European allies, but the contrast with what the United States is doing with its State Department budget is particularly striking. Having perhaps learned from the period 2001-04, the US is beefing up its soft diplomatic power quite considerably. On 26 November 2007, the US Defence Secretary, Robert Gates said:
“What is clear to me is that there is a need for a dramatic increase in spending on the civilian instruments of national security—diplomacy, strategic communications, foreign assistance, civic action, and economic reconstruction and development”.
In 2006, when launching the transformational diplomacy initiative, the Secretary of State, Condoleezza Rice, talked about the need for more diplomats to be sent to trouble hotspots, creating regional public diplomacy centres and small, localised posts outside foreign capitals, and training diplomats in new skills.
In the State Department’s budget for the financial year that has just finished, $124.8 million was allocated to transformational diplomacy. That included $40 million for the geographical repositioning of jobs and about $36 million for language training, public diplomacy, technological training and so on. That $125 million was up from $103 million the previous year. Between 2007 and 2008, the United States increased its overall foreign affairs spending by $6 billion. In terms of sheer numbers, therefore, our budget is not only contracting in real terms, but, unfortunately, going in the opposite direction to that of our leading ally and those of some of our European allies.
The change in the number of our embassies and consulates over the past 10 years has been particularly stark. Since May 1997, the Government have closed eight embassies, six high commissions and 18 consulates—that is 32 closures in the past 11 years, and two more high commissions will close this year. To be fair, some new outposts have opened in that time, but only 13, most of which have been in new countries, such as Montenegro, where an embassy had obviously become a necessity. Overall, however, there has been a significant decline in the number of Foreign and Commonwealth Office outposts abroad.
I find it particularly striking that we have less presence across the world than other European countries of comparable size. In Latin America, for example, we have four fewer outposts than France and two fewer than Germany. Strikingly, we are directly represented in fewer UN countries than France, Germany or Italy. In Africa, Lord Malloch-Brown was challenged over why we had no representation in 23 of the 53 African states. He conceded the point, but rather incongruously said that the Government were
“trying to grow our diplomatic footprint in Africa”.
I question how we can do that when the number of outposts is rapidly contracting.
On 8 November 2006, Lord Hannay told the Foreign Affairs Committee:
“When I was doing the job…as ambassador to the UN, the world had an inconvenient habit of finding itself in the middle of crises in places where Britain did not have embassies: Kigali in Rwanda, Haiti, Somalia and Afghanistan. Your capacity to operate effectively was cut by a large amount by not having an independent, objective flow of information coming in.”
Today, we have no representation on the ground in 50 to 60 states. That includes obvious places such as San Marino and Liechtenstein, where nobody would argue that Britain should be represented. However, it also includes serious trouble spots, such as Chad, Equatorial Guinea, Kyrgyzstan and Somalia. Our diplomatic footprint has therefore been dangerously shrinking, contrary to assurances given in Parliament.
The number of diplomats has also been declining, and that decline is projected to increase. As many people know, at various times the Foreign Office has too many people in a particular coterie to fill certain positions, because of its pyramid structure. I believe that currently it has a lot of people in their early, mid and later forties. Given the number of diplomats that the Foreign Office projects it will shed over the coming years, however, the situation will become very dangerous, particularly in the lower ranks. The Foreign Office recently announced that it would cut the number of diplomats from 6,000 to 5,400 in the next five years, but such people are vital to our efforts. On 8 November 2006, Sir Jeremy Greenstock, also a former ambassador to the United Nations, told the Foreign Affairs Committee:
“We are finding that the size of post, the spread of the Foreign Office’s work, the capacity to construct relationships and to negotiate, the experience gained by a slimmer number each year of men and women in important but more junior roles in embassies abroad because numbers have been cut is leading to a progressive decline in the capacity of the Foreign Office to cover every aspect of diplomacy.”
We are, therefore, looking at not only a reduction in the number of postings, but a significant reduction in the number of those who are posted. Again, that leads me to doubt whether the strategic framework will be realised.
I want to discuss the specific issue of the Foreign and Commonwealth Office’s language school, which is earmarked for closure. I am not sure whether the closure has already taken place or is about to take place, but it seems that it will go ahead. The closure will save only £1.5 million a year as part of what is described as the “new business model”. The number of diplomats in the FCO who receive language training has been in decline for some time—that is not a new phenomenon. Figures from the Foreign Affairs Committee show that 405 people received language training in 2005-06 and that that fell to 252 in the 2007 financial year. The language school is, however, a crown jewel, which it might be difficult, if not impossible, to recreate in future years.
Of course, languages can be learned elsewhere, and no one would deny that there is no point the Foreign Office setting up a whole infrastructure for small and minority languages where that expertise exists, such as in the School of Oriental and African Studies or the School of Slavonic and East European Studies. While I was at university, I attended Czech language classes that were part-funded by the Foreign Office, and I want to use my experience to illustrate the importance and utility of learning minority languages, which have turned out to be rather useful in ways that one could not have predicted 20 years ago.
I want to use a practical example and to name one of our diplomats. I have not spoken to him about the debate and I have not had any contact with him since I met him in November. However, he is a good example of somebody who has used language training to augment and improve our diplomatic efforts on the ground.
I have in mind our excellent ambassador in Skopje, in Macedonia, Mr. Andrew Key. As part of its work, the European Scrutiny Committee visited Macedonia in November 2007, and the FCO website says that Mr. Key presented his credentials only at the beginning of September 2007. None the less, he was pretty much the only ambassador from one of the major European countries to have put significant effort into learning Macedonian. He was already fluent in Chinese and had taken out two months to learn Macedonian.
We had a meeting with the Prime Minister of Macedonia, Mr. Nikola Gruevski, and my knowledge of Czech allowed me to understand enough Macedonian to get the gist of what was going on. It was quite clear from the exchanges with the Prime Minister that Mr. Key could speak Macedonian to an extremely good level. The Prime Minister said to me how important that was, and what a message it sent: although the Prime Minister could speak very good English, and most other people whom our ambassador would come across could speak it in their official capacity, it still conveyed a positive impression and gave our ambassador an edge over some of the other people on the ground.
Macedonian is a small language, but Macedonia is an extremely important country at the moment, not least for being next door to Kosovo and being an EU applicant country. It is also a potential trouble spot in its own right. It is important for us that our ambassador can engage fully in his role there. I do not know whether he learned his Macedonian at the Foreign Office language school, and do not want to give that impression if it is not so. I merely use the example to show how important the knowledge of languages—even obscure minority languages—can be for our efforts on the ground. The language school decision will obviously save a little money, but over a longer period it will prove a false economy. Greater savings could be made elsewhere in Government.
I want to deal briefly with two or three other matters, starting with the BBC World Service and the economies being driven through in the Russian language service. The eastern European services were closed a year or two ago, which probably made sense. It did not seem to make much sense still to broadcast in Polish and Czech when those countries were pretty much fully integrated members of the EU. However, many of the cuts in the Russian language service are disturbing. The reliance placed on local providers—especially on shortwave networks that have since been closed down by the Russian Government—is a disturbing phenomenon.
The second topic I want to mention is Commonwealth scholarships, which are featured in the annual departmental report. I understand that they have been greatly reduced or eliminated. I mentioned earlier that in Nigeria I met two or three people who had such scholarships and that it struck me that the value for money was extremely good.
The third issue, which is very important and which I am surprised has led to budget problems, is increased security in several of our consulates and embassies. The Istanbul consulate bombing was in 2002 and I know for a fact that in a number of our embassies and consulates, such as in north Africa and the middle east, it led to a serious and understandable review of security. The embassy in Algiers, for example, is undergoing, or is about to undergo, an expensive reconstruction project. That seems inevitable and right, but I am disturbed to hear that, in a general sense, some of the budget for security improvements and changes that was already agreed has been cut out by the Treasury.
An Opposition politician may say that spending should not be cut on this, that or the other, but where could savings be made? The Foreign Office could make significant savings by looking at one of its biggest projects: the FCO website. Everyone recognises the importance of a good, capable website for the FCO, but I doubt whether it will replace highly trained staff on the ground and fixed facilities. The FCO is not like other Departments in the matter of trying to find economies. It strikes me that the money being poured into the development of what must be one of the world’s most expensive websites could be better deployed.
In a parliamentary answer to my hon. Friend the Member for Eddisbury (Mr. O’Brien) on 25 April, the Minister for Europe called the website change an “upgrade”, with an
“initial cost of £9.7 million”.
That is just for one website. Admittedly, it is a portal serving the whole FCO globally, with all our embassies, consulates, high commissions and so on being run out of the same website, but as well as that initial cost of £9.7 million, we were told that
“the project is on target to cost £19.2 million over five years”.
We were also told:
“The web is vital for the delivery of the FCO’s Departmental Strategic Objectives.” —[Official Report, 25 April 2008; Vol. 474, c. 2321W.]
I agree with that, but the amount being poured into the website—almost £20 million, which is far more than has been spent on the language school—is questionable. I am interested to hear the Minister’s defence of spending that enormous sum on one website.
I disagree not so much about the Foreign Office’s strategic framework as about how it can be achieved, and about some of the directions being taken by the FCO. I believe strongly that the FCO will need a growing number of experienced and highly trained diplomats on the ground—skilled in languages, technology, commercial and other important skills—in as many key places as resources allow. Ironically, the United States and some of our European allies are showing the way forward in that respect, and we seem to be going in the wrong direction.
I look forward to the Minister’s response to the points that I have made. It seems to me that we are asking more and more of the FCO and giving it in return fewer and fewer resources to achieve it.
I congratulate the hon. Member for Hammersmith and Fulham (Mr. Hands) on securing this debate, which gives us an opportunity to highlight the important topic of how the Foreign and Commonwealth Office can best promote UK interests internationally. Although the hon. Gentleman’s title for the debate should perhaps have referred to the budget, rather than the strategic framework, I shall try my best to answer the points he made.
As globalisation proceeds and speeds up, the barriers between domestic and international affairs are breaking down. Almost every area of domestic policy now has important international dimensions. The role of the FCO has to change in response to those changing circumstances, to ensure that it continues to deliver for the UK. We keep the role and objectives of the FCO under regular review and, as the hon. Gentleman knows, the latest such review was announced by my right hon. Friend the Foreign Secretary on 23 January. I stress that it was not an efficiency exercise, but was carried out to provide greater clarity about the purpose of the Department, and to focus our resources where they can achieve the greatest positive impact for the UK.
The new strategy identifies the three main roles for the Foreign Office: providing a flexible global network serving the Government as a whole; delivering essential services to the British public and business; and shaping and delivering the Government’s foreign policy. The new strategic framework will replace the 10 strategic priorities set out in the Foreign Office’s 2006 White Paper. That is in line with the view expressed by the Foreign Affairs Committee, among others, that
“ten strategic priorities is too many”
and that they should be
“simplified and reduced in number”.
The conclusions of the latest review were the result of a dialogue which took place externally with key stakeholders and on the FCO’s website; across Government, through discussions with other Departments; and internally, through contributions from staff across the world. The new strategic framework has been welcomed for its clarity by stakeholders and staff. The new strategy explicitly recognises for the first time the importance of the Foreign Office’s global network. We provide that network for the whole of the British Government, giving a platform for achieving the UK’s international objectives and for serving British people and businesses.
The global network remains vital and we continue to review it to ensure that resources are deployed in line with priorities and that they provide the best possible value for money. That is where the hon. Gentleman is plain wrong. Since 1997, the overall number of Foreign Office posts around the world has increased, from 242 to a total of 261 today. That includes three more embassies than there were in 1997.
The hon. Gentleman has misunderstood the strategic framework. In no way have we hived off the promotion of democracy to the Department for International Development or anybody else. It continues to be mainstream Foreign Office work, just like a range of other issues, including human rights. The Foreign Office regularly discusses such matters with Governments overseas, as do Foreign Office Ministers with their counterparts.
The new strategy recognises the importance of the essential services that we provide to the British people and British business. Our consular services will be sustained and our dedicated staff will continue to provide invaluable assistance around the world to Britons living, working and travelling abroad. Incidentally, the FCO website is a key platform for that work. Not only can people access information about the FCO there, but our new service, Locate, which I have launched in the past few days, enables people to register where in the world they will be. It has already had benefits in identifying where people are in crisis situations, such as the China earthquake.
I am talking about the whole range of our work. I merely point out to the hon. Gentleman that the website is an important part of everything else that we do.
We will continue to help British business and the UK economy through UK Trade and Investment. In addition, the Foreign Office will continue to support Britain’s migration objectives through our own work and in co-operation with the UK Border Agency.
To help to focus the Department’s policy efforts, the new strategic framework identified four policy goals where we can make the most difference: countering terrorism and proliferation, preventing and resolving conflict, promoting a low-carbon, high-growth global economy and developing effective international institutions, especially the UN and EU. As the new strategic framework is implemented, resources are being reallocated to the new priorities. We must ensure that our limited resources are deployed where they can have the greatest impact, including the new resources provided under the comprehensive spending review.
Contrary to what the hon. Gentleman suggested, the Foreign Office’s budget will increase from £1.6 billion in 2007-08 to £1.7 billion in 2010-11. That will provide substantial increases in resources, particularly for counter-terrorism—I thank him for his kind comments on that—climate change and our work in Afghanistan.
May I make a bit more progress? I am conscious of the time. I shall come back to the budget issues.
Funding for counter-proliferation, conflict prevention and international institutions is also set to increase, but by more modest amounts. We are increasing substantially the number of front-line officers in priority countries. About 60 extra policy staff will work on or in south Asia, Afghanistan and Asia Pacific. The number working on or in the middle east will also increase significantly, and more modest increases will occur in Africa, Russia, central Asia and multilateral organisations.
In our work force planning, staff numbers are predicted to decline slightly during that period. We are saving on back office and administrative functions to put resources more precisely into front-line work. At the same time, we have agreed a decrease of diplomatic staff in Europe. It is not that we consider Europe to be less important now; Europe will remain vital for the UK, not least because we live in it. However, we can do the essential work with fewer staff by delivering in a more flexible and targeted manner. Whitehall Departments can now operate more efficiently with fewer staff by taking advantage of modern technology and quicker and easier travel.
Similarly, we are reducing funding for certain policy areas, including three areas for which other Departments will take on more responsibility: sustainable development, science and innovation, and crime and drugs. We will not withdraw from those areas. Our ambassadors will remain heavily engaged where they are of particular importance to the UK, such as in the fights against drugs in Colombia and crime in Jamaica. Our posts overseas will continue to operate as bases where all Departments can locate their own staff and resources to deliver their own priorities. Our ambassadors will continue to offer Departments advice and act locally on their behalf on all the major issues affecting the UK.
Can I take the Minister back to the budget for a moment? She lauded what she called a substantial increase in funding for the FCO; I think that she said that its budget would increase from £1.6 billion to £1.7 billion over five years. That is only a 6 per cent. increase over five years, which is way below current and projected rates of inflation. Surely that means that the Select Committee on Foreign Affairs was right to point out the real-terms budget decreases? Does she agree with the Committee? From the evidence that she has just given, she must agree that they are real-terms cuts.
I said that there was an increase, and I set out the amount. The hon. Gentleman has obviously been sitting there using his calculator, or indeed mental arithmetic, to work that out. We make no apologies for becoming a more efficient and streamlined organisation. I am not sure whether we will get more information from him today about Conservative commitments to spend more money. I am not sure that his Front Bench Members would thank him for that. We are looking at how to work more effectively. I have said that we will reduce administrative posts to put more into the front line. I must correct his figures: the increase will take place over three years, not five. I assure him, as he raised so many points about the financial aspects, that I have not finished with the budget.
Our new priorities are also reflected in the work of our partner agencies. The BBC World Service will launch a new Persian television channel and extend its Arabic language TV broadcasting to 24 hours a day, seven days a week. In addition, the British Council will extend its efforts to build mutual understanding with Muslim societies—the hon. Gentleman praised that work, for which I thank him—particularly among alienated younger populations. With the BBC World Service and the British Council, we are pursuing ambitious efficiency programmes, and I make no apology for that. We are jointly committed to delivering £144 million in efficiency savings over the next three years through a wide range of projects.
The process is carefully managed. We have defined our strategy goals and we are aligning our resources with them over time, so that the sorts of problem that the hon. Gentleman wrongly suggested would occur will not occur. The decision on the language centre predates the strategic framework. It was undertaken under the previous Foreign Secretary. Having considered it, FCO Services concluded in 2006 that its language training services cost between 15 and 40 per cent. more than those offered by comparable providers. It is important that we look at the matter sensibly and put our resources where they are needed, ensuring that we are using the money in the best way. I should have thought that the hon. Gentleman would welcome that.
On scholarships and fellowships, we have consolidated our scholarship programmes and are focusing on the Chevening and Marshall schemes, the purpose of which is to build strong relations with the international leaders of the future. Again, I make no apologies for considering carefully where we want to have the most impact and putting our resources there.
As my right hon. Friend the Foreign Secretary explained in his statement to the House:
“every organisation, including every Government Department, should regularly reassess its own aims and priorities. Successful organisations stay focused on the biggest issues on which they can make the biggest difference, and they regularly readjust that focus as circumstances and priorities change.”—[Official Report, 23 January 2008; Vol. 470, c. 54WS.]
The Foreign Office’s new strategic framework will do that. It will refocus our efforts, reprioritise our resources and refresh our strategic approach. The four new policy goals that emerged from the review present a clear and concise picture of what we are trying to achieve, and associated changes to the resourcing of our network overseas indicate how we are going to achieve it.
Although we have a new strategic focus, we are determined to preserve the strengths of the Foreign Office and its staff: world-class diplomatic skills, understanding of other countries, and a sense of public service. I assure the hon. Gentleman that the combination of those talents with a sharper set of priorities will ensure that the FCO can better serve the UK’s interests internationally.
North East Ambulance Service
I have been trying to secure this debate for several months, and am very happy that I have now been able to do so. I would like to put on the record my thanks to Mr. Speaker for giving me the opportunity to raise this very important issue. I am also very pleased to see the Minister in her place. It will be the first time since she was appointed as a Minister that she will have responded to one of my debates. I praise her for all the good work that she is doing in the Department of Health.
Right hon. and hon. Members representing constituencies in Tees valley, some of whom are present, support the cause that I want to articulate today. I also have the strong support of all local councils in the Tees valley area.
I wish to speak about plans by the North East Ambulance Service NHS Trust to reconfigure its ambulance control rooms. The trust covers the whole of the north-east and, in Teesside, includes the whole of the former Cleveland county area. I make no criticism of any of the hard-working staff; my concern is about management proposals to alter the control arrangements. Currently, the NEAS structure has two command and control centres: one in Newcastle, operating out of Bernicia house—the NEAS headquarters in Newcastle business park—and one in Middlesbrough serving as a satellite centre to Newcastle and covering the old Cleveland county council area.
The Middlesbrough centre, which employs 25 staff, is based at Cleveland police headquarters in Coulby Newham, in my constituency. Close links have been developed with the existing Newcastle centre, and the technology is such that the Newcastle centre can act as a back-up for the Middlesbrough centre in call handling and ambulance dispatching. In a sense, therefore, we have an arrangement that functions well, and which meets the current need. However, the demands of the ambulance service are evolving. In particular, over the past few years, there has been an increasing demand on ambulance services, partly as a result of changes to out-of-hours coverage by general practitioners.
In that context, the demands by the Department for all ambulance trusts to install new digital radio communications systems had to be considered by the NEAS, as did the need to plan for heightened civil resilience in light of continuing terrorist threats. Those demands led the NEAS to set up a review of its own control and command facilities. However, I believe that it has come to a conclusion that is potentially damaging to the service provided in Teesside. It started by considering what form of configuration is needed to meet Department of Heath challenges.
On the basis of operation effectiveness, risk and cost, it came to the following conclusions. The first was that a single centre could be operationally effective and cheaply built, but face a high risk of disruption, through a technical breakdown, natural disaster or terrorist attack. The second conclusion was that, although having three or more centres would reduce the risk in such circumstances, the configuration could be confusing in an emergency. It decided, therefore, that having two independent, but linked centres was the option to pursue. It argued that such a configuration would be robust when dealing with risk or attack at one location. The second location could easily increase its level of service through shared software infrastructure. If built correctly, it could physically accommodate staff from the affected centre, which would, I believe, provide an effective service for the benefit of local people and for local hospitals. Looking at those options in the same manner, I would have come to the same conclusion.
That issue having been resolved, the next question was where best to locate the two centres, which is where our views diverge. The NEAS looked at possible locations across the whole region, including the current centres in Newcastle and Coulby Newham in Middlesbrough. It argues that a key factor that it had to consider was the need to conform with the requirements of the Civil Contingencies Act 2004. One requirement is that when planning for control and command resilience, split sites able to assume back-up
“should ideally not share common utility services”,
“be between 15 miles and one hour’s journey from the main, or affected, site”.
On that basis, and on the ability to redeploy staff, the NEAS decided that its preferred option for two centres would be its control room in Newcastle and a second centre, 10 miles away, at Hebburn on south Tyneside.
I do not disagree that the main Newcastle control room should be one such centre—that is operationally logical—but I question the possible location of the second centre, which, for the following reasons, should be on Teesside. First, we already have dedicated staff at Coulby Newham, and relocating to Tyneside would add up to two hours daily travelling for those living south of Coulby Newham or in areas such as Stokesley, Redcar or east Cleveland, which could reduce operational ability in facilitating staff shift handovers. Secondly, there has been an offer from Cleveland police for the centre to be operated from force premises, which would either be at the existing centre at Ladgate lane or at a newly built facility for any future move. There is little evidence, however, that that offer has been carefully considered.
Thirdly, the close proximity of the two proposed centres poses risks. Both rely on the same utilities for electricity and telephone lines. I gather that most major telephone trunk lines on Tyneside radiate out on a hub and spoke basis from central Newcastle. If a major incident were to happen in Newcastle, therefore, the outlying exchanges serving the Newburn and Hebburn areas could be cut off from each other. Likewise, although I am not certain about the pattern of high voltage distribution in Tyneside, I suspect that the same pattern might be replicated in that utility area. That would not be the case for Teesside, which is in an entirely different trunk route and telephone route, and relies on differing national grid connections.
My single biggest objection, however, is that Teesside has one special characteristic that demands an ambulance control room presence in this sub-region. Teesside is one of the global centres for chemical production with almost all the key global players having plants in the area. It deals with the processing and shipping in and out of millions of tonnes of volatile and highly flammable chemicals every year. It also has two major power stations—one gas fired and one nuclear, the latter of which is in the constituency of the Under-Secretary for Communities and Local Government my hon. Friend the Member for Hartlepool (Mr. Wright). It is probably the one nuclear power station in the UK that lies close to a densely populated area. Teesside also has Europe’s deepest mine—the Boulby potash mine, which is in my own constituency.
We have never had a major industrial incident on Teesside, but the raw materials for such an incident are there in quantity. Together with the rest of the UK, Teesside now faces the threat of terrorism. In that context, it is inconceivable that potential terrorists would overlook industrial targets of opportunity. Indeed, at one recent trial, evidence showed references to Teesside on a possible hit list. Given that heightened threat, it is clear to me that traditional joint working of all three emergency services on Teesside needs to be maintained. That must allow for a focused and localised response to all the dangers and challenges that Teesside could face. That approach has been overlooked by the NEAS.
The Cleveland emergency planning officer, Mr. Dennis Hampson, in a report presented to an emergency planning joint committee earlier this month, said that the NEAS proposal
“has the potential to make the Cleveland area less resilient.”
He went on to say that it could cause
“a loss of local knowledge of control room staff.”
On the point of local knowledge, will my hon. Friend accept that, to date, the consultation with users and staff has been abysmal, and that the consultation with the local authority scrutiny committees has been lamentable? I have asked a series of questions about the problems that we would face on Teesside should the move take place, and they have not been answered. My hon. Friend is outlining the dangers that are there and I am saying that the consultation has not been full enough or sensibly carried out. Therefore, if, at the end of this, a decision is taken to move our Teesside ambulance services to Tyneside, we will ask the national health service’s reconfiguration panel to reconsider the whole process in the belief that the decision will be changed and the ambulance service will be left on Teesside.
I agree with every word that my hon. Friend has said. In fact, I think that she has been looking over my script because that is exactly what I was going to say. I totally agree with what she said about the consultation. Many staff have said similar things to me.
Mr. Hampson also said that there was
“a need for specialist knowledge of how ambulance accident and emergency crews should respond to chemical and nuclear incidents.”
That view has also been echoed by the local council, through the health scrutiny committees and the Cleveland joint emergency planning unit. The overview and scrutiny powers of local councils are crucial in that respect. However diligent or effective the NHS trust is, it is still an appointed trust. Local councils and local councillors are directly elected. Therefore, members serving on the health overview and scrutiny committees reflect the views of their communities. They can refer matters to the Secretary of State on the grounds that the consultation on changes by the NHS trust is flawed or not in the best interests of the public. The Secretary of State can then refer the issue to the independent configuration panel for an overarching reassessment and, if necessary, a full review.
I understand that the NEAS board is meeting on 22 May and that its proposals remain unaltered. It is clear that if the proposal is approved by the board, the matter will be referred to the Secretary of State. I then expect the proposals to be passed as a matter of urgency to the independent configuration panel, which would take on board the views of the other emergency services on Teesside. That would allow us to build an ambulance control service that truly represents the people and the needs of Teesside.
In the 11 years that I have been a Member of Parliament, I have always supported the Government. I have never even abstained on an issue. If the Government go ahead with the proposal, there will be consequences in the future. We are rushing into a zone in which we should not be. I appeal to the Minister to consider my biggest objection to the proposal regarding Teesside and its chemical plants. In the end, the buck will stop with her or the Secretary of State. The Minister knows the area very well, and I appeal to her to take note of what I have said. She knows that I have the support of all Tees valley Members on this issue, and I hope that she will give a positive response.
I congratulate my hon. Friend the Member for Middlesbrough, South and East Cleveland (Dr. Kumar) on securing this debate, which he has wanted for some time. He has shown an active interest in the organisation of ambulance control rooms and other health issues in the north-east, and I commend the dedication with which he serves the needs of his constituents. The same is true of my hon. Friend the Member for Stockton, South (Ms Taylor) and the Under-Secretary of State for Communities and Local Government, my hon. Friend the Member for Hartlepool (Mr. Wright) who are present today and other hon. Members who were unable to be in the Chamber for this very important debate.
I recognise that there has been considerable public interest in the control-room organisation of the North East Ambulance Service NHS Trust. I welcome the opportunity to respond to those concerns and to try to give some reassurance. I must stress, though, that the decision on the proposals for the location of control rooms to which my hon. Friend referred has not yet been made. I understand that the trust board is due to make the decision at a meeting on 22 May, so it would be inappropriate for me to comment on the specifics of the case at this time. However, I hope that an explanation of Government policy on ambulance provision may address some of my hon. Friend’s concerns.
I want to stress that the Department of Health expects all ambulance trusts to ensure that their control rooms are fit for purpose. It is their responsibility to make sure that control rooms have the capacity, capability and resilience to deal with the needs and demands of the local area. I am referring here to the needs and demands that my hon. Friend the Member for Middlesbrough, South and East Cleveland has raised in the debate. The changes being made in the NEAS should be considered within a much wider programme of improvements in ambulance provision.
In 2005, the Department published an ambulance review, which made a number of recommendations to transform the ambulance service. To support those improvements and following a consultation, the number of ambulance trusts was reduced to 12 broadly to reflect strategic health authority boundaries. As a result of the merger, some trusts needed to streamline and improve their operations. It is right and proper that the decisions about local services are made at a local level, but, in order to support the trusts through this process, the Department of Health commissioned a review of ambulance control rooms to provide it with an overview on a range of control-room issues.
The review concluded that the needs of the English ambulance trusts would probably be best served by adopting a small number of multiple sites—a minimum of two—with each site complying with a range of minimum standards outlined in the report. There was no single recommended operational configuration, but a series of options for trusts to consider. The review made it clear that within overall best practice, it was for the trusts to determine their own control-room organisation. Trusts considering control-room changes need to make their own decisions locally about how to meet the needs of their populations and their own operational challenges.
I have been advised by the trust that the current position for ambulance provision in the north-east is not sustainable for a number of reasons. In the north-east, NHS Direct provides back-up to the ambulance service, which is not the most appropriate solution. In addition, the control room in Middlesbrough can manage only 60 per cent. of 999 calls originating in the Tees area. The proposals that the board is deciding on aim to ensure resilience and business continuity in those areas.
I will go on to inform my hon. Friend of some of the progress that has been made in that area.
In identifying proposals for the north-east, the trust drew on the national control room review, but also employed a consultancy to evaluate a number of existing and potential new sites for its control centres. The consultancy provided a set of independent recommendations that were shared with all stakeholders prior to a formal consultation. Five proposals were outlined in the consultation. I understand that the NEAS preferred the option of establishing two independent contact centres. It believed that that would best achieve continuation of service and provide adequate contingency in case of emergency.
I believe, however, that two further proposals have been suggested during the consultation period. One, suggested by Cleveland police, was that the facilities at the control room in Middlesbrough should be extended to make it an independent contact centre. The second was put forward by my hon. Friend the Member for Stockton, North (Frank Cook), who is not in his place. He suggested that the second contact centre be located in Wynyard. I commend Cleveland police and my hon. Friend on their interest and engagement in the matter, and I believe that both options will be considered by the board alongside all the others.
The NEAS has made it clear that it views its proposals as having been drawn from extensive investigations by independent and nationally recognised industry experts in emergency service control rooms. They are intended to achieve the best possible resilience and an uninterruptible emergency service, and to make the most of technological and medical advances.
The role of the Department of Health and the Secretary of State in local reorganisation is rightly limited. If my hon. Friend the Member for Middlesbrough, South and East Cleveland and others still have concerns once the board’s decision has been made, I advise them to make every effort to resolve them with the NEAS. Should it be necessary, the second course of redress would be to raise concerns with the local authority’s overview and scrutiny committee. If that committee wished to contest the proposals on the basis that the consultation was inadequate or that they were not in the interests of the health service, it could refer the case to the Secretary of State. The Secretary of State would then ask the independent reconfiguration panel to undertake an initial assessment to determine whether a full review was needed.
I have been reassured by the NEAS that it is keen to avoid redundancies. My hon. Friend mentioned the potential loss of not only jobs but expertise, which is vital to the service. It is keen to avoid any such redundancies, regardless of the board’s decision about the reorganisation of the control rooms. The trust has been in close contact with the unions, and I am assured that it will hold one-to-one interviews with staff to discuss the options available once a decision is known. I encourage the trust to continue to support its staff through the period of change, particularly while waiting for decisions. Once decisions have been made, I encourage it to acknowledge the knowledge and expertise in the area.
I take my hon. Friend’s comments seriously, and I shall ask officials to look into that and inform myself and the Minister responsible for the ambulance service. I acknowledge the request that she has made of us.
I recognise that patients and the public feel very strongly about the organisation of ambulance control rooms. As a former nurse who worked in the health service for more than 25 years, I am fully aware of the commitment of our control room staff and ambulance crews and the debt that we owe to such skilled and highly professional people. Understandably, people want to feel secure in the knowledge that the services that they need will be there for them at times of life-threatening emergency.
My hon. Friend the Member for Middlesbrough, South and East Cleveland has outlined the seriousness of what faces us all, including the threat of terrorism, particularly to the chemical plants in the area. My understanding is that no decision has been made about where any future control room would be located. The area is important to all of us—including its football team, Middlesbrough. I would be failing in my duty as the chairman of the all-party group on football if I did not give it a mention. I reassure my hon. Friend that rather than compromise the services there, the Government are committed to making services better, not worse, for patients and ambulance staff at every level.
I note the comments that have been made, and I shall take them back to officials. However, I reinforce my point about the procedure that is open to hon. Members. I hope that the decision to be made by the NEAS board on 22 May will provide a robust ambulance service that meets patients’ needs both in my hon. Friend’s constituency and across the north-east. They deserve to have that.
Question put and agreed to.
Adjourned accordingly at five minutes to Two o’clock.