Westminster Hall
Wednesday 15 October 2008
[Mr. Eric Illsley in the Chair]
British Business (China)
Motion made, and Question proposed, That the sitting be now adjourned.—[Mark Tami.]
In view of the inordinate temperature in the Chamber, exceptionally, hon. Members have my permission to remove their jackets. That would not normally be the case, but I think that the circumstances dictate it.
I hope that it will be a distinct pleasure to serve under your chairmanship, Mr. Illsley. I am delighted to have secured this debate on a crucial topic. It was important in May and, given the global situation, it is even more important now that British businesses can operate globally and particularly in China. I am delighted to see here today so many of my colleagues who accompanied me on the Industry and Parliament Trust’s most informative and highly educational visit to China in May—[Interruption.] I am gently reminded that we went to Shanghai, which I thought was in China! We did spend some time in the Shanghai region though.
I am also pleased that in the Public Gallery we have representatives from the Chinese embassy and British businesses who provided people and resources to make the parliamentary fellowship programme possible. I pay tribute to the chairman of the all-party China group, my hon. Friend the Member for Wirral, South (Ben Chapman), who accompanied us on our visit and who, over many years, has done tremendous work in fostering relationships between China and the UK. While I am in the business of giving my sincere thanks, I should mention that we were accompanied by two very helpful representatives from the Shanghai People’s Congress, who made things work and were very informative and supportive. My thanks to them.
All hon. Members, particularly those in the Chamber today, will be familiar with the work of the IPT, of which many here are fellows. They have benefited from the opportunity to undertake an attachment in industry to see at first hand the challenges and successes of British industry both in the UK and overseas. As chairman of the IPT, I remind hon. Members that its mission is to foster understanding between us as legislators and those who, over the years, have created the industrial wealth of our country. We have done that very successfully, and recently the IPT took the next step of integrating with Europe, so that we could understand European industry and Parliaments, too. Our trip to China was our first venture to look at the global marketplace, which was what made the visit so educational.
I concur with what my hon. Friend says about the IPT and the way in which it is branching out, not only in the UK, but across Europe and globally. I was fortunate enough yesterday to receive my fellowship to the IPT from PricewaterhouseCoopers, to which I pay tribute not only for providing me with that opportunity, but for the chance to visit Brussels and Shanghai to see its business operations in those places.
Everyone in the delegation was a great ambassador, not only for the IPT but for the UK Parliament. I do think that the trip was important. It was non-political and formed a genuine basis on which we could learn better about how UK business operates and works in China and the rest of the world. I agree with my hon. Friend that that happens because of the sincerity of the relationship between the UK businesses that support the IPT and the fellows who get attached to them. I think that bond is very unique. We would be challenged if we tried to emulate it, because it has developed over many years.
We were impressed by our visit to the Suzhou industrial park—a joint venture with Singapore. Following an agreement signed in 2002, funding was made available and within five years we saw a massive industrial park offering every facility to Chinese and international businesses.
We also learned about how China is handling climate change. BP China is at the forefront of investigating clean technology and has invested in a university-scale research unit that employs more scientists and climate change experts than I care to mention. Not only did we hear about its extensive research and development, which will produce remarkable results in reducing emissions, but about its skill in handling a major joint venture with China to shape a way forward for energy to serve a country of 1.5 billion people. I think that when the Chinese consider the scale of what is being done, and needs to be done, in their country, their position becomes apparent to them and they think, “We might be China, and we might punch a bit, but there is a real big world out there that we need to know about.”
Having arrived shortly after the earthquake in Sichuan, we paid our sincere respects to all those who tragically died in that natural disaster and signed the book of condolences at the foreign ministry. The power of nature can make us realise how frail human beings are.
As my hon. Friend the Member for Preston (Mr. Hendrick) said, we were presented with an excellent overview of Chinese operations by PricewaterhouseCoopers. We also learned from Arup about eco-city initiatives and saw many of the magnificent earthquake-proof high buildings, which are very visible on the skyline. China is an earthquake region and major engineering is needed to ensure that buildings are safe. We also visited the consul and were advised by UK trade investors on their initiatives on UK investment in and out of China and the major Expo scheduled for 2010. Sadly, that has attracted little UK funding. Are we doing enough at ministerial level to provide aid and assistance to UK businesses, particularly in China?
Education was also a focus of our visit. British interests were represented in various joint ventures delivering high-quality secondary and higher education on a major scale. With the British Council, we visited the campuses of the universities of Nottingham and Liverpool and of Dulwich college to see how non-Chinese children can receive an international education and hopefully contribute in the future to China’s fast-growing economy.
While in Shanghai, I did my fellowship with GKN, and it was very good to witness the GKN experience in Shanghai. It was making automotive products for the Chinese automotive industry. Some of my colleagues on that visit said that my face became a little more animated when I saw metal being cut and other things that I fully understood and was au fait with. I congratulate GKN and others on being able to move into that sphere and contributing to Chinese automotive industries.
The purpose of today’s debate is threefold. First, if they catch your eye, Mr. Illsley, it gives an opportunity for hon. Members to recount their experiences and impressions and to tell us what perceptions they formed on the visit. Secondly, I want it to raise awareness of what more British business could do in China, and how that could be helpful. I should be grateful if the Minister, even though he is new to his job, told us how important he thinks that relationship is.
Thirdly, given the global crisis that we face, with Chinese sovereign reserves amounting to something like $1.8 trillion, we should foster our relationship with China and encourage it to invest more in British businesses. Global economies have changed a great deal in the past six months, and that makes it even more important that the UK is a major player in the global field of business in both China and the wider world.
Order. Before I call the next speaker, I remind hon. Members that they are not to refer to the Public Gallery in any way.
Thank you, Mr. Illsley. I start by warmly commending the hon. Member for Nuneaton (Mr. Olner) for securing the debate and for his excellent leadership of the trip, in conjunction with the hon. Member for Wirral, South (Ben Chapman). Perhaps I should confirm that I was a member of the delegation, although I suspect you will have gathered that, Mr. Illsley. As a trustee, I was impressed by the organisation provided by the IPT’s staff and by the wonderful support and involvement given by the companies that sponsored and supported the trip. It was immensely helpful to have UK businesses alongside us while we were in Shanghai.
I am aware that a good number of colleagues wish to contribute, so I shall move quickly through three broad points that I hope will add to the debate. First, reflecting on our trip to Shanghai from a little distance, I note that China is not a single market. In business and politics, we tend to talk in shorthand as though it were one large, homogenous market, perhaps because the Han ethnic group makes up about 90 per cent. of the population, or because Mandarin tends to be the language that most UK businesses or politicians encounter. There is an assumption that there is a homogenous whole, but if one looks carefully, one sees that the continent is just as diverse as Europe.
Let us consider the north-south divide. In the south, cities such as Shanghai are fast moving and entrepreneurial. We saw that on our trip. Time and money matter there, as they do in many western cities. That is a crucial characteristic for such cities, and is one reason why Shanghai is the financial centre of China, although there may be competition from Hong Kong in that regard. There is a cultural focus on entrepreneurship. However, when I talk to UK businesses, they tell me that their experiences in the north of the country—north of the Yangtze—are of a relatively slower and perhaps more bureaucratic way of dealing with business. That might be because Beijing, like Washington in the USA, is a corporate town and the corporation is government, making the culture somewhat different to that in Shanghai, Hong Kong or Shenzhen. It is important to understand that there is a difference between the areas to the north and south of the Yangtze.
It is also important to remember, when thinking about whether China is a single market and how businesses should approach it, the difference between the eastern seaboard and the rural hinterland. Roughly half of the 1.3 billion people in China live not in major urban centres or sprawling suburbs, but in the poorer and more remote towns and villages. We saw on our trip that there has been a huge migration of labour into the cities, with many such people working unofficially on construction sites. However, a substantial section of the population are not part of the economic revolution, perhaps because of their income level, location or age. From a business point of view, when thinking about the scale of that marketplace, it is worth remembering its characteristics and how it is differentiated.
My second point is that China is not becoming a western nation, as might initially have appeared to be the case. It is simply becoming a modern nation. My first impressions of Shanghai were, I suspect, the same as those of most hon. Members present. It seemed remarkably like our western cities, with the shops and brand names, the people’s adoption of western fashion, and even traffic jams. However, on talking to UK and local business people I realised that there are still vital differences to living and doing business there. I offer hon. Members a simple, but perhaps controversial, example. When we arrived at the hotel, a letter awaited us that set out the Government’s rules and regulations governing use of the internet. I shall not test the patience of the House by giving all nine rules, but they included the following examples. When using the internet, one should not:
“Endanger China’s unification of the country, territorial integrity and sovereignty…Betray China’s national interests or endanger the security and honor of the country…Violate religious policy, publicize or promote any evil cult organisation…Spread rumors and disturb the social order and stability of the country”.
Those rules might seem strange, but they are not simply the demands of a one-party state. The character of rules such as the one about the country’s honour, suggests something very different to our social norms.
As I suspect my hon. Friends will realise, I am no expert on the teachings of Confucius, but it seems to me that certain values that are distinctly different to our own remain central to the people of China. We believe in democracy and freedom of the individual, whereas they instinctively respect their rulers and always put family first. We believe in equality before the law, whereas they have far more regard for the quality of the ruler. Even with the upheaval of huge migration between rural and urban areas, there is still a strict hierarchy of relationships in China that shapes every family, business, community and political organisation. What we might perceive as subservience, they regard as respect. The paramount importance of face, or mianzi, matters greatly to every person, business and part of that nation.
On my trips to Shanghai and to Hong Kong the previous year, I saw that things are changing. One interesting dynamic is what changes will come of the “Little Emperor” generation. Children grow up with considerable demands on them, but they also have considerable opportunity and might become more self-centred than their parents. If we look across the piece, British businesses that want to succeed in China will continue to need to understand the distinct values of that nation.
My third point is that UK plc needs to do better. As I have said, I have been to both Hong Kong and Shanghai in the past 18 months, and I have been immensely impressed by many of the UK players whom I have met, such as the team at BP. I am sure that hon. Members will agree that they showed a long-term vision and professionalism that could match any competing company in the world. Other companies that are leading players, such as GKN and Arup, command immense respect in China. However, I fear that the overall effort of UK plc is not working as well as it might. Although our exports to China have grown, French exports have grown at twice the rate of ours, and German exports at three times the rate. In my discussions with businesses in Shanghai and subsequently, I have met several people who believe that the UK’s official representation is not as effective as it should be.
One of the problems is the unnecessary duplication of effort by Government agencies—the peculiarity of having different offices in different parts of Shanghai that often go to the same meetings and pitch for the same opportunities. The regional development agencies and UK Trade and Investment should not be jostling with each other for the same business. There should be one strong team working for the whole country, pooling resources and operating in each of the key cities. I would be particularly interested to hear the Minister’s response to that point, given that the former Secretary of State for Business, Enterprise and Regulatory Reform made it clear, quite rightly, that he wanted to see that duplication ended.
Equally, there is evidence to suggest that some of the original dynamism of the China-Britain Business Council has been lost and that British businesses and politicians are not getting in to see the right people in the Government at the right time. That problem was much commented on. I hope improvements have been made. If it can be demonstrated that things have changed, that would be fantastic; if it cannot, urgent work is needed.
The opening up of China and the rapid expansion that that has created is a great opportunity for businesses in this country. We already have world-class players there—people who are regarded highly in China because they have taken the time to understand the markets and the people with whom they are working—yet UK plc is falling behind. Politicians in government and the business world generally need to realise that China is not a single market, but a continent of different cities and peoples and a truly segmented marketplace. We need to strengthen and unify our presence on the ground. Indeed, as the global economy turns down, we must become even more competitive. Our trip last May certainly helped me to understand the opportunity and challenges before us—I suspect that the same is true for other hon. Members—and I hope that it will inform Government policy in the coming months.
May I first refer to my entry in the Register of Members’ Interests? I am delighted that my hon. Friend the Member for Nuneaton (Mr. Olner) has secured the debate. As chairman of the all-party China group, I was delighted to join him in leading the delegation and contributing to it. The all-party China group has nearly 500 members, and it is vastly important that all parliamentarians and not only members of the group are aware of the scale, speed and nature of change in China. There is simply insufficient knowledge on China, not only among the general public, but among parliamentarians. I try to take a delegation of around 10 Members to China each year, but even assuming the group’s membership of 500 did not change, it would take me 50 years to get through the list, so I will lose no opportunity to get hon. Members to see and believe what is happening in China, and particularly in Shanghai. It is also particularly important that visits are as focused as ours was on the specific issue of British business in China.
I congratulate the staff of the IPT on their work and initiative. I would like to join the other members of the delegation who have already spoken in thanking all those who received us and helped us on both the British and Chinese sides. We have not yet mentioned Virgin, which was helpful, not only in getting us to China, but in briefing us on the issues that it and other companies face there. Overall, we could scarcely have received a more rounded view of the issues and opportunities of the business environment.
When I first went to China in 1986 as commercial counsellor, it was a very different place from the China we see now. It was a country of Mao suits and bicycles, and doing business was pioneering and difficult. Commercial practice and law was not as we know it, negotiations were a special art form and intellectual property issues were problematic at best. However, many of the companies we saw in Shanghai in May were in China before I went in 1986, which is a fulsome demonstration of their commitment to the market.
For many years China was the biggest potential market in the world. It took a number of years for the actuality to arrive, but now that it has we can see that in rounded terms the Chinese economy has grown at about 10 per cent. per annum since 1978. My maths is not so good, but I know that that is a lot of growth. It is a phenomenon that has changed the shape of the world. It is clear that an organisation that is in business in any serious way needs to be part of what is happening there.
The perception of China has been changing ambiguously over the years, from booming market to challenging competitor. For many years it was regarded as an exporter of deflation, but more recently it has been regarded not only as a good place to do business, but as an exporter of inflation and a voracious consumer of raw materials and other goods for which the rest of the world has a need.
Attention has long been focused on China’s human rights record, pollution, its role in Africa and its challenge in other markets. Despite the image at the time of the Olympic torch, the prevailing image of China is of an economic powerhouse, as exemplified in Shanghai, and the nation that produced the most sensational and successful Olympic games. China has for some years been an attractor of foreign direct investment and is increasingly an outward investor. Of course, China is not standing alone. If one looks at the east, one is looking at India, Vietnam, the Asian dragons and tigers and the old economies of Korea and Japan. The sum of that is that the world is becoming oriental rather than occidental. It means that the economic centre of gravity is moving eastwards, and the political centre of gravity with it. That has profound implications for all that we do in relation to China.
China has been the pac-man effect in action, and becoming part of it has been an imperative and not an option. Whether the biggest challenge for us would be China’s continuing success and growth or its relative slowing-down and failure—not that one can look at it in those terms—has long been an interesting question.
As we saw in May, any reference to China as the workshop of the world simply fails to capture the incredible and rapid changes taking place within its borders and limits the nature of Sino-British partnership. We would be unwise to ignore, for example, the implications of a vast and growing Chinese middle class that would potentially consist of more than 500 million consumers by 2025. As we have said, British industry is very much aware of those opportunities. As science and technology take centre stage within the Chinese Government’s strategy for sustainable development, so a space has opened for expertise and experience in that area. Perhaps a prime example of that is Arup’s involvement in the Dongtan eco-city close to Shanghai.
The build-up to the Beijing games gave us many opportunities, and British firms were able to play a part in many sectors, such as the provision of temporary power for Olympic facilities, the design of the “Bird’s Nest” stadium, representing the British Olympics organising committee and the design of the magnificent terminal 3 building at Beijing airport. Those are but a few examples. It would be impossible in the time available to represent the range and diversity of opportunities and the successes that we have achieved in recent years.
Although we can celebrate the strength of the Sino-British economic partnership, we must be careful to avoid complacency. We are told that the UK is Europe’s largest investor in China, but we should be aware, echoing the point made by the hon. Member for Hertford and Stortford (Mr. Prisk), that in 2006 the net investment in China by British businesses fell compared with 2005. Furthermore, we should remember that that investment is dominated by a few companies, notably the oil companies. If we are to maintain an upward trajectory, and continue to capitalise on Chinese economic expansion, we must think about China with even greater interest and commitment than that which we have previously reserved for the US and Europe. Our trade deficit in Chinese goods, again reflecting the point made by the hon. Member for Hertford and Stortford, was £12 billion in 2006, and it continues to grow. At the same time, China was our 13th most important destination for goods, and 20th on the list for our services. That simply is not good enough when we consider that China is positioned to become the world’s largest economy within two decades.
It is a courageous man who will speculate how China is affected by the current global economic crisis, and on present form it is not clear. On the latest statistics, our trade continues to grow, but it will certainly be affected, as will China’s growth—still between 9 and 10 per cent.—as it is hit by what is happening in the wider global economy. There is a minimum economic growth level that China must maintain in order to maintain social cohesion, given the absence of a sophisticated social security net, growing aspiration among the Chinese people and, notwithstanding the one-child-per-family policy, population growth. At this stage, while China sees economic turmoil as principally a western phenomenon, its exposure to problem assets cannot be assessed. Some factories are affected and some are closing. Basic production in steel, for example, is being cut.
China is making its contribution to a global solution and, like the west, is cutting interest rates. While having a relatively closed financial market, the Chinese economy will be affected. However, the supertanker effect—I am sorry to be so corny—is in play, as is the level of technological development, so the effect will probably be relative and China will remain in global terms an attractive place to do business. This is not a time to switch resources or attention from our business with China.
The second question I want to deal with, which has not been raised as much since stock markets started to rise again, is whether China will use its massive foreign exchange reserves and sovereign funds to buy up our assets at knock-down prices, and whether that would be a good thing. China has been an increasingly responsible global and regional player, both financially and politically. It played an extremely important leadership role in the Asian financial crisis and it will do so now. Thus far, to the best of my knowledge, it has used its sovereign funds in equity investment and in banks, which hon. Members might be surprised to learn, among other things. China also recognises its responsibilities and its lack of knowledge in running Western businesses. We have long sought Chinese investment and in the current climate we will want more. After all, it was a Chinese company that relaunched auto production at Longbridge.
The role of British business in China is crucial, but the Government are always central to achieving its aims, and the resources that they devote to this end must reflect both the scale of the challenge and the aspirations of industry. Our trade and investment team total 91 full-time equivalent staff in China to promote the interests of British goods and services there. That has increased by a quarter since 2005, which is obviously a step in the right direction.
I pay tribute to the China-Britain Business Council, which does excellent work in China for British companies, and to its current and past chairmen. As a nation, however, despite our task forces, prime ministerial and high-level visits, we still have not sufficiently moved on from an “us and them” relationship to one of greater partnership. We still treat China as if it was just another country, albeit an important one, but the fact is that the world has changed and we need to take account of that. We have not sufficiently changed our institutions or our attitudes to take account of the new global centre of gravity and the historic shift. We must do more.
I congratulate the hon. Member for Nuneaton (Mr. Olner) on securing the debate. As so many people wish to speak, I shall dump most of my speech and talk about suits, ties and watches on another occasion. I congratulate the Industry and Parliament Trust on this initiative. The hon. Gentleman is the chairman of the group, and the delegation was ably led by him and the hon. Member for Wirral, South (Ben Chapman). They did a splendid job, and I believe that every member of the delegation got something out of the trip.
We owe a debt of gratitude to the wonderful staff at the IPT, which is a wonderful organisation. I did my fellowship donkeys’ years ago with Esso, and am hoping to start a masters with Bank of America shortly. I understand that it will want to fly me to New York, so I am greatly looking forward to that. But as someone who had never been to China, the opportunity to go there changed my mind dramatically about a number of issues.
The chief executive of the IPT, Mrs. Sally Muggeridge, stated:
“This fellowship was a fantastic educational opportunity for the group of MPs to gain a strong knowledge of issues surrounding China relevant to industry in the UK together with first-hand experience of business and growth in the country.
The China Fellowship was a natural extension of the IPT’s work over the past 30 years in encouraging parliamentarians to improve their knowledge and understanding of business and the issues that affect it. Many of the delegates have already completed an 18-day IPT fellowship programme spending time within UK business.”
However, many of us need to go back. One visit to Shanghai hardly makes us experts, and I would like the opportunity to see a little more of the country.
One reason to go back would be to revisit PricewaterhouseCoopers, KPMG and several of the people whom we met there to discuss their analysis of the investments of the Chinese financial system, Bank of China and so on. Forgoing what appeared to be easy profits from investing in the wrong end of the American housing market and adopting a long-term and stable view of investments will pay off for them. Given the recent crisis, we could learn lessons from them.
The hon. Gentleman makes the point better than I would be able to, and I agree with everything he said. We are not making as much as we could of existing possibilities. Enforcement issues, consistent implementation of intellectual property rights, market access, red tape and subsidies to domestic companies all continue to feature among the barriers to doing business in the market. Such concerns need to be fully addressed in order to support UK exports and investments. We really could and should be doing better. My goodness, having visited Shanghai, I can understand why the Americans are slightly fearful of the competition.
I shall end with just a few remarks about the Essex-Jiangsu partnership. As all hon. Members know, Essex is the finest county in the country, and it always leads the way. The Essex-Jiangsu partnership has been running since 1988 and was formalised in 1992 by Lord Hanningfield, who just celebrated 10 years as a Member of the House of Lords. It was established with the overall goal of developing firm and long-term bonds with Jiangsu province and creating a harmonious relationship between Essex and China, and it has indeed done that.
The partnership aims to give practical support from the Jiangsu authorities to the county’s exporters, and to attract inward investment to Essex. The relationship has already produced great benefits for the county. In 2006, 30 businesses, including three Essex companies that have since set up operations in the province, were helped to find opportunities in Jiangsu.
Thirty-five Essex schools are actively engaged in curriculum links with Jiangsu schools, and a group of 12 primary and secondary schools has pioneered a successful drive to promote the teaching of Mandarin in Essex. Many teachers from Essex schools have already visited schools in Jiangsu and partnership links are developing.
The county council is aiming for the partnership to be recognised as the most productive relationship between a British local authority and a Chinese provincial government by 2010. Two years ahead of 2010, I am prepared to announce that it is the most successful relationship.
Essex county council is also holding a cultural festival to celebrate its 20-year partnership with Jiangsu province. Hundreds of celebratory events are taking place up to March 2009. This is a prime example of the kind of proactive, innovative approach to Chinese education and trade links needed in all parts of the UK and, as ever, Essex leads the way.
If we are talking about second languages in our schools, let us encourage Mandarin. It is a difficult language, and most of us have trouble speaking English, let alone a foreign language, but let us encourage people to speak Mandarin. As my hon. Friend the Member for Hertford and Stortford (Mr. Prisk) said earlier, let us try to make the most of our opportunities.
I visited Shanghai zoo and I am determined that we secure a couple of pandas for London zoo—whether they will be leased or rented to us I do not know—and a couple for Colchester zoo.
This was a fun trip, but every member of the delegation would agree that it was worth while. I already had an image of China, but the trip changed my perception. What a wonderful country China is and what wonderful opportunities it provides for each and every one of us, particularly in these challenging times.
Before I call the next speaker, can I just remind hon. Members that the wind-ups must commence at 10.30 am?
I thank my hon. Friends the Members for Nuneaton and Shanghai (Mr. Olner) and for Wirral, South and Beijing (Ben Chapman) for the way that they masterfully looked after us in Shanghai. It was by some way the best trip I have ever been on. It was the best prepared trip—we had a number of seminars, language tuition and a marvellous pre-run before we got there.
Everyone has said “Well done” to the Industry and Parliament Trust and I commend it for its utter professionalism, which was outstanding. I, too, have done an IPT fellowship: mine was with Motorola 10 years ago. Motorola was the first company in America to be in China, 25 years ago. That was a hard call.
I was pleased to be in Shanghai, having been brought up in Hong Kong. It was good to see, in a sense, a second side of the Chinese face.
Some of the presentations that we received were outstanding. I still remember the BP presentation on intellectual property. The Chinese have struggled with that, but they are trying to get to grips with it, and BP is taking a global lead on that with them.
I share hon. Members’ reservations about whether we are really clued-in to what is going on in China. I ask the Minister to set up a China council on the same level as the National Economic Council on the credit crunch that we are considering at the moment, because I do not think that Departments understand what is going on. If the 19th century was the British century for the world and the 20th century was America’s, last week the 21st century became the Chinese century. China has $3 trillion of reserves, which is much more than the Federal Reserve has and certainly more than the Bank of England and Frankfurt have. This is the changing of the guard and we were lucky to just be on the edge of it in May and June.
A totally new approach is required. I shall try to illustrate that by looking at our Foreign Office representation. In China, we have one embassy and four consulates for a population of 1.3 billion. In India, we have one high commission, three deputy high commissions and three trade offices for a population of 1.2 billion. In America, we have one embassy and seven consulates for a population of 302 million. In Europe, we have 27 embassies and nine consulates general for a population of just under 500 million. That works out, in representation terms, as one embassy or consulate in China per 260 million people and, in India, one in 172 million. That is completely wrong.
We are so out of—I cannot think what the word is. We have misread the tea leaves about China and India at every level of Government in this country. We have done some good things in India—for example, we set up the UK India Business Council, and the UK-India education and research initiative to look at universities exchanging students and courses and trying to build relationships—but we have not done that in China.
I hope that out of this—although it is too early for the Minister to comment—comes the recognition that we need to have a proper all-engaging discussion about what we do about China. The events of the past two weeks have been so profound that I am not confident that we get it. That was one of the good things about going on the trip: not only was there terrific fellowship from all parties, but it was good fun and hard work and, because we were well prepared, we got so much more out of it than has been the case on previous visits.
One of many statistics given in a presentation threw me completely: 80 new cities of 5 million people each will be built in China over the next 10 years. That means 400 million new houses and other buildings, including schools and hospitals, as well as roads and goodness knows what. The demand for British product would be absolutely enormous, but where are we? We are behind Germany and France already.
To echo my hon. Friend’s point, we visited Suzhou, which is an old town with a new city, probably the size of Birmingham, built alongside it over some 15 years. Suzhou makes Milton Keynes—our new city—seem like a village.
I agree. At the same time that that city has been built, we have had the Thames Gateway proposals. I am at the edge of that at Sittingbourne and Sheppey, but I can tell hon. Members that we will still have the Thames Gateway in another 20 years and not much will have moved. A fundamental shift in thinking is required and China is leading the way, although it has borrowed, largely from Singapore. There are models out there that we can use, but for some reason we are becoming more isolationist in our thinking, which, in a global environment, unnerves me.
Those 80 new cities built over the next 10 years will, with a combined population of 400 million, have twice the population of Britain, France, Germany and Italy. We have to get our minds round the staggering economic change that is going to happen in China.
There were many highlights to the visit, but I should like to pay tribute to my favourite architect, I. M. Pei. We were privileged to see his new, beautifully designed, elegant, sensitive museum in Suzhou. He has done that while finishing the new cultural museum in Doha. I do not know where he finds the time: he is only 91. I sense that the museum in Suzhou will be his last ever commission. It was wonderful to meet his daughter and to spend time walking round the building. As somebody who loves architecture, I would not have missed it.
I want the Minister—although he may not be able to say anything about it now—to galvanise his Department to go to No. 10 and create a China council.
I start, as my colleagues did, by paying tribute to the excellent work of the IPT. Sally Muggeridge and her team did a great deal to prepare us for this visit. I also thank the firms that sponsored the visit, including PricewaterhouseCoopers, Virgin and many others.
My interest in the visit came from two perspectives. First, my background before becoming a politician was in engineering and science, and seeing how China has developed industrially and technologically was of great interest to me. My other area of interest, which sparked my fascination with China, is education. My first visit to Shanghai just over two years ago was to two universities that were working closely with the university of Central Lancashire in my constituency.
The university of Central Lancashire has more than 1,000 students from mainland China, one of whom, I am sorry to say, sadly died last week in an accident when he was hit by a bus when on a bicycle in Preston. I send my condolences to that student’s family. Many students from China are in Preston studying at UCLan. Many are spending two years in China and one year in Preston to obtain a bachelor’s degree, and many are doing two plus two to obtain a master’s degree in a variety of subjects. Two and a half weeks ago, I was fortunate to attend the opening of the Confucius centre at the university of Central Lancashire in Preston with the Chinese vice-consul, who came from Manchester to attend the opening. My constituency and its university have many ties, and I have many interests.
When visiting China with the delegation, I was impressed to see that other educational institutions, such as Liverpool university and Nottingham, have a presence there with my university. I spoke to two young students from Liverpool university about their experience, which was reminiscent of mine 26 or 27 years ago, when I had a placement in Germany. The two students from Liverpool were studying in China and now see the world from a different perspective, in which China is becoming a major player.
To draw a parallel with my experience, I trained as an engineer 27 years ago in Germany. I had learnt the language and a great deal about the history of Germany and its people at a time when the Common Market was developing into the European Community and what we have now with the Berlin wall down—a European Union of 27 member states. What we have now in China, partly through the engagement with Singapore and the Government of Lee Kwan Yew at the time, is an opening up over the past 20 years, with huge technological advancement, huge technological investment and huge educational investment. Much of the value that we export to China is education, not only from my local university, but from other universities that I have mentioned.
To put into perspective what my hon. Friend the Member for Sittingbourne and Sheppey (Derek Wyatt) said, China has as many people studying for PhDs—not just bachelor’s degrees—as we have in the population of this country. One realises why, as my hon. Friend said, in the next 80 or 90 years, China will play a role in the world that America played during the last century and Britain played during the century before that. There are great challenges ahead and great opportunities.
My newly ennobled Friend Baron Mandelson of Hartlepool and Foy and the Minister have a big responsibility on their shoulders to ensure that Britain can work with our European partners to create the sort of market and economy that can compete with the challenges facing us from China. There are many opportunities, and British business could benefit from working with our Chinese friends and partners.
I have referred to the scale of the development at Suzhou, which is breathtaking. We are doing a little in this country to improve matters, and I had the pleasure last week of visiting Daresbury laboratory in Cheshire, which has become a science and innovation centre in the north-west. I spent six years working there as an electronics design engineer before coming into full-time politics. That institution should have had the Diamond project, but I shall not re-enact old battles. Nevertheless, it is developing leading-edge research facilities and the innovation that will drive many of the products and services that this country needs to compete with countries such as China, but that is happening on a much smaller scale than what we witnessed during our visit.
We need more investment in education, and science and technology. We have the expertise, the drive and the institutions, but we obviously do not have the population to provide the number of engineers and scientists to bring about that major competition. We can achieve that only through greater co-operation and, I dare say, integration with the European Union. Apart from competition, we can work together with China. We can co-operate through business and the technological links that we are developing. We can work together culturally through education and institutions such as the Confucius institute in my constituency and others throughout the country. We can work together politically through visits such as that organised by the IPT, and Government-to-Government relations, which are also important.
I have only one or two brief points to make, because my colleagues have made their points eloquently about the importance of the visit.
I shall not compliment IPT more than to say that the trip was the hardest-working one that I have ever been on, and the most fun, because, as my hon. Friend the Member for Sittingbourne and Sheppey (Derek Wyatt) said, we were properly prepared. That is not always the case with such visits. I thank all those who were involved in making the trip work by doing so much advance work with us, so that we understood what we were seeing when we got out there.
One of the great benefits of the visit was that Labour Members did not have to be present to hear the result of the Crewe and Nantwich by-election, although it came through with great speed. Conservative Members made no bones about relishing the majority that was secured for the time being in that by-election.
I was interested in the question of information technology and its liberalising or restrictive effect. We continue to need to work with the Chinese in that area, or they might go as far as insisting that everyone with a television requires a licence from the Government to watch it. We would not want to go in that direction, would we, Mr. Illsley?
My final and more serious point is that we were asked by our hosts whether we would like to see an industrial park. I was up for that because I have an industrial park in my constituency that provides around 1,000 jobs, so I am very proud of it and we work hard to keep it. The industrial park in China had 6 million people living inside it. When we visited the university, I said that it was good to have a university inside the park, and my host said that it was one of 10.
I went home to my constituency in Nottingham, where we have 31,000 people on incapacity and related benefits. The experience of being in China and seeing the pace at which things are moving, and comparing that with what was happening in my constituency, before the financial crisis, was sobering. I am not necessarily pessimistic, but all of us and particularly those of us who are in Government or who aspire to Government must learn certain lessons. We need to learn about long-term financial stability and long-term planning and about not looking at the next quarter’s results, but the next decade’s results. We need to invest for the future. It might be that we do that in a different way, but some of the fundamental lessons are to be learnt from China and we ignore them at our peril. There are tremendous advantages to looking at the long term, and part of that means looking for long-term partnerships with the Chinese Government, so that we can all benefit from a different regime and a different global economy.
I thank my colleagues for their tremendous fellowship on the journey and all those responsible for making it such a success. I am certainly one of those whose eyes were opened. I relished visiting a beautiful country and meeting some marvellous people.
I congratulate the hon. Member for Nuneaton (Mr. Olner) on securing the debate and the hon. Member for Wirral, South (Ben Chapman) on his joint leadership of the delegation, of which I was a part. I thank the Industry and Parliament Trust and the many British companies including Virgin, PricewaterhouseCoopers, BP, GKN, Arup and others who helped to make the trip so informative and such a success.
I should like to echo many of the themes discussed by the hon. Member for Nottingham, North (Mr. Allen). My motivation for going on the trip was that I had never been to China before. I am a reasonably well-travelled person and felt ignorant that I did not have any first-hand experience of a country that is becoming increasingly important both across the world and for Britain. I was interested in what the development of China meant for the British economy and people, and I was blown away by what I saw. My experience was so serious and dramatic that it had a profound impact on me and has influenced my thinking about politics and the future of the world.
I went with everyone else to Shanghai and one evening we were having a nice dinner in a building that was about five or six storeys high and was originally a British mercantile building. We were on the top floor of a restaurant overlooking the river and during the meal, I sat next to a British person who had been living in Shanghai for many years. He asked me what I thought of the view. It was night and the view was lit up, so that there was an Asian version of a Manhattan skyline on the other side of the river. It was an impressive backdrop and I told the person I was sat next to that I thought the view was fantastic and he said that 11, 12 or 13 years ago the area was all fields. That demonstrates the pace of change.
The hon. Member for Hertford and Stortford (Mr. Prisk) made the point that China has 1.3 billion people. There is an east-west divide, rather than a north-south divide, and on the eastern side—for the ease of mathematical breakdown—there are perhaps 300 million people who are part of the new economy. Within that area, perhaps 50 million to 70 million people—roughly the population of Britain—are consumers in the western sense. That shows China’s potential.
The hon. Member for Sittingbourne and Sheppey (Derek Wyatt) made the point that there is a reserve pool of labour of about 1 billion people. We, in this country, think of China as a great exporter; indeed, it is a great exporter, and that is an important part of the world economy. However, the domestic market in China will lead to huge changes for British business and is a big opportunity. It does not take a huge leap of imagination to realise that as more and more Chinese people increase their wealth and prosperity and become consumers themselves, the Chinese economy will be fuelled by the need to satisfy domestic consumption, not just international consumption.
Other contributors to this debate have mentioned the increasing quality of the Chinese work force. Too often in this country we think that all the Chinese do is make cheap clothes for western consumers to buy, and that that keeps down our headline rate of inflation. China does that extremely well, but Shanghai has about 400,000 university students. As the hon. Member for Nottingham, North said, we went to Shuzhou and looked around a university that was a joint enterprise with the university of Liverpool. We commented on what a successful university had been put together. There were 10 universities on one street and the students there were studying engineering, information technology and science. They were motivated and focused on what their studies meant for their country economically and their own life prospects.
China will overtake the United States. I agree with the point made about the 19th century being the British century and the 20th century being the American century. American still has a huge role to play in the world—not just economically, but militarily, culturally, politically and in other ways—but China is growing and growing in influence and I entirely endorse what has been said about how the British Government must respond to that. I welcome the new Secretary of State for Business, Enterprise and Regulatory Reform. It is important to have a politician of his stature and international reach in that role and I hope that he can bring his influence and political skills to bear to the advantage of our country.
The hon. Gentleman rightly mentioned the growth in levels of consumption in China. Considering the global turndown, does he agree that in production terms, ironically, it is even more important now for Chinese consumers to take up some of the slack in terms of the goods that the rest of the world is no longer seeking from its factories and other industrial outlets?
That is important. China is growing at a rate of 10 or 12 per cent. a year and will perhaps itself experience a dip, but the fundamentals in terms of medium and longer-term growth prospects for the Chinese economy are extremely good. It is an occasionally foolish or brave politician who makes critical observations about his or her own country, but I worry that, by contrast, we in Britain are sometimes gripped by a sense of national fatalism—whether in relation to the millennium dome, terminal 5 at Heathrow, Wembley stadium or the 2012 Olympics.
In China I was struck by the sense of opportunity and the pace of change. We have to be able to respond to that. However, we need to consider the crumbling infrastructure and the unsatisfactory levels of educational attainment in the British system. The hon. Member for Sittingbourne and Sheppey made a point about our inability to deliver infrastructure projects on time and on budget. We cannot afford to allow that indulgence to continue.
We allow ourselves to believe that there is some sort of settled world order. For example, when the G8 summit is held, the eight leaders stand on the stairs and, with the exception of the Japanese Prime Minister, they are all western faces—I was going to say men, but that is not the case with the German Chancellor. We think that that represents the global hierarchy; and it has done for a long time. I am not saying that America, Britain, Germany, France, Italy, or even Canada will not have a role to play in the future—of course they will. However, the order is changing and we have to reflect that changing order—whether through our Foreign Office, our national mindset or in the way in which our companies do business.
What are the potential risks for China? One risk is the enormous disparity in wealth. Shanghai is the only place in China I have ever been to, but it is like going to New York and thinking one has seen America; there is a lot of China beyond Shanghai. Some people still live in extremely straitened circumstances. It is difficult for any country—particularly one that claims to represent some sort of vaguely communist ideal—to sustain such disparities of wealth. As the hon. Member for Wirral, South said, the Chinese economy needs to grow rapidly in order to ensure that the gap does not grow to the extent that it causes greater social tension.
The depletion of natural resources is also an issue. If 400 million people move to cities in the space of a couple of decades, it has huge implications for raw building materials. We delude ourselves if we think that we are an advanced nation with a huge amount of environmental heightened awareness, and that the Chinese are not aware of such subjects. When we went to BP, I was struck by the fact that it had an American international director of global innovation—in BP terms, innovation means anything other than oil. I, or one of us, said to him, “You are an American, so why aren’t you in America or based in London?” He said, “Because if you’re interested in innovation and change, you have to be in the country where innovation and change is moving at the faster pace, and that is here in China.” BP is investing more in research in China than in its university partnerships in Britain and the United States.
The big question for China is whether it can let the economic liberalism genie out of the bottle but keep the political liberalism genie inside. We shall no doubt discover the answer in the months and years ahead, but if European Governments think that they can pull up the drawbridge and, with protectionism and restrictive labour laws, resist the changes that are happening in China, they are deluding themselves. The challenge for Britain is to show that we have the ambition, confidence, innovation, application, energy and education to compete and succeed. The task for the new Secretary of State, his ministerial team and officials and our country as a whole is to show that we can live up to that challenge.
It is a great pleasure to serve under your chairmanship, Mr. Illsley. It is also a great pleasure to take part in a debate secured by my old friend the hon. Member for Nuneaton (Mr. Olner). I shall let hon. Members into a little secret. I did my Industry and Parliament Trust fellowship with British American Tobacco and I used to be given free cigarettes, which I gave to the hon. Gentleman. I hope that that has not contributed to the fact that he is retiring from the House at the next election. The House will miss him sorely when he does retire. It was great to hear from him this morning.
I congratulate the hon. Gentleman and the chairman of the all-party group on China, the hon. Member for Wirral, South (Ben Chapman), on jointly leading what was obviously a fantastic trip. I think that the Minister and I are feeling rather left out. We seem to be the only ones in the debate who were not on that trip, but I cannot really feel left out, because I have been to China twice and I am to go to Hong Kong and China again in November. What has been said today proves that we need to understand a great deal more about that rather strange country that many people in this country do not know enough about. By travelling and seeing with one’s own eyes what is going on there, one can get a snapshot of how the world is changing.
I echo the comments made by the hon. Member for Wirral, South. The world is changing, in his excellent phrase, from occidental to oriental. Having been to a number of other south-east Asian countries, I know that the world is moving eastwards. We need to use all our assets to try to get into that world with trade and everything else. Currently, not enough of those assets are used. The hon. Member for Sittingbourne and Sheppey (Derek Wyatt) mentioned the figures for the UK consuls. We need to use the Foreign Office, UK Trade and Investment, the China-Britain Business Council, the British Council, the BBC World Service and, indeed, our ancient contacts with Hong Kong to get into the Chinese market. We do not use those contacts enough.
Let me put the Chinese market in context. Whereas the gross domestic product per head in America is $45,000 and in the UK is $33,000, it is only $5,300 in China and $2,700 in India. The staggering facts are that, over the past seven years, whereas the US has grown by only about one third and, interestingly, the figure for the UK has doubled, the figures for China and India have gone up by three times. That gives an idea of the pace of relative change of the so-called western world and the eastern world. I take on board the fact that China’s economy is predicted to be larger than that of the US by 2040.
Several hon. Members have criticised the fact that our trade deficit with China is growing—a fact that we need to bear in mind. It has grown by 67 per cent. in the past six years alone. We are importing more goods from China, and yes, in many ways that is good for the economy. Contrary to what was said, I think that that is deflationary because we have been importing cheap rather than expensive goods. I think that we have had a deflationary effect from our trade with China, but ultimately we must try to ensure that the trade gap with China is closed.
There was a lot of criticism in the debate. I do not want to major on that, but my hon. Friend the Member for Hertford and Stortford (Mr. Prisk) put his finger on the issue. The fact that we have nine regional development agencies, all with offices around the world, many in the same city—for example, Shanghai—pitching for the same business, dilutes the UK brand. It was said that in the past 10 years France has doubled its trade with China and Germany has trebled its trade, yet Britain still lags behind. I spent a great deal of time with UKTI earlier this week, but with the best will in the world, Britain needs to do a better job. It simply is not doing a good enough job.
China has had five golden years of economic prosperity, but as the hon. Member for Wirral, South mentioned, there are fears that the Chinese economy is slowing. Inevitably, with the worldwide financial problems that we face, China’s economy will slow from a growth rate of 10 per cent. perhaps to 8 per cent. or less. The real worry for the world at the moment—or perhaps the benefit; I am not sure—is that Chinese factories are beginning to slow down. They are using less commodities, which is why we are seeing a drop in commodity prices and particularly in oil prices, from a high of $140 a barrel to the current price of about $90. That may help the world to recover.
We need to consider carefully what China is doing in respect of its trade with the rest of the world. We have heard about the sovereign wealth funds—huge funds. The figure given was $1.8 trillion; mine is $1.5 trillion. Nevertheless, those are enormous funds, built up from currency reserves. If they are used benignly, as seems to be happening at the moment—for example, a 9 per cent. stake has been taken in Morgan Stanley and a 3.1 per cent. stake in Barclays—that can be a very positive thing for the world.
What we do not want is China using its might through sovereign wealth funds or, indeed, its trade with Africa for unfair trade advantage. We want to watch carefully what the Chinese are doing in Africa, because we want to see fair treatment of African countries. Basically, what China is doing in Africa is providing infrastructure in return for mining rights. Those deals need to be scrutinised very carefully to ensure that China is not mortgaging the future of some of those countries.
I congratulate the chamber of trade in the area represented by my hon. Friend the Member for Southend, West (Mr. Amess) on the Essex-Jiangsu partnership. That is a fantastic effort. It is a pity that the Government cannot follow that effort by promoting the same proportion of trade leads as Essex county council manages to do. Essex chamber of trade may well have something to teach UKTI and the Government on how to do business with China, because it is clear that we are not doing the amount of business that we should, and fears have been expressed about the effectiveness of the China-Britain Business Council. I do not want to knock the council; it has done a great deal of good over many years, but that does not mean that it cannot improve its performance from now on.
The other important factor that my hon. Friend mentioned was the need to teach Mandarin in schools. He may be interested to know that a school in my constituency is a Chinese academy and teaches Mandarin. I got the Chinese ambassador to go to the school, and the delight of the children—not so much the delight of the ambassador, because their Mandarin was not up to his expected standard—in being able to converse with the ambassador in Mandarin was fantastic. We perhaps need to stop the over-preponderance of teaching French in this country and start to teach Mandarin and Spanish, which are two of the most widely spoken languages in the world.
The market that we are discussing is huge. China has 1.3 billion people. It has moved 200 million people out of poverty in the past 10 years. They have moved from rural to urban areas. There is still a huge disparity of wealth between the rural and the urban areas. I have been into the hinterland in China. I have seen some of that disparity of wealth, but I have also been to Urumchi, which is one of the cities in the far west, and it is similar to a modern western city, so whereas everyone talks about the eastern seaboard with regard to doing trade with China, there is plenty of trade to be done within China.
I have a lasting memory of China—I almost lost my life there. I fell 20 ft down a concrete shaft in China, but I survived and I am going back, because I want to discover more about that exciting country. It was when I was in Urumchi, talking to the Speaker of that Parliament, that I coined the phrase that the 19th century belonged to Britain, the 20th century belonged to America and the 21st century will belong to China.
We must make friends with China. We must do more trade with it; we must have more cultural links with it; we must have more exchange with it; and we must have more educational exchange with it. Every time I have visited China, I have been to a school: to see those young people’s enthusiasm for learning English is fantastic. We should capitalise on the fact.
Thank you, Mr. Illsley, for guiding us this morning. I thank my hon. Friend the Member for Nuneaton (Mr. Olner) for hosting our debate.
As we heard, the genesis for this debate was the Industry and Parliament Trust’s visit to Shanghai and Suzhou in May. We heard many contributions from hon. Members who were on that trip. The visit obviously had a profound effect on those who went. We also heard praise for the IPT. I read with pleasure the blogs, diaries and various accounts written by hon. Members during and after their trip. What struck me was the scale and speed of the changes in China, which had an impact on everyone on the trip.
The group visited China shortly after the earthquake. I therefore record the Government’s support for the recovery effort in Sichuan province, noting that the former Secretary of State for Business, Enterprise and Regulatory Reform, the right hon. Member for Barrow and Furness (Mr. Hutton), now the Secretary of State for Defence, visited China a few weeks ago. During his visit, he met the Government to discuss how United Kingdom companies could contribute to the huge reconstruction effort that will be required. Construction firms, architects and many others will be needed; if we can, contributing to that as a country is something that we would want to do.
The underlying question today is whether the Government and the country get it. I believe that we do. Among world leaders, my right hon. Friend the Prime Minister is uniquely focused on the opportunities presented by globalisation. The changes in the world order that we heard about today—the rising importance of China, India and other countries—is a constant thread running through my right hon. Friend’s speeches and policies, and the stance that he wants Britain to take. That is not surprising because the economic world order is changing in a big and fast way.
The assumptions of the 20th century will not hold in the 21st century. All countries, including the UK, must reassess their priorities in trading and business. Although any discussion of globalisation must take as its backdrop the events of recent months and weeks, I do not want to go into detail; the Chancellor has made many statements to the House in recent weeks outlining the Government’s response. However, Britain must not allow the recent financial storms to alter our stance as a globalisation optimist—as a county that believes in looking outward and making the most of trading opportunities around the world. We will not allow that to happen; we will continue to be champions of openness and flexibility, and not retreat into protectionism or economic nationalism.
On one point, I gently disagree with my hon. Friend the Member for Sittingbourne and Sheppey (Derek Wyatt). He said that we were becoming more isolationist. I believe that the events of recent weeks have proven profoundly that that is not the case. We are not becoming more isolationist; we will continue to champion openness and flexibility, always being outward-looking.
In the time available, I shall respond to some of the points raised during the debate, in particular about British business opportunities with China. The first, on a political level, is how seriously we take engagement with China. There are regular high-level political meetings with China. There is an annual prime ministerial summit; this year, it took place in January between the Prime Minister and Premier Wen. As a result, a range of new trade and economic collaboration activities was announced. That includes a bilateral trade target for trade in goods and services that will reach $60 billion by 2010, which represents a 50 per cent. increase over 2007.
There was agreement also on a high-level annual economic and financial dialogue between the Chancellor and Chinese Vice-Premier Wang Qishan; we will be the first European Union country to match similar existing arrangements between China and the EU and China and the United States. There is also an agreement to maximise trade and investment in the environmental sector. We are pursuing that in many ways, including through the sustainable cities initiative, which also featured during the Secretary of State’s recent visit. Obviously, a host of ministerial visits took place at the time of the Beijing Olympics. However, over the past year the Secretary of State visited China three times; the Trade Minister, Lord Jones of Birmingham, visited twice; and the Lord Mayor of London visited once. Those high-level visits are an important part of our strategy.
I turn to the backing for our business presence in China. UK Trade and Investment has been a key element on those visits. It includes not only politicians; often there are high-level business delegations. UKTI works to support British business in China, with the aim of delivering a measurable improvement in the business performance of UKTI’s trade customers, improving two-way trade with China, dealing with the question of market access and beating the drum for British business in China.
Reference was made to the numbers involved in the UKTI operation. It is the biggest such operation in the world. As my hon. Friend the Member for Wirral, South (Ben Chapman) said, its numbers have increased by 25 per cent. over recent years. Hon. Members say that they want more. Of course people want more, but that is evidence that we take the matter extremely seriously. We are putting more resources into it.
I say this in a constructive way. When I talk to people in China and elsewhere, they say, “Yes, we get plenty of high-level visits, and plenty of interest for business in the first flurry, but somehow that interest is not translated into actual business.” I ask the Minister, with UKTI, to see whether we can improve on that aspect.
I thank the hon. Gentleman for that most important intervention. I am glad that he made it. Of course, it is important that visits are backed up by results. Our exports to China have increased significantly in recent months.
Reference has been made to the new Secretary of State, Lord Mandelson. He will be an important addition to our armoury when increasing business and trade opportunities. Few people in the world have his experience of China, and many countries would like someone with experience as a Trade Commissioner to join their Government in order to champion that policy.
The question was raised of whether our representation in China is right. We have the embassy; and we have three consulates that operate each in their own area. The point has been made that we have too many offices—and that we have too few. The point has been made that local offices for the regions clutter the process—and that local offices are valuable in providing links to the local area. We must make up our minds on whether we want more or less and whether we want local or national.
We are right to seek value for money. A review by Arthur D. Little and others made certain recommendations, which we shall put into practice, to ensure that the taxpayer gets the best value for money from our important trade representations in China.
I would like to say more, but time does not permit me to do so. The issue is hugely important, and as a Government we do get it.
Rugby League
I raised this debate to put the spotlight on the Rugby Football League’s decision of 22 July 2008 to reject the application made by Widnes Vikings for a licence to secure entry to super league for the 2009 to 2011 seasons. It might surprise some supporters in Widnes that I have not spoken on the matter before, but having recently ceased to be a Minister, I now have the opportunity for such a debate, which I welcome. It was my decision, made on my initiative, to introduce this debate—it had nothing to do with Widnes rugby league football club.
I should make it clear that although I see some merit in the super league licence system, I am unconvinced that it is the right way to go for the game in this country. I have always been and I remain firmly of the view that there should be a system of promotion and relegation. I am in favour of super league expansion, but that should not happen at the expense of heartland clubs such as Widnes.
This has been a sad episode in the club’s long and illustrious history. Widnes rugby union club was established in 1873 and was a founding member of rugby league’s northern union in 1895. Since 1920, the club has boasted numerous Lancashire cup and Challenge cup titles, three championship titles and the coveted world club championship. A super league member from 2002, the club was relegated in 2005. In the following two years, it narrowly missed out on promotion to super league; however, the club was beset by financial problems and went into temporary administration. Salvation came in the form of local business man Mr. Steve O’Connor. He purchased the club in November 2007, injecting £1.3 million of investment to reinvigorate the Vikings with new facilities, logo and management structure—he became chairman—in preparation for the super league licence bid. That unfortunately came to an end when the RFL announced the 14 successful applicant teams, which did not include the Widnes Vikings.
In Widnes, there is a widely held view that the RFL has an inherent dislike of the Widnes club because of something that went on in the past that no one can quite fathom. To back that up, Widnes supporters point to the club’s inexplicable exclusion from the inaugural super league in 1996 and the fact that the club was relegated in 2005 to allow the Catalan Dragons into super league. The treatment of the club in relation to the super league licence further reinforced the view that the RFL has it in for Widnes.
As a long-standing Widnes Vikings supporter, I have been impressed by the new energy and enthusiasm surrounding the club, and its dynamic and professional approach. The club’s board, staff and players have been commended for the way in which they have taken full advantage of the O’Connor-Stobart investment and the successful partnership with Halton borough council to modernise the club. I have seen the excellent facilities and the hard work that they have produced, ranging from the new players’ gym and treatment rooms and a new media club room, to better seating in the stadium and impressive innovations in electronic ticketing, marketing and community activities. Further achievements include the new website, fans forum and updated merchandising and season ticket sales.
I firmly believe that the RFL shifted the goalposts when assessing Widnes Vikings’s application, rejecting it on the basis not of its specified criteria but on a predetermined bias against the club’s recent financial past. In doing so, I believe that it brought the entire franchise system into disrepute. I am sure that the Minister will appreciate that that has led to massive disappointment, frustration and anger within the local community in Widnes and in my Halton constituency, and I will welcome his comments on that.
Despite the club’s highly successful record and its state-of-the-art modern facilities, which are further enhanced by new investment, the RFL rejected Widnes Vikings’s super league licence application, mainly because of its recent financial past, despite previous reassurances to the contrary. That is a key point. The application was rejected even though the club felt that it had complied fully with the application criteria for a super league licence, and was led to believe that its recent liquidation status would not impinge on its application.
In post-22 July discussions with the Rugby Football League, chairman Steve O’Connor was told that his turnaround of the Widnes Vikings was not of sufficient duration for the RFL to be confident of the club’s long-term viability. That was despite Steve O’Connor’s personal cash bond offer of £500,000—that is important—to ensure the solvency of Widnes Vikings over the three years of the super league licence period. I am not aware that any other club offered such a guarantee.
Appearing on the Sky Sports rugby league “Boots ‘n’ All” programme on 23 July, the RFL executive chairman Richard Lewis denied giving any prior assurance to Steve O’Connor regarding the administration situation in response to a fan’s e-mail question. When questioned by interviewer Eddie Hemmings, he said:
“The insolvency issue played a significant part”.
In a reply to a letter that I sent on 29 July, Mr. Lewis stated on 5 August:
“Their financial background was a major factor and this was always going to be the case”.
However, in the very next sentence, Mr. Lewis wrote,
“it was perfectly possible for Widnes to be awarded a licence and without revealing any confidentialities, they did finish well ahead of several other clubs”.
I am not 100 per cent. sure what that means, but it raises a concern. That prompts the question: if the granting or otherwise of a super league licence was determined by the club’s recent insolvency, why was it allowed to bid on the basis of other criteria, which the club, in my view, more than fulfilled? That is a key point.
At the time of the proposed O’Connor takeover of the club, I rang Richard Lewis with three aims in mind: first, to tell him my views on the O’Connor proposal and the current local situation; secondly, to ask the RFL not to impose too harsh a penalty on Widnes; and thirdly, to clarify whether Widnes would be allowed to bid for a super league licence. I was assured that the club would be allowed to do so and that any application would be judged solely on its merits. To this day, the RFL has provided no substantive evidence to explain why, against its own criteria, Widnes Vikings was refused a super league licence, other than its past financial situation. However, if that was always going to be a problem, why was the club allowed to bid?
I thank my hon. Friend for introducing this debate—it is important that we get such things on the record. However, I think that he ought to spell out the true merits of Widnes. It not only has a great history—we should not rely on that—and is a great club, but the club’s ground was used in this season’s play-offs. Wigan had to borrow Widnes’s ground, because its standards are higher than most other grounds in super league. It is one of the best grounds outside super league, and would be one of the best in super league. We should spell out how great a ground it is, and how it meets all the standards when other grounds do not.
I thank my hon. Friend—he is a stalwart supporter of rugby league and does a lot of work in support of the game. I do not think that I need to say more—he said it for me—but I will talk about the ground later.
One must also ask whether, if the RFL had been clear from the outset that Widnes’s recent financial past was a hurdle that they could not get over, Steve O’Connor would have opted to invest a substantial amount of money immediately and gone hell for leather to secure super league status, or whether he would have consolidated and built the club’s financial capacity gradually in a concerted effort to secure entry to super league in the next round.
I do not have a problem with Wakefield Trinity Wildcats. I see that a great supporter of that club is in the Chamber, my hon. Friend the Member for Wakefield (Mary Creagh). It is a great club and I have been to the ground, but I wish to highlight one issue. Before I do so, I should like to offer my condolences to the family of the 31-year old Wakefield player, Adam Watene, who suddenly passed away this week. I am sure that the thoughts of the entire rugby league community are with his family at this difficult time.
My hon. Friend the Member for Weaver Vale (Mr. Hall) and I wrote to the RFL last month to ask it to consider Widnes Vikings’s super league application afresh, given that Wakefield’s new stadium plans collapsed within weeks of the licence announcement. In response to the comments on the Wakefield situation made by Widnes Vikings supporters club chairman Alan Rae, the RFL said that it will seek to learn more about the club’s plans to move the situation forward, but remain fully committed to the principles of the licensing process, which require all super league clubs to stage matches in venues of appropriate size and quality.
Appendix 1, page 14, of the super league minimum standards summary in the 2008 super league criteria assessment checklist clearly states that the minimum capacity must be 8,000, and that the minimum number of permanent seats should be 1,500. Through Halton council, I checked the current situation based on information held by the building control officer at Wakefield council. He said that the seated area holds 1,382, which does not meet the 1,500 minimum capacity. We are also not completely sure that the stadium fulfils the 2,500 minimum capacity covered area criterion. We will be following that up further with the RFL, but it is important.
In his response of 2 October to my stated concerns about Wakefield’s status, the RFL’s Richard Lewis stated that Wakefield’s application for a licence
“was assessed against their current ground. The RFL placed relatively little emphasis on their plans for a new stadium as it was clear those plans were at an early stage.”
It is difficult to see how that assertion is in line with the RFL’s published view on Wakefield’s successful application when it was critical about the fact that there was no plan B and that everything was based on the new stadium. Richard Lewis went on to say:
“Whilst well maintained, the ground is limited and old fashioned. However, the club recognise this and have plans for a new stadium. These are not as far advanced as might be the case despite projected occupation by 2010 and evidence of Plan B would have been beneficial”.
I raise that specific point about Wakefield because it relates to the criteria applied and the fairness of the system. Widnes has a very modern state-of-the-art stadium, which was used as part of their argument for a super league licence.
I want to back up my hon. Friend and say that, historically, the criteria for promotion—this was certainly true when I was involved in rugby league and a member of the council—included a requirement for grounds to meet certain standards. Those standards were enshrined within rugby league. It was about improving the grounds for the future of the game. It has always been the case that the grounds were part of the criteria for a club to get promotion. A club might win the championship, but that did not automatically mean entry into super league. Part of the entry was that a club had to have minimum ground standards. I totally agree with my hon. Friend that Widnes’ standards are beyond everyone else’s. Does he agree with me that it might be better if we accepted Widnes as an extra team, as part of the family? All families grow. Let us grow it by one more club and put Widnes within super league.
I endorse what my hon. Friend says. Given the quality of the Widnes Vikings’ bid, it beggars belief that the super league did not increase to 15 clubs. We have had no real explanation for that. It should have happened, given the comments that I have had from Richard Lewis about the quality of Widnes’ bid. With regard to the other clubs, I am for expansion of the game, but I am not sure about the Crusaders’ bid given the low base of their support. Their away support is almost minuscule, they are relatively new and the ground is of a completely different standard to the Widnes Vikings’ ground. How could their bid outdo that of the Widnes Vikings? I will leave that for others to discuss at a later date.
As my hon. Friend mentioned, if the bid was judged against the current ground, it would appear that the existing stadium fails to meet the minimum standards. I am referring to the situation in Wakefield. Furthermore, the requirement for the home stadium strategy in the super league application form states:
“Home stadium is of a standard to be expected of a premier international sporting competition in the 21st century.”
At the end, it states:
“It is anticipated that any club planning or embarking on new stadium builds or significant improvements to current facilities will not satisfy this criteria.”
Again, that seems to be a contradiction. I do not think that they can have it both ways.
It is encouraging to note that solidarity with Widnes Vikings has been expressed across the country, not least in Yorkshire itself. On 24 July, in an article entitled “Licence farce is a dark day for the RL,” reporter James Roberts of the Halifax and Calderdale Evening Courier delivered a stinging verdict on the RFL’s handling of the entire process, pointing primarily to the rejection of a super league licence for Widnes as his central argument. He said:
“In the end, the Super League licence process turned out to be exactly what its critics feared: a giant carve up of the kind you simply would not experience in any other sport. Before anyone starts, my cynicism is not born out of Halifax’s rejections.”
He continues:
“No, my sympathy lies with the people of Widnes, who have been mugged by the game’s powerbrokers for the third time in a little over a decade. The Vikings missed the original Super League cut in 1996, were relegated to make way for Catalans three years ago and have now been tossed aside once again, despite having a case for inclusion that was arguably more compelling than a handful of other competitors. To summarise: Widnes have the ground, heritage, a solid fan base, the development set up and the money.
In the debit column was their flirtation with administration last year, before the arrival of transport mogul Steve O’Connor and his millions. The Vikings certainly weren’t expecting that to hamper them though. Even as they fought out Sunday’s 26-26 thriller at the Shay, the club’s hierarchy were utterly convinced of their own success. With some justification too.
The Rugby Football League’s own assessment of the 19 bids—which incidentally contains more holes than the proverbial Swiss cheese—highlights the fact that Tuesday’s big winners, Salford and Celtic, have poor ground facilities. And poor old Widnes? Well, I’m still no nearer to understanding that one. I have never made any secret of the fact that I fundamentally disagree with the franchise system. But if we’re going to do it, let’s at least do it fairly.”
Mr. Roberts has this damning conclusion.
“At this moment in time, it is difficult to avoid the impression that the RFL picked the 14 clubs, on grounds of geography, a couple of years ago and have been acting out a long-winded pantomime ever since.”
In undermining the entire super league licence process with the get-out that it could ignore the criteria it set down and make discretionary decisions outside the process, the RFL has effectively played fast and loose with the entire scheme. At the end of the day, in seemingly moving the goalposts for super league licence approval and showing a breathtaking and arbitrary disregard for its own criteria, the RFL has made a mockery of the entire process from the outset.
Throughout the whole process, Mr. Steve O’Connor and his dedicated team at Widnes Vikings have demonstrated a forward-looking, get-on-with-the-job-and-not-go-about-sulking approach that speaks volumes about the professional integrity and the characters of those involved. I pay tribute to Mr. O’Connor and the staff and players at Widnes for their professionalism and the way in which they have borne this terribly disappointing news.
Halton council was well ahead of the game in ensuring that its rugby league club had a modern stadium with excellent facilities in which to play. The stadium also hosts other sports, including the north-west’s regional table tennis centre. I ask the Minister what message it sends to other local authorities that are putting in massive investment and championing their key sporting institutions if Halton is treated in such a way.
In conclusion, Widnes Vikings are under new leadership and have the resources to go forward. They have a fantastic modern stadium—as we have been hearing about—a solid and sizeable fan base with a clear potential to grow, an excellent community development and marketing strategy and they have in place the necessary people and resources to develop young players.
I also want to mention Widnes’ large away support. Some of the local derbies will take between 2,000 and 3,000 supporters. That is a sizeable amount of money. Even crossing the border into Yorkshire and elsewhere, the club takes a sizeable number of supporters, which shows their great commitment. That is now lost to rugby super league. In addition, Widnes are sponsored by Stobarts, one of the most well known brands in the country. Surely the super league would have wanted to be associated with that brand, which is the sort of brand it is particularly looking for. Those are the other things that the super league is missing out on.
It is difficult to consider the situation objectively. If Widnes’ application was judged on its merits, as the RFL told me it would, how could they fail? That is the point I keep coming back to. The system has not been transparent as the RFL promised. When my hon. Friend the Minister next meets the RFL, will he raise the concerns that I have set out today and seek assurances that the next licence application process will be much more transparent, and that any expansion of the game should not be at the expense of rugby league heartland clubs such as Widnes?
I congratulate my hon. Friend the Member for Halton (Derek Twigg) on securing the debate on Widnes rugby football club and its relationship with rugby league. I know that sport is his passion—not only rugby but football as well. I am grateful to him for making his remarks on a personal basis. He is speaking entirely as a constituency MP and his remarks have not been promoted by the club. He was quite right to make that point. He has put his arguments in relation to the super league with some force.
May I start by adding my condolences to the family and colleagues of Adam Watene, the Wakefield Wildcats prop who passed away suddenly this week. Adam served a number of clubs and made his mark at all of them, including my own club, the Bradford Bulls. He was a talented player and a popular man and will be sadly missed. I know that my hon. Friend the Member for Wakefield (Mary Creagh) will pass on the condolences of the House to him and to his family.
My hon. Friend the Member for Halton has made his support for rugby very clear, and I will come to the nub of his argument in a few moments. The debate gives us an opportunity to talk about the benefits of rugby league and what rugby league is doing as a sport.
Given that it is a great game and one of the best sports—the best sport as far as I am concerned—will the Minister tell us when we will see rugby league as a category A sport? Perhaps in his conclusions, he can tell us why and when that will take place.
I am grateful to my hon. Friend for that intervention. Perhaps we will not go down that track this morning, but I will discuss the matter with him later, because I think that there is some confusion about what the Rugby Football League applied for.
As I was saying, I try to get to as many rugby league games as possible. I was at Old Trafford for the super league final on 4 October and I congratulate Leeds Rhinos on their wonderful win. Being a Bradford Bulls fan, it is difficult for me to praise Leeds Rhinos, but they won a great match. In my view, it was a wonderful showcase for the game of rugby league.
Rugby league is a game that is going from strength to strength. In the 2008 season, record crowds were achieved in both super league and the national leagues. As we all know, sport plays an important role in improving the health of the nation and rugby league is playing its part in that process.
Through Sport England, the Government have invested more than £18 million in rugby league since 2005. Rugby league is one of the 46 sports that are about to submit a whole sport plan to Sport England for funding for 2009. It is right that the sport receives Government funding, as rugby league continues to help to deliver the Government’s sporting aims.
As my hon. Friend the Member for Halton said in questioning some of the governance arrangements for rugby league, it is important that all sports are governed correctly and appropriately. The Government attach great importance to strong and effective governance in sport, especially because of our investment in the grass roots of sport. However, I must say that I believe that in Richard Lewis, the RFL’s executive chairman, and Nigel Wood, the chief executive, the sport of rugby league is in good hands. Richard and his team have done a tremendous job to ensure that the sport is run effectively and in a modern, efficient way. Rugby league is being managed by a strong leadership and by people who are able to take difficult decisions for the long-term good of the game and to protect and grow the sport.
Of course, one of those difficult decisions was the awarding of the super league licences. The licensing scheme was first launched in 2005 as part of the super league strategy. All clubs had the opportunity to influence the application process and the criteria in one-to-one meetings and in club meetings. They also had two dry runs of the application process, in 2006 and 2007, to ensure fairness and robustness in the process. All clubs applying for a super league licence confirmed that they agreed with the objectives of licensing and with the application and selection process. Clubs were entitled to appeal to an independent tribunal if they felt that the process was conducted unfairly. Decisions were made by an independent RFL board of directors after an exhaustive and extensive process.
As my hon. Friend said, there were four main criteria for assessment: facilities; financial stability and business management; player production; and communities, marketing and social strategies. My hon. Friend is obviously particularly interested in and concerned about the Widnes Vikings. I have to agree with him that it is a great club with a long and varied history, with many highs and a few lows along the way.
I invite my hon. Friend the Minister, perhaps the next time he is in the right part of the country, to take the time, within the demands of his itinerary, to visit the Widnes Vikings in the Stobart stadium, to see the amazing facilities that they have there, particularly the community development and the work that is taking place within the community, including with children and youngsters with difficulties and challenges.
I am happy to acknowledge the work that Widnes has done with Halton council and indeed I will try to get to the stadium. I have been to Leeds and Warrington to see the facilities and the tremendous work that is going on in the multi-sports clubs facilities there. Similarly, my hon. Friend mentioned in his speech the table tennis that takes place at Widnes too. I have no problem with how Widnes Vikings are run as a club and how they work with their local authority, and I appreciate the work that my hon. Friend does in trying to ensure that the club will grow.
Of course I sympathise with the situation that Widnes Vikings find themselves in and I appreciate how frustrating it must be for the club and their loyal supporters not to be playing in the super league now. However, I know that my hon. Friend will agree that the organisation of rugby league is essentially for the sport to manage and it is not for the Government to intervene.
I believe that the RFL has been diligent and fair in its decisions, although I will pass on the comments that my hon. Friend has made today, and I am sure that the RFL will look at the debate today to see what he has said and whether there are still any questions that need to be answered.
I understand the point that my hon. Friend the Minister has made, and I would not like to put him on the spot in any way. However, does he agree that if Widnes’ financial situation—that of having gone into administration—was going to be the major stumbling block in achieving the super league licence, which has been confirmed by the RFL’s chief executive himself, the RFL should have said that at the beginning? If it had, Widnes would not have bid in the first place and the club would have avoided going through a process that it was never going to win anyway, because of its former financial situation.
My hon. Friend tempts to get me personally involved in this issue, which I do not want to do. As I said, there was an opportunity to express any concerns in the discussions that were had with the RFL and in the dummy run process in 2006 and 2007. I know that there was a problem because Widnes went straight into administration, or insolvency, in 2005.
However, from what I have been told by the RFL, the licensing application process was a fair process. In all processes, there are winners and losers. My hon. Friend is aggrieved because he believes that Widnes are unfair losers. I will raise his concerns with Richard Lewis and Nigel Wood, but in my view it is for the RFL to run the league, and I think that it does so very well.
My hon. Friend said at the start that he did not agree with the franchise system. The RFL believes that licensing offers the best of both worlds. One national league club is guaranteed a place in super league in 2012, and with a three-year licence it will be given every chance of success, thereby removing the yo-yo effect of clubs chasing and overstretching for promotion. We know in rugby league, as in other sports, that that has been a problem. All licences into super league were issued for three years and clubs will be judged on how well they deliver their agreed plans.
My hon. Friend mentioned Wakefield Trinity Wildcats. I can confirm that I have received the same information that he did: that the change in the plans for the new ground made no difference to the licensing application. That was not a consideration in relation to the licence.
Super league’s licensing is one of the drivers for the development of new stadiums, which produces benefits for the community and, on game days, for spectators, players and officials. As my hon. Friend knows, Widnes Vikings finished sixth in the Co-operative national league one this season, and things are looking good for next season, both on and off the field, with nearly £10,000 worth of season tickets purchased already and a number of good player signings.
I also know that exciting plans have been mapped out for the national league for 2009 onwards, including a 150 per cent. increase in funding, live TV coverage every week, a weekly magazine, corporate website production and the inclusion of a French club, which will add extra vibrancy and interest to that national league. There will also be significant extra income for clubs from the Challenge cup.
Only two clubs can be admitted to the super league for next season, and inevitably other good clubs will miss out. However, the door is not shut and the players and fans of Widnes Vikings should be reassured and confident that, with their current management team in place, they will be in a far stronger position in two years’ time, when the club can apply again for a super league licence. I wish the club really well in their endeavours.
Rugby league is a fast-growing sport and it is important that we try to give support to the national league and to the other leagues right across the country that rugby league has been developing. In the last two years, rugby league has experienced a 27 per cent. increase in participation, with almost 250,000 people currently involved as players, coaches, match officials or volunteers. The Active People survey reports that more than 110,000 people take part in rugby league at least once a month. Furthermore, in Halton, my hon. Friend’s constituency, Sport England has invested £44,000 over three years in its contribution to a rugby league development officer, who is charged with getting more people to participate in rugby league in that area.
I am also pleased to say that participation among women and girls has also seen a healthy year-on-year increase of 42 per cent. There are now 579 girls registered with age groups from under-12s to under-16s, and the RFL runs festivals for girls fortnightly between March and October.
As my hon. Friend has said, it is important that football and rugby clubs become the heart of their communities. I know that the investment has gone in from Halton borough council to the Widnes Vikings club, to try to increase participation and ensure that more people are involved in sport, so I understand that it was a great disappointment to everyone concerned that Widnes Vikings did not get into super league. However, Widnes Vikings now have a position—a platform—to build on and hopefully they will be successful in the national league. Then they will be in a position to ensure that they do not return to the horrors of the past, particularly when they went down after their last game in the super league and became insolvent almost immediately. The club has turned that situation around and is now looking forward to the future, from the secure base that my hon. Friend has talked about.
I think that it is difficult for the RFL to put forward a process that it sees as fair and rational but that also withstands challenge. Where there are outstanding questions that my hon. Friend feels the RFL has not answered, I will certainly pursue those questions with Mr. Lewis and Mr. Wood. I must say that there will always be disappointments when we have this type of process. However, for the good of the game, it is important that we move forward.
Sitting suspended.
Learning Difficulties (NHS Treatment)
[Joan Walley in the Chair]
It is a great pleasure to be under your watchful eye this afternoon, Ms Walley. I am grateful for this opportunity to discuss care for those with learning difficulties in the NHS. Only a few months ago, in a similar debate, I was fortunate enough to be able to raise the parallel issue of care for the elderly in the NHS. In that debate, I made a point that I shall repeat now for the record. Most of us receive excellent care in the NHS. It is an institution of which we are rightly proud and in which skilled and dedicated people respond superbly to the daily challenges that they face. However, as hon. Members’ casework makes clear, all too many cases of neglect and failure in relation to two groups—the elderly and those with learning difficulties—show that there is a problem that must be recognised and acted on at the highest level of Government.
I am here today to give voice to the family of my constituent, Emma Kemp, who had a severe learning disability. She died in 2004 of cancer, not after months of chemotherapy or intensive drug treatments, but without receiving any treatment for it at all—and, until the last month, without pain relief—despite being given a 40 to 50 per cent. chance of survival when she was first diagnosed.
I will talk further in a moment about Emma’s tragic story and her mother’s brave campaign to ensure that it is not repeated for any family, but I start by acknowledging that society has come a long way in our attitudes toward those with learning disabilities. Thankfully, episodes such as the Mental Deficiency (Amendment) Act 1927, which defined people with learning difficulties in the most horrendous way, are in the past, yet Government policy has not gone nearly far enough to reduce the inequalities and discrimination faced by people with a learning disability. The discrimination that my constituent Emma faced is at odds with the values of the modern world and of the NHS. What is the point of the Government’s talk about patient rights and an NHS constitution when even the most basic right to treatment cannot be provided for some of the most vulnerable people in our society?
Many hon. Members will recall that Emma’s case was first highlighted in a Mencap report aptly named “Death by Indifference”, about which I am sure we shall hear more in this debate. The report told not only Emma’s story but those of five other people with a learning disability who suffered pain and died, perhaps unnecessarily, while in the care of the NHS. Mencap has worked ceaselessly with the families of those people and many others across the country, with PCTs and health trusts and in the media to raise the profile of those with learning difficulties and their treatment in the NHS. I have nothing but praise for the fantastic job that Mencap has done in supporting Emma Kemp’s family and for its campaigning work.
Let me state clearly that this debate is not about knocking one or even six hospitals or GPs and clinicians; it is about facing up to a systemic failure. Understandably, the injustices revealed in “Death by Indifference” provoked a media and public outcry. In response to the criticism, the then Secretary of State for Health, the right hon. Member for Leicester, West (Ms Hewitt), to her credit, announced both a health ombudsman’s investigation into the six individual cases and an independent inquiry to investigate the general health inequalities experienced by people with a learning disability.
Although we are still waiting for the health ombudsman’s report, the independent inquiry chaired by Sir Jonathan Michael published its report just after Parliament went into recess this July. The report contained criticism of current practices and made a host of recommendations, many of which would have made a difference to my constituent Emma’s chances of survival if they had been accepted practice at the time.
As I have said, Emma was a lively and loved 26-year-old with a severe learning disability who was living in a supported living environment close to her family when her mother noticed that Emma was losing her appetite. Emma’s mother, Jane, for whom I have enormous respect, is one of those rare people whom one meets in such a role. She is a real campaigner and has been a fantastic witness in presenting the case for Emma and similar people throughout the country. Jane took Emma to a GP who, although Emma had not eaten for eight days, sent them away, saying that it might be a virus. Not satisfied with her daughter’s diagnosis, Jane took Emma to her own GP, who advised that Emma be admitted to hospital. Despite Emma’s obvious pain and distress, the medical professionals could not diagnose a physical problem. It was left to Emma’s family to point out to doctors that Emma had a lump in her groin, which they had found while helping to wash her in hospital.
Emma’s learning disability meant that she exhibited challenging behaviour. She was frightened of being in hospital and of being examined by doctors. Nevertheless, the doctor investigating the lump in her groin was able to take a biopsy under local anaesthetic. After that, despite the fact that Emma was still not eating, she and her mother were sent home from hospital with painkillers in oral tablet form, although it was understood that Emma could not swallow tablets. Once at home, Jane was left to chase the medical professionals for Emma’s diagnosis. Finally, on 18 June 2004, Emma was diagnosed with type B1 lymphoma, which attacks the lymph nodes and can enter the bloodstream. The doctors gave Emma a 40 to 50 per cent. chance of survival but said that Emma’s behaviour meant that they could not treat her.
What the doctors failed to understand was that due to her learning disability, Emma lacked the capacity to consent to treatment. Just because Emma was in pain and frightened of the treatment that the doctors wanted to give her did not mean that she understood the consequences of refusing treatment or that she was choosing to die. I do not understand why the doctors did not listen to Emma’s mother, who demanded treatment for her daughter, or apply their own General Medical Council guidelines. The guidelines are specific. They make it clear that if a patient has no capacity to consent, doctors should make all attempts to make the patient as comfortable as possible so that they can be treated. The fact that one of the doctors could take a biopsy of the lump in Emma’s groin is evidence that, with the right approach, it would have been possible to treat her. However, instead of receiving treatment, Emma was sent home—still starving, in immense pain and without a solution for providing her with pain relief.
Five days later, alarmed by Emma’s continued distress, Jane brought her back to hospital, where she languished for a further two days without any pain treatment. By that time, Emma had also stopped drinking. So determined was Jane to protect her child from the pain that she instructed a solicitor to serve notice on the doctors to start pain relief. When even that made no difference, the solicitor started an action in the High Court, which had the desired effect. The hospital finally provided Emma with pain relief in a patch.
Emma’s mother also demanded a second opinion, which showed that Emma had only a 10 per cent. chance of survival. Reluctantly, Emma’s mother agreed to palliative care, which was provided through an excellent facility in the Newbury community hospital called the Rainbow Room. Emma died there on 25 July 2004.
As I said earlier, we are still awaiting the report from the health ombudsman, but it appears possible that the large reduction from a 40 to 50 per cent. to a 10 per cent. chance of survival may have been based not on the spread of the cancer but on the capacity to consent. Should that be true, it is indeed alarming.
Reading Sir Jonathan Michael’s excellent report, it is easy to see what a difference his recommendations could have made to prevent the tragic delays and failure to provide treatment that I outlined. Two of his recommendations stand out. The first is:
“Family and other carers should be involved as a matter of course as partners in the provision of treatment and care, unless good reason is given”.
As hon. Members know, had doctors listened to Emma’s mother’s instinct that there was something seriously wrong with Emma’s health when she first stopped eating, who knows how early they could have caught the cancer? Mencap says that too often the parents and carers of people with learning disabilities are ignored by medical professionals, despite the fact that their knowledge is vital. It is they who live day in, day out with the individual with the learning disability, and it is they who will be the first to notice behavioural changes and be able to help to interpret non-verbal communications of pain and distress.
Another crucial recommendation of the inquiry states:
“Those with responsibility for the provision and regulation of undergraduate and postgraduate clinical training must ensure that curricula include mandatory training in learning disabilities. It should be competence-based and involve people with learning disabilities and their carers in providing training.”
At the moment, medical professionals do not understand enough about people with learning disabilities, but understanding their health needs and the ways in which they communicate is crucial. Research commissioned by Mencap found that 75 per cent. of general practitioners had no training to help them deal with patients with learning disabilities and that 95 per cent. felt that a patient’s learning disability made it more difficult for them to make a diagnosis. Even doctors acknowledge that they need to be given the confidence to intervene early and to take seriously the health needs of a person with a learning disability. In evidence taken by the independent inquiry, three quarters of health and social care professionals who responded mentioned the need for better education and training for staff.
Will the Minister tell us when we can expect to hear the Government’s response to the independent inquiry? It made 10 very good recommendations. We have had good assurances from Ministers about it, but we want action and to know how the recommendations will be implemented. Mencap, the families of the six people whose cases were described in the “Death by Indifference” report, and many hon. Members are calling on the Government to accept all the recommendations in the inquiry. It is worth noting what the chief executive of Mencap, Jo Williams, said on the day of the report’s publication:
“The independent inquiry proves that people with a learning disability are being discriminated against in the NHS, which is leading to unnecessary pain and death.”
She continued:
“It is clear that there is a desperate need for mandatory learning disability training for all health care professionals, and for people with a learning disability and their families and carers to be at the centre of all decisions made surrounding their healthcare.”
The health inequalities faced by people with a learning disability are not limited to Emma and the five other individuals referred to in “Death by Indifference”. The Department of Health reports that there are 1.5 million people in this country with a learning disability, an estimated 40,000 of whom have a profound and multiple learning disability such as Emma’s. People with a learning disability have higher health needs than the rest of us, yet many of them receive some of the worst treatment. For example, they are three times more likely to die from a respiratory disease, have a higher risk of coronary heart disease—the second most common cause of death among those with learning disabilities—and higher rates of gastrointestinal cancer and stomach disorders. We need to hear today what the Government will do to respond to this growing need.
Why the Government have taken so long to improve the services available to people with a learning disability is beyond me. In his first speech as Secretary of State for Health, a year ago, the right hon. Member for Kingston upon Hull, West and Hessle (Alan Johnson) admitted that people with a learning disability face some of the greatest health inequalities. What action has been taken to resolve such inequality? If the Government had taken action after Mencap’s first report, “Treat me Right: Better Healthcare for People with a Learning Disability”, published in 2004, which outlined the same types of inequality as those we are discussing today, how many lives might have been saved? That report made very clear and open recommendations, many of them very similar to those made in Sir Jonathan Michael’s report. The independent inquiry states that
“leadership is essential to deliver policy effectively for vulnerable groups in society”.
We want to hear from the Minister that the Government are stepping up to the call for leadership.
It is not only hon. Members here today who are concerned about the treatment provided to people with a learning disability. Back in May our very own Joint Committee on Human Rights published a report on the human rights of those with learning disabilities, and found that
“for many adults with a learning disability, the violation of their human rights is seen as a normal part of their everyday lives”.
The Committee expressed concern that adults with learning disabilities in health and residential settings suffer neglect, abuse, discrimination and indifference. It also stated that
“the Department of Health could do much more to promote a culture change and a human rights-led approach”.
It seems that once again we return to failures of leadership from the Department.
Debates on health inequalities are too often focused on dry statistics and numerical calculations of outcomes. What we have talked about today is a real human tragedy, and I hope that I have helped the Minister to understand the human cost of health inequalities. I leave her with the words spoken to my constituent, Jane Kemp, about her daughter, Emma: “If she had been a normal young woman, we would not hesitate to treat her.” As Mencap said to me, such comments cannot be proved, because they were not recorded in health notes. However, just because discrimination and health inequalities are difficult to prove, does not mean that they do not exist.
I hope that the Government will take the recommendations of the independent inquiry seriously. We want to hear not just assurances and warm words, but whether the Government intend to implement all 10 recommendations, and if not, why not. If they do, how will that implementation be carried out, and on what time scale? I believe that the six families in the report, “Death by Indifference”, deserve no less.
I sincerely congratulate the hon. Member for Newbury (Mr. Benyon) on obtaining this debate on this very important matter and on his very comprehensive speech. At times, it was very touching, particularly when he dealt with the important case study of which he quite rightly reminded us. This debate is about people and families and their concerns.
For some years, I have had the privilege, with Lord Rix, to Chair the all-party learning disability group. The input from Mencap and the support for our work is quite profound. I hope to turn to that in a few moments. First, however, I say to my right hon. Friend, the Minister, that nothing that I shall say in the next few moments takes away from what I think are the Government’s quite incredible achievements in the field of disability over the past 10 years. In particular, I welcome her support for advocacy, which she has expressed on many occasions, and which is central to the many issues being debated.
Almost two years ago, the all-party group on learning disability met to discuss the Healthcare Commission’s report into learning disability services in Cornwall. Some 18 months ago, the Disability Rights Commission, as it then was, spoke to us about the findings in its report, “Equal Treatment: closing the gap”. Those reports addressed systemac failings—the hon. Gentleman has rightly used that term today—in the NHS regarding patients with learning disabilities. In his response to those reports, the Minister who then had responsibility for those matters, my hon. Friend the Member for Bury, South (Mr. Lewis), now the Under-Secretary of State for International Development—we congratulate him on his promotion and thank him for his great work in his former role—was quite trenchant in recognising the problems. He said that things were not good enough and that there was evidence of “systemic indifference”. That is what we are addressing today.
There have been positive aspects to the Government’s response to the report, as we will no doubt hear from my right hon. Friend when she winds up. In its recently published strategy on health inequalities, the Department stated that it plans to use the reduction of health inequalities for people with learning disabilities as a standard against which to measure improvements for all vulnerable groups. I strongly welcome that, and I hope that the Minister will bring us up to date not only on those plans but on the Government’s thinking as we move forward.
The Government’s independent inquiry, published in July, to which the hon. Gentleman has referred, points us in the direction in which we want to go. It recommended that the Department should
“immediately amend Core Standards for Better Health, to include an explicit reference to the requirement to make ‘reasonable adjustments’ to the provision and delivery of services for vulnerable groups, in accordance with the disability equality legislation.”
As we have heard, however, the NHS has largely failed to make reasonable adjustments to ensure that people with learning disabilities are not discriminated against. Health care information leaflets are not produced in easy-read format and they do not reach people with learning disabilities, their carers or their advocates. In many cases, no side rooms are made available for people for whom the confusion of an open waiting room and ward would prompt challenging behaviour. As a result, individuals might become stressed and feel obliged to leave, and some will be unable to access the treatment that they need.
I accept that seeking a solution to such problems, making progress and ensuring that there is not a postcode lottery means investing resources. I must make the point again that it is deplorable that sometimes in Scotland, there is no evidence that funding that has been clearly allocated for specific purposes is being spent on those purposes. That applies especially in relation to the Barnett formula and in the field of learning difficulties. I understand that in addition to the £34 million for disabled children and their families that was allocated to the Scottish Government under the Barnett formula—we have previously debated that matter in this Chamber—a further £20 million was recently allocated specifically to the NHS in Scotland. We are still looking for evidence that that money has been going where it was intended to go. I shall not dwell on that issue, although I feel passionately about it, as it will probably be an ongoing issue in debates between the Scottish Government and the UK Parliament.
The hon. Gentleman talked about the work that many of us do with Mencap. Mine has introduced me to the numerous alarming episodes experienced in hospital by people who have learning disabilities. I warmly congratulate Lord Rix on the fantastic job that he has done on this issue, among others. He approaches campaigns with all his fervour, intelligence and experience. We must thank him and Dame Jo Williams for everything they do. I also thank the individual supporters of Mencap throughout the country, particularly parents and carers, who do so much to focus attention on these important issues through their involvement in campaigns such as the “Death by Indifference” campaign.
One story that emerged from Mencap’s research was about Laura—an active, talkative and independent woman with a learning disability who went into hospital for an emergency operation. After the operation, she was visited by her carer, who became concerned that no matter how much she chatted to Laura, she did not say a word. The carer said:
“On the third day I asked one of the nurses if she knew why Laura wasn’t speaking. She looked surprised and said: ‘Can she speak?’ I told her that Laura could speak as well as anybody else. There was no reason for anybody to assume otherwise. I went back in to see Laura and I offered her a pen and paper, thinking that she might be able to communicate with me that way. Laura couldn’t even hold the pen. When I saw the pen roll on to the floor, I suddenly thought, oh my god, she’s had a stroke.”
It took doctors another two days to confirm that Laura had indeed suffered a stroke during her operation.
The right hon. Gentleman is making a powerful speech. Laura’s case is one of the most moving that one can read. It is in the “Treat me right!” report of 2004, but we are four years on from that. Does he agree that we have to start learning from such cases—and fast?
Way back in 1986, when I was fortunate enough to be first in the ballot for private Members’ Bills, the first person whom I met was Lord Brian Rix. Unfortunately, some of the issues that we are debating today were raised in that meeting and addressed in that Act. If I may say so, with great respect, I am not sure that it does any service to the cause that we are promoting simply to address these problems in relation to one particular Government as though they did not exist before. [Interruption.] Let me put on record that the hon. Gentleman appears to agree.
The independent inquiry also made several important points about the often sensitive health needs of children with a learning disability. They are particularly important in light of the fact that medical advances and neonatal care improvements mean that more children with profound and multiple learning disabilities and complex health needs are surviving into childhood. Of course, we strongly welcome that, but the health service must adapt to that reality.
I conclude by noting that the Government’s aim of achieving equality, by 2025, for people with a disability is a worthy one. If we can do it earlier, that will be very welcome. If the Government were to adopt the recommendations in the independent inquiry, that would go a long way toward helping the Minister and her colleagues in other Departments to achieve their goals. In that, they have our full support.
People with a learning disability are 58 times more likely to die before the age of 50 than the general population. I was stunned when I read that horrific fact in a Mencap paper, as I am over 50 and am very close to a little four-year-old girl with learning difficulties called Maria. It leaves me fearing for her future, unless we can be sure that the NHS gives everyone equal service.
I should possibly declare an interest as that little girl is my granddaughter, and she would not be alive today were it not for the dedicated team at the new Edinburgh Royal infirmary, headed by Dr. Ian Laing. Her treatment and care have been second to none, partly because communication with newborns is to a large extent exactly the same, regardless of whether they have a disability. The parents and the medical team know how to get the information they need for the right treatment for that child. Unfortunately, the problems change as the child becomes an adult.
I congratulate the hon. Member for Newbury (Mr. Benyon) on securing the debate and on a powerful and emotional speech and the right hon. Member for Coatbridge, Chryston and Bellshill (Mr. Clarke) on his excellent contribution.
Today we heard stories of patients who died because they were not listened to or understood. It might be more difficult to communicate with some people than with others, but that can never be an excuse when deciding on their treatment. Anyone who has witnessed an accident and emergency unit at a major hospital at the weekend, when drunks who have self-inflicted wounds clog up the system and sometimes attack the doctors and nurses, is amazed at the patience and tolerance of the staff while they establish exactly what treatment is required. We need that level of understanding and patience delivered to everyone with a learning disability. It is not too much to ask, and indeed, anything less is completely unacceptable.
Some of the examples supplied by Mencap, whose work I highly commend, highlight the problem we face. People have been left for days or weeks to suffer in pain, often in extreme agony, and some of them eventually die. Mencap gave many examples; one was that of Mark, who was admitted to hospital with a broken leg, only to die after eight weeks of suffering. I mention that case because NHS staff are experts in the reduction and management of pain.
When my mother was being cared for at home while suffering from terminal cancer, we were told that she need not suffer as the pain could be brought under control. When people with cerebral palsy were asked how the condition affected their quality of life, they claimed—to the surprise of many—that the No. 1 issue was not the problem of communicating or walking, but the pain: if the pain was controlled, life could be far more tolerable, but if it was not, life could be a nightmare. That is why good communication is at the heart of the debate. Those with learning difficulties may have associated problems for the rest of their lives, but they should not have pain, and the treatment they receive in the NHS should be of the standard that we expect for everyone else.
The hard evidence that people with learning disabilities face health inequalities is simply overwhelming. From the Joint Committee on Human Rights to the independent inspection bodies who regulate and review the provision of health and social care, everyone accepts and agrees that we are facing a genuine problem. For people between the ages of 20 and 29 with a learning disability, mortality is nine times higher for men and 17 times higher for women. Forty per cent. of people with a learning disability have hearing problems. People with a learning disability are more likely than the general population to be either underweight or overweight.
In July 2006 the Healthcare Commission and the Commission for Social Care Inspection published their joint report into the abuse of people with learning disabilities in the Cornwall Partnership NHS Trust. Inspectors found evidence of 64 incidents of abuse in the five years to October 2005, including staff hitting, pushing, shoving, dragging, belittling, mocking and goading people who used the trust’s services. They also found incidents of staff withholding food, giving cold showers and making over-zealous or premature use of restraint—the list goes on. The families of those with a learning disability and carers were not involved in the delivery of services, yet staff routinely made decisions about almost every aspect of their life—whether they could go outside, which cup was to be used, how they spent their money and who lived with whom. The Healthcare Commission and the CSCI made a damning assessment of the failure of the whole system to protect adequately the people in its care, identifying a “whole system failure.”
In the Sutton and Merton Primary Care Trust, the finding of the report on learning disability services showed that they were similarly concerned, with institutional abuse being prevalent in most parts of the learning disability service. The report stated that
“the model of care was largely based on the convenience of the service providers, rather than the needs of the individuals.”
The situations in Cornwall and in Sutton and Merton are by no means unique. The excellent independent inquiry found that there had been appalling examples of discrimination, abuse and neglect of people with learning disabilities across the range of health services. Those examples all underline our systematic failure to provide the proper framework, the adequate training and the proper inspection regime needed to provide the basic levels of care and support that those with severe learning difficulties deserve.
As hon. and right hon. Members will know, the new Care Quality Commission will take over the functions of the Healthcare Commission, the CSCI and the Mental Health Act Commission. It is absolutely vital that the new Commission has the teeth and independence to make a real impact on the standard of health treatment given to vulnerable groups such as those with learning disabilities. Recommendation 7 of the independent inquiry highlights the importance of greatly improving the monitoring of the standard of general health services provided for people with learning disabilities. I look forward to hearing from the Minister today that that will be the case.
I congratulate my hon. Friend the Member for Newbury (Mr. Benyon) on securing the debate. It was extremely moving to hear his account of Emma and the experience of her mother, Jane, in trying to get the right treatment for her.
I welcomed the setting up of the independent inquiry back in 2007 and the publication over the summer, but we should remember that some of the inquiry’s recommendations are the same as those set out in the Government’s own document, “Valuing People”, which was published as long ago as 2001. Although I do not want to fall foul of the right hon. Member for Coatbridge, Chryston and Bellshill (Mr. Clarke), whom I respect greatly for his knowledge and care in these matters, the purpose of today’s debate is surely to seek an assurance from the Minister that those ongoing problems and distressing matters will be addressed in such a way that we can all feel that progress is being made, and the parents and carers of those with a learning disability can feel more confident that their children are in touch with the statutory services and will be treated equally, with real understanding of their particular needs and how they can be supported.
I was particularly concerned that the independent inquiry found that very few nurses specially trained in learning disabilities were working in the NHS, as they are often the main point of contact for those with a learning disability, as we have heard this afternoon, and that is also the case with primary care services. Learning disability liaison nurses assist with admissions, help to assess needs and give help and advice to ward staff on meeting the needs of patients with a learning disability. As the inquiry states, they can challenge preconceived notions of learning difficulty and help to ensure that the patients’ lives are valued. The presence of those nurses can have a significant impact on the quality of the treatment provided to an individual with a learning disability. Will the Department of Health act on the inquiry’s recommendation that the work force of those nurses be strengthened?
The inquiry also recommended that annual health checks be brought forward for everyone with a learning disability, and although I am pleased that the Government last month announced that they would be brought in as part of the GP contract, I wonder why it has taken the Government so long to introduce them when the evidence that they work has been available for some time. For example, a study of annual health checks in Australia revealed a sixfold increase in the detection of conditions such as visual impairment and in the take-up of immunisation.
We have heard some harrowing accounts concerning individual people who were mentioned in the Mencap “Death by Indifference” report, which prompted the Government to set up the independent inquiry. Sadly, those are not isolated cases. After the publicity that the report received, the charity Mencap was contacted by a large number of people who wanted to share their stories about the experiences of people with a learning disability when accessing mainstream health services. The accounts that we have heard today, of Emma, Laura and Mark, are not isolated cases. I was particularly struck by the case, in the report, of Sara, a young woman who ended up with an 8 cm brain tumour. When she presented with symptoms she was merely given paracetamol and when it was eventually discovered that she had a brain tumour it was much too late to operate.
What struck me about the personal accounts that we have discussed was that all the people involved had parents who were by their side speaking on their behalf; presumably they were worried out of their minds—but there were people there to be advocates. I have raised that point in other debates about other forms of disability, and in particular, as hon. Members will know, about people on the autistic spectrum. We all understand that when professionals—doctors and others—come across someone whom they are treating for a physical condition, who presents with behaviour that is sometimes challenging and sometimes merely what I would merely describe as rather strange, or with a particularly high pain threshold, which is not uncommon in the relevant group, it is quite a challenge to get beyond that to identify the physical condition and the appropriate pathway.
We all understand the time pressures on such professionals. However, as the hon. Member for Edinburgh, West (John Barrett) said, it is a matter of communication and of giving the individual patient the time needed to get beyond what is presented. The fast track to doing that, if a parent is with the patient, is to listen to parents. Unfortunately—although I do not think that one should apologise for the fact—parents in such stressful conditions are sometimes quite emotional, and I worry that professionals, including quite experienced doctors, sometimes find their distress and emotion difficult to deal with. Perhaps instead of addressing that distress, those professionals are led by it to ignore key things to which they should give more time. However, none of that excuses the situation that we have been discussing. There is a real need to deal with it. I hope that nurses with experience in learning disability can help to be the bridge between the parent, the patient and the health professional.
Of course, not every patient has with them a close relative or carer who can explain how they normally behave, their difficulties and how they present themselves to many people. That applies particularly as people get older. People with learning disabilities get older as the rest of us do, and they may not have a close person who knows them well enough to advocate for them. As hon. Members know, the Mental Capacity Act 2005 established an independent mental capacity advocate service—the IMCAs, as they are called. I served on the scrutiny Committee for the Mental Capacity Act 2005, and on the Bill Committee, and I clearly recall, because it was only three years ago, our conversations in Committee about how the advocacy service would help to solve the problem for people in exactly the situation I have described, with no one to speak up for them or articulate their concerns. The Act also introduced a legal duty on NHS and social care staff to refer eligible people to the IMCA service.
The advocates provide a real chance to redress the health inequalities experienced by people with a learning disability, as they act as champions for those who would not otherwise have a voice. Sadly, however, as the Department’s report found, referrals from medical professionals
“for Serious Medical Treatment are particularly low across the whole country, raising concerns about the extent to which the NHS is, at present, complying with the requirements of the Act.”
That does not require a lot of research or any new legislation. It concerns something that is on the statute book now. I particularly hope that the Minister will act today: if an NHS body is not putting into place what statute requires, that should be addressed extremely urgently.
My hon. Friend is making a powerful speech. Advocacy is a strand of concern that runs right across the health and social care services and we have been examining it for many years. In particular, in relation to advocacy for the group of people we are considering, has any thought been given to whether the advocacy service could have some teeth—some sanction to help to prompt action, rather than simply recommendation?
I agree with my hon. Friend. The same report continues by saying that
“ doctors do not agree with the statutory duty to make referrals. They choose to disregard it”.
That is outrageous and unacceptable. They do not have an option; they are disregarding the requirement. The fact that it is mentioned in the report needs to be addressed as a matter of urgency.
Another issue that I want to deal with is that of people with a learning disability being prescribed anti-psychotic drugs inappropriately—as a chemical cosh. Between 20 and 60 per cent. of people with a learning disability are given psychotropic medication not as a treatment for a mental health problem, but as a medical restraint. Okay, nowadays, we have chemicals and medication that will carry out that purpose; but if it were suggested that patients should be restrained physically, rather than chemically, there would be outrage, and people would march on this place—rightly. However, a doctor can write out a script and medication can be given to the patient to keep them quiet. We understand that there are difficulties with behaviour, other patients to consider and other considerations. However, again those facts do not give an excuse for using medication in that way. The complications associated with those drugs can have serious implications for the overall health of the individual who takes them. I hope that the Minister will deal with that.
Finally, I know that the Minister’s predecessor, the hon. Member for Bury, South (Mr. Lewis), now the Under-Secretary of State for International Development, declined to widen the Department’s current review into the prescribing of anti-psychotic drugs. A report is already under way on their inappropriate use for people with dementia. It would be very welcome if the Minister agreed to broaden its scope to take in people with learning disabilities. I urge her to reconsider the matter.
I welcome many of the comments already made by right hon. and hon. Members, and congratulate the hon. Member for Newbury (Mr. Benyon) in particular on securing the debate and sharing with us Emma’s powerful story. Sadly, I, too, speak as the MP for a family who were failed by the services that are supposed to provide for us in our moments of greatest need. I also speak as someone who is appalled that in this day and age someone can be left in pain—ultimately to die—because they have a disability. I want to say at the outset, not least as the husband of an NHS professional, that I do not believe that there was any malicious intent at any stage on the part of school or NHS staff. Yet the system failed in the most horrific way imaginable. In practice, competent staff, whatever their intentions, discriminated in the care that they gave.
Tom Wakefield was a humorous and sociable young man and a well loved son, brother and twin. He was born with profound multiple learning disabilities but could understand speech and was able to communicate using facial expressions and arm movements. He needed support in most things in his life, but gave plenty of affection and humour in return. I am in absolutely no doubt that Tom Wakefield would be alive today if he had not had a disability.
Tom was in a residential school in Oxfordshire and had a very close relationship with his family, including his twin sister, Judy. However, as the time came for Tom to leave his school, his family found that no plans had been made to find him an appropriate placement. At the same time, Tom’s health was deteriorating; he was losing weight and expressing signs of pain and distress. Tom’s mother, Sara, describes calling the school every evening to find out how her son was and hearing him crying in pain, each night for months on end. She kept raising her concerns about Tom’s health but she was told that his problems were behavioural, not physical.
Attempts to get Tom’s GP to listen to Tom and respond to the pain that he was in failed. Tom’s GP did not listen to Tom’s mother, Sara, and investigate why Tom was in such distress. From my own background in a dementia charity, I know how important it is for professionals to value the unique bond that people with communications difficulties have with their carers and their families, and for the insights of their families to be listened to and acted on.
Eventually, Sara got Tom to an outstanding specialist, Dr. Julian Amory, who recommended investigations into his oesophagus to see if that was the cause of his pain and distress, but those investigations were never carried out. Problems with digestion are common in people with profound learning disabilities and can be managed well, but only if they are investigated and diagnosed.
In the autumn of 2003, Tom’s health was deteriorating and his behaviour was getting worse too, as might be expected given the pain that he was in. The school gave him six weeks’ notice to leave. Social services then found him a place in an NHS in-patient facility in Cheltenham’s Delancey hospital. The family were not persuaded that this was a good idea, but they were at least told that medical assessments would be carried out and they might discover why Tom’s health was declining so rapidly. However, the ward was a psychiatric ward and, once again, no physical investigations took place. Tom was no nearer receiving a diagnosis for his increasing pain and he received no pain relief treatment. His health and behaviour deteriorated further. I think that hon. Members will agree that his story, by this stage, is the stuff of nightmares.
Tom was in such serious pain at this point that the only way that he could express it was to use his fingernails to scratch his head so hard that he drew blood. His family were desperate to get him help, but they were unable to get the health or social care professionals who were involved in his life to respond.
Finally, after two and a half months, a place was found for Tom at Prospect Place in Cirencester. In an all-too-rare example of good practice, staff there quickly realised that he was in serious pain and was physically very unwell. They had him admitted to Cheltenham general hospital, where he was found to have an ulcerated oesophagus. If Dr. Amory’s recommendations had been followed, that problem would have been discovered years before and action could have been taken in time. By this stage, however, Tom’s oesophageal tract was in a bad state. It would have been causing him intense pain and distress for a long period of time and it would also have made it very difficult for him to eat. A feeding tube was put into his stomach, to try to get much-needed nutrition into him. Even then, that tube was removed and Tom was left for long periods of time without appropriate food and nutrition. Tom’s twin sister, Judy, recalls desperately trying to get the consultants in the hospital to see how valuable his life was, explaining that the young man in the hospital bed was “the other half” of her, with a life equally worthwhile.
Tom Wakefield died of aspiration pneumonia and reflux oesophagitis in May 2004. His family were forced to watch him suffer for two and a half years, unable, until the end, to get any health professional seriously to investigate what was wrong with him and make efforts to help. Tom was passed from hand to hand, with professionals finding it impossible to take responsibility. All the while, his family continually fought a system that was supposed to be caring for him.
When Tom’s family entered the complaints process, in an attempt to get justice for Tom, they found that the discrimination that he had experienced in his life continued after his death. The Healthcare Commission’s response to their complaint suggested that Tom could not have expected better, stating that
“individuals like Tom are unique”
and
“the medical needs of disabled people like Tom with complex physical and mental issues are rarely well met by generic services”.
Do we have a national health service that is unable to meet the needs of an entire section of the population because their needs are too complex? I do not believe that that is acceptable and I am sure that the Minister does not think it is either, not least because Tom’s needs were not “unique”. Indeed, the numbers of people with profound and multiple learning disability is increasing. All such people need to be able to access health services to keep them well, and the NHS needs to respond to the increase in their numbers. It is not acceptable to assume that specialist services will always fill the gap. People with a learning disability must be able to access mainstream as well as specialist health care, or in some cases we will be condemning them to no health care at all.
It is impossible to listen to Paul, Sara, Judy and Richard Wakefield and not be touched by the bravery that it has taken, and continues to take, for them to share this awful episode in their lives with the world, knowing that it will not take away what they have been through, but doing so in the hope that it might bring about change in the future for disabled people and their families. Mrs. Wakefield continues to work with profoundly disabled children in Cheltenham and, along with the rest of her family, she is determined that what happened to Tom must not be allowed to happen to anybody else.
Tom’s story was the germ for Mencap’s “Death by Indifference” campaign, and I would also like to pay tribute to Mencap for its exceptional work on this issue. My hon. Friend the Member for Edinburgh, West (John Barrett) referred to an earlier Mencap report and in 2006 the Disability Rights Commission highlighted the fact that people with learning disability were not receiving equal health care. The evidence of poorer health and poorer health care was already mounting, but it was not enough to prompt action. It was not until this inequality was thrust into the light by stories such as Tom’s that this issue really received the attention that it deserved.
In response to “Death by Indifference”, an independent inquiry was established and that inquiry has now reported; I commend the report to the Minister. It confirms what many people have been saying for a long time—that people with a learning disability are not receiving equal health care—and makes strong recommendations about what needs to change. In my view, the overarching message from the report is that, despite reams of legislation and policy, the NHS is still not meeting its obligations to people with learning disabilities.
With good training, some of the steps that need to be taken are astonishingly simple. For example, there should be longer appointment times, to give health professionals time to communicate properly with their patients who have a learning difficulty. Tom could answer yes/no questions with very clear arm gestures, but his family found that the vast majority of doctors and nurses did not have time to communicate directly with him, despite the family’s explanations of his means of communicating with them. Those health professionals needed to take more time to understand Tom and to communicate with him on his own terms.
As my hon. Friend the Member for Edinburgh, West said, communication is key to every doctor-patient relationship. However, as is the case with people with dementia, more creative ways are needed to understand patients with a learning disability who find speech difficult or who do not understand how to explain their symptoms. If any of us were in hospital following an accident that left us unable to speak, we would rightly expect our doctor to make every effort to discover what was wrong, to read other signs and to use tests to rule out serious problems, but no one tried to rule out serious problems in Tom’s case. Tom could not tell the doctors that he was in pain, or where the pain was, so his pain was ignored. He needed health professionals who would not simply dismiss his changes in behaviour as part of his learning disability but who would instead ensure that any physical causes of distress were eliminated.
Tools such as the disability distress assessment tool, or DisDAT, which was developed in St. Oswald’s hospice in Gosforth, use the knowledge of family and carers, with careful observation of patients with profound and multiple learning disabilities, to enable health staff to spot signs of distress and ensure that pain can be identified and managed.
I was delighted to see Sir Jonathan Michael recommending in his report that families should be included as a matter of course as partners in the provision of treatment and care. If Paul and Sara Wakefield had been listened to, their son might well be alive today. The Department of Health needs to ensure that the involvement of family, as recommended by Sir Jonathan, is embedded into practices across the NHS.
Tom’s story also highlights the interconnected failures that people with a learning disability and their families often face. Tom’s father had to give up his permanent teaching job to find his son a suitable place to live when he left school, and even with that sacrifice the hospital that Tom was sent to initially was a totally inappropriate stop-gap. Tom went there because, despite years of warning, social services had not found the time to plan where he could go after he left school. It was left until the situation reached crisis point and then this vulnerable young man, whose health was going downhill fast, was, frankly, dumped in the only place that had space for him. Only later was Tom cared for, diagnosed and noticed in a way that his parents had sought for so long, and it was only then that they discovered that he was a very ill young man.
Speaking to his family today, I know that they are still understandably angry, but they are also increasingly impatient. I call on the Government to accept the recommendations of the independent inquiry in full. Training and the involvement of families are, for me, the absolute top priorities. Therefore, I also call on the Government to ensure that they respond separately to those specific matters, so that this issue does not slip from the radar and the report does not become another dusty report on a shelf. It should lead to real change, and we should all know when that change will take place.
I congratulate the hon. Member for Newbury (Mr. Benyon) on introducing this debate, which has been very moving. The fact that there have been so few interventions indicates how powerful some of the speeches have been.
Debates such as this are often prompted by constituency casework, but the individual stories we have heard today are probably indicative of a wider problem. We have heard the stories of Emma and Tom, and there are other cases in the report. I was taken by the story of Warren, who died aged 30 following perforation of the appendix. His mother and father repeatedly asked the doctors who visited him whether he had appendicitis or a blocked bowel, but they were told that he had a virus. Warren died on 25 September 2004. He had a severe learning disability and very little speech, but he could make himself understood to his family.
A powerful theme developed today is one of families being ignored, and we ignore it at our peril. I have come across the ethos many times in constituency cases of people with a lesser learning disability, but it does not always involve dismissing problems as part of the condition. Sometimes the problems are caused by professionals viewing the person as an adult who has rights but taking no account of the fact that that adult might have a low mental age. One would not necessarily treat a six or seven-year-old without recourse to their parents, who might understand their condition. Factors in society such as political correctness sometimes militate against best practice.
The two most powerful comments today were made by the hon. Member for Newbury, who said that the doctors did not listen to Emma’s mother, and by my hon. Friend the Member for Cheltenham (Martin Horwood), who said that Tom would be alive today if doctors had listened to Paul and Sara Wakefield. One cannot dismiss those examples as individual cases because similar problems were uncovered in the Cornwall Partnership NHS Trust and the Sutton and Merton primary care trust. Again, the behaviours uncovered were bad enough, but the problems in those cases had been raised by parents, carers or friends. The biggest scandal is that it took the authorities such a long time to listen to them, to investigate properly and to start to do something. Many people were involved.
We heard some facts about learning disability, but it is worth repeating them briefly for the record. People with learning disabilities have poorer health and receive poorer health care than the general population. My hon. Friend the Member for Edinburgh, West (John Barrett) opened his comments by saying that a person with a learning disability is 58 times more likely to die before the age of 50 than someone from the general population. In some respects, the problems are the same as for mental health. Health professionals often do not see beyond the initial diagnosis to the problems underneath. That goes back to fundamental problems of lack of training specifically in dealing with people with disabilities.
People with learning disabilities are also more likely to have health conditions such as epilepsy, heart disease, gastrointestinal problems and cancer. They are more likely to develop mental illness and Alzheimer’s, and are much more likely to have problems with weight. It really is not much fun.
I pay tribute to the work done by Mencap, in particular the “Death by Indifference” report. It highlighted the extent of the problem and led to the independent inquiry mentioned by previous speakers. The inquiry, conducted under the leadership of Sir Jonathan Michael, confirmed that people with a learning disability are not receiving equal service and that legislation designed to ensure equality is not being followed. The report made a series of recommendations, and, understandably, Mencap is keen to have all of them adopted.
The inquiry took the view that much stronger action is required at all levels to deliver equal access to routine health care services, including ill health prevention, health promotion and timely action to address general health problems. I shall briefly mention some of the findings of the inquiry.
Problems of access have been mentioned, but a fundamental underlying problem is that trusts and the people who are delivering services do not seem to realise that it is their responsibility to make reasonable adjustments to support the delivery of equal treatment. They say that they are not discriminating—they feel that they are treating everybody in the same way—but they do not realise that the required method of delivery or communication may be different, and that neglect in that category means that people are not actually receiving the service that they need.
The biggest problem identified is that parents and carers are often ignored. If the Minister does little else today other than undertake to deal with that specific problem, many of the other measures will follow. The inquiry found that there is limited knowledge among health service staff and that there is a strong need for training and education. Partnership working is poor, so there is little joined-up thinking between health and education providers.
It was not in the report, but my hon. Friend the Member for Cheltenham highlighted the problem that often arises when people with learning difficulties transfer from child services to adult services. There is often a gap—a lack of forward planning. Hampshire county council has just introduced a slightly bizarre system in which the transition worker is somebody who does not know the person who has been under the care of the local authority for 18 years. I find that hard to understand.
Witnesses described appalling examples of discrimination, abuse and neglect across the range of services, particularly in primary care. We often look at the more acute end of the spectrum—secondary care—in which the horrible examples that we heard today happened, but much that happens in primary care could be improved to make the entire experience much better.
We lack data on this group of people and their experience of services. Depressingly, we do not need more legislation, for there is plenty of legislation and guidance. The problem, as highlighted by the hon. Member for Tiverton and Honiton (Angela Browning), is that people are being ignored. She said that doctors disregard their duty. There are ways to take action against those who are guilty of dereliction of duty, but people are too busy fighting the system to think of doing that.
I do not wish to be entirely negative because there are examples of good practice. In Westminster, local enhanced schemes are being developed. In Bristol, a learning disability specialist provides input to public health teams. Torbay has a record system that highlights someone who has a communication problem, and Sheffield and Gloucestershire have a traffic light scheme that signals special needs. There are other examples, but I do not have time to go through them all. Good things are happening, but we need to find a way to spread best practice. That is something that the national health service does not do very well anyway, but it seems to be particularly poor in this area.
Some of the recommendations made have been mentioned. It would be helpful if, when the Minister sums up, she could give some indication of what notice the Government are taking of the recommendations, particularly those to do with training in learning disabilities. It should be mandatory not just for doctors but for all health service workers. Are there any plans to provide such training?
Are there any plans to collect data? How will parents and families be involved, and what onus will be put on PCTs to identify and assess the needs of people with learning disabilities and their carers? If PCTs do not know what needs to be done, they will not commission services.
Does the Minister have any plans for a confidential inquiry into premature deaths among people with learning disabilities? Many charities have called for one. There were other recommendations but, again, time precludes my mentioning them.
I just mention “Valuing People”, which was published in 2001. The hon. Member for Tiverton and Honiton discussed that valuable and useful document. It dealt with people having rights and the importance of their being included in local communities, having choice in daily life and having real chances to be independent. There has been some good initial work, but there are many signs that efforts are almost going into reverse because of financial pressures on local authorities.
I conclude with an article that sums up the situation. A lady called Jean Wilson, who is a carer, says that she “has a PhD” in the breadth of the challenges that she has faced in trying to secure adequate health care for her daughter, who is now 38. She stated:
“We get to go to the best London teaching hospitals, but still we get aggravation…It’s about accessibility, understanding and language, but it’s more about attitude. We were recently waiting in a corridor for a blood test and Victoria was yelling a bit. I heard the technician say to a colleague: ‘I’m not having that in my room.’
There was a time when I would have smacked round the head with my handbag, but I’ve learned to behave myself. I just walked up to him and said: ‘Have you got a problem with my daughter? Because if you have, I am going to go away to find your chief executive and discuss your discriminatory practice.’ I find that works wonders.”
None of us would have blamed her if she had smacked him round the head with her handbag, but to avoid that in future it would be helpful if the Minister told us how she is going to tackle the problem.
I, too, congratulate my hon. Friend the Member for Newbury (Mr. Benyon) on securing this important and timely debate. He mentioned that over the past few years he has supported his constituent, Jane Kemp, during the still ongoing complaints process into the death of her daughter Emma. We heard a moving account from my hon. Friend. Likewise, the other hon. Members who have expressed their testimony on behalf of their constituents are in a similar position.
My hon. Friend’s speech, and other hon. Members’ contributions to this vital debate, will, like all other speeches in this place, be recorded word for word for ever, but unusually, unlike so many of the speeches made in the House, those made today will also have the added merit of being memorable and therefore influential in terms of trying to shift the whole legislative, statutory and attitudinal basis for making improvements as we go forward.
In the Chamber today are two Members of Parliament from Scotland, where many such matters are devolved, and are acknowledged as such. It is important that we see the universality of the issues and recognise that, although our responsibility in this Chamber is effectively under English jurisdiction, there is cross-reference that is valid and important.
Given that this debate is substantially concerned with the independent inquiry into access to health care for people with learning disabilities, by Sir Jonathan Michael, published in the recess, and given that the inquiry report’s 10 recommendations apply to the Department of Health, or to its sphere of influence, and given the seriousness of the failings—involving people’s lives—that the inquiry is seeking to reverse, it is vital that the Health Minister, who is here listening, is also here to act. As a former Treasury Minister, she knows more than most how to flex the channels and influence the Government to find the necessary funds to support the action called for today. I am much encouraged that she is the Minister answering the debate.
During his speech, my hon. Friend the Member for Newbury mentioned the importance of training for doctors and nurses in how to engage with and meet the health needs of those with a learning disability. There is clearly an advantage to both undergraduates and those already registered having meaningful contact with individuals with a learning disability and their family carers to improve their understanding of what it means to have a learning disability.
I, too, pay tribute to all that Mencap has done over many years, under the initiative and leadership of Lord Rix and also, more recently, under Dame Jo Williams, whom I first met when she was in charge of Cheshire social services, when I was first elected. I pay tribute to her, and all her colleagues, not least because of their influential “Death by Indifference” report.
Mencap has highlighted the case of Cathy, who has Down’s syndrome. Cathy visited an audiologist for a hearing test, as she had experienced a little discomfort. That should have been a routine procedure, but, sadly, as the audiologist did not know that people with Down’s syndrome have short, straight ear canals, he pushed the otoscope too far into Cathy’s ear and perforated her eardrum. It was not possible to repair the perforation and Cathy has had to wear a hearing aid ever since.
My hon. Friend the Member for Tiverton and Honiton (Angela Browning) mentioned the Government’s recent announcement that the provision of annual health checks for people with a learning disability will be one of the five new categories of directed enhanced schemes included in the general practitioner’s contract. That is good news. However, as my hon. Friend said, the evidence for the positive impact that annual health checks can have on the health of people with a learning disability has been clear since 2001. The Australian evidence that she cited has given us confidence that it is effective.
The Welsh Assembly has provided a financial incentive to GPs to introduce regular health checks for people with a learning disability since April 2006. Initial findings are that, in the first year, 51 per cent. of those with a learning disability who received a health check had a newly identified health need and 9 per cent. had a serious health problem. Subsequent checks a year later identified further new health needs among 68 per cent. of those tested and serious problems were identified in 11 per cent. of those people.
Some primary care trusts, such as the one in Birmingham, have already commissioned directed enhanced services in their areas to provide annual health checks. In Birmingham, out of 1,500 health checks, 205 previously unknown health problems were identified.
Bearing all this in mind, it is no surprise that, back in 2001, the Government first acknowledged the value of annual health checks in their policy paper, “Valuing People”, which hon. Members have cited. Some 18 months ago, the Government said:
“We agree that health checks are the most effective way to improve the health of people with learning disabilities”.
Therefore, the Department of Health has known for a long time what is needed to ensure that people with a learning disability get equal health outcomes—indeed, it has known for seven years. Despite all the evidence that such provisions would have a major impact on addressing health inequalities faced by people with a learning disability and that those would have helped them overcome the barrier of access and entry into the health care system, the Department did not give priority to ensuring that good practice was implemented until just last month. We had been questioning the Government about how they were dithering. Let us acknowledge that the implementation has now happened and let us hope that the Minister will say that they will not dither over certain matters that we have identified and that they will go forward.
In July 2006, the then Secretary of State for Health was asked the following question:
“one of the important recommendations in ‘Valuing People’ back in March 2001 was that everyone with a learning disability should have received a
‘Health Action Plan by June 2005.’
Will the Secretary of State say whether that has indeed happened? If it has not happened yet, when will it have happened?”—[Official Report, 11 July 2006; Vol. 448, c. 1257.]
The right hon. Member for Leicester, West (Ms Hewitt) responded, saying:
“I understand that some areas have put those in place for all people covered by the recommendation. However, that is not the case universally”.—[Official Report, 11 July 2006; Vol. 448, c. 1258.]
I hope that the Minister will tell us in a moment whether, two years since that exchange and seven years after the promise was made, health action plans have been rolled out across the country. If not, will she agree to write to me, listing the places where they have and have not been put in place?
The impact is clear. For example, people with learning disabilities and other health problems, such as diabetes or stroke, such as the moving case that we heard about from the right hon. Member for Coatbridge, Chryston and Bellshill (Mr. Clarke), have fewer measurements of their body mass index taken than others with diabetes, and those with stroke have fewer blood pressure checks than others with stroke. They often experience diagnostic overshadowing, which is when reports of physical ill health are viewed as part of the learning disability and may not be investigated or treated.
A central principle of our NHS is that care should be available to all, free at the point of use and according to need, not ability to pay. Yet for those with a learning disability access to services is often far from ideal. I pay tribute to the work of Diabetes UK with Speakup, the self-help and advocacy charity, to produce accessible information and education to ensure that people with learning disabilities are able to have their health needs met by primary care services: GPs, practice nurses and other staff. Diabetes UK and others are calling for work towards improving early intervention for high-risk groups and flexible and integrated care packages for vulnerable people with diabetes. I hope that the Minister will outline what work the Government are taking forward in those areas.
Part of the problem is that, as usual, the Government are avoiding collecting the data needed to be able to assess accurately the health inequalities experienced by people with a learning disability. For example, as my hon. Friend the member for Tiverton and Honiton commented, the independent inquiry calls for an increase in the number of learning disability liaison nurses and health facilitators. Can the Minister tell us how many there are at the moment? I suspect that she will have to say, “Of course not.” Can the Minister tell us how many of each are on permanent and fixed-term contracts? Again, I fear that she cannot. Can she even tell us how many NHS trusts have a disability equality scheme or how many people with a learning disability have a health action plan in place? I fear that she cannot. There is a grave danger that by not collecting information centrally we do not have the data on which the relevant action can be taken under ministerial direction and guidance. There is a mismatch between aspiration and the data required.
One reason why people with a learning disability seem to face such health inequalities might be found in the fact that 30 years ago at least 60,000 people with a learning disability lived in long-stay hospitals. Although those numbers have been reduced, many of the services that are needed to replace them, in the community, have not come through and have not been available. Poorer people, in particular, experience difficult access and poorer health outcomes. I should be grateful if the Minister stated explicitly how the Government will respond to each of the 10 recommendations in the Michael report. I shall not list them because they are well known, and I prefer to give the time to the Minister for her response.
An important point was made a moment ago about the 18-year-old cliff edge, and I want it to be well understood. I look forward to the Minister’s response, and hope that she will implement the independent inquiry’s recommendations, which we have discussed, as well as the full involvement of families—we heard about that especially in the case of Tom, described by the hon. Member for Cheltenham (Martin Horwood). Let us ensure that the medical profession conforms to its statutory duty, and thus enables advocates to have teeth.
Many families of people with learning disabilities report that some doctors, consciously or unconsciously, believe that their son’s or daughter’s health problem is a result of the learning disability and that not much can be done about it. That is a dangerous assumption and, as we have heard today, can lead to undiagnosed or misdiagnosed conditions.
I congratulate the hon. Member for Newbury (Mr. Benyon) on securing this important debate, and I hope that he understands that if hon. Members take longer to read out questions than the time that I have left to reply, it is regrettably not always possible to answer each one.
I apologise on behalf of the new Minister for Care Services, my hon. Friend the Member for Corby (Phil Hope), who is attending a Standing Committee and unable to attend our debate here. I know that he shares his predecessor’s concern about the issues that hon. Member have raised, and that he is equally committed to putting matters right. Those issues are also at the front of the Secretary of State’s mind. Earlier this summer, he met the families of those patients whose tragic deaths are described in the report, “Death by Indifference”. He has maintained a close personal interest in the ongoing inquiry.
I have listened carefully to what has been said this afternoon, and I thank the hon. Member for Newbury and other hon. Members for speaking with such passion and clarity on such a vital issue. The principles that govern the NHS are simple, powerful and enduring. We believe that it should be inclusive, responsive and compassionate. Those qualities are paramount when providing health care for people with learning disabilities, who may have multiple needs and require a tailored approach.
The hon. Member for Tiverton and Honiton (Angela Browning) spoke powerfully, as she always does on such issues, as did other hon. Members, and made it clear that such qualities are not being met in every setting for every patient. That cannot be tolerated. She pressed the Government on a number of issues, and I shall respond to them.
I share the hon. Lady’s dismay at the evidence that medical practitioners are disregarding the requirements of the Mental Capacity Act 2005. When I leave the Chamber, I shall ask my officials immediately to take up the issue and to report back to my hon. Friend. I agree that the abuse of people with learning disabilities is absolutely unacceptable—I can think of no other words to state that more strongly—and that we must take the matter forward. Other hon. Members spoke eloquently, and I agree with them that it is necessary to listen to family members. My officials are working closely with the National Family Carer Network to ensure that their concerns are addressed, and that families are given support and are listened to as an expert partner.
Other issues of transition were also raised. The Government are taking work forward to unblock the processes, and to combine assessments to ensure that young people with complex needs have that smooth transition that the hon. Lady so eloquently identified. As the hon. Member for Romsey (Sandra Gidley) said, there are many examples of outstanding work throughout the country, and of health and care professionals working together to deliver for people with learning disabilities, and going that extra mile. That shows that the NHS can do it, which makes it all the more unacceptable if parts of it do not.
The family cases that hon. Members described are deeply distressing, and inexcusable. They are anathema to what the NHS represents and, as my right hon. Friend the Member for Coatbridge, Chryston and Bellshill (Mr. Clarke) said, addressing inequalities has been one of the most important priorities for the NHS, but much remains to be done, and we are not shirking that.
Much has been said about the Government’s alleged inactivity in many areas, and I want to make a couple of points before going on to say what we shall do next. The Government have taken action to improve access to health care through the operating framework for the NHS for 2008-09. We have specifically directed improvements in the NHS in the quality of care for people with learning disabilities and inequality of access to care. That includes developing personalised plans that address health and care needs. We have directed enhanced services for GP practices to provide annual health checks. That is not all we have done because we were doing things previously, which are in progress, but we are going further.
We have published the primary care service framework to support PCTs to deliver that better primary care. We have launched the national awareness campaign to examine education and the programmes that we need to introduce and which hon. Members rightly identified. We have also made clear what we intend to do in the next stage review. We want to ensure good practice so that everyone can expect the health care from professionals that they are entitled to. We responded to the Joint Committee and have taken work forward to improve services.
We considered the report from the Disability Rights Commission and took action, but I shall not describe that because it is on the record.
Following publication of the report about abuse in Cornwall and in Sutton and Merton, the Secretary of State, the NHS chief executive and the director general of social care wrote to the NHS and social services, reminding them of their responsibilities to provide the highest care.
There is a wider job to do, and hon. Members were quite right about driving a culture of change through the entire NHS and eradicating the problems, whether they are based on ignorance or fear among NHS staff when they encounter patients with learning difficulties.
Reference was made to Sir Jonathan Michael’s report, and although I cannot pre-announce our response, I want to make absolutely clear our commitment to respond effectively to the 10 recommendations, and to ensure that our response is included in the Government’s forthcoming cross-cutting strategy, “Valuing People Now.” I hope that hon. Members understand why I cannot pre-empt that. My colleagues and I want deep, effective change, not a quick fix.
I thank hon. Members, Mencap and all those families who have continued to bring these important issues to our attention. We are determined to act on them, not just in the Department of Health, but throughout the Government. I am confident that we can transform the way in which the NHS responds to the needs of people with learning disabilities, and ensure that all NHS staff understand individuals, their needs and how to deliver the best possible health care and outcomes.
It is unacceptable for any trained health professional not to discharge their responsibilities for the care of any patient in the NHS. We intend to continue to make that clear, and to bring about the necessary cultural change to deliver the services that all hon. Members want for all members of our society.
Sheep (Electronic Identification)
It is a pleasure to serve under your chairmanship this afternoon, Ms Walley. I welcome the Minister to her new role. When she was in her previous job, I was supposed to meet her yesterday to talk about the Aberystwyth tax office, so we were obviously destined to meet one way or another this week. I am pleased she is here to respond to a matter of acute concern for many farmers in my constituency, across Wales, and more generally across the United Kingdom.
Sheep electronic identification has certain limited benefits in terms of tracking disease, but those are far outweighed by the many problems that have emerged since EU regulation 21/2004 was first proposed. The rationale for electronic identification came from the widespread foot and mouth outbreak in 2001, when there were problems with tracking animal movement. That presented a severe problem because, at that point, subsidy was linked to headage. That is no longer the case and therefore, from the outset, there is a fundamental problem with the rationale behind EID.
The ID and batch recording system, which is backed up by the six day standstill situation, already tracks disease and works perfectly adequately, as I am sure the Minister realises. There is not really a problem, yet we have a supposed solution that will potentially pile misery on the farmers whom I and the hon. Members here from all parties represent. I believe that the Department for Environment, Food and Rural Affairs will not be introducing a national database to hold the records, but I would be grateful if the Minister confirmed that. Without a database to record the information, all we will be left with is a huge paper trail that will make it difficult for us to assess the small amount of useful information produced.
The system cannot provide us with secure traceability within the food chain because when animals are taken to slaughter, the tags will be removed. There will be no way of retaining a traceability function beyond that point. I do not dismiss EID out of hand; in fact, there may well be a case for some countries to adopt it, but, as far as I can tell, the UK farming community is virtually unanimous in its belief that it is not right for the UK, and it is certainly not right for Wales.
Farmers have told me that the benefits are minimal and are certainly not worth the additional costs and difficulties that they would experience. The experience of those who have taken part in the trials is instructive; for some it worked fine, but even those who did not experience problems did not think it was particularly worth while or beneficial. If we are going to introduce an added burden on our farmers and the wider rural community, there needs to be a good reason for the regulation to be introduced. I am yet to meet anybody in the UK farming community who believes that to be the case.
The hon. Gentleman has made the important point that the proposal might be applicable to other countries. One of the problems with traceability in the food chain is that much imported food comes from countries with far lower standards. Should Europe and the UK not concentrate on those other countries, rather than on a system that works within the United Kingdom and Wales?
I am grateful to the hon. Gentleman for that intervention; he is, of course, right. The trials and the intuitive work undertaken confirm that point—in other words, there is a target that does not need to be targeted.
The trials introduced have encountered serious—perhaps even insurmountable—problems. Chief among those concerns are the problems with the technology itself. First, it should be pointed out that there is no one system of standardised technology to carry out EID, rather there are several systems that each have their own problems. Even if the technology is working, there will potentially be problems when one sheep switches from one system to another. That will obviously compromise the effectiveness of the scheme from the start.
Several problems have been identified during the trials—for example, interference affects the readers at markets and abattoirs. That, obviously, would be a serious downside, given that one of the most important aspects of tracking is to record movements between farms. There have also been difficulties with something as basic as the weather. In my constituency, the equipment will not work in cold or wet conditions. The equipment is useless and worthless, and undermines what is being proposed.
The hon. Gentleman is making an important point about the technology. Does he agree that that is a particular problem in relation to auction sales? I understand that the requirement will be for every single sheep to have its tag read before it is sold at auction. In an auction, such the one at Ruthin, 5,000 head of sheep might be sold in a single session. The proposal will render the process of auction almost impossible.
I thank the hon. Gentleman for that intervention. He is, of course, right. That situation is replicated in Tregaron, Aberystwyth, elsewhere in my constituency and across the United Kingdom. I will return to that point later on and discuss the issue of the wider rural community and the implications of this policy.
The trials have also indicated that 90 per cent. of farmers using the system have had to have IT training to use the readers. Hon. Members in this Chamber will be well versed in the many meetings we have had with our farming unions about red tape and bureaucracy. The idea that our farmers will go down to the nearest IT centre to receive training when they have other work to do is, frankly, ludicrous.
The upshot of these myriad technical concerns is a practical one. If the electronic system is fundamentally flawed, technically, a manual record system will have to be kept as well. In effect, it is not simply one new system of identification and tracking being introduced, but two. When we cannot trust the technology to work reliably in our constituencies and on our farms, it seems ludicrous to introduce compulsion.
I congratulate the hon. Gentleman on securing the debate. One of the pilot projects has been run in Trawsfynydd, which is in my constituency, where the person involved is totally familiar with IT, but could not get a single reading on the scanner of the machine—try as he might, he could not do it. It is not the hilliest place in Wales and there will be other places where it is even worse, but he has completely failed, despite being something of an expert at IT.
I thank the hon. Gentleman for that telling intervention. That situation has, I know, been replicated throughout Wales. Regardless of the constituency we represent, that is the reality of this technology. The whole process is rendered useless and costly, and that is not without a certain willingness among farmers to at least try.
As my hon. Friend the Member for Ceredigion (Mark Williams) lists that and other problems, does it strike him that the Government have perhaps not done a regulatory impact assessment? If they have, they certainly have not taken it seriously because there have been problems in markets, such as Welshpool, and pressure has been put on my farmers in Montgomeryshire and elsewhere. The completely unnecessary nature of the process seems to suggest that the costs far outweigh the benefits. Does my hon. Friend think that the Government need to talk about cost and benefit more considerately and that if they did so, they would abandon the scheme?
They would certainly reach that conclusion if an adequate appraisal had been undertaken. Most hon. Members in this Chamber have certainly reached that conclusion.
I would like to return to the practical difficulties with tagging. Farmers are not just worried about the electronic system itself, but the need for individual tagging. On a small scale that might not be deemed a particular problem, but when we are talking about farmers with flocks of 1,000 sheep or more, it is suddenly a much more difficult task. I am not convinced that that has been fully appreciated by the Commission or, indeed, by the Government.
There are numerous difficulties for hill farmers, and I declare an interest as the secretary of the all-party group on hill farming. I understand that some of those who have trialled the technology have found that when the time has come to bring sheep back down from the highlands to the lowlands, as many as 20 per cent. of the tags have gone missing. Clearly, both the cost—estimated at as much as £1.50 per tag—and the additional labour required to refit the tags will be a further burden that our hard-pressed farmers can ill afford.
In Wales, 80 per cent. of farms are in less favoured areas, which inevitably means that we are more dependent on moving animals from the high to the lowlands. That means we will have to invest more in the technology. I know that the Minister will be unable to comment specifically on Wales—I think it is right that she should not—but I hope she will acknowledge that because of the nature of the agricultural industry of some parts of the UK, those areas will be particularly badly affected by the regulation.
I give way to the chairman of the all-party hill farming group.
I thank my hon. Friend for giving way. In my area—like in his—the farmers need no lessons in the importance of being secure against the threat of disease. The trauma and tragedy of foot and mouth still hangs very heavy in Cumbria, as it does in other parts of rural and, particularly, upland Britain. He talked about weighing benefits earlier on. Is it not also important that the Government understand the importance of weighing risk? The risk posed by foot and mouth and other diseases to the farming community is huge, and we must be vigilant, but is it not also important that we weigh that against the risk of crippling the sheep industry and putting those people out of business by way of an excessive, costly and, it appears, pointless regulation system?
I am particularly grateful to my hon. Friend for raising that point; it is the next one in my speech. At this time, farm incomes are falling, so the additional burden is particularly unwelcome. In less favoured areas, incomes for the year ending February 2008 were forecast at £5,900 for sheep and cattle farms, and for non-LFA sheep and cattle farms the figure was £8,700. Bearing in mind that the scheme is expected to cost farmers thousands of pounds—I have seen figures suggesting that 18 per cent. of those amounts would need to be diverted towards compliance with the scheme—it is not difficult to envisage yet more farmers leaving the industry. I hope that even if the Minister cannot promise to lobby for a derogation for the UK from the regulation, she will be able to outline what the Government plan to do to assist farmers to be able to implement the regulation without it costing their livelihoods.
Sheep farmers are struggling to stay in business without these additional concerns. One example raised in the excellent report by the Country Landowners Association and the Scottish Rural Property and Business Association was that of fertiliser. In 2006, that cost £160 a tonne, but is going up to £450 a tonne now. That was contrasted with the average price of fat lambs, which has increased only to £55 from £40. The economics of sheep farming has become more problematic in recent years—indeed, in recent weeks and days. By introducing the regulation, we are reducing our farmers’ competitiveness relative to other nations that do not have that burden, which is a very dangerous route for us to go down with a very vulnerable industry.
Last year, I asked questions about the exact financial cost that farms would face in implementing the regulation. At that time, I was given a figure of about £1,900 for a 1,000-ewe farm and about £1,000 for a 200-ewe farm. Has the Minister reviewed that figure in the intervening time and in the light of intervening experiences?
We should not forget that the debate is not just about farmers. They are my main concern this afternoon, but the issue goes much wider, as the hon. Member for Clwyd, West (Mr. Jones) said. Markets and abattoirs will have to take expensive action to ensure that they comply with the regulation. We are talking about the viability of rural communities as a whole. Abattoirs face an additional cost in the form of the new meat hygiene regulations. I know that that is not a responsibility of the Minister or her Department and that it is outside the remit of this debate. However, I will ask what consideration the Government are giving to ensure that regulation as a whole is not designed in such a way that it becomes inevitable that farmers give up their livelihoods and communities lose vital amenities. I have only one abattoir in my constituency, but if it was forced to close as a result of the regulation, that would have all sorts of implications for local sourcing and attempts to reduce food miles, as well as the obvious economic effect on the broader community.
That is the problem. It is a big problem. I hope that in delaying implementation of the regulation until 2010, the Government have at least accepted some of the arguments that I have made. I surmise from the fact that the Government have pursued that course of action that they recognise that there are real problems facing farmers, and I hope that they will continue to make representations on those concerns.
The Minister’s predecessor, Lord Rooker, was quoted as saying after a recent meeting in Limoges to discuss the scheme:
“There was a complete slamming of EID—almost all speakers were against it. I made the point that from our individual trials, EID is not cost-effective and there are better ways of achieving disease control. We want a review of the regulation so it imposes fewer burdens.”
I hope that the new Minister will echo those sentiments when she responds to my speech.
I acknowledge that the concerns raised so far have come largely from the UK and Ireland—particularly vocal has been the National Assembly for Wales—but increasingly it is becoming apparent that some other countries that will come under the regulation are growing anxious about whether that is appropriate. I appreciate that the Minister is new to her job, but I urge her and her officials, if they have not done so to date, to meet the Governments of other European countries that may be coming round to our point of view.
One difficulty that we face on the politics of this is that more member states will not be subject to EID than will. A national flock of 600,000 or more, or 160,000 for goats, is required before a member state becomes subject to the full extent of the regulation, thus 16 member states will not have to introduce EID. That is not to say that they will not be affected by it. I wonder what discussions there have been with member states that will not be required to introduce EID and whether there has been any attempt to persuade them of our concerns.
I have not secured the debate on the basis that farmers are luddites, that they are refusing to change or that they have not expressed concerns about security. I believe that the farming community would be happy, with support, to implement regulations that brought benefits and were cost-effective, but EID is ineffectual and expensive and the burdens that it will place on farmers are extremely onerous. I strongly urge the Minister to do all that she can to fight the corner of our farmers and rural communities as a whole. I hope that she will tell us that she will continue to fight this all the way. There is consensus among hon. Members on both sides of the Chamber who are concerned about the regulation. I hope that at the very least she will work with us to ensure that the extent of the burden is reduced and that we help the farmers in some of our most deprived communities as much as we can.
Order. I understand that the Minister is happy to speak at 4.18 pm to allow the hon. Member for Brecon and Radnorshire (Mr. Williams) to enter the debate. I will be watching the clock carefully.
I thank the Minister for her generosity in allowing me to speak, as I sought a debate on this subject as well.
We welcome the Minister to her post. The Department for Environment, Food and Rural Affairs has done sterling work in securing derogations in the past, and we are here today to encourage the Minister to continue that work on behalf of the sheep industry. I want to impress on her the sheer scale of the issue. There are 33 million adult sheep in the UK and 9 million in Wales. With no derogation or allowances, 20 million new tags every year would have to be fixed to sheep in the UK and 6 million in Wales. That gives some idea of the complexity of the project. The Government know something about how difficult IT schemes are to deliver and the difficulties that one can get into—I need only mention the Rural Payments Agency. I am not sure whether it was on the Minister’s watch that the IT scheme for the health service was introduced.
On this occasion, it will be not a Government project, but an industry project. DEFRA has already said that it will not implement a central database. DEFRA has called for cost sharing in animal health and disease programmes, but actually the cost is just being dumped on the industry; it is not sharing in any way. It would be in DEFRA’s interest to ensure that the industry does not have to bear that extreme cost. I call on the Minister to reflect the views of the industry most vigorously in Brussels, with the support of colleagues from Wales, Scotland and Northern Ireland, and rule out compulsory EID and, indeed, individual farm records for sheep.
It is a pleasure to serve under your chairmanship, Ms Walley.
After I had spent a year as Financial Secretary to the Treasury, it was obviously deemed that the financial markets needed a rest from my exertions, and I am delighted to be here in my new role, with such a diverse brief. I am very pleased to be learning today about the difficulties that sheep farmers face. I congratulate the hon. Member for Ceredigion (Mark Williams) on securing the debate and giving me the opportunity to examine the issue early on in my tenure as Minister responsible for farming and the environment.
Let me share with hon. Members the words of my right hon. Friend the Secretary of State for Environment, Food and Rural Affairs in a discussion at Chatham house last week. He said:
“As for EID, it may have seemed like a good idea at the time it was originally adopted, but times have changed and the costs clearly outweigh the benefits to the sheep sector. Regulation—from wherever it comes—has to recognise when circumstances change.”
I hope that it will give those who are, quite properly, defending the interests of sheep farmers some comfort to know that we share many of their concerns, although we believe that there are benefits from the system. I give credit to my predecessor, Lord Rooker, and to my ministerial colleagues in the House of Commons who responded to such debates and who have been working very hard to defend and protect the interests of sheep farmers, with particular reference to the directive that we are discussing today.
In 2007, the sheep industry was worth £628 million overall. However, the events of recent years have shown that the sheep industry is vulnerable to the incursion and spread of disease. The outbreak of foot and mouth across much of the country in 2001 had a major impact on the industry—and on the taxpayer. The cost of the epidemic was in the order of £6 billion, and it was estimated to have reduced the United Kingdom’s gross domestic product by about 0.2 per cent. One of the difficulties that we faced in trying to control the disease was knowing where potentially infected sheep had been moved from, and to where. As with other species, disease control in sheep is not something to be taken lightly.
The rest of Europe saw the problems that we faced in 2001 and, like us, started to develop their own systems. Different solutions emerged in various European countries. The UK has the largest sheep population in the European Union. We have traditionally used a stratified production system. Hon. Members will know more about it than I do, so I shall not dwell on the detail, but under that system the sheep are born on the hills and then moved to lowland pastures. The more sheep we have, the more often they are moved. Even those sheep destined to be slaughtered before they are 12 months old are moved from farm to farm at least once. Not only do we have the largest sheep flock in Europe, but each sheep tends to be moved more often.
Is the Minister is aware that there are 500,000 sheep in my constituency? The loss of 20 per cent. of tags means that about 100,000 tags a year will be lost in my constituency. Aside from the pollution that it will cause on the hillsides, surely she agrees that unscrupulous farmers, none of whom live in Montgomeryshire, could use the claim of a lost tag to subvert the system, making it pointless for those who might chance the system and making it inconvenient and expensive for those who are law-abiding?
What the hon. Gentleman says must be true. We have to implement the directive, as not to implement it would put at risk the payments upon which sheep farmers depend. We have to go forward, and I shall tell the House of some of the steps that we are taking.
Following the 2001 foot and mouth outbreak, we and Ireland concluded that although we did not need to give each sheep an individual identity, it was essential to know when and where batches of sheep were being moved. We set up a system, and put in place identification arrangements for batches of sheep, and a central database was developed to record how many sheep had moved from A to B and on which date. Hon. Members know better than I that it was known as batch recording.
The European regulation of 2004 was agreed at the end of 2003. As is usual in European legislation, what emerged from debate in the Council was a political compromise. Industry stakeholders at the time were supportive of our approach and the concessions that we negotiated. In particular, they were pleased that the introduction of the requirement to introduce electronic identification and the individual recording of sheep was delayed until the beginning of 2008. We also secured a derogation that enabled the UK and Ireland to continue to use our system of batch recording until the introduction of EID, while the rest of Europe had to double tag their sheep.
I acknowledge that some countries in Europe are not affected; none the less, those are the facts. Unfortunately—the hon. Member for Ceredigion alluded to the matter—we, but not Ireland, lost that derogation in 2007 due to repeated compliance issues identified by three consecutive Food and Veterinary Office missions. It is worth pointing out that those compliance issues, together with our difficulties in 2001, did not help our negotiating position on EID.
The legislation took effect in 2005, and it called upon the Commission to report to the Council by June 2006 on the implementation of EID, and especially on whether the implementation date needed to be changed. The report, when it emerged in November 2007, confirmed that further analysis would need to be made jointly with industry, particularly of the economic impact of the introduction of EID and individual recording.
With the active help of Administrations across the United Kingdom—I shall not speak for Wales, although I hope that Members representing Welsh constituencies will accept that DEFRA is working closely not only with the Welsh Assembly but with the Scottish Executive and the Northern Ireland Assembly—we submitted an evidence dossier to the Commission in order to influence its report. Although there were some disease control benefits, as my right hon. Friend the Secretary of State said, the cost of EID outweighed the benefits; and we identified ongoing concerns about the ability of EID to cope with our high-volume markets.
Armed with that evidence, we persuaded the Commission to propose delaying the introduction of EID, and at Council we secured a delay until the end of 2009. That has been welcomed. Officials, with the help of the industry, have worked closely with the Commission to identify and resolve the real practical difficulties that the UK sheep industry will face with EID and individual recording, some of which have been described today. As a result, we were successful in securing changes to the regulation that phases in the individual recording requirements. Those changes will allow industry further time to adapt to the new requirements, and they will reduce the record-keeping and form-filling burden, particularly for older non-electronically identified sheep.
There are benefits to EID, but I shall not extol its virtues as time is short. It is generally agreed that Great Britain would not have implemented it, as my right hon. Friend made clear. The costs outweigh the benefits.
The comments of the Secretary of State, to which the Minister alluded at the start of her speech, are very welcome. How much analysis has been undertaken of the financial effect on the small family farms that many of us represent, and the bigger economic picture that affects the marts and abattoirs? I appreciate what she said about the technology, but what about the broader economic picture? It is fundamental to the rural community.
That is a fair question. I assure the hon. Gentleman that a regulatory impact assessment was undertaken. He also asked about a figure of 18 per cent. If he will allow me, given my newness to the subject, I shall get proper answers and write to him and the other Members who have participated in the debate giving the details that he seeks.
The House may be interested to know that there is considerable activity in the European Parliament on EID. The chairman of the European Parliament agriculture committee, Neil Parish MEP, has been working closely with industry representatives, and there was a joint industry presentation at the EP regulatory committee on 7 October. However, the Commissioner has made it clear that the regulation will not be reviewed before implementation, notwithstanding the fact that my right hon. Friend has made it clear to Commissioner Vassiliou that he believes that the Commission should conduct the review that its report said was necessary. Unfortunately, the Commissioner believes that too many member states have already invested in the implementation of EID for there to be any support for a review in the short term.
As I said, I cannot speak for Wales, but we are working closely with the sheep industry to minimise the burdens that will be imposed by introducing EID. In particular, it is our intention whenever possible to make use of the derogations and flexibility provided for in the EU regulation, a factor alluded to by other speakers.
In the last few seconds left to me, I congratulate the hon. Member for Ceredigion on securing this debate. I assure him of the Government’s continued determination to assist sheep farmers to respond to what could have been a disastrous regulation. We have been working to ensure that it will be implemented in such a way that the benefits that we foresee can be maximised.
Refractory Angina
Refractory Angina is a painful condition that affects up to 50,000 people in the UK, many of whom have had unnecessary treatment. At this point, I should like to express my gratitude to councillor Ken McGlashan, a colleague and friend of my hon. Friend the Member for Knowsley, South (Mr. O'Hara) and I, for drawing our attention to the problem, and to Professor Michael Chester, who has provided much of the briefing that I am making use of today.
Compared with a decade ago, much is known about how to treat the condition, yet because awareness of that knowledge is low, many patients live in unnecessary fear, and our health care system does not adequately cater for them. Improving care for refractory angina is important because it can make a direct improvement to patients’ lives. Greater knowledge and awareness can save unnecessary operations and improving care teaches us lessons on how to structure our health care system’s rewards and incentives.
Before I talk about the availability of treatment for the condition and the associated challenges, I should first explain the difference between stable and refractory angina. According to the British Heart Foundation, stable angina is an increasingly common condition and affects around 1.2 to 1.4 million people. Improvements in medicines, coupled with technological advances, have allowed more angina sufferers to be treated than ever before, which is welcome. However, inevitably, those approaches are certainly not universally effective, and a growing number of patients experience severe debilitating symptoms that do not respond to the measures available—in other words, refractory angina. Typically, refractory angina patients are frightened, confused and vulnerable. Most have previously undergone cardiac procedures that have afforded temporary relief of the symptoms, but which have failed after a period. Long-term recurrence of symptoms following bypass surgery and angioplasty is well known and although many patients undergo further procedures, that are not appropriate for a growing number of others. That is particularly true for elderly and infirm angina sufferers, for whom the risk of further surgery can outweigh the benefits.
Refractory angina is characterised by disabling symptoms of chest pain, breathlessness, significantly impaired function and poor quality of life—the last of those things applies both to the sufferer and their carers. Sufferers are often further burdened by misconceptions about the causes and implications of their chest pain, and many hold the incorrect belief that the symptoms of what is in fact usually a stable condition are warning signs of an imminent heart attack or even death.
How does the NHS respond to such patients? I should first say that the problem is not new. The March 2000 national service framework for stable angina recognised the existence of the problem of refractory angina, but set no targets. In 1999, Baroness Hayman, then a Health Minister, responding to calls for a national strategy to deal with the condition, stated:
“I do understand that refractory angina is a difficult and distressing problem…There is a growing recognition of the problem and the likelihood that the number of people who suffer from refractory angina will increase”.
We have a growing problem and, at the moment, no clear strategy to address it.
As Baroness Hayman predicted, the number of sufferers has increased. That is partly because when the number of revascularisation procedures rises, so does the number of patients whose symptoms return after a period of post-procedural remission, often within three years of the operation. Another reason is that we have an ageing population, and the elderly tend to want to avoid invasive procedures if possible. That is certainly understandable in the case of invasive coronary interventions such as percutaneous coronary intervention, which is also known as stents, for stable angina, because even small risks of a heart attack, stroke or death increase in significance when such procedures are performed only to relieve symptoms.
In 2002, the European Society of Cardiology, prompted by the work of the UK National Refractory Angina Centre, sponsored a special study group to investigate the problem of refractory angina. Based on its estimates, there could be as many as 50,000 sufferers in the UK. More recently, the respected Cheshire and Merseyside Cardiac Network and the North Wales Cardiac Network predicted that, in their regions, where there is a population of around 2 million, there will be 2,400 sufferers by 2017. If that estimate is correct, the NHS might expect to have 78,000 sufferers to cater for by the end of the decade.
I said that refractory angina is characterised by disabling symptoms of chest pain, breathlessness, significantly impaired function and, additionally, poor quality of life for sufferers. Often, sufferers have misconceptions about the causes and implications of their chest pains, and many believe that the symptoms are warning signs of imminent heart attack or death, so their ability to manage their condition and lead healthy lives is unnecessarily affected. Many sufferers dramatically reduce their levels of activity in the mistaken belief that that will reduce their risk of heart attack. In fact, on the contrary, in doing that, they increase the risk and, at the same time, their quality of life diminishes. People with refractory angina become frequent attendees at GP surgeries, undergo multiple emergency admissions to hospital and suffer exacerbated chest pain. Many patients and carers live in an unfounded perpetual fear of sudden death.
As well as the human cost, there are clear implications for the efficient use of precious health care resources. An audit in 1998 showed wide variations in refractory angina care practice. There is no doubt that, although dedicated health care professionals in different parts of the country provide what they honestly believe to be the best treatment available, patients are offered dramatically different management strategies depending on where they live.
Despite the growing number of patients with refractory angina, there is currently only one specialist centre available: the multi-award winning and internationally acclaimed NRAC in Liverpool, which has pioneered consumer-centred service design and delivery since 1996, is the only dedicated NHS specialist service for patients suffering from chronic refractory angina. Under the highly respected leadership of Professor Chester, the centre has received a number of prestigious NHS awards. Last year, he won the highly prized Sunday Times and Henley business school customer experience leadership award.
In 2000, the then Prime Minister described NRAC as
“representing the very best of the NHS”.
The then Secretary of State for Health, my right hon. Friend the Member for Darlington (Mr. Milburn), stated:
“NRAC is leading modernisation in the NHS”,
and in 2003, the then chief executive of the NHS, Sir Nigel Crisp, stated:
“By putting the patient first and making a commitment to customer service, the centre has a vital role in modernising the NHS and making it fit for the 21st century”.
I draw attention to those accolades not to flatter the centre for its leadership, although it deserves immense credit, but to point out that in a national context of highly variable care quality, it is possible to deliver outstanding results and to have a real effect on people’s lives. Moreover, that leads to real and profound efficiency benefits. Published research and audits show that NRAC produces savings that substantially exceed costs by preventing unscheduled admissions and unnecessary palliative procedures. NRAC’s value for money has been endorsed by senior commissioners and Department of Health advisers.
This specialist patient-centred, cost-saving approach to refractory angina management developed at NRAC is available to fewer than 100 of the predicted 10,000 new patients who present with the condition each year. Despite repeated calls going back to 1998, there still appears to be no clear national strategy. It is vital that we have a proper appreciation of the growing scale of the problem to equip local NHS providers with the appropriate knowledge, skills and facilities to be able to respond effectively. There is an added challenge that the very definition of the condition—refractory meaning angina that has resisted treatment—signifies a failure of previous treatments. Perhaps that explains why professional representative organisations representing the cardiologists and surgeons have avoided dwelling on how to respond to the problem.
We need a number of approaches to help the health service address the condition more effectively. First, training should be considered. NRAC has a state of the art multi-professional training programme and has shown that health care professionals can be trained to deliver high-quality refractory angina care.
Secondly, we need to consider funding across the system as a whole. Primary care trusts continue to focus on high-cost palliative revascularisation targets, which were set by the national service frameworks nearly a decade ago, before the full impact of refractory angina was properly understood. It has been estimated that, of the £2.5 billion that will be spent on coronary revascularisation over the next decade, more than £1 billion will be on purely palliative procedures. Much of that will go to pay for expensive equipment brought in from abroad and could be saved if the simple out-patient education programme provided by refractory angina specialists was offered. The cost reductions are not clear, but some experts estimate that it could be as much as 90 per cent.
Thirdly, we need to consider funding for NRAC. Only yesterday, the centre received referrals from Leicester, Inverness, Birmingham and Blackburn. While NRAC remains the only specialist centre in the country, it is vital that it has adequate resources for the care that it provides directly and also for the education of health care providers further afield so that patients do not have to travel so far for treatment.
Fourthly, we should look at rewarding outcomes. It is no secret that the Department is working on a large set of patient-reported outcome measures that will be published for consultation shortly. It is right that NHS provision should focus on quality, and the proposals are, therefore, welcome in principle. There are a number of detailed points that also need attention for them to work effectively for patients with refractory angina.
PROMs take as their starting point a treatment intervention, but as I have discussed earlier, there are many examples of patients with refractory angina undergoing unnecessary treatments. There is a gap in the process of giving consent. That needs to be quality assured so that we can be sure that patients understand all the issues before an “informed” decision can meaningfully be given. Ignorance of the alternatives is not consistent with valid consent. One solution would be to give patients a checklist of evidence-based alternatives to palliative surgery. At the very least, that would ensure that they have heard of them. It would also reduce medico-legal vulnerability by ensuring that patients were aware of the options before treatment began.
I congratulate my right hon. Friend on securing this important debate. I echo his words of commendation for councillor Ken McGlashan, NRAC and Professor Chester. Does he think that it would be useful for the Minister to give a commitment to meet Professor Chester to learn directly from his experience?
I am grateful to my hon. Friend for intervening. It is a very helpful suggestion, and I hope that my hon. Friend the Minister will pick that up when she winds up the debate.
Finally, I will close by quoting from an NRAC patient, who wrote to me on learning of this debate. For the sake of 50,000 patients currently living with refractory angina, his experience eloquently sums up why we need to improve the service the NHS offers such patients. Kevin Mockler said:
“Like many patients who have successful bypass, my angina eventually returned. I am grateful for what was done originally but I felt that I had been ‘forgotten’ by the system and when I was finally seen in the standard cardiology clinic I was told that there was nothing more that they could do. You can imagine how demoralising it is to be told this, especially after hearing all the stories that imply modern advances have all the answers. Eventually I was referred to the National Refractory Angina Centre, who, for the first time, listened to what I had to say and took the time to make sure that I understood my condition. They have helped me enormously and there is no doubt that many more patients like me could benefit if the service was able to cope with the referrals. It amazes me that the NHS appears to have no long term plan to tackle refractory angina. NRAC knows the problem inside out and has been arguing for a systematic approach for years. I think the Health Department should sit down around a table with Mike and his team and work out what it is going to do.”
May I say what a privilege it is to be with you, Ms Walley, during your chairmanship of this debate? I congratulate my right hon. Friend the Member for Knowsley, North and Sefton, East (Mr. Howarth) on his success in the ballot and on taking the opportunity to bring to our attention the excellent services being provided in the north-west for patients with refractory angina.
Coronary heart disease is one of the biggest killers in this country. More than 1.4 million people suffer from angina and 110,000 people have heart attacks every year. A similar number of people die of heart problems in England every year. I am sure that my right hon. and hon. Friends congratulate the Prime Minister and the Department of Health on their screening initiative for cardiovascular disease, which will be rolled out this year for everyone between the ages of 40 and 75.
Since the launch of the national service framework for coronary heart disease in March 2000, we have taken huge steps forward in the detection, treatment and care of those with coronary heart disease and other cardiovascular conditions. Death rates from cardiovascular disease among people under the age of 75 are now down by 44 per cent. from the 1995 to 1997 baseline, saving nearly 33,000 lives in 2006 compared with 1996. We have met our target of reducing premature mortality from CHD, stroke and related conditions by at least 40 per cent, which, I am proud to say, is five years ahead of schedule. Rapid access chest pain clinics are now in operation in all acute trusts, giving diagnosis or the “all clear” to patients within two weeks, instead of the months they used to have to wait.
In emergency care, there has been steady improvement in the time it takes for heart attack patients to receive thrombolysis, which is a treatment with life-saving clot-busting drugs. In 2007-08, 71 per cent. of patients received thrombolysis within 60 minutes of calling for help, compared with 24 per cent. before the NSF was implemented. That exceeds the national target of 68 per cent.
Excellent progress has been made to reduce waiting times for heart patients. Since March 2005 no one has waited more than three months for heart surgery, and since the end of 2005, no one has waited more than six months for an angiograph. I congratulate the health service and its staff on the way in which they have dealt with that capacity and those numbers. We have saved the lives of people we know—families and neighbours—and people whom we will never know.
A £735 million capital programme is providing world-class facilities to treat patients with heart disease where those facilities are needed most. The programme has provided new and refurbished buildings, equipment and technology, including cardiothoracic centres. An additional 72 catheter laboratories have been provided, and 18 others have been replaced. Catheters that go into coronary arteries to look for blockages are an amazing technological advance.
The new facilities have provided the setting for substantially more cardiologists, increasing the capacity available by more than 50 per cent. However, as we know and have discussed, particular expertise is needed to detect and manage some conditions relating to coronary heart disease. Patients with refractory angina do not respond to the same types of treatment as patients with stable angina, as my right hon. Friend said when introducing this debate. The symptoms of many people with angina who do not react well to medication can be improved by revascularisation, but unfortunately there are others with angina for whom revascularisation is not suitable.
Patients with refractory angina understandably need a complex mix of specialist and innovative treatment coupled with care and support to ensure that their quality of life is protected as much as possible and their length of life compromised as little as possible. Providing patients with that sort of service is not easy. The role of specialist nurses in particular in dealing with cardiac conditions has been acknowledged at all times by patients and families. As a former nurse, I am fully aware of the fear cardiac patients experience when having chest pain and when they are discharged, still having chest pain, to their family, who may not have the expertise to help. It is very different from being inside a unit.
I am pleased that today’s debate has focused on the work of the National Refractory Angina Centre in Liverpool. That award-winning service’s mission is
“to improve and harmonise the standard of care of patients and their carers with chronic refractory angina”.
It is easy to forget that the management of chronic disease relies not only on excellent clinical treatment but on protection of quality of life. Several services for patients with refractory angina are developing around the country, particularly in the context of chronic pain management, but the NRAC in Liverpool has led the way. It is important to place on record that, although I believe and am guided to say that Liverpool is the best, other centres provide or are developing facilities after the Liverpool model, including Royal Brompton and Harefield hospitals, Bradford Royal infirmary, Barnsley hospital, Castle Hill hospital in Hull, Pilgrim hospital in Boston, Queen Mary’s hospital, Roehampton and Southend university hospital. There are probably more, but I have given a flavour of the developments taking place, which it would be wrong not to mention.
The NRAC provides an extensive and comprehensive service for those with this chronic disease. The centre is to be congratulated on what it has achieved and, although the provision of such services locally is ultimately something for local service commissioners and providers to decide, I hope that the NRAC and how it has been developed and run will act as an exemplar for developing or planned services elsewhere in England.
The NRAC’s service is patient-centred. As well as raising awareness of the condition, its treatment and its management, the NRAC produces information for clinicians and patients. I hope that that information will be accessed by more clinicians and patients around the country as a result of this debate. I praise the guidelines produced by the centre under the guidance of the Cheshire and Merseyside cardiac network.
It would be remiss of me not to recognise, the personal contributions made to the development of the services by cardiologist Professor Mike Chester and pain management specialist Dr. Austin Leach. More than 10 years ago, they had the foresight to see that with that type of chronic condition, it was important not to focus solely on clinical results. Turning that foresight into action took commitment, as well as ability and innovation. They suggested, quite rightly, that success should be measured by what services mean to the patient and their quality of life. Mike and his collaborators have proved that NHS services of that sort can be changed to employ a more patient-focused way of working, and that that approach delivers results in both health care outcomes and patient satisfaction.
The Cheshire and Merseyside cardiac network has produced guidelines on the diagnosis and management of stable angina for use throughout Cheshire and Merseyside. I am pleased to have ministerial responsibility for that issue, and would also be pleased to visit the centre. The guidelines contain details of which patients would benefit from the services offered at NRAC, what is offered and how to refer patients. They also contain details on the development and provision of refractory angina services. Again, I hope that developing services will refer to those guidelines.
The ongoing development of the NRAC as a national and international centre of excellence for the treatment and management of refractory angina, coupled with support from the cardiac network and local service commissioners, means that we have not only the best possible service to which people in this country can be referred for that condition, but a blueprint for the development of other such services elsewhere. My right hon. Friend suggested that I should have a meeting with the professors and the experts. I will do so gladly. To sit around the table with them would be a good initiative. Our national standard framework includes a chapter on angina, but it is not sufficient now because we have progressed, thanks in particular to the NRAC.
We must all do what we can to ensure that the lessons learned from that collaborative approach are used to develop not just other refractory angina services, but patient-centred chronic disease management generally. We are moving our national health service into the 21st century following Lord Darzi’s report on patient-centred quality. The evidence is there; we must now use the science and research to do what we can to remove patients’ fear that their angina is different and not manageable. We must do everything we can within the health service and our medical and nursing professions to provide first-class, quality care. That is obviously taking place at the NRAC. I thank my right hon. Friend for securing this debate and bringing the matter to my attention.
Question put and agreed to.
Adjourned accordingly at three minutes to Five o’clock.