Tuesday 18 November 2008
[Hywel Williams in the Chair]
Motion made, and Question proposed, That the sitting be now adjourned.—[Mark Tami.]
It is a great pleasure to serve under your chairmanship for the first time, Mr. Williams, in this important debate. A number of colleagues from both sides of the House are here this morning, some of whom have suffered strokes and some of whom have family members and close friends who have suffered strokes. I am sure that that applies to almost everyone in Westminster Hall this morning.
In my constituency last year, 72 people were killed by strokes. A stroke is a brain attack—the brain equivalent of a heart attack. It is caused by an interruption of the blood supply to the brain, and one in 10 of us will die as a result of a stroke. If we thought of a stroke as a heart attack needing the same emergency and specialist response, followed by sustained treatment, we could save thousands of lives and thousands of years of disability.
In my city, 700 people had a stroke last year. One third of strokes result in death, one third of sufferers recover and one third are left with a disability. Strokes are also the leading cause of severe adult disability. One in four long-term beds in the NHS are occupied by stroke patients. The disabilities resulting directly from strokes are more widespread than those resulting from any other cause, and can blight people’s lives for years and even decades.
For many years in the UK, stroke was the poor relation in the health service. The Stroke Association, the work of which I commend, as I am sure will other hon. Members, labelled the United Kingdom as having
“the unenviable reputation of having one of the worst outcomes for stroke patients in Western Europe.”
However, I congratulate the Government on what they have done to rid themselves and our country of that reputation, and the gap is slowly beginning to close.
I have 14 questions, and I have sent them with a copy of my speech to the Minister. If he cannot answer any, I shall be pleased if he will write to me and other hon. Members. First, will he tell us whether we are in fact closing the gap between the UK and western Europe on stroke outcomes, which is one of the strongest measures that we can look for? The Secretary of State has said:
“we know that if a stroke patient is treated quickly, and the simple things are done right, death rates can be halved and outcomes can be substantially improved.
So we have two clear aims in this strategy: to reduce the number of strokes experienced each year and to ensure that we provide effective acute and follow up care when strokes happen.”
The hon. Gentleman—my hon. Friend—has brought an important matter to the House, and I congratulate him on the way in which he started the debate. I declare an interest because my mother had a stroke about eight years ago and has not said a word since, although she is happy. My son is a consultant neurosurgeon, and deals with strokes.
Early intervention is the key to a decent quality of life after a stroke. If the Queen had a stroke, she would go from a paramedic to a specialist stroke-busting drug within three hours. That is for sure, but why cannot Mrs. Smith in Hadleigh have that same treatment? Will the hon. Gentleman’s questions to the Minister include asking him how we can get rid of the postcode lottery and ensure that everyone in this country receives the early treatment that makes all the difference to their lives afterwards?
It is always instructive when hon. Members, from whatever side of the House they come, bring personal experience to bear, and that applies to the hon. Gentleman’s comment. On the Government’s objectives, I will let the Minister explain how the Government have done so far, but if the hon. Gentleman allows me to make my case, he will hear that we now have a strategy, for the first time, on some aspects. I hope that we shall move towards implementation and action on those aspects.
There have been many improvements, even in the past two years. Next month will be the first anniversary of the launch of the national stroke strategy for England. At that time, the Secretary of State said:
“It has the potential to create a revolution in stroke care.”
What a marvellous comment for any Secretary of State to be able to make about any issue—that it will create a revolution if we do it right. He also said:
“The strategy is constructed around twenty ‘quality markers’ of a good stroke service covering four key areas”—
I shall cover those four areas this morning. They are:
“raising awareness and prevention; the importance of rapid assessment and treatment; provision of rehabilitation and care after stroke; and developing the workforce to meet these markers.”—[Official Report, 5 December 2007; Vol. 468, c. 70WS.]
Although we are only a year on from that publication, there are some good initial signs that stroke care is now being afforded a higher priority by health and social care providers. The most obvious example is that the existing cardiac networks throughout the UK have taken on the additional responsibility of stroke, so there are now 29 stroke and cardiac networks covering the whole of England. In addition, the operating framework for the NHS now identifies stroke as a national priority, and in addition to that, the requirements on primary care trusts are reinforced in the three-year operational plans that they must put forward, which are monitored and performance-managed by strategic health authorities. Implementation of the stroke strategy is a “must-do”. It is no longer a Cinderella; it is no longer marginalised; it is no longer on the periphery. It is now a “must-do” at the centre of the operational plans. I am sure that all hon. Members welcome that.
Monitoring will include two key indicators: the number of patients who spend at least 90 per cent. of their time on a stroke unit, and the percentage of patients with higher risk transient ischaemic attacks—mini-strokes—who are treated within 24 hours. When will the information on progress on those two indicators be published so that all of us—MPs, the Stroke Association, stroke patients and so on—will be able to measure progress?
Will my hon. Friend give way?
I congratulate my hon. Friend on securing this one-and-a-half hour debate, during which 25 people in the country will have a stroke, 10 of whom will die. Many of them could be saved, but only one in 20 of those who could benefit from clot-busting drugs will receive them. Improving the provision of those drugs would drive those figures down.
My hon. Friend often plays the straight man to me, and he has again fed me the perfect line to take me on to raising awareness and prevention. I agree with the points that he made, and I will reinforce them in my next couple of paragraphs.
More than 40 per cent. of all strokes could be prevented if people kept their blood pressure under control, monitored cholesterol levels, ate healthily, stopped smoking, and took regular exercise. I am not yet on to awareness; I am talking about prevention. The Government have introduced a programme of vascular checks for 40 to 74-year-olds, which I would like to know a little more about. Will the Minister tell me when I, as a 55-year-old, and perhaps others here can expect to receive our personal invitation for a check under that important step forward? Is it possible to use similar techniques to identify and target those with a family history of or a propensity for strokes and give information on how to avoid them, and what they and their families should do at the outset? The first moments when someone detects that a person does not quite look how they did yesterday are crucial. What can we do to get information to the people in families with a propensity for stroke to enable them to see that action needs to be taken really early and quickly? Will the Minister consider the techniques of direct mail and the use of data tracking to ensure that we get to those people much earlier?
Both public and professional awareness of risk factors and symptoms of stroke are frighteningly low. The face, arms and speech test—FAST—relates to some of the key signs to act on early. Someone may notice that a person is not speaking as accurately as they did before, that they have trouble raising an arm or have a slight drooping or tingling of the face. The symptoms of stroke are often not as dramatic as those of a heart attack, in which people may clutch their chest and fall to the ground in agony. However, the symptoms of stroke are of equal importance. If we can act early, we will save thousands of lives and prevent years of unnecessary disability.
It is worrying that people do not know—I admit my own ignorance on this—that when a person has a stroke, they should dial 999 in the same way as when someone has a heart attack. That means that a person suffering a stroke can be treated quickly. I have one small quibble with the fantastic people—those in the voluntary sector and the professionals, who do an incredible job—who have provided some of the information for me on this subject. When we are trying to raise awareness, can we please not use acronyms and medical jargon? We should talk in a way that ordinary people understand, so that they can obtain treatment and help themselves and their families. When we talk about TIAs, coronary heart disease, aphasia, vascular, FASTs and so on, it is little wonder that people are confused. If we keep things simple, we will raise awareness throughout the UK in the same way as awareness has been raised of some of the key symptoms of heart attack.
The issue of professional awareness also needs to be examined. Some 20 per cent. of GPs admit to not referring one in five cases of mild and major strokes to hospital immediately. It is honest of them to say that, but we need to ensure that they are aware of the issue so that they can rectify the situation and save lives. Last year, the Stroke Association invested £500,000 in a press and radio advertising campaign to raise awareness of the fact that
“stroke is a brain attack”.
To implement the kind of sustained wide-ranging campaign that we need to make permanent improvements, the Government must play a role and take the lead, alongside the great work being done by the Stroke Association. I hope that when the Government do that, they will also consider the impact that raising awareness will have because there will obviously be an increased demand on services. I also hope that the Government will consider the impact on stakeholders, including those who offer advice and support to the public, as they may well have a steep increase in requests for their services.
I am pleased to say that my city is apparently doing well in relation to strokes. We are already responding to the national strategy and the Nottingham City primary care trust and Nottinghamshire Healthcare NHS Trust are holding a week-long campaign this week that will encourage people to become more aware of the symptoms of strokes and to change their lifestyle. Nottingham City PCT has commissioned community services, such as the new leaf stop smoking scheme, health trainers, exercise referral schemes and food and cooking schemes to support people at risk in the community and encourage them to be more active and eat more healthily. Lack of exercise and an unhealthy diet are important risk factors for stroke.
A locally enhanced service, which is basically the incentivisation of GPs, has been commissioned with all GP practices to identify and manage patients who are at high risk of cardiovascular disease. I am happy to say that it includes a partnership scheme with the pharmaceutical industry in Nottingham called “happy hearts”. That scheme is doing well. The “change makers” project also works with local community volunteers to improve awareness of stroke symptoms and risk factors. So, as a result of Government action and colleagues from all parties repeatedly raising the matter—including a debate that took place around 18 months ago on the Floor of the House—we have progressed from a big national strategy to real projects on the ground. What further plans are there to improve public and professional awareness of stroke symptoms and what people should do at the onset of a stroke? Equally important, what plans are there to make those campaigns sustainable? One-offs are really welcome, but it is also important to have a sustained campaign to change our view and the culture surrounding the treatment of stroke.
I now come to the point already made by my hon. Friend the. Member for North-West Leicestershire (David Taylor) about the need for rapid assessment and treatment. Time is of the essence when treating stroke. According to the Secretary of State, there is a window of only three hours in which stroke patients must be seen, scanned and treated. For each one-minute delay, 2 million neurons are lost from the brain, yet people who know this subject far better than me say that awareness of stroke is at the level of awareness of heart disease that existed 10 years ago. We still have a lot more to do, but that does not mean we need bags more money—of course, resources are always welcome—but the Royal College of Physicians has clearly stated:
“we do not necessarily need more resourses just better organisation of what we have already”.
I congratulate my hon. Friend on securing this important debate. May I give an example that reaffirms what he is talking about and perhaps touches on a point made earlier about treatment being not a postcode lottery but an organisational matter? I am aware of a couple whose experiences were very diverse. The wife suffered a severe stroke and was admitted to a specialist stroke unit. After six weeks, she was discharged having made almost a total recovery, apart from some speech impairment. She had no further episodes. A short time later, her husband was admitted via an accident and emergency department to a geriatric unit and died two weeks later from a second stroke. Does that not exemplify what we are talking about in terms of organisation: one couple and one place, but two pathways and two outcomes?
My hon. Friend has put it more eloquently than I can. I am not going to say that everyone will be as right as rain, but if we get to people early and give them the right treatment, they can go on to lead a full and productive life. In essence, during a stroke parts of the brain lose oxygen, which is the source of life for the brain. The longer the brain is left to suffocate, the greater the damage that will take place and the greater chance there is of irreparable damage. Early intervention is really important. My hon. Friend has clearly described the stark contrast between what happens if a stroke is dealt with quickly and what happens if it is not dealt with quite so expeditiously.
Nigel Mason of GE Healthcare goes further than the Royal College of Physicians and says
“reconfiguring staff and procedures for a daily two-hour immediate access clinic would save lives and generate £42 million savings as well”.
We all care about the individuals concerned, but even if we consider the matter purely in terms of a sensible way to manage resources, we can save immense amounts of money by getting it right. There are many other examples of that.
Stroke patients are around 25 per cent. more likely to survive, they make a better recovery and they spend six days less in hospital if they are admitted to a stroke unit, rapidly assessed and receive specialist care from a multi-disciplinary team. The national stroke strategy sets a clear standard to ensure that effective urgent care is in place, including transfer to an acute stroke centre that provides scans and thrombolysis—I hope I have got the pronunciation correct—where appropriate. The medical profession will shriek at this, but, for ordinary mortals, thrombolysis is basically souped-up aspirin. The national stroke strategy also refers to prompt admission to a specialist stroke unit. All those things in a line mean that we have done a great deal to reduce the number of deaths and disabilities arising from strokes. In addition, one of the hopes in the strategy is for more specialist stroke nurses to be available. We are only a year into the strategy, but perhaps the Minister will give an indication of when he hopes to have complete coverage, and when every hospital will have a stroke nurse.
With regard to thrombolysis, which is probably better known to people in the business as clot-buster drugs, the Secretary of State said last year:
“Right now, less than 1 per cent. of people who have a stroke are receiving thrombolysis. If we can get that number up to 10 per cent., 1,000 people a year would regain their independence, rather than die or be disabled for life. By following the guidelines set out in this strategy, 1,600 potential strokes can be averted through preventive work and a further 6,800 deaths and disabilities can be avoided.”
What a prize for something so simple and inexpensive; 6,800 deaths and disabilities could be avoided. Clot-busting, thrombolytic drugs can be the difference between someone leaving hospital on foot and beginning a lifetime in a wheelchair. In Ontario, 37 per cent. of patients get clot busters. Will the Minister bring us up to date on the level of use of clot-busting drugs in this country? The Secretary of State said more than a year ago that it was less than 1 per cent., but I am sure that that figure has improved. Perhaps the Minister will tell us how well we are doing and what the curve is. I do not expect the figure to leap to 37 per cent., but we would like to know what the curve is to ensure that people receive those very simple drugs at the moment when they need them most.
My hon. Friend has moved on to mobility, which is one of the problems that frequently follow a stroke, whether it is a transient ischemic attack or a severe stroke, but is there not a need to do more for those who have a communications disability? I am referring to disabilities relating to speaking, understanding, reading and writing. About 250,000 people have to grapple with such a disability for years and years. Will my hon. Friend commend, as I do, the Leicestershire County and Rutland primary care trust? It has a specialist stroke unit at Leicester general hospital, where stroke victims go, but then they are discharged via two rehabilitation units. One is in Coalville community hospital, which covers the northern part of the county, and the other is at Market Harborough. That type of initiative can help a great deal, can it not?
Again, my hon. Friend is absolutely right, and again he is at least five pages ahead of me in my argument. I will come on to some of the issues that he raises. I am very happy to commend the organisations to which he referred. I will speak about those issues later, but next I want to say a few words about scans.
I, too, congratulate the hon. Gentleman on securing this very important debate. If I may, I should like to follow up the intervention from the hon. Member for North-West Leicestershire (David Taylor) with regard to community care after a patient has been treated in hospital and is back at home. There seems to be great inconsistency across the country. There are some excellent examples of outreach services, particularly in the north-east, which I have seen myself, but that does not seem to be the case everywhere. I hope that the hon. Member for Nottingham, North (Mr. Allen) will come on to that issue.
I thank the hon. Gentleman for his comments. Yes, I will come on to those issues, and no doubt the Minister will respond on the patchy nature of provision. We need to look for the trend lines. Is something improving, and is it improving everywhere? Is there convergence in levels of provision? It would be unfair to say in a year’s time, “Has this problem been solved?” Of course it will not have been, but colleagues on both sides of the House will hope to see the trend lines going in the right direction.
Why do we do scans? I understand that the main reason is to exclude the other cause of strokes, which is a bleed in the brain. Clearly, we do not want to administer clot-busting drugs if the cause is a bleed, and a scan will immediately eliminate that possibility. The National Institute for Health and Clinical Excellence recommended in July 2008, just a few months ago, that a brain scan should take place within one hour of someone being admitted to hospital. The strategy emphasises the need to improve access to scans and stipulates that brain imaging should be performed in the next scan slot, or within 60 minutes of a request out-of-hours. In 2006, only one in 10 people were scanned within three hours. We need a tight target to make scans available 24/7. Any unit unable to deliver scans by a particular time should not be called a specialised stroke unit. I hope that the Minister will consider that. In Sweden, 100 per cent. of those who need a scan get one, and we should aspire to that in this country. Will the Minister tell us the percentage of scans in the UK and in my own city of Nottingham, and by what date we aspire to reach 100 per cent.?
The hon. Gentleman is being most generous in giving way. Does he agree that the ambulance service has a part to play, as it is not just a question of getting someone to a hospital—any hospital—as quickly as possible; it is a question of getting someone, even if it takes 15 minutes longer, to the right hospital for specialist treatment of their problem? If someone gets into a hospital and then has to be transferred to another hospital to have that work done, valuable time is often lost.
The only difficulty with the hon. Gentleman sitting immediately behind me is that clearly he is looking over my shoulder at what my next paragraph is about. He makes a very pertinent point, which runs on from the one about scans. We need to get people in the right place to have the scan. All local stroke networks should ensure that patients who could benefit from urgent care are transferred to an acute stroke centre that provides 24-hour access to scans and other specialist stroke care.
In Nottingham, ambulance staff all use FAST—the face, arms and speech test—to identify emergency stroke patients. The Secretary of State said last year:
“We are consulting about upgrading strokes from category B to category A events so that ambulances arrive within nine, rather than 18 minutes.”—[Official Report, 11 July 2007; Vol. 462, c. 1484.]
For the Department to consult on a nine-minute difference shows how important the Secretary of State and the Department consider the matter. Will the Minister tell us whether that review—that consultation—on changing the category from B to A has been completed and what the outcome is? Those minutes really can be the difference between life and death for many hundreds of people.
While I am talking about the way in which things are done in Nottingham, I will, if I am permitted, make a small boast. Nottingham university hospitals stroke services have been shortlisted for the forthcoming Health Service Journal awards in the “improving access” category for their work on TIA and hyper-acute services. There are four stroke units in Nottingham—one acute stroke unit and three rehabilitation units—and a system of virtual beds means that a bed is highly likely to be free for those patients who are FAST-positive. The stroke services are centralised in a 72-bed unit on the City hospital campus. There is direct access to the stroke unit through agreed protocols with the ambulance service. In other words, ambulance staff can drive by other medical facilities to go to the right place. That is not only permitted but encouraged. Thrombolysis—I keep getting my tongue twisted round that one—is available Monday to Friday from nine to five. That is excellent, but we need to be greedy. We need to say that it has to be available 24/7. Strokes happen at the most inconvenient time and they also happen at weekends. We have a daily one-stop clinic for high-risk minor strokes and acute care and rehabilitation were located in one unit in response to patient feedback.
I now come to a number of points raised by colleagues. The third part of my argument is about the provision of after-stroke rehabilitation care, which my hon. Friend the Member for North-West Leicestershire mentioned. As I discovered in a debate on incontinence last year in Westminster Hall—I think that you may have been present, Mr. Williams—when it comes to NHS matters, treatments and state of the art technologies are not the problem. The problem is that in soft skills and empathetic aftercare, medical culture requires serious transformation. That is the hardest thing to do, but it is at least as important as the medication, surgery and all those other things that we are so good at.
According to the Healthcare Commission, one year after leaving hospital, 80 per cent. of stroke patients think that they are not receiving adequate care. There is no magic wand and no one expects the Minister to pop up and suddenly deliver an answer to the problem. It needs lots of hard work, grinding organisation, staff training, supervision—all those things that are criticised under the general heading of bureaucracy. To make the health service work for an individual patient who has suffered something life changing, whether incontinence, a stroke or something else, we need the human interaction that, in many cases, makes life worth living. That must be examined and worked on over and over again.
Seven of the 20 new national stroke strategy quality markers are directly linked to the support and community services needed by those who have suffered a stroke and their carers. They include high-quality rehabilitation, information, advice and the practical and peer support that colleagues have mentioned. Such support should be provided throughout the care pathway and in line with individual need. There is no one-size-fits-all solution. For my next question, will the Minister tell us how we secure effective discharge planning that is built around the needs of the individual?
Can I insert subsection (a) to that question, unless it is down as the next question on my hon. Friend’s list? As part of rehabilitation after discharge from hospital, the stroke unit or a community hospital, does my hon. Friend agree that stroke clubs are important? People get a great deal from such clubs, which are often run by volunteers, stroke victims, families and carers on a shoestring. Such clubs play an important part in getting people back on to their feet with greater confidence. Many MPs visit stroke clubs. I have the good fortune to be the president of Ibstock stroke club, and I know how valuable the work done by it and similar stroke clubs is for the process of rehabilitation and recovery.
I know from reading up for this debate and from past debates, how committed my hon. Friend is to this topic, and the effort that he has put into it over many years. I agree with him, and I will come on to say a few words about stroke clubs and the difference between them and communication support groups, which are also very important.
As part of the stroke improvement programme, there is a central national team—I am pleased to say that it is based in the east midlands—which supports the development of the 29 local stroke care networks I mentioned. In Nottingham, a well-established partnership works across the local health and social care community through the stroke services strategy group with representation from the Stroke Association and an excellent relationship with @astroke, the local patients forum. There are also strong local research links with the university. Professor Marion Walker and Ossie Newell, a stroke survivor, were winners of a local media “reach out” award for their work in developing research and rehabilitation programmes for people who have had strokes.
My next question is about rehabilitation. NICE recommended 45 minutes of rehabilitation a day. Does the Minister know when that target is likely to be met? What steps are we taking towards it? As part of the national stroke strategy, the Department of Health published a local authority circular last May entitled, “Demonstrating how to deliver care for adults in the community.” It stated that councils with adult social services responsibilities in England receive funding to deliver long-term stroke care for adults in the community, and it encouraged more joint working between health and social care providers. That is important to enable stroke survivors to receive a seamless transfer of care from the hospital to the community, and to ensure that they receive the support they need for as long as necessary.
Does the Minister know specifically whether information about how that grant is spent by local authorities will be made public, so that we can see the implementation of the stroke strategy as it unrolls and overall monitoring can take place? The money is apparently ring-fenced, and we must ensure that it stays that way. The funding, however small, must be sustainable—I do not know how many debates in Westminster Hall I have attended where I have said that. Quick bursts of activity for one year or for three, are often worse than useless. I would prefer to have smaller amounts of money sustained over a longer period, so that people know where that central core of money is and can build around it.
Colleagues from all parties have mentioned community services. A particularly pleasing part of the new strategy are the references to the value of communication support groups for stroke survivors. The Stroke Association has pioneered work in that area with its “Lost without words” campaign. Communication difficulties include aphasia and speech impacts, which affect approximately one third of stroke survivors. Without support, survivors can experience problems including depression, isolation and an inability to return to work. Currently there are no communication support services in the Nottingham area. The group Aphasia Nottingham aims to help, but it is entirely voluntary and receives no statutory funding. However, there is a real need for that service in Nottingham.
At present only 12 per cent. of stroke survivors in England have access to communication support groups organised by the Stroke Association. That figure is even lower in my area, which I share with my hon. Friend the Member for North-West Leicestershire. Historically, there have been challenges to the discharge of stroke survivors back into the community, thereby creating bed blocking. Nationally, a community stroke team is in place, and from January next year, there will be a system of early supported discharge, which should help to address that problem. Nottingham City primary care trust is currently recruiting a team for that system.
Community care for stroke survivors is fragmented. The level of care that someone receives seems to depend on the area in which they live. In Nottingham, adult social services care for stroke survivors, and a 12-week programme called Stroke Ability is heavily exercise-based and has elements of prevention and awareness work. As my hon. Friend said, there are a number of stroke clubs in the area. From next year, a further family and carer support service in the south of the county will be funded by new local authority funding to help people with the transition from hospital to home. It is imperative that the Government encourage local authorities and PCTs to take account of the communication support needs of stroke survivors in their communities, and ensure that they keep that money ring-fenced for stroke-specific services.
Finally, the National Sentinel audit of stroke care by the Royal College of Physicians has proved an extremely useful tool for monitoring the implementation of standards and service improvements in the acute sector. However, there has not been a similar focus on monitoring community services. The Healthcare Commission’s patient survey 12 months after discharge from hospital was published in 2006, and gave an excellent snapshot of the standard of care and support for stroke survivors in the community. For my 13th question—there is just one more before I sit down—may I ask the Minister whether further surveys along those lines or an extension of the Royal College of Physicians auditing process into community care will be undertaken?
My final and briefest question is about the development of the work force to meet the markers that the Secretary of State mentioned when announcing the strategy. In Nottingham, we have a stroke training programme for all staff working for the stroke service, and we have one of the 10 Government-funded medical stroke specialist training posts. However, although the funding is welcome, again it is non-recurrent. We need specialist staff with stroke knowledge and skills, and Department of Health training for an agreed competency framework. When will that framework be ready and how will it be managed? Will units receive accreditation for providing different levels of specialist care? How much sustainable support are the Government providing to all levels of stroke care staffing?
I hope that I have been generous in accepting interventions to allow a large number of colleagues to contribute, and I apologise for taking up a lot of time. I believe that the Government are to be congratulated heartily on putting in place an excellent, although long overdue, stroke strategy. People who care about this subject, from all parties, inside and outside this House, campaigned for it for a long time. We must now put stroke awareness high on the agenda and ensure timely and urgent treatment to improve the quality of life of people suffering the after-effects of a stroke. I hope that this debate gives the Minister an opportunity to tell us what progress has been made since the national strategy was announced and what milestones he hopes can be achieved over the next year. The key message that I have received in putting together this debate is that it is not so much about money, but about organisation. As with so much public policy, if we choose to intervene early, the impacts will be cheaper, more effective and, in this instance, will save many lost and broken lives. I thank you, Mr. Williams, for allowing me to make my case at some length.
I congratulate the hon. Member for Nottingham, North (Mr. Allen) on securing this important debate. If others bring to it as much wisdom as he has, we will be tremendously privileged.
I am pleased to take part in this debate, particularly because almost two years ago I suffered a serious stroke. It is often said that every stroke is different, but still I would like to say a few words about my experience. When I first came round in hospital, I was in a pretty bad way. Two friends were there with my partner, Carole, and one leaned over me and said, “Don’t worry, your solicitor and your undertaker are here”. I am very glad to say that I did not need either of them professionally, but I did, in those first few weeks, have to learn, almost from scratch, how to function and communicate again.
I could not walk properly, so physiotherapists worked with me to restore my movement. My vision was affected. For a while, I could not judge distances, and I kept bumping into things. Over and over again, I had to use flash cards to help me to remember the words for dog, horse, cat, cow and so on. I have paid tribute before to the staff of St. Mary’s, my local hospital, and am pleased to do so again, for the excellent care that I received. I know I am very, very lucky. I have recovered from my stroke well and medical tests show that I am at no greater risk of another stroke than anyone else of my age—indeed, I am at less risk than many people.
I am sure that other hon. Members will make valuable contributions about the medical needs of stroke sufferers, but I shall raise a slightly different issue. I was in hospital for six weeks. After I was discharged, I needed no further medical treatment, although I did receive a fortnightly hour of speech therapy. In many areas, even that is not available owing to a lack of qualified therapists. That support was invaluable to me, but equally important was the experience of simply talking to lots of different people, and the mental stimulation that that brings.
As I said before, I was very lucky. My movement came back relatively quickly, and I could get out and about and meet people. It must have been trying for them, sometimes, because I could not always find the words I needed to get my ideas across. Almost one third of stroke sufferers are left with some kind of communication difficulty—it is called aphasia, and it is a hidden disability. I looked all right, my mind was functioning as it always had, my thoughts were in perfect order, and I was still the same person, but my brain sometimes let me down in getting the correct words out in the right order.
Aphasia has been likened to a filing cabinet falling over and all the files getting mixed up. The filing cabinet in my brain is now getting itself in order, but sometimes I still cannot find the exact word that I need when I need it. If that ever gets me down, I think of the blindness overcome by the right hon. Member for Sheffield, Brightside (Mr. Blunkett) or the silent world of Lord Ashley, who was so effective despite being completely deaf, and I remember that things are not that bad. Before my stroke, I could make a speech like this off the cuff, but these days I need to use notes—although, actually, I have found that having to think before opening one’s mouth is not necessarily a bad thing for an MP, and I commend it to colleagues in all parties.
I had the support of friends and family and was able to get out and about. As I am well known on the Isle of Wight and islanders are a friendly lot, I had plenty of people to talk to, but not all stroke sufferers are so blessed. Many are elderly and live alone. Aphasia makes them lose confidence, which makes it even harder to communicate. That is where the voluntary organisations come into their own. The Isle of Wight is home to just 130,000 people, but they have lots of voluntary support, including from the Stroke Association, the stroke club and Different Strokes, which do an amazing job. They provide the information that people need about every aspect of life following a stroke.
Such voluntary organisations arrange weekly exercise classes and events where people can meet others experiencing the same problems. They provide a forum where people can get the mental stimulation that they need from talking to other people without embarrassment. Quite simply, they make people realise that they are not alone, which is a great help. Such voluntary organisations gave me enormous support, and I thank everyone involved on the island. There are too many individuals to mention, but it is humbling that so many people willingly give up so much of their free time to help others.
Without the help and support of so many islanders, I simply would not be here today. I could have simply given up, but with so many people willing to help me to get well again, that was never really an option. However, the first time that I stood up to speak in the House after my stroke was a most terrifying experience.
My plea is for everyone to recognise and applaud the work that the charitable organisations do in helping people on the road to recovery. The support that they give can improve confidence and independence. It can overcome isolation and depression and improve communication skills. It is not the job of the national health service to provide someone to whom victims can talk. I know from experience how important talking is to recovery. The greatest help that can be given to many sufferers is the opportunity to communicate, and to practise talking so that they can build up their speech again. It is something that charities do very well, but it is also something simple that anyone can do.
I would never have chosen to have a stroke; however, I have learned a great deal from it. I hope that I can use that knowledge to bring an extra dimension to my life.
It is a particular pleasure to serve under your chairmanship, Mr. Williams. We are indebted to the hon. Member for Nottingham, North (Mr. Allen) for raising this very important debate. However, I am sure that he will understand when I say that tributes should be directed to the hon. Member for Isle of Wight (Mr. Turner) for his contribution. The test of time will show that he has been an inspiration to many thousands of people who have had the same experience.
I represent a Welsh constituency, so the responsibility for Government policy that affects my constituents is a matter for the Welsh National Assembly, and I am reminded by the Chair not to stray into devolved matters. Like the hon. Member for Isle of Wight, I want to spend a few minutes talking about the invaluable work of the voluntary sector and, in particular, of two or three organisations with which I have had the privilege of working over the past couple of years.
The hon. Gentleman said that we cannot build rehabilitation services without the voluntary sector. We have heard a lot about the Government’s laudable 10-year strategy and the contribution that social services departments make, but we must also acknowledge the work of the voluntary sector; without it, the lives of many thousands of people would be considerably worse. It has risen to meet the challenges mentioned earlier. For example, strokes are the third most common form of death in the United Kingdom, accounting for 9 per cent. of the deaths of men and 13 per cent. of women. The Aberystwyth and district stroke club in my constituency has 60 members, 40 of whom have had strokes. Many carers attend the meetings. We have not heard a huge amount about the carers and the unique advice and support that should be directed toward them.
The Aberystwyth and district stroke club was borne out of frustration with the lack of provision, yet, in its 20-year history, it has never received any public funding. A similar such point was alluded to by the hon. Member for North-West Leicestershire (David Taylor). The club has been reliant on the generosity of businesses and local residents to keep it going. It offers important confidence-building services, weekend breaks and help for people who may not have the chance or the resources to get away. It runs a bus, which is funded by the lottery’s “awards for all” scheme, which costs between £4,000 and £5,000 a year. However, more importantly, it enables stroke victims to meet other people in the same position as themselves—people who are some way along the path to rehabilitation, and who can offer the wisdom of their experience.
A central focus of the debate so far has been the need for immediate care and diagnosis. Everybody in this Chamber will agree with that goal, which has been raised by the Aberystwyth and district stroke club. Many of its members have had to wait 24 or 48 hours for a scan.
Like many others here, I represent a rural constituency. If we put into that context the misfortune of suffering a stroke and mix it with living in some of the most isolated and scattered communities in the country, it is a frightening experience. Ambulance times are already challenging. I ask the Minister to comment on the role of telemedicine throughout the country. The service has been pioneered in my constituency in Bronglais hospital, in Aberystwyth, and plays an invaluable role in assisting early diagnosis. It brings the expertise that may be available elsewhere into more scattered communities—a point made by Professor Boyle in his analysis.
We were disturbed to hear the story from the hon. Member for Pudsey (Mr. Truswell) about the couple in his constituency. We need to remind ourselves that recovery from stroke can be an incredibly long-term process; 25 per cent. of all long-term beds in hospital are occupied by stroke patients. We need to ensure that support is available in hospital and that the voluntary mechanisms are in place to enable people to have the moral support and encouragement to make the long journey to full health.
I applaud the Government for their announcement about the ring-fenced money, but I echo the views of the hon. Member for Nottingham, North about the need for us to monitor where that money is going and to ensure that our social services are delivering the services that we and the Government expect of them. For those who are able to live at home after suffering a stroke, the support provided by the voluntary sector is invaluable. I know that we are only a year into the strategy, but will the Minister tell us whether an early appraisal has been made of the adequacy of the ring-fenced funds?
Some voluntary groups have raised real concerns about the grants and funding made available to them. Positive Action for Stroke, which is based in my constituency, has had real difficulty obtaining funding. The Progressive Action Group in Aberystwyth faces similar concerns. I hope that the Minister will reflect on the importance of voluntary organisations in helping those who have had strokes, even if he cannot get into the nitty-gritty of the funding. Some public bodies have been reluctant to fund voluntary groups when lottery funding has not been available, and it has been a great challenge to find alternative sources of funds. If the Minister pointed the voluntary groups in the direction of funding, that would be very welcome.
I want to emphasise the importance of the services that voluntary groups offer. Progressive Action arranges what it calls “fun activities”, such as computing and arts and crafts. However, such activities also help stroke victims to return to the employment market. We have heard about the depression faced by many stroke victims. Again, in a rural constituency, that should be seen in the context of rural isolation, the feeling that one is not getting the services to which one is perhaps entitled, compounded by the health condition that has to be endured.
The ability to have organised breaks and activities allows people to be much more active than they might otherwise be. We are all aware that activity and dialogue, which the hon. Member for Isle of Wight mentioned, are integral to recovery. Such activity also ensures that victims can redevelop motor skills. The care is delivered as part of a care package, but once that time in hospital has ended, the recovery process can go on for many months and years. Having help and support outside the hospital environment is extremely valuable in aiding recovery. It is also very beneficial for people to be able to make new friends, and to meet those who have had similar experiences and been through the same process.
The hon. Member for Nottingham, North put his case very concisely. I, too, believe that part of the emphasis should be on the importance of raising awareness to prevent strokes. However, as the hon. Member for Isle of Wight said—my contribution is humble compared with his—it is important to recognise the work done by the voluntary sector in providing assistance to those affected by strokes.
I want to finish by praising the work of our health professionals. We have talked about developing skills and expertise in our hospitals. We have all had our family experiences in these matters; mine involved a dear aunt. I remember the fateful phone conversation when her husband told me that she had suffered a stroke and had lost the power of speech. She was a chatty, enthusiastic and vibrant individual who did a huge amount for her community: then—stop. Two years on, she has recovered her power of speech and is as active a member of the community as she used to be. That is no small tribute to her abilities and enthusiasm, but also to the health professionals who have helped her so much, and to the voluntary sector.
I congratulate the hon. Member for Nottingham, North (Mr. Allen) not only—nor most importantly—on securing the debate, but on the speech that he made, and the many points he put to the Minister. I pay tribute to his work and that of members of the all-party group, and I want to echo his comments, which were widely applauded around the Chamber, about the vital and wonderful work of the Stroke Association. The number of questions in the hon. Gentleman’s speech went up from 13 to 14 by the time he delivered it, so presumably he came up with another one overnight; he has helpfully shared his speech with us. I think that we all agree that if the Minister can answer the 14 questions, today and on a continuing basis, we shall be much closer to assessing our progress in the past year.
It is a pleasure to follow my hon. Friend the Member for Ceredigion (Mark Williams) and to hear something of his personal experience of the issue—something that has echoes around the Chamber, whether the experience is personal or whether it concerns constituents, as in the case raised by my neighbour, the hon. Member for Pudsey (Mr. Truswell).
That was my mistake. I thank the hon. Gentleman for that correction.
I want to echo the comments of my hon. Friend, and I pay tribute, too, to the hon. Member for Isle of Wight (Mr. Turner). It was incredibly humbling to hear of his personal experience, as well as enormously informative for us all. I think we all want to thank him for sharing it, and for his contribution to the debate. I reiterate what has been said about his being an inspiration to many people who have suffered strokes, in showing what people can do and how they can come back from a stroke. The way in which he has served his constituents is a tribute to him. The hon. Gentleman also made an interesting point when he mentioned the wisdom of thinking before we speak. Many hon. Members should remember that—and I certainly do not exempt myself from that group.
I had a vivid reminder about strokes a few weeks ago, when the mother of one of my best friends unfortunately suffered a severe stroke. She was in the highlands of Scotland and it was only thanks to the response of the air ambulance, and the wonderful medical care that I am delighted to say she received, that she is still with us. She is now recovering. It is a slow recovery but she is making good progress.
As we have heard, the effects of stroke can vary enormously. Stroke is the third biggest cause of death in the UK—there are about 50,000 such deaths every year—and the largest single cause of disability. Each year, 110,000 people in England alone suffer a stroke. Stroke affects more women than breast cancer. It is estimated that the overall costs of treatment for strokes and related and subsequent disabilities is a staggering £2.8 billion a year. As we have heard in eloquent speeches from the hon. Member for Nottingham, North and other hon. Members, the debate is important because we must ensure that care of the best quality, including consistent access to treatment, is available for those who suffer strokes, but also because of the need for prevention. That is why the Liberal Democrats warmly welcome the national stroke strategy, which was published in December. The chief executive of the Stroke Association, Jon Barrick, described it as
“a momentous opportunity to transform the outcomes and lives of stroke survivors.”
What the debate is about—as I am sure we would all agree and the Minister would acknowledge—is checking that we are taking that momentous opportunity, and seeing whether people are receiving better care than they were 10 months ago.
The initial signs are that some progress is being made. Even before the strategy was announced, 97 per cent. of hospitals had a stroke unit, and more than 90 per cent. of stroke units providing acute care had access to brain imaging within 24 hours of admission. That is a big increase—82 per cent.—since 2004, and is to be commended. However, there are certain points that we need to examine, and the audit this year by the Royal College of Physicians found that only 45 per cent. of hospitals could meet the recommendation made in the strategy that high-risk patients who had a transient ischemic attack or mini-stroke—and I share the wish of the hon. Member for Nottingham, North to use ordinary phrases that mean something to people—should be examined and treated within 48 hours. Given that the Stroke Association has pointed out that meeting that one target could result in an 80 per cent. reduction in the number of people going on to have a full stroke, the standard is one that needs real focus both now and as the strategy progresses.
A requirement has been placed on primary care trusts to set out their plans for improving stroke services for 2008-09. The House should welcome that, and monitor it. However, the Stroke Association has voiced concern that an absence of national targets and time scales for those targets in the strategy may affect progress. It is important to say that some strategic health authorities have gone further than the strategy specifies, and have included a timetable for the implementation of selected recommendations, but serious consideration should be given to setting a timetable across the board for implementation of the targets, so that we can achieve the speed of change that we need, and be confident that people are getting consistent access to services in all areas. Good progress has been made, which is enormously encouraging, and we all welcome that. I want to ask the Minister whether we can examine progress annually. Today’s debate is useful, but we should continue to monitor what happens.
Most of the debate today has rightly focused on issues such as prevention and acute hospital treatment and care, but the speech of the hon. Member for Isle of Wight in particular dealt with the huge importance of long-term care and community support following a stroke. The importance of effective long-term care and the need for stroke sufferers to be active participants in their treatment has been well documented. According to the Stroke Association, only about half the individuals who have experienced a stroke receive the rehabilitation that they need in the first six months following their discharge from hospital. In the next six months only one in five receive the help, support and treatment they are deemed to need. That is something on which the strategy should focus, and I hope that the Minister will agree.
One of the most important issues in the debate is embodied in one of the figures that has been quoted: 40 per cent. of strokes can be prevented. The importance of awareness of strokes cannot be overestimated. One concern is that polling by the Stroke Association found that one in five GPs do not refer about 20 per cent. of cases of mini-stroke. Just over half of GPs said that they would refer someone with a suspected stroke immediately. A concentrated effort must be made to ensure that strokes are regarded as nothing short of a medical emergency, in which time is of the essence, and that all treatment is recommended with that in mind. I am aware that NICE and the Royal College of Physicians recently published guidelines, and I hope that there will be a concerted effort across the board.
I pay tribute to the Government for the £12 million that is to be invested in the next few years in awareness activity. That is a common-sense thing to do, considering the enormous cost of £2.8 billion that I have already mentioned. I should like an assurance from the Minister that any public awareness campaign will take account of the needs of some ethnic minority groups that are at greater risk of strokes, and of the possibility that it may be more difficult to reach those groups. Finally, there is a need for more research. The Stroke Association funds £2.5 million of research, and we must always look for ways to improve what is done.
To conclude, this has been an excellent debate. It could not have been more timely and I do not think that it could have been more informative or constructive for all of us. I simply urge the Minister to allow us all to continue to contribute to monitoring the progress of this very important and very welcome strategy, and I look forward to hearing his response to the debate.
I am pleased, Mr. Williams, to see you in the Chair.
I want to reiterate the comments of other hon. Members in congratulating the hon. Member for Nottingham, North (Mr. Allen) on securing this important debate. I also want to congratulate him on the very comprehensive and detailed way in which he introduced this significant topic. He set out very clearly the importance of ensuring that the Government maintain the momentum that has been generated recently, first by the National Audit Office report, then by the Public Accounts Committee report and finally by the stroke strategy, which was released roughly a year ago. I thought that he made his points in a very constructive and thoughtful manner, and hopefully the Minister will respond in a similar vein.
The hon. Gentleman was right to congratulate the Stroke Association, which does fantastic work in this area. I will not repeat them, but he was also right to highlight the four key markers that the Government set down. He was also correct to summarise the four distinct areas—the patient pathway—of awareness, diagnosis, treatment and subsequently community care and rehabilitation. If all those areas are addressed, that will make a significant difference to patient outcomes. The Minister will probably not have time to answer in detail all of the 14 questions that the hon. Gentleman put to him today, but I am sure that he will respond in writing to the hon. Members who are here with answers to all of those excellent questions.
I also must say to my hon. Friend the Member for Isle of Wight (Mr. Turner) that his contribution today was exceptional and inspirational, and I am delighted to see that he has clearly made a full recovery and is back on full form, both in articulation and humour, which is very good to see. He was absolutely correct to highlight the important contribution of the charitable and voluntary organisations, particularly in rehabilitation and community support. He was also right to ask all of us, irrespective of our party political persuasions, to thank and congratulate the people involved in those organisations. As an additional question, it would be helpful if the Minister would address the point made both by my hon. Friend and by the hon. Member for North-West Leicestershire (David Taylor) about the potential to fund or assist charitable and voluntary organisations in the community and rehabilitation aspects of their work.
We heard, too, from the hon. Member for Ceredigion (Mark Williams), who raised the important issue of the contributions of the voluntary and charitable sector. Furthermore, he stressed the overriding importance of people who have experienced strokes meeting others who have gone through a similar experience, if only to ensure that those people understand that they are not alone and that they are not unique in their experience of stroke. The hon. Gentleman was right to highlight the problems that are exacerbated in large rural constituencies. I, too, represent a rural constituency—the Lincolnshire constituency of Boston and Skegness—and I suspect that we have problems that are similar to those that he faces in north Wales. I sometimes think that the Government do not necessarily address the needs of those who represent physically great but sparsely populated rural areas and provide the requisite funding, although that is not the specific issue that we are debating today. The hon. Gentleman was also right to praise health professionals who are involved in stroke care.
Of course, there is cross-party support for the enhancement of stroke services, particularly those that improve patient outcomes and survival rates, although it must also be said that, despite the stroke strategy, we still have fairly low survival rates in the UK in comparison with some other EU countries. Nevertheless, we recognise and welcome the progress that has been made since the publication of the stroke strategy, particularly in the development of stroke networks. However, it was a shame that it took the Government so long to produce that strategy, and I suspect that they did so only in response to the highly critical reports from the NAO and the Public Accounts Committee.
Despite all the evidence that care in a specialist stroke unit increases a patient’s chance of survival and recovery by 25 per cent. and reduces their stay in hospital by six days, in 2006 just 15 per cent. of stroke patients were admitted to stroke units on the day of admission. I accept and acknowledge that that is a slightly historic statistic. However, it would be helpful if the Minister could update it, either today or subsequently, particularly in the context of the overriding importance that is now correctly attributed to stroke and stroke care, both in the operating framework, which identifies stroke as a national priority, and in the primary care trusts’ operational requirements, which was a point quite rightly made by the hon. Member for Nottingham, North.
There are some background statistics that I briefly want to put on the record, because some of them are worrying. The national audit by the Royal College of Physicians this year showed that only 45 per cent. of hospitals were able to meet the target in the stroke strategy of investigating and treating high-risk patients with transient ischemic attack, or TIA, within 24 hours, and yet that is clearly one of the key methods of identifying patients at risk of stroke and preventing patients from going on to have a full stroke.
Fast access to stroke units and fast treatment is a key to a patient’s survival, whether that treatment is the CT scans that were mentioned earlier or the three-hour time limit for thrombolysis. These two methods of treatment must be linked, as the hon. Gentleman pointed out, so that the thrombolysis is not administered to patients who would not benefit from it or to patients to whose health it would be detrimental. One statistic that has already been given is from Sweden, and it is absolutely startling compared with our own performance here in the UK; in Sweden, 100 per cent. of stroke patients have access to a CT scan within 24 hours.
A quarter of British hospitals have no specialist stroke nurse and only 22 per cent. of hospitals have an early supported discharge team. Specialist teams working in a multidisciplinary framework are best placed to improve outcomes and reduce mortality. Last year, I visited the North Tyneside general hospital near Newcastle, which has a fantastic specialist stroke team. That team not only works in the hospital but goes into the community, with outreach workers and specialist nurses. I very much hope that that the Minister will ensure that that model is rolled out across the UK.
One of the disparities that seems to exist between statements made by the hon. Gentleman and the previous Government announcements relates to the population screening that the Prime Minister announced in January. It was clear from the Prime Minister’s announcement that the screening would be whole-population screening with cardiovascular checks, which would also include looking for tell-tale signs of a stroke. It would be interesting if the Minister could say, first, whether or not the funding has been provided to support that whole-population screening and also whether or not the clinical evidence supports that type of screening, or is the hon. Gentleman correct that screening should be limited to those between the ages of 40 and 74?
We also support the “hub and spoke” strategy for specialist stroke centres. Clearly, there is a direct correlation between specialist stroke centres and better patient outcomes and survival rates; in those centres, patients are scanned and given thrombolysis if appropriate and necessary. However, that does not necessarily mean that there should be closures of small stroke wards in local hospitals. Indeed, Manchester is perhaps the best example of a good system; in the local service plan for Manchester, a hyper-acute unit has been proposed, where all stroke patients would be taken for the initial scan and treatment, before they are referred back to their district general hospitals for treatment to be continued and for subsequent treatment in the community.
In the remaining few minutes, I have just a couple of additional questions for the Minister. Again, if he does not have time today—I clearly understand that this is the hon. Gentleman’s debate—it would be helpful if he could write to me. For example, how much of the funding pledged for the stroke strategy has been delivered? How many of the stroke centres to date have achieved all 20 quality markers for a good stroke strategy? I assume that not all of them have achieved that target and, if so, what is the time scale for enabling all stroke centres to achieve it? Would the Minister also say a little about the awareness campaign that will begin next year? Has thought been given to the fact that it may stimulate additional demand, and does the NHS have the facilities and sufficient capacity to deal with such additional demand? Furthermore, what are the Government doing to support the communication needs of people who have suffered a stroke? That point was quite rightly made by other hon. Members.
I also want to reiterate two key points made by other hon. Members; again, if the Minister does not have time to address them today, he and his team at least need to think about them. The first point is about awareness, including public awareness of stroke. A recent NOP poll demonstrated that there is both confusion and ignorance about the signs of stroke. Promoting awareness also includes the important factor of GPs. I was very concerned, as other hon. Members were, when I saw the statistic that about 20 per cent. of patients who go to GPs with a TIA are not referred on. The second key issue that hon. Members have raised, which the Minister will want to address, is the concern about ring-fenced money going to local authorities. That money has clearly been used, in some instances, for purposes for which it was not intended. That issue needs to be looked at, because it could have a detrimental impact on stroke care.
In conclusion, we spend more on stroke services, as a nation, and there is rightly an increased focus on them, but we still have worse outcomes than comparable European nations. We should adopt more of the recommendations of the National Audit Office and the Select Committee on Public Accounts to enable our dedicated and hard-working stroke physicians, nurses and associated health care professionals to improve the quality of stroke care in the shortest possible time.
First, I congratulate my hon. Friend the Member for Nottingham, North (Mr. Allen) on securing the debate on this important subject. Secondly, I apologise that the Under-Secretary of State for Health, my hon. Friend the Member for Brentford and Isleworth (Ann Keen), who leads on stroke policy, could not be with us this morning due to two long-standing ministerial engagements.
I calculate that to answer 14 questions in nine minutes I will have to spend only about 35 seconds on each of them, so I shall throw aside the usual niceties of going through the history of the issue, as other hon. Members have done that. I shall not go into why we have a new stroke strategy or the importance of stroke, because those issues have been discussed so eloquently, not least by the hon. Member for Isle of Wight (Mr. Turner) in his moving and effective testimony.
I shall move straight to answering the questions that have been asked. On awareness, my hon. Friend the Member for Nottingham, North will know that a major awareness campaign is planned for the spring. It will include the face, arms, speech approach that he advocates, as well as stressing the importance of dialling 999. It will be along the lines of the successful British Heart Foundation campaign that many people will remember from the past year or so, which used posters and advertising of great impact on our streets and buses.
On prevention, my hon. Friend will be aware that we have asked primary care trusts to begin rolling out, from April 2009, vascular checks for the whole population aged between 40 and 74. As for when he can expect his check, in his local area, we expect the full system to be up and running by 2012-13. He has said that his area already has good practice and a good model, so he might get his check a little earlier. It is not only people’s risk of heart disease, stroke and kidney problems that will be assessed. The system will also work on the preventive messages on lifestyle and public health that he has rightly identified as being important. Those issues are the same as those for heart disease, and include smoking, obesity and physical exercise. Where necessary, people will be recommended courses on weight management and even cookery, assistance with smoking cessation, exercise classes and walking clubs. My hon. Friend is right to say that prevention is very important.
My hon. Friend is also right to stress the importance of rapid response, including the use of thrombolysis. That is recognised in the strategy, which is clear about the importance of acting quickly in the event of a stroke. It recommends the immediate referral for assessment of all patients with recent transient ischaemic attack—I, too, hate the acronym—or minor stroke. Those with a higher risk of subsequent major stroke will be assessed within 24 hours. For those with major stroke, the strategy suggests immediate transfer to a centre that provides hyper-acute services.
On clot-busting drugs, my hon. Friend asked where we were on the roll-out of thrombolysis. The National Sentinel stroke audit of 2008 states that thrombolysis services are increasing rapidly, albeit from a low base. We should, as he said, be aiming for at least 10 per cent. of stroke admissions being thrombolysed. Services are being reorganised to achieve that, and we are funding specialist stroke training, but it is important that thrombolysis is given in a safe and appropriate setting.
On scanning, I am informed that all hospitals now provide CT scanning, and that the great majority also offer MRI and carotid doppler scanning. However, access to imaging continues to present a major barrier to delivering high-quality care to all stroke patients, and the new strategy aims to address that problem.
The ambulance review has been completed. Of the 70 recommendations that have been made, some have been introduced and the rest will be completed by 2010. I understand that recategorisation as category A has been recommended, and provisions to ensure that that is implemented are being put in place.
On rehabilitation immediately after stroke, my hon. Friend has mentioned that operating across the seven-day week can limit disability and improve recovery. The strategy recommends that specialist rehabilitation should continue across the transition to home, or care home, to ensure that health, social care and voluntary services are joined up to provide the long-term care that people need. We have, as he has acknowledged, provided local authorities with £45 million—£15 million a year for three years—to develop improved models for delivering that joined-up care. As for whether information will be made public and how it will be monitored, we expect the evaluation of the strategy’s implementation to provide details on spending and information on its effect.
My hon. Friend asked whether the NICE-recommended target of 45 minutes of rehabilitation a day would be met and, if so, when. The strategy is a 10-year strategy, and we cannot comment on when any particular measure will be successfully implemented, but we expect all service providers to be making progress now. We intend to begin the evaluation of the strategy’s implementation soon, and that will give us detailed information about what is happening locally.
My hon. Friend stressed the importance of communication and helping people with speech. The strategy lists communication as a component of the joined-up rehabilitation approach, and will rely on a multidisciplinary approach being taken locally to ensure that patients receive the right support both in hospital and when they are discharged into the community. He rightly points to the recent problems that he has highlighted in a letter to my hon. Friend the Under-Secretary of State about speech therapy services in his local area. I am pleased to say that the PCT is now addressing those problems.
My hon. Friend is absolutely right that the work force in both health and social care is important to the strategy’s delivery. We have allocated £16 million of central funding to enable the training of new stroke-specialist physicians, thus allowing services to expand their stroke work forces appropriately. We have also established a national training forum to develop a stroke educational framework, and we are supporting leadership programmes to improve skills and provide champions for stroke services at a local level. He asked particularly about the competency framework, which is under development. It includes looking for suitable institutions to provide accreditation. We hope to put the framework out for consultation in the spring, and there will be funding to support work force development, but exact details of spending levels cannot be agreed until the framework is in place.
On whether we are closing the gap between the UK and comparable western European countries, there have not been any international comparisons since the 2005 NAO report. However, the strategy is seen as a model by others. Professor Roger Boyle has been invited to Australia to give a presentation on how the strategy has been drawn up and how it will be implemented. A year into its implementation, we are confident that good progress is being made.
Hon. Members have mentioned the importance of the operating framework, and I should like to reassure them that the data that are included in the indicators will be published. The performance of PCTs and acute trusts will be measured against that publication. The inclusion of stroke in the vital signs means that PCTs will have to take performance seriously. They and acute providers know that they will be closely watched and judged on their performance. Furthermore, Lord Darzi’s report, “High Quality Care for All”, has offered welcome reinforcement of the key themes of the stroke strategy. The independent health watchdog, the Healthcare Commission provides indicators that will help to measure progress on the stroke strategy.
None that will add to what I was going to say, but I thank my hon. Friend for his helpful intervention.
There have already been encouraging signs of early progress. The 2008 National Sentinel audit of stroke states that almost every hospital now has an acute stroke unit, and that, between 2006 and 2008, there were substantial improvements in organisational scores on the provision of and access to minor stroke services. We expect that the strategy’s implementation could prevent 6,800 deaths or cases of disability. A further 1,600 strokes could be averted through preventive work. I shall finish with a quote from Jon Barrick, the chief executive of the Stroke Association. He has said of the strategy that this is a “historic time for stroke” and a
“momentous opportunity to transform the outcomes and lives of stroke survivors in this country.”
I begin by saying that it is a pleasure to serve under your chairmanship, Mr. Williams. I welcome the opportunity to engage in debate on regional broadcasting.
I wish particularly to talk about commercial public service broadcasting, especially regional production quotas, the provision of regional news and non-news items and the development of local online services. I do so in the light of the Secretary of State’s statement last week that we needed a debate
“to establish the best way in which to sustain the aspects that the public like and on which they depend, which will mean devising a new way of sustaining public service content beyond the BBC in the future.”—[Official Report, 10 November 2008; Vol. 482, c. 478.]
I do so also in the light of a clear statement from Ofcom:
“Regional news and productions from the nations and regions are at the heart of Ofcom’s long-term vision for public service broadcasting—audiences value this programming, so our object is to sustain and enhance it for the long-term”.
Those two statements set out one thing, but in September the chief executive of ITV announced massive cutbacks in regional broadcasting and regional news and non-news items. Then there was a further Ofcom review, the consultation on which will end on 4 December.
The current situation is that ITV receives its television signal spectrum from Ofcom free, in exchange for its public service broadcasting. In addition, it receives its position on the electronic programme guide and the unquantifiable commercial value associated with being a public service broadcaster. When the UK goes digital in 2012, it is expected that that spectrum will be worth considerably less—perhaps only £40 million, compared with £200 million now. The chief executive of ITV has warned:
“In the very near future the various channel 3 licences will start to go negative, the cost of their obligations exceeding their benefits.”
That is why changes have been announced this year, and it is important that Members get an opportunity to discuss them before final changes are made.
The Secretary of State stated on 17 June:
“I’m very disappointed that ITV has missed its regional production quota for two years. These are legal requirements and not things to be negotiated or brushed away.”
The out-of-London production quota for ITV was originally set in 2005 at 50 per cent. Last year it was only 44 per cent., having been 46 per cent. in 2006. Stuart Prebble, a former chief executive of ITV, has said:
“The original ITV network was designed as ‘Britain talking to Britain’, not ‘London talking to Britain’.”
I hope that in the context of what we are discussing, that important principle can be maintained.
To save money, ITV has planned to cut more than 1,000 jobs by the end of next February, including 430 in regional newsrooms. We know that the UK has other public broadcasters—the BBC and Channel 4—but Ofcom’s research has found that the public overwhelmingly want to see regional news and programming as part of what is on offer on ITV. Michael Grade has said:
“ITV does not itself want any direct public money. We wish only to operate as a free-standing commercial business”.
However, we know that the public want regional news and programming to be retained. The question that must be asked is: how we can do that without the use of public money?
In September 2007, ITV announced the reform of regional news in England and the Scottish borders, reducing the number of regions from 17 to nine. That meant abolishing existing sub-regional news bulletins such as Anglia west and east, and the merger of the two smallest regions, Border and Westcountry. ITV is a private business, and those changes will reduce the number of people employed by more than 1,000. ITV plc will prioritise prime-time regional news by reducing the amount of news broadcast in the daytime. Some news-gathering will be shared between large areas of the country, such as the West and Westcountry regions.
The minimum non-news regional quota will be cut from 30 to 15 minutes a week, and I wonder what value there can be in such short segments of programming. I have made the point to ITV that I would like to see that quota lumped together so that there can be longer programmes, although perhaps not every week. For Wales, STV and Ulster, the non-news minimum will be cut from three hours to one and a half hours a week. ITV’s original UK production and peak-time current affairs requirements will remain unchanged, but the non-peak current affairs requirement will fall by 40 minutes a week. The quota for programmes made outside the M25 will be reduced from 50 per cent. to 35 per cent.
For Five, original productions will be reduced from 53 per cent. to 50 per cent., and from 42 per cent. to 40 per cent. in peak time. For Channel 4, programmes from outside the M25 will increase from 30 per cent. to 35 per cent., including a new quota for the devolved nations.
My hon. Friend is making a very strong case. He mentioned the Westcountry and West regions. Although recent negotiations resulted in their altering the proposal for the provision of evening news from six to 15 minutes, they will be providing a threadbare service with the same level of staff and resources as they would have had under the original six-minute proposal. That will give them no capability really to investigate or dig below, with what will inevitably be a thin and reactive service.
I agree with my hon. Friend. Indeed, I understand that in Plymouth, for example, the number of people in the newsroom will be reduced from 100 to six. I question whether any meaningful programmes can be produced by that limited number of people.
Border and Tyne Tees will be merged, but they will have separate 15-minute sequences in weekday programmes and separate late-evening bulletins. Of the 168 workers there, 91 are to go. Sub-regional output in single licence areas will be reduced in volume, but they will retain short sequences in peak time and after “News at Ten”. Fringe areas will see a few minutes of local news each day.
I contrast that with the strong public support that has been shown for regional broadcasting. The recent Ofcom consultation showed the high value that audiences put on the provision of public service content outside the BBC, even if they may have to pay for it. Audiences believe that competition for the BBC is critically important, as has been shown by their rejection of Ofcom’s BBC-only model. According to the Ofcom report, nine out of 10 people do not want the BBC to be the only provider of public service content in the future.
I pay tribute to my hon. Friend for securing this debate. He alluded to a survey. He will be interested to know that 40 per cent. of viewers in Wales watch the Welsh news in preference to the BBC news, and that in the consultation that he mentioned, not one respondent supported the BBC-only model. Does he think that that is a reflection that Wales, in its quest for pluralism, has a separate political institution and a separate political culture that necessitate both channels?
My hon. Friend makes a powerful case. His evidence comes from the reaction on the ground.
We know that the majority of people want ITV to continue to provide regional and national news. Fifty per cent. of consumers say that they are personally interested in events in their region or nation, or events where they live. That confirms that audience support for the accessible and effective delivery of the public services that underpin public service broadcasting remains strong. At the Broadcasting Press Guild lunch in June, the Secretary of State said:
“I do sense at times that the media world talks to itself a lot and misses where the viewers are, at home, in my constituency, watching Granada Reports…We have to route this debate back in the interests of viewers.”
That is an important point.
There has been strong political support in the House for the retention of regional news and production. That is evidenced by early-day motion 2283, which was tabled by the hon. Member for Selby (Mr. Grogan), who is here this morning. It has been signed by 74 MPs, all from the north-west. Early-day motion 2164 has 25 signatures, and several other such early-day motions have been signed.
I question whether the proposals that have been made are sustainable, a short-term fix or the beginning of the long, slow death of regional broadcasting. In talking about ITV’s coverage, I want to compare that with what happens on the BBC. The BBC provides 15 regional news programmes, which are broadcast at 6.30 on BBC 1 every night. The audience of 16 million people is the largest television audience for news. If the BBC can get that number of people watching regional news, why is ITV not able to generate an audience that is similar, if not the same, at its time? What is the advertising revenue minutage for regional news, and why can regional news not be made profitable?
I do not see the situation as one in which we have to accept the proposals that have been made. The BBC plays a central role in public service broadcasting and in regional output but it cannot operate in isolation—it needs competition. If we can get profitability for the BBC, why not for ITV?
Having said that, does my hon. Friend not share the concern of many Members about the use of the licence fee to subsidise local video systems, which are now putting the BBC in competition with regional and local press providers? There is enormous disquiet about the way in which the BBC is straying into areas that may undermine the viability of independent providers.
I agree entirely with what my hon. Friend says. Indeed, that was the third point at the beginning of my speech. This week, the BBC Trust is to make a decision on the future of BBC Local. ITV already provides a similar service, and I believe that it would be wrong for licence fee money to be used to destabilise commercial services—whether local and sub-regional ones such as we have in Manchester or the wider ones provided by ITV Local. If other hon. Members agree, I hope that they will say so.
I congratulate the hon. Gentleman on obtaining this important debate. Does he agree that public service broadcasting has long been a cornerstone not just of the BBC but also of ITV, and that some regional companies have a good track record? I instance Granada, which I believe covers his area. Is it not a pity that, as we move from analogue to digital broadcasting and all the broader technical improvements that will be possible, ITV’s public service broadcasting is going in the opposite direction? This is an opportunity for it, not a problem.
I agree entirely with the hon. Gentleman. It is for this House to set out clearly what we want, as the Secretary of State said, and to signpost some ways forward. We do not want a short-term sticking plaster until 2012, which is what Ofcom’s proposals appear to be. I doubt that when we get to 2012, we will ever be able to get back to what we have now, or to some of the excellent programmes of the past. I think of Anglia programmes such as “Survival”, for example. That small company produced world-class programmes. We have to find a way to protect that level of public service provision.
In the consultation, which ends on 4 December, Ofcom has put forward various models. The first was the BBC-only model for public service broadcasting, which was resoundingly rejected by everyone. There was an evolutionary model, with all terrestrial channels continuing to have public service obligations and additional funding for regional news and news obligations falling on ITV. It is favoured by the Broadcasting Entertainment Cinematograph and Theatre Union, which is opposed to all the other models. It said clearly that commercial public service broadcasters should retain their public service role.
Another model was the BBC-Channel 4 model, with both channels receiving public funding and regulatory assets. Other terrestrial channels would lose benefits, and regional broadcasting could be opened to a number of potential providers.
Another option was a competitive funding model, in which content complementary to the BBC would be opened up to competition, content and distribution methods would not be not specified, and the BBC would retain its central role. It could lead to a reduced role for the BBC. Greg Dyke, the former director-general of the BBC, commented in October that it would take only £300 million to secure the future of Channel 4 and support regional broadcasting. We should say clearly that that is the route we wish to retain.
On possible sources of funding, there could be direct public funding, taxation or spectrum auctions. BECTU opposes that model. The excess licence fee funding ring-fenced for the digital switchover could be used to help with scheme costs and Digital UK’s costs. Regulatory assets include spectrum pricing, advertising and public service broadcasting status for more channels. Finally, there could be industry funding through levies. Those are some of the possible options.
We should be saying clearly that we wish to retain local news, local news broadcasting and regional production. Lots of other countries—for example, France, Germany, Italy and Spain—have developed a range of regional TV stations, the autonomy and independence status of which are fiercely protected. Why can we not do the same here?
We need to find a way forward. It is not acceptable for us to accept Ofcom’s short-term fix. We should be saying now that it seems that the regulatory framework is being rewritten because ITV does not like it. We need to set a regulatory framework that delivers what the public want and what we regard as important. There is a cost to that, and we need to find a way to fund that cost. It is possible, within some of the suggestions that have been made for Ofcom, for that to be done.
If ITV does not want to provide that service using public subsidy, we should suggest that ITN become the arm with which such services are provided, so that there is, and remains, a strong regional news output in the regions, provided by ITN if not by ITV. We ought to be setting higher standards for what is being produced than those in the model advanced by Ofcom. We ought to be looking to the future, not in terms of a diminution in provision, but as an opportunity, using the benefits of the digital dividend, to expand the range of provision. If that means that a subsidy of some sort is put on the use of the digital media, that should be used to fund that public service broadcasting element.
This is an important debate because our constituents want and value regional news and programming. There is a short-term problem with ITV funding, but that should not lead to our losing sight of the fundamental founding principles on which independent television was set up. The value that ITV has given to the regions and the nations of the United Kingdom must not be lost. We need a debate, as the Secretary of State says, and I hope that this is a contribution to that debate. I hope that we can go forward and that, when Ofcom reports in the new year on the results of its consultation, we see something a lot better than what we are being presented with, which seems very much like a fait accompli.
I intend to be brief, which means that we may have an opportunity to give the Minister very adequate time in which to respond to this debate and, perhaps, to take a number of interventions.
I hope that hon. Members will not mind if I remind them that we in Parliament tend to be rightly obsessed about the requirements of a functioning democracy. One cannot take this debate about regional broadcasting in isolation; it is about broadcasting and broadcasting standards generally and the importance of ensuring that our broadcasters are able to provide information and to delve below the surface of what is going on in this country and worldwide. That is essential in ensuring that we have a functioning democracy. We can either accept the model whereby one state corporation—the BBC—fulfills that public service broadcasting function, with perhaps a few add-ons from Channel 4 and elsewhere, or we can accept that if we are to have an effective organ to provide the background, investigative programmes, information and debate that is vital to a functioning democracy, we need independent broadcasters as well.
I am probably one of the most IT-challenged people on earth—I do not understand digital systems—but if this is the brave new world that we must accept with open arms and if this is the inevitable future of broadcasting in this country, we should consider something before we step beyond the precipice and accept the final Americanisation of British broadcasting and fully engage in the multi-channel culture. I fear that such a culture will be an acceleration of the race to the bottom and a continuation of the celebrity game show/makeover programmes that involve the ritual humiliation of the working classes by their apparent betters, or reality TV and “Big Brother” programmes. Broadcasters tend to revert to such a diet of programmes when they can think of nothing else to do. I fear that that will largely be the kind of thing that the multiple channels will provide. If that is what commercial TV is going to provide, before we go down that route I hope that we hon. Members—in the debating chamber of the nation—will engage in the debate and encourage the Government to stop and think and allow us the space in which we might recognise that broadcasters provide a vital service to the nation and to the regions.
When talking about regions it is important that we do not simply accept the Government’s ideas of regions, which are, in fact, Government zones; they are not places that people identify with. There is no internal integrity or community of interest within the Government zones. I speak for myself in respect of the Government zone of the south-west. Those zones are not the basis on which to provide the local news and information input into the kind of debate that we require.
Does the hon. Gentleman agree that it is perverse that, at a time when it would appear that regional TV is retrenching and shrinking, sub-regional digital TV at city level, such as City TV Birmingham, which may be online next year, will be providing a much narrower service to the areas around their studios? Is it not likely that the quality, quantity, reach and range of regional programming will be diminished as a result of what we are seeing?
I am certain that it will be diminished by the results of the decisions that are currently being taken by ITV. It is clear, both in conversation and in debate, and from the pronouncements of Michael Grade on behalf of ITV, that he wants ITV to be a stand-alone commercial company and does not want to accept public subsidy for the service that ITV provides, in whatever form. I am not sure what his and the company’s attitude is to tax credits or tax breaks that might be made available as an inducement to provide public service broadcasting, but by and large ITV’s position is as I have said. As a result of that, as night follows day, bearing in mind the costs of the news gathering and reporting—the investigative work—that are required to broadcast the kind of programmes that we have seen in the past and at regional level, ITV cannot achieve programming at the sub-regional level as it has managed to do in the past. That means that people are less likely to follow the programmes, because they are statistically less likely to get news from the areas about which they are most concerned.
It could be argued that, as a result of the campaigning that I and others have done on behalf of the excellent service provided by a number of companies since the early ’60s, beginning with Westward Television’s coverage of Cornwall and Devon, ITV has agreed to extend the local cutaway within the evening broadcast. That is welcome. However, as I said in an intervention, it will be a threadbare service with hardly any staff and without the studios and resources enjoyed in the past.
It is important that our regional broadcasters should be able to put in the resources and, if they provide a valuable service, to dig below the surface and ask questions, not simply report on press releases and turn up, if they can get there, at tragic events to stand outside and give us reports. We want the service to provide us with more in-depth analysis and with the same quality of information as in the past. Given the resources planned at the moment, I fear that that simply will not happen.
I will now ask an entirely naïve question. If what we are trying to achieve—I believe that we should be trying to achieve it—is a good-quality, well-resourced public service broadcaster in the independent sector, and if ITV is not prepared to provide that, should we not offer channel 3 to someone else? If that is the easiest, most accessible number for people to find on their gizmo—
Their EPG—whatever that stands for. If that is the case, channel 3 should be offered to someone who is prepared to accept the tax breaks, public subsidy or whatever is required to give us the quality of public service broadcasting, independent of the BBC, that this nation and its regions and local parts require to achieve the functioning democracy that we need. My fear, which also underlies the comments made by my hon. Friend the Member for Rochdale (Paul Rowen), is that if there is no independent provider of such a service, the quality of the local BBC service, with the best will in the world, will decline. Without some competitor holding it to its mettle and challenging it, I fear that the BBC will both withdraw services and fail to maintain its present high standard.
Does the hon. Gentleman recall the comment made by the hon. Member for Rochdale (Paul Rowen), in his excellent opening remarks, that it was never the objective for London to talk to the regions? There is a risk that that will happen, with the shrinkage of regional broadcasting. The English midlands have a bigger population than London, cover a bigger geographical area and contribute a bigger slice of GDP. London is a fine city—we spend half our time here—but it would be utterly unacceptable for the only non-London news in the midlands or indeed the south-west to be restricted to a minute and a half or so every evening. It is true that we need a critical mass—ITV would say that it needs a critical mass—but that would be utterly unacceptable.
I agree entirely. A lot of us who feel rather cynical about what ITV proposes anticipate that it will not be many years before the currently proposed regional broadcasting provision will be reduced further, until regional broadcasts are effectively provided from studios in London. That fear may be unrealised, but if ITV is going to find it difficult to maintain the rather bland regional programming planned at present, when that proves unsuccessful—I think that it will, because it will not provide the local news and views required—I fear that a further diminution will occur, and that ITV will justify it by citing falling audience numbers.
My final comment and plea to the Minister—and, through her, to Ofcom and ITV—is that I do not stand here as someone who looks back to the dewy-eyed days when my birthday was read out by Gus Honeybun on Westward Television and I got five bunny hops. It is not about attempting to rekindle the old days; it is about maintaining a vital information broadcasting source in people’s homes that ensures and underpins a functioning democracy. I also fear that ITV will lose out, because its unique selling point is that, unlike all the other channels with which it wants to compete, that produce the same bland stuff—game shows, celebrity programmes and so on—it includes a brand that is local to each area in which it broadcasts.
I congratulate my hon. Friend the Member for Rochdale (Paul Rowen) on securing this debate and giving an excellent introduction to the complex issues with which many people are struggling. I think that he and all Members would agree that public service broadcasting in the United Kingdom is the envy of the world, but for a variety of reasons, we are in danger of losing that reputation.
My hon. Friend made a powerful case for regional programming—both news and programmes produced in individual regions that reflect those regions to the rest of the country—and gave a clear analysis of the concerns expressed by many people about the ITV proposals to cut regional broadcasting. He described it as the long slow death of regional broadcasting, and I share his concern. I have only to look at what is happening in my own region, with the proposed amalgamation of ITV West and ITV Westcountry. As I will describe, there is already a problem with the arrangements for ITV West. There are people in my constituency who are not that interested in regional news coverage for the areas outside Bath, but I am absolutely certain that people in Bath are not very interested in what happens in Truro and other such places in the far south-west.
The amalgamation will diminish a service that many people think is important, and that view is backed up by research. Ofcom’s most recent research shows that 78 per cent. of consumers attach high value to the news from the nations and regions. The BBC Trust’s most recent report showed that 83 per cent. of people surveyed by the trust thought it important that the nations and regions were accurately represented to the rest of the United Kingdom. ITV’s proposals will clearly damage what people in those surveys have demonstrated is important to them.
I urge people not to wear rose-tinted spectacles when addressing the issue. If we look in depth at that research, we can see that only 20 per cent. of the people surveyed are very satisfied with the current regional news programming from both ITV and BBC. The satisfaction level drops even further when people are asked what they think about regional news programming as a way of finding out about specific local issues that affect them. We should not just address the question posed by my hon. Friend about how to maintain current regional programming, but consider more carefully what people really want, and try to find solutions to provide what they want.
There is no doubt that the criticisms of current regional broadcasting are real, and that is before any changes are introduced. The BBC Trust, for example, is critical of the BBC for producing news through a “London-centric prism”. If we are to have proper regional broadcasting, we must address the issues that my hon. Friend the Member for St. Ives (Andrew George) raised about properly resourcing it and ensuring that we have the news gatherers, equipment and so on to provide it. There is then a problem with how to fund that, and I shall return to that shortly.
Another area of concern about regional broadcasting is that the regions that we seek to protect are perhaps not necessarily the best ones. After all, they were developed around existing transmitters, and not to try to reflect particular communities of interest. There are a number of issues to be considered. Is what we are getting providing good-quality material? Answer: there are some concerns. Are the areas the right ones? Answer: probably not. Does provision really meet what people want, which on the whole is more locally focused news that reflects what is happening in their immediate local community?
That last concern was forcibly picked up in November last year when the Select Committee on Culture, Media and Sport produced a report in which it said that
“local television services in the UK are underdeveloped in relation to almost the whole of the rest of the free world”.
I have no doubt whatsoever that in future we must find ways, whether alongside regional news or replacing it—I hope that it is alongside—to provide high-quality, local news, not just as we already have on radio, but on television.
Some people say that local programmes are already beginning to be developed on the web—more will develop if the BBC local video proposal goes ahead—but that is increasingly where more and more people, particularly young people, are looking for news. Indeed, the evidence shows a huge growth in the number of young people who have switched off from watching the ordinary television news, whether national or regional news, and are turning to the worldwide web for news. I shall go further and say that the technology is being developed—it already exists to some extent—to enable material on the web to be placed on our television screens and the miraculous electronic programme guide.
I am listening carefully to my hon. Friend, and I appreciate his point about the use of the worldwide web. Does he agree with the point that I made earlier about the threat that the BBC, with its fat licence fee, poses to the sort of programming that ITV Local is providing on the web? Does he agree that we should strengthen that programming before allowing the BBC, with licence fee payers’ money, to swamp the commercial opposition out of the way?
If my hon. Friend will allow me, instead of giving a quick, glib answer, I would prefer to develop my thoughts about that in more detail in a moment, because it is critical.
Before we move forward, having begun to put together thoughts about what we want—national programming, regional programming and the addition of high-quality local programming—we must be aware of the context in which a debate about how to achieve that takes place. That is why, as my hon. Friend said, Ofcom is conducting a major review and why the Government are simultaneously conducting a review so that proposals for a way forward may be made early in the new year. The context in which we do so has been summed up succinctly and admirably by Ofcom:
“The existing system of public service broadcasting…—a publicly owned BBC with competition from commercially funded broadcaster—is under huge pressure, and will not survive the transition to an all-digital broadcast world.”
That will not survive, so we must do something and not just bemoan the problems facing us. We must come forward with radical solutions to determine what we want, how to deliver it, and how it can be funded.
The same Ofcom report explains why there is a problem:
“With more digital channels and new online, TV-like programmes the market will continue to make a significant contribution to content that meets public purposes, particularly in entertainment, sport, archive programmes and, in one exceptional case, news.
However, the commercial prospects for areas like regional and national news, children's television, UK drama and current affairs are poor. Nor can these most highly valued genres be sustained on ITV, Channel 4 and Five under the existing system as competition intensifies. Indeed, our extensive analysis indicates they will not deliver genres that require large and risky investment.”
That is the context in which we are operating. Simply wishing to retain regional programming as it exists at the moment will not help us. We must talk about how to move forward, so we must have the debate. I welcome my hon. Friend’s debate, as it is the start. It is the first time that the issue has been debated seriously in Parliament.
My hon. Friend the Member for St. Ives asked about the BBC local video. You will be aware, Mr. Williams, that the matter is being considered by the BBC Trust. The result of that consideration will be combined with Ofcom’s market impact assessment, and by Friday it will bring those two pieces of work together and make its judgment. Although I was critical of the hon. Member for Wantage (Mr. Vaizey), who speaks for the Conservative party on such issues, for not having clear views during a previous debate on another issue—he said that he would prefer to see the outcome of research—I confess that on this occasion I shall join him, because the critical piece of work is that market impact assessment, and my hon. Friend rightly said that newspapers, ITV and others are concerned about the impact of the BBC’s proposals. Frankly, I am not competent to conduct that market impact assessment and will have to leave it to others, including the hon. Gentleman, who might have done some of his own research.
Indeed, I was aware of that. I was happy to give way to the hon. Gentleman to allow him to give us the highlight now and the details later on.
The hon. Gentleman and his party have already said that they reject the proposals for BBC Local in all forms. However, I am not as robust in my attack on the proposals. The BBC proposes to attach video news to 60 existing websites and increase the linkages between those websites and the websites of local newspapers and others. It also proposes to limit the number of news stories to a maximum of 10 a day for each of those areas, and it has said that it will work with all the organisations that might be affected to minimise the impact of the proposals. There are people who, like me, believe that local television is important—I welcome the work already done on that subject by ITV—for driving up e-democracy and ensuring that there is greater and easier access to council services and local information about events taking place in the immediate area. We must therefore seriously consider a proposal that mentions 60 sites in areas that are occupied by 1,300 local newspapers, particularly if genuine attempts are made to minimise and support other organisations. As I have said, our response still has to be tempered by the seriousness of the impact on those other local organisations, which is why I am not prepared to say to my hon. Friend the Member for Rochdale that I support his total and outright objection to the proposals; I want to see how serious the impact will be on others.
Having said that we must identify what we want and who will deliver it, I welcome the point made by my hon. Friend that if we are determined to continue regional news in something like existing arrangements, and if ITV is not prepared to do so or is unable to provide it, we certainly ought to look to others to enable that to happen. We must start to consider radical solutions to provide a way forward. I end by pointing out to my hon. Friend that it is very well saying that we simply want to put pressure on ITV to continue to do what it is doing, but last November its share price was 130p; only yesterday, the share price had plummeted to about 30p. Commercial public service broadcasters face serious financial problems, and radical solutions are needed if we are to move forward.
May I say what a pleasure it is to serve under your chairmanship this morning, Mr. Williams? I congratulate the hon. Member for Rochdale (Paul Rowen) on initiating this extremely important debate, which is effectively about the future of public service broadcasting. An important aspect of that is regional broadcasting—both in terms of regional production and of regional news. As usual, it is a pleasure to speak after my mentor, the hon. Member for Bath (Mr. Foster), who finished with a market update on the stock price of ITV. Given that the stock price is only 30p, I was tempted to suggest that perhaps hon. Members in the Chamber could have a whip-round and buy ITV. We would then solve the problem ourselves and be able to carry forward our solutions for regional broadcasting and news.
That slightly facetious remark leads me to a serious point. All of us would like to return to an ideal world. In the run-up to this debate, many broadcasters pointed out how much regional broadcasting and production they do. Channel 4 told us that it has invested more than £100 million a year in out-of-London companies for each of the past 10 years. ITV rightly points out that, hitherto, it has spent about £800 million a year outside London and that, as a proportion of its total spend on broadcasting, it spends a far larger amount outside London than any other broadcaster.
[Robert Key in the Chair]
No one has mentioned the commercial radio companies that exist up and down the country. They have had an extremely tough time and are still stuck with a tough regulatory regime that holds them back from expansion. Of course, all hon. Members have made fond reference to the BBC, which has 40 local radio stations and a now famous out-of-London strategy to increase regional production up to the level of 50 per cent. In any debate about broadcasting, one is tempted to take refuge in some anecdotes. As a constituency MP, I see no particular difference in the regional coverage given by BBC Oxford, Fox FM and my local newspapers.
For example, last week was a typical week for me, during which I worked hard for my constituents. I am regularly on the excellent BBC Oxford programme, hosted by the indefatigable and unique Bill Heine, who is a peer among regional and national broadcasters. However, I receive equal amounts of coverage from other broadcasters—for example, only ITV regional news covered my extraordinarily important debate on proposals for a reservoir in my constituency. BBC television news did not do so—although the breakfast TV programme did cover it. Only Fox FM covered my extraordinary meeting with the Didcot thong rangers last Saturday, who are a group of men who regularly raise money for charity by pulling large trucks through the streets of Didcot dressed only in thongs. I joined them. May I welcome you to the Chair at this important moment, Mr. Key?
I would like to make it clear that for health and safety reasons, I was not wearing a thong—mainly for the health and safety of the people watching. However, only Fox FM covered the important event of young men raising thousands of pounds for national and local good causes in Didcot. I pay tribute to the hard work of those young men.
No one has made the point in this important debate that “The times they are a’changin’”. We now live in an extremely different broadcasting world from the one that existed two or three years ago. As the hon. Member for Bath pointed out, it is in fact the market that has noticed such changes, rather than hon. Members. As we move into a digital environment, ITV is under an extraordinary amount of pressure to make the same profits it used to and to provide the same quality of service. The way in which we gather information and news has changed completely. Almost all young people get their news from the web and social networking sites, and they spend more time on their computers than watching television. We all have hundreds of channels from which to chose to watch our news and broadcasting—whether we have Freeview or a subscription to a commercial company. It is a testament to ITV and Channel 4 that they have been able to maintain anything resembling their previous market share.
There has been virtually no leadership on the issue from the Government. It has been fascinating to watch how they have dealt with it. First, the entire subject of public service broadcasting was handed over to Ofcom, which treads a fine line between being a regulator and a policymaker. Ofcom certainly came up with a series of interesting policies on the future of public service broadcasting, many of which have now been cast aside—including the proposal to have a public service internet site. When Ofcom got too big for its boots, the convergence think-tank was created to enable the Secretary of State to call people together. That has cost the taxpayer the princely sum of £300,000. Not content with a large and expensive building in Cockspur street where he could perhaps call people together to discuss the future of convergence, the Secretary of State hired Arsenal football stadium for his first meeting. The convergence think-thank did not come up with much and the issue then went back to Ofcom.
We now have the land grab by the Department for Business, Enterprise and Regulatory Reform. The arrival of Peter Mandelson seems to have spelled the demise of the Department for Culture, Media and Sport as a force in broadcasting policy. Lord Carter of Barnes is now installed in Victoria street and he has commissioned yet another review of the impact of digitisation on television and numerous other areas. We are told that the Government will come up with their policy in January. We wait with bated breath to see what emerges from either Lord Carter or the Secretary of State; it is not clear who will make the announcement. Government policy is all over the place on this issue, and meanwhile, as every hon. Member has pointed out, we are witnessing the slow decline, potentially, of regional broadcasting and regional news.
I would like to echo the comments made by many hon. Members about the importance of regional news in particular. Four fifths of people say that TV is an important provider of local news; 90 per cent. of people in the devolved nations say that. Eighty-eight per cent. of people say that it is important that the main TV channels provide news from the nations and regions, and 70 per cent. said that it was important for ITV to make programmes in different parts of the UK.
At the same time, it is worth pointing out that in most regions about 40 per cent. of people said that if there was no regional news, they would get their regional news from other sources. It is also important to point out that even with the current set-up of regional news, many of us do not identify with those regions. For example, there is very little coverage of the events in my constituency on local BBC news.
Although many of us in this Chamber will of course regret the cuts being made by ITV to regional news, we cannot, as I think the hon. Member for Bath said, look on this issue with rose-tinted spectacles. ITV is taking what it regards as proper action in the face of the difficulties it faces now in having an analogue regulatory system while competing in a digital world. Again, it is a matter of regret that the Government seem no further forward in easing the regulatory burden on ITV. There are a number of things—I am not saying that they are panaceas—that would make life much easier for ITV. For example, under the audiovisual media services directive, we have a consultation on product placement. Product placement would not necessarily fill the coffers of ITV, but it would make life much easier.
I was lucky enough to visit the set of “Coronation Street” with ITV’s head of public policy, the estimable Jane Luca. We went round and had a good look at the shop in “Coronation Street”, where all products have to be covered up from view. It is impossible in “Coronation Street”, unlike the rest of the country, to buy a Kit Kat or a Mars bar. I do not think that if someone bought a Kit Kat or a Mars bar in “Coronation Street”, the world would come to an end, but ITV might be able to make slightly more money. We live in this bizarre world where people watching “Desperate Housewives” on Channel 4 will see no end of product placement, from an Aston Martin downwards, but in British programming, no product placement is allowed.
What is the Secretary of State’s reaction when he launches the review? It is to say that he is completely against product placement—he has cut the review off at the knees even before it has begun. There is no news on contract rights renewal. There is no news on flexibility on advertising minutage. On all those regulatory burdens imposed on ITV, there is no leadership from the Government. Therefore, ITV has to react. It has to save £40 million a year and to merge regional news operations, but again I counsel hon. Members against sounding like Cassandra. As I understand it, the key bulletins that ITV is planning to drop are the weekday mid-morning bulletins—it would be interesting to know how many people watch those—and the lunchtime weekend bulletins. The main bulletins—the ones that hon. Members and their constituents watch—the early evening and late evening bulletins, will remain.
In addition, ITV is hoping that Ofcom will allow it to drop its regional production quota from 50 to 35 per cent., but at the same time there will be an increase in Channel 4’s regional production quota from 30 to 35 per cent. I am told by Ofcom that although that will save ITV some money, it will also result, if we take into account what the BBC is doing as well, in an increase overall in regional production from all broadcasters. That is a necessary and sensible move to give ITV the opportunity not to go bust.
We would be well advised to take account of exactly what pressures companies such as ITV are under. We learned only last week that almost 2,500 people had lost their jobs in media companies such as Virgin Media, Haymarket and Time Out, and another 4,000 jobs are likely to go not just at ITV, but at Channel 4 and in national and local newspaper groups. That is why the current consultation on local television is so important. As the hon. Gentleman pointed out, this is an interesting issue because the Conservative party has a clear position on it, which is that we firmly oppose the BBC’s proposal to introduce local video. Again, ITV is doing its bit: itvlocal.com provides 1,900 hours of video content viewed by 1 million people a month. It is due to break even next year. That system will be decimated if the BBC gets its way. As ITV points out, it will “jeopardise commercial services”. Local commercial radio companies have called the BBC’s proposals a “damaging intervention”.
A couple of weeks ago, I received a letter from Simon O’Neill, the brilliant editor of my local newspaper, the Oxford Mail, and his colleague, Derek Holmes, the equally brilliant editor of the Herald Series, from which I get my local news and which occasionally I am very lucky and privileged to appear in. They point out that, in Oxfordshire alone, 15 websites are already run by seven local newspapers with local video. They say that if the BBC goes ahead and broadcasts local video services, that will be a serious threat to their business. The point that they make, which I think is one of the most powerful arguments made, is this: why is the BBC allowed to do online what it would not be able to do offline? Let us imagine the furore if the BBC announced tomorrow that it was to publish a national daily newspaper. People would think it utterly absurd that the BBC was choosing to compete in a market that was already saturated, so why on earth is it being allowed to compete with taxpayers’ money, licence fee payers’ money, in a market that is being served by local newspapers, local commercial radio companies and ITV?
Although I remain, as I said earlier, agnostic as to the final decision that will be made on Friday, I fail to understand this point and I would be grateful if the hon. Gentleman explained it. Given that, as he said earlier, a lot of younger people are getting their news online and the BBC has a charter requirement to reach out to all age groups and all sectors of the community, how do he and his party believe that the BBC could meet the charter requirements if it did not at least look at initiatives such as the one that he is discussing?
The BBC is perfectly entitled to look at such an initiative, but we would say that it is not entitled to go ahead with it. There are numerous ways in which the BBC could reach out to young people that all of us would find unacceptable. For example, it could publish a daily newspaper. It could start competing with Metro or London Lite by handing out a daily newspaper at tube stations. [Interruption.] The website is being used by the BBC to impinge on a potentially thriving commercial sector. That commercial sector should be given the chance to grow and thrive before the BBC comes in with its size 12 boots.
Let me set out for the Minister’s benefit—
No, I will not give way. I just want to set out some Conservative policy, which I think is very important.
First, we are clear that we will allow local newspaper groups to own local television stations. We shall ask Ofcom to ensure that, as much as possible, interleaved spectrum can be used for the benefit of local television stations. We shall also provide clear leadership to supply super-fast broadband for most homes in the country. Again, that potentially offers an incredibly important platform for local news provided by commercial stations. As I said earlier—despite the heckling from the Liberal Democrats—we do not believe that the BBC should enter that territory at this sensitive point.
All I wanted to ask the hon. Gentleman was that, if he has concerns—I share them—about the threat to pluralism in online services as a result of the BBC’s activities, why is he not equally concerned about the dominance of the BBC in the broadcasting sphere, particularly with regard to regional news coverage? Does he share my concern that if ITV goes ahead with its proposals, a state news broadcaster will dominate regional news broadcasting?
We can all play the “what if” game. What if a Conservative Government had been in power for the last two years and had grasped the nettle of the threat facing our commercial companies? They could have eased the regulatory burden on ITV, talked to commercial radio companies and removed a lot of the restrictions that they are under, particularly regarding cross-ownership. That might have allowed such companies to thrive in a more lightly regulated environment, and we might have seen ITV regional news surviving, thriving and perhaps even expanding.
Of course, I am massively concerned about the growth and power of the BBC. The BBC has £3.5 billion of licence fee payers’ money with which to compete against commercial companies—television broadcasters and radio companies—which have their hands tied behind their backs by the regulatory environment. My worry has translated into policy, and that is why we do not want the BBC to expand by creating local video content on its website. We must allow commercial companies to thrive and survive.
With those remarks, I bring my speech to a close. I urge the Minister to go back to her colleagues and ask for clarity. The commercial broadcasters can no longer wait for yet another Government review. Perhaps she will close down the convergence think-tank, call a meeting with Lord Carter and the Secretary of State, sit down over the Christmas turkey, make some decisions and return in the new year and tell us what the future of public service broadcasting is going to be.
It is a pleasure to serve under you, Mr. Key. First, I would like to congratulate the hon. Member for Rochdale (Paul Rowen) on securing the debate and on making such a thoughtful and measured contribution to it. It was very valuable.
I want to reassure hon. Members that the Government remain committed to retaining public service broadcasting as an important part of their work, and to preserving free access to high-quality content that reflects the needs and interests of everyone, wherever they are in this great country of ours. As hon. Members have noted, the question for us as legislators, for Ofcom as the regulator and for broadcasters, is how we can create a sustainable model for public service content, particularly for commercial broadcasters in the future.
The hon. Member for Bath (Mr. Foster) alluded to the drop in the share price. It went down by a further 0.5 per cent. while the shadow spokesperson, the hon. Member for Wantage (Mr. Vaizey) was speaking.
I am stressing that there has been a big drop in ITV’s share price; it is something that fluctuates all the time. Hon. Members will know that the economics of the commercial broadcasting industry have changed radically over the past few years. That is a significant challenge to the viability of the traditional funding models that we have lived with since 1955. At the back of that change is the switchover to digital TV, which has broadly taken place in at least one television set in 88 per cent. of households in the United Kingdom.
On the theme of pressure on commercial television, is the Minister aware that today Ofcom has released its estimates of the possible costs of ITV’s various public service obligations? They were put at £5 million for national news, £7 million for current affairs, £5 million for out-of-London production—which the hon. Member for Rochdale (Paul Rowen) mentioned—and £8 million for original British production. If those figures are totalled, they come to less than the residual value of ITV’s use of spectrum and position on the electronic programme guide. Should the House expect ITV at least to keep up its out-of-London and British production and national news? According to Ofcom, that costs less than its residual value and spectrum.
I thank my hon. Friend for that contribution. We must keep up those services. However, we must remember that the licences currently held by Ofcom are worth £200 million today, but in a couple of years’ time they will be worth about £40 million. That is a significant drop and shows that its ability to attract money is lessening rapidly.
The switchover to digital TV, with its greater numbers of free-to-air commercial channels, is eroding and fragmenting ITV’s audience and therefore its ability to attract advertising revenue. That process has caused ITV’s share of the advertising market to drop by more than 10 percentage points between 2004 and 2007. Hon. Members have alluded to the growing popularity of new audiovisual services, from online content to video on demand and catch-up TV. I know that many of us in the Chamber are probably not young enough to understand the mechanics of catch-up TV, but the coming generations use it all the time in the way that we—or at least I—used to switch on Muffin the Mule.
As a result of those and other challenges, Ofcom believes that by 2011, the cost of public service obligations will exceed the benefit that they offer to commercial public service broadcasters. That alarming assessment gives the Government, Ofcom and broadcasters difficult issues to address and I would like to outline how we intend to do that. The hon. Member for Wantage said that we had lost control, and that Lord Carter had moved to the Department for Business, Enterprise and Regulatory Reform. I assure the hon. Gentleman that Lord Carter has not moved—he happens to share a suite of offices with me in Cockspur street, and communication between us remains strong.
We foresaw this problem when we introduced the Communications Act 2003. That Act imposed a duty on Ofcom to report every five years on the state of public service television broadcasting. It also ensured that Ofcom had the flexibility to make changes to a significant proportion of obligations as and when necessary. I reassure the hon. Gentleman that we are in discussion with it about that. Ofcom is currently in the middle of a public service broadcasting review. Such reviews are necessary because today we do not manage top-down but through consultation. We talk to people and try to reach an agreement that is backed by them. In other words, we seek to work by consensus, not authoritarian diktat.
Ofcom’s phase 2 document was published on 25 September and clearly showed, as hon. Members have done today, that the public value public service broadcasting, and want it to continue. The Government and Parliament have the responsibility for designing the statutory framework for the provision of public service content. That includes the purposes, the delivery mechanisms and the funding framework.
As hon. Members said, in its report, Ofcom identified three models that it felt merited further discussion: the enhanced evolution model, a refined BBC and Channel 4 model, and a refined competitive funding model. It is clear from today’s discussions that those three models attract criticism and approval from various groups—the review will weigh up those positions and consider what each model offers. I urge hon. Members, and anyone else who is interested, to contribute quickly to the consultation, which closes on 4 December, because we want everybody to get involved.
It is also clear from Ofcom’s report that certain programme genres are much more at risk than others, especially regional programming and national and regional news, which were the key themes of the remarks by the hon. Member for Rochdale. I assure him and other hon. Members that the Government remain committed to ensuring that programmes are made for, and in, the regions, and not just in London, or inside the M25 belt. That is why we embedded a regional dimension in the Communications Act 2003, which should facilitate the development of a critical mass of production outside London and the M25 area. It should also ensure that broadcasters continue to invest time and money in producing high-quality programming for the regions—I said “should” several times just then, because, disappointingly, ITV failed to meet its out-of-London production quotas in 2006 and 2007. The quotas are set by Ofcom and are statutory obligations, and the Government expect the relevant broadcasters to meet them. However, the possible sanctions for failure to do so are a matter for Ofcom, whose decision on ITV we await.
Currently, the BBC and ITV offer viewers programmes that are made in their region, about their region. As Minister for the East of England, I take the point that local people do not always identify closely with those regions—indeed, living in Hertfordshire, I find it difficult sometimes to identify with content beamed broadly at the East Anglian coast—but that problem probably extends beyond the remit of this debate, so I shall put it to one side for now.
In addition to the regional programming, ITV, Channel 4 and Channel 5 are required to produce a proportion of programmes outside the M25. However, it is clear from today’s debate that the main concern of the majority of people is ITV and its regional programming dimension, which has played a crucial part in ITV’s unique appeal since it was launched in 1955. I am old enough to remember the launch and can tell hon. Members what a change the first commercial broadcasting company brought. Nationwide, audiences gathered around their television sets to watch high-quality programmes, including regional programmes. However, in the 53 years since, things have changed. Although ITV offered a big change from the London-centric programmes that people had been used to until 1955, and although ITV produced a big change in the BBC—it had to up its regional content—things have now changed again, and ITV’s market price reflects the enormity of that change, as the hon. Member for Wantage said.
Popular programmes such as “Coronation Street” and “Doc Martin” continue to ensure that television is not only, or mainly, about London. Although ITV spends about £120 million a year on regional services, and provides around 5,000 hours of regional programming every year, its regional news represents the vast majority of its output in volume and cost. That is what we are talking about today. ITV spends more than £100 million a year on news provision alone. The key question is how sustainable this is in the light of competition from multi-channel television and the proliferation of new media in this country.
In a strategy document on content-led recovery published last year, ITV expressed, and attempted to address, concerns about the validity of its business model. One of the key components of that strategy was a new approach to regional news, which the hon. Member for Bath outlined. However, I shall repeat it quickly. The strategy would provide nine flagship regional news programmes in place of the 17 currently provided and would involve merging some of the smaller regions, such as ITV Westcountry, ITV West, ITV Border and ITV Tyne Tees.
ITV has confirmed, however, that it is committed to ensuring that each region will be fully equipped with journalists, camera crews and news-gathering equipment in order to cover breaking and emergency stories. It will also provide segments within news programmes to provide an even more localised service in areas such as Border and Tyne Tees. However, the Government accept that there is a fear that the quality of coverage provided is under threat and that those stories best covered in the regions will be buried or reported inaccurately. In difficult times—for example, during a flood or a hospital crisis—it is crucial that people get the information for their area. As a regional Minister, I had to deal with the outbreak of avian flu, when we really needed regional information, so I understand fully the high value that people place on regional news services. I am glad, therefore, that Ofcom is consulting on its proposals.
In these difficult times, the fact that people are facing job cuts in all ITV regions must be causing great concern, and I sympathise with journalists whose jobs are under threat. The Government and Ofcom have taken a twin-track approach to the current difficulties that public service and commercial broadcasting is facing. We are looking at policies and the practicalities of the situation, and despite the ominous warnings from the hon. Member for Wantage, Lord Carter is very engaged in this policy area—and in Cockspur street, not Victoria street.
Yes, in fact I shall conclude with that.
Early next year—hopefully in January—the Government plan to publish an interim digital Britain report, and in the spring a final report, which will consider what future legislative and non-legislative measures are required to support the development of the UK’s creative and economic sectors. Unlike the hon. Member for Wantage, I do not favour product placement as a solution. We have enough of that in films today, and I fear my children and grandchildren are becoming too commercially inclined.
I thank the hon. Member for Rochdale again and assure him of the Government’s continuing concern about this matter.
It is a pleasure to serve under your chairmanship, Mr. Key. I want to raise the issue of the consular assistance that was provided to one of my constituents in relation to her brother, who tragically died in the Pertamina hospital in Jakarta while he was on holiday in Indonesia. The case revolves around the refusal of the hospital to treat Mr. Nord until he provided a cash payment to the doctors who were on duty that evening. This was not about paying for treatment through a credit card or cheque. It was a demand for money—American dollars—to be paid up front before the hospital would consider any treatment. In the event, Mr. Nord died. His death was entirely preventable. My constituent, his sister, believes that the consular assistance that was provided was inadequate to say the least.
Mr. Dale Nord was taken ill on Friday 4 January. He spent the whole day in bed in his hotel room. He was persuaded to go to hospital that evening. His condition had deteriorated to such an extent that by the time he arrived at hospital, he was unconscious. From that point on, he never recovered consciousness. When presented with Mr. Nord, the hospital refused to treat him until his companion had provided $1,700 in cash.
Mr. Nord received no treatment for several hours until his companion was able to contact friends to raise part of the money. As it turned out, his friends raised $700. After that, the hospital began to consider treating Mr. Nord. I want to point out that, contrary to what the Foreign Office has been told and to the information that it provided in our exchange of correspondence, up until that point no treatment, be it good, bad or indifferent, had been given to Mr. Nord. In a letter—admittedly not written by my hon. Friend the Minister—the Foreign Office said:
“Our records show that at no time was medical treatment withheld from Mr Nord”.
That is not the case; medical treatment was withheld until Mr. Nord’s companion could produce a cash payment in US dollars to the doctors on duty in the hospital.
Mr. Nord’s companion, his girlfriend Anna, was an Indonesian national. Obviously, she could speak the language. She was well aware of what was happening at the hospital, of what was being demanded and of the fact that Mr. Nord was not being treated. She did not have the money available to her, and so she contacted April Nord, Mr. Nord’s sister and my constituent, to ask for her help. April Nord then contacted the embassy, through the embassy’s emergency telephone line, and spoke to Mr. Golding, the officer on duty that evening. Unfortunately, Mr. Golding responded by saying that it was not his day job, and that he was not used to doing that type of work. He said that he did not want to go to the hospital that evening because he did not have an interpreter and he did not have the required language skills. He said that he would not go to the hospital until 7.30 the following day.
Why was an emergency duty officer on duty that weekend in Indonesia when he did not have the requisite language skills or the skills to deal with the situation? Mr. Golding said that such work was not his day job, which one takes to mean that he had been seconded into the job of duty officer without any experience.
Throughout the time, the hospital was pressurising Mr. Nord’s companions for cash payments. It said that it could not put Mr. Nord in intensive care, which is what it said that he required, until the money had been paid. It was made crystal clear to Mr. Nord’s companion that he would not be moved until money had changed hands.
My constituent, April Nord, had a number of conversations with Mr. Golding throughout the course of the evening. She was anxious to get money to the hospital to pay for any treatment that her brother required. During her conversation with Mr. Golding, she was told that everything in Jakarta works on bribery and that the request for $1,700 was probably a request for a bribe. By this time, things were becoming a little frantic to say the least. The companion of Mr. Nord and Mr. Nord’s sister were told that Mr. Nord was in a diabetic coma and that he had suffered multiple organ failure, neither of which turned out to be true. It was suggested that a credit card payment might be acceptable. That suggestion came from Mr. Golding himself and not from my constituent, as has been suggested in the correspondence with the Foreign Office.
Unfortunately, the hospital refused to take a credit card payment on the basis that it did not have sight of the credit card—it was Mr. Nord’s sister’s credit card and she was in the UK. By the same token, the Foreign Office refused to guarantee or loan any money in accordance with the Foreign Office consular advice. Therefore, there appeared to be no way in which money could be paid to the hospital to obtain treatment for Mr. Nord. Yet all the time the doctors kept saying that he was in a diabetic coma, that he was suffering multiple organ failure and that he required intensive care.
After Mr. Nord had been in hospital without treatment for several hours, a friend provided $700, which had been collected from friends. At that point, the hospital agreed to begin some assessment of Mr. Nord’s condition. However, at 5 am, Mr. Nord allegedly suffered a cardiac arrest, and later that day, he died. All of that happened between 1 o’clock in the morning and 3 o’clock in the afternoon, Indonesian time.
Throughout the whole of the period that he was in hospital, Mr. Nord had been unconscious. Even if the man had had insurance, a credit card or cash with him, he could not have communicated that information to anybody; he was unconscious. He could not say whether he had funding available. The Foreign Office provides clear consular advice. A person in those circumstances could be any one of us; incapacitated and unconscious and unable to communicate with the hospital. The hospital would not provide treatment until a payment was made, but the situation was such that it was impossible to provide that payment. I find it strange that the embassy staff, faced with a situation involving a clear demand for money, which the individual concerned had difficulty in meeting, could not have done more to provide assistance to him. I appreciate that the guidelines state that no financial assistance is available, but by the same token it is strange that the Foreign Office was willing simply to stand by and allow the man to die for the want of $1,700.
To make matters worse, when Mr. Nord’s body was returned to the UK, the West Yorkshire coroner undertook a post mortem examination of the body and the medical notes from the hospital were referred to specialists in West Yorkshire, for an analysis of what had happened to Mr. Nord while he was in hospital. Mr. Nord had no history of diabetes and there was no diabetes in his body. There was no question that he had been in a diabetic coma. He had not suffered any cardiac arrest. Nor had he suffered multiple organ failure. The consultant’s conclusion was that the
“heart and kidneys were unremarkable.”
The conclusion reached by the specialist was that Mr. Nord had been suffering from something known as ketoacidosis or, in layman’s terms, dehydration. Had he been given fluids he would easily have been resuscitated. That raises the question why that treatment was not given. Probably, Mr. Nord, being on holiday in Indonesia, had drunk too much and not looked after his diet as he should have done, and developed a severe case of dehydration, which led to his death. That death, according to the specialist, was entirely preventable.
Several questions about consular assistance to individuals abroad are raised by this case. I repeat my question: if a person is incapacitated and cannot speak or is unconscious when admitted to hospital—even if they have insurance or money—what assistance can or should be provided to ensure that the individual is not put in Mr. Nord’s situation and left to die? Why was the consular officer on duty that evening, by his own admission, so badly equipped to deal with the situation? He mentioned that it was not his day job and that he required an interpreter before he went to the hospital. In the end when he found out that Mr. Nord’s companion was Indonesian and could interpret, he visited the hospital. The officer mentioned that he knew that the country operated on a system of bribery. Why does the Foreign Office not have protocols or procedures in place, so that if it is known that there might be a request for a cash payment in advance of medical treatment an attempt can be made to get round the situation and assist an individual? Obviously it is not the easiest matter for the Foreign Office to make reference to another country’s being corrupt. However, it happens. There are countries where a level of corruption is acceptable, when it is not here. There should be some system to get round situations in which a bribe or some such payment could be anticipated.
Even if there was no request for a bribe, and even if the hospital was the best in Jakarta and had, in the words of the Foreign Office,
“the highest reputation within Indonesia”,
why was Mr. Nord allowed to die while embassy officers and doctors stood and let him? Surely there is something wrong with the system, no matter how good the hospital and its procedures, when a man is admitted to hospital and dies in this way in 12 hours. There is something wrong with the system and we need to consider it again.
I appreciate that the Foreign Office goes to great lengths to publicise its consular guidance and make individuals aware that there is no financial assistance and that there are no medical payments or guarantees. However, surely there must be a system that allows for a situation such as the one I have set out, and in which a person can be given some assistance at least to prevent a tragic outcome. If the Foreign Office takes the view that the guidance is sound and there is no reason to change it, surely the information that is provided must go further, and include such situations. Individuals should be alerted to the fact that they could be asked for cash payments, with no question of insurance or credit cards being used. The people in Mr. Nord’s case were not asked for insurance or a credit card payment. They were asked for 1,700 US dollars—not sterling or Indonesian currency. It was quite specific. Surely some reference should be made in the guidance to the fact that there are countries where such a demand will be made.
The version of events in the correspondence that I exchanged with the Foreign Office does not equate to the version in statements provided by people who were present at the hospital. I question why the Foreign Office has chosen to accept its version of events in the light of clear evidence that some information given by the doctors on the fateful night was absolutely wrong. The man in question did not receive treatment, and was not asked for payments in the normal course of private treatment. He was asked for a cash payment up front.
I accept that the Foreign Office consular guidance is clear and that consular officials are not medically trained and should not be required to give medical advice. However, I am sure that I and the British public expect a better service from our consular staff abroad than was provided to Mr. Nord on the day he died.
I congratulate my hon. Friend the Member for Barnsley, Central (Mr. Illsley) on securing this debate, on behalf of his constituent, about the Foreign and Commonwealth Office’s consular assistance policy and, more specifically, the handling of the case of Dale Nord who, as he has said, tragically died in Indonesia in January. I know that the issue has greatly concerned my hon. Friend, who has pursued it vigorously. I would like to take this opportunity to express my condolences to the Nord family. I can only imagine how hard it must be to lose a member of one’s family in such circumstances. This is a particularly poignant time as the first anniversary of Dale Nord’s death approaches.
There has been much correspondence between Mr Nord’s sister, April Nord, and the FCO about the events on the day of Mr Nord’s death and I fully appreciate the family’s need to know as much detail as possible about the circumstances. Consular staff in Jakarta and London have tried to provide Ms Nord with as much support and information as we can. I regret it if discrepancies between our records and Ms Nord’s have added further to the family’s distress. I know that Ms Nord does not agree with aspects of the version of events that our duty officer in Jakarta recorded. As we have made clear to her, that is simply a record of what the embassy duty officer was told at the time and the action he took.
My hon. Friend has said that Ms Nord feels she received inaccurate information on the medical condition of her brother from our duty officer. I do not think that it is appropriate in this forum to go into the detail of the information relayed about Mr. Nord’s medical condition, but I reiterate what we have said in previous correspondence: our duty officers are not medically trained personnel; their role in such situations is to relay information between the various parties. They cannot and should not interpret medical information. Any diagnosis and decisions on treatment are made by the relevant medical staff. If there was a misdiagnosis of Mr. Nord’s condition—I do not know whether that is the case—our duty officer in no way contributed to it. He was simply passing on the information that he had been given. I must say that, in the circumstances, I do not see what other course of action was available to him.
My hon. Friend also said that the West Yorkshire coroner, who has opened an inquest into Mr. Nord’s death, has concerns in relation to this case. As my hon. Friend knows, in addition to the documents from the hospital that the coroner requested, we have provided him with a statement from the embassy officer who was on duty at the time of Mr. Nord’s death, which records the information that the duty officer was given and the actions that he took, and a statement from the vice-consul in Jakarta, whom the duty officer had consulted. The coroner has not expressed to the FCO any dissatisfaction or reservations about those statements, nor has he asked for any further evidence from the two individuals concerned. I understand that there is one outstanding request from the coroner for information from the hospital itself, which our staff in Jakarta are trying to obtain on his behalf. I hope that we can achieve that outcome.
Clearly, a particularly distressing issue for Mr. Nord’s family is their belief that treatment was withheld from Mr. Nord until such time as the hospital received payment. Hospital treatment in Indonesia is not free and requires either a deposit or a confirmed undertaking to pay from an insurance policy, so it is not unusual that the friends who were with Mr. Nord would have been asked for an initial payment. However, it is our clear understanding from what Mr. Nord’s friend said to the duty officer at the time that in fact, the hospital did not withhold treatment from Mr. Nord until it received the payment that it had requested.
Our belief is that Mr. Nord was treated by the hospital throughout that night and he was certainly being treated when the duty officer from the embassy arrived. Our understanding is that, on his arrival at the hospital at 1.50 am, Mr. Nord was moved to the intensive care unit. Further, the hospital log shows that treatment took place at 3 am and the duty officer from the embassy was first contacted at 3.35 am. That record certainly demonstrates that Mr. Nord had received treatment before the duty officer from the embassy arrived.
One of the main concerns that my hon. Friend and Ms Nord have raised with us is why the FCO could not guarantee payment of Mr. Nord’s medical costs. My hon. Friend has also said that he believes that the FCO should have procedures in place to assist British nationals who need funding in medical emergencies such as this. However, I must say that I do not agree with that view. Unfortunately, a huge number of British nationals end up in hospital overseas each and every year, needing treatment. Indeed, there have been almost 3,000 cases already this year that we have been notified about. The UK Government cannot pay the medical costs of those individuals, nor can we provide financial guarantees on their behalf.
The FCO has invested substantial resources in making it clear to British nationals who are travelling or living overseas that they need to have full travel insurance. Our consular directorate’s “Know before you go” campaign was launched in 2001 to encourage British nationals to take the necessary precautions to ensure that they have safe and trouble-free travel abroad. The need to obtain comprehensive insurance is one of the campaign’s key messages, and a wide range of methods and partnerships are used to promote it. The FCO’s travel advice on its website includes suggestions about what a travel insurance policy should cover, and what the real cost of medical treatment could be for those who travel without insurance.
As my hon. Friend is probably also aware, in 2006 the FCO published a booklet, “Support for British Nationals Abroad: A Guide”, which clearly sets out what we can do and, just as importantly, what we cannot do for British nationals overseas. Page 16 of that booklet explicitly states:
“We will expect you to have full travel insurance for your trip, or health care and other appropriate cover if you are living abroad. The Government cannot cover medical costs”.
With regard to this specific case, our duty officer was therefore correct in saying that he could not guarantee payment of the medical bills on the Nord family’s behalf. I must say that if we were to make such an undertaking in individual cases, we would have to do it in every case, the cost of which would be colossal, and I believe that the resulting burden on the taxpayer would be both unreasonable and unaffordable.
As my hon. Friend knows, the duty officer at the embassy went to the hospital where Mr. Nord was being treated and he tried to facilitate a credit card payment by Mr. Nord’s family, but I understand that that payment was refused because the hospital’s standing instructions required its accounts office to see the original credit card. Of course, I understand the additional distress that can be caused when funds are needed in an emergency and that any time delay in the transfer of funds adds to that distress. Although it will bring little comfort to the Nord family at this time, they may want to know that the FCO is examining the possibility that in some emergencies where British nationals are in urgent need of funds, we will be able to take card payments ourselves directly from friends or family in the UK, and thereby, in situations such as this one, quickly facilitate payment to a hospital overseas.
Ms Nord has also expressed reservations that the person on duty at the embassy, who was not a consular officer, may not have been best placed to provide assistance to her brother and herself; indeed, those concerns have also been expressed by my hon. Friend this afternoon. I must point out that duty officers deal with all inquiries to an embassy’s out-of-hours emergency number, many of which are not about consular issues. In this case, although the duty officer was not working in a consular position in the Jakarta embassy, he had previous consular experience. He also spoke to the vice-consul at the post to brief him on the situation and on the actions that he had taken. The vice-consul confirmed to the duty officer that he was following consular guidance in dealing with this situation.
Although I again appreciate that it will not alleviate the Nord family’s distress at their loss, the FCO is reviewing how we deal with out-of-hours calls to our missions overseas and examining how we can ensure that we have as consistent and professional a service as possible out of hours, as well as during the working day. As I have said, I appreciate that that does not help Ms Nord and her family, but I hope that the House will note that we are continually looking for ways to improve the consular service that we offer to British nationals overseas, particularly those in serious distress.
Having said all that, I genuinely understand the concerns of relatives when, as in this case, someone dies tragically thousands of miles away in a situation that the relatives feel they have no influence over. It is a tragic situation; this incident was a tragic accident. However, nothing will bring Mr. Nord back. Nevertheless, if it would help I am happy to meet my hon. Friend and his constituent to explain as fully as possible our actions and those of our consular staff, and our understanding of exactly what took place. Sometimes, such a meeting can be a better forum within which to discuss these matters than an Adjournment debate in the House.
As I said at the beginning of this debate, I genuinely and deeply regret that this tragic situation has been made worse for Mr. Nord’s family by their belief that he was treated neither promptly nor correctly by medical staff at Pertamina hospital, and by their dissatisfaction with the assistance that the duty officer at our embassy in Jakarta provided. However, I am satisfied that the duty officer provided the appropriate consular assistance. Much as we might like it to be otherwise, it was not in his power to guarantee payments for Mr. Nord’s treatment, nor was it in his power to interpret any medical diagnoses. I simply do not think that either of those actions would have been possible in the circumstances. Nevertheless, the offer that I have made to meet my hon. Friend to discuss this case is a genuine one, and I will happily meet him if that is what he wishes to do.
Digital Broadcasting (West Dorset)
I can genuinely say, Mr. Key, that it is a delight to serve under your chairmanship.
I asked for this debate because, a few years ago, I found myself, as Members of Parliament do from time to time, at a meeting in a Committee Room that had been booked by outsiders who were explaining some matters to us. I was not at all sure that I really needed to be there but I had gone along for the ride, so to speak. At the meeting, a rather large map of Great Britain was projected electronically on the wall. It was very heavily shaded in some parts, and it showed the digital coverage that would be achieved with the digital switchover. There were just a very few points of white on this impressively shaded map. The people who held the meeting were from what is now Digital UK, as well as other groups, and they explained that the coverage was magnificent and it was only the tiny white points where there would not be any coverage.
I am as blind as a bat, as you might know, Mr. Key, so I had to take out my glasses, but even that did not work. I had to walk over and get close to the screen to see that my constituency and that of my neighbour in South Dorset were pinpointed with unerring accuracy as the two in the whole of the south of England that will not be well covered by digital broadcasting. As you might imagine, Mr. Key, I suddenly became extremely interested in the meeting.
That meeting led to the formation of the Dorset broadcasting action group, which is known as DorBAG. We have had a series of constructive and useful meetings with representatives of Digital UK and the BBC at various levels. I have also had meetings with the director-general of the BBC and members of the central staff, as well as with Ofcom and a range of other relevant parties, and some progress has been made. Many of my constituents who will not be served by digital terrestrial broadcasting, due to the lie of the land, will nevertheless be able to get hold of Freesat, which was not available when I was stuck in that room looking at the map. That will enable them to receive digital broadcasts without having to deal with Mr. Murdoch. However, my constituents, and those in South Dorset, experience significant problems with news coverage that are bound up with more persistent problems that have nothing to do with digital switchover.
The main issue is the so-called “three mux, six mux” problem with which the Minister will be familiar. It so happens that my constituents are served by relay transmitters, although why that is the case is lost in the mists of history. For reasons that I dimly understand—too dimly to give the House any adequate explanation—when digital switchover occurs, people who are served by relays will not receive the full suite of channels that they would get if they were served by a main transmitter. For reasons that I understand even less, that effect is not uniform, so only some of my constituents will have access to the full range of channels.
Having sat down with the experts—of whom I am not one, of course—I have discovered that on some streets in my constituency, people on one side will receive the full set of channels whereas those on the other side will not. You will understand, Mr. Key, from your extensive experience as the conscientious Member for Salisbury, the kind of civil unrest and the postbag that will be generated for me and my neighbour in South Dorset—whoever that may be—if our constituents can compare notes. Suppose that Mrs. Jones discourses, in the shop, on the merits of the programme that she saw the night before, but Mrs. Smith could not get it. That will not make Mrs. Smith happy, not least because she is paying the same licence fee as Mrs. Jones. Nothing on earth will persuade Mrs. Smith that that situation should have occurred.
The Government’s account—I know this because I have tabled parliamentary questions and have written letters on the matter—is that the decision is a commercial one, and it is not theirs to take. They say that it is the commercial broadcasters that have decided not to foot the bill for making a full suite of channels available to all my constituents, but there is a hitch in that argument. It is true that the broadcasters have taken that decision, but I have no doubt that if there were no regulation at all, they would have chosen to serve only the urban concentrations. They might well have decided that it simply was not worth serving people in West Dorset or, while we are at it, perhaps even those in Salisbury. In general, what compels them to serve a wide population and to give access to programming is the regulatory framework that is partly designed to have exactly that effect, and rightly so. I do not think that the Government can skip out of the matter by arguing that it is a commercial decision, because underpinning that decision is a regulatory framework that does not compel broadcasters to provide equivalent levels of service where technically possible, which it is in this case, to all the residents of an area.
There has been a regulatory failure, but we do not necessarily need a regulatory solution. There is a practical, humdrum solution that would also solve a second problem that I want to raise with the Minister. I have already raised it with the director-general of the BBC and some of his colleagues, and DorBAG has raised it at various levels within the BBC. In West Dorset and South Dorset, we suffer from being on the margin. Poole and Bournemouth are, culturally speaking, part of the south of England, whereas Exeter and Plymouth are, culturally speaking, part of south-west England. Dorset, particularly West Dorset and South Dorset, lies betwixt the two.
For many years, the BBC and other broadcasters have been unable to decide quite where in the cultural map of Britain South Dorset and West Dorset fit. That problem is not shared by the people of South Dorset and West Dorset. My constituents, who differ in many other respects would, if asked—although I have never tried it—probably respond to a deed poll with a 90 per cent. return answering that they are culturally part of the south-west. We do not feel allied to Hampshire, and we do not look to it. Part of the reason why the geographical county of Dorset was split into the unitaries of Bournemouth and Poole and the rural county of Dorset was precisely because the rural county of Dorset looks west, not east.
There is extraordinarily little interest in my constituency in news about Bournemouth, although it is a fine place and we have nothing against it. Bournemouth is of great interest to the people who live in it, but to the people of my constituency, who rarely go anywhere near it, it is not a place of great interest; it is just a place. News about Bournemouth and Poole, of which one can see a lot on TV screens in South Dorset and West Dorset, if one can get coverage, which many people cannot, is of no interest. Moreover, the southern offices of the news-gathering organisations do not regard Dorset as part of their remit any more than West Dorset regards itself as being part of their culture, so they do not provide any serious amount of broadcast news about events in West Dorset or South Dorset. The south-western parts of the BBC would be keen to do so, because they do regard us as being part of them, but, alas, they are not mainly responsible, and most of the broadcasts do not come from them.
As a result of DorBAG’s efforts, the BBC has made considerable advances on news gathering, particularly for radio news, and it has made partial moves to set up a team of journalists who will work from Dorchester and Weymouth and will concern themselves with events in rural Dorset. Unfortunately, however, the configuration reflects the very problem that I describe, because responsibility for that group of journalists will be shared. There is so-called matrix management. Whenever I hear such words, I know that I am hearing a confusion. Those poor people, who will be earnestly working for truth in the news-gathering organisation that will be established in Dorchester, will have two masters—south-west and south—and will not know whether they are coming or going. Because they have two masters, they will have no patron, as that would not be core to the offering of either. They will be at the margin of each. Their chances of getting the editor of either to take seriously the product that they provide will be reduced. If an editor is fundamentally focusing on a particular area, most of the news that he wants to put on will be from that area. The rather inconvenient fact of a half share in West Dorset and South Dorset news gathering will not make them think that that area should be the centrepiece of their news programming.
Why do I go into this long excursus about news and its origin? Because the very same solution that would solve the three mux, six mux problem, and the problem of some people having very few channels compared with others after switchover, would also solve the problem of news broadcasts. If there were a new main transmitter that provided the full suite of channels for all those in my constituency and South Dorset who can receive terrestrial TV, and if that transmitter were linked to the south-west so that BBC South West were responsible for the news content that went out to the locality, we would get not only all the channels but news programming that was local and became part of the core offering of the south-western part of the Beeb. That would be a huge advance for my constituents.
I do not think that there would be huge expense involved. There would be some—the capital expense of establishing the mast—but that is a very small part of the cost of digital switchover. As I understand it, running costs would not be increased by the manoeuvre. Moreover, we have established that there would be positive enthusiasm in BBC South West about taking on the responsibility for West Dorset and South Dorset broadcasting. We would have a lasting arrangement that would satisfy my constituents and relieve both the Minister and me of an endless stream of irate constituents complaining about getting half as much broadcasting as they have paid for, and still not getting the news to which they think they are entitled. Of course, we shall make that proposal to the BBC Trust and the director-general. I hope that the Minister will give it a fair wind and ensure that my constituents are not left at the margins of news and in the unfortunate position of receiving, in many cases, only half the channels that other people receive.
I congratulate the right hon. Member for West Dorset (Mr. Letwin) on his success in securing this debate on digital broadcasting and the use of relays in West Dorset, and on his work on the matter as a constituency MP. He really is an example to us all, and the setting up of the Dorset broadcasting action group has obviously already produced some results.
I should like to go through broadly what the Government are doing and some of the reasons for the situation in West Dorset, and then turn to the right hon. Gentleman’s suggestions. As he will know, the process of switching over from terrestrial, or analogue, television to digital television began in earnest on 6 November, with the progressive switch-off of the analogue broadcasting signal in Selkirk and the border region. The process will take four years to complete, and there are sound economic reasons for doing it. The benefits will extend to consumers, because only by switching off the analogue signal will it be possible to increase the coverage of digital terrestrial television so that it reaches almost everyone, excluding only those white areas on the map to which the right hon. Gentleman referred.
Public service broadcasters will benefit from efficiencies and long-term cost savings, and the UK economy will benefit because the switchover will allow the development of new services through greater spectrum efficiency. In 2005, when the timetable for switchover was established, it was estimated that there would be a benefit to the economy of some £1.7 billion in net present value. I am glad to say that that estimate is now thought to be somewhat on the low side.
The co-ordination of the process falls to Digital UK. Ofcom’s digital progress report for the second quarter of 2008 revealed that multi-channel take-up on main sets in the UK is now 88 per cent, so about 88 per cent. of the right hon. Gentleman’s constituents already have one television that can receive digital signals. More than half—55 per cent.—of secondary TV sets have now been converted, which means that 69 per cent. of all TV sets in the land can now receive multi-channel TV. The switchover is well on its way, without people having to wait for the Government’s progress. Nationally, about 89 per cent. of the population are aware of switchover and 68 per cent. understand what is happening. Quite a few people even understand when it is going to happen in their area. Those figures suggest that we are heading for a successful process.
The right hon. Gentleman will know about the digital switchover help scheme and the various levels of qualification for it. From work that we have done in Whitehaven and Selkirk, we know that take-up of the scheme has been pretty good. The help that it has given to some of the 7 million households in the land that will be eligible for it has been much appreciated. Its key feature is that it should be platform-neutral, not unfairly discriminating between platforms. That is to ensure not only that we secure value for money but that the scheme does not fall foul of EU state aid rules. I am glad to say that reports back from the two regions where we have completed switchover have shown that on the whole, people appreciate the service that they are receiving.
I turn to the west country and the “three mux, six mux” problem. Switchover in Selkirk and the borders will be completed on Thursday 20 November. As one would expect, work is firmly in hand to ensure that switchover in the next region, the west country, can begin in April 2009 as planned. The latest Digital UK and Ofcom tracker survey reveals that nearly nine out of 10 households in the west country TV region— 87 per cent., which is just under the national average—have connected their main set to digital TV. More than half—58 per cent., which is above the national average—have connected and converted every set in their home, and nine out of 10 people in the west country, 88 per cent., know what to do about switchover. Some 28 per cent. know the quarter of the year in which they will switch, so knowledge is quite high. Among older people in the region, however, particularly those aged 75 and over, there are markedly lower levels of conversion to digital TV—73 per cent., as against 87 per cent. nationwide—and of understanding: 54 per cent., as against 68 per cent. nationwide.
Digital UK and its partners are examining ways of improving that situation, which cannot be helped by the marginality of people’s situation in West Dorset. I have enormous sympathy with the right hon. Gentleman for the situation in which he finds himself, because that marginality is repeated in my own constituency and my own region—I am Minister for the East of England. People in Hertfordshire and Bedfordshire are not that keen on knowing details of life in Great Yarmouth or Lowestoft, of which we sometimes get rather more than we would like because of how our aerials and the transmitters are angled. People there, vice versa, do not really want to know what is happening in Bedford or Stevenage. There is a problem with the way in which the regions have been carved up. They do not correspond to the Government’s regions but to a TV region programme.
There is also a problem with where the transmitters are situated. I happen to live in a white spot. Twenty-nine miles from London, I cannot get six mux; I can only get three mux. The right hon. Gentleman is right: roads and communities are divided, and people can get very angry about the situation. The right hon. Gentleman said that he was not too sure how the lack of coverage had come about. The beginnings of the problem are somewhat lost in the mists of time, but they are to do with the fact that when the ITV franchise came in in 1955, the cost of transmitters was very high. Too few were delivered, especially for rural areas. We have an historical situation in respect of the location of the transmitters, which are expensive to install.
DorBAG’s efforts to alert the BBC and the Government to the situation in the Dorset region is greatly appreciated, and I think that other hon. Members would do well to follow the right hon. Gentleman’s example. There are some inequities that will be difficult and, frankly, exorbitantly expensive to correct. I know that matrix management sounds terrifyingly like something from a James Bond film, but it could work, particularly in today’s far more consensual business environment. I hope for the sake of the right hon. Gentleman’s constituents that it can be made to work.
I shall give a little more detail on the technical background to the situation in the west country, if the right hon. Gentleman will forgive me, as he has raised the issue of a new transmitter and relays. It may help if I give a quick overview of the transmitters that operate in the region and the dates on which they are expected to switch over.
The west country TV region consists of five main transmitter groups. The Beacon hill transmitter group has 23 relay transmitters serving some 147,000 homes in Torbay and south Devon. It will switch in two stages on 8 and 22 April next year. The Stockland hill transmitter group has 24 relays serving some 218,000 homes in Exeter, parts of Devon, Somerset and Dorset. It will switch in two stages on 6 and 20 May. The Huntshaw Cross transmitter group has 14 relay transmitters serving some 70,000 homes in north Devon. It will switch in two stages on 1 and 29 July. The Redruth transmitter group has 16 relays serving some 129,000 homes in west Cornwall and the Isles of Scilly. It will switch in two stages on 8 July and 5 August. The Caradon hill transmitter group has 29 relay transmitters serving some 279,000 homes in Plymouth, Devon and east Cornwall. It will switch in two stages on 12 August and 9 September. That gives some idea of the complexity and the number of relay transmitters involved.
Some 63 per cent. of households in the west country TV region as a whole can currently receive digital TV through a Freeview aerial. I am glad to say that that will increase to 96 per cent. after digital switchover. It is predicted that 74 per cent. of those households will receive a six-mux package, or all 48 Freeview TV channels. The remainder of the households will be able to receive only three mux, or about 20 channels. That is the problem that the right hon. Gentleman has brought before the House today.
Households served by local relay transmitters receive only analogue channels at present. At switchover, however, Freeview services will be added to all local relay masts to enable access to 20 of the most popular channels for the first time, including all the public service broadcasting channels and a good deal more. Those viewers who, like me, are in a white spot and require more channels will be able to choose from a range of free or subscription satellite services offering 90 to 400 TV channels. That is the solution that I and others in my constituency have had to pursue.
As the right hon. Gentleman is aware, the Government and Ofcom are wholly committed to ensuring that digital coverage for the five main public service broadcasting channels substantially matches current analogue services—that is, 98.5 per cent. of UK households—at digital switchover. Coverage by commercial multiplex operators is a matter for them, although regulations will not allow coverage levels post-switchover to fall below current levels. The commercial operators must make a commercial decision about extending coverage, balancing the costs of doing so against the extra coverage that could be achieved. That is obviously the key to the right hon. Gentleman’s problem.
I should like to take this opportunity to thank the right hon. Gentleman for raising these important issues. The switch from terrestrial television to digital television is a vital component in the United Kingdom’s journey towards a digital society. By the end of the switchover process, just four years from now, every household with a television set will have entered the multi-channel, interactive age.
I hope that all hon. Members will take as close an interest in the switchover process in their constituencies as the right hon. Gentleman has. By working together, we can ensure that switchover benefits everyone and that no one is left without access to a range of TV channels. That said, I do understand the situation of his constituents who fall in white spots, and I wish him every success in his endeavours to persuade the commercial channels to extend coverage.
Disability Living Allowance
There are two important campaigns at this time that seek changes to the mobility component of disability living allowance. One, which has been under way for some years and is led by Help the Aged, calls for the benefit to be extended to disabled people who make their claim after the age of 65. I support that objective. The fact that elderly people cannot get help with mobility costs, access Motability or the specialised vehicle fund or get exemption from vehicle excise duty prevents them from living the independent, healthy and active lives that they otherwise might.
The second campaign, which is led by the Royal National Institute of Blind People, aims to make blind people eligible for the higher rate mobility component of DLA. Like many Members of this House, I met a constituent with severe sight impairment at the lobby in Westminster on 15 October. He explained to me what a difference the extra money to help him get around would make to the quality of his life. I know that Ministers have expressed sympathy with the objectives of the campaign, and I look forward to the necessary changes being made in the near future.
However, what I want to talk about this afternoon is how the lower age limit for eligibility for the mobility component of DLA affects some severely disabled young children. In one important sense, it relates to the case for extending the mobility component to sight-impaired people. In both cases, for beneficial reform to take place, we have to stop basing eligibility only on the physical inability to walk.
The rules of eligibility for the mobility component of DLA mean that children under the age of three cannot have it claimed for them. On the face of it, that might seem a perfectly sensible provision. After all, until now, entitlement to the benefit has been based on the inability, or virtual inability, to perform the physical act of walking. It is perfectly logical, therefore, to say that as children in their first years of life do not walk, or certainly do not get around independently, they should not receive the mobility component. Most kids, until they are three, will mostly be pushed around in pushchairs, so there is no reason to take compensatory action because of their inability to walk. That approach is logical but ignores two things: first, the advances in therapeutic technology—often, bulky, heavy technology—to help disabled children develop more successfully as they grow in the early years or just to have a more comfortable life and, secondly, the difference that access to this benefit could make to families with a disabled child in the first years of coming to terms with an entirely new situation.
I became aware of this serious omission in disability provision just over four years ago when I met Mr. and Mrs. Owen—Alison and Andrew—and their daughter Seren, who live in my constituency. Seren was born on 14 April 2002, by caesarean section, in Singleton hospital, Swansea. She was in a very poor way and Alison and Andrew were warned after 18 hours that she was likely to die and the only treatment that might be able to save her was available at Glenfield hospital, Leicester. A Sea King helicopter was sent to Leicester, for necessary equipment and a nurse, and then to Swansea for Seren. Alison and Andrew were told that they should name the child in case she did not survive. As it was night time when she was being picked up and taken up into the sky, they called her Seren, which means “star” in the Welsh language.
Seren was, and is, a fighter. She lived and returned to Swansea. When she was 12 days old her parents were told that Seren had cerebral palsy. In fact, she had quadriplegic cerebral palsy with hypertonia in all four limbs and hypotonia in her torso and cerebral visual impairment and some sensory hearing impairment. When I met her, Seren was about two and a half years old. Even at that age, she had already had a lot of medical attention and hospital treatments. The good news, from her parents’ point of view, was that comparatively recent developments in equipment for children with her sort of condition meant that operations and other intrusive treatment that would, in the past, have been necessary as she grew up could be avoided.
Seren’s parents, like all parents, wanted to give her the best, highest quality of life possible so they got hold of a range of positioning and seating equipment designed to aid postural management. I visited the Owen family in their home to see this equipment. I lifted, or tried to lift, some of it. I can tell hon. Members that it was extremely bulky and some of it was very heavy.
I would just like to tell the Minister what the Owens needed to take with them when they took Seren out for a day, or for part of the day, and what they needed if they wanted to take her away for any longer period of time, to visit her grandparents or go on holiday. On a day out in Andrew’s Golf, the first essential was the specialist car seat, which gave total postural support and kept Seren’s spine straight, hopefully helping to remove the need for operations to correct curvature at a later stage. This was extremely heavy and, of the members of the family, only Andrew could lift it, and that was not good for his health. But living and working arrangements meant that it had to be transferred between vehicles at times.
When they reached their destination they also needed Seren’s special wheelchair, which was issued by the artificial limb and appliance centre at Rookwood. This was a CAPS II seating system fitted within a Blade Plus wheelchair, which is what is called an aggressive form of seating and support that, as with the car seat, gave the postural management that she needed. This was a very solid piece of equipment that did not fold down like a normal pushchair or some other wheelchairs. In the Golf, it completely filled the boot. When they added the tubes and feeding sets that Seren needed, as well as all the normal baby stuff for a child of her age, there was only room for mum, dad and Seren. If any members of the extended family, especially grandparents, wanted to accompany them, a second car had to be taken.
At that time, Alison and Andrew only had Seren, but they were conscious that it would be even more difficult for a family with more children, as well as a severely disabled child of under three years. Would they be denied the opportunity of going out as a family at all? Of course, even apart from Alison and Andrew’s determination that they should go out as a family to do all the things that we all do as families, Seren needed to be transported to different places for her development—to physiotherapy and hydrotherapy, the NCH “Stepping Stones” project, occupational therapy, speech therapy and work with her vision impairment teacher.
What happened, then, if they wanted to take Seren somewhere and stay overnight or over several nights? What was needed then? Of course, all the things I have mentioned for a day trip were needed, but with the addition of Seren’s Jenx standing frame, which she needed because otherwise, as she could not walk or stand, the ball and socket joint in her hips would not develop normally. The standing frame helped compensate for this, again hopefully reducing the likelihood of the need for restorative surgery or other treatment later in life. She needed her R82 Panda hi/lo chair, which was basically her feeding and social interaction chair; it was a sort of waistcoat design that provided total support of the torso but freed the arms to reduce tension. That piece of equipment, on its own, also completely filled the boot of the Golf. Seren could not at that time take all her food by mouth. She received food overnight through a pump feeding system that involved a stand and pump. That needed to be taken along, as did the foods and medicines that she required.
On a longer stay away, Alison and Andrew would want to take Seren’s special toys—bead curtains, for instance—which are designed to aid the development of children with severe learning difficulties. They would have liked to be able to take Seren’s other more comfortable Tumbleform chair, made from foam sponge and in which she could spend up to half an hour without harm being done. They would want Seren’s wedge and Dreama sleep system, which kept her legs separated when she was sleeping, which was also important for her future development.
It was impossible for the Owen family to travel in one car on a visit overnight, or for longer, at least without leaving beneficial pieces of equipment behind. Fortunately, Alison managed to run another small car, so although they could not travel as a family they had the means to get themselves and all Seren’s stuff from A to B. But, again, they asked the question, “How do families manage who do not have access to a second vehicle?” I suspect that they are trapped in their own homes, to a very large extent.
To add to the difficulties for Seren’s family, she had just had Botox injections to loosen her hips and she was supposed to spend time in a plaster cast, so transporting her in a normal family car was again made that bit more difficult. The Owens had identified the vehicle that would have made their lives so much more easily managed: a specially adapted large people mover with any lip on the boot removed and a ramp or lift on the back so that Seren could be wheeled straight in. Of course, from their own incomes they just could not afford this. If the mobility component of disability living allowance and, therefore, access to a Motability deal were available to under threes, they could have had that from the time they first needed it. Alison and Andrew, through a combination of determination, superb logistical planning and buckets full of love, made sure that they provided Seren with everything that could help her, including getting her out and around. Seren reached the age of three in April 2005 and they were able to use Motability to get the transport that she needed.
During a street surgery in their village this summer, I met the Owen family, now extended again. They were just returning from a holiday in the vehicle that makes life so much easier for them. Seeing Seren again and noting how successful those heavy therapeutic devices had been made me think again that these people should have had that vehicle from the day they first needed it, and it made me determined to try again to persuade the Government to, at least, reconsider their approach to the needs of disabled children under three.
I have collected other testimony from affected parents, not just in my constituency but across the country.
I am listening to what the hon. Gentleman is saying. This is a tragic situation for parents throughout the country. I hope that the hon. Gentleman is successful in what he is pushing for. I emphasise that the case that he is describing is repeated throughout the country. The Liberal Democrats would be glad to give any support that they can to push the Government to be flexible about the age three limit.
I appreciate that. I am sure that that is true.
I give some testimony from other parents who are affected, some in quite different situations to those of Seren’s parents. Apart from failing to keep up with the sort of therapeutic technology that Seren needed, the three-years rule also fails to recognise that some disabled children under three have powered wheelchairs. Many ordinary family cars cannot take such wheelchairs or, even if they can, it is difficult to get them into the vehicle. Mrs. S’s daughter, who falls into this category, says:
“The allowance should take into consideration what the child needs—not how old they are.”
Mrs. DP has a disabled child and believes that the independence provided by her powered wheelchair
“has been so good for her self esteem and quality of life”.
Unfortunately, this cannot be transported in the family car. Another parent said,
“If your child is disabled, it’s not about their age it’s about them and what they need.”
I have been told about a one-year-old girl with spina bifida, hydrocephalus and cleft pallet, who is being tube-fed into her jejunum and is oxygen-dependent. The family relies on taxis to transport all her equipment on the frequent hospital visits that they have to make.
I have been provided with numerous other examples, but the picture is the same. What was true for Seren before she reached the age of three is true for a number of other very young disabled children. There is a need here that we are failing to meet and it is time we started thinking about how we can meet it.
I congratulate my hon. Friend the Member for Gower (Mr. Caton) on securing this important debate and setting out his case so eloquently. I send my regards to Alison and Andrew, Seren and the other additions to the Owen family, whom he did not name. I also congratulate him on his Adjournment debate on the subject in 2004, which I believe was instrumental, or at least a catalyst, in lowering the age from five to three.
My hon. Friend, as an expert in these matters, will know that disability living allowance is the principal benefit available to severely disabled people who acquire their disability early or relatively early in life and who have had restricted opportunities to work, earn and save, unlike those who become disabled in later life. It is not a compensatory benefit, but it is intended to provide a measure of financial assistance to help disabled people meet the diverse range of additional costs that arise from disability. The benefit is not based on someone having a particular disability or medical condition. Although it is important to know what someone’s disability is, the key to entitlement is what effect the disability has on a disabled person’s requirement for personal care or supervision and/or whether they have mobility difficulties.
Disability living allowance is made up of two components: a care component paid at one of three rates and a mobility component paid at one of two rates. Broadly speaking, the care component is awarded on the basis that an individual requires personal care or supervision because they have a physical and/or mental disability, and the rate at which it is paid increases with need. The mobility component is not awarded on a sliding scale of need. Its two separate rates recognise the two key features that can restrict people’s mobility out of doors. For the higher rate, that means physical inability or near inability to make progress on foot, and for the lower rate, it means a requirement to have someone to provide guidance or supervision when out of doors on unfamiliar routes because of a physical or mental disability.
That, briefly, is the basis for entitlement, but entitlement to either component does not mean that the recipient is compelled to spend their benefit on care or mobility-related extra costs. For example, someone in receipt of the care component could, if they wished, spend their benefit on other disability-related expenses, such as additional heating or washing. DLA puts the disabled person in control and lets them decide how to spend their benefit according to their own unique priorities. My hon. Friend will know that nearly 3 million people receive the allowance, including more than 300,000 children, and the numbers continue to grow year on year.
On the specific issue of the higher rate mobility component, I am not—he will be tired of hearing this—unsympathetic to the arguments that my hon. Friend put forward, but the higher rate mobility component is determined, rightly, by the inability or virtual inability to walk when out of doors. When deciding entitlement to that component, decision makers must consider how far the person can walk, the speed of their walking, the manner of their walking, whether walking brings on severe discomfort and whether the act of walking could be detrimental to their health.
Those are the statutory requirements, which are intended to achieve a reasonable view of someone’s walking ability. I know that my hon. Friend is not challenging those criteria and that his argument is simply that a different set of criteria should be invoked for the under-threes, given the impact of the child’s needs, including for heavy therapeutic machinery to assist them. I am not saying that outlining the current criteria smashes entirely his argument that there should be an extra component for under-threes, and I will return to that point.
I mentioned the campaign by the Royal National Institute of Blind People in which blind people are seeking a higher mobility rate. We have heard Ministers give that campaign sympathetic responses. If that can happen for blind people, the walking criterion has gone anyway. Surely that gives us the opportunity to consider the rights of very young severely disabled children.
I will come on to the RNIB campaign. At the moment, at least, it is not something that we plan to deal with in a positive fashion. However, I take my hon. Friend’s point about the criteria and the wider point made by him and others that the needs of the individual should predominate over administrative and bureaucratic criteria. I accept that; it is a perfectly reasonable point of view.
With reference to young children, I think that we can all agree that the great majority of non-disabled children can walk by their third birthday, and many much earlier than that, but that very few can walk considerable distances. Most still require significant help from their parents and rely absolutely on prams, buggies and so on. However, hugely significant scientific and medical advances over recent years have enabled more children who might, sadly, have died to have a good quality of life up to three and beyond. They are not confined to long-term residential care or worse but can, through a variety of technical innovations, live extended and fulfilling lives at home. That is something that we all celebrate. I take my hon. Friend’s point that sometimes the equipment used to support such children can prove bulky, heavy or awkward and place a great strain not only on parents’ and siblings’ time, resources and finances but on their quality of life, as he eloquently explained, and on normality of life, which I am sure is what they strive to achieve.
A range of measures already exists over and above the care component of disability living allowance to help families with young disabled children. The disability-related premiums in the income-related benefits and the additional elements for disabled children in tax credits are two such statutory provisions. Extra statutory schemes such as the family fund can also provide help for poorer families who find themselves in situations such as those described earlier. The fund can help with travelling costs and can extend to the purchase of vehicles in exceptional cases, although all decisions are taken, rightly, on a case-by-case basis. As I have said, just over 306,000 children are in receipt of DLA, 42,000 of whom are under the age of five. They represent the Caton gap, if I may call it that, in terms of the reduction from five to three.
I will carry on attributing it to my hon. Friend. He was there in spirit, if not in actuality.
We keep matters under constant review. I would be grateful, as would the Under-Secretary of State for Work and Pensions, my hon. Friend the Member for Chatham and Aylesford (Jonathan Shaw)—he would normally respond to such a debate, but he has the great delight of appearing today before the Joint Committee on Human Rights—if my hon. Friend, the hon. Member for Edinburgh, West (John Barrett) and others submitted to us the examples that they gave and more. I shall endeavour, as my parliamentary colleague did in 2004, to get officials to reconsider not just the higher mobility component of DLA but the broader context of the benefits and statutory programmes that might have assisted my hon. Friend’s constituents Alison and Andrew when Seren was under three.
When Ministers say that they will keep something under review, that sometimes implies, “I’ve given you half a bone; now go away, please.” I actually mean it in this case. The cases that my hon. Friend has cited are significant, sensitive and serious. The matter is worth revisiting, and a responsible Government should do so regularly, but he will forgive me if I consider it in detail as well as in the round along with other options. I think that the answer will involve more than just flicking the switch for under-threes in terms of the higher component of DLA, but there might be some way to look across the piece at the statutory provision and see whether we can get much-needed equipment for people like Seren and her family, whom I use as a proxy, as Seren is now over three. I will ensure that I give my hon. Friend a full response at the earliest opportunity after we have gone into that much more detail.
Just about, but you will forgive me, Mr. Key, for saying, because I am a bit of a stickler for these things, that in Adjournment debates here or in the Chamber, it is customary, to my mind—it might be old-fashioned—for anyone other than the person who introduces the debate to at least let the Minister know that they want to intervene. I am happy for the hon. Gentleman to do so, but I said that because I am a bit of a stickler and an old fuddy-duddy.
I apologise to you, Mr. Key, and to the Minister for not asking about intervening. I want to be supportive in the debate. I should like to forward examples from my constituency to the Minister so that he can look at the position around the country. As was eloquently stated, the problem is suffered by many families and young children up and down the country.
I accept that, which is why I tried to frame the debate in the spirit that I did. We should always keep such things under review. I would value that evidence, because it can inform the Under-Secretary of State for Work and Pensions, my hon. Friend the Member for Chatham and Aylesford, and me, once officials have looked at the matter again. I thank my hon. Friend the Member for Gower for raising the issue. In the broadest sense—it is not only about DLA and the higher mobility component—it should be incumbent on the Government and the Department for Work and Pensions to consider and take his comments very seriously.
Question put and agreed to.
Adjourned accordingly at nine minutes to Two o’clock.