Wednesday 16 December 2009
[Frank Cook in the Chair]
Child Support Agency
Motion made, and Question proposed, That the sitting be now adjourned.—(Mr. Watts .)
I am grateful for the opportunity to take part in this important debate on the Child Support Agency. Let me start with a bit of history. As everyone knows, the CSA was established in 1993 under the Child Support Act 1991. I was not a Member of Parliament when the Act was passed—that was just before I became an MP—but I have talked to those who were here and took part in the examination of the Bill in Committee. The problem at that time, which remains a problem to this day, was that there was not the investigation and scrutiny that there should have been of the mechanics of the Act that was put on the statute book. There has not been sufficient scrutiny in this place of what was proposed or of all the alterations that have taken place over the years.
There is constant talk of simplifying the child support system. The Government have made more and more new proposals over the years, but that does not seem to have been reflected at the sharp end, where I work as a constituency MP. Every week, I have at least two new cases where there are major problems. As I make my speech, I will demonstrate through at least six examples that some of my constituents face a major problem.
Surprisingly, when it was explained to those constituents that I was taking part in this debate and that, if they wanted, I would use their names, they were more than happy for that to happen. I am surprised that that is the case, given that most people would want to hide away from the publicity that such a debate engenders. Yet the constituents concerned were adamant and insisted that I use their cases to demonstrate what is wrong with the system. Many of those cases are known to the Department, because I have written directly to the Secretary of State and had replies from the Minister who is here today.
I congratulate the hon. Gentleman on initiating the debate. Christmas is a time when all families should be together and fathers and mothers should have access to children. However, the CSA is getting in the way of that. Although he talks about the action that the Government rightly have taken to try to simplify the Act, does he agree that that has led to inconsistencies, because different fathers, different people and absent parents are treated differently, particularly in relation to the financial calculations? That issue is leading to major difficulties and should be resolved.
I think I will show that in the six cases that I am about to put to the Minister in order to get some answers. There is absolutely no doubt that we live within a complicated state of affairs in the modern world. I had one case that hon. Members would not believe, where I could not understand why the calculations were coming out the way they were. A woman was getting an incredible amount of money and I found out that the reason for that was that she had five children to five different fathers. As a consequence, the calculations were done in that way, which bamboozled me. I agree with everything the hon. Gentleman has said in that sense.
I shall now turn to my constituents’ cases, and the first is that of Marian Morris from Prestwick. Marian has been coming to see me since January this year. She has been pursuing the CSA against her ex-husband and, to this date, is owed more than £44,000 by him. The man concerned is a charlatan. He has managed to disappear—to go offshore—and has run rings round all the agency’s staff. Later, I will come to some of the elements that concern me about how the agency does things.
Marian’s ex-husband deserted her and her two daughters back in November 1999, which is more than 10 years ago. The lady immediately put in a claim to the CSA, but to this day she has not received a single penny, either in child support payments or through any other support. Her ex-husband left suddenly, wiped out all the joint accounts and assets, and left her without a penny, yet he has not repaid a single thing to her.
During the past 10 years, Marian has worked and still does so. She has had three jobs in order to support and raise her daughters without assistance, and she feels extremely bitter that her daughters, now aged 16 and 14, have had to grow up so quickly and fend for themselves while she worked long hours—often 15 hours a day—because she had little money to pay for quality child care and has no family nearby to help.
As I say, Marian is owed more than £44,000 to date and the man concerned has run rings round the relevant agencies. I had a meeting with agency staff on Friday. The agency sent three officers down to see Marian and all they could do was constantly apologise for the current system. She has had a one-off consolatory payment of £150 from the agency itself in respect of ongoing delays, but I find such gestures derisory—in fact, it could be argued that they are a slap in the face to the individual.
Marian’s case keeps dragging on and no one seems to be able to do anything about it, so she keeps writing to me, and staff in my office have to be constantly on the phone to the CSA—I will come back to the problems associated with that.
More than anything else, the problem has been summed up in an e-mail sent to me by Marian, in which she writes:
“Once again, I feel that my case is being bounced from one incompetent team to another. I have yet to be assigned a case officer who sees any action through from start to finish.”
That is the nub of the problems I am seeing and those are the difficulties we face as far as Marian is concerned.
I also commend the hon. Gentleman on introducing the debate. I am listening with great interest to the case studies he is describing. Part of the nub of the problem in Northern Ireland—I do not know whether it is the same in Scotland—is that staff retention is low and turnover of staff in the CSA is inordinately high. That means that time is not given for good-quality training of staff to ensure that the problems he is outlining are dealt with at the coal face.
I am grateful to the hon. Gentleman for that intervention. I will cover that point, because something that was working some time ago was the geographical distinction. For example, staff in the agency in Falkirk had various parts of Scotland to deal with. As a result, not only the Member of Parliament, but the individual, had five or six members of staff dealing with, for example, Ayrshire. That meant there was a good chance that they knew what was going on in Ayrshire, whereas now staff deal with all areas. The geographical distinction was one part of the old set-up that worked to the advantage of my constituents.
Does the hon. Gentleman agree that one of the problems is that the CSA is not listening to Members of Parliament who make representations? I made representations for a constituent who was being taken to court after allegedly not paying for two years. That father was eventually taken to court, even though I asked for a stay of those proceedings because I had the evidence that he had been paying.
After the court proceedings and judgment, the CSA accepted that a mistake meant that his payments were put down as being made by someone with the same name. The agency had also used the new man’s national insurance number by mistake, and it now accepts that it was totally in error. The CSA failed to listen to common sense from the MP, proceeded with the court case and is still proceeding against the man concerned. Hon. Members can imagine what that has done to his relationship with his ex-wife and children—destroyed it. That is just not on.
I agree, and that is another example of the aspects of the CSA that, even after all the organisational and structural change, require a much closer look. The hon. Gentleman’s intervention gives me the opportunity to say more on that: clearly, were the same officers to deal with the same cases right through the procedures, at least there would be an opportunity to introduce an ounce of common sense to the scheme. That is what is wrong with it, and I do not think it will ever recover to the position that once existed, even though in the olden days there were court cases as a result, which was not a great idea either. I accept what he says and trust that the Minister will take it on board.
The second case I would like to mention is that of Euan Loutit, a police officer who was married to another police officer. He thought that he was to be taken from the old scheme to the new, with all that entails, but it transpired that the confusion involved did not allow that change to take place. He came to see me many years ago about the problem he faced and indicated that he had major concerns about the parent with care. The CSA has investigated his case over the intervening period and concluded that everything is in order, but Euan has indicated to me that he does not believe that the CSA, as it could and should have done, investigated his wife’s income. She had an accident while a police officer and was awarded £250,000 in compensation, and she earns money from tenants in her house that is not taken into account. As far as Euan is concerned, nothing with the case seems right.
In August 2009, the CSA wrote to me, stating that it would like to offer an assurance that the officer concerned in Mr. Loutit’s case had
“investigated the parent-with-care’s, Louise White, current circumstances and she was correctly treated as having no assessable income for the £107.34 assessment, completed on 11 June 2009.”
Perhaps I have not been listening hard enough, but is Mr. Loutit the parent with care or the non-resident parent?
Mr. Loutit is the non-resident parent. I raise that case because it demonstrates a universal problem. The CSA’s letter went on to state that
“we cannot negotiate the regular maintenance payments as this figure has been calculated in accordance with legislation.”
That ties the hands of the CSA and does not let it see a bit of common sense. It gives no flexibility at all. That is the difficulty as far as Mr. Loutit sees it. When there is such confusion in the system, the arrears build up, so Mr. Loutit has enormous arrears and, as a consequence, the CSA claims that it all must be paid back within two years. At the same time, there is a restriction on the amount of money that can be taken from an individual—I think it is 40 per cent. of take-home pay.
My final point about that case, which beggars belief, is that the CSA now claims:
“It is not possible for Mr Loutit’s case to be transferred to the new rules legislative system, which is calculated using a straight percentage of a parent’s take home pay. This is because we have no legislation in place at present to allow such a transfer.”
We need legislation in place, and that is what I ask the Minister to consider.
In November 2008 our transition to the new Child Maintenance and Enforcement Commission commenced. It is anticipated that a single statutory maintenance calculation will be introduced from 2011, with the transition of all existing cases to that new system taking approximately three years. All parents involved will be kept abreast of how those changes will affect their situation. That, in itself, is something I would like the Minister to address as soon as is practical.
The third case is that of Andrew and Jacqui Jess. Andrew’s problem is that they have been to the CSA over the years, arguing on the basis of a system that they settled amicably between them, but Jacqui and the children now live in Australia. The CSA will not take that into account when making the calculation because, it claims, if they had gone through the court, or if the case had been through a court or a similar system in Australia, he would be fine and that would be taken into account, but because the children are in Australia and he settled things of his own volition, the CSA says, “Sorry, we are not taking that into account at all.”
Another problem that that case highlighted, and which was also mentioned at a meeting just last Friday with the CSA officers who came to my office, is that the CSA will not take the clear evidence individuals provide of their communication with the CSA. A parent might have telephone records showing clearly that there were conversations, and the CSA tells everyone who phones that their calls are likely to be monitored, so why is there no track and why are no records kept? There must be records that are kept, and they are just not telling the truth to my constituents; that must be looked at much more closely.
The other element of that case concerns the office of the independent case examiner, who is looking at the situation of Andrew and Jacqui Jess. The examiner apparently arbitrates, but the CSA can still revisit the situation later and overrule the examiner’s decision. There needs to be more consistency in the whole system.
No, the independent case examiner obviously will not be overruled on the conditions that are put to them, but it is possible that after the event situations will change so that we are back to square one. I have had such cases, and that is a problem. One would think that, once the independent case examiner had made what they thought was a ruling, that would stay for ever more; but the case can be revisited and altered, which does not seem particularly fair.
The fourth case is that of Tom Tait, who has worked diligently all his life. His company went into administration, and during the course of his employment his wages were arrested. He was paying and has proof of the fact—the wage slips are there for all to see. Money was taken from him, the company went into administration and the CSA told him that the employer had never written a cheque to it. He is being held responsible and has to pay the arrears, so we are told.
There is something absolutely, ridiculously wrong with the system if that is the case. The man is paying for one of his sons, who is 19 years old. He has shown his pay slips to the CSA. The son is an apprentice in a local factory, yet because he serves some of his apprenticeship in full-time education, the father has been told that he still has to pay for him. That individual’s case must be looked at much more closely. He feels aggrieved about his position, as he has every entitlement to do.
We move to the fifth case, that of Paul McKendrick. He is not in the highest-paid job. He has been paying £30 a week, but arrears have accumulated, which means that the calculation has been worked out at £33. However, he cannot afford to pay any more, so his arrears are running up and nobody seems to want to do anything. He has all kinds of pay slips to show what his salary is, but nobody is taking into account his real circumstances. He states:
“They constantly come back to us saying there is nothing more they can do because they ARE applying the rules set by the Government!”
The CSA is blaming the Government as an escape route. That means that when I am sitting with Mr. McKendrick, he is blaming me. If the Government cannot look at these cases as they should, set better parameters and apply a bit of common sense, the position will continue to be difficult.
The final case I have this morning is that of Steven Mallinson, who is also a policeman. The latest letter that I received from him is dated 11 November and is worth reading to give a flavour of his problem:
“To get straight to the point, yes I still remain unhappy and I would like you to continue with your efforts to contact somebody within the CSA who is in a position to do something about my problem. I believe this may be Janis Crook, Client Services Director? Failing that I believe there is still an option to involve an independent party to look at my case.
Unfortunately the people I have dealt with so far seem content to hide behind unfathomable formulae and appear to be using ‘new’ legislation to justify incompetency in instances when ‘old’ legislation applies. My main example of this would be that my travel to work costs were not considered when a re-assessment was carried out in February using the old legislation however when I queried this I was palmed off and told that under the new legislation (which my case is now on) travelling to work costs are not considered. This is unacceptable.
Once again I find I am repeating myself and nobody appears to be listening. The main issue is the re-assessment carried out in February using the old legislation. There does not seem to be alarm bells ringing anywhere that up until this date I was paying £52 per month on the old legislation and from June 2009 it was calculated I should pay £150 per month on the new legislation, yet in a short space in between, in February 2009 it has been calculated that I should have been paying £650 per month (effective from April 2009, so in reality only for two months) and the knock on effect this calculation has had is that I am now paying £500 per month in a “phasing period” for the next year at least. There needs to be some common sense applied here and I need somebody who is in a position to apply common sense, and not hide behind an obviously flawed calculation system, to look at my case.
Again I raise the point that this phasing period exists so as there is not a financial impact on the resident parent when changing from the old legislation to the new legislation. Again I highlight that I was paying £52 per month from May 2005 until March 2009. I paid £105 per month from April 2009 until June 2009. I paid £152 at the start of July 2009. Again I raise the question, how could”—
let us call her Miss X—
“possibly experience any financial impact given the trend of the aforementioned amounts that would result in her requiring £500 per month? There was no negative financial impact on her. There has, however, been a huge financial impact on myself going from the stated monthly sums to the now ridiculous £500 per month. When I raise this point nobody at the CSA seems to be able to apply common sense and realise how valid a point I have here and instead reply as they always do by spouting confusing figures and formulae in the hope I will just disappear and accept this nonsense. I am not an idiot and I will not accept this. If you contact the CSA they will confirm the above stated reason for the ‘phasing period’ and they will also confirm the payments I have made up until July 2009. I would ask that you do that and I would ask that you question how they can justify taking £500 per month from me.
The agency is named the CHILD support agency.”
Again, let us call her Miss X,
“is now splashing out on pedigree pets, luxury holidays and full Sky television packages. I can no longer afford to take my children to the cinema or the zoo or ten pin bowling without having to rely on hand outs from my parents. How is that in the best interest of either of my children?”
Mr. Mallinson then asks how he is supposed to support his children in such circumstances. That is a typical letter from a parent who is at their wits’ end.
The hon. Gentleman has raised many important issues, but he has used the phrase “common sense” several times. Is this not a bit difficult for the CSA, which is given legislation that we pass and has to implement it? Surely, if it were to say, “We just don’t think that feels right. We’ll come up with a different number”, would it not be vulnerable to challenge from the other party, who would say, “No, that is the law. You should have applied it”? Is it not rather hard on the CSA to say that it is not using common sense when it is actually applying the laws that we have given it to apply?
The hon. Gentleman has hit the nail on the head, because that is the problem. When courts were dealing with these matters, the judge sat there and did the act of Solomon, and both parties had to accept what he or she said. The position now is that there have been many changes to the legislation, people are very confused and cases are very complicated. That is why we are getting what we are getting, and why I say that perhaps common sense should apply. I am grateful to the hon. Gentleman for intervening.
In summary, in the first case I mentioned, everything had been involved: all the agencies, bailiffs, everybody from outside. Can the Minister tell me what the cost of all that was? Perhaps she cannot today, but I would like to know what the cost is of bailiffs coming into cases when it is clear they are not getting any satisfaction. They run around all the time, probably getting a fair amount in fees, but they are not delivering any of the outstanding money.
I would also like to know in a general sense why the compensation is so derisory. I heard this morning that farmers are looking for compensation, and they are talking about literally tens of thousands of pounds, but in this case, a Government agency is making fundamental mistakes and delaying matters, and people are whacking up enormous arrears. At the same time, compensation of sometimes £75, sometimes £150, is given. If there is to be what I would consider satisfactory compensation, the Government will have to revisit the matter.
Apparently, no legislation is in place at present to allow transfer from one scheme to the other, and the Government should address that. I am told that the reason for the three-year changeover date is a problem in the Department, which operates three different computer systems that cannot be married together. Is that so? Is that why we are talking about a three-year delay? In that circumstance, somebody surely needs to revisit the issue far more quickly.
There is a broader, cross-government issue that has always been of concern to me: the apparent lack of joined-up thinking between all the agencies and Departments involved. It only takes a micro-second to find out whether somebody has a driving licence or a national insurance number, or what the Treasury is taking from them in tax, but none of that happens. That is an outstanding issue as far as self-employed people are concerned, because although those on pay-as-you-earn are caught easily, those who are self-employed and have a smart accountant can, and often do, run rings round the agency. I have seen that at first hand on at least a couple of occasions in my constituency case load.
If someone’s wages or salary is arrested, who is responsible for making that happen? In certain cases, that course of action has not been continued. I cannot understand that.
There is always talk in the agency about targets, which it speaks of in glowing terms. There is talk about how it is now bang on target regarding the income from the parents. But there are two sides to a target. People could be overpaying and the calculation may be wrong. If I were in an agency that had an upper-level target, I would not be examining that position too closely. Has that been taken into account inside the agency as a matter of course? If it just shies away from examining a case where an individual is challenging the amount, because doing so means it will not meet its target for the month, there is a problem.
My next point has already been made in an intervention, but it is worth while reinforcing it. It would be useful for hon. Members to deal with the same staff when phoning the MP hotline, and it would be useful if our constituents dealt with the same staff when they phoned. At least that happened under the old system, but no longer, as I found out in my office when talking to both my members of staff, Ruth Brown and Samantha Mair. They told me they are not getting the same service now that they were getting six or nine months ago.
I congratulate the hon. Gentleman on securing this important debate. Staff turnover and not being able to contact the same person are common complaints. Part of the problem is morale and staff turnover in the agency. When I had some ministerial responsibility in Northern Ireland, in the Department for Social Development a number of years ago, that was an issue even then, but it still appears to be a problem. Has the hon. Gentleman any suggestions about how that could be addressed?
I have to say something as an ex-trade union official: I emphasise “ex”, because it is more than 20 years ago. I was responsible for housing officers in local government, who were under such enormous pressures that they had to put up screens between themselves and the public. A parallel could be drawn with how those working at the sharp end in the CSA must feel, going into work and being hammered every minute of the day by people who are irate because they think things are wrong. That is why we are in the situation we are in today.
I should like the Minister to tell me, although perhaps not today, what the staff turnover is in the CSA. There were 8,700 members of staff as of September, but I saw a worrying figure showing that as many as 600 members of staff have been transferred out of the CSA, which must put more pressure on the agency. Why has that been allowed to happen? There are pressures in Jobcentre Plus, but why have so many staff been taken out of the CSA, when it is dealing with people’s lives? That point is worth making. I am grateful to the hon. Member for Belfast, North (Mr. Dodds) for his intervention.
I worry about the driving disqualification element—taking away the driving licence—putting people in jail and taking away their passports. On more than 900 occasions in 2007-08, the CSA applied at hearings for the most serious sanctions at its disposal: imprisonment or driving disqualification. On 695 occasions—a fifth of all such hearings that year—the defendants did not even bother to turn up, at a significant cost to the taxpayer. In such circumstances, the agency surely must endure further delay and the expense of taking out an arrest warrant to bring the defendant forcibly before the court. Is that not a waste of public money? At the end of all this, there is unnecessary further delay, and the parent caring for the child is still without his or her maintenance.
All those issues are of major concern to me and have become more so over the past few months. That is the main reason why I asked for this debate. I look forward to hearing the Minister’s response.
I congratulate the hon. Member for Central Ayrshire (Mr. Donohoe) on securing the debate and I thank him.
I should briefly like to outline for the Minister an issue involving a constituent of mine who has been shown to be infertile, but is still being chased by the CSA even though it has now dropped the main case against him. I cannot name the man because in the community I am from, which he is also from, he is probably known by about 80 to 90 per cent. of the people. Also, the grown-up child and the grandmother in question do not know about the non-paternity. Mentioning his name would effectively shatter lives.
I have been in correspondence with the Minister on the main point, and the outline is as follows. In 2001 the Child Support Agency started requesting maintenance from my constituent. In early 2002 he denied paternity, but because he had signed the birth certificate the CSA decided that he was the father. Despite his denying his paternity the CSA started to charge him some £73 a week as well as a penalty. In 2006 his maintenance charges were adjusted and levelled out to about £127.60 a week. He did not pay maintenance to the CSA and it then placed a bill of inhibition on him and attempted to freeze his bank accounts. Over the period 2006-09, maintenance charges were at about £27,000 and the CSA attempted to have him incarcerated. However, he produced a doctor’s letter in court stating that he was infertile. Two leading figures in the British Medical Association in Scotland have been supporting and helping him, and the letter they produced put the arrest warrant on hold.
In February, the mother of the child was asked to produce DNA samples from herself and the child to prove paternity. She refused. My constituent then began a process of declaration of non-parentage in court. In August, the mother declared that she did not want payment of arrears, and the CSA dropped the case, but it is still pursuing my constituent for £2,400 in fees. The bill of inhibition still stands against him, so he cannot sell any property to pay off the debt. I met him in October, having met him many times previously. His house was under threat of repossession, and in November he was denied legal aid for declaration of non-parentage. The process has been long and difficult for him, and I shall give an idea of how long it has been. The former Prime Minister was in power, the Afghan war had not started, and Saddam Hussein was in charge of Iraq. That is a long period in someone’s life, and a number of questions arise.
Why did the CSA not go after the mother who made the claim against my constituent? Why is he being made to repay some funds? Where is the apology after 10 years of persecution? Where is the compensation from the CSA? His house was nearly foreclosed, his social life was destroyed because it is difficult in his community to lead a normal life with the stigma hanging over his head, and his career has been severely hampered. The CSA has effectively walked away from the case, but not without trying to charge him £2,400. Why is it charging him when it was found that he could not possibly have been the father? The fundamental point is that he is infertile, and has been declared so by eminent doctors, but his life has been turned upside down by the CSA. I have seen him in harrowing circumstances.
I have been in correspondence with the Minister, her predecessors, and a number of people at the CSA. I plead with her to get the case sorted as best she can, so that someone who has lost a decade of his life because of the difficulties in the CSA can get it back on track.
I congratulate the hon. Member for Central Ayrshire (Mr. Donohoe) on raising this important and under-debated issue. All of us, including Ministers, have constituents at our surgeries complaining about the Child Support Agency, and several attempts have been made to reform it. The Liberal Democrats have often been critical of those attempts, and one of our concerns has been the very point that the hon. Gentleman made. In my view, the ideal system would have a simple baseline assessment with a safety valve for hard cases. That seems to be the right combination, however it is administered and enforced.
I am a father, and I think one tends to underestimate the cost of bringing up a child, so it is important to have a benchmark figure on which to base the system. In many cases, that will be more or less fair, but there will always be individual circumstances in which common sense shows that the formula does not do justice to the story, so there needs to be an exceptional safety valve to provide a fairer assessment in a small number of cases. The hon. Gentleman talked about the wisdom of Solomon, and that is sometimes needed. We need a mechanism by which the bulk of cases are assessed or do not go through the CSA, based on a fairly simple set of guideline figures, but a safety valve is needed for exceptional circumstances. That would deal with many of the issues that have been raised this morning.
I thank the hon. Gentleman for describing the six cases, which highlight a number of issues common to many of us, and I have some sympathy with some of his points. He mentioned the woeful inadequacy of consolatory payments, and the CSA’s line will be that they are not replacement for maintenance that should have been provided, but a few pounds to say sorry. That is not much consolation when hundreds or thousands of pounds are involved, and we should consider more carefully whether, in extremis, the agency should replace the maintenance that should have been paid if it was at fault and the person who lost out has done everything possible. If the agency has clearly failed, there must be a case for its having a duty to replace the maintenance that should have been collected. That should not be the norm, because it would be an extreme position, but sending someone £50 and saying sorry several years later is not good enough. I agree with the hon. Gentleman about that.
I was interested in the hon. Gentleman’s comments about the independent case examiner. The history is that the CSA was so awful that cases were swamping the parliamentary ombudsman, so we had to have an ombudsman just for the CSA. I value and respect the work of the independent case examiner, but I was slightly disappointed about a recent case in which the case examiner found in favour of my constituent, and the CSA ignored that. The only answer was to go to the ombudsman, which was complete nonsense. Will the Minister clarify whether the independent case examiner is advisory or has teeth? Constituents are frustrated when they go to what seems to be an independent third party, but months go by, evidence is collected, it finds in their favour, and the CSA then fails to act on the recommendations, so the case goes to an ombudsman and the process may take another year. That is in no one’s interest, and I hope the Minister will clarify the status of the independent case examiner’s conclusions.
I was interested in the hon. Gentleman’s comments about, for example, members of the public phoning the CSA and reaching a different person every time. There is bound to be an element of that, because people work part time and so on, so the same person will not always be available, but the principle of people having a case load would provide some continuity, and that is important. A constituent who came to see me recently had phoned the CSA time and again over a year and had spoken to a different person every time. People kept promising to phone him back, but did not do so, and when he phoned again someone else promised to phone back. I raised that with the CSA, and pointed out that there was a problem because there seemed not to be a trigger. Someone may say that a matter has been passed to another section and that when it responds that person will contact the member of the public, but there seems not to be a trigger if that section does not respond until the applicant chases it up.
The agency told me that there is a casework system and a trigger, but when the chief executive looked at the case to which I referred, he said it was a clerical case—one where things have gone wrong and are a mess. The answer was that clerical cases are just different. They may be different, but surely people whose cases are being dealt with clerically should expect the same standard of customer service as everyone else. It is not their fault if the data on a computer are wrong, for example. Basic customer service is not sufficiently in place.
When I asked for account breakdowns, the chief executive told me that they will take 20 weeks, and that that is the customer service standard. When I asked him whether that appalled him, he said, “If you want them done quicker, what do you want us not to do? If the figures are wanted quickly and the task is a difficult clerical one, people must stop doing something else. What do you want us to do—stop chasing maintenance?”
That raises the issue of resourcing the CSA, which the hon. Gentleman touched on. I appreciate that serious money goes into it and that staff have been transferred out to deal with the rise in unemployment, but I wonder whether an assessment has been made of the adequacy of the CSA’s resourcing to do its job. If it takes nearly five months just to obtain a statement, something is not right. If that is the performance standard and all that it is expected to do, something has gone wrong.
A problem I sometimes come across is the money having gone to the CSA but not being allocated to the right person. The hon. Gentleman mentioned a case of money going to someone else with the same name. When one contacts the CSA, one sometimes detects a shrugging of shoulders and the attitude that it was just put in the wrong account, which is no big deal. However, it is a big deal for the families concerned. The attitude seems to be that the CSA is a big organisation with millions of payments coming and going, and the odd one will go astray, so get over it. That is not good enough. Just describing what has gone wrong and saying that it will be put right next month is not good enough.
Having said all that, I noticed that five of the six cases that the hon. Gentleman raised—this may be coincidence—involved non-resident parents. The first involved vast arrears of £44,000, and the others involved dads complaining about how their arrears and so on had been handled. There is a balance to be struck. When a family with a CSA case are sitting in front of me, I try to remember that the spouse or the children may also be constituents. What we want is fairness for the person who must pay the money, and proper money and support for the child and the family. Clearly, it would be wrong, unfair and distressing if the hon. Gentleman’s constituent had his “deduction from earnings order” money snaffled by the company, and I cannot comment on how the arrears arose, but in general if someone has arrears, it may be because the CSA has messed up or because the money to be provided for their children has not been paid. We need a balance.
In my constituency, there have been occasions when I have had one parent sitting in front of me, and the other parent sitting outside waiting to come in. There might be an imbalance in the six cases that I have spoken about today, but both parties come to see me, normally at different times.
I am sure that is right—the same thing has happened to me. My point is that whenever somebody has to pay arrears that seem unfair, it is important to bear in mind the fact that there is a child at the other end of the transaction. In the first case mentioned by the hon. Gentleman, arrears ran into tens of thousands of pounds. That is tens of thousands of pounds that were meant for the welfare of the child but did not get through.
Typically, that is apparent when one sees the mother, for example, but when a father is in front of me, occasionally I will say, “Where do these arrears come from? Why didn’t you pay for the past 18 months?” Sometimes the answers that I receive are not as convincing as they might be. We need a system that is seen to be fair, transparent and responsive to the individual case, but we must always remember that the welfare of the child is central.
As I said in an intervention, we cannot condemn the CSA for implementing the laws that we have given it to implement. We must take responsibility and, as the hon. Gentleman intimated, CSA legislation was scrutinised appallingly when it was introduced—there was a feeling that something had to be done. Everybody was in favour of the legislation, and I always think that the worst laws passed in the House are those that everyone supports, as they do not get the scrutiny they deserve. Perhaps, together with our predecessors, we are all responsible in different ways for having allowed the situation to get to this point.
One of my concerns for the future regards those families who no longer go through the CSA. I have tabled some questions on that issue, and have received some helpful letters from the CSA. The presumption now is that partners should try to make a deal, and in an ideal world that is how things would proceed. Someone once famously said that when it comes to family breakdown, the CSA has never been part of the healing process, and that is correct. Obviously, it is a good thing if a couple, albeit separated, can agree on a fair assessment for a child that can be implemented without acrimony or the need for enforcement. I welcome the fact that that is happening more.
My concern is about when there are two partners, one of whom is perhaps articulate and well-lawyered, as it were. An initial deal might be struck and, for the sake of argument, the mother might be offered a cash lump sum and a modest monthly maintenance assessment. On day one, it might seem like a lot of money—£5,000 or something—and beyond the dreams of avarice. A year later, the lump sum is gone, the monthly maintenance is not much and money is needed for a new pair of trainers, a school trip or whatever.
It might be too early to know whether such a thing is happening, but I worry that, at that point, the mother might be in a poor negotiating position. She might talk to her ex-husband or ex-partner and say, “I need more money”, and he might reply, “I gave you £5,000. What have you done with that? I give you money every month; you get benefits. Go away. I have lawyers who say you can’t have any more.”
Clearly, that is not true, and such a woman could go to the CSA, ring the options helpline and so on. I hope she would do that. However, I want the Minister to ensure that we closely monitor what happens to people who in the past would have gone through the CSA process, but who have made a deal and fallen off the official radar because they do not need contact with the authorities.
I am pleased that the CSA has done some internal survey work, and that over the first quarter of next year it will do some formal surveying and look at the terms of the agreements of those people who have private arrangements. However, that work needs following up six or 12 months down the track to see what has happened to those who have gone off the radar. I worry that a small number of people will fall through the gap and not realise that they have the right to go back to the CSA, even if a private deal has been made.
I was interested in the comments made by the hon. Member for Na h-Eileanan an Iar (Mr. MacNeil). Returning to the point about common sense, we sometimes find that the CSA is slow to back down when things have gone wrong. The hon. Member for Central Ayrshire mentioned a case that had to go to court. I am aware that the CSA regards measures on driving licences and passports as a last resort for somebody who has probably evaded payment and tried to avoid every means of paying, and sometimes extreme approaches are taken. If someone does not turn up in court, that is not necessarily the fault of the CSA, but it raises issues about joint working between different Government agencies.
In such cases, we need the Government and the CSA to be able to tap in more smoothly to Inland Revenue data, which I know happens to some extent, as well as benefits and other data, to ensure that when an allegation is made about someone’s income or job, it can be verified.
My constituents say to me—I am sure this is the case for other hon. Members—that the CSA wants them to turn into private investigators. If someone says “My ex is working,” the CSA says, “Prove it.” How should they prove it? They are asked to go and stand outside the gates and take photographs and so on. When I told the CSA that my constituents feel that they have to don a dirty mac and turn into private investigators, its response was, “We don’t have the powers or the resources to do it ourselves.” That creates a tension.
We do not want malicious allegations, but where serious and well-founded allegations are made, we need a system whereby the CSA can investigate more vigorously, instead of putting so much onus of proof on the person who makes the claim. I understand that a balance is required, but sometimes people know a lot about what their ex-partner is doing—where they work or where they go to the pub. They also overhear conversations and so on, especially if they are still living in the same community.
Where a reasonably substantiated allegation is made about undisclosed earnings or something similar, perhaps the CSA errs too much towards saying, “Until you show us cast-iron, black and white, verifiable proof, we won’t do anything.” Given a well-founded allegation, I would like the CSA to be more proactive and say, “Yes, there is something in this. We will take it seriously and use our data sources to act on it.” That would be a fairer system.
Let me repeat my appreciation for the hon. Member for Central Ayrshire, who has given us the opportunity to debate this issue. As MPs, we always see the bad cases, and I suspect that there are many instances of people getting their maintenance assessed and paid on time. Such people think the system is fair and the children get the money. Those cases never come across our desks, and we should place on the record our appreciation of those who ensure that hundreds of thousands of children in this country receive child maintenance that they might not otherwise get.
Nevertheless, there is considerable room for improvement, especially in areas such as the derisory consolatory payments, the powers of the independent case examiner and continuity of staffing and contact with members of the public. I hope that the Minister will help the CSA to improve the service that it provides for the public.
I, too, congratulate the hon. Member for Central Ayrshire (Mr. Donohoe) on securing this timely and important debate. As a Back Bencher, I did exactly what he has done, and brought seven or eight of my constituency cases to the attention of the Minister who was then responsible for the CSA. It is sad that an hon. Member still needs to do that after considerable efforts have been made by all parties to try to improve the CSA.
We all agree that a well-functioning child support system is vital. The Government will not meet their child poverty targets for 2010 or 2020 unless the CSA is effective and does its job well. The CSA can play a part in ensuring that there are fewer unwanted pregnancies if fathers know that the agency is effective and will come after them, and that they will have to pay for 18 years for the child that they brought into the world. There is also a little evidence to suggest that an effective CSA has some influence in reducing relationship breakdown, according to Professor Nick Wikeley. I was struck by a comment made by the journalist Polly Toynbee in The Guardian on 27 January this year. She said that
“the big story is the mass refusal of so many fathers to pay anything—ever.”
Earlier in the article, she said that
“two-thirds of all absent fathers pay nothing at all.”
That figure is a little too high, according to the latest information that I have seen. The 2007 families and children study produced by the Department for Work and Pensions showed in table 15.1 that 61 per cent. of all parents with care were not receiving child maintenance.
It is important when we consider the CSA that it tells us its performance on the number of cases for which there is a child maintenance liability, but as politicians we need to be aware of the situation throughout the country. That matters hugely, because if a clear majority of non-resident parents—about 60 per cent. or, for argument’s sake, somewhere between 60 and 70 per cent.—are not paying child maintenance, the word on the street, or the culture, is that people can avoid paying it. That is deeply unhelpful to what all of us in the Chamber are trying to achieve.
I commend the attempts that we heard about yesterday to inculcate a greater sense of financial responsibility among non-resident parents, and sometimes even among parents with care. In a recent survey, 22 per cent. of parents with care were saying, rather surprisingly and counter-intuitively, that they did not really want child maintenance. Perhaps the relationships had broken up very badly. That figure surprised me, but it was from a piece of work undertaken by the Department.
The hon. Gentleman is correct. Now that there are voluntary arrangements and we have repealed section 6 of the 1991 Act, people do not have to come within the CSA’s net. I was trying to make a slightly broader point and saying that if we look across society as a whole—not just at the CSA cases and the voluntary arrangement cases, but at those cases in which neither applies—we see that there is unfortunately a clear majority of cases in which parents split up and no money is moving. That worries me and we need to bear it in mind. Polly Toynbee was right to draw attention to it earlier this year. Indeed, when Sir David Henshaw produced his excellent report in 2006, he said that in only 30 per cent. of cases was some maintenance paid. I think that the figure has improved slightly, but we need to be aware of the broader picture.
I want better co-operation between Her Majesty’s Revenue and Customs—the Inland Revenue, as we used to know it—and the CSA. I agree with the comment that many parents feel that they are forced to act as private detectives to establish the non-resident parent’s income. Will the Minister tell us what further co-operation is in the pipeline between HMRC and the CSA? That was one of the best things that we put in the Child Maintenance and Other Payments Act 2008. It should have happened long ago, but I am not convinced that we are yet reaping the full benefit in data transfer and tracking all income available to non-resident parents to make the CSA as effective as it could be.
I shall refer briefly to the case of one of my constituents, who is also calling for greater co-operation between HMRC and the CSA. Her ex-partner signed on as unemployed. She says that when Mr. X signed on earlier this year,
“it should have been quite simple to take the measly £5 a week from his benefit but still all I have received since April is… £10 or £15… this system is quite simply failing children. My children go without because of this terrible situation”.
She says that all she wants is
“justice for my children who have… holes in their… shoes… until I can afford to get some more!”
She goes on to say that she is convinced that her ex-partner is working, even though he is signing on. She has pretty good evidence of that and is extremely frustrated that that information does not seem to have been captured and taken forward.
This is just a practical point. I would like to know from the Minister why e-mail communication with the CSA is not now an option. That point was raised with me by Families Need Fathers, whose representatives I met on Monday. As they put it to me, e-mail communication would save considerable time, money and anger, not least when assessments are sent to old addresses, resulting sometimes in huge child maintenance liabilities arising without the non-resident parent’s knowledge. May we please move into the 21st century and ensure that e-mail communication can happen between the agency and parents with care and non-resident parents? That would be practical and helpful.
We need strong and robust enforcement powers in the CSA. For many years during the previous Parliament, I used to question DWP Ministers about the number of driving licences that had been taken away. I think that, although the agency had the powers, only two licences had been taken away. However, the effect of threatening to take such action can be beneficial. I understand from the helpful House of Commons Library debate briefing pack that, in the state of Maine in the USA, $89 million was collected through threatening to remove driving licences and that, in Australia, an extra 11 million Australian dollars was raised through threatening to stop non-payers travelling abroad.
I do not want anyone’s driving licence or passport to be taken away, but if the threat of that is effective when all other options have failed, those are tools that, sadly, the CSA needs in its armoury—there must be consequences. Child support matters. Children’s lives and futures are at stake, and we will not meet our child poverty targets unless we have a CSA that works.
The system needs to be fair, however. Fairness to non-resident parents—fairness to, in the main, fathers—is critical to a well functioning CSA that has broad public support. A couple of practical issues worry me in that regard. One is the fact that liability orders are not stayed if the application is appealed. We need a quick and fair appeal system so that cases are not held up indefinitely, but it seems to go against natural justice that the liability order keeps on going if there is an appeal. That should be looked into quickly and fairly, and an adjudication made fast.
It also seems odd that non-resident parents should have to pay the costs of challenging the use of administrative powers even if they have been wrongly used. There was provision in the 2008 Act; I remember debating that point when it went through the House. I have a great deal of sympathy for the case raised by the hon. Member for Na h-Eileanan an Iar (Mr. MacNeil), in respect of the £2,400 that his constituent has been asked for when he never could have been a father. It is worrying that in such cases the mother has the right to refuse a DNA test. What if his constituent had not been proved to be infertile? Would those liability assessments have gone on piling up if the mother could refuse a DNA test? We have the technology to decide these things decisively now. That issue worries me as well and possibly needs to be examined.
I am concerned about the 25 per cent. variation of income figure that was mentioned when we were putting the 2008 Act on the statute book. Will the Minister confirm whether the Department still has that figure in mind?
I think that cases will soon be hitting the press of people who have lost their jobs and who are now on benefit, but whose maintenance liability has not been reduced, because the fall in their income was just below the CSA’s 25 per cent. variation figure. I appreciate that the CSA went for such a high figure because it was so scarred by the amount of work caused by very minor variations. However, as it gains in confidence and its systems become more robust, the 25 per cent. figure will need to change. If someone’s income drops by 24 per cent., should they really go on paying maintenance at the level at which they were first assessed? That seems to go against natural justice.
I want briefly to mention the one-year rule, which I thought the hon. Member for Central Ayrshire would bring up. It is a concern that parties who have happily and voluntarily gone to court to produce flexible arrangements that suit them to deal with their assets and income, can see those arrangements unwound within a year, to the detriment of either the parent with care or the non-resident parent. All parties raised that issue when the Child Maintenance and Other Payments Bill went through the House, and it is a bit of unfinished business, so I leave it on the Minister’s radar screen.
Child maintenance arrears, or the debt as they are commonly known, have recently come down slightly, which is excellent—let us give credit where it is due. They are now just under £3.8 billion, although that is a slightly fictitious figure because a lot of the assessments were not really accurate. Furthermore, about half that sum is owed to the Secretary of State, rather than to parents with care. However, it matters that we collect those arrears.
It also matters that we collect arrears where the children are over 18, and I am a bit concerned that the focus seems to have been on collecting debt only where the children are under 18. If someone has been deprived throughout their childhood, the fact that they can get a lump sum when they are 19 or 20—perhaps to help them to go through college or university or to get a small deposit on a house—is important, and we must not forget that.
I recently visited a CSA office and talked to some of the staff, who work extremely hard in difficult circumstances, as was said earlier. I heard of the joy that someone who has got nothing for years feels when a cheque for £15,000 or £20,000 comes through. The difference that that can make to a young person’s life is phenomenal. These things matter. Ideally, we want the income to be there as people go through their childhood, but if they have not had that income, we must not give up on the collectable debt. If the non-resident parent has assets, I would support the CSA in going after those assets.
On the debt, I am worried that up-to-date information has not been published. Gingerbread has pressed for the publication of client fund accounts throughout October, November and December. It worries me that there is no official published deadline. Many Government figures come out at set times of the year; indeed, the unemployment figures came out at 9.30 this morning. The DWP cannot say, “Sorry, we don’t feel like doing them this month. We’ll do them next month.” That is simply not good enough. We need the figures to come out regularly, because lobby groups such as Gingerbread study them carefully. Maintenance arrears matter, and we must make sure that we do not lose sight of them.
As the CSA grows in confidence, I hope that it will take a leaf out of the Australian CSA’s book by trying to ensure that the relationship between separated parents is as good as it can be. I say that because there is evidence that if the relationship is better, rather than worse, more money is likely to flow. I understand why the CSA has been wary of going down that route, but I hope that it will look at the issue as it gains in confidence. I have with me two booklets from the Australian CSA called “Me and my Kids—Parenting from a distance” and “Me, my Kids and my Ex—Forming a workable relationship for the benefit of your children”. The Australian CSA produces those because it recognises that if we can make relationships better, make contact amicable and help with parenting from a distance, more money is likely to flow. That is also better for children. I therefore commend that approach.
Finally, I share the concerns raised by the hon. Member for Central Ayrshire. It will be five years before we get the gross-income scheme. We passed the Child Maintenance and Other Payments Act in 2008, and it will be five years—2009, 2010, 2011, 2012 and 2013—before we get to 2014 and one gross-income scheme. We all back the scheme, because it is simpler and easier. It will also net the self-employed and take in rental and dividend income. It is scandalous that the original legislation did not include such income—I do not know what MPs were doing when we passed it. That was wrong, because all income should be included. Why have these changes taken so long? Five years seems a very long time. We have seen the differences between the old scheme, the new scheme and the future scheme, so let us move ahead as quickly as we can.
May I say what a pleasure it is to serve under your chairmanship, Mr. Cook? I congratulate my hon. Friend the Member for Central Ayrshire (Mr. Donohoe) on securing this important debate. Over the years, he has done a lot of work on these matters for his constituents and he is completely committed to seeing a better system introduced. Yesterday, a lot of hon. Members went to an event run by the Child Maintenance and Enforcement Commission in the House and they saw the huge amount of work that is going on to improve the situation.
One of the key issues that has been raised this morning is enforcement powers. Judging the rights and wrongs as between the parent with care and the non-resident parent will always be a difficult balancing act. Over the past 10 years, however, we have discovered that the balance was previously in the wrong place. The points that the hon. Member for South-West Bedfordshire (Andrew Selous) has just made about there being a significantly problematic culture are absolutely right. It is a problem if, as is currently the case, only 45 per cent. of non-resident parents pay their maintenance in full.
In the measures that we have recently introduced, we have therefore strengthened enforcement powers. In October 2008, it became an offence for the non-resident parent to withhold information pertaining to a change of address. In August this year, CMEC assumed the power to deduct payments from non-resident parents’ bank accounts without recourse to the courts. It also has the power to ask the court to impose a curfew on a non-resident parent. Under the Welfare Reform Act 2009, which secured Royal Assent last month, the commission now also has the power to remove the passports and driving licences of parents who have wilfully or culpably failed to meet their child maintenance obligations. Those powers are controversial, but it is important that we have them, given the context in which we operate.
Hon. Members are clearly still getting a large number of extremely complex cases in their constituency mailbags, and those cases have not been handled properly or as well as any of us would wish. Leaving aside those complex cases, however, the number of complaints against the CSA has fallen by more than half since 2004-05, which is an indication of its improved performance, as are the other performance statistics. The number of children benefiting from the CSA’s work has increased by 250,000 over the past five years. The number of cases in receipt of maintenance has gone up from 400,000 to 600,000.
Hon. Members have talked a lot about the quality of the administration, where there have also been significant improvements. In 2004, only 27 per cent. of cases were dealt with within 12 weeks, but that number has gone up to 84 per cent. In 2005, the average time it took to answer the telephone was one minute 40 seconds, but it is now down to eight seconds. I fully understand hon. Members’ concerns about their constituents telephoning the CSA and getting different people answering. In essence, the reason is that we have extended the CSA’s opening hours so that it can be more available to people. The problem is that of course people cannot work the entire 60 hours a week during which the agency is open.
My hon. Friend is right about that. However, there are two things I want to say—and I do not want to wipe away the frustration of his constituents when they do not get the service to which they are entitled. First, the level of resources going into CMEC and the CSA must take account of the state of the public finances. We must look for efficiencies just as we are doing throughout the public services. Secondly, the reductions have been achieved while increasing the efficiency of the organisation. It is not as if we have been taking resources from the organisation and finding that service provision has collapsed.
One of the main points raised by my hon. Friend was the question of why people cannot move from the old scheme to the current scheme. There is a fundamental reason why we do not do that. We do it only after a significant change of circumstances, by which I do not mean someone’s income going up or down, but rather a new child in the family or one or other of the parties making a new partnership. We cannot allow people to choose the scheme they want to enter, because for every parent who would choose to move there would be one in an equal and opposite position of not wanting to move. Giving people that choice would intensify the degree of conflict. I accept that that means people being treated differently, but in running a system we must consider the level of justice being achieved overall.
My hon. Friend and the hon. Member for South-West Bedfordshire asked why it was taking so long to introduce the future scheme. We have the legislation and we must embed the new computer systems. We are doing that on a different basis from previously and are learning from the bad experiences we had. Now we are using off-the-shelf computer systems rather than building our own, which should make them more economical and flexible. We intend new cases to go on to the future scheme from 2011 and everyone to be transferred to it in 2014.
Will the Minister confirm that under the new system it will be possible to have cross-fertilisation of thinking between the agency, the Treasury and all the driving agencies? If that is the case, many of the complications that I have encountered would be overturned.
Among the main benefits of the future scheme will be the fact that it will get data from HMRC and that we shall move from a formula using net income to one using gross income. That system has been used in other countries with significant success.
I am sorry that I shall not be able to comment on every case that hon. Members have raised this morning, because there is not time to do so in detail, and I do not have all the information. However, hon. Members can, if they have not already done so, write to me about cases, which I can look into. I shall comment on a couple of cases of particular concern, starting with the company going into liquidation and the man who was asked to pay twice. The non-resident parent remains liable to pay child maintenance, but he should be able to claim the payments that have been deducted from the liquidator. If he is unsuccessful, the CSA will discuss with him how to handle the arrears.
My hon. Friend makes his point with characteristic force and I shall take that thought away with me.
The hon. Member for Na h-Eileanan an Iar (Mr. MacNeil) raised another case of some concern, about a non-resident parent whose name was on the birth certificate, but who could not possibly have been the father. Once the non-resident parent has provided proof of his infertility or a DNA test has shown that he is not the father, the CSA can revise its original decision, extinguishing all liability for child maintenance, and any payments may be refunded.
The honest answer, I am afraid, is that I do not know, and I shall have to get back to the hon. Gentleman on that point.
The hon. Member for Northavon (Steve Webb) gave a characteristically well- informed speech and set out a general schema in which we would deal in a fairly automatic way with straightforward cases, but pay greater attention to the hard cases. Generally, that is a good way of administering the scheme, and that is what we are attempting to do. I guess that the difficulty is in discussing which cases are hard.
The hon. Gentleman also made a valid point about people moving off the system altogether and whether people will get everything to which they are entitled from the options service. Gingerbread, for example, is particularly concerned about the re-establishment of what I shall call traditional gender relations, in which for the sake of peace women might not push as hard as they ought. I agree that that is an issue, and I am on top of it. We are considering how we can monitor that effectively.
The hon. Member for South-West Bedfordshire made a good point about the overall culture in which we operate and the difficulties that we face. I hope that hon. Members feel that we are making significant improvements to the child support system overall. We are succeeding at the moment in lifting 100,000 children out of child poverty because of the way in which the system currently runs.
GP Practice Boundaries
I am pleased to see you in the Chair, Mr. Cook, presiding over a debate on a subject that is highly important to all our constituents. It is good that the Minister responding to the debate is my right hon. and learned Friend the Member for North Warwickshire (Mr. O'Brien), who is my constituency neighbour to the south-west.
If we look at the Government’s policy on the NHS since 1997, we can see that a welter of statistics confirm the excellent and vital progress that has been made in many areas. For example, we have over 44,000 more doctors and almost 90,000 more nurses, and 3 million more operations are carried out each year than in 1997, with the number of heart operations more than doubling. Net public spending on the NHS has nearly tripled since 1997. Then it was £35 billion; it is now more than £90 billion. Waiting times are at the lowest level in NHS history.
The risk, however, is that the effectiveness and durability of those fantastic achievements may be undermined by an obsession with organisational and administrative reform of the NHS. In the view of many NHS workers, of patients and indeed of Members of Parliament and community representatives, the commercial mantra of choice is being used as a cloak for the marketisation and privatisation of the NHS.
At the Brighton Labour party conference in September, the Secretary of State for Health said:
“I cannot see why families shouldn’t register with the GP practice that suits them best. So, I’ve said we’ll abolish GP practice boundaries within a year.”
That did not exactly come out of the blue, but it caused a great deal of concern among GPs in my constituency and elsewhere. Even those GPs who saw some benefits from that rather rushed reform, such as Dr. Theresa Eynon of the Hugglescote surgery, were quick to express to me their fear that abolishing GP practice boundaries could worsen the plight of those patients most vulnerable to serious long-term health problems.
The Government’s plans provide further proof that the inverse care law is alive and well. As the Minister will know, the idea was first proposed by Julian Tudor Hart in 1971. His law states that the availability of good medical care tends to vary inversely to the need for it in the population that it serves. Put simply, those who need health care services the least use them more, and more effectively, than those with the most need.
That is not to say that there is anything inherently wrong with allowing people to register with a GP practice closer to their workplace, thus enabling easier access to the surgery during the working week. Of course there is nothing wrong with wanting to offer more convenient NHS primary care, although I would quietly suggest that employers could be more flexible in allowing their employees to attend GP appointments; the wheels would not come off the local or national economy if such flexibility were more readily available.
If that was what was being proposed, I would not argue with it, and would not be debating the matter today, but that is not the full story. The Minister said in a speech to the Royal College of General Practitioners conference last month:
“The focus has to be on responding to the needs of patients…Enabling people to choose a different practice near home. Or one near to where they work. Or one with better overall quality scores and patient satisfaction but in a different location altogether.”
That confirms that the Government’s intentions are much more fundamental than an improvement to GP accessibility.
The proposal is more to do with the promotion of competition among GP services, supplemented by initiatives such as NHS Choices that utilise the information gleaned from the quality and outcomes framework to give the public somewhat simplistic statistics on GP practice performance. Given all the academic talk of quality and values, the most crucial issue is the future of the truly local services that GPs provide, particularly the invaluable home visits that they make to the homes of the long-term sick, the immobile and the terminally ill.
In the rush, in the words of the Health Secretary, to turn the NHS from “good to great”, the Government risk ignoring the needs of that most vulnerable group of patients. I note parenthetically that the next debate in this Chamber is about age discrimination in health care. I shall read the Hansard report of that debate with great interest. The proposed reform does not seek to end home visits, but there is a very real risk that the needs of our fellow citizens with the most complex health problems will be put in direct competition with the health-care requirements of the more affluent workers and families. Each will have a QOF score, but there are no prizes for guessing who attracts the most points and, therefore, funding.
I regret to say that the potential of the change to worsen health inequalities goes even deeper than that. Those with the most complex health needs, particularly psychiatric ones, rely on social services that are geographically tied to the local authority. It does not take much imagination to realise that the consequences of abolishing GP practice boundaries may include an increase in the administrative complexity and cost of providing appropriate care packages for all who need them. Dementia patients living at home will be particularly vulnerable to instability and uncertainty.
All Labour Members hope that the Personal Care at Home Bill, which received its Second Reading this week, and the national care service will together ride to the rescue of all those with social care needs, but a period of uncertainty could result from the abolition of GP practice boundaries. I urge the Government and the Minister to think again, on these grounds alone. I should be most grateful if the Minister made a specific response about the impact of the reform on social care provision.
I turn to the intellectual threads of this reform. The spiritual leader of private health care in the NHS and former Health Secretary, my right hon. Friend the Member for Darlington (Mr. Milburn), has rightly stated on numerous occasions that the health gap between rich and poor has grown inexorably since the creation of the NHS. However, that inescapable conclusion has little to do with structural failings within the NHS, as he would be quick to assert; it has more to do with the wealth of a small number of individuals and the private companies that respond to their every ailment, whether cosmetic or chronic.
It goes without saying that widening health inequality is a national concern, and I am pleased that the Government have commissioned Professor Sir Michael Marmot of University College London to consider how we could tackle health inequalities more effectively. We should all look closely at his findings and recommendations, and I hope that we will have an opportunity to debate them in the Chamber.
Men and women in our poorest communities are dying on average a decade or more before those of their generation in the most affluent areas. Putting it at its mildest, that is deeply troubling. However, that is due as much to the increased and inherent politicisation of this totemic institution since the 1980s. That culminated in the Labour Government putting up the money—but rarely the arguments—for maintaining the NHS wholly within the public sector.
With the abolition of practice boundaries, we will undoubtedly increase competition within the NHS. That will be especially so in urban areas, as GP practices have to compete for patients with NHS walk-in centres and one-stop primary care centres—the polyclinics championed in the Darzi review. That will merely distract the NHS from tackling health inequalities, as consistent and lengthy patient records will become more difficult to compile.
As someone with three decades in public sector IT, it would be remiss of me not to acknowledge that computer systems have a role to play in solving the problem, but the less said about the benighted NHS agency Connecting for Health the better. There is little doubt in my mind, however, that we would have had greater success in tackling health inequalities since 1997 if we had trusted and promoted the efficiency of the public sector over that of the private sector and its unseen and unaccountable backers and exploiters.
I mentioned the Darzi review a moment ago. We are all familiar with its aim of putting quality at the heart of the NHS. Who could disagree with that? I certainly would not, although I would question the use of other commercially-loaded terms by a senior Government appointee, who is supposed to be a clinical health specialist and not a management guru. Those phrases are more likely to come out of the mouth of the Chief Secretary to the Treasury, my right hon. Friend the Member for Birmingham, Hodge Hill (Mr. Byrne), than one of our most successful and respected surgeons.
However, when my right hon. Friend the Member for Darlington was Health Secretary, he said in a speech to the Commonwealth Fund in Washington 2002 that
“health care works best…when it harnesses the commitment and knowledge of clinicians to improve care for patients.”
Private health insurer Kaiser Permanente of the US is cited as an example of that health care harmony, but I shall resist the temptation to be lured down that profitable but politically promiscuous avenue.
The Darzi review is the foundation for these troubling proposals in primary care, with a specific quote from Lord Darzi’s summary letter in “High Quality Care for All” establishing the foundation upon which the Secretary of State decided to proceed.
Lord Darzi said:
“Patients will have greater choice of GP practice and better information to help them choose.”
That raises the role of primary care trusts in designing and commissioning local primary care services, as they also have a vital role to play in the democratisation of health care. By that I mean involving patients in the decisions that most affect their health, which is a welcome development. Leicestershire County and Rutland PCT seems to be going out of its way to illustrate to patients the worst excesses of the catchment area system that currently operates. For example, patients registered at Whitwick surgery who lived four miles or so away in Hugglescote were told by the PCT that they would have to leave that practice and re-register at Hugglescote. That was immensely distressing to the patients concerned, particularly pensioners who had built up a good relationship with the GPs at Whitwick over a number of years.
At this point, it is worth quoting Dr. Orest Mulka of the Measham medical unit. He is a highly respected GP at a well-regarded surgery in my constituency, and he said:
“Of course boundaries can be misused...but boundaries aren’t just for the management of GP workload. They are there to allow a practice to identify with a community and see the health of their community as more than just the sum of individual conditions that are brought to them. They allow practices to develop a sense of pride of caring for their patch.”
“They allow practices to develop a sense of pride of caring for their patch.”
He went on to say:
“ In my practice we don’t discriminate—anyone living in our area is accepted on our list.”
I shall use Dr. Mulka’s comments as evidence against the Government’s claim that abolishing practice boundaries will increase local accountability. If a patient is not a member of the local community, their needs may well be at odds and even in competition with those who live closest and who may have greater clinical need.
Whatever the number of patient participation groups, welcome though they are, they cannot hope to replace that local link. That reminds us of the consumer-led nature of the Government’s proposal, which has been described as a move toward a “medical supermarket” where increasing numbers of patients are routinely seen, not by GPs, doctors or nurses, but by “health care professionals” such as “nurse consultants”. We are some way from such dystopian scenarios, but the Government’s obsessive delivery of pro-private policies in the NHS inevitably leads in that direction. Many people see the death knell of a publicly resourced and run NHS in proposals such as abolishing GP practice boundaries; creating polyclinics; making PCTs commissioners rather than providers of health care; encouraging NHS hospitals trusts to apply for foundation status; local improvement finance trusts; and—do not get me going on this—private finance initiatives. Moreover, there are other inappropriate and unnecessary market devices.
Such reforms are the logical conclusion to the brave new world of health care partnerships piloted by my right hon. Friend the Member for Darlington when he was Health Secretary. The frequent speeches made during his tenure in Richmond house seemed intent on sending a chill down the spine of GPs and patients and included such baleful gems as the following examples. He said that
“tax funded health care can only be sustainable if it sits side by side with diversity in provision and choice for patients.”
What he meant is that it is sustainable only when the local commissioning arrangements allow and indeed favour private sector bids for NHS work. He also talked about
“new private sector providers becoming a permanent feature of the NHS landscape.”
Finally, he said:
“The NHS scores well on fairness but is weak on choice.”
Those quotes are all from the same 2002 speech, but seem more akin to a sales pitch than a policy debate. Let us not forget that from 2001 to 2004 our former Prime Minister and right hon. Friend, Tony Blair, was advised on the NHS by Simon Stevens, who promptly joined the US firm UnitedHealth Group, which made $78.85 billion from health care services in 2008, after leaving the Downing street policy unit. By way of a footnote, let me say that at the same time as vehemently opposing President Obama’s modest health care reforms in the US, UnitedHealth, with Simon Stevens on board, is bidding for and winning NHS contracts, and will no doubt regard the abolition of GP practice boundaries as welcome “mood music” at the very least.
To return to the local impact of the Government’s plan, Dr. Eynon has concluded that, once again, the change is one that suits the well, working person. That brings to mind the inverse care law that I cited at the start of my speech. We must not shape our primary care system around the needs of the middle-class, peripatetic, urban elite who go to their local paper and MP every time they cannot get an appointment to treat their squash injury, as we should not normalise or accommodate the social and environmental impact of fundamentally selfish lifestyles.
By 2018, when the NHS reaches its biblical span of three score years and 10, we shall have seen GPs metamorphose from the avuncular community leaders of “Dr. Finlay’s Casebook” to profit-generating assets in a Dr. Foster’s cost centre. The NHS was not created to serve a minority who shout loud enough to see a doctor whenever they want, wherever they are. This proposal is designed to satisfy the few, not the many. To abolish practice boundaries is to hasten the demise of the family doctor.
I congratulate my hon. Friend the Member for North-West Leicestershire (David Taylor), my constituency neighbour, on securing the debate and on his lively and interesting speech.
Although practice boundaries will be the main focus of my remarks, I also want to address the wider issue of competition and choice within the NHS, because my hon. Friend has made his feelings so plain. It will not surprise him to know that I have some sympathy with a few of his points. I, too, am very conscious of the fact that our party founded the NHS. It was a service to be paid for from taxation, free at the point of need and primarily provided through the public service.
However, in respect of some of the comments about marketisation in primary care, we need to bear it in mind that the NHS has always been a deal between the private and public sectors, because most GPs operate independent private businesses that contract with the NHS, and have done since 1948. Therefore, we must be a little careful when we discuss the private sector, because some GPs talk about the private sector as if it were something different from them. Actually, they are in the private sector, but they contract with the public sector.
We have an excellent record in primary care, as confirmed by a report earlier this year from the prestigious Commonwealth Fund, but we should never be satisfied. Although many GP practices are excellent, not all are. I agree with my hon. Friend that the most deprived parts of the country sometimes have the poorest provision of primary care with fewer doctors and greater demand—poorer areas tend to have people with a number of medical conditions that need urgent care.
We cannot simply rely on current general practice to address such problems. That approach has been tried for 60 years and it just has not worked. In some places, patients may be restricted to a single practice. They may wish to move, but find it difficult to do so. That is all very well if their practice is good, but what if it is not? We are now pursuing a different approach, investing in 112 new GP practices delivered by any willing provider with a strong track record on reducing health inequalities.
Choice and competition can drive up access and quality, which is important. We are working to improve the quality of primary care in different areas. One thing that GP-led health centres have done is locate in some of the most deprived areas in the country. We have had great difficulty in getting GPs to work in such areas. They find the work hard and the profits small, because the amount of private work that they get is limited. We have invested huge sums over the past decade in new premises, new technology and many more doctors, nurses and other health care professionals.
Yesterday, I went to Barking where a new family centre has been set up. GPs and dentists were encouraged to locate in a deprived area to ensure that it offered the quality of care that local people needed. As a result of many of those people training in that area—I also visited a centre in the Isle of Dogs—some GPs and dentists have chosen to come back and work there because the facilities are good and the buildings new, and they realise that deprived areas can bring a great deal of job satisfaction.
I am listening very carefully to what the Minister has to say. Does he agree that the bigger polyclinics that are envisaged—where a patient may go and, in a sense, be allocated at random a doctor from a very large panel—will make it very difficult indeed to build a relationship of the type that has been the foundation of our health service since 1948, which is that between a patient and a family doctor?
I think that the NHS and the relationship between patients and GPs have changed since 1948. Some patients want to see the same doctor, particularly if they have a long-term medical condition and they do not want to have to explain their problems all over again to a new doctor. However, some patients are not worried about whether they see the same doctor. If a patient does not have a long-term condition and is, in effect, seeing a GP at random—they might have developed a condition that they just want advice on—they may not be bothered about which GP they see.
There is a tradition of sorts that the relationship between patient and doctor is sanctified. For some people it is, but for others it is not, and we must provide an NHS that enables those people who want to see a particular doctor to see that doctor and those people who are not bothered in the least about which doctor they see not to have to see the same doctor continually. Some people I know do not want to see their allocated doctor at all. They happen to have been allocated to that doctor and end up seeing them. I remember that at some point in the past, although thankfully not at the moment, that was the case for people in my family.
Therefore, we need to ensure that people are able to see the GP who best suits them. My hon. Friend is absolutely right that many people want to see the same GP, but some are not bothered about which GP they see.
We need to provide people with choice, because choice and competition can both make a difference to patients and improve the quality of care. The polyclinics are based in London; we do not have them elsewhere. We have GP-led health centres elsewhere and many are very successful, but the development of polyclinics, which was restricted to the capital, has been enormously successful, particularly in deprived areas. Polyclinics have brought GPs to deprived areas and improved the quality of care in those areas, which we want to continue to work on.
We have pushed power away from Westminster and Whitehall into the hands of primary care trusts, through the world-class commissioning programme, and directly to individual and groups of GPs, through practice-based commissioning. That is all about providing the best possible service for patients—an aspiration that I am sure my hon. Friend shares.
As the Secretary of State has set out, where NHS services are providing excellent quality and performing at the level of the very best, there is no ideological predisposition to look to the market. On the contrary—we want health care provided in the best way that the NHS can possibly provide it. The public service is our preferred provider, but if it is not providing we have to look elsewhere, because the patient comes first.
Where NHS services can deliver, that is good—we want them to deliver—but we are also saying that patients need more power to choose the service that suits them. We in the Labour party created patient choice, precisely because we believe that it should be the interests of patients, rather than those of providers, that determine how health care is provided in this country.
We have already given people far greater choice through the introduction of 90 NHS walk-in centres, which are used by 3 million people every year, and, more recently, through the introduction of GP-led health centres, which enables someone to walk in to see a GP or a nurse while remaining registered at their own GP practice. People can go to the GP-led health centre if they have a random or minor health issue, but if they have a long-term health issue they can still go to see their own GP. They have a choice. Despite fierce opposition to GP-led health centres from some parts of the medical profession and from elsewhere, they have, by and large, proved very popular with patients. Overall, nearly 3 million people have used such a centre already.
Evidence from the UK and from overseas shows that treatments are more effective if patients choose, understand and control their own care. We are putting ever more information about services in the hands of the public. That information will include the waiting times for a particular hospital and the personal comments of patients at a GP practice, so patients can comment on how good their GP practice is.
This process is slowly transforming the traditional doctor-patient relationship, in a way that gives the patient more power. Some GPs do not like it, but it gives patients more power. A more empowered and informed patient can take a more active role in their own care. They can decide, with their own doctor, which hospital to be treated at, and they can take a rational decision about which GP practice is best for them.
The NHS constitution already gives people the right to choose their own GP practice, but for many people that choice is severely limited. Most patients can choose between only a few practices and some patients have no choice at all. That limited choice reduces the competition between practices to attract patients and weakens the incentive for some GP practices to improve quality. Under the constitution, a GP practice must accept a patient’s choice unless there are reasonable grounds for not doing so. At the moment, being outside a practice’s boundary counts as reasonable grounds.
As my hon. Friend said, in September the Secretary of State set out our intention that, within 12 months, people should be able to register wherever they choose. For now, the practice that lies closest to someone’s home may not be the easiest for them to get to.
I ask my hon. Friend to consider his constituents who commute to work and who may find it far simpler to see a GP near their work rather than taking half a day off to see a GP closer to their home. It is all very well to say, as he did, that employers should be more understanding, but some employers just are not so understanding. In addition, many people get paid by the hour, so they would lose money if they had to take more time off work to see a GP.
I also ask my hon. Friend to consider people with children who go to school beyond the boundary of their GP’s practice. Those people may find it easier to register with a GP nearer the school, keeping time off school to a minimum should their child need to see a doctor. Furthermore, some of his constituents may want to change their GP practice because of the better quality of services available at other practices in their area. They may even want to register with the practice closest to their home but cannot do so because it lies just the other side of a line or boundary, or perhaps because of the “closed shop” arrangements that exist in some areas, because a GP practice’s list of patients is full or because lines have been agreed about where the boundary between practices will exist.
The qualities and outcomes framework—the new arrangements to ensure that GPs provide greater health care—has attracted a lot of attention, because money is attached to it. The key thing is that the funding formula is weighted in favour of those people with long-term medical conditions and the elderly. Indeed, there is clear evidence that, since QOF was introduced, health inequalities have narrowed—that is what it is all about. Money follows the patient, so offering people a choice gives practices a strong incentive to improve and attract new patients and retain existing ones.
Similarly, part of the positive impact of the new GP-led health centres has been that they have led other practices to open for longer and to expand their practice boundaries, so that they can compete with new services such as the GP-led health centres. Choice means better access to higher-quality medical care and I cannot see how anyone would want people not to have choice, if that is what choice indeed means.
Of course, given a choice most people will stay exactly where they are; I believe that that is what most people will do. Only a limited number of people want to exercise choice in this regard and, yes, sometimes they are well, middle-class people who just want the choice. Why on earth should they not have it? If they want it, the NHS should be able to provide them with it.
I do not want people to have to go off somewhere and pay privately to get a choice that they really ought to have within the NHS. Frankly, if people are well, young and middle-class, I want them to use the NHS and stay with it. I want them to realise that the NHS will give them a choice, so that later on, when they perhaps really need the NHS for their kids or for themselves when they develop a long-term condition, they will stay with the NHS—those are the people we want too.
However, my hon. Friend is right that we also need to ensure that we care for the people who really need the NHS. They include people from the mining community, such as some of his constituents and some of mine, who have long-term health care conditions. We want to ensure that such people receive the service and the priority that they need.
People with complex long-term medical conditions will want to maintain the continuity of being registered with their local GP, especially when so much of their care will involve other local organisations such as social services, community nursing and diagnostic services.
We want to ensure that where patients want choice, they get it. However, most patients who do not need that choice should not have it forced upon them. In the end, it remains something that patients should choose or not choose for themselves. It is a matter for them.
Age Discrimination (Health Care)
I am grateful for the opportunity to address this important issue on the day on which we rise for the Christmas recess. One curious thing about the lottery process for Adjournment debates is that one can apply assiduously for a topic for many a week, then find that one has the pleasure of securing it on the last day before we adjourn for Christmas. I am sure that we can therefore look forward to a quality debate but not a quantitatively long one.
Many aspects of health care give rise to concerns about how age is used as a proxy to determine—or, in some cases, deny—access to health care, even when the evidence does not support such practices. There is plenty of evidence that age discrimination takes place in cancer and stroke care, cardiology, foot care and continence and palliative care. Rather than going through the evidence for discrimination relating to each of those conditions, I will focus on one area that demands urgent attention—mental health.
After reviewing the literature and evidence, it is hard not to reach the conclusion that the national health service is institutionally ageist. That is certainly the view of doctors specialising in the care of older people, so I welcomed the Secretary of State’s admission in October that age discrimination is still commonplace in health care a decade after the national service framework for older people was meant to have banned age bars and age discrimination across the NHS. It is clear that relative to mental health services for people of working age, the mental health services available to older people have got worse. I stress the word “relative” because there have been clear improvements in some aspects of mental health care for working-age people.
I recently hosted a reception in the House on behalf of the Royal College of Psychiatrists to highlight its call to action at a local level and on the part of individual clinicians. I am grateful to the Royal College for providing me with a briefing for this debate. If we took what we know from the published research and applied it to a typical group of 10,000 people over 64, this is what we would find: 2,500 would have a diagnosable mental illness. Of those, 1,350 would have depression, 500 would have dementia and 650 would have other mental illnesses. Most of those people would go undiagnosed and untreated. According to the King’s Fund, older people are the only part of the population in which the number of people with mental illness will increase by 2026. If nothing else, we are required to address that demographic demand. A concerted response from Government and the NHS at all levels is necessary.
Inevitably, debates such as this—I am sure that the Minister has experienced this on many occasions—turn on what is wrong and needs to be put right rather than dwelling on what is good and wonderful. I make no apology for that, as I hope that he understands that this debate is about raising concerns. I accept that the present Government have not been idle. National service frameworks, “New Horizons”, psychological therapies and the national dementia strategy are just a few of the initiatives that they have taken. However, I am concerned that insufficient attention has been paid to the mental health needs of older people. That lack of attention is not just harmful to the individuals concerned; it wastes taxpayers’ money on late and inappropriate interventions and treatment.
To illustrate, in a typical 500-bed district hospital, an average of 330 beds are occupied by older people, 220 of whom have a mental illness. A shortage of trained staff and age-appropriate services mean that those patients remain in hospital for longer and are more likely to be readmitted as emergencies later. The Government have focused on dementia, with good reason; I have no objection whatever to that. The national strategy is welcome, as was the recent announcement on anti-psychotic drugs. I thank the Minister for getting in touch with me on the day of that announcement. However, a much broader approach to the development of age-appropriate mental health services is required in order to drive change.
The World Health Organisation forecasts that depression will be the second biggest contributor to health costs by 2020, just 10 years from now. The rate of depression is set to rise by 30 per cent. among over-75s, and by 80 per cent. among over-85s by 2026, just 16 years from now. Depression is three times more common than dementia and it increases with age, with the poorest most at risk. It is linked to a greater reduction in health than any other long-term condition, and it leads to a sharper decline in overall health when combined with any other long-term condition.
Nevertheless, just one in six older people with depression receives any treatment, compared with one in two younger people with depression. It is a major risk factor for suicide and the cause of 80 per cent. of suicides. Although it is good news that the suicide rate has fallen in the past decade, it has not changed among older people. As a result, the suicide rate in people over 65 is double that of people under 25. Research evidence also shows that older people with mental illness stay in hospital longer and are more likely to die in hospital or to lose their independence and be discharged to a care home.
I have been listening to the hon. Gentleman’s remarks, and I accept that he might be about to develop this point. However, does he agree that one concern, which I suspect we share, is that the amount of research effort, particularly into dementia, Alzheimer’s and the mental health of the elderly, needs to match the demographic curve? We need to put the research effort behind where things are going. At the moment, there is some question in most people’s minds about that. Is he equally concerned?
The hon. Gentleman is absolutely right to raise that concern, which I hope is shared by all parties. He is two pages ahead of me, but I will return to that point, if I may.
One study found that a person suffering from undiagnosed dementia is three times more likely to die in hospital than other older people. The same research also found that a large number of admissions were inappropriate and could have been prevented by prompt medical care in the community. Lack of specialist assessment is a recurring theme linked to poor-quality care, poor outcomes and waste of taxpayers’ money.
Why are things like this, and what needs to change? The introduction of a national service framework on mental health in 1999 kick-started change and investment in new services, but the drafting of the frameworks reflects an age bias. One need only look at the fact that 149 pages in the NSF for mental health are devoted to the mental health of people of working age, compared with just 17 pages on mental health in the older people’s national service framework. What does that tell us about relative priorities a decade ago? The national directors of both mental health and older people’s services accepted in 2004 that not as much progress had been made in developing new mental health services for older people, and I am told by the Royal College of Psychiatrists that little has changed since then.
As I said earlier, the progress made for working-age people means that older people with mental health issues are worse off now in relative terms than they were 10 years ago. A serious lack of equity remains in access to mental health services. My point is not to claim a lack of good intent on the Government’s part; policy initiatives and national guidelines exist. However, the evidence is compelling that none of that has gained any traction on resource allocation and practice. The National Audit Office has documented how older people have been denied access to assertive outreach, crisis resolution, home treatment and early intervention services available to adults of working age. Other research has revealed a similar pattern of exclusion from hospital liaison, rehabilitation and psychotherapy.
What needs to be done? As I said, the national dementia strategy is welcome. It is an essential although insufficient response to the mental health needs of older people. The Minister and the hon. Member for Eddisbury (Mr. O'Brien) will know that I have a keen interest in dementia research. Only yesterday, I had the pleasure of receiving an answer to a written question to the Minister about the new ministerial taskforce on dementia research. I was fascinated by the answer:
“The remit of the group will be to maintain the momentum begun at the summit by developing a new vision for the future of dementia research and advising on practicable ways to achieve that vision.”
Visions are all well and good. They are useful because people can be pointed towards them. However, a taskforce on research must assemble the building blocks of the additional cash that needs to be invested in the area.
The answer goes on to say that the first part of the body’s remit is
“to devise ways to use available resources more effectively to help increase the volume and impact of high quality dementia research”.—[Official Report, 14 December 2009; Vol. 502, c. 739W.]
That implies that existing cash is to be used, rather than that more will be allocated, and we know that there is a huge gulf between the amounts committed to dementia research and to conditions such as stroke, heart disease and cancer. Finally, the answer states that membership of the body has yet to be finalised. It was announced in July. Five months on, it has not met and its membership is not yet set. Will the Minister say when it will begin its task?
Investment in improving psychological therapies is welcome. However, time will tell whether we will see an equitable roll-out. One in five older people’s mental health services report having no access to clinical psychology and one in three community teams do not include clinical psychologists. The British Association for Counselling and Psychotherapy commissioned an independent review on counselling older people, which concluded that counselling is effective with older people, particularly in the treatment of depression.
It is disappointing that mental health services are not included in the Government’s new entitlements regime that replaces the existing framework. For example, if a person is waiting for cognitive behavioural therapy and the 18-week milestone is passed, there is no redress. There is no funding to allow them to get the provision elsewhere. Why were mental health services left out of the entitlements approach? I am sure that will be of interest to many people outside the House.
An evidence-based approach to developing age-appropriate mental health services would save money and deliver better outcomes for older people. Older people’s hospital liaison services save money. They reduce the length of hospital stays, cut readmissions and result in better outcomes. For example, a Liverpool hospital that had a high readmission rate for older people set up a specialist liaison mental health team for older people in 1999. An analysis of 324 high-risk people who were referred to the team’s social worker because they had complex needs found that they had a 7 per cent. lower six-month readmission rate than the hospital’s older patients in general. It also found that 96 per cent. of referrals were assessed on the day of referral and, of the readmissions, only 13.5 per cent. were considered inappropriate.
Care home liaison can save time and money. It can also help to reduce anti-psychotic drug prescribing—something on which I have campaigned for many years, so I welcome the recent announcements. It is estimated if we made the changes needed in that area we would save £55 million a year. A specialist older people’s mental health care team in Doncaster runs a home liaison team to provide services to care homes. That has helped to reduce admissions to hospital, improve the quality of care and provide training to care home staff. In its first year, the team received 460 referrals and admissions to hospital reduced by 75 per cent.
Crisis home treatment teams can cut hospital admission rates by a third, reduce the length of hospital stays and reduce admissions to long-term care. In west Suffolk, a crisis resolution home treatment team for working-age adults was extended to include over-65s. Older people had previously had no alternative to being admitted to hospital. Most people with whom the team dealt were suffering from depression. The number of older people admitted fell by 31 per cent. as a result of the extension of the scheme, without any loss in patient or carer satisfaction. There is huge potential to unlock resources and reallocate them to services that deliver better outcomes for patients.
Delivering age-appropriate mental health services requires a more informed work force in primary care, general hospitals, care homes and social care, as they must be able to tailor services to fit individual and age-specific needs. The last remaining barriers within and between health and social care need to be torn down. Integration of services is essential to delivering equity and efficiency. Mechanisms such as local area agreements should play a part in ensuring that we have seamless services with integration and multi-agency working on the ground.
Older people’s mental health should be a national priority in the NHS operating framework. I was disappointed to read today in a written answer from the Secretary of State that the new operating framework for 2010-11 is silent on that and that mental health services do not register as a national priority. Not even the dementia strategy registers as a national priority. That is a missed opportunity and a great shame. If guidance, policies and strategies are to get traction, they need to be backed up.
I did not spot the written answer, as I was engaged on something else this morning. However, if the framework suggests that mental health, let alone dementia, is not a national priority, does the hon. Gentleman think that that is an admitted change from what was promulgated under previous Secretaries of State, which was that cancer, cardiac and mental health services were the three priorities that the Government were seeking to address?
That was my reading of the Secretary of State’s written answer. If there is a misunderstanding, I would rather the Minister cleared it up today. Certainly, my reading of the written answer that was published today is that mental health services, including dementia services, do not feature at the top level of the operating framework. They have to be placed at the top level to get the traction that I assume the Government and the Department want the national strategy to have. I know that there is a debate over whether such decisions should be devolved locally. However, the Government clearly intend to drive change in dementia services. The only way to signal that intention is by making it clear in the framework. I want to get that on the record, and I hope that the Minister will clarify this matter in his response.
In conclusion, the biggest challenge to our health and social care system is the ageing population, as it has been for a decade or more. In particular, the challenge is the mental health of our ageing population. Currently, need is not being meet and evidence is not being translated into practice. There must be a shift in Government policy to the health needs of older people and a comprehensive approach must be developed. That must be a clear and unambiguous national priority. It is unsustainable to do nothing. There are huge opportunities in unlocking resources to make improvements. The case for concerted action is unanswerable. I look forward to the contributions of other hon. Members and to the Minister’s response.
It is a pleasure to serve under your chairmanship, Mr. Cook, and to speak in this important debate on the last day before the House rises. I congratulate my hon. Friend the Member for Sutton and Cheam (Mr. Burstow) on securing the debate and on his consistent and vigorous leadership on older people’s issues. Long may he continue to be such a champion for older people.
According to leading older people’s organisations, age discrimination remains the most common form of discrimination in this country. We must take it much more seriously. Perhaps this point is for a different debate, but that is largely due to the failure to put age discrimination on the same footing as other forms of discrimination. Although there are attempts to address that, concerns exist that there will not be the same clarity regarding age discrimination that there rightly is for other forms of discrimination. In a less obvious way, prejudice plays a part in the health and social care systems. Unfortunately, we still hear examples of older people facing neglect, receiving second-class services, being socially segregated and having restricted opportunities. Far more needs to be done to address that.
The figure to which my hon. Friend referred is shocking: almost half of all geriatricians think that the NHS’s failure to provide older people with the level of care to which they are entitled amounts to institutional ageism. That is according to the leading geriatricians in the country, and we should all be deeply concerned about such comments. More than half of those same geriatricians—55 per cent.—said they were personally worried about their own prospects for receiving adequate care from the NHS when they are over 65. Alex Mair, chief executive of the British Geriatrics Society, was quoted in The Guardian as saying
“the NHS is currently failing older people”.
The figures show that people over 65 already account for more than 60 per cent. of hospital bed days, and therefore are responsible for the greatest proportion of expenditure on health and social care. In 2007, 8.2 million people were aged over 65 in England and Wales. That figure is projected to increase to 11.6 million by 2026, which is an extraordinary increase of 46 per cent. Similar rises are projected for the prevalence of disability and dependency. The burden on the health and social care system will therefore increase.
A number of reports are worth mentioning: first, the report on the barriers facing older people, which was undertaken by Sir Ian Carruthers, the chief executive of NHS South West, and the Bristol council chief executive, Jan Ormondroyd. It found that older stroke patients received less adequate care than young sufferers, and that almost half of doctors who cared for older people believed that the NHS was institutionally ageist. I was concerned to see that the report goes on to show in some detail the treatment that my hon. Friend has outlined, particularly regarding mental health. The report “Equality in Later Life” also demonstrates that older people are discriminated against regarding access to out-of-hours and crisis services, psychological treatment and alcohol services.
I am afraid that there still appears to be institutional ageism within some of the main NHS services. On cancer, women aged over 70 are not automatically called for breast cancer screening, despite firm medical evidence of a clinical need for that service. Older women with breast cancer receive a lower level of care than younger women, and are less likely to be diagnosed via needle biopsy and triple assessment. They are also less likely to undergo surgery or receive radiotherapy than younger women. When compared with a 65 to 69 year-old woman, a woman aged 80 or older is five and a half times less likely to receive triple assessment for operable breast cancer, and 40 times less likely to undergo surgery. Even women as young as 70 or 74 are more than seven times less likely to receive radiotherapy following breast conservation surgery.
Department of Health figures suggest that compared with other comparable countries, the UK experiences 15,000 extra deaths from cancer a year in the over-75 age group. In relation to that figure, the gap between the UK and other countries appears to be widening, as does the gap between older and younger age groups in UK.
On stroke treatment, older people are less likely to receive cholesterol-lowering treatments recommended for the secondary prevention of stroke, despite the treatment being equally medically effective across all age groups. Although rates of secondary drug prevention are generally low—26.4 per cent. of patients aged 50 to 59 received treatment compared with 15.6 per cent. of patients aged 80 to 89, with a figure of just 4.2 per cent. for those aged 90 or over—there are lower rates of treatment to prevent stroke in older people, and substantial under-investigation in routine clinical practices for patients aged 80 or over.
On cardiology, according to Age Concern and Help the Aged, 46 per cent. of GPs and care of the elderly specialists and 48 per cent. of cardiologists treated patients aged over 65 differently from other patients. People aged over 65 were less likely to be referred to a cardiologist, given an angiogram or given a heart stress test. Cardiologists were less likely to recommend operations to open up blocked coronary arteries for older patients, and older patients were less likely than younger people to be prescribed cholesterol-lowering statins.
I make those points before coming to the main topic covered by my hon. Friend: mental health. According to Age Concern and Help the Aged, mental health is the clearest example of age discrimination in health and social care policy. A report published in 2009 by the Royal College of Psychiatrists states that tens of thousands of people over the age of 65 are being denied access to specialist mental health services because of arbitrary age limits. That is primarily because the national service framework for mental health extends only to working adults up to the age of 65. There is simply not enough cross-over between such frameworks for mental health and older people. What steps will the Minister take to try to ensure that the frameworks work together more coherently, to ensure that older people cease to get a rough deal by apparently falling outside those frameworks and falling between two stools?
In a survey carried out by the Royal College of Psychiatrists, members of the old-age faculty reported having been
“told of evidence that specialist services for older people with mental health problems, including dementia, are being cut purely to meet the financial pressures created elsewhere in the NHS, and to meet the demands of the Secretary of State that financial balance must be achieved”.
Will the Minister say whether that survey finding is correct, because clearly that is of real concern? We are having a debate about already inadequate mental health services for older people, yet the Royal College of Psychiatrists survey shows that concern exists that services will be cut further.
The Government have of course invested extra money to fund working-age adult mental health services up to the age of 65 during the past three years. Clearly, that is welcome, and I think that people would say that services are improving. However, why should that stop at 65? If the framework is going to stop at 65, why is there not more of a mental health strategy for older people from the age of 65 onwards?
I share my hon. Friend’s passion for pushing the dementia issue up the agenda, both in our hospitals and care homes and on the research side. That point was made by the hon. Member for Eddisbury (Mr. O'Brien), who speaks for the Conservatives. Unless we can start to ameliorate the effects of the many distressing conditions that come under the umbrella of dementia—and hopefully prevent those conditions and perhaps even find the cure—the real concern remains not only that we will fail to tackle the problem of inadequate health care for older people, but that we simply will not deal with the financial time bomb that will affect the NHS and the care system.
The amount of funding for dementia care—I have raised this issue directly with the Prime Minister—remains inadequate. We are all aware that the recession and the reduced funds available to the Government and to us all is an issue; nevertheless, we must look at the impact of not investing more in dementia research. Dementia still receives only 3 per cent. of the medical research budget. I suspect we would all agree that that simply does not add up to a sensible proportion, considering the number of people currently suffering from forms of dementia, the effect on their families and on their ability to work, and the huge demographic increase in the number of older people projected to take place in the coming years.
The report, “New Horizons: A shared vision for mental health”, states that funding for mental health research will triple. Will part of that be research on dementia, or is that a separate budget? Where will that money come from: is it from the existing research budget or a different pot of money? Can he say where the money will be targeted specifically? Will it deal with some of the mental health issues facing older people that we have raised today?
This is an important debate and I am pleased to have been able to contribute; it is a shame that more hon. Members have been unable to do so, perhaps because of the timing, as I am sure it is a matter of concern to many of us. Until older people receive the same care and service from our national health service as everyone else, there will still be a feeling that the institutional ageism that has been commented on by our leading physicians does exist.
I am well aware that St. Nicholas will be rushing down chimneys across the country in the coming week. He was born in 270 A.D. and is still going strong, so he should be a model for us all as we head into mature age. I have also discovered that the etymology of Nicholas is “victory of the people”—it may sound amazing, but it is—so it seems fitting to invoke him here in the mother of Parliaments. Whether he is a redistributive socialist or a right-wing philanthropist is a debate for another time, I suspect, however much hon. Members might encourage me to stray from our subject. All that allows me to wish you, Mr. Cook, the Minister and the hon. Members for Sutton and Cheam (Mr. Burstow) and for Leeds, North-West (Greg Mulholland) a very merry Christmas.
The issue we are discussing is serious and one on which it is our job to hold the Government to account. I hope that the Government’s response will be redolent of the spirit of good will to all men, and all women, and not disproportionately to some who are not old. It is also right during our debate, in thinking about discrimination, age, health care and general well-being, that we remember that many people cannot look forward to Christmases as we do, because of poverty or loneliness in this country or due to war abroad.
However much we disagree in this place, we are all here with equal mandates to make a difference and, through our aspirations, in their diverse ways, to make this country, and indeed this world, a better place for all people of all ages. I congratulate the hon. Member for Sutton and Cheam on securing the debate and giving the matter the airing it indubitably merits, and the hon. Member for Leeds, North-West on the reinforcement he provided.
With the Equality Bill having received its Second Reading in the other place only yesterday, it seems apt to begin with the Government’s pronouncements in that Bill on age discrimination. The Opposition have made it clear that we welcome the Government’s inclusion of age discrimination in the debate surrounding the Bill. The Minister for Women and Equality asserted on Second Reading of the Bill in this place:
“No one should suffer the indignity of discrimination—to be told, ‘You’re old, so you’re past it’”.—[Official Report, 11 May 2009; Vol. 492, c. 553.]
Although she no doubt intended her words to apply primarily to the workplace, they highlight a chasm in the Government’s thinking on age discrimination—the NHS and social services.
Our social care system is still predicated on age banding, at 18 and—topically—at 65. Indeed, the Government are clutching somewhat desperately to the 65 cliff edge in their rapidly collapsing attempts to reform social care. Disability living allowance has been safeguarded for those under 65, but not for those over 65, under the recent pronouncements and the very words of the Secretary of State for Health. I say “rapidly collapsing” because last week the Secretary of State said, as we all heard, that there would be “no cash losers” among those currently receiving attendance allowance and disability living allowance. Given that the reforms in the Green Paper are based on the roll-up of such benefits into the funding package, presumably the Government are not planning to reform social care for those in receipt of those benefits.
Furthermore, the Government have given no pledge that people in the future who have needs similar to those who currently receive attendance allowance and disability living allowance will receive an equivalent cash benefit. That is why we continue to hold them to account over that issue. To pick up on the Prime Minister’s pre-election report, we will soon be fighting an election to protect not only today’s pensioners, but those of the future.
The great irony is that if the Government had not played politics with the Green Paper; if they had been open and honest and published the full modelling that we and all the charities in the Care and Support Alliance called for in advance of the deadline for responses to the Green Paper consultation, but which was not forthcoming—I stress that point in case they reply that they have published something; and if the Prime Minister had not decided to run an election manifesto through the reform with his attempted but failed dividing lines, they might never have caused that confusion over the issue in the policy world, in charities and, above all, in the minds of older, and often vulnerable, people.
The reforms of social care being debated by the Government have also failed to address carers and their benefits. Nothing has been done about the cliff edge that exists for carers who earn; I am focusing on the reference to age discrimination in the title of the debate. There is no ability set out in the reforms to smooth benefits to reward work. More pertinent to the debate is the Government’s failure to instigate a discussion of the fact that carer’s allowance stops at 65. Where will the equality legislation leave that issue? I hope the Minister clarifies that.
That is a fair request, so perhaps the Minister will take the opportunity to address it. It is particularly fair in the light of how the social care reform Green Paper has been transmuting and transforming itself over recent days, rather than over a planned period of years, or even weeks or months. It has undergone the most radical transformation of policy in the past few days, some would say on the hoof.
The hon. Gentleman’s point is fair, because the Government seem to be inconsonant with the timetable, which seems to be advancing rapidly on one side, but with the benefits not being addressed effectively and being postponed until 2018. The Minister will have the opportunity to respond to that.
Only last month a report commissioned by the former Secretary of State for Health, the right hon. Member for Kingston upon Hull, West and Hessle (Alan Johnson), found that elderly people frequently receive worse health care than their younger counterparts—a point that has already been referred to. It laid the serious charge that, in an institutional sense, the NHS discriminates against those people. That was covered fairly extensively in media reports at the end of October. Doctors identified patients over the age of 65 and suffering from mental illness as particularly prone to discrimination, as has been emphasised.
I turn now to mental health. A Royal College of Psychiatrists report found that tens of thousands of people over 65 are being denied access to specialist mental health services because of the “arbitrary” age limits, which is precisely the point that has already been referred to. Mental health services have traditionally been configured by age, which means that someone aged 65 can receive a wide range of support through adult mental health services, but a person who is only one year older, regardless of their need, might be placed in an older people’s service where the same support is simply not available.
The over-65s are also denied access to a range of services available to younger adults, including psychological therapies, early intervention, and rehabilitation and addiction services. The hon. Member for Sutton and Cheam placed particular emphasis on that point. I should therefore emphasise equally the fact that I hope that the Minister will clarify the situation, particularly given that several interventions were made, which have been answered.
The written answer that the hon. Gentleman received restates the Government’s priorities, but omits mental health, which we thought was one of the three issues to have been promulgated as being of great importance over the past decade.
The other question that has arisen relates to the priority that will be given to different areas. Will there be a reallocation of resources? Will there be any extra resources? The issue cropped up during our most recent proceedings on the Personal Care at Home Bill in our debate about the potential for an increase or a reduction in the cash available to dementia research, commensurate with the demographics. We would expect the research effort to match the curve of rising demand.
I hope that the Minister explains what impact the Equality Bill will have. I hope, too, that he tells us what work his Department is doing to change cultures in our NHS. He will readily agree that the blunt weapon of legislation is simply not enough to bring about systemic change.
Earlier this year, as a result of a large exercise involving written parliamentary questions and freedom of information requests, the shocking number of older people who suffer malnutrition in our NHS hospitals became clear to me, and I decided to expose it. The figures show that 70 per cent. of all malnutrition deaths occur among the elderly. The Minister will know that every year—certainly over the past 12 years—an average of 204 people have died of malnutrition. In 2006-07, the number of patients discharged from hospital with a diagnosis of malnutrition, nutritional anaemia or other nutritional deficiencies was 139,127—an 84 per cent. increase over 1997-98 levels. There was a 12 per cent. increase in the number of patients discharged from hospital in such a state in the last year alone.
Such things matter because the number of patients leaving hospital with a diagnosis of malnutrition was 8,533 more than the number of people entering hospital in a malnourished state. That includes those who, unfortunately, went into hospital and, whatever their condition, died there, so the number is all the more worrying. The figures suggest that the nutritional status of at least that number of patients worsened while they were in hospital in 2007.
Malnutrition is not a condition that we associate with Britain, and least of all with our NHS, but the Government have presided over that increase. My colleagues and I have exposed the figures, and we wait to see what the Government response will be to these malnutrition cases, particularly those among the elderly. Surely, such things can be avoided.
The rise of malnutrition among the elderly points to underlying problems in the most basic forms of care that our elderly receive. If our elderly cannot even guarantee that they will be fed well in hospital, no wonder an increasing number of older people and their relatives are expressing concerns about the standard of care that the elderly receive through the NHS.
That is not to run down the NHS. There are solutions and there are some absolutely marvellous examples of best practice, such as the red tray system, which provides an alert without the need to face down the older person over their need for help with feeding. Above all, however, we need enough capacity so that nurses can sit at an older person’s bedside and help them feed, rather than sitting behind a screen filling out target forms.
It is important to explain how we create a stronger voice for patients, particularly the elderly and the vulnerable. Legislation may make the NHS accountable to the Government, but the patients should be given the real power to hold the NHS to account. The local involvement networks initiative, or LINks, betrays the Government’s failure to create an effective and prominent platform to allow patients to voice their views about the NHS. The Government have not been prepared to make the initiative independent of the NHS. It has been a mark of this Government that they have consistently sought to undermine the patient voice.
In that respect, I am particularly critical of the Government. At Prime Minister’s questions, I exposed the former Prime Minister, Tony Blair, who said that he had consulted before axing community health councils. He then had to write me a grovelling three-page apology to say that the Government had done no such thing and that they just did not like CHCs because they criticised the NHS. All but four of the 107 CHCs were excellent, but Labour abolished them without consultation. They did not like the criticism from CHCs, which were able to amalgamate much of the evidence. In that respect, things such as Bedwatch were very important.
The CHC system was not particularly comfortable for the Government or, let us face it, the previous Conservative Government, because CHCs were independent. However, patients trusted them because they felt that they could have their hands held without being put offside with the NHS, whose services they still needed because they were vulnerable. Patients needed the respect that they could get from organisations that they could trust, and that was possible because CHCs were independent.
Having replaced CHCs with patient and public involvement forums, the Government found that those, too, were too outspoken—particularly the Commission for Patient and Public Involvement in Health, which was the national voice. The Government therefore abolished those forums and replaced them with LINks. The contempt in which the Government held the patient voice was shown by their tagging of the issue on to another portmanteau Bill—this time, a local government Bill.
Now, Ministers are starving LINks of the resources that they need to become established and effective. I dare say that many hon. Members are receiving representations from LINks that are trying to make it clear that they do not have the resources that they need to do the job that they are required to do.
How does the hon. Gentleman see the arrangement with LINks going forward? One reason why CHCs were successful and trusted was that they had been around for a long time—a feature that we have not seen for the past decade because of the constant changes. Do we not now need some stability and an opportunity for LINks to bed down? That is certainly true in my patch, where they have been delivering some quite interesting reports, including on age discrimination.
I am grateful to the hon. Gentleman for raising that important point. Some of the better-performing LINks have often been those that bravely stuck with it through the changes. They have provided continuity and a sense of expertise, and they have benefited from a familiarity with the labyrinthine processes of the NHS, social care and other areas.
Rather than completely abandoning LINks, the solution is to ensure that they develop healthily and fit into the context of the Health Watch policy, which the hon. Gentleman will know well, because the Conservative party has had it in the public domain for the past four years, and I will describe it in a second. That will help to cover the point.
One lesson to be learned from what recently took place in Stafford relates in part to the Government’s poor support for LINks and to the lack of a strong local patient voice that can hold trust executives, NHS executives and, ultimately, Ministers to account. That is an ongoing problem. The Conservative party has therefore suggested a national and local independent voice to allow patients to highlight their concerns, as well as increased choice over services, which will enable patients to vote with their feet.
As we begin to move towards a system of payment under which local NHS services are funded according to the outcomes that they achieve for patients, rather than top-down bureaucratic targets, the patient’s perspective on their treatment will become increasingly important.
As I made clear to the Older People’s Advocacy Alliance earlier this year, we must ensure that older people, particularly those who lack the capacity to express concerns about their care, are given equal access to forums through relatives and appointed advocates. Again, we return to the important distinction between central legislation and grass-roots activity. Legislation can go only so far before older people require local advocates and trained, sympathetic staff—sometimes NHS staff—to ensure that the care they receive off the national radar is of a high quality.
As a corollary to that, I am pleased that the Government are finally conceding that quality is a far better indicator of improved health care than activity-based targets. However, cases such as that of Staffordshire general hospital and, most recently, that of Basildon and Thurrock University Hospitals NHS Foundation Trust demonstrate the distance that there is to travel before the rhetoric penetrates to the grass roots of patient care.
Conservatives strongly advocate a shift towards clinical outcomes as a measure of performance in the NHS. With that shift comes a great deal of responsibility towards vulnerable older people, in whose cases it may not be possible to achieve a better outcome or a full recovery. That is an important qualification.
We must ensure that measures such as dignity, nutrition and comfort are rewarded as highly as clinical outcomes in caring for the elderly. There must be no disincentive to delivering quality care to a person whose health is unlikely to improve. On the contrary, we must incentivise NHS staff to ensure that older people receive the care that is appropriate to their needs, regardless of their health.
Our pledge, of which the Minister is well aware, to introduce a payment by results tariff for palliative care will help to ensure that there are services on offer for older people who are terminally ill and who want a dignified and comfortable death. It was with great regret that I witnessed the Government voting against the Palliative Care Bill presented by my hon. Friend the Member for Meriden (Mrs. Spelman) earlier this year. The Bill was intended to give people the right to choose where they die, whether at home, in a hospice or in hospital. Too many older people do not have that choice and are forced to die in hospital because palliative care cannot be made available elsewhere.
I have already mentioned the case of Stafford and the more recent revelations about the standards of care at Basildon and Thurrock University Hospitals NHS Foundation Trust and elsewhere. Those cases have emphasised the fact that a hospital’s foundation trust status does not offer patients a guarantee of quality health care. It is more important than ever that we should have an effective and rigorous system of regulation at an appropriate level to ensure that hospitals that are failing vulnerable patients such as the elderly do not slip through the net. What is more, regulation must penetrate deeper into standards of care than tick-box targets. The news headlines of recent months only accentuate further the disparity that can exist between a hospital’s record on paper and the reality of the care it delivers. So often it is the elderly who are caught in the vortex.
It is vital that inspections should be carried out in person by professionals equipped with the expertise needed to identify poor care. Serious questions have been raised about the effectiveness of the Care Quality Commission, and the Government must prove to patients that they can establish a robust and trusted regulator who can act on their complaints and root out poor practice in the NHS—a regulator who is not at anyone’s beck and call, least of all of politicians, but who acts independently on the basis of evidence. Effective regulation is more important than ever in the case of many elderly people who are not in a position to stand up for their own rights or treatment.
I want to touch on the subject of cancer care. It goes without saying that older people’s health needs are typically more complex than those of other NHS patients, yet it is older people who face the brunt of discrimination in the NHS. Cancer predominantly affects older people, and the risk of developing many cancers increases with age. Nearly two thirds of cancer diagnoses occur in those over the age of 60, yet despite the high proportion of elderly people who face a cancer diagnosis, access to treatment is far from fair.
Women aged over 70 are not automatically called for breast cancer screening, despite evidence that eight out of 10 breast cancer cases occur in post-menopausal women. What is more, a Roche report reveals that only 30 per cent. of oncologists would prescribe the cancer-fighting drug Herceptin for breast cancer in a 73-year-old patient, compared to 90 per cent. who would prescribe the drug to a 55-year-old.
Inequalities are also prevalent in the treatment of lung cancer. The findings of the national lung cancer audit indicate that the proportion of lung cancer patients in England and Wales who receive active anti-cancer treatment falls with age from more than 60 per cent. for those under 54 to 50 per cent. at 70 to 74 and less than 30 per cent. at 80 to 84. Older people also struggle to get access to stroke treatment and cardiology services—a point that has already been made in the debate—and find that they are frequently pushed to the back of the queue for referral to a specialist and for preventive treatments.
In conclusion, in the next 20 years the number of people over the age of 65 will double, and the number over the age of 100 will quadruple. As pressure on the NHS increases, it is more important than ever to iron out discrimination and ensure that health care is delivered on the basis of need, not age. I hope that the Minister will today give a firm pledge to tackle discrimination head on and ensure that our elderly people, many of whom come to the NHS in a vulnerable and fragile state, are treated with the dignity and respect that they deserve, and above all equally.
I congratulate the hon. Member for Sutton and Cheam (Mr. Burstow) on securing this debate.
The Government believe—we always have believed and will always believe—that we must do everything we can to end discrimination against all age groups, including older people. Today’s debate focuses primarily on discrimination against older people, which is a defining issue of our times. It gives me an excellent opportunity, unlike some other Westminster Hall debates, to lay out the breadth of the Government’s response to the issue of discrimination in health care for older people and what we are doing to address it, as well as to deal with some of the issues that hon. Members raised during the debate.
It has been interesting for me to hear the views of the Front-Bench spokesmen—the hon. Member for Leeds, North-West (Greg Mulholland) for the Liberal Democrats and the hon. Member for Eddisbury (Mr. O'Brien) for the Conservatives—on what their priorities are, or are not, and the commitments that they are making at this stage in the electoral cycle. Older people will be paying attention to that. I did not hear a single commitment from either party, but it is for those listening to and observing the debate to draw their own conclusions.
As demography reshapes society, Governments, employers and public services have to find new ways to improve the support that is available to older people, not just in sickness but in health. We need to create a society of all ages, and that is the explicit goal of our new ageing strategy, which none of the hon. Members who have spoken in the debate have mentioned. I agree that high-quality, patient-centred health services are a key to that.
Hon. Members will know that when the Equality Bill, which is now being considered in the other place, is enacted—and I hope that it will be—it will make age discrimination illegal across all sectors, including health and social care, and will extend the public sector equality duty to cover age. We plan to bring the new public sector equality duty into force from April 2011 and the discrimination ban from 2012. Hon. Members have failed during the debate to mention the NHS constitution, which makes the commitment to a
“comprehensive health service, available to all irrespective of gender, race, disability, age, sexual orientation, religion or belief.”
Those are powerful statements of intent from the Government and will certainly sharpen minds in the years ahead. However, they must be backed up by real action on the ground.
Before I come to the specifics, I want to highlight the broader sweep of the action that we are taking. The recent age equality review by Sir Ian Carruthers and Jan Ormondroyd will help us to make further inroads. It contains many of the sentiments expressed in the Age Concern and Help the Aged report published yesterday. It has also been commended by the Equality and Human Rights Commission, which produced a briefing for today’s debate, and which has welcomed the fact that its recommendation of a 2012 deadline for implementation of the ban has been taken up by the Government. It is good to know that the commission is powerfully on the side of the Government in this case. I hope that it is not among the organisations that the Opposition threaten to close if they ever return to power.
The age equality review recognises that the national health service has made progress on reducing age discrimination and provides sensible ideas on how to move things forward. We are consulting on the best way to put those recommendations into practice. One of the important messages coming out of the review was that reducing discrimination first and foremost means improving the quality of the existing services. If we can create the preventive, person-centred NHS described in Lord Darzi’s report, “High quality care for all”, and more recently in another report that hon. Members have failed to refer to in the debate, “From good to great”, which is the new five year plan for the NHS, we shall automatically remove many of the problems that hon. Members have spoken about today.
Specific aspects of treatment and care for older people have been a problem in the past, but we have taken measures to address them. The main engine of change is the 2001 national service framework for older people, a 10-year programme to improve access to screening, treatments and other services. I am delighted to say, as others have not, that the framework has led to significant increases in the number of hip replacements and cataract operations, and a more than doubling in breast screenings for the over-65s, for instance. The next steps for the framework will be to address shortcomings in audiology and to improve the commissioning of services in connection with falls, fractures and osteoporosis.
Alongside the framework, many other Government programmes are directly or indirectly improving the quality of care for older people. No mention has been made this afternoon, for example, of the dignity champions campaign. We have 11,000 dignity champions in every part of our health and social care system, from front-line care workers to chief executives of primary care trusts and local authorities, making sure that older people are treated with respect and dignity. There is a drive to abolish mixed-sex accommodation, which is a particular concern for older patients. All hospitals must abolish mixed-sex wards next year unless they are clinically necessary, or face a financial penalty. That is another important milestone for the Government.
As hon. Members said—this is something that has been mentioned—we introduced the national dementia strategy, which I was proud to launch earlier this year. It will deliver real change in the quality and scope of services for people—mainly older people, as we know—who are affected by dementia. “Living well with dementia” is the title of the strategy, and it includes new measures for diagnosis so that we can get earlier intervention and treatment for older people and support them at the outset. New ideas such as memory clinics are being developed around best practice, better services and care.
The issue that Members have particularly highlighted is dementia research, which is one of 17 key objectives in the national dementia strategy. I opened and launched a national summit on dementia research in July. It was not then but in November that I announced the creation of a ministerial group on dementia research. I am putting the hon. Member for Sutton and Cheam right on the date on which I made the announcement in Harrogate. It is my intention that the first meeting of the group will be held on 24 February. I hope that that specifically answers his question. He has a habit in debates like this of getting information out of me on specifics, and I am always delighted, if I can, to take the opportunity to give him such information.
Spending on dementia research is the key issue that the group will look at. The hon. Gentleman read out the group’s terms of reference—what it is all about. We know that by next year there will be a £1 billion ring-fenced budget for research on health services in this country. The question is how much of it will be allocated to dementia. This is not about Ministers saying, “This amount of money will be put in.” It is about independent clinicians looking at the bids coming in from the various sectors that seek research funds. Part of the problem that we have had is that the dementia researchers have not been putting in quality bids to win cash from the large pot of money, which has been growing year on year, that we spend on research in this country.
My concern is that the Dementias and Neurodegenerative Diseases Research Network, or DeNDRoN, is fully equipped and supported to improve the quality of its bids and to win more of the resource for dementia research, whether on analysis of the causes of dementia—we are a long way from finding a cure—on the care of people with dementia, on how people are treated using dementia drugs and so on. There is a great deal of work to be done. Dementia is where cancer was 20 years ago in terms of there being a talented group of individuals in research who are coming up with good ideas. The work that the third sector does in raising money and resources in its own way, international collaboration and co-ordination are all things that need to be driven forward, which is why I created a ministerial group to do just that, and to ensure that we raise our game on dementia research.
I am happy to take suggestions of any kind about how we make the group work well. I want to ensure that it covers the broadest aspects around dementia research and involves all the key players such as researchers in the public sector and the private sector, if that be the case, and advice from the business community—frankly, wherever and whenever we can do the work that we need to do. We need to make the group manageable, so we must think about its membership. I have come up with a list of people. In practice, I am sure that we can engage many of the people out there, not just in this country but abroad as well.
The hon. Gentleman makes a good point, and I shall certainly liaise with ministerial colleagues. However, it will be my group. I will run it and ensure that it works well.
Another key aspect and plank of Government policy that hon. Members failed to mention is the end-of-life care strategy. It is worth mentioning in the tour d’horizon—the line of work that we are carrying out—as something that the Government are taking forward. The strategy is improving how older people are treated at the end of their lives, and deals with how and where they die. In addition, we are undertaking vital work in social care as well as health care.
The putting people first programme provides £500 million of extra resources to local councils. It is ring-fenced and helps them to build more personalised care services, not least for older people. In the partnerships for older people project, health and social services have joined charities and community groups to take action to reduce the incidence of people falling in their own homes, and to increase older people’s independence.
Of course, as mentioned by the hon. Member for Eddisbury, we have introduced radical proposals for social care which involve creating a national care service for the future. Despite all the arguments made in the House on Monday on Second Reading of the Personal Care at Home Bill, both Opposition parties decided not to oppose it and, I am delighted to say, it has gone to Committee. Clearly, this Government have touched on something, and we are leading the way and ensuring that those people with the greatest needs—mainly older people living in their own homes—are supported so that they can continue to live in their own homes independently, with choice and control over their life.
Another strategy that the Opposition parties failed to give the credit it deserved is the carers strategy. We will not be bringing it forward because it is a 10-year strategy—it is defined by that length of time. We have a three to five year delivery programme in place to make it a reality. It includes extra cash—not least for respite care—for local authorities, primary care trusts and groups in the community.
The hon. Member for Eddisbury raised a particular issue concerning carer’s allowance. I was intrigued by his query, because, as we know, carer’s allowance is an income replacement benefit. Someone cannot be paid two benefits at the same time, which is why carer’s allowance comes to an end when somebody receives a pension. The pension is paid, and there are premiums on top of that—the carers premium—for pensioners in particular circumstances.
As the Minister seeks to challenge me, I was drawing an analogy to show where a great deal of age discrimination is institutionalised within the process. I did not make any of the allusions that he spoke about. It is well known that carer’s allowance is an income replacement benefit, although it is often perceived very differently by those who are in receipt of it. That is one of the challenges and issues that he and, indeed, all of us face.
On the subject of respite care, the Princess Royal Trust for Carers has come up with the shocking finding that, of the £50 million out of the £150 million allocated under the Government’s strategy to cover respite care—we would hope planned care as much as emergency respite care—£40 million has gone missing, yet the only response so far from Ministers is that it is up to all MPs to harry their local trust. That is obviously an inadequate answer, and I hope that the Minister can tell us where the £40 million has gone.
So no change on carer’s allowance. When parliamentary representatives from the Opposition ask me questions, it implies that they are going to do something, but clearly not in this case.
On respite care spend, the hon. Gentleman is right to highlight the question raised by many carers organisations: is the money that we have allocated to the non-ring-fenced devolved budget being spent? The Liberal Democrats have fought very hard for that in their localist agenda, yet they press me hard in the national setting on why it is not being spent locally. However, to point out that contradiction, I would need to repeat something that I have already said in many debates in the past. There is an obvious contradiction in the Liberal Democrat position.
In fact, I have met the Princess Royal Trust for Carers and others from the carer’s allowance unit to discuss this particular concern, to see whether we can do more to monitor the work that is being done on the spend of the resource, to find out where there may not be sufficient allocation, as they would see it, and to see what more strategic health authorities, for example, might do with the PCTs in their area to ensure that the respite care that is needed is properly commissioned through the new guidance that we are issuing to PCTs on how to commission services for carers, and to see that that happens in practice.
That is all very well. In previous debates on this issue I have mentioned the need for transparency to the Minister. If we are to have local accountability for decisions made by local primary care trusts about the spending of this money, we need transparency locally. However, that is missing, which is why we have not been able to hold PCTs to account locally. Surely the Minister can help with transparency.
Of course, transparency is an essential part of how a good national health service will work locally—being accountable to local people. Many things have been put in place to ensure that commissioners are given guidance on how to carry out good commissioning for services for carers, including respite care. Those local groups can take that guidance to their PCTs and discuss it with them and ensure that the local PCT is commissioning to the best quality practice that we can make available. A number of steps are in place. I can give the hon. Gentleman the assurances he requires, so that the Liberal Democrat policy is as consistent as we all would like it to be.
The hon. Member for Eddisbury mentioned malnutrition. He is right. We established a working group that produced a report earlier this year. We are preparing our response to that—he will just have to wait a little longer until we can make clear how we wish to take matters forward. I agree that practical steps can happen now to deal with issues relating to malnutrition. The hon. Gentleman mentioned a couple of good examples—red trays, and so on. I have visited hospitals where picture menus are used. Asking people to look at a picture of food rather than a description of it on a menu is a practical way of getting them to choose the food they really want. When the food arrives, it matches the picture. The cooks have to ensure that it actually matches the picture that is chosen, which raises the quality of the food provided.
There are many other aspects of the dignity campaign, including dignity champions.
I am grateful for the Minister’s time and, in the spirit of Christmas, for his generosity.
What will the future be of the board that was set up to write the report on malnutrition to which he is considering a response? Writing a report is one thing, but there is a need to see its recommendations implemented. Will that board be in place afterwards?
The hon. Gentleman will have to wait just a little longer. I am generous in giving him answers in these debates, but on this occasion he will have to wait for my analysis of the recommendations regarding what needs to happen and how that might be pursued, so that action happens on the ground. It is not a question of our not knowing what to do; what matters is making things happen on the ground, and that is what I am bending my mind to as I take my considerations forward.
The hon. Members for Leeds, North-West and for Eddisbury mentioned cancer treatment. There is more to do here. I am pleased to say that cancer death rates across all age groups have declined over the last decade, although the decline among older people has been much less significant than for other ages, as hon. Members have mentioned in detail. That is why we have established a national cancer equality initiative to tackle all inequalities in cancer care, including improving the treatment and services offered to older people. Early next year, there will be a new practical guide on reducing inequality, including detailed analysis from the national cancer intelligence network of data by cancer type, age and geography, so we can show where our efforts need to be focused in future. We are also looking at pilots to improve the way that older people are assessed for cancer treatment, to ensure that that is always done on the basis of clinical safety and effectiveness and never on the basis of age alone.
Other questions were raised about cancer screening. Our screening programmes are well respected internationally, with high-quality services and high levels of coverage. It is vital that we base all our screening programmes on the best international evidence. We must weigh up the effectiveness of screening certain age groups against the harm that may be caused—the possibility of false positives and false negatives—and the stress and anxiety that screening can lead to. It is not for Ministers to make any decision on the age range for screening; it is, rightly, a decision for the clinical experts. As the age equality review recommended, we will commission a programme of research into the upper age limits on breast screening.
I want to put hon. Members right on something that has been mentioned today. We are now extending our routine screening programmes for breast cancer to include women aged up to 73, and extending the programme for bowel cancer for men and women to those aged up to 75. It is important to get those facts on the record. I remind hon. Members that people beyond those age ranges can still self-refer to these screening programmes, and I strongly encourage them to do so if they have a history of cancer in the family.
The hon. Member for Sutton and Cheam began with mental health, and that is where I should like to conclude. I am grateful to hon. Members for mentioning that we have launched “New Horizons”, our new national strategy for mental health. However, before I get into that, I should like to say something about the national operating framework, which the hon. Gentleman mentioned.
I am at a loss to know what the hon. Gentleman is referring to that suggests there has been some kind of change. Perhaps he and I can correspond on this issue afterwards. Mental health is explicitly mentioned a number of times in the national operating framework, and is specifically mentioned in “New Horizons”. In the framework we highlight the importance of intervening earlier in mental health problems so that we get better outcomes and better value for money. There are five explicit references to mental health in “New Horizons”, although I will not read them out, and two explicit references to dementia. The whole of the “New Horizons” strategy is a lifespan approach. I do not think there has been a change of the kind the hon. Gentleman mentioned. Perhaps afterwards, through correspondence, we can confirm what I know to be true: that we have not changed the priorities in the way he suggested.
I was trying to clarify whether mental health has become a “must do” in the operating framework. I understand that it has tiers, and that there are some things that are nice to do but which are not mandatory for local NHS organisations to deliver on. Has mental health been elevated to a “must do”?
That is a different question from the one the hon. Gentleman raised in the debate. I thought he asked whether it had been downgraded in some way—[Interruption.] I understand now. With that in mind mental health services and the operating framework are not where they were before, with vital signs listed and five references made. We have moved on from the 10-year mental health service framework, which is now over—this is its last year—to “New Horizons”, which went out to consultation and has now been published. That supersedes the old national service framework for mental health and will tackle the historic differences, which hon. Members were right to highlight, in the way some older people are treated compared with working-age adults.
The new strategy will build on firm foundations. Spending is up by £2 billion over the past decade. We have two thirds more psychiatrists, a fifth more psychiatric nurses and more than 700 new community mental health teams, giving us a firm foundation and meaning that we can help people of all ages to access the services they are going to need.
For the avoidance of doubt, I have brought a copy of “New Horizons” with me. I shall mention annexe A particularly for the benefit of the hon. Member for Leeds, North-West, whom I do not think has read the detail. Annexe A is entitled,
“Characteristics or Descriptors of Non-discriminatory Services for Older People”,
and that is mentioned in the main body of the text, which also covers primary care, mental health services, physical health problems, issues to do with research, and so on. It specifically refers to
“community mental health teams”,
which I think the hon. Gentleman mentioned,
“Crisis Resolution and Home Treatment services, assertive outreach services, Improving Access to Psychological Therapies (IAPT) and psychological services”,
and so on. All older people should have the same access to these services that we have been building up over the past few years. I hope that that gives the hon. Gentleman the assurances that he and the hon. Member for Sutton and Cheam want about older people, who feature large in the strategy and are an important part of the future of mental health services. It is not only about mental health services; it is also about preventing mental ill health in the first place, through a cross-government strategy.
Let me provide some specifics. I will be doing a lot of work over the next few years, chairing a new ministerial advisory group on mental health inequalities to lead this agenda. We will work with the Royal College of Psychiatrists and other professional bodies to help providers re-design these services and tackle some of the cultural issues that mean that older people sometimes lose out. Training programmes for general practitioners and practice nurses, for example, will be developed, helping them become more sensitive to signs of depression among older people. This may also mean longer consultations by GPs, so they have more time to check on an older person’s mental well-being and on the physical health reason about which they may have attended the surgery in the first place; and strengthening the availability of services for older people living in residential care homes, as was mentioned earlier, where depression issues can be strong.
For clarification, the 18-week wait to which reference was made applies to consultant-led mental health services, so there is an element of this in the present system. I believe that there are signs that mental health services are changing for the better. We have seen some great examples of GPs, therapists, social workers and care providers working together to provide the integrated personal support that we need.
I am delighted that this debate on the last day before the House rises for the Christmas recess has provided an opportunity to air the matter of support for older people and of tackling age discrimination in health care. It has given me the rare opportunity to spell out at length the Government’s high and strong track record on such matters, which is all about quality and consistency. Age discrimination, like any form of discrimination, is unacceptable. We have taken some important steps to remove it from health and social care, but there is of course more to do. I look forward in the months and years ahead to addressing the many issues that I have set out today as we move closer to what everyone supports—a full ban on age discrimination across all services.
Teesside Steel Industry
It is a pleasure to see you presiding over this important debate, Mr. Cook. Had you not been presiding, I am sure you would have joined in the debate, as I know that this subject is close to your heart.
First, I thank Mr. Speaker for granting me this debate on what is an important subject for my area—steel is the lifeblood of our economy. Nearly a fortnight ago, Teesside was rocked by the disastrous news about the mothballing of the integrated iron and steel plants of Redcar and Lackenby. That news has destroyed the festive spirit of thousands of families across Teesside. The plants are in constituency of my hon. and learned Friend the Member for Redcar (Vera Baird), who is taking a lead on this matter and has been fighting hard. However, many of the job losses are in my constituency.
I was once one of the many thousands of people who worked at that plant. As a young graduate engineer, I worked on bringing the Redcar blast furnace—the biggest blast furnace in western Europe—online in 1978-79. I worked on that furnace for eight months, and many years later I remember my many trials and experiences with it. Therefore, I have a deep, emotional attachment to this matter.
I shall talk generally about the steel industry on Teesside, including the importance of research and development. Then I shall say a few words about the steel industry in my own constituency, in particular the Skinningrove works. Then I shall raise the big issue that I mentioned earlier—the mothballing of the integrated plants in Redcar and Lackenby.
The importance of the manufacturing industry for our economy has been underestimated. We cannot survive as a nation on an economy that seems to range from pizza parlours to DVDs or sportswear retail warehousing. Manufacturing accounted for more than 20 per cent. of the economy in 1997 when Labour came to power and criticised the country for having too narrow an industrial base. However, by 2007, that share had declined to 12.4 per cent. Why is manufacturing important? Quite simply, it acts as a multiplier across all boundaries of the economy. It encourages the development of human skills, and the development of an infrastructure to support those skills. It also encourages research and development and the spread of innovation.
I will say a few words about steelmaking on Teesside. Steelmaking has been central to our economy since the mid-Victorian age, and has evolved over the decades to the position that it is now in. The main works line the River Tees and the core of those works is found in the Teesside Cast Products iron and steelmaking complex, whose mothballing has been announced.
At Grangetown, we have a fully functioning and impressive steel technology centre. That centre has an international reputation with an outstanding pilot plan, and many brilliant metallurgists, engineers, technologists and scientists work there. I must declare an interest, as I am a former employee of the research centre, and I had 14 happy years working there. Some of the work that I undertook at the Teesside technology centre was connected with the completion of what was then the British Steel Redcar works, and the commissioning of the new blast furnace. At that time, the furnace was considered the biggest in the UK; I seem to recall that it was the biggest in Europe.
The furnace in Redcar was a great British achievement. It was to make iron for feeding to the Lackenby basic oxygen steel plant, and the associated continuous casting plant. Both were then state-of-the-art steelmaking and processing plants and, due to regular upgrading, they are still world-class plants today. They deserve more than merely being consigned to the scrap heap of past manufacturing glories, left to be of interest only to the industrial archaeologists of the future.
It is an honour to be here with you today, Mr. Cook, and I congratulate my hon. Friend and praise him for the great work that he and other Teesside MPs have done on this issue.
The reality is that we need to keep this plant going. If we are ever to deliver the low-carbon economy that we have promised for the north-east, and develop things such as underground gasification of coal, carbon capture and storage, and sequestration of CO2, we need to develop skills, not lose them. We should not consign them to history as has happened to so much of our industry in the north.
I must declare an interest because members of my family work at Corus on Teesside. The Copenhagen summit is taking place as we speak, and a low-carbon future for the world is being discussed. Does the hon. Gentleman agree that there is no better place than Teesside, with the skills, industrial heritage and facilities that it has available, to lead the world in that? Is this news not a bitter blow that must be overcome so that we can use that fantastic potential on Teesside?
I agree with every word that the hon. Gentleman has said. I hope he is saying that we have to keep the works open. If he is, I am wholeheartedly with him all the way. The sentiments he expresses are similar to those expressed by my hon. Friend the Member for Blaydon (Mr. Anderson).
In my constituency, we have the world-class Skinningrove rolling mills, which until now have concentrated on small sections for the construction machinery sector. They have recently moved into supplying sections for the wind farm industry, which is seen as a sector where exponential growth can be expected. The mills have a vigorous and dynamic management and a committed work force who want the plant to grow and prosper.
I have helped the mills over recent months by brokering an offer from the local authority, Redcar and Cleveland borough council, for business rate relief. That offer is substantial, and I hope the Minister will join me in praising the dynamic management and the work force of Skinningrove works for their hard work and commitment.
I come to the subject of Teesside Cast Products and the disastrous news about the mothballing of the integrated iron and steel plants of Redcar and Lackenby. There is also the sad news that 1,700 steelworkers might be made unemployed. Furthermore, it is estimated that 8,000 people down the supply chain will lose their livelihoods.
The autonomous complex within Corus called Teesside Cast Products was once seen as the future of steelmaking—not just in the north-east, but in the whole country. The future of Teesside Cast Products was secured by a deal with a consortium that agreed to purchase almost 80 per cent. of the plant’s output until 2014. That consortium included steel traders from Korea, Mexico and Italy. However, when the demand for steel across the world dried up, the partners, led by the Italians, tore up the agreement and announced that they would not buy any more steel.
I place on the record my great praise for all the efforts made by my hon. and learned Friend the Member for Redcar to reach commercial solutions with the consortium to preserve production at Teesside Cast Products. In fact, she went to Italy to try to persuade the Italians to come back to the table. She displayed great courage.
On Teesside, all is not lost. After all, the Teesside Cast Products plant has not been closed completely and, according to Corus, will be kept in a state of total readiness for any possible restart. A full maintenance team will be kept in employment purely for such an eventuality. I need to stress the fact that bringing a blast furnace back online can be done. It was recently done at Port Talbot, after a year’s shutdown. It was also done at the associated Corus plant at IJmuiden in the Netherlands.
I recognise that the Government have said that they are prepared to help Corus on Teesside, but that seems to be limited to the same recipe of cash for training and retraining. That support is important and helps those displaced by the Corus announcement to find other employment in the local labour market. Positive action in finding other industrial uses for the Redcar and Lackenby site is also welcome. That could be one of the new generation of carbon capture power stations recently given the go-ahead by Government, or used for other low-carbon applications. However, I still believe that that is not enough.
I am delighted that my hon. Friend has secured the debate; I am only sad that it lasts just 30 minutes. References have been made, and he is now making them, to the amounts of money that we require to ensure that we keep steel making on the Tees. Reference has also been made to the European globalisation adjustment fund, which we could tap into. That is a seriously large sum of money. In his opinion, will that be the next step that we take to ensure that we retain and maintain steel making on the Tees?
I thank my hon. Friend for being here and supporting me. I agree with her on the globalisation adjustment fund. That is one of the questions that I intend to raise with the Minister.
We need to keep the plant alive and making a contribution to the regional and national economy, both as we go into the economic upturn in the new year and in the coming years. I feel strongly that there is a 10 per cent. chance of keeping the Redcar steel complex open and we must do everything possible to keep it open. Also, to realise the vision originally held for Teesside Cast Products of a high-quality producer of bulk steel for the world re-rolling market, we must urgently search for new partners. The responsibility for that lies with Corus and the Government.
There are still, I believe, windows of opportunity. I am told that the Pacific rim, for example, has hardly been affected by the downturn in terms of infrastructure projects. Granted, new steel-making capacity will be coming on stream in future years in that region, but that will take a long time to bed in. Teesside is an existing world-class iron and steel-making complex and its products are tried and tested.
While my hon. and learned Friend the Member for Redcar has taken the lead with Corus, I have made every effort and used all my links with Tata to find possible solutions. In the many conversations that I have had with the members of the Tata board, it has been clear that they feel that the Government have not done enough to help the industry; they had lost confidence in the Government’s support for steel.
I welcome the announcement that the Government allocated £60 million in a response package, but the Minister will know that there has been some concern in the media and on Teesside about that announcement. I shall therefore ask some important questions and seek reassurances. How much of that cash will come from existing budgets within his Department and the regional development agency, One NorthEast, and is that cash guaranteed for Teesside?
Will the Minister reassure me that the cash allocated to help apprentices is safe, and will he name the agency that is to handle that work? Will the cash from the strategic investment fund, boosting efforts to build a low-carbon economy in the region, come to Teesside, given that previous commitments to the new and renewable energies cluster were for the whole north-east? Are those low-carbon funds as yet unallocated? Will the cash for biotechnology initiatives be used to offer new employment openings for displaced process workers affected by the Corus mothballing?
Companies such as Progressive Energy, bidding to build an 850 MW power station on a site nearby, have suggested that their work could keep the Corus plant open by capturing carbon dioxide from Corus operations, thereby allowing Corus to bid for carbon credits. Will the Government, through the Department of Energy and Climate Change, examine that possibility, along with similar opportunities?
Will the Government apply for financial assistance under the European globalisation adjustment fund, mentioned by my hon. Friend the Member for Stockton, South (Ms Taylor)? That could be used to lessen the blow to individuals by allowing cash from the fund to supplement the training packages being devised. Will the Minister accept the Government’s role in providing match funding for that if it is required?
Crucially, even at this late stage, I urge my right hon. Friend the Prime Minister to pick up the phone and call Ratan Tata, chairman of the Tata Group, and Mr. Muthuraman, former managing director of Tata Steel who is now the vice-chair of the Tata board, to invite them, along with Corus chief executive Kirby Adams, to an urgent steel summit in No. 10 Downing street with the trade unions.
I urge the Prime Minister to approach that meeting as he did the meetings with the bankers, to ask Mr. Tata what the Government can do to keep the plant open, and to do it for the sake of all the people on Teesside whose livelihoods are threatened. I can tell the Minister that I have spoken to the representatives of the Tata board and they are willing to come to No. 10 Downing street to discuss with the Prime Minister a rescue package to keep the Redcar steel complex open.
Steel and Teesside are inseparable in the consciousness of my constituents. In more practical terms, the livelihoods of tens of thousands of Teessiders and their families depend on steel. I hope that the Labour Government, whom I have supported passionately on every occasion since 1997, will join me and give further support to the ideas that I have suggested today, because the opportunity exists. I want our Prime Minister and his Ministers to take that opportunity. Do not let us down at this time.
I congratulate my hon. Friend the Member for Middlesbrough, South and East Cleveland (Dr. Kumar) on securing this debate. I know how much the steel industry means to him personally—as he said, he worked for many years in the steel industry at Teesside—and to his constituents. It is in his blood, as it is in theirs.
I note the presence here today of other Members from the area, including my hon. Friends the Members for Blaydon (Mr. Anderson), for Stockton, South (Ms Taylor) and for Hartlepool (Mr. Wright), and my hon. and learned Friend the Member for Redcar (Vera Baird)—and you, Mr. Cook. As my hon. Friend the Member for Middlesbrough, South and East Cleveland said, as a constituency MP you too have a great interest in the subject.
If anyone doubted the strength of feeling in the local community about what is happening at the Teesside plant, they need only to have seen the demonstration of support at Middlesbrough’s Riverside football ground over the weekend. I understand that. I understand the pain caused by the loss of a steelworks in a local community, as steel runs through my constituency too. It is now 30 years since the Bilston steelworks closed, but local people remember it as though it was yesterday. It has taken a long, long time for the area to recover.
The current recession has hit the steel industry hard. Three specific factors serve as the backdrop for Corus’s decision to mothball the Teesside plant. The first is a fall in demand. This year, steel production at Corus is expected to be some 33 per cent. down on 2008, and only about 60 per cent. of capacity. Teesside Cast Products—TCP—makes steel for export, but if we compare the first nine months of 2008 with the same period in 2009, we see that steel demand throughout Europe has fallen by 40 per cent. The potential for the company to trade its way out of its difficulties in this country is severely limited.
The second factor is a fall in price. Between July 2008, when prices peaked at just over $1,000 per tonne, and December 2009 the price per tonne of the kind of steel produced at Teesside has fallen by nearly 60 per cent. That has left Corus struggling to cope with the twin problems of a fall in demand for its product and a fall in price. Not surprisingly, that has put severe pressure on Corus’s finances and the economics of its steelmaking operations, hence the announcement of large-scale job losses twice this year, even before the Teesside announcement a couple of weeks ago.
Given the time that is available, I do not think that Teesside wants an explanation of the problems faced by Corus; it wants to know why the Government have failed to act in bringing together the right sort of people in a summit to save Corus. Will the Minister move on to that?
If the hon. Gentleman wants to talk about failure, I simply turn to the Opposition’s continued opposition to the fiscal stimulus that has boosted demand for steel products. I am not going to take any lessons on inaction from a party that, throughout the recession, has consistently called on us to cut spending. That would have hurt steelmaking even more than the difficulties I have outlined.
It is important for us to hear from the Minister. The press say that the Government are apparently blocking attempts by the regional development agencies to access funds, and are failing to match the support given by other European countries to their core manufacturing industries. We need to know this afternoon whether there is any truth or credibility in that.
I assure my hon. Friend that we are not in the business of blocking anything that might be constructive for the future of the Teesside plant or the area. In contrast, our response has been both swift and significant in scale.
The third reason for Corus’s decision, to which my hon. Friend the Member for Middlesbrough, South and East Cleveland referred, is specific to the Teesside plant: the collapse of the off-take agreement to buy the steel produced there. The agreement was reached in December 2004. Under it, 78 per cent. of the slab steel produced at Teesside was to be sold at cost over a 10-year period to a consortium of four foreign steel companies. Earlier this year, that agreement broke down, in part because the world market cost of steel had fallen below the cost of producing steel at Teesside; the off-takers walked away from the agreement.
I spoke at the time to Corus chief executive Kirby Adams and to Antonio Marcegaglia of Marcegaglia steel, the lead partner in the consortium, to encourage them to resurrect the off-take agreement. I asked the two sides to meet again to try to resurrect the agreement, and stressed how critical it was to the future of the plant and to the thousands of people of Teesside who depended for their livelihoods on the continued operation of the plant—the reason for the agreement. Members will know that that meeting took place in July, but no agreement was reached.
Against a background of falling demand and a depressed price, and with no partner for its product, the future for TCP looked bleak. Despite that, Corus tried to keep the plant alive, transferring internal work to it and securing some short-term export work. Eventually, however, the three factors that I mentioned earlier took their toll, and the decision to mothball the plant was announced.
Throughout, the Government did what we could to keep up demand for steel. We brought forward capital spending on construction, which accounts for about half the steel used in the UK. Without that investment, the UK construction industry would be flat on its back. We also committed £400 million to the car scrappage scheme to underpin the vital automotive sector, another very large user of steel. Again, I stress that those stimulus measures were opposed every step of the way by the Opposition. Had we taken their advice—if they had had their way—demand for steel would have been hurt even more than was dictated by the market conditions.
I set out the background in order to make it clear that Corus’s decision of a couple weeks ago was not taken as a result of Government inaction. We went the extra mile to try to boost demand and to resurrect the off-take agreement upon which TCP depended. Corus has not asked for aid to keep the plant open, which in any case is not possible under state aid rules. The fact is that Corus cannot run the plant without customers and without demand for the product it makes.
I am keen to press on if my hon. Friend will forgive me.
As a result of Corus’s decision, 1,700 people employed directly by the company will lose their jobs, as will a further 1,000 sub-contractors.
In the couple of minutes left to me, I want to move on to the questions about the support package that have been asked today. The Government have moved quickly. The Prime Minister and I have both spoken to the chief executive of Corus. The chief executive has stressed that the site is mothballed and that no decision has been taken to close it permanently. Of course, market conditions may change, a new partner may be found and steel could be produced again at the site. I tell my hon. Friend the Member for Middlesbrough, South and East Cleveland that if we can help to bring that about, we will do so.
However, those possibilities will not come about easily, and it would be wrong of the Government to stand back and wait for that to happen. The people affected by this announcement need help now. That is why my right hon. Friend the Secretary of State announced a £60 million package of support. My hon. Friend asked some questions about that funding. It includes £30 million of new money from the Government’s strategic investment fund, and £30 million from One North East, the RDA, which is to be reprioritised from within its existing resources.
Much has been said about low carbon, rightly so, as it is critical to the future of manufacturing in the area. We will use the money to equip Teesside to become part of our low carbon manufacturing base. We know that low carbon is the future. If we are to succeed, we must have a national low carbon capability. It will include £6 million of support for research and development of bio-based materials, £3 million to undertake engineering design, and £20 million for infrastructure development. We will also support the critical Wilton chemicals cluster; we want to see it continue and prosper as part of the low carbon future.
The Government are committed to the people of the north-east, and wish to help them recover from this decision. I have seen what can happen when whole communities are left on their own. We will not let that happen in this case. Rarely can a Government have moved so fast and on such a scale in response to a closure, but the people of Teesside deserve it. They deserve our help, and we will stand by them in future.
Neuroblastoma (Monoclonal Antibody Therapy)
I thank Mr. Speaker for granting me this debate so quickly. Not many people know about this very nasty form of cancer, which affects a small number of children in this country each year. I welcome the hon. Member for Brentford and Isleworth (Ann Keen) to the Chamber as the Minister who will respond to this debate. We are very fortunate to have her here because she is renowned throughout the House for her compassion, genuineness and her ability to get things done behind the scenes. I will be asking her to employ all those qualities to solve a difficult problem and to give hope to a little boy called Zac.
Zac is a constituent of mine who suffers from a rare form of cancer called neuroblastoma. He is five years old and was diagnosed with stage 4 acute neuroblastoma in February this year. Doctors discovered a 10 cm tumour in his stomach, and smaller growths on his thigh and pelvis. Such news would have been devastating to any family, but it was made all the worse by the fact that Zac’s three-year-old cousin Chelsea had been diagnosed with the same horrible cancer 18 months earlier, when she was just two years old.
Sadly, after more than two years of bravely battling the cancer, Chelsea passed away on 9 August 2009, just one month before her fourth birthday. The treatment that Chelsea received in the UK gave her a 20 to 30 per cent. chance of survival. Treatment in America would have given her a 70 per cent. chance of survival, but it would have cost her family a quarter of a million pounds.
Michelle Tomkins, Chelsea’s aunt told me:
“Chelsea passed away because we did not have enough time to raise the money to get her to a hospital in New York offering a treatment that gives a 70 per cent. chance of survival, whereas here in the United Kingdom, it is only 30 per cent. The UK could do no more for Chelsea and this was her only hope, but we struggled so much. I can’t bear seeing them having to go through this all over again. A child’s life should not have a price on it.”
I want to emphasise two clear points that Mrs. Tomkins made. She said that the UK could do no more, and that a child’s life should not have a price on it. In this day and age, such statements should never have to be said, but sadly both are true.
Neuroblastoma is a rare cancer of the sympathetic nervous system—a nerve network that carries messages from the brain throughout the body. It is usually found in young children, and it is the most common cancer among infants. The solid tumours, which take the form of a lump or mass, may begin in nerve tissues in the neck, chest, abdomen, pelvis, or, most commonly, in the adrenal gland. They may also spread to other areas of the body, including bone and bone marrow.
The disease affects about 100 children in the UK. Fewer than 30 cases are diagnosed each year, with the majority of cases affecting children aged one to four. Neuroblastoma is the second most common solid tumour in childhood, and makes up 8 per cent. of the total number of children’s cancers. However, the odds on having two cases of neuroblastoma in the same family are one in 10 million, and sadly that has happened to Chelsea and Zac.
Detecting the cancer can be difficult. The first signs are that the child becomes tired and loses their appetite. The symptoms also depend on where the disease is in the body. For example, if the tumour is in the abdomen, the belly will swell. However, because many of the symptoms can be seen as symptoms of less serious illnesses, diagnosing it can come at a late stage when the tumour has spread to other parts of the body.
There are different ways of treating neuroblastoma, but prognosis is dependent on age, stage of disease, and the molecular biologic and cytogenetic characteristics of the tumour. Surgery is a way of curing the disease, but it is only possible if the tumour has not spread, and is not in a position of high risk. As the disease is hard to diagnose at an early stage, that is rarely a viable option. However, the next stage would be intensive chemotherapy, which can reduce the size of the tumour and prepare it for surgery, but that, too, can be dangerous to the child.
High-dose chemotherapy with stem cell rescue can also be given. If the neuroblastoma has spread to several parts of the body, or is high-risk with MYCN amplification, high-dose chemotherapy with stem cell rescue is used after the initial courses of chemotherapy. High doses of chemotherapy wipe out any remaining neuroblastoma cells, but they also wipe out the body’s bone marrow, where blood cells are made. To prevent the problems that that causes, stem cells—blood cells at their earliest stages of development—are collected from the child through a drip, before the chemotherapy is given. The stem cells are then frozen and stored. After the chemotherapy, the stem cells are given back to the child through a drip. The stem cells make their way into the bone marrow, where they grow and develop into mature blood cells over a period of 14 to 21 days.
Imagine that treatment, Mr. Cook, for your own child. It would be bad enough for an adult, but for a toddler it must be almost unbearable. Radiotherapy is another avenue that sufferers can pursue, but it has high risks and can harm normal cells. Those options are bad enough for any child and any family, but they lead to a survival rate of only 20 to 30 per cent., which is simply not good enough.
Another treatment is available in America that can improve that sad statistic of 20 to 30 per cent. to a respectable 70 per cent.-plus survival rate. The treatment is called 3F8 monoclonal antibody therapy. Normally a person’s immune system makes antibodies to attack germs such as bacteria or viruses, but unfortunately it will not attack neuroblastoma because the tumour is part of our own bodies. However, an antibody that attaches to neuroblastoma can be made in a laboratory, then given intravenously to a patient. That antibody will circulate in the bloodstream until it finds and attaches itself to a neuroblastoma cell, then the patient’s own immune system will attack and kill that neuroblastoma cell.
On Thursday 10 December 2009, I tabled a parliamentary question asking the Secretary of State for Health
“if he will make it his policy that monoclonal antibody therapy is available to NHS patients diagnosed with neuroblastoma.”
In response, the Under-Secretary of State for Health said:
“The National Institute for Health and Clinical Excellence (NICE) has not issued any guidance on monoclonal antibody therapy…In the absence of NICE guidance, it is a matter for local national health service organisations to decide whether to fund a particular drug or treatment. The NHS Constitution gives patients the right to expect local funding decisions on the availability of drugs and treatments to be made rationally following consideration of the available evidence.”—[Official Report, 10 December 2009; Vol. 502, c. 551W.]
It is therefore quite clear that there is nothing to prevent the NHS from providing my constituent with monoclonal antibody therapy. In fact, the NHS constitution would lead my constituents to expect such treatment. It is also clear that this is an exceptional case. For one family to have suffered two cases of this dreadful killing cancer is more than unfortunate.
Little Chelsea’s final wish to her mummy and daddy
“was for them to help other poorly children.”
Recently, I met Chelsea’s mother and I was amazed at her courage and fortitude after what has happened to her. This is what she said to me:
“If we help with making these children smile, our angel will be smiling too.”
That is exactly what needs to be done. Little Zac needs this monoclonal antibody therapy.
I have spoken to Zac’s consultant, Dr. Johan Visser, and he believes that the monoclonal antibody therapy is especially helpful to children who have responded well to the traditional treatment of surgery and chemotherapy. Six weeks ago, Zac had a very large tumour successfully removed and subsequently he has had more chemotherapy, to mop up any remaining cancerous cells. However, to give Zac the very best chance of a full recovery, he needs monoclonal antibody therapy in March or early April next year, so time is of the essence.
Michelle Tomkins, Zac’s aunt, eloquently states:
“My cousin’s family needs to raise this extortionate amount of money to stop another little child in their family dying.”
A life, especially a child’s life, should not have a price tag, but sadly £250,000 is needed—that sum needs to be raised to send Zac across to the United States to receive treatment. Zac’s family have set up an appeal, which people can donate to online at www.zacsappeal.org. Zac’s appeal has raised a fantastic £8,000. Among other things, the appeal has sold Zac wristbands and calendars, and even arranged a charity football game between two local teams. It has also received media attention, with the help of my excellent local newspaper, the Northamptonshire Evening Telegraph. Like my eight-year-old son, Zac is a Manchester United fan and he was the mascot for the match on 21 November 2009 between Manchester United and Everton. Nevertheless, after all these valiant efforts Zac’s appeal is still short of £242,000, so it has raised only 3 per cent. of what is needed.
However, it is not all doom and gloom. There is another solution. This disease affects approximately 24 children a year in the United Kingdom, so treating it is not a huge cost to the taxpayer. There is even better news. The Children’s Cancer and Leukaemia Group, or CCLG, has announced a clinical trial using monoclonal antibody therapy. However, as it is a trial, all the children need to have had the same therapy for the same period of time. Unfortunately, Zac misses this trial as he started his treatment six weeks too soon.
Zac is one of a handful of children who have missed this clinical trial who would have benefited from treatment with monoclonal antibody therapy. In future, all children who are diagnosed with neuroblastoma will go into such trials, but there is a small group of about half a dozen children who are not in the existing trial and who will not take part in future trials. They are the ones stuck in the middle.
The point or crux of this debate, and the reason why I am here today, is to get that treatment for a handful of children who need it, but who just miss out on the trial. I believe that those half a dozen or so children need to be treated here in our country and treated now. Dr. Visser has stated that he is happy to administer the treatment to Zac if funding is provided. The Government spend £100 billion on the NHS a year. Funding for those half a dozen or so children would be just a drop in the ocean.
I know that the Minister has close links with the Prime Minister and we all know of her compassion and that she can get things done. The biggest Christmas present that she could give to Zac and these other children is to go from this debate today to the Prime Minister and get the funding for them sorted out.
I am pleased to serve under your chairmanship today, Mr. Cook.
Of course, I want to thank the hon. Member for Wellingborough (Mr. Bone) for securing this extremely important debate. I also congratulate him on the manner in which he has conducted it. I have also had the opportunity to chat with him in his office and that has been incredibly helpful.
I am sure that all Members and all of us present today will sympathise with Zac and his family, and we appreciate how heartbreaking it must be for a parent to discover that his or her child has cancer. In my many years as a nurse, including my involvement with children’s nursing, I have had what I suppose I would call the privilege of being with children when they have died, and also with their families.
It is incredibly difficult for a family to cope with a child who is very seriously ill. It has knock-on effects on that family and the extended family, because of the obvious stress that it causes and because of the energy that is taken out of mum and dad, and, indeed, out of siblings if there are any. So I fully understand where the hon. Gentleman is coming from with this debate.
Thankfully, cancer in children is rare, with about 1,700 new cases being diagnosed in the UK in 2007. We estimate that about 2 per cent. of those cases were neuroblastoma cases. There have been remarkable improvements in the survival rates for most childhood malignancies in the past 30 years. Between 1970 and 2000, the overall five-year childhood cancer survival rate in Britain has increased from 28 per cent. to 77 per cent. and, in the case of neuroblastoma in the same period, the childhood cancer survival rate has increased from 19 to 59 per cent. I do not want my contribution to this debate to consist of stating lots of percentages. However, it is important that we put on record the progress that has been made in treating childhood cancer. Improving the care of children with cancer is one of our country’s success stories and we need to thank the clinicians, researchers and other scientists for the fact that some of the best children’s cancer services in the world are in the UK.
However, I am very aware that survival rates for children diagnosed with neuroblastoma are not as high as for some other cancers and, of course, even one child’s death is too many. We are not complacent and we are determined to continue to improve survival rates for all childhood cancers. We are doing that by helping GPs to identify children who are most likely to have cancer and who therefore need an urgent assessment; by ensuring that children diagnosed with cancer, including neuroblastoma, receive treatment as quickly as possible, and by organising services to ensure optimal outcomes for children and improved experiences, so that a little one’s journey through that clinical work, which the hon. Gentleman explained can be very difficult and painful, can be improved. We also need to improve our treatment process and research into children’s cancer, which is essential, and we are doing that as quickly as possible.
I would like to say a few words on each of the issues. As with all cancers, the earlier that childhood cancer is diagnosed, the better the prognosis for the child. The National Institute for Health and Clinical Excellence, or NICE as we commonly refer to it in debates, published updated referral guidelines for suspected cancers in 2005. Those guidelines are aimed at helping primary care health professionals to identify those patients who are most likely to have cancer and who therefore require urgent assessment by specialists. The guidelines include a section on cancers in children and young people.
Also, as set out in the second annual report of the cancer reform strategy, promotion of early diagnosis for all cancers is a priority for 2010. We have pledged to all patients in England access within one week to tests that can confirm or exclude cancer, and we will start rolling that out over five years from 2011-12. Quicker access to diagnostic tests, alongside work on early detection, will save 10,000 lives a year. Through the national awareness and early diagnosis initiative, we have committed £6 million to help GPs diagnose cancer earlier and to make the public aware of the symptoms so that they get them checked out early.
However, the distinct needs of children and young people with cancer have been recognised increasingly over recent years, which is why we asked NICE to produce service guidance for the NHS on improving outcomes for children and young people with cancer. The guidance was published in August 2005 and is aimed at those responsible for planning, commissioning and organising services for children and young people with cancer.
The guidance recommends principal treatment centres for each cancer type, with associated referral pathways to centres that might be outside the patient’s area of residence; access and support to clinical trials where the patient is eligible; care delivered by multi-disciplinary teams, including all relevant specialist staff, and care offered in age-appropriate facilities. The cancer reform strategy made a commitment to implement the guidance by the end of 2011.
The hon. Gentleman highlighted that research into the disease has brought good news that will give children diagnosed with neuroblastoma the chance to receive monoclonal antibody treatment in this country as part of a European trial announced last week. I will say more about the research later, but it is with sadness that I learned that Zac will not meet the eligibility criteria for the trial.
The hon. Gentleman stated that Zac’s consultant is happy to administer treatment in this country if funding is provided. As with other unlicensed drugs, it is down to clinicians to decide whether the drug is the best treatment for an individual patient and to clarify the potential risks with the patient. Because the drug is not licensed and the treatment has not been appraised by NICE, the primary care trust must take the decision on whether to fund the treatment. I have done my best to investigate what has been applied for in Zac’s PCT. I am led to believe that no formal application has been made, so I urge that one be made. I will take a close interest in the decision.
I am grateful to the Minister for her serious and helpful response to the debate. I am sure that she is right that a formal application has not been made, as I do not think that the family realised that it was possible to do so. My only concern is that, if the treatment costs £250,000 and the local primary care trust must fund it, it will be a bit unfortunate. Not many children are affected by the disease. Could the cost not be spread out over the whole NHS?
The hon. Gentleman makes a valid point. I know that other such drugs, called orphan drugs, are considered by the strategic health authority for the area or nationally. I would have to take advice about whether that could happen in this particular case, but I do not believe that the dialogue on Zac and the other children affected will be finished during this debate; I would expect us to carry on discussing the cases concerned.
In the past week, the launch of a major new clinical trial into the use of immunotherapy to treat children with neuroblastoma was announced. Cancer Research UK is funding the research costs in this country of the Europe-wide trial. The Government will provide infrastructure support via our national cancer research network. I understand that the trial will run in all 20 childhood cancer clinical trial centres across the UK starting this month. For the first time, that form of immunotherapy will be available in the UK to eligible UK patients. We will continue our long tradition of research excellence in helping build on earlier trials and devise even better ways of using the therapy.
The hon. Gentleman said that Zac missed eligibility by some weeks. I urge the clinicians involved to reconsider. Trials are trials, and they must have criteria, but it became evident to me while researching my reply that it might be possible to look at the matter. It would be wrong to raise hope; I am just asking for clarification of when the trial will commence. Of course, because not every child with neuroblastoma will benefit from immunotherapy, eligibility criteria, as in all well-designed trials, must be precisely defined. There will be a careful and necessary selection process. The trial will offer new hope to the children who benefit—it could be as many as 40 a year—and their families.
Children who take part in the Cancer Research UK trial will join the many other children and adults involved in clinical trials of cancer treatments. It is a tribute to all those working in the NHS, the cancer charities and the commercial sector that the percentage of cancer patients who enter trials each year is higher in England than anywhere else in the world.
The existence of the National Cancer Research Network, which the Government set up in 2001 and continue to fund, has been key to that achievement. Each cancer service network receives funds for an integral cancer research network. The £18 million we put into the NCRN this year provides dedicated research nurses, data managers, medical staff sessions and other services such as radiology and pathology.
As we all recognise, the new international trial is an exciting development, and it is right that we should focus on it, but I also take note of the six other children whom the hon. Gentleman mentioned. At all times, we urge clinicians—as I urge them today—to apply to the PCT where the child lives for funding. If that has been done and an appeal process is in place, I urge the PCTs to consider it.
This is our last debate of the year. It is so important to Zac and his family and to the other children. I thank the hon. Gentleman for securing this debate. I wish him and his family well this Christmas, as I know that his son is serving in Afghanistan. I wish him all the best during this distressing time.
Question put and agreed to.