Wednesday 7 July 2010
[Mr Clive Betts in the Chair]
Fuel Poverty (Rural Britain)
Motion made, and Question proposed, That the sitting be now adjourned.—(Mr Goodwill.)
First, I thank Mr Speaker for granting what I hope will be an important exploratory debate. I welcome the number of contributions that we shall hear, and I am delighted that after such a late sitting last night, so many people are still interested in fuel poverty in rural Britain.
Fuel poverty is defined as when someone spends more than 10% of their net income on fuel. As we know, the main contributory factors are a low income, the high price of energy, high energy consumption or houses with low energy efficiency. There have been plenty of debates and petitions on the subject, but I felt that it was important to raise it again at the start of this Parliament and in advance of the spending review, so that Ministers understand the concerns of their constituents in rural areas.
Yesterday, the Commission for Rural Communities published a report entitled, “The state of the countryside 2010”, which made specific reference to fuel poverty, and noted that things are getting worse rather than better. Across the House, we must recognise that fuel poverty has continued to increase rather than decrease, and we need to look for radical solutions to change that. Instead of an ambitious strategy of eliminating fuel poverty for vulnerable households by 2010, the number of households starting to enter fuel poverty has risen from about 2.5 million to about 5 million.
I recognise that this is a devolved matter, and that the Welsh Assembly Government and the Scottish Government have their own schemes. It is important to learn from some of the shared issues, and look at how different challenges are approached.
I recognise that there are issues such as competition, and the impact made by Calor Gas was a successful change. The Office of Fair Trading is monitoring the situation to assess its effectiveness. At some point in the near future, we should like a review to see whether that change has worked, or whether people are still in what is effectively a false market. From speaking to some of my constituents, I understand that the change has allowed them an element of choice, whereas before they were handcuffed to one supplier.
My constituency of Suffolk Coastal has 17% fuel poverty, which is slightly lower than the national average where about one in four rural households face fuel poverty. I should perhaps declare—although I was told that it was not a declaration—that I am off the gas grid and reliant on oil for central heating in my rented cottage in Westleton. I want to focus on people who live with no access to the gas mains, even though 20% of them live within a mile and a half of national gas connections, and I welcome some of the efforts made by the National Grid Company to start connecting more households. All hon. Members share concerns about people who are reliant on oil, solid fuel and liquefied petroleum gas, as that is where the problems lie.
In 2009, in a parliamentary question, the Government were asked what they were doing to tackle fuel poverty, and the answer was Warm Front. However, I am afraid that Warm Front is not working in areas that are difficult to reach, and that is reflected in the evidence gathered by various organisations. Time and again, people in my constituency—or other hard-to-reach areas, such as the constituencies of some Members in the Chamber today—are losing out in such schemes. There has been limited success, and I recognise that some energy companies have been kicked and told that they must start doing something about the situation, but these are early days and we need to kick even harder.
I congratulate the hon. Lady on bringing this subject before the House. She makes an important point about the difficulties and challenges in rural areas. Is not one of the added challenges the fact that so far, schemes have tended to come up with the simplest way of making a house more efficient? It is right to make efficiency a priority because relying on prices proved a mistake for the previous Government. However, in rural areas, much of the housing stock is not constructed in such a way that it is easy to make it more efficient. Any scheme must be far more robust and long-term to transform such houses into places where people can live without fuel poverty.
My hon. Friend is absolutely right. The extent of solid-wall housing is a particular issue that cavity insulation fails to address. It is mainly prevalent in rural areas, but also in London where the challenge is damp Victorian houses. Instead of national schemes, I would like the Government to consider more local schemes and ensure that any grants available address local needs. My constituents, and many others, would then be able to access help that is relevant for them, rather than being told either that they do not qualify for a scheme, or that a scheme is useless for them. Such local schemes would be welcomed by people who feel that they are on the fringes of society when it comes to Government help on this issue.
The hon. Lady is making good progress on this matter. She mentioned Warm Front, which was a national scheme, and the need for a better, more tailored local delivery. Does she agree that one of the biggest problems with Warm Front—although it was set up with the best of intentions—was the usual difficulty that Governments face due to the strange and highly centralised method of public procurement, which means that they have to narrow down and reduce the number of companies with which they can contract? Therefore, the prices for much of the work undertaken are astronomical and much higher than they would be if provided by a local small company.
My hon. Friend is right. The issue is particularly prevalent in rural areas, where prices have meant that less work can be done with the available grant. One of my constituents suggested that I promote a private Member’s Bill on making sustainable energy more local, and I hope that the Government will address that point by absorbing elements of that idea in their thinking on any future schemes.
Many hon. Members are present, so I will move on and speak a little about the market. I recognise that Calor Gas and similar LPG suppliers provide an opportunity for people to heat their houses without having everything provided electrically. A premium is paid for that because of the delivery method. However, I would like LPG suppliers to go further, to challenge their efficiencies and work with particular groups to ensure that the people they serve receive the best value possible. Micro combined heat and power boilers are being developed, and I would like more investment in technology so that we can address those kinds of problem.
There are no social tariffs for oil or LPG, and it is challenging to think about how they could be created for the relatively small group of people who access that type of fuel. I could argue that we should receive some money from the mains gas and electricity companies to redress the balance. I am pleased that people can now hold a post office bank account or, if they do not have access to that, can get a direct debit discount. Without straying too far from the subject, dare I say that the number of post offices in my part of the world has reduced dramatically over the past 10 years? That presents its own challenge.
I understand that at least one company, EDF Energy, offers dual fuel discounts to people who have access only to electricity rather than electricity and gas, although I do not know how much the company advertises the discount. I will do my best in forthcoming weeks to advertise it to my constituents—I might take up the offer myself. I was not aware of it until I spoke to somebody from EDF Energy yesterday.
There are things the market can do. I recognise, though, that as the price of social tariffs or similar measures add costs to industry, they end up being paid for through increasing fuel prices. However, it is an important part of social responsibility to ensure that people in rural areas are not freezing to death and being ignored.
In terms of the Government, I hope that we shall see a change in the balance of schemes. I have talked about more local solutions. I want any possible future investment to be rebalanced in favour of rural schemes and—dare I say it?—not just for people on benefits. A number of people just miss out here or there, but like everyone else, they still need to heat their homes. The cost of oil goes up; the cost of LPG is going up. That is hurting more and more people. We are trying to reach some of the communities that have never been on benefits and do not necessarily want to start now—it is an element of dignity for them. By the way, I want to correct a misconception. Although fuel poverty affects a number of pensioners, and two thirds of my constituents are, I believe, over 60, it affects people of all ages, including people with young families. We need to remember that.
What else am I looking for? We are expecting £6,500 grants, which will be repaid through efficiency savings in fuel bills. I would like rural people to be able to access higher up-front cash advances, because if people have an oil central heating system, they cannot switch suddenly to photovoltaics and everything is fine. They have to rip out the entire heating system and put in a brand-new one.
Such measures would help the people of Suffolk Coastal because our climate is similar to that of Jerusalem. It may not be sunny every day, but there is plenty of sun and little rain. We are missing out on marvellous resources all around us, because the amount of cash that we need to spend up front to change our systems is just prohibitive. Bold thinking, rebalancing in favour of rural communities and tailoring solutions to allow local people to make the decisions that best suit them, rather than having top-down schemes, are some of the issues that I want to raise today in addressing fuel poverty in rural Britain.
I congratulate the hon. Member for Suffolk Coastal (Dr Coffey) on initiating this very important debate. It is also timely, given the election of a new Government. I have already been in correspondence with the Department of Energy and Climate Change and I shall come to that in a moment.
I want to start by pointing out that this issue is about rural Britain—the periphery areas of Great Britain and Northern Ireland. The periphery area that I represent in north-west Wales suffers from a double whammy: most of the household customers pay extra for their fuel, but they also pay extra fuel costs for their transport. We have had a number of debates on the issue in this Chamber, and I appreciate what the Chancellor of the Exchequer said in the Budget about looking at rural areas and pilot schemes whereby transport costs and the price of petrol at the pump can be considered. Pilot schemes should also consider rural areas on the periphery of the United Kingdom when it comes to energy prices and energy costs as well. That is what I believe the hon. Lady was developing in her argument.
Periphery areas are a special case. I do not accept that in the 21st century, areas on the periphery should have to pay much more in fuel costs. I know from having the port that is the gateway to Ireland and Wales in my constituency that Northern Ireland’s problem is compounded by fuel smuggling from the Irish Republic. Fuel is smuggled in and out of the United Kingdom via the south of Ireland. There are huge problems that we need to grapple with.
I have campaigned to reduce both the cost of petrol at the pumps and the cost of energy supplies to homes. People living in periphery areas and rural areas are being ripped off. The hon. Lady says that she wants to give the companies a kicking. I will join her and I think that all of us should, because mass profits have been made by many of the companies over a long time and the people who are paying for it predominantly live in the rural areas of Britain. The market is letting people down badly in those areas.
All that my constituents and those of the hon. Lady and every other hon. Member in the Chamber are asking for is a level playing field. Yes, they want reduced costs, but they want to pay the same as people in urban areas and other parts of the United Kingdom, and importantly they want choice. Quite often in isolated rural areas, people just have the choice of propane gas, coal or other things. Off-grid areas do not have access to mains gas and are losing out. The market says that it will provide choice to customers, but in rural areas they simply do not have that choice and they are penalised for it through the price that they pay. That limited choice and paying more for fuel is a huge problem.
I said that I had already raised the matter in correspondence with the Department, and I first did so at business questions, when I asked for a debate on the issue. A debate in Government time would be very much welcome in addition to this important Adjournment debate. I have had, over many years, helpful responses from Energy Ministers and progress has been made. Warm Front is a good national project that has helped an awful lot, and good energy efficiency measures are available. I am certainly familiar with what has been done by the Welsh Assembly and I know that other devolved Administrations are working on the issue, too. This Parliament, local government and the Welsh Assembly can work together with the distribution network to ensure that we get better services to people in these areas.
In the very helpful reply that I received from the Minister of State, Department of Energy and Climate Change, the hon. Member for Wealden (Charles Hendry), he said that he recognised that more needed to be done. One option that he came up with was a further roll-out of energy efficiency measures. I disagree with the hon. Member for West Aberdeenshire and Kincardine (Sir Robert Smith), who said that we have been concentrating just on price. Huge amounts of money have been invested in energy efficiency measures. In my constituency, most of the houses have been done, and to a very high standard, but the price is the issue.
The hon. Gentleman is right to say that the price is the issue. The problem was that in the early days of the previous Government, because of the way in which the market was working, prices for domestic gas were falling so dramatically that people were coming out of fuel poverty and it seemed as if the job was being done. Then the price started to go up relentlessly and it became clear that much greater work should have been done in the good times to make the housing stock more efficient, rather than responding after the fact.
I agree partly with what the hon. Gentleman says. It is easy to be wise after the event. He will remember that at the time we were in the “dash for gas”, gas was relatively cheap across the whole United Kingdom and our eye was off the ball, because people were getting cheap fuel. Yes, more could and should have been done then, and it should have been done over the past 13 years. I hope that more will be done over the next few years to ensure that we alleviate fuel poverty in rural areas.
The Minister told me he was involved in the option of promoting renewable heating, which is another important way forward. Although I shall argue for the gas network to be extended throughout the United Kingdom, we need, particularly with the low-carbon economy that we are moving towards, to consider renewables. Geothermal energy is important in many areas. It would be helpful if new estates and new housing, including affordable housing, such measures installed at the construction stage.
In my constituency—I am sure that other hon. Members have experience of this—many of the problems are not just with stone houses that are a century old or more, but with estates that were built in the 1960s and ’70s, where the developers simply did not put gas mains in and did not provide for up-to-date fuel, leaving people on the periphery of the gas mains area. I am sure that at that time people would happily have paid for access to the gas mains from those properties, and it would have been a selling point for the builders, who were very short-sighted.
When I talk about areas off the grid, I am talking about not individual isolated properties but more often about small villages, towns and hamlets that are a short distance from the mains. There are issues about getting the pressure to the level needed but, again, I am sure that in the 21st century that can be done relatively simply.
Does the hon. Gentleman accept that there are two problems with that? First, there are many rural areas where the gas main will simply never go, because of practical difficulties. Secondly, in an era of rising gas prices and a possible shortage of gas, does he believe that gas is really the way forward for dealing with rural fuel poverty?
I welcome that intervention, but that is not the point that I am making. I am saying that we should have renewables as well. Areas close to the gas mains should be offered a choice. I have seen the price differential between the bills of people who are off the gas mains grid and people who are on it, and it is simply wrong and unfair that some people are paying so much more.
I agree with the hon. Gentleman. He will be aware that the level at which ground source heat pumps are sold does not ensure cost efficiency for homes. In fact, the payback period required is 25 to 40 years, and we will achieve something only by rolling things out in larger numbers. However, given the hon. Gentleman’s excellent record in arguing this case, does he share my disappointment that the previous Government failed to support—indeed talked out—the Fuel Poverty Bill introduced by my hon. Friend the Member for Somerton and Frome (Mr Heath), whose private Member’s Bill included many of the measures for which the hon. Gentleman is arguing?
The hon. Gentleman knows me well enough to know that I would not pander to the previous Labour Government when they were in office, and I will certainly not try to defend their record now when I think that it is wrong. The hon. Member for Somerton and Frome (Mr Heath) has an excellent record on this issue, and now that he is in the Government I hope that he will able to use greater leverage on Ministers to ensure that measures are introduced. As Deputy Leader of the House, he is in the privileged cross-governmental position of being able to bring everyone together to get things done as soon as possible, and he will get my 100% support in doing so.
In his helpful letter to me, the Energy Minister said that some schemes are working and that Ofgem has made progress on connecting vulnerable households to the gas networks by encouraging large gas distribution networks to work with agencies to produce results. He said that about 20,000 households would be connected to the grid by 2013, but we simply do not have the agencies or the local authority initiative in my area, so there is no lead partner. I urge the Government to look at that, because we need a thrust from central Government, and from regional and national Government in Wales and Scotland, to push the issue forward. I acknowledge that there are many excellent energy efficiency measures, and I repeat that the Welsh Assembly Government have an excellent record in this field and are taking fuel poverty and their part in dealing with it very seriously, but we all need to work together.
The boiler scrappage scheme was useful in helping many people to replace equipment. That is a big issue, and the hon. Member for Suffolk Coastal is right that there are a lot of associated costs with changing to another source of energy and not least to another supplier. People have to remove the gas storage equipment in their properties, which is costly, although some companies will take over that cost because they will get the business in the future. However, when people apply, they are hampered by additional costs, so the process is not easy. People feel trapped with their supplier, which is putting an extra cost on them.
Things certainly have improved, but the change has not been advertised very openly. When people were approached in the past, it is clear that they felt trapped. The customer needs clarity to ensure that they can get a better deal from a different supplier.
The core of the problem remains the cost of domestic fuel, particularly in rural areas and areas on the periphery, and that is why the debate is so important. A constituent in her 80s who came to see me in late May was very grateful for the additional Government support that she received through the winter fuel allowance, which helped to alleviate some of the problems that she faced, but she was still paying huge amounts for her propane gas. From 2008 to April 2010, her company supplied her at a unit cost of between 45p and 51p per litre. That gave her an average quarterly bill of between £400 and £700, which is an enormous amount for an elderly person living on her own in an older property. The property and the dozen like it on the same small estate are not that old, but I was astonished to find that the properties that did not have access to mains gas were all paying different prices to the same supplier. The households had to go through something like an auction to get the basic unit cost down—they had to negotiate.
I raised the issue with the company. In addition to the unit cost, there was the cost of associated charges such as the standing charge and gas surcharges, which took the price up considerably. When the company replied to the correspondence I had sent on behalf of my constituent, it said that the variations were due to the geography, the seasons and the type of agreement, but I am talking about households in the same estate paying different prices.
Those issues need to be looked at, which is why I want to move on to the excellent campaign by Which?, the consumer group, which is looking for greater transparency in energy prices. The old chestnut from many of the suppliers and fuel companies is that the retail price is linked to the wholesale price. When wholesale prices go up, the companies say that they are forced to put their retail prices up, but when wholesale prices come down, companies say that the system is very complicated and sophisticated, and it does not necessarily follow that the retail price is linked to the wholesale price. We therefore need greater transparency.
I am asking for a breakdown from suppliers to show exactly the amount of bulk gas that they get at wholesale prices and what they pay for it. Some of the electricity companies, and the companies that supply gas and electricity, are now more open and transparent, and they are gaining from that—greater transparency is in the interests of the suppliers, as well as the consumer. The Committee of Selection is meeting today, and as a member of the new Select Committee on Energy and Climate Change, I will push for greater transparency so that we can see exactly the link between wholesale and retail prices. That is an important move forward, which would benefit consumers, particularly in rural areas, and I would welcome it. The Government should be encouraged to work with the consumer watchdog to bring about greater transparency.
I know that a number of Members want to speak in the debate, and I do not want to detain them, but I have concentrated on off-mains gas areas because they are being hit particularly hard, and we need to look again at extending the network; indeed, hon. Members in previous Parliaments raised the issue. The irony is that although my constituency is on the periphery, I am promoting the concept of an energy island because we have energy generation in the area. We have a nuclear power station and wind farms, and we welcome both because they generate employment and contribute to the United Kingdom’s energy security. We also have projects that are looking at tidal energy, so we are well positioned to provide the new renewable energy that the Energy Minister told me was a way forward. However, although the Wylfa power station in my constituency supplies more than 30% of energy in Wales, some people living in close proximity to it pay some of the highest prices in Wales for their energy because they do not have the opportunity to use the gas network and they do not have the same choice as many people in non-rural and urban areas of the United Kingdom.
I welcome the response that I received from the Energy Minister. He is a sincere man and he will work with the Deputy Leader of the House and others to ensure that we get a good deal for people in my constituency, in peripheral areas and in rural Britain. Once again, I congratulate the hon. Member for Suffolk Coastal, because this is a hot subject. It needs dealing with now, and I hope that we can move forward.
Order. Five hon. Members are indicating that they want to speak, which means that they have about eight minutes each if we are to get the winding-up speeches in. I cannot insist on that, but it would be helpful if hon. Members bore it in mind.
It is a pleasure to serve under your chairmanship, Mr. Betts. I pay tribute to the hon. Member for Suffolk Coastal (Dr Coffey) and congratulate her on securing the debate, which is incredibly important for a range of reasons, many of which were set out by the hon. Member for Ynys Môn (Albert Owen).
One important reason to discuss the issue is the incorrect assumption made, I dare say, throughout Whitehall and other places that rural areas are affluent. That is a staggeringly inaccurate assumption, but it is understandable, based on the headline figures. My constituency has the second lowest unemployment in England—I probably should not say that out loud; we will be off the list for every grant going—and average house prices are £250,000. So far, so good, but the largest number of jobs available in my patch, which I suspect also applies for many hon. Members present, is at the minimum wage.
The average wage is about £18,000 a year, which means that the gap between house prices and average incomes is the largest outside the south-east of England. We have only 3,500 council homes left, following the foolish and damaging sell-off of the 1980s, with a waiting list of 5,000. All that means that although benefit uptake is low in the south lakes, the incidence of poverty, housing need and, especially, fuel poverty is extremely high—above 20%. In addition, the average age is 10 years above the national average. Many people who live in the communities that I represent are retired and do not, therefore, appear in unemployment figures, but they live in real poverty.
It is vital that the Government should understand that fuel poverty is more likely in rural communities because of the age of the housing stock, which has been explained by both hon. Members who have already spoken. I shall not go into further detail, except to say that homes are harder to insulate the older they are, and if they have no cavity wall to fill.
In addition, as we have heard, many homes in rural, sparsely populated areas are off the mains for gas, and sometimes even for electricity, and are much harder and more expensive to heat. However, although villages such as Hawkshead, Coniston, Grasmere, the Langdales, Dent and other areas in my constituency are rural and have an elderly housing stock, it is important to remember that many of the larger towns—larger, that is, by our standards—such as Kendal, which is a huge metropolis of 14,000 to 15,000 houses, have benefited hugely from Warm Front. It is important not to knock it too much. It did the easy things quickly and tackled fuel poverty among some of the poorest families. The areas they were living in might have been built-up, but they were not necessarily in urban areas.
Those homes were built in a way that enabled Warm Front to get at them quickly to insulate cavity walls and so on. It is important to celebrate easy, quick wins. The Government need to get plenty of those, too, in their first few months in power. I want the Government to build on Warm Front, not sweep it away thinking it has done damage—it has not.
There are great opportunities in rural communities—to build on something that the hon. Member for Ynys Môn said—for the provision of renewable energy resources, which can be enormously beneficial to the wider country in tackling climate change and creating energy security, which has also been mentioned. However, there is also an economic benefit to the struggling communities that are served.
I want to get in a word for my county. Cumbria has the fastest-falling water in England but only six plugged-in hydro schemes. That is scandalous, and I would like the Government to redress the situation quickly. Last week, I met a team from Kentmere, the charitable trust running the Kentmere Hydro project. The 350 kW scheme has the full backing of planners in the national park, which is staggering. It also has the backing of the community, which is less staggering. The one thing that could hold the project up, of course, is finance.
The trust is not looking for handouts, particularly at this time, but I ask the Minister to make it clear that the green investment bank announced by the Chancellor will be able to provide loan finance for such charitable trusts, and that those trusts will be able to qualify in their bid for feed-in tariffs. That community project could be replicated across rural Britain, as long as there are clear signs of active, practical encouragement from the Government. The same applies to anaerobic digestion. I hope that the Government will back anaerobic digester start-ups in rural communities as a way to generate income and green energy from waste.
I spoke last week to an older couple living in the Lake district, whose income is just under £10,000. They spend £2,000 a year on council tax and just over £2,000 a year on fuel. They are very typical. Their plight is worsened by the price of petrol. I urge the Minister to consider the impact of fuel duty on rural communities where little or no public transport is available and there is no choice for many people, however poor they may be, but to use the car.
I am sure that other hon. Members know, as I do, many people who must make the appalling choice between petrol in the car or food on the table. I welcome the Government’s investigation of rural exemptions on fuel duty, and of course I call for Cumbria, the Lake district and the dales to be included in any such pilot.
They key factor behind all fuel poverty, as we all know, is the cost of fuel. That is why it is vital that there should be further social tariffs covering all fuel systems—not just mains fuel systems—and moves to ensure that the cheapest unit costs are the ones that people pay for first. As things stand, an elderly couple in fuel poverty heating their cottage in Grasmere could easily pay more per unit for the energy they use than a City banker heating his luxurious second home next door. If I had a fiver for every time a politician said we are living in difficult times, I could probably pay off the national debt, but however fair the Government try to be in reducing the deficit, these difficult times are bound to be most difficult for those in the most marginal financial situations. That is why the Government must demonstrate that they will go out of their way to eliminate fuel poverty, especially in rural Britain, and that they will take practical steps. Otherwise, a bad situation could get worse.
I am very pleased to take part in the debate and I congratulate the hon. Member for Suffolk Coastal (Dr Coffey) on obtaining it. This is an important issue. I was interested in the concept of building a new Jerusalem in Suffolk Coastal.
I have raised the issue of fuel poverty many times in Parliament and the stock answer that I normally get from Ministers about off-grid gas is that they are taking action to ensure the extension of the gas grid. However, in reality, many of my constituents will never have access to the gas grid. It will never go to the glens of Angus, or to many other parts of rural Scotland, especially the islands, however much it is extended. There is no option for those constituents but to rely on liquefied petroleum gas, home fuel gas or some other alternative fuel. It has been estimated that some 4.3 million consumers—mostly, but importantly, not exclusively in rural areas—are not on the gas network. In some areas, although the gas network is technically available, the cost of connection to it is prohibitive and people cannot do it.
Consumers who are off the gas network face particular problems. A typical gas bill is now rising to around £1,000 a year, but it has been estimated that those who are off-grid face bills of about £1,700 a year. That is a significant difference. I refer hon. Members to the table in the report on fuel poverty produced just before the general election by the Select Committee on Energy and Climate Change. It relates only to England, but it shows the extent of the problem of cost between different fuel sources.
Does the hon. Gentleman think that the differential could become a more serious problem? Given the changing nature of the world market for natural gas, with shale gas and liquefied natural gas potentially bringing the price down in Europe, and if we ensure that the market works and those on the gas main get the benefit of a lower gas price feeding through, it will be all the more important to tackle the situation for people who do not have mains gas, because fuels such as oil and coal are not necessarily following the market down.
The hon. Gentleman makes an excellent point, but there are other pressures, not least climate change, against the extension of the use of gas. The Government are only now considering the decarbonisation of the gas supply and generation from gas. Many issues arise in connection with that.
There are many excellent schemes to help with insulation and energy efficiency, and many homes in rural areas are hard to treat, which exacerbates the situation. The Select Committee report noted that Ministers in the previous Government said that they were very enthusiastic about innovative technologies to tackle the problem, but we expressed disappointment at the slow pace of implementation. I do not think that the Government have yet responded to that report, and it will be interesting to hear what the new Minister has to say.
As has been mentioned, people who are off the grid do not have the same access to the social tariffs as mains gas customers. I accept to some extent that they have access to electricity tariffs, but many off-grid consumers use home fuel oil or LPG as the main fuel for heating their homes and water, and that is likely to be the major part of their energy spending. They do not get the full benefit that others do for those things.
The Department’s annual report on fuel poverty statistics for 2009 states:
“The highest proportion of fuel poverty is amongst households without gas, where nearly 23 per cent of households are fuel poor, compared to around 17 per cent of both standard credit and pre-payment meter customers.”
In Scotland, the situation may be slightly worse because of geography and the lack of a grid in the highlands and islands. The latest Scottish house conditions survey states:
“Households that use electricity, oil or other fuel types (such as coal or peat) are around twice as likely as those who use gas to experience fuel poverty. Also, those who use... ‘other fuel types’ (not gas or electricity) are more than twice as likely to experience extreme fuel poverty than gas users”.
I understand that the number of off-grid customers in fuel poverty in Scotland is around 116,000—about 47% of all who are off-grid.
There are other problems than price. For example, in many areas customers have to make an up-front payment to get a supply—and many suppliers demand a minimum supply quantity. That can be a substantial sum, and those on low incomes cannot afford to pay up front. That causes another problem—people may be forced to go without as a result.
Those who use gas or electricity will have pipes and so on coming to them, but those who use some of the alternative fuels find in bad weather that it is difficult to get a supply. It is interesting to note that in the recent harsh weather the Department for Transport had to allow a derogation from the driving hours regulations to enable deliveries to be made in many parts of Scotland and northern England. However, this is a long-running issue.
At the conclusion of consideration in Committee of the Energy Act 2008, the Energy Minister, the former Member for Stafford, arranged a meeting of representatives of the various bodies concerned with the matter. There seemed to be a willingness to consider things, but frankly the problem lies in difficulties caused by the nature of the market, which has already been touched on. That market is very different from that for domestic gas and electricity, and we need to find ways around the problem because those consumers have fallen through the cracks.
The domestic electricity and gas market is dominated by the six big energy companies, and it is easy to get social tariffs from them. The market for other fuels is much more diffuse and difficult to regulate. However, in many areas I would question whether there is real competition, as there is effectively only one supplier. With recent amalgamations in Scotland, the situation is getting worse. We need radical solutions to tackle the problem.
The Minister may remember that, during consideration in Committee of the Energy Act 2010, I suggested how the matter might be dealt with. Section 10 of the Act allows the Secretary of State to introduce a reconciliation mechanism, such that if one company had more fuel-poor customers than the others, it would not be particularly badly hit. The burden would be spread among all companies and, as far as possible, each would meet an equitable amount of the cost of meeting their obligations under the social tariff.
That principle is a good one, and it could be extended to cover all fuel suppliers, allowing a general sharing of the cost of meeting the obligation to help the fuel poor. Because of the difficulties in that particular market, it would not be easy to introduce individual social tariffs, but a general reconciliation mechanism would bring suppliers within the ambit of the scheme. Allowing the overall cost to be shared between all the energy suppliers would enable us to make progress and extend the social tariff concept to that disadvantaged group.
That is a radical way to deal with the problem. Otherwise, it will always be filed under the “too difficult” heading and nothing will be done. Such a mechanism would ensure that the cost were shared more widely—as the benefits would be. It would ensure that all energy suppliers could operate equivalent social tariffs for all their customers, whether they used electricity, gas or other forms of fuel. In what the hon. Member for Westmorland and Lonsdale (Tim Farron) said are troubled times, Ministers might be attracted by the fact that it would have a revenue-neutral approach for the Treasury. It would not impose a greater burden on the taxpayer, but I can already hear the howls of protest from the major energy companies. However, it would deal with what has become a most intractable problem.
As was suggested by the hon. Member for West Aberdeenshire and Kincardine (Sir Robert Smith), the problem will get worse. Whether we like it or not, the price of fuel will continue to rise as we try to move to a low-carbon economy. We will effectively be subsidising various renewables and possibly—and unfortunately—nuclear power, which will have an impact on all electricity bills. I ask the Minister to consider the suggestion.
In another aside—I realise that this is strictly not within the Minister’s brief—the Select Committee report suggested that we should consider how the winter fuel payment is made. It is paid in the winter, the most expensive quarter. For many off-grid customers, winter is not the best time to be given that money. If they were to receive it earlier in the year, they could buy oil or other fuels in bulk when they were cheaper. That would allow them to stockpile for the winter. Staggering the payment for off-grid customers would allow them to take advantage of cheaper prices. Again, importantly, it would be revenue-neutral for the Treasury.
I am trying to be helpful to the Minister by not simply calling for more spending; I am calling for us to consider things in a new way and to look at more radical solutions. If we do not, we shall continue to file the problem under the heading “too difficult” and nothing will happen to help those people. That would be a wasted opportunity, and fuel poverty would continue to increase in rural areas throughout the United Kingdom.
I congratulate my hon. Friend the Member for Suffolk Coastal (Dr Coffey) on securing the debate. Many hon. Members have suggested solutions to the problem, but I want to emphasise a particular reason why the Minister and the House should be concerned. It is the excess of winter deaths. The fact is that 36,700 more people died in the winter of 2008-09 than expected. Even more worrying is the fact that, of the most vulnerable—those aged 75 and over—29,400 more died.
We do not have figures for excess winter deaths last year, which is unfortunate as it was a very cold winter. The figures are calculated by taking the number of deaths over the winter and comparing them with figures for the previous autumn and the summer, to the end of July. We will have those figures at the end of the month, and I expect that we will be in for a further shock. However, the figures for 2008-09 were themselves shocking, being the highest for a decade.
It is an interesting phenomenon that the further south or west one is in Europe, the higher the excess—between 5% and 30%—but we have a particular problem in this country. A study in the British Medical Journal found that a prime reason was the inadequacy of housing; it considered whether improving housing and heating would protect vulnerable people. Of course there were many other reasons, but I hope that the Minister will consider why that problem is crucial.
What the hon. Lady says about the inadequacy of housing stock is important. Does she agree that in many regions of the UK the problem is not with housing associations or housing authorities, but with the private sector? Landlords are not always assertive in establishing whatever Warm Front schemes are available to provide better heated homes for the private-sector tenants.
I thank the hon. Gentleman for that comment. Unfortunately, the BMJ study did not comment on that aspect, but it is an interesting point.
In the south-west, 11.7% of households, or 259,000 people, live in fuel poverty. It is a serious problem, and many Members have spoken about why that is the case in rural areas. Hard-to-treat housing stock with solid walls is a particular problem. The hon. Member for Westmorland and Lonsdale (Tim Farron) spoke strongly about rural households being disadvantaged because fuel costs for transport are so high. There is an inadequate bus service, which means that people have to travel quite long distances by car, thus putting them at a double disadvantage. Moreover, they are hit again by the fact that their housing costs are high. In my constituency, we have some of the lowest wages in Britain, so we are disadvantaged on all fronts. I hope that the Minister will address those points.
It is pleasure to serve under your chairmanship, Mr Betts. In the short time available to me, I will emphasise some of the points that have been made. First, let me pay tribute to the hon. Member for Suffolk Coastal (Dr Coffey) for introducing the debate. The hon. Member for Totnes (Dr Wollaston) introduced a salutary note by speaking about why we are here. By stressing the need to avoid those winter deaths, she summed up the importance of this debate better than I can.
The 147 villages and hamlets across Ceredigion are subject to the monopolistic practices of the energy suppliers. In too many of our communities, there is simply no choice. Across Wales, 8% of all households are off the mains gas network. The Competition Commission has examined the issues surrounding liquefied petroleum gas, but we need a wholesale review of the energy market, as it is clear that there are some very real problems.
I am glad that we are debating rural areas so early in the Session. Rural constituencies face a package of issues, including an ageing population, the lack of transport, and an ageing housing stock, which are hard to remedy.
The hon. Gentleman mentioned the package of issues that face us. Some 53% of people in my constituency of Na h-Eileanan an Iar are in fuel poverty, which is the highest proportion in Scotland and probably the UK. Heating and transport are very expensive, which is why during the debate on the Finance Bill yesterday, some hon. Members might have heard me arguing for a rural fuel derogation. The issue today is about the winter fuel payments. My hon. Friend the Member for Angus (Mr Weir) made a good point about that, and I noticed the Minister taking a note about the issue of earlier payments. When making such payments, wind-chill factors as well as fuel poverty should be taken into account. Including wind chill would make a difference to my constituents.
I am happy to endorse that point. Although I represent a coastal constituency and live on a cliff top, my experience cannot be compared with that of the hon. Gentleman or of his constituents, so I commend his proposal to the Minister. I concur with what has been said about the differential between retail and wholesale unit prices, and the lack of social tariffs. We are all aware that the Government have fewer resources to offer, but in commending what the hon. Member for Ynys Môn (Albert Owen) said about some of the schemes that have been pursued in Wales, I suggest that the Minister consult widely with the devolved Administrations to ensure that where there is good practice in England-only schemes, the Assembly Government can follow suit in a swift manner. After the announcement of the boiler scrappage scheme in England, a somewhat limited substandard scheme was launched in Wales very late in the day. In fact, the scheme was announced in April, when replacing boilers is perhaps the last thing on people’s minds.
In defence of the Welsh Assembly Government, they tried to amend the scheme so that the elderly and the vulnerable could apply for it. I thought that that was why we were here today—to protect the most vulnerable against fuel poverty. I thought that it was an excellent idea to limit the scheme to senior citizens and vulnerable people.
I welcome that aspect, but I question its timing. That was the point I was trying to make.
Last December, a consultation on fuel poverty in rural areas was initiated by the Commission for Rural Communities—I do not know what my English colleagues would say, but some of us regret the loss of that commission because it has been an independent voice offering strong messages for those of us elsewhere. Its interim report offered some key points to consider. Some 50% of the UK’s carbon emissions from housing come from hard-to-treat homes—off-gas, solid and non-traditional wall construction, high-rise or properties without a fillable loft or cavity. That is a huge proportion of the households that many of use represent. As we have heard, many of those hard-to-treat homes are in rural areas, and there is a clear need to take action to reduce emissions, tackle climate change, and reduce bills. In 2005, the figures got worse. Some 14.6% of households in villages and hamlets were living in fuel poverty compared with a national average of 7%. That is the background to the huge challenge facing the Minister.
Interim recommendations from the CRC report include updating data to improve its scope and definitions so that we have a clearer view of where the problems lie; improving data sharing; and, critically, learning from best-practice examples. As my friend, the hon. Member for Ynys Môn, said, the coalition Government need to prioritise certain pilot areas.
Although it seems hard to believe now, we had a particularly cold winter last year and cold weather payments were of great use to my constituents. However, I worry that the need for seven consecutive days of temperatures below zero may have distorted the payments. Despite experiencing very similar weather, towns and villages in the northern part of Ceredigion received three triggers while in the south just one trigger has been reached. Will the Minister look into that—again, that relates to the point made by the hon. Member for Na h-Eileanan an Iar (Mr MacNeil)—and say whether he is confident that the level of cold weather payments received truly reflects the problems people are experiencing on the ground?
Moreover, there are many people who were eligible for cold weather payments but who missed out on them altogether because of a failure to claim pension credit—the most recent figures show that between 1.1 million and 1.7 million eligible pensioners are not claiming pension credit. I will stop now, but there is much more to be said. The Chamber is aware of the enormity of the problem. It is good to see not just the Celtic nations but all the rural parts of this country represented in the debate. The Minister has a huge job on his hands and we look forward to what he will say in a few moments’ time.
It is a great privilege to take part in this important debate. I congratulate the hon. Member for Suffolk Coastal (Dr Coffey) on securing it and I warmly welcome her to the gang. I am sure that her contributions will always be valued. Without prejudging the Minister’s response, which will be very helpful, let me say that this is an issue to which we will return from time to time.
I shall concentrate on competition issues because they are clearly the responsibility of the Minister and his colleagues at the Department for Business, Innovation and Skills. When I was elected in 2001, I contacted the Office of Fair Trading and the Competition Commission because there were some uncompetitive practices in the LPG market. I built on the work of my predecessor, Lord Livsey, who was very active in the matter. We were surprised when, in the end, the Competition Commission decided to take up the issue, because there was huge resistance from LPG suppliers.
Some of those uncompetitive practices were quite clear. There were issues over the different types of connection and appliance and whether ownership of the bulk tank could be transferred from one company to another. Some regulations have been introduced to ensure that there is more competition in the marketplace. In fact, Calor Gas is to hold a reception in this place tonight.
The hon. Gentleman anticipates a point that I was about to make. Let me repeat though that a reception will be hosted tonight by Calor Gas, which is one of the major LPG suppliers. The Minister may like to go along—he may even be speaking at it—and make some of the points that he has heard during this debate.
One of the key issues about fuel poverty, which has already been referred to by my hon. Friend the Member for Ceredigion (Mr Williams), is the opportunity to buy in bulk. I visited some old-age pensioners’ bungalows owned by Powys county council in a little village called Garth, where pensioners switched off their LPG heating in the middle of winter and consequently had no heating in their houses at all, because they just could not afford it. Nobody was responsible for ordering the LPG and the local authority—the pensioners’ landlord at the time—was taking no interest at all in the pricing mechanism for the tenants, and the tenants themselves were not sufficiently empowered to take hold of the situation. I contrast that with what happened in another village, Llanspyddid, where members of the community got together and negotiated to buy in bulk for a little estate, so they got a good reduction in price.
However, the point that I want to make to the Minister is that many LPG users do not know their rights and powers under the new regulations. One of the things that the Government could do, which would not cost a lot of money, is to publicise the new powers and opportunities that exist under the new regulations.
I bring it to the attention of the House that although there is a freer regulatory system in the LPG market, some suppliers still want customers to enter two-year contracts, or even longer contracts in some places. That may be within the letter of the regulations, but I am not sure that it is within their spirit.
A number of people on the lowest incomes, particularly retired people, live in park homes. The best one could say about the position regarding competition for the supply of LPG to park homes is that it is unclear. I raised the issue in the all-party group on park homes the other evening. Representatives both of the owners of park homes and of the estates where park homes are located confirmed that the position on competition is unclear. However, it is a difficult issue so given the short time available to me in this debate, I would be better off writing to the Minister about it.
Another issue is that the new free market applies only to bulk LPG; it does not apply to small cylinders of LPG. Some of the poorest people in our communities use small cylinders of LPG. Buying those cylinders is even more expensive than buying LPG in bulk, which itself is much more expensive than mains gas. Many of the poorest people use mobile heaters, bringing them into their bedrooms late at night when they go to bed; they put them on in the morning in the bedroom and then take them into the kitchen when they are making their breakfast. They take the heaters round the house. However, those LPG cylinders are not covered at all by the regulations, which is an issue the Minister might want to familiarise himself with.
On a related point, we are all concerned about the future of public houses in rural areas, yet it is not clear to me whether the regulations apply to small businesses, such as public houses, as well as to residential properties. Perhaps that is another issue that the Minister might inquire about.
I turn quickly to what I think is a solution to some of the fuel poverty issues: taking mains gas not to individual isolated properties but to communities that do not yet have that facility. I am thinking in particular of communities such as the former mining community in Abercrave in my constituency. One can understand why there was no huge impetus to connect communities such as Abercrave to mains gas, because so many people were in coal mining families and received free coal as part of the miners’ terms and conditions; indeed, miners’ widows, if they survived, received free coal too. Of course, very few people receive free coal now, and they are living in fuel poverty because they have to use either heating oil, which we have talked about, or LPG.
That solution—connecting such communities to mains gas—is very expensive and I am not in any way belittling the cost. But it is a long-term solution and not a short-term fix. Are there any facilities that could be brought into play to ensure that such communities enjoyed the facility of mains gas?
In another village in my constituency, Llangynidr, the problem is that the mains gas pipeline runs on the other side of the River Usk from the village. Making the pipeline cross the river would be the main cost involved in ensuring that Llangynidr received a mains gas supply.
Those are some of the issues that I want to put to the Minister, particularly the points about competition and how we can ensure that the regulations, which are already in place and doing a good thing for LPG users, can be fine-tuned, so that everybody enjoys the benefits that only a few people are enjoying at the moment.
May I begin, Mr Betts, by saying that it is a pleasure to serve under your chairmanship for the first time?
I congratulate the hon. Member for Suffolk Coastal (Dr Coffey) on securing this debate. I listened to her maiden speech in the Chamber with great interest and I concluded that, although it was highly unlikely that we would agree politically, she would undoubtedly serve her constituents well. Indeed, we now know those constituents as the people of the new Jerusalem. I also concluded that she was likely to be a formidable advocate for them, and frankly this place can never have enough formidable women.
This debate is one of great importance. More than one in four households in rural areas are in fuel poverty. In sparsely inhabited English communities, every second home has an energy efficiency rating of less than 30, which amounts to a significant health risk. Fuel poverty is a knotty and difficult problem with which the Labour Government struggled. Although we made progress, much more needs to be done. Our concern is that the emerging political philosophy of the coalition Government may prove to be a significant handicap—that might be putting it mildly.
The coalition agreement brags about the way the two governing parties were brought together by a shared ideology that is antithetical to Government intervention. It says that they
“share a conviction that the days of big government are over”.
However, there are times when Government leadership is necessary and when the market will not solve a problem. Climate change, for example, is, in itself, the ultimate failure of the market economy. There are times when we need to intervene. Furthermore, the effectiveness of Government intervention must be measured and quantified, so that we can account to the public for the spending of their money.
We have heard from the Secretary of State for Energy and Climate Change that he did not have any Government targets for the creation of green jobs and that he did not want to borrow our targets, for fear of seeming to copy the Soviet Union’s Gosplan. However, that judgment is wrong. I urge the ministerial team to reconsider their attitude to targets. In relation to fuel poverty, my first question to the Minister is this: will the coalition keep our 2016 fuel poverty target? If it will not do so, how many people do the Government intend to lift out of fuel poverty by any of their schemes, in either rural or urban areas?
Throughout my contribution, I will put a number of questions to the Minister. I asked some of them in a debate last week and during the somewhat rushed winding-up speeches, the Minister of State, Department of Energy and Climate Change, the hon. Member for Wealden (Charles Hendry), overlooked many of them; I am sure that he did so unintentionally. Therefore, I thought that it might be helpful if I numbered my questions today, for ease of reference.
My second question relates to access to the grid and fuel poverty. The number of off-gas properties is much higher in rural area than in urban areas. Those properties are dependent on solid fuels, heating oil and liquefied natural gas, but the prices of those fuels are higher and they fluctuate more than gas prices. Households that are off the gas network face typical energy bills of £1,700 per annum as opposed to £1,000 per annum for households on mains gas. What steps will the Government take to increase the number of homes on the gas grid?
Another problem is that rural areas have lower average wage levels than urban areas, and the take-up of Government assistance has been more difficult in rural areas. It costs more for contractors to install energy efficiency measures in rural homes, and there is evidence that consumers in rural areas are less aware than consumers in urban areas of the availability of financial support, so my third question is, how does the Minister intend to tackle that problem, especially in the light of recent budget cuts to the Energy Saving Trust?
Another problem, as we heard from many contributors, is that there are fewer cavity walls in rural areas, and solid walls are harder to heat and more expensive to insulate. My fourth question is, what consideration have the Government given to the arguments in favour of making grants available to the rural poor who cannot be connected to the grid, so they can install microgeneration projects, such as ground source heat pumps? Will the Government consider the findings of the Warm Front pilots on air source heat pumps in areas off the gas network for occupants in fuel poverty?
I encourage the Government to be proactive and confident; if we take action, we can get results. Labour achievements on fuel poverty include Warm Front assisting more than 2 million households since 2000, which National Energy Action described as “an extremely successful programme”. Despite early problems with take-up of the scheme, improvements were made and the number of grants increased in 2005-08. I listened with interest to the criticisms of the hon. Member for Suffolk Coastal of Warm Front, but saying that rural communities such as hers lose out on schemes over and over again is overstating the case. In the past five years, Warm Front has helped 2,000 households in her constituency. My fifth question is, can the Minister give his assurance that Warm Front will be retained?
Under the carbon emissions reduction target, major energy suppliers had an obligation to direct at least 40% of carbon savings to priority group households, so, my sixth question is whether the super-priority group of 15%, which was announced on 30 June, in addition to the 40% priority group, can be contained within it. Seventhly, what will the Minister do to ensure that the carbon emissions reduction target takes account of the greater difficulty and cost of insulation in rural areas? In the Energy Act 2010, Labour put a statutory obligation on energy suppliers to offer social tariffs to those in fuel poverty. Under Labour, Ofgem provided incentives for gas networks to connect deprived communities. Households assisted under the scheme qualified as being within the 20% identified in the index of multiple deprivation.
My hon. Friend talks about incentives for gas networks to be extended and for the grid distributors to take the lead, but is it not the case that we need an agency, a local authority or even a community group to do so? Does she agree that we should look at it in that way? We need to ensure that we have local champions in rural areas because, with the greatest of respect, Ofgem in central London does not understand small rural communities. Agencies must work with local government at a local level.
That is right, and, in fact, many of the characteristics to which my hon. Friend refers are part of the community energy saving programme, to which I will return in a moment.
In the Suffolk Coastal constituency, 29,960 people receive winter fuel payments. Eighthly, given the fact that payments have benefited millions of people, will the Minister guarantee that they will continue in the age of austerity? The Government recently announced the dissolution of the Commission for Rural Communities, which I agree is unfortunate, as many hon. Members have said, particularly given that it did a great deal of the analysis on rural fuel poverty that led to significant changes in energy efficiency policy to allow for better targeting of fuel-poor rural households. Everyone knows that Labour did not eliminate fuel poverty and that great challenges remain. Nevertheless, without Government measures, there would have been 400,000 to 800,000 more fuel poor households in England in 2008.
Ninthly, how are the pay-as-you-save pilots established under the previous Government going? Will they run their course and inform the Government’s plans or not? Is the green deal just our pay-as-you-save scheme with a different name, as commentators have said? Tenthly, will the Minister clear up the confusion over whether there will be any form of Government subsidy for the green deal? Will it impose any cost on the public purse? We have had contradictory statements from the Minister of State, Department for Communities and Local Government, the right hon. Member for Tunbridge Wells (Greg Clark), and the Minister of State, Department of Energy and Climate Change, the hon. Member for Wealden, this year. Eleventhly, will the amount available per household be £6,500 or up to £6,500? Twelfthly, will it be more for harder-to-heat homes? In the debate last week, the Minister in the Chamber today told us, with characteristic enthusiasm, about the potential deal with companies such as Tesco, B&Q and Marks & Spencer on the green deal. What will companies get out of this? That was question 13. How confident is he that the private sector will see it as a good proposition?
Most important is my 14th question: how will the Minister ensure that all households that need to improve their energy efficiency take advantage of the scheme? How will the poorest take advantage of it, and how will it work for those on low incomes and those with poor credit ratings? If poorer households do not take up the scheme, does he agree that it will have failed? On 24 June, the Minister’s new boss, the Secretary of State, said at the UK energy summit organised by The Economist:
“Some people—such as the fuel-poor, and those in hard-to-heat homes…—will need extra help because energy savings alone will not be enough. We intend to provide that help by refocusing the obligations on energy companies. Local authorities could also join with energy companies to reach those who live in houses that need it most. Insulation measures are often cheaper if implemented a street at a time. And we are planning to strengthen the Government’s powers to target energy insulation measures on the highest priority cases.”
Does that mean that CESP is saved? Perhaps the Minister will give it another name; I always thought that it sounded more like something that needed a strong dose of antibiotics, but it is a good scheme and the Government should look at it carefully. Will it continue?
At the beginning of my speech, I referred to the profound health problems associated with fuel poverty, and those problems are urgent. If we hit another severe winter this year, there are likely to be tens of thousands of excess deaths. The Government are under an obligation to be proactive, and I hope that they will be.
I, too, am glad to be serving under your chairmanship for the first time as a Minister in Westminster Hall, Mr Betts. I congratulate my hon. Friend the Member for Suffolk Coastal (Dr Coffey) on her maiden Westminster Hall speech. She made a fine start in the main Chamber.
It has been a really terrific debate, and I have learnt a lot. It is the first time that I have listened to a fuel poverty debate as a Minister, and it is striking how much cumulative knowledge there is, not just in one party, but on both sides of the House. In the coming months and years of coalition, I hope that we can be inclusive, not only with our coalition partners, but with other parties, because it is clear that concerns about fuel poverty go beyond party boundaries. Although we come from different sides of the political argument, and may have different priorities or apply different principles to problems that lead to different solutions, there is much more common ground on this issue than is often the case. I hope to have an open-door policy and will be open to new ideas from all parties.
We have a radical programme on energy efficiency and we approach it with new vigour and ideas. I appreciate that the hon. Member for Islington South and Finsbury (Emily Thornberry) is new to her job as well and mustard keen to defend the record of the Labour Government, but we all have to wake up and smell the coffee. She asked whether the Government would keep the 2016 target. Keeping targets is not difficult at all, but meeting them is tough. Her Government, whom she defends, were reversing at speed on fuel poverty despite their best efforts. Over 4 million more people—more like 5 million more—are in fuel poverty than in 2004.
Despite good schemes—the hon. Lady rattled off a number of them—the best efforts of Ministers and a great deal of public spending, we are nowhere close to meeting the fuel poverty targets. We have to do some big thinking, ask ourselves some serious questions and redeploy our resources more effectively to deliver for the fuel-poor, particularly for the rural fuel-poor.
My hon. Friend the Member for Suffolk Coastal addressed clearly what everyone in the Chamber feels: the rural fuel-poor get overlooked and are part of a forgotten population. Many of the schemes introduced under the previous Government have treated people’s homes in urban areas. However, the rural fuel-poor often get a worse deal, particularly those who are off the gas network, because there is a lack of social tariffs for those who are off the grid. That issue has been a reoccurring theme of the debate. My hon. Friend is right to be concerned that metropolitan-centric, top-down schemes that are not embedded in their local communities do not always deliver.
It is difficult to find many of the rural poor. The hon. Member for Westmorland and Lonsdale (Tim Farron) spoke well and reminded us that it is often more difficult to find and treat fuel-poor homes that are in, or surrounded by, areas of relative prosperity than those that are concentrated in a metropolitan area. That is a challenge and it is why such homes have been harder to treat in the past. However, it does not mean they are any less deserving of support and concern.
I cannot commit the Chancellor to anything, because doing so is way above my pay grade. However, I heard what the hon. Gentleman said about the potential for a green investment bank—the Green Investment Bank Commission published its report last week—and I have taken on board his suggestions. I encourage him to have a dialogue with Ministers to discuss such a function for the GIB. I would welcome that opportunity.
The hon. Member for Brecon and Radnorshire (Roger Williams) gave a very good speech. He focused on concerns about competition and ensuring that reforms of competition in the market drive right across and reach target groups that have, so far, not been helped sufficiently.
I was particularly interested in the ideas mentioned in an intervention about supporting and enhancing local group purchasing schemes. When I go back to the Department, I will ask my officials to consider what we can do in relation to that, because the measure does not necessarily involve a lot of spending. I will consider what we can do to try to support and encourage such schemes, because empowering communities is an aspiration that is shared right across the coalition. If one wants to refer to an ideology, it would not be any of those listed by the hon. Member for Islington South and Finsbury. We believe in localism, the need to empower our communities far more and the fact that the solutions to our nation’s problems are not locked in Departments in Whitehall.
I say to the hon. Member for Ceredigion (Mr Williams) that, of course, we are committed to consultation and best practice, not just with devolved Governments, but with local government and communities. Learning best practice is not a one-way street; there is a great deal more that we can learn from what is successful in communities. Although I am not familiar with the triggers for cold weather payments, I know how important they are. I will look into the problems he mentioned and write to him.
The hon. Member for Ynys Môn (Albert Owen) spoke at length and with great expertise about the extra costs suffered by particularly far-flung areas—not just in his constituency, but in the whole of the British Isles. He focused on partnership-working with devolved Governments, local authorities and communities. I assure him that we are committed to doing that. He also wanted to know what the coalition had to say about off-grid support and protection. The coalition agreement is not a manifesto; it is a relatively tight document. However, he will see that it specifically mentions the need to support and protect off-grid customers. We want to do a lot more.
I hope the hon. Gentleman will not regret offering an open-door policy to Members such as me. He is talking about the coalition and localism, with which I agree. However, there must be more than warm words. Although I agree with the devolution of powers, which I have fought for in referendums for many years, we do not simply need it to happen; we need resources. That is the important thing. Dealing with the issue is not just about passing powers from Whitehall to Cardiff, and to rural areas in Wales; it is about making sure that the resources follow those powers.
I appreciate the hon. Gentleman’s comments, but he will also appreciate that we are in a resource-constrained environment for reasons that we do not need to rehearse here. As well as resources, another factor that empowers communities is knowledge. He made a good point about the need for greater transparency about wholesale and retail prices. I agree with him about that, but we also need greater transparency about billing, tariffs and the costs of switching to a different tariff or the best tariff, or paying by direct debit. Those are all important points.
My hon. Friend the Member for Totnes (Dr Wollaston) brought her medical expertise to bear when she talked about the excessive number of winter deaths. She reminded us of the shocking figures that were published last year and of the impact that poor housing has on not just health outcomes, but life expectancy. That helped to bring the debate into sharp focus.
The hon. Member for Angus (Mr Weir) was right to point out that a minority of the population will always be off-grid and that price is important. He made a crucial point about up-front payments and minimum deliveries. I will consider his ideas on section 10 of the Energy Act 2010. I cannot promise that we will act on them, but we will look at the matter with fresh eyes, because we are interested in radical steps forward and new thinking. As I said, we cannot go on as we are.
We have a big plan of our own: the green deal. It does not involve grants, loans or mortgages and it certainly does not involve the very modest proposals—pilot schemes—that the previous Government introduced. The green deal is a bold, unprecedented scheme that will not involve personal debt, as the pay-as-you-save model of the previous Government did.
I shall not take interventions, because I am very short on time. The green deal will bring in new capital, new finance providers, new installers and local providers. A constant complaint about Warm Front and its provisions is that it has not empowered local suppliers. The green deal will mean that as long as a local provider can deliver the standards, they can do the work. That will even apply to a village supplier if they get the accreditation, which should be simple and easy to do. I hope that we will see many community enterprises and community partnerships working on the green deal.
The green deal is fundamentally a pay-as-you-save model. We accept that many of those who live in rural homes and some of the most fuel-poor cannot make the savings to justify the significant investment in building infrastructure that is needed; for example, those who have solid wall houses often fall into that category. That is why we intend radically to reform the supplier obligation. We have started doing that with our carbon emissions reduction target extension, where we have increased the amount that we can direct is spent on insulation; if we take into account DIY, it is now 80%. We have stopped the lunacy of mailing or subsidising light bulbs. The green deal is focused on real insulation efforts. We have increased the super-priority group—made up of pensioners, people with children and those from low-income households—from 10% to 15%, so that it is larger than under the Labour consultation. That is really important, but we want to go further.
I am afraid that I do not have time.
We want to go further to ensure that support is available. The carbon emissions reduction target will raise more than £1 billion, which is much greater than under the Warm Front programme. Potentially there is a significant amount of revenue, but it needs to be much more focused.
I welcome the thoughts of all hon. Members in the Chamber today about how we should focus on the fuel-poor. We will be considering reforming the supplier obligation, so that there is no hiatus beyond the CERT extension in 2012. There is a new deal—a green deal—and there will be a new supplier obligation. Real, substantial resources will be made available for the long term, and we are absolutely certain that we need to continue to deliver for the fuel-poor.
However, fundamentally, we cannot keep chasing the fuel price and subsidising fossil fuels. We need to spend the money we have on investment in building infrastructure to make homes not only warmer, but cheaper to heat in the long term. We must reduce people’s dependency—whether they are on-grid or off—on gas, coal and oil.
I again congratulate my hon. Friend the Member for Suffolk Coastal on initiating the debate. I am sorry that I have not been able to answer everyone’s questions, but I am sure that this is the first of many Westminster Hall debates on this vital issue.
Road Networks (Harlow)
On “The Andrew Marr Show” on Sunday 4 July, the Secretary of State for Transport was straight and honest about the state of British finances. He quite rightly said:
“We will have to prioritise aggressively, and do the things that most promote economic growth.”
We know that there will be fewer major road projects and that our money must be targeted more effectively, which is why I strongly support his drive to obtain value for money. He said in the same interview that improvements to the strategic road network must focus “very specifically on bottlenecks”.
First and foremost, the case for an extra junction on the M11 is about eliminating the bottleneck leading in and out of Harlow. Yes, it would bring much-needed regeneration to one of the most deprived towns in the east of England, and yes, it would transform the lives of tens of thousands of miserable commuters and businesses, but fundamentally it is about economic growth, higher tax receipts and more jobs.
There are five key arguments in favour of an additional junction on the M11. Harlow is uniquely disadvantaged compared with other towns. As I mentioned in Transport questions on 17 June:
“Harlow has just one entrance to a motorway, whereas similar towns, such as Welwyn Garden City, have two or three and Basildon has four”.—[Official Report, 17 June 2010; Vol. 511, c. 1008.]
That has been a regional problem for 30 years. I noted in my maiden speech:
“Inexplicably, Harlow was built with just one entrance, with most of the industrial quarter being at the opposite end. As a result, traffic in Harlow has reached gridlock, with large lorries trundling along from one end of the town to another. If Harlow is to have a viable future, a bypass is not a luxury but a necessity.”—[Official Report, 2 June 2010; Vol. 510, c. 488.]
Recent improvements have not solved the fundamental problem. Harlow is set to benefit from several small transport improvements, including a repaired train station, the dualling of the A414 and the introduction of bus lanes and cycle paths. However, a town of 80,000 people is like the human body; it needs circulation to live, and when its arteries become blocked, something must relieve the pressure.
The fundamental problem has been, and will always be, access to the motorways for businesses and commuters. Everyone agrees with that analysis, which is why every public sector body and major private business from the region have come together to make the case for an extra junction on the M11. The recently formed Harlow-Stansted Gateway Transportation Board includes Essex county council, Hertfordshire county council, Harlow district council, East Hertfordshire district council, Epping Forest district council, the Highways Agency, the Department for Transport, the East of England Development Agency, Harlow Renaissance, and private sector interests such as BAA and National Express. All those public sector bodies and private businesses agreed jointly in the board’s annual report that over the next few years Harlow will become
“a major economic hub, close to London and at a key strategic location in the M11 growth corridor.”
The recent improvements to Harlow’s roads are welcome, but they are just that: improvements. They are a sticking plaster and, sadly, will not transform Harlow’s road network.
Congestion has a huge economic cost. Pollution and noise aside, economic growth in the M11 corridor is clogged by congestion. The Harlow-Stansted Gateway Transportation Board’s report states:
“EEDA’s recent Transport Economic Evidence Study identified that the area of the London Arc containing Harlow was the most congested in the region, but also the area which could see the highest level of economic return from transport investment.”
The proposed extra junction would be situated in a key growth area in Harlow, with the potential for about 5,000 additional homes. If the proper infrastructure is not built and access to the motorway is not provided, congestion will become significantly worse. The latest survey on traffic from the Essex Federation of Small Businesses showed that its members lose on average seven hours per week per driver to congestion. A back-of-the-envelope calculation shows that, with an average hourly cost of £15, that equates to £105 per driver per week, or £5,460 per driver per year. When one considers that there are 40,000 jobs in Harlow, one starts to realise that that means a loss in economic output of about £218 million a year. Hours spent in traffic jams and congestion are wasted; they are a drag on the economy.
For people who work overtime there is also a direct financial cost, as well as the indirect cost of potential output that is not achieved. The Essex Federation of Small Businesses has stated that its members
“strongly support the need for a new junction linking Harlow to the M11 as the current junction cannot cope with the traffic. A new junction which enabled traffic to flow easily into Harlow would soon cover its cost just in time saved by business people currently caught in traffic queues.”
An extra junction would massively boost jobs and private sector investment. I am glad to join my hon. Friend the Member for Ilford North (Mr Scott) and several other hon. Friends in reminding the House that the M11 corridor is a dynamic growth economy. All the evidence suggests that when the Government invest in the M11 corridor, the benefits hugely outweigh the costs. Harlow district council’s 2009 business survey showed that three quarters of companies regard Harlow’s location as the strongest reason to invest, which is a solid foundation on which to build. One in two respondents cited Harlow’s traffic congestion as a major barrier to business growth—in fact, it was the second highest barrier to growth overall, after the recession. Finally, the survey showed that four out of five Harlow companies felt that a new motorway junction would be
“the single most effective mechanism to improve congestion.”
Therefore, the private sector is highly confident that with the right road investment in Harlow, substantial economic and social benefits will accrue to both the town and the wider M11 region. The Harlow area provides a strong case for investment and has many clear advantages. It has an unrivalled location, which is why the Health Protection Agency is seeking to move to the town. It is close to London, Stansted Airport, Cambridge and the ports at Harwich and Felixstowe, all regarded by businesses as strong attributes.
There is spare employment land in Harlow, so there is both the capacity and opportunity to deliver economic growth. The town already provides significant sub-regional employment—40,000 jobs—and can increase that significantly. The town has a brave and ambitious vision for its future, with an upgraded town centre now being developed. A better road network will help to retain existing businesses and attract new ones. In a region with considerable growth pressures, Harlow can not only accommodate economic growth, but welcome it. The town is a true centre of excellence for the haulage and distribution industry, which needs quick access to the M11 to thrive.
The cost of an extra junction would be very modest, given the investment available from local housing developers. Essex county council has already committed more than £500,000 for a detailed study of an extra junction. That will be spent in two stages: £130,000 in phase 1, to build an outline business case; and £435,000 in phase 2, to look at more specific issues, such as where pressures would accrue on the road network. It is right that local people should shoulder some of the up-front costs to reduce the burden on the British taxpayer. Councillor Norman Hume, cabinet member for highways at Essex county council, is clear on just how important the scheme is locally:
“A new junction on the M11 North of Harlow is now the number one transport priority for the business community of Harlow, and Essex County Council. A new junction will relieve existing congestion and promote the growth and much needed regeneration of Harlow. In order to promote and justify the case for investment, we are developing a business case through Growth Area Funding.”
Phase 1 of the study will report in autumn 2010 and phase 2 in early 2011. Councillor Hume and the highways officers at Essex county council are absolutely pioneering in their approach to the road network in Harlow, as are the officers at Harlow district council. Their plans are in harmony with the new Government, with value for money and economic growth at the heart of what they hope to achieve. Harlow district council is equally supportive. Its leader, Councillor Andrew Johnson, said in a statement that a new junction is
“vital to achieving the town’s regeneration and creating a prime location for business. It is fundamental to unlocking the economic potential of the town.”
Essex county council estimates that the total cost of the new junction on the M11 could be as little as £25 million. It would be located in a key Harlow growth area of up to 5,000 homes. Much of the £25 million cost could be funded through section 106 agreements, making this an opportunity for the taxpayer to get the full economic benefits but pay only part of the already modest costs. The Essex Federation of Small Businesses has studied the cost of congestion and believes that congestion in Harlow is reducing economic output in the region of £218 million a year. When that is set against a cost of less than £25 million, the figures speak for themselves.
I am a realist, and I accept that Ministers’ first priority must be to reduce the public debt, which early this year ballooned to £900 billion. I also accept that a project of this scale would normally take 10 years to deliver. The people of Harlow do not expect miracles overnight—they have been waiting 20 years already—but I believe that the case is very strong. Harlow has only one motorway entrance, unlike other major towns of its size. Recent road improvements have not solved the fundamental problems. Congestion results in a huge economic cost to Harlow and to the M11 corridor. An extra junction on the M11 would boost jobs and private sector investment massively, and the cost would be very modest, given the available investment from local housing developers and sector 106 agreements.
I close with the point made on Sunday by the Secretary of State:
“We will have to prioritise aggressively, and do the things that most promote economic growth.”
An extra junction on the M11 would most promote economic growth. Yes, of course, this is about transforming the lives of tens of thousands of commuters and businesses in Harlow. Yes, it would bring much-needed regeneration to my constituency, which is one of the most deprived towns in the east of England. Fundamentally, however, my argument for an extra junction on the M11 is about economic growth, higher tax receipts and more jobs.
I simply want to support my hon. Friend’s statement. I represent Great Yarmouth, and although the M11 is not there, or in Norfolk, it is the closest motorway to my constituency. It is a vital part of the artery joining the A11 and the A47 that runs through to our outer harbour and to Norwich airport, so it is hugely important to the economic development and growth of Great Yarmouth, which has pockets of high deprivation. Anything that we can do to alleviate the traffic problems along that artery, which this junction could—and clearly will—do, is of benefit to Great Yarmouth. Does my hon. Friend agree that that is important for Harlow, but also for the wider business community throughout East Anglia and the eastern region?
In terms of procedure, normally the hon. Member initiating the debate would speak, then the Minister would respond. The hon. Member would not come back. It would have helped if the hon. Member for Great Yarmouth (Brandon Lewis) had intervened beforehand, but I will allow a brief response.
Thank you, Mr Betts, for allowing me to respond. Having a close association with the area—a constituency in the east of England—and travelling on the M11, my hon. Friend knows better than most the traffic problems that we have in Harlow. I am very grateful for his support, which will be noted by the people of Harlow and all the businesses and commuters who use the M11 on a daily basis.
I congratulate my hon. Friend the Member for Harlow (Robert Halfon) on securing this debate on traffic and the road network in Harlow, and on the strong presentation of his case this morning. Although only recently elected to the House, he has already asked questions about traffic and road issues in Harlow, and I am pleased to respond to his first Adjournment debate on a subject that is clearly of great importance to him and his constituents.
It might be helpful if I explain that within the Department for Transport the Under-Secretary of State for Transport, the hon. Member for Hemel Hempstead (Mike Penning), has responsibilities for the motorway network and I have responsibilities for other roads and for general traffic issues. My hon. Friend the Member for Harlow has concentrated solely on the M11, which is a matter that would normally fall to my colleague, but I will do my best to respond to the issues he has raised. However, given the title of the debate, I will also refer to other issues that relate to traffic and transport in the Harlow area.
Before I turn specifically to Harlow issues, I need to make some general points. My hon. Friend will not be surprised if I make them on behalf of the Department—the point he made himself. In particular, I must make it clear at the outset that the overriding need the coalition Government have identified is to tackle the national deficit. That means that the decisions we take and the speed with which we are able to implement transport improvements will need to be determined in the context of the comprehensive spending review. The Department for Transport is playing a full part in that spending review, which will report in the autumn.
We have already announced a range of measures aimed at delivering reductions in spending. On 24 May the Chancellor of the Exchequer and the Chief Secretary to the Treasury gave details of £6.2 billion of savings in Government spending in 2010-11, and the Department for Transport is contributing by finding savings of £683 million this year. That has meant taking difficult decisions on funding, and deferring decisions on some transport schemes until after the outcome of the spending review. On 10 June, the Department for Communities and Local Government published further details of local government savings, including £309 million in local transport funding.
The Department and I understand that those reductions and deferrals are difficult for many places. Through reductions in ring-fencing, we have maximised the flexibility for local authorities to reshape their budgets according to local priorities, and to identify where efficiencies can be found. There is also an opportunity to rethink transport plans and priorities, to ensure that proposals are environmentally as well as financially sustainable. However, given the current financial constraints, it is essential to ensure that any new infrastructure is affordable and offers value for money.
Turning to Harlow-specific matters, it is first worth reflecting on the history of Harlow’s development, as therein lies some of the answers as to why Harlow, a new town, suffers the level of congestion experienced by my hon. Friend’s constituents. When Sir Frederick Gibberd drew up the original master plan for Harlow, he did so with the expectation that a new motorway would be built to the west and north of the urban area. He therefore positioned the town’s industrial areas and town centre where they would have easy access to the new motorway, probably with multiple access points. However, the M11 was subsequently built to the east, giving rise to some of the problems that are now being experienced. Access to the town was via junction 7 and the A414 from the south. As a result, as my hon. Friend knows only too well, traffic in and out of Harlow has to traverse a series of mainly single-lane carriageways to reach key destinations such as the town centre and areas of employment. Frequent congestion is the result, and the Department acknowledges that. I fully understand that congestion is seen as a barrier to achieving the town’s regeneration and economic growth ambitions.
My hon. Friend will be aware that, for some time, many people have seen the solution as the provision of a new junction—7A—on the M11 to the north of Harlow, along with realigning and extending the A414 to provide a northern bypass to Harlow. I am advised by officials that the cost of the full scheme is estimated as in excess of £250 million. However, the feasibility of such a proposal has yet to be established.
I am aware that, on behalf of the Harlow-Stansted Gateway Transportation Board, Essex county council is undertaking a feasibility study—to which my hon. Friend referred—of the options for a reduced scheme to include a new motorway junction and connection to the existing local road network to the north-east of the town. The study will give an indication of whether that is a potential solution. There may of course be effective, lower-cost solutions that emerge from that or other work that the county council or others undertake locally, and I will follow developments closely, as will my colleague the Under-Secretary.
I thank the Minister for what he has said so far. I want to make it clear that, as he acknowledged, I am just asking for the extra junction on the M11, because I recognise the huge cost of something that would happen in the distant future. I am asking just for that, because it is much better value for money for the taxpayer.
I am grateful to my hon. Friend. As we will undoubtedly have less money in the future, we have to be much more careful about how we spend it, and to ensure that rigorous cost-benefit is applied to any scheme. I suggest that the cheaper a scheme comes in, the more likely it is to proceed.
It is also worth pointing out that the context has changed, given that some of the justification for the northern bypass came from the significant northern expansion of Harlow that would have been needed to meet the regional spatial strategy—RSS—housing targets. With the revocation of the RSS—I am sure my hon. Friend will welcome the increased move towards devolution—there will no longer be a regional policy basis for that level of development. Obviously, we have devolution coming forward in the decentralisation and localism Bill that the Department for Communities and Local Government will introduce and in the enterprise boards it proposes. We will see what comes from those local economic partnerships.
The M11 junction feasibility study will consider the transport needs of future development within Harlow’s boundaries but, ultimately, it will be for Harlow, together with partner authorities, to agree on how best to develop beyond that. Such discussions will be based on what local communities want, and my Department will try to respond as positively as it can.
I acknowledge that congestion in Harlow is of particular importance locally. I am pleased that rapid progress is being made by Essex county council to dual the A414 carriageway between junction 7 of the M11 and the Southern Way junction. When that work is completed in early 2011, the scheme will significantly alleviate the bottleneck.
However, I make it clear on behalf of the Department that extra road capacity is not the only answer to tackling congestion. Nor, indeed, depending on the circumstances, is it necessarily the best answer. In March, Essex county council successfully completed the First Avenue multi-modal corridor, which provides fast bus access from the New Hall development to the town centre. It includes a shared cycleway and provision of real-time information, and is an example of the kind of sustainable transport solution that the Government are keen to bring forward. Obviously, if people can be persuaded to transfer from cars to other modes of transport, that will free up existing road capacity for motorists who are still on the network.
I understand that the feasibility of other ideas for congestion-relieving projects has been investigated locally, including the potential reopening of the Central line from Epping to Ongar and an extension to Harlow. I shall be interested to see whether that washes its face economically.
We made clear in the coalition agreement our commitment to a modern, low-carbon transport infrastructure as an essential element of a dynamic and entrepreneurial economy. An effective and efficient low-carbon transport infrastructure can help to support economic development and, at the same time, help to tackle climate change and, indeed, congestion on the road network. Securing that objective in our current economic climate is, of course, a challenge, but I am confident that we can rise to it and foster a transport system that works for the economy, the environment and local communities.
The Government are committed to making the best use of the rail network as part of their commitment to creating a low-carbon economy and improving the travelling experience for passengers. I am pleased to note that National Express East Anglia’s refurbishment of Harlow Town station is near completion. That work was funded by £200,000 from my Department, matched by £200,000 from Essex county council. In addition, the delivery of new rolling stock will allow longer and more frequent trains to run on services for Harlow Town and Harlow Mill.
My hon. Friend will be aware that £8 million was earmarked for the Harlow public transport scheme in the regional funding allocation submission made to the Government in February 2009. Essex county council began developing proposals, but the matter is now on hold while the comprehensive spending review takes place. I hope that my hon. Friend will agree that the review provides communities and the Government with an opportunity for wider reflection on possible alternative options for tackling congestion and addressing other transport issues, and on how we assess the feasibility of transport schemes big and small.
The coalition agreement includes a commitment to make the transport sector greener and more sustainable, including reforming how decisions are made on prioritising transport projects so that the benefits of low-carbon proposals are fully recognised. That work is ongoing in parallel with the spending review, and it is clear that the decisions taken after the spending review is completed will be influenced by work on the appraisal of transport schemes.
The coalition agreement refers to making the transport sector greener. Building on that policy framework and on the success of the first round of the green bus fund, on Monday I announced a second round of the fund worth £15 million, which will support the procurement of another 150 low-carbon buses in England. All transport authorities, including Essex county council, are encouraged to submit a bid. Perhaps my hon. Friend will take that point back to the council, which may be able to get some money for green buses for the area.
The first round of the fund will support the 24 successful winners in purchasing about 350 new low-carbon buses, the first of which will be in operation from this summer. Low-carbon buses use at least 30% less fuel than standard diesel buses with the same passenger capacity and emit around one third less greenhouse gas emissions, yet they account for only 0.2% of the buses on the road in England.
In identifying their needs and priorities, Harlow council and Essex county council should consider the full range of options available and the potential for attracting funding from other than public sector sources. My hon. Friend was right to refer to section 106 agreements, which could indeed provide sources of funding for transport infrastructure improvements. Frankly, at this stage, it is clear that more money secured from the private sector will not only improve the appraisal outcome for individual schemes, but make it less likely that they are lost in the mix. In the current financial climate, I cannot offer assurance about the future time scale for schemes that have been identified, but reviewing the feasibility of options should mean that Harlow is well placed to benefit from available investment when the financial position eases.
In conclusion, it is clear that we face a challenging situation. Tough decisions have already been necessary to tackle the UK’s budget deficit, which the Government have identified as their most urgent priority, and transport must play a full part in the process, as my hon. Friend recognises. Only when the Government’s spending review has been concluded will the Department be in a position to identify what investment can be made. In a period when we face tight financial restraints, it is essential that we take a step back to consider what options are available, and which schemes should be prioritised. By doing that, we will place ourselves in a strong position to make best use of the funds available, and to establish a sound base for the future development of a transport system that can contribute to a low-carbon economy.
As I said, additional road capacity may not be the only answer to congestion. There are real opportunities for communities to reassess whether they can deal with congestion in their locality in ways that contribute to other ambitions such as reducing greenhouse gas emissions, improving the environment and encouraging healthier lifestyles. My hon. Friend has put on the record his strong support for junction improvements to the M11. His Adjournment debate is timely, in that this is a period of reflection and reconsideration for the Department for Transport as to how it wants to proceed. I will ensure that his remarks are drawn to the attention of the Secretary of State and my colleague the Under-Secretary, who has responsibility for motorway issues.
Child and Adolescent Mental Health Services
[Mr Joe Benton in the Chair]
I appreciate having been able to secure the debate. I thank the Minister and shadow Minister for their attendance, and am grateful to the other MPs present. A lot of people watching the debate on the Parliament website might not be aware that we all had a late night last night, debating the finer points of the Finance Bill, so I am grateful to hon. Members for turning up. I also thank the National Autistic Society for providing me with statistical information. I remind the Chamber that I have declared an interest in the subject of the debate, as the parent of a child with autism.
I want to discuss the experience of many families with autism; their feedback on the support provided by child and adolescent mental health services, or CAMHS; and problems of communication, misdiagnosis and the training of CAMHS professionals. I will then make the case for more specialist autism support and ask the Minister a number of questions.
Autism is a serious, lifelong, disabling condition that affects how a person communicates with and relates to other people. It is a spectrum disorder that affects each individual differently. Some people with autism can lead independent and fulfilling lives with little support, while others need specialist support throughout their lives.
People with autism have said that, to them, the world is a mass of people, places and events of which they struggle to make sense, and which can cause them considerable anxiety. In particular, understanding and relating to other people and taking part in everyday family and social life may be harder for them, while other people appear to know intuitively how to communicate and interact with each other. Approximately one child in 100 has autism.
Autism is not a mental health problem, but a recent study by Professors Simonoff and Charman found that 71% of children with autism have a co-occurring mental health problem, and 40% have two or more. Such problems include serious conditions such as depression, anxiety disorders and obsessive-compulsive disorder, which can be debilitating without the right support. Seven out of 10 children with autism develop such conditions, which is far too high a figure. However, with the right support from people who understand autism, such children can have mental health as good as any other child’s. Unfortunately, that support is often unavailable in our society.
Children with autism find it difficult to understand the world around them. They may not understand social cues and expectations or be able to identify patterns and routines in their lives. Help with understanding what to do in different situations or what happens next in a sequence of events, or with coping with changes in routine, can make a big difference, but without such support, children with autism can become anxious or frustrated.
Children with autism are also less likely than other children to have strong social relationships. One Office for National Statistics study found that 42% of children with autism had no friends, compared to 1% of other children. Children with autism may act in unusual ways, or may try to fit in with their peers in socially inappropriate ways. Other children may ridicule or bully them as a result.
Difficulties at school and elsewhere may affect the self-esteem of children with autism. An inability to express their feelings can lead to escalating emotions or leave them unable to deal with experiences such as loss or grief. A supportive educational setting that works for the child, in partnership with mental health services, can be crucial to maintaining emotional well-being and preventing mental health problems from developing, yet the NAS found that 34% of parents said that a delay in accessing the right support at school had had a negative impact on their child’s mental health, and that half of children with autism are not in the kind of school that their parents believe would best suit them. Awareness and consideration among the general public also play a part. Whether in shops and restaurants, on public transport or in the park, children with autism and their parents can face intolerance and lack of understanding that can cause considerable stress and anxiety.
It does not have to be like that. Most of those difficulties can be overcome with the right support for children with autism and their families. Children with autism can live happy, healthy, fulfilled lives, do well at school and reach their full potential. Everyone in society must take some responsibility for making that happen.
I intend to concentrate on the support that children with autism and their families receive when mental health problems develop. According to Government-commissioned research conducted by the university of Durham, one child in every 10 who accesses child and adolescent mental health services has an autism spectrum disorder. That amounts to more than 10,000 children a year. Such children are often extremely vulnerable and in dire need of support that works for them. Another ONS study for the Government found that 25% of children with autism either self-harm or have suicidal thoughts. Their families are desperate for skilled help that can improve their children’s mental health and quality of life.
The NAS has been carrying out in-depth research on the subject since last summer, as problems with CAMHS were being mentioned consistently through its helpline and regional offices. When NAS members were surveyed on the organisation’s campaigning priorities, 99% rated improving CAMHS as either important or very important. The NAS held focus groups with parents and one-to-one interviews with children who had experienced CAMHS, followed by a mass survey of parents. It also visited several CAMHS sites and spoke to professionals and clinical directors.
Through its research, the NAS has found that, sadly, most children with autism and mental health problems are not getting the service that they need from CAMHS. According to the NAS survey, CAMHS fails to improve the mental health of two thirds of children with autism. We must improve on that.
One young woman said of her experiences as a nine-year-old accessing CAMHS that
“when I went in to the meeting I was miserable and depressed. When I came out I was suicidal. I was trying to throw myself out of my windows and hang myself… It took me several years to recover and I didn’t ever want anything to do with them.”
The NAS consistently heard from professionals, parents and children that, despite the huge proportion of children with autism in the system, understanding of autism among professionals is generally poor. Only half of parents feel that CAMHS staff have a good understanding of autism, and fewer than half think that CAMHS staff know how to communicate properly with their child.
To work successfully with a child with autism, a CAMHS professional must have a good understanding of autism. Autism is a communication difficulty, so the professional must generally adapt how they communicate, which requires a good understanding of autism. With respect to some children, that involves speaking more clearly and directly, while others have limited or no verbal communication and may need visual cues to help them to make sense of and communicate their feelings. A child with autism is likely to take longer than other children to trust the professional and communicate openly.
Professionals may also have to adapt their explanations to be less abstract or hypothetical and relate more directly to the specifics of the child’s situation. For example, if a professional works with a child with autism to deal with a certain situation in a classroom setting, the child will usually struggle to generalise, applying the same techniques at home or on the school bus. The professional will have to work through each situation in turn, which is not necessary for other children.
Children with autism can also struggle to explain difficulties that they are not currently experiencing. One child said:
“They need to be there when things happen, because when I went to see the doctor at our local CAMHS I never felt bad and couldn’t talk about what had been hard because it wasn’t happening then”.
When professionals are given the time and training to get to know the child and their family, understand the child’s autism and how they communicate best, and adapt their approach accordingly, outcomes are greatly improved. However, a professional who does not understand autism is unlikely to make such adjustments, leading to a breakdown in communication and making effective intervention extremely difficult.
When a child with autism also has a mental health problem, it is crucial that the right support is provided for the right diagnosis. If a child is wrongly assessed, the wrong support will inevitably follow. Practitioners who do not have a good understanding of autism can misdiagnose children as a result, leading to inappropriate or unsuitable interventions. Without a sound working knowledge of autism, some behaviours that are common in children with autism can easily be interpreted as mental health problems. For example, autism-related personal obsessions, rituals and routines can lead to a false diagnosis of OCD. Peculiarities and fads about what a child eats can come across as an eating disorder. Sleeping difficulties or an aversion to human touch can wrongly lead to suspicions of abuse-related trauma.
The NAS found that some children who had been diagnosed with autism were wrongly undiagnosed by a professional who was convinced that their behaviour was symptomatic of a different condition. Other children’s mental health conditions were overshadowed by their autism, when professionals were unable to distinguish the symptoms of mental health problems from autism-related behaviours: if the CAMHS team focused on autism, mental health issues were ignored. Some parents said that the professionals they met considered conditions such as anxiety disorders inevitable and unavoidable side-effects of autism, rather than as the separate, treatable conditions that they are.
Many of the professionals told the NAS that they wanted more opportunities for professional training and development, so that they and their colleagues would be better able to work with children with autism and mental health problems. Many children with autism receive either inappropriate support or no support at all because the right support simply does not exist in their area. Some CAMHS professionals told the NAS that their waiting lists for children with autism were much longer than those for children without autism, and that, because so few staff had autism training, the vast majority lacked the skills to treat children with autism, so those children were left waiting for the handful of staff with sufficient autism expertise.
As chair of the all-party group on autism, I congratulate the hon. Gentleman on securing this debate on an immensely important subject. The NAS has done fantastic work raising these issues with colleagues. What training did CAMHS staff receive under the previous Government and does he think it was adequate? If not, what improvements might be made?
I am grateful to the hon. Lady for her intervention, and I acknowledge her work and expertise in this field. I approach this subject primarily as a parent, so I am happy to say that more needs to be done. I am not making this a party political issue between this Government and the previous one. I am trying to highlight the issue and, I hope, move forward together, across the House.
I wish to identify some good practice relating to the hon. Lady’s question. Dudley primary care trust operates an autism clinic that focuses on diagnosis and assessment, and has the specialist expertise to assess complex autism cases. The clinic takes a “broad apprenticeship” approach to training new staff, which gives them the opportunity to observe specialists and more experienced clinicians assessing children from behind a one-way mirror.
After new staff have watched several assessments, they progress to shadowing colleagues and then to taking the lead with children with autism, with support from a specialist. Finally, they are able to work alone and train new starters themselves. They learn through practical experience, rather than theory. The clinic also shares its expertise more widely and trains external agencies. For instance, it trained a group of specialist autism teachers and key workers to provide social skills training to children, meaning that social skills training could continue once a child had left CAMHS, making it far more effective than if it had been delivered once and then discontinued.
There is clear evidence that a good understanding of autism is vital to delivering an effective service to the high number of children with autism in the CAMHS system. All professionals working in CAMHS must have their training needs relating to autism recognised and addressed. In “Fulfilling and rewarding lives”, the Government’s recently published strategy for adults with autism, there is a commitment for
“all NHS practitioners”
“be able to identify potential signs of autism, so they can refer for clinical diagnosis if necessary… but more importantly so they can understand how to adapt their behaviour, and particularly their communication, when a patient either has been diagnosed with autism or displays these signs.”
The same strategy commits the Government to working with the General Medical Council and various professional bodies
“to improve the quality of autism awareness training in their curricula.”
What action do the Government intend to take to ensure that the NHS training objectives made in the autism strategy, “Fulfilling and rewarding lives”, are met, so that all CAMHS practitioners receive some basic training in autism?
The hon. Gentleman has made two distinct points so far: that mental health problems can be masked by autism so that a person who really has mental health problems may be seen only as having autism, and that autistic behaviour can be misdiagnosed as a mental health issue. Surely that is a very tricky situation for any diagnostician to be in.
Yes, it is difficult. To be clear, my point is that the prevalence and frequency of co-occurring mental health problems with autism require CAMHS professionals to have specialist training. Without that support, there can be misdiagnosis, which can lead to the situation that the hon. Gentleman referred to.
Does the Minister agree that, given the high proportion of children with autism who access CAMHS, all CAMHS professionals should receive some autism training?
I have explained how a basic knowledge of autism among all CAMHS staff is essential to ensuring that appropriate interventions are delivered to children with autism, but that alone is not enough. Providing mental health support to a child with autism is a specialist skill. Research has found that when an autism specialist has been involved in the support of a child, the outcomes and service satisfaction both improve dramatically.
The NAS found that parents who reported that their child had received support from a professional specialising in autism were twice as likely as those whose children had not to agree that CAMHS had improved their child’s mental health. They were also four times as likely to say that a good understanding of autism by mental health professionals had positively influenced their child’s mental health. However, only two in five parents say that their child has had such support.
I congratulate the hon. Gentleman on securing the debate. As a parent of an autistic child, does he support the idea that children on the autistic spectrum should be educated in special schools, or are such children better off in mainstream schools?
Speaking as a parent, we must recognise that this is a spectrum disorder. Therefore, children with autism are in different situations and have different symptoms, and each requires a response particular to them. Generalisations of the kind that the hon. Gentleman asks about cannot be made. Each parent and professional would, in respect of the support that they had, have to make the decision based on what was best for that particular child.
The professionals who spoke to the NAS stressed the importance of specialist autism expertise when dealing with a child with autism and mental health problems. They explained how in many cases a specific skill-set is required to treat these children and that without that specialist knowledge it can be very difficult to effect any real improvement. They felt that specialist expertise was often required to get a real understanding of how the child’s mental health problems related to their autism, and how they would need to adapt the interventions they provided to take account of the child’s autism.
Although basic autism knowledge will help a professional to communicate better with the child and understand better why the child displays certain behaviours or symptoms, greater expertise is often needed to make a positive difference to the child’s mental health. That is because many therapies and interventions rely on thought processes and communication techniques that do not make sense to children with autism, and only skilful adaptation from a specialist can make them relevant and useful. Children with autism often will not gain any benefit from treatment that is applied in the standard way. Indeed, such treatment can make things worse.
Again, we should recognise good practice where it exists. West Berkshire has a social communication team that provides home and community-based assessment and intervention for young people with complex diagnostic issues or needs that cannot be met by local services. That team works with children with autism and a co-occurring mental health disorder. It takes a multidisciplinary approach, incorporating speech and language therapists, two clinical psychologists and a psychiatrist. The team is also part of a wider multidisciplinary group that provides services for children with autism in west Berkshire. The team recognises the need to adapt therapies to account for autism. Psychologists divide their time between diagnosis and follow-up appointments, and provide behavioural and mental health interventions.
I have worked in this area for many years, with many children and CAMHS services. I have found across the country that there is massive inconsistency in the quality of CAMHS services, but there is absolute consistency in the lack of those services for children. Quality is variable throughout the country. Although the services that my hon. Friend is talking about are at the upper end of the scale, for many children they simply do not exist.
I am tremendously grateful to my hon. Friend for her intervention. She has great expertise in this and other matters, and in another capacity was responsible for the education system that I went through. I hope that I am not letting her down.
Following on from that, as so many children who access CAMHS have autism, what action will the Government take to ensure that specialist autism support is available to all children with autism and mental health problems? To take up what my hon. Friend has said, I think we would all agree that one matter that always arises when we talk to parents and campaigners is the inconsistency in service delivery across the country. For every example of innovative or positive practice, there are often many examples of children with autism and mental health problems facing inadequate or non-existent provision.
Local commissioners are supposed to plan services based on the needs of the local population, but it seems that in many instances commissioners are unaware of either the number of children with autism and mental health problems in their area, or that those children need specific support from people who understand autism, or both. When commissioners fail to recognise and address the needs of children with autism and mental health problems, those extremely vulnerable children and their families do not receive the support that they need. Commissioning is a local exercise, but there is no doubt that direction from the Government at national level can make a huge difference to what is commissioned.
Previous Government directives—for example, the national indicators, Care Quality Commission inspections and the national service framework for children—have instructed commissioners to prioritise specific areas of CAMHS, such as age-appropriate in-patient wards for teenagers, early intervention services, and services for children with a learning disability. Those directives drive commissioning in those areas, and lead to greater availability of services and greater consistency across the country.
The National Autistic Society has provided strong evidence that CAMHS are failing children with autism, and that results for such children can be greatly improved by improving autism understanding and specialisms within CAMHS. We know that only 10% of CAMHS provide targeted support to children with autism. Surely, there is a strong argument for the Government to prioritise the commissioning of services for children with autism.
Ten thousand children with autism access CAMHS each year. Given that the mental health of two thirds of children with autism is not improved by the support that they receive, that is a huge waste of NHS resources when we can ill afford such a waste. Furthermore, when children with autism receive services that do not work for them, or receive no support because none is available, their problems escalate and become more complex. Not only does that mean that it is much harder for families to cope; it means that, ultimately, those children are much more expensive for the NHS to treat. A relatively short period of appropriate therapy from an autism specialist at an early stage could prevent a child from needing a long stretch in an expensive in-patient unit.
If commissioners were given more guidance and direction to help them to commission the right services for children with autism in the first instance, we could stop wasting money and stop wasting lives. What action will the Government take at national level to ensure that the right services for children with autism are commissioned locally across the country?
Order. The debate lasts only one and a half hours. Several hon. Members have indicated that they would like to speak—I will do my best to call them all—so perhaps they will bear that time limit in mind, and that I propose to start the winding-up speeches at 3.40 pm.
I congratulate the hon. Member for Stalybridge and Hyde (Jonathan Reynolds) on securing this debate, and providing comprehensive coverage of the vital issues. I also congratulate the National Autistic Society on its “You Need to Know” campaign, because we must make services work better for people with autism. An important aspect of that is to make CAMHS services throughout the country work effectively for children with autism.
I have been contacted by constituents asking me to support the campaign, and I want to begin my brief contribution by describing some of their experiences, because they illustrate all the general points that the National Autistic Society makes. One constituent wrote:
“I first realised there was something wrong with Jon’s development at the age of 2 but was told by my Health Visitor that I was comparing him to his older exceptionally bright brother and that he was fine. I continued over the next 2 years to say that ‘something wasn’t right’ until she eventually agreed to get his hearing checked—he wasn’t interacting with me, seemed in his own little world and wouldn’t even respond to his name. His hearing was fine so she referred him to a speech therapist as he didn’t talk much but after a few weeks of attending, he was discharged saying he was ok. It was only once he’d started school that he was referred”—
to the local hospital—
“But the consultant…decided that Jon must have a form of epilepsy as he would ‘switch off’ in the playground and was oblivious to his surroundings. He did months of tests but they revealed nothing”.
Eventually, Asperger’s syndrome was diagnosed, and my constituent went through years of seeking help. She continued:
“I have no idea what or how to access services which may or may not be available to Jon especially CAMHS. He is 17, 14 stone and 6ft 3, and can have tantrums like a 2 year old—just as sudden and just as violent. I asked my GP if there was some kind of Anger Management course available to him or if he could see a psychologist that could help him. He said I would have to see Jon’s consultant”.
And so it went on. My constituent believes that training is needed across the board for GPs, nurses and psychologists, as well as with direct CAMHS services.
Another constituent who works with children and young people with autism said:
“I feel that many health professionals are unaware of the battles faced by those living with autism. I have often found those from outside agencies quite hostile towards our clients…not realising that they need to be treated differently from neurotypical people. Most of these students have diagnosis in other things such as Obsessive Compulsive Disorder, ADHD and Pathological Demand Avoidance and attachment disorders.”
They say that it is
“hard to find people with the right expertise to deal with these disorders as they usually have not dealt with people with autism before, leaving these other diagnoses untreated. Add this to the fact that the provision for all of these services usually drop away once a person with autism reaches 19 and are transferred into adult services and it seems we are failing those with a diagnosis”
Another constituent said:
“My experience with CAMHS for Sam has been quite negative. We saw an ASD Nurse Specialist from CAMHS for about 6 months. He knew very little about autism, in fact he used to borrow books on autism from parents”.
Another constituent wrote:
“We are consistently told by professionals that they are severely overstretched which from personal experience and talking to other parents leads to very few families receiving adequate support…Maybe if money was invested on these children as they deserve…then they would be more likely to develop into functioning adults who are able to contribute to society in a positive way rather than developing into adults with mental health issues who are totally reliant on the state.”
Those four experiences sum up many of the issues that we are debating.
Autism is not a mental health problem, which makes it difficult for people to access appropriate services. As we have heard from the hon. Gentleman, a large proportion of children with autism have mental health problems, which may develop because of the symptoms that they express and subsequent interaction with other people. They may become more socially isolated at school because of their characteristics. The problem snowballs if the symptoms of autism are not identified early, and the child’s journey does not include trained people who understand its complexities and varieties.
The debate is rightly concentrating on the inadequacies of CAMHS, but my hon. Friend knows of my interest in teacher training and teachers’ awareness of identifying the characteristics of autism. There is understandable frustration among teachers at the lack of training facilities and opportunities available to them.
My hon. Friend and I, along with many others, have worked hard on education, and we are slowly making progress. Today’s debate takes us further afield because we have to get the whole package right for children with autism.
Being mindful of the time, Mr Benton, I would like to touch on two issues. First, I would like to emphasise the need for training for CAMHS professionals, which is vital for all the communication issues mentioned by the hon. Member for Stalybridge and Hyde. The issue is not straightforward, which means that there must be training; there must be flexibility, patience, skill and understanding. The local CAMHS commissioning process is designed to identify and address skills gaps in the local work force. What steps will the Government take to ensure that such gaps are identified and addressed with regard to autism?
I have been involved with the Every Disabled Child Matters campaign, and one area of concern that we have identified is the falling apart of services for disabled children during the transition period. There is a lack of forward planning for the transition, starting about age 14. That is particularly true for children and young people with autism, because they are likely to require ongoing mental health support and to need a smooth changeover between children’s services and those for adults. One issue that I have with children’s trusts is that in some local authorities, there is a great dichotomy between children’s and adult’s services. The best local authorities manage the transition well, but there is the potential for people to fall through the gap. How do the Government intend to ensure that CAMHS and relevant adult services work together to plan appropriate ongoing support for children with a mental health problem and an additional disability, such as autism, and for all young people who require ongoing mental health support?
I, too, congratulate my hon. Friend the Member for Stalybridge and Hyde (Jonathan Reynolds) on securing this important debate. Hon. Members who know that I come from north of the border may wonder why I choose to speak on a matter that essentially relates to devolved issues in Scotland. However, in a number of areas, we have to look across the UK, and the National Autistic Society has a facility—Daldorch House—in my constituency, which has become a centre of excellence in the local area and is looked to by a number of local authorities, not just in Scotland but across the UK, for advice on how to approach work with young people with disorders on the autistic spectrum.
I have taken an interest in this subject over many years, and I first came across young people with disorders on the autistic spectrum 30 years ago as a young art therapist. It is fair to say that there have been a number of positive moves both in recognising the range of issues that people face, and in looking at different ways of working with people and the different services required. Despite all those improvements, all of us as elected Members of Parliament will come across people in our constituencies who still have to battle, fight and almost scream from the rooftops to get the services that they need for their children.
One difficulty that people often face—I certainly experienced this as the Minister responsible for education in Scotland when I tried to introduce legislation that should have provided additional support for learning—arises because parents are suspicious of any change, as they feel that it might lessen the rights of young people, rather than give them increased rights to education and other support.
This morning, I received in my e-mail inbox a piece of correspondence from a constituent, which I think sums up how much further we still have to go. The parents were writing about the needs of their teenage son, and the difficulties that they have encountered in finding appropriate educational placements. Their son is already in a school but, according to the parents, that school does not have the necessary skills and experience to cope with him and does not want him there for reasons of health and safety. Another school has been identified in the local authority area, and although it has the skills and expertise, it does not have enough support staff to take the teenager on. The parents are extremely worried about the impact of budget cuts that are already being made in the local authority, with learning support assistants—and others—being made redundant.
As a result, those parents told me that they do not know whether any schooling will be available for their son after the summer break. They have been advised by both schools that they are unlikely to hear anything from the education authority until two days before the start of the new school term. All hon. Members who are aware of the issues surrounding education for young people with disorders on the autistic spectrum will know that that is an unacceptable way to deal with young people who require support and preparation, and for their parents, who need to know what is going to happen.
I am conscious of the time, but I want to say that we must work to identify who these young people are. Every local authority and health board has a responsibility to identify young people with disorders on the autistic spectrum and put in place appropriate support packages. I am concerned that we are not doing enough to recognise that those young people will grow into adults, and at some stage will require not only support to enter further education or employment and all that goes with that, but support with the ageing process. At some stage, there will be a significant number of people approaching their elderly years who are diagnosed as having a disorder on the autistic spectrum. We have not done anything to look at that issue.
It is important that parents receive support. Everyone who has been the parent of a teenager knows that it is a difficult time. I used to joke that my son disappeared into his bedroom aged 14, and came out a better person aged 17. [Hon. Members: “Too early!”] Perhaps I was lucky. For people who have teenagers with disorders on the autistic spectrum, it is a difficult enough period. The added pressures and the support that parents require have not been adequately recognised.
We must pay attention to the number of people who end up in young offenders institutions and prison systems but who probably, had their condition been picked up at an earlier stage, would have been diagnosed as being somewhere on the autistic spectrum. I have also raised that issue in a Scottish context. When people are in a place such as a young offenders institution or prison, we should be able to identify the problem, get them the appropriate help and support, and look specifically at how we can help them in the future.
I am grateful for the opportunity to make a brief contribution to the debate. When the Minister responds, perhaps she will say something about what the Government are planning to do about the transition from education into employment, and about the specific issue of how we can provide support for people as they go through the ageing process and inevitably require a degree of support from the state.
Thank you, Mr Benton, for giving me my father’s name. Robert Buckland is my true name. I am grateful for the opportunity to speak in this debate, and I congratulate the hon. Member for Stalybridge and Hyde (Jonathan Reynolds) on an excellent and comprehensive analysis of the report from the National Autistic Society, which many of us have read and found extremely useful.
I declare an interest because, like the hon. Gentleman, I am the parent of a child on the autistic spectrum. My experience, although initially negative, is something that I have decided to try to be positive about, again like the hon. Gentleman. Having had the honour of being elected to this place, I regard it as my duty to raise those experiences, talk about them and do whatever I can to advance the cause of children, young people and adults with autism, the autistic spectrum disorder and Asperger’s syndrome.
The “You Need to Know” campaign touches on an issue that all of us, whether Members of Parliament, parents, professionals or members of the public, may have experienced in recent years, as the extent of the diagnosis of autism has dramatically increased. A group of individuals and their families feel utterly isolated because their experiences have, in the words of the hon. Member for Mid Dorset and North Poole (Annette Brooke), resulted in their having to scream and shout from the rooftops, bang on doors and adopt behaviour that they might never have contemplated at the beginning of their journey. I simply ask the eternal question: why does it have to be like this? Why on earth are we still in this position in the second decade of the 21st century? The National Autistic Society was founded nearly 50 years ago. Medical research on, and analysis of, the condition that we now know as autism began as long as 70 years ago. I appreciate that the calls on the public purse are immense, but progress on this issue is too slow, and that is betraying an entire generation of children and young people.
Provision for the transition from youth to adulthood is—I hesitate to say this, but I will press on none the less—nothing short of scandalous. The excellent provision in the education and children’s services sector suddenly vanishes when the young person reaches the magic, or should I say tragic, age of adulthood. Time and again, I have met constituents who are crying out for the help and support that they thoroughly deserve, but who are not getting it. They understand and are conscious of the fact that they are increasingly a burden on our society, but it should not be like that. They should not be a burden on the rest of us; they should be making a valuable and meaningful contribution to our society. We should not forget the talents, idiosyncrasies and amazing abilities of children and young people with such lifelong conditions. I talked about the initially negative experience of learning and understanding that one’s child has autism. As I said at the beginning, however, the positive aspect of such conditions must not be forgotten. These children and young people are not a burden; they add to the mosaic of human experience, and we need to understand and embrace that as we address the questions.
I know that we have touched on this point in the debate, but we should not forget the position of parents and carers of young people with autism. All of us with experience and knowledge of the position of parents and carers will understand that the pressure on them is often intolerable. They often need support and access to mental health services themselves if we are to avoid some appalling scenarios. In one appalling case in south Wales recently—I will not go into it, because it is sub judice—a parent was detained under the Mental Health Act 1983, and a young child lost his life. In the second decade of the 21st century, that is unacceptable in any book.
Hon. Members have eloquently outlined the need for training, and I need not repeat what they have said. Professionals who are outside this place, or who may be present, will say that they are doing all they can with limited resources to deal with the huge variety of problems they are presented with as paediatricians in the national health service or as mental health practitioners. I understand that resources are tight, but as has been said—I make no apology for repeating it—there is huge potential for saving money by intervening early and recognising problems. In these times, when finance is understandably the Government’s paramount consideration, is that not a strong and persuasive argument for supporting provision?
My hon. Friend the Member for Stalybridge and Hyde (Jonathan Reynolds) mentioned west Berkshire. As a result of the pressure that I and others in my locality have put on our local health board, we now have an integrated ASD network, with speech and language therapists and a whole host of professionals. The hon. Gentleman has hit on the central point: early intervention, with good, sound, solid professionals working together as a team, will make the difference. That can save money in the long term, but, more important, it can alter the quality of life for young people and their families.
I thank the hon. Gentleman for that important intervention, which leads to the point that I was about to make. We could spend hours in a chicken-and-egg argument about whether mental health conditions precede autism. Let us not forget that autism is often accompanied by physical disabilities and a range of other conditions, so it is a complex area. Similarly, mental health problems will accompany autism in some families for hereditary or genetic reasons, so it is probably not worth getting into the chicken-and-egg argument.
There is, however, no doubt that a number of young people who present themselves to CAMHS will have had an imperfect or late diagnosis of their condition, and I am afraid that my personal experience in that respect has been rather negative. Experienced paediatricians, whom I will not name, because they are distinguished in their field—one in particular is very distinguished in the medical-legal field—told me that diagnosis at two or three was not possible for autism and ASD. I was a mere layman in those days, and I had not made the journey that I have now, so I accepted what I was told at the time, but I learned later that it was not the case. If that attitude is still prevalent, we have a problem. I do not want to criticise health care professionals, who do a wonderful job, but the point being made by the National Autistic Society is that we need more training, awareness and understanding. That is all we ask for in this debate.
The hon. Member for Mid Dorset and North Poole asked the proper question about transition provisions. We now have the Autism Act 2009, and we await the statutory guidance, which is all-important in fleshing out the bones of the Act. The guidance is key, and we need the Government to give a clear steer in it as to how we manage the transition from childhood to adulthood. That is a key time, but there is, as I have said, a scandalous dislocation in provision, which needs to be dealt with properly.
As the hon. Member for Dumfries and Galloway (Mr Brown) so eloquently said, we need to look at key intervention at the earliest stage. A lot of the mental health conditions that accompany autism can be avoided through early intervention, which would mean that there was less pressure on CAMHS and less of a crisis in the key early and mid-teen years.
I know that other hon. Members want to contribute, so I will finish on this point. We have seen some excellent examples of provision, and west Berkshire has been cited. In authorities such as mine in Swindon, the PCT and children’s services are integrated and work very well. They are starting to do the outreach work in CAMHS in the primary sector that will help to identify problems and improve early intervention. However, although that integration is all very well, the question, which the hon. Member for Mid Dorset and North Poole posed, is whether there is proper integration with adult services. Therein lies the problem, and more work needs to be done.
I am grateful for being allowed to contribute to the debate. I hope that this will be the first of many contributions that I make on the subject in the years ahead. I thank you for allowing me to speak, Mr Benton.
I, too, congratulate my hon. Friend the Member for Stalybridge and Hyde (Jonathan Reynolds) on securing this important debate and on his well informed and persuasive speech. It is encouraging that the debate is so well attended and that it is informed by the personal experience of parents of children with autism.
Like other hon. Members I have received a number of representations from constituents in support of the National Autistic Society “You Need to Know” campaign. I applaud the work of the society and its supporters in raising the profile of the needs of children and young people with autism and of the importance of ensuring that there is proper diagnosis and support from CAMHS, GPs and other health professionals for the 70% of children with autism who also have mental health issues.
My hon. Friend set out both the range of difficulties that young people face as they go through life and the opportunities that are opened up by the right skilled help. I want to raise a couple of points that I think are important. The first is the interaction between autism and mental health and the number of young people who are not in education, employment or training. An interesting Audit Commission report on re-engaging young people—published today, coincidentally—includes an analysis of the characteristics of young people in the NEET category, and shows for example that whereas young people with either learning difficulties and disabilities or one or more special educational needs statements comprise 10% of all young people, they comprise 23% of young people who are not in education, employment or training for six months or more. It does not give figures specifically on those with autism, but the proportion will be significant—not counting, of course, those who have not been properly diagnosed. That is an important issue.
One of the key recommendations of the Audit Commission report is that local councils, especially with the transfer of 16-19 funding, and all the existing and coming pressures on local budgets, need to understand the nature of their local NEET population and to target their support appropriately. I urge that understanding the extent of autism and mental health difficulties among those young people should be a key part of the analysis and of the supportive action that needs to be provided by health, education and training professionals.
Another point that I would like to stress follows from the comments of the hon. Members for Mid Dorset and North Poole (Annette Brooke) and for South Swindon (Mr Buckland): it is the importance of improving and joining up support for young people with autism as they move into adulthood, which is understandably a particularly stressful time for the individuals concerned and their parents. Certainly in my area in Oxford, although there is still some way to go, there have been welcome improvements in support for children and young people in education. Parents have praised to me the work done by Oxford and Cherwell Valley further education college. However, as youngsters become adults it can be an especially uncertain time, when the prospects for work, other meaningful activity, further training, social relationships and housing become problematic, and their parents are getting older. There needs to be a better joined-up approach between health, social services and housing providers so that there is a coherent system of support. As the Audit Commission report recommends, there is a need for better co-ordination between Connexions and Jobcentre Plus, and better handover arrangements as people move forward and look to the possibilities of work.
At a time when local council budgets face huge cuts, it is all the more important that we should speak up for the needs of those young people, which have so often been misunderstood and neglected in the past. They must not be marginalised in the battles for funding ahead. One crucial point from the Audit Commission report is that early intervention and the right early support not only make a huge difference to people’s quality of life, but, as the hon. Member for South Swindon said, can save big sums of public money in the long run. The report illustrates that fact by contrasting the example of a young man with Asperger’s who gets the right support and ends up with a life in work, and one who does not, and ends up with a life on benefits.
I would be grateful if the Minister let us know what guidance and support will be given to local councils, health authorities and others on relevant matters so that young people with autism and their families can face the future with more confidence, and in particular what action the Government will take to ensure that CAMHS and adult mental health teams work together so that there is the right continuing support.
I want to add a few footnotes to the excellent introduction to the debate by the hon. Member for Stalybridge and Hyde (Jonathan Reynolds), who set out the major issues carefully and meticulously. Mental health and autism cropped up emphatically in debates on the Mental Health Act 2007. We were then largely concerned with the treatment of young people, including making treatment specific to them, rather than putting young people into adult accommodation or the like, or giving them adult services when juvenile services would be appropriate. While recognising that that was not always possible, I pay tribute to the campaign by YoungMinds for adolescents to receive adequate, full treatment no matter what their condition or mental health.
I pay tribute to the work done on the 2007 Act by the hon. Member for East Worthing and Shoreham (Tim Loughton), who has gone on to greater things, and to Baroness Browning, the former Member for Tiverton and Honiton, who was a champion of autistic people in this place and who pioneered the work that was taken on by other hands as the basis for the private Member’s Bill that subsequently became the Autism Act 2009. Off the back of the 2007 Act, I carried out my own research on provision for children and adolescents and wrote to every PCT for which I could obtain a name. I wanted to focus particularly on adolescent mental health provision, rather than childhood provision, and on waiting times. I accept the point that all the hon. Members who have spoken have made about the critical nature for families and, obviously, patients, of waiting times—the time between a suspicion that something is wrong and getting a diagnosis and treatment. Those are of course different things—one can get an early diagnosis but be slow in getting treatment.
It is not surprising that that issue is crucial during adolescence, when huge hormonal, physiological, social and personality changes are happening. That is a stage in life when, often, psychotic and other disturbances first become evident. One of the more depressing passages included in the Library debate pack deals with that fact. It states:
“Mental illnesses are the chronic diseases of young people.”
“It is a curious paradox that better physical health in young people has been accompanied by steadily worsening mental health.”
That is indeed what the national statistics show, and it is why early intervention matters, because if it is successful and efficacious it means someone does not have a life of ongoing suffering and disturbances.
My inquiries of the various PCTs unsurprisingly produced patchy results, in accordance with the well-documented contributions made by other hon. Members. There was a general variation in standards, which I think people might expect, and which has been vouched for today, but what disturbed me more was the lack of clarity about who was responsible for the standards. My inquiries were passed from PCT to CAMHS and back. People did not seem clear about who would carry the can if provision were less than adequate. The implication is that for people using the services no one is ultimately responsible; that is the nagging feeling.
Another feature that cropped up in my research was an apparent lack of dedicated facilities and expertise in many places, and a recognition that although in some places there were adequate facilities for children, facilities for adolescents were wholly inadequate. There is no excuse for that state of affairs in relation to Asperger’s syndrome and the autistic spectrum, because what is required for progress is very clear. Certainly, early diagnosis is required, but the National Audit Office report that I have seen—which I think Baroness Browning did something to trigger—clearly stated that specialist autism teams were the way forward, coupled with good integration, and so on. That is all known, but hon. Members have reported that across the country none of it has been perfectly accomplished.
May I make a personal constituency point? I increasingly receive complaints from parents of children who are mildly autistic but are now being excluded from services because needs must—there are pressures on local authority resources, as the right hon. Member for Oxford East (Mr Smith) illustrated. That is profoundly depressing, because the result is that people who could progress to independence and, in later life, manage far better for themselves and not become problems as adults are not making progress at the key point at which they could be making the progress necessary to become independent of parents and institutions.
My conclusion and, I think, the conclusion of the whole debate is that we are confronted with a situation in which there is a known complaint, a known solution, enormous support from the voluntary sector and clarity about what is required, but on the statutory side there is a somewhat ham-fisted response. Getting that ham-fisted response removed and replaced with something better is the thrust of the debate.
It is a great pleasure and privilege to contribute briefly to the debate. I congratulate the hon. Members for Stalybridge and Hyde (Jonathan Reynolds) and for South Swindon (Mr Buckland) on making contributions based on their personal and family experience of this matter. Many of us have not had that experience and our comments come from a different level of understanding. However, the message that I get from the debate is that given the level of understanding and competence that there is for this condition, there should be much better training for the professionals involved and much better working together and co-ordination between those professionals—between people in the medical profession, between people in education and between people in social services.
Some of the things that I shall say may seem a little cold and uncaring, but although the diagnosis of autism and the triad of impairments—the three conditions that lead to a classical diagnosis of autism—have been established, we have since realised that this is a spectrum condition. Every child, every young person—and every adult, for that matter—is an individual and their needs are different.
I first became aware of this issue a long time ago, when I became a governor of a special school at about the time that Baroness Warnock produced her report that changed our attitude to the education of children with special needs. The idea was that every child should have the support appropriate to them. We have moved on a long way: at that time, autism was hardly ever talked about, and I did not really have an understanding of it. Our knowledge has moved on a lot and improved, and professionals have a much better opportunity to use it. My point this afternoon is that we still need to do more fundamental research on the condition. What causes it? Is there a genetic element to it? Is there an environmental element? Is there a social element? At the moment, we just do not have the necessary understanding of those issues, and unless we can understand them, the way we intervene will not be as effective as it should be.
The other day, I was at the Hay festival, which is in my constituency—if anyone wants to attend, they will be very welcome—at an event with Simon Baron-Cohen, who is a researcher at Cambridge university. He was looking at personality disorders and then autism. Obviously, autism is not a personality disorder, but the issue of empathy is relevant. People with personality disorders are unable to relate to other people, and there is an element within autism of finding it difficult to understand the nature of a person’s response. The good news was that that gentleman, doing his research, felt that there were ways in which the research could be used to ensure that interventions and the way autism is treated are more successfully dealt with and lead to great improvements in the quality of people’s lives.
My message to the Minister is therefore: please, in all this, do not forget the fundamental research that is essential if we are to make progress. Yes, make use of the knowledge that we have, but do not think that that knowledge is comprehensive, because it can be improved and then the lives of people with this condition will be improved as well.
I thank my hon. Friend the Member for Stalybridge and Hyde (Jonathan Reynolds) for securing the debate, which has been excellent. I do not disagree with anything that I have heard, nor do I intend to repeat any of it. I shall concentrate on the areas that I have the most concerns about.
We have come a long way in recent years and there have been improvements, particularly in education, but we must not be complacent and there is still a long way to go. The two areas that I have the greatest concern about are transition, which I shall come on to, and diagnosis. This refers back to the issues of child and adolescent mental health services. In my experience, far too many children still receive a diagnosis that is less related to their symptoms and difficulties than to who they are and where they live. I still see too many cases in which clinicians go down the route of attention deficit hyperactivity disorder or EBD—emotional and behavioural difficulties—first, because of the family and where they live. That means that those children and their families do not gain access to the diagnosis, services and provision that they need. That is one concern, and it relates to what I said in an intervention about the quality and consistency of CAMHS across the country. If people look at the issue geographically—on a map, as I have done—they will see hot spots of certain diagnoses, and sometimes around certain clinicians. Those issues need to be addressed.
Everything that I have heard today about transition, particularly transition in the early years, is absolutely correct. If we get that right and provide access to the right services—good, well co-ordinated provision—the mental health of those children and their families will be much improved, outcomes will be much improved and we will save money in the long run. Transition in the early years is crucial and will save us money in a time of austerity.
The transition at the other end is also an issue. A lot of emphasis has been placed on that in recent years, but in my experience that has been about the process—the right forms filled in by the right people, and the right people being at the right meetings at the right time. For the families, the process can be fabulous, but if there is nothing to transition on to, it is a disaster for them.
When I was in my former role in education, we recognised that there was almost a time bomb here. Children are going through the education services and coming up to the adult services, but those services are not there for them. Will the Minister consider the issues of diagnosis and quality of provision across the country to ensure that a child’s diagnosis is right and not based on the family’s circumstances or socio-economic grouping? Will she also consider transition in relation to the quality of provision, not just the processes, forms and meetings?
I thank the hon. Member for North West Durham (Pat Glass) and my hon. Friend the Member for Brecon and Radnorshire (Roger Williams) for the speed with which they spoke. I intended to make a bigger contribution about some of the good precedents and good practice that we have experienced in Wales, in the hope that the Minister might have a look at that, but I shall just highlight the launch on 28 June by the Welsh Assembly Government of their new child and adolescent mental health strategy and the work commissioned by the Assembly Government from Professor Sue Leekam of the Wales Autism Research Centre. It is undertaking evaluation of the assessment and diagnosis of children with disorders on the autistic spectrum, which will analyse and strategically examine CAMHS provision and many of the inadequacies of that, particularly in professional training, which we have heard about from hon. Members.
I wish to highlight also the work being undertaken by the Betsi Cadwaladr university health board, which operates in north Wales, to develop a register for children and young people with autism. I applaud what the hon. Member for North West Durham said about the lottery of service provision, but the strong message is that we must identify the extent of the challenges that face the nation. The problem was not addressed by previous Governments; I hope that it will be addressed by this one.
I end with a brief anecdote. We have heard some powerful stories this afternoon. My earlier intervention about teacher training was deliberate. I spent 12 years in the classroom and I always realised that, even as a professional, I was sometimes failing the children in my care. The problem of the little girl who used to wander around the playground with no friends should have been addressed, but teachers are not often equipped to do so. The fact was that when we told her, “Don’t touch the hot boiler in the corner of the room,” we knew that she would probably end up touching it and burn herself. I should have been equipped to deal with the many problems that that girl presented.
However, there are huge opportunities, which is a point that was made strongly by the hon. Member for Stalybridge and Hyde (Jonathan Reynolds) and others. If we create the right environment—a nurturing, caring and enriching environment—in our classrooms and in our health service provision, people on the autistic spectrum will be able to make a huge and valuable contribution to society.
I am sorry for speaking so quickly, Mr Benton, but thank you for allowing me to contribute.
It is a pleasure to serve under your chairmanship again, Mr Benton, and I congratulate my hon. Friend the Member for Stalybridge and Hyde (Jonathan Reynolds) on securing an important debate to which many hon. Members have contributed.
I pay tribute to my hon. Friend and to those parents—we heard about them again today, and our debate has been enriched—who have campaigned for vital improvements to services. As of yesterday, 136 Members from all parties, including my hon. Friend and, I expect, others here today, had signed early-day motion 160, which highlights the fact that 10,000 children with autism use child and adolescent mental health services every year. It also highlights a survey showing that using such services will not improve the mental health of two thirds of those children. As my hon. Friend said, the children are not getting the support that they need.
Children with autism are particularly susceptible to developing mental health problems, and many Members mentioned the fact that there is a range of reasons for that. Such children may experience social isolation, and 70% of children with autism struggle to make and keep friends, compared to 10% of other children. Children and young people with autism also find it challenging or impossible to express how they are feeling. The struggle to communicate causes frustration and anger, which can lead to mental health problems.
With the right support given at the right time, many of those problems can be prevented. Given that one child in 10 who accesses child and adolescent mental health services has autism, that should be a priority for the professionals in that service. However, only just over half the parents surveyed by the National Autistic Society thought that staff working in CAMHS had a good understanding of autism. Many of the professionals to whom the society spoke felt strongly that there were not enough training opportunities—many hon. Members touched on that point. Professionals need to develop their clinical expertise in order to work with children with autism and mental health problems. There is good experience of that happening up and down the country.
The high number of children with autism, coupled with the lack of skilled professionals, leads to many children being seen by professionals who are unable to meet their needs or simply being turned away. I have some questions for the Minister; I may be repeating some of them, but it will not hurt to do so. Will the Government ensure that all child and adolescent mental health professionals are provided at least with basic autism training, so that they can meet their duties to make “reasonable adjustments” under the Disability Discrimination Act 1995 and provide services that meet children’s needs? How will the Government ensure that specialist autism support is available within CAMHS?
As we have heard, autism is a complex disability. When mental health problems arise in children with autism, they are harder to recognise, evaluate and treat. Professionals need a good working knowledge of autism to do those things. Providing mental health support to children with autism is a specialist skill, and research conducted by the National Autistic Society found that if an autism specialist is involved in the support of such children, outcomes and service satisfaction improve dramatically. Indeed, those parents whose children had received support from a specialist in autism were twice as likely as those whose children had not to agree that the child and adolescent mental health service had improved their child’s mental health. Sadly, coverage is not good, and only two in five parents say that their child has had such support.
Specialist autism support is vital. We need to adapt therapies and interventions so that they are effective. Skilful adaptations will obviously make them relevant and useful to children with autism. Many Members spoke of the importance of early intervention. Autism specialists can also help other professionals to develop their skills, and they should share their experience with schools and social services.
The subject of commissioning was mentioned by a number of Members. It is particularly important, given the radical changes that the Government have indicated that they wish to make to local commissioning. The way services are commissioned locally for children with autism and mental health problems is clearly important.
Commissioners obviously need to know how many children with autism live in their area, how many of those children also have mental health problems and how local services are working. They need expert advice on what is needed to deliver the right mental health services. They then need to use those data to plan the right services for the children. If the commissioning changes that have been signalled are to be made, it is important to take those factors on board.
Commissioning must also take account of CAMHS waiting times, rates of return and family outcomes for children with autism. Specific local pathways should be developed for the mental health support of children with autism. Parents and children affected should be involved in the commissioning process, together with front-line professionals.
The Labour Government introduced a vital new duty, which came into force in April 2010. Children’s trusts now have to plan to meet the needs of children with special needs and disabilities. That represents a significant step forward. What action will the Government take to build on Labour’s work, to ensure that services are planned and commissioned at the local level so that every child with autism and mental health problems starts to get the support they need? How will the Government ensure that parents and young people are involved in the development of services to ensure that they meet local needs?
We know that the number of children with learning disabilities and of children with autism who use such services are similar. It is clear from improvements to services for children with learning disabilities achieved under Labour that having the right measures in place does make a difference, which was mentioned during the debate. As my hon. Friend the Member for Stalybridge and Hyde said, the Labour Government achieved improvements to services for children with learning disabilities through the 2004 national service framework. That highlighted the importance of providing adequate child and adolescent mental health services for children and young people with learning disabilities.
Specialist training, the adequate resourcing of learning disability specialist support and access to specialist in-patient support were also recommended. As we heard, a specific indicator was recommended for local authorities to rate themselves on their provision. As a result, specialist support for children with learning disabilities more than doubled between 2005 and 2007. In 2010, two thirds of primary care trusts rated themselves four out of four for their provision of CAMHS for children with learning disabilities. Based on the improvements for children with learning disabilities made under Labour, I urge the Government to commit themselves to achieving the same benefits in the coming months and years for children and young people with autism.
I shall speak briefly about early intervention. As was said by my hon. Friend the Member for Dumfries and Galloway (Mr Brown) and my right hon. Friend the Member for Oxford East (Mr Smith), putting support in place early makes a big difference in the long run. It can help to prevent difficulties from escalating into mental health problems. Over recent years, there has been a strong focus on improving support for children with autism and improving the emotional well-being of children with autism in schools. I hope that that continues.
The autism inclusion development programme has helped to improve teacher training. The social and emotional aspects of learning programme has helped pupils at school to gain emotional and social skills, and has helped them with self-awareness and managing their emotions. The early support programme has helped families of disabled children under the age of five to get co-ordinated support and information early, so that problems do not escalate.
Hon. Members touched on the fact that Labour initiatives, such as the Every Child Matters agenda, also helped to ensure that agencies work together, which is important in providing support to our most vulnerable children. Parents at the Every Disabled Child Matters reception in the House yesterday wanted assurances from the Minister that schools would continue with the initiative. They felt that they had created the initiative, and that it was not just a Government thing.
Government leadership over recent years has made a significant difference to aspects of the mental health system for children. In today’s debate, we are asking for similar action for this other group of children. We must continue to prioritise children and young people with autism because they are among some of the most vulnerable people in our society.
The Minister with responsibility for care services, the hon. Member for Sutton and Cheam (Mr Burstow), spoke about the campaign to make good mental health for children with autism a reality:
“There is no doubt that these changes can happen, where there is a will on the ground to make them happen.”
I hope the Minister confirms that the Government have that will, as many hon. Members from all parts of the House have shown that they have in the debate today.
I congratulate the hon. Member for Stalybridge and Hyde (Jonathan Reynolds) on securing both this debate and his seat. The subject is of huge importance to him, and he brought with him his invaluable personal experience, as indeed did the hon. Member for Manchester, Withington (Mr Leech) and my hon. Friend the Member for South Swindon (Mr Buckland). Those personal experiences are crucial to the debate, as are the contributions from those who are experienced in the provision of services. This debate is vital, and I will ensure that all the representations that have been made today are fed back into the policy process. Time is short, but I will just say to the hon. Member for Worsley and Eccles South (Barbara Keeley), who speaks for the Opposition, that some of us were fortunate enough to have listened to and participated in debates on the Autism Act 2009, promoted by my right hon. Friend the Member for Chesham and Amersham (Mrs Gillan), as it made its passage through the previous Parliament. At the time, there was an increasing dislike of and disillusionment with politicians, so I mention that measure because it showed this place in its very best light. It was about cross-party working and building a consensus. It was a genuine attempt by Members from all parts of the House to work together to improve the lives of others—in this instance it was the lives of those with autism. I pay tribute to Angela Browning, the former Member for Tiverton and Honiton, who was sometimes a lone voice calling for services for people with autism. She, too, brought her own personal experiences to the debate thereby helping to raise us to the next level.
I echo the comments made by the Minister of State, Department of Health, my hon. Friend the. Member for Sutton and Cheam (Mr Burstow), at the recent National Autistic Society reception. He said that the standards of care highlighted by the society in its “You Need to Know” report are unacceptable. He was grateful to the society—as indeed we all are—for its tireless campaigning, and was struck by the particular contribution of the young campaigners group. I am sure that he would pay tribute to them were he able to be here today.
The coalition’s programme for government makes it clear that we are committed to supporting the most vulnerable and to tackling health inequalities. There is strong consensus on what needs to be done to improve the emotional well-being and mental health of children and young people. More work is needed on prevention, early diagnosis and early intervention. Those are the key things that are needed by people with autism and mental health problems. We need better integrated working and more evidence-based approaches. The work force must be developed, and, crucially, we must do more to tackle stigma for people not only with autism but with mental ill health.
The National Advisory Council for Children’s Mental Health and Emotional Wellbeing report earlier this year reinforced the scale of that challenge. It called for action to strengthen leadership, build a confident and skilled work force, improve commissioning and ensure real participation by children and young people in service development. For me, commissioning is a vital part of that. It has never been done that well, but there is a general acceptance of the fact that if we improve commissioning, the services will then follow. As has been mentioned during this debate, there are examples of best practice, which we need to be able to transport to other areas. We need to consider all those issues to get the services that we want.
The Government have also promised to deliver measures in “Fulfilling and rewarding lives: the strategy for adults with autism in England”. There are many areas in which improvement in adult autism services will yield benefits for children’s services, such as developing local autism teams, improving access to diagnosis, better planning and better commissioning of services. As several hon. Members have said, raising awareness of the issue and improving skills in the work force should go much wider than just those working in the autism field, and should include teachers and sports clubs and all those who are involved with young people.
Our focus must be on improving the quality of services that we provide to all children. We must ensure that no one suffers the indignities and difficulties that are sadly all too common. I am referring to the frightened young person who is restrained by police because crisis services were not available; the child who feels isolated and frustrated, only to find that health care staff are not trained to help or able to understand them; the parents who desperately want to see an improvement but feel let down by services that do not treat their children as people with individual needs; and parents who are desperate, isolated and at the end of their tether. That is why it is so important to improve the standard of care across the board.
We must plan and build on the work that has been done on integrating services so that local partnerships can work together to deliver what we want. It will require incredible commitment from local NHS providers to engage with the work force to resolve difficult issues such as training and service design. Improving the reach and quality of child and adolescent mental health care means looking carefully at the different services that make up the whole picture. I am referring to universal services that play a pivotal role in promotion for all children and young people; targeted services that provide early interventions for vulnerable children and young people; and specialist services, which the hon. Member for Stalybridge and Hyde mentioned, for young people with complex, severe or persistent needs.
I am sorry for that error. I thought that I said that I would write. I thank the hon. Lady for raising that.
I have only two minutes left. The hon. Member for Stalybridge and Hyde said that staff working in child and adolescent mental health services should have the necessary values, competences and skills. That is vital. The coalition document made it clear that we are committed to supporting the most vulnerable and to tackling health inequalities, and we will make more announcements about public health. Appropriate tier 4 child and adolescent mental health services should be available to all children who require them, including children with autism. There are a number of other vital issues, including diagnosis and transition. I am proud of my own field, which was highlighted by the previous Government, for some of the things that they achieved on transition. I should also like to pay tribute to Sara Truman, who has done a huge amount of work with the National Autistic Society.
We have not touched on the health outcomes for people with autism and mental health problems, but if we look at them we will find that they are truly shocking. Parents and carers carry a huge burden. There are many issues that we have not covered, including respite and research. We still do not understand why people get autism. We also need to look at those children who are not yet diagnosed. There are significant challenges that will require real commitment and buy-in from the staff who work hard in CAMHS across the country, but I am greatly encouraged by the number of contributions here today and by the amount of expertise that is sitting here. There is a role for Government to play. I hope that hon. Members appreciate that we cannot provide all the answers—
Court Closures (Yorkshire)
Thank you, Mr Benton, for allowing me my first Westminster Hall debate on an issue that is of particular importance to my constituents in Goole.
Before I go any further, I just want to say that I understand many of the pressures on Her Majesty’s Courts Service, particularly given the fact that in the last three years of the previous Government, magistrates services received a 7.5% funding cut in the—[Interruption.]
As I was saying, Mr Benton, there was a 7.5% cut in magistrates budgets, which occurred for each of the three years before the general election. There is also a massive backlog in refurbishment and capital projects, which built up in HMCS in the previous few years. In Goole, that backlog stands at £80,000. I could make some comments about the fact that it was a shame that in the run-up to the general election, when Labour Ministers were heading to my constituency with all sorts of blank cheques, they did not offer a blank cheque on court services.
I want to confine most of my comments this afternoon to the proposal to deal with the court at Goole. As I have made clear to the Speaker’s Office, my hon. Friend the Member for Selby and Ainsty (Nigel Adams) will, with your permission, Mr Benton, take some of my allotted time to speak about the closures in Selby. There is a proposal to close the county court in Goole and to merge the local justice areas, but that proposal is less controversial, and indeed it is something that the magistrates in the Goole area do not oppose.
There are a number of reasons why the magistrates service in Goole should continue. Those reasons relate to the efficiency of the court, which was shown by a review just 10 years ago, and to the cost implications for my constituents in the Goole area if the court should close. Goole magistrates court is administered within the Humber and South Yorkshire region, which consists of the courts in the East Riding of Yorkshire, northern Lincolnshire and south Yorkshire. There is evidence that the throughput of work at Goole is the second most efficient in the Humber and South Yorkshire grouping of magistrates courts. There is a very low ineffective trial rate at Goole, and trials at Goole are listed much more quickly than in larger courts. The proposal is to move the work from Goole to a much larger court at Beverley. Breaches of court orders can be dealt with very quickly at Goole. My own personal view—and what I hoped was the view of the new Government—is that bigger is not always better when it comes to the delivery of services.
The courts building at Goole is fully compliant with the Disability Discrimination Act 1995, which is made clear in the consultation document about the proposed closure. There is a peppercorn rent for the facilities in Goole, and there is a 125-year lease for the building that will not expire until 2130, so there will be no problems in relation to those running costs in the next few years. There is also a modern prison and vulnerable witness link in place, and the court building itself is situated right next to the police station, with adjoining access to modern and recently refurbished cells.
The utilisation rate in the two courts at Goole would be at 80% but for the fact that a number of meetings and other hearings are held in court two. That utilisation rate compares with what we are told in the consultation document is a relatively low utilisation rate of the courts at Beverley. I would like an assurance from the Minister that the court at Goole is not being closed simply to solve that under-utilisation problem.
Of course, there is also a huge issue relating to localism. As a coalition, we are committed to a localism agenda and I am increasingly concerned that, if we should lose the court in Goole along with the magistrates court in Selby, we will effectively be left with a justice “black hole” in our part of the country. Our court in Goole deals with a number of family matters, which are best dealt with locally. As I said a few moments ago, the courthouse in Goole is situated next to the local police station, which itself was recently renovated at a cost of £2 million. The cells at the police station were also recently refurbished, at a substantial cost to the local police authority.
A review was undertaken of the court services in the East Riding of Yorkshire about 10 years ago. At that time, our county lost the magistrates courts at Howden, Pocklington, Brough, Driffield and Withernsea. We were left with the court in Beverley—anyone who knows the geography of the East Riding of Yorkshire, as I hope hon. Members do, will know that Beverley is roughly in the centre of the East Riding—and courts at the two extremes of the East Riding. One is in the east at Bridlington and the other is in Goole, in the western part of the East Riding. Of course, we also have the magistrates court in the large city of Hull.
Little has changed in Goole or indeed in much of the East Riding since that review was undertaken, except that we have had an influx of immigration from eastern Europe, which—I must be careful with my wording—has presented the courts with certain issues. I would suggest that that actually strengthens the case in favour of retaining our court in Goole. After the review 10 years ago, the rural parts of the East Riding were left with courts at Beverley, Bridlington and Goole. The arguments that are being used to close the court at Goole now are exactly the same arguments that could be used in relation to the court at Bridlington, although there are no proposals to change what is happening there—and I am not suggesting that we should save the court at Goole and sacrifice the court at Bridlington. There is a strong case to keep both courts.
The consultation document makes it very clear that the court in Goole is administered from Beverley and that legal advisers travel from Beverley to attend the court in Goole. The same administrative unit also covers the magistrates courts in Beverley and Bridlington. We in the Goole area are therefore a little confused as to why the area is being treated differently from Bridlington, which is 22.5 miles away from Beverley, compared to Goole, which is 28 miles away from Beverley.
If the closure of the court at Goole goes ahead, there will be massive cost issues. Goole is one of the most deprived areas in the East Riding, and on certain measures it is among the 10 most deprived areas in England. A high proportion of our residents are on low incomes or in receipt of benefits, so I have a huge concern about the transport costs involved in getting to Goole from Beverley if the closure goes ahead. There are not just the costs of witnesses to consider, but the costs of family members who may wish to go and support people in court.
There are no direct buses to Beverley from Goole. To get to Beverley from Goole, someone would have to take a public bus to Hull, in the process almost going past the magistrates court in Hull, before changing bus to continue the journey up to Beverley. That journey would be close to 40 miles in total, so the distance of 28 miles that was quoted in the consultation document only applies to those who have access to a vehicle. There is a train service from Goole to Beverley but, equally bizarrely, the train service, too, passes through Hull before going on to Beverley. The cost of a return train journey is £11.90 and travelling by bus from Goole to Beverley would take a minimum of 1 hour and 25 minutes, involving the change in Hull that I have just mentioned, so there would be huge costs for anybody who wants to travel to Beverley from Goole via public transport. Furthermore, Beverley has some of the highest parking charges in the East Riding for anybody who wished to drive there.
We must also consider the historical value of the court building at Goole. We are trying to build up awareness of the history and heritage of the town. The court building is a late Victorian building, and one of the oldest buildings in Goole. Although its historical value may not be much of an argument in the rationalisation of HMCS, its closure would have a huge impact on the regeneration of Goole. The building is particularly beautiful, and we are concerned about what would happen to it should we lose the court.
I would like the Minister to tell us whether we can have a full breakdown of the running costs in 2009-10 of the court at Goole. Some broad figures are given in the consultation document, none of which tell us a great deal. I want to know how those running costs were quantified and how they compare with the running costs of the court at Bridlington. Can the Minister also give us an assessment of the likely costs for justices of the peace and witnesses to travel to Beverley, and say what consideration has been given to diversifying work at Goole? I am not in favour of someone being against something unless they have other solutions. Has any work been undertaken on bringing other services into the court at Goole, such as the tribunal service?
The new coalition Government have made a commitment to localism. I hope that in the 10 minutes in which I have spoken, I have made a strong case for why we in the Goole area, on the edge of the East Riding, deserve to be treated a little differently in the closure programme. The East Riding is the biggest unitary authority in the country and the decisions made 10 years ago were made for very sensible reasons: to maintain one service in the centre and two on the extremes either side of the East Riding. With your permission, Mr Benton, I shall hand over to my hon. Friend and colleague the Member for Selby and Ainsty, who will no doubt wish to speak about the issues affecting Selby.
I am grateful to my hon. Friend the Member for Brigg and Goole (Andrew Percy) for securing this Westminster Hall debate. Although I understand that the consultation is ongoing, I would like to use this opportunity to put forward a case for retaining Selby magistrates court.
Both Selby and Goole magistrates courts are in vital positions, and the closure of either or both presents a real risk of what my hon. Friend referred to as a justice black hole in our local area. If Selby magistrates court is closed, the nearest courthouse for my constituents is York, which will involve defendants and witnesses leaving the constituency to travel there. For my constituents in the southern district of Selby and Ainsty, that is a particularly long journey. It is incredibly inconvenient to get to York using public transport, and it would be almost impossible to arrive on time for an early morning hearing. From the south of my constituency—below the M62—there is no direct access to buses or trains to York and constituents would instead have to go via Selby or Leeds to travel to York magistrates court.
The Magistrates Association has specified that everyone should be able to reach their local magistrates court within an hour. For people in the south of my constituency, that will not be possible if the court in Selby is closed. I have been informed by the area director of Her Majesty’s Courts Service in north and west Yorkshire that no HMCS staff are currently based at Selby magistrates court, and that it is now seen as a satellite court. However, it would be preferable for court staff to travel from York to work, rather than to expect, hope and assume that witnesses and defendants, particularly those from the south of my constituency, will make the extra journey to York magistrates court.
The rolling monthly average percentage of courtroom utilisation in Selby magistrates court was 60.6% in the financial year 2009-10, which is just below the national average of 64%. Courtroom utilisation is defined as the time a courtroom is used, against the hours that it is available for use. Given that the usage of Selby magistrates court is aligned with the national average, it does not make much sense that it is closed instead of other magistrates courts, such as those in Blandford, Bournemouth, Poole, Weymouth and Wimborne in Dorset. The overall reduction in work load in those courts led to a utilisation rate in Dorset in 2009-10 of just 38.8%, which is almost half that of Selby. The situation is similar in Lincolnshire; there are courts in Boston, Grantham, Lincoln, Skegness, and Spalding, and courtroom utilisation is just 37.2%.
Over the past 18 months, Selby magistrates court has actually transferred certain motoring and trading standards cases to, among other places, Northallerton magistrates court. Those courts were under threat of closure because of lack of work. Selby came under the threat of closure in 2003, but—as is the case now—the proposal came up against strong opposition from the Selby bench, and a casting vote at the North Yorkshire magistrates court committee decided the matter.
Is the Minister aware that after securing the future of Selby magistrates court in 2003, substantial improvement and remedial work was carried out on the courthouse, which cost the taxpayer around £821,000? It was reopened in 2008 following that refurbishment. The overhaul included facilities for the disabled, which are not provided in York. Selby is therefore the designated court for York’s disabled population. We also have vulnerable witness capabilities at Selby, such as a specialist court for hearing domestic violence cases, and the technology to view CCTV evidence and to use video links for vulnerable witnesses. None of those facilities is provided at York magistrates court.
By bringing York’s services up to the same standard as those in Selby the Minister would be creating more expense for the taxpayer. It is estimated that an investment of £170,000 would be needed to provide the facilities required under the Disability Discrimination Act 1995, and which are currently available at Selby. The dock in court two at York would also need refurbishment if the decision to close Selby went ahead.
There is a case for retaining Selby magistrates court in light of the £821,000 recently spent and the special facilities it offers. I fully appreciate the dire financial legacy that the previous Government have left behind and the need to make cost savings, but I would find it difficult to justify closure of a service that has recently cost the taxpayer almost £1 million. Selling off the whole building would not realise anywhere near that sum. I urge the Minister to take those points into account during his consultation.
I thank my hon. Friends the Members for Brigg and Goole (Andrew Percy) and for Selby and Ainsty (Nigel Adams) for contributing to the debate. I compliment them on the quality and sincerity of their defence of their local courts.
I shall set out the Government’s position on the court reform proposals, and provide some details about the courts that currently sit in Goole and Selby. I shall also explain the reasoning behind the inclusion of those courts on the list of possible closures.
In my new role, I have taken the opportunity to visit courts and meet the staff, professional judiciary and magistrates who work hard to deliver justice in communities throughout England and Wales. I have been very impressed by all that I have seen so far. It is evident that courts are run by a dedicated partnership of Her Majesty’s Courts Service staff and judiciary, and I am personally committed to continuing to support their contribution to justice.
What has also been clear in my first few weeks in office is the country’s economic position, and the immediate need to take action to address the structural deficit. Following the emergency Budget, my right hon. and learned Friend the Lord Chancellor outlined our plans to consult on the closure of a number of courts, as well as to seek wider views on how court services could be modernised. That is one strand of the Ministry of Justice’s plans to look critically and holistically at how we deliver justice, and to think about how we continue to deliver those critical services in the future. We have also announced plans to consider sentencing and legal aid.
The decision to consult on the closure of courts was not taken lightly or in isolation. We know we cannot deliver the quality of facilities the public rightly expect and deserve, because we are working out of too many courts. Our low utilisation rate—only 65% across England and Wales—shows that we do not need the number of courts we currently have. Recent improvements in transport and communication links mean that people can travel further in less time if they need to. More can be done to access justice online and via the telephone, which reduces the circumstances in which a visit to court would be necessary.
We need some fresh thinking about the wider issue of access to local justice. We need to consider whether past ideas about needing a court in every town are relevant today or whether—as with almost every other aspect of modern life—things can be done differently, and innovation and technology can be embraced to meet the needs of modern society and ensure better access to justice.
We are already doing a lot to improve the service experienced by witnesses, defendants and other court users. We have increased access to online and telephone services. Currently 70% of money claims, and the vast majority of possession actions are issued centrally via electronic channels. People can pay fines online for driving infringements, or for not paying their TV licence on time. They can also pay off debts or court fees online using a wide variety of methods. We are improving the availability of information provided on the web and over the telephone from dedicated information centres. That will allow front-line staff to focus on people who need to see a judge. We are increasing the use of video link technology between prisons and courts, and piloting video links between police stations and courts.
Whenever possible, we need to support people to explore a variety of dispute resolution routes for family and civil cases. Such routes are better for those involved in cases that can be mediated, as they can avoid unpleasant prolonged and expensive litigation. Such a situation is also better for the courts because it should reduce court time and overall costs.
We are exploring how local communities can support those charged with a minor offence before their criminality escalates. We are working closely with local support agencies and networks to ensure that appropriate help is available for people with multiple underlying problems that drive their offending behaviour.
The court reform consultation seeks views on the proposed closure of 103 magistrates courts and 54 county courts that are underused and have inadequate facilities. It began on 23 June and will run until 15 September. All responses will be fully considered before decisions are made. The consultation will set out a sustainable arrangement of court services across England and Wales to meet the needs of local communities and will allow us to deliver services in the most efficient way. The proposals would achieve savings of £15.3 million a year in running costs and enable us to avoid a maintenance backlog costing £21.5 million. A further assessment will be necessary of the savings that could be achieved and the value that could be released from disposal of the properties. However, I appreciate that those are generalities.
My hon. Friends asked about the two magistrates courts in their constituencies. I have listened to what they have said and will continue to listen to what they and others say during the consultation. The Lord Chancellor’s decision on whether to close Goole and Selby magistrates courts will not be easy; nor will his decisions on the other courts listed in the consultation. Each decision is balanced against several factors, including utilisation, maintenance costs and proximity to other courts. My hon. Friends’ points are valid, but we have to look at each court’s work load in the context of local justice across each area.
Goole magistrates court has a low utilisation rate, as it sits for less than a third of the available time. It sits in a local criminal justice board area whose overall utilisation rate is low, which we consider does not deliver value for money to taxpayers. Given that we know that there is so little demand for a magistrates court in Goole, I find the argument for investing considerable public spending there on backlog maintenance work of around £80,000 difficult to make, especially as Beverley, where the work would move, is only 28 miles away and has ample capacity to take on the additional work.
With regard to the point my hon. Friend the Member for Brigg and Goole made about distance, we consider a one-hour journey by public transport acceptable for travel to court. Not many people are frequent users of magistrates courts. I assure him that we do not propose closing the court in Goole only because of the performance of the court in Beverley, but we must look at utilisation over the whole area.
My hon. Friend asked why we do not close Bridlington magistrates court. The decision was taken by local management and took into account a range of aspects to ensure sufficient capacity in the area, based on the total number of courtrooms in each court.
On the point about people being within an hour’s journey of the court, the figures I mentioned indicate that it would take at least an hour and 25 minutes to travel by bus from Goole to Beverley, including a change in Hull because there is no direct bus. Incidentally, there is a direct bus service between Bridlington and Beverley, although I do not suggest the closure of Bridlington. The figure of one hour and 25 minutes is a minimum, and the journey time is more likely to be one hour and 39 minutes.
My hon. Friend makes a fair and relevant point, which he should submit for consideration in the consultation. The original reason for the location of many courts is that they were intended to be half an hour’s horse ride away from population centres. We thought that a one-hour journey by public transport was probably more in tune with modern thinking. I assure him that we will do our best to provide him with information on running costs and the other statistics he requested. Again, he should advise us in his response to the consultation of any statistics he has.
As Goole is the only magistrates court in the local justice area of Goole and Howdenshire, we propose that the three LJAs should merge to create a single entity for east Yorkshire, covering the whole of the East Riding. Relatively few magistrates sit at the three benches we propose to combine—only 95 in total. Combining the three will provide a pool large enough to facilitate a more efficient listing of work and reduce the amount of administrative work involved. There will also be advantages for magistrates, allowing them more flexibility in sittings and a wider variety of work.
Although Selby magistrates court has good facilities, as my hon. Friend the Member for Selby and Ainsty said, it too is underused, sitting only around 60% of the time available. Like Goole, it sits in a local criminal justice board area that has a low overall utilisation rate. Selby benefits from being located only 15 miles from York, which is capable of absorbing the work from Selby and has good transport links to all parts of west and north Yorkshire, although I believe my hon. Friend questioned that in his earlier remarks. His point was that people in the south of his constituency did not have such good access. I encourage him to make that point in the consultation. I was aware of the refurbishment of the Selby magistrates court, but I believe that there is currently a backlog of maintenance work to the value of about £100,000.
Selby and York local justice areas already have joint panels, so merging the two would simply formalise that arrangement and reap the administrative benefits. I understand that the closure of courts in several communities will concern hon. Members and some of their constituents. I welcome views on the proposal, and they will be taken into account before decisions are made. However, I want to make it clear that I believe that operating out of around 530 court houses is unsustainable and does not offer the taxpayer value for money. I reiterate the point that we need to think more widely than bricks and mortar when considering access to justice; we need to embrace in the justice sector many of the technological advances that we take for granted in our work and social lives.
Another point I will address in the time remaining is the impact the proposals will have on local justice. That important point was picked up in different ways by both my hon. Friends. My answer is that there absolutely will not be an impact on local justice. The Government remain committed to a system in which justice is done and seen to be done in the communities affected by crime. The quality of justice matters equally. It is not assured simply by having a court building in each small town, as populations are more mobile and use more sophisticated communications than ever before. The speed with which cases are decided, the facilities we provide to meet the needs of all court users and the respect for the quality of our justice system must be as important, if not more important, than locality. The involvement of communities in the justice system is absolutely key to that, both as magistrates and assistants. With more than 95% of criminal cases heard by magistrates, there is no doubt about the scale of community involvement in justice. I will continue to support magistrates as the bedrock of our justice system. I have held meetings with magistrates’ associations and individual magistrates, and will continue to do so to prove the Government’s support for the magistracy.
HMCS provided £21,000 of funding in 2009-10 for magistrates in the community scheme run by the Magistrates Association. On community engagement, HMCS works with magistrates and other justice agencies to host regular open days that provide local communities with insight on how justice agencies work together to serve the community, staging mock trials to encourage understanding of the justice system.
We want people to resolve civil disputes more quickly and effectively. County courts, of course, are involved in the proposals as well. Justice does not take place only in court; uncontested money and property disputes can be resolved through our online services, Money Claims Online and Property Claims Online. We are exploring ways of increasing the use of alternative dispute resolution when it can provide more effective and satisfactory solutions than a day in court.
The time is right to take a fresh look at the provision of court services to meet the challenging and changing needs of the justice agencies and society. Work loads are falling in the magistrates courts and court time has been saved by magistrates and court staff working together with increased efficiency. An example is the success of “Criminal justice: simple, speedy, summary”, which speeds up the time from charge to disposal and drastically reduces the need for adjournment. We are developing better ways of delivering justice and will continue to improve them.
Paediatric Cardiac Surgery
It is a pleasure to serve under your chairmanship, Mr Benton, and to have secured this debate on the Government’s review of children’s heart surgery.
I am sure that Members in all parts of the House agree that children who need heart surgery should have the best-quality care. Outstanding treatment is provided in many parts of the country, including at the congenital heart centre at Glenfield hospital in my constituency. My first visit as the new Member of Parliament for Leicester West was to the centre. I met staff in the paediatric intensive care unit, which is the seventh busiest such unit in the country, and staff on the children’s ward and from the cardiac nurse liaison team, seeing for myself the excellent professional and high-quality care that they provide.
I also talked to parents about their experiences, and they spoke about their shock at discovering that their child had a congenital heart problem, their fears about the operation and other procedures, and whether their child would survive. They talked about how they were coping with having a very sick child at the same time as holding down a job and looking after other children, particularly if they lived a long way from the hospital, as many of the parents do. Above all, however, they talked about the excellent care that they receive at Glenfield and about how the help and support from the doctors, nurses and other staff is second to none. I am proud to have Glenfield’s congenital heart centre in my constituency, and I express my gratitude to all the staff for their excellent work.
Although excellent care is already available in many parts of the country, experts in children’s heart surgery have for some while argued that change is necessary, to ensure that all children get the highest-quality care. Those experts include the Royal College of Surgeons, the Society for Cardiothoracic Surgery, the national clinical director for children, young people and maternity services, and the NHS medical director.
Children’s heart surgery is complex, and is becoming ever more sophisticated. Technological advances mean that care is becoming increasingly specialised, capable of saving more lives and improving outcomes for very sick children. Many clinicians, however, argue that services have grown up in an ad hoc manner and now need to be better planned to ensure that all care is safe and sustainable, and that surgeons need to treat sufficient children and have sufficient variety in their case load to be skilled and experienced enough to deliver care of the highest quality. They further argue that that is likely to require fewer and larger specialist centres. I have always believed that when changes in hospital services are necessary to improve patient care, we should have the courage to make them happen. I therefore welcome the review, which was initiated by the previous Government.
However, we need to ensure that the right principles and criteria drive the review, the right balance is struck, the right weight is given to the different criteria and principles, and the views of parents and families are properly heard. The Government document “Children’s Heart Surgery: The Need for Change” sets out four key principles to guide the review:
“High standards. All children in England who need heart surgery must receive the very highest standards of NHS care, regardless of where they live… Personal service. The care that every centre provides must be based around the needs of each child and family… Local where possible. Other than surgery and interventional procedures all relevant treatment should be provided as close as possible to where each family lives… Quality. Standards are being developed and must be met to ensure that services deliver the best care.”
I want to say more about those principles. My first point is about the number of surgeons and of patients required in each centre to ensure that all children receive the best possible care. “The Need for Change” stresses that each unit needs enough surgeons to provide care 24/7 and to avoid surgeon burn-out in this complex and demanding field. It questions whether units with two or fewer surgeons can achieve that goal, and states that four surgeons is “the magic number.”
The document also emphasises that surgeons need to treat enough patients and have a sufficient variety of cases to get the skills and experience they need, and to ensure that junior doctors have the best training. I fully accept the review’s concerns about units with two or fewer surgeons, but from talking to clinicians I understand that the clinical evidence on the optimum number of surgeons and the precise number of patients a centre should treat a year is the subject of some discussion, both in this country and internationally.
The centre at Glenfield hospital provides care 24 hours a day, seven days a week. It has three surgeons, treating about 300 cases a year. The staff in the centre are determined to continue to improve the quality of care that they provide, and are planning to appoint a fourth surgeon in the next few months and increase the number of operations to more than 400 a year. Nevertheless, Glenfield hospital and my local primary care trust are very clear about the fact that the centre already delivers high-quality, safe and sustainable care.
Wider clinical issues also need to be considered by the review. Many children who need heart surgery often have other complex conditions, so the review needs to consider the range of surgical and other specialties available in hospitals with children’s heart surgery units, and look at how they all link together. Glenfield deals with congenital heart defects in babies, and follows them through childhood and into adult life. Staff and patients say that that continuity of care is a crucial factor in delivering high-quality, personalised services, and it will become increasingly important as survival rates improve.
Glenfield is also the busiest of four ECMO centres in the UK. ECMO—extra corporeal membrane oxygenation—allows blood that has been drained out of a patient’s body to have the carbon dioxide removed and oxygen added before being returned to the body, thereby allowing the heart and lungs to rest and recover. Because of its ECMO facility, Glenfield can provide complex thoracic, or chest, surgery in children, especially for those who also have cardiac problems, as well as cardiac surgery for children who have reduced heart or lung function and who otherwise might not be able to have heart surgery, or recover.
Glenfield is the only centre in the country that provides ECMO for patients of all ages, from newborns to adults. It treated 180 patients last year, including 50 swine flu patients. ECMO is provided by the same staff who work in the congenital heart centre, so if the centre closed, Glenfield would lose its ECMO service too—a service used by patients across the country.
Another issue that the review must fully consider is access to care. “The Need for Change” says that most parents would travel long distances to ensure that their children got the best possible care. That is true. Parents would travel to the ends of the earth if they had to. Many parents whose children need heart surgery are, however, already travelling very long distances. Glenfield’s centre serves the entire east midlands, with outreach clinics in Nottingham, Derby, Mansfield, Peterborough, Boston, Grantham, Lincoln and Kettering.
I congratulate my hon. Friend on securing the debate. I know that the time available is limited, but I wish to underline the importance of the point that she has just made in relation to our own heart centre in Oxford. It is critically important that there is close liaison and consultation with the parents whose babies are affected and who are campaigning to save the centres.
I agree absolutely with my right hon. Friend. Many parents and staff are rightly concerned about the implications of travelling longer distances, particularly in emergencies.
I am a former director of the Ambulance Service Network, and I know that paramedics are highly trained professionals—increasingly to degree level—who can provide lifesaving treatment for patients while taking them to specialist centres further away, but that is not always possible, and the review must thoroughly consider the implications of further travel for the lives that could and will be saved.
High-quality care is not just about standards of surgery, the links with other specialisms or the ability to access planned and emergency care. A recent event organised to discuss children’s heart surgery in Leicester was attended by more than 800 parents and former patients, and those present felt that many more people would have attended if the event had not been held mid-week and during working hours.
The families said that the help and support that they get from the nurses, doctors and other staff at Glenfield are outstanding, and the key point that came up time and again was the excellent communication and support provided by the centre. Parents spoke about how staff go the extra mile to explain diagnoses and procedures simply and clearly, often at a frightening and worrying time. Every child gets a diary that explains in a way the whole family can understand what care they have received. It provides something for the children to look back at when they are older.
Parents said that the staff were like members of their own family; they could ring them day or night if they had any concerns. That familiarity with individual patients and families is crucial. All the studies by groups such as the Picker Institute of patients’ experience of care prove that individual, personalised care and communication are vital. One young man said that the staff knew him as a person, not as just another case, and that he was worried that that would be lost in a larger unit or if his care were split between outreach clinics and other centres.
Families also spoke about the fantastic help they get from the Heartlink charity at Glenfield, which has raised money to provide accommodation so that parents can stay overnight with their children, a play area so that brothers and sisters can play while families are visiting the child, and day trips for the patients as they get older. Those wider aspects of care are vital to parents and patients, but are barely mentioned in “The Need for Change”. I urge the Minister to ensure that the review has fully considered those issues when it makes its recommendations.
The final factor that the review of children’s heart surgery needs to take into account is affordability. It must be driven by the need to improve quality, not to cut costs, and, in these financially constrained times, it must acknowledge that there will be costs associated with changing children’s heart surgery in England.
Like the hon. Lady, I have visited the Glenfield centre, which is close to my constituency. As the parent of a healthy child, I felt humbled by the care that I saw there. The point that she is making about cost is important, because we appear to be achieving neither safer care—there has always been safe care—nor more efficient care. I understand that the reconfiguration would be very expensive, and she speaks rightly about straitened economic circumstances at this time.
I agree absolutely with the hon. Lady. The costs associated with changing children’s heart surgery centres include not just physically expanding a centre’s buildings, beds and equipment, but retraining staff. When I went to Glenfield, I was told that many of the staff would not move if the centre were changed. It takes time and money to train new staff, particularly in such a specialised area, and the review must take that into account when it makes its recommendations.
I, too, congratulate my hon. Friend on obtaining this timely debate and on how she is expressing her concerns. She obviously has considerable understanding and experience of and expertise in these matters. Will she join me in asking the Minister to give an assurance that cost will not be the overwhelming issue that drives the decisions, and that the concerns, fears and wishes of parents and practitioners will be foremost in his consideration?
I very much agree with my hon. Friend. The review must not be driven by a desire to cut costs, and it must acknowledge that increased costs are likely with any change to services.
I welcome the Government’s review of children’s heart surgery and their objective of ensuring that all children get the best quality care, but I urge the Minister to ensure that the full range of clinical factors—not just the ratio of surgeons to patients—is taken into account as part of the review, in particular implications for accessing care, including in emergencies, and the knock-on effects for other specialisms. I urge him to ensure that other aspects of care that are critical to parents and families, such as the quality of communication, and the wider facilities and support, are properly considered.
I urge the Minister not to conduct the review on the basis of cutting costs—there will be costs associated with any changes—and to ensure that the views of parents, other family members and former patients are fully taken into account before recommendations are made in the autumn. I look forward to his response.
I congratulate the hon. Member for Leicester West (Liz Kendall) on securing this important debate on the national review of paediatric cardiac surgery. I pay tribute to the dedicated national health service staff who work in paediatric cardiac care. It goes without saying—hon. Friends will agree—that during the course of their working day they do tremendous and fantastic work looking after critically ill and vulnerable children.
As the hon. Lady said, this is a complex and understandably emotional area. In 2008, the NHS management board asked the national specialised commissioning group to explore whether a reconfiguration of paediatric cardiac surgery services in England could improve levels of safety and sustainability. There had not been a problem at a particular centre, but surgeons, other clinicians, parent groups and the media had raised concerns over the risks posed by the unsustainable nature of smaller surgical centres.
The national review aims to ensure that paediatric cardiac services deliver the highest standard of care, regardless of where patients live or which hospital provides their care. All 11 centres in England that currently provide paediatric cardiac surgery, including Glenfield hospital in Leicester, are being assessed as part of the review. The objective of the review is not to close paediatric cardiac centres—I assure the hon. Lady that this is not a cost-cutting exercise.
Surgery may cease at some centres, but they would continue to provide specialist, non-surgical paediatric cardiology services for their local population. The review seeks to ensure that as much non-surgical care as possible is delivered as close as possible to the child’s home through the development of local paediatric cardiology networks. I emphasise that no recommendations have yet been made about which centres should continue to undertake surgery.
Recommendations on future services will be published for the three-month consultation in the autumn this year. The trend in paediatric cardiac care is towards increasingly complex surgery, which requires large surgical teams that provide sufficient capacity to train and mentor the next generation of surgeons. The focus of the review is to develop services that are clinically appropriate, sustainable and safe.
As I said earlier, paediatric cardiac services are complex, and it has taken time to set up a transparent review structure that takes into account the views of patient and parent groups, and relevant professional societies. As part of the review, the commissioning group has held 10 stakeholder events. The invaluable contributions from parents and NHS staff will inform future stages of the review process.
The commissioning group has set a series of service standards, developed by experts, that take into account the contributions of parents and professionals. The standards cover the whole of paediatric cardiac services and emphasise the need for networks of providers to ensure a coherent service for children and their families. The current centres have been asked to assess themselves against those standards, and an expert panel chaired by Professor Sir Ian Kennedy has visited and independently assessed each centre. The standards will be subject to public consultation this autumn together with the recommendations for change.
I shall now deal with the standard for the numbers of procedures and of surgeons to which the hon. Lady referred. Questions have been raised about the evidence that underpins the standards for the minimum number of paediatric cardiac surgical procedures per year, and for minimum staffing levels. The recommended level of activity—between 400 and 500 procedures a year—is based on the level needed to provide good quality care around the clock while enabling ongoing training and mentoring of new surgeons. The professional consensus is that having four surgeons in each centre should enable services to avoid the risk of surgeons performing only a small number of some of the more complex procedures, which may not be enough to maintain their skills. Transforming a service from adequate to optimal requires sufficient volume, expertise and experience to develop what Sir Bruce Keogh calls “accomplished teams”.
As I said a minute ago, that recommendation is the consensus within the professional bodies. However, I am more than happy to give the hon. Lady a commitment that I will write to her after this debate to elaborate, providing as much extra detail as I can, if she believes that will be helpful.
Turning to the other criteria, the review will also take account of surgical centres’ physical location relative to others and the impact of reconfiguration on other important services, including the highly regarded ECMO or total life support service at Glenfield hospital in the hon. Lady’s constituency, which she described with such eloquence in her remarks. The final part of the review will involve centres’ ability to attract key clinical staff and their families. I hope I can reassure the hon. Lady that transportation options and travel distances will be evaluated, including travel times specifically. The Paediatric Intensive Care Society has advised on the issue, and we continue to investigate and seek advice. I appreciate fully the importance of the issue and the concern that it causes many families.
Will the review also consider the impact on other services? For example, at Glenfield, there are two intensive care units for children in the city, and I understand that one team covers both. If the centre were to be closed—this might also apply to other centres—it might destabilise other services within the hospital.
The short answer is that I cannot make that commitment myself. As my hon. Friend will appreciate, the review is independent and will be carried out at arm’s length from the Department of Health and Ministers. I do not have a role, and it would not be correct for me to seek to interfere in the process. However, having said that, I am confident that my hon. Friend’s point will be considered as part of the review, because it will be comprehensive and across the board, considering all aspects of this highly specialised and important health care provision. I hope that reassures her.
The available research evidence suggests that larger surgical centres deliver better clinical outcomes. As cardiac expertise is available round the clock, they can perform a wider range of complex procedures, meaning fewer transfers between centres. Larger centres can still provide a personalised service. The service standards make it clear that tailoring services to the needs of each child is critical. That is an extremely important factor that I know the hon. Member for Leicester West understands and accepts fully.
I also assure the hon. Lady that any changes to local health services will not be driven from the top down. The review has strong support from external organisations. It has been instigated at the request of parent and patient groups, clinicians working in the service and professional associations, including the Children’s Heart Federation, the Royal College of Surgeons, the Royal College of Paediatrics and Child Health, the Royal College of Nursing, the British Congenital Cardiac Association and the Society for Cardiothoracic Surgery in Great Britain and Ireland. It is important to understand that any recommendations on the future number and location of surgical centres will be made not by any central body but by the 10 specialised commissioning groups working with local NHS commissioners. The review will consider access to services for the whole country.
The national specialised commissioning group was asked to lead the review because of its co-ordinating role across the 10 specialised commissioning groups. I am sure that the hon. Lady will agree that that was the most sensible approach to take when the review was devised and set up just over two years ago in 2008. The group was ideally positioned to engage with commissioners and clinicians from across the country.
I reiterate that the review is being undertaken in response to the concerns of parents and professionals about the future capacity and capability of paediatric cardiac services. It will be an open process; I assure the hon. Lady that the outcomes are not predetermined. It is a genuine review seeking genuine answers in order to maintain the highest standards of quality in a specialised and difficult area of patient care. The national specialised commissioning group will set up a consultation process on its recommendations and standards this autumn. We must wait and see what the review says and then go through the consultation process, during which anyone will be able to input their thoughts, recommendations, comments, criticisms or praises of the review’s findings, before any final decisions are taken.
I thank our external partners and their patients for their input to the review so far. I find it encouraging that the review has broad support across the board. As the hon. Lady will accept, children deserve the best possible care. The Government are determined to provide the best paediatric cardiac care possible after the review and consultation processes have been concluded and the final decisions reached.
Question put and agreed to.