Wednesday 15 September 2010
[Mr Peter Bone in the Chair]
Criminal Bar (Public Funding)
Motion made, and Question proposed, That the sitting be now adjourned.—(Jeremy Wright.)
It is a great pleasure to see you preside over this debate, Mr Bone. I am pleased to have secured a debate on such a topical and important subject, and to be able to welcome the Under-Secretary of State for Justice, my hon. Friend the Member for Huntingdon (Mr Djanogly) to his position. It is my first opportunity to do so in this Chamber, and I hope that he is enjoying the multifarious complexities of the task with which he has been entrusted, because it is an unenviable one. In many respects, he inherits an unfortunate and complicated history, and it is one through which he will no doubt tread with a combination of charm, urbanity and skill. Certainly, he will need all three.
I should declare an interest here. For the last 28 years, I have made my living at the Bar, a large part of which has been at the criminal Bar. Therefore, it is right for me to declare at the outset of this debate a strong financial personal interest. It was that interest that has caused me, over the past few years, to hesitate long and hard before bringing to the Floor of the House any issue to do with the professional structure or remuneration of the profession of which I have been a member for so long. It is precisely because of the gravity of the current situation and the need for a voice to be raised in defence of what are often minority, quiet and civilised professional values—they lack a voice in the discussions of the House—that I decided to overcome my hesitation. Given that I have been contacted by many members of the Bar and that I head my own chambers in Lincoln’s Inn fields, I can say that I am conscious of the interests of many junior and young barristers who are affected by the current predicament with which the criminal Bar is faced, and with those qualifications and caveats, I felt that it was right to bring such issues to the House’s attention.
At the heart of the criminal justice system is the professional exercise of the art of advocacy. The efficient conduct of cases in the courts is the essential pivot around which revolves the entire administration of justice. Incompetence and poor quality in the representation of prosecution or defence will inevitably lead to the failure of justice, prolonged delays, aborted trials, appeals and much greater cost. I hope that the Minister and I will at least agree on that important statement. It goes without saying that the heart of the criminal courts in our system is the adversarial combat between advocates on either side. If that combat is conducted with expedition, skill, relevance and a strict fidelity to the relevant issues in a case, it assists the judiciary to make its decisions. The judiciary knows that, which is why it has a direct interest and a powerful voice on behalf of the quality of advocacy in our courts.
The criminal Bar is the profession of specialist advocates in the criminal courts. It has a long and proud tradition. Its codes and professional atmosphere are exacting and competitive. It upholds high standards, celebrates and seeks to emulate the examples of luminaries of the past and present. Those include names who have bestridden the parliamentary stage in ages gone by, including Carson, Smith, Hastings, Marshall Hall, Peter Rawlinson and—I dare to add a name of which I am particularly fond—Marshall-Andrews.
A strong emphasis on ethical conduct is instilled into the novice barrister from his earliest experience. On the consistent reliability of such standards of moral integrity and of skill in the efficient dispatch of cases rests the trust of the judiciary, which knows that the accuracy and justice of its decisions are substantially dependent on the quality of those who represent Crown and accused. It is largely from their senior ranks that the judiciary are drawn.
Furthermore, the availability of an independent, fearless and professional cadre of advocates, who are obliged under the rules of their profession to take up a case regardless of the unpopularity of the cause or the power of the opponent, is a vital constitutional protection of the individual. It is by the efforts of such men and women in seminal cases throughout the years that many of the rights that we take for granted today were first established. No dictatorship or tyranny can long tolerate the existence of such a profession. Therefore, the continuing vigorous existence of the criminal Bar is a potent public good. I am afraid to say that the previous Government in their language and conduct did not appear to recognise that. It is important to many in this House that this Government—I dare to say our Government—recognise the value to the public interest of the criminal Bar and its professional values.
If this debate—I look at the Minister directly here—could elicit from the Minister a firm statement in support of the value of the criminal Bar and its professional values, it would have done some good. It would give enormous encouragement to many hundreds of junior barristers and others to believe that this Government were going to restore to pride of place in their considerations of the criminal justice system a respect and understanding of professional values.
For 20 years now, the Bar has been joined in the practice of advocacy in the higher courts by solicitor-advocates. A previous Conservative Government accepted the argument that the public should have the choice not to be represented by a barrister. I do not believe that the criminal Bar as a whole was, at the time, particularly resistant to that innovation. The view was held, and I agreed with it, that provided the criminal Bar occupied a level playing field it would, by virtue of its specialisation and standards of training and skill, be able to hold its own. Few believed back then that many solicitors in busy litigation practices would have the time or the inclination to visit the courts, and for some time that is how it proved.
However, that is no longer the case. For good or ill, higher courts advocates are now established and increasingly a prevalent feature of the criminal courts. As pressure on the available rewards have increased in other areas, the lure of the advocacy fee has been impossible to resist. The solicitor occupies the shop window. He is also the contractor with the Legal Services Commission for the provision of legal services. If a barrister is to be engaged, it is he who must refer the case. Traditionally he has done so by seeking out barristers whose reputations and proven records have staked a claim to his attention.
However, the solicitor’s position in the high street and in the police station means that he is able if he wishes to do so—and why should he not wish to do so?—to represent his firm’s client from the inception of criminal proceedings through to their end. If he is unable to manage all the case load that his practice brings him, he is now able to return some of it to another solicitor-advocate, who, as I understand it, can often be expected to split the fee and to return the favour some time later. In an age of decreasing margins, these are attractive options. Thus, the criminal Bar is being gradually stranded by a steadily withdrawing tide of work.
At the same time, the criminal Bar has sustained a consistent and dramatic reduction in the rates of legal aid for advocacy in criminal cases. Very few citizens are able to bear the cost of a serious criminal trial. However, the last Government made legal aid available without means-testing to anyone charged with a sufficiently serious offence. That was no doubt an attempt to control the costs recovered by a defendant in the event of acquittal and the costs of the bureaucracy associated with the assessment of means. However, it brought about some startling results, such as the sight of MPs being granted legal aid for expenses abuse cases and the sight of millionaires being represented on public funds. It also meant that the last Government in effect took predominant control of the market, making individuals less likely to pay for their own representation while simultaneously taking an axe to the remuneration.
I ask the Minister if he accepts that the rates of remuneration of the criminal Bar have been severely reduced; I hope that he does. In the course of my speech, I intend to ask him a number of questions, to which the answers would be welcome.
Let me give some examples of how the rates of remuneration of the criminal Bar have been severely reduced. For the most complex very-high-costs cases that are more than 60 days in length, the rates of remuneration have been actually reduced—not in real terms, but in actual terms, in the sense that these are headline figures and, therefore, have been cut by up to 20% since 2004. This year, according to the Ministry of Justice’s own figures, remuneration for cases of between 40 and 60 days has been reduced by 39.5%. On any view, those are extraordinary reductions. A barrister in a complex case can now be working for between 20% and 39.5% less than he was either in 2004 or in 2009.
Finally, on the very day that the House dissolved, 6 April, the statutory instrument was laid, amid rumours that civil servants were being bussed in at weekends to complete the processes, that enacted a further cut of 13.5% across the board in remuneration over the next three years. Another 13.5% was simply wiped out from the margins that criminal barristers are able to earn.
On any view, those examples, which are typical of the general trend of the last seven years, represent a severe contraction of public funding for the criminal Bar. The combined effect of all these developments has been to cause a crisis of confidence in the profession; I do not believe it to be an exaggeration to describe it as that.
The criminal Bar knows that it cannot expect special treatment and in the current financial climate it knows that it has no right to ask for such treatment. However, I believe that the present Government must take into account this recent history in responding to the imperative need to curtail public expenditure in the next few years. If the criminal Bar is to survive, with the powerful public interest that it represents, the Bar, the Law Society and the Government must be prepared to work together to rectify some of the competitive disadvantages, imbalances and unintended consequences that have resulted from recent changes.
My hon. Friend the Minister will know that the leadership of the Bar has been active in promoting imaginative—even radical—ideas to help to resolve these problems. For example, it has set up a working group to find and suggest to the Government savings in the criminal legal aid budget. These savings include those that would accrue from the lifting of the present rule that prevents the use of funds restrained pending trial, under the Proceeds of Crime Act 2002, from being used to finance the legal costs of a trial. I strongly commend to the Minister that modest proposal.
However, by far the most significant proposal is for members of the Bar to form companies, which would be given the unwieldy working title of Procure Cos. Those companies would become direct contractors with the Legal Services Commission for the commissioning of legal services. This idea does not meet with universal accord within the profession. It is revolutionary in its ramifications. These new entities, which would be controlled by barristers, would commission solicitors to carry out legal work for the first time, thus standing on its head the traditional, centuries-old arrangement.
It is not at all clear how such a system would operate. At the moment, an advocate at the criminal Bar is retained in a competitive market, in which professional ability is at least a factor in his selection. Even where the barrister is unknown to the solicitor, the latter will have received an account from the barrister’s clerk of the barrister’s strengths and recent experience and he will have been given a choice, perhaps, of one or two other barristers. The solicitor, with his professional knowledge of the case, will choose the barrister who he thinks will best suit his client.
Under the new proposal, however, the clerk in the barrister’s chambers—the chambers from which the Procure Co that is run by the same barristers has agreed to commission services—will have only the accused to consult. There will be no professional intermediary. That is difficult, for all kinds of reasons, for many within the profession to contemplate.
There are further major reservations. How will the new entities set up in sufficient time the administrative and commercial infrastructure required to manage all the complex considerations that are involved both in commissioning services from other lawyers, experts and others, and in competing in a tender exercise for contracts, given that they have no established trading history on which to assess the viability of their bid, particularly if the contract is awarded on price?
However, I say to the Minister that, if these problems can be surmounted, there are clear public gains from allowing the Bar to have access to the commissioning of legal services. First, the Bar is the specialist advocacy profession. The preparation and presentation of a case in court is the major part of the legal services that are provided in criminal litigation and yet the profession that specialises in that core service has until now been unable to participate in managing the delivery of that service. If the Bar is widely acknowledged—as it is—to be a driver of quality and exacting professional standards, there can be nothing but good in allowing it to compete. Secondly, since the cost base of the Bar is low, that will help to keep down costs.
Nevertheless, I say to the Minister that it is plain that, if the Government are interested in this idea, it is essential that the entry of the Bar into commissioning legal services is facilitated by rules that it will be able to adhere to and conditions that it will be able to fulfil from a standing start. The criteria for the awarding of contracts must attach an appropriately high priority to the quality of advocacy and the depth and range of experience in specific areas that are offered by the potential bid. To that end, the promotion of a system of quality-assured advocacy standards, with defined levels of competence, is not only inherently desirable in itself but a necessary element. Similarly the Bar must be given adequate time to prepare for such massive and fundamental change to its structure.
If the Government believe that there is merit in this idea, the Minister must soon indicate so and begin to consider a timetable for change. We know that there will be a legal Green Paper this year. Will it contain the Government’s preliminary view of these proposals for new structures? What view do the Government take of the proposal to pay a single fee for a case without the ring-fencing of the advocacy element within it? As the Minister knows, that alone could dramatically increase the competitive imbalance that I have described.
When will the criteria for the new tender for contracts be set out? What will the Government learn from the recent civil family tender? I understand that a serious problem has arisen from exaggerated overbidding. Some solicitors have applied for contracts far beyond their capacity to cope with; others have been careful to apply only for what they do well. The Ministry scaled down the bids across the board, leaving some well-established firms of good reputation in the field with nothing. How will the Minister prevent such mischief from happening again?
The last Government proposed a draconian reduction in the number of solicitors’ firms able to offer legal services in the criminal courts. I do not hesitate to say to the Minister that although I understand the advantage of having fewer contractors, those considerations must be tempered by a realistic awareness of the damage such an unmitigated approach will do. I hope that the new Government, whom I am proud to support, will measure the impact of their reforms carefully and calibrate them according to clear and transparent principles and criteria. Those must include, above all, a high if not decisive regard for professional quality and skill in both sides of the profession and a clear commitment to entities with proven merit and track records in the provision of legal services in the criminal courts.
I conclude with four critical questions. First, will the Minister assert the Government’s belief in the value of the independent referral criminal Bar as a professional source of essential expertise and quality in the provision of advocacy in the criminal courts? Secondly, will he accept that the criminal Bar has already sustained recent, substantial and even severe cuts in remuneration and that it should not, as a result, have to sustain a disproportionate burden as a result of additional measures of that kind? Thirdly, will he accept that the Bar must be afforded adequate time to adapt its systems and administration before the introduction of the new round of tendering for legal aid contracts?
The hon. and learned Gentleman says that he wishes funding for the profession to be safeguarded. Given that the comprehensive spending review for the Ministry of Justice proposes a £2 billion cut in its £9 billion budget, where does he think that should fall—prisons, probation, sentencing or other issues? Or does he oppose the Government’s CSR proposals for the Ministry of Justice?
I recognise that the Government must find £2 billion out of a budget of £9 billion, but I ask them to recognise that the Labour Government imposed 13.5% in cuts over the next three years, against a background of consistent reductions in remuneration over the previous seven years.
I say to the Government—I was careful to word my question as accurately as I could—that any burden sustained by the criminal Bar should be proportionate and take into account the measures already passed. I have not asked for the Bar to be excluded from the exercise of necessary retrenchment, nor does the Bar ask it. It asks for fairness and proportionality. It asks for what has gone before—recently, and as a result of the Government to which the right hon. Member for Delyn (Mr Hanson) belonged; the statutory instrument was laid on 6 April—to be taken properly into account.
Thirdly, will the Minister accept that the Bar must be afforded adequate time to adapt its systems? That is crucial, as I said, if the Bar is to enter the commissioning process. It is also important that the means of entry should be facilitated so that it can do so from a standing start.
Finally, will the Minister accept that it is fundamentally in the public interest that the Bar should be able to enter the competitive market for legal aid contracts? If so, although the profession is deeply uneasy about the revolutionary changes that it would impose, as I think he knows, the Bar and its leadership are prepared to work with him and this Government to find new structures and new savings in the criminal legal aid budget. That answers the question asked by the right hon. Member for Delyn.
I hope and believe that in partnership and amity, and above all with a respect for the professional skill, expertise, quality and values represented by the criminal Bar—a novel departure from the attitude of the past decade—solutions can be found, and the vital public interest represented by the criminal Bar can be preserved in its continuing prosperous existence.
I apologise for being late, Mr Bone. I am afraid that public transport let me down.
I declare an interest as a criminal lawyer. I was called to the Bar in 2005 and practised criminal law from a firm of solicitors in Hull for a number of years. Shortly before my election to the House, I was in the latter stages of pupillage at my local chambers, of which I remain a member. I hope, therefore, to bring practical experience to the debate as both a junior member of the criminal Bar and a solicitor who has practised criminal law and been heavily reliant on public funding.
In the time allowed, I hope to dispel a couple of myths. The first is that publicly funded criminal lawyers are taking excessive sums from the public purse. In my experience, the opposite is true. Colleagues at the Bar work long hours and receive modest fees for their services. In preparing for this debate, I asked a criminal solicitor in Hull, Mr Waddington of Williamsons solicitors, what a 25% cut to his criminal practice would mean to his business. It is worth mentioning that Williamsons is the biggest criminal firm providing services to my constituents. Mr Waddington described the prospect of 25% cuts as “disastrous”, and greater cuts as “catastrophic”.
Although no one would expect Mr Waddington to clap his hands at such a prospect, it is important to mention that he was also concerned about access to justice for the most vulnerable. As a law-abiding citizen, as he put it, he was particularly concerned about the potential effects on innocent parties in criminal proceedings, such as victims of crime and witnesses who might be subject to cross-examination by unrepresented defendants if criminal solicitors and barristers were forced to refuse instructions.
In my experience, colleagues at the criminal Bar and solicitors do not feel that the previous Government were overly generous during the past 13 years, but the cuts threatened by the new Justice Secretary and the coalition Government are likely to force them to close their doors for good.
Despite the consistent accusations of irresponsible spending, it is indisputable that the previous Labour Government streamlined and made efficiency savings, especially in criminal legal aid. As recently as March, the previous Justice Secretary, my right hon. Friend the Member for Blackburn (Mr Straw), said:
“The Government strongly believe that there must be a significant restructuring of the provision of criminal defence services in order to achieve greater value for money from legal aid, while still ensuring fair access to justice and enabling legal aid providers to remain profitable and sustainable.”—[Official Report, 22 March 2010; Vol. 508, c. 13WS.]
That is a crucial point. The solicitors and barristers to whom I speak are genuinely concerned about their practices and about whether they will be sustainable after £2 billion of cuts to the Ministry of Justice budget.
It is true that the Labour Government carried out significant reform of legal aid. Most prominently, Lord Carter carried out a review of legal aid procurement, a key aim of which was to reduce criminal defence rates. Those were substantially reduced—by 13.5%—but I am not saying that what happened was perfect, because I am aware of examples where injustice resulted. Cutting costs is clearly a priority for the Government, but at what cost? The Justice Secretary has confirmed that his Department will play its part in reducing public spending, but I submit that legal aid has been stretched enough. If the coalition Government try to stretch legal aid yet further, I fear it will snap.
The Labour Government recognised that legal aid could not reasonably be exempt from efficiency savings and, of course, I recognise that the criminal legal aid bill is more than £1 billion. However, I urge the Government to consider a number of issues in the comprehensive spending review. Cuts to criminal legal aid may well lead to defendants being unable to access appropriate legal representation, because criminal practitioners will decide that enough is enough, and that may compel defendants to represent themselves. That will inevitably lead to the system being clogged up, as defendants battle through what is a procedural and legal minefield. Miscarriages of justice may result from poor-quality advocacy caused by defendants representing themselves, or by the inappropriate use of inexperienced advocates, and there may also be expensive delays in court time.
Cuts to legal aid for criminal cases have already encouraged the use of employed higher court advocates, who offer less experienced representation. Speaking from my experience as a criminal solicitor and, indeed, a junior member of the Bar, I can say that there are some good-quality higher court advocates. However, the truth is that the Bar is very special. The training for it is very different, and there is no comparison between higher court advocacy and barristers. The Bar is far superior because barristers do the job all the time. Higher court advocates will waltz into a Crown court once a fortnight or once a month, but a member of the Bar is there continually.
The hon. Gentleman makes a very powerful point about the lack of experience of higher court advocates. Would he agree that one of the absurdities of the Crown Prosecution Service’s obsession with using higher court advocates is that people who are highly qualified in terms of civil service work are taken out of the system and away from the work that they should be doing in reviewing cases? That work is then delegated to often less experienced assistants within the CPS. The public sector unions frequently complain about that current fad, because it puts employees within the CPS under pressure.
I am grateful for that intervention. I could not agree more with the hon. Gentleman or have put it better myself.
Criminal practitioners are still coming to terms with a number of the significant reforms introduced by the previous Government that have impacted on pay and the availability of work. In particular, the graduated fees scheme has led to solicitors keeping work in-house, rather than instructing the criminal Bar.
As I have said, there has been a real reduction in fees of 13.5% over three years. A 4.5% reduction took place this financial year, which is bound to have a significant impact. Regardless of the merits of the reforms, they have resulted in a considerable upheaval in the funding of the criminal Bar. That should be taken into account in any future review and in any decision that the Minister needs to take. Further cuts to criminal legal aid, whether to the criminal Bar or to criminal solicitors’ fees, will lead to the social exclusion of the most vulnerable at a time when they are already likely to be suffering cuts in other publicly funded services, on which they rely heavily.
In conclusion, the criminal Bar plays an essential role in maintaining a fair justice system. Further cuts to legal aid will result in an unfair system, with access to justice being available only to those who are able to pay for it. That will inevitably undermine democracy and justice. Given the lack of sympathy that the electorate will have for the offender, it seems too easy to attack criminal legal aid. However, there is a real danger of taking that less politically damaging action and, in doing so, seriously undermining the very foundation of our society. I am very proud of being a member of the Bar and of the traditions of the profession, which I respectfully submit are being put at risk by the actions that I believe will be taken by the Government. I therefore urge the coalition to carefully consider those points and to resist dropping the axe on criminal legal aid and on such essential services.
It is a pleasure to speak under your chairmanship, Mr Bone. I congratulate my hon. and learned Friend the Member for Torridge and West Devon (Mr Cox) on securing an important debate, in which I must declare an interest. I have been a practising solicitor, albeit infrequently, for more than 16 years and for 11 years I was involved with instructing the criminal Bar. I therefore certainly have an interest in the debate.
There is obviously the risk of being accused of special pleading for the profession, but there is no risk of winning any votes in this debate—we all know that there are few votes to be won in standing up for lawyers. I also want to declare an interest in the rule of law, which I am sure all hon. Members who have contributed will share. That subject is of interest to my constituents and to this country. Clearly, a principle of the rule of law is that it cannot exist without there being access to justice for every citizen. An independent legal profession, of which the criminal Bar is clearly a crucial component, is the foundation of that principle.
We, in this country, can be proud of our record—of our principles, of upholding the rule of law and of our legal aid record. In any legal aid debate the statistic is always mentioned that we spend more per capita—per head—than almost any other country. However, at the same time—and rightly—one must consider public services and outcomes. So what is the outcome of this expenditure on legal aid? A recent report entitled “Effective Criminal Defence in Europe” considered which jurisdiction was best at providing an effective criminal defence. It will not surprise hon. Members to learn that the jurisdiction that came out best, along with Finland, was this country. That was largely due to the source of legal aid.
Why do we have this legal aid system? It was established some 60 years ago not because we were cajoled by an international agreement or because we felt we should be subject to any European convention; it was established because we wanted to apply the principle of the rule of law. That was summed up well by the US Supreme Court Justice Hugo Black in 1965, when he said:
“There can be no equal justice where the kind of trial a man gets depends on the amount of money he has.”
An independent criminal Bar funded through the legal aid system helps—indeed, it is crucial—to uphold equal justice. What is that equal justice? It is equal justice for the innocent and the guilty, for the falsely accused who gain publicly sympathy, and for the evil criminals who command public contempt. Looking back over my 16 years in the profession, I can think of some clients for whom the public would not want a penny of public money spent, but legal aid provides it and the rule of law demands it.
It might be helpful to have some distance when making the case for the criminal defence service. The following words were written by a solicitor, Paul Booty of McCarthy Stewart Booty:
“As far as those outside the profession are concerned, we get little sympathy, as all we do is drain the public purse ‘getting off’ undeserving, unemployed, drug-taking individuals on technicalities. We twist the law to our own advantage and are thoroughly unscrupulous, with no sympathy for the victims of horrendous crime. It is not surprising, therefore, that we should endure pay cuts from the government year on year; and who cares anyway, because we all drive Bentleys.
The reality could not be further from the truth. We are called to the police station at any time of the day or night. Quite often we are faced with detainees who, if they are ‘regulars’, are extremely vulnerable individuals, often living on benefit with mental illness, depression and dependency. These people are human beings and deserve dignity and fair treatment.”
And so say all of us, both those with a direct professional interest and those outside in the country.
However, although we certainly want to ensure that the system upholds dignity and respect, we also recognise, particularly in these economic times, that it cannot be immune from cuts. When looking for cashable savings in the Ministry of Justice budget, it is obvious that the legal aid budget will have to shoulder a distinct burden when cuts are made. The hon. Member for Kingston upon Hull East (Karl Turner) was too generous about the previous Government’s record, particularly their legacy for the economy and for the criminal defence service, which has been cut to the bone in many areas and left with great concerns for the future. We can certainly look at how cuts can be made and at high-cost cases, and means-testing is at last coming back to play a part. There will also be proper case management, particularly in preliminary hearings, where we can be much smarter and more cost-effective.
I want to look briefly at the relationship between barristers and solicitors. It is all too easy to play off barristers and solicitors. Historically, they are complementary professions, which is one of the reasons that we have such a proud record. There are enormous strengths in both professions. In comparison to international litigation, the relationship between barristers and solicitors in the UK makes us pre-eminent as a profession. Similarly, in criminal law there is, in the main, a good relationship. The contrast between High Court advocates and the Bar has often been characterised too starkly. In the main, the improvement is helpful, but it needs to be dealt with carefully, with proper training and quality, particularly for High Court advocates.
Obviously, we need to avoid the abuse of the referral fee arrangements that sadly seems to be emerging in various areas. However, we should not pit one against the other. That is not the real threat to the independence of the legal profession and the Bar. There are opportunities in the commissioning arrangements for smaller solicitors’ firms to be subcontracted by barristers and brought into the family of commissioning, where previously they could be excluded by large contracts. The big threat is in the commissioning field, where we are entering a brave new world, and in the contracting process presently applied by the LSC. I believe that the way in which the LSC has operated in the past provides the biggest threat.
There are warnings that must be taken into account and that are already clear in the field of practice, and there are warnings in procurement processes. What has happened to family legal aid is a legacy of how the previous Government oversaw the decimation of highly skilled and committed solicitors, often with great experience of dealing with key issues and vulnerable clients carefully. Existing experience has, in many ways, been excluded from the process. The rug has been pulled from under the feet of many providers. We have been left with legal aid deserts, as we prophesised when in opposition. Poole in Dorset, with a population of 138,299, has been left with one family law solicitor to provide publicly funded work.
Providing solicitors of choice for vulnerable defendants is a matter of concern. In mental health law, those who currently provide for the most vulnerable often have expertise in dealing with vulnerable clients, but now solicitors are effectively being imposed on those clients by the LSC. In the area of administration, there was an example in July of the duty solicitor rotas being reissued twice for a six-month period. Firms were missed off the rotas, areas were put in the wrong position and a simple process led to chaos. Is that the prospect for the commissioning process for the Bar and others?
Is my hon. Friend aware that across England and Wales the number of solicitors’ firms is diminishing fast? In Stapleford, a town in my constituency, there is now no solicitor available to provide advice for people with real need in family circumstances. They must travel many miles into Nottingham for that advice, and they are often vulnerable, quite literally, faced with a violent partner.
My hon. Friend makes her point well. In that context, the Minister is facing difficult decisions on funding restraints. That context is so important that I am sure he will take account of it. There is an impression that the Ministry is in chaos and that it is having to pick up the bill, but it is not the same the other way round; there is zero tolerance of any minor error when the LSC submits a bill and funding is not provided. As the Public Accounts Committee rightly concluded, the LSC lacks a grip of the basics and is ripe for reform, and I look forward to that reform being pursued by the Government.
Finally, we have to talk about money—something we do not like doing—because there is a concern about cash flow and payment. Solicitors often have to wait some time for payment, and now the goalposts have been moved by the LSC. Previously, it would step in to help if 5% of a bill was awaiting payment, but now it has moved that to 10%. That is a warning to the Bar about what happens when we get into bed with that area of commissioning.
In conclusion, it is important that we stand up for the important principles of the rule of law that underpin legal aid. We of course must cut waste and inefficiencies, which I am sure the Minister has been tasked with, look at high-cost cases and properly reform the LSC to ensure that it is fit for purpose, whatever form it takes, to deal with the new environment. Above all, we must ensure that we do not undermine the strengths of the criminal justice system and an independent legal profession accessible to all.
It is always a pleasure to follow my hon. Friend the Member for Enfield, Southgate (Mr Burrowes); as a young barrister it was always a pleasure to receive instructions from him in chambers. I must declare that for the past seven years I was a member of the junior Bar, practising first in London and then in-house for a firm in Kent before coming to this place.
The key point for me, having been through the system—practising, not going through the criminal justice system in another way—is that we have in our society a great belief in our liberty and freedom. The criminal justice system and the legal profession might not be perfect, but when one looks around the world one sees that it is one of the finest. It is the front-line professionals—those at the Bar, in-house barristers and High Court advocates—who ensure that people’s liberty is preserved. If there is any chance that people’s liberty may be put in danger, we must consider seriously, in terms of the whole concept of our society, how to preserve that liberty and freedom.
On the point about criminal legal aid and the criminal Bar, the people on the front line are those at the junior Bar. For a case in the magistrates court, it will be a member of the criminal Bar who will have to travel to the court, take instructions, give advice and, after that, pass the case on to the more experienced member, if so be, of Queen’s counsel.
It was a real pleasure to listen to my hon. and learned Friend the Member for Torridge and West Devon (Mr Cox), and I fully agreed with his eloquent speech. If there are drastic cuts in legal aid, the junior members of the Bar will be most affected. Over the past 20 years, the Bar has worked hard to ensure that it is diverse, that it is not simply people with independent means who can come to the Bar, and that people from all different backgrounds are able to come to the Bar on merit. If there are drastic cuts, there will be an element of going back 20 years, and that cannot in any way, shape or form be right.
People often equate barristers with high earnings, but there is a key difference for members of the Bar: income tax is linked to earnings. They have to pay tax on their earnings, not their receipts. Legal aid is already at difficult levels; any further reduction would mean that if there was a delay in money coming in, those who could carry on in fair weather, and who have been there for a long time, would no longer be able to do so. The taxation system must take into account the fact that members of the Bar pay tax on earnings, not receipts.
It is accepted that the monitoring and regulation work of the Legal Services Commission over the past number of years has been absolutely awful. We hear stories—and facts, such as those that are set out in the report that I have here—of lawyers being overpaid by £25 million. When the person in the street hears that, they say, “Lawyers are paid a lot.” We must ensure proper regulation and monitoring of the current system, to see whether it is having an adverse effect on criminal justice, and to see how the current means-testing approach, brought in by the previous Government, is being applied.
I spoke to a practitioner on the front line—a solicitor in Kent—who said that there is a four-week delay in legal aid. Then, when the case goes to the Crown court, there could be a situation at a preliminary hearing, or a plea and case management hearing, where someone turns up without a representative, and the case has to be adjourned. Adjourning the case takes us back to a position where taxpayers’ money is wasted. We are far from having an efficient, well-run and proper system, but that is what must be put into practice.
We have at present a means-tested system that leads to scenarios in which people act either pro bono or under fixed-fee rates, and they may not be of the quality or have the expertise that the independent Bar can provide. Defendants may decide that they are better off just pleading guilty because, at the end of the day, they do not have the means. That goes against our fundamental principles. If someone is innocent, they should be able to fight their case all the way. We should go back to a position that this country can be proud of, in which innocent people have the means to fight for their freedom.
I know that other hon. Members wish to come into the debate. I was taught at the Bar that brevity is a virtue, not a vice, and I am very much going to apply that advice. My hon. and learned Friend the Member for Torridge and West Devon discussed independent commissioning by the Bar, direct access, and regulatory caveats in respect of quality assurance. At this time, when there are difficulties, we must consider carefully how we can move forward and preserve the Bar’s independence. That is one of the best ways, at this difficult time, to move forward and preserve the Bar’s identity.
Before calling the last Back-Bench speaker, I would like to remind Members, especially the new Members here, that it is normal practice for the Chairman to be notified in advance that a Member wants to speak in a one-and-a-half-hour debate.
It is a pleasure to serve under your chairmanship, Mr Bone. I congratulate the hon. and learned Member for Torridge and West Devon (Mr Cox) on securing this debate. I shall not attempt to claim anything like the level of detailed expertise that he and other hon. Members have on this subject, nor shall I be able to defend the livelihood of the criminal Bar quite as assiduously as they have this morning. The hon. Member for Enfield, Southgate (Mr Burrowes) referred to special pleading. I am not sure whether any of what has been said this morning falls into that category. I feel that perhaps my role here is to make it clear to anyone flicking through the TV channels who stumbles across this debate that they are not actually watching a courtroom drama.
I am pleased that the coalition programme includes a fundamental review of the legal aid system. That was inevitable and unavoidable, in today’s economic climate. The hon. Member for Enfield, Southgate referred to the fact that we have the most generous system of legal aid in the common-law world. Of course, we should be proud of that, if all the money is being spent well.
I acknowledge that a comparison of the costs of our legal aid system and those incurred in inquisitorial systems is not necessarily straightforward because of the differences between the two. The basic principle, which I am sure that all of us support, is that, whatever the outcome of the comprehensive spending review as it relates to the legal aid system, we should not be in a position where people are not represented in criminal cases.
There are clearly some failings in the present system. All the previous speakers expressed concerns about the level of fees. As Members will know, if 50% of the legal aid budget is being spent on 1% of the cases, it may not be that the fees are excessively high but that perhaps the cases are taking longer than is necessary—not deliberately, but perhaps there is a slight incentive to ensure that they go on longer than is totally necessary. That needs to be looked at, particularly if it means that less funding is available for less high-profile cases in which we would also want people to be properly represented.
I assume that what the Prime Minister said about senior people working in the public sector earning a multiple of no more than 20 times what the lowest-paid workers in their field receive may impose some interesting restrictions on the level of fees that might be available to barristers doing work that is funded by legal aid. I wonder whether the Minister would like to comment on that when he responds to the debate.
On another aspect that I am sure other Members are concerned about—the hon. and learned Member for Torridge and West Devon referred to the availability of legal aid in MPs’ expenses cases—the name van Hoogstraten will be familiar to all Members here today. The safest thing I can say is that he is a colourful gentleman. Estimates of his fortune vary widely—hundreds of millions would probably be a safe figure to quote—yet apparently he received £1.12 million in legal aid. I do not know whether there have been changes since he received that funding that would preclude that from happening now. Very helpfully, the hon. and learned Gentleman shakes his head, which indicates that perhaps nothing has changed, and that such funding would still be available to someone who claims that they have no cash assets—Mr van Hoogstraten’s assets had been frozen. We clearly have to address that.
What sort of action can we take? If a small number of complex cases ties down half the available funding for legal aid, can anything be done to shorten the process without impacting on the quality of legal advice and the handling of the case? The difficult balance between setting the fees at a publicly acceptable level, and setting them at one that ensures that there are people able and willing to advocate, needs to be found. When the Minister responds, I hope that he will clarify his view on whether the Legal Services Commission has a better idea of the costs and profits associated with legal aid cases, to which other hon. Members referred. The Minister will know that the Legal Services Commission was criticised by the Public Accounts Committee.
There are no panaceas. Some have advocated no win, no fee arrangements as a solution, but, clearly, it is unlikely that anyone would want to pursue, on that basis, cases involving the police.
I am grateful for the hon. Gentleman’s analysis of the problem of funding criminal legal aid cases, but does he accept that one problem is whether it is right to make people of means who are acquitted pay for their legal representation when they emerge from the court free and not guilty? We have to grapple with that question. Ultimately, although van Hoogstraten was convicted by a jury, the Court of Appeal ordered a retrial and, for legal reasons, it was adjudged that there could be no further trial, so he is not, perhaps, the best example. We should focus on people of means who have been convicted. Finally, and I do not want to take up too much time, one problem is—
May I apologise to the hon. Gentleman for not giving way earlier? I was not aware that he was rising until I caught sight of him in the corner of my eye. He makes a valid point, and I was going to come on to financial contributions and to what extent people should be willing to contribute to support their case. I am interested to hear what the Minister has to say. The hon. Gentleman is right in relation to Mr van Hoogstraten: he was eventually acquitted in the criminal case. As I understand it, however, he was found guilty in a civil case, although he has stated that he will not be handing over a single penny in relation to the outcome of that case. The hon. Gentleman has raised important points for the Minister to respond to.
On the CPS, if cases are adjourned unnecessarily, costs are incurred, and there may be scope for improving on that. Clearly, this would not assist the legal profession, but it would be interesting to hear from the Minister what success he is having in stopping cases going to court through the use of virtual courts, and the extent to which they can contribute to the process. As someone who is not legally qualified, in any shape or form, I hope that my few comments still inform today’s debate, and that we hear some convincing responses from the Minister shortly.
Thank you for calling me, Mr Bone; I share the pleasure of others in serving under your chairmanship for the first time. I congratulate the hon. and learned Member for Torridge and West Devon (Mr Cox) on securing the debate. I also congratulate my hon. Friend the Member for Kingston upon Hull East (Karl Turner) and the hon. Members for Enfield, Southgate (Mr Burrowes), for Gillingham and Rainham (Rehman Chishti) and for Carshalton and Wallington (Tom Brake) on contributing to it. It is also worth mentioning the hon. Members for Enfield North (Nick de Bois), for Broxtowe (Anna Soubry) and for South Swindon (Mr Buckland) who have sat through the debate and shown an interest in this matter, and the contribution of the Whip, the hon. Member for Kenilworth and Southam (Jeremy Wright). It shows that there is considerable interest in the matter before us.
The hon. and learned Member for Torridge and West Devon began by saying that the art of advocacy was key to his profession. I declare a non-interest in that I am not a barrister and never have been. Today, I am undertaking the art of advocacy on behalf of my noble Friend Lord Bach, who was the Minister in the Department responsible for these matters, and obviously cannot speak here today and defend the previous Government’s record. Prior to the election I had responsibility for prisons, probation and, latterly, the police, so I contributed to the work of the Bar in that role. I hope we can discuss some of the key issues that the hon. and learned Gentleman raised and hear some of the solutions that the new Government wish to bring forward.
I begin by, in a sense, disagreeing with the hon. and learned Gentleman in what I hope is a positive, constructive and amiable way. The previous Government did recognise that the Bar and the criminal Bar have an important role in our democratic society. I wish to place on the record the fact that the right to a fair trial and representation is essential in a democratic society, because it is just as much a part of our democratic process as this House and this debate today. As my hon. Friend the Member for Kingston upon Hull East also recognises, there are challenges in that role that demand skills, professionalism and the support of Government, not only to achieve independence, but to recognise and value the profession as a whole. I hope that there will be common ground on that, whatever our political differences on other issues.
I hope hon. Members understand that the, perhaps, acerbity with which I referred to the previous Government’s record was coloured by remarks from successive Home Secretaries about bent briefs and lawyers who tried too hard. In the light of the extremely enlightened comments that the right hon. Gentleman has just made, I am sure he will agree that those were unfortunate remarks, which gave the profession the belief that its values were not shared by the then Government.
I said what I said, and I hope the hon. and learned Gentleman recognises that I know the Bar has a valuable role and that it serves a full position in our democratic society.
The previous Government had to look at the difficult decisions that we faced in terms of the potential deficit, which we are now challenged to look at across the board, and at how we find efficiencies in the way in which we support the legal aid system financially. My noble Friend Lord Bach, as Minister before the election, tackled that issue head-on. The hon. and learned Gentleman referred to the notice and order issued on 6 April, before the dissolution of Parliament, which placed on record some decisions that we had to take.
In 2008-09, £2.1 billion was spent on legal aid between the criminal and civil budgets; that is an important amount of resource. It is important work and it is vital that we recognise that legal aid is essential, as is the advocacy role, in developing a civilised society. People depend on legal aid for access to representation in both criminal and civil cases, particularly those who have difficult legal problems, particularly in times of economic hardship. Legal aid practitioners provide a fantastic service and should be paid accordingly. As the previous Government recognised, there are issues with how we rebalance the funding, identify the best efficiencies and run the system in the future, and the Minister will have to face those challenges.
We have seen a huge increase in the legal aid budget from £545 million in 1982-83 to £2.1 billion in 2008-09, which is an average increase of 5.3% a year. The previous Government believed that that was unsustainable, as I believe the current Government will.
The figures for the legal aid budget show that it has increased, but is it not important to break them down to show where there have been increases? For example, the criminal legal aid budget in the lower courts is under control, and indeed savings are being made, which is unique in recent years.
I accept what the hon. Gentleman said. I was coming to the fact that at the moment the criminal legal aid budget is about £1.1 billion of the £2 billion, and that the civil and family legal aid budget is around £900 million. What has happened over the years—this is why Lord Bach made his decision when he was the Minister—is that the criminal law side of the legal aid budget was beginning to eat into the resources available for the civil and family legal aid budget.
There are cases to be made for all sorts of things. The fact that crime fell by 36% might have something to do with some of the issues that we brought forward over the past 13 years, but such matters are for a wider debate in due course.
We had to consider how to make savings on that budget, and the hon. and learned Gentleman mentioned his concern that we made cuts of around 4.5% a year for the following three years, including this year, which totalled about 13.5%, in advocates’ graduated fees, coupled with extending those fees to cases due to last up to 60 days. We had a choice, and Lord Bach could have taken that hit in one go—proposals were before him to make a drastic cut of 17.9% immediately—but we chose to phase that in over three years as part of the savings that we knew we had to make in the Ministry to ensure that we met the coming CSR obligations. The Minister will surely face similar obligations, perhaps with the increasing difficulty of a further £2 billion of savings in his Ministry’s budget if we believe what the Lord Chancellor and other hon. Members have said. My hon. Friend the Member for Kingston upon Hull East said that that would be very difficult for the Ministry and the people who depend on legal aid, particularly if further cuts to the service are driven forward over and above the challenges that we had to face and which the hon. and learned Gentleman mentioned.
The Labour Government highlighted the importance of driving down costs and of ensuring that we consider areas such as the tendering process and developing alternatives. We considered a range of reforms and, as the hon. Member for Enfield, Southgate said, more must be considered, such as high-cost cases and the status of the LSC. We had planned to introduce proposals, if we were re-elected, on agency status for the LSC. Efficiencies could be made in the system as a whole, and we need to consider them generally to ensure that we receive extra value from the system.
I want to give the Minister 15 minutes to respond, but I shall touch on three areas of concern to Labour Members. As my hon. Friend the Member for Kingston upon Hull East said, we face proposed cuts of £2 billion in the Ministry of Justice over the next three years if we believe what is said about the CSR. Will the Minister say whether that will fall in part on legal aid in the next year and beyond? If not, how does he expect the Prison Service, the probation service, sentencing policy and other aspects of the Ministry’s funding to be able to meet that level of cuts, which I believe are unnecessary given the choices that the new Government could have made on those issues and public spending?
We were not afraid of saving resources, which is why we introduced the measures that the hon. and learned Gentleman is concerned about, but a line must be drawn, and I would welcome the Minister’s support for protection of the public and defence of people’s right to enjoy the services of the profession. What consultation will he have with the Bar and service users on those issues and the points that have been mentioned? How will he ensure that the social and welfare aspects of the legal aid budget—this was raised by my hon. Friend the Member for Kingston upon Hull East—for those who depend most on legal aid services are considered? Such people depend on those for housing and employment issues, and in civil cases dealing with social welfare concerns. An article in The Times in August tantalisingly raised the possibility of that being a major target for the Government. That choice would be wrong, because the Government would again ensure that the burden of public spending cuts fell on those who are least able to bear them: the vulnerable, and those who need the service most and do not have recourse to other forms of finance for their legal requirements.
There are key issues for the Government to address, and I welcome this debate. The Labour Government took a responsible approach to these issues, and tried to save resources efficiently and effectively. Opposition Front-Bench spokesmen will watch carefully to see how the Government respond to the challenges that they, not the economy, have set for themselves ideologically to cut public spending still further. We shall watch to see whether that impacts on the poorest and damages the safety of our society through other choices being made on prisons, probation and sentencing.
I welcome you to the Chair, Mr Bone. I believe that this is your first debate as Chairman, and I hope that it is the first of many. I am a non-practising solicitor, but I have never engaged in legal aid work. I congratulate my hon. and learned Friend the Member for Torridge and West Devon (Mr Cox) on securing this debate, which is timely. Many issues have been raised, and I will do my best in the time available to address them.
My hon. and learned Friend is an experienced criminal barrister and, as I would expect of a leading silk, argued his case strongly, as did my hon. Friends the Members for Carshalton and Wallington (Tom Brake), for Gillingham and Rainham (Rehman Chishti) and for Enfield, Southgate (Mr Burrowes), and the hon. Member for Kingston upon Hull East (Karl Turner).
I should say at the outset that the Government agree that we need good-quality advocates to prosecute and defend in criminal cases, and to ensure that the criminal justice system works effectively and fairly. My hon. and learned Friend the Member for Torridge and West Devon and others have argued passionately for the continued future need for an independent Bar, and I support that. However, it is important to recognise that the legal landscape in this country is changing and we must all acknowledge that; we must adapt to it, and to the financial realities of the current economic climate.
I will deal later with the various points made, but before that it may help if I speak about legal aid more widely in the current context. As hon. Members know, the Government have pledged to reduce the budget deficit to deal with the acute financial crisis and to encourage economic recovery. That is something that the whole Government must do. However, we are not driven only by economic considerations; the financial situation is a rare and urgent opportunity to develop imaginative and creative policies. I accept that our policy should not be determined only by the need to deal with the deficit.
In June, we announced that we were considering our policy on legal aid. That reflects the aim of creating a more efficient legal aid system as set out in the coalition Government’s document of 20 May. My hon. Friends the Members for Enfield, Southgate, and for Carshalton and Wallington voiced their concerns about the operation of the Legal Services Commission. I confirm that I have established a good working relationship with the LSC and that we are working through some of the issues. I should also say that the Government have decided to replace the LSC with an executive agency of the Ministry of Justice, in the belief that that will strengthen accountability and control of the legal aid fund.
As the right hon. Member for Delyn (Mr Hanson) said, there have been several reviews of legal aid in recent years under the previous Government. For example, Lord Carter of Coles’s report of July 2006 proposed a market-based approach to reform. The previous Administration implemented some of Lord Carter’s recommendations, but they did not succeed in implementing price competition for criminal legal aid work.
I can confirm to the right hon. Member for Delyn that we are seeking to develop an approach to legal aid spending that takes into account the necessary financial constraints, the interests of justice and the wider public interest. We are seeking to develop an approach that is compatible with necessary access to justice for those who need it most, the protection of the most vulnerable in our society, the efficient performance of the justice system and our legal obligations.
The cost of the legal aid system as a whole has risen over time. The scheme now costs over £2 billion per annum and, as has been recognised by my hon. Friend the Member for Enfield, Southgate, it is one of the most generous schemes in the world. We spend significantly more on legal aid than most other comparable countries. For example, the per capita spend on legal aid is about £9 per head in Australia and Canada, and £11 in New Zealand, but we spend £38 for every man, woman and child in England and Wales. In the current financial situation, that is unsustainable.
My point is not directly related to the debate, but I would like to raise a point with the Minister about legal aid, particularly the availability of legal aid to British citizens in foreign countries and the extent to which the Government are able to publicise its availability.
As I have said, the cost of the legal aid system has risen over time. The problems were well recognised by the previous Administration, but their piecemeal attempts at reform often served only to add to the upward pressures on cost, and they did little to address the underlying causes of cost or to look at the situation in the round; they found it too complicated to deal with. We want to take a different approach and look at the whole legal aid system and the wider justice system. With respect to my hon. and learned Friend the Member for Torridge and West Devon, legal aid is not only about the fees paid to lawyers; that is the wrong starting point. The starting point should be more fundamental questions, such as: what is legal aid for? What is the role of the state in legal aid? Who needs access to legal aid? How should we fund legal aid? What are the alternatives, in civil cases, for resolving disputes in a way that avoids expensive court processes and the need for lawyers? How should we set the price we pay when legal aid is required? Importantly, what can be done to encourage the resolution of legal problems, both criminal and civil, in a timely and proportionate way?
My hon. and learned Friend asked about timing. We have been assessing such questions over the summer as part of our consideration of legal aid, and I can confirm to him, and to the right hon. Member for Delyn, that by autumn we will be in a position to seek views on our emerging proposals in a full consultation. I also confirm that the resulting Green Paper will outline our proposals for the way forward for criminal legal aid.
I will now look specifically at issues of criminal advocacy. The world is changing in a number of ways. I have already mentioned the need to reduce public spending, and my hon. and learned Friend the Member for Torridge and West Devon has rightly highlighted the fact that in the dying days of the last Parliament, the previous Administration decided to reduce advocate fees by 13.5% over three years, with the first stage of that cut coming into effect last April, and he provided details of those statements. Although we have no plans to reverse that decision, I confirm to my hon. and learned Friend that we want to look at the efficiency of the whole legal aid system, which I agree will go beyond the criminal Bar. At this stage, however, I am not prepared to rule out any specific types of reform.
Another change in the landscape is the increasing number of higher court advocates competing for work with the criminal Bar. I understand that there are now at least 2,500 solicitor-advocates in practice in the higher courts. That means that the Bar no longer has exclusive access to Crown court work. I know that the Bar welcomes healthy competition and believes that it is well placed to offer specialist expertise in advocacy, particularly in more complex cases. Equally, the Bar has grown over time. Thirty years ago, there were just over 4,500 barristers in self-employed practice. Twenty years ago there were more than 6,500, and today the number of barristers in private practice is greater than 12,000. Taken together, the changes mean that it is unlikely that there will be enough publicly funded criminal case work to support the number of people who wish to earn a living from publicly funded practice at the criminal Bar. That is a simple economic fact of life.
My hon. Friend the Member for Gillingham and Rainham spoke about the need to recognise and protect the diversity of the Bar. I agree with his sentiments and it is an important issue. However, the numbers of black, minority ethnic and women barristers are affected by issues other than simply fees. As I have already argued, legal aid exists to provide help for those who need it. In criminal cases, that means the defendant who cannot afford to pay for representation in cases that pass the “interests of justice” test, which in practice tends to exclude the more minor criminal cases. Let me be clear: it is not the purpose of legal aid to provide a living for any particular number of lawyers. Instead, taxpayers’ money should be targeted at those who cannot afford to pay for their own defence, when that is required in the interests of justice.
My hon. and learned Friend the Member for Torridge and West Devon raised the issue of a single fee for Crown court litigation and advocacy. Given the likelihood that a single fee for Crown court cases covering litigation and advocacy would encourage greater efficiency between litigator and advocate, one should expect that point to be considered carefully, among other options for reform. That point was also raised by my hon. Friend the Member for Carshalton and Wallington.
As a point of principle, the so-called VHCCs—very high-cost cases—consume a disproportionate amount of the legal aid budget. Half the Crown court legal aid budget is now swallowed up by fewer than 1% of cases. I am keen to do all that we can to reduce the number and costs of long, complex cases that are bad for the justice system. We will look at that issue in the Green Paper but to clarify, contributions are returned to acquitted defendants, although means-tested contributions now mean that those who can afford to do so pay towards the cost of their representation.
Earnings at the criminal Bar vary enormously. We know that some barristers at the most junior end are far from fully occupied, and as a result their earnings are low. However, at the more senior end of the Bar, earnings can be high. My hon. Friend the Member for Carshalton and Wallington asked about fee levels. The previous Administration published information on that, which showed that for 2008-09, the highest-paid barristers took £928,000 from the criminal legal aid budget. One hundred and twenty barristers were paid more than £250,000 in criminal legal aid, and a total of 416 were paid more than £150,000. I accept that those figures are subject to a number of caveats. In particular, those fees include VAT and do not take into account chamber expenses.
I do accept that, but I wanted to give some idea of the amount of public money that is being paid out.
Looking at the wider regulatory picture, we are currently commencing the Legal Services Act 2007, which will encourage greater competition and innovation in the provision of legal services and a better focus on the consumer. That programme of work has already made important changes to the way that legal services are regulated in England and Wales, and it will also allow for alternative business structures. It will allow lawyers and non-lawyers to work together as one enterprise to provide legal and non-legal services.
To help pave the way for those new business structures, legal disciplinary practices have already been introduced. That has made it possible for different types of lawyers to work collaboratively to provide legal services. For decades, members of the criminal Bar have complained that solicitors have the whip hand. It is time for the Bar to embrace the new opportunities and equality of position that the Legal Services Act will provide. I hope that that opportunity will be grabbed.
As recognised by my hon. and learned Friend the Member for Torridge and West Devon, I was encouraged to hear Nicholas Green, QC, the chairman of the Bar, recently indicate that the Bar is preparing to change and adapt by setting up procurement companies that will enable groups of barristers to bid for criminal defence work. I have met Mr Green and other senior members of the Bar, and I will continue to work closely with them on the issue. Mr Green has been travelling the length and breadth of England and Wales to explain to members of the Bar, face to face, why it is time for the Bar to prepare for change. That is a sensible course to advocate, and I urge all members of the Bar to look carefully at the material that the Bar Council is producing on the subject. I do not think that the majority of members of the Bar, as part of a referral profession, can afford to be aloof as we move forward in what is likely to be an increasingly competitive environment.
I do not want to pre-empt the consultation paper that we plan to publish this autumn, but we must consider whether there is a case for the greater use of competition in providing legal aid. I think that my hon. and learned Friend will accept that, as long as it is done correctly and fairly.
In conclusion, I say to my hon. and learned Friend that however our thinking develops, I want a level playing field so that barristers, other advocates and litigators can compete on an equal basis. The Bar Council is right to advocate change, so that the Bar can not only survive but prosper in the longer term in a changed legal services market.
Rail Services (Enfield)
I was delighted to hear that this is the first time that you have chaired Westminster Hall, Mr Bone. I can confirm that this is my first debate in Westminster Hall. I am sure that you will agree that at our respective ages, it is good to be maidens in anything.
I am grateful to have secured the debate. I requested it because of the significant disquiet about delays and overcrowding from Enfield Town, Turkey Street, Southbury, Enfield Lock and Brimsdown railway stations. Unlike in other parts of north London, there are barely any alternatives to rail for commuters in Enfield. I am grateful to have had my right hon. Friend the Minister’s time on many previous occasions, when she has shown considerable interest in commuter services for my constituents. I also welcome my hon. Friend the Member for Enfield, Southgate (Mr Burrowes), who has worked closely with me on the issues under discussion today.
I am keen to show that the new franchise agreements could be used positively to support wider community objectives as well as to deal with the immediate transport issues, but to understand that opportunity, we need to appreciate the local geography and how the railway is organised. That will enable us to learn from past mistakes and look to the future.
Let me start with the local area. Enfield as a community is already changing. There are, of course, classic suburbs, but it is worth noting that across the wider borough, there are six of the most deprived areas not just in London, but in Europe. However, there are also opportunities, particularly in the Lea valley, where we can succeed in regenerating and place shaping for the future. Such plans exist, but they will depend on the right infrastructure. In theory, the Lea valley and Enfield as a whole are linked by the umbilical cord of the railway system. Clearly, there is commuting straight out of London, through Enfield and up to Cambridge, Stansted and beyond. We can attract, but also need services to attract, inward commuting to help to support regeneration.
What is the railway offer? In our part of London, we have one main line from Cambridge and Stansted that goes through the eastern corridor of Enfield and the Lea valley to Tottenham Hale and Liverpool Street. It is run by National Express East Anglia. That franchise also runs the suburban line through central Enfield, which serves two end points—Cheshunt and Enfield Town—running through Seven Sisters. There is a second suburban line, run by First Capital Connect into Moorgate via Finsbury Park, which serves western Enfield.
Both suburban lines are overcrowded. There is no question about that, particularly for the underground interchanges, and the train capacities are limited. In particular, from Cheshunt and Enfield Town via Seven Sisters, there are at best six trains an hour, with perhaps six to eight coaches. In the off-peak period, there are at best two services an hour from Enfield Town. Such services can hardly be described as underground or even metro standard. The problems have been compounded by limited investment in recent years. I should add that only five stations across the whole west Anglia network are gated, and revenue is being lost as a result.
As for the main eastern Lea valley line, which goes through Enfield Lock and Brimsdown, we have a mix of limited-stop and local trains, governed by 15-minute scheduled Stansted Expresses. West Anglia is one of the most demanding and pressurised rail corridors in the country. There is no place for a fast train to pass a slower one until Broxbourne, some 17 miles from central London, with the obvious result that the faster trains do not go fast enough and the slower trains are going slower than required and are not able to stop and serve all the stations. That leads to immense frustration for commuters on platforms, who are quite keen to get on those trains. There are no winners at the moment.
The railway area that I am talking about is predicted to grow, in passenger transport terms, by up to 37%. Admittedly, we may see some variation in that, given current economic circumstances, but it is a fast-growth area. It is true that over the whole franchise, there will be up to 120 new carriages in 2011-12, but they will principally be focused on the 12-coach train fast services. The losers will be Enfield suburban services. So it really is a case of when, not if, we can invest in additional track and signalling as well.
I now turn to the wider national picture, examining the linkage between Government rail policies and the franchising process. As we know, National Express operates under a franchise awarded by the Strategic Rail Authority in 2004. The specification focused on improving performance, but it also allowed more Stansted Express trains, which, as I have explained, did not do Enfield services any favours. At best, we were marking time, but services were made worse on the eastern Lea valley line.
With the benefit of hindsight, we can see that the franchise agreement did not deal with the underlying problems, but just worked the existing railway harder. Of course, that has not necessarily been to our advantage. It shows that we have lacked investment and are still waiting for that investment. In that respect, the previous Government cannot avoid the blame, because they had been controlling the SRA since 2005.
Latterly, the Labour Government had three simultaneous desires: to maintain a command-and-control process in relation to the railways, to move the taxpayer to fare-payer ratio from 50:50 to about 30:70, and to try to breathe life into a money-go-round of fares generating profits for investment. That led to the unacceptable highly leveraged bids for a number of franchises. The most notorious was the east coast bid by National Express, which failed commercially in 2009. Sadly, the record shows that that was not the only failure; there was one in 2006 as well. I am no great literary scholar, but as Oscar Wilde might have put it, to lose one operator is a misfortune; to lose two is somewhat careless. Unfortunately, it proves that the franchising money-go-round is not working.
That brings us to the national position on franchising. If the money-go-round is not working, the funding rules must change, but that depends on how franchises are constructed. The basis of franchising has a history of always changing. Objectives have focused on lowest net subsidy, highest premiums or achieving specified service performance and quality for passengers. That meant increasingly that although operators might have been working in the private sector, they had a straitjacket on them that prevented them adding the value that passengers and commuters want.
In parallel, the contractual length of franchises had been adjusted. Sometimes they were on a bespoke basis. A franchise was longer if a railway needed more investment in trains. However, in recent times the norm has been about seven years, sometimes with an extension for good behaviour. Fundamentally, as many of us recognise, that short-termism does not incentivise major investment by the private sector.
Furthermore, the franchising rules did not achieve the right outcomes for National Express East Anglia lines in Enfield. Passengers’ overall satisfaction is measured by the national passenger survey. The operator has consistently performed below the London and south-east sector average and well below the highest franchise in the sector. That is despite punctuality having improved.
I noticed today—I trust that the Financial Times is correct—that an announcement has been made to grant a temporary extension to the franchise for another seven months. I understand the reasons behind that and accept it fully, but what concerns me is that many passengers might interpret that as an endorsement of what has happened in the past. That clearly is not the case. It is designed ultimately to allow us to have a better system for the future.
The new franchising reform consultation suggests that future franchise bids will be judged on the quality of the overall package of proposals. My constituents will welcome that. Let us look to the future. Public funds are tight. We must look to a new partnership between the Government and the private sector to secure long-term funding by train operators to leverage better services and facilities. That is good news. Enfield is awaiting a new franchise; it will be one of the first. The Government emphasis on outcomes and long-term franchises presents us with short and long-term opportunities.
I am grateful for that intervention. In fact, I will go on to address such issues—particularly local ones in London, which I am sure my hon. Friend faces in his constituency. That is exactly my point: now is the time to be bold and imaginative, notwithstanding the constraints that we are all working within.
I shall turn to the priorities that commuters wish to see. These include refurbishing trains, so that we can get consistent appearance and quality, and improving security by introducing ticket barriers, and perhaps increasing CCTV as well. More stations protected by ticket barriers will lead to better revenue protection. In addition, investing in the key interchanges of Seven Sisters and Tottenham Hale, which service Enfield, will be crucial in making them more accessible. A fundamental priority is train frequency.
I accept that, in the short term, infrastructure will largely be as it is now, which limits what can be achieved. I commend to the Minister an interesting recent report from the London borough of Enfield showing a positive case for a more frequent local train service between Enfield and Liverpool Street in the off-peak. That analysis is based on journey-time savings and does not include the other expected community and economic benefits. I believe the benefit-cost ratio, as the report demonstrates, would be under current rules of 1.46:1. That is before we take into account the greater community and economic benefits. I understand that 1.5 is the guideline for investment. There is a strong case.
As an aside, many stakeholders regret that the current official proposals for four trains per hour to Stratford from the Lea valley line through Enfield will only exist for the 2012 Olympic games. The Enfield report shows how a revision to train-stopping patterns on the Lea valley line could regularly achieve four trains per hour, peak and off-peak, to the busiest stations in the areas requiring regeneration. I am happy to commend the report, on which much work was done, to the Minister.
Other short-term matters must be highlighted, including work to solve passenger crowding at the Victoria line interchanges. I look to action on the local level crossings, which are a source of risk—all too tragically, in Enfield, very recently. I also look to action on performance delay. Improving disability access, particularly at the key interchange routes, is a must.
Further progress on studies about expenditure during the new investment periods is needed. For example, a long-term franchise should be able to address the broader spectrum of opportunities, including the case for partial four-tracking on the Lea valley line, which will improve the service, as I have explained, as previously it was two-track.
To conclude, I fully support the approach taken by my right hon. Friend the Secretary of State when he said that he will involve all elements of the rail industry more fully in the decision-making process. I support the decision, and regard it as vital to accelerate the rail value-for-money review under the leadership of Sir Roy McNulty. It is vital that we look to improve our existing infrastructure even in these hard times and his work should help drive that forward.
For Enfield, it is crucial that franchise agreements set out not just clear performance indicators but levels of investment and service agreements that can be benchmarks, and that they send a clear signal that economically important areas served by railways—such as my constituency and neighbouring areas—are open for business and that we can help rail services to support that and regenerate the area. Our business community and developers will be keenly watching franchise agreements before making investment decisions. West Anglia will, as my hon. Friend the Member for Beckenham (Bob Stewart) pointed out, be a test for the new Government of the new rail management and franchising system. Those routes could be exemplary and even a fast-track trial area for a new approach to delivery. A new franchising policy presents us with such an opportunity, delivering, as it says in the coalition agreement,
“the improvements that passengers want—like better services, better stations, longer trains and better rolling stock”.
It is a pleasure to serve under your chairmanship, Mr Bone. I congratulate my hon. Friend the Member for Enfield North (Nick de Bois) on securing the debate and presenting an impassioned case for improvement to rail services in the borough of Enfield. I recall him raising the issue in Transport Question Time shortly before the summer recess. I know that he is a staunch campaigner on these matters in his constituency, standing up for the interests of local commuters in a highly effective way, alongside my hon. Friend the Member for Enfield, Southgate (Mr Burrowes), whom it is great to see in the Chamber today. As the near neighbour of both my hon. Friends—I represent Chipping Barnet—I well understand the importance of transport links in the London suburbs.
My hon. Friend the Member for Enfield North set out his concerns about reliability and performance. As we have heard this morning, train services to Enfield are operated by both National Express East Anglia and First Capital Connect. In my ministerial capacity, I take a close interest in the performance of all train operators, but my role as MP for Chipping Barnet means that I have an additional reason to scrutinise the performance of FCC on the Great Northern line, as it serves my constituency as well as Enfield.
That franchise experienced significant disruption between October 2009 and January of this year. That was largely caused by industrial action, and Thameslink services were the worst affected. However, there were also problems on the Great Northern line, which serves Enfield. It was particularly regrettable that action by drivers meant that no trains ran on Remembrance Sunday last year on the suburban Great Northern line services. I am relieved that the problems that led to that disruption have gone away for the moment, and that First Capital Connect’s overall public performance measure has recovered to reach the levels prevailing prior to that episode. However, the underlying issue for the railway—namely that on a number of routes drivers are not under a contractual obligation to work on Sunday—obviously has yet to be resolved.
As far as National Express East Anglia—the main focus of my hon. Friend’s remarks this morning—is concerned, in the latest period for which complete performance data are available, 90.8% of NXEA’s trains arrived on time, according to the PPM moving annual average figure. That is an improvement, albeit a modest one, on the 88.6% reliability levels that it inherited from the previous franchise in 2005. It is also worth noting that PPM figures are aggregated across a diverse franchise, covering long-distance, rural and commuter services. That means that they do not necessarily give us all the answers, when it comes to the specific performance of Enfield services. As my hon. Friend pointed out, NXEA’s most recent national passenger survey results indicate that it is below the average for London and the south-east. I agree with my hon. Friend that there is room for improvement.
My hon. Friend referred in some detail to capacity and his constituents’ concerns about crowding. The latest passenger loading data confirm that overcrowding is indeed an important issue on some Enfield services. Anxiety about overcrowding in a number of parts of the UK’s rail network increased during the previous Government’s term in office. In my view, one of Labour’s most serious mistakes was that it took far too long to wake up to the seriousness of this problem. It took, for example, over a decade to get moving on projects such as Crossrail and Thameslink. Four successive Labour Secretaries of State for Transport promised extra carriages under the HLOS—high-level output specification— programme, but that political decision came late in the day and less than a quarter of what they promised had arrived by the time that Labour left office. That leaves the current Government to deal with the problem during very lean times, when the pressing need to deal with the deficit that we inherited from our predecessors places intense pressure on the public finances.
The issue for consideration today is how we address the problems experienced by commuters—problems of the kind outlined by my hon. Friend—in an affordable way, consistent with our pledge to address the deficit that we inherited from the previous Government.
First, I should mention that I meet senior representatives of the rail industry and the Office of Rail Regulation every month to assess performance levels on all lines, and to scrutinise carefully the record of Network Rail and the train operators. Of course, the ORR takes the lead on these matters, but I am grateful to those who participate in what is a very useful process for me. Following on from my hon. Friend’s intervention at Transport questions, I raised the issue of NXEA services in Enfield with the group.
As my hon. Friend was kind enough to acknowledge, the Government’s wider reform agenda has the potential to drive forward progress in addressing a number of the issues that he raised. Our approach has three parts: first, reform of Network Rail; secondly, reform of rail franchising; and thirdly, taking forward capacity enhancement programmes where they can be reconciled with our commitment to address the deficit.
As hon. Members will be aware, making progress on reliability and delivering extra capacity depends in no small part on ensuring that Network Rail, as the infrastructure provider, delivers high-quality services to its customers in an efficient and cost-effective way. In the case of the NXEA services that we are considering, the most recent industry figures indicate that Network Rail was responsible for just over 60% of delays on the franchise. In particular, I am advised that Network Rail infrastructure has suffered a number of overhead line problems.
I very much welcome the fact that the franchise operator and Network Rail are working together to try to address the problem. However, if we are to improve Network Rail’s performance and reduce its costs, the company needs to be made more accountable for its actions, and that includes demonstrating greater accountability for its decisions on executive bonuses. We are considering a number of options, and we are working with the ORR and other stakeholders to take that work forward. I should make it plain, however, that the status quo is not acceptable, and we will be making changes in due course.
As we heard this morning, the Government are consulting on reforms to the rail franchising system, and those are the second element of our strategy for addressing the problems outlined by my hon. Friend. The reforms are aimed at moving away from a system in which Whitehall specifies highly detailed and prescriptive inputs for franchises—what my hon. Friend referred to as the command-and-control approach to the railways. Instead, we want a stronger focus on the quality of outcomes for passengers, while giving the professionals who run our railways more flexibility to apply innovation, enterprise and specialist expertise in working out the best way to deliver outcomes.
We need a more qualitative approach to the assessment of franchise bids—an approach that judges the quality of a bid’s overall package of proposals to invest in the railways, improve services and grow passenger numbers—rather than focusing solely and exclusively on the binary question of the level of subsidy or the premiums to be paid. Again, I hope that that will address some of the problems involved in what my hon. Friend referred to as the money-go-round.
Franchises should also be longer. We expect 10 to 15 years to become the normal, expected length, with the possibility of franchises running for up to 22 and a half years, where significant investment is promised. The increased certainty that longer franchises will give train operators will encourage private sector investment in the railways and help to deliver the improvements that passengers want. My hon. Friend called for us to include better services, better stations, longer trains and better rolling stock. On the specific improvements that he asked for, I hope that he will understand that I cannot prejudge the process that will commence once the franchise re-let is under discussion, but I encourage him to take part in the consultation on the re-let as and when it starts.
Our reformed franchises will set demanding passenger satisfaction outcomes for train operators to achieve. Train operators that do not comply with franchise requirements will face sanctions. Ultimately, in the case of very serious failure, sanctions will include termination of the franchise. The approach that we have set out in our consultation document will enable and incentivise train operators to respond more effectively and efficiently to commuters’ concerns. I expect our proposed measures to help address a range of the customer service and capacity issues that my hon. Friend outlined.
At this point, I should respond to my hon. Friend’s questions about the timetable for re-letting the East Anglia franchise. I reiterate that I decided to cancel the franchise competition initiated by the previous Government to ensure that the new franchise was issued under the reformed system, and to ensure that passengers using NXEA services could have the benefits of the changes that the coalition has promised to deliver. The franchise was due to be re-let and to commence on 1 April 2011, but a contractual extension has been agreed until October 2011.
I turn now to the third element of Government policy that is relevant to the matters under consideration: delivering additional capacity, where that can be reconciled with our commitment to address the crisis in the public finances that we inherited from the previous Government. The Department for Transport is funding 120 new carriages for the East Anglia franchise. Most will be used on the Stansted Express route, with some deployed on Cambridge commuter services. The carriages are expected to enter service from March 2011, and that will free up carriages that will be used to strengthen services on other parts of the NXEA network. The decisions on exactly where those carriages will go have yet to be made, but I am advised that stations in Enfield will be among those that benefit from the extra capacity.
Additional capacity will be introduced on First Capital Connect lines to Enfield in December 2010. In the morning peak, five of the six stations in the borough—Gordon Hill, Enfield Chase, Grange Park, Winchmore Hill and Palmers Green—will have three additional six-car train services to Moorgate, and one of the existing services will be doubled in size from a three-car to a six-car train. The five stations will also be served by additional services to Hertford North and Gordon Hill from Moorgate. The remaining station, Crews Hill, will be served by two additional six-car train services.
In the evening peak, the same five stations will have an additional three services, two of which will go to Gordon Hill, with the third going to Hertford North. That is except for Grange Park, which will have two additional services running to Gordon Hill. All those additional services will be six-car trains. Additional services will also run from Gordon Hill to Moorgate. Crews Hill will benefit from an additional six-car train running to Hertford North. There will be three more services during the morning peak, and extra carriages will be added to one of the existing services. Evening peak service capacity will see similar improvements and increases in capacity. Those morning and evening peak improvements are part of the additional 3,800 peak-time seats being added to Moorgate services from December.
In conclusion, I understand my hon. Friend’s concerns. The Government are working to ensure that we have a reliable railway and that crowding problems are addressed. We face the difficult task of achieving that at the same time as tackling the state of the public finances that we inherited from the Labour Government. I have summarised some of the most important initiatives that we are taking to seek to achieve those important goals. When the consultation process begins for the re-let of the franchises serving my hon. Friend’s constituency, I very much hope that he will make his views known. I am sure that they will be a valuable and welcome contribution to that important process, just as his remarks this morning have been a valuable and welcome contribution to the debate.
Diabetes (Young People)
[Mrs Linda Riordan in the Chair]
It is a pleasure to serve under your chairmanship, Mrs Riordan.
First, I would like to acknowledge the help that I have received in preparing the background information for today’s debate. I particularly wish to mention the Juvenile Diabetes Research Foundation, Diabetes UK, the Eye Health Alliance, the Aintree University Hospitals NHS Foundation Trust in my constituency, and last, but by no means least, my daughter Siân, who suffers from type 1 diabetes and who has helped in the preparation of what I am about to say.
In the past, too often health policy discussions have focused on hospitals, doctors and nurses, with no real recognition of the millions of people who live with long-term conditions. Over the past few years the situation has improved, and now we at least recognise that health care is as much about helping patients to manage their conditions more effectively throughout their lives as it is about mending broken bones in hospital, although the latter is, of course, important. Nevertheless, we are on a long journey. We now recognise that demographic pressures and lifestyle-related conditions, including obesity and the rising incidence of diabetes, pose major public health risks, yet every time we make that statement we risk overlooking a serious and growing problem, because it ignores people with type 1 diabetes—many of them children—whose condition cannot be prevented by changing their lifestyle.
So, what is type 1 diabetes? It is a chronic, life-threatening condition that occurs when the body’s immune system attacks insulin-producing cells in the pancreas. A normal, healthy body will regulate blood glucose using insulin, but in someone with type 1 diabetes, the blood sugar level can go too high or too low because there is insufficient, or no, insulin to control it. Insulin is the hormone that transfers glucose from the bloodstream into the cells to be used for energy. Type 1 diabetes is typically diagnosed in childhood. The peak age is between eight and 12 years, although in some cases it can be much higher. I heard today of a case in which the age on diagnosis was 23. As a result, most patients with type 1 diabetes live with the complications of uncontrolled blood sugar for many more years than those who suffer from type 2. Unlike type 2, type 1 diabetes is not in any way linked to being overweight, to lack of exercise or to any other lifestyle factor. Living with type 1 diabetes involves a relentless process of managing the condition, and there are no days off.
People with the condition have to rely on a programme of finger-prick blood sugar tests and insulin pump infusions or injections up to 10 times a day, just to stay alive. Although these tools prolong life, they are not a cure. Even with insulin injections, type 1 diabetes brings devastating long-term complications, including heart disease, stroke, blindness, kidney failure and, in some cases, limb amputation. In addition, there is a small but very real chance of sudden death, and life expectancy is reduced by about 20 years.
I recently tabled a question to the Department of Health about its estimate of the number of people with type 1 diabetes. It turns out that the Department does not have an estimate of the total number, but extrapolations from quality outcomes and framework data suggest that the figure might be about 230,000, which is some 10% of the diabetes population.
It is important that the Department of Health and the coalition Government show leadership in this area. Is my right hon. Friend not concerned by the latest figures, which seem to suggest that the incidence of type 1 diabetes is increasing by about 4% a year, with the biggest increase in children under five, in whom there has been a fivefold increase in the past 20 years? Does my right hon. Friend not agree with me that we need assurances from the Government that they will look into what is happening, and will look at what can be done both to tackle the condition when children are diagnosed, and to understand why it is occurring and increasing in the way that it is?
I am grateful to my right hon. Friend for that intervention. The figures that she has cited are correct, and I was about to go on to mention them.
I have mentioned the Department of Health’s estimate. The Juvenile Diabetes Research Foundation cites estimates that put the number of children and adults living with type 1 diabetes as high as 390,000, or 15% of the diabetes population. In a political context, that translates into approximately 500 people in every parliamentary constituency. There seems to be more consensus on the number of children and young people with type 1 diabetes: about 25,000 children in the UK have it. That means that as many as one child in every 700 has type 1 diabetes. Of all children and young people with diabetes, 98.6% will have type 1.
It is also worth noting that although the condition is not linked to lifestyle factors, the incidence of type 1 diabetes is increasing by about 4% a year. The biggest increase is in children under five, in whom there has been a fivefold increase in the past 20 years, as my right hon. Friend has said. To summarise, this is a complex condition that affects children and young people in significant numbers, and it has a profound impact on their lives.
Diagnosis often occurs on the occasion of the first major episode of diabetic ketoacidosis, with symptoms typically evolving over a 24-hour period. The symptoms are predominantly nausea and vomiting, pronounced thirst, excessive urine production and abdominal pain that might, in some cases, be severe. Left undiagnosed and untreated, diabetic ketoacidosis is fatal. In 2009, an eight-year-old boy died from undiagnosed diabetic ketoacidosis. An ambulance was called but, as it was thought that the boy was a low priority, was never dispatched. When an out-of-hours GP was called, the boy was diagnosed with swine flu and prescribed Tamiflu. He died days later. A major problem is that many GPs are not properly trained to recognise the symptoms and make a diagnosis, and there are countless examples of young people being treated for an entirely separate condition, when the real problem is that diabetes has been uncontrolled and not even recognised, and appropriate action therefore not taken.
As well as creating the risk of a major catastrophe and having ongoing consequences for physical health, type 1 diabetes has a profound effect on the lives of children with the condition and their families. It pervades every aspect of a sufferer’s life. Everything that the person eats, drinks and does involves a mathematical equation. For the child and their family there are no days off, and even a few hours of trying to forget can be dangerous. Living with this complex, chronic condition is at times very distressing and stressful for many parents, and it is a source of constant anxiety, and often embarrassment, for young sufferers.
A survey carried out by the parent group, Children with Diabetes, showed that a significant majority of parents had seen their household income decrease, and that there had been a notable impact on family life. The potential for long-term complications is clear and present, and is obviously a worry for many parents. Many children worry about being seen as different from their peers, and a disturbing 50% of parents say that their children have been bullied as a result of having type 1 diabetes. Although children and young people with diabetes are different in the sense that they continually have to manage their condition, they are like any other young person in most other ways. They are subject to the same pressures and temptations, such as the ones to use alcohol or illegal drugs, which could be fatal in their case.
Young people with diabetes have also succumbed to a trend that is informally known as diabulimia. They manipulate their insulin to achieve significant weight loss. In 2004, in “Living with Diabetes”, Susan Caltieri bravely explained how the phenomenon had affected her life. She said:
“Instead of dealing with the root of the problems—the relationship I had with my diabetes—1 started blaming my weight, thinking the only way to achieve my ambitions of getting on to the stage was to be skinny. I discovered that by decreasing my insulin and eating less, I could lose weight quickly. Eventually there were periods of time where I didn't inject insulin at all and could lose up to half a stone a day. 1 had developed a serious eating disorder...I don’t know how I actually survived. I was completely oblivious to the damage I was doing my body.”
I thank my right hon. Friend for giving way a second time and I congratulate him on securing this debate. What he is outlining to us is a worrying trend among young women who feel that they have to be a certain size to be attractive. Does he not agree that it is also worrying that we have heard nothing from the coalition Government, in the form of a public health measure, about how they will ensure that young people, particularly young women, with type 1 diabetes are supported so that they understand the dangers to their health of not taking their insulin? Moreover, how will the support that is there be affected by the unnecessary change to GP commissioning at a local level?
My right hon. Friend makes a strong point. It is a worry that the change in the system, which will vest more power with GPs, could have a negative effect; I hope that it does not. Will the Minister give serious consideration to the way in which conditions such as diabetes will be managed in those changed circumstances? I fear that GPs’ knowledge of the subject is too sketchy for them to be able to deal with the matter properly. As and when a Bill comes before the House, I will—if my party’s Front Benchers do not—table some amendments on the issue. To be fair, I should mention that the Minister for Equalities, the hon. Member for Hornsey and Wood Green (Lynne Featherstone), has raised the important issue of young women and body size and image and so on. The idea that young women have to be stick-thin to be attractive or employable is outrageous. I had not intended to raise this subject, but I have discussed it in the past with my right hon. Friend the Member for Don Valley (Caroline Flint) and the Minister for Equalities.
Although this story does not involve a diabetic, it is related to the issue that has just been raised. A young woman spent her entire life, from the age of seven, training to be a violinist. She performs in concerts and provides backing music for groups. I am talking about the way in which rock groups have attractive young women playing a violin and a cello behind them. This particular young woman had to perform at a festival. The agent who recruited her said that one of the requirements in the contract was that she got down to size zero. I am not talking about a pop star or a model—although I condemn such behaviour in those cases as well—but a serious musician who was expected to get down to that sort of weight. It is outrageous, and I am so glad that my right hon. Friend the Member for Don Valley raised the matter.
Diabetes UK has estimated that the number of young people with type 1 diabetes who manipulate their insulin to achieve weight loss could be as much as one third of all patients. Although it is possible that the figure may not be that high, discussions that I have had with one of my local hospitals—Aintree University Hospitals NHS Foundation Trust—and specifically with Maureen Wallymahmed, revealed that it is extremely hard to quantify the problem because young people tend to hide the condition from medical staff. I warmly commend the work of the unit at Aintree. It manages the transition in treatment from childhood through to adulthood, which is another area that requires attention.
The causes of the trend to manipulate insulin are deeply ingrained in society and cannot be simply addressed. One thing is clear, though: young people with type 1 diabetes need easily available help and constant access to support. Where appropriate, that should include access to relevant psychological therapies.
One obvious difference between young people with diabetes and older patients is that those young people spend far longer periods of their lives living with variable blood sugar levels. Consequently, the ongoing physical risks that they face typically occur much earlier in life than with type 2 diabetic patients. Complications can include heart disease, stroke, blindness, kidney failure and limb amputation.
For the purpose of this debate, I shall take one example of those complications. Diabetes can affect vision in several ways, but the most serious impact is generally on the blood supply to and within the retina. Most sight loss due to diabetes can be prevented, but it is crucial that the condition is diagnosed early and treated promptly. Up to one third of patients with diabetes will have background diabetic retinopathy, which needs to be monitored carefully as it can develop into irreversible sight loss. Early detection through screening and treatment is vital to prevent unnecessary sight loss. The Department of Health figures suggest that more people with diabetes are now being offered screening for retinopathy than ever before and to a higher standard, which is very welcome. However, the speed of progress appears to vary significantly across the country, with some primary care trusts not offering screening to old people with diabetes, which is a cause for concern.
In these difficult financial times, it is worth focusing on the cost of diabetes management to ensure that we are making the most of all available resources across the whole health system. Treating diabetes and its complications is extremely expensive. Each year, the NHS spends 10% of its budget on the condition. Given the lack of reliable data it is difficult to put a definitive figure on the cost to the NHS of treating type 1 diabetes. However, we know that once diagnosed, type 1 diabetes requires intensive control for the rest of the person’s life, and with the risk of complications, the cost of treating the condition in the NHS is high.
One of the major challenges that the NHS faces is to help patients manage their conditions more effectively, so that the necessary admissions for acute care can be avoided. Better management not only saves huge potential costs, but makes a significant contribution to improving the lives of patients with type 1 diabetes. To achieve that, we need to ensure that funding within the NHS supports care pathways and innovations that help patients manage their condition effectively, which means that medical research is vital.
At present, there are no definitive answers about what causes type 1 diabetes or how we can cure it. The only way that a cure will be found is through greater investment in medical research. In 2009, the Government funding bodies—the Medical Research Council and the National Institute for Health Research—committed £51 million to research to tackle the growing problem of diabetes. Of that amount, only £6 million was applicable to type 1 diabetes. By contrast, last year the United States Government spent $150 million, the Australian Government $36 million and the Canadian Government $20 million on funding world-class research to cure, treat and prevent type 1 diabetes.
We could take the easy option and leave it to others to carry out the research, but aside from the dubious ethics that that would involve, it would of course miss the point that investment in medical research provides wider economic gains as well as obvious health benefits. A recent report by the Office of Health Economics, a health think-tank, concluded that a £1 increase in UK Government or UK charity spending on medical research could lead to an increase in private research spending by the pharmaceutical industry of between £2.20 and £5.10. Other research by the Wellcome Trust has estimated that every £1 spent on public or charitable medical research yields additional GDP for the UK that is equivalent to a net return of 30p per year in perpetuity.
Once innovative treatments or technologies are available, it is essential that patients with type 1 diabetes have access to them. Insulin pump therapy is internationally viewed as the gold standard treatment for type 1 diabetes, reducing the risk of hypoglycaemia—very low blood sugar—and long-term complications. Despite that, however, less than 4% of the UK’s type 1 population use a pump—far behind Europe, at 15% to 20%, and the United States, at 35%. Given the long-term costs of managing the complications of type 1 diabetes and the immediate-term costs of unnecessary unplanned hospital admissions, the UK figure has all the hallmarks of a false economy. Indeed, I have heard of instances of young people being refused a pump because the control of their blood sugar levels has not been considered bad enough. Clearly, there is an issue that needs looking at, regarding the advice that medical practitioners are following.
Guidance from the National Institute for Health and Clinical Excellence recommends that insulin pump therapy is used as a treatment option for adults and children over 12 if attempts to meet long-term blood sugar levels fail or result in the patient having disabling hypoglycaemia. The NICE guidance also recommends that children under 12 with type 1 diabetes have access to insulin pump therapy if multiple daily injections are considered impractical or inappropriate.
However, despite that NICE guidance on eligibility, there is considerable inequity in insulin pump provision across the country. In some areas, less than 1% of people with type 1 diabetes use an insulin pump. Figures released earlier this month by the Medical Technology Group indicate that there is indeed a “postcode lottery” of insulin pump access across the UK, with access varying from 0.4% of the type 1 population in Luton to 17% in Blackburn.
Only five of 113 primary care trusts that were questioned had any kind of strategy in place to implement the NICE guidance on insulin pumps in line with their statutory duty to adhere to NICE technology appraisals within three months of issue. I hope the Minister will follow up that issue with PCTs. Decisions about funding for pump services seem to be based on cash-flow benefits rather than on the benefits that such services would provide for patients.
Another exciting development that offers real hope to patients, as long as they are able to access any future solution, is the artificial pancreas—the first realistic hope for a cure for type 1 diabetes, albeit a mechanical one. Vital research supported by the Juvenile Diabetes Research Foundation is working towards developing an artificial pancreas system, a technology that will do the job of a healthy pancreas. Such a system would provide exactly the right amount of insulin to the body exactly when it is needed.
The artificial pancreas system requires three things: an insulin pump, a continuous glucose monitor and an algorithm. Insulin pumps and CGMs are already available and researchers from the Juvenile Diabetes Research Foundation have developed an algorithm that will allow the two devices to communicate with each other. Artificial pancreas systems are expected to be publicly available within the next five years.
However, there is a real risk that while people with type 1 diabetes in the US and other countries will be able to use that new technology, people with type 1 diabetes in the UK will miss out, because they do not have access to an insulin pump or a CGM, and because the structures and expertise are not in place here to support the existing technology, let alone the next sophisticated technological development. Rectifying those problems would be a real indicator that we are serious about having an NHS that has the principles of excellence, efficiency and equity at its heart.
I recognise that the cost of an insulin pump, which is about £3,000, is significant. However, given that NICE recognises the value of bariatric surgery—what is normally known as the insertion of a gastric band—as a mechanism to tackle type 2 diabetes and given that such surgery costs up to £7,000, we need to get the costs of adopting innovative medical technology such as an insulin pump into perspective.
In conclusion, what needs to be done? Given that many cases of type 1 diabetes go undiagnosed, we need to improve awareness among GPs, so that the condition can be diagnosed in the first place. There is an argument that GPs should be given a series of protocols on how they should deal with certain symptoms. Increased understanding of the nature of type 1 diabetes is particularly important given that Government proposals envisage that GPs will take the responsibility for commissioning care as well as being the first point of call for diagnosis.
In addition to the early identification of diabetes, we need to encourage commissioners to plan adequately for treating the long-term complications. That would include ensuring adequate provision for retinal screening, to close the gap between those being offered screening and those actually receiving the test. In particular, we must address the “postcode lottery” that exists in relation to that procedure.
Above all, we need to ensure that patients have easy access to care that is shaped around their personal needs. In many cases, that will mean providing access to a multidisciplinary team, with patients enjoying a consistent relationship with advisers. In addition, psychologists and all those involved in the care of vulnerable young people need to understand the risks of behavioural complications, such as diabulimia, and the social pressures that can lead to those complications.
It is hugely important that GPs are made aware of type 1 diabetes. If they do not know about the condition, they will not recognise it; if they do not recognise it, they will not diagnose it; and if they do not diagnose it, the consequences for some young people could be fatal.
We therefore need to be imaginative in the way that the NHS funds and provides new therapies. There are numerous ways to provide advice. The important thing is that patients get that advice when and where they need it. Although special hospital units, such as the one at Aintree that serves my constituency, will continue to play a vital role, we need to be open to the idea of using other locations as a means of delivering care, particularly in the primary care sector.
Ongoing telephone support, community-based pharmacy care and mobile technology all have a role to play. The key is to ensure that we integrate these solutions, so that they work effectively across the local health economy to avoid unnecessary hospital admissions and reduce long-term complications.
If I have painted a gloomy picture, perhaps I can conclude by making a slightly more upbeat point. The dangers and risks to young people of type 1 diabetes are great, and recent developments can make them even more serious, but there are examples of leading sportsmen and women, entertainers and a host of other people successful in their chosen professions who manage to cope with type 1 diabetes, have a life and career and even bring up a family. In many respects, their lives exceed their expectations and those of society. With help, type 1 diabetes can be managed, and young people who have it can achieve everything in life of which they are capable. Our responsibility is to ensure that they get that help.
I congratulate the right hon. Member for Knowsley (Mr Howarth) on securing this important and pertinent debate. It is timely, given that we have a new Government and a new Health Secretary with responsibility for the issue. This is a great opportunity for us to help him to help those with the condition. I register that I am a type 1 diabetic whose condition is controlled by injections of insulin.
Diabetes, whether type 1 or type 2, is a chronic condition for which there is as yet no cure. Type 1 diabetes is believed to be genetic, rather than a consequence of lifestyle; type 2 diabetes is firmly believed to be a consequence of lifestyle and diet, and not necessarily of genetic factors.
The treatment regimes for types 1 and 2 are slightly different. Treatment of type 2 is very much about diet, exercise and changing a sedentary lifestyle. Medicines might be introduced to induce what insulin the body still produces to work better, although injections of insulin are increasingly being prescribed for people with type 2 diabetes, particularly those who have had the condition for a long time. The type 1 diabetic is someone whose pancreas has effectively packed up and said goodbye, so in order to stay alive, they must take injections of insulin—there is no alternative. Medication is sometimes prescribed later in life to ensure that the insulin taken works a little faster or more efficiently. For those considered to be at risk of other complications that tend to come with diabetes, such as strokes or heart problems, statins and other such drugs can be prescribed.
Just under one in five people with diabetes has type 1. Most are likely to have been diagnosed before age 40; I have had the condition since my late 20s. This debate is about diabetes in young people, so I will focus on that. I am glad that I was not diagnosed with diabetes as a young person, because it has a major impact on a young person’s life, educational chances, social interactions and psychological attitude to life.
The typical treatment for somebody with type 1 diabetes is perhaps three injections a day of fairly fast-acting insulin, taken at meal times. Before going to bed, they might take a fourth injection of a slightly longer-lasting insulin to maintain their body’s balance through the night, when they are not exerting themselves and require a different type of insulin. There are dozens of types of insulin—fast-acting, slow-acting, mixed—and which insulin or insulin mix is right is a decision for the patient and their GP in light of their circumstances.
The condition changes with age. The first insulin that someone is prescribed is not necessarily the one with which they will continue later in life. New insulins come on the market all the time, promising better control and fewer complications, and from time to time the treatment regime is reviewed and the GP or consultant may recommend change. Of course, that can cause complications, as the effect of any change is specific to the person. I am sure that the right hon. Member for Knowsley will know, if his daughter has ever been asked to change her treatment regime, that a degree of adjustment must take place before the patient is comfortable with the new regime.
Many people with diabetes make contact with the health service only once a year. It is a condition that must be managed by the diabetic themselves. For 364 days of the year, they are their own consultant. They know their body better than anyone else, and they must take the decision whether to increase or decrease the dose according to how much energy they are expending or what type of food they are about to eat. Once a year, the diabetic has a medical check-up. Some good GP practices bring in people twice a year: once to see the GP, once to see a specialist nurse. Some diabetics might see a medical professional three times a year in addition to seeing their consultant in hospital, but most people who have been diagnosed and are living with the condition normally come into contact with the health service only once a year. It is vital, therefore, that at that point the health service can detect whether there is a problem, analyse what it is and make correct suggestions about any changes in treatment.
For young people of primary and secondary school age, one big problem is the stigma of diabetes. There are a lot of misconceptions out there about what the disease is, what it does and what the condition brings. A young person might be told, “I’m sorry, you’re going to have to inject yourself,” but there is a stigma to that. They need a clean, perhaps private environment in which to make that injection. Although great advances have been made in injection devices—some are disguised as pens—there is still a stigma attached to having an injection, even a small, subcutaneous one. They are not great big syringes, as they used to be in the old days, but even with those advances, there is still a stigma.
Injections are not the only part of it. A sensible diabetic will want to test their blood sugars, which means taking a blood sample and putting it through a testing machine so the reading can advise them what injection of insulin is required. A clean, discreet environment is needed, which is difficult to find for someone in school—far more difficult than for me, a Member of Parliament. That is another reason why I am glad I did not have the condition as a child.
There are three stages for a young person with diabetes. Often, in a primary school environment, they may be the only person with the condition. Kids are quick to pick up on somebody who is a little bit different or has special requirements. Often, the primary school might have difficulty coping with a child who has diabetes. Many cases are on record—Diabetes UK has done a lot of work to highlight the issue—in which primary schoolchildren have not been able to get teachers or other school staff to assist them with testing or injecting because the school insists that a parent come in to do so. Working parents simply cannot do that, so in some cases, parents have had to move children away from their desired school to a bigger school, or one that can cope with a child who has diabetes.
We then move to secondary school. Although secondary school is ever longer ago, we can perhaps remember what we were like as teenagers, and the reality is that people do not want to be different when they are at secondary school. They do not want to admit that there is something that they cannot do, particularly if they are male. The reality, however, is that, with the right treatment, there is nothing that they cannot do. However, if they cannot, for whatever reason, do what they need to do, they will have difficulties doing what they wish to do.
We then come to the third stage—higher education. Things are different again when people go up to university. They may break the link with their home-town medical support, whether it is a GP or a consultant. They suddenly come into a university environment, which is very different from the home environment. The encouragement to do all the things that a diabetic should not do, in terms of when and what to eat and how much to drink, becomes that much greater. Young students with diabetes have reported to me that whatever medical support services there are at universities lack an understanding of that pressure, so there needs to be some improvement in that area.
The right hon. Member for Knowsley rightly mentioned the NICE guidelines on insulin pumps, and it is worth realising what they say, because they are quite limiting, in terms of the number of people who can be prescribed pumps. The guidelines recommend that the therapy be used when every other treatment has failed. Someone who has not got on well with injecting insulin or medication will be put on an insulin pump as a last resort. The NICE guideline for children under 12 says that they
“can have access to insulin pump therapy if multiple daily injections are considered impractical or inappropriate.”
There are lots of incidences of young children finding that injections are impractical and inappropriate because their school cannot help them, but their cases do not always come to light.
The criteria are very narrow. In many respects, a child should be put on a pump as soon as they are diagnosed—that should be done straight away, no question. What seems to be holding us back is not simply the cost of the machine, which is about the size of an iPhone, and which is permanently attached, giving the wearer a small dose of insulin throughout the day so that they can go off and do everything they want without having to worry about syringes, needles and all the rest of the paraphernalia. What is important, however, is that pumps have proper back-up from technical and medical staff who understand them, and that is where there is a big gap. The all-party group on diabetes came across the case of a child on a pump who lives in Portsmouth, but who is supported by a hospital in Leeds.
I apologise for missing the start of the debate, which is particularly topical, given that my hon. Friend the Member for Salisbury (John Glen) and I had a meeting with the JDRF this morning and discussed the very point that the hon. Member for Torbay (Mr Sanders) raises. I was struck by a number of points, which I hope that he will agree with. One is that the importance of what he has just said about managing the disease in a far more cost-effective and efficient way cannot be overstated, and we can have remote monitoring of blood sugar and dosage levels with a pump. The most shocking thing that I have heard is that although our wonderful scientists in Cambridge are developing an artificial pancreas, which is an amazing breakthrough that will mean a mechanical solution to type 1 diabetes, UK citizens will not be able to avail themselves of the technology. Pump usage is only at about 4%, including among the young group that we are discussing, but levels of pump take-up in the US and other areas are as high as 40%. It is absolutely self-evident from the point of view of cost-effectiveness and long-term treatment that the adoption of pumps should be a high priority—
The points about take-up were also made extremely well by the right hon. Member for Knowsley. Getting in place the support systems for pumps will help those who make decisions about budgets locally to ensure that the equipment is there and in play for everybody who is prescribed one.
In a sense, the great hope for the future is a pump that also tests blood sugar, adjusts the dose accordingly and communicates, if the patient wishes, with a medical professional about what is happening to the patient’s body. When that happens, clinicians will be able to gather much more information from diabetics, rather than just hearing what they have to say. Of course, people will tell their GP, “I’m doing everything you said I should,” but the reality may be just a little different, so that new information will take things much further forward.
In conclusion, I have a couple of questions for the Minister. How much notice does his Department take of international comparisons regarding care and research? The hon. Member for Devizes (Claire Perry) mentioned the fact that take-up here is much lower than in the United States. Should that factor be taken into consideration when we discuss what are appropriate treatments and what budgets should be? What efforts are being made to co-ordinate international research into effective treatments and a cure for diabetes? A cure may be a long-term possibility, but it would be silly if several different countries, with several different groups of taxpayers, funded the same research at the same time. Some international co-ordination would be in everybody’s interest.
Once again, I thank the right hon. Member for Knowsley for securing the debate. I look forward to hearing the Minister’s response.
Several hon. Members rose—
I can assure you, Mrs Riordan, that I will not speak for that long.
I want to highlight the impact that diabetes, like all chronic conditions, has on not only the individual, but their family, friends and community. That is particularly relevant, given the age at which people are being diagnosed with type 1 diabetes and the huge increase in the number of children who are diagnosed with it. About 25,000 children in the UK have type 1 diabetes. Some 98.6% of children and young people with diabetes have type 1. The incidence of type 1 diabetes increases by about 4% each year. The biggest increase is in children under the age of five, among whom there has been a fivefold increase in the past 20 years.
When children are diagnosed with diabetes, it has a profound effect on their families. The parent group, Children with Diabetes, did a survey of parents, in which 85% said that their household income had gone down; 83% said that they had problems with their marriage and family life; 84% said that their child’s treatment was affected by where they lived; 71% said that they were concerned about long-term complications; 60% said that their children were most worried about being seen as different, as the hon. Member for Torbay (Mr Sanders) said; and 50% reported that their children had been bullied at school as a result of suffering from type 1 diabetes.
My right hon. Friend the Member for Knowsley (Mr Howarth) asked me to contribute to the debate because of its importance to him as an individual. That made me think about constituents I have seen and the problems that they have had. My hairdresser, who is a very important person in my life, told me that his niece, Sophia, was diagnosed with type 1 diabetes at the age of five. There was no history of diabetes in the family. The family spent ages completely terrified, wondering what the problem with their young daughter was, only to find that she had type 1 diabetes. Her mother, Nicole, tells me that she came home on the day of diagnosis with a load of equipment, not knowing what to do or understanding the consequences. She knew that she had to give up her employment, because she could not control the diabetes and did not know the consequences for her daughter. Her husband had to accept the fact that, unlike other married couples, they could not leave their daughter with other people, because those others were frightened about knowing how to care for her. Nicole was concerned about just not knowing how the family would approach routine family life, celebrations, festivals and even Christmas.
Nicole told me today that the single thing that was of benefit to her was the recently set up parent group at St. George’s hospital in Tooting. The scales fell from her eyes as the clinical paediatric nurse, Richard Todd, told her how she could cope with Christmas—all the food and treats of the period—and how she could have access as a carer to discount cards, which no one had told her about in the past, although her daughter has had type 1 diabetes for seven years. She could also just meet other families and mums, and discuss the consequences, for them and their family, of their children’s diabetes. If there is anything I would ask the Minister to do, it is to consider the fact that St. George’s will not carry on the parent support service, because it does not feel able to keep Mr Todd’s services. I am sure that there are many demands on the hospital, but that parent group—just from one parent’s perspective—had an enormous impact.
The other time when a problem begins to arise in a family’s life is when children transfer from primary to secondary school. While having a pacemaker, or another condition, might affect a child’s school preference place, despite having type 1 diabetes Sophia did not obtain a school place in the Minister’s constituency, although her mum and dad wanted her to go to school there so that they could be close at hand if anything happened and so that all the burden would not fall on the school. At the school, in turn, there was a fear about having Sophia there. Of course, with the transfer to secondary school the issue of puberty comes into play, with its impact on the treatment of type 1 diabetes, and the need to understand whether mood changes result from the illness or the normal changes that any teenager goes through.
Having a child with type 1 diabetes can also have a financial impact. I know from other families who have been to see me that that can involve simple things such as school uniforms. One mum who came to see me bought the uniform for her daughter who was going to secondary school, only for her to be diagnosed with the condition over the summer holidays; in that period she lost two or three dress sizes. Apart from the sheer fear that that must have created, the financial impact for a single mum on benefit is huge. There are implications for all the things that we would want to happen: getting mums back into work; flexible working; the need to work close to home; and the need for the wider family to understand things. I am sure that that is only a small and perhaps secondary consideration, but in the treatment of this chronic disorder, diagnosed in children so young, it has a huge impact for the wider family. The soft services of parent groups, which might be seen as less important in times of financial restraint, are crucial in enabling parents to understand the difficulties and problems, and in preventing some of the problems that other families have probably been through.
It is a great pleasure to serve under your chairmanship, Mrs Riordan, for the first time, or certainly the first time in my experience. I congratulate my right hon. Friend the Member for Knowsley (Mr Howarth) on securing the debate.
We have heard a number of telling statistics about diabetes. As has been said, of the young people and children who have diabetes in the UK, about 98.6%—a very large proportion—have type 1 diabetes. It is estimated—and it is a pity that we have to talk of estimates, and do not really know the true figures—that type 1 diabetes affects more than 25,000 children and young people. As we have heard—there are some very useful definitions—it is a chronic condition, which can be life-threatening, and which occurs when the body’s immune system attacks insulin production cells in the pancreas. It is usually diagnosed in childhood, but as with most other conditions children are often kept waiting for a diagnosis. People must live with and manage the condition for the rest of their lives. Even when it is managed through regular injections, type 1 diabetes can bring long-term complications, such as heart disease, stroke or blindness, as my right hon. Friend the Member for Knowsley mentioned.
On that point, a shocking statistic that I was told this morning is that the management of the disease is so sub-optimal that it is estimated that more than 80% of relevant children have blood sugar levels that are too high, despite the best efforts of their parents, the community, hospitals and support groups. That has enormous long-term health and economic consequences. Surely better management of the disease at an early stage would save the children, the family and the taxpayer enormously in the long run.
Indeed, and we heard earlier that the incidence of type 1 diabetes is increasing by about 4% each year. The biggest increase is in children under five. A fivefold increase in the past 20 years, as my right hon. Friend the Member for Don Valley (Caroline Flint) said earlier, is a matter of great concern. It is important that more attention be paid to helping GPs, pharmacists, other health practitioners and teachers to identify type 1 diabetes in children and young people. As with many long-term conditions, early identification is the key, because the later the diagnosis of diabetes, the greater the impact.
My right hon. Friend the Member for Knowsley asked the Minister in an Adjournment debate on diabetes last week to introduce protocols for GPs on dealing with certain symptoms. That would ensure that GPs were better equipped to diagnose diabetes. The Minister said then that he would consider the point and would have more to say on it during today’s debate. I hope that we shall hear his answer.
As we have heard, the Government’s NHS White Paper proposes to give GPs the power to commission services, instead of primary care trusts, which will be abolished. I have raised on a number of occasions recently the fact that there is great concern that many GPs do not have the depth of knowledge required to commission specialist services for conditions such as diabetes. GPs may not have the skills, experience or desire to assess whole-population health care needs, to manage the market, to negotiate contracts and to monitor performance. That is becoming a key point of concern, because GPs did not necessarily come into medicine to do those things. Indeed, I understand that the Royal College of General Practitioners is urging the Secretary of State for Health to put back his plans for GP commissioning. The college’s report on the Government’s consultation has unearthed “major concerns”. That is in line with the responses from medical charities such as Rethink and campaigns such as the Muscular Dystrophy Campaign, which also have concerns that GPs lack the skills and experience for commissioning across such a range of conditions.
There are also concerns that in taking on such a wide role, GPs’ primary role of making diagnoses and providing patients with all the information and support that they need could be affected. Some of the statistics are already becoming a cause for concern. Surveys by Diabetes UK have found that 20% of young people feel that they rarely, if at all, discuss their goals for their diabetes care during check-ups. Further, only 26% have attended a course to help them learn about managing their diabetes. The essence of managing a long-term condition is recognising that people must become expert patients. If they are young, their family members must become expert carers. Will the Minister outline what steps the Government will take to make sure that GPs are better equipped to diagnose conditions such as type 1 diabetes and to continue, and improve, their support for people with the condition?
There is a clear need for people with diabetes to be given better information about how to manage their condition. The hon. Member for Torbay (Mr Sanders), who chairs the all-party group on diabetes, has tabled early-day motion 72, which notes that 65% of the 2 million people in the UK with diabetes are not taking their medication as prescribed, because two out of three do not understand what those medications are for or how to take them. We have heard from my hon. Friend the Member for Mitcham and Morden (Siobhain McDonagh) what it is like to land at home with a host of medications, without having a real idea of what to do with them.
It is helpful that the hon. Lady has raised that point, because it is an important element of the issue. There are enormous savings to be made by preventing wastage, but we are not just talking about tablets—there is also medical equipment. Increasingly, people with chronic conditions depend on medical equipment. Being able properly to take and analyse a blood sugar reading is a very important aspect of a diabetic’s ability to treat themselves.
Indeed. I understand that the early-day motion argues that people with diabetes have a right to expect a personalised information prescription, so that they receive clear and consistent information on diabetes, which will enable them to start to understand their condition and treatment options.
Will the Minister outline what action the Government plan to take to ensure that the NHS at a local level provides diabetes care and support in line with the standards set out in the EDM? The Minister will know that I am always concerned to ensure that we consider carers’ issues in the House, and my hon. Friend the Member for Mitcham and Morden has just touched on some of those issues. We should consider the effect that long-term conditions, such as type 1 diabetes, have on family members and carers. My hon. Friend described it as a soft issue, but carers are the backbone of support for children and young people in this situation, and there is an impact on them.
The Juvenile Diabetes Research Foundation states:
“Type 1 diabetes pervades every aspect of a person’s life.”
Of course, it also affects their family. As we have heard, everyday activities, such as eating and drinking, which are often difficult enough with children—particularly young children—involve much thought and planning on the part of carers of children and young people with type 1 diabetes.
My hon. Friend the Member for Mitcham and Morden mentioned the survey carried out by the parent group, Children with Diabetes. As she said, it found that 83% of parents said that their family life was affected by a diagnosis of type 1 diabetes—quite understandably—and 84% of parents said that the treatment that they received was affected by where they live. That should not be the case; we should not have a postcode lottery. Some 60% of parents said that their children were most worried about being seen as different—children are, of course, always worried about that—and, most worryingly, 50% reported that their children had been bullied as a result of having type 1 diabetes.
The hon. Member for Torbay talked about the stigma associated with treatment by injection. Clearly, bullying in schools can be a result of stigma and perceived difference in children. That is of great concern. Diabetes UK has found that many parents of children with diabetes are forced to give up work, for reasons outlined in today’s debate. In a recent survey, half of primary school pupils with type 1 diabetes and a third of their secondary school counterparts reported that their parents had to reduce their hours or give up work to help to administer insulin injections.
The report also revealed that two thirds of primary school pupils and four fifths of secondary school pupils questioned think that school staff do not have enough training in diabetes. That is not surprising given the findings of an earlier 2008 survey of primary schools. It found that 42% of schools that had children with diabetes did not have any policy advising staff about the supervision of blood glucose monitoring by the child, 48% did not have a policy advising staff on how to help carry that out, 41% did not have a policy advising staff on how to supervise medication of any sort, and 59% did not have a policy advising staff on how to give medication. So the load is falling directly back on to the parents, because the schools do not have a policy.
When we consider type 1 diabetes, it is important to look at the people around the child or young person with the condition and to consider the level of support, information and training that is needed. The children’s charter for diabetes states that discrimination in education should end and that children with diabetes should be treated with respect. I hope that the Minister agrees with that sentiment.
As I say, one of the major concerns among diabetes charities and groups, such as the Juvenile Diabetes Research Foundation, is the postcode lottery that they feel exists regarding the treatment of type 1 diabetes. We have talked a lot in this debate about insulin pump therapy, because that is rightly viewed as the gold standard of treatment for the condition. Insulin pump therapy reduces hypoglycaemia and long-term complications, and it can make life easier. As we have heard, the treatment involves a bleeper that delivers small amounts of insulin throughout the day.
Those pumps are a cost-effective treatment that can help reduce contact with primary care, reduce hospital out-patient and in-patient admissions and, most importantly for children and young people, deliver a better quality of life. As we have heard, less than 4% of the population with type 1 diabetes use a pump. As right hon. and hon. Members have said, that figure is far below the level of use in Europe, where it is at 15% to 20%, and the United States, where it is at 35%. In fact, given the number of children and young people who go on holiday to the States, it is likely that they will run into pump therapy when they are there. Of course, people also read about the therapies available in other countries on the internet.
It is clearly important that insulin pump therapy becomes available. As we have heard, it can be used by adults and children over 12 and, as my right hon. Friend the Member for Knowsley mentioned, NICE guidance also recommends that children under 12 with type 1 diabetes have access to insulin pump therapy if multiple daily injections are considered impractical or inappropriate.
The hon. Member for Torbay provided a vivid description of the stigma, bullying and other issues that arise in school. For example, he mentioned how hard it is to find a clean and private place in which to administer injections. I have touched on the difficulties of schools not having policies, and teachers not supervising the situation. Clearly, children of almost any age will almost always find it impractical in a school setting to administer injections. In those cases, insulin pump therapy will always be better for the child or young person.
As we have heard, it is worrying that there is considerable inequity in insulin pump provision across the country. My hon. Friend the Member for Mitcham and Morden talked about the figures released this month by the Medical Technology Group, which show that there is a postcode lottery, in terms of access to insulin pumps in the UK. We can compare the cost of insulin pumps, which are £3,000, with the cost of bariatric surgery for the morbidly obese, which is about £7,000. Both of those treatments have beneficial effects, save the NHS money and improve the quality of life for the patient. Bariatric surgery use has increased tenfold from 2000 to 2007 but, as we have heard, our levels of prescribing insulin pumps are only a quarter—or a fifth—of levels of usage in Europe. Given that GPs are to take on a commissioning role, will the Minister state what action the Government plan to take to ensure that insulin pumps become much more readily and evenly available across the UK?
I would like to thank the Juvenile Diabetes Research Foundation, the Eye Health Alliance, Diabetes UK and, of course, the Members’ Library for their excellent briefings on the subject, which have helped us all in today’s debate. I started my preparation for the debate not really understanding very much about the condition, and particularly how it affects children and young people, and I feel that I do understand it now. Given the number of people involved with the issue in every constituency and the prevalence of the condition, all hon. Members should understand it as well as I hope we will by the end of the debate; the discussion has been excellent from that point of view. I pay tribute to the children and young people who are living with this condition, and to their parents. I hope that through this debate and the questions that we are asking the Minister, we can improve the service and support that they receive from health and other services in future.
I congratulate the right hon. Member for Knowsley (Mr Howarth) on securing the debate and, indeed, on taking part in last week’s debate. He has brought a sharp focus to an issue that is often not debated—even when we discuss diabetes, it gets rather lost in the broader picture.
I have a constituency interest in the matter. Before the general election, a number of children in my constituency who were supported by Diabetes UK wanted to make me aware of what could be done in schools and families to support them better. There are beacons of hope and places that are doing exceptionally good things that make a huge difference. However, as has been well documented in the debate, there is clearly a lot of work to be done. I have a lot to say in response to the very many good points that have been made in the debate.
It is helpful that the debate is not just grounded in the technicalities of the issue, but grounded in the life experiences of individuals. We have heard such points made by the hon. Member for Mitcham and Morden (Siobhain McDonagh), the right hon. Member for Knowsley and, of course, my hon. Friend the Member for Torbay (Mr Sanders), who has direct experience of the matter. That is powerful because when it is done well, it helps to give a real sense of the difference that can be made to a person’s life—they no longer have to be defined by the condition; they can get on with their life. I hope we share that goal as we discuss how to shape services going forward.
I pay tribute to Diabetes UK and the Juvenile Diabetes Research Foundation, which, through the speeches of hon. Members from all parties, has contributed to the debate and does much well beyond that. This is a welcome opportunity to focus on a condition that does not get the same headlines as cancer, cardiovascular disease or, for that matter, type 2 diabetes. It presents a threat not only to children’s health but, as we have heard in the debate, to their well-being and, in turn, that of their families.
The debate has rightly focused on what we can do to improve matters. The right hon. Member for Don Valley (Caroline Flint), who understandably has had to leave to attend to other business, raised a few points with a policy emphasis that were rather churlish, but I understand that they were well meant. I am sure that she and I will have an opportunity to debate those on another occasion.
I am loth to rise to defend my right hon. Friend the Member for Don Valley (Caroline Flint), on the grounds that she is more than capable of defending herself, but the key issue that she raised was not too party political; it was about how young women are viewed and how they respond to the pressures to conform to a particular body shape.
I will come shortly to the point, which was absolutely well made, and certainly line up with the right hon. Lady’s comments on that. As has been mentioned, the Minister for Equalities has done a sterling job on behalf of the Government to place the issue at the front and centre. She has not resiled from the issue and will continue to pursue it as she has done so far. I was more anxious about that concern being aligned with the Government’s direction of travel on GP commissioning, which I will return to because it was raised, quite fairly, in the debate.
We have heard today about type 1 diabetes—a complex, lifelong, progressive condition that requires careful long-term management to prevent the severe and sometimes fatal complications that have been described. A 2009 survey of children with diabetes in England revealed that 23,000 children and young people currently have type 1 diabetes. There has also been a national diabetes audit, which included a separate report on paediatric diabetes that gives us a fair picture of the extent of childhood diabetes and how well it is being managed. Although Britain has one of the highest numbers of children diagnosed with diabetes in Europe, we have one of the lowest numbers of children controlling their diabetes well, and we have heard what the implications can be for those children and their families. That is extremely worrying, because poor glucose management increases the chance of the child experiencing complications. I echo the view, expressed by many Members in the debate, that that is an area where we can make significant and sustained improvements. I want to describe what we are trying to do about that.
The first question is: how can we ensure that more children receive an early and accurate diagnosis of diabetes? The challenge for GPs is that type 1 diabetes can be difficult to spot. A child might present with the vague symptoms of extreme tiredness and weight loss, which can be mistaken for other illnesses. Type 1 diabetes is quite rare, so GPs might not come across many cases in their practice. That explains why there have been instances of the sort that have been described today: tragic cases of symptoms being overlooked and children diagnosed only after becoming seriously ill.
The National Patient Safety Agency is currently looking at a number of reports of misdiagnosis and delayed diagnosis and is working with the national clinical director for diabetes to look at what we can do to improve diagnosis rates and reduce emergency admissions. Clearly, we will have to look at protocols and how they might serve as a tool that can be used, but we need to ensure that the work is properly concluded before we decide whether that is an appropriate mechanism.
It is true that building professional awareness is key to improving diagnosis rates. We need GPs and A and E staff, in particular, to consider diabetes as a possibility when they see children with appropriate symptoms, and we must ensure that they are equipped with a range of diagnostic tools to do so. NHS Diabetes, the improvement body for diabetes care, is working with various royal colleges and other bodies to improve professional standards and ensure that best practice is reflected in their training curricula. NHS Diabetes is also working with Diabetes UK to publish best practice guides on how a child with type 1 diabetes should be cared for. Therefore, material is being generated that will help a wide range of professionals not only in the NHS, but in education and social services, to recognise the symptoms and understand what good care looks like. In addition, the Juvenile Diabetes Research Foundation has been placing posters in GPs’ surgeries, highlighting the signs and symptoms to help people recognise the condition.
Once diagnosed, children need a combination of high-quality clinical care and wider support to ensure that they manage their diabetes effectively. I concede that across the NHS we have a mixed picture, as has been well described. That is the picture the Government have inherited, and we are determined to improve it. Children with diabetes often need multiple referrals to different specialist services, so well integrated multidisciplinary care is crucial to service delivery.
The right hon. Member for Knowsley broke the ground for the building of the centre in Aintree that he described, which I understand will bring diabetes clinics closer together and make it much easier to access those services. We want to see more such centres of excellence. I welcome that development but stress, rather as he did, that too often the focus is on how many hospitals, doctors and nurses there are. Beds and buildings are not as important as good services, particularly when it comes to managing long-term conditions such as diabetes, as well co-ordinated and well thought-out services that are closer to the patient and can respond to their personal circumstances and fit around their lives will meet their needs better.
While preparing for the debate, I noted that my right hon. Friend the Member for Knowsley (Mr Howarth) and the hon. Member for Torbay (Mr Sanders) are lucky enough to represent the two parts of the country where integrated health and social care is thought to be working the best. While talking with the King’s Fund the other day, I learned that there are only six places in the country where it is judged to be working that well. On GP commissioning—several Members touched on this point—how can the Minister ensure that that will improve, because our fear is that that major, top-down reorganisation will mean that those five or six places will be the only ones in the country?
Had I turned to the next page in my brief, I would have reached an answer to that question, so I will come back to it in a moment. My final point about care is that the latest paediatric diabetes service survey suggests that the picture is improving. It is important to stress that there is movement in the right direction, but there are still deficiencies.
On the question of GP commissioning and how we better integrate the commissioning and joining up of services, a point that the hon. Lady and others have missed in much of the commentary on the White Paper is the clear intention for local authorities to hold a new role in assessing population need. That assessment will be critical to the future of the commissioning of health and social care and to the new role of local authorities in public health, which is key to early prevention of type 2 diabetes. The notion that there is fragmentation and atomisation is far from the truth. The intention is to ensure that we have that alignment of services, which would be much better achieved through the partnership between local authorities and GP consortiums.
I recognise the problem to which the Minister refers, but Knowsley primary care trust and Knowsley council, for example, already have a number of integrated posts; the chief executive of the PCT is also the director of social services. The process that the Minister is seeking to create through the reforms to a large extent already exists in places such as Knowsley, yet it seems that they will undo what has already been created.
As the hon. Member for Worsley and Eccles South (Barbara Keeley) has already said from the Front Bench, that is not the norm but the exception. We want that to become the norm. The point is that that has not happened everywhere. We need approaches that ensure that we design services in ways that involve all the key players, including clinicians and local authority social services, where appropriate. That is the ambition of the White Paper.
We want to unleash the potential of GPs by aligning them much more closely as commissioners with the services. I note that the Juvenile Diabetes Research Foundation supports the White Paper and sees it as a key way to lever the changes that Members have argued for in the debate. It sees the reforms as an opportunity to secure things that are not delivered under the current NHS architecture, such as insulin pumps, and I certainly wish to ensure that that happens.
I apologise for making so many interventions, but I want to make this simple point. One of the consistent themes in this debate has been that the weakest link in the system for treating young people with diabetes is the service that GPs provide, particularly in diagnosing diabetes in the first place. I cannot see the logic, from a diabetes point of view, in handing all the power and control to people who do not understand the disease.
The right hon. Gentleman and the Juvenile Diabetes Research Foundation seem to be in different places. The foundation takes the view that the condition is best managed through primary care. As I said, we must upskill, ensure that the signs and symptoms are better understood, and use the clinical skills of GPs more effectively.
I will give way in just a moment—I want to pick up on another point. I am surprised that the hon. Lady keeps going on about GP commissioning, when it was her Government who introduced practice-based commissioning. We are building on those reforms, and see them as an essential way of ensuring that taxpayers’ money is most effectively geared to delivering the best possible health outcomes for people with diabetes and other conditions.
I do not think that Opposition Members are alone now that the Royal College of General Practitioners has expressed major concerns about GP commissioning and is pleading with the Health Secretary to put the reforms back.
I want to raise a point about local authorities and coterminosity with PCTs. We have a better coterminosity situation—and have struggled to get to it—but I know that some local authorities around Greater Manchester will be faced with having not one but two, four or five GP consortiums. As I said, health and social care integration is working in places such as Knowsley and Torbay, where great work has been done to bring things together. The fragmentation is coming out because of the nature of the reorganisation.
Again, I do not recognise that characterisation, in that coterminosity does not exist in many parts of the country under the current model. As the hon. Lady has rightly said, integrated models of care, and collaborative approaches and behaviours are not present in many places. The desire and intent behind the White Paper is to make them the norm.
I want to do justice to this debate. We could have a debate about the White Paper, and I am sure that at some point the Opposition will choose to do so. If they do that, we would be only too happy to meet them point by point, but I want to talk about some of the key developments that will bear down on this problem and really help to transform lives.
The coalition Government want to make a significant move in respect of their commitment to introducing a much stronger payment system for children’s diabetes services, which will help to bring them out of the shadow of other NHS services. As a start to the process, a new mandatory tariff, which we plan to introduce in stages from April 2011, will recognise paediatric diabetes care as a clear and discrete specialism within the NHS, and will provide a clear funding stream to support such services over the long term.
At present there is a non-mandatory tariff, which was rushed in for April 2010, but it is wholly inadequate because it fails to take into account the complex nature of paediatric care, which this debate has articulated. As a result, under the current system, many paediatric diabetes services either continue to be under-resourced—we have heard about that today—or are funded through other budgets. Hence, they can sometimes be relegated to a second-class status in the NHS. The new tariff, as part of a more patient-focused funding model, will help to put us on the right track.
We have reached the point about money, and I can assure the Minister that the first concern of a parent of a child diagnosed with type 1 diabetes is the health of the child, not money. My hon. Friend the Member for Mitcham and Morden (Siobhain McDonagh) discussed support for families. May I ask what representation the Minister has made to the Department for Work and Pensions on disability living allowance, which is available to many families of young people with type 1 diabetes?
I obviously have many conversations with colleagues in the DWP, but as that is the first occasion on which that matter has been raised in this debate, and as I want to do justice to other speakers, I shall move on to ensure that I answer their questions.
Let us deal with family support more generally. The hon. Member for Mitcham and Morden took us through some of the statistics; the impacts on families’ lives are truly disturbing. We need to ensure that appropriate and tailored support services are in place, including the right support for carers.
I am concerned that where peer support services are provided, they are not given priority. However, not all peer support services need funding; they need willingness and support to ensure that they carry on. I would certainly commend peer support as one of the ways in which people can cope with self-care and the ongoing management of the conditions that have been discussed in this debate.
Let me deal briefly with emotional support for children in particular, and the children’s charter, which has been mentioned several times. My hon. Friend the Member for Torbay spoke about the impact of a diagnosis at a young age. Part of that comes back to providing proper emotional support in formal settings—schools and other settings. We must ensure better alignment in the way that we develop our thinking around public mental health strategies, and we will be saying more about that in a cross-Government strategy on mental health later this year. I am sure we will want to pick up, at least in thematic terms, on the public health issues in the White Paper that we will publish, also later this year.
I very much welcome Diabetes UK’s children’s charter, which will help to establish the kind of support that children and young people need to help them cope. Also, a guide has been developed to help commissioners ensure that children with diabetes receive the emotional and psychological care that they need.
In the last four minutes, I want to speak about insulin pumps. The right hon. Member for Knowsley rightly raised that key issue in the debate and in an article that he published today. The National Institute for Health and Clinical Excellence has clearly recommended pump therapy for children and young people if daily injections are not working. Frankly, I am disappointed and shamed that many primary care trusts are dragging their feet on making pumps available. That should have been sorted out; I should not have to come to this Chamber to explain why that has not been done, given how long the recommendations have been there. It is a pity that the delay was not challenged more in the past, and that the previous Government did not get around to sorting it out. I expect to see real improvement in this area as a result of the new funding arrangements that have been discussed in the debate.
My hon. Friend the Member for Torbay raised some important points about obstacles, and I want to ensure that, through the all-party group on diabetes, we have further conversations about what we can do to kick down those obstacles, and to ensure that the important research on artificial pancreases that is being done in this country is not undermined by the treatment not being available because there is not a route through the pumps. That point has been powerfully made in the debate, and I want to ensure that we follow through on it.
Research has been touched on in broader terms, and I want to mention a couple of examples of work that is being done at present. We are looking at how to provide better psychological support for children with diabetes, and how we can improve education and training in diabetes for children and families. We are also funding a major trial on the effectiveness of insulin infusion treatments versus standard injections. Alongside that, there is a vibrant third sector investing in research.
We have heard about work at Cambridge university to develop an artificial pancreas to reduce the risk of hypoglycaemia in children and adolescents. The link to telehealth that my hon. Friend the Member for Torbay referred to is important, and I want to ensure that the message is clearly understood and that we build it into some of the work that the Department is doing. I am about to run out of time, so I will have to write to my hon. Friend about international research.
Hon. Members raised points about schools. I shall elaborate in more detail by writing to all those who have taken part in the debate, but it is key that schools understand their responsibilities in respect of well-being and safety, and that they provide appropriate support for children who need to take medication at school.
The Government are determined to improve care for type 1 and type 2 diabetes. This is not something that we will put on the back burner. We have inherited a legacy but intend to build on and really improve those services.
Inter-city Express Programme
I asked for the debate today to give voice to the north-east’s campaign to ensure that the inter-city express programme is allowed to go ahead, due to the economic impact it would have on the region. It would have profound implications for the north-east because the investment would be the biggest in the north-east since Nissan in the 1980s. That is how important it is, not only for the north-east, but for the rail infrastructure and the UK economy at large. Hitachi has already said to me in writing that the preferred site for the factory to manufacture the trains would be in Newton Aycliffe in my constituency.
My area’s involvement in the railways goes back to their beginning. Locomotion No. 1 travelled along the railway line a few hundred yards from the potential factory site on its way to Darlington in September 1825 to start the Stockton and Darlington Railway. That is how long my area has had its historic relationship with the railway. For something like 160 years, train building was a massive industry in south Durham, just a few miles away from Newton Aycliffe at Shildon wagon works, which closed in 1984 with the loss of more than 2,000 jobs. The inter-city express programme provides us with the opportunity to bring train building home.
In 2007, the Department for Transport issued an invitation to tender to transform the UK’s inter-city train services and replace the outdated diesel high-speed trains that have provided the service since the 1970s. Agility Trains, a joint venture between Hitachi and John Laing, won that contract. Agility Trains will deliver state-of-the-art super-express trains based on the highly successful 395 Javelin trains in Kent, which have recently won a Passenger Focus independent survey for being the best trains. Hitachi also manufactures the bullet train in Japan.
If the programme goes ahead, Hitachi will build a purpose-built factory in my constituency alongside the second largest industrial estate in the north-east. The best way of describing the inter-city express programme is as a service and supply contract to provide new trains and a dramatic improvement to the inter-city services on the east coast main line between London, south Wales and the south-west. The contract was privately financed and managed on a pay-as-you-go basis, which means that payments are not due until the trains are delivered in 2015, after the next election. The cost of the service is spread over 27 years of operation, with payments made on a per train, per day basis. Payments depend upon delivery of a clean, reliable and fully serviceable train, thereby ensuring that the interests of the supplier—Hitachi—and the passengers are aligned.
The programme will deliver a significant increase in seating capacity, a reduction in journey times and a huge increase in reliability and comfort without need for hugely expensive track upgrades. It will also mean that passengers will be able to travel on trains that do not dump toilet waste on the track. We need to move on from the Austin Allegro era of technology.
On 26 February 2010, a written ministerial statement said that Sir Andrew Foster would subject the inter-city express scheme to a value-for-money assessment. On 6 July, the Secretary of State for Transport published the results of that assessment:
“Sir Andrew suggests that the inter-city express proposition is ‘positive and attractive’ in a number of ways. He suggests that the PFI-style funding arrangement is novel and well aligned in terms of financial incentives. The faster acceleration and longer carriages would have a positive impact on network and passenger capacity, and the specification has also taken network sustainability and environmental imperatives seriously.”
Sir Andrew raised some technical questions about the trains, but the Secretary of State said:
“I see this as a lesser issue”.—[Official Report, 6 July 2010; Vol. 513, c. 10WS.]
Hitachi has been working closely with the Department since July regarding the issues raised by Sir Andrew, and I am sure that they can be resolved. It wants to simplify the bi-modal technology for example, to bring down costs. Bearing that in mind, the economic case for the inter-city express programme to go ahead is significant.
Not only will the programme bring improved rolling stock to the railway infrastructure, which is required in the 21st century if the economy is to grow, it will also mean so much to the economic growth of the north-east. The programme helps fulfil the Government’s stated aim of rebalancing the north-east economy in favour of private sector growth. Public financial input will not be needed until after the next election, and will be recouped through the innovative financial formula Hitachi has drawn up.
Some argue that it should be left to the train operators to acquire the trains they need, but, surely, economy of scale means that this proposal is the cheaper option, and it offers sufficient volume to attract a major manufacturer to the UK. Therefore, it goes some way towards meeting the Government’s stated aim of growing the private sector—something we all want to see—and Hitachi will put in the investment up front. If the inter-city express programme goes ahead, and I know that the Minister cannot give an answer today, Hitachi has said that its preferred site is Newton Aycliffe. In a letter to me, it stated that, on a range of criteria, including required land size, test track availability, road access, proximity to deep sea ports, local labour availability and flexibility, and ease of business with local and regional agencies and authorities, County Durham and Newton Aycliffe scored highly. That is a tribute to the people of Newton Aycliffe, to local decision makers, and to the north-east’s ability to attract foreign investors, of which there are 500, about 100 of which are in County Durham.
However, what benefits will Hitachi bring to the region? Some 800 direct jobs; up to 9,000 jobs in the supply chain, seven out of 10 of which will be in manufacturing, mainly in the region but also nationally; and for every £1 of investment there will be £48 return over 20 years. Hitachi will start building a £90 million purpose-built factory next year. Some 200 construction jobs will be generated, and private sector investment precedes any public sector investment, which will be over a 20-year-plus period. Over two decades, the region will benefit in net gross value added terms by £660 million, and Teesport will also benefit because some components will be imported from Japan.
The inter-city express programme will replace the rolling stock on the east coast main line. As someone who uses the east coast main line weekly, I know that the rolling stock needs replacing. At present, demand outstrips supply on the line. With rail travel from the north-east to London costing three times as much as flying, and as there are no longer flights from Durham Tees Valley airport to Heathrow, but only from Newcastle, there is an acute problem that needs to be remedied. The new carriages with extra passenger capacity will help to resolve the problem.
The 800 jobs will help to pump much needed expenditure into the local economy through wages. Newton Aycliffe town centre is going through a period of regeneration, and the boost to the local economy that Hitachi offers will help see the local shops boom and breathe new life into the town. Newton Aycliffe has the skills that Hitachi requires. The recent global economic downturn has seen many people with those skills put out of work. The initiative will help to put those idle hands back to work.
I have said that the initiative will match some of the Government’s stated objectives—rebalancing the north-east economy in favour of the private sector and providing work to those who have skills, as well as offering apprenticeships to our young people who do not have those skills. The Government want to create 2 million private sector jobs in the next five years, and this initiative will help to do that. The programme is private-sector led. Hitachi has also committed to using local suppliers first and foremost. If it goes ahead, the investment and the presence of Hitachi will provide the north-east with the largest private sector investment since Nissan 25 years ago.
The issue has united the north-east in a campaign to ensure that the inter-city express, and Hitachi’s presence in Newton Aycliffe, goes ahead, and to put the case for the region. The groups that have got together to do that include: North East chamber of commerce; Durham county council, with the support of the leaders of the Conservative and Liberal groups, as well as the controlling Labour group; the Federation of Small Businesses; the northern TUC and Unite. They have come together to promote the importance of this project to the north-east. The Northern Echo is running a “back on track” campaign because this is so important to local people. A petition launched by the partners is attracting thousands of signatures.
The Secretary of State for Transport has kindly agreed to meet a delegation of business people from the north-east next Tuesday so that we can again make the case for the opportunities that the proposal will provide for the north-east. The partnership has produced a report stating the north-east’s case for the inter-city programme to go ahead, and I sent a copy to the Minister earlier today. I hope that she found it useful. The north-east has learned over the years to stand up for itself, and is saying “We’re here and we can do the job.” Hitachi, one of the biggest companies in the world, has faith in the region, and I hope that the Government also have faith in it.
The right hon. Member for Berwick-upon-Tweed (Sir Alan Beith) said:
“I welcome Hitachi’s interest in building rolling stock in the North-East, and I very much hope the project will go ahead—it would bring enormous benefit to our region.”
In a letter to me, the Minister of State, Department for Business, Innovation and Skills, the hon. Member for Hertford and Stortford (Mr Prisk) said:
“I am pleased that Hitachi has announced publicly that it intends to establish a new train assembly plant in the UK, should the Intercity Express Programme go ahead. We recognise that this would represent a significant boost to the economy in your constituency. This is to be welcome.”
The Foreign Secretary said in a speech in Tokyo on 12 August:
“I am…here to announce the significant new emphasis that the British Foreign Office will give to providing direct support to the UK economy, helping British business secure new opportunities in the emerging economies and putting our diplomatic weight behind British enterprise as well as helping to bring Japanese and other investors to Britain.”
He went on to say:
“We will work alongside British businesses and the rest of Government and other Governments around the world to use our political influence to help to unblock obstacles to commercial success”.
The Secretary of State for Transport met the president of Hitachi, and the Japanese ambassador, and talks have taken place between our Prime Minister and the Prime Minister of Japan because the issue is so important for bilateral relations.
I understand that a decision on the programme will be made as part of the comprehensive spending review. Will the Minister tell me whether the announcement will be part of the statement, or ancillary to it? How are the talks with Hitachi going since the Secretary of State made his written statement in July? How does the Department’s position marry up with the Foreign Secretary’s position that everything must be done to attract Japanese companies to Britain, and to remove any obstacles to that? What prospect does the Minister see for the north-east’s economy if the proposal does not go ahead?
I am not a deficit denier, but one way of solving the problems of the deficit is to increase the economy by increasing the private sector. The inter-city express programme and the Hitachi plan for locating in the north-east would do just that. When the decision on the inter-city express programme is eventually made, I hope that those who make it know the difference between slimming and starving, because starving the north-east’s economy is not the answer.
I am here today to promote the interests of my constituents and those of the north-east. There is great support in the region throughout businesses and parties. I hope that the Minister will consider these representations when her colleagues make the final decision on the inter-city express programme, and that they make the right decision. I believe she knows that that is to let the project go ahead.
I congratulate the hon. Member for Sedgefield (Phil Wilson) on securing this debate on this important issue.
Sitting suspended for a Division in the House.
Before the interval for voting, I was congratulating the hon. Member for Sedgefield on his passionate support for the IEP. I thank him for the correspondence that he has sent to the Department, setting out a number of the points that he has raised, and for the report that I received today on the case that he has prepared for the IEP project. I am grateful for all of those. My colleagues at the Department and I will be giving serious consideration to all the points raised in the report and in today’s debate.
I welcome the fact that the hon. Gentleman, alongside a delegation from his constituency and around the north-east, is due to meet my right hon. Friend the Secretary of State for Transport to put these points to him directly. The coalition Government have made it clear that rail has a key part to play in our transport strategy. Although our priority has to be tackling the deficit that we inherited, the Government fully recognise the significant economic benefits generated by investment in transport infrastructure—a point that has been explicitly acknowledged by the Chancellor of the Exchequer. Nevertheless, we must apply a rigorous cost-benefit analysis to all our planned infrastructure projects, targeting investment where it makes the most difference and where it will generate the greatest economic benefit.
That is the background against which we need to assess the future of the IEP. There can be no doubt that the project has encountered a degree of controversy since the previous Government embarked on it over half a decade ago. The objective was, as we have heard, to replace Britain’s fleet of InterCity 125 trains, and to invest in capacity and passenger journey improvements on the east coast and Great Western lines. The procurement process began early in 2007, and two years later, Agility Trains was announced as the preferred bidder. An important component of Agility is Hitachi, the manufacturers of the Japanese bullet train.
As we heard from the hon. Member for Sedgefield, Hitachi simultaneously announced its plans to build the new train order in the UK. This summer, the company announced that its preferred site for a new manufacturing facility is Newton Aycliffe in the hon. Gentleman’s constituency. As he has explained, that town has historic ties with the railways. As we heard today, Hitachi has said that it proposes to use the site in County Durham to bid for orders abroad, and has aspirations to export British-built trains to Europe. The parallel with the successful model used by many Japanese car manufacturers is obvious; it is a very positive example of what can be achieved. As the hon. Gentleman explained, the facility has the potential to create hundreds of new jobs, and potentially many more in supplier industries. He has put the case articulately and strongly for the economic benefit that will accrue to his constituents and the wider north-east.
Of course, such inward investment would be very welcome and entirely consistent with the Government’s stated goal of rebalancing the economy and promoting manufacturing industry. I take on board the strong points that the hon. Gentleman made about the skills base in the north-east, and how appropriate it would be to support a facility of the kind that Hitachi has announced the intention to build.
However, the hon. Gentleman will, I am sure, appreciate that the decision on the IEP needs to focus on objective and established procurement principles—namely, on whether the project provides the right solution for passengers and the railways; whether it delivers value for money, compared to the alternatives; and whether it is affordable for the taxpayer.
In its original form, the order would have been the single largest procurement of rolling stock ever, and one of the biggest private finance initiative transactions in British history. During the later part of 2008 and 2009, the capacity of the debt market contracted and the previous Government decided that it would be better to split the transaction into smaller parts.
The deteriorating state of the debt market was just one of the challenges that faced the project. A further issue arose when the previous Administration changed their mind on electrification. Having published in 2007 a long-term plan for the railways that had a limited role for electrification, the Government put out the tender for a fleet, with a significant proportion of diesel trains as part of the IEP proposal. Two years later, at the height of the contractual negotiations, the Government announced they had changed their views and proposed to electrify. That meant that the order had to be changed to an electric and bi-mode mix, which led to an increase in costs. By the time Labour left office in May, £26 million had been spent on consultancy and preparation costs, without the contractual close stage even having been reached. That has caused a degree of concern.
The project was in some difficulty when the previous Secretary of State, the noble Lord Adonis, decided to commission an independent review by Sir Andrew Foster. When it was published in July, the Foster report presented a measured and thoughtful analysis of the relevant issues. As the hon. Gentleman has correctly pointed out, Sir Andrew had some very positive things to say about the IEP. He described the proposition as “positive and attractive” in a number of ways. He described the PFI-style funding arrangements as
“novel and well-aligned in terms of financial incentives”.
He concluded that faster acceleration and longer carriages would have a positive impact on network and passenger capacity. He acknowledged that the specification had also taken network sustainability and environmental imperatives seriously. Unfortunately, he also had some concerns about the project. He concluded that the previous Administration had made a number of mistakes on the programme. In particular, they did not engage the railway industry well enough and had sought to micro-manage the process. Importantly, the Foster report also highlighted that although the project has always exceeded the Department for Transport’s economic thresholds, its value for money has seen a decline over time, while its costs have increased.
Although I acknowledge and am extremely sympathetic to the case made by the hon. Member for Sedgefield (Phil Wilson) on behalf of his constituents and the north-east, is the Minister considering carefully Sir Andrew Foster’s conclusion that he is not convinced that all credible alternatives to IEP have been identified? He sets out the case in his report for a short-term IC125 refurbishment, which would be both cost-effective and technically feasible. The skills, buildings and infrastructure enabling that work to be done already exist in places such as my constituency of Crewe, where Bombardier can already carry out that work.
My hon. Friend’s intervention is timely, as I am just about to come to that point. As he rightly says, Sir Andrew did make some points about the possible alternatives to the current IEP proposition.
In response to Sir Andrew Foster’s report, my right hon. Friend the Secretary of State for Transport announced that the Government would use the period up to the spending review to give further consideration to the future of the IEP. In accordance with Sir Andrew’s recommendations, the Government are reviewing all the credible options in light of value for money, affordability and their compatibility with the plans for further rail electrification. That means careful consideration of how the IEP proposal could be reduced in cost, and evaluating alternative ways of addressing the problem that the IEP was designed initially to solve—that is, how to address the problems surrounding the ageing high-speed train fleet. As my hon. Friend points out, the alternatives include the possibility of refurbishing and extending the life of the existing InterCity 125 rolling stock. In that regard, compliance with disability deadlines will be an important factor to bear in mind in the assessment.
One thing was omitted from the original planned routes for the implementation of IEP, and that is the inclusion of the London-Norwich line, to the great disappointment of the people who live along it. The problem is that the rolling stock is not only ageing, as is that of the high-speed train fleet, but actually the cast-offs from the main lines to the north-east and north-west. If the routes are to be renegotiated, I hope that the line will be included, but I have to say that this is a lunatic way to procure trains. We heard about the Austin Allegro, famously specified by civil servants. I would not like this to be a similar instance of specification by civil servants that is not suitable for industry.
Many parts of the network would like to have extra capacity, and I shall take my hon. Friend’s concerns on board as a representation. Regarding additional projects of that sort, it clearly all depends on what proves to be affordable, but we intend to learn lessons for the procurement process from the experience of the IEP.
As regards reappraisal of the original IEP concept, the Department has listened with great care to the ideas put forward by Agility on how to improve the value for money of its proposition, and I would like to put on record our sincere thanks to Agility for the diligent and constructive work that it has done, in contributing to both the Foster review and the re-evaluation process that followed. I am very aware that the issue is taken seriously in Japan.
Does the right hon. Lady agree with me that the answer is not to give the existing rolling stock a lick of paint, but to invest in the infrastructure? The rolling stock has been around since the 1970s, and the technology that we have brought on board through Hitachi is cutting-edge. The trains that it uses are comparable with the Javelin ones used in Kent, which are some of the best in the country. The kind of technology that Hitachi wants to bring on board is suitable for people in the north-east of England and elsewhere who would benefit from it.
I can assure the hon. Gentleman that the respective merits of the different options will be carefully and rigorously considered before a decision is made. This entire debate will be a helpful contribution to the decision-making process.
The hon. Gentleman mentioned that the Secretary of State for Transport has met the president of Hitachi, as has the Secretary of State for Business, Innovation and Skills. I have discussed the project with the former Japanese Minister for Transport, and the Minister of State, Foreign and Commonwealth Office, my hon. Friend the Member for Taunton Deane (Mr Browne), discussed the matter on a visit to Japan. We are taking the concerns of the Japanese Government on board in discussions on the process. Agility’s proposals are due shortly, and they are likely to include plans to standardise the design of the new trains, as was recently reported in the railway press. I am also advised that Agility expects to offer a significant cost-saving, while still meeting the specification that it was originally asked to meet. We will then be able to complete our assessment of both the IEP and the credible alternatives on an equal footing.
In conclusion, I would like to assure the hon. Gentleman that the Government will take into account the representations that we have received from him today, and the representations in the report that he has submitted to us, along with those that he and colleagues have made in the past. The decision on the future of the IEP will be made on the basis of the fullest possible evaluation of all the relevant matters. I am, of course, well aware that the recent period of uncertainty has been a cause for concern to those with an interest in the project, such as the hon. Gentleman and his constituents, and the Government really appreciate the patience shown by all concerned, not least Agility Trains. However, there is a complex interaction between the IEP and other key programmes under review as part of the comprehensive spending review. In light of that inescapable fact, it seemed impossible to make a sensible and objective decision on the IEP in isolation from the conclusions that we have to reach on those other interdependent projects, and from the overall decisions on the resources available for transport infrastructure.
Although the stage that we have reached means that I cannot give the hon. Gentleman all the answers on the programme, as he has kindly acknowledged, the Government are anxious to resolve the matter, and we will convey the decision to the House as soon as we can, as part of the spending review process in October. I thank the hon. Gentleman again for his contribution, and I look forward to continuing discussions with him on the subject. As I say, we will report to the House as soon as is practical regarding this decision, which is crucial not just for the north-east but for the future of the railway network in this country.
Fresh Produce Procurement (Prisons)
I am really pleased to have this opportunity to highlight an issue of some concern to me and, I hope, to convince the Government to put right a couple of misguided policies introduced by the previous Administration. Ministers not only have an opportunity early next year to take action on at least one of those policies; they also have the opportunity to promote the localism agenda that is at the very heart of the coalition agreement.
Until 2007, prisons were supplied with fresh produce by local suppliers, one of which, Brambledown (Kent) Ltd, is based in my constituency of Sittingbourne and Sheppey. Indeed, Brambledown used to supply a wide range of fruit and vegetables to both the Sheppey prison cluster and a number of other Kent prisons. In 2007, the then Government changed their procurement policy for prisons. They scrapped local supply contracts and introduced a national framework contract. That contract was awarded to a company called 3663 First for Foodservice, which is part of a multinational group based in South Africa.
I would have understood the logic of the previous Government changing their procurement policy if such a move was designed to save taxpayers’ money, but written answers that I have received to questions show that not to be the case. In the two years prior to the changeover, the average annual cost to the public purse for the provision of fresh produce to prisons was £8.7 million, whereas in the three years after the changeover it was just over £9 million. What those figures show is that the only people who appear to have lost out in this deal are the local suppliers who have seen their business plummet in the past four years.
To give an idea of the extent of the impact that the Government’s policy had on individual companies, Brambledown (Kent) Ltd saw its annual income from the Prison Service drop from £345,000 in 2004 to just £375 in 2008. I have spoken to a number of prison governors and they have confirmed what I suspected, which is that the service and quality of food have not improved under the national procurement regime, and prisons have lost their much-valued link with local suppliers. I think that if the Minister were to ask governors, he would find that many of them would welcome the opportunity to purchase more of their fresh food locally, because it enhances their position in their local community.
Of course, one advantage of buying from local suppliers is that often much of the produce is grown locally, which leads me neatly on to another aspect of the previous Government’s procurement policy: the Government’s lamentable record on supporting British farmers, producers and processors. The Department for Environment, Food and Rural Affairs publishes statistics that show the proportion of domestically produced food both used by Departments and supplied to hospitals and prisons under contracts negotiated by the NHS supply chain and the National Offender Management Service. Coincidently, the latter was established in 2007, the same year as the food procurement policy for prisons was changed. Or perhaps that is not a coincidence, because the decision to change the procurement policy and the decision to create the National Offender Management Service were, in my view, equally misconceived. Setting aside the merits of those particular policies, the statistics contained in the DEFRA document make interesting, but very depressing, reading, particularly coming as I do from a constituency in the garden of England with a sizeable farming community.
Let me quote a handful of product groups from DEFRA’s statistics. Just 2% of poultry used by the Prison Service comes from British producers. A miserable 18% of pork meat is home bred. If we think that is bad, it gets worse. The proportion of orchard fruit, which includes apples, pears and plums, that the Prison Service sources from domestic producers is 0%. Not a single apple sourced by the Prison Service comes from domestic producers, and the same goes for soft fruit and bacon, which to my mind is scandalous and deeply unpatriotic.
No doubt I will be told that foreign produce is cheaper, but I do not accept that argument; cheap is not always best. It might be that buying French Golden Delicious apples instead of Braeburn apples from Kent is superficially advantageous. However, when one considers the harm being done to British farmers by this policy and the impact that transporting fruit and vegetables long distances in chilled containers has on our carbon footprint, buying local starts to make an awful lot more sense.
I hope that my hon. Friend the Member for Reigate (Mr Blunt), the new Prisons Minister, and his colleagues in other Departments will pursue a different procurement policy from that of the previous Government, who set a very bad example. How can we expect consumers to support British farmers if Ministers are not prepared to do so? Let us not forget that it is taxpayers’ money that Ministers are spending. I am pretty sure that British taxpayers would much prefer their money to be spent on British food.
I urge my hon. Friend to do two things that would make him popular not only with farmers in my constituency but with the public at large. These days, being popular with anybody is a very rare thing for a politician. First, I should like the Minister to issue a guidance note to his Department officials instructing them always to purchase domestically produced goods unless doing so would place a disproportionately high burden on the taxpayer. Secondly, I should like my hon. Friend to refuse to renew the national framework contract when it comes up for renewal next May, and instead revert to a system of allowing prisons to enter into contracts with local suppliers. Pursuing such policies would help to promote the coalition Government’s localism strategy, and that must be worth a brownie point to any Minister.
I congratulate my hon. Friend the Member for Sittingbourne and Sheppey (Gordon Henderson) on securing this important debate, and I am grateful to him for providing me with the opportunity to examine our strategy in this area and to see whether it should change when the contracts come up for renewal next May. There is a significant attraction in my hon. Friend’s arguments. Anyone arguing for a politician to be popular is likely to be on pretty strong ground. He helpfully outlined his arguments to the Ministry of Justice, which has enabled me to provide a comprehensive answer to him.
Before I focus in depth on my hon. Friend’s remarks, I should like to respond to the point he raised in a letter to me in September concerning Brambledown (Kent) Ltd. He kindly told us in private that we appeared to have missed that company off the list of contracted suppliers, which gave me the opportunity to examine the position without public embarrassment to the Ministry if we got our answer wrong. He was correct to say that Brambledown did not appear on the list of contracted food suppliers. The reason for our response, which did not mention Brambledown, is that it was not a contracted supplier to the National Offender Management Service, but it continued to supply the Sheppey cluster of prisons under existing local ad hoc arrangements. That continued until an electronic ordering system was introduced in 2007-08, which brought the transitional arrangements to an end.
Contracted suppliers are those who are awarded contracts to provide goods to prisons following a fairly contested tender process, which ensures that they meet minimum criteria and are capable of meeting the Department’s requirements. The response listed 18 fresh produce suppliers who were contracted to supply prison sites.
Despite the charm and skills with which my hon. Friend made his case, there is a strong argument for the existing method of supply. Food supply contracts that are awarded by the Ministry of Justice, particularly those for prisons, are not just a straightforward matter of whether the supplier operates on a national or local basis. There are many key factors in deciding the best approach and I should like to share a few of them with the Chamber.
Operational concerns are very much at the forefront of our decision making. It is worth remembering that discontent about the quality of food, changes to menus, and failure to deliver what was previously promised have been known to be the catalyst for serious disturbances. As well as being a key issue in control, food demonstrably contributes to prisoners’ overall well-being. A high proportion of prisoners are from socially excluded sections of the community, with lifestyles that are more likely to put them at risk of ill health than the rest of the population. Many have never registered with a doctor or a dentist, have drug habits and/or mental illness and live chaotic lives without a stable home. Prison gives an opportunity to improve the health and lifestyle of prisoners to the benefit of all, and diet is a major component of a healthy lifestyle.
Prisons aim to provide food that is nutritious, well prepared and served, reasonably varied and sufficient in quantity and that also meets a range of religious and cultural needs. Inadequate portion sizes, lack of variety and poorly cooked food can contribute to serious complaints and dissention. Providing prisoners with the opportunity to choose a healthy, nutritionally balanced diet, with enough knowledge to make informed choices, is important because prisoners can be in custody for long periods and are largely dependent on prison food.
Then there are the commercial and supply chain considerations. In the 2009-10 financial year, the Department spent around £60 million on food for prisoners. Although that is a big sum in itself, it amounts to an average cost of just £2.22 per prisoner per day for all food and beverages. Given that contaminated food can have disastrous consequences among a closed prison population, those costs have been achieved against a background of tight regulation and control.
I could go on with the list of factors that require consideration, and I have not even begun to touch on the environmental footprint of the vehicles that deliver food. The point is that any contractor appointed to supply food to prisons must meet all of those stringent criteria. Typically, smaller suppliers do not have the organisational infrastructure and resilience to meet the requirements day in, day out, which results in a higher proportion of contracts being awarded to larger suppliers.
Before moving on, I should also point out that the choice of a supplier that operates nationally as opposed to just locally does not mean that the produce is not sourced locally. That is an issue for our supplier—in this case it is 3663. National operators draw heavily on domestically produced food and will obviously use it when it makes commercial sense to do so. It is also not the case that our arrangements cause unnecessary mileage in delivery. National operators often have regional depots and use them to keep their mileage and costs to a minimum. Because those depots can carry the full range of products required by a prison, they are able to send just one vehicle to that prison, whereas several vehicles would be used by a number of locally based suppliers to fulfil the same overall requirement.
I will now turn to the specifics of the current food supply arrangements serving prisons. The Department uses two contractors to fulfil its requirement for food. The first of these, 3663 First for Foodservice, provides groceries, fresh produce, chilled and frozen food. The other supplier, Hovis, provides fresh bread and morning goods. Contracts with those suppliers have operated since 2007 and they offer 1,500 products for prisons to create meals with.
The delivery of products is only the beginning of the meals service. The 128 public sector prisons in England and Wales employ about 1,050 catering staff and 3,500 prisoners to prepare the food for more than 75,000 prisoners each day of the year, which amounts to more than 82 million meals a year, all served at predetermined times through 900 service points. That service is particularly challenging, given the tight financial constraints that prison kitchens must operate under.
Prisoners are provided with three meals a day, choosing from a multi-choice, pre-select menu system that is compiled to cover a minimum of four weeks. That menu format takes account of seasonal variations and prisoners’ preferences, and it is capable of meeting differing dietary requirements, such as vegetarian, vegan and religious meals.
Prison governors bear the ultimate responsibility for prisoners’ diets. They are required to approve food as being fit for service to prisoners and to approve local food budgets. The prison kitchens are run by catering managers, who are responsible for implementation of standards, training of staff and control of the food budget.
I hear everything that my hon. Friend has said and it is quite logical. He says that it is the governors’ responsibility to ensure that inmates receive proper food. However, why is it that the governors themselves would prefer to revert to using local suppliers?
I heard what my hon. Friend said about that issue. I confess that, in the visits to 20 or so prisons that I have already made, I have not discussed the issue of food supply with governors. Food supply has not been raised with me directly as an issue of concern for the governors. Following this debate, however, I will make my own inquiries on my future visits to prisons as to whether there is an issue about food supply. I am looking at all the services that are provided in prison, to see whether nationally provided services are better than locally provided services or not.
I will quite happily share my prejudice that I would prefer it if things were locally managed and locally resourced. As far as I am concerned, there needs to be a pretty high test to move to a nationally provided system. As my hon. Friend will have gathered from the tenor of my remarks, on the basis of what I have seen so far the argument that I am making is that I actually think the national food service supply chain that we have at the moment is meeting that test. However, as I get to the end of my remarks I may give him a little glimmer of hope.
More than 20,000 items of food are ordered each week across all temperature ranges. That means that the total cost of the delivery of food per day tops £230,000. To put that into perspective, it is equivalent to visiting a cash and carry warehouse to empty the shelves each day. Even if such visits were practical, there could be no guarantee of the consistency or the completeness that the prison environment demands.
The supply chain infrastructure to support this volume of food is significant and yet it also manages to deal with a wide variety of prison locations. Those locations range from Victorian prisons, which have small entry gates, low arches and limited turning space, to prisons in city centres and prisons in rural areas, which are accessed by small country lanes that vehicles have to negotiate. Few prison buildings are conducive to the delivery of the volume of food that is required and yet deliveries must be made each day, without fail, to ensure the continued running of the prison.
As I mentioned previously, food deliveries are made from a number of regional supplier depots. The deliveries are consolidated as far as possible, given the constraints that I have just outlined, so that the number of gate openings and associated security risks are minimised. Each delivery can take up to two hours to complete, depending on the security and regime of the prison. For that reason, deliveries are centrally co-ordinated to an exacting timetable. That maximises the efficiency of deliveries and minimises their impact on the prison operation.
Hovis and 3663 have introduced consistent working practices in their depots for their contracts with us. That means that each depot is easily able to support other regions in the event of a supply chain interruption. The two suppliers that are in place have been rigorously tested through open and fair competition, to ensure that they are capable of managing deliveries into prisons and can support those deliveries with robust contract management. There is little as challenging in this field as procuring food for the 82 million meals that are served in prison each year, given the limited facilities offered by prison kitchens and the tight financial constraints that they have to operate under.
The food suppliers comply with central specifications, to ensure that all food that is delivered is of good quality, safe and free from any contamination. Products are tested, where appropriate, to ensure that quality and quantity standards are met.
Reliable management information gives prisons the assurance of safety, traceability, provenance and quality that they need for the prison regime to operate with confidence. Central to that relationship between prisons and suppliers is the confidence that the suppliers can provide consistency. An undersize apple handed out at the servery will create issues of order and control, so we use suppliers that are sensitive to that need and that use their sourcing ability to maintain consistency from their supply base.
I apologise to my hon. Friend, who is a representative of the garden of England, that I used the example of an apple just now. [Laughter.]
Happily, the effect of this existing contract is that that is not a matter for me; it is a matter for our supplier, which is 3663. It is its responsibility to procure apples for us. I do not know the details of its apple procurement contract and I am delighted that I do not have to know them. As I say, that is a matter for 3663.
It is very proper for my hon. Friend to pursue that point with 3663 on behalf of his local orchards—to ask, “Why not? Why are these local orchards unable to compete in that way?” Like him, I have a prejudice in favour of domestically produced food and as long as the interests of the taxpayer are protected, of course we should be buying British.
Both suppliers—3663 and Hovis—are large national organisations. That is appropriate to the needs of the Ministry of Justice in terms of volume, spend and complexity. An arrangement such as the existing one exploits the capabilities of large suppliers in terms of volume leverage, sourcing capability and relationships with brand manufacturers. It provides more product choice, given that large suppliers have access to wider product ranges and have a strong capability in procuring from specialist subcontractors, hopefully including suppliers of Braeburn apples.
There are some other factors to consider in the type of supplier tiering that is being promulgated. The EU procurement directives preclude the Ministry of Justice from negotiating with suppliers on prices, but the main contractors can negotiate with subcontractors on prices and pass on the benefits. In addition, small and medium-sized enterprises are spared the costs of having to conform to onerous public procurement processes and the costs of having to interface with Government e-procurement systems, because the main contractor does it for them.
Furthermore, the supply chain risks rest with the main contractor, which allows prison caterers and governors to focus on the day-to-day operation of their prisons. The unit prices currently paid by each prison reflect that. Consequently, they are homogeneous and fully inclusive of all risks. Unit prices also cover charges for keeping vehicles waiting and they do not vary according to the actual cost of delivery or indeed the number of deliveries.
Any attempt to base prices on local circumstances would introduce complications into budget allocation. In other words, prisons that could benefit from low delivery charges would have to release part of their budget to those prisons that would have to pay more because of their remote location.
Prices are carefully managed and are determined by the price of the raw commodity, the costs of processing and packaging, transportation and distribution costs, overheads and an element of profit, which is around 1%. The cost to serve the contract is spread across the total range of products, keeping administrative and management costs to a minimum. The cost to provide meals varies from prison to prison. That is due to the differences in the prison populations and the choice of products ordered, which vary depending on the age, sex and cultural mix in the prison.
I know that my hon. Friend regards value for money as being extremely important. Value for money is tested and secured throughout the life of each contract. Prices are examined through open-book reviews and by reference to commodity indices. The Ministry of Justice undertakes monthly product reviews to determine the optimum spend profile for each product area. Each opportunity to improve on efficiency or to save money, without detriment to the quality of the product, is thoroughly explored.
I am advised that overall this national contract, which is being maintained in an era of high food price inflation—10.5% in 2009 and 4.1% for the current year so far—will deliver £5.1 million of cash savings during the period of the contract, between 2007 and 2011. When inflation is factored in, the real savings to the National Offender Management Service run to tens of millions of pounds.
However, product price is not the only driver behind contracts. Underpinning them all is the need to support prisoners and rehabilitate them back into society. When 3663 recently opened a new depot in Kent, it sought prisoners on release to form part of its new team. Subsequently, 11 ex-offenders were employed in depot operations, benefiting the supply base, the community and the Ministry of Justice.
Social sustainability is only one element of the total cost to the Department. A false choice is often posited between value for money or efficiency and sustainability. Unsustainable procurement is not good stewardship of taxpayers’ money. The Ministry of Justice is committed to reducing its impact on the environment by continuously improving the environmental performance of its operations and estate. For example, 3663 delivers virgin cooking oil to prisons. After use, the waste vegetable oil is collected by a national oil collection company and sent to a third-party operator for recycling and conversion into biodiesel, which is then returned to the 3663 depots, where it is used to fuel trucks loaded with supplies for delivery to prisons, thus completing the circle and reducing distribution costs for the Department.
The supply of food is of significant benefit in reducing risk and contributing to the overall objectives of the Ministry of Justice. Nevertheless, given the importance of food in prisons, we will re-examine how it is delivered and consider every option. If my hon. Friend, who has listened to my arguments in this debate as I have listened to his, can identify further proposals, I invite him to continue this conversation. It need not take place formally on the Floor of the House, but I am happy to listen to any further submissions that he wishes to make.
The timing of this debate is ideal, given that the current generation of contracts is due to expire in May 2011 and that planning is already under way. In considering every option, I want not just to look at the obvious but to challenge thinking on the issue. For example, most of what used to be a large network of farms and market gardens operating in prisons were closed in the past decade. There is certainly merit in revisiting the idea in order to make prisons more self-sufficient, lower costs, and get more prisoners working. About 425 prisoners already assemble some 100,000 breakfast packs every day as part of a supply chain developed with our current suppliers.
To conclude, this has been an excellent opportunity to discuss a subject that might seem uninspiring and that risks being considered simplistically. As I have outlined today, it is complex and of great importance, so I will be paying close attention to the development of policies and procurement strategies in the area. I welcome the attention that my hon. Friend has given it and the constructive contribution that he has made with this debate.
Question put and agreed to.