Skip to main content

Westminster Hall

Volume 523: debated on Wednesday 9 February 2011

Westminster Hall

Wednesday 9 February 2011

[Philip Davies in the Chair]

Neuromuscular Care (North-West)

Motion made, and Question proposed, That the sitting be now adjourned.—(Paul Burstow.)

I thank Mr Speaker for allocating time for this important subject. I pay tribute to the excellent Muscular Dystrophy Campaign, which does such brilliant work in this field and has assisted me in preparing for the debate. This morning, I will bring to the attention of the Minister the significant gaps in specialist neuromuscular care services in the north-west region that many people living with muscular dystrophy and related neuromuscular conditions currently experience. Vital review work undertaken by the NHS North West specialised commissioning group in the past six months is encouraging, but families need to see it translated into real improvements to services. It also provides an opportunity to improve patient outcomes and to reduce the amount of money spent on unplanned emergency admissions to hospital for people in the north-west with neuromuscular conditions.

Let me briefly outline my personal connection to muscular dystrophy. I am 47 years old, and I had a cousin, Stephen Payne, who, if he was still alive today, would be of the same age. He was diagnosed with Duchenne muscular dystrophy at the age of six, and I remember the devastating effects that it had on our family. This was in the late 1960s, when not a lot was known about the condition. I remember my uncle, Mr Barrie Payne, taking his son to Harley street for a diagnosis. I am afraid to say that it was not good. None the less, Mr Barrie Payne is a fighter and a campaigner and he threw all his energies into fundraising to see if a cure could be found for Duchenne.

My very earliest memories, therefore, are of a family fighting and campaigning for a cure for that dreadful disease. I also have very early memories of politicians getting involved in this vital subject. I pay tribute to Lord Alf Morris of Manchester, who, at the time, was the MP for Wythenshawe. Coincidentally, Lord Morris’s sister lived on my council estate, and I remember him driving to our estate in his Wolseley car. At the time, those cars were for very special people. He came to see my family when he visited his sister and I remember thinking at the time what a special man he was. In those days, in the ’60s and ’70s, it was thought that politicians could help ordinary people from working-class backgrounds such as mine. I remember so well the work that my family and Mr Morris did to get a change in legislation. I am pleased to say that Alf Morris was behind the Chronically Sick and Disabled Persons Act 1970, which was the first Act in the world to give rights to people with disabilities.

I did my best to raise money for the muscular dystrophy charity. I used to sell pens, pencils, rulers and pencil cases in my school yard at primary school. Imagine a head teacher allowing a child to go into school with a bag full of goods to sell for cash in these politically correct times. Coincidentally, my head teacher lived next door to my cousin, Stephen Payne, and at school fairs he used every opportunity to raise money for muscular dystrophy.

My uncle continued to campaign to raise money and awareness. People in wheelchairs were often not allowed access to places such as airports and museums, which led to considerable arguments. My uncle rightly felt that people with disabilities should be allowed in. I am glad to say that in the 21st century, things are a lot different.

Stephen was a bright and articulate individual, and he was always forthright in his opinions. He was a Manchester City fan, while I was a Manchester United fan. When Manchester United got relegated in 1973, he certainly let it be known how pleased he was about that. Stephen died in California when he was 21. His peers died when they were in their very early teens, which just goes to show that palliative care and hydrotherapy can extend the lives of people with Duchenne.

The Muscular Dystrophy Campaign is the leading UK charity and focuses on all neuromuscular conditions. It is dedicated to improving the lives of all people with such conditions. Founded in 1959, the Muscular Dystrophy Campaign funds vital research, provides and supports care services and gives information, advice and direct help to individuals living with neuromuscular conditions. I am honoured to be a member of the all-party parliamentary group for muscular dystrophy, which has highlighted shocking gaps in service across the UK and continues to call for improvements in access to specialist neuromuscular care to follow up recommendations in the Walton report.

There are more than 60 types of muscular dystrophy and related neuromuscular conditions. It is estimated that more than 1,000 children and adults in every million of the population are affected by muscle-wasting neuromuscular diseases—in the north-west around 8,000 people in total. Such disorders can be genetic or acquired. A number of conditions, such as Duchenne muscular dystrophy, are particularly aggressive. They cause progressive muscle wasting, weakness, orthopaedic deformity and cardiac and respiratory compromise, and result in premature death. Many young boys in the UK with Duchenne muscular dystrophy are dying before they get beyond their teens; that is unacceptable.

Specialist multidisciplinary care has been developed by leading clinicians as the best model for delivering effective care for such complex multi-system diseases. The provision of expert orthopaedics and early cardiac monitoring and intervention has been shown to improve muscle function and maintain independent mobility. People with neuromuscular conditions, therefore, need specialist multidisciplinary care, support and intervention from a range of professionals and specialists. That was recognised as part of the specialised services national definitions set. Leading neuromuscular clinicians fought hard to get those services recognised as specialist by the Department of Health.

Specialised services are defined in law as services with a planning population of more than 1 million people, which means that a specialised service is not provided by every hospital in England. The SSNDS describes the services in more detail. The definitions provide a helpful basis for service reviews and strategic planning, which enables commissioners to make comparisons of activity levels and spend. They help with the identification of activity that should be regarded as specialised and therefore subject to collaborative commissioning arrangements. The 10 specialised commissioning groups, acting on behalf of the members of primary care trusts, are responsible for the commissioning arrangements for specialised services.

Neuromuscular conditions come under the auspices of a number of specialities; they are genetic conditions, so geneticists sometimes deal with patients. The conditions sometimes affect children, so paediatricians are involved. A number of the adult forms come under the heading of neurology. Some of the conditions require respiratory care, which is provided by a respiratory practitioner, and some are metabolic conditions such as Pompe, and patients are treated by specialists for metabolic disorders. Therefore, health care for people is quite fragmented, and that clouds professional responsibility. “Neuromuscular” must be recognised as a speciality along with neurology.

Dr Ros Quinlivan, a leading consultant in paediatrics and neuromuscular disorders, has outlined the effects of neuromuscular conditions and how they need to be managed:

“Neuromuscular conditions are rare and include: Muscular dystrophies, metabolic myopathies, congenital myopathies, inflammatory myopathies, Spinal Muscular Atrophies. Many of these conditions affect only skeletal muscle and thus cannot be considered to be neurological disorders, in fact skeletal muscle can be considered to be the largest organ in the body. Most neuromuscular disorders are genetic in origin and affect families, but the inflammatory myopathies are acquired and require specific treatment. Affected patients range from newborn infants to elderly people. The effect of many of these conditions is on the skeleton causing skeletal deformities due to muscle contractures and on the heart and lungs causing respiratory or cardiac failure which can significantly limit life expectancy.

The physical management of these disorders is quite distinct compared with conditions affecting either the nervous system or the musculo-skeletal system (bone and joints). Proximal and axial muscle weakness caused specific functional difficulties not seen in patients attending clinics in other specialist areas. The progressive nature of these conditions means that a multi-disciplinary approach to care, with experienced clinicians specialising in neuromuscular disorders, is essential to achieve the best outcomes.”

It is now felt by the clinical community that it is time to make a neuromuscular curriculum part of the medical career, to establish the neuromuscular field in its own right. The conditions have a lot in common, so it makes sense that they are treated by the same person. For example, some forms of limb-girdle muscular dystrophy exhibit similar symptoms to some forms of spinal muscular atrophy, but one is a muscle disease and the other more a neurological disease. They are long-term rare conditions, which makes them quite different from neurological diseases such as Alzheimer’s and Parkinson’s.

Neuromuscular services need to be commissioned on a regional basis. Currently they are commissioned by the 10 regional NHS specialised commissioning groups, with top-slicing of PCTs. That method of commissioning services for these rare and very rare conditions has been endorsed by a new body of experts, the British Myology Society. It makes no sense for one PCT to commission specialised services. Unlike conditions such as Parkinson’s or multiple sclerosis, there are no guidelines from the National Institute for Health and Clinical Excellence for these neuromuscular conditions, which presents real difficulties when trying to set standards of care across the country.

That situation has been a contributing factor to the postcode lottery that has arisen, and which was highlighted in the all-party group on muscular dystrophy’s Walton report, published in August 2009. That followed reports by the Muscular Dystrophy Campaign, as part of the charity’s “Building on the Foundations” campaign, which revealed the shocking lack of specialist care in many parts of the country. The lack of knowledge, training and skills in the sector is a significant concern. For example, there is no specific training or curriculum for neuromuscular services in the neurological field.

I am sure that hon. Members will share my concerns and the frustrations of people living with neuromuscular conditions in the north-west, as expressed in the Muscular Dystrophy Campaign’s patient survey in 2010. Deborah Hurst from Liverpool is affected by facioscapulohumeral—FSH—muscular dystrophy. However, she was not diagnosed with it until she was in her late thirties. She is now 47. Her two daughters were born before she was correctly diagnosed and one of them, who is now aged 25, has inherited the condition. Deborah says:

“I have two daughters and I knew one was affected, but the doctor told me I was fussing and silly. When I finally got them tested, he congratulated me on my actions, which I was very mad about as my daughter took her diagnosis very badly at the time and ‘congratulations’ was not what we wanted to hear.”

Mrs H from Lancashire has a son affected by a neuromuscular condition. She says that in her experience, GPs do not understand such conditions:

“My GP is very good but says, ‘We have about two hours of tutorial on muscular dystrophy in the whole medical training.’ So therefore they have no in-depth knowledge.”

Elaine Sands from Stockport is also affected by FSH muscular dystrophy. She does not receive any specialist care, but she would value the support of a neuromuscular care adviser. She says:

“As I am housebound, it would be nice to have someone give me physiotherapy and also some kind of visitor who knows about my condition, as I live alone and I would appreciate being able to talk to someone who understands the disease.”

However, the situation is different for Joanne Ashton. She has a five-year-old son, Liam, who has Duchenne muscular dystrophy. Through the specialist neuromuscular service at Alder Hey hospital, Joanne and her family have access to a specialist consultant, Dr Stefan Spinty, and to a full multidisciplinary service, including a neuromuscular care adviser. Joanne says:

“Shirley, our Care advisor, is fantastic. We only have to ask and she’s there. Liam had his wish granted, through the “Make A Wish Foundation”, because he was nominated by Shirley. So we are all impressed with the care advisors.”

The Muscular Dystrophy Campaign’s clinician-led report, “Building on the Foundations in the North West”, which was published in June 2009, made a number of findings about neuromuscular services in the north-west.

I thank the hon. Gentleman for giving way and I congratulate him on securing this debate. He has rightly referred to the issue of care advisers. Obviously I understand that the north-west of England is his particular concern, but does he agree that if more emphasis were put on having excellent care advisers right across the UK, like the adviser who he has just referred to, that would help those who suffer from this condition immensely in trying to come to terms with it?

I thank the hon. Gentleman for that intervention. I wholeheartedly agree. When someone is suffering from a condition, there is nothing quite like having people trying to help who understand what they are going through, both physically and mentally. So I wholeheartedly agree.

As I was saying, the “Building on the Foundations in the North West” report found that three out of four neuromuscular patients and their families have no access to a key worker or a care co-ordinator. About 6.5 regional care advisers are needed to serve the estimated 8,000 people —which is up from an earlier estimate of 6,500 people—in the north-west area who have a neuromuscular condition. Many of those people are simply not known to providers of health services.

The report also found that neuromuscular patients have very limited access to treatment, in particular to ongoing physiotherapy. Specialist physiotherapists are required to support outreach clinics and to provide training and professional development for community physiotherapists. In the north-west, two fifths of neuromuscular patients said that they do not receive enough physiotherapy.

Another finding of the report was that there is no dedicated physiological service for neuromuscular patients, despite the importance of such a service as part of multidisciplinary care for that patient group, who have rare and very progressive conditions. Those conditions are often genetic, there are no known cures and there are only limited treatments available. Greater support at the transition from paediatric services to adult services is needed, given the evidence that services are removed or greatly reduced when patients leave paediatric services, even though their needs may well increase given the progressive nature of many of these conditions.

I thank the hon. Gentleman for giving way and I congratulate him on raising an important subject. In fact, he highlights a very significant problem. If I understand him correctly, he is saying that we need an adequate clinical network for the rare disease that he is speaking about and a range of providers need to be joined seamlessly, as it were, in some way for the good of the patient. Normally, we expect the strategic health authority to identify the failures to provide such a seamless service and to somehow levy the PCTs to deliver it, which the patients expect and deserve. Is he saying that the central problem is how such a service will progress under the new arrangements, when PCTs, SHAs and other such organisations, which are mandated to resolve these problems, no longer exist?

I thank my hon. Friend for that intervention. He makes a very good point. The new arrangements are a threat, but they are also an opportunity, because services are currently provided by the PCTs but not all of them understand these neuromuscular conditions. The new arrangements are a real opportunity for the Muscular Dystrophy Campaign to get its point across, so that we get off on the right foot when the changes come in. However the GP-led consortia really need to understand and appreciate what is required. It is about having a holistic approach. Shortly I will discuss an excellent neuromuscular centre in Cheshire, which makes a huge difference to patients. It encompasses physiotherapy and the other aspects of care that make life so much more comfortable for those people who have muscular dystrophy.

I apologise to the hon. Gentleman and to you, Mr Davies, because I will not be able to stay for the duration of the debate. Consequently, I will not find the answer to the problem that I have just referred to.

I apologise to my hon. Friend for intervening immediately after another intervention. He has just raised an interesting point about the transition from paediatric services to adult services. In my own area of the south-central region, which is clearly outside the geographical area that is the focus of this debate, we have recently managed to secure at least an advertisement for a new care adviser in the area. However, I understand that that care adviser will not be able to advise on paediatric conditions but only on transition and adult services. Is it not the case that we need a full range of services for all sufferers of this disease and a proper range of advice across all ages?

My hon. Friend makes a very good point and I totally agree. A holistic approach is needed and there should be a seamless transition from being a young person and receiving paediatric services to receiving adult services. However, this point does not just apply to muscular dystrophy. For example, lots of mental health care services suffer from similar problems. Nevertheless, my hon. Friend is quite right. There should be a seamless transition from one service to another.

Greater support at transition from paediatric to adult services is necessary to provide evidence of services being removed or greatly reduced when patients leave paediatric services, even though, as I have said, their needs may well increase given the progressive nature of many of these neuromuscular conditions. There is a three-monthly transitional clinic in Manchester and a monthly transitional clinic that alternates between Alder Hey children’s hospital and the Walton centre, which are both in Liverpool. Both those services—in Manchester and Liverpool—are extremely vulnerable and entirely dependent on the availability of their respective consultants. A transitional clinic at Preston is evolving, but it is not formally funded and is based on the good will of the clinicians. The transitional clinic at Alder Hey children’s hospital is the only one that is attended by the required multidisciplinary team. None of the transitional services in the region is funded or appropriately staffed.

The Walton report, published in August 2009, expressed the concerns that the all-party group on muscular dystrophy developed as a result of its inquiry into access to specialist neuromuscular care. Martyn Blenkharn, chair of the Muscular Dystrophy Campaign’s North West Muscle Group, expressed in written evidence to the all-party group his frustrations about attempts to access NHS physiotherapy:

“No hydrotherapy available in the area - private arrangements can be made, but no assistance from NHS physiotherapists can be obtained. Compared with the previous PCT area (North Cumbria) which covered the area where I used to live, the service in my current PCT area (North Lancashire) is totally unsatisfactory - the quality of care from those who treat me directly is fantastic, but their hands are tied to provide what is really needed.”

The all-party group concluded in its regional summary about the NHS North West region:

“We heard from clinicians in the North West region about the problems facing the multi-disciplinary North West Neuromuscular Network - founded and chaired by Dr Stefan Spinty, Consultant Paediatric Neurologist and lead neuromuscular clinician at Alder Hey Children’s Hospital, Liverpool. Dr Spinty is currently managing this vital network single-handedly without any funding. We believe that the Network should at least be supported by a Network Coordinator. Greater support at transition from paediatric to adult services is also needed, given the evidence of services being removed or greatly reduced when people leave paediatric services. Existing transition services are extremely vulnerable and we were concerned to learn from clinicians that none of the transitional services in the region are funded nor appropriately staffed. Having met with commissioners from the North West Specialised Commissioning Group to discuss these concerns, local clinicians and representatives from the Muscular Dystrophy Campaign were disappointed to be told that there are competing priorities in the region, and that PCT budgets were under strain. We urge the North West SCG and the local PCTs to undertake a service review to address the weaknesses highlighted by clinicians, patients and the Muscular Dystrophy Campaign.”

The NHS North West specialised commissioning group has taken significant steps forward since those findings, and I will outline them shortly.

The North West Muscle Group raises awareness of neuromuscular conditions and provides a forum for people living with the condition to share experiences and advice about access to local and regional services. Since its launch in June 2009, the group has been actively campaigning to improve access to neuromuscular services in the region, engaging with MPs and with the NHS North West specialised commissioning group. Pressure from the North West Muscle Group, alongside the Muscular Dystrophy Campaign and the all-party group, was instrumental in ensuring that the NHS North West specialised commissioning group conducted a thorough review of neuromuscular services.

Joanne Ashton, a member of the North West Muscle Group, commented:

“I’m glad I joined the Muscle Group. It means I’ve got all this information early on and I won’t come up against a brick wall later - I feel I’ve been pre-armed. It’s nice to know I’m not on my own and it’s good to meet other people at different stages. Every day I imagine how bad things could get, but at the Muscle Group I met young lads with Duchenne muscular dystrophy who are in wheelchairs and they’re fantastic, they’re doing so well. Everything had a real positive spin on it too, and I realised that it’s not all doom and gloom.”

The campaign in the north-west was further spurred on by a comment made by Mike Farrar, NHS North West’s chief executive, to Lord Walton of Detchant at an event in Parliament in November 2009. Having referred to the review of neuromuscular services in the south-west, which Sir Ian Carruthers, NHS South West’s chief executive pushed through, Mike Farrar commented:

“Anything Sir Ian Carruthers can do, we can do better”.

As a result of lobbying by the Muscular Dystrophy Campaign, a review of services was set up in the NHS South West specialised commissioning group in February 2008. In February 2009, local primary care trusts approved a new £1 million neuromuscular strategy to reduce the £6.9 million spent in the region on unplanned emergency admissions to hospital for people with neuromuscular conditions.

I am fully aware, as are several hon. Friends, of the excellent work by the NeuroMuscular Centre in Winsford, Cheshire, which is in the constituency of my hon. Friend the Member for Eddisbury (Mr O'Brien). That centre provides ongoing specialist physiotherapy, which reduces the number of falls among people with neuromuscular conditions, and it also offers social enterprise opportunities. However, although the physiotherapy provision is regarded as excellent by those who go to the centre, difficulties are encountered with PCTs and funding, as reported in the Muscular Dystrophy Campaign’s patient survey 2010. Mr A from Cheshire has Charcot-Marie-Tooth disease and travels to the centre for specialist physiotherapy and hydrotherapy, but his local PCT is unwilling to pay, despite not offering him any alternative physiotherapy or hydrotherapy provision. Following concerted pressure by the Muscular Dystrophy Campaign, the North West Muscle Group and the all-party group, Jon Develing, chief officer of the NHS North West specialised commissioning team, made a personal commitment to the all-party group in January to recommend that the NHS North West specialised commissioning group undertake a review of neuromuscular services.

The review was set up by the commissioning group in May 2010, and the steering group set up an effective model for the NHS working with the Muscular Dystrophy Campaign, patients and expert clinicians from the region. To further involve people living with neuromuscular conditions, a stakeholder day was held in September 2010, which represented a vital opportunity for people to have their say about the services that are crucial for an acceptable standard of specialist neuromuscular care in the region. That led to a gap analysis and a report with recommendations for service improvements— the first time ever that neuromuscular services have been looked at in this way, across the whole region.

The recommendations are currently being put to local primary care trusts to approve new investment for a neuromuscular strategy. The proposed minimal required investment to reduce the £13.6 million spent on unplanned emergency admissions to hospital for neuromuscular conditions and to sustain neuromuscular services across the north-west includes 2.5 new fully NHS-funded care advisers, 2.5 specialist consultants, two to three specialist physiotherapists and one specialist neuromuscular nurse.

Will the Minister agree to write to the specialised commissioning group and to PCTs, endorsing the recommendations as necessary steps to save money and reduce unplanned emergency admissions? Will he ensure that a named individual in the NHS in the north-west will take the work forward once the specialised commissioning groups disappear? The neuromuscular network approach is hugely important to ensure the co-ordination of neuromuscular services in specialist multidisciplinary teams, as demonstrated in the south-west of England and by the Scottish Muscle Network, and to ensure links to the primary and secondary care that plays a crucial part in the management of neuromuscular conditions.

Dr Stefan Spinty, consultant paediatric neurologist at Alder Hey children’s hospital, who played a leading role in the north-west neuromuscular service review, said:

“In order to improve patient outcomes and help to reduce unnecessary and costly hospital admissions, it is important that the recommendations from the North West Specialised Commissioning Group report, which is due to be published soon, are implemented. All neuromuscular clinicians who have been involved in the North West neuromuscular service review are committed to support the implementation process to further improve and secure service provision for individuals affected by neuromuscular conditions in the future.”

Christine Ogden, a campaigner and fundraiser from Bolton, whose grandson has Duchenne muscular dystrophy, said:

“It is vital, that essential increase in care, support and advice for families outlined in the North West Specialised Commissioning Group’s report recommendations, which will make a real difference for families living with muscle disease. It is also so important that information for health professionals about neuromuscular conditions is significantly developed.”

Beryl Swords from Liverpool, whose son John has FSH muscular dystrophy, has commented on the provision of physiotherapy for adults with neuromuscular conditions:

“I feel strongly that physiotherapy for adults with muscular dystrophy is totally inadequate. If improvements were made to North West neuromuscular services, then perhaps this area of care could be more freely available, keeping people with the condition mobile for longer.”

The urgency of improving neuromuscular services in the north-west is encapsulated in the following comments by Nicci Geraghty, a north-west campaigner and fundraiser:

“I have two nephews with Duchenne muscular dystrophy. This is not only a cruel condition for my nephews to suffer from, but also very harrowing at times for us as a family to watch each stage of progression knowing that the postcode lottery already exists throughout the country. This has a huge impact on survival rates and I don’t wish to see my nephews robbed of any chance they have to lead the best quality of life possible.”

The evidence provided makes a compelling case for the urgent necessity of developing and improving neuromuscular services in the north-west in order to save money. Will the Minister write to NICE stressing the importance of a NICE quality standard for Duchenne muscular dystrophy, as well as one on home ventilation and respiratory support? Will he attend the next meeting of the all-party group on muscular dystrophy on Wednesday 9 March to update the group on progress, and will he agree to meet clinicians who have been developing a neuromuscular curriculum with the Association of British Neurologists? Thank you for calling me, Mr Davies.

It is a pleasure to serve under your chairmanship, Mr Davies. I congratulate the hon. Member for Weaver Vale (Graham Evans) on securing this debate, which is important to many people. Although the title of the debate refers to neuromuscular services in the north-west, my constituency neighbour the hon. Member for East Londonderry (Mr Campbell) and I come from the north-west of a different island. This is not revenge for the map-reading errors that many of us would have heard excuses for over the years in border areas in Northern Ireland, nor is it an attempt to hijack this debate. I want to give positive support to the articulate efforts of the hon. Member for Weaver Vale, who spoke compellingly about what muscular dystrophy can mean for the individuals affected and their families.

Unlike the hon. Gentleman, I do not have a relative who suffers from muscular dystrophy, but I remember being particularly impressed by a young constituent of mine and his family. My constituent, who unfortunately died a couple of years ago, was named Donovan McKeever. When his parents, Brendan and Teresa, heard Donovan’s diagnosis, they were confounded by the degree to which nobody knew what to say to them or what they were talking about, asking about or looking for. Donovan’s father Brendan wrote a small book about his experience, titled “It Shouldn’t Have to Be Like This”.

Unfortunately, when a child is diagnosed with muscular dystrophy—this also happens with many other conditions, such as autism—parents often have to navigate systems and negotiate between services as though they were the first to find themselves in that situation. The hon. Gentleman’s speech reflected such frustrations. Because people know the good work of the Muscular Dystrophy Campaign and know that it is a recognised disease, they assume that care services are in place and that the system kicks in and knows what to do, how to pass people on and how to connect services. They assume that key workers exist to ensure that needs are met, whether that involves a disabled facilities grant for adapting housing, or assistance deciding which school environment will be most conducive or accessible. Families need support, and they expect the system to provide it. For people with muscular dystrophy—Donovan had Duchenne muscular dystrophy—that does not always happen.

The hon. Gentleman mentioned the importance of care advisers, as did the hon. Member for East Londonderry in his intervention. Northern Ireland has a muscular dystrophy care adviser, but unfortunately the funding for that care adviser is committed only until the end of March, and no long-term funding is in place. Not only are things not as they should be, but the existing service and the commitments that have been made may well disappear in the context of budget squeezes and other changes.

We should use this occasion to call for better services, planning and support, not just in the interest of individuals with such conditions and their families but in the interest of providing well-managed public services and savings. The hon. Member for Weaver Vale mentioned unplanned emergency admissions. Some 2,000 people in Northern Ireland suffer from muscular disease, and their unplanned emergency admissions cost at least £2.25 million a year. Better and more appropriate and available services would lead to savings. Making people present themselves in a less appropriate context puts pressure on other services and adds to costs, which is not efficient. Cutting corners in such areas in the name of efficiency savings is wrong, and some of the cuts and squeezes taking place are counter-efficient.

I know that the Minister is particularly concerned about the health services that the hon. Gentleman and I have mentioned. The issues on which patients need to engage the public policy system are not confined to clinical presentations. In the context of some other changes that the Government are introducing, such as changes to disability living allowance and medical assessments, I would hope that the Minister acts as an advocate for patients with muscular dystrophy to ensure that they are not overburdened by medical assessments. They find it difficult enough to navigate the system and get the services that they expect; it should not be made harder for them to get support such as disability living allowance and the mobility component.

On the intended removal of the mobility component of DLA from people in residential care, many young adults with muscular dystrophy choose to live in a residential care setting because of their situation. Their parents may have passed on, and other family members may have moved on. It is nonsense for people who have made that choice to lose the mobility component, with all the social support, access, personal outlets and socialising that it allows. I hope that this debate is not purely about the important issue of clinical and medical services for those with muscular dystrophy; I hope that we will take a holistic approach to people’s particular needs.

The hon. Member for Weaver Vale mentioned specialist multidisciplinary care. If we break the issue down to our different locations, whether we are talking about the new single commissioner for Northern Ireland, the Health and Social Care Board—

Order. I do not wish to interrupt the hon. Gentleman’s flow, but I hope that he appreciates that the terms of the debate relate specifically to the north-west. Although his comments on Northern Ireland are interesting, I hope that he will tie them in to the situation in the north-west, as that is the title of the debate.

I fully accept your admonition, Mr Davies. I made that point at the start.

If we consider specialist multidisciplinary care in relation only to different localities—whether primary care trusts and GP-led commissioning in the north-west of England or purely within the devolved regions of Scotland or Northern Ireland—we might miss a point. In the case of rarer diseases and conditions, a bigger commitment and wider consideration at a UK level provides a better context of scale. As we have heard, individual GPs sometimes are not good at responding to particular needs or realising the importance of a condition because they do not see enough instances of it. That problem applies not only to GPs but, more broadly, to other services and public management bodies.

I hope that, during the Minister’s tenure, the Joint Ministerial Committee, which brings together Ministers from the devolved entities as well as those from Whitehall, and the British-Irish Council will undertake initiatives to examine whether we can learn lessons from one another. When I was a Minister in the Northern Ireland Assembly, I was privileged to attend the council’s very first meeting. I remember the late Donald Dewar saying that one of the most undervalued art forms was plagiarism and that we needed a vehicle to bring together public policy planners and overseers, such as Ministers, from different parts of these islands. We need that not just in order to see who is doing well at what and to copy them, but in order to be honest and admit what we are all doing badly; to discuss the serious issues that we are not doing enough about; and to constantly agree, as public representatives, that more should be done and that there should be better laws, better services and better funding. If we cannot do enough of that in relation to our own individual pressures, perhaps the British-Irish Council and the Joint Ministerial Committee can together ask some of the fundamental questions, at the heart of government, that were raised by the hon. Member for Weaver Vale.

I have the temerity to believe, Mr Davies, that this debate might finish early, so I will make a brief contribution. I congratulate the hon. Member for Weaver Vale (Graham Evans) on introducing the topic. His preamble was very touching—I have a vision of him as an enormously public-spirited child, raising money for charity. He has clearly carried that public-spiritedness into later life and into politics. I disagree with him, however, about the poshness of Wolseley cars—there were certainly some fairly ordinary Wolseley cars in my day.

I want to elaborate on my intervention on the hon. Gentleman. He explicitly said in his articulate presentation that he has some concerns about the abolition of the specialist commissioning bodies that were set up by the strategic health authorities. Such concerns have been generally well recorded by a number of people with an interest in a variety of rare diseases, not just those of a muscular kind. Although renal problems are not particularly rare, the SHA in my constituency has dealt with the huge problem of elderly people needing renal services by saying that those services need to be in Southport where the demand is. A facility has been produced that is beyond the cost limits of the primary care trust: in fact, it is a regional facility and has been established on the basis of a regional strategy.

The case has been well made across the piece that we need specialist commissioning groups. They have been necessary to deal with rare diseases and to construct the necessary clinical networks. Often, people need not a specialist secondary care facility, but adequate facilities and therapies in the primary care setting. Moreover, those facilities need to somehow integrate, talk to one another and form a clinical network.

What will happen when the SHAs and, presumably, the commissioning units that they set up go? I hope that the Minister will solve that problem. There are two possible answers to the question. The first is that we do not know. The other answer—the Minister may wish to enlarge upon this—is that we will get outposts of the national commissioning board that will do very much the same job as the SHAs. If we have regional commissioning groups, which are generally aware of what is required in the region, we replicate the existing solution, which may be perfected and improved in the process. Few would have problems with that. Some would question the necessity to deconstruct then reconstruct everything, but such a solution is acceptable to many who are concerned about a range of rare diseases, including those that the hon. Gentleman has spoken about. Therefore, my single, simple contribution to this debate is to pose the Minister a question: is that the solution to the problem and, if not, what is?

It is a pleasure to serve under your chairmanship, Mr Davies. It is also a pleasure to take part in Westminster Hall debates, which I usually find to be of much higher quality than those in the main Chamber. It is a shame that so few people attend these debates, because they can be outstanding.

I found today’s contribution by the hon. Member for Weaver Vale (Graham Evans) profoundly moving, and I am grateful to have had the opportunity to listen to him. The image of him selling rulers in the playground will stay with me, and those with muscular dystrophy are lucky to have such a passionate and committed campaigner on their side and in their corner. I too shall always remember to plagiarise Donald Dewar, but in a much less generous way than the hon. Member for Foyle (Mark Durkan). He attributed to Donald Dewar the phrase that plagiarism was undervalued, but I fear that I will simply use it as my own from now on.

Joking aside, this is a serious issue. I was not aware that there are 60 types of muscular dystrophy and that 1,000 children and adults in every 1 million of the population are affected by the disease. It is hugely important to learn such things in my job. It is unfortunate that so few people know about them and that I have to be in this position to learn about them. It is also of great interest that 8,000 people are affected by the condition in the north-west region. We have heard how aggressive Duchenne muscular dystrophy is, and the effect that it has on young boys is a great worry. I have also learned about the stupendous work of Stefan Spinty; it is important to remind the Department of Health that he is trying to run his network without any funding.

In broader terms, treatment for muscular dystrophy in the north-west faces two challenges. The hon. Member for Foyle touched on the first, which is the challenge of cutbacks to services in general. We heard of the cutbacks to special assistance for those with muscular dystrophy in the hon. Gentleman’s area. The cutbacks to mobility and adaptation in relation to people’s homes are larger concerns. Those things are very worrying.

The other challenge relates to the changes in GP commissioning coming at us if the Health and Social Care Bill is passed. We heard this morning that GPs often do not have a great deal of expertise in relation to muscular dystrophy. One could quote statistics that GPs will come across the condition only once or twice a year, but the stories we have heard from the hon. Member for Weaver Vale are more important. He talked about the woman with muscular dystrophy whose daughter clearly had the same condition, but when she told a doctor that there was something wrong with the child, she was told that she was fussing and silly. On the back of that, we heard that doctors have only about two hours of teaching on the condition, so we should all be worried about exactly what will happen to its treatment when GPs take over commissioning. The Government must reassure us about what the specific commissioning pathways will be for this condition, and what the role of the national board will be in relation to muscular dystrophy. It is only right that people with muscular dystrophy, their families and those who represent them are reassured that they will be treated properly and that their particular condition will be treated.

The hon. Lady’s point seems slightly tangential. If her argument is that what is wrong with the arrangements is the current ignorance of GPs about referral pathways, that situation has pre-existed these arrangements and may succeed them. It is an independent issue, is it not? It is not about structures.

As the structures currently stand, it is understood by GPs that they can receive back-up, through the specialised services national definition set, from the various networks that have already been established. If the national health service is to be grabbed by the ankles, turned upside down and shaken hard, the problem is that in the ensuing chaos, GPs will be distracted and, in the short term, people with muscular dystrophy might not get the services that they deserve. That is a legitimate concern, which it is only right to lay at the Minister’s door, because it is this Government who will be putting the national health service through that process.

As I have already asked, will the Minister confirm that specialist neuromuscular services will fall under the remit of the national commissioning board? How will the board work with other services, such as community nursing, speech and language therapy, and continuing care and physiotherapy, which I understand will be commissioned by GPs? How will that work, and how will people with muscular dystrophy not fall between the gaps? Will the Minister provide more information about regional commissioning—already mentioned during the debate—which might arise under the national commissioning board? It would be reassuring for many to learn that the national commissioning board might have regional hubs, but we have yet to hear that stated specifically. If it were to be stated this morning, it would be good news for many people.

The other issue that I know the Minister shares my great passion for and interest in is the importance of increasing integration of services. People with the conditions we are discussing are clearly exactly the sort of people who need integrated services, so that they can have assistance in hospital—hopefully as an out-patient—and care in the community. There is a continuing disconnect between social care and health care. We all know that when those services do not connect properly, people end up as an emergency admission. We have already heard that £68.5 million is spent across England on unpaid emergency hospital admissions for people with muscle disease.

It is clear that savings can be made, and the holy grail for all of us is to ensure that there is better integration between the various services—both between primary and secondary care, and social care and health care. The challenge in the near future is to consider exactly how the Health and Social Care Bill will help with that integration. There is concern that, in fact, it will do the opposite.

It is important that the legacy is protected. The Muscular Dystrophy Campaign has been working constructively with the 10 NHS specialised commissioning groups across England, and significant progress has been made on improvements to neuromuscular services and on an increase in the number of muscular dystrophy care advisers. In the context of the changes to the national health service and the cutbacks in funding, there is concern that a lot of that good work may fall by the wayside. This morning would be a timely moment for the Minister to reassure us that the legacy will not be lost. Will he reassure me that the work being carried out by the regional specialised commissioning groups will not be put in jeopardy following the proposed reforms for their abolition?

I congratulate the hon. Member for Weaver Vale (Graham Evans) on the passionate and powerful way in which he clearly set out the case. He has done a great service to the interests of those who suffer from muscular dystrophy and their families. I thank him for securing the debate. I also congratulate him on the work he has done in his role as a member of the all-party group on muscular dystrophy, not only for his region but in raising the issue more thoroughly around the country. I join him in paying tribute to the work of the Muscular Dystrophy Campaign and the North West Muscle Group. Both those organisations operate as powerful advocates for people affected by these lifelong and life-limiting conditions.

It is 18 months since the all-party group published the Walton report, which showed how far we had to go—as the hon. Gentleman has described only too clearly— to improve the care of those with muscular dystrophy and other neuromuscular conditions. There are historic weaknesses. The intervention of my hon. Friend the Member for Southport (John Pugh) just now underscored that point. There are weaknesses in the current system and in how we organise the things that have rightly been highlighted by today’s debate.

There is a real sense of urgency for change, not least because of the simple fact that we know about the huge personal and family costs of this condition and how it impacts upon people’s lives. Unless care is properly co-ordinated and well conducted, NHS resources will be wasted. They will be invested in the wrong places and will not deliver good outcomes. That cannot be acceptable in our modern health care system. Several colleagues alluded to the costs. The figure of £13.6 million was mentioned as the overall cost of unplanned hospital admissions for those with neuromuscular conditions in the north-west. If we analyse the journeys that people make through our health care system, that shows the actual cost.

Some hospital admissions are necessary and unavoidable. A person who contracts a respiratory infection is a good example of where there is an unavoidable need. However, if we consider the figures in greater detail, the number of people admitted for non-invasive, elective care, shows that there are many preventable costs in the system. That amounts to just under £5 million in the north-west alone. Those costs could be avoided and the money could be spent better. That has to be a key message. It is not just about spending more; it is also about spending better in our system. We need to ensure that we consider the economic case for investing wisely in services that can, in fact, provide a better quality of life. We must also ensure that we avoid unnecessary admissions in the first place.

Positive steps have been taken in the north-west. That progress has been hard fought, and it deserves to be recognised and applauded. Indeed, the strategic health authority has told me that £4.2 million has been spent on developing neuromuscular services over the past four years. As mentioned, a dedicated neuromuscular service at Alder Hey has been set up to provide excellent care for children. Out of that £4.2 million, £289,000 was invested as a commitment to the service provided and led by Dr Spinty. There appear to be some grounds for dispute over whether such services are funded or unfunded. However, we certainly need to keep ensuring that resources go in. There is a case to be made for ensuring that resources are well spent. Paediatric critical care services have improved with a dedicated paediatric intensive care transport team. There are additional beds at Alder Hey and the Royal Manchester for ventilation services, with similar investment in both invasive and non-invasive respiratory services for adults, too.

Although those developments are welcome, the local NHS accepts that many issues still have to be addressed, many of which have been aired today. The specialised commissioning group is responding to the Walton review by reviewing the region’s neuromuscular services. In essence, that review group—made up of clinicians, commissioners, patients and families—is aiming to address exactly the issues aired today: how to improve the poor support available to those diagnosed with neuromuscular conditions in adulthood; how to address the variability and patchiness in the availability of specialised neuro-rehab and wheelchair services; and how to improve transitional arrangements to help young people to move from paediatric to adult services. That is an absolutely key issue that comes up time and again in relation to rarer conditions when considering how well or how poorly the NHS manages those vital transitions from child and adolescent services to adult services.

The review group has updated the all-party group on muscular dystrophy on the review’s progress. On the kind invitation that has been extended to me to attend the meeting of the all-party group, I do not know whether I can attend on the specific date mentioned. However, I will certainly undertake to attend a meeting of the group as soon as I can and take questions from the group’s members.

I understand that the NHS North West specialised commissioning group will consider the review’s recommendations in March, and that the full report will be published shortly after. Clearly, I do not wish to pre-empt that report in any way but, based on the conversations I have been having in preparation for the debate, I think that the review team is asking some important and necessary questions. Those questions are on sharing best practice to ensure greater consistency, on work force planning, so that there is better co-ordination and leadership across care pathways, and on finding efficiencies across the system in line with the region’s quality, innovation, prevention and productivity plans.

The key to all of this is to have a much clearer split of responsibility—a sense of joined-up access across the care pathways to deliver a less fragmented and more person-centred approach to planning. I will say a bit more about the point that the hon. Member for Islington South and Finsbury (Emily Thornberry) raised on that in a moment. For me, the greatest challenge for the modern NHS is how to make sure that we have much more joined-up delivery. We have to accept that care and support for those with long-term conditions is a particular area where we do not get it right often enough, and it is unfinished business. There is too often a disconnect between what is commissioned at a regional level by specialised commissioning groups and what is available at a local level as commissioned by primary care trusts. It not only confuses patients and compromises both their care and quality of life; it also leads to inefficiency and duplication within the system.

Putting that right means thinking radically. It means putting greater emphasis on managing pain and helping people with multiple conditions. It means finally developing a personalised system to end the attachment to bricks and mortar institutions and to reinvent health care in a modern context—a health system that is much more about what can be delivered in the home and in the community than it is about clinics and consulting groups.

When it comes to long-term conditions such as muscular dystrophy, attention tends to fall on specialised commissioning groups, and that is what has been rightly talked about today—the response in terms of tertiary care. Tertiary care is clearly important. We can see, from the important work at Alder Hey and Royal Manchester children’s hospital, the difference that such specialist centres can make. However, there also needs to be an equal onus on community-based support—the ongoing day-to-day care that is so important to support quality of life and to keep people out of hospital in the first place.

Primary care trusts and in the future GP commissioning consortia and health and well-being boards, not the specialised commissioning teams, will be responsible for that. They will shape the services that clinicians and social care need to provide to meet the needs of patients, such as hydrotherapy, wheelchair services, speech and language therapy, respiratory support and help with swallowing. It is therefore essential to have better co-ordination, a better link-up between commissioning teams across health and social care and beyond, and, rather than individual bits, a person-centred approach to planning across the whole care pathway. That needs a whole life course approach, which is why I return to the point that we need a focus on transitions between childhood services and adult services. The review’s recommendations will help to bring that about in the north-west. I look forward, as I am sure the hon. Member for Weaver Vale does, to its publication and to it being put into effect.

To take the case of specialist physiotherapy, the SHA recognises that there is pressure on tertiary centres, which is something that the hon. Gentleman talked about. The challenge must be met by a whole system approach that makes full use of the available resources. NHS North West tells me that it is already mapping out in more detail what neurophysiotherapy services are available across the north-west. The current specialist physiotherapists are being encouraged to work with community physiotherapy to improve their skills and to help them to offer appropriate services at a local level. That outreach to upskill other parts of the work force will be a key way to improve delivery. I understand that Manchester PCT is also doing some exciting work in piloting a neuro-rehab service that treats people at home or in the community, rather than in a clinic. That brings into relief the potential benefits of integrating tertiary and community-based services—of how, by doing things differently, we can improve services for patients.

The hon. Gentleman talked about the NICE guidelines. He is absolutely correct, as are other hon. Members who have spoken in the debate: we need greater consistency, and being more consistent means being clear about what “good” looks like. I have already mentioned NHS North West’s neuromuscular services framework, which is a helpful starting point for bringing different organisations together. My hon. Friend the Member for Southport also raised the issue of the need for clinical networks, and I will say a bit more about that in a moment. The review group is also making the case for the clinical networks and clinical network managers to provide leadership, to share best practice, and to provide challenge to commissioners. Again, that would seem to be a sensible approach not just in the north-west, but around the country. I would expect the NHS commissioning board to help to take that forward when it takes up the reins of specialist commissioning.

Of course, another issue mentioned by hon. Members is the need for clear guidelines and quality standards from NICE to cover muscular dystrophy and various aspects of the delivery of care and treatment for people with the condition. I hope that Members understand that it is not for me to direct NICE. Its strength as an organisation rests on its independence from Government, and therefore I will not compromise that. What I will do, and which is important to do, is ensure that it is made aware of today’s debate, so that it can take it into account in its deliberations. The East of England specialised commissioning group is leading on quality standards work and service specifications, so there is work to help influence that going forward.

Another influence on NICE are the conversations with the leadership group of the Neurological Alliance on how it can develop stronger clinical advice for a range of rare neurological conditions. I strongly urge the Muscular Dystrophy Campaign to actively engage with that leadership group, so that it is also at the table with NICE. NICE is part of that forum, which presents an important opportunity to achieve faster progress and effective action. We are also, in the context of the work of health and well-being boards and GP commissioning consortia, looking at how to update the guidance for joint strategic needs assessments. I urge the Muscular Dystrophy Campaign to have an input, through the Neurological Alliance, on that work, too.

Equally, the National Quality Board is working on a broad library of quality standards to cover all areas of NHS care. Again, there will be opportunities for the Muscular Dystrophy Campaign and others to feed into that process. Input through the leadership group of the Neurological Alliance would be a very effective way of getting its voice heard.

Careers and training have been referred to in the debate. I suggest that, rather than a Minister trying to dare to dictate the curricula of the medical professions, it might be more prudent to ensure that they are also aware of this debate, with a covering letter from me to draw it to their attention so that they can take it into account as they reflect on future curricula.

On the issue of advice and support for patients, a strong case has been made for the case-management approach. It is important that we look outwards to patients and their families. At the moment, people with long-term conditions can feel disempowered and frustrated by the complexity of the system. It can be a fight, as the hon. Member for Weaver Vale has described, to understand what is available. As the hon. Member for Foyle (Mark Durkan) rightly said, it should not be the case that every time someone enters the system it feels like they are navigating it for the first time, as if no one else has ever gone through that before. That is a perfect way of describing how the system should not feel and how it must not feel as we go forward. The hon. Member for Weaver Vale described the example of Liam. That example makes a very strong case for increasing the number of neuromuscular care co-ordinators, who are known to be extremely helpful in improving patient care and outcomes. I understand that that is something that the review group is exploring and it will, through its contracting arrangements that go beyond that, help to drive that forward. I have no doubt in my mind that there is a strong economic case for the co-ordinators.

I am also pleased that the Manchester PCT is looking at how personal budgets can be used to help people with neuromuscular conditions to get the help they need. Personal budgets are more than a lever to give patients more control. They can be a catalyst for bringing services together around the needs of the individual—another way in which we can integrate at an individual level. In fact, a number of the pilots that are testing personal health budgets are actively involving people with neuromuscular conditions.

The final question, asked by both my hon. Friend the Member for Southport and the hon. Member for Islington South and Finsbury, is how do we maintain continuity during the transition period? The Health and Social Care Bill is clear that highly specialised services would, in future, be commissioned by the NHS commissioning board. I can confirm that this condition is included among them, as it is already designated as a specialist commissioning area. The board will decide how best to organise itself to deliver, on a case-by-case basis, different commissioning activities on different specialist conditions. It would be wrong, when the Government are saying in the Bill that we are giving autonomy to an NHS commissioning board, for the Minister to then specify, in an Adjournment debate, to the nth degree precisely how the NHS commissioning board should discharge that function.

The NHS commissioning board has that responsibility, and that comes with a responsibility on patient and public engagement as well. It is important that lessons from existing experience of specialised commissioning are drawn together to inform the way in which those responsibilities are discharged in the new system. I will undertake to ensure that this debate is drawn to the attention of those who are doing that work at the moment. Again, I think that the Specialised Healthcare Alliance provides the Muscular Dystrophy Campaign with a way in to influence and shape those opportunities. I note from comments to the Health Committee before the general election that there was a recognition that we could do much more by moving to a national commissioning board that can streamline, simplify and ensure greater consistency around contracting for these services.

That brings me to the other element of the new architecture, which is general practitioner commissioning consortia. Clearly, integrated planning between consortia and the NHS commissioning board will be essential, just as joint working between primary care trusts and specialised commissioning groups is at present. I am keen that strategic health authorities will encourage GP pathfinders, along with the early implementers of health and well-being boards, to work with the specialised commissioning groups to explore how the relationship can work best on the ground so that we develop the best case examples to inform the system as we move to the new arrangements.

As the hon. Member for Weaver Vale rightly highlighted, GP consortia will need advice and guidance as they take up the reins. There will be a great opportunity for patient groups to step in and provide support in that way, and I would certainly encourage that kind of active engagement. Also, health and well-being boards will have a key role as system integrators—they will have a major part to play in developing the more joined-up system. We will consider whether that is enough or whether we need to do more as we scrutinise the Health and Social Care Bill clause by clause in the coming weeks. The most effective way of operating will be through the regional networks that the Neurological Alliance is setting up. Again, I hope that the Muscular Dystrophy Campaign will be part of that.

Yes, we have to ensure that we get specialist commissioning right, but we also have to ensure that we get commissioning for long-term conditions in general right, and we have to do that at a local level.

I thank the hon. Gentleman for securing this debate and for setting out the issues so clearly, and I thank other hon. Members for their contributions. We know that there is much to do to improve the care of those with neuromuscular conditions, and that we are not doing enough yet. We know that the system that we inherited has not delivered uniform and consistent access to services—we must do more. We also know that financial pressures should not block progress because, all too often, action here saves money that can then be better spent on improving the quality of services.

I look forward to reading the final report of the north-west review group—and, indeed, the other reviews that are taking place—and I hope that it can be a catalyst for real improvements in the years ahead. The hon. Gentleman is right to say that we have to translate the intentions behind the review into tangible actions that transform the lives of his and many other hon. Members’ constituents up and down the land.

Sitting suspended.

Unscrupulous Builders

Thank you, Mr Davies, for giving me the opportunity to speak in the debate. I welcome the Minister, and look forward to his response after we have all spoken.

As an officer of the all-party groups on ageing and older people and on consumer affairs and trading standards, I feel that the issue of unscrupulous builders is of the utmost importance and warrants the thorough consideration it will be given now. I come from a business background—I run a small company and have worked as a business development director in the corporate sector—so I am not a politician whose default position is, “Let’s have more regulation.” However, in the building and renovation trade, many rogue builders across the UK have been ripping people off for far too long.

In my judgment, something must be done, and the Government must take steps to protect vulnerable people from cowboy builders. There are three core issues to address: first, the routine targeting of the most vulnerable people in our society; secondly, the way that unscrupulous traders create an unfair marketplace and plague the legitimate building industry; and thirdly, how we can act to stop the proliferation of fraudulent work.

Recently, a rogue trader was convicted in my constituency. That was a good result considering how difficult it is to prosecute such criminals under current legislation. During the proceedings, it came to light that he had accepted cash and cheques from customers in Eastbourne for sums of up to £23,000. One of the victims was an elderly widower, which is not uncommon. He received redress from the television show “Cowboy Builders.” The programme surprised my constituent by fixing the damage done to his property while he was in hospital recovering from a heart attack. That was a good deed and much appreciated, even if it was for the purposes of entertainment. Although we can take comfort from the happy ending to my constituent’s ordeal, it is unacceptable that he felt compelled to turn to a television show rather than to the authorities. However, given the lack of adequate, robust legislation to protect citizens from such criminals, his decision is easily understood and was, frankly, wholly rational.

We have a duty to those whom we serve to do something about the weakness of the current legislation, and I hope that colleagues will join me in calling for a formal consultation into the merits of a compulsory licensing system for the construction industry. Gangs such as the group of Gloucestershire scam builders convicted and jailed in January for defrauding householders of nearly £1 million cannot be allowed to continue unabated. The three men involved conned more than 50 people in 14 counties, and I extend my sincere appreciation to Gloucestershire police, who worked tirelessly and diligently throughout the three-year investigation to bring the fraudsters to justice. I echo the sentiments of the detective chief inspector who led the investigation. He characterised the perpetrators as, “Criminals, pure and simple.”

Such unlawful behaviour must be taken seriously. Consumer rights experts report an average of 100,000 complaints about rogue builders each year, and trading standards organisations reveal that £170 million is stolen from UK home owners by cowboy builders every year. We are told that 2.4 million people have had problems with cold-calling property repairers; it is imperative that we take action.

I congratulate my hon. Friend on securing the debate, and support the clarity that he seeks through a licensing regime. Does he agree that one of the strongest arguments in favour of that is the frustration shared by many of our constituents? One of my constituents, in pursuit of justice after an experience with a cowboy builder, has written to the Royal Institution of Chartered Surveyors, the Insolvency Service, the Property Ombudsman, the Legal Complaints Service and the Trading Standards Institute, but so far to no avail. I welcome my hon. Friend’s attempts to bring some clarity to this area of concern.

I thank my hon. Friend for his extremely well-made intervention. I have heard about such cases again and again both in my constituency and as an officer of the all-party group for consumer affairs and trading standards. We are in a ludicrous position where criminals are ripping off people, often elderly people, up and down the country. However, because they are clever at using—or abusing—the law, it is almost impossible to pin them down and seek redress. That is an absurdity, and times need to change.

The issue is not simply about providing adequate protection to the public; the trouble caused by such activities is far-reaching and widespread. I know some tremendous local builders in Eastbourne, but the actions of the cowboy builders impede legitimate businesses and create an unfair marketplace for the many—the vast majority of builders, renovation companies and tradespeople who are wholly legitimate. The problem causes particular difficulty for the small firms that we are counting on to help bring us out of recession. Because the unscrupulous individuals who prey on the public operate outside the law, they often do not pay VAT. That gives cowboy builders an illegitimate financial advantage by enabling them to charge much lower prices—20% lower—than responsible legitimate companies, thereby distorting the marketplace and creating unfair competition.

That practice results in a significant loss of tax revenue, because much of the work that would be invoiced is currently paid cash in hand and is off the books, resulting in an enormous revenue loss to the Exchequer. Given the current economic situation, it would be foolish to pass up the opportunity to clamp down on such behaviour. It is deeply unfair to law-abiding citizens who pay their taxes to continue allowing fraudsters and charlatan building companies not to contribute their fair share. Beyond that, a further worry must be addressed. Around 80% of the informal economy—sometimes known as the black economy—is work undertaken by companies that are completely outside the tax system. I have already mentioned VAT, but such evaders are much more likely to avoid other key legal obligations, such as health and safety legislation. That puts their customers not only at a financial, pecuniary risk, but at physical risk.

Everyone has seen the programme, “Cowboy Builders”, that the hon. Gentleman referred to. It illustrates that a small number of people will take advantage of vulnerable people. Does the hon. Gentleman feel that one way of monitoring and keeping an eye on things and regulating the system would be to use local government to oversee work and say whether it should be passed? Perhaps that would be one way of resolving the situation.

That is a good point. It is not the conclusion that I have reached, but it is a strong point. The challenge with local government oversight is that it varies a lot around the country. Some local authorities would make it a high priority, while others would not. It is an option, but the conclusion I have drawn is that the Government must start taking steps to look at a licensing proposal.

I am aware that there are already programmes to help regulate the construction industry and mitigate fears, and I do not wish to undermine the valuable work of organisations such as TrustMark and the National House-Building Council. However, those schemes are taken up mainly by large companies that operate at national or regional level, and they are not the problem. The administration and cost involved in registering with such schemes is a natural deterrent to the individuals and small firms that I, and many of my colleagues, want to help. Because the vast majority of substandard work is carried out by individuals or small gangs of rogue builders, the current measures are inadequate.

According to Local Authority Building Control, TrustMark has insufficient funding to deal with the problem. Therefore, we need serious consideration about how to proceed with more effective methods of regulation. The seriousness of the matter is heightened by the well-known target of the illegitimate traders—older people, who are often the most vulnerable in our society. An ageing population coupled with increased home ownership necessitates a Government response.

Between 1981 and 2001, the proportion of the population over 75 years old increased by more than 30%. The number of pensioners living alone increased by 150,000 between 1991 and 2002, and now accounts for 14.4% of all households. That means that there are now more than 5 million pensioner-only households. Let me be clear: MPs in the House know that unscrupulous builders target vulnerable, often elderly, people. That is a growing market, and unless something is done, those builders will have ever more opportunities to rip people off.

Numerous investigations have shown that unscrupulous builders are taking full advantage of the gaps in our legislation and our rising pensioner population. Crooked salespeople are commonly overbearing, persistent and totally unscrupulous. That is a particular problem for older people, as they often live alone and are trapped by such intrusive door-to-door sales techniques. Once a salesperson is in their home, a vulnerable individual has limited means by which to end the transaction. The option of asking someone to leave is not always available to them because many home owners feel too intimidated in that situation to broach things so directly. That may sound absurd, but our experience as Members of Parliament, dealing with a large amount of casework and listening to constituents, who are often elderly, means that we know that they will be too frightened to ask the cowboy builder to leave.

When hard-sell tactics are used, many individuals feel trapped in their homes and have nowhere to retreat, leading to increased pressure and a desire to rid their home of the unwanted guests as quickly as possible, often—crucially—by accepting the service being offered. In fact, there are even reports of people being driven to their bank immediately to draw out large sums of money when faced with threatening demands.

I am grateful to my hon. Friend for securing a debate that is important to constituents from throughout the country and represented by hon. Members on both sides of the Chamber. Does he agree that one way in which we could consider regulating the sector is by extending what we have done with the gas industry to the building industry? The Gas Safe register gives older people confidence that the engineers coming into their home are qualified and professional.

I thank my hon. Friend for his intervention. That is a good idea as long as it is managed properly. My concern is that it might end up a bit like TrustMark. Many people do not know about that scheme and even among those who do know about it, there is some concern that it is not robustly policed. I like the idea, but we have come to the point when we need to introduce licensing. I will explain how I propose that we fund it.

In my judgment and that of many others, none of the current legislation is able sufficiently to protect the public from such threats. I hope that hon. Members will forgive me because I am going to give them a bit of a history lesson. The Pedlars Act 1871—that is a wonderful phrase; “the Pedlars Act”—excludes virtually all callers involving property maintenance and repairs. The cancellation of contract concluded away from business premises section of the consumer protection regulations is an important statutory consumer measure, but it will generally offer little or no protection from criminal practices when the traders’ names and addresses are not known. Large amounts of cash change hands, yet there is no intention of operating in a fair manner. That is absolutely appalling. It is systemic and we simply cannot let it continue. Section 16 of the Theft Act 1968 has left a loophole in legislation, as its definition of theft covers only actions when a person, by deception, dishonestly obtains property belonging to another with the intention of permanently depriving the other of it.

Cowboy builders are fully aware of the flaw in consumer protection and know that as long as they carry out at least some activity, the incident will be classified as a contractual disagreement and therefore not a criminal offence. Prosecution of those perpetrators is very tough, as the necessary evidence is often very difficult to obtain; I could go on and on. That is why the market has been expanding and the actions of those deplorable individuals have got bigger every year. They know the law is an ass.

There is a logistical problem for any witnesses asked to stand up in court and face those who wronged them. That is a particular concern when the victims are already among the most vulnerable. It is another reason why action must be taken to halt the spread of these fraudulent criminals.

I am coming to the end of my speech because I want to give the Minister plenty of time to reply. In raising these issues, I make it absolutely clear that I do not want to cast aspersions on the legitimate business men and women who provide an important and welcome buildings and renovation service to many people up and down the country. In my constituency, a noted builder, Ellis Builders, has given me advice on how I can present and pitch a proposal in a way that will work for legitimate builders. I appreciate the support that its managing director, Derek Godfrey, gave me.

We must consider the possible courses of action open to us and the ways in which we can aid genuine tradesmen and end the scourge of rogue builders. Naturally, a central aspect of any reform would have to be an increase in public awareness. The public must know how to confirm whether the workers being hired are legitimate. One reason why the current voluntary schemes are ineffectual is the lack of public knowledge surrounding programmes such as TrustMark. I believe that to make any significant advance in protecting the well-being of individuals, it is critical that we provide one clear method for assessing the competence of a building tradesman. On that point, I agree with the National Federation of Roofing Contractors and join it in advocating a means of appraisal that will provide confidence that the tradesman or woman in someone’s home is competent, trustworthy and reliable.

There are many ways in which that may be achieved. Successful licensing schemes already operating in Australia and the US could provide a useful starting point for the consultation that surely must follow this debate. However, at such a difficult time for our economy, I appreciate that we must be extremely careful not to overburden a crucial sector of that economy—construction. It is necessary to strike a careful balance. We need to provide regulation and protection for the consumer on the one hand without disproportionately increasing costs or deterring compliance on the other.

It is time to consider seriously a national licensing scheme. The fee need not be too expensive. It could be £500 per annum and tiered, with smaller companies paying less and larger ones more. Any legitimate builder would see that as a worthwhile investment in their business. It would give the public the security of knowing that a builder was licensed. They could say to someone, “Do you have a licence?” If the answer was no, they could say, “You won’t be doing any work in my home.” If the answer was yes, they could open the door. In my judgment, that sum, if it was tiered as well, would be sufficient to fund a licensing body.

We cannot keep sweeping this issue under the carpet. The legitimate building trade—companies of all sizes—deserves more. The public deserve more. We can do more. To misquote the great and one and only Gary Cooper, “It is time to run the cowboys out of town.”

I congratulate my hon. Friend the Member for Eastbourne (Stephen Lloyd) on securing the debate. I thank all hon. Members for contributing. Listening to my hon. Friends the Members for Ceredigion (Mr Williams) and for St Austell and Newquay (Stephen Gilbert) in particular, it was clear that this issue affects many of our constituents. I can confirm that it has affected my constituents. I represented one of my own members of staff on this issue. She ended up having to use the TV programme dealing with cowboy builders to sort out the problem. Through dealing with that, I understood how difficult these problems can be. My hon. Friend the Member for Eastbourne was therefore right to bring the issue to the House. Although I do not agree with his proposal for a compulsory licensing scheme, let me say up front that I hope that when he hears some of my other remarks, he will know that the Government take the issue seriously, along with many other consumer affairs where there is consumer detriment. Some of the general reforms that we want to make and the general research that we are undertaking will help to ensure that this issue and others like it can be better dealt with in future.

Let me say for the record, and so that my hon. Friend understands why I am less attracted by his proposal, that there are issues of practicality and proportionality, which I know that he, as a small business person, will be very mindful of. Many people are employed in the construction industry. The UK construction industry is one of the largest in Europe, with more than 2 million people employed and 200,000 businesses. That gives a sense of what a compulsory licensing scheme would have to do and the sheer scale and size of it. That would bring with it costs and complexity.

As my hon. Friend rightly said, some rogue, cowboy builders behave appallingly, but we must balance a number of issues as we put together our measures, and I hope to reassure him about those measures in the course of my speech. I am sure that he will agree that the vast majority of people operating in the construction industry do good jobs, work hard and perform well. We are talking about a relatively small number of rogue traders, and the question, therefore, is whether we put huge cost and complexity on 2 million people and 200,000 businesses to target that tiny minority. I say that not least because it is unclear whether a compulsory licence scheme would deal with the rogues who tend to work outside the system. One would have to be sure, even under my hon. Friend’s proposals, that the enforcement measures were such that one could catch these people. I have some concerns about such issues, not least when they are married to the costs and complexities that would come about under such a scheme.

Let me reassure my hon. Friend about one or two points that came up in the debate. We want a proportionate scheme. Through licensing and regulation, we want to target those trades where there is a high risk to public safety, and my hon. Friend’s points about health and safety were extremely well made. That is why the gas safe register scheme, which used to be known as the CORGI scheme, is important. It deals with the technical competence of people who ply their trade. There is also the competent persons scheme for electrical work. Clearly, gas and electricity raise other issues, and we need to ensure that they are properly regulated. However, it would be disproportionate to have similar schemes for the work done by painters, decorators and others.

I hope my hon. Friend realises that we are trying to take a proportionate approach that ensures that while legitimate businesses doing a fantastic job are not penalised with costs, measures are targeted on the real cowboys. If my hon. Friend looks at the legislative framework, he will see that it is designed to clamp down on underhand practices. The Supply of Goods and Services Act 1982 requires traders to provide a service with reasonable care and skill, in a timely manner and at a reasonable cost. The Government are examining how the Act might be modernised and simplified so that consumers have a clearer understanding of their rights, including their rights to redress when they have experienced shoddy workmanship or paid for goods that turn out to be defective. I hope that that work will lead to ideas that improve the situation.

The general consumer rights set out in the Act are accompanied by specific legislation to protect consumers from unfair selling in their own home. Builders, of course, fall within the scope of those provisions. The Cancellation of Contracts made in a Consumer’s Home or Place of Work etc. Regulations 2008—I am sure my hon. Friend is familiar with them—give consumers the right to cancel a contract they have signed without penalty within seven days. That cooling-off period is a valuable protection, especially for those who may have felt pressurised into agreeing to have work done as a result of the tactics of an unscrupulous builder. My hon. Friend will note that those regulations came in in 2008, and they are still being rolled out, so an understanding of them is still developing among many trading standards officers and the wider public. Those measures are in place, however, and I think that they will be increasingly effective.

As regards other protections given to consumers, it is important to ensure that the enforcers—at national level, it is the Office of Fair Trading, but there are also local authority trading standards officers—have the right tools at their disposal to deal with dodgy builders. The Consumer Protection from Unfair Trading Regulations 2008—again, they are relatively recent—give the enforcement bodies more effective means of tackling unscrupulous practices and rogue traders. Indeed, they ban traders in all sectors from unfair commercial practices against consumers, particularly in relation to the sale and marketing of services. They set out broad rules, which enforcers can use to determine whether a practice is unfair. As I said about the other set of regulations from 2008, these regulations are still relatively new. Trading standards officers are beginning to use them and beginning to understand their use. The regulations are spreading best practice. These tools have come into the toolkit relatively recently, and they will help. They also ban any commercial practices that use harassment, coercion or undue influence that is likely significantly to impair the average consumer’s freedom of choice in relation to goods or services.

If we take those various measures together, it is clear that the legislative framework is quite robust, but I would not claim that it is perfect, and we always need to think about how it could be improved. That is why the Government support a project being undertaken jointly by the Law Commission and the Scottish Law Commission to examine how private law might be reformed to provide consumers with a clear, simple right of redress when they are victims of misleading or aggressive selling. My hon. Friend may be aware of that because it comes from a Liberal Democrat consumer document called “Are you being served?”, which he may have read before the election.

In addition to providing effective remedies for people who have suffered at the hands of rip-off builders, it is important that we put resources into preventing problems from occurring in the first place. At the end of last year, we announced £3.2 million of funding for scambuster teams so that they can continue the fight against rogue traders and builders who deliberately set out to defraud consumers. The fact that we have been able to continue this important work, despite the tough choices that we have had to make elsewhere, is a clear sign of how important we think this issue is. Rogue builders and others who prey on vulnerable and elderly people will not be tolerated, and scambuster teams will lead the fight against them. My hon. Friend valiantly champions the needs of elderly people in all areas of public policy, and I hope that he will talk to scambuster teams in his area to ensure that constituents who are occasionally preyed on by rogue builders are aware of the teams’ work.

I appreciate that it can be difficult for consumers to judge whether a builder is genuine. For extra peace of mind, therefore, they can look for tradespeople who belong to approved traders schemes. This is where the TrustMark scheme, which has been mentioned, comes in. TrustMark is an easy way for consumers to identify a builder who has agreed to abide by industry standards of competence and fair trading and to be independently inspected to ensure that they are meeting those standards—the point my hon. Friend made about enforcement. Those in the industry who are approved by one of the operators of the TrustMark scheme are independently inspected, which can give people reassurance. This is a free service to the consumer. Last year, there were 3.5 million inquiries, with people checking out builders and other tradespeople. My hon. Friend is right that we need to raise awareness of the scheme, but the 3.5 million inquiries last year suggest that an awful lot of people are aware of it. That awareness is growing, and we need to continue to help it grow. In addition to the TrustMark scheme, many local authorities run assured trader schemes in their areas to help residents find trustworthy local builders. Again, I would encourage consumers to use those schemes wherever they exist.

The debate is timely because we need to ensure that colleagues across the House and others who are interested in this issue know that the Government take it seriously. As we look at general consumer legislation and do a lot of detailed work on it and the consumer landscape, we will be thinking about the difficult cases that have been mentioned. In the back of our minds, we will be thinking about how provisions will apply to cases in which constituents have been very badly done by. I give my hon. Friend my assurance as consumer affairs Minister that the Government will bear such cases in mind as we review the legislation— indeed, we are doing that very actively.

I reassure my hon. Friend that regulations are now in force—I admit that they are very recent—and that they will assist our work. I assure him that TrustMark is a very good scheme, and I would encourage hon. Members to promulgate it, and local authority trader schemes, when they talk to constituents.

I thank my hon. Friend once again for bringing this matter to the House. Although I have not been tempted by the compulsory licence scheme that he so eloquently proposed, I hope that I have reassured him that many other measures that are in place, or which we are considering, will have a good effect on the problems that he raised.

Sitting suspended.

Flood Risk Management

[Jim Sheridan in the Chair]

There is a contradiction at the heart of the Government’s policy on flood alleviation. In answer to a parliamentary question about flood risk, the Minister told me that

“The latest UK climate science confirms that rising sea levels and more severe and frequent rain storms are likely to occur—resulting in increasing flood and coastal erosion risk.”—[Official Report, 20 January 2011; Vol. 521, c. 922W.]

He said that the Environment Agency suggests that river flows may increase by 20% by later this century.

On the same day but in answer to another question, the Minister said that the flood risk management budget, paid by the Department for Environment, Food and Rural Affairs to the Environment Agency, would fall from £354 million this financial year—the Government inherited that figure from the former Labour Administration—to £259 million next year. That is a reduction of 27%. It does not make sense to reduce public investment in flood risk management when those risks, and the costs that flow from those risks, are increasing.

Capital funding in Yorkshire has been hit harder than in any other region. According to a letter from the deputy chairman of the Environment Agency to the Yorkshire regional flood defence committee, funding has fallen by more than 50% compared with last year. Why has my region suffered a larger cut in Government funding than all the others?

The consequences for Yorkshire have been blunt. Three schemes in the Environment Agency’s programme were to have gone ahead in 2011-12. All three have been axed. The York scheme would have provided improved flood defences for the Water End and Leeman road areas of the city. There was a scheme for Thirsk. There was a large scheme to protect Leeds city centre, and York still needs flood defences to be provided in the Clementhorpe area, but that was not included in the original programme.

The Environment Agency tells me that those schemes have been deferred indefinitely, but I was pleased to hear the Minister saying in response to an urgent question in the House earlier today that the schemes have not been cancelled. Will he explain to my constituents the exact status of those schemes? If they have not been cancelled, I presume that it is envisaged that they will go ahead. Will he give us a time scale for when those schemes are to go ahead?

Does my hon. Friend not agree that there is considerable urgency for flood schemes in the city of York? I shall be talking about Leeds later, but when I lived in the city of York the Kings Arms was flooded almost to extinction almost every other year. Does he not agree that we badly need these schemes, especially those for York and Leeds?

The River Ouse, which flows through the centre of York, drains water from about 3,000 sq km of the Pennines. When there is heavy rainfall, the river rises enormously. At the moment, York has severe floods; the river has risen by about 15 feet above its summer level. When that happens, the Kings Arms public house gets flooded. I am sorry to say that there is no defence in the world that will stop it being flooded several times a year. It almost trades on the novelty of being built in such a way that people can simply hose down the mess and get on with the drinking.

Hundreds of private homes in York—and hundreds of businesses in York; I shall say more about them later—suffer catastrophically when the river rises. In 2000, when the River Ouse rose to its highest recorded level in 400 years, some 350 homes were flooded, and hundreds more came within a whisker of devastation. I left my job as a junior Minister then and went back to York to join Silver Command, which managed the crisis. I remember clearly the November night when hundreds of local residents and 500 soldiers from the 2nd Signal Regiment were sandbagging the Leeman road and Water End area, putting sandbags on top of the existing flood defences to protect the homes behind. Those homes came within a centimetre of being inundated. About 380 homes most certainly would have been inundated, and perhaps another 120 were at risk. Indeed, the leader of York city council was evacuated from his home; he lived in the area at the time.

I shall quote from a statement prepared for this debate by York city council’s chief engineer:

“Water End is shown in the York Strategic Flood Risk Plan as being an area of Rapid Inundation and failure of the existing defences in times of a severe flood could result in a depth of water inside properties in excess of l m, in a very short period of time.”

I remember preparing evacuation plans 10 years ago. Our fear was not that we would have seepage and slowly rising water levels in people’s homes, but that the flood defences might collapse. The engineers believed that that was a real danger, so much so that we tipped thousands of tons of sand and gravel behind the built flood defences to strengthen them. If they had collapsed, we could have had a wall of water running through the centre of York, which would have caused absolute devastation.

The City of York council received advice from the Association of British Insurers about the cost of repairs if the Leeman road and Water End flood defences were overtopped. The calculations were based on 382 homes being inundated. ABI’s advice was that the cost of repairing each of those homes would be between £20,000 and £40,000. The total cost of repairs for one flooding event would be £11.5 million, almost twice the cost of the flood defence scheme that the Environment Agency has deferred. The community largely consists of two-bedroom Victorian railway cottages. Many of them are privately rented, and others are owned by people on low to modest incomes—the priority group that the Government say should be helped by the new flood defence plans.

Ten years ago, 100 or so homes in the Clementhorpe area of York were inundated. It received a lot of attention because one of the streets involved is called River street. The papers all carried pictures of firemen evacuating people by boat. That area, too, needs protection. A temporary scheme has been provided by a private benefactor, but it does not work as the council would like, so it is not being used at the moment. Before this debate, I asked the Association of British Insurers and individual insurers, and I am grateful for their advice. For obvious reasons, insurers are always cautious about telling the public how much they pay out in claims. One told me that in York it has paid out £12.5 million in claims for flood damage—800 claims in all—over the past decade. The claims peaked in 2000 when it paid out in respect of 286 properties, and again in 2007 when it paid out in respect of 247 properties. The average claim per property flooded was £25,000.

When we debate the problems and risks of flooding, we often talk about home owners and households. It is quite right that individual people—our constituents—should be at the front of our minds, but we must not forget that businesses are very seriously affected, too. I see that my hon. Friend the Member for Workington (Tony Cunningham) is nodding his head. He has had a much more recent experience of flooding than, thankfully, we have had in York.

In response to the Government cuts in capital flood defence schemes, Gary Williamson, the chief executive of the Leeds, York and North Yorkshire chamber of commerce said:

“I find it extremely concerning that the Government would take such a gamble with York and North Yorkshire economies. The cost of flood damage can have a devastating effect on businesses and is something that small, independent businesses and retailers may struggle to recover from.”

The impact of the floods in 2000 on businesses in York was catastrophic. Visits to main attractions, such as York Minster and the Jorvik Viking Centre, dropped by 94%, from 5,425 in November 1999 to 356 in November 2000. Once the flood had gone, the number of visits was down by 86%. Bed occupancy in hotels was down by a third. Retail business was down between 30% and 50%—it varied from shop to shop—in the busy pre-Christmas shopping period. The York Minster shop suffered a 72% fall in sales. Overall, as a result of the floods in 2000, there were 200,000 fewer visitors to the city, costing something in the region of £10 million, and that ignores all the other business and commerce in the city that suffered as a result of the flood and the subsequent severing of a railway line. The railway is an extremely important commercial highway, pipeline or communication link for York. When the line just south of York in Selby was severed by the flooding, it cost the city far, far more.

What will the Minister do to get the Leeman road and Water End scheme back on track, working with me, as MP for the city, and the local authority, the City of York council? Like all hon. Members, I understand that the country’s macro-economic position is weak. In the last published quarterly figures, we learned that the economy had contracted by 0.5%. Economists are now asking what the Chancellor’s plan B is should the country fall back into recession; in other words, two consecutive quarters of contraction of the national economy. Of course Labour has argued that the deficit must be brought under control, but the way in which the Chancellor is doing that is too fast and the cuts that he is implementing are too deep. In the run-up to the Budget, the Chancellor will obviously be considering his options. He may not announce it in the Budget, but it is perfectly obvious to all of us in this Chamber that the Treasury is considering a plan B. If the Chancellor were to respond to the worsening economic situation by relaxing the pace of public expenditure cuts, the most obvious place to provide an expansion—or perhaps a lesser contraction—of public expenditure would be in relation to capital schemes. We know that there is a current account deficit, but even when Governments are running a current account deficit, they continue to invest over the long term, and rightly so. When someone buys a house, they take out a mortgage for 25 years. When the Government invest in flood defences, they also need to borrow and pay back over a long period of time and pay back, because flood risk is a long-term risk and the flood defence will be there for 50 or 100 years and the capital scheme needs to be financed over that period.

Perhaps the best example that I can give my hon. Friend is Carlisle in Cumbria, which was flooded a number of years ago. In 2009, as a result of a £35 million investment in flood defences, Carlisle did not flood. As a Government, we spent £35 million to prevent flooding. If we had not spent that amount and Carlisle had been flooded, it is estimated that it would have cost between £70 million and £80 million to clean up and repair the damage. Surely that is a good example of how we need to spend in the short term to ensure that we are not stacking up long-term problems.

My hon. Friend gives an extremely good example. The Environment Agency says that the cost-benefit ratio of its schemes in the pipeline are 8:1, which was confirmed by the Environment, Food and Rural Affairs Committee’s recent excellent report on flood and water management legislation. That means that we get back much more than we pay. If we leave it to each individual to try to insure themselves—if they are able to insure themselves—the cost to them and the private insurance companies will be much greater than the cost of investing in flood protection. Moreover, if we were to relax the squeeze on publicly funded capital schemes, the jobs that would be created would be in the private sector, precisely where we need to create jobs to pull the economy back on track and to get the Government’s fiscal position looking better than it does now.

I ask the Minister to talk this matter through with the Treasury in the run-up to the Budget. I do not expect any feedback in the purdah period before the Budget. None the less, I hope that his Department will make representations, so that if the Chancellor is talking about relaxing the squeeze on public expenditure, he looks at capital works, particularly the cost-effective investments in flood alleviation.

I will try to be brief because I know many Members want to speak. The City of York council and the Yorkshire regional flood defence committee are considering alternative sources of funding for the Leeman road and Water End scheme, including the possibility of funding from the European Union, which is available to support businesses. I have talked earlier about the enormous impact that flooding can have on commerce. Is the Minister prepared to work with the council and the Environment Agency to try to get support for such a scheme?

Consultation documents from the Minister’s Department reveal that the Government are seeking to transfer part of the cost of providing flood defences from central Government budgets to local communities. I am not making a particular point about that, but I hope that the Minister will listen and focus on what I am saying. He can describe it slightly differently if he wants. It would be a mistake to have a flood tax added to local authority taxation because the boundaries of local authorities do not match the boundaries of river catchment areas. If we are planning to deal with flood waters, we need to plan for the river catchment as a whole.

When York floods, we provide a service for places upstream, because we take the water away from them and prevent them from flooding. Equally, when Selby floods it does a service for the city of York, as it takes our water away and saves us from flooding. That is precisely what Selby is doing at the moment and hopefully it will not flood as a consequence. We are interdependent—that is how nature works—and the funding response needs to take account of how nature works and be based on river catchments rather than local authority areas.

One way in which we might do that is through giving responsibility, in part or in whole, to water and sewage management companies, which of course have been set up to follow river catchment areas. We talk about the “Severn Trent” region. Why is that a region? It is a region because anyone extracting water needs to follow the river courses. Equally, anyone dealing with flood water needs to follow the river courses.

It would be wholly unfair if people in York had to pay for draining water away from upland areas on the east side of the Pennines—the 300,000 square kilometres of land that York drains—or if Leeds city centre had to pay for draining water away from people living upstream in the Wharfe valley. Yet it would be fair for people living in those valley catchments to work out collectively how to deal with the water as a whole. That is what the Environment Agency says they need to do.

I will give way in just a moment.

I see excellent work that the Environment Agency has done upstream from York, creating small ponds on agricultural land, planting trees and building dams that can be closed at times when there is a lot of water, so that water can be stored. If we can slow the run-off, we can convert an 18-foot flood over 24 hours in York, which would be catastrophic, into a 15-foot flood over three days in York, which would be quite manageable. The Minister will have seen such schemes. They exist because we cannot expect small communities—working village by village, town by town, city by city—to protect themselves without a scheme being worked out for the catchment area as a whole.

I ask the Minister to consider an interesting proposal that has been put to me by Yorkshire Water that the company could perhaps buy flood defence infrastructure from the Environment Agency, which would give the Government a capital receipt. Yorkshire Water would be able to do so because it can go to equity markets, which a Government cannot do. Of course such a scheme would increase the cost of water, because the company would have to repay the cost of managing floods more effectively. However, it would mean that those increased charges were spread across the river catchment area as a whole—upstream and downstream communities—rather than on downstream communities exclusively.

I said that I would give way to the hon. Gentleman. I will do so, then I will give way to the right hon. Member for Berwick-upon-Tweed (Sir Alan Beith) and then I will sit down.

I just want to support what the hon. Gentleman has been saying about the need to think strategically. In my constituency of Stroud we have the Slad valley, which is a relatively small valley. However, if we had a co-operative Environment Agency, a less rigorous interpretation of the water directive and a general willingness to allow local people to do what they think should be done we would solve a huge number of problems for Stroud, which has nearly 5,000 houses in total that are vulnerable to flooding. My appeal is for more local flexibility, so that we can take action and implement flood alleviation measures.

I am glad to receive support from the hon. Gentleman. However, I hope that he will join me in saying that these risks, which people in both our constituencies face, are present and real risks now and that we need Government funding now to address them. I say that because by the time that we work out a new system in five years’ time, our constituencies might have flooded.

In fairness to everyone else who wants to speak, I will take an intervention from the right hon. Member for Berwick-upon-Tweed and then I will draw my remarks to a close.

I just want to make the point that upstream flooding, which the hon. Gentleman describes as a form of alleviation in main urban centres, has a cost for the agricultural communities in the areas concerned. Even as far away as Northumberland, we were aware that in east Yorkshire there was considerable resistance to such schemes, but they are an essential part of flood management. Nevertheless, it requires a lot of co-operation and discussion with the farming community, to ensure that a proper balance of interests is recognised.

That is obviously right and it is a very important contribution. We cannot get flood risk management for free, whether it involves building flood defences in York city centre or paying farmers to let their winter cropping fields flood at a time when they would otherwise be planting root vegetables or some other crop. However, it might be both cheaper and more environmentally sustainable to pay the farmers to grow more trees, create ponds and use other measures to retain some of the water long enough to protect downstream areas from inundation.

I could say much more about the consultation documents, about what the insurers are telling me or about the Environment, Food and Rural Affairs Committee report, but I will sit down now so that other Members can have their say.

Thank you, Mr Sheridan. It is a pleasure to serve under your chairmanship. I am somewhat nervous, because I have known the gentleman sitting to the left of you—the Clerk, Mr Hennessy—for 30 years and I have never spoken in front of him before. It is a new experience for me.

I congratulate the hon. Member for York Central (Hugh Bayley) on securing the debate. As Members may know, I will bore for Britain on the topic of coastal defences and, of course, river defences too. I mentioned the issue of flood defences in my maiden speech and in recent debates on shoreline management plans, and I will continue to do so because it is absolutely the No. 1 defining issue in my constituency of Suffolk Coastal.

I pay tribute to the Minister who is here today. He is actually very popular in our constituency, not only because he yet again confirmed the situation regarding Felixstowe’s flood defences in the main Chamber earlier today but because he visited my constituency. When he did so, people liked the fact that he listened, reflected on the facts and actually did something about them. We have seen that in some of the thinking expressed in the consultation paper and also in his encouragement of officials at the Environment Agency and Natural England to do the right thing by working with local people and landowners, to get more for less out of the budget. Sadly, due to the economic legacy that we inherited, that budget is slightly reduced from what we would of course like it to be.

In fact, I will go further and say that the Minister has been so successful that the risk is that he will get promoted, but we desperately do not want that to happen because we need him to sort out the fish problem too. Having said that, I will move on to other issues.

I generally welcome the change in thinking on flood defences. For me, there is an incentive, as that change in thinking will help people and communities who help themselves. It is that partnership model that I recognise, but it is a model that still provides protection, within the funding formula, so that where there are wards of deprivation the formula acknowledges that deprivation and will work towards alleviating it.

That gives a fresh element of hope to my constituents who, under the shoreline management plans, were told, “You’re on your own”. Actually, this new model is a way forward. The Minister has already seen some of the schemes in my area that I want to commend to the House. For example, at Bawdsey there was a situation whereby the economic benefits under the calculations did not derive any financing in particular. What happened was that some local farmers came together and offered up land for development. The local council agreed to grant planning permission for houses to be built on that land. Together the council and the farmers put the money from that development into a trust, which has now paid for coastal defences to protect the area around Bawdsey for some time to come.

More recently, in Thorpeness local home owners came together—I must admit that not all of them did so; one or two decided not to put their hands in their pockets. However, the rest came together and said, “We want to protect our shoreline along here”, and the Environment Agency, working with Suffolk Coastal district council, came up with a scheme that will make a difference to people’s lives.

There are ideas for future schemes. I am hesitant to speak about them, but one can see other opportunities whereby communities decide to have infrastructure development. I say that I am hesitant to speak about them, because I do not want my constituents to write in and say, “Thérèse Coffey demands turbine be placed in Felixstowe”; nor do I want my local paper to get the wrong end of the stick. However, there is an opportunity for communities around the country to come up with imaginative ideas for possible schemes.

For example, if we had a wind turbine in Felixstowe, that would work in a high wind when the port itself, down the road, is closed, because the cranes there cannot operate in high winds. That would contribute to the local economy, and the income could be ring-fenced and put into future sustainable defences, not only for Felixstowe itself but for areas, such as Felixstowe Ferry, at the mouth of the River Deben, that face particular difficulties at the moment. The Environment Agency is being very kind at the moment, but I recognise that that kindness cannot go on for ever with our future policy.

I am also interested to learn from the Minister how the pathfinder evaluations might fit into the consultation on the future of funding for flood defences and whether any element of that evaluation process will be incorporated in the consultation.

In Happisburgh, people are very excited because they have been offered some compensation for their houses that are about to fall into the sea. I mentioned that in the shoreline management plans debate, but unfortunately the Minister was in Brussels at the time, trying to do his best for us on fish. Although flooding is terribly disruptive to home owners in places such as York, the water normally goes away, and repairs are needed, but the risk with erosion is that it is terminal. Once someone’s house has gone into the sea, it has gone; not only that, the owner is liable for its safe disposal. With a ’60s or ’70s house with lots of asbestos in it, the owner might be able to apply for a grant of up to £5,000, but that might not cover the costs. The Pitt review constantly referred to in the consultation is based on fluvial flooding rather than on coastal erosion, which has been an add-on.

One thing that is mentioned in the document is that with homes built since 2009 it is the developers who are supposed to take on the flood risk. That is a reasonable suggestion, and I hope that anyone who has bought a house in a flood-risk area since 2009 realises that. With good design, housing can be a lot more resilient to flooding.

Under OM1 in the consultation, I am slightly disappointed to note that the agricultural land value estimate has not been updated or upgraded since the 2007 comprehensive spending review, despite in the other part of the Department for Environment, Food and Rural Affairs there being thoughts on food security and about ensuring that we have that element. It would have been nice to see a slightly more generous value attributed to agricultural land.

Under OM5 to OM7, a lot of money is set aside per acre and per hectare for the recreation or preservation of habitats, to comply with the European habitats and water directives, and that, I am afraid, reinforces the view held by some that nature is more important than people. OM3 gives the figure of £3,050 rental income per year for properties at risk of coastal erosion. In my constituency, trying to rent a coastal property for £3,050 a year simply would not happen—a beach hut, perhaps, would be about it. The figure is probably more generous than it has been previously, but I urge the Department to think again on that.

I have to hold my hand up: I have not yet gone through the document with a fine-toothed comb, but will be working on that to ensure that I get my consultation response in by 16 February. However, the document contains some very encouraging phrases that reinforce the principle of partnership and give an opportunity to constituents who are being told that there is no public funding available for them.

I shall finish on two issues, one of which is the cost of delivery. There is an element of red tape in councils, with planning permission, and there are the aspects of the costliness of permits and studies for Natural England, and the consents from the Environment Agency. I know that the Minister has already taken action, and is committed to removing as many blocks as possible to make it as easy and cheap as possible for land owners to protect their defences—all force to his elbow. The Environment Agency told me a couple of weeks ago that it would not prevent land owners in “no active intervention” areas under the shoreline management plans from defending their property. That came as a bit of a surprise yesterday to some of the people at the all-party coastal and marine parliamentary group, and it was thrown up— perhaps anecdotally; I do not have enough evidence—that the Environment Agency might say that but Natural England will stop us anyway.

There is a tendency for one agency to say that the other agency will not allow it to do something, but in my experience getting them all together in the same room—ideally on site—means that some of that starts to fall away. Fruitful co-operation between agencies is the way forward, instead of blaming someone else for not doing something.

My right hon. Friend is absolutely right. I am relaying some of the anecdotes about the frustrations of landowners, but I agree that getting people in the same room to talk things through leads to constructive solutions, once the initial hurdles have been surmounted.

On the funding process, one of my local Suffolk Coastal councillors, Andy Smith, who is a lead council member on coastal matters, has raised with me the annual allocation of funding process. Some schemes take more than a year, and things are unclear or uncertain. There could be a project that was agreed a couple of years previously but which constantly comes up for review regarding the annual allocation of cash. There is something not quite right with that process, and I hope that we can get it right.

Finally, I am encouraging internal drainage boards to participate in the consultation because they could be effective delivery partners for a lot of the work that we want to do. IDBs are not the only solution, but they are a good one. They combine local landowners and councillors, and have an element of democratic authority. The future is quite bright, and could be very bright for coastal and river defences, but I urge the Minister to ensure that the policies of the previous Government, of making 100-year decisions on the basis of three years’ funding, are a thing of the past. There are many generations of families in Suffolk who have done their bit for their bit of land over the years, passing it on from generation to generation. Let us not kill off the chances of this generation for the sake of 100-year hindsight.

I am very grateful to my hon. Friend the Member for York Central (Hugh Bayley) for initiating the debate this afternoon.

After the then Secretary of State for Environment, Food and Rural Affairs, my right hon. Friend the Member for Leeds Central (Hilary Benn), had made a statement to the House on flooding on 17 December 2008, I asked him a question about his proposed trial areas for surface water management in Leeds. My question was about an area in the Roundhay ward of my constituency called the Wellhouses—a series of residential streets through the middle of which runs Gledhow beck. I had been approached by local residents who were concerned that they had the responsibility for maintaining the banks of the beck, which frequently overflows during heavy rain, exacerbated by the excessive outflows of water from the balancing lake in Roundhay park. As always, my right hon. Friend was courteous and helpful in his reply, and promised to let me know whether Gledhow beck would come under his plans to transfer surface water management to local authorities such as Leeds—one of his trial areas—in 2011. The subsequent answer was that it would.

Surface water management might appear to many to be a rather dry and uninteresting issue until their homes are flooded by exceptional rainfall or overflowing balancing lakes. I took up the issue affecting the residents of the Wellhouses because I was shown first hand the appalling damage that could be done in an instant to the homes of people I am privileged to represent. Most people never give a moment’s thought to the merest possibility of their homes being flooded, until it happens.

It is true that many parts of the hilly city of Leeds will never be in danger of flooding. Where I am fortunate to live—in Pudsey to the west of the city, between Leeds and Bradford—we are more than 650 feet above sea level and can be complacent. However, much of Leeds is built around the River Aire, and is therefore susceptible to flooding. On 15 June 2007, Leeds city centre came very close indeed to being overwhelmed by water, after days of appalling weather when a whole month’s rainfall fell in 24 hours—Leeds was not unique in that, that summer. Many city centre roads were under water, and the city almost came to a juddering, squelchy halt. On 27 June 2007, the Yorkshire Evening Post reported that more than 6 cm of rain had fallen during the previous nine hours,

“causing millions of pounds worth of damage to flooded homes, schools and businesses. Dozens of trains were cancelled and roads were gridlocked as the city tried to cope with the torrential downpour, the heaviest on a single day for 50 years.”

Suzanne McTaggart’s report added:

“The latest stormy weather comes after heavy rain hit Leeds just over a week ago, when rivers threatened to burst their banks and roads became waterways. Many areas saw six weeks worth of rain in just 24 hours yesterday…making this the wettest June ever—and possibly the wettest month since Met Office records began in 1882.”

On its excellent website, the Environment Agency says of its proposed Leeds River Aire flood alleviation scheme:

“Leeds has suffered from localised flooding in recent years which caused significant disruption to local residents, businesses and commuters. However, these floods were relatively small and there is always the risk of a much larger flood.”

The Environment Agency’s latest briefing on the Leeds scheme tells us that the agency is now working closely with Leeds city council to come up with an affordable scheme. It estimates that the current comprehensive scheme would cost about £190 million and would involve building raised defences on the River Aire, thus directly protecting 255 residential and 495 commercial properties and indirectly helping to avoid the flooding of 3,800 residential and commercial properties. The briefing suggests that if the city of Leeds were inundated by floodwater, the damage would total at least £480 million —several times the cost of the flood defences. DEFRA has asked the Environment Agency to continue working with Leeds city council to secure alternative sources of funding or to find ways to reduce the costs of the project, but initial indications from DEFRA, which I understand have now been confirmed, show that sufficient funding will not be available in 2011-12 to proceed to detailed design.

I intend no disrespect to my good friends who represent the great Yorkshire cities of Hull, Bradford and Sheffield, or, of course, to the wonderful people who live in those cities, when I say that Leeds is without doubt the engine of the whole Yorkshire regional economy. Like every other city in the UK, with the possible exception of London, Leeds has been badly hit by the economic downturn, but it still draws in tens of thousands of commuters every day, who come to work in the many businesses, legal practices and financial institutions that operate from Leeds city centre. Leeds is still the largest financial centre in England outside London—hon. Members can forget about Manchester. Imagine what would happen if the “relatively small” floods in 2007 became a much larger flood, as the Environment Agency fears they might, swamping the centre of Leeds, its wealth-generating businesses and its newly built apartments and homes.

Spending a relatively small amount now could, however, help to prevent catastrophe in the future. With climate change making rainfall in these islands ever more unpredictable, the River Aire will burst its banks sooner or later and drown our city. Not only will thousands of homes be affected, but millions, if not billions, of pounds of business activity will be halted, and thousands of hard-working citizens will have their jobs or their lives ruined—all for the want of the flood defences that could have been built, but which the Government cut because the deficit simply had to be repaid in four years, rather than five, six or even seven. [Interruption.] Sorry, does the hon. Member for Shrewsbury and Atcham (Daniel Kawczynski) want to intervene?

In the summer of 2009, I was approached by the residents of Valley terrace, which is in an area of housing just off the Leeds outer ring road, in the Roundhay ward. They were upset that woodland between their homes and the noisy, busy dual-carriageway ring road was to be destroyed and built on by developers.

I assume that the hon. Gentleman’s city, like my constituency, suffered bad floods in 2007. If it did, he should surely attach some of the blame for the lack of action on building flood defences to the Labour Government, rather than blaming this Government, who have had only six months to do anything about this.

I have fought hard for 10 years for flood defences to be improved in York and I would accept—

Will the hon. Gentleman listen for a minute? I accept that the Labour Government, who put in millions of pounds and improved many flood defences, protecting some areas of the city, did not finish the job. However, I should tell the hon. Gentleman, who I hope will have the opportunity to speak, that while Labour was in power, we increased Government funding to the Environment Agency for flood risk management from £249 million in 2000 to more than £500 million in 2008-09—in other words, we more than doubled it. We provided funding for more flood management and protection schemes than was the case before. Our concern is that this Government are reducing funding.

I thank my hon. Friend for that timely intervention. I was going to respond simply by saying that we cannot design flood defences in two or three years; it takes a long time to make sure that we have the protection that is appropriate to the environment and needs of a particular area to ensure that the system will work. A great deal of research has to go into these issues, from not only the Environment Agency, but every other agency involved. That is why these things were not done instantly after the 2007 floods.

Let me return to the points I was trying to make about the little piece of land between the ring road and Valley terrace. Some may accuse my constituents there of being no more than nimbys—that stands for “not in my back yard”—who do not want any further development now that they have their homes in such a lovely area. However, I supported their bid to stop the planning application, which would have destroyed that small area of woodland, because the woodland soaks up rainwater coming down from the hills into the valley where the ring road is situated. I am increasingly concerned—I would be interested in the Minister’s response—that planning authorities are allowing more homes to be built on woodland with no regard to the excessive surface water drainage problems that might occur as a result. I am delighted to say that planning permission was refused on this occasion—whether that was to do with my intervention, I simply cannot say.

That brings me back to the Wellhouses. June 2008 saw the publication of a not very entertaining, but very important DEFRA report, entitled “The West Garforth Integrated Urban Drainage Pilot Study”—hon. Members should try saying that when they have had a few drinks. Among its many conclusions was:

“The report shows that, as soon as serious resources are made available for investigating flooding problems and inspecting the condition of culverted watercourses, then opportunities for relatively modest actions become apparent that can have a significant beneficial impact.”

I am grateful to the Environment Agency, the leader of Leeds city council—Councillor Keith Wakefield—the Leeds, York and North Yorkshire chamber of commerce and my friend and constituent, Chris Say, for all their help in getting me the information, facts and figures on which I have based my contribution. This is an important issue for every resident of Leeds and has an impact on a much wider population. I therefore hope the Government are listening and will make our flood defences a priority at a time when money is in short supply—the futures of so many, and the economy of a whole region, depend on it.

It would be unfair of those of us from Leeds to take up all the time, because flooding is such an important matter, which affects people directly and in such a traumatic way, and other hon. Members must have their opportunity. I will therefore be very quick.

I had the opportunity to raise a question about this issue with the Minister on the Floor of the House earlier this afternoon. I should say that I am not making a political point. I will certainly not get involved in any political nonsense about which Government spent more. We are where we are, and we can settle political differences and arguments elsewhere. We are talking about flooding, which, as we all know, affects people in a very personal way. I say that in my defence. What I would also say, however, in what I hope will be a brief speech is that one difficulty with flooding assistance is that it seems to relate, on a cost-benefit basis, to the number of households. That is where the Minister and I were at cross purposes earlier this afternoon.

To illustrate what my hon. Friend the Member for Leeds North East (Fabian Hamilton) was saying, let me use the words of the flood risk manager in Leeds, who puts the case better than I could:

“the Government should treat this scheme as a special case”—

which is fine; we would expect him to say that. He continued by saying that

“a major flood to Leeds could set the economic recovery of the north back many years and the cost of that would far exceed the cost of the works.”

My hon. Friend the Member for Leeds North East mentioned the £500 million of damage that could be done. I do not know whether the Minister has been to Leeds, but the river runs through the business and retail centre—the river and the canal run below the main train station—and it is a compact city centre, which flooding would damage tremendously.

The Environment Agency brief—when I mentioned it previously, the Secretary of State was talking to the Minister and seemed to disagree—stated:

“The city centre escaped inundation by a matter of centimetres in 2000, and there were further near misses in 2004, 2007 and 2008.”

I simply make the point to the Minister that the major economic centre and engine for growth for millions of people in west Yorkshire is the Leeds centre, and it has come disastrously near being put out of operation in a major way. The train station is built over the rivers. The 2000 flood threatened electricity supply in the city centre, which, in turn, threatened the major Leeds general infirmary. This is a question of a major catastrophe. The Minister will not think I am doing him any favours, but I do not want him to be on world or national television in his wellies standing looking at a flooded national city—the largest in the north. I do not want that to happen, for the sake of the city and its people and the surrounding towns and cities. That is how close we are, if the matter is judged on number of households and cost.

We are where we are. It is accepted that any Government would have to pull back the deficit, whatever the time scale. These are difficult times and priorities must be set. I understand the situation. I even offer something additional—without being patronising. I shall say this so that the Minister can use it against me—and the city—but I think that the scheme was designed in slightly better times. I question the £190 million scheme, especially given the number of schemes lining up throughout the city. In the Chamber, the Minister offered a meeting. I should welcome one, but its outcome would be to make it clear to the Environment Agency and the city, within agreed parameters, if possible, what type of scheme and expenditure are realistic in this day and age. We would say “Go away and if you can get something within those parameters we will look at the design work.” We are not speaking about this year or next year. The design work would be started on a more modest, but realistic, scheme. That would help.

There is an additional way in which it would help. The Minister will appreciate the problems. Quite rightly the previous and present Governments have told the city to get private involvement. Businesses and houses are being saved, and there is development, so they have told it to put some funding in and it has found, it thinks, £20 million. That is a lot of money but when it is compared with a £190 million scheme one might say, “I think you’ll have to do better,” and that causes problems. What if we were all to meet in a room and say, “Let’s get real with one another; let’s get this scheme down”? The city centre must be protected and we cannot have a national economic asset knocked out—but the work should not be at any price. We should get a realistic price and a realistic public contribution, and all agree to do the work as quickly as possible.

As I am chairing a Committee upstairs at a quarter to 4, I shall have to leave the debate, and I give my apologies now—I am not leaving out of disrespect. However, I should hope that the Minister would see my remarks as helpful. They are heartfelt on behalf of the city of Leeds, and west Yorkshire.

I, too, congratulate my hon. Friend the Member for York Central (Hugh Bayley) on securing a timely debate on the same day as today’s announcement.

In my own patch in Wansbeck, following the most intense rainfall in living memory on 5 and 6 September 2008, a month’s rain fell in 24 hours, which meant that the river Wansbeck burst its banks and the whole town of Morpeth was flooded. That was compounded by other flooding problems including flooding from the Cotting burn, the Church burn and the Postern burn in Morpeth. There was extensive flooding throughout the town centre and nearly 1,000 properties, including many businesses on the main street, were directly affected, causing huge problems. Hundreds of residents had to be evacuated and emergency shelter was provided in the King Edward VI high school, at county hall and in the town hall in Morpeth. Iconic buildings such as the chantry and St George’s church suffered considerable damage, as did landmark shops. The emergency ambulance station, the doctors’ surgery, the health centre at Gas House lane, the Riverside leisure centre and the town’s main library were also inundated and had to close for a considerable period.

Firefighters, ambulance crews, the RAF, the Royal National Lifeboat Institution and the British Red Cross were among the emergency services involved in the rescue and recovery operations over the whole weekend. A collection of voluntary groups and the town’s churches came together to help hundreds of flood victims and the campaign was spearheaded by the Morpeth Lions club. Families were out of their homes for more than a year and businesses were closed for months, and still people from within the floodplain are not back in their properties.

Prior to the devastating flood, there was a huge flood in Morpeth in 1963, which was before I was born—people might question that. In an attempt to protect the community from further devastation in the future, I am working closely with the Morpeth flood action group, officers of Northumberland county council and the Environment Agency to try to progress the proposals for the Morpeth flood alleviation scheme. The proposed scheme for Morpeth is designed to reduce the risk of flooding from the River Wansbeck and the main burns in the town. It involves the storage of water upstream of Morpeth on the Mitford estate, the building of new defences in the town where none currently exist, and the replacement and refurbishment of some existing defences.

It is imperative that the flood alleviation scheme should be delivered to protect communities and businesses in the town of Morpeth. Local people need the reassurance that their homes are safe from the ravages of the extreme weather conditions and they deserve the peace of mind that those assurances will bring. Shops and businesses need to be assured that they will not suffer a reoccurrence of the devastation of 6 September 2008 and that they can have a secure future in Morpeth where they can build their businesses for the benefit of their employees, local communities and the local economy.

The hon. Gentleman presents his case eloquently. Many of the businesses he mentions are either owned by my constituents or employ them. A large area of my constituency will face the upstream flooding that is part of the alleviation scheme, but I think we all want to work together to ensure that Morpeth and Rothbury do not have to go through such an experience again.

I agree with that and understand the right hon. Gentleman’s remarks, bearing in mind that his constituency is next to mine. I understand the associated problems, particularly upstream, as compared with those in the town centre of Morpeth.

In addition to the trauma and devastating personal and physical effects of the floods, local residents and visitors must now come to terms with problems obtaining buildings and contents insurance, which has been mentioned. It is a huge problem for people living on floodplains. The current agreement with insurance companies will continue until 2013, and who knows what will happen after that? It must be considered as a matter of extreme urgency. Many people living in Morpeth face huge rises in premiums and excesses. One gentleman living in the Morpeth floodplain was asked, after going to court, to pay £300 a month in insurance, and the excess was £20,000. That is not insurance. It is a massive problem. Individuals, families and businesses who have experienced the horror and trauma of flooding have had their lives turned upside down, and they should not have to face additional problems that cause them further distress and upset as well as imposing a huge financial burden on them. Those issues must be tackled as a matter of urgency.

I have not got much more to say, but I pay tribute to the men and women of the emergency services who, on all occasions up and down the country, have been absolutely fantastic when such things occur. They put their lives at risk to ensure that everyone else is safe.

To move on slightly from local issues, recommendation 39 of the Pitt review, which both the Conservatives and Liberal Democrats supported before the election, stated:

“The Government should urgently put in place a fully funded national capability for flood rescue, with Fire and Rescue Authorities playing a leading role, underpinned as necessary by a statutory duty”.

The coalition agreement committed to

“take forward the findings of the Pitt Review to improve our flood defences, and prevent unnecessary building in areas of high flood risk.”

Both the Liberal Democrats and the Conservatives supported a statutory duty, and it is in the coalition agreement.

Will the hon. Gentleman pay tribute to the flood wardens of south Derbyshire, who have taken duties on themselves as part of the big society? While waiting for other things to get better, we are looking after ourselves. We get out there on horses and take out flood signs. We know that those in the community are looking after themselves. We have professionals to look after us, but it is important for our villages and communities to do their best for themselves too.

Of course I pay tribute to those people. I am not sure whether flood defences and removing water from our towns, villages and city centres should be left to the whim of some big society, as I am not too sure what that actually means, but I certainly pay tribute to anybody who volunteers to secure their community against flooding problems. I am not sure whether people in my area would have access to horses. Maybe the hon. Lady can tell me after this debate exactly how it happened. It is interesting.

Now that the Minister is in office, does he still agree with recommendation 39 on a statutory duty involving the emergency services? If so, as it is in the coalition agreement, might that take place in the not-too-distant future?

The decision today not to make funding for the Morpeth flood alleviation scheme readily available in the next 12 months is disappointing to me, the people concerned who are heavily involved in the community, the local council and many others. As the Member of Parliament for Wansbeck, I will be working tirelessly with those organisations and interested parties to ensure that the scheme is progressed in its entirety. It is important not to consider flood alleviation schemes on a piecemeal basis, because that is not effective economically or in terms of flood prevention. I ask the Minister for the third time this week—I hope that he will bear with me; I have had two assurances from him already, and I am sure he does not mind giving me a third one—to assure me that everything will be done to ensure that the Morpeth flood alleviation scheme will be completed in the near future without delay, as quickly as possible and in its entirety.

It is my intention to call the Front-Bench spokesmen no later than 3.40. There are two Members wishing to speak, so they should be brief.

I am grateful to have caught your eye, Mr Sheridan. I will speak for two minutes only, in the hope that the hon. Member for Workington (Tony Cunningham) will also be able to speak. I do not want political differences about who did what. Other than a fire, nothing worse can happen to a home than to be flooded with a mixture of water and sewage, as I saw when walking around the streets of Fairford after the 2007 floods.

I will make one or two brief remarks. In the 2007 floods, 250 buildings in the Cotswolds were flooded, including a school on which £1 million had to be spent, doctors’ surgeries and so on. I am a little concerned about a letter that I received from the Environment Agency. I pay tribute to its author, Barry Russell. In my 18 years as a Member of Parliament, I do not think that I have found such a helpful civil servant anywhere else in the country. He has been to public meeting after public meeting with me to explain what the Environment Agency can and cannot do. I do not blame him at all for what I am about to quote from his letter, but I would like the Minister’s observation on it.

Barry Russell says:

“In previous years, the local authority projects received funding from a ring-fenced pot of money. This is not the case for next year (2011-12), and all projects are competing on a like for like basis—both local authority projects as well as our own. Ultimately the allocations were based on the OM score, and funding was allocated to projects with a higher score than those submitted by the Cotswold District Council. I share your disappointment in not receiving the funding that you were anticipating for this scheme.”

It is easy to come up with statistics to show, in order of priority, which projects will give the best value for money and save the most houses. The problem in a highly rural constituency such as the Cotswolds, which has 110 villages, lots of which have flooding problems, is that it will never meet those criteria. Most of my constituency—with the exception of Cirencester, which flooded in 2000, 2007 and 2008—will never get any funding under the system. I accept that my hon. Friend the Minister has a limited pot of funding, but I ask him to look at the system of allocation.

I will be brief, as I know that I have only a couple of minutes.

The emphasis in this debate has been, rightly, on flood defence. I ask the Minister to ensure that the Environment Agency budget has sufficient funds to deal with two other issues. One is maintenance. One contributory factor to the floods in west Cumbria in November 2009 was the lack of dredging and maintenance of becks, streams and rivers. We must ensure that there is sufficient funding for that.

The other issue is flood resilience measures. It is all right having flood defences and doing maintenance, but individual houses and businesses need protection, and we must ensure that funds for flood resilience measures are sufficient.

I thank my hon. Friend the Member for York Central (Hugh Bayley) for securing this debate. He has demonstrated yet again his considerable knowledge of the issues, and I think that Members of all parties are grateful to him for securing this debate so that we can air them. I commend the Environment Agency workers who have been working around the clock, as they always do, in the north-west of England over the past few weeks, where rainfall has been high, heightening flood risks considerably.

Communities at risk of flooding require certainty from Government, and that is what I think has been at the core of everyone’s argument today. As I have said, we seek to work with the Government where we can and when we agree that they are doing the right thing. Issues such as flooding and flood defences should be above the typical, tribal knockabout of this House and of British politics in general, but we will hold the Government to account when we believe that they are not doing the right thing or acting in the public interest, and when we believe that their actions are likely to hurt those most in need.

We are all agreed that flooding is a life-changing issue. It is also a complex one and its policy solutions, or the solutions that we as politicians can provide towards the problem, are not simple. Sadly, flood defence in this country, as well as the Department for Environment, Food and Rural Affairs the bodies that rely upon it, and the people whom those organisations serve, are now beginning to pay the price for what many people and independent commentators believe is the Secretary of State’s fevered desire to be the first Secretary of State in the new Government to give the Chancellor what he wants—big, indiscriminate cuts, with little regard for how they could be accommodated, or for the effect that they will have on the Department’s core areas of work. We cannot escape that fact.

In many ways, the debacle over forestry privatisation has illustrated what we already knew about the Government—they are riven with contradictions and lack a clear focus on issues of real concern to people in too many areas throughout the country. There is no argument about the fact that there will be a 27% cut in flood defence spending this year—it has been confirmed by the Environment Agency. I have the greatest respect for the Minister—we have a good working relationship on the whole—but he has himself confirmed to the Environment, Food and Rural Affairs Committee that cuts are taking place. The Prime Minister, however, is apparently unaware of that, or simply disinterested in the detail of the policies that his Government are prosecuting.

The Prime Minister has told the House that it is “simply not the case” that there will be a reduction in spending on flood defences, and that the comprehensive spending review settlement is “roughly the same” as in previous years but, in fact, it is not. Cutting is not the way to deliver the savings that the country needs; it is, in fact, a false economy. I trust that the Minister will encourage the Prime Minister to correct the record.

As I have said, communities that are at risk of flooding—we are talking about 5.2 million homes, as well as business properties—require certainty from Government, not a changing of the goal posts or an abandonment or reneging on agreements. The communities of York, Thirsk, Morpeth and elsewhere feel that sense of abandonment right now as their flood defence schemes fall by the wayside. It is a fact that the Government have announced a 27% cut in capital investment for flood defence spending for 2011-12, which means that many communities will face genuine uncertainty about their futures as projects are delayed or shelved. The cuts will leave many homes and businesses at a heightened risk of flooding.

The Minister said in the main Chamber today that those are deferrals, not cancellations, but they will feel like cancellations. The statement of principles is likely to expire before any investments are made, so those areas that are today missing out on flood defence investments face the prospect of being thrown at the mercy of a bear market when trying to find future insurance. Will the Minister confirm that he will not allow the insurance premiums or excess payments of anyone in any area to go through the roof as a result of his Government’s cancellations or delays? Does he agree that those areas that had expected investments, and that were told that investments would be forthcoming before the expiry of the statement of principles in 2013 have now been prejudiced? If that is not the case, how is it not the case? How much public money has been spent designing, characterising and consulting upon the schemes that will not now go ahead?

We know that York is the tip of the iceberg, that many more cancellations are in the pipeline, and that the Government’s spending cuts will determine which schemes go ahead and which do not. Today is the day that the Government can finally choose to be honest with those home owners, communities and business owners who live in areas at risk of flooding, and tell all of us which schemes will be cancelled and which will go ahead, and not just for the next financial year—there is no security in that at all. I urge the Minister and all his colleagues in DEFRA not to hide behind the Environment Agency—today’s announcement was by DEFRA, not the Environment Agency.

Even after today’s announcement, there are many unanswered questions, an awful lot of drift and there remains a significant lack of transparency. One of the principal concerns is the expiry of the statement of principles in 2013. The statement is the agreement between Government and the insurance industry that currently underpins household insurance provision. So far, we have heard nothing that will reassure home owners or business property owners that the Government are working in an effective way with the insurance industry to resolve the real threat of some homes and businesses becoming uninsurable and unmortgageable following the expiry of the statement of principles.

Some insurance experts have warned that when the statement of principles comes to an end, it will be devastating for consumers. Others have warned that it will be bad for consumers but a great opportunity for brokers. Does the Minister agree with that? Simon Douglas of the AA’s insurance division told the Secretary of State in a letter:

“Millions of people are at risk of inundation from overflowing rivers, coasts and estuaries during extremes of weather and that risk is increasing all the time. If spending isn’t maintained, it will compromise the statement of principles, which could see many homes become uninsurable.”

David Williams of AXA went even further by saying:

“We are committed to the Statement of Principles, subject to spending. Now that spending has been reduced, you could say all bets are off. The Government is in breach of its side of the bargain, so if insurers wanted to stop providing cover, they would probably be able to. The problem is nobody wants to be the first and end up getting harangued in the press.”

I think that all Members on both sides of the House would agree that the expiration of the statement of principles is a ticking time bomb, not just for individuals, home owners or business people, but for whole communities. It is hugely economically and socially significant.

What assessment have the Government undertaken on the impact of their budget cuts on the universal coverage of insurance provision for homes at risk of flooding? Will the Minister publish that assessment? The ongoing negotiations between the insurance industry and Government are of profound importance, so will he tell us, categorically, whether he is committed to the principle of universal insurance cover? If so, will he be transparent about his negotiations with the insurance industry and publish an update on them in the House of Commons Library? Finally on this issue, does he agree that the expiry of the statement of principles, without any meaningful system to replace it, will be a disaster for consumers, and will he seek a system of universal insurance cover for whatever follows the current one beyond 2013?

There are other critical questions for the Minister to answer. In 2010-11, the previous Labour Government allocated £35 million for Pitt and for adaptation budgets. That was outlined in the CSR for 2007-08 to 2010-11. Recently, the Minister announced that £21 million will be provided in 2011-12 to lead local flood authorities. Will he confirm that that is different money from that announced by the previous Government? Is it new money?

The Minister will be aware that local authorities were awarded £100 million for flood funding in 2010-11 through the Communities and Local Government formula grant. What contact has he had with his counterpart in CLG about the level of funding available to local authorities next year for flooding and related investment? The concern throughout the House is that local authorities have been given new responsibilities but no new money, and that local flood defence schemes in many areas face a double cut.

Local authorities are, of course, key to our national efforts to improve flood resilience. The 2009 DEFRA annual report states:

“Over the next 2 years we aim to offer an improved standard of protection against flooding or coastal erosion risk for 145,000 more homes”.

According to a written answer form the Minister on 27 July 2010, we are actually due to exceed that figure and reach “at least 160,000 households”, which is a glowing endorsement of the investment that we made, and I welcome his recognition of it. The Secretary of State said of the next CSR period:

“We intend that, by March 2015, 145,000 households will be better protected”—[Official Report, 19 November 2010; Vol. 518, c. 57WS.]

Will the Minister therefore confirm that the Government plan to do less over four years than we achieved in just two—yes or no?

The Minister said in today’s announcement that 112,000 homes would be protected. Will he confirm that that 112,000 is part of the 145,000 target previously mentioned? If so, what will become of the schemes for the remaining 33,000? The Minister also mentioned the role of specialist providers in relation to the provision of insurance cover. I think that many would say that that hinted towards an end to universal coverage, but I hope that he will refute that. What does he expect specialist providers to do, and how will they keep their excess and insurance premium costs comparable with today’s rates?

My hon. Friend the Member for Wansbeck (Ian Lavery) talked about the cancellation of the Morpeth scheme, which has been halted because budget cuts have changed the outcome measures via which the EA has to assess projects. Will the Minister admit that that is the reason for the scheme’s delay and give the people of that town the clarity they deserve?

This is an essential point. The Minister talked briefly about value for money. Of course, anyone in his position is tasked with spending public money properly and I support him in doing that, but what is his definition of value for money in relation to public spending to protect homes? Will he acknowledge that there is a real fear that his Department’s budget cuts and his changing definitions of value for money mean that particularly sparsely populated areas at heightened flood risk, such as the one I represent and those that many hon. Members here represent, are on their own and that the Government have abandoned them? Will he give a guarantee that his budgets cuts will not prejudice flood defence schemes in the more rural, disparate towns and villages that are outside the larger urban conurbations? Such a move would be a scandal and I condemn it.

Finally, will the Minister lay a copy of the full Environment Agency funding allocation in the Library, so that hon. Members from all parties can examine the detail and inform their constituents about the current state of affairs? I am proud of my Government’s record in office in relation to flood defence spending: £2.36 billion over the past four years, 160,000 homes protected and the introduction of the Flood and Water Management Act 2010. I am grateful to the hon. Member for York Central for introducing the debate. We need to debate these issues urgently in Government time on the Floor of the House. I hope that the Minister will be able to give us that assurance today.

The hon. Member for Copeland (Mr Reed), who is excellent in so many ways, has a habit of asking me a plethora of questions and not leaving me enough time to even begin to answer them, but I will see what I can do.

As announced in the Chamber earlier today, the Government have announced £521 million to be invested in flood and coastal defences over the next year. Some 112,000 homes in England will benefit once the work has been completed. That money will help to fund 109 schemes that are already under construction, and work will begin on 39 new flood and coastal defence projects. Of those projects, 18 will provide vital repairs and safety enhancements to existing defences, and the remaining 21 will provide additional protection to 13,000 households at risk of flooding. I am sure that the hon. Gentleman will be pleased that some of that investment is taking place in his constituency.

I pay great tribute to the hon. Member for York Central (Hugh Bayley) for securing the debate and for his undoubted passion in standing up for his constituents on this important issue. One question he asked me is why his region is apparently missing out so much on the allocation of schemes this year. Yorkshire has received a smaller settlement in 2011-12 than in previous years—before he includes that quote in a press release, I ask him to listen on—but that is because a large number of flood defence projects have recently been completed in the region. Hundreds of households in Yorkshire are already enjoying better protection against floods and coastal erosion as a result of projects that have been completed—I concede—over a number of years.

That is an important point because we have to take a long-term view of the spending on flood defences. Very few schemes—almost none at all—go from conception to commissioning in one year. Some of them, particularly the one we have been talking about in Leeds, are very large schemes and run over a number of years. For example, a £2 million scheme in north Doncaster was completed in 2009, which reduces flood risk to 3,000 properties. A £10 million refurbishment of the Hull tidal surge barrier was completed in 2010, and reduces flood risk to 17,000 properties. There are many more schemes.

May I address the specific points that the hon. Gentleman and others have raised in this important debate? He asked what I would do to get the Leeman road scheme back on track. I assure him that the Environment Agency and I will work with him at every stage to make sure that we can get some movement on that scheme, but I cannot guarantee where it will sit in any future year because of the variety of other schemes that will come forward. I can assure him that, if our payment for outcomes scheme becomes the modus operandi of taking forward such initiatives in future years, there will be much more clarity for constituents about where they stand on the issue.

The hon. Gentleman raised a rather more macro issue about the current economic climate, and how this issue sits within it. He is right: the deficit issue is a current account matter. Our national debt is about everything; it is not just current or capital account. There are siren voices that say that we must invest more in infrastructure. We are investing in a variety of infrastructure—not just flooding schemes, but a variety of different ones. It is a question of having a balanced approach.

The hon. Gentleman talked about whether we can assist his flood defence committee in Yorkshire in obtaining European money. I assure him that he will have the full co-operation of my Department, the Environment Agency and other colleagues across Government in trying to secure any sort of funding that we can lever out of any organisation. I very much include the European Union in that. He rightly talked about the need for slow-water schemes and to think up-stream. I have been discussing the value of that with the hon. Member for Wansbeck (Ian Lavery). We recognise that the beneficiaries in one community sometimes pay for flood defences in another area, which may well affect the viability of farming businesses and the like. We have to take a large regional approach to the matter, which is why our new payment for outcomes scheme takes a much broader view. The scheme recognises where beneficiaries are and what can be done to alleviate the problems in affected communities.

I was also asked how we are protecting businesses. The economic benefits from protecting businesses from flooding are taken into account in the prioritisation schemes included in the payment for outcomes system. That has been the situation in the past and it will continue to be so. We are working with the City of York council and the Environment Agency to consider opportunities for external funding. It is crucial that there is greater local involvement at the heart of reforming the funding for flooding and coastal erosion risk management.

My hon. Friend the Member for Suffolk Coastal (Dr Coffey) made an excellent speech and raised some important issues. I was so impressed by the level of innovation from her area. From my visit to her constituency, I remember sitting in the minibus with representatives from the Environment Agency, Natural England, the local authority, local landowners and the local community. We drove along and ensured that none of them could get out, so that we could hack out some of the problems facing landowners who just want to make a small improvement and come up against two different agencies plus the local authority. The complications of the process are, I hope, being ironed out. That was an extremely useful session. My hon. Friend is absolutely right: we need to take a longer-term view, and internal drainage boards are absolutely crucial to many of these schemes.

There was an intervention from my hon. Friend the Member for Stroud—

For Stroud actually. He was talking about the scheme concerning small changes that can be made. We must have that level of flexibility.

The hon. Member for Leeds North East (Fabian Hamilton) spoke with passion about the Leeds scheme and the cost of flooding to his community. I absolutely understand that and the commercial driver that his community—that great city—is to that region. If we follow that logical argument and consider the 5.2 million homes that are at risk from flooding, for every single one of those homes that can get protection from flooding, there will be a financial return. We have to make sure that the financial return is as high as possible. That is why work can be done on that scheme in particular. As the equally sensible contribution from his colleague the hon. Member for Leeds East (Mr Mudie) made clear, we might risk having a Rolls-Royce when a reasonably priced family car might have served some of the purpose. I cannot go into more detail about the matter now, but I will continue to look at it very closely to ensure that we get a result.

I shall quickly mention the point about the woodlands that were being built over. I cannot remember who raised the matter, but we need to understand the impact of the issue. That is why I have been totally opposed to so much of the infill development that we have seen, with building in back gardens and green spaces. The Government have a very clear policy on that which we want to take forward.

I would love to address many of the other valid points raised by, not least, the hon. Members for Copeland, for Wansbeck and others, but I see that the clock is against me. I do not want to repeat the increasingly sterile debate about where we are and whether we are comparing apples with apples or apples with pears. In the case of the hon. Member for Copeland, I suggest it is the latter.

Citizens Advice Bureaux (Birmingham)

Thank you, Mr Sheridan, it is a pleasure to serve under your chairmanship.

This is a debate of immense importance for the people of Birmingham. The Birmingham citizens advice bureau is the oldest and largest in the country, dating back to 1939. Progressively, the Birmingham CAB opened five offices in Birmingham to meet great and growing demand. Last year, the Birmingham CAB provided advice and support to 56,000 people. For those who find it hard to access mainstream services, it also provides a comprehensive web of outreach services in, for example, GP practices, children’s centres, hospitals, dementia advice projects and Macmillan Cancer Support.

The Birmingham CAB employs 100 full-time staff, who work with a dedicated army of 166 volunteers, including the excellent Paul Ballantyne who is here today and who is the chair of the trustees, and the excellent John Orchard, a volunteer for the CAB. Both have both devoted many years’ work to the CAB in support of the most vulnerable people in Birmingham. And vulnerable they certainly are; in Kingstanding, in my constituency, we have a CAB in one of the poorest and most deprived wards in Britain—much cherished by the people who live in the ward.

Birmingham has been hard hit. The west midlands has the highest unemployment anywhere in Britain. Just when the people of Birmingham need somewhere to go for support and advice, the generalist advice services of all five citizens advice bureaux will close. Why? On the one hand, it is a combination of the callous cuts being made by the Government to local government services in Birmingham, where £170 million will come out of the budget next year alone; and on the other hand, the cruel incompetence of the council.

I do not know if my hon. Friend saw the Prime Minister’s very helpful comment in The Sunday Telegraph, when he said that councils should look to reduce their chief executives’ salaries before they cut citizens advice bureaux. Given that the chief executive of Birmingham is one of the highest-paid in the country, should he and some of his senior officers not take a cut before the CAB?

My hon. Friend makes a powerful point. The last thing that should be cut is advice to the people of Britain from citizens advice bureaux. If there are to be reductions, they should start at the top in Birmingham city council.

The CAB had been planning for some council cuts for some time, going back to March 2010, but suddenly, out of the blue, the bureaux were told in December just before Christmas that they would lose all their funding from March 2011. The CAB then made repeated approaches to the council to try to find a way forward. What have they been told? “Sorry, you will have to close by March, but you can reapply for a fresh funding stream in August this year.” That means that the CAB’s generalist advice services will close down for five months, with no certainty whatever that there will be support afterwards.

Does the hon. Gentleman not accept that the city council is in fact offering interim funding to maintain the service, and that the CAB had not actually made proposals for any savings whatever?

This is an intervention on my hon. Friend, but before I start it I think the answer to the question asked by the hon. Member for Birmingham, Yardley is no.

Would my hon. Friend comment on the fact that in the other place, Baroness Wilcox said:

“Central Government has not been notified of the closure of any citizens advice bureaux since the spending review settlement 2010. The Government are aware that local authorities that fund citizens advice bureaux are facing tough decisions but do not expect them when making those decisions to pass on disproportionate cuts to other service providers, especially in the voluntary sector.”—[Official Report, House of Lords, 26 January 2011; Vol. 724, c. WA166.]

Would my hon. Friend join me in inviting the Minister, when he responds, to tell us what it means, other than just words, if the Government let happen what looks like happening in Birmingham?

My hon. Friend is absolutely right. It is proof positive, once again, that the Government are simply out of contact with the consequences of their actions. What is happening in Birmingham is clear beyond any doubt. The question that we will be asking today is what Ministers intend to do about it.

On the point about the council, the hon. Member for Birmingham, Yardley asked whether the CAB had explored alternatives. It has explored alternatives repeatedly. I have seen the correspondence going backwards and forwards. The CAB has tried to find a way forward, but what has it been met with? Among other things, abuse from the cabinet member concerned, Councillor Ayoub Khan. Just when the CAB was looking for a co-operative approach to try to find a way forward, including making economies consistent with protecting the service to the community, it ran up against a brick wall.

Earlier, the hon. Gentleman claimed that there was no proposal for any funding from April onwards. In fact, there is a proposal to make interim funding available. That, to be fair, is something that I have discussed with the CAB.

There will be a crucial meeting on Monday next week. As things stand, the CAB will have no alternative but to close down its generalist advice services—no alternative. If, as a consequence of today, the Government say, standing by previous statements, that they mean what they say and that CAB should not close, and if the council sees sense, not only will the CAB celebrate, so too will the people of Birmingham.

If there is no change, let us bring home what the consequences will be for the people of Birmingham. All Members who represent Birmingham can give examples—the kinds of problems that my hon. Friend the Member for Coventry South (Mr Cunningham) sees as well—but I shall give the House three. First, a quote:

“I didn’t know what sort of help to get regarding family difficulty with breach of custody agreement. I was terrified that I may lose my son to a hostel and wouldn’t know who to go to about my rights as a father if it wasn’t for the CAB.”

That difficult family problem was successfully resolved.

Secondly, a client of the CAB, disabled and living alone in an empty flat on a low income with no furniture, had no idea about the support available—social tariffs for utilities, community care grant or budgeting loans for furniture. Thanks to the CAB, that disabled woman now lives in comfort and is properly supported. Thirdly, there is the case of a client with cancer, who without the help of the CAB would not have been able to challenge successfully a decision not to award her benefits.

The consequences for people like them, and for the people of Birmingham more generally, will be severe indeed. Where will they turn at their time of need, and just at a time when demand is increasing?

The issue for a great many of us as elected representatives and as MPs is that we recognise the good work that CAB do, but we also recognise that with the changes the coalition Government are putting forward on benefits, demand for CAB services will increase and concerns will increase. Homelessness, loss of benefits and loss of income will be critical issues over the next four to five years.

The hon. Gentleman makes a very powerful point indeed. I suspect that all Members of Parliament, let alone advice agencies, are seeing the same trend of growing demand for support from us: advice on housing, advice on homelessness, advice on benefits and advice on debt. A whole range of issues is coming to us because there is growing demand when the economy is in difficulties and at the same time the Government are cutting back vital services to the people of Britain and Northern Ireland.

Does my hon. Friend agree that CAB and other advice agencies are facing a double whammy because of the cuts? The closure of the financial inclusion fund will leave 100,000 people who were served last year with nowhere to turn in the future, and more than 500 skilled and trained advice workers are currently serving their notice.

My hon. Friend is absolutely right. She brings to this debate the wisdom and experience of her many years in the CAB. Her contribution is welcome, and she is right to bring home once again the consequences of what the Government are doing.

On the folly of the cuts, interesting independent academic research has demonstrated that every £1 invested in advice yields a return of up to £10 because early intervention produces the best results. What will happen—it is as simple as this—is that the CAB and other advice services will be run down and closed, and there will be greater risk of debt, homelessness, poverty, mental health problems and relationship breakdown simply because tried and tested services upon which people depend at a time of need have gone.

Does my hon. Friend, as a fellow Birmingham MP, share my experience? The two agencies that I rely on most heavily when constituents come to my advice surgeries are the CAB and the Immigration Advisory Service. The CAB is a source of reliable, independent advice, and there is no alternative. If we lose it, our people will lose.

My hon. Friend speaks from her great experience in Birmingham, Edgbaston. She is absolutely right: these services, including the one for immigration, are vital. The question then arises—Ministers will have to answer it—of where people will go if the fabric of our advice services is torn apart. As I shall say in a moment, it is not just the CAB; a total of 13 services will close in Birmingham.

I agree with the hon. Gentleman that the CAB is a vital service, but does he agree that it should not take an all-or-nothing approach but be willing to compromise with the city council and aim to maintain a service at a lower cost?

The hon. Gentleman is, to be frank, wrong. The CAB has made it consistently clear that it is prepared to do precisely that, but dialogue with Birmingham city council has proved to be a dialogue with the deaf. If he will speak out today and call on Birmingham city council, and join the Labour MPs of Birmingham in hoping that good sense will break out next Monday, that would be very welcome indeed.

I have been working with the city council on funding proposals to maintain a substantial part of the CAB service, so that has been happening.

The hon. Member for Birmingham, Yardley (John Hemming) is not dealing with the real issue. I have two CAB in my area—one in my constituency and one just outside—which serve some of the most deprived people in the area. Those people have real issues in respect of health, housing and mental health. An organisation called COPE: Black Mental Health Foundation, which provides advice on mental health issues, will close in the next two months because the city council is not providing any support. The Asian Resource Centre is also closing. As my hon. Friend the Member for Birmingham, Erdington (Jack Dromey) says, there will be huge issues around support for the most vulnerable in our society, but there has been no dialogue at all with the city council on that.

My hon. Friend is, of course, right; it is not just the CAB. Some of the 13 organisations that are threatened are the Afro-Caribbean Millennium Centre, Age Concern in Birmingham and Perry Barr, the Birmingham Asian Resource Centre, the TUC Centre for the Unemployed and the Chinese Community Centre. A whole range of advice services catering for the needs of the various communities of Birmingham are all facing closure. In total, between 80,000 and 100,000 people seek advice from those 13 advice services each year. That is one in 10 of Birmingham’s citizens, or one in four families. Such is the scale of need that those admirable institutions meet at present.

It would appear that the cuts are not just cruel and callous; they may be unlawful as well. The National Council for Voluntary Organisations, an admirable organisation, has written to Birmingham city council to raise concerns over the legality of the cuts in relation to consultation and equality impact assessments. Many of us will give evidence in any proceedings that are held because we know from our experience that there was no proper consultation in advance, and that no serious impact assessments were conducted. The council made the decisions just before Christmas, and it has gone hell for leather to implement the next stages without proper consultation or impact assessments.

It is essential that the Government and the council act. If a solution is to be found that will secure the long-term future of these admirable organisations, there will need to be at least interim funding while we seek a long-term solution.

I thank the hon. Gentleman for his comments. The situation is the same across the country. In my constituency, the CAB in Goole is facing a similar threat. I want to reinforce the point that he has just made. There has to be a long-term solution, because this is not something that has not happened before. CABs are constantly battling for various funding streams, but what we really need is something that puts their vital service on a proper, long-term footing. I entirely agree with what he has been saying.

I am grateful to the hon. Gentleman. He makes a powerful point based on his experience. The current arrangements mean that this admirable institution, the CAB, lives from hand to mouth, never quite certain that it can count on the next funding round or stream, which makes it difficult to plan. John and Paul, who are here today, are outstanding at doing precisely that, but it is impossible for them to plan if they are told in December that they will have to close in March but they might or might not get money in August. That is, to be blunt, an absolute farce and something that requires urgent action by the Government to put right.

Let me close on exactly those points. Clear views have been expressed on both sides of the Chamber that we need action by Ministers. I say this with the greatest of respect to the Minister: Ministers cannot wash their hands of responsibility. If the big society means anything—they proclaim that the CAB and advice agencies are a key part—what do the Government intend to do about the situation? Will they call on Birmingham city council to think again? That is precisely what we hope for—that Birmingham city council will think again—when the meeting takes place on Monday next week.

I pay tribute to Citizens Advice. It is an outstanding institution with outstanding employees and volunteers. It needs to be able to serve the people of Birmingham well for the next 70 years, as it has for the past 70.

I congratulate the hon. Member for Birmingham, Erdington (Jack Dromey) on securing this debate on what I agree is an important subject. I would like to thank the Members who intervened in the debate.

The hon. Gentleman used the adjective “admirable” on many occasions in describing the CABs in Birmingham, and I am sure that he meant CABs everywhere. I concur with him totally in that regard.

In a second—I just want to finish this point.

Like other hon. Members, I have advice surgeries in my constituency every week. In fact, I have two every week, and have done so every week since 1997: every Monday morning at 8 am in my office, and on Thursday or Friday night, or Saturday morning. I spend between five and six hours—sometimes even nine hours—face to face with constituents every week, so I see many of the kind of cases that the hon. Member for Birmingham, Erdington spoke about, whether about benefits, debt, housing or antisocial behaviour.

My staff and I work with the CAB in Kingston. We work with organisations such as Kingston Churches Action on Homelessness and several others to help the most vulnerable in our society, and we do that willingly, as does every Member in this Chamber. We understand the importance of the CAB. I understand the importance that it has in our society, whether it is called the big society or something else. I am afraid that the hon. Gentleman will have to get behind me in the queue to praise the work of the volunteers and professional staff of CABs in every community in our country and the work of the national organisation. I hope that when he hears my remarks, he will understand that the Government do support CABs.

It helps to put the history on record. Yes, the decision was taken in November that money needed to be saved in this area, but the objective was to maintain services, and, therefore, interim funding was made available. The CAB took the view that it was all or nothing; it wanted to continue interim funding at the same rate at which the funding was being withdrawn. To be fair, since then I have met with the chief executive of Citizens Advice, and although the meeting started with the position that it needed to maintain interim funding at the same rate, it has now agreed to look for savings, but that is far too late. I have a meeting with Councillor Ayoub Khan about the matter on Friday, and let us hope that the CAB, rather than issuing threats of legal action, is willing to co-operate to maintain services. I ask the CAB to co-operate to maintain—

I ask that the Minister co-operates because there are other funding streams, which are also crucial.

Let me answer the intervention first, and then I will take subsequent interventions.

The information that my hon. Friend provided then and in other interventions backs up the information I received—in no way has there been a final deal. People locally, both on the council and in Birmingham CAB, are talking to each other. Local MPs such as my hon. Friend are trying to help to resolve the issue, and are working hard on behalf of local people in Birmingham. That is exactly how it should be.

May I gently put it to the Minister that those of us who have experience working with Birmingham city council know that all too often it is like trying to knit fog? Unlike the hon. Member for Birmingham, Yardley (John Hemming), rather than get my knitting needles out, I would rather get rid of the fog. If the Minister has looked into the issue, will he answer the following question? Has he taken a view on whether Birmingham city council’s actions so far in dealing with this are compact-compliant?

The hon. Gentleman will not be surprised to hear that it would be wrong for a Minister to second-guess every action of every council in the country. I hope that he will agree with that. If he agrees with localism, I hope that he will agree that local authorities, and the councillors who are elected to serve, should take responsibility and be accountable to their local electors. It is important that local councillors of all parties play their role in sorting out local problems in their areas.

I will take interventions, but if I make some progress, I can talk about other issues germane to the wider debate on Citizens Advice.

I am grateful to the Minister for giving way. Given that six out of the 10 Birmingham MPs are here, and they have considerable experience of working with the council, will he say whether in his view Birmingham is compact-compliant? It is a very important point.

I am afraid that I am not going to give the hon. Lady an answer to that question. It is important that, as this is being settled and as the meetings we have heard about—the one that has happened, the meeting on Friday, and the meeting on Monday—try to resolve the matter, they will ensure that any regulatory demands from central Government are met.

Does the Minister agree that the best way forward is for the CAB and the council to op-operate on how to maintain services, rather than issue threats of legal action?

This is a wider point that applies beyond Birmingham. I certainly agree that it is important that local authorities and citizens advice bureaux in these difficult times try to work together. I will talk about that in a moment, if I can make some progress.

I can give a view from the heart. A few years ago in my constituency, my local council signed up to a three-year strategic partnership with Kingston CAB to ensure that it had stability of funding. That is one issue discussed in the debate. I understand that local authorities are under serious pressure at the moment, as are Government, Whitehall Departments and all those across the public sector. We have some difficult funding times, which is hardly a secret, and such long-term deals need to be seen in that context. From my local experience, I can recommend that strategic partnerships with key voluntary players, such as the CAB and the local council, can resolve such problems more easily.

I simply wanted to ask the Minister whether he is responding as part of a double act with the hon. Member for Birmingham, Yardley (John Hemming). Will he ask the hon. Gentleman why there was no mention of transitional funds in the council report in November? That seems to have emerged when the hon. Gentleman made his contribution today.

When I eventually get to that point in my speech, I will say that prior to today I was aware that there was transitional funding. I do not think that it has emerged in the past few minutes. [Interruption.] Labour Members need to hear this, because there is a backdrop to the debate, which is the record deficit that the Administration inherited.

We have had to take very difficult decisions. One of the most difficult decisions I have had to take as Minister meant telling the chief executive of Citizens Advice that his budget—this was before Gillian Guy took over—had to be cut in-year by a significant percentage. I did not like having to deliver that decision, but I knew that we had to take tough decisions because we have such a difficult spending climate. It is exceedingly important that those tough decisions are taken fairly and are implemented. Local authorities will have to face up to that issue—Birmingham city council, Kingston council and other councils as well. I shall give way to my hon. Friend, but I hope that he realises that I need to make progress after his intervention.

I presume that the Minister agrees that CAB funding in Birmingham was perfectly stable until the Labour Government almost bankrupted the country.

It is very tempting to answer that question, but I shall make some progress.

As a result of the financial difficulties, all councils must re-examine how services are organised and run—finding efficiencies and unlocking savings. We have sought to make that task easier by scrapping most ring-fencing constraints on councils’ funding, so they have greater freedom to manage resources in the best possible way. That involves joining up back-office functions, sharing chief executives and other senior managers, and cutting out the duplication and waste associated with procurement. Where possible, that should not mean cuts to front-line services. We say that not only to Birmingham city council, but to all local authorities.

It is worth noting that, although all citizens advice bureaux are members of the national umbrella organisation, Citizens Advice, they operate independently. I am sure that the hon. Member for Birmingham, Erdington will admit that at least. Their funding is determined locally. That is not new, but has been the case for many years under the previous Administration and the Administration before that. Funding is determined by the relevant local authority. That is how it should be, because the need for advice and such services varies dramatically across the country. I am sure that the needs of Birmingham are different from the needs of Kingston. There should not be any doubt about the fact that these should be local services.

I will give way to the hon. Lady because I know that she has worked so hard in this area and has been a chief executive of a CAB.

Does the Minister agree that funding from the local authority often acts as seed-corn funding for the other funding that citizens advice bureaux get? For every £1 that the local authority puts in, £10, on average, from other sources is gained by bureaux.

I agree that funding from local authorities can be critical to how citizens advice bureaux plan budgets, so I do not disagree with the point that the hon. Lady has made.

We are getting close to the end of the debate, and it is of the highest importance that a clear message be sent to the people of Birmingham. A meeting is scheduled for next Monday and we hope progress will be made. In the event of progress not being made next Monday, will the Minister be prepared to meet a delegation from the Birmingham CAB—the admirable people who work for it, the admirable people who volunteer and some of the people who depend upon it?

I would not want to prejudge the meetings that will happen over the next few days. It is up to individual councils such as Birmingham to work with partner organisations to sort out some of the difficulties. I understand that Birmingham city council has reviewed advice provision within the whole city and will be moving towards a new commissioning process in the summer. All the independent advice providers will be eligible to apply, and that will, of course, include the bureaux.

I also understand that the council recognises that there may be short-term problems for some of the independent advice providers during the period until new contracts are awarded. I believe that it has a transition fund, to which my hon. Friend the Member for Birmingham, Yardley referred, which might be used to help those organisations through that period. The meeting, scheduled for Monday, will focus on discussing that.

Those are positive developments, which the hon. Member for Birmingham, Erdington did not touch on in his speech, and it is worth putting them on record because I hope they will result in a successful outcome. I am concerned that hasty decisions taken by councils now could lead to the unnecessary loss of important CAB services not only in Birmingham, but in other areas. I trust that, when local authorities work carefully with their citizens advice bureaux to strike up the strategic partnerships I talked about, that will not happen.

Hospital Services (Shropshire)

This important debate is on the reconfiguration of hospital services in Shropshire, and in almost six years as Member of Parliament for Shrewsbury, I have never received so many letters, e-mails and telephone calls from concerned constituents over a single issue. Many of those calls have been emotional, and even though the consultation process is still ongoing, I feel it is my duty to use the platform that I have in the House of Commons to highlight a few of the concerns to the Minister.

Part of the reconfiguration proposals would involve maternity and paediatric services moving from Shrewsbury to Telford. I want the Minister to imagine the geography of Shropshire and mid-Wales. The Royal Shrewsbury hospital covers not just the whole of Shropshire, but the whole of mid-Wales—a vast expanse just across the border. I am pleased that my hon. Friend the Member for Montgomeryshire (Glyn Davies) is present in the debate today.

Picture the wheel of a bicycle, and at the centre, the spokes coming into the middle. That is where Shrewsbury is in the area. Now imagine moving paediatric and maternity services right to the edge of the wheel. How would that wheel function? Telford is at the edge of the area, on the extreme eastern border close to Staffordshire. What is the sense in moving services so far away from the rest of central Shropshire and mid-Wales?

I am so passionate about this issue that I raised it during Prime Minister’s Question Time last week. The Prime Minister referred to the importance of public engagement and consultation, which he said was a fundamental aspect of any reconfiguration proposals. Therefore, I have asked the chief executive and the primary care trust for a public meeting to be held in Shrewsbury on 11 February at the football stadium in our town. I believe that hundreds and hundreds of people will attend. I intend to make a transcript of that meeting and of all questions put to the PCT and the chief executive, and I will be sending that transcript to the Minister.

My hon. Friend knows that I also have a huge interest in this issue as I represent Montgomeryshire over the border. Does he agree that the meetings that will be held in Montgomeryshire on 18, 23 and 24 February are of equal importance, and that it is crucial for the health board and PCTs to take notice of them? We also depend on the services in Shropshire.

I agree with my hon. Friend. We are cognisant of the fact that his constituents, the citizens of mid-Wales, do not have facilities across the border and are dependent on the Royal Shrewsbury hospital. The people of Wales must be listened to equally, in the same way as the people of Shropshire.

I have slight concerns about the lack of sufficient engagement by the authorities with local people. I pay tribute to the chief executive and his colleagues. There have been public meetings, and the chief executive has met some of my constituents who have serious questions to ask on a one-to-one basis. Nevertheless, many letters and e-mails have not been answered in a timely way or to the degree that people wished for. Some people who have written in are retired senior consultants and experts in the field. I hope that all their questions will be answered.

I am also concerned about the dates of the public consultation. In began on 9 December and will finish on 14 March. I find 9 December a rather strange time to start a public consultation. We all know how stressful Christmas is at the best of times, and we would have been gearing up to buy the Christmas tree and presents and get our homes ready for festivities. A lot of people in Shropshire will not have been thinking about the consultation as intently and with as much time and focus as they might have done, because they were distracted by the coming festivities. If we are to have a public consultation, it must be held at the right time of the year and there must be sufficient time for people to make their views heard.

I am grateful to my hon. Friend—I use that phrase pointedly—for giving way. There will be a consultation in Telford next week, and I hope that people will come to it. It is important that people across Shropshire express their opinions. Does my hon. Friend accept that under the proposals, both hospitals have to give something in order to sustain health services in Shropshire? Acute surgery would move to Shrewsbury, and some elements of paediatric and maternity services would move to Telford. There will be a balance between the two hospitals. We do not want to see services move out of the county, and if we are to sustain services in Shropshire, I think this is the best plan we are going to get.

I will reciprocate by referring to the hon. Gentleman as my hon. Friend. We are from different parties but we are colleagues. We get on well, and across the parties we have a passion for Shropshire. I will come later to the importance of retaining services in Shropshire. However, constituents do not pay attention to services that come to their area; they are focused on those that are leaving. That is why they are pressing me to highlight these issues in Parliament.

My other concern is that there is no plan B. This is a consultation process in which the chief executive and the board come forward with proposals. However, there are no shades of grey—it is take it or leave it. I speak purely as a layman, but if there is only one option, it is difficult for a large group of people, many of whom do not have medical experience, to scrutinise that proposal. Surely, if we are to genuinely engage with local people, differences and alternative options could be put forward so that the community as a whole could come together, debate them and make recommendations.

Does my hon. Friend accept that in an ideal world, both hospital sites would have all-singing, all-dancing acute and clinical services? However, we do not live in an ideal world, but in a time of constrained public finances. Does he accept that the current consultation recognises the importance of having an accident and emergency ward at both Shrewsbury and Telford? That is a breakthrough from the original consultation process and shows that the hospital trust has listened to Shrewsbury and Telford on that important point.

I concur with my hon. Friend and with the point that he makes in his usual eloquent way. I have been told by the chief executive, and others, that if we do not go for the proposals, we will potentially put our foundation trust status at risk. If we put that at risk, there is the possibility of losing services—and the management of those services—out of the county. Again, I speak without medical experience, but I do not understand how we could enter into a consultation process but be told that if we do not go for the proposals, services will be lost from Shropshire.

I cannot envisage a time when we have no maternity or paediatric services in the whole of Shropshire. That is unthinkable to me, so I do not understand the logic of the trust. It is saying, “Take it or leave it, but if you leave it, that’s it. We won’t get our foundation trust status and you’ll lose your services.” That position needs to be clarified because many people see it as a gun being pointed at their heads and are therefore frightened to challenge the proposals.

I am grateful to my hon. Friend for his tolerance in allowing me to make a second intervention. The point that he has just raised is key. Everyone, including, I am sure, my hon. Friend, recognises that there must be a reconfiguration of services. The points that have been made are crucial. However, that does not necessarily mean that the reconfiguration of services that is before us has to be the case. The argument is not about whether there should be a reconfiguration of services, but about how that should take place. In the interests of the people of Montgomeryshire, I think that services are best placed not where it is convenient for a balance in Shropshire, but where they are accessible to the people who will use them.

I completely concur with my hon. Friend on that point.

I shall briefly relate a couple of specific cases. I have been inundated with hundreds of letters on this issue. My own daughter was born at the Royal Shrewsbury hospital, and it was the proudest day of my life when my daughter was born within the community that I represent. She is not just a Salopian; she is a Shrewsbury girl and she will have that with her for the rest of her life. For us in Shrewsbury, being a Salopian is important, but being a Shrewsbury girl? Now that is something special. I feel so passionately about that.

One constituent’s family is directly affected by the proposals, as her three-year-old son needs 24-hour open access to the children’s ward at the Royal Shrewsbury hospital because he suffers from severe haemophilia. He needs treatment to be administered every other day and any additional treatment on demand if he should cut himself. I was told that it was vital for my constituent’s son to be admitted immediately to the children’s ward via A and E and not to be sent down the motorway to the Princess Royal hospital. How can that mother of a son with haemophilia empower herself to make her views known if the overview and scrutiny committee is not minded to refer this issue to the Minister?

The issue has also been raised with me by the father of a child who was previously a cancer patient treated at the Royal Shrewsbury hospital. He talks about the appeal in 2003 for a designated children’s cancer unit at the Shrewsbury hospital. It raised £500,000 and the unit was completed in 2005. My constituent told me that

“many people across Shropshire and Mid Wales donated or gave up many hours to fundraise, only to now find that the purpose built unit will…stand unused as Children’s services are being moved to Telford with no provision for this desperately needed unit which provides an essential service to families facing unimaginable turmoil whose children are being treated for cancer.”

I have been told of the severe disruption and anguish that will result from the need for seriously ill patients to travel from Shrewsbury if it is left with no consultant-led surgery, which may result in a catastrophic delay in emergency treatment.

I also want to mention Joshua, a young boy in my constituency who has chronic lung disease. His mother, Hayley Corfield, wrote to me about him. He has had bronchial problems since birth and is now 14 and constantly in and out of hospital. I have been given the most extraordinary list, which I will send to the Minister, of the medications that this poor young boy is on. He lives in Shrewsbury. His mother tells me that there have been many near misses in the last few years in terms of saving his life—resuscitating him. She is desperately worried about the impact on her son and the chances of his survival if, suffering from this chronic disease, he has to travel for an extra 20 minutes to Telford. I am therefore raising these issues with the Minister today.

The Minister kindly wrote to me. In his letter, he notes that I am planning to call a public meeting and encourages me

“to ensure views from that meeting are fed back to the local NHS via the consultation mechanism, so local concerns are fully taken into account.”

The next part is the bit that I am excited and happy about and grateful to him for—I know that he is one of the best Ministers we have. He says:

“The Department will be watching the outcomes from the consultation exercise with interest.”

I know that he cannot get involved at this stage, but I am extremely grateful that he has said that he will be watching with interest the outcome of that consultation process.

I have today written to all the general practitioners who practise in Shrewsbury and Atcham. Again, the Prime Minister stated at Prime Minister’s questions, and it was reconfirmed to me by my right hon. Friend the Secretary of State for Health, that the views of local general practitioners would have to be taken into account before any reconfiguration process could occur. I wanted an independent assessment of their views, rather than it being handed to me by the PCT or anyone else. I have therefore written today to all the general practitioners in my constituency and I urge my hon. Friends to do likewise if they so wish. I will compile the results of the views of local general practitioners in Shrewsbury and will share their views anonymously. I will not refer to specific people, but I will share their views with the Minister.

I am extremely grateful for the 15 minutes that I have had and for the constructive way in which we have debated this issue. It is extremely emotive. I do not want to get into a Shrewsbury-Telford pillow fight. We have had enough of that over the years. I want to work constructively with my colleagues and with the trust to come up with the best possible solution for our beautiful county.

I congratulate my hon. Friend the Member for Shrewsbury and Atcham (Daniel Kawczynski) on securing this debate on hospital services in Shropshire. I am sure that his constituents will be pleased to know that he has raised an issue of such great importance to his local community. I also pay tribute to the staff of the NHS across the whole of the county of Shropshire, who do such an incredible job caring for the constituents of my hon. Friend and the hon. Member for Telford (David Wright). They deserve and will receive the Government’s full support.

Before I come to the specifics of Shropshire, I shall set out the Government’s general approach to the reconfiguration of health services, as my hon. Friend referred to the answer that he received from my right hon. Friend the Prime Minister last week. The Government passionately believe that local decision making is essential to improve outcomes for patients and to drive up quality. We do more than just talk about pushing power to the local level; we are doing it.

In May 2010, my right hon. Friend the Secretary of State for Health identified four crucial tests that all reconfigurations must pass. First, they must have the support of GP commissioners. Secondly, arrangements for public and patient engagement, including local authorities, must be further strengthened. Thirdly, there must be greater clarity about the clinical evidence base underpinning any proposals. Fourthly, any proposals must take into account the need to develop and support patient choice.

I understand that NHS West Midlands has given an assurance that the case for change is underpinned by those tests. Let me be clear what that means. Hospital closures that do not have the support of GPs, local clinicians, patients and the local community should not happen. There should be ample opportunity for patients, local GPs and clinicians and local councils to have a far greater role in how services are shaped and to ensure that these changes will lead to the best outcomes for patients.

It is important to remember that local public consultation is the vehicle through which to ensure that everyone with an active interest in proposed changes to their local health service gets their say. In this case, local consultations began on 9 December 2010 and are scheduled to conclude on 14 March 2011. My hon. Friend mentioned it, but if it is any consolation to him, Christmas and the new year holidays came during that period. The normal consultation time is 12 weeks, and if my maths is right this consultation process will take 13 and a half weeks including the holidays.

It should be stressed that consultation is by no means a fait accompli. It is a democratic process that allows full and open participation in considering all the options for service change. If an overview and scrutiny committee is not satisfied that adequate NHS consultation has taken place, or decides that proposals do not meet the needs of the local community, it may refer the matter to the Secretary of State for Health.

I understand that there has been a long history of debate on the best way to organise hospital services in Shropshire. A previous review failed to provide a lasting way forward for the county. Local organisations are now taking this review forward, and they believe that changes need to be made in the near future to ensure that services continue to be provided safely. Over the last decade, the NHS in Shropshire has identified a number of services, including accident and emergency, acute surgery, maternity, neo-natal, in-patient, paediatrics and urology, that face an increasing challenge in trying to provide 24-hour cover by senior medical staff at local hospitals.

As the public consultation document explains, there are five main reasons for that. First, the increasing specialisation of staff means that fewer consultants are able to provide general emergency cover. That is a particular problem in general surgery if it is split between two sites. Secondly, out-of-hours arrangements mean that some consultants have to cover a number of services and sites at the same time. That places unrealistic pressure on staff, and it can put patients at risk. Thirdly, the European working time directive limits the time that medical staff are allowed to work to an average of 48 hours a week. Fourthly, due to the relatively spread-out nature of the Shropshire sites and the area’s rurality, it can be difficult for junior doctors to see the wide range of patients necessary for their training. Fifthly, those factors collectively could make it difficult to recruit high-quality medical staff, particularly consultants.

The current configuration of services results in duplication between the Royal Shrewsbury and Princess Royal hospitals. It also limits the ability to develop the more specialised services that could be provided in Shropshire, Telford and The Wrekin. That is not sustainable.

This is the opportunity for all those with an interest in making changes to local health services to become involved. My hon. Friend has called for an additional public meeting in Shrewsbury; that takes place on Friday 11 February. As I said in my letter, I strongly encourage my hon. Friend to note the views raised at the public meeting, so that they can be fed in to the consultation process. Before a final decision is made following the conclusion of the consultation process, those views will have been heard and considered.

The consultation document explores four options. Option 1 is to do nothing. That is not considered feasible by the local NHS. A second option is to concentrate all major and emergency activity on the site of one or other of the existing two hospitals, with planned activity at the other. That has been looked at carefully, and I understand that that is not considered feasible either. A third option is to build a new hospital, but that has been discounted because of the financial climate. A fourth option, the preferred local NHS option, means moving services between the two sites to make the most effective use of staff, equipment, and buildings.

The consultation document suggests that this is likely to mean that the bulk of in-patient, children and maternity services—

Sitting suspended for a Division in the House.

On resuming—

As I was saying when we broke for the Division, the consultation document suggests that this is likely to mean that the bulk of in-patient, children and maternity services will be provided at the Princess Royal hospital in Telford. A range of acute surgery, including trauma and orthopaedic surgery, and various surgical and other services would remain at, or move to, Shrewsbury. Both sites would continue to provide midwife-led maternity units, with improved accommodation provided for the midwife-led unit at the Royal Shrewsbury hospital site. All pregnant women who are assessed as being likely to have a low risk of complication in the later stages of pregnancy would still have the opportunity to choose to have their baby in a midwife-led maternity unit or at home.

Gynaecological services and antenatal out-patient and day care services will continue to be available at both sites, as will children’s out-patient services. It is proposed that a number of specialist surgery services, whether for planned or emergency operations, would be concentrated at the Royal Shrewsbury hospital: vascular surgery; colorectal surgery, and upper gastro-intestinal surgery. I also understand that funding will be made available so that the Royal Shrewsbury hospital will gain phase 3 status as a specialist aortic aneurism centre.

The consultation states that most surgery for life-threatening trauma is already carried out by surgeons at the Royal Shrewsbury hospital and that would continue to be the case under these proposals. Also, 24-hour accident and emergency services will remain at both hospitals. Therefore, proposals in the consultation document appear to point to a vision of both hospitals providing a diverse range of services that complement each other.

This review has been led by clinicians. Proposals are based on work led by senior doctors, nurses and other health care professionals in the county, working with partners from local authorities, community and voluntary organisations, and patient and public representatives. I understand that the local NHS has involved a number of clinical staff in its local assurance process, including clinical experts from outside Shropshire, such as the director of nursing from Leicester Royal Infirmary and a consultant paediatrician from Manchester, as well as a number of clinical staff with related experience who work within the trust but who had not been involved previously in developing future options.

I am assured that NHS West Midlands will consider results of the public consultation, as is appropriate, before any results are presented to the local NHS boards. I also understand that the local NHS is keeping all local MPs briefed on the consultation process.

I know that my hon. Friend the Member for Shrewsbury and Atcham has campaigned vigorously in the past for retaining services at his local hospital. May I assure him that I fully appreciate his desire for a process that is open and transparent, one that does not end with decisions made behind closed doors after only a derisory nod to public consultation? His constituents, like those of all right hon. and hon. Members, deserve local health services that have the confidence of local GP commissioners and of local people themselves.

I also point out to my hon. Friend that because we are in the middle of a consultation process it would be totally inappropriate for me to seek to influence or compromise that process by becoming directly involved. There are avenues open through the consultation process, as my hon. Friend knows well, and I know that he is working vigorously, as demonstrated by his holding a meeting in Shrewsbury on 11 February, to make sure that the voice of his constituents is heard and considered as part of what is a very important consultation process for the whole county of Shropshire, to ensure the right configuration of services in local hospitals to meet the needs of local people.

Question put and agreed to.

Sitting adjourned.