Wednesday 7 September 2011
[Mr Philip Hollobone in the Chair]
Disabled Young People (Support)
Motion made, and Question proposed, That the sitting be now adjourned.—[Mr Dunne.]
It is a privilege to serve under your chairmanship, Mr Hollobone. I am delighted to have secured this debate on support for disabled young people. I have called for this debate today because I have had serious concerns for some time about the inadequate transitional arrangements for many disabled children, particularly those with learning disabilities in the key period from childhood to adulthood. Having spoken to a number of disability charities such as Mencap and the National Autistic Society, as well as others, it is clear that problems with transition, as many of us in the Chamber know, have been going on for many years. I wished to secure the debate so that the Minister could reassure me that the coalition Government understand that there is a problem with transition and can outline how they propose to tackle that problem.
I should like to outline the common challenges that many parents of disabled children, and the young men and women themselves, experience once they are over the age of 17 or, in some cases, 16. Preparation for adulthood is a time of challenge and celebration for all young people, but for disabled young people, more often than not, it is a time of particular challenges. The Transition Support Programme and the wider Aiming High for Disabled Children programme, 2008-2011, resulted in improved consistency of support to young people and families across the country, including greater expectations that disabled young people would achieve their goals for adult life, so I am disappointed that those programmes are no longer running and would welcome the Minister’s comments on what will replace them.
As many hon. Members know from their postbags, parents of disabled people have to deal with numerous statutory services, from local councils in relation to disability access and provision in the home, to social services with regard to helping them to manage and providing respite care. Parents often have a great deal of contact with the local hospital or NHS to help the family with whatever the disability may be, particularly if it is a profound disability. For each disabled child, there is supposed to be a social worker who helps to co-ordinate all the different services. However, that key worker service ceases once the child reaches adulthood—if they were fortunate enough to have had a key worker.
Tussie Myerson, who contacted my office to share her daughter’s story, told me about one such case. Her daughter Emmy is 20 and profoundly disabled. Incidentally, Emmy’s story was first told in Parliament eight years ago, when the right hon. Member for Witney (Mr Cameron) was her MP. Since then, regretfully, her story has not much improved. Emmy, and her mother and father, have not had contact with a social worker for six years and have never had any contact with a key worker or benefited from any transition arrangements.
In 2006, the National Autistic Society surveyed its members on their experience of transition. It found that only 53% of young people with statements received transition plans during the course of their education, with the figure falling to 34% of students in mainstream schools—and that is a legal obligation. Unsurprisingly, 45% of those who participated in transition planning were dissatisfied with the whole process. One issue has crept up again and again as I have delved into the provision of support for young disabled people: the lack of—forgive the cliché—joined up, co-ordinated provision and a failure to share best practice between different authorities, leaving many parents to feel that the transition is something of a postcode lottery.
Emmy also had the misfortune of moving from one local authority to another, which her mother deemed to be a fiasco, to put it mildly. Emmy is now in her eighth year of legal wrangling with the local authority. She receives legal aid. I dread to think what the total cost of her legal fees might be, not to mention those of the local authority, but I am certain that without legal aid Emmy and her parents would not have been able to fight her case.
That is just one example. There are plenty more like it. When we get it wrong, disabled people suffer, their families suffer and, sadly, it can and does often lead up to the break-up of families.
I, too, have had parents of disabled children come to see me. It puts a terrible stress on them. Parents worry very much about the future. They do not know what the future holds for their child, particularly when they are no longer with us.
I agree. Sometimes the parents split due to the sheer strain—and not just of looking after a severely disabled child, which is a challenge, no matter how much the parents love them. The situation often leads to irrevocable strain between parents, which is one of the saddest things that I have seen. Like all hon. Members, I have seen a lot of desperate cases. Often, the reason why parents split up is because statutory authorities, though they often try to be helpful, are clunky, and lack consideration and co-ordination. That, as I will go on to explain, makes it much worse. It also costs a great deal of money for the family, local authorities and all the agencies. It is therefore imperative, particularly for disabled children going into transition, that we get it right first time. I am sure that the Minister and hon. Members can appreciate how complex and challenging such a scenario must be for both the disabled young adult and the parents.
I have been liaising for the debate with Mencap, which has been very helpful and supportive. It has put together a document that defines what a good transition must look like. In its view, which I share, it is defined by three stages: planning, process and destination. To be a successful transition, each stage must be followed effectively and, most importantly, tailored to the individual, but there are general principles that can be applied to each stage. It is recognised that all young people should be at the centre of their transition planning—that is incredibly obvious. That is important for parents, uncles and aunts, and children without disability, but is doubly important when working with a disabled young adult. For young people with a learning disability, a plan will be achieved only if it is timely, accessible and diverse. To be ready for the start of their transition, young people should be encouraged to think about their options in year 8, so that they are adequately prepared for their review in year 9. In the run-up to and following their review, young people should have access to appropriate information about their rights and their options regarding their future. Ideally, the options presented to young disabled adults should be limitless. For all of us and for all disabled children, transition should be an exciting time for exploration, not a restricted choice of a predefined future.
No particular Governments or Government are at fault here; this has been a challenge for a long time. Even well before I was elected, I had people in my constituency come to see me who were absolutely petrified because their child was getting to the end of teenagedom and going into young adulthood. They knew that the key worker was going and that the services that supposedly, and often do, come automatically with young disabled children would disappear. It is no exaggeration to say that they were petrified.
If choice is to be at the heart of young people’s transition, it is crucial that they be given the opportunity to explore their aspirations with the aim of reaching their potential. For young disabled people to have such aspirations, those around them must be aiming to achieve the highest quality of life for them. None of that is complicated or different—it is exactly the same for non-disabled young adults as for those who are disabled.
Throughout a young person’s transition, the process should be co-ordinated and resourced. Although young disabled adults must be the director of their transition journey, it is crucial that the services supporting them be aware of each other’s role in the process. The position of key worker for a young disabled adult is therefore vital, to keep all the professionals in the loop. Obviously, within that, it is about working very closely with the parents of someone who has a profound learning disability, because as well as the work done with the young disabled adult, the parents are best suited to help and guide the child to decide what is best. Often, profound learning disability is accompanied by communication challenges.
For each service to play its part, adequate resources must be provided, mainly that of time. Each professional involved must be prepared to work alongside the young person regularly, to offer support and advice. The transition process should, however, be as unobtrusive as possible, to allow the young disabled person to enjoy as best as possible an ordinary teenhood.
I am sure that the hon. Gentleman and many others in the House are aware of the good work of some voluntary organisations, such as the Prince’s Trust, which I have visited and where I have spoken to some of the young people. Clearly, organisations out there are giving of their effort, time and commitment to help young people. Does he feel that the work of the Prince’s Trust ought to be recognised and complimented in this Chamber today?
I agree totally. The Prince’s Trust does outstanding work in this area throughout the United Kingdom. I am delighted to add that compliment into Hansard. The Prince’s Trust does a fantastic job.
The final stage, which is the destination, is the most important. Young people’s quality of life, as does everyone’s, depends on satisfaction with their destination and opportunity to thrive in the future. The best outcome of a transition is for the young people to be living in a place that they have chosen and to be doing what they want to do, with the support that is right for them. If the transition planning and process are followed in the way that Mencap describes and that I have been delighted to outline, in our view the outcome can be expected to be positive.
On other challenges with older disabled children or young disabled adults, a report published by Ofsted last month has highlighted some significant failings in the system. Too many children in further education with disabilities are failing to gain the qualifications needed to get a job or to continue with their education. The report also highlights the reduced support available once such individuals reach 19, which means that they are often burdened with insufficient advice about personal budgets, the requirement to pay fees and uncertainty about benefits entitlement. In fact, a recent study reported that in 2009 an estimated 30% of young people who had a statement of special educational needs when they were in year 11 and 22% of young people with a declared disability were not in any form of education, employment or training when they reached the age of 18, compared with 13% of their peers. Current figures from the labour force survey for the first quarter of 2011 show that 41% of men and 43% of women designated longer-term disabled were economically inactive. Surely such a high figure historically shows that little progress has been made in recent years. It is time that we all do more to do better by our young disabled fellow citizens.
Although since 2008 local authorities have been required to carry out multi-agency assessments for pupils with statements of need or in receipt of support before their transition to a post-16 provider, inspectors found that those arrangements were not working effectively. Providers had received a completed learning difficulty assessment in only a third of the case studies in which one should have been made available.
I am delighted that the hon. Gentleman secured this important debate. Does he agree that there also is a problem earlier in the process, in the through-planning as children move from primary to secondary school? The assessments often take place after the child has arrived in secondary school, rather than in advance to enable preparation to be made for it.
Yes, I agree. I will touch on what the Green Paper says about SEN, but the problem that the hon. Lady raises is clearly of long standing.
The learning difficulty assessments were found to be not always timely or adequately completed, and did not form a reliable basis on which to plan support or an appropriate programme of learning. The transition at age 19 from children’s to adult services, and from the Young People’s Learning Agency to the Skills Funding Agency, created barriers for learners when they encountered different criteria for funding. Learners and their parents or carers identified that they would have welcomed more advice and careers guidance when they received a personal budget for purchasing a learning programme, care and support.
I am conscious, as I am sure the Minister is, that I am covering a range of responsibilities which is perhaps broader than her remit, but that is the reality of disability, in particular in the transition for disabled children or young adults, because so many different areas of Government and statutory services are touched. As I was drafting my speech, I half envisaged five different Ministers from the different Departments attending today because the subject covers such a wide area, but somehow I knew, even with my delusions of grandeur, that that would be unlikely.
Too little is known about the destinations of learners once they leave post-16 provision. A more systematic national approach to the collection and analysis of data about learners’ destinations would help to ensure that limited public resources were deployed effectively to support learners in making a successful transition to adult life.
Finally, I come to the Government’s proposed welfare changes, such as the transfer from the disability living allowance to the personal independence payment and the reforms to housing benefit. I am a member of the Select Committee on Work and Pensions—I am delighted to see some colleagues are present—and I support the direction of travel of many of the changes being proposed by the Department for Work and Pensions, in particular the Work programme. We are discussing young adults and children, but about 2 million children today are growing up in households in which no one works. That is a national scandal which I hope that the Work programme will address rationally and productively—I think that it is doing so.
I congratulate the hon. Gentleman on obtaining the debate. Many of us in the Chamber have in our constituencies special needs schools and schools dealing with children who have disabilities and learning difficulties, and I agree entirely with what he said about the dearth of activity for young people with special needs post-16 and post-19. He mentioned multi-agency work to help those young people, but does he agree that the CBI, the Federation of Small Businesses and their like should be encouraging their members to employ young people who might have learning difficulties or some form of disability?
I thank the hon. Gentleman for making that important point, which I will discuss when I talk about the Work programme and the black box principle, which I am excited about. Having been in business for many years before coming into politics, I passionately support more businesses employing and recruiting disabled people, because more often than not they are very good employees, but I am conscious that because many small businesses lack understanding of disability, they often will not let disabled people through the door, irrespective of the Disability Discrimination Act 1995.
The hon. Gentleman makes a crucial point. Many employees make assumptions that disabled young people are capable of doing only certain jobs. That is wrong, and is a particular problem when dealing with mental health issues. Many employers make assumptions and do not want to employ such people.
I thank the hon. Gentleman for his intervention. Again, he makes a good point about mental health, which still causes fear in people. As vice-chair of the all-party parliamentary group on mental health and having grown up with a mother who had bipolar disorder, I have experience of and am familiar with mental health issues. I know that they may be a real challenge, but I also know that anxiety, fear and lack of understanding on the part of many people stop many of their fellow citizens contributing very effectively in jobs. Most people with mental health incapacity manage their incapacity.
The challenge of persuading the Federation of Small Businesses, the CBI and so on to take on more disabled people needs a push, and it will be underpinned by the Work programme. Some specialist small charities and training companies understand mental health and learning disability, and part of the opportunity of the black box principle and the Work programme is that there should be enough money for those smaller organisations to engage with local employers to help to break down that barrier. I would like the major trade associations to take more responsibility and to step up to the plate. I would like them to make a commitment. I am a parliamentary champion of the FSB, and I have a meeting with it tomorrow when I shall remind it of that. I appreciate the hon. Gentleman’s intervention.
I have specific concerns about the welfare changes involving young adults and children, and the change from disability living allowance to personal independence payment. I shall be grateful if the Minister puts them to rest. The Government have stated clearly that they intend initially to migrate working-age people to the new PIP, which means that until all age groups are migrated on to PIP, there will be two very different benefit systems for disabled people. The Every Disabled Child Matters campaign group, with which I have worked closely, is calling for under-16s not to be brought on to the PIP system before full public consultation and analysis of how the new system works for over-16s has taken place.
Although I welcome the Government’s decision to have a different commencement date for children and working-age adults on PIP, I share with the Every Disabled Child Matters campaign group its concern about the impact that the two systems may have on disabled young people who turn 16 in 2013. We are both concerned that the migration to PIP may result in those disabled young people testing out the new system. The Minister has responded to such inquiries in the House, but to my knowledge she has yet to give a firm acknowledgement that young people turning 16 in 2013 will not be the first to go through the new assessment. I shall be grateful if she provides an update.
That brings me to the proposed benefit cap and changes to housing benefit. We all want an end to taxpayers having to foot the bill for some of the absurd and astronomical rents for some families living on housing benefit. I do not have a problem with the broad thrust of that narrative, but we must be careful about unintended, disproportionate and unfair changes to the circumstances of disabled people and their families. The changes to the shared-room rate and the implementation of an overall cap on housing benefit cause me concern in relation to young disabled adults. Let me explain why.
The Government propose to increase the age limit for the shared-room rate from 25 to 35, so single people without children aged up to 35 and claiming housing benefit will be restricted to the rate for a single room in a shared house, instead of the rate for a self-contained, one-bedroom property. I shall give an example of why that causes me concern from the disability perspective. The disability of someone with high-functioning Asperger's syndrome—autism—more often than not makes it very difficult for them to share with strangers. A constituent who is a tremendous volunteer, and who helped me during the election by delivering Lord knows how many leaflets, has high-functioning Asperger’s syndrome and finds it difficult to go into a room where there are people he does not know—let alone to share a house with people he does not know, which the benefit changes may lead to. He struggles to go into a room where there are people he does not know, and frankly he will not unless I am right next to him. The Government’s proposal is a real problem for those with some disabilities, and I ask the Minister to take that on board.
I am seeking clarification from the Minister on that point, which I thank the hon. Gentleman for raising. On the one hand, we have been told that there will be one universal system from 2013, but on the other, the Minister has said in the House that she understands that there may be a problem, and my understanding is that she will return with clarification. I too am a little confused, but I am cunningly fleshing it out—at least, that is the plan.
I emphasise that the equality impact assessment of a benefit cap shows that approximately 50,000 households, approximately half of which have a disabled member, stand to receive lower benefit payments. The Minister knows that I have general concerns about some of the housing benefit changes, but today I am focusing on the disability perspective, because I believe that if the changes are handled incorrectly, they could be catastrophic for some young disabled adults and their families. Some 52% of families with a disabled child are at risk of experiencing poverty. With more than 40% of disabled people aged 16 to 24 already living in accommodation that does not meet their needs—there is a long history to the problem—we must be careful of any resettlement as a result of a cap on housing benefit and an overall cap on benefits that disproportionately affect young disabled adults.
The SEN and disability Green Paper has been heralded by many who are hopeful of developing a more transparent, less conflict-ridden and more family-friendly system of support that gives parents a greater say in decision-making processes. I am hopeful that the White Paper will set out detailed proposals for radical legislative and policy changes. I mention the Green Paper because I think it contains some good and progressive potential protocols. I urge the Minister to continue to work closely with my hon. Friend the Minister of State, Department for Education (Sarah Teather), who is leading on that Green Paper. Disability never affects one Department, but involves a range of statutory bodies.
The Government have taken some positive steps, which I applaud. I have already mentioned the Work programme and emphasise that I am keen on the funding model, with its inherent black box principle. Over the years, I have worked with many disabled people. I know that too many large companies do not really understand disability and that the best people to work with young disabled people and help them to get into jobs are often specific groups and organisations, such as the Prince’s Trust, that not only understand disability but have a passion to make things better. The principle behind the Work programme and its funding is that much of the money and many of the resources should be downstreamed from prime providers to subcontractors which have a greater understanding of disability. I am hopeful that that approach will work.
I remind the Minister of what I said at the start of my speech about the main thrust of my anxieties. The system for the transition from childhood to the cusp of young adulthood is inadequate and has been for many years; support for young people on that cusp is poor, lacks joined-up thinking and provision for teenagers. I am also concerned about possible unintended consequence of changes to the welfare programme disproportionately affecting young disabled people. I am grateful to the Minister for listening to my remarks. I am aware that her Department has to cover a wide range of issues, and I look forward to her response.
Three hon. Members are standing up—a wealth of talent before me. I want to begin the winding-up speeches no later than 10.40 am. Three people wish to speak, so you can work that out and will all get a reasonable amount of time if you are fair to one another.
I thank the hon. Member for Eastbourne (Stephen Lloyd) for securing this debate because the issue is important. I do not intend to speak at length, but I want to touch on some issues that have come to me as constituency problems. They concern individuals but show some areas of policy where the situation could be improved. One issue concerned a young disabled lad who had just left his special school. He had stayed in that school until he was nearly 20, but to be honest he would probably be described as a three-year-old in a 20-year-old’s body. In many ways he is very happy and friendly, but he has no language. He suffers from Down’s syndrome and is severely autistic so his capacity is obviously limited. I am not an expert, but on meeting him and his mother I could quickly tell that the likelihood of someone like him being able to consider any form of employment was no more probable than my three-year-old grandchild entering employment.
The specific issue raised was his mother’s great concern about what had happened as soon as her son left his special school. When I first saw her, she was in the midst of filling in a form for employment and support allowance—she had to fill that in because he clearly could not, and she found it quite difficult. She also made inquiries to the Department about the possibility of a face-to-face assessment she had been told about. When she made contact, she was told that there were no exceptions, that there would have to be a face-to-face assessment, and that she would have to bring in her son. She explained that one aspect of his condition means that he finds it difficult to go into strange places, to the extent that even with all her powers and being used to the situation, she sometimes cannot make him do it.
As it turned out, I am glad to say that, on the basis of the forms and medical report it received, the DWP decided to award employment and support allowance in the support group without a face-to-face assessment. However, the family—the mother in particular—suffered unnecessary stress because of information she had received previously when her son’s circumstances were not fully taken into account. It occurred to me that such cases could be dealt with more quickly and effectively, and with less stress, if the DWP undertook outreach work in schools where young people are about to leave that form of education. The Department could have carried out its assessment quickly and easily within the school setting because nobody, other than his mother, knew better of what that young man was capable than the school. A great deal of stress and time would have been saved, especially had other forms of appeal become necessary. That is a matter of process where, with a little thought, a more humane system could be adopted.
That young man currently receives DLA, but when we look at the transition that will be made from DLA to the personal independence payment, we must think about the processes involved and the fact that we do not necessarily need to put everybody through a complex process if it is manifestly unnecessary. However much the Minister may feel that it would be useful for many people to go through such a system, there will be some cases in which, on anybody’s analysis, that should not be required. I urge her to give that issue some special thought before we get embroiled in the system and people are given conflicting messages about what is likely to happen. Even at the point of applying for ESA, my constituent was given certain information over the phone by officers in the DWP that increased her stress levels considerably.
Another minor aspect that my constituent raised—I accept this is not new and has been in the system for some time—was the financial position in which the family found themselves. That is obviously an important issue when it comes to purchasing the additional help and assistance that is often necessary outwith the local authority care package. Because my constituent’s son has been placed in a support group, once the first 13 weeks are up, a non-dependant charge will be placed on his mother in respect of housing benefit. She is over 60 and retired, but I think that even in earlier years she found it difficult to remain in employment, given her son’s condition.
At the moment, her son is on the lower rate of ESA because it is still within the 13-week assessment period, although it has been agreed that he will move into the support group and receive the higher rate of ESA. At the end of that period, he will be regarded as a non-dependant, and his mother’s housing benefit and the finances available to the family will in effect be reduced. Since the higher rate of ESA is supposed to meet a family’s additional needs, it seems somewhat perverse to take that support away because the mother is over retirement age, even if she is not working. I accept that that situation is not new, but it is perhaps something we should look at if we seek to improve the situation for families.
The mother said something else that I felt was worth pursuing. She has done a little research on this issue and talked to other people. She felt that, when her son suddenly became an adult for the system, the attitudes towards him and her suddenly became more difficult. That was not just about the benefits issues. She gave me another example. He has been given a care package and a place at a day centre and she was trying to get him used to the idea of that. He had been at a very good special school in Edinburgh, but the day centre is obviously a completely different environment. He was to have transport to go there but, given his particular difficulties with strangers, she asked whether he would have an opportunity to meet beforehand the person who would be doing the transportation. She was told, “No, because he is now an adult.” When he was a child and his arrangements changed, that opportunity was always given, but now she was just told, “No. Under the adult system, we don’t do that sort of thing.”
I thank the hon. Lady for making an incredibly powerful point about disability. The system does not appreciate that, for many disabled people, the nature of their disability means that in terms of age they may be an adult, but in terms of intellectual capacity and their ability to manage things, they are not. The system cannot cope with that. It is a very strong point. Does she agree that more needs to be done and understood in that area?
I certainly do agree, which is why I was trying to bring out that point. Sometimes there are unintended consequences from the important breakthrough whereby a lot of people with disabilities started to be treated as people with the right to make their own decisions and as an adult, like any other adult. Many people had been campaigning for that for a long time, and for many disabled people it has been a huge breakthrough and beneficial, but there are some people—my constituent and others whom I have come into contact with would fall into this category—for whom it does not work. All it does as far as the family is concerned is make life slightly more difficult. They do not see any purpose in it. Sadly, the young man to whom I have been referring will never grow into adulthood in that sense. Nothing in the field of medicine is likely to change that, so his mother felt that that blinkered view—“This is what we do”—was not helpful. It probably originated from something that was intended to be good, but it has turned out to have a downside.
The mother’s suggestion, which I think we should consider, was that there could almost be a separate category when it comes to the way in which people are treated. Her contention was that in some countries that is what happens—there is more understanding of the different nuances of disability and someone like her son is not treated in exactly the same way as other adults. She was keen to say to me that she thought that local government at all levels should be considering that type of option and trying to improve its practice. I know that there will always be difficulties about definitions and about the point at which those distinctions are made, but if we could apply that perspective and it improved the experience of disabled people—in this case, young disabled people—and their families, it would be beneficial.
It is a pleasure to participate in the debate under your chairmanship, Mr Hollobone. I am also pleased that the Minister responsible for disabled people will respond to it because, as was said by my hon. Friend the Member for Eastbourne (Stephen Lloyd)—I have called him my hon. Friend because we are colleagues on the Select Committee on Work and Pensions and have discussed these matters in that Committee on many occasions—we are covering a very wide ambit of departmental responsibilities in the debate. It is good that the Minister who can draw all those together for us in government will respond to the debate. We are pleased that she is here this morning.
Like the hon. Member for Eastbourne, I want to focus on some of the transition issues. Of course, for disabled young people, transition is quite a protracted process. It begins when they are in their mid-teens and can stretch right through until they are in their mid-20s as they transfer from children’s services to adult services in terms of how the social care package and social support are provided. Like all young people, they may move on from school to a college or higher education setting and, in due course, to employment. During that period, they may also seek to leave the family home and set up on their own. It is important that we consider how we support young people through those transitions economically, as well as through the care packages that they receive.
I am fortunate to have had some extremely helpful briefing from Every Disabled Child Matters, as other hon. Members have, and from the transition support co-ordinator at my local authority. One message that comes through clearly is the need for a planned approach to the transition; it cannot be left to chance. In addition, it is important that that planning begins early and is done with the young person and his or her family. Underlying what I want to get across today is the need to support disabled young people in achieving their aspirations. Too often, our aspirations for those young people, employers’ aspirations for them or even the aspirations of colleges, schools and social services for them are too low.
First, however, I will talk about some of the financial issues and I would be grateful if the Minister addressed them. The hon. Member for Eastbourne has already alluded to the implications of the introduction of the personal independence payment in due course. The Minister was good enough to write to me before the summer recess about the arrangements that will be consulted on in relation to children and young people, who are not currently to migrate immediately on to PIP. I think that at that stage she was saying that no firm plans were in place and there would be wide consultation as plans were developed. I certainly welcome that, but she must understand that there is an awful lot of uncertainty and concern as a result of the process still not being firmly available to people so that they can understand what the Government might be contemplating, and for some young people—for example, a young man I met in my constituency who is on the autistic spectrum—uncertainty is a particular worry. We were told that he already, at the age of 17, was beginning to worry about what the transition would mean for him. I therefore hope that the Minister can give us more information about the process today.
If young people aged 16 to 18 are placed on a benefit, as I accept they are now with DLA, that is identical to what adults receive, how will that be designed appropriately to meet their needs? We are particularly concerned about that. We are also concerned—other hon. Members alluded to this—about the assessment process for young people. In his comments to me, the transition support co-ordinator in Trafford highlighted the fact that young people already go through multiple assessments for different packages of support and benefits. My hon. Friend the Member for Edinburgh East (Sheila Gilmore) has highlighted one way in which we might ease the assessment process, by going to the individual rather than setting up a series of assessment hurdles that they have to come to and cross. It is a very imaginative idea, which I hope the Minister will explore.
I am concerned about another issue. The Minister has indicated in the past that it is not necessarily the case that young people as they turn 16 in 2013 will automatically be migrated on to PIP, but I would like to know what further thinking she has developed in relation to the transition period. Does she envisage a phased transfer of young people on to PIP from DLA? If so, what will the time scale be and who might go first?
The Minister will know that real concerns remain about the situation of children and young people if the extended qualifying period for PIP that is proposed for adults is also applied to them. Children’s conditions develop and change incredibly quickly in some cases. CLIC Sargent has estimated that, if the extended qualifying period for PIP were applied to children and young people, that could lead to nine out of 10 families, and 60% of all its clients, suffering financially.
It is an important point that CLIC Sargent raises, because the onset of a cancer is very sudden and, although some children react very well to the treatment, some children do not and there is an up-and-down pattern, so it cannot be said that there is a consistent level of requirement for those children. It is therefore very important that the support is in place straight away and particularly when the parents have received that devastating news.
My hon. Friend is absolutely right. As I say, many children’s conditions vary, progress and retreat much more suddenly and rapidly than those of adults. Crucially, children’s educational and social development is also taking place as they grow into young adulthood. If there are concerns about the financial support for children with medical conditions, that will also have wider developmental implications for them.
There is continuing uncertainty about children and young people in residential settings. I am particularly interested in young adults, some of whom are quite likely to want to look at residential colleges for their further education. The Minister wants to remove any duplication in funding in relation to the mobility component that people receive as part of DLA. I would be grateful if she could tell us how she expects to assess whether there is actually any duplication, because I have so far been unable to uncover much evidence of it. What assessment has she made of the implications for young people over the age of 16 in residential colleges, and particularly for their ability to participate as fully as possible in not only educational life but wider social life?
I echo the comments of the hon. Member for Eastbourne on housing benefit. I also want to highlight the concern that constituents have raised with me about the substantial costs of adapting housing and about the implications for them if the housing benefit changes and the housing benefit cap force them to move. It seems quite ridiculous that, as a result of other policies, we should disrupt families who might have had to make substantial investments to adapt their home accommodation. I hope that the Minister will indicate that there will be flexibility in the system to ensure that families of young disabled people, in particular, are not subject to great instability and do not have to move as a result of housing benefit changes. That is particularly important for the young people we are talking about, because such instability disrupts not only their social and educational networks but their medical and care networks in many cases.
Clearly, that is an incredibly serious concern, which the Minister will want to take seriously. Like the hon. Gentleman, I very much look forward to hearing her reply to his suggestion.
I want to say something about employment and education. I echo other hon. Members’ comments about the need to encourage employers to be more willing to take on disabled people and to recognise the extensive capacity that many of them can bring to the workplace. However, I want to raise a few points with the Minister about the education and training environment in which young people prepare for employment.
Following the loss of the education maintenance allowance, what assessment is being made of the extent to which young disabled people in financial need can access other sources of financial support, including those provided by colleges and schools to enable people to continue and complete their education? With the loss of Connexions next year, how will the new predominantly web-based information and advice service for careers be tailored and adapted to meet the needs of young disabled people? How will the structure of integrated budgets, which are meant for young people’s living needs, be protected, so that people are not forced to dip into them to pay for their education, including transport to educational settings, books and equipment? Like other hon. Members, I am interested to hear what further steps the Minister thinks she can take in government to encourage employers to become more willing to employ young disabled people.
I am pleased to have had the opportunity to contribute to the debate. There are many more issues that I would like to raise and which I am sure colleagues would like to raise. I am pleased that the Minister is here to listen to the debate, and I look forward to her response.
I am pleased to be able to take part in the debate. I congratulate the hon. Member for Eastbourne (Stephen Lloyd) on securing it. We can never devote enough time to the subject in this place.
Like others, I want to begin by asking about the personal independence payment. I have to say that I like the concept of an independence payment, and it sounds attractive. Like others, however, I am not quite sure what it will mean in reality. I do not want to end up with a crude, Orwellian sleight of hand, whereby the word “independence” results in a set of arrangements that mean the exact opposite. I do not say that that is the intention of the Minister or the Government, but I hope she understands the concerns many Members and organisations representing disabled people have about how the provisions will work in practice. Like others, I hope that she will be able to give us a bit more information and that we will be able to secure a promise that she will provide more information to people across the country, because it is important that she does so.
It is important to recognise that having great support needs does not mean that dependence and exclusion are inevitable, but that depends very much on how we choose to approach people and on whether we give the right kind of support—support that facilitates independence and assists those who are trying to help them. In an intervention earlier we heard about the pressure that is sometimes put on parents. I read a recent study looking at young disabled people who seemed to have made quite a success of their lives, in that they had secured employment and found a place to live independently. They highlighted the fact that their parents had been critical in helping them through those different phases. As in many other areas of life, it is true that good parents—parents who provide the right support—are a great help. However, where we are talking about parents who are coping with children with disabilities—often quite severe disabilities—we should never underestimate the pressure they are under, and that was illustrated in the example given by the hon. Member for Eastbourne. We should never underestimate the pressure on parents, how easy it is for one final incident or episode to be the straw that breaks the camel’s back or how insensitive agencies can be at times to the pressures on parents.
I want briefly to mention two groups. The first is young soldiers. I obviously see a lot of young injured service personnel at the Queen Elizabeth hospital in Birmingham. The lives of these young people will be changed beyond all recognition from what they would have anticipated when they joined the services a few years ago. As we think about the support and provision that will be available in future, it is important that we do everything to assist the independence of these people, to whom we already owe an enormous debt, and who have every right to expect to lead a fulfilling and independent life. We can either assist or hinder that process by the way in which we shape the support and services we make available.
The other group is young people with terminal illnesses. In the past, they would tend to die at a relatively young age—perhaps before or in their early teens. Quite often, the support we provided was limited to a bit of hospice provision and a bit of social services or other independent agency provision at critical times in the illness. Nowadays, youngsters with terminal illnesses tend to live much longer, into their early 20s or early adulthood. Like every one else making that transition in life, they have all sorts of demands and expectations, and they want to go to college and have jobs. Quite often, they are capable of doing those things, but they need different kinds of support and services. We need to recognise that there will be an increasing demand for that in the years ahead, so the more we can shape and prepare services now, to cater for those young people, the more we will be able to help them, and the more we will get ahead of the game, rather than playing the traditional game of catch-up.
I want to mention two issues, the first of which is mobility. It seems to me that that is the key to any sense of independence. If someone cannot decide for themselves where to go, when to go there, and how to organise their life to achieve things, their independence is severely restricted. I hope that as the Government think about how to reshape support and benefits, they will think about mobility for young people, particularly those in residential establishments. It is not right, when they are trying to make the transition to adulthood, that they should be dependent on someone else deciding what time they will get to go out socially or visit the shops. They need some degree of independence.
To go back to the issue of parents, it is extraordinary how insensitive agencies can be to the needs of parents and disabled youngsters. Birmingham city council, which is trying to save a bit of money because of the budget predicament—and that is perfectly understandable—recently introduced a proposal to restrict school bus access for children going to special needs schools, subjecting them to the same arrangements as other children. I cannot remember the exact distance now, but I think that they must live further than something like a quarter of a mile away. Of course, the reality is that children going to special needs establishments have special needs. Some of them do not like massive changes and disruption; they need a predictable route. Some of them could not possibly travel by themselves on public transport. It would not be feasible for them to get taxis, because that would cost the local authority more than the existing transport provision. The parents found out about the change through a blanket letter from the council to all parents, informing them of the intention; so of course we had people phoning up in floods of tears, saying “What am I going to do next week?”
That is the kind of thing that came up in the exchange between my hon. Friend the Member for Edinburgh East (Sheila Gilmore) and the hon. Member for Eastbourne: far too often the agencies are inflexible with their rules. They are oblivious to the needs of the population they are trying to serve. I think that perhaps, without any more cost, a bit of Government guidance and direction about the way in which the agencies must perform, both in providing services and when there is any intention of changing them, could make a significant difference.
That brings me to the other issue I want to raise, which is schooling. I am dealing with a situation concerning a young woman in my constituency who is on the far end of the autism spectrum. She has a great deal of personal need. At times she self-harms. She is challenging at home and gets very frustrated; she often attacks her parents and the other children. She is a challenge. Her parents have coped with that for 14 years, as well as bringing up two other children. They have done a remarkable job. However, in the past year, the secondary school that she attends in Birmingham, which is not a special needs school, has decided that it cannot cope with her. It has come to the conclusion that it is not the right place for her.
I do not blame the school for that decision, which is possibly a quite professional one, if those concerned have genuinely looked at the situation and thought about it; but of course the parents need to know that now that that has happened the authorities will take a good, honest look at the situation and come up with a proposal that will serve the needs of that young girl. What they have done instead is to withhold the minutes of the initial meeting that took place; they appear to have edited them to exclude some of the things said at the meeting, and have now come up with a set of proposals insisting that she return to the school—which the school rejects. They are essentially making those decisions on cost grounds; there is no doubt about that. As a result, although other children are back at school this week for the start of the new term, the girl is at home with her mother, who is at the end of her tether. Of course, every time her father must take time off work to try to deal with the crisis, he loses money, which plunges the family further into financial difficulty.
That seems to me not only insensitive but a completely unprofessional, unacceptable and irresponsible way to deal with people. I am happy to discuss the personal details of the case with the Minister. If there is anything that she can do to help I would appreciate it; but generally I want to say that local authorities must be given clearer direction on such issues. I do not think that it is entirely a matter of money. I am aware of the budget pressures that face Birmingham and other authorities; if money is a consideration, so is the way in which people behave, and the way in which they treat those they are there to serve. I do not think that the state of affairs I have described is remotely acceptable.
I thank the hon. Member for Eastbourne for obtaining the debate. I hope that the Minister will respond to some of the issues raised, and that we shall have many more debates like this one, so that we can shape some provision in a way that genuinely reflects the needs of the people we hope to assist.
I am grateful to be here today under your chairmanship, Mr Hollobone, and I shall do my best to be equitable in the distribution of time.
I of course begin by congratulating the hon. Member for Eastbourne (Stephen Lloyd) on obtaining the debate. I call him an hon. Member as he sits on the Government Benches, but like my hon. Friend the Member for Stretford and Urmston (Kate Green) I regard him as a friend. I have got to know him well and he has this morning demonstrated his commitment to disability issues. His pursuance of those matters is well recognised in this Chamber and I hope to continue to work closely with him.
The debate has been very interesting, and hon. Members have spoken convincingly of the points that need to be addressed. I shall focus particularly on those that lie within my responsibility, but perhaps I will make one or two wider remarks. In an extremely moving speech, my hon. Friend the Member for Birmingham, Selly Oak (Steve McCabe) dealt with the range of issues that must be grappled with, at the heart of which is the pressure on families. We should always be reminded of the daily grind that many families face. We can never have enough time to deal with those issues, and have just touched on them today. I hope we can continue to deal with them.
In my time working with this brief, I have met the Spink family and the Kennedy family. I do not know whether any hon. Members present have come across them, but I am sure that they are known to the Minister. They have spoken in shocking detail of their experience of services—their inflexibility—and the unwillingness, perhaps of us all, to fully appreciate the depth of the challenge that many families face. We say that we have made progress—I will defend the progress made by my party’s Government, and the Minister will defend hers—but there has never been enough progress to address the reality for those families.
My hon. Friend spoke very well, particularly about the last family he mentioned, and about veterans, as well as the amount of work we still have to do. Of course, the briefings that we received from the Children’s Society put it very well when speaking about the different culture and the different eligibility criteria that the hon. Member for Eastbourne drew to our attention, and the impact that that can have on the lives of young disabled people and their families. We must force ourselves to improve services.
I was tempted to talk about services, local authority funding and suchlike, but I do not want to go down that route because of the lack of time. I shall concentrate instead on welfare reform, which is clearly part of the Minister’s remit. The reforms relating to disability are perhaps some of the most controversial elements in the Government’s proposals in the Welfare Reform Bill. The Government will say that the Bill is the hallmark of their Administration and a flagship policy. I am grateful to have the opportunity this morning to interrogate the Government in more detail, but we will obviously continue to do so.
The hon. Member for Upper Bann (David Simpson) referred to universal credit; we have not focused enough on that, yet it is vital for disabled people. I also want to consider the personal independence payment, and I shall of course return to my hobby-horse, the disability living allowance mobility allowance, which has also been mentioned.
I start with DLA reform because of its importance to children, of which all who have seen the briefings will be aware. As has been mentioned, 1.8 million working adults will be migrated to the new benefit, and there are implications for those who turn 16 in 2013, but we do not know much about what will happen to the 300,000 children currently in receipt of DLA, other than the fact that their situation will be considered once the proposed reassessment of adults is under way. That is controversial in itself and is causing enormous alarm among charities, families and individuals.
It is vital that we deal with this quickly because clause 87 of the Welfare Reform Bill, which is making its way through Parliament, removes clauses 71 to 76 of the Social Security Contributions and Benefits Act 1992—the legislation that currently provides DLA to disabled children. Alternative arrangements clearly have to be put in place quickly and we need to know the details soon. The Minister will be aware that in Committee we asked what the proposals for children were likely to be, and my hon. Friend the Member for Stretford and Urmston mentioned several times the need to consider the matter. A number of amendments were tabled—they were not successful—on reassessing the impact of the six months delay in receiving benefit and whether the ending of automatic entitlement would affect children. A number of substantial questions need to be dealt with in depth.
Disability premiums in universal credit are vital, and I ask the House to focus on them because charities are deeply concerned about the changes. Those on the middle and lower rates of DLA care who receive only the disability element receive £52, and those on the higher rate, who receive both the disability element and the enhanced element, receive £73. Under the new system of universal credit, the rates for children will be aligned with those for adults, so that there will be two rates of award: £25.95 and £74.50. That change means that people will now be eligible for either the lower or the upper rate of premium, rather than the combined amount. The important point is that those families on the higher rate will be slightly better off, receiving £74.50, an increase of £1.50; but those on the middle and lower rate will receive £25.95, a substantial reduction from £52. I ask the House to focus on that as the Welfare Reform Bill makes its way through Parliament—it is in the other place now. Support for disabled children on the middle and lower rate of DLA will be halved.
Charities estimate that about 100,000 families—including, for example, families with autistic children—will lose up to £1,366 a year, amounting to about £20,000 by the time a child reaches the age of 16. That is a substantial loss of benefit. As the hon. Member for Eastbourne pointed out, 52% of families with a disabled child are at risk of poverty. The benefit is means-tested, so the poorest families will suffer the greatest hit. That is a significant change. I note the hon. Gentleman’s gentle challenge to the Government to rethink some parts of the Bill, and I encourage him to take up that cause. Universal credit is seen as a panacea to the challenges of the current benefit system, but I caution Members not to rush to that conclusion, because many disabled children will lose out.
The DLA mobility component is one of the most highly publicised and controversial elements of the Government’s policy, and it applies to children as well as to adults. Specific reference has been made to children in residential schools and colleges who depend on mobility support. The briefing from Every Disabled Child Matters states that for all young people aged 16 to 25, the ability to get around independently is vital to allowing them to lead the ordinary lives of young people and for developing the life skills that will lead to independent living later in life. It would be devastating for these disabled young people to find that financial support for mobility was withdrawn just as their adult lives were beginning. The campaign to save the DLA mobility component is ongoing. I appreciate that the Government have announced a review, but some confusion remains about how the policy will work and what impact it will have. I ask the Minister to answer one simple question. Do any children in residential settings face the prospect of losing their mobility component? If so, I ask all Members to join me in saying that that should not happen. We should try to prevent that group of vulnerable people from losing such a critical benefit.
It is a pleasure to serve under your chairmanship, Mr Hollobone, for what I think is the first time. You have presided over an extremely informed and useful debate. I thank my hon. Friend the Member for Eastbourne (Stephen Lloyd) for securing the debate. He and I have had a number of conversations about disability matters over the past 18 months, and he brings a great deal of expertise to the House.
The debate covered a broad range of issues and I hope to do justice to them in my response, but if I cannot answer them all in the time allowed, I will be happy to deal with them separately should Members wish me do so. First, I shall set out the Government’s approach to supporting disabled young people. I shall then answer some of the important questions raised today.
When I talk to disabled young people, as I did only last week and over the weekend in my constituency, I find them to be as ambitious as non-disabled people—no one in the Chamber today will find that surprising—and their hopes for the future are no different. They want a job in which they can excel, a home, a family and friends. They want to live independent lives, and those lives will be different for each of them.
The catch-all title of disabled can sometimes be unhelpful. As Minister with responsibility for disabled people, I have to deal with the wide range of conditions, illnesses and challenges that these people face. We heard today that it is only by joining together the work of social care, health, education and employment effectively that we can ensure adequate support for disabled young people. All of those elements have a part to play. Joining up those services to ensure that disabled young people live independent lives is at the heart of the Government’s work, but in doing so we must also ensure that we retain the ambition that every disabled young person and their family have for their lives, including the ability to take on the challenges of the future so that they can reach their true potential as an individual.
The hon. Member for Edinburgh East (Sheila Gilmore) rightly said that families have a critical role to play. Sometimes, though, it is important to separate an individual’s passions and desires for the future from the family. Although we need to ensure that families retain their vital role, we must at the same time recognise that it is the disabled young person and their individual needs that we must focus on first and foremost to ensure that they can enjoy an independent life, whatever that means for that individual. The hon. Member for Birmingham, Selly Oak (Steve McCabe) also made the point that by enabling disabled people to live independent lives, we can avoid many of the mental health problems that we all see in our own constituency surgeries. All too often such problems accompany disabilities.
Let me outline a few of the measures that the Government are taking. I pay testament to the work that my hon. Friend the Member for Brent Central (Sarah Teather) is doing in this area as a Minister in the Department for Education. It is under her stewardship that the special educational needs and disability Green Paper has been produced. I am thankful that she has agreed to work closely with me on that key reform affecting some of the transition problems that have been raised today. The single assessment that my hon. Friend sets out in the Green Paper will start to deal with some of the problems that the hon. Member for Stretford and Urmston (Kate Green) so eloquently articulated today. We are looking for local authorities to trailblaze the new approach, so that we can avoid some of the complications and hurdles that currently face disabled people and their families.
My hon. Friend the Member for Eastbourne talked about the importance of effective support for transition. Again, the SEN Green Paper clearly sets out the importance the Government attach to dealing with the variable support that is sometimes provided for parents and disabled children after they turn 16. It is precisely to resolve the problems post-16 that we are considering testing the new approach of having a single assessment across the full zero-to-25 age range, as well as ensuring that it is portable. The Minister of State, Department of Health, my hon. Friend the Member for Sutton and Cheam (Paul Burstow), is also involved in that.
My hon. Friend the Member for Eastbourne talked about key workers and how they support disabled people in transition. We are in full agreement that key workers can play a hugely important role in supporting families and young people to navigate through transition, which is why we commit in the Green Paper to invest in key worker training. We are in the process of appointing a voluntary, non-profit-making organisation to lead. Those are important and exciting developments that we can look forward to in the future.
[Mr Bone in the Chair]
Personal budgets are also pertinent. In our constituencies, we all see a great deal of money being invested in supporting individuals, but all too often it can feel that that money is not well co-ordinated. The Department for Health’s commitment to personal budgets and to allowing every disabled individual to access them is an important step forward and will help to ensure that all the available money is used to best effect. Last Thursday, I was fortunate enough to meet a wide range of individuals from disability organisations and a group of disabled people in Barnsley. I was told about the important benefits personal budgets gave in disabled people’s day-to day lives, including allowing them to lead the sort of independent lives they wanted. Barnsley is part of the right to control trailblazer initiative that was extremely well put together under the previous Administration. We are continuing the initiative because it gives more flexibility to disabled young people to start their lives in a strong and independent way.
The Government are also conducting an important review of employment support for disabled people. It is vital that we understand that the majority of disabled young people aspire to be in employment. All too often that aspiration does not come to fruition—perhaps through an inability to navigate the system or to get the right support in place at the time. Earlier this year, the Secretary of State for Work and Pensions asked Liz Sayce to produce an independent review of employment support for disabled people. That review, which was published before the summer break, highlighted that disabled people want the same access to jobs as everybody else, and the best way to make that happen is to ensure that employment support is built around the individual. We are consulting on the proposals set out in the Sayce review and we will publish a response in due course. At the heart of Liz’s proposals is support for access to work, which, for young people in particular, can give the sort of personalised support that they need not just to get into work, but to stay in work and to give them the opportunity to live independent lives.
The hon. Member for Birmingham, Selly Oak mentioned the importance of supporting disabled former members of the armed services. One of the recommendations from the Sayce review was to set up a cross-departmental group to consider the employment of disabled people, and I have done that straight away because I thought that it was a superb recommendation. One of my colleagues from the Ministry of Defence will be on that ministerial group for the very reason that the hon. Gentleman talked about. I hope that that reassures him that I understand his point. Many young people who have served our country have come out with severe disabilities and they require that support. The ministerial group will also include a Minister from the Department for Transport. As hon. Members recognised, transport is important in ensuring that disabled young people have independence and are able to get into the workplace.
Some of our work is about ensuring that the profile of disabled young people is positive. The Paralympics has an important role to play in that, but we are also investing heavily in user-led organisations to ensure that disabled young people have strong voices in the future. We also have a strong policy of ensuring that more disabled people have access to elected office, which is an important way to get one’s voice heard.
I will answer as many of the specific points made in the debate as I can now, but I will write to Members if I am not able to answer their questions in detail. “Aiming Higher” is a three-year programme set up by the previous Administration. It includes short breaks and transition support, both of which the present Government are continuing to fund. The fruitful work under “Aiming Higher” is therefore continuing.
To reassure Members who raised the implications of the personal independence payment, let me say that I recognise that the transition from DLA to PIP at 16 is an important and sensitive matter. I have already begun meeting organisations and representatives to ensure that they have clear input into our work. I recently met a number of organisations, including CLIC Sargent, to help to inform our thinking on the qualifying period. I am sure that the debate on the matter will continue in the Lords. I will be looking at the needs of individuals in residential colleges in the same way as the needs of other recipients of DLA. I understand the arguments that hon. Members have made today on that point. We have done some detailed work on the order of migration from DLA to PIP. We will make sure that it is a fair process and it will be considered as part of the equality impact assessment.
I apologise for not being able to cover all of points hon. Members raised today. Suffice it to say, the work that the Government are doing puts support for disabled young people very high on our priority list.
It is a pleasure to serve under your chairmanship, Mr Bone; I thank Mr Speaker for granting me permission to hold this debate this morning; and I welcome the Under-Secretary of State for Justice, the hon. Member for Reigate (Mr Blunt), to his seat, from which he will listen to and respond to this debate on an issue that I want to raise not only on my own behalf but most importantly on behalf of my constituents.
That issue is what I have called judicial scorecards. The idea is that each judge and magistrate should be presented with an annual report of those people who have appeared before them and who have been sentenced by them, including details of any reoffending that has taken place since sentencing. Every year, each judge and magistrate would be given a simple and straightforward report that would detail the names of the defendants who have appeared before them, the crimes of which those defendants were accused and the sentence that was imposed, compared with the sentence that could have been imposed under the maximum terms set out in the relevant legislation. The report would also include details of any subsequent reoffending, not only for the crime for which the defendants appeared before the judge or magistrate but for other crimes that the defendants may have committed.
There is a fundamental gap in our criminal justice system. Judges and magistrates do their best, but as far as I can tell they never actually know what happens to those defendants whom they sentence. Judges and magistrates arrive at their sentencing decision, having taken into account the guidelines produced by the Sentencing Council; using their best opinion, they arrive at a decision as to what is the most appropriate sentence and that sentence is then imposed; but they never know subsequently whether or not that sentence was effective.
The same is true for police officers. I declare an interest as a special constable with the British Transport police. I often talk to police officers about the arrests they have made and I ask, “Oh, what happened to Joe Smith, whom you arrested for fare evasion?”, or, “What happened to Joe Bloggs, whom you arrested for burglary?” The officer will reply, “Oh, I don’t know.” I ask, “Do you have any idea what sentence he was awarded?” They reply, “No, I don’t know. My job was done. I arrested the offender and he was presented before the courts, or otherwise.” It is a great shame that police officers do not know that information; they are not informed about what happens to the people they arrest. The same is true for the judiciary, regarding the people they sentence.
Our criminal justice system would be improved if judges and magistrates knew more about what happened to the people they sentence. At one level, that is a very human thing. We are dealing with individuals who have broken the law and the judges and magistrates are doing their best to impose the correct sentence, but unless they are updated on whether or not that sentence was effective there will continue to be a big gap in our criminal justice system.
Mr Bone, you will know that 10% of criminals commit 50% of the crime in this country. You, I, the Minister and everyone in this House, as well as all of our constituents, are really concerned about the high reoffending rates in this country. When I asked the Minister about reoffending on 11 January, he provided some very helpful statistics to the House. I asked him:
“What the reoffending rates were for those sentenced to jail terms of (a) one year, (b) five years and (c) 10 years in the latest period for which figures are available”.
He helpfully replied:
“In 2008, the rate of reconviction within one year for adults discharged from custody after a sentence of less than a year was 61.1%; it was 31.0% for those given sentences of one to five years; 17.5% for offenders given sentences of five to 10 years, and 6.4% for 10 years or more.”
I then asked:
“Does the Minister agree that…the longer prisoners spend in prison the greater the chance of ensuring their effective rehabilitation before being released?”
“We have to ensure that longer sentences are given to recidivist offenders and that we effectively rehabilitate people and break the cycle of crime through the proposals that we have presented in the Green Paper to drive that number down.”—[Official Report, 11 January 2011; Vol. 521, c. 147.]
I absolutely agree with that—we have to get those reoffending rates down. The Minister and I are in complete agreement that when 10% of criminals are committing 50% of the crime, those recidivist offenders must receive longer sentences, and yet, as we all know, the problem, again and again, is that those recidivist offenders are not being given the stiff sentences early enough in their criminal careers to deter them from a life of crime. Part of the reason why I am so enthusiastic about the idea of judicial scorecards is that they would help to alert judges and magistrates at an early stage in a criminal’s career that the criminal was not being given a sentence that was stiff enough.
I raised the proposal for judicial scorecards on the Floor of the House with the Minister’s boss, the Lord Chancellor and Secretary of State for Justice, on 28 June. I asked him:
“If he will take steps to ensure that judges and magistrates are informed of incidents of reoffending of each offender they have sentenced”.
“We have begun work to improve access to local criminal justice statistics. For example, criminal justice and sentencing statistics are now broken down to court level and are available online. In terms of individuals, pre-sentence reports provide the court with details of a defendant’s offending history and compliance with any previous sentences.”
I then said:
“Although it is important to have judicial independence, surely it is not beyond the wit of the Department that each judge and each magistrate should be given an annual report card on the effectiveness of their sentencing decisions. If they have given out a string of sentences and the convicts have reoffended regularly, that judge or magistrate will know that something is wrong with their approach.”
“As I said, we have begun work, and that is certainly an interesting suggestion. A massive amount of data would be involved in providing every judge and magistrate with full information about everybody they had ever sentenced”. —[Official Report, 28 June 2011; Vol. 530, c. 738.]
I was pleased that the Lord Chancellor and Secretary of State for Justice saw this idea of judicial scorecards as an “interesting” approach, but it sounds to me from his responses in June that the Ministry of Justice is already making some progress towards them. If statistics are being
“broken down to court level and are available online”,
we are going in the right direction, and I do not believe that it would necessarily involve a massive amount of data to tie up an offender’s criminal history with the judge or magistrate before whom they appeared. It would help to make the criminal justice system far more effective. At the end of the day, what my constituents want is judges and magistrates to award sentences that are effective in preventing reoffending. Introducing more transparency into the system to reveal whether judges and magistrates are awarding such sentences would assist the judges and magistrate themselves, and help to improve the effectiveness of our criminal justice system.
In the exchange on the Floor of the House that I mentioned earlier, another Member asked:
“There is considerable evidence that judges do not know enough about what happens once they sentence prisoners and those sentences have been disposed of. Will the Justice Secretary do what he can to increase the experience obtained by judges of those disposals and will he ask the Sentencing Council to advise, with a particular focus on what works in preventing offending and reoffending?”
The Justice Secretary replied:
“The Sentencing Council is already under a duty to provide information about the effectiveness of sentencing practice”.—[Official Report, 28 June 2011; Vol. 530, c. 738.]
It seems to me, however, that that duty to provide information about the effectiveness of sentencing practice is not specific enough to the individual judges and magistrates making the decisions. We do not have that far to go from the collection of statistics at a court level to doing it on an individual level for each judge and magistrate.
That is not to criticise judges and magistrates; it is to help them. We know that every time we stand up and speak in this place, and every time we vote, information is recorded for every member of the public to access online, to see whether we are turning up and representing constituents’ concerns. Every time a premier league footballer kicks a ball, the data are recorded and a scorecard is produced of his effectiveness throughout the season. I believe that the information is there in the court process, and it could be distilled in a simplified way in an annual report card, helping to inform judges and magistrates about whether they are making the right decisions.
Evidence about this sort of thing was presented to the Select Committee on Justice in 2009-10, and included in its January 2010 report entitled “Cutting crime: the case for justice reinvestment”. Michael Marcus, a circuit court judge from Portland, Oregon, presented evidence to the Committee about how this sort of approach can help the judicial system to be more effective because of the awarding of correct sentences. With yesterday’s welcome announcement from the Ministry of Justice about the introduction of television into courts, it seems that the Department is receptive to making our criminal justice system more transparent.
The Justice Minister will know, as will you, Mr Bone, that many of our constituents do not have the confidence they ought to have in our criminal justice system, because some of the sentencing decisions are not consistent. We have the recent example of the riots in London and other metropolitan areas in August, when the clerks to the magistrates seemed to be saying, “You don’t have to adhere to the guidelines that have been issued by the Sentencing Council; make the riots a special case.” My constituents would say, “The stiff sentences awarded to rioters should be the same as the stiff sentences awarded to everyone, not just in August 2011 but all the time.” There should be consistency in sentencing, and the judicial scorecard approach would help.
It comes down to the number of people we sentence to prison terms, and I think that my constituents’ view is that not enough criminals go to jail. There seems to be a myth in this country that we have too many people in prison, but I contest that that is absolutely not the case. If we look at the percentage of prisoners per 100,000 people, we are pretty near the global average, but if we look at the number of prisoners in relation to the number of crimes committed we do not have the highest prison population in the western world; we have the lowest. On that measure, compared with the United States, Canada, Australia and the EU as a whole, the UK has the lowest prison population of all. For every 1,000 crimes committed in the UK, we have about 13 prisoners, compared with about 15 in Canada and Australia, considerably more than 20 for the EU as a whole, and a whopping 166 in the United States. The country with the lowest prison rate—the UK—has the highest crime rate. Is that a coincidence? I do not think so.
We have more than 10,000 crimes for every 100,000 people. The country with the highest prison rate —the United States—has the lowest crime rate, with about 4,500 crimes for every 100,000 people. Canada, which is the country with the second lowest prison rate, has the second highest crime rate. The EU as a whole has the second highest prison rate and the second lowest crime rate. In my view, those are not coincidences.
The purpose of today’s debate is to be helpful to Her Majesty’s Government. I have come here with a constructive suggestion to make our judicial system more transparent. I thank judges and magistrates for the work that they do on behalf of us all, but they need assistance in the form of information about how effective their well-meaning sentencing decisions are. My constituents would like to see stiffer justice; they would like to see recidivist offenders put behind bars for longer, not only as a punishment but to aid their rehabilitation. I know that the Justice Minister is very sympathetic to that view because he has said so to the House. A judicial scorecard system need not be complex; it could be very simple and straightforward. Presenting each judge and each magistrate with an annual report about the effectiveness of their sentencing decisions would be a good thing for the criminal justice system in this country.
It is a pleasure to serve under your chairmanship, Mr Bone, and particularly to reply to your near neighbour, my hon. Friend the Member for Kettering (Mr Hollobone), whom I congratulate on securing the debate and bringing up the matter of judicial scorecards.
I have, of course, noted the question that my hon. Friend put to the Justice Secretary during oral questions about whether steps would be taken to ensure that judges and magistrates were informed of incidents of reoffending of every offender they had sentenced. As my hon. Friend has made clear, he is aiming for feedback and public transparency for individual sentencers on the effectiveness of their sentencing practices, so that they are able to identify where something is wrong with their individual approach. I have listened to my hon. Friend very carefully, with my usual level of interest, and I concur with the Justice Secretary that his suggestion is interesting.
My hon. Friend knows from previous debates we have had on foreign national prisoners that I very much welcome his interest, and his providing a spur to the system to ensure that we are kept up to the mark in areas of public interest. However, I am going to have to be reasonably plain with him here: yes, the topic is interesting, but I am unsympathetic with the particular matter of individual judicial accountability by way of scorecards for judges.
Let me explain why. We need to acknowledge that this topic raises issues of significant constitutional importance, and I want to touch on those before I address some of the other matters that my hon. Friend mentioned. We might not have quite enough time for a full debate on the whole of penal policy, the issue that he raised at the end of his remarks, but if I end up having enough time, I will cheerfully move into that area.
The rule of law is, of course, the foundation of our democracy. For that tenet to be real, it is imperative that the independence of the judiciary is maintained. As my hon. Friend will recognise, that is particularly relevant in respect of sentencing decisions. Parliament has established the offence and sentencing framework that the judiciary apply in individual cases, and the courts have a duty to follow sentencing guidelines, which are issued by the independent Sentencing Council to promote greater consistency in sentencing while maintaining judicial independence. If courts depart from those guidelines in the interest of justice, they must explain in open court why they are doing so.
Although the sentencing decisions of the judiciary are rightly independent, they do not operate in an accountability vacuum. Checks and balances within the current system, such as the right of appeal, operate within the public domain. If certain sentences are seen as too lenient, the Attorney-General can appeal them. Equally, if it is felt that the final sentence is too harsh relative to the circumstances of the case, the defendant has the right to appeal. Like the hearings at which offenders are sentenced, such appeals are heard in public. The Sentencing Council has a duty to monitor the operation of its sentencing guidelines. Part of that involves considering the frequency and extent to which those handing down sentences depart from the guidelines, the factors that influence sentences imposed by courts and the effect of guidelines on consistency in sentencing and on public confidence in the criminal justice system.
More generally, the judiciary support efforts towards greater transparency that allow the public improved access to sentencing outcomes for individual crimes in their local area while bearing in mind any reporting restrictions. However, it would not be right to draw inferences about the performance of an individual judge— or, for that matter, anyone involved in bringing a case to court—based simply on whether the defendant goes on to commit further crimes. There is a risk that, if we introduced scorecards linking sentencing to reoffending outcomes, individual sentencing decisions would be criticised because the offender went on to reoffend. The sentence handed down is only one of many factors that affect reoffending.
Towards the end of his remarks, my hon. Friend used the phrase “simple and straightforward”. I must tell him that dealing with the rehabilitation of offenders—trying to act on all the levers that affect an individual, determining how easy it will be to rehabilitate him and considering all the desistance factors from crime—is far from simple and straightforward, and it does not simply involve the sentencing decision. The judiciary work in an environment where no two cases are alike and each sentence reflects individual circumstances unique to the offence, the defendant and the impact on the victim. Examining sentences in isolation from the particular circumstances of the case and the defendant’s mitigating or aggravating factors is almost certain to confuse those who were not present in the courtroom about why the final sentence was imposed. Many factors affect the effectiveness of a specific sentence in preventing reoffending. Some are unique to the individual; some are socio-economic. Given the unique nature of each case, it would be impossible for the effectiveness of sentences on reoffending to be deduced in a meaningful way. Any suggestion that such information could be provided would be misleading to the public.
My hon. Friend knows that tackling reoffending is a major priority for this Government. We are considering innovative ways to decrease reoffending rates. The Green Paper “Breaking the Cycle” set out a different approach to rehabilitation based on paying only for what works to deliver reduced levels of crime. Although I am sure that judges would welcome being informed of what happens to each defendant sentenced, if such a practice became regulated in the form that my hon. Friend suggests, it would be prohibitively expensive to administer and might well take resource away from the front line, particularly the probation service.
That said, judges and magistrates take a close interest in the outcome of the sentences that they pass and whether defendants go on to commit further offences. I suspect that, like me and no doubt you, Mr Bone, my hon. Friend welcomed the statements made by the recorder of Manchester during the recent trial of Regina v. Carter, when he was sentencing one of the earliest people to be brought to justice for the riots. In the robust terms of his sentence, the recorder made it clear in what peril people placed themselves by their outrageous behaviour in those circumstances. If my hon. Friend has had the chance to read it, he will have noted that, at the end of the judgment against one defendant in the trial, who was sentenced to oversight in the community, the recorder of Manchester reserved to himself the right to deal with breaches of that community supervision. He took the opportunity judicially to take a keen interest in how that defendant, who will be supervised by the probation service, got on.
That can happen in our system. It happens in the west London drugs court, for example, where repeat offenders who entered the system because of their addiction are brought back month by month to the same judge, as part of their sentence oversight, to see how they are getting on. It is possible within our system for judges to continue to exercise supervision of and interest in the people who come before them. Probation officers, also, often provide the courts with general information about outcomes, especially in relation to community orders, so that any judge or bench can make informed decisions about the suitability of a particular sentence for the offender before them.
In May this year, my Department published details of the relative effectiveness of different sentences in reducing reoffending. One can interpret such data in different ways, but those data showed that, after controlling for differences between offenders, those receiving community orders and suspended sentence orders have a significantly lower reoffending rate—8% and 9% lower respectively—than similar offenders who receive a short custodial sentence. My hon. Friend may say, “Indeed; then they should get a longer prison sentence rather than a short prison sentence or a community sentence”, but we must have some regard to the circumstances of the offence. He seems to be driving at the idea that first-time offenders should receive an exemplary sentence in order to get them into prison so that they can be rehabilitated. I am not sure that I am in precisely the same place as him on that matter. Overall, most people entering the justice system for the first time and receiving community sentences will have a significantly lower reoffending rate than other repeat offenders. We must find proper strategies, including prison at one level but also proper supervision between prisons, the probation service and the police, as is delivered through integrated offender management, in order to find a more effective route to desistance for such people. We are experimenting with a bunch of different pilots to see where to place the responsibility in order to deliver rehabilitation.
I think that my hon. Friend will welcome the fact that the Government also have a significant transparency agenda, which will go some way towards meeting the concerns that underlie his case. We are committed to increasing transparency in public services in order better to hold public services to account, increase trust in services through greater openness and encourage engagement between citizens and local services. The criminal justice system is no exception. Criminal cases are almost always held in public, and a great deal of information on court proceedings is already placed in the public domain.
However, we recognise that not everyone goes to their local court on a daily basis, so we are planning a significant release of individual court performance data in January that will enable local communities to find out how their local court is performing on a range of measures. The data will include, among other things, information on case timeliness in criminal and civil courts and the proportion of cracked and ineffective trials at the Crown court. That represents a significant step towards keeping the public informed of how the courts are operating in their area. When looking at the data, it will be important to bear in mind that courts’ performance is not a matter for the judiciary or court staff alone, but depends on all the elements of the criminal justice system.
Yesterday, the Justice Secretary announced his intention to legislate to remove the ban on cameras in courts. I am grateful for my hon. Friend’s welcome of that announcement. It is a cautious but important step that, taken with the data commitments, will open up the courts more widely. In addition to the data that we plan to publish on court performance, we have taken several other notable steps to provide the public with information on how the criminal justice system works locally. In October last year, we released court-level sentencing data for each court for 2009, and in May this year, we released data covering 2005 to 2010. In January this year, street-level crime information was made available to the public via the Police.uk website. It has been very popular, with 430 million hits on the site since the launch. In November, we will publish individual offender-level sentencing data by court, so that the public will be able—
[Dr William McCrea in the Chair]
It is a pleasure to serve under your chairmanship, Dr McCrea, on an issue that is close to my heart or, perhaps I should say, to my small intestine, because I suffer from coeliac disease. I am also a member of Coeliac UK.
Coeliac disease causes damage, through gluten, to the surface of the small intestine and results in a reduced ability to digest and absorb food. This causes malabsorption of essential nutrients such as iron, folic acid and calcium. In infants and children this can result in health problems such as faltering growth, unexplained anaemia, chronic diarrhoea and abdominal distension. In childhood, the presenting features are often relatively subtle and it is much easier to diagnose if coeliac disease is on the radar with a GP at an early stage. For adults, coeliac disease often presents with symptoms of tiredness, reduced appetite, weight loss, mouth ulcers, abdominal bloating, diarrhoea and anaemia.
Many people with coeliac disease present with apparently mild or non-specific complaints, but from their perspective these complaints are anything but trivial. The type and degree of symptoms with which an individual presents are not always directly related to the gut damage that has been done. It can therefore be difficult to secure a diagnosis, and patients may present to primary care on a number of occasions with a large range of symptoms before any diagnosis is made.
Health risks linked to untreated coeliac disease include poor growth in childhood, osteopenia, osteoporosis, infertility, and an increased risk of non-Hodgkin’s lymphoma, Hodgkin’s lymphoma and intestinal malignancy. Other auto-immune conditions are also associated with coeliac disease. The prevalence of auto-immune thyroid disease in people with coeliac disease is up to 7%, and the prevalence of type 1 diabetes is between 2% and 10%. With all these complications, it is hard to understand why coeliac disease is not routinely checked for.
People can endure long periods of suffering before they are diagnosed, and the most recent research shows the time from the onset of symptoms to diagnosis as a lengthy 13 years, during which people are at risk of contracting a wealth of other conditions. One in 100 people in the UK have coeliac disease, but only 10% to 15% of them are clinically diagnosed. An estimated half a million people in the UK are living with the condition but do not know it. That is too many people whose quality of life is being diminished by years of ill health. Many people are living with a misdiagnosis of irritable bowel syndrome or other gut conditions, and receiving treatment for those conditions that is not effective. That costs the NHS money, which we are told it does not have, and which is wasted because of the lack of a quick and accurate diagnosis of the gut condition.
Does my hon. Friend agree that it is possible to diagnose or find out whether someone has a gluten intolerance through a relatively simple blood test? Kits can be bought at a pharmacy, so there should be no excuse for failing to pick up coeliac disease earlier in many patients.
My hon. Friend is perfectly correct. The diagnosis for coeliac disease, or certainly the first part of the diagnosis, is extremely simple—it requires a simple blood test. In fact, as a coeliac sufferer, I never received a gut biopsy test, because my blood test was so overwhelmingly positive. It is relatively easy and the implementation of, or access to, these new tests, which are available in chemists, is a step in the right direction.
Simple though that may be, too many GPs do not recognise coeliac disease, never mind test for it, which is something that we urgently need to address. As I have indicated, it is first tested for via a simple blood test, followed by a gut biopsy. The blood test in itself is inexpensive. My hon. Friend has mentioned a test that the public can buy for only £20 in pharmacies. Within the health service, there is obviously an economy of scale.
I would like to describe some of the disease’s impacts in more detail, because it would be better for the Minister to hear it from the horse’s mouth rather than read about it on pieces of paper. When gluten is present in our diet, it destroys the villi in the small intestine. They are eroded so that the small intestine becomes basically like a garden hose. In good Scottish parlance, Dr McCrea, your food just scoots through it. As I have said, that prevents the absorption of nutrients, and the knock-on effects that that can have on young children and the elderly mean that this in itself—the pure lack of nutrients—can be life-threatening.
Gluten is a protein found in wheat, barley and rye. Although some might think that it is easy to avoid consuming such products, I would challenge them to try to do so for the rest of their lives. A gluten-free diet may sound like the latest Hollywood fad, designed to make a sylph-like body, but if that was the case I would want my money back, because it has not done that for me. The point that I am trying to make is that, while continuing to take gluten when diagnosed with coeliac disease has serious consequences for one’s health, diagnosis also comes with serious lifestyle trade-offs.
Imagine a busy day at work where all one wants to do is grab a quick sandwich from the cafeteria. I am sure that the Minister has eaten a sandwich at his desk many times. It cannot be done. Imagine the end of a long day at work when one would rather grab a take-away than cook dinner at home. That cannot be done either. Imagine an invitation from friends to go for a meal at an Italian restaurant. Although the pizza and pasta look nice, they just cannot be eaten. One may want to go to the pub and have a bottle of beer with friends, but that cannot be done either. One becomes an expert at reading the label on every piece of food that is bought, from crisps, sweets to soups—literally everything. Even Marks and Spencer’s diet coke has gluten in it.
I do not want to say much more about food lines at this point, but I want the Minister to think about the price of a loaf of bread. Tesco’s website states that an 800-gram loaf of white sliced bread can be bought for 47p, which is 6p per 100 grams. What does a loaf of gluten-free bread cost? It costs £2 for 400 grams, which is 50p per 100 grams—833% more. I will leave the Minister with that thought and return to it later.
I am glad that my hon. Friend has picked up the issue of gluten-free food, because I am also on a gluten-free diet, which is why—surprise, surprise—I am present at this debate. It is very expensive for people on gluten-free diets, but will my hon. Friend acknowledge that access to gluten-free products has improved immensely? Almost every supermarket now has some gluten-free shelves. I have seen a remarkable difference in the availability of gluten-free food during the four years in which I have been on a gluten-free diet. However, part of the problem is that the ready-meal versions of foods to which one would not add gluten if they were being cooked at home often include gluten, which makes it difficult for those who lead busy lives and do not have time to cook.
My hon. Friend is right. The range has improved, as indeed has the quality of food. In some ways, perhaps I was fortunate to be diagnosed in the past 10, 12 or 13 years. I am glad that I was not diagnosed 25 years ago, because I did not have to eat the rubbish that one had to eat 20 or 25 years ago to try to survive on a gluten-free diet. There is more choice. That is another issue about which we have concerns following the introduction of new regulations. We are worried about how supermarkets will react, because everything that they do is driven by the desire and the need to make profit at the end of the day.
I want to talk about my own experiences without being too graphic. In the early 1990s, feeling unwell I went to my GP, who eventually referred me to a specialist. After having cameras inserted everywhere, I was diagnosed with duodenal ulcers and put on medication. Unsurprisingly, that did not help much. I was then diagnosed with the catch-all complaint of irritable bowel syndrome. I endured a number of years where my routine comprised of largely being locked in the toilet until about 11 o’clock in the morning, and I had a rash on my face that looked like I had exfoliated with 80-grit sandpaper. I returned to my GP after a number of years and he referred me to another specialist who, simply on reading my notes, said, “I think I know what’s wrong with you. I think you have coeliac disease,” and he was right. If my memory serves me right, his name was Dr Wright and he turned out to be a bit of a wizard in the diagnosis of coeliac disease in the Forth valley and Scotland. I and others will be eternally grateful to him for that.
Hon. Members might be wondering why there has been a personal lesson from me and whether it is designed to foster sympathy. No, it is not. It is designed to highlight the fact that, as I have said, the average time for diagnosis in the UK is 13 years. That is sometimes 13 years of not being able to work; 13 years of worry about dying; 13 years of someone worrying that their wife thinks they are dying; and 13 years when the only people who are happy are the manufacturers of toilet roll. Part of the purpose of today’s debate is simply to stress that that is not good enough. Much more needs to be done to recognise coeliac disease and the array of symptoms in people presenting to a GP. They should not be told what my GP said to me when I returned to him after being diagnosed: “Oh coeliac disease. I never think of that. That’s two I have missed this month.” That is not good enough.
Why is it important to improve diagnosis times? It saves being given expensive drugs for other complaints that are totally unnecessary and, as I said, it saves a sufferer from not being able to lead anything like a normal life in all areas of work, rest and play. Early diagnosis reduces the risk of intestinal cancer, bowel cancer and osteoporosis among other things. In effect, early diagnosis saves not only lives, but money.
There is no cure for coeliac disease, which leaves the NHS with the task of managing sufferers’ condition. For me, diagnosis happened in my early 40s. However, that is not good enough and there remains a lack of guidance in the area. In 2009, the National Institute for Health and Clinical Excellence published guideline 86 on the recognition and assessment of coeliac disease. That short clinical guideline offers best-practice advice on the recognition and assessment of coeliac disease and the care of those undergoing diagnosis. Although that guideline was a great result for people with coeliac disease, it is not mandatory to follow it and more needs to be done.
Coeliac UK—the national charity for people with coeliac disease—has worked with NICE on that guideline, forming part of the guideline development group. It is anxious to take the matter further for very good reasons. Gastrointestinal disorders account for about 10% of NHS clinical work, and there is evidence that they are not always well managed in general practice. Few quality criteria are available to guide the management of such disorders. The treatment of coeliac disease requires support, with a gluten-free diet, the monitoring and management of symptoms and the screening and management of complications and other associated conditions for the rest of the patient’s life. There has been huge oversight on the part of the Department of Health, as GPs are struggling to meet targets for diagnosing conditions on the quality and outcomes framework and, with no points for gastroenterological conditions, there is an enormous gap.
The QOF is a key way to ensure that GPs are incentivised and is a means by which we could start to see an improved and accelerated rate of diagnosis and find the 500,000 people who are living with the condition but who do not know it. Sadly, a number of applications to QOF have been unsuccessful, which is not good news for people with coeliac disease.
There is also some evidence that the condition is hereditary, so testing family members of a diagnosed coeliac is an obvious way to identify such individuals. If doctors diagnose somebody as coeliac, would my hon. Friend suggest that other family members should also be tested?
I do and I will. I shall come on to that later. My hon. Friend is perfectly right.
Moving back to the QOF, approaches for groupings of gastroenterological conditions are being made. Those are important because coeliac disease is four times more prevalent among patients with clinical presentation of IBS, as in my case, than among the non-IBS population. There is also a NICE guideline that recommends the screening of patients with type 1 diabetes, but we do not know whether that screening is taking place. Without more stringent ways to incentivise and measure, we will not know.
As my hon. Friend says, screening family members when coeliac disease is present in the family is also a key concern. He might be interested to know that prevalence rates increase from one in 100 to one in 10 when a first degree relative has the condition. GPs should be screening, but we know that that is not happening routinely. I know full well is has not happened in my family, but it should. Coeliac disease is also more prevalent in people with other auto-immune conditions such as type 1 diabetes, as I have mentioned, and auto-immune thyroid disease. Hence, antibody testing for family members where coeliac disease has been diagnosed and for patients with autoimmune conditions is recommended by the NICE coeliac recognition and assessment guideline.
The Minister will be glad to hear that improving diagnosis is only one part of the answer; we also need improvement in the management of the condition after diagnosis. There are established clinical guidelines from, among others, the British Society of Gastroenterology, the British Society of Paediatric Gastroenterology, Hepatology and Nutrition and the Primary Care Society for Gastroenterology, which recommend an annual review for patients with coeliac disease and, indeed, dermatitis herpetiformis. Although that has traditionally been undertaken in specialist clinics in secondary care—or, indeed, not undertaken at all—it is an activity increasingly seen as suitable for primary care. We know of locally enhanced services where practices provide a structured annual review, but there are not enough of them. We would like annual reviews to be put more firmly into place to ensure that patients are complying with the gluten-free diets and safeguarding against potential associated conditions.
The improving management in gastroenterology—IMAGE—project provides a model for the development of quality markers for chronic disease management including coeliac disease. The project has developed patient-centred quality criteria based on current guidelines and has already been a source of a range of published papers, but health inequality is also a key concern in this area. Research has shown that coeliac disease is twice as likely to be diagnosed for the least deprived quintile of socio-economic groups than for the most deprived; it is usually the other way around. There is more work to be done to understand those results, but the working hypothesis is that the disease is under-recognised in the most deprived socio-economic groupings as a result of the wide-ranging nature of symptoms and, indeed, access to health care.
Where do we go from here? The NICE guidelines on recognition and assessment of coeliac disease showed that the “no diagnosis” strategy is the least effective strategy because of the low quality of life of patients and the costs resulting from undiagnosed coeliac disease. In applying accepted NICE thresholds, any testing strategy was shown to be more cost-effective than no testing strategy, despite the costs of the tests. Work also indicates that serological testing for coeliac disease in patients with symptoms such as irritable bowel syndrome, as I mentioned earlier, is, indeed, cost-effective.
The new NHS reforms may provide some opportunities for people with coeliac disease and provide different ways for them to be catered for within the new framework. Perhaps the Minister can say whether coeliac will be considered for one of the 150 quality standards soon to be rolled out, so that we can see diagnosis rates start to improve.
As I have said, once diagnosed, the only way forward is to manage the condition through a gluten-free diet. Many people do that through relying on prescriptions as the foundation of their condition management. On prescriptions, as the NHS looks to drive costs down during the past 12 months, a number of PCTs have placed strict limits on what can be prescribed for patients with coeliac disease. Those cuts, which include a blanket removal of almost 200 products prescribed to patients in Surrey, East Sussex and Kent, appear to be a knee-jerk reaction to costs linked to gluten-free foods on prescription. At the same time, they potentially threaten the long-term health of people with coeliac disease.
Hon. Members may have seen that, in July, a story broke in the national press that gluten-free bread on prescription was costing the NHS in Wales £35 a loaf. The story came from misinterpreted data following a question posed in the Welsh Assembly. Similar anecdotal figures had been used earlier in the year by medicine management teams linked to the south-east strategic health authority. Although the figures given in the national media were incorrect, sadly the story missed the real point about some high administrative charges added to a very small number of products, which appear to be unjustified.
People with coeliac disease rely on a gluten-free diet, and the fact they can only get gluten free through a prescription suggests that management of the condition is seen very much as a medical model rather than a disability model, which is what normally happens when someone has a chronic condition and they have learned to live with it. Instead of providing gluten-free food through a prescription, might not the Government consider making it one of the criteria that would allow people to get the lower care rate of disability living allowance? That would give people the money in their hand and give them the choice to buy off the shelf, particularly now that most supermarkets have a range of gluten-free goods available. It is more expensive, so it would be an extra cost of their disability, but that might be a cheaper and better solution for the Government. I wonder whether Coeliac UK, or anyone else, has thought of that.
In fact, Coeliac UK, myself and, I think, my hon. Friend the Member for North Durham met Ministers in the previous Government to discuss that very issue. It does not seem to be something that Governments want to embrace, but my hon. Friend the Member for Aberdeen South (Dame Anne Begg) is right—there are other ways to skin the cat. I will discuss those when I talk about the method of prescribing.
Overcharging or excessive charges within the NHS prescription process need to be investigated at national level to hold NHS suppliers to account. It is crucial to patients and to the taxpayer that we implement a cost-effective service that gives the NHS real savings and enhances provision to patients.
As I have said, people with coeliac disease must avoid all foods that contain gluten, a protein found in wheat, rye and barley. Wheat is the most widely consumed cereal in the UK, so a gluten-free diet requires the elimination of staple foods including bread, flour, pasta and biscuits. Gluten is also found in cakes, pastries and in foods that one might not expect, such as many sauces, soups, soy sauce, ready meals and some cooked meats and sausages. Removing wheat, barley and rye-containing ingredients from the diet can therefore result in a restricted and potentially unbalanced nutritional intake. People with coeliac disease may obtain gluten-free specialist foods from a wide variety of sources including supermarkets, health food shops, mail order and, as we have mentioned, on prescription, but some of the gluten-free brands that are available on prescription are not available from other outlets. It is extremely important that health care professionals provide advice, support and information to ensure that people with coeliac disease have a nutritionally balanced and varied gluten-free diet. Diagnosis should not lead the patient down the path to other unnecessary problems.
Coeliac UK, the Primary Care Society for Gastroenterology and the British Dietetic Association have written guidelines to help health care professionals in prescribing gluten-free foods. The guidelines define different categories—children, male adults, pregnant women and the ages of patients—allocating each a number of units per month per group to maintain adequate nutrition. Each gluten-free product is assigned a number of units: for example, a 400-gram loaf of gluten-free bread is one unit and a 800-gram packet of gluten-free spaghetti is two units. The recommended amount of gluten-free staple food, in units, is based on the total carbohydrate intake providing approximately 50% of the energy intake, with gluten-free foods on prescription making up 15% of that total.
As I have said, coeliac disease is unique in that a specific and effective treatment is available in the form of a lifelong exclusion of gluten from the diet. Those who adhere strictly to a gluten-free diet can lead full, active lives—they can even become Members of Parliament—and are protected from the development of health risks associated with the untreated condition. Research by Hall and Rubin in 2009 shows that among adult patients with coeliac disease, adherence to a strict gluten-free diet is variable, with compliance ranging from 36% to 96%. The evidence also shows that following a gluten-free diet is particularly difficult for those patients with no obvious symptoms. Medical experts and research agree that access to a range of gluten-free food on prescription is important to support people with coeliac disease and to help them to maintain their nutritional needs.
Research undertaken by Coeliac UK, among the charity’s membership in 2006, suggests that access to gluten-free food on prescription is regarded as the most important factor for people with coeliac disease in terms of adherence to a gluten-free diet: nearly 87% cited it as an important factor in maintaining a gluten-free diet and 47% cited it as the single most important factor. A further survey on gluten-free prescribing undertaken by the charity in 2011 among 400 people with the condition showed that 60% of respondents rated gluten-free food on prescription as the most important way of obtaining gluten-free foods for their diet. Although people with coeliac disease have varying requirements for gluten-free foods, depending on their age, gender, occupation and lifestyle, having a wide range of specially formulated gluten-free products available on prescription and easily accessible is vital to promote strict dietary compliance.
On the cost of the gluten-free diet to the patient, having the disease does not entitle people to be exempt from prescription charges. People with coeliac disease in England are charged £7.10 per order unless they have a medical exemption due to different health conditions, age or financial circumstance—although they can use a pre-payment certificate, of course. Research from King’s College London earlier this year found that there is limited availability of gluten-free foods in different stores and that they are more expensive than their counterparts—I refer the Minister to my Tesco bread comparison. That finding has been supported anecdotally by stories from Coeliac UK members, who often report having to travel to more than one supermarket to complete a shopping trip owing to the limited range of foods in their local stores. The problem is noticeably worse for people living in rural communities, so it is not solely about price; access is also a factor. If one cannot travel to a range of supermarkets for shopping, the lack of a bus service may impact on health.
In the past three years, Coeliac UK has undertaken research into cost comparisons between gluten-free and gluten-containing foods on the high street. On average, gluten-free foods have been found to cost three to four times more than their gluten-containing equivalents. Some foods, such as gluten-free pitta bread, cost seven times more. Again, I refer the Minister to the Tesco bread comparison, to which we will keep coming back. For the average shopper, that can mean a difference of approximately £400 a year for staple foods such as bread, flour and pasta alone. Evidence suggests that people on lower incomes, or families with multiple members with coeliac disease, already struggle to maintain a gluten-free diet and that without access to gluten-free prescriptions their long-term health could be put at real risk.
I understand that there is a number of reasons for the higher cost of specialist gluten-free foods; they include the expense of buying alternative grains to replace wheat, product development, nutritional composition by fortifying with other items such as calcium and the considerable need for food science. However, that does not change the impact on the individual. It is therefore vital that gluten-free foods remain on prescription, as they have done for the past 40 years.
The Advisory Committee on Borderline Substances approves a number of products, such as foods and supplements, that can be available to patients on prescription. When a manufacturer applies to have its product available on prescription, it needs to have it approved by the ACBS. The ACBS will look at the type of product, its nutritional value, cost, and even its wrapping and the words written on the wrapping. The cost covers the cost of the product, plus postage and packaging. That cost should be the total cost to get it from the factory to the pharmacy. Slightly fewer than 200 products are currently approved by the ACBS for people with coeliac disease. They include a range of staple products, as outlined earlier, some ethnic foods and products such as biscuits, if they are necessary for an elderly person’s diet or someone who needs a high sugar intake.
Following an internal review earlier this year, the ACBS has agreed that in future it will consider only products that are considered to be dietary staples, including plain breakfast cereals, breads and rolls, crackers and crispbreads, flours and bread mixes, pastry mixes, pasta, pizza bases and xanthan gum. That list will become a very firm base to be adhered to. It is, however, worth spending a moment or two on the supply chain for these prescriptions, because that is where I will bring the Minister back to the cost implications that I spoke about earlier.
The supply chain is made up of a web of individual contractual agreements between manufacturers, wholesalers and other distributors and pharmacists. Those individual contracts are not regulated by the NHS. The end price to the NHS is agreed with the manufacturer by the ACBS, and that is the so-called drug tariff price. The end price should include any related transport costs—a point reinforced by the ACBS earlier this year. The costs associated with gluten-free prescriptions hit the NHS when the pharmacist reclaims them, and there are two potential components: the drug tariff price agreed by the ACBS and what are called out-of-pocket expenses, which are very interesting.
The headline costs to the NHS of gluten-free products arise largely from the impact of those out-of-pocket expenses claimed by pharmacists as a result of additional charges invoked by wholesalers and distributors for what is called non-standard supply. For example, the product might not be stocked as a standard item by the wholesalers, it might require ordering from an intermediary, or it might be treated as special because it has a short shelf-life, such as a fresh product has. Those additional costs remain relatively uncontrolled, however, because there is no specific agreement on how much may be charged by the wholesaler. The pharmacists will need to reclaim those out-of-pocket expenses if they are not to be disadvantaged.
The application of such costs varies considerably and depends on the individual contracts up and down the supply chain. It might be difficult for a manufacturer to control the addition of such costs further down the supply chain, just as it might be difficult for pharmacists to control such costs when they are tied to a particular wholesaler. Such practices may be seen in relation to other products supplied to the NHS, and might be increasing as the NHS strikes harder bargains on the supply of high-value contracts for more common treatments. The impact of such practices is not currently understood, so it would be useful if the Minister today commits to a robust assessment of the real costs to the NHS of additional charges associated with the supply of products—not only gluten-free ones—and to instructing relevant bodies to enter negotiations with the supply chain to explore the possibility of reducing costs overall. That might even involve looking at the drug tariff price.
We all recognise the financial constraints currently faced by PCTs and health boards throughout the UK, but responding to those constraints by eliminating access to gluten-free foods is potentially damaging to overall patient health, while there are more proven effective ways of managing the costs of gluten-free prescribing. The NHS should not be subject to excessive charging, but nor should patients be left unnecessarily paying the price of additional costs; instead, we need to be smarter.
We can be smarter by using local enhanced service contracts. Pharmacy-led prescribing schemes allow gluten-free foods to be supplied directly from community pharmacies, thus bypassing the GP. They allow commissioners to standardise prescribing habits, which would address NHS concerns about excessive and off-tariff prescribing. Furthermore, they might help to tackle handling charges by placing limits on what charges may be reclaimed by pharmacists without compromising patient satisfaction.
Looking for ways to streamline the system is not new. In 2001, the Cabinet Office regulatory impact unit published a report on reducing GP paperwork. It recommended that GPs should no longer need to issue prescriptions for gluten-free foods; instead, patients with coeliac disease should be able to obtain supplies from a pharmacy. The proposal was supported by the Royal College of General Practitioners, Coeliac UK and the Pharmaceutical Services Negotiating Committee. The National Pharmacy Association has developed a toolkit for NHS commissioners outlining the business case for an alternative supply route for gluten-free foods on prescription. That is due to be launched this month and is supported by the Primary Care Society for Gastroenterology and the Dispensing Doctors’ Association. The toolkit is being promoted to all PCTs, health boards and GP commissioning groups, which are urged to implement the pharmacy-led schemes as soon as possible—but why?
The potential benefits of a pharmacy-led prescribing scheme are many and include: improved dietary compliance and health outcomes, as good dietary adherence is aided by the ease with which patients can obtain appropriate amounts of gluten-free products on prescription; and a reduction in the annual cost per patient for the supply of gluten-free foods. According to surveys of costs from Northamptonshire and Cumbria, savings of between 20% and 40% are possible in the ingredient cost of gluten-free foods. Members might be interested to note that the annual ingredient cost in England for the provision of ACBS-approved gluten-free foods in 2010 was approximately £28.6 million, yet gluten-free foods comprised only 0.32% of the total net ingredient costs of all prescribed products. However, the introduction of a pharmacy-led scheme in England for gluten-free products alone would be expected to produce savings of between £5 million and £11 million in the first year.
Another benefit would be the release of clinical time. In 2002, the Royal College of General Practitioners estimated that the initiative, had it been implemented at that time, would have saved 209,000 appointments or more than 20,000 GP hours of clinical time. In a survey undertaken by Coeliac UK, GPs have confirmed that a change to pharmacy supply eases demands on their time. Also, overprescribing could be prevented by application of national guidelines, as all pharmacy-led schemes are based on the 2004 prescribing guidelines. By following a set monthly allowance, it is possible to prevent individual or nutritionally unsuitable prescribing—that benefit was identified in the roll-out of the Cumbria PCT pilot scheme.
Better cost control could be another benefit, as the pharmacy-led schemes provide better individual patient cost control because the pharmacy supply schemes are based on a system of units of gluten-free foods linked to the patient’s dietary needs, rather than on patient-led prescribing by GPs using form FP10. There is a need for better cost control as more people with coeliac disease are diagnosed, in accordance with NICE recommendations. More diagnosis will itself bring a subsequent risk to GP prescribing costs and time, both of which could be better managed in pharmacy-led prescribing.
A pharmacy-led scheme would also be in line with the 2008 White Paper, “Pharmacy in England: Building on strengths—delivering the future”, in that it would reduce the time-consuming administration of repeat prescriptions in GP surgeries; contribute to the range of clinical services offered by pharmacies, in particular to those with a long-term condition; expand patients’ access to treatment, making better use of pharmacists’ skills; and improve the patient experience, giving more rapid access to gluten-free foods by eliminating the need for GP signature of repeat prescriptions, and allowing more flexibility as products are launched or removed from the market.
Feedback from GP, pharmacy and patient stakeholders in Cumbria and Northamptonshire has been overwhelmingly positive. Cumbria, a county I know well, having lived there as a child, has been at the forefront of GP commissioning and, as such, has been able to assess pharmacy-led prescribing from two different perspectives: that of a GP in a clinical practice and that of a commissioning GP with budgetary responsibility. Dr Fayyaz Chaudhri, a GP in Maryport, said:
“I have been involved with this scheme in Cumbria for a number of years and have first-hand experience of the benefits to both patient and GP. There is a real issue to address in ensuring the supply of gluten-free foods. It is cost-effective for NHS, patient and taxpayer, and I believe that this toolkit needs to be rolled out across the country.”
To sum up on prescriptions, I would like the Minister to take note of the price of the Tesco bread I referred to earlier—he wrote it down, I think. Many people cannot afford to pay 800% more for a loaf of bread, more than 100% more for spaghetti, or five times as much for a bag of flour. Prescriptions are important to maintain the health of coeliac sufferers. Evidence from Coeliac UK already suggests that those disadvantaged by such costs will find maintaining a gluten-free diet a real challenge and their heath might suffer in consequence. Experts in gastroenterology have confirmed that access to gluten-free food is an essential part of the treatment for sufferers of coeliac disease. I urge the Minister to look at smarter ways of achieving it and I condemn rash reactions such as withdrawing prescribing, as we have seen in some places.
Le me say a word or two about eating out, to reinforce what I touched on earlier. I know that it is not the Minister’s direct responsibility, but he will no doubt feed it back to the appropriate Minister—though he looks puzzled. Currently, eating out is a lottery for people with coeliac disease. The gluten-free diet is not well provided for in the catering industry and dealing with the issue would have significant impact on the quality of life of people with coeliac disease. Although the industry is responding to some degree to the needs of people on a gluten-free diet, provision is not uniform.
Those who eat out often have to draw attention to themselves, asking to see the chef or the list of the ingredients that make up the meal. Often, they are faced with a member of the front-of-house team who has no idea what they are talking about, or they are passed to the chef, who might have a better understanding of their diet, but not necessarily. Catering for a gluten-free diet is not uniformly included in training for chefs and front-of-house staff, and including such training would better equip staff as they move forward in their careers.
Many people with the condition feel that eating establishments lack knowledge and understanding when it comes to offering safe, gluten-free food, so they stay in, keeping their health and money safe at home. We have not discussed cross-contamination, but it is a serious concern, and the nature of the catering industry, with its high staff turnover, can make trusting others with one’s diet difficult. As I said, many people therefore take the easy way out and stay at home.
People with coeliac disease represent 1% of the population, or 600,000 people, but the loss to the catering industry is greater, because coeliacs drive the venue decisions of the people they eat with. Research among more than 3,000 people with coeliac disease found that those who eat out do so with a minimum of two to three other people. With an average spend of between £10 and £20 per head, each coeliac meal is technically worth £60.
As I said, however, fears about finding safe, gluten-free options keep thousands of people at home. Some 62% of people suffering from coeliac disease eat out once a month or less, while only 38% eat out once every two weeks or more. When people were asked how often they would eat out if more safe, gluten-free options were available, the figures nearly reverse, with 74% saying they would eat out once or more every two weeks, and only 26% saying they would eat out once a month or less.
In these difficult times for the UK economy, harnessing that untapped market has obvious potential financial benefits for the catering sector. More than 40 pubs and restaurants nationally close every week, and coeliacs represent a huge market, which the hospitality sector cannot afford to miss. People with coeliac disease want to eat out more often, and they would be ready and willing to spend their money, if only they felt confident about gluten-free provision. The catering industry needs to help, and with new EU regulations coming into force next year requiring a reduction to 20 parts per million of gluten for food to qualify as gluten free, it needs to do more to convince coeliacs that it is aware of the law and working within it.
Being elected to this place in 2005 was a challenge to me in more ways than one, given that I was diagnosed with osteoporosis during the election campaign and that I came down here not knowing whether I would be able to eat between Monday and Thursday because of my coeliac disease. However, as a result of contact with Coeliac UK, and with the help of others, such as Lord Bilston and my hon. Friend the Member for North Durham, it was possible to constitute the all-party group. That was done not only to help coeliacs in Parliament, but to allow parliamentarians to use their personal experiences of, or interest in coeliac disease to help to raise the issue directly with the Government, and I am happy that we have been able to do that further today.
I am glad to see both my hon. Friends in their places, and I am sure my hon. Friend the Member for North Durham will not mind me outing him as a fellow diagnosed coeliac. However, there is a serious point here. As I said, one in 100 people in the UK suffer from coeliac disease, but about 500,000 of them have yet to be diagnosed. While some of us in the Room share the unenviable label of being among the few MPs to have been diagnosed with coeliac disease, there is a good chance that other Members also have it—they just have not heard the good news yet.
We last debated issues related to coeliac disease in February 2007, so today’s debate is long overdue. I am grateful to have this opportunity to lay my thoughts and hopes before the Minister, and I look forward to hearing his comments in a minute.
Before my hon. Friend finishes, I should pay tribute to the work that he has done to make sure that the catering outlets in the House of Commons offer a gluten-free alternative on every menu. That has made life a lot easier for those of us who are trying to follow a gluten-free diet. More restaurants are following that example, but he is right that eating out, which is often part and parcel of an MP’s job, is difficult. However, the House authorities should be congratulated.
They should, and I thank my hon. Friend for her comments. We are just waiting for one of us to be elevated to the House of Lords, because there are some difficulties over there.
I might be pushing my luck, but I would like to invite the Minister and his officials to come to a future meeting of the all-party group to talk a little more about what the Government are doing and to hear first hand from non-parliamentary coeliacs, because many of the issues that were relevant to the February 2007 debate are still relevant four years later.
I have talked about the challenges created by eating out. Research from Coeliac UK has shown that almost seven out of 10 people with coeliac disease prefer to eat at home, rather than to go out for a meal. I happen to be making one of my irregular sorties to a restaurant on Friday night, so I hope that the staff at Aldo’s in Alloa can cope with me. However, this is not just a social problem. Members of the all-party group will be aware of cases that have been brought to us in which sufferers of coeliac disease have been prevented from joining the police or the Army because of their condition.
Sufferers are looking not for sympathy, but for action, understanding and knowledge. Too often, that knowledge is missing, even among the professionals. I therefore return to some of the points I made earlier. We need to ensure that there is much wider knowledge and understanding of coeliac disease among the public and, perhaps more importantly, among the medical and catering communities. We need that knowledge not only among catering or hospitality staff in local restaurants or hotels; staff in hospitals need a greater understanding of the illness, too.
Let me give an example. A friend of mine who is a social worker told me about an elderly woman from his care home who had been hospitalised. Despite staff from the care home advising the hospital of her need for a gluten-free diet and of her coeliac condition, her social worker walked into the hospital one day and found her sitting up in bed eating toast. If we cannot get this right in hospitals, what chance do we have in the wider community?
We have talked about the economic impact on the hospitality sector, but there is a wider economic issue. For example, children who are off school unnecessarily may face educational challenges that impact on not only their schooling but their employability in later life. Similarly, having part of the work force stuck in the toilet rather than sitting at their desks is clearly something that the country needs to avoid. We all know that a healthier country is a more productive country. Indeed, figures obtained by Coeliac UK show that pre-diagnosis coeliac sufferers took an average of 21 sick days off per year, whereas those who had been diagnosed took an average of only three days off per year.
Work carried out by Coeliac UK suggests that the average age for diagnosis is 41, and the average time taken for diagnosis is 13 years. A great deal of work is therefore required to reduce those unnecessary years of suffering and the worry that accompanies them. There are a number of key messages I want the Minister to take away from the debate—I am sure he already knows them, but I would like to reinforce them. First, early diagnosis is vital. The later the diagnosis, the worse the condition and the worse the implications for other conditions that are likely to be inherited as a result of coeliac disease. Secondly, better management of the condition is possible and will save money.
I have moaned a lot this afternoon about the many problems facing those suffering with coeliac disease, and it would be wrong of me to create the impression that improvements have not been made. Indeed, my hon. Friends have mentioned some of them. Just to take Parliament as an example, the cafeteria was a risk too far for me when I came here in 2005, and my hon. Friend the Member for Aberdeen South alluded to that. Now we have better labelling and greater understanding among the staff, so it is much easier to eat in Parliament, and the staff deserve a big thank you for that. As my hon. Friend mentioned, however, that progress needs to be replicated in work canteens, restaurants, bars and shops across the UK. The products have also got better, even though that is reflected in their cost. It is important to accept that the food must be edible, not repulsive, as it was a number of years ago.
Before I wind up, I want to return to the issue of awareness and to say a few thanks. I never thought I would say this in my parliamentary career, but I would like first to thank the world’s No. 1 tennis player, Novak Djokovic, who has been following a gluten-free diet for the past year. That coincides with his rise to the top of the world rankings. It is difficult for me to admit this, but he may serve as a better ambassador for the health benefits of a gluten-free diet than me or any of my hon. Friends here today.
I also thank Phil Vickery, the well known chef, who has focused on gluten-free food and how it can be accommodated in the catering industry, and who is a Coeliac UK food ambassador, and Dr Chris Steele, the well known TV doctor, and another coeliac ambassador, who was fairly recently diagnosed with the condition. The biggest thanks must go to Coeliac UK, where Sarah Sleet and her staff, including Jo Archer, are committed to tackling all the matters that I have raised in a determined and professional way. They represent coeliac sufferers splendidly, and long may they continue to do so.
To sum up, coeliacs want and need better awareness of their condition among the medical profession, an informed approach from the catering and hospitality industry, and an understanding from the Minister that prescriptions are vital but that we may be able to do things better.
I congratulate my hon. Friend the Member for Ochil and South Perthshire (Gordon Banks) on securing the debate. I also thank Coeliac UK for its work in campaigning and research, and the information that it gives to many thousands of individuals who are diagnosed with coeliac disease.
I have two interests to declare. I am the chair of the all-party coeliac disease group and, as my hon. Friend the Member for Ochil and South Perthshire said, I was diagnosed with coeliac disease nearly 10 years ago. I want to reiterate a point that my hon. Friend made, which is that what we are discussing is not the latest fashionable diet, or a lifestyle choice: it is a medical condition. Sometimes it seems from media coverage, and media understanding of the gluten-free diet, that people have a choice whether to eat foodstuffs containing gluten. We do not have that choice, because of the serious health conditions that my hon. Friend has already mentioned. It is important to ensure awareness and wider understanding, including among GPs.
It is worth reflecting on how people are diagnosed. I was diagnosed 10 years ago, at the age of 37. Did I know I was intolerant to gluten? No, I did not. It was only following a serious stomach operation that the consultant who treated me did tests and biopsies, and said, “You do realise that you are suffering from coeliac disease.” Had I heard of coeliac disease? No, I had not. As with all such things, people learn quickly. I have heard stories from talking to many members of Coeliac UK regional groups—and I thank the volunteers who run local groups for providing information. More often than not, the people I have talked to received mistaken diagnoses. Awareness among consultants, as well as GPs, is an issue.
One may ask what the average age of a coeliac is, but there is not one. I have met parents whose children became ill soon after they began eating food, by two and three years old. My 71-year-old mother was diagnosed only last year, and that was only because I asked her to insist that her doctor tested her for it. Interestingly, many of the complaints and health issues that she has had over many years were explained by coeliac disease, and the diagnosis has changed the way she feels. Awareness is important, therefore, not just in the wider population, but among GPs, to ensure that they ask the questions to find out whether a patient’s symptoms are down to coeliac disease—and the symptoms can be quite varied, as my hon. Friend the Member for Ochil and South Perthshire said.
I do not think that matters have been helped in the past few months by press coverage of prescription charges. Some of the debate is ill-informed. Earlier in the year a headline in The Sun ran: “NHS pays £32.27 for a loaf of bread”. As my hon. Friend has mentioned, if the story had been looked into, it would have been found that the sum was paid not for one loaf of bread, but for a number of products. However, there are underlying issues, which can be remedied by some of my hon. Friend’s suggestions. Nevertheless, the entire tenor of the article was that people are somehow getting free food on the NHS—not just loaves of bread but biscuits, cakes and things like that, which is not the case. Gluten-free products are a very expensive part of the household budget, certainly for families with more than one person affected. I do not get products on prescription, but purchase them. My hon. Friend the Member for Aberdeen South (Dame Anne Begg) is right; the range of products available now is far wider than when I was diagnosed. As for the idea that people are getting foods free, as has been said, they are not: if they receive them on prescription they will pay for that anyway. Many people do not choose to take anything in that way.
The reaction to the publicity, and the pressure on NHS budgets to secure value for money, which we would all support, has been a knee-jerk reaction to go the other way and reduce the number of products that people can get. That is not acceptable for low-income families and those who rely on gluten-free products on prescription. My hon. Friend the Member for Ochil and South Perthshire talked about a cost of about £400 a year, but in some cases it could be more, depending on how many affected people there are in a family. It has been recognised that the condition is not a fad or lifestyle choice, but a disease that needs treatment; and proper management can save the NHS money. People will not present at GPs’ surgeries with undiagnosed conditions. They can live perfectly well with the condition if it is properly managed; and my hon. Friend might agree that in some cases that improves health, because the diet is quite healthy—including, in my case, not being able to drink beer.
There has been a knee-jerk reaction from some PCTs. Is it acceptable that arrangements with suppliers are costing the NHS money? No—and I think that the Cumbrian and Northamptonshire examples are a way forward. If we encourage PCTs to adopt the approach of having prescriptions managed by the pharmacist, not only will the NHS save a lot of money, but that will be better for people who suffer from coeliac disease than going to the doctor for a prescription. I have talked to my GP about it, and doctors do not really review what is on the prescription. They just keep signing it. At least if the process happens in the pharmacy, the pharmacist, who knows the people involved, may review the quantity or type of products that the individual wants. I think that it would reduce the possibility of people getting the same prescription repeatedly, whether they need it or not. The pharmacist would be able to manage things. If someone has a prescription for eight loaves, but does not need them, why keep paying for them?
The examples and pilots in Cumbria and Northamptonshire show that not only can costs be driven down, but the service to the patient can be improved. There is an easy win there, and Coeliac UK and pharmacists are quite keen on the idea, and so are GPs, because it would cut the person hours taken up in writing the prescriptions. The pilots provide good instances of how GPs’ time is freed up. I urge the Government to look seriously at that, and consider how such best practice can be moved across. Quite rightly, when there are lurid headlines about people paying £32 for gluten-free bread, on top of the actual costs, that is not acceptable. If we can do something to reduce that problem, it would be good. We need to see more positive and constructive articles. To be fair, the Daily Mail in its health section has carried quite a few good articles about coeliac disease, explaining its symptoms, and promoting the suitable food that is available.
Some quick wins are available for the Government and the NHS, if they are allowed to take them on board. As chair of the all-party group, I would like the Minister to attend a meeting if that could be fitted into his diary commitments, and to meet the members of the group and others from around the country.
I am grateful to the hon. Gentleman, and it would be extremely useful to attend such a meeting. However, he may wish to invite the Minister of State, Department of Health, my hon. Friend the Member for Sutton and Cheam (Paul Burstow), who is the lead Minister on this medical condition.
I am disappointed about that, because I was looking forward to the right hon. Gentleman’s attendance. He is a good friend, but I will obviously leave it to the Department to decide who is the best person to come, and we will certainly issue that invitation in the next few days.
I want to pick up some of the issues that my hon. Friend the Member for Ochil and South Perthshire raised, including the products that are available. My hon. Friend the Member for Aberdeen South was right when she said that products have changed remarkably in the last 10 years from bread like cardboard that was hardly edible without a pint of water to some very good products on the market now. It is interesting that on the commercial side, large bread manufacturers such as Warburtons are producing gluten-free bread, so it obviously sees a market. I have tried its bread, and it is very good. Likewise, the invention of products such as Genius bread has completely changed the type of bread that is available, and the technology for producing it.
The supermarkets have also changed. Asda, Tesco and Sainsbury’s in particular have done two things. First, they have shelving dedicated to gluten-free products, which is important. Secondly, labelling has changed, which is important for people who suffer from coeliac disease, because it is amazing how many products contain gluten. Some flavours of crisps contain gluten, but others from the same producer do not. Correct labelling is important for all products so that people may buy with confidence, and see that the products that they are buying are gluten-free. It is important that the supermarkets recognise that there is a large and growing market for such products, so anything we can do to encourage better labelling of food content is important.
My hon. Friend referred to eating out, which can be difficult, although some restaurants recognise the problem of gluten in certain foods. However, the bane of my life is organisations that provide food on airlines and National Express, on which I sometimes travel. The people serving the food have no understanding of what a gluten-free diet is, and offer everything from sandwiches to sausages. When asked whether those foods contain gluten, they look blank.
The other reaction, which one gets from British Airways and which is amazing, is that whenever one asks for a gluten-free meal it thinks that that means vegetarian. I am not sure why, but it seems to think that one can eat what everyone else eats, but without the sauce. It seems to think that coeliacs are vegetarians, and my usual response is to ask whether I look like a vegetarian. There should be a campaign to persuade airlines and train companies that provide meals to ensure that their staff know what a gluten-free diet is. They could also be more imaginative about what they provide, because it is often inedible.
My hon. Friend may agree that if one tells an organisation that is providing a sandwich lunch that one wants a gluten-free sandwich, it always seems to provide the worst possible gluten-free bread, without the same filling as everyone else. One is given processed cheese or a bit of cold ham, and looks lovingly at the filling in everyone else’s sandwiches. Not only does one get the worst bread in the world, one gets the worst filling in the world, when it would have been easier to take out the original filling and put it on a plate to make quite a good salad.
I agree with my hon. Friend. When I was a Minister, it took at least six months to convince those in my private office at the Ministry of Defence that I did not want a salad whenever I went anywhere.
I congratulate the House authorities on the steps that they have taken in the House of Commons to provide gluten-free products, including meals, and to put the crossed grain logo on menus and so on to inform people. I hope that the House of Lords will eventually follow the same principle. That shows that it is possible for catering establishments to provide for people who need a gluten-free diet, and the House of Commons should be congratulated. There are some important issues to consider, and I hope that today’s debate has raised awareness about people who suffer coeliac disease, and provided some practical suggestions, which I hope the Minister will consider.
I apologise for being a few minutes late for the debate. I was speaking in the debate on Health and Social Care (Re-committed) Bill that is taking place in another part of the building.
I congratulate my hon. Friend the Member for Ochil and South Perthshire (Gordon Banks) on securing this important debate. It is always important when hon. Members with personal experience of an issue or condition take the opportunity to make the rest of us aware of that experience, as he has done.
As we have heard, Coeliac UK is doing excellent work, and one of the concerns that it has raised with parliamentarians is the challenge that people with coeliac disease face when eating in hospital. It says that hospital food is often restricted, and even unsafe. It receives many calls from members who have been in hospital, and have returned home malnourished and having suffered considerable weight loss. Sometimes friends and family have to provide gluten-free food. I hope that the Minister will tell us what action his Department is taking to ensure the availability of gluten-free food in hospitals throughout England and Wales.
Hon. Members will be aware that as well as securing today’s debate, my hon. Friend tabled an early-day motion in June 2010 to raise the issue of diagnosis rates. He has spoken very well on the matter this afternoon. In a parliamentary question, my hon. Friend the Member for Slough (Fiona Mactaggart) asked what information the NHS provides to people who are diagnosed with coeliac disease on managing their condition. The departmental response referred to a website with detailed information. The site also has information on how to ensure a gluten-free diet, with helpful examples of food to avoid. However, in the light of the large number of undiagnosed cases that we have heard about, I wonder whether the Minister has recently discussed the diagnosis and management of coeliac disease with representatives of the Royal colleges and other bodies representing medical professions.
My hon. Friend the Member for Aberdeen South (Dame Anne Begg) tabled an early-day motion early this year on issues relating to the hospitality industry, which we have heard more about this afternoon. What discussions, if any, has the Department held with the hospitability industry?
Outside Parliament a wide range of organisations, including Coeliac UK and the British Society of Gastroenterology, carry out excellent work on the condition. In particular, the British Society of Gastroenterology feels that an active case-finding strategy will increase the number of patients detected with coeliac disease. Does the Department have such a strategy at present?
Last year the British Society of Gastroenterology published its “Guidelines for the management of patients with coeliac disease”, in which it made a number of recommendations on what testing for coeliac disease should incorporate and how to best manage patients. Has the Department looked at those recommendations, and does it have a position on the management of patients with coeliac disease?
We have already touched on the excellent work of Coeliac UK and its ongoing campaigns such as the “Eating Out” campaign, which focuses on the food service sector, or the “Product” campaign mentioned earlier, which is about having a greater availability of gluten-free foods in supermarkets and on prescription. Of course, Coeliac UK is concerned that the medical profession has under-recognised coeliac disease so far. It is not routinely tested for, and Coeliac UK is campaigning to change that. We must build on the successes achieved, and I would be interested to hear how the Department plans to support the ongoing campaigns and the further work of Coeliac UK.
We have already heard about diagnosis, and the Minister will know that Coeliac UK has petitioned the Government to improve the rate of diagnosis of coeliac disease by including a target for GPs in the quality and outcomes framework. If a target on coeliac disease were to be included into that framework, GPs would have to deliver a better rate of diagnosis of the condition. That campaign has attracted nearly 9,000 signatures, and Coeliac UK is continuing with that and has made a new submission to the National Institute for Health and Clinical Excellence for such a target to be included. It would be helpful if the Minister updated us on the Government’s position on the issues raised in that petition.
Apart from early diagnosis and the management of coeliac disease, my hon. Friend the Member for Ochil and South Perthshire called this debate to discuss community-led pharmacy prescriptions. He has spoken effectively on that matter.
Moving on to the socio-economic impact of coeliac disease, we know that it is difficult to assess the overall burden of the disease owing to the absence of recorded information on diagnosis rates. There is a need for a central register of patients with coeliac disease, and I wonder whether the Minister will comment on that. We know that coeliac disease has an impact on both the individual and the community because of its high prevalence and the long-term complications arising from late diagnosis. The development of osteoporosis or bowel cancer has an impact not only on the individual affected but on the community and the health service. Even in the short term, the absence of diagnosis has a socio-economic impact. My hon. Friend said how shocked he was when his GP said, almost lightly, that he had missed two other cases of the disease that month. According to an independent study commissioned by Coeliac UK in 2006, just under half of people with coeliac disease who had been wrongly diagnosed believed that their job or career had suffered due to the condition prior to diagnosis.
As we have heard, Coeliac UK wants to see greater understanding and familiarity with the disease among GPs, and higher levels of referral to dieticians. A survey of registered dieticians conducted by Coeliac UK showed a wide variation nationally in the provision of dietetic expertise for patients with coeliac disease. Current provision is around one third of what it would be were we to provide diagnosed coeliacs in the UK with basic support and an annual review.
I will conclude my remarks by saying to the Minister that there is a continued cost to the health service due to repeat visits to GPs by people with undiagnosed coeliac disease—my hon. Friend referred to that in his personal case. Furthermore, left untreated or undiagnosed, coeliac disease can lead to more serious complications such as bowel cancer, which puts an even bigger drain on health service resources. Coeliac UK recognises the competing demands on health service resources and budgets, but coeliac disease is easily controllable once diagnosed—we can see that by looking at my two hon. Friends the Members for Ochil and South Perthshire and for North Durham (Mr Jones), who are able to be excellent and inspirational Members of Parliament because their coeliac disease is so well managed. It is a disease that can be self-managed if diagnosed early enough in life.
Government policy needs to acknowledge the scale of the impact of coeliac disease across a large segment of the population. Policy must also take into account the potentially serious nature of the disease, the cost in financial terms, and the suffering of the undiagnosed. In particular, measures should be taken to address the lack of awareness about the disease and provide a framework to ensure that GPs receive appropriate training and resources. Ongoing training should be provided to enable GPs to give better care in the community.
Once again, I congratulate my hon. Friend the Member for Ochil and South Perthshire on securing this debate, and my hon. Friend the Member for North Durham on chairing the all-party group on coeliac disease and dermatitis herpetiformis. A number of colleagues from all sides of the House take a keen interest in this issue and wish to commend the work of the all-party group in promoting awareness about the disease. I look forward to the Minister’s response.
May I say what a pleasure it is to serve under your chairmanship again, Dr McCrea? I will begin with some congratulations and an apology. The congratulations go to the hon. Member for Ochil and South Perthshire (Gordon Banks) on securing this debate and on raising the issues faced by people living with coeliac disease. It was genuinely fascinating to listen to him speak about a long-term condition that, as was mentioned by other hon. Members, is unknown to a vast majority of people in this country. To hear at first hand about the day-to-day living of someone with that long-term condition was extremely interesting and illuminating.
The question of illumination is where I get to my apology. I must apologise to the hon. Gentleman because I am afraid he got the monkey rather than the organ grinder this afternoon. As he will know, the Minister of State, Department of Health, my hon. Friend the Member for Sutton and Cheam (Paul Burstow), is the lead Minister in the Department for issues such as coeliac disease and other long-term conditions. As the hon. Gentleman will understand, deliberations on the Health and Social Care Bill are reaching their concluding hours on the Floor of the House of Commons as the legislation approaches Report and Third Reading. The Minister of State’s debate on Report clashed with this debate in Westminster Hall, so I am an inadequate stand-in for him. I assure hon. Members, however, that I will draw his attention to a number of points that have been raised this afternoon, and I know that he will be interested to read the debate tomorrow. If there are other issues that he needs to answer, I will make sure that he does so. In the time available, I will try to respond to as many points raised by hon. Members as I can. If time does not allow all those points to be answered, I will ensure that they receive a letter to clarify any outstanding issues.
For those hon. Members who are not aware of coeliac disease—I know that there are none in the Chamber today, but I am sure that there will be some MPs who follow health issues assiduously in Hansard but who are not as knowledgeable as those present in the debate—let me say that the disease is a common condition that affects approximately one in every 100 people in the UK. Rather surprisingly, women are two to three times more likely to develop the condition than men, although there seems to be no apparent reason for why that should be the case. Cases of coeliac disease have been diagnosed in people of all ages, as the hon. Member for North Durham (Mr Jones) mentioned when illustrating one of his points. It is therefore crucial that information, education and support are available for individuals as well as the other people involved in their lives, such as parents, teachers, carers, employers and others.
There is only one clear path to get properly diagnosed—again, early diagnosis was another theme that was echoed by all three hon. Members who took part in the debate. That is an extremely important issue. The points that hon. Members raised in making the case for early diagnosis are unanswerable. It is crucial. However, as they will know, getting a proper diagnosis requires a blood test and endoscopy with biopsy. We of course welcome any new tools that can help to get more people diagnosed. However, it must be recognised that pinprick self-testing kits do not replace a medical diagnosis. Indeed, for a definitive diagnosis, it is important that people have not already taken gluten out of their diet as a result of self-diagnosis, because that can lead to the diagnostic tests being inconclusive, with all the unfortunate results that that has.
Anyone experiencing symptoms of coeliac disease should seek the advice of their doctor to get a proper diagnosis and professional dietary advice on how to manage their condition. We must ensure that people living with coeliac disease get the best clinical advice and support available, that they are involved in decisions about their care and that they are fully supported to make informed choices.
The hon. Member for Ochil and South Perthshire said, “Why not use the QOF?” With regard to the testing of people and of members of their family to see whether they may have the disease, we believe that it is up to people to raise any concerns that they have as a result of a family member having the disease, and that is likely to result in a test for coeliac disease for those people.
I think that the hon. Gentleman specifically asked—I hope that I have got this right—when or if there would be NICE guidelines. On that issue, I have what I hope is some rather good news for him. There are already NICE guidelines on diagnosis and recognition. They were published on 27 May 2009. The reason that the guidelines were drawn up is that they were part of a determined campaign in the NHS and, to be fair, by the Government of the day to improve recognition of the disease and to increase the number of people diagnosed with it.
I am well aware of what the Minister is referring to; indeed, I alluded to it in my contribution. What I am saying is that there is now an opportunity through the QOF framework to make coeliac disease one of the 150 measurable outcomes for GPs to be measured against.
I am grateful to the hon. Gentleman. He makes a perfectly reasonable point. I will certainly ensure that his comments are drawn to the attention of NICE, because of course it will be NICE, working with the Department of Health, that draws up the list of conditions. That is apart from the standards that it is already working on. As the hon. Gentleman said, between 150 and 180 are being considered. I will ensure that his comments are drawn to NICE’s attention.
I am grateful and I will ensure that the hon. Gentleman’s recommendation and the points associated with that are drawn to the attention of the relevant bodies, so that they can be considered as NICE considers its programme for the standards.
The question of managing coeliac disease in the NHS featured in a number of contributions today. The NHS is best placed to determine and manage its services locally, supported by clinical guidelines and close community and partnership working. The NICE guidelines on recognition and diagnosis of the condition are supported by prescribing guidelines for professionals on prescribing gluten-free foods, developed in association with the British Dietetic Association, the Primary Care Society for Gastroenterology and Coeliac UK.
The NHS also has to ensure that the resources that it has available are used to greatest effect. That is another theme that I think was developed by all three hon. Members who took part in the debate. Some of the comments concentrated on the question of prescriptions. One area in which spending needs to be more effective in order to meet rising demand for services is prescribing, as hon. Members said. A range of programmes is in place to try to reduce the money spent on prescribing drugs, and the review of gluten-free food prescribing is part of that process.
Discussions are taking place throughout the country on that matter. In the south-east—the hon. Member for Ochil and South Perthshire referred to this—a review was conducted of gluten-free prescribing policies across the region. That was led by medicines management leads, who are pharmacists, from the different counties. They made recommendations that caused concern to some patients. However, as a result of their subsequent discussions with patients and, indeed, the role played by Coeliac UK, a number of changes are to be made to their original proposals. I will add that GPs are not prevented from such prescribing if specific patients are considered to have a special clinical need. I hope that that reassures the hon. Gentleman.
It is a matter for doctors’ clinical judgment which products they prescribe for their individual patients. They are not prevented from such prescribing if patients are considered to have a special clinical need. We fully expect GPs and other health professionals who prescribe gluten-free products to assess the dietary requirements of individual patients, taking into account not only their nutritional requirements but their lifestyle and other needs. We expect the provision of food items to be based on individual needs, not on a preconceived idea of what someone ought to receive.
We believe that patients stand to benefit from the modernisation of commissioning, as that will enable GPs to focus resources to meet the local needs of their population and enable local people to be involved in shaping services that are crucial to them. It will be for consortia to determine how they organise themselves to commission services for patients affected by coeliac disease. The new arrangements in the NHS are designed to ensure that GPs are in the driving seat on commissioning services for their local population.
In my contribution, I spent a considerable amount of time talking about pharmacy-led prescribing. The Minister has gone around the houses on that; he has not really addressed it directly. In the last two and a half minutes of the debate, could he deal with it in a little more detail?
I am planning to come to that, but first I want to deal with another issue that the hon. Gentleman raised—food labelling. I will then move on to prescribing. If I run out of time, I will ensure, as I promised, that I write to him.
Food labelling is crucial to patients’ quality of life, and improvements have needed to be made. The coalition Government want to see health and social care provided in a way that achieves better outcomes and delivers personalised services, focused around individuals, not organisations, and ending up with care and support that is of a higher quality and safer than ever before.
For people living with coeliac disease, having the right information about the gluten content of food is crucial. That has certainly emerged in the course of this debate. Prescribed foods represent a small proportion of an individual’s diet. People with coeliac disease buy most of their food from high street shops, like everyone else. It is therefore important that food labelling is comprehensive and reliable. It has got better in recent years, particularly in supermarkets, which the hon. Member for North Durham mentioned, and in some restaurants—although there is a long way to go—as more and more people become aware of the condition. Indeed, a wide selection of gluten-free foods is now available at supermarkets. That was not the case 10 years ago.
New labelling requirements introduced in January 2009 for full implementation on 1 January next year are designed to reduce confusion and to help people with coeliac disease to make safer choices about the food that they eat. The legislation sets out new low limits for gluten in foods making “gluten-free” and “very low gluten” claims, so that consumers can understand how much gluten there is in the foods that they buy. The Government are working with industry, health professionals and Coeliac UK to provide advice for consumers on what the new legislation means for them.
As I am running out of time and sadly have not been able to cover all the points, I give hon. Members a categorical assurance that they will receive a letter answering in detail the outstanding points that they have validly raised during an extremely interesting and high-quality debate.
Wind Farm Development (Sedgefield)
It is a pleasure to speak under your chairmanship, Dr McCrea.
Whenever we have a debate about wind farm development and the instigator of the debate opposes a planned wind farm, there are cries of nimbyism or of the Member being at the climate-change-denial end of the spectrum. I am the instigator of this debate, but I am not a nimbyist or a climate-change denier. Nevertheless, I am opposed to E.ON’s proposal to build a wind farm in my constituency of up to 45 wind turbines, each four times the height of the Angel of the North. It will cover 7½ square miles of my constituency, or 5% of its geographic area—equivalent to the size of Newton Aycliffe just to the west of the proposed site, which has a population of about 30,000.
If E.ON’s proposal was for the only wind farm in County Durham, I could stand accused of nimbyism, but it is not. There are already 16 in the county, and another has received planning consent but has yet to be built. The site in the Sedgefield county ward where E.ON proposes to build has a cluster of 17 wind turbines, 10 of which are run by E.ON and seven by Wind Prospect. If the E.ON proposal goes ahead, there could be as many as 62 turbines in one ward, and that does not include a further application for three turbines at Foxton lane, which is south of Sedgefield village and in the same ward. However, those are not the only developments that are being proposed or granted. It seems as if there is a steady stream of developers coming to my door proclaiming the merits of their schemes. In isolation, one scheme may have a lot going for it, but as one of many they have a cumulative impact, and the landscape’s capacity to take more turbines is questionable.
I thank the hon. Gentleman for allowing me to intervene. I wish to express sympathy with his cause. We have exactly the same problem in my constituency, with a huge number of wind farms coming along that will completely destroy the area. The hon. Gentleman should know that he is not alone; others feel the same. Virtually every resident of Montgomeryshire will sympathise with him.
I thank the hon. Gentleman for his intervention. There is a lot of discontent in certain parts of the country, because the matter is pertinent to parts of Wales and Scotland, as well as to County Durham and to one or two other parts of the country. A case can be made for wind farms, but when there are dozens in one area it has an impact on the local landscape.
I am grateful to my hon. Friend for giving way. His is a neighbouring constituency.
County Durham was the first county to reach its 2010 target, and it is well on its way to reaching its 2020 target for renewable energy. Like my hon. Friend, I have many wind farms in my constituency, which is largely rural and has two areas of outstanding natural beauty. Energy providers now acknowledge that the cumulative effect of ever more developers rushing to build wind farms is reaching saturation point in the county.
I thank my hon. Friend for her intervention. In a moment, I shall be pointing out how much of a role County Durham and Sedgefield residents are playing in combating climate change.
It is the job of each developer to promote their schemes, but because the planning system is run on a first-come, first-served basis there is a rush to the planning authorities, and local people are left feeling under siege and helpless. I shall give an example by detailing the level of interest in and around my constituency by developers. I say “in and around the constituency”, because when my constituents look out of the windows they do not see the boundaries between constituencies; they see pleasant countryside. Indeed, from certain parts of the constituency they can see magnificent views of the North Yorkshire moors and Cleveland hills.
This is the state of play. As I said, 16 wind farms are up and running in County Durham, and another has been permitted but has not yet been built; 67 turbines are generating 126 MW. A further five wind farms are in planning, with a further 10 turbines; and three are in pre-planning with 18 turbines. That is a total of 95 turbines. Then there is the mother of all wind farms, the Isles wind farm proposed by E.ON, which will raise the number of turbines, operational and proposed, to as many as 140.
Within hundreds of metres of the Durham county council border at Sedgefield, three turbines are operational near Elwick. Just to the south, along the A1, a further six have been granted at Red Gap farm. Three turbines have received planning consent at Lambs hill near Stockton, and they directly affect my constituency because of their proximity. In the borough of Darlington, an area that I share with my hon. Friend the Member for Darlington (Mrs Chapman), three are proposed at East and West Newbiggin. Banks Renewables has gone to appeal on a wind farm of 10 turbines at Moor House farm, just to the south of E.ON’s large proposal. The list goes on.
Local people feel inundated and helpless. I am sorry to say that they are resentful of a planning regime that does not seem to listen to them. I accept that not all the proposed wind farms will go ahead. However, the Minister cannot deny that they will have a cumulative impact in County Durham and the Tees valley plain. When I say no to the Isles wind farm, I do so because I know that my constituents in County Durham are doing their bit. Even the developers are starting to concede that point. A representative of Banks Renewables, wind farm developers that have sites in the county, was interviewed by the Teesdale Mercury on 24 August 2011. He said:
“An unfortunate repercussion of County Durham being forward thinking in its approach to renewable energy development is the potential for cumulative impact to occur...The pursuit of several wind farms within the county by competing developers has potential to cause an unacceptable impact upon the landscape.”
He is absolutely right; in my view we are already at that stage.
County Durham’s record on renewable energy is another reason why I believe that we are not being nimbyist in our approach. The county council was the first local authority in England to have a renewable energy strategy; it dates back to 1994. The renewable electricity target for County Durham in the regional spatial strategy—I realise that it does not apply any more—was 82 MW installed capacity by 2010. Since then, about 165 MW of installed capacity of renewable energy development has been permitted in the county. Only 11 MW of that was permitted on appeal—the majority, 154MW, was granted by the council.
A capacity of 165 MW will meet about 55% of County Durham’s household electricity consumption, or 22% of the county’s overall electricity consumption. That is a fantastic record, and one of the best in England. I am sure that the Minister will agree that County Durham is doing its bit, and I hope that he will pay tribute to the county’s record.
County Durham’s 2010 target has been met and exceeded by a substantial margin. The aspiration to double that target by 2020 has already been achieved, and progress is being made towards the more recent national target of 30% by 2020. That has been achieved through a planned approach based on the north-east region’s renewable energy strategy and development capacity studies commissioned and endorsed by local authorities in the region.
The Tees plain was identified as a broad area of least constraint for wind energy development. Its capacity was identified as being between 20 and 25 turbines. It is covered by four local planning authorities—Durham county council, and Stockton, Hartlepool and Darlington borough councils. A development capacity study was carried out by consultants Arup in 2008, when there were a total of 20 operational or permitted turbines in three wind farms. It concluded that there was potential to exceed the level of development anticipated, and that two additional wind farms totalling between nine and 15 turbines might be acceptable.
Since then, two additional wind farms totalling nine turbines have been permitted. The area is therefore at or approaching the capacity identified in the Arup report. Currently, there are planning applications for three additional wind farms and a single turbine development in the area, totalling 13 turbines; and one planning application for 10 turbines is in abeyance. Those applications will be determined against the development plans of the relevant planning authorities, having regard to both the Arup capacity study and the evolving cumulative impact picture as they progress through the system. According to impact assessment studies, the area chosen by E.ON at the Isles—the company has built many wind farms in the area—can cope with only four to six turbines, but E.ON plans between 25 and 45. Durham can meet its targets because we have proved willing to embrace other renewable technologies in the same area. In Chilton, which is in my constituency and north of the Isles, Dalkia has just opened a biomass facility, producing 15 to 17 MW of electricity. Some 24.4 MW of electricity is generated from biomass in the county, 12.7 MW from landfill and 2.1 MW from hydro. County Durham is playing its part. Everyone wants to share the benefits of renewable energy, but we also need to share the burden.
I hope my hon. Friend and my neighbouring MP will forgive me if I go off on a slight tangent. Does he agree that while our constituents are getting the pain of wind farms, they are not getting the benefits? That was perhaps best illustrated this week when EDF awarded all its contracts for a massive wind farm off the Teesside coast to companies abroad, instead of creating jobs in our constituencies for our people who have the skills and facilities with which to build that farm.
My hon. Friend makes a very important point. Although the landscape in the area has begun to be reindustrialised, we are not getting any of the benefits.
We are getting energy from other renewable sources such as hydro, landfill, and biomass, and now our constituents are beginning to wonder whether we are all in this together. They look at Hampshire, which is using three times as much energy as Durham but taking only about 4% of it from renewables. Moreover, there is not one on-shore wind farm in the area, despite the fact that it is the county in which the Secretary of State for the Department of Energy and Climate Change has his constituency.
Only five members of the Cabinet have wind farms in their constituency. Some have a lot. The Chief Secretary to the Treasury has 259 in his constituency of Inverness, Nairn, Badenoch and Strathspey, but his constituency covers l,911 square miles—almost as many as there are amendments to the Health and Social Care Bill. The Scottish Secretary has 226 turbines in a constituency covering almost 1,500 square miles. The Foreign Secretary, whose constituency is adjacent to mine, has 24 turbines in an area covering 739 square miles. Sedgefield covers 151 square miles. If the developers get their way and all 87 turbines get the go-ahead, we could see one turbine for every 1.7 square miles. Does the Minister not agree that the planning system for such huge structures is chaotic?
Is my hon. Friend aware of the concerns of Newcastle airport about the concentration of wind farms and of the Ministry of Defence over the effects that such a concentration will have on using parts of the north-east for low flying?
That is an important point. Durham and Tees Valley airport, which is in my constituency, occasionally raises important issues about radar. I have seen the wind farms on its radar scopes. Pilots have to navigate their way round the wind farms to avoid hitting them. Moreover smaller aircraft have to cope with the turbulence that these turbines generate.
What we are facing in County Durham is the reindustrialisation of the landscape, but without the jobs. Durham county council has done tremendous work over the past 30 or 40 years in reclaiming the pit heaps that scarred the landscape for generations. At the height of the coal mining era, thousands of jobs were created in the area. Wind turbines are not bringing that kind of benefit to the region. Reindustrialisation with jobs is one thing; without jobs, both the land and the people are being taken for granted. Their good nature is being abused and that is simply not good enough.
According to the Renewable Energy Foundation, if the Isles wind farm goes ahead with 45 turbines, E.ON will see a revenue stream of more than £570 million over 25 years, some 54% of which is subsidised through our utility bills. E.ON has said that the Isles wind farm could generate enough electricity for 53,000 households. The subsidy would equate to £235 per household per year. The community benefit that it proposes is £460,000 a year or £8.60 per household. The company is taking with one hand and giving us back peanuts with the other. What plans do the Government have to reform or review the subsidy system for wind farms and for renewable energy in the round?
Only a handful of landowners on the Isles will benefit from the rental income from the turbines on their land. One developer said that the income from each turbine is, on average, between £10,000 and £15,000. I do not know the rental figure for the Isles, but even at £10,000, 45 turbines will bring in some £450,000 income for a handful of landlords—the equivalent in community gain for a population in the area of between 40,000 and 50,000.
The Government are looking at the business rates that would be generated if the wind turbines stayed with the local authority. According to the House of Commons Library, business rates income from the Isles would be less than £1 million. That may seem a lot of money, but it is not when we consider the plans of the Department for Communities and Local Government for business rates retention, which could see tens of millions of pounds removed from Durham county council’s budget. Again, this is about taking with one hand and giving back peanuts with the other.
The designs for the Isles place the turbines on either side of the A1 and the east coast main line—the main transport arteries through the north-east. If someone enters County Durham by road or rail from the south, they have to go through my constituency. I do not want the first thing that they see to be a massive wind farm of between 25 and 45 wind turbines, each four times the height of the Angel of the North, each a clone of its neighbour and each working only intermittently. Durham county council has informed me that the average capacity factor for a wind turbine nationally between 2004 and 2008 was 27%. Recently, the average for wind turbines in County Durham has been almost 20%. That belies the claim of many developers, especially E.ON, who say that the Tees valley plain is appropriate for wind farm development. They would not develop wind farms if it were not for the subsidy. Does the Minister not agree that it is time for that process to be reviewed and changed?
E.ON’s imposition on the landscape will affect tourism and the willingness of housing developers to build in the area. I want to see new industry come into the area, Hitachi is to build a train factory at Newton Aycliffe and I want that to be followed by more industry, which means that we need further housing in the area—not just affordable but executive as well—and leisure facilities. This massive wind farm could have a negative impact on such developments.
The Duke of Northumberland has said he will not allow wind farm development on his land. In The Daily Telegraph, he said:
“I have come to the personal conclusion that wind farms divide communities, ruin landscapes, affect tourism, and make minimal contribution to our energy needs and a negligible contribution towards reducing C02 emissions. The landowner and developer are enriched while the consumer is impoverished by higher energy costs. Turbines are ugly, noisy and completely out of place in our beautiful, historic landscape.”
Will the Minister look closely at wind farm development in County Durham, as it has caused a great deal of anxiety in the community? I believe he will see that the cumulative impact is not just a threat but is already with us. He will find that developers are targeting the county because of the good nature of its people. Low incomes will provide the incentive for local people to accept the small amount of money from community gain and ensure that they will find it difficult to raise sufficient funds to campaign against the wind farms.
Local people feel as if they are involved in a David versus Goliath contest in taking on E.ON. Campaigners against the Isles have come together. The following towns and parish councils are against the development: Bradbury, Brafferton, Bishop Middleham, Bishopton, Bolam, Chilton, Coatham Mundeville, Elstob, Ferryhill, Fishburn, Foxton, Great Stainston, Little Stainton, Mordon, Newton Aycliffe, Nunstainston, Preston Le Skerne, Rushyford, Sedgefield, Trimdon, Windlestone and Woodham. The campaign group against the E.ON wind farm can be found on the web at www. theislescommunities.com.
It is now time to look at a planning system and an energy policy that fight climate change by taking people with them, rather than taking them for granted or making them feel helpless. We need a strategic view that ensures that all parts of the country share the burden as well as the benefit of renewable energy. My constituents are united in opposition to the massive imposition of the E.ON wind farm for the Isles. Durham County is known as the land of the prince bishops. I will not stand by to watch County Durham become the land of the wind turbine.
Thank you very much, Dr McCrea, for calling me to respond to the debate. I thank the hon. Member for Sedgefield (Phil Wilson) for securing the debate and introducing it in a very thoughtful and considered way. I understand that the subject is very emotional and emotive, and I am grateful to him for the points that he made. We have heard many of the points that he and his hon. Friends made before, but that does not reduce in any way the strength of the argument behind them. I hope to address as many as I can in the time available to me.
I hope that the hon. Gentleman understands that I cannot comment on particular applications, because their nature is such that they may well come to a Minister for final determination and I cannot say anything to prejudge that. However, it is important to say on the record that the E.ON process is currently a consultation. I think that he would wish his speech today to be considered as part of that process, and that the company will be keen to know the views of the local community and local business people on what they consider to be the right way forward on the application.
All applications for major energy infrastructure are dealt with on a case-by-case basis, taking into account the views of local people. To the hon. Member for North Durham (Mr Jones), I say that it is entirely proper that the views of the airport and the Ministry of Defence should also be taken into account in that process. That will continue to be the case under the national policy statements as they become part of planning policy. In addition, the decision maker has a duty to make a decision only after full consideration of the balance of the proposed development’s benefits and negative impacts; that includes consideration of the environmental impacts, which he and others might feel should be taken into account.
I think that the hon. Member for Sedgefield and I agree on the two most critical points: that renewable energy is necessary for energy security and environmental reasons, and that local communities should be given a say in shaping the environment in which they live. Consequently, in the few minutes that I have today I will seek to explain how I see those two aims coming together and set out the steps we are taking to ensure that they do. I also want to address the democratic deficit and show that wind farms can bring real benefits to communities, as long as they are situated in the right place and they have democratic approval.
Our challenge is to build an economy that cuts our carbon emissions to tackle the threat of climate change, that makes our energy secure in a volatile world and that creates sustainable green jobs to help to bring back economic prosperity. As one of the most cost-effective and mature large-scale renewable technologies, the appropriate deployment of onshore wind will play a key role in meeting that challenge. We want Britain to be a global leader in the transition to a low-carbon economy. We are committed to producing 15% of our energy from renewable sources by 2020 and to reducing our carbon emissions by 80% by 2050. In July, we published the renewable energy road map, which sets out our approach to unlocking our renewable potential. It includes a comprehensive suite of targeted, practical actions to accelerate the development of renewable energy in this country.
Given that I only have 10 minutes to respond to the whole debate, I hope that the hon. Gentleman will allow me to try to respond to as many of the points made as possible.
Our analysis suggests that approximately 90% of the generation needed to meet that target can be delivered from a subset of eight technologies and that onshore wind has the potential to contribute perhaps 10% to 14% of overall generation. Currently, there is 4.2 GW of operational onshore wind capacity in the UK; in capacity terms, it is the single most deployed renewable electricity technology.
As the hon. Gentleman said, the Government support the deployment of renewable energy through the renewables obligation which, by supporting generation rather than capacity, is structured in a way to incentivise the best use of the available resources and to maximise efficiencies. If an application has a very low load—I would consider 20% to be a low load—it will receive little benefit through the renewables obligation. The higher the load factor, the greater the support that an application will receive through the renewables obligation. However, we have recognised that it is time to review that approach; the review was scheduled for next year, but we have brought it forward because we think that it is right that communities and developers have early clarity about the thinking.
I was not entirely clear about the thinking behind the points the hon. Gentleman made about Cabinet members’ constituencies and how that factor plays in. Most of the applications that we have seen were made well before they were actually in the Cabinet and it was a different set of Cabinet Ministers who were responsible for the policy. Indeed, much of the policy was developed under the leadership of the previous MP for Sedgefield when he was Prime Minister. I am not quite sure where the hon. Gentleman was seeking to go in that part of his contribution.
None the less, I acknowledge the important role that the north-east is playing in the transition to a low-carbon economy. I pay specific tribute to what is being done in Durham already. All of us who know the county know that it is an incredibly beautiful county—a very special part of the country—so we understand the competitive pressures already present there. We recognise the contribution that the county is making.
As a whole, the region has 150 MW of operational onshore wind capacity, which is 3.5% of the total UK deployed resource. Those onshore wind projects have also helped to deliver real economic growth and benefit to the local community, such as the work being done by the National Renewable Energy Centre to develop the region’s old manufacturing heritage, to help to pull the region out of recession and into recovery with new industries for the future.
I understand the concerns expressed today about the impacts that such a level of deployment might have. As the market brings forward applications for wind farms, we need to ensure that they are in suitable locations, taking account of viability and the concerns of local communities. Part of the renewables obligation certificate review is designed to ensure that wind turbines go where the resource is best, not anywhere in the country. The Government are keen to avoid a one-size-fits-all approach and we consider that planning applications for wind farms are best assessed on a case-by-case basis. The national policy statements and the national planning framework set out a clear and simplified framework to do that, but it is a requirement of a planning regime that cumulative impacts, for example those in locations such as Durham, are considered in the total. We would expect the local planning authority to set out important local issues in its local impact report, just as we want host communities for the installations to reap the benefits of taking the assets into their communities.
I am pleased to say that through the Localism Bill we are proposing changes aimed at addressing some of the concerns that have been raised in this debate. They include abolishing regional spatial strategies and their top-down regional energy targets to move towards a localism-driven approach, so that more control is given to local authorities, as the hon. Gentleman wants; introducing provisions for projects submitted to local planning authorities, so that developers will have to show how they have worked with communities in developing their planning applications; closing the Infrastructure Planning Commission and merging its functions with a more efficient and effective Planning Inspectorate, which means that the ultimate responsibility for making decisions on nationally significant infrastructure, such as the application that the hon. Gentleman raised today, will return to democratically elected Ministers; and ensuring that energy decisions on major infrastructure projects are made by the Secretary of State for Energy and Climate Change based upon recommendations from the new expert unit within the Planning Inspectorate. All decisions will be made in accordance with our recently designated national policy statements and important local considerations.
Our aim is to support appropriate renewable energy development, which the country needs, while maintaining environmental safeguards and, through local and neighbourhood plans, giving local authorities and communities a much greater say in how development is delivered. More broadly, if it is agreed, the framework will also enable local communities to set their own growth agenda according to local needs, and to plan and manage development to deliver that agenda.
As well as ensuring that local people have a real say in what happens in areas near to them, it is right that communities hosting renewable energy projects are rewarded for the contribution they are making to the wider society. As the hon. Gentleman pointed out, there is a concentration of renewable energy resources in different parts of the country and all of us are benefiting from the actions of the communities that decide to host those facilities.
As part of achieving that, we announced that local authorities in England, on behalf of individual communities, will be able to retain the business rates generated by renewable energy deployments, not just for one year, but on a continuing basis. I am pleased that, in parallel, the wind energy industry has published agreed minimum standards for the contributions that wind farm developers will make to community development in England, as part of an ongoing commitment to close consultation with communities. Financial contributions might include, for example, building new community assets, or investment in energy efficiency measures to reduce electricity bills. That would be on top of any direct benefits for those living in the area, such as economic activity, jobs or rent paid to landowners. Of course, the most powerful reward for a community is to have a direct stake in a project and we want to encourage that.
There are real economic benefits that can be delivered by these projects. The hon. Member for Stockton North (Alex Cunningham) talked about that and we want to prioritise it much further to ensure that where major applications happen, we see more jobs coming to the UK.
In these few minutes, I hope that I have been able to show that we very much understand the points that the hon. Member for Sedgefield made in his expertly argued speech—I am very grateful to him for making those points—and, that the Government are using our review of the renewables obligation and the wider policy framework to ensure that we respond appropriately.
It is a pleasure to serve under your chairmanship, Dr McCrea. I am grateful to the Speaker for granting me the opportunity to have this debate because, as the Minister for Europe already knows, one of my biggest complaints has been that we do not have enough time in Parliament to debate the EU and its institutions.
I want to cover a wide range of matters specific to various European institutions, those of both the European Union and the Strasbourg-based Council of Europe, because I fundamentally feel that these institutions have grown in power and that, if they are left unchecked, without action by the Government, they will become more and more powerful, with potentially serious consequences for our country. I would like to stress to the Minister the importance of there being more debate on European affairs in the House of Commons, not just on the matters that I will touch on today, but on the broader issues right now within the eurozone, which is the first topic that I want to mention.
There has, of course, been continued speculation about the eurozone, and we have heard a great deal from France and Germany about proposed financial transaction taxes, which, in my view, would have disastrous consequences for the City and its position as a world leader in financial services. There is a clear determination across the eurozone to prop up the euro, irrespective, as we have seen with the Greek bail-outs, of the wider concerns about the ability of other eurozone countries to pay their way. I take the view that we have seen some politically questionable arrangements in relation to bail-outs, regardless of the overall economic consequences, and I am concerned about the exposure of the British taxpayer, which is also somewhat questionable. It is not that surprising that we are now hearing alarm bells in relation to wider talk and discussion of fiscal union: a single regime of taxation and treasury, and unified public borrowing. That is not the solution to the continual problem, and it will, if nothing else, result in the further haemorrhaging of taxpayers’ money to Europe and the further surrender of powers.
What I would really like is for the Minister and the Government to clarify their position on fiscal union, as that could involve a new constitutional settlement with Brussels and could impact on British national sovereignty. British taxpayers must be protected further from any moves towards integration. If any change should come about, we should consider a referendum—we have heard a bit about that topic in the news today—because the British public must have a final say on the course of action that they ultimately look to the Government to take. I would welcome from the Minister a view on the current debate and discussions, and on the proposals that might be emerging in Europe right now. I would like to hear what position the Government might find acceptable or unacceptable, and on what it is that they are prepared to firmly stand up to Europe and question the future direction of travel. It is clear that the European institutions are very focused on closer European union. They are, in my view, using the current eurozone crisis as an opportunity to go for further integration.
Regarding EU directives and their regulatory impact on British business—on businesses in my constituency in particular—the businesses all recognise that we are dealing with the uncompetitive aspect of the EU, which has become a drag upon our economy and upon them individually. I refer specifically to the raft of gold-plated directives that keep coming out of Europe and have a disproportional effect on and an ultimate cost to British businesses, not only affecting jobs in this country but having an overall impact on economic growth. I urge the Minister and the Government to use every opportunity to renegotiate and to repatriate powers to the UK and, where possible, to axe the costly red tape and regulations that are coming out from Europe and affecting, and strangling, British business.
I also look at the advancement of the Europe 2020 strategy and the possible further threats in the form of Europe’s influence on economic, employment and social policies. I again urge the Government and their Ministers to resist all attempts at further competence creep in that area. Both business and the public have become fed up and feel isolated, because of Europe controlling more and more aspects of our lives and our country. Having been denied a referendum on the Lisbon treaty under the previous Government, there is an understandable degree of cynicism and distrust towards the Government—any Government—on this matter.
My views on all matters Europe are well known. If the Government have a sense of conviction and determination to bring an era of transparency and accountability to Europe—we see that more in our domestic policies, and there is a greater case to be made to use Britain’s role to urge Europe to do more of it—we can effectively find ways for the British public to bring powers back to Britain and at the same time engage the British public in the wider debate on matters such as transparency and accountability. If that does not happen, the Government will continue to face this wall of pressure, both from the public and parliamentarians, including me, to hold a referendum on the future of Europe, and on withdrawal from the EU as well. In the years ahead, the Government must pursue the virtues of less Europe and more Britain.
In addition to repatriating powers to Britain, we need an assertive approach to challenging the EU on its budget. The British Government must stand firm in this area, because culturally and institutionally the EU is wedded to an unreformed culture of high budgets. The European Council press release in July said that the EU budget for 2012 was to be trimmed in recognition of the difficult economic circumstances—somewhat an understatement—in many EU countries. What did the so-called trimming result in? It led to an approved increase in the EU budget of more than 2%. The public want the Government to stand up for hard-pressed British taxpayers. How can it be right that we are all financially squeezed here at home while we are bankrolling increased expenditure abroad and footing the bill for what I see as EU propaganda programmes—vanity projects such as EU citizenship programmes?
As part of budget negotiations, I also urge the Government to take a tough stance on defending the UK’s rebate, which is worth £65 billion to British taxpayers, and in particular to stand up against continued attempts by Europe to take what is left of that rebate. The Office for Budget Responsibility has already stated that the UK’s net contribution to the EU will increase to somewhere in the region of £8 billion to £9 billion per year during this Parliament alone. British taxpayers need a commitment from the Government that they will take all necessary action to block any future increases in the budget and to ensure that our rebate is safe.
Another subject that I want to touch on briefly is EU immigration. With the EU set to expand to include Croatia and other Balkan countries, we need stringent immigration controls. I look to the Minister for some assurances, primarily because we have suffered from uncontrolled levels of immigration following the expansion of the EU into eastern Europe. At a time when we need to get Britain working again, we cannot afford to lose more UK jobs to the next generation of European workers.
It is time for Britain to take robust action on the Strasbourg-based Council of Europe and its associated institutions, which include the European Court of Human Rights. From November, the UK will hold the chairmanship of the Council of Europe and in advance of that it is essential that this Parliament gets to debate the UK’s priority. The opportunity for reform must be grasped, as there are plenty of areas in which the UK should focus its attention to protect British sovereignty and the sovereignty of our Parliament, specifically in relation to human rights. Currently the Committee of Ministers, the Commissioner for Human Rights and other officials pass a lot of diktats and impose burdens upon countries, and we have heard a lot about some of the burdens that they would like to impose upon us. Those diktats are used by the European Court of Human Rights to influence judgments but we do not get the debates—they are agreed but the British public do not get to have a say on them.
One issue on which that has effectively happened this year is prisoner votes. The European institutions are thoroughly unaccountable to the British public, yet they exert an outrageous degree of control over this country. While the Government are seeking further delays in introducing legislation on prisoner votes because another test case is being considered by the Court, there is a chance to send a clear message to Europe that this country will not be bullied any more into changing its laws. This Parliament has spoken on prisoner votes, and our view should remain as it was in the debate in February. By doing so, the Government could set a precedent, demonstrate a clear commitment to defending British interests from power-hungry European institutions and provide the effective check on their undemocratic and unaccountable ways for which this country is crying out.
I make a final plea. Ministers must not miss this opportunity to pursue transparency and accountability and to tell Europe to bring its powers back into the hands of the British people, where they belong.
This is the second day in succession that I have had the pleasure of serving under your chairmanship, Dr McCrea. I congratulate my hon. Friend the Member for Witham (Priti Patel) on securing this debate. I am certainly aware of her long-standing interest in the European Union and European institutions. As she rightly said, it would be good to have more opportunities to discuss such issues, and I would welcome the prospect of many more Members taking part in those debates. It is a pity that, often, only a number of committed aficionados attend European debates. I would like the issues to be debated more generally. As she rightly said, the decisions that British Ministers negotiate at European level have a direct and, in many cases, significant impact on the lives of the people whom we represent.
I listened carefully to the points that my hon. Friend raised and I agree that the European institutions that she mentioned have many shortcomings that, coupled with the previous Government’s reluctance to involve the people in important decisions about the European Union, have led to a growing sense of disconnection between the British electorate and the European institutions. I assure her that this Government are committed to addressing that disconnection and the issues underlying it.
I am grateful to my hon. Friend for raising a subject to which I was planning to come in the next stage of my remarks. The Government are intent on working hard within Europe to deliver the kind of Europe that suits British interests and the British people, in the knowledge that we now have, for the first time, a proper guarantee that, if it is ever proposed to pass new competencies or powers from this country to Brussels, the British people will get a vote in a referendum. That guarantee is provided by the European Union Act 2011, which recently came into force. For the first time, British voters will have their rightful say over any further expansion of EU powers. I believe that that will put our participation in the EU on a sturdier and more democratic footing. If a new treaty amendment or a brand-new treaty were to be introduced that involved the transfer of further competencies or powers from this country to the European Union, that treaty or amendment would be caught by our new Act of Parliament, and a referendum would be required subsequent to primary legislation here so that the British people would have the final say over whether those powers were transferred to Brussels.
That is all very well, and it is welcome as far as the future is concerned, but is not the problem that, under the Lisbon treaty and other measures, far too much power has already been ceded to Brussels? What we need is to get some of it back. Should it not be the Government’s priority to use the current situation in Europe to negotiate the repatriation of powers to the British people? That is the key issue as we move forward.
As the right hon. Gentleman says, the Act is not a panacea, and I have never claimed that it would be. It does not address the repatriation of powers. That was not its purpose. Under the coalition agreement, the Government are committed to examining the existing balance of competencies and what they mean for Britain, and we continue to consider that issue. I appreciate that both he and my hon. Friend the Member for Witham would have liked the coalition agreement to commit us to returning important powers from the EU to the United Kingdom. During the 2010 general election, I stood on and campaigned for exactly the same manifesto as my hon. Friend did. I do not resile from anything to which I committed myself then, but we must abide by the political reality of the outcome of that election, which the British people delivered. The coalition agreement forms the basis for this Government’s policy.
My hon. Friend argued that ongoing negotiations on EU reform could be an opportunity to deliver a new EU agenda. The current problems in the eurozone were predictable—and, indeed, predicted, not least by British Conservatives—but that does not change the fact that, although we seek to expand British trade with the world’s emerging powers, 40% of it is still with the countries of the eurozone, so it is in our national interests that the eurozone countries prosper and find a way through their difficulties.
The economic logic of a monetary union, as British Conservatives have argued frequently, is greater fiscal and economic union, and we see some signs that the eurozone countries are moving in that direction. If they wish to do so, we should not stand in the way of their progress. If, at some stage in the future, moves towards greater fiscal union among the eurozone countries lead to a treaty, there will be an opportunity for the United Kingdom to ask, “What is in our national interest?” That is the approach that we took on the treaty change to establish a European stability mechanism for eurozone members. As the Prime Minister said, Britain would benefit from taking some powers back from Brussels. However, I caution my hon. Friend that although events are fast-moving and predictions risky, there is no sign of an immediate move towards such a treaty change. Treaty change is neither easy nor straightforward, and the eurozone countries know that, whatever the position in the United Kingdom, several countries, including the Netherlands, Denmark and Slovakia, have provision in their constitutional arrangements for referendums in some circumstances, so it would be a complicated matter. For that reason, I do not think that there is pressure at the moment to go down that road.
My hon. Friend raised more general points about the future of the eurozone. Although the Franco-German proposals appear to be a step in the right direction, we must consider the detail carefully. She is absolutely right that we should not let ourselves be sucked into the deeper fiscal integration on which the eurozone appears to be embarking. That is important to the Government.
On financial transaction taxes, clearly, unless such taxes applied to all financial centres globally, we would see a relocation of trading from centres where taxes apply to centres where they do not. Therefore, a financial transaction tax that applied only to European Union countries would be extraordinarily damaging for every financial centre in the EU, including the City of London. The Government are taking an active role in international discussions exploring financial sector taxation. The Chancellor of the Exchequer has made it clear on many occasions that he thinks that the idea of an EU-only financial transaction tax would be profoundly counter-productive and unwelcome.
My hon. Friend mentioned budgetary discipline and financial efficiency in Europe. Both are cornerstones of the Government’s policy towards the European Union. We want all institutions to ensure that their spending and activity produce genuine benefits for our citizens. We are taking firm action on the 2012 EU budget. Of course, the annual budgets of the European Union are ultimately determined by qualified majority voting. We do not have a right of veto. Although the current proposal for an increase of about 2% is greater than the British Government would have wished, it is still roughly equivalent to a real-terms freeze in that budget, and it is significantly less than the Commission’s original proposal of 4.9%. I also note that it is almost €8 billion less than the budget ceiling for 2011, which was agreed by the previous Labour Government in 2005. We will continue to work with other like-minded countries to get the very best deal possible for the taxpayer. I shall embark on a further stage of that work when I go to Brussels next Monday for the General Affairs Council.
Is it possible that we could just say, “No, we are not giving you that money”? We know that that would break a treaty, but surely we are not alone in Europe in that respect. Would not one option for us to think about be for Britain to say no, as Margaret Thatcher did?
However tempting my hon. Friend’s suggestion might be, the problem with unilateral action is that it can so easily be used to justify unilateral action by others that would be profoundly detrimental to our national interest. Aspects of the European Union—most obviously the single market, the creation of Margaret Thatcher’s Conservative Government—have benefited the prosperity of and employment among British citizens. They have helped attract vast foreign direct investment to these shores. Other European countries have, at times, fumed and sworn at the fact that the single market meant that they had to dismantle protectionist barriers. However frustrating some aspects of the way in which the EU is organised may be, and however we might aspire to see changes in those structures, I caution my hon. Friend against unilateral action, because that could set a damaging precedent.
We in this Government believe that tax policy is for member states to determine at national level. The Commission has proposed certain new EU taxes. We think that those would introduce additional burdens and damage European—not just British—competitiveness. The United Kingdom will oppose any such new EU taxes.
If we look beyond the annual 2012 budget to the next, probably seven-year, financial perspective, where unanimity rather than qualified majority voting applies, we will see that the Prime Minister has stated jointly with his EU counterparts that the maximum acceptable expenditure increase is a real freeze in payments and that that should be year on year from the actual level of payments in 2013, not from the level of commitment, which is usually above the level of the money actually paid out.
I also assure my hon. Friends that the Government will certainly defend the United Kingdom rebate, which remains fully justified owing to expenditure distortions in the EU budget. We should not cease to remind the British people of the fact that the increases in our direct contributions, to which my hon. Friend the Member for Beckenham has referred, are the product of the shoddy budgetary deal negotiated by our predecessors, Mr Blair and the right hon. Member for Kirkcaldy and Cowdenbeath (Mr Brown), when they were in office.
I welcome what the Minister has said about EU taxes and his approach to the budget, but what are we going to do about some of the social directives about temporary workers and so on when we desperately need to deregulate our economy to get growth? What are we going to do about that avalanche of new regulation coming from Europe?
The Minister of State, Department for Work and Pensions, my right hon. Friend the Member for Epsom and Ewell (Chris Grayling), is working hard to assemble a coalition of like-minded Ministers and is engaging with the Commission to seek to avoid the sort of damaging additional social regulation to which my hon. Friend rightly refers. We are also keeping a particularly close eye on the position of the working time directive. The Commission may come forward with new proposals in the next 12 months. Our priority will be to protect the opt-out, which is valuable to British competitiveness. If there also prove to be ways in which to mitigate or reverse the impact of the European Court of Justice judgments that defined time on call as working time we would seek to do that as well.
My hon. Friend the Member for Witham called for greater efficiency and the reduction of waste. I support her on that, as I do on her call for increased transparency over all the activity and detailed expenditure of the institutions. The more transparency we have over EU spending and the legislative process, the greater evidence we will find to support our arguments for improved efficiency and the reduction of waste. An important part of transparency is scrutiny, and I am keen to ensure that we do everything possible to make our own parliamentary scrutiny processes still more significant. It is a vital part of the democratic process and the Government are committed to ensuring that scrutiny committees can clear proposals before we agree to them at ministerial level.
My hon. Friend is right that the priority should be growth, competitiveness and jobs. That is where Europe should be focusing its energy and attention now. We are pushing for a further drive on the liberalisation of the single market, on breaking down barriers to trade, and on making European regulation less burdensome and expensive, especially for small and medium-sized enterprises, on which so many jobs throughout Europe, not just the United Kingdom, depend. We are determined to resist any gold-plating of European Union legislation.
My hon. Friend talked about the Council of Europe and prisoner voting. The Commons has given a clear view that prisoners should not have the vote. Indeed, my right hon. Friend the Prime Minister has echoed that call. The Government believe that it is right to consider the final judgment in the Italian case of Scoppola, as well as the wider legal context, before setting out the next steps on prisoner voting. I want those next steps to be as close as possible to the clearly expressed will of the House of Commons.
Forgive me, but I want to reply to my hon. Friend the Member for Witham. On immigration, the Government are committed to applying transitional measures on the migration of workers from new member states. The framework for this has already been agreed with Croatia for controls of up to seven years. Under the terms of Croatia’s accession negotiations, member states can apply the same type and length of restrictions to Croatian workers as those that apply to Romanian and Bulgarian workers, who may obtain permission to work on the basis that they are highly skilled or have the offer of a skilled job. The precise controls that we will apply for Croatia have not yet been determined. My colleagues in the Home Office are considering that at the moment.
The Government believe in championing the British national interest within the EU. We champion the UK position on every issue. Sometimes, getting the reforms that we want to see is a hard and slow business, but we will be relentless in our commitment to get the best possible deal for the prosperity, security and well-being of our own citizens.
Question put and agreed to.