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Westminster Hall

Volume 533: debated on Wednesday 12 October 2011

Westminster Hall

Wednesday 12 October 2011

[Andrew Rosindell in the Chair]

Ovarian Cancer

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

It is a pleasure to serve under your chairmanship, Mr Rosindell. It has been a good many years since I last did so, when I was chairman of the Welsh Young Conservatives and you were chairman of the national Young Conservatives. I am grateful for the opportunity to raise this important subject. I am conscious that many hon. Members wish to contribute, many of whom have personal and constituency experience of the disease. It is important to hear from as many of them as possible, so I shall make my opening comments as brief as I can.

My personal experience of the effects of ovarian cancer occurred some 40 years ago, and it meant that I never knew my grandmother. In her 50s, she suffered from the disease, which sadly took her life in my first year of life. She was buried on my first birthday. Clearly, at that age I was too young to know, but she was, by all accounts, a truly wonderful lady and, due to the cruel nature of the disease, her death was a loss that impacted on my family for many years.

Some 40 years on, I was elected a Member of Parliament in 2010, and like all new MPs, I am sure, I felt somewhat overwhelmed when I came to this place. What staggered me more than anything was the volume of invitations that I received from many different charities. One stood out—that from Target Ovarian Cancer. It stood out because it informed me that a constituent would be attending a reception, and because of the impact that the disease had had on my family.

I worked in the charity sector for 16 years and, as I was involved in politics, I thought I knew how to get to Members of Parliament, but I realised how wrong I was when I saw the volume of correspondence that I received. I thought it clever of Target Ovarian Cancer to make its invitation personal by bringing a constituent down here. In June, I attended that reception and had the opportunity to meet my constituent, Chris Shagouri. She is one of those people with whom one instantly clicks; she is inspirational. I listened to her speak about how late diagnosis of the cancer had impacted on her, her husband and her family. She talked about her ongoing battle to keep the disease at bay, and it is clear that she has great determination, but it was easy to wonder how much easier it might have been had the diagnosis been made earlier.

As the reception continued, I heard, time and again, moving stories from other women about their experiences. That and Chris’s persuasive manner convinced me to support the all-party group on ovarian cancer, which was being set up.

Sadly, diary clashes have restricted the number of meetings that I have been able to attend, but it is impressive that they are regularly attended by women who reinforce over and again the message that early diagnosis is necessary. At the most recent meeting, we heard again from women from throughout the UK about their experiences. At the most recent reception, four women gave personal accounts of their problems, which motivated me to bid for this debate. I am grateful to have been given that opportunity.

Ovarian cancer is not rare. It is the fourth most common cause of cancer death in women after breast, lung and bowel cancers. Every year, some 6,500 women are diagnosed and, staggeringly, 4,400 die every year. Just 36% of women who are diagnosed survive for a further five years. Those figures are staggering, compared with more than 80% for those who suffer breast cancer. It is also staggering that in three quarters of women who are diagnosed, the cancer has already started to spread. Those figures are scary.

The holding of this debate prompted someone to contact me this week. They wrote:

“My mother died aged 67 in 2009 with Ovarian Cancer. By the time she was diagnosed, the cancer wasn’t in the early stages and she was given only a 2% chance of living for 5 years. She fought all the way with various treatments and lived for 7 years after diagnosis.”

I congratulate the hon. Gentleman on raising the issue. As he rightly said, every one of us can relate to a constituent or family member with the disease, and most people are aware that the cancer is hereditary or genetic. Does he believe that whenever someone is diagnosed with ovarian cancer there should be immediate checks on other family members—sisters, nieces, and daughters—to ensure that the hereditary effect is not passed on? Does he believe that that should be done quickly after diagnosis?

I am grateful for that intervention. I agree absolutely that anything we can do to ensure early diagnosis of conditions can only help. In the long term, it is better for the individual concerned, and certainly better for the rest of the family, who go through equal concern.

I congratulate the hon. Gentleman on securing the debate. Not long ago in my constituency, we ran an event to raise money for ovarian cancer treatment. An astounding finding was the number of young women aged 18 to 25 who are affected. I was astonished, because my impression had been that the disease affected older women, but it seems to be on the rise among younger women and is known as the silent killer. Does the hon. Gentleman agree that early intervention is vital? That could be done with blood tests, which some GPs have called for, and perhaps in schools, to identify this tragic killer of women.

The hon. Gentleman makes an important point. I will talk about early diagnosis, which is crucial, as is awareness—making people aware of the symptoms. That is crucial in the campaign to fight this terrible disease.

I return to the letter that I was quoting from, which is relevant to the point that the hon. Gentleman made:

“I really hope the message regarding this disease can increase, as I wouldn’t want anyone else to suffer as my mother did. If she had gone to her GP straight away when she presented with symptoms and the GP acted straight away, then she may still be with her family, who miss her so much.”

That is a powerful testament to the problem that the disease causes.

According to figures from the National Cancer Intelligence Network, only pancreatic cancer involves a higher proportion of people diagnosed with the late stage of the disease. but with ovarian cancer, unlike pancreatic cancer, we know what the symptoms are. That was not always the case. The hon. Gentleman referred to it as the silent killer, which is often how it is referred to, but in most cases the symptoms go unrecognised for some time by the women or their GPs. It is alarming that Target Ovarian Cancer has found that one third of women waited six months or more after visiting their GP for a correct diagnosis. That is staggering.

The National Institute for Health and Clinical Excellence has published guidance on the recognition and initial management of ovarian cancer, and listed symptoms such as persistent bloating or increased abdominal size, abdominal or pelvic pain, difficulty eating and feeling full quickly, and the need to urinate more frequently. If women experience such symptoms frequently, particularly more than 12 times a month, they should undergo tests.

Under NICE guidelines, the first thing that should be done is a CA 125 test. Is the hon. Gentleman concerned that there are apparently restrictions on a GP’s ability to obtain that test for their patients, and importantly that there have been attempts block those tests from being carried through to pathology laboratories? The CA 125 test is the one thing that can spot the disease and increase the possibility of early diagnosis and greater chances of success.

I am grateful for that intervention, which proves the need for the debate. I hope that we can take forward many of the issues raised today to try to tackle the disease. The hon. Gentleman’s point is incredibly valid and important.

NICE’s information is a step forward because it offers women, and importantly GPs, the chance to distinguish between ovarian cancer and more common but less serious conditions such as irritable bowel syndrome, which is the most common misdiagnosis. The ovarian cancer awareness measure, which is an accredited tool used by Target Ovarian Cancer in its pathfinder study, showed that only 4% of women felt confident of spotting the symptoms of the disease, and just 9% were aware that persistent bloating is the most common symptom of ovarian cancer. Compare that with 76% of women who recognise that a lump is the most common symptom of breast cancer.

Does the hon. Gentleman agree that because of the specificity of the symptoms of ovarian cancer, there is a case for a specific campaign to raise awareness of the disease, rather than relying on a generic campaign, which is the approach that the Government have tended to favour so far?

The hon. Gentleman is in danger of stealing my thunder, but I am glad that he has emphasised my point before I have made it.

I congratulate my hon. Friend on bringing this important matter before the House. He is right to highlight awareness, but there is also the need for better information for women and their families following diagnosis. A close relative of mine was diagnosed with the condition, but there was a lack of knowledge of where to find more information about it. That led me and others to look online at a condition that was similar, but had a very different five-year survival rate. That caused a lot of unnecessary anguish to close family members.

My hon. Friend raises a valid point. I worked in the hospice movement for about 15 years, and time and again we heard from parents of children at the hospice or patients in the adult hospice that when they were told of their disease, they almost went blank; they heard not the rest of the information, but just the dreaded diagnosis. It is crucial that people are given as much information as possible to take away and digest later.

As I said, 76% of women recognise the most common symptom of breast cancer, but there is clearly a lack of understanding about the significance of symptoms that they may experience due to ovarian cancer. Furthermore, GPs are not picking up the disease quickly enough. Just 22% of women are urgently referred to the two-week cancer referral route, and the rest are either sent away, or treated or referred inappropriately. Late diagnosis has been identified by the cancer benchmarking study, funded by the Department of Health, as a key driver for the poor ovarian cancer survival rates. That study seeks to understand the differing survival rates between countries for breast, lung, bowel and ovarian cancer. For some reason, despite the findings, ovarian cancer was the only cancer in the study not to be included in subsequent awareness campaigns. A large majority of women who are diagnosed in the later stages of the disease will experience recurrences, and many will develop resistance to chemotherapy.

My constituent, Chris Shagouri, is undergoing treatment yet again to try to slow the progress of the disease. Her strength and commitment to help to improve the lives of women who are diagnosed with ovarian cancer is amazing, especially when she could be forgiven for wanting to concentrate her efforts on herself and her close family. Chris Shagouri is representative of the many women who have attended meetings of the all-party group on ovarian cancer, and who share a determination to change the status quo. They often say that if just one woman gets a quicker diagnosis it will have been worth it, because for that woman this really is a matter of life and death. I hope that we can reach a better total than just one woman.

Treatments for ovarian cancer are highly intensive and invasive. An American study showed that, compared with women who have breast cancer, those with ovarian cancer spend nearly 10 times as long being treated in hospital in the first year after diagnosis and the last year of life. There have been no new life extending treatments for women with ovarian cancer during the past 20 years.

Why do members of the all-party group on ovarian cancer want to have this debate? Because we feel that, right now, an important opportunity to make much needed progress is being overlooked. I welcome the Government’s work, and commend them for it, with the cancer drug fund and the palliative care strategy —it was long overdue. In January, the Government published their new cancer strategy, which contained a strong commitment to improving early diagnosis and a multimillion pound investment in cancer awareness campaigns—fantastic stuff. It initially included regional breast, lung and bowel cancer campaigns, and recently we have heard that a national bowel cancer awareness programme will be rolled out next year, following the success of the pilots. New campaigns on oesophogastric cancers, and kidney or bladder cancer, will be run at a local level. The all-party group remains frustrated that ovarian cancer is not included in that admirable work.

The Government are committed to saving more than 5,000 lives a year from cancer by 2014-15, and women with ovarian cancer could represent 10% of that figure. Each year, up to 500 women lose their lives unnecessarily to ovarian cancer because we do not do as well as other European countries. The Government’s study showed that late diagnosis is a key driver of deaths from ovarian cancer in the UK, and it is curious that the condition was not included in the awareness campaigns in this country.

Why can an awareness campaign on ovarian cancer not be started now, even in pilot form? We applaud the Minister for the commitment to improve people’s chances of surviving cancer, but urge him to include ovarian cancer in the awareness work that is being done. Every day we wait, another one or two women, like my grandmother or such as Chris Shagouri, and many others who have been campaigning will lose their lives unnecessarily. As a matter of urgency, I ask the Minister whether he will consider an awareness campaign and whether he will meet with representatives from the all-party group on ovarian cancer to discuss how we can take such a campaign forward and stop other women suffering in future.

I should start this speech by telling the House that I should be dead, because only two out of every five women with ovarian cancer survive beyond four years and my cancer was diagnosed eight years ago, at the start of 2003. I remember the dates well. Throughout that autumn term, I had been on a very serious diet. As hon. Members know, I need to do that, and I was completely unaware that the loss of appetite that was caused by my cancer was being helpful to my dieting. At the end of that autumn term, I went to see my GP about symptoms that actually were irrelevant to the cancer, but she is a very insightful woman. She took a very careful history from me and did a CA 125 test. This was about December. She referred me and I did the CA 125 test. I remember the dates fairly well because it was just before I went away for a Christmas holiday. The level was elevated. Of course, I had no idea how significant that was. I cannot remember what it was at that point—45 or something like that. I said, “Is that serious?” She said, “Well, yes.” I did not quite work out how serious it was, but she had referred me to a specialist. I came back from my Christmas holiday and had an intravaginal ultrasound in January. I went to see the doctor about the results and was told on, I think, 15 January that I was going to have a hysterectomy in an operation that might be related to cancer on 14 February—not a date one forgets.

Although I was late detecting the symptoms and, indeed, the symptoms that I went to see my GP about were not symptoms caused by my cancer, it was a very short time before I had an intervention. In fact, it was quicker than that. It was this time of day on a Wednesday. The day before, we had lost, by just three votes, a cross-party vote on an 80% elected House of Lords. Those three votes were hon. Gentlemen who had had too good a dinner. I was trying to do press and so on about the House of Lords vote. I was trying to get across the point that a majority of the House of Commons thought that we should have an 80% elected House of Lords, but some hon. Members went in the wrong door because they cannot manage when they do not have Whips telling them where to go. Those calls were interrupted by a telephone call from St Thomas’ hospital, which said, “We have a cancellation. Can you come in today?” I burst into tears. Then I went to the Army & Navy Stores and bought a nightie and a pair of slippers and set off to St Thomas’ hospital.

As can be imagined, I arrived at the hospital not with my head in the place where a cancer patient needs it to be, but still trying to sort everything out, because although I had known that I was to have the operation, it was originally to take place about two weeks after the House of Lords vote that I was working towards. So I arrived all shouty and dictating things, putting out press releases, bellowing into a phone and so on. I was put in my bed and was still shouting down the phone, but then this woman came up to me, took my hand and put it in a bowl. I was on the phone and I said to her, “What are you doing?” She said, “I’m giving you a manicure.” I said, “Why?” She said, “I’m a volunteer. I come into the women’s ward in St Thomas’ hospital on a Wednesday and give women manicures.” I have told the Minister that story because that volunteer helped me through the experience, as I stopped being an MP and started facing being a patient. I strongly urge the Minister to recognise how powerful such roles, which do not look clinically essential, are in the care of people. That is my first message.

My second message is that my story tells us how good the NHS can be—how fast it can respond. In my case, it was eight to 10 weeks between first going to the GP—and not reporting the right symptoms—and having an operation. One cannot ask for better than that. I know that a big reason for it was the targets that we had set, because when I was told when my operation would take place, the consultant said to me, “Oh, I’m bumping up against the date.” I therefore urge the Minister both to look after the role of volunteers and voluntary organisations and to retain those targets that put pressure on the system to help people like me to live.

I congratulate my hon. Friend the Member for Pudsey (Stuart Andrew) on initiating this important debate. Does the hon. Member for Slough (Fiona Mactaggart) agree that although it is wonderful that she had such rapid access to treatment, such access to diagnosis is not uniformly available throughout the country? My experience is that it is difficult for general practitioners to gain rapid access to ultrasound scans, which was a crucial factor in the hon. Lady’s diagnosis. Equally, access to CA 125 measurements, although included in the NICE draft guidelines, which is welcome, is not uniformly available to GPs throughout the country.

The fact that those things are not accessible is condemning women to die. It is very simple, and they are not complicated tests. I have had an awful lot of CA 125 tests because women have a lot before and a lot afterwards to see what is happening to the markers in their blood. It is a very simple test and certainly should be available in primary care so that GPs can do it quickly and reassure themselves and their patients. It was thanks to Ovacome that I began to realise how important knowing one’s CA 125 level is. Until I started reading the educative materials produced by voluntary organisations, I did not know that.

I want to say one thing about all the voluntary help available to people with cancer. It is very confusing. People never really know who does the thing that they need—who provides the help. Today, the question might be, “Should I wear a wig, or are they all horrible and uncomfortable?” The answer is yes, by the way. It might be, “Do I need someone to hold my hand and explain what’s wrong with me?” People do not know these things. I wish that somehow all the wonderful charities could get together and have one doorway through which the patient goes and can say, “This is what my life’s like. I can’t afford to park at the hospital” or “The wig that I got is itching” or “Is my reaction to chemotherapy appropriate? Do other people have it?” Who are the right people to help? People in this situation never know who the right people are, so one thing that I wish the Department of Health would do is find some way of resourcing those organisations to provide a better entry to their services for people with cancer.

However, I want to focus on diagnosis and helping people to detect their symptoms early. I did not detect mine particularly early; indeed, it was my GP who detected them, not me. Many hon. Members have written to the Minister, and at the annual general meeting of the all-party group in July we considered the response that he had sent us. Frankly, to me, it seems that the message is not getting through. The work being done to improve early diagnosis of cancer, particularly awareness, will not make a difference to the women who have ovarian cancer. I am very glad to receive an account of the work being done on breast, lung and bowel cancer, but frankly it is a bit insensitive. Someone who is concerned about ovarian cancer will see all those wonderful information campaigns on other cancers, but none of them applies to the symptoms of ovarian cancer. That will not do, and it particularly will not do when ovarian cancer is such a killer.

In the letter to the all-party group, the Minister said that

“future activity will depend on the success of the Be Clear on Cancer campaigns”.

His Department has since announced that following the success of the regional pilot campaign for bowel cancer, it will be rolled out nationally. Now that we know that those awareness campaigns work, when will we have a commitment to work on ovarian cancer? We have extended the work to include stomach, oesophageal, bladder and kidney cancer. Why not ovarian cancer? It was not until long after I had had a hysterectomy, chemotherapy and so on that I realised which of the symptoms that I had had were clues to my cancer. We really must help people to know that they are at risk. Ovarian cancer is the fourth most common cause of cancer death in women. Is it just because it affects women that we are not seeing action? If men had it too, we might be doing better, although, of course, we have a good history on breast cancer.

I worry that ovarian cancer is being put in the “too difficult” box, and it is not acceptable to do that with the most fatal gynaecological cancer. Ovarian cancer kills four times as many women as cervical cancer, for which we have a national screening programme. Is it not time that we put in place a national screening programme for ovarian cancer and gave GPs and others proper access to diagnostic tests that will save thousands of women’s lives? It is not acceptable that so many women die of this cancer when we know how to stop it, and I urge the Minister quickly to put in train action to deal with this issue.

It is a pleasure to follow such a powerful speech. I pay tribute to my hon. Friend the Member for Pudsey (Stuart Andrew). We have worked together before, and he is getting quite a reputation for calling good debates in this place. I pay tribute to him for bringing this issue before us.

Like my hon. Friend, I come to the House with many experiences, which have shaped my life thus far. Cancer—not just ovarian cancer—has touched my life many times, and I have fought it many times. So far, it has won more times than I have, and such experiences shape the work that I do in the House.

In the next few minutes, I will not rehearse the arguments we have heard or repeat the statistics that my hon. Friend set out, but I will reinforce some of the things that have been said. Clearly, the most effective way of promoting awareness and understanding of the symptoms of ovarian cancer is to raise its public profile, and I hope that this debate will, if nothing else, go some way towards doing that.

I am a member of the all-party group and I pay great tribute to Target Ovarian Cancer and cancer charities generally, which do such an excellent job on this issue. I, too, have been struck by how effective they are as a lobby and by how powerful they are; the fact that so many Members are here today and that so many are interested in this issue is testament to that.

I thought that I would give Members a few reflections on my role as co-chair of the all-party group on breast cancer. I hope that is not insensitive; it is meant to be helpful, because there are really powerful lessons to be learned from the fight against breast cancer, and I hope that they can help women with ovarian cancer.

Thirty years ago, the breast cancer survival rate in this country was barely 50%; today, it is more than 80%. My goodness, that is testament to the effort that has been made. There have been many debates in the House, which have played a tiny role. There has also been funding, and large amounts of research and expertise have been applied to the issue. Awareness, too, has been critical. Similarly, there have been new treatments and a screening programme. All those things have made a difference, and they have all been essential to the significant progress we have achieved.

What has been key, however, has been the number of women who have been prepared to stand up and put their personal experiences on the record to keep breast cancer high on the nation’s agenda. Obviously, there have also been some high-profile deaths. There are so many to list, but what struck me, and it is often quoted, was when Linda McCartney lost her fight against the disease. So many women had grown up with the McCartneys, and her death did so much to place breast cancer on the agenda.

Breast cancer ambassadors continue to play a crucial role in raising awareness by sharing their personal experiences and promoting cancer campaigns in their local areas, as well as nationally, through the national media and through this place. That really brings home issues of which people might otherwise have remained unaware. It was not always the case that women immediately thought a lump might mean breast cancer; that was due to a huge amount of hard work and a huge number of awareness campaigns. The ambassadors really filled the gap effectively, and I hope we can see more of that in the fight against ovarian cancer.

As a member of the all-party group on ovarian cancer, I know that some representatives of the charities might be thinking that the lack of survivors makes fighting this disease more difficult, but that is a reason to try harder, not to give up. The lack of survivors means that people such as the hon. Member for Slough (Fiona Mactaggart) and other Members who take part in debates such as this are more important than ever in raising the issue and in keeping it high on the political agenda, and we will raise it again and again.

The high number of fundraising and public awareness drives promoted by the Department that the Minister represents, as well as politicians’ willingness seriously to grapple with the issue, have meant that the fight against breast cancer has retained its high profile, to the benefit of tens of thousands of women and their friends and families. Governments have produced very effective awareness campaigns over the years to encourage women regularly to check themselves and to ensure they know what they are looking for. The TLC—touch, look, check—campaign by Breakthrough Breast Cancer, which Target Ovarian Cancer works closely with, has been incredibly effective, and TLC day is part of breast cancer awareness month, which is this month. That is another exceptionally powerful way of reminding the public of that issue and of raising awareness of the fight against breast cancer.

Such simple messages, which can be spread through the champions I mentioned, can be used successfully and powerfully in the fight against ovarian cancer. We can send a bold message that women can fight the disease and beat it, and the hon. Member for Slough is wonderful living proof of that.

Many large national studies with large research grants were carried out in years gone by in the fight against breast cancer, and we need greater commitment and funding for research grants from the Government and charitable bodies at national level in fighting ovarian cancer. By demonstrating the commitment that exists in the research community to provide the wherewithal for large studies, huge strides can be made in bringing ovarian cancer to political and public attention. Perhaps the Minister can shed some light on his Department’s proposals on the future funding and commissioning of studies on the disease. Any information that he can share with us would be much appreciated.

Notwithstanding the connection between the familial forms of breast and ovarian cancer, which share the same defective genes to some extent, the age profile of the women affected is broadly similar, although, as the hon. Member for Upper Bann (David Simpson) rightly said, a striking number of younger women are affected by ovarian cancer. In that respect, I received the briefing from the Teenage Cancer Trust, which was very powerful.

It is not inconceivable that the same women who take on board the messaging about breast cancer symptoms will be open to messaging about ovarian cancer. We are always told, so it must be true, that women are much more receptive to health messages than men. That is absolutely right, so we have an important opportunity to make significant and potentially life-saving progress.

Obviously, there are still huge improvements to make in the fight against breast cancer, and that is even truer of the fight against ovarian cancer—particularly in terms of diagnosis and treatment. Like other Members, I urge the Minister to take action on ovarian cancer awareness as soon as possible. Currently, we are barely getting past first base. This is a silent killer, but it is also a silent national scandal. If we achieved what has been achieved in the fight against breast cancer in the past couple of decades through raising awareness, screening and better treatments, 3,000 of the 4,000 deaths a year from ovarian cancer might not occur. That might have saved the grandmother of my hon. Friend the Member for Pudsey, and it might have saved mine.

I ask the Minister please to ensure that the Government take swift action and make a start on dealing with this issue. At the moment, there is little DOH-led activity to improve awareness of symptoms among women and GPs, despite the fact that the Government have rightly committed themselves to saving the lives of 5,000 cancer sufferers a year as part of their excellent cancer strategy. I have worked closely with the Minister on the Health and Social Care Bill, and he knows that I am a huge supporter of that cancer strategy. With investment of £12 million in awareness work towards achieving that pledge, some might describe tackling ovarian cancer as low-hanging fruit.

The Minister said earlier in the year that the main focus for the Government’s national symptoms awareness campaign would be bowel cancer, but he also stated that new campaigns were being piloted on other cancers and their symptoms. I hope that he will update hon. Members on the progress that his Department has made in piloting the campaigns. Including ovarian cancer in the awareness budget will help the Government to meet their targets—I am sure of that—while enabling them to improve survival rates for those with ovarian cancer, which are among the worst in Europe at the moment. If they improve, the lives of many women can be saved.

Target Ovarian Cancer gave me an excellent booklet, “An MP’s guide to ovarian cancer”, shortly after I was elected, and it contains a lovely quotation from a lady whom I met at an ovarian cancer reception last year. Her name is Eilish Colclough—I always get it wrong when I attempt it—and she is a mother of five. We have seen her speak before, and she is fighting terminal ovarian cancer. She says:

“I look at myself as living not dying.”

Whenever she speaks, and whenever such patients, survivors, fighters and livers come to speak to the all-party groups that I am involved in, it is always infinitely more powerful than any Member or Minister. In my experience—and I have had a lot of it, as I have said—people with cancer are not just their cancer; they are everything else as well. I hope that we can find many more people such as Eilish—survivors—to give more proof of that, to help us fight ovarian cancer, and to drive down the number of women we lose to it.

Order. We have 30 minutes left for general debate, so I ask hon. Members to limit their remarks to no more than five minutes.

I, too, congratulate the hon. Member for Pudsey (Stuart Andrew) on securing this important debate, which I hope will be a springboard for increasing awareness and for encouraging the Department to pick up the gauntlet set before it today.

In the next 12 months, between 11 and 15 women in my constituency will die because of ovarian cancer. That is not a high or low figure; it is the average across the United Kingdom. We must wake up to the reality and that figure must be checked. We must embark seriously on a national campaign that will achieve better survival results, as has happened with major cancers such as breast and lung cancer.

I want to put four important and sobering statistics before the House. Most of the women who are diagnosed—75%—have late-stage disease, when survival rates are very poor. That is a very high figure. Also, 30% of women are diagnosed following admission to their local accident and emergency ward, not by their GP. Women with ovarian cancer are five times more likely to die within a month of diagnosis than women with breast cancer, and the UK’s late diagnosis is thought to be the key driver for those survival rates. Only 4% of women are confident that they can spot the symptoms of ovarian cancer.

I have two questions for the Minister. First, why, as the hon. Member for Winchester (Mr Brine) said, is there not yet any Department of Health-led activity to improve awareness of symptoms? That is the key to addressing the issue. Secondly, I take the view that what is not measured is not done, so why is there no national measurement for ovarian cancer?

Does my hon. Friend agree that greater awareness and early detection were the key to the significant progress made with other cancers? Many charities became involved with departmental officials to ensure that those things became the driver, which led to reductions in numbers. That is the key for ovarian cancer as well.

I thank my hon. Friend for making that point incredibly well. We have all come to realise that there is a lack of awareness because of lobby groups, patients in our constituencies and the families who come to see us saying, “Why did we not know? If we had known, we would have done something else and gone to the GP earlier.”

As I have said, a gauntlet has been thrown down to the Department. Let us have better national measurement of outcomes established and followed up—year in, year out—so that the disease, which has been described as a silent killer, can be properly tackled and we can achieve the same successes as we have with breast, lung and bowel cancer survival rates.

I congratulate my hon. Friend the Member for Pudsey (Stuart Andrew) on securing the debate. I want to focus on a small area of it, but first I pay tribute to the hon. Member for Slough (Fiona Mactaggart), who gave us a very personal story and identified a key problem—the complexity of the symptoms, the fact that they are sometimes confusing and the general lack of awareness of what they are.

I thank Target Ovarian Cancer for its approach to me, which was quite personal. It was one of those approaches, which I sometimes receive, that make me think, “Ouch!” It would have been great if I had been approached by the Teenage Cancer Trust to be asked to emphasise the number of very young women who suffer, but, unfortunately, as I am approaching a large birthday, Target decided that I was in the key target group of women who really should know more. That is a key point. When I added in some other risk factors, such as lifestyle and weight, I began to scratch my head and think that perhaps I should take it all very seriously and think more closely about the symptoms that present when someone is suffering from ovarian cancer.

Despite the fact that women tend to be more aware of symptoms and keener than men to go to the GP—I apologise, as there are many male MPs present in the Chamber—they also have a serious tendency to grin and bear it, and get on with things. Sadly, symptoms such as bloating are not uncommon. I see the hon. Member for Slough nodding in agreement.

We are missing an opportunity, because by the time women get to a significant birthday they are already well used to some forms of screening for cancer. Great, next year I get mammograms as well—fantastic. That is an opportunity to talk to women about the symptoms of ovarian cancer. I do not want to appear controversial or to denigrate the idea that we need a general awareness campaign, which is important, but as any good advertising company will explain, a targeted message to the audience likely to be most affected is the best way to get something across.

I suggest to the Minister that we need to look at ways to approach the women most likely to be affected. That is not in any way intended to undermine the work of the Teenage Cancer Trust. The incidence in younger women is important and alarming, but age, genetics and hereditary disposition are the largest contributory factors in ovarian cancer, and we need to give close attention to the idea that when women are called for routine cervical smear tests or mammograms they are in exactly the right caring, knowledgeable environment for explaining the symptoms. I hope that the message will get out a little more effectively to those women who are at risk and who could contribute significantly to the Government target on reducing deaths from cancer.

I, too, congratulate the hon. Member for Pudsey (Stuart Andrew) on securing today’s debate. It is good to follow hon. Members who have made powerful and reflective comments.

Like other hon. Members, I have a personal interest in the issue. My mam died from ovarian cancer when she was aged just 42, in our hometown of Tredegar in Blaenau Gwent—too, too young. My two sisters were just teenagers. I want women in my constituency and across the UK to have the best possible treatment if they have ovarian cancer today, or the earliest possible diagnosis if they get it in future.

A comprehensive report on cancer in Wales is published every three years. The latest was published just last month, and there are good stats on Wales that are important. The report covers nearly 15 years from 1995 to 2009, and, as the hon. Member for Pudsey said, it notes that ovarian cancer is the fourth most common cancer in females. We have to shout that out loudly across the UK from here today and hope that it is picked up in other places—it is a powerful statistic.

As in the rest of the UK, there has been a slight decrease in incidence over time, but of the countries studied, most of which are European, Wales is top of the incidence table. Wales has an incidence rate of 18.8 per 100,000 of population, which is significantly above the UK average. I know that Wales has a larger older population than other parts of the UK, which leads to higher levels of cancer, but the particular worry about ovarian cancer is that women seek medical help only at a relatively late stage, so the survival rate is poorer than for other gynaecological cancers. The “Cancer in Wales” report notes:

“There is no clear link with incidence and degree of deprivation”

but there

“seems to be a slight trend towards increased survival in patients with lower levels of deprivation.”

The mean age of diagnosis in Wales is 65.1.

What has particularly struck me—this has come out in today’s discussion—is that women who often take responsibility for the health care of their families, particularly children, and visit the family GP do not themselves recognise the symptoms of the cancer. In Wales, 29% of the public said that they were not at all confident, and a further 29% were not very confident, in identifying the symptoms. Together, that makes a high 58%. As others have said, only 2% were confident in recognising the symptoms. Public Health Wales is running important public education campaigns on skin, bowel and mouth cancer, but not, to my knowledge, on ovarian cancer. It is important, again as others have said, that we have a wide public health campaign on the issue.

I have long experience of working in the voluntary sector, most recently for the National Society for the Prevention of Cruelty to Children, and, before that, the Royal College of Speech and Language Therapists. I know that the sector is fertile ground for innovation. For example, I understand that some charities in the sector have developed training programmes for women and GPs, including an online symptoms tracker called Ovacome. That will be a good initiative. Such programmes are excellent and clearly show commitment to provide early diagnosis. However, like others, I ask the Minister to give assurances that the Government will look into providing a nationwide campaign to help women to identify symptoms of the cancer and build on the important work that is taking place with other charities.

I note that there are two screening trials under way—one for women in the general population, the other for women with a strong family history in this regard, such as my two sisters. I hope that the evidence from those trials will support a national screening programme. As we know, if ovarian cancer can be caught in its earliest stages, survival rates can be above 70%, which is a strong stat. We could save the lives of hundreds of women in the UK and save their families from the pain of a premature and preventable death.

Where they live also impacts on the support received by women with ovarian cancer. The Minister will be aware of the significant impact of the clinical nurse specialists and what they can do to support women with ovarian cancer, yet the 2009 Target Ovarian Cancer pathfinder study showed that many clinical nurse specialist posts were under threat, with a lack of cover for sickness and leave, and with a heavy work load. Many women cited the clinical nurse specialist as the single most helpful point of contact throughout their cancer journey, yet in large parts of the country the nurses are sole operators, as it has been phrased. Certainly in Wales, we have experienced difficulty in providing such posts. Elsewhere, I hear of posts being frozen and sometimes not filled.

Finally, while ovarian cancer is noted with respect to the lack of available and new drugs, a couple can be accessed via the cancer drugs fund, but again, where someone lives determines whether they get access. I hope that the Minister will give us the assurance that, no matter where a woman lives, she will receive early diagnosis and access to the high-quality treatment she needs. I hope that I have emphasised the importance of increased care and support for the large number of women with that terrible condition, which is often fatal, but, if caught early, survivable.

I pay tribute to my hon. Friend the Member for Pudsey (Stuart Andrew) for securing the debate and to all other colleagues who have contributed. In my patch, in the southern end of Cumbria, we have run awareness campaigns locally with our general practitioners on the symptoms of ovarian cancer. Most people here have had a tale to tell about how ovarian cancer has touched them, and my motivation is very personal: my mother was diagnosed with ovarian cancer in October 2002 and passed away in July 2004. She was one of the 75% of women who are diagnosed at stage 3 or 4. It is depressing that things have not progressed even since then. I go back to the cancer strategy and the Government’s announcement in January, with clear awareness and honesty that we are behind in survival rates for all sorts of cancers and that lack of awareness and lack of early diagnosis is the common theme in the failure to reach targets and save lives.

With regard to lack of awareness and lack of early diagnosis, ovarian cancer comes top of a pretty grisly league. It is brilliant that breast, lung and bowel cancer were included in the awareness programme, but I was dismayed, as I am sure many others were, to see that ovarian cancer was not. My hon. Friend the Member for Winchester (Mr Brine) used the phrase, “low-hanging fruit”. If we look at the cold stats on how we can save lives in big numbers pretty quickly, ovarian cancer is potentially the low-hanging fruit.

I will repeat quickly some of the stats already used: 500 women die unnecessarily every year from the disease; a third of cases take longer than six months to be diagnosed; and 29% are diagnosed at A and E, which shows a complete failure of the pathway. It is the fourth biggest killer of women in terms of cancer. Although I am hugely grateful for the stuff from Target Ovarian Cancer and other ovarian cancer organisations, I repeat those stats because my mum found them on the web nearly 10 years ago—and they have not got any flaming better! It is utterly depressing that the statistics have not improved in that time.

As the hon. Member for Blaenau Gwent (Nick Smith) rightly pointed out, survival rates are very bad, given what they could be. If women are diagnosed early, ovarian cancer is relatively easy to cure, with a 70% survival rate. Things are so bad that, by investing now, a huge difference will be made, and we will see lives saved in big numbers in no time.

As is the case for all people in such circumstances, my mum’s ovarian cancer was an appalling family tragedy, which, in many ways, brought us together. She had 20 or 21 months of extremely high-quality life following her diagnosis, and I pay huge tribute to the Macmillan nurses and to Rosemere trust at Preston hospital, who made her life bearable—indeed, made all our lives bearable, and sometimes even a joy. My mum was aware that there was a genetic potential, and her concern was for my sister, my sister’s kids and my kids. I would put a plea in, with the other pleas that I will make in a moment on behalf of all of us, for effort to be put into looking at diagnosis and at the potential for genetically tracking the disease early, before it even arises.

Our collective plea—I do not see any dissent here—is for the Department of Health to act quickly to make the issue a priority and for the Minister to meet Target Ovarian Cancer, the other ovarian cancer charities and members of the all-party group to discuss a practical strategy and to invest now in a targeted awareness campaign, without waiting for the results of the diagnostic test and the trial, which I think will arrive in 2015. Two thousand more women will die unnecessarily if we sit around and wait for that. We need action now, and I would like the Minister to undertake to do just that.

I congratulate the hon. Member for Pudsey (Stuart Andrew) on securing this important debate. I am sure that other hon. Members will not mind if I also single out my hon. Friend the Member for Slough (Fiona Mactaggart), who gave such a personal and passionate speech about how ovarian cancer has affected her. Like so many others here, my family has been affected by the disease. My first cousin, Mary, died in her 30s from ovarian cancer, leaving behind a young son. I am sure that all of us here are aware of the impact of this terrible disease.

The recently published report “Cancer in Wales: 1995-2009”, which my hon. Friend the Member for Blaenau Gwent (Nick Smith) mentioned, highlights the fact that, on average, 394 women a year have been diagnosed with ovarian cancer in Wales over that period. The average number of mortalities due to ovarian cancer between those years was 237, which translates into 60.3% of those diagnosed with the disease ending up dying from it. Such startling statistics demonstrate what all hon. Members have been saying about the lack of awareness of the symptoms of this disease.

If ovarian cancer mortality rates in this country were the same as those in other EU countries, we could save 500 lives a year. That statistic on its own should make us all sit up and take notice and realise that, over many years, not enough has been done to highlight this terrible disease.

We have debated the kind of awareness campaign that needs to be run. A generic campaign is clearly not adequate in this case. There needs to be a specific campaign around ovarian cancer. As other hon. Members have said, only 3% of women recognise that increased abdominal size is potentially a serious symptom of ovarian cancer. That compares with three-quarters of women who know that a lump in their breast is potentially a serious symptom of cancer. If educating the public about the symptoms of this disease is important, of equal importance is the need for GPs to consider ovarian cancer as a possibility when patients display the symptoms.

It has been mentioned already that nearly a third of women who are diagnosed are diagnosed following an admission into accident and emergency, which also tells us that there is a serious problem.

My constituent Hazel Burrows contacted me via her granddaughter earlier this year. In her e-mail, Georgette Burrows said:

“Everywhere you look, whether it’s when you're watching your favourite soap opera or doing your weekly shop, there are campaigns for breast cancer, and rightly so. Although I do believe more needs to be done in order to make women aware of ovarian cancer.”

She is right and today’s debate has demonstrated that very clearly.

I will work with my hon. Friend the Member for Blaenau Gwent in relation to Wales and with Mark Drakeford in the Welsh Assembly on this matter. Let me say to the Minister that all of us come into politics because, whatever our views, we believe in the possibility of changing things for the better. If today’s debate has highlighted anything it is that that is possible and that we can save people’s lives. Being able to achieve that rests partly with the Minister who is in his seat today.

As all former Ministers know—I include my hon. Friend the Member for Slough—we go on in a job for some time, getting our submissions from officials, turning up at Adjournment debates, reading out the speech that has been provided and then carrying on as before. The Minister cannot do that after today’s debate. He must go back and say to his officials, “I want fresh on my desk, as soon as possible, a new strategy for raising awareness around ovarian cancer because what we have now is not good enough.” He has that opportunity to make a difference. It is a great privilege to be a Minister—I told myself that every day I walked into my ministerial office. The Minister has a chance to save people’s lives and I hope that he takes that opportunity.

I congratulate the hon. Member for Pudsey (Stuart Andrew) on securing today’s debate.

Before the general election, I met a gentleman called Eddie O’Hara, who lives in East Kilbride, which is part of my constituency—at least it is until midday today. Eddie’s wife, Linda, was diagnosed with ovarian cancer on Good Friday 2000. Like so many women, the diagnosis came far too late. I did not have the good fortune to meet her, but by all accounts she was a truly gifted and inspirational woman. It was in her memory that Eddie O’Hara set up the charity, Ovarian Lets Shout For Linda, to raise awareness of the symptoms and to support all those affected by that terrible disease. I cannot help but feel that those groups that have been set up to highlight the disease are filling a gap that should really be filled by our national health service.

Like the hon. Member for Pudsey, when I was elected to Parliament last year, I had to go through a Kilimanjaro-esque mountain of mail. Underneath the big pile, I found an invitation to a Target Ovarian Cancer event. I signed up and learned much more about the killer disease. People gave all sorts of statistics and views, but the big one that got me was that 75% of women are diagnosed too late. Surely that is the saddest indictment of our health service. Much more needs to be done and, as hon. Members have outlined, there are different ways in which things can be done.

Let me give a practical example of why we should do more. I met Eilish Colclough—hopefully I have pronounced her name correctly—at the Target Ovarian Cancer event last year. I do not know whether she will thank me for saying this but she is a 42-year-old mother of five. In case she is listening to this debate, I hasten to add that she looks much younger. She was diagnosed with ovarian cancer when she was 39. She had all the symptoms but her GP dismissed her fears of cancer.

After the TOC event, Eilish and her friends joined me and some other colleagues on the Terrace because she did not want to be in the company of the doctors. She preferred to speak to people who were chatting about things other than the disease. She explained in stark terms that she did not know how long she would live. She is still here, and the world is a better place with Eilish among us. She is a tireless campaigner. She brought to mind that wonderful quote of Ralph Waldo Emerson, who said:

“For every minute you remain angry, you give up sixty seconds of peace of mind.”

As all the statistics have already been mentioned, let me ask the Minister what he is going to do to heighten awareness and improve treatment so that women across the United Kingdom do not have to suffer the anguish that Linda did or the anguish that Eilish endures today.

Let me start by congratulating the hon. Member for Pudsey (Stuart Andrew) on securing this important and well-attended debate. Every Member who spoke made an effective and moving speech. However, the speech that stands out for me is that of my hon. Friend the Member for Slough (Fiona Mactaggart). We have already heard that ovarian cancer is a very serious condition and that it is the fifth most common cancer among UK women. Members have also set out the relatively low survival rates for ovarian cancer—they are around 40% compared with 79% for breast cancer. That is largely due to the fact that three out of four women are diagnosed late, once the cancer has spread. It is worth repeating that survival rates could be as high as 90% if the cancer were diagnosed at an early stage. In Hackney, in east London, the five-year ovarian cancer survival rate is only 35%, which is significantly below average.

Despite the evidence relating to lack of awareness, the rates of late diagnosis and the delays in diagnosis admissions by A & E, there is still no Department of Health-led activity to improve awareness of symptoms among women and GPs. That is despite the Government’s commitment to save 5,000 lives a year from cancer by 2014. I welcome the new National Institute for Health and Clinical Excellence guidance on symptoms and the increased access to diagnostics that was announced in the cancer strategy, which mean that there will be new opportunities to improve early diagnosis. But unless women know when to visit their GP, unless the symptoms of ovarian cancer become as well known among ordinary women as the symptoms of breast cancer are and unless GPs know how to consider ovarian cancer, rates of late diagnosis and delays will not improve.

We have already heard, but it is worth repeating, that there is no national outcome measure for ovarian cancer; there are only such measures for breast, lung and bowel cancer. That is already impacting on the ability of PCTs and cancer networks to undertake awareness work about ovarian cancer, as funding for awareness work is being channelled to breast, lung and bowel cancer. That will potentially lead to a worsening of the situation, because it means in practice that there will be a decline in activity.

The quality standard for ovarian cancer will be one of the first of the new suite of quality standards to be introduced by NICE to inform local commissioners, but as yet it is not clear how the standard can be used effectively. Can the Minister tell us whether the Department of Health is considering introducing a national outcome measure for ovarian cancer? Can he also say how the Department will ensure that the quality standard is used effectively?

The Minister will be aware that the first findings of the international cancer benchmarking study—a study led by the Department of Health—showed that in the UK late diagnosis is thought to be a key driver of survival rates, which are poor compared to those in other countries in the study. However, ovarian cancer is the only cancer type in the study not to have had remedial action taken to improve awareness.

The Minister will forgive me when I say that under the last Government we saw substantial investment in cancer services and consequently outcomes improved; for instance, the survival rate for breast cancer rose from 50% to more than 80%. In the case of ovarian cancer, although the figures are not necessarily much better than they were when the hon. Member for Westmorland and Lonsdale (Tim Farron) faced the issues in relation to his mother, the survival rate has in fact doubled in the past 30 years. The commitment shown by the last Labour Government meant that in excess of 1,000 more women per year in England and Wales are now surviving ovarian cancer. However, the UK survival rate for ovarian cancer is still among the lowest in Europe, at 36%. If we achieve the average European survival rate, we will save 500 lives per year.

All of us, including the Minister, know that two major trials are currently taking place: the first is for women in the general population; and the second is for women with a strong family history of ovarian cancer. The former trial will report in 2015 and the latter trial in 2012. However, it is not at all certain that the findings of those trials will result in a national screening programme. Perhaps the Minister can tell the House what the Government’s position is on that issue.

Cancer Research UK tells me that it is concerned that the Health and Social Care Bill, which is currently being debated in another place, risks fragmenting responsibility for the early diagnosis of cancer between Public Health England, local authorities and the NHS. Cancer Research UK’s proposal for guarding against fragmentation is that local authorities and clinical commissioning groups should be jointly incentivised to prioritise early diagnosis, including shared indicators in the public health and NHS outcomes frameworks. That process should be supported by shared budgets, to ensure joint responsibility for delivering improvements in awareness and early diagnosis of cancer. In other words, Cancer Research UK is concerned that policies and responsibilities around early diagnosis will fall through the cracks. How will the Minister respond to that proposal by Cancer Research UK?

The Minister will be aware that, earlier this year, at the 12th international forum of the Helene Harris Memorial Trust, which was originated and facilitated by Ovarian Cancer Action, 50 of the world’s leading researchers and clinicians in ovarian cancer came together to discuss the future for ovarian cancer research. Out of those discussions came nine key actions: improving recognition that “ovarian cancer” is a general term; better targeting of clinical trials; identifying patients at increased genetic risk; developing new approaches to identify targets for treatment; ensuring that both the tumour and the tumour micro-environment are treated; better understanding of relapses of treatment-resistant ovarian cancer; setting up international collaboration to enable tissue samples to be shared and analysed in research; developing better experimental models; and ensuring that clinical trials include measures of quality of life and symptom benefit. Ovarian Cancer Action believes that those nine actions would not only help to improve the quality of life and ovarian cancer survival rates for women in the UK, but help to position the UK as an international leader in the fight against this deadly disease. Is the Minister aware of those recommendations and what is his response to them?

My hon. Friend the Member for Cardiff West (Kevin Brennan) made the point that, in the sometimes humdrum routine of the life of a junior Minister, there is occasionally a genuine opportunity to make a difference. Having listened to the informed, personal and passionate contributions of colleagues and other hon. Members this morning, I hope that the Minister will go away from this debate determined to move ahead—on the very strong basis of what the last Labour Government did and what his Government have done up to now—and actually make a difference in relation to ovarian cancer.

Thank you very much, Mr Rosindell, for calling me to speak.

I assure the hon. Member for Hackney North and Stoke Newington (Ms Abbott) that I have not found my last 12 months “humdrum” at all and I agree entirely with the comment by the hon. Member for Cardiff West (Kevin Brennan) that being a Minister is a privilege, and a privilege that one should use fully to serve the common good and the purposes that our constituents send us here for.

I want to try to do justice to the debate, and if I do not cover any issues that have been raised, that will purely be because of time and I will write to hon. Members about those issues. However, I will try to cover as much ground as I can.

I congratulate the hon. Member for Pudsey (Stuart Andrew) on securing the debate and congratulate all those who have taken part. I particularly congratulate the all-party group on ovarian cancer, which has done an excellent job in mobilising colleagues to be here in Westminster Hall today and to be persistent and persuasive in their arguments on the issue.

As others have rightly said, the speech by the hon. Member for Slough (Fiona Mactaggart) was typically powerful and typically persuasive. I think that I have served in the House as long as the hon. Lady, and during the time that she fought her cancer I certainly admired the way that she did so, while continuing to provide the service that she gives to her constituents and the House. She made a very powerful set of points today.

I think that everyone who has spoken in the debate has been touched by ovarian cancer. I had not planned to refer to my own experience, but, given that others have talked about their experiences, I will say that my aunt died of ovarian cancer some years ago. Having fought the disease for some time, she sadly died at the Royal Marsden hospital, despite receiving excellent treatment there. Ovarian cancer touches many of us.

I thank Target Ovarian Cancer, Ovarian Cancer Action, Ovacome and the Eve Appeal, which have all done an excellent job in raising MPs’ awareness of ovarian cancer, in the ways that the hon. Member for Pudsey and others have described today. That work has done a lot, not only to initiate debates in this place, but to assist us as MPs to play our part in our communities to help to raise awareness of those issues.

I could rehearse the statistics again, but will not do so because they have already been well rehearsed and powerfully illustrated with personal stories. I certainly recognise the urgency that we need to attach to our fight against cancers and I particularly note the points that have been made today about ovarian cancer. That is why we urgently came forward with the strategy that we published in January and why we have been fast in trialling and rolling out awareness campaigns. I will say more about those awareness campaigns shortly.

As has been pointed out, late diagnosis is one of the main reasons for the relatively poor cancer survival rates in England. I must crave the forgiveness of those colleagues who have spoken today from the perspective of Northern Ireland, Scotland and Wales. They all made important points and they need to continue, as I know they will, to raise them with their colleagues in the devolved Administrations who have responsibility for health.

Research by the National Cancer Intelligence Network showed that nearly a quarter of all cancers are diagnosed through an emergency route, as my hon. Friend the Member for Westmorland and Lonsdale (Tim Farron) said. That is at a stage when the cancer is very advanced. The research also showed that one in five patients did not visit their GP before being diagnosed with cancer. Diagnosis of ovarian cancer often comes late because the symptoms in the early stages—they have been powerfully set out—are often ignored or thought to be something else.

The hon. Member for Slough talked about volunteers, and about the volunteer who did the manicure on that day when her head was in another place. I have visited hospitals where Macmillan Cancer Support and other voluntary organisations play a part. Such volunteers bring back the key human dimension, which the hon. Lady was absolutely right to underline. We will ensure that the role of volunteers in the NHS is valued by including that point in the Department of Health’s message to the NHS in its soon-to-be-published updated volunteer strategy.

Reference has been made to the £450 million for early diagnosis work that the Government have put in as part of the spending review. The funds will support campaigns to raise public awareness of the symptoms of cancers, encouraging people to present with persistent symptoms. They will also support GPs in more effectively assessing people with possible cancer symptoms and improve access to diagnostic tests. In 2010-11, we ran local cancer awareness campaigns and a regional pilot campaign for bowel cancer, and in 2011-12 we are running a national campaign on bowel cancer, a regional campaign on lung cancer and 18 local campaigns to raise awareness of breast cancer among women over 70 and of the symptoms of some less common cancers.

A question that has been rightly put is, why, so far, have we not addressed ourselves to ovarian cancer? Understandably, Members want answers, not least because of the evidence that if we were performing at, I believe, just the average of our European neighbours—certainly if we were matching the best of them—500 additional lives would be saved every year. We are considering whether there is scope for piloting ovarian cancer awareness campaigns, drawing on the experience of our more generic campaigns on blood in urine, which can be a marker for bladder and kidney cancers, and on the evaluations of awareness campaigns on specific disease sites. That will inform us how we can most effectively roll out further campaigns. I give that undertaking, and I am more than happy to meet with members of the all-party group.

The hon. Member for Romsey and Southampton North (Caroline Nokes) spoke very persuasively about the scope for using existing screening programmes to deliver awareness-raising messages about other cancers, and ovarian cancer in particular, and we will consider how we might implement such a practical solution. Nevertheless, I hope that hon. Members appreciate that awareness raising is just one of a range of actions and that we need to look at the other aspects of the strategy that we set out earlier this year. We are working on other fronts to try to drive up earlier diagnosis and treatment.

A key focus of the cancer outcome strategy is primary care, which is why we are investing in providing GPs with practical tools for assessing patients who might have cancer. In addition, some of the cancer networks are reviewing referral pathways to help to shorten the time taken for patients to access diagnostic tests. I welcome the contribution of the cancer charities that have been working with primary care professionals to promote early diagnosis of cancer, and I specifically pay tribute to Target Ovarian Cancer, which, in partnership with BMJ Learning, has produced an online GP learning tool that covers the signs and symptoms of ovarian cancer, and diagnostic tests based on the latest evidence.

I want to try to do justice to the debate and ensure that I get to answer a couple more of the questions posed, but I will give way in a moment if I can.

If a GP suspects cancer, it is vital that they can refer people urgently for further tests, using the two-week referral pathway. For women who do not meet the criteria for that pathway for suspected cancer but have symptoms that require investigation, we are providing additional funds over the next four years to support the diagnosis of ovarian cancer by giving GPs direct access to four key diagnostic tests, including non-obstetric ultrasound. Questions have been asked about what data are collected. We plan routinely to collect data on GP usage of the four tests and to publish them alongside data on GP usage of the two-week referral pathway, so that we can benchmark performance and expose areas that are not performing as well as others.

Several hon. Members asked about the CA 125 test and suggested that there are restrictions. I can assure Members that if there were restrictions we would challenge them. Just last month, Bruce Keogh, NHS medical director, wrote to strategic health authorities to raise questions about general access to diagnostics, and David Flory, deputy NHS chief executive, reiterated in the September edition of The Quarter that there must be no “arbitrary restrictions on access”. That would apply to the CA 125 test, not least because it is clearly covered in NICE guidance.

Hon. Members referred to the two ongoing trials, which are evidence of the research taking place. The UK collaborative trial of ovarian cancer screening offers real prospects for a screening tool, but on screening the Government of the day take the advice of the UK National Screening Committee, which considers the evidence from trials of the sort going on at the moment. A randomised control trial of 200,000 post-menopausal women aged between 50 and 74 is studying the use of annual CA 125 blood tests as a way to identify—along with annual trans-vaginal ultrasound—which women are most at risk of ovarian cancer. The results of the study will be available in 2015, and the Government will then respond to the recommendations that the UK National Screening Committee makes on the basis of the evidence. I hope that there will be a positive recommendation that enables us to roll out such a screening programme.

Familial ovarian cancer screening was referred to early in the debate, and a study has shown that up to 10% of ovarian cancers can be attributed to an inherited genetic predisposition. It was mentioned that the results of that research would be available in 2012, but we understand that the study will close in 2013. We would want to act on the evidence from that study.

Research, therefore, is taking place in those two fields. High-quality applications are the key to getting research funding; we do not fund solely on the basis of something being a priority. The hon. Member for Hackney North and Stoke Newington asked about Ovarian Cancer Action’s nine recommendations, and I will respond to her in writing, with copies to colleagues.

National measurement was mentioned. The NHS operating framework for England for 2011-12 requires that cancer registries record the stage of cancer, which is a key proxy for predicting outcomes, and publish one-year, as well as five-year, survival rates. We are benchmarking, providing a useful way to see who is performing well and who is not, and, as the hon. Lady mentioned, we are in the international benchmarking partnership with other nations. Would she like to make her intervention in the remaining time?

In conclusion, I hope that I have responded positively to the debate. We must make progress on a broad front in this area to improve early diagnosis and get the treatment that people need, so that we can cut the death toll in this country from all cancers. Ovarian cancer is, and will continue to be, a priority for this Government.

Innovation (NHS)

It is a pleasure to serve under your chairmanship, Mr Rosindell. I requested this debate in order to raise important issues about the ongoing review of how the national health service extracts the full potential from innovative, commercially realisable ideas generated by NHS employees and to seek clarification from the Minister about the scope of the Carruthers review of innovation in the NHS announced this July.

I was led to the subject by my involvement with Odstock Medical Ltd in my constituency, a company that has grown from Salisbury NHS Foundation Trust. OML has pioneered a technique called functional electrical stimulation that produces contractions in paralysed muscles by applying small pulses of electrical stimulation. Having experienced it myself, I can attest that it assists walking. OML has developed a range of neuromuscular stimulators to improve the functional ability of people with neurological conditions such as multiple sclerosis. The devices have been developed during many years of collaboration among clinical engineers, clinicians and patients at the National Clinical FES Centre at Salisbury NHS Foundation Trust.

Last year, it came to my attention that, because OML is partly owned by the local NHS foundation trust, under EU rules, it cannot be classified as a small or medium-sized enterprise, and therefore cannot access grants and support through normal Department for Business, Innovation and Skills channels. That seems ludicrous. I met the Minister of State, Department for Business, Innovation and Skills, my hon. Friend the Member for Hertford and Stortford (Mr Prisk), who has responsibility for small business, along with Professor Ian Swain from OML. Little progress could be made, although attempts were made to access specific funds and schemes. It is a systemic failing.

Anxious to overcome that barrier and explore other aspects of innovation in the NHS, more recently, I met with Alun Williams, the CEO of NHS Innovations South West, who has an office in my constituency and is here today. Alun is wholly committed to the NHS and is passionate, as am I, about finding ways to develop streams of revenue for the NHS. I thank him for his support and advice as we have discussed the subject in recent months.

My key concern is this: as populations age, as the cost of drugs and treatments rises faster than inflation and as medical science, thankfully, finds ever more treatments for human ailments and medical conditions, the NHS must be more radical in exploiting the bright ideas of its staff to ensure that the commercial potential of those ideas are realised fully by the NHS.

I congratulate the hon. Gentleman on securing this enormously important debate. I was brought to the subject by NHS Innovations South East. Does he agree that NHS staff can come up with innovations—examples cited to me include improvements in child protection investigations and adolescent mental health programmes—that do not readily or easily translate or crystallise into commercial benefit? Is it therefore not short-sighted for the Government to insist, as I understand they do, that innovation bodies must be totally self-supporting commercially?

I certainly contend that there are significant pockets of innovation. The challenge is bringing those ideas to their full commercial potential and getting them into the NHS so that they are cheaper for the user. The adoption and uptake of NHS-grown ideas is not wide or deep enough, few hospitals showcase their ideas and the wider benefits are not really felt across the NHS. Some ideas, when fully exploited, might realise significant streams of revenue, easing the cost pressures that I mentioned.

The review led by Sir Ian Carruthers, announced at the beginning of July by the Department of Health, will seek in its report next month to inform the strategic approach to innovation in the modernised NHS. However, it must not simply set up another framework or broad aspirations; it must deal convincingly with the gritty realities of what is needed to take a proven idea that has been honed, challenged and assessed by the innovation hubs to its full commercially realised potential.

The report must also recognise that, unless a way is found to invest in such ideas, their commercial potential will be exploited by private sector entrepreneurs who can move more rapidly and access finance more quickly. Intellectual property will thus be patented not by individual NHS trusts, as is desirable, but by the private sector, which will then charge the NHS for products and services at rates that the NHS would rather not pay. I urge the Minister to push the boundaries and ensure that we do not risk allowing the ideas of excellent NHS employees to be lost, thus losing the value and savings that could accrue.

I congratulate my hon. Friend on securing this important debate. Does he agree that, although it is important for the NHS to realise the commercial value of innovation, it is also fundamental to the improvement of patient care that innovations take hold more rapidly? Did he see this morning’s comments by Professor Williams, president of the Royal College of Surgeons, who warned of a 20-year wait before innovations start saving lives if we base innovation progress on previous experience? He cited reduced deaths from bowel cancer as a result of keyhole surgery, which took years to become widespread practice.

I thank my hon. Friend for that extremely helpful intervention. I met Professor Williams last week, and he made that point to me. That is the nub of the matter. If the NHS does not move quickly on such ideas, someone else will, and it will cost more. My hon. Friend is absolutely right. The impact on outcomes is negative. We must move matters forward so that the advantages can accrue to the NHS.

It is important to realise that, in the big picture of NHS politics, there is an almost pathological fear of doing anything that could imply the use of the word “cut” or the even more toxic P-word, privatisation. I am not arguing for either, but I am saying that, unless we adopt savvy practices to incubate and develop proven concepts more speedily, I fail to see how the NHS can deal with the increasingly more intense systemic supply and demand pressures that it will face. Efficiency savings and ring-fenced budgets, although welcome, will not be enough to save the NHS and provide the money that it needs to continue in its present form. We need more realism about that and a radical solution that has the potential to create more money.

I recognise that it should not be the NHS’s primary objective to develop income streams from medical devices, new treatments or services. Equally, given that great ideas are an unintended by-product of taxpayer investment in providing a world-class national health service, it would surely be wrong not to look hard at making innovation work to the NHS’s advantage. So many ideas derive from employees whom the state pays quite handsomely.

Furthermore, after initial investment, funding innovation could be self-financing, using royalties from previous successful investment. It just needs to unlock that potential. Alongside producing efficiency savings, this significant reform need not require significant capital outlay at the outset.

It feels as though successive Governments have been so concerned to avoid the tag of allowing the waste of capital on ideas that do not immediately point to a return, or being portrayed as blurring the boundaries of the NHS, that they have not fully established the means and mechanisms of making ideas realise their potential. Lip service is paid to the desire to innovate, but practical measures that make it possible on anything like the scale that is possible are not in place. It is more a question of whether the NHS can afford not to exploit the potential savings and revenue streams presented by these ideas.

I am aware that the current position is not completely bleak. The Minister will be able to cite a pipeline of ideas and he will know that the UK has established capabilities in this field. The medical device sector alone makes a significant contribution to the UK economy, with an industry turnover of £13 billion and 55,000 employees. That industry, however, is generally a supplier to the NHS. We need to move to a situation in which the NHS itself generates devices that can save—with a small s—the NHS from bearing the full commercial costs of products that the private sector has developed in its place. Why is it not possible for the Government to establish an innovation strategy with a real focus on extracting value from the pipeline?

I am not suggesting that there should be centrally driven, random speculative investment of taxpayers’ money in half-baked ideas suggested by any clinician. The regional innovation hubs are already primed to sift ideas. For example, NHS Innovations South West has criteria that each product has to meet before it can receive further assistance. First and foremost, it must bring significant benefit to patients in terms of better outcomes and quality of life. It must also be patentable. The return on investment must meet a minimum threshold and it must be commercially viable—that is, there must be an assessment of a global need for the technology, making it a worthwhile investment for commercial partners.

Once that has been established, the issue is how to develop the ideas to their full potential. Several ideas exist in the south-west. A cancer diagnostic endoscope and meniscus knee repair device are both, subject to completing clinical trials, able to meet the criteria to which I have referred. Given that oesophageal cancer is one of the fastest growing cancers globally and early diagnosis can have a significant impact on savings in the NHS, it is highly desirable that that progresses quickly. The meniscus device should significantly improve patients’ quality of life and postpone the need for an expensive total knee replacement by up to five years, thereby again saving the NHS huge sums of money.

My concern is that it is purely by chance that the private sector has not taken this work further. The current NHS process for capitalising on these innovations is not quick enough. There is limited access to NHS funding, and progress is inhibited by insufficient incentives and enabling mechanisms to encourage trusts to invest in such promising cost-saving technologies. Hospitals exploit these ideas elsewhere in the world and significant royalty streams accrue. They would make a recurring contribution to the much required efficiency savings that the chairman and chief executive of my hospital trust are desperately trying to find at present.

In conclusion, I believe that the NHS is a powerhouse of innovation, but that that is not being harnessed sufficiently to accrue the tens of millions that would be available to individual NHS trusts if a bolder approach were taken by Government. I urge the Minister to consider carefully the potential of the ideas in the NHS and to do all he can to ensure that the scope of the Carruthers review is broad enough to deliver recommendations that will allow the huge value that exists to be realised.

It is a pleasure to serve under your chairmanship, Mr Rosindell. I congratulate my hon. Friend the Member for Salisbury (John Glen) on securing this debate on what is widely recognised as an important issue for the NHS because of the crucial role that innovation plays in the present and will play in the future. Given his ideas, views and thoughts, he might seek to arrange a meeting, if he has not already done so, with my noble Friend the Earl Howe, who is the Health Minister with responsibility for innovation.

I shall respond by first setting out the Government’s approach to innovation, before looking at the specific issues that have been raised by my hon. Friend. As we all know, and as he has reiterated, we face a significant challenge. Without real change, the cost of health care will grow faster than the rest of the economy. Moreover, the quality of care in vital areas such as cancer will lag behind other countries, and the gap between the best and the worst NHS care will continue to grow. More of the same simply will not do. We cannot afford it and patients do not deserve it. We need, in other words, to innovate, as my hon. Friend has said.

Fortunately, there is a vast reservoir of innovation to tap within the NHS. It has a long history of innovation, invention and research by great people and great institutions. Ian Donald, for instance, pioneered the use of ultrasound in the 1950s. Sir Peter Mansfield’s work led to the MRI scanner in the 1970s. The Sanger Institute developed the first working draft of the human genome in 2000. We continue to lead the way in cutting-edge research, as the recently announced first European trial of embryonic stem cell research at Moorfields eye hospital demonstrates.

The creative spark that kick starts the long and difficult journey from initial idea to widely adopted treatment is a precious and delicate thing. We need to do all we can to encourage that creativity within the NHS—to grow and propagate the ideas that clinicians and others have for the benefit of their patients. While we continue to achieve great things, we must always strive for more.

Innovation does not happen when power is centralised and people are told what to do, so the single biggest thing that we are doing to encourage innovation is to devolve power to clinical professionals, trusting their professional judgment and their desire to do their best for their patients.

Our modernisation of the NHS will encourage innovation in three main ways. First, it will place the patient at the centre of decision-making about their own care—informed, empowered and able to choose the best possible appropriate care—so that providers will have to innovate to stand out. Secondly, it will have a resolute focus on improving health outcomes—publishing the data and rewarding excellence—so that hospitals and others will have a powerful incentive to innovate and improve. Thirdly, it will place power in the hands of local clinicians, thereby getting rid of the huge and wasteful bureaucracy that can strangle and frustrate innovation, and let the knowledge and expertise of clinicians drive innovation locally.

That will lead to a more personalised NHS, with services tailored to patients’ needs; a more integrated NHS, with solutions that tackle inequalities, improve access and deliver care closer to home; and a better quality NHS, with every provider encouraged, rewarded and incentivised to constantly improve outcomes for patients.

There is also a wider economic imperative for innovation. The health care sector, including pharmaceuticals, medical technology, research, equipment and services, directly or indirectly employs hundreds of thousands of highly skilled people in companies, from small and medium-sized enterprises to global giants, generating billions of pounds in revenues, all helping to drive future economic growth. Innovation in health care applies to everyone—scientists, nurses, doctors and managers. In fact, it applies to all those working to deliver better health, better care and better value. We must ensure that innovation is not simply the preserve of elite minds at the top of august institutions, because it is not just about the latest drugs or high-tech pieces of equipment. The spirit of innovation should be part and parcel of every part and every level of the NHS.

One of my favourite examples of innovation in action is a jug—a health care assistant in Milton Keynes decided that patients whose fluid intake needed close attention should each have a bright red water jug. That particular innovation gave ward staff a clear visual reminder of those patients’ specific needs, helped them to better care for patients, avoided the need for drips, reduced the risk of infection, cut patients’ stays in hospital and consequently cut the cost of their care. That is all because of a bright red jug and one very bright idea from a health care assistant.

We have also made a strong and ongoing commitment to innovation through research. The Government’s plan for growth cements our commitment to health care and the life sciences as a force for growth in the economy. The Government’s National Institute for Health Research aims to support outstanding individuals, working in world-class facilities and conducting leading-edge research focused on the needs of patients and the public. We have recently announced a record £800 million in additional NIHR funding for experimental medicine and translational health research. We will also streamline regulation and improve the cost-effectiveness of clinical trials, speeding up the process of translating research into better lives for patients, their families and their carers.

However, no matter how extraordinary the innovation or how miraculous the invention, it is worthless if it is not used, as my hon. Friend the Member for Salisbury said. Any innovation that is not widely adopted is a tragic waste. Like many large organisations, the NHS’s uptake and spread of innovation has often been slow. We need to raise our game, as my hon. Friend alluded to. We need to do more to recognise the contribution that innovators and innovative organisations make and to encourage adoption and diffusion across the NHS on a scale never seen before.

In that context, can the Minister say what future he sees for the work presently being undertaken by the regional NHS hubs, especially in the area to which I alluded earlier where there might not be an immediate commercial return?

I am grateful to the right hon. Gentleman for that intervention. I will certainly come to that matter during my comments and before we finish the debate.

A substantial amount of work is already under way, including the £60 million that has been invested in regional innovation funds, which support front-line staff to develop and spread new ideas and validate the notion that it is good to challenge the way things have always been done. The funds are massively over-subscribed and have to date given money to more than 300 projects. Further work includes the innovative technology adoption procurement programme, which aims to encourage the NHS-wide adoption of high-impact innovative medical technologies, and the innovation challenge prizes, which reward the ideas that tackle some of our big health and social care challenges, improving productivity and the quality of health care. The first innovation challenge prizes—ranging from £35,000 to £100,000—were awarded in March. Winning entries helped to reduce waste and increase the benefits of medicines, helped people with kidney failure to lead a more independent lifestyle and helped in the early diagnosis of cancer. An expert panel is going through this year’s round of applications and I very much look forward to seeing the results later in the autumn.

There is also much of value in the innovation hubs, to which the right hon. Gentleman referred. Identifying, developing and commercialising new ideas within the NHS is a must, and we need to adopt a systematic approach to that. We also need to ensure that all parts of the innovation pipeline—invention, adoption and diffusion—are more efficient and effective. The NHS chief executive’s innovation review will consider that and how we can achieve better value for money.

As announced in “The Plan for Growth,” NHS Global is being developed to help NHS organisations to compete in the global market. NHS Global seeks to build and grow the NHS brand and reputation overseas, enabling the NHS to compete in the international health care market and to exploit the commercial value of its technologies, products and knowledge. In doing so, NHS Global acts as another mechanism to support great ideas generated in the NHS being widely accepted across the world.

In the case of the company mentioned by my hon. Friend the Member for Salisbury—Odstock Medical Ltd—if it has not done so already, I suggest that it contacts the NIHR’s invention for innovation scheme. i4i supports product development and the guided progression of innovative medical product prototypes, and I strongly advise the company to get in touch with it if it has not done so.

The Health and Social Care Bill, now passing through the House of Lords, will place a legal duty on the NHS commissioning board and on clinical commissioning groups to promote innovation and research. Soon the NHS chief executive, Sir David Nicholson, will set out achievable, high-impact recommendations that will inform the strategic approach to innovation that is so important within a modernised NHS. We will open up NHS procurement to small and medium-sized enterprises, simplify the process and challenge them to come up with solutions to problems within the NHS. We have committed £10 million to the small business research initiative.

Innovation can never be mandated and it should never be restricted to a particular group. Innovation in health and social care will come from a wide variety of partners—for example, NHS staff and patients, private companies, the voluntary sector and academia. They all have a crucial role to play in pushing forward the boundaries in developing and dreaming up innovative products and services to meet the ever-increasing demands of a modernised NHS.

Innovation is not easy. It takes more than just a good idea to innovate; it takes courage to speak out against how things have always been. Innovators have to hold and develop an idea often in the face of opposition and keep pushing forward until it begins to bear fruit. I fully appreciate that the process of innovation can be a very frustrating time. We must encourage people, so that they do not become frustrated and give up. They should be able to pursue dreams and ideas that will bring a greater improvement to the general provision of health care and the NHS.

Let us imagine a world without antibiotics, without insulin, without cancer screening. Then let us imagine a world with a cure for cancer or where we can reverse dementia and end heart disease. Without innovation none of that would be, or could be, possible. Innovation is essential for the future of our NHS and for the future of the UK economy. I assure hon. Members that the Government will do everything in their power to continue to promote innovation, so that it can flourish and develop along the lines that we would wish.

Sitting suspended.

Public Transport (Disabled Access)

[John Robertson in the Chair]

Earlier this year, I was visited by a group of my constituents in Wigan who were from Hunter Lodge, a facility for people with disabilities in the borough. They told me about the endless difficulties they faced in trying to do some of the simplest things that most of us take for granted—shopping, visiting friends or getting to work. They tried to go by train to a nearby town, but had been forced to travel by relay because there was only one wheelchair space available on the train. When the train arrived, the space was already taken. They were told that instead of travelling in the carriage with other people, they would have to go in the guard’s van alongside the bags, parcels, bikes and other goods.

I am angry that, in 2011, that is still considered by some people an acceptable way to treat fellow human beings. Astonishingly, when I looked into this matter, I found that they were the fortunate ones. Half of all train stations do not have level access, so it turns out that they were actually lucky to even be able to get on to the train platform in the first place. Despite some real improvements—not just under the previous Government, but under the Government before that—we are not moving fast enough. The Association of Train Operating Companies said earlier this year that progress on making train station platforms accessible to people with physical immobility is far too slow, and that Network Rail and the Department for Transport need to get a grip of this situation.

I am also concerned about the closure of ticket offices, an issue that many people have raised with me. Without a ticket office, it is nigh on impossible for many people—particularly those who have sight problems, are in wheelchairs, or have learning difficulties—to even buy a ticket to get on the train. In many instances, ticket office staff are the only people available to assist people physically to get on to the train. The McNulty review recommended closing 675 ticket offices around the country. I am aware of the economic realities, but I would like to see a commitment today from the Minister to assure us that he will not sanction proposals that would leave ticket offices entirely unmanned. That is not just because ticket office staff are often the only people available to help people on to the train. Many people contacted me in advance of this debate to say that so much of the staffing issue is about feeling safe on public transport—having the security of being able to get to where they are going without being stranded, which had happened to them in too many cases.

When I secured this debate, I was contacted by young people from across the country, who described to me, in a compelling way, how they had been unable to even get on and off trains because there were no ramps available, the ramps that were available were too short or too long, or nobody was there to help them use those ramps. More than anything else, I was struck by the indignity and humiliation that ran like a thread through all those stories. They need electronic ramps on every train so that they do not have to suffer both the indignity and the anxiety of hoping desperately that somebody will be available to help them, having to make a fuss as they stand on a train simply to get off it, and, in some cases, being stranded on a train because there is no one available to help them.

Although some train companies have made adjustments that already meet the demands of the law, the situation is still not good enough. For example, Virgin Trains has three spaces for wheelchairs on its “Pendolino” service. Although that is welcome, it makes it extremely difficult for people to travel together. Is it seriously too much to ask to adapt trains so that young people, such as those in the Chamber today who are listening so intently to the debate, can go out with their friends? Is that seriously, in 2011, too much to ask? Early next year, the franchise for the west coast main line will be put out to tender. Will the Minister give me a commitment today that one of the criteria for interested companies will be the progress they make on this issue?

I am also deeply concerned that the rhetoric flying around at the moment, about people on incapacity benefit, is making an already dreadful situation much worse. In an independent survey for the charity Scope, 15% said they had suffered high-level abuse on public transport. It is a damning indictment of the current situation that the campaigning organisation Trailblazers struggled to find young people who would even take part in a recent report on the issue, because they found the prospect of engaging with public transport too distressing to contemplate. People with concessionary railcards tell me that they have been questioned to a humiliating degree on public transport about the nature of their disability, particularly when that disability is not physically obvious. Will the Minister agree to take this up with the rail companies to ensure that the practice stops urgently?

The difficulty is not just restricted to trains, although that was one of the key issues raised with me by my constituents. I have also been sent stories about people trying to travel on airlines who have been asked to pay extra charges to carry medical supplies—even oxygen canisters—which were classed as excess baggage.

On air travel, my hon. Friend might want to comment on the practice of some airlines. Even when an air bridge is available at an airport to take passengers off without the need for stepped access, airlines use the access stairways to reach aircraft for what I suspect are financial reasons. In such situations, a person in a wheelchair often has to wait until a winch or lifting vehicle is brought out from the terminal. Apart from the delay that that involves, it is very embarrassing to be picked out in such a way when the facilities are available in the airport to avoid that. That should also be addressed as part of the joined-up approach that is needed.

I could not agree with my hon. Friend more. The example he gives highlights exactly the indignity and humiliation that far too many people must face when they try to do something that the rest of us take for granted. I am grateful to him for raising that point.

On the buses, people seem to fare little better. Half of all disabled people say that buses are a concern for them. Even something as simple as boarding the bus presents a problem. Many buses still do not have ramps and, even when they do, a common story emerges from all the reports that I have been sent from across the country of drivers refusing to stop because it would take too long to allow somebody to board, or because the space allocated for a wheelchair is taken up by a pushchair. I want to be absolutely clear on this point: I am not advocating that there should not be space for pushchairs; it is simply unacceptable that there is not room for everybody.

I congratulate the hon. Lady on securing the debate. This is an issue that concerns the whole of the United Kingdom, although this debate obviously relates to the UK mainland. In my previous job as a Member of the Northern Ireland Assembly, I sat on a Committee that was responsible for bringing forward legislative change that enabled public transport, both bus and rail, to ensure access for disabled people in wheelchairs in particular, but for visually disabled people, too. That is starting to roll off the Assembly line, to use a pun, in Northern Ireland. Does the hon. Lady feel that the Government might take that as an example of how legislation could be introduced and delivered, in conjunction with local councils and other responsible bodies, to ensure disabled access for those who are wheelchair bound or visually disabled, not just to public transport—bus and rail—but to taxis as well?

I am grateful to the hon. Gentleman, because he gives me the opportunity to pay tribute to some of the public transport companies that have worked hard to make real strides forward on this issue. All those examples show that it can be done if there is a will for it to be done. It is up to all of us here in the Chamber to ensure that we push as hard as we can to make this happen.

Seat belts on buses are not routinely provided for wheelchair users. I have been sent some absolutely appalling stories of the indignity that people suffer when the bus drives off too fast and their wheelchair is not properly secured. Blind people have told me of their particular difficulties in identifying which bus is arriving, and knowing when to get off. Those issues could be rectified by introducing talking buses, by introducing seat belts, by introducing more space for buggies and wheelchairs, and training for drivers.

My hon. Friend has made an incredibly compelling case. May I commend to her the campaign of Guide Dogs Cymru, “Walk a Mile in My Shoes”, which I had the pleasure of taking part in last week with councillors and Assembly Members? She was talking about a joined-up approach, and that event brought home to me the difficulties experienced by people with sight loss and other disabilities negotiating city centres and getting to the bus or train station in the first place, let alone dealing with announcements and so on.

I am grateful to my hon. Friend for making that point. Guide Dogs for the Blind was one of the most helpful organisations when I was preparing for today’s debate. I am sure that the Minister will want to consult it further about some of the difficulties my hon. Friend mentioned.

Almost half of all bus operator revenue comes from public funding. I want to see the Government putting serious pressure on companies in receipt of that public subsidy to ensure that the changes that I am outlining today happen. We not only can use our procurement power to make this happen, but we must and should do so, and make it happen quickly. What is so strikingly clear is that laws and training are essential, but alone they are not enough to solve the problem.

Several years ago I had the privilege to work for the former Member for Walthamstow, Neil Gerrard, an inspirational MP who, among many other things, while I worked for him brought into law the Private Hire Vehicle (Carriage of Guide Dogs etc.) Act 2002. It closed a loophole in the law under which black cabs had to carry guide dogs but private hire vehicles did not. It was symbolically important and particularly important to blind people, who obviously rely more on private hire vehicles than any other form of transport, but Guide Dogs for the Blind tells me that, since then, the situation has not got much better because the Act has not been enforced. That underlines how enforcement is essential if we are to make progress.

I congratulate the hon. Lady on securing the debate and on an excellent speech so far. On the subject of guide dogs, will she join me in congratulating my colleague in the London Assembly, Caroline Pidgeon, who has recently run a successful campaign to force Transport for London and the Government to lift the ban on guide dogs for disabled people on the escalators of the tube, docklands light railway and overground railway? That is another part of the whole picture.

I am grateful to the hon. Gentleman for mentioning that, making it clear that the issue is cross-party. The Disability Discrimination Act 1995, which started so much, was passed with cross-party consensus, and it is on that basis that we ought to go forward. All of us ought to play our part in making things happen.

Given that enforcement is so badly needed, I would like to hear a commitment from the Minister that mystery shopping exercises should be part of the franchising agreement on the railways and that he will find a mechanism to impose that condition on companies in receipt of public subsidy. Although feedback and surveys are an important part of any organisation, what is clear from the evidence sent to me by a whole range of organisations is that feedback alone is not enough. Often people’s experiences on public transport are so distressing that they do not want to relive those experiences by having to send in a survey response or make a complaint, so I want the commitment to mystery shopping exercises to be part of our agreements with such companies.

Sixteen years ago, the landmark Disability Discrimination Act was passed in this House with cross-party support, making a promise to people up and down the country that we have simply not fulfilled. We have failed many of those observing in the Chamber, and others up and down the country. A full 13 years after the regulations that breathed life into the Act came into force, it is nothing short of appalling that the situation is not better than it is. There are 12 million people with disabilities in the UK and, as we all live longer, that number is increasing. There is not only a moral imperative to take urgent action, but a social and economic one. Yet, in advance of the debate, I was contacted by Scope, Whizz-Kidz, Transport for All, the National Children’s Bureau, the Every Disabled Child Matters campaign, the National Union of Rail, Maritime and Transport Workers, the Association of Train Operating Companies, Passenger Focus, the Muscular Dystrophy Campaign and many others all expressing exactly the same concerns: not only did they say that the situation is not getting better fast enough, but many are concerned that the situation is getting worse and not better.

With cancelled station upgrades, cuts to discretionary travel and ticket office closures, we need a renewed focus on the area, and urgently. That is one reason why I am so deeply concerned that the Disabled Persons Transport Advisory Committee has been abolished. Will the Minister at least commit to setting up a working group, with transport companies and people with disabilities represented, to drive forward the necessary improvements to public transport by the 2020 deadline? Many of the organisations that I mentioned, which are far more expert in the area than I am, have expressed real concerns to me that we will not meet even those most basic standards that we promised to meet 16 years ago. The Government have made it a real priority to get disabled people into work. Setting up a working group would at least send a strong signal that they are committed to that. If they are going to ask people to go to work, they ought to be committed to enabling them to have the means to achieve that.

One of the most shocking things that I have found since my constituents came to see me in Wigan several months ago is that many of us—myself included—live our lives blissfully unaware that such an appalling situation is a daily reality for people up and down the country. I am pleased that so many Members are present today, and that we are using our position in this House to shine a spotlight on that situation. I am concerned, however, about what happens after today. Too often in this place we have a debate, express concerns and make our views known, but nothing happens next. Will the Minister commit to ensuring that any company in receipt of public subsidy will be required to report annually to Parliament on the progress that it makes in the area? The requirement need not be onerous—perhaps an annual letter to the Select Committee on Transport, for example. However brief, it would help to ensure that those of us who have the luxury of ignoring the problem are not allowed to do so.

Finally, I want to tell the Chamber about one of my constituents, Michael. He is 15-years-old; because of illness he is in a wheelchair and has been all his life. He was born alongside the Disability Discrimination Act which gave hope to people in his situation throughout the country. Essentially, if we will not take action to meet by 2020 the commitments made 16 years ago, we are saying to Michael, “You have lived all your lifetime with these problems. By the time that you are 24 years old, you will still struggle to work and to see friends. We will not give you the freedom that you both need and deserve.” We in the House are simply not doing enough to help Michael to live his life.

If we are to resolve the situation, it will require not just action but a shift in our collective mindset. It is not people with disabilities who need to adapt their lives—they have already done their bit. It is the rest of us who need to change our attitudes towards them. In the end, the question is about the sort of society that we want to live in. Do we want to live in the sort of country in which we say to my 15-year-old constituent, Michael, that we have no place for him? That is not the sort of country that I want to see. We should be ashamed, and I hope that all of us, in every part of the House, will make the issue a long overdue priority.

It is a pleasure to serve under your chairmanship, Mr Robertson. I congratulate the hon. Member for Wigan (Lisa Nandy) on a compelling and powerful speech, even if I did not quite agree with everything that she said—but such is life.

I do not wish to pre-empt my ten-minute rule Bill next Tuesday, which I recommend to everyone, but I have a few preliminary comments. All in the Chamber know how much the concessionary fares are valued by our constituents, even if we tend to argue about them at election time. One particular imbalance, however, needs to be addressed. Able-bodied pensioners who can use the buses get the concessionary fare, but disabled pensioners who cannot use the buses and have to rely on dial-a-ride services, demand-responsive services or other community transport must pay their own way. That seems to me to be a glaring imbalance, which no doubt runs contrary to the spirit of the legislation when introduced by the Labour party—none the less, an imbalance.

I understand that certain councils choose to provide free transport for the disabled, but not every council does. With the increasing budgetary pressures, I fear that fewer and fewer will. The imbalance seems not only unfair but contrary to the spirit of equality and of human dignity. However, I realise that a spending commitment would be involved, which is no doubt frowned upon. To many of the pensioners who contact me and say, “I don’t need the card; I am wealthy enough to pay myself,” I make the point that people can always pay their own way—no one is forcing them to have a card. Equally, however, my constituents in Blackpool do not deserve to be treated differently from my constituents in Wyre. Everyone should have the same right to free transport and free travel, and any hon. Member who wants to support my Bill, may add their name after the debate.

One of the great honours of being an MP is the opportunity to chair the all-party group on young disabled people. Its secretariat is wonderfully provided by the Muscular Dystrophy Campaign. I am not a great fan of the all-party group system as a whole because too many strike me as unnecessary vanity projects, or an excuse to visit obscure countries that I have never heard of. However, when I was approached, I said that I would be the chairman on one condition—that the group is meaningful. I wanted outcomes, processes and reports. I did not want to sit around just talking about the problems; I wanted to hear what we could do about them. That is certainly what I got.

Report No. 1 of the “Inclusion Now” series is called “End of the Line”. Leaving aside the fact that that was also the title of the Conservative party’s report on coastal towns when in opposition and that that is now in the Government’s bottom drawer, I welcome it because it explains what happens to many disabled people. They may want to get off at a station, but when they arrive no one is there to help them, and they may go to the end of the line, which is often many stations away, because no one will help them to get off.

The report was followed by a public hearing of the all-party group to which we invited numerous transport providers. At the start of the meeting, I said that I did not want negativity, and to hear just the bad. As the hon. Member for Wigan said, we have made strides, and if we tell train, bus and taxi companies only what they are doing wrong, they will not be encouraged to fix what is wrong.

Some dreadful cases came to light. Buses pulled away sharply with wheelchairs going everywhere, and passengers with imbalance issues were sent flying. The assisted passenger registration service limits people’s spontaneity because they must give 24 hours’ notice. If I had to give 24 hours’ notice of where I wanted to go, I am not sure that I could live my life as it is.

The hon. Lady referred to accessibility issues at stations. I know that many of the buildings are old—they have been around for a long time—but with better creativity and a bit of thought, I am sure that solutions could be found. Perhaps the most controversial issue was staff awareness and individual members of staff who did not meet the standards expected by their own company. That is a difficult issue. Many people think that such members of staff just need more training. I take a slightly more libertarian view, because we cannot control what occurs in people’s minds. I would love to make them all think as they should think, but that cannot happen. However, every disabled person who suffers should have the confidence to enter the complaints process knowing that they will be listened to, and knowing that they will not be dismissed.

We cannot have passengers being left on trains, and we cannot have staff members ignoring them at stations. We cannot have that attitude, but we must recognise that there is a problem because of the age of many of our trains, buses and so on. I often travel by train into Manchester from Preston on what is essentially a bus on wheels. I suspect that it is older than me. It is unrealistic to expect it to have all the knobs and flashing buttons that a modern train might have to enable passengers to draw attention to the fact that a disabled passenger may be trying to get off. Such technology might ease the problems for staff also.

I pay tribute to National Express, which does an excellent job in providing for disabled people. There are issues about the Government’s funding of coach services that might threaten some of the subsidies, but I had better not go there. However, I have asked National Express why it does not introduce a 50% reduction card. If it has so many disabled passengers, I am sure it will keep them if it introduces a card under its own steam.

The hon. Lady was critical of the abolition of the Disabled Persons Transport Advisory Committee, but I do not share that criticism. We are having a quango cull, with many worthy bodies disappearing, but Equality 2025, which is based at the Home Office, will absorb its responsibilities, and a wider equality framework may be more effective at achieving the goals that she wants.

I do not want negativity, so I shall mention a success from the Trailblazer campaign. Carrie-Ann Fleming, who lives in Kendal, often had to wait an hour at a bus stop for the right disabled-access bus to come along. She thought that that was not good enough, so she launched a campaign and fought really hard. For once, a local council listened to someone complaining about something. That rarely happens, but it did in this case, and the council will alter the timetables to ensure that she can get on a bus without having to wait an hour.

I will close with a plea for human dignity. Some 47% of disabled people experience some form of abuse on public transport, according to Alice Maynard of Scope. She is no relation; I do not know which of us is more relieved about that. Even I have experienced abuse. I take a bus to the station every morning on my way here. At 7 am, I am often a bit groggy and a bit woolly-headed, and I do not always keep my balance when the driver puts his foot down and roars off from the bus stop. I may go flying, and on one occasion I crashed into a business lady who was not very happy about that. I apologised, and explained that my balance is by no means perfect, and that I struggle on buses. She said that I should not be on a bus if I cannot stand up straight. I just said, “I beg your pardon?” I could not believe it, because I have as much right as she does to be on the bus. It is not called able-body transport; it is called public transport. That means that we should all be able to use it, not just the able-bodied.

It is a pleasure to serve under your chairmanship, Mr Robertson, and I congratulate my hon. Friend the Member for Wigan (Lisa Nandy) on the way she introduced this important subject. I also congratulate the hon. Member for Blackpool North and Cleveleys (Paul Maynard). I have spoken about the issue in several debates, and I am grateful for the opportunity to make a few further points.

The starting point must be that measures to make it easier for disabled people to use mainstream public transport are simply part of a wider objective of ensuring equality for disabled people in society overall. Public transport should be accessible and affordable, so that disabled people can travel when and where they like. That is a basic principle of equality and human rights, and it underlines all that we should be doing in this area. I know that many hon. Members want to speak, so I shall make only a few comments.

As my hon. Friend the Member for Wigan said, the percentage of the population with a disability is substantial, and the figures for Scotland are even higher than those for the United Kingdom. It is estimated that about 20% of the population of Scotland have a disability. At some stage, almost all of us in the Chamber will have a disability, which shows the scale of the issue. People with mobility issues make around one third fewer trips than those without such difficulties. Disabled people are disproportionately dependent on public transport, and 60% have no car in the household, compared with 27% in the general population. In March 2009, only 53% of licensed taxis in Britain were wheelchair accessible, and in 2009-10, 39% of buses in Great Britain did not meet the accessibility requirements in disability discrimination legislation.

I am pleased to say that in my constituency the situation is considerably better. Every taxi, but not private hire cars, in Edinburgh must be wheelchair accessible. Two bus companies serve Edinburgh, and 100% of the buses operated by Lothian Buses, which is Britain’s largest publicly owned bus company, are accessible, as are 85% to 90% of the buses operated by First Group, to be fair. That illustrates the fact that we can make a difference and that changes can be made. It is a matter of political will, as well as legislation and regulations.

I am grateful to my hon. Friend the Member for Wigan (Lisa Nandy) for securing the debate. Before coming to the House, I spent 30 years working in the area of special needs and disabilities, and my hon. Friend the Member for Edinburgh North and Leith (Mark Lazarowicz) is right to say that planning sits at the centre of those issues. If we put the needs of disabled people at the centre of our planning, whether for a leisure centre, a system, a school, a college or a train, we will get it right for those disabled people, but also for everybody else—that comes from 30 years’ experience.

Absolutely. I intended to make that point later, but I shall deal with it now. It is essential that regulations are tightened and that funding is provided. The wonderful phrase “joined-up government” needs to apply in this area because there are many examples of simple things that could be done to improve access for disabled people. There are also examples of where the consequences of a minor local policy or local works were not thought through and had a detrimental effect on access for disabled people. I believe it would be good to retain the Disabled Persons Transport Advisory Committee, because whatever support is provided in-house by the Department for Transport, it will not have the same voice as an independent body that speaks for its users. I shall not go into that in detail, but we shall see what the Government have to say on the matter.

A lack of joined-up thinking can make a difference. For example, I have seen trains that have good accessibility, such as spaces for disabled people and a ramp that is operated either manually or automatically, so that when the train arrives at a station, people can leave it easily. However, there may be temporary works at the station—perhaps a barrier or building work has been set up, or a load of bricks has appeared at the end of the ramp—and people cannot get off. That point is not only about accessibility for people in wheelchairs; accessibility can be difficult for all sorts of people because, to put it bluntly, not enough thinking has been done on how to join up different aspects of a service.

I will refer again to Edinburgh, where 100% of Lothian Buses are now accessible to disabled people. A few years ago, a number of buses were introduced with an increased number of spaces for wheelchairs. However, there were a number of complaints, particularly from pensioner groups, because the buses would drive off quickly and people would lose their balance and fall over. The issue was solved simply by installing more rails and grips for people to hold on to once on the bus—a common-sense approach that was not thought of at the time, but which, due to consultation with local people, was resolved quickly. That is an example of the need for simple, joined-up government, as well as regulations and spending, and it is why the voice of disabled people is particularly important. There is no better way to understand where services or adaptations are needed than talking to those who use them.

I have two final points to make. First, the campaign for talking buses is an eminently sensible proposal that seeks the mandatory installation of audio and visual announcements on all new buses. The cost would be small compared with the overall cost of new buses, and that provision could be attained by amending the Public Service Vehicles Accessibility Regulations 2000. As I understand it, the Department for Transport currently does not intend to legislate on that, but I hope that the Government will change their position. Such a measure would make great common sense and be useful to all passengers, not just those with issues of accessibility.

I am grateful to my hon. Friend the Member for Wigan (Lisa Nandy) for securing this important debate. Is my hon. Friend the Member for Edinburgh North and Leith (Mark Lazarowicz) aware that in many countries campaigns such as that for talking buses, run by Guide Dogs for the Blind, are commonplace? When I worked in Japan more than 20 years ago, talking buses were the norm and were not seen as unusual. I do not know when that began, but it is imperative that such a system is introduced in this country as soon as possible. If that is not carried out voluntarily by bus companies in receipt of public funding, strong pressure should be put on them.

My hon. Friend makes a good point; I have been on buses with that facility in other parts of Europe. If regulations are not changed, the speed with which that facility spreads through the bus network will be so slow that it will take 10, 20 or 30 years for a reasonable number of buses to be equipped, if it happens at all.

Just before the previous intervention, the hon. Gentleman touched on the point that I wish to raise. A lot of the interventions that we have mentioned—not all of them, but those such as talking buses and having more grab rails—would benefit everybody. For too long, and in so many ways, we have accepted a design that is no good for either disabled or non-disabled people. The principles of inclusive design should help everybody, and we should encourage that as well as those things that specifically help some groups of disabled people.

Indeed. I do not want to turn this into a debate about the advantages of publicly owned bus companies, although I am sure some hon. Members would like me to do so. However, Lothian Buses is an example of a company that, because of its nature, has the advantage of being close to local needs. The newer double-decker buses are longer and provide more space for buggies, pushchairs and wheelchair access. They are gradually introducing audio and visual announcements. It can be done; it is about making a choice and taking a decision on what is needed. I suspect that legislation on public transport might allow local authorities to specify regulations on improving local access more clearly—perhaps that point is for another day.

My final point is to emphasise the need for a joined-up approach. We will not get every bus and train in the country fully accessible overnight—it takes time to make such things happen. People on train journeys frequently use more than one operator. They may get on a train that is accessible, but change en route to a service that is entirely inaccessible. They may not have realised that and assumed, or even inquired and been assured, that the next train would be accessible. However, if it is not, they will be stuck on a station, perhaps without assistance, and will have difficulty in completing their journey. A bit more thinking and a more joined-up approach would improve such situations, although I accept that that cannot be done overnight in every part of the country.

That takes us back to the issue of equality. Every passenger, whatever their position, should have the right to start and complete their journey without unreasonable obstruction or a lack of facilities that prevents them from doing so. In spite of the work carried out by the previous Government, which I hope will be continued by this Government, the issue needs to be pushed up the agenda more often. Thinking and regulation need to change, or else, despite all the improvements, it will be many decades before we can say that we have a fully accessible transport service in this country.

It is a pleasure to serve under your chairmanship, Mr Robertson, and I pay tribute to my hon. Friend the Member for Wigan (Lisa Nandy) for securing the debate and for her passionate advocacy of a noble cause.

My hon. Friend is right: how we support and care for the blind, the partially sighted and the disabled in our communities is the hallmark of a civilised society. I pay tribute to many friends from over many years, including those I represent in my constituency of Erdington, who have battled against adversity, often in the most extreme circumstances. Their approach to life was captured by one sufferer of multiple sclerosis from Castle Vale who has been confined to a wheelchair for many years, but said, “I’m disabled, but I’m proud of being disabled.” Disabled people do not want our pity; they want to play a full part in society. They expect us to discharge our moral duty to them, and for those with responsibility to comply with obligations in the law.

My hon. Friend was right to say that there was all-party consensus on some of the landmark changes over the past 20 years, including the Disability Discrimination Act 1995. However, if that is the hallmark of a civilised society, by that test and under successive Governments, our society has sadly too often failed the disabled. Having said that, this Government are moving in the wrong direction.

Today, we rightly focus on transport, and the problems with it are set out in the excellent Trailblazers report. That report includes the personal experiences of an admirable woman, Jagdeep Kaur Sehmbi—Jagz, to her friends—who is here today. She has undertaken tremendous work on behalf of those who are wheelchair bound and the disabled more generally, and she has demonstrated just what the problem is. Let me quote just two paragraphs from what she says in the report. On the issue of trains, she says:

“A couple of times there has been no one with the ramp to help me off the train at my destination platform, even though I had informed them at the other station and been assured that someone would have the ramps ready.”

On the issue of buses, she says:

“Once the driver didn’t drive up to the pavement, not because he couldn’t, but because it was easier for him to drive off after the other passengers had got on, so I had to get off in the road, which meant the ramp was very steep and then I had to find a place to get up onto the pavement.”

Jagz has not been deterred from continuing to travel, but it is clear from my experience that many who have such bitter experiences give up and stay at home, just when they want to play a full part in society.

The report goes on to detail its findings, and I want to refer briefly to four. First, on transport, the disabled end up having less choice and paying more. Secondly, the young disabled, in particular, feel very much that they are second-class citizens. Thirdly, disabled people cannot always access the first taxi, train or bus to come along. As a result, one disabled person told me, “I felt humiliated about being there on the pavement. Everyone else could get on board, but I couldn’t.” Fourthly, the assisted passenger registration scheme demands 24 hours’ notice, which in turn restricts spontaneity and independence. It also fails to provide a service that passengers can count on, which again is evidenced by Jagz’s experience.

Of course, there is an obligation on the companies that provide those services, and I will come to one such company in a moment. Crucially, however, the Government must also act—not only on the framework of regulation, but where there is evidence that companies are not discharging their obligations properly.

That leads me to London Midland. The company is proposing—the proposals are on the Secretary of State’s desk right now—to make significant changes, including to the manning of stations. In my constituency, for example, Gravelly Hill station and Erdington station will no longer be manned after 5 o’clock in the evening. Centro has concluded a consultation process, and 18,000 representations have been made, including many from the disabled, objecting to the proposals and seeking to bring home what they would mean.

I have been working with the Royal National Institute of Blind People, Mencap and the Muscular Dystrophy Campaign to bring home what the impact of the proposals will be, and I want to give one example. The formidable Mike Hughes, who is a former police officer, is now blind. He is chair of the west midlands region of the RNIB. He tells a story about how he got off at Sutton Coldfield station at 9.30 one evening. Normally, he immediately rings for a taxi—he has two numbers programmed into his phone—but this time he could not get a signal. He was completely lost, and this is a strong, self-confident individual. Fortunately, the person manning the ticket office, who was about to close it down, helped him out and took him somewhere where he could get a signal and call a taxi. Like Jagz, Mike said, “I wasn’t deterred, Jack, but I know many people like me who’ve had bad experiences and who were deterred from travelling.”

As a result of the growing concern among the disabled, I and the organisations that I mentioned met London Midland in July. With me was the admirable Rebecca Swift, the RNIB’s regional director. The people we met from London Midland were perfectly decent individuals, but I hope that hon. Members will forgive me for saying that they were somewhat uncomprehending of their proposals’ consequences for the disabled. We asked whether the company had consulted. They replied, “We think we did.” We asked how. They said, and I kid thee not, “For example, we put up posters in the stations.” Our next question was, “Posters for the blind and partially sighted?”

We then asked, “Do you think you’re covered by the obligations in the law?” The London Midland people said, “Not sure. We’ll go away and write to you.” They wrote back and said, “We don’t think we are, but in future we will act as if we were and consult properly.” That was in accordance with what we had argued. The problem is that they now propose to go full steam ahead with their proposals; there has been no change. That is simply not good enough, which is why I have written to the Secretary of State asking whether he will intervene. I will say more about that in a moment.

Others have contributed to this important debate. Mencap, for example, has focused on National Express, a company I know very well. It is the biggest long-distance coach company and it is a reputable company. It is also a good employer and it is sensitive to the needs of the communities it serves. However, on 18 routes, the 30% of fares that are concessionary are now at risk because of the changes to the bus service operators grant. I wrote to the Under-Secretary of State for Transport, the hon. Member for Lewes (Norman Baker), and the reply I got today said:

“All coach operators, including National Express, are free to continue to offer half-price concessionary travel to older and eligible disabled people on a commercial basis.”

That sounds like the legendary saying by Anatole France that the rich and the poor are both free to sleep under Paris bridges at night. National Express is not a charity; it is a good company, but if it is to continue to offer concessionary fares in a significant way, it will require continuing Government support.

What is so admirable about the initiative taken by my hon. Friend the Member for Wigan is that she has ensured that the voice of the blind, the partially sighted and the disabled is properly heard in the debate. I know that the Minister understands some of the issues, and when he responds to what he has heard today I hope he says how the Government intend to proceed. Specifically, London Midland cannot be allowed to blunder on regardless if the disabled are the casualties of its actions. It has not consulted properly, but the organisations representing the disabled have, crucially, offered to work with it on a consultation. That is why I have requested a meeting with the Secretary of State that involves Jagz and the Muscular Dystrophy Campaign, the RNIB and Mencap. No fundamental decisions that impact seriously on public transport and, in turn, on the disabled should be taken unless the voice of the disabled has been properly heard.

I congratulate my hon. Friend the Member for Wigan (Lisa Nandy) on securing the debate and on the excellent way in which she introduced the subject for us. The background is that 60% of people with disabilities have no access to a car and are therefore totally reliant on public transport, whether bus, train, tube or taxi. For them, public transport is of even greater importance than for the rest of the population, and that fundamental point should underlie the debate.

In London, the treatment of passengers with disabilities is probably, although it does not always feel like it, rather better than it is in many other parts of the country. That is not an accident; it has happened because we have a regulated bus service and a unitary transport authority. It has also happened because of the hands-on approach taken by the former Greater London council and, for most of the period since their introduction, by the Greater London authority and the Mayor in pushing the whole disability agenda. The Mayor’s office also has a very effective advisory network that can ensure that it delivers on those issues. Under the previous Mayor, Ken Livingstone, there was an ambitious programme to convert a large number of tube stations to disability access, for which he should be commended. That is the issue that I want to refer to in a local context.

There are 11 stations—Network Rail and underground— that serve my constituency. Of the Network Rail ones, on the North London line, Upper Holloway, Crouch Hill and Canonbury have proper disability access, with ramps and so on, and all are staffed at present. With the stations that are mixed London Underground and Network Rail, there is an utterly ridiculous situation. In the case of Highbury and Islington, for example, the London overground station has disability access—it has recently been refurbished to bring in the East London line—but the underground station does not, so it is impossible to get off an overground train and on to an underground train there, because there is not proper access to enable people to do so.

Finsbury Park is a very old, busy and crowded underground station, and Network Rail, the underground and buses converge there. After a lot of argument, Network Rail has agreed to put in a lift between street level and the mainline platforms, which are well above street level. At the same time, Transport for London has cancelled its plans to put in a lift to the underground platforms underneath. Thus we have a ludicrous situation in which someone in a wheelchair, arriving at Finsbury Park station by the overground, will be able to get from the mainline platforms to the street, but will not be able to get to the underground.

I use that station frequently and every day passengers carry people with wheelchairs, and carry buggies, up and down. The overcrowding and lack of accessibility, and the danger that goes with that, are ridiculous. I hope that the Minister will pass on to his friend the Mayor of London what I have to say to him: please think again about the cancellation of the conversion scheme for a large number of London stations. It is making the lives of many people a misery and something should be done about it. The conversion needs to happen much more widely, across the network.

At other stations there is no access for people with disabilities. Those include Archway, which was also the subject of a plan from Ken Livingstone. Three stations that were due to be converted have had their plans cancelled. Highbury and Islington is the other, and only one station—Tufnell Park—has accessibility to the tube, which is by means of a lift. The situation is ridiculous, but I do not plead that case just for my constituency. I am using it as an example that could be repeated across London; it is not exclusive to my area.

My second general point is about buses and accessibility. After a lot of campaigning, London buses have ramps, and drivers are supposed to stop in such a way that the ramp can be used, enabling wheelchair users to get on the bus. Many drivers are good, reasonable, responsible and decent, and they stop in the proper place, giving people time to get on. That is fine, but unfortunately some drivers do not do it. Buses are often crowded, so often people with a wheelchair have to wait for many buses to go by before they can get on. On a cold winter’s morning, it is no joke when a person in a wheelchair is stuck for a long time simply trying to get on a bus. Space is lacking, because it is taken up with buggies and other things, so while I obviously accept the point that awareness is needed, we need training to go with it.

I hope that the hon. Gentleman will dwell on that point for a moment. He referred to gaps in his constituency, but in the past 15 or 20 years there has been movement on the issue of infrastructure across the UK. However, there appears still to be a gap in staff training and awareness of problems. Although there has been some progress on that in the past 10 years, more needs to be done, particularly as some people do not seem to be aware of the crucial issues that affect partially-sighted and disabled people.

I absolutely accept that attitudes, awareness and training have improved, but we need only look at the building we are in to see that we still have very far to go in achieving proper accessibility. I realise that those things are not simple, but nevertheless they must be achieved.

Outside London, where the bus service is largely less regulated, facilities tend to be much worse, and we need a much tougher approach from central Government to ensure that bus companies do as they should, bus stops are appropriate, and buses are sufficiently regulated and regular to enable people to get around. It is no fun to be waiting in a wheelchair in the cold, unable to move around to get warm, as other people who are not in wheelchairs can.

As to Network Rail, the McNulty review stated:

“The Study recommends that the default position for all services on the GB rail network should be DOO”—

driver-only operations—

“with a second member of train crew only being provided where there is a commercial, technical or other imperative.”

How many times have we seen people trying to get on or off trains at remote or suburban stations at night, when there are no staff on the station or the train—only a driver, who cannot see everything or be everywhere? It is then a great struggle simply to get on or off a train. The McNulty proposal to go to a largely driver-only-operated service means that many suburban and rural services will have no member of staff on them, and in addition there will be unstaffed stations. That is obviously a huge deterrent to anyone who has special needs getting into the station and on to the train. I hope that the Minister will make it clear that he does not want that aspect of the McNulty proposals to be introduced.

Additionally, it is often difficult for people, particularly those with sight difficulties, when there are no staff on the station and only ticket vending machines are used. The machines are often the wrong height or badly placed. Getting a ticket and getting on the train when there are no staff becomes a nightmare. It is unnecessary and wrong to have such arrangements; they are uncivilised and we should put a stop to them.

As many as 10,000 ticket staff across the country could lose their jobs between now and 2013 if McNulty is implemented. Those people are there to help, bring security and support people. Surely we need to give a lot of thought to that, and quickly. I commend my hon. Friend the Member for Wigan on obtaining the debate, and I hope that the Minister understands that the role of the Government is to regulate and to ensure that services are provided: because 60% of people with disabilities have no access to a car, public transport is the only option for them. Buses and trains must be accessible, stations must be staffed and the staff must be trained to assist people as necessary. That is the only right and proper thing to do.

It is a privilege to be called to speak in the debate following so many excellent speeches that covered so much ground. I congratulate the hon. Member for Wigan (Lisa Nandy) on securing the debate and setting out the grounds for it so well. So much has been covered that those listening can benefit from a shorter speech by me. [Hon. Members: “Hear, hear!”] It is good to have support for that from colleagues.

Of course, many of us take access to public transport for granted. When a train is delayed or we wait a bit for a bus, we all grumble about the inconvenience and how much more arduous the journey is. However, for many people, a delayed train is insignificant compared with the difficulties that they face every time they try to travel. If their bus in London is diverted, they may not simply be able to use the underground instead. If they are lucky enough to be in an underground station with full access for people with physical disabilities, they can travel to only 59 other stations out of the 270. Public transport should be just that—a transport service accessible by all members of the public, no matter what their need.

Disabled people in this country have the right not to be discriminated against or harassed in relation to the use of transport services. A right of access to transport for disabled people was first set out in the Disability Discrimination Act 1995, before a broader right to access was enshrined in the Equality Act 2010. However, as many disabled people know only too well and tell me at constituency surgeries and on the streets, that right simply has not become a tangible reality. We desperately need to ensure that what we have put on the statute book is embedded in reality in all local services.

I am sure that we will hear from the Minister about the work that the Government have done, but there is much more to do. Just over 50% of bus stops in London are fully accessible. That represents a huge increase, but is still a very disappointing number, given what is needed. Almost every group that represents people with disabilities has highlighted the problems with the lack of proper transport provision. We have heard several times about Trailblazers. I have met representatives of several disability groups in Cambridge. They raise those problems regularly.

However, we must not concentrate just on people with physical disabilities. There is an idea that someone who is disabled can only be someone in a wheelchair. The issues affecting people in wheelchairs are, of course, very important and have been discussed, but disabilities are not always obvious. I want to highlight some of the particular issues faced by people on the autism spectrum, including those with Asperger’s syndrome. We have a number of such people in Cambridge, which is why I raise the issue. Roughly one child in 100 under the age of 18 has an autism spectrum disorder. The National Autistic Society recently produced a very good video, which I urge hon. Members to watch. It highlights what autistic people face when trying to use public transport. That is particularly hard for them because it is not obvious that they have any issues at all.

We need to consider the issue more broadly than just by thinking about how people get from A to B. We must consider how the problem with access to transport affects people’s overall well-being—their entire lives. If people are discouraged from travelling, what does that do to other areas of their lives? I am referring to their ability to meet people, form friendships, find work and pursue interests—to have all the life experiences that the rest of us take for granted. This is not just about transport; it is about everything else that happens.

Clearly, it is important to pick up a lot of the details. Many very small things could be fixed. That is why I highlighted the work on guide dog access done by Caroline Pidgeon in the London assembly. These are not hard things to do, but they are very important.

There is much still to do that requires a bit more. We need to ensure, for example, that all the Crossrail stations have proper toilet facilities. It is important to remember that something as simple as a toilet facility can represent a huge block for people who are disabled, whether because they are in a wheelchair or because they have one of the range of conditions, such as Crohn’s disease, that have a huge effect—

This may be an obvious point, but toilets at stations should be open. The same goes for toilets on trains as well.

Indeed. We need not only to build such facilities, but to ensure that they are open, accessible and functional. That is a very important point. There are too many instances in which that is not the case. We have a particular issue in Cambridge, although it does not involve transport. A developer wants to move the disabled toilet up a few floors in a shopping area. Of course, that would make it very hard to get to.

I will not say too much about the concerns over the reductions in relation to discretionary fares. That issue has been highlighted, and I share the concerns expressed. However, as well as the detailed changes and the infrastructure changes, which are extremely important—

I know that my hon. Friend is keen to proceed, but infrastructure is certainly a concern of the Chippenham Accessible Rail Transport group. The group and I have thrown our weight behind Network Rail’s attempts to bring disabled access to Chippenham railway station, but Brunel’s railway is considered a heritage asset. I hope that my hon. Friend and the Minister would agree that when the council consults heritage groups about changes to achieve decent disabled access on our public transport, we need those groups to get behind such proposals and work with the industry to make them a reality—they should not be allowed to become a block to progress.

I thank my hon. Friend for his intervention. From my role as co-chair of the Lib Dem transport group, I know that he campaigns very hard for his railways and I congratulate him on that. We have had a number of conversations on what is a real issue not just for his station, but for a number of others. There is a tendency for some heritage groups and people who work in that area to take the attitude that nothing must ever be changed, which is simply not what we want. Freezing all old buildings as they were in the ’70s is not always the right thing to do. The point of public transport is not to be a beautiful monument, but to enable people to travel, and travel easily. I hope that we see more movement, which is happening with much of the heritage sector, towards the idea that we need to come up with creative solutions that enable things to work, as well as, we hope, to look good and continue that heritage. That is a very important point, and there are a number of other points that one could talk about in relation to infrastructure.

As well as the piecemeal changes and infrastructure changes, which affect disabled people on a personal level, there is the issue of planning a long-distance journey. The sheer lack of information and the complexity involved in finding information make it very hard. If someone wants to travel between two places that they do not regularly travel between and that are a long way apart, rather than within a city, they have to check the accessibility of every service, or they risk taking a tube, a train and a bus and then finding that they cannot take the next bus. It is extremely hard to plan a long-distance journey. There is a huge need to ensure that there is linked-up availability of information, whether that is available online or in other ways—different people want to use different methods—so that people know that their entire route is accessible and they will not end up at the end of the line with the problems that have been identified.

This has been a very useful debate and it has been good to see mostly cross-party consensus on what we need to do. I look forward to the Minister explaining what we will be doing to deliver on the hopes and aspirations that we all have. In some ways, the issue is simple: we need to ensure that the transport service that we provide as a nation is fit for everyone. I look forward to hearing how that will be achieved.

It is a pleasure to speak under your chairmanship, Mr Robertson, particularly as this is my first time speaking from the Front Bench. I congratulate my hon. Friend the Member for Wigan (Lisa Nandy) on securing the debate. As ever, she spoke with great passion on behalf of those in society whose voices are too often unheard or ignored. She painted a very clear picture of the difficulties, indignities and anxieties that disabled people face in trying to travel on public transport and feel safe. It is clear from the number of people here today to listen to the debate and from the number of hon. Members from every part of the UK who have participated that there is a collective, cross-party will to tackle that inequality.

The hon. Member for Blackpool North and Cleveleys (Paul Maynard) also spoke with passion, and this place is richer for his being here and speaking with the real understanding that comes from personal experience. Among the many issues that he raised, what struck me was the importance of changing attitudes. That is difficult and we cannot legislate for it, but I want to hear from the Minister what the Government are doing to ensure that staff are aware of and trained to respond to the needs of disabled passengers, so that they do not face the same bitter experiences that my hon. Friend the Member for Birmingham, Erdington (Jack Dromey) described, which he had heard about from his constituents.

My hon. Friend the Member for Edinburgh North and Leith (Mark Lazarowicz) made important points about the practical steps that can be taken to improve accessibility and rightly pointed out that this is about not just buses, trams and trains, but airports and taxis. My hon. Friend the Member for Islington North (Jeremy Corbyn) reminded us that 60% of disabled people have no access to a car and spelled out both the progress made and the challenges that remain here in London. The hon. Member for Cambridge (Dr Huppert) rightly highlighted the needs of people with hidden disabilities, such as autism or learning difficulties.

We would all agree that good public transport is vital to disabled people and their families. It provides access to education, employment, health care, sports, leisure and volunteering opportunities. It enables disabled people to live independent lives. It helps to combat social isolation. Using public transport empowers disabled people, allowing them to develop self-confidence and skills.

The previous Labour Government made huge strides forward in improving public transport, including by making it more accessible for disabled people. However, there is clearly more to do. As we have heard today, disabled people still cannot access the services that many of us take for granted, but during the 13 years of Labour government the UK saw spending on rail that was almost two and a half times higher than we inherited. The creation of Network Rail brought significant modernisation of lines and stations, and a programme of replacing the ageing train fleet began, with 4,800 new accessible train carriages built since 1999.

Labour also significantly increased the support for local transport services, with investment more than doubling on our watch, including improvements here in London to buses and the tube, as we have already heard. Local bus services saw investment rise by almost 300%, and across the country bus fleets were modernised, often incorporating features to make them more accessible.

The Rail Vehicle Accessibility Regulations 1998 and the Public Service Vehicle Accessibility Regulations 2000 made a number of changes to make using public transport easier and safer for disabled people. The majority of buses now have handrails and wheelchair spaces. All new tram and train carriages must be accessible, and there is a requirement for audio-visual systems—vital improvements for disabled people, but benefiting everyone else, too.

Parents with pushchairs find it easier to get on a bus because it has a low floor and a space for the pram. They no longer have to struggle to fold a buggy while holding a toddler and bags of shopping; I speak from experience. Visitors feel more confident in using the train and tram because there is a display showing where they are and what the final destination is. I cannot resist an example from my own city. It is reassuring to hear Wendy Smith, the voice of Nottingham’s tram, tell someone what the next stop is when it is dark outside or pouring with rain, or when the tram is crowded.

In 2005, the Department for Transport began trials of on-board audio and visual passenger information systems, with a view to amending the 2000 regulations to make such equipment mandatory if the trials prove successful. We need to ensure that that research progresses, and I ask the Minister to set out clearly what his Department is doing to extend such provision across the bus network. As my hon. Friend the Member for Wigan said, under the 1998 regulations, all trams and trains must be fully accessible by 1 January 2020. What is the Department doing to ensure that train companies meet that deadline?

Unfortunately, the progress achieved under Labour is now under threat as a result of this Government’s reckless deficit reduction plans. We recognise that transport spending needs to be reduced, even though that means making difficult and unpopular decisions, but the Government are going too far and too fast, with serious consequences. Funding for local transport will be reduced by 26% by 2015—over a quarter of the budget gone. With ring-fencing removed and local authorities under pressure, transport spending could even be lower. Worryingly, the Financial Times reported today that Campaign for Better Transport has uncovered the fact that English regions have already lost more than 1,000 bus services—over a fifth of all those supported by local authority funding. Funding for the concessionary fare scheme has already been cut by £223 million, and the bus service operators’ grant will be cut by £254 million by 2013.

Overall, the Government are taking away half a billion pounds from local transport funding, causing unaffordable fare rises and the closure of routes, which will hit everyone in our communities. Disabled people, who are often on low incomes and especially reliant on public transport, will be hit even harder. The scheme that provides half-price coach travel will be wiped out a stroke at the end of this month, putting long-distance travel out of reach for many pensioners and disabled people, and threatening some routes.

In many areas, school transport, which is particularly important for disabled children and young people, is being cut or removed, hitting family budgets and excluding disabled youngsters from after-school activities such as sports, drama and music. That comes on top of the removal of education maintenance allowance and a threefold hike in tuition fees. No wonder so many young people feel that they are being priced out of opportunity.

Quite rightly, many hon. Members have focused on the need for physical changes to public transport vehicles to make them more accessible to disabled people, but such changes will simply be irrelevant if the services that people need are not running, or if disabled people cannot afford to travel on them. Families up and down the country, including those of the disabled, face a cost-of-living crisis. Household bills are going up as a result of rising prices, wages are stagnant for those in work and many people face unemployment, including nearly 1 million young people, as today’s figures show. They have to rely on benefits, which are not keeping pace with inflation. How on earth will they cope with the 28% increase in rail fares planned for the next three years?

Disabled people face the additional worry that scrapping disability living allowance and replacing it with the personal independence payment might mean that they lose the help that they have been receiving with the extra costs of mobility. That fear is particularly acute for disabled people in residential care, including young people living in residential schools and colleges. As it stands, the Welfare Reform Bill will remove the mobility component of PIP from those young people, even though there is no evidence of the double funding that the Government claim. What discussions has the Minister had with his colleagues in the Department for Work and Pensions about their internal review of those proposals? Will he update us on their progress?

Disabled people already face barriers to their inclusion and participation in society. The Government should be on their side, breaking down those barriers, not building them even higher. How will the Minister do that? What assessment has his Department made of the impact on disabled people’s access to public transport, particularly that of young disabled people, of his 26% local transport funding cut? Will his Government’s decision to increase rail fares by 3% above inflation for the next three years have a disproportionate impact on disabled people? If so, how will he militate against it? Has he assessed how the loss of ticket-office staff will affect disabled passengers and what are his conclusions?

As the Disabled Persons Transport Advisory Committee goes up in smoke as part of the bonfire of the quangos, how will the Minister ensure that disabled people, including young disabled people, are properly consulted on decisions that can have a profound impact on their lives? As we have heard today, disabled access to public transport is an issue in constituencies across the country. He needs to explain why disabled people are being asked to bear the brunt of his Department’s spending cuts.

As always, it is a pleasure and honour to serve under your chairmanship, Mr Robertson. May I pay tribute to the hon. Member for Wigan (Lisa Nandy), not only for the work that she has done today, but for her career at the Children’s Society and Centrepoint? She has been a stalwart of the disability lobby for many years, and I am sure that she will be here for many years to come.

It was a pleasure listening to the debate. It is a shame that some colleagues have not stayed. There is a problem with this Chamber sometimes; people say their bit and then disappear, which I think is wrong, no matter which side of the House they are from. The debate was going well until the brand new shadow Minister, the hon. Member for Nottingham South (Lilian Greenwood), stood up. I welcome her to her post. Perhaps in future she will listen to the debate a little bit more, rather than read a prepared speech, which was a party political rant. The issue is not party political, and we had agreed before the debate started that the previous Government had done brilliantly when they were in power. Previous Governments have tried hard. We were left with a difficult economic situation. One of reasons why the previous Government had not done more was that it was difficult and expensive to do so. If we all admitted that, we would get a proper debate in the future.

I apologise to the hon. Member for Wigan. I am not the Minister responsible for the portfolio; I do roads and shipping. The Minister responsible is away on other ministerial business, and in my response I will not be able to answer directly many questions that have been raised by hon. Members today. Each individual will be written to by the Minister responsible and the officials.

I am grateful to the Minister for stepping in at short notice to cover his colleague’s brief. Will he take a request back to his colleague to meet me and a small number of representatives from some of the campaigns that I have mentioned to put to his colleague directly some of our concerns and proposals? I am concerned that the issue could get lost as part of a wider Government agenda.

The hon. Lady is absolutely right. One of the things in the many notes that were being passed back and forth here was that that would take place and that I would put my colleague on the spot, because the hon. Lady asked for a working group. Yes, we will have a working group while other proposals go forward. That is certainly important.

In my constituency—we are all constituency MPs at heart—I have raised such issues to my own station, where the lift is out of operation. The station is managed by London Midland. I have had detailed and quite strong conversations before I became a Minister, and certainly since.

There is often no sense as to why certain things happen. A profoundly deaf and blind constituent of mine had long been campaigning for a suitable bus for a disabled person to stop in my town centre, and it is there and has happened, which is great. However, the stop is next to a river and the railings have been taken down. Probably no one would believe that, but imagine someone who is blind, like my constituent, getting off the bus where the railings have been taken away and there is a river. Although it is not deep, we know what the problems would be. What was the logic of that? Where were the brain cells when that decision was made? Who knows what engineer decided to do that, but, as a constituency MP, I shall find out.

The points that have been raised today cross a spectrum of disabilities. Very often we talk about those who are wheelchair bound. The problem is that there are a plethora of different types of wheelchair. A lovely young man called Jack asked if he could do his work experience with me in the House of Commons—this story relates to what the hon. Member for Islington North (Jeremy Corbyn) said about the state of the Palace and its lack of accessibility. I said yes to the work experience and a risk assessment and an access assessment were carried out. The answer was then no, because they could not accommodate the size of Jack’s wheelchair. Well, in the end we did. It was a long-drawn-out route around the Palace, as I was in Norman Shaw at the time, but we did it. So often, we are told why we cannot do something instead of how we can do something.

Jack and one of my closest friends who sustained some of the worst injuries in the London bombings and survived spoke to me about the matter. They said, “Don’t keep wrapping us up in cotton wool. We’ll tell you how we can do things. We’ll tell you how we can get there, rather than you telling us.” That is why working groups and the different lobby groups are so important.

Interestingly, when it comes to access into buildings, I was told that we should ask disabled people how much access they need because we are paying through the nose—Jack’s words not mine—for the works. A whole industry has grown up around access into buildings for disabled people. Actually, the whole matter could be dealt with much more simply and easily.

Why on earth would they want to put the toilets two floors up in Cambridge? I know exactly where the hon. Member for Cambridge (Dr Huppert) is talking about because my daughter is studying at the Anglia Ruskin college in Cambridge and has a Saturday job in the place mentioned. The question that we must ask, as constituency MPs and Ministers, is why. Tell me the reason why that has happened and why we are in that position? As I mentioned earlier, I will pass on any question that I cannot answer this afternoon to my colleague who will then respond in writing.

All front-line rail staff are supposed to be trained, but will it make any difference if they do not have the will, inclination or empathy to help? One thing that we can all do is to say to young people, “Let us be your voice.” That is what we are here for. They do not want to fill in survey forms; they have had enough of that. I say, “Just give us a little whisper and tell us on what train or on what bus a member of staff was rude to you or did not do what they should have done.” It is amazing, colleagues, what a letter or a size 10 boot from an MP can do to energise employers to look at what their staff are doing.

When the Minister argues that we should offer to be the voice of some of these people, I assume that he would also support the various parliament-type organisations that enable disabled people to be their own voices and to represent themselves much more strongly.

Such organisations do a fantastic job, but we need to ensure that there is access to this place. The all-party parliamentary groups, of which my hon. Friend is a member—I was chairman of several all party groups when I was a Back Bencher—are about access. They are not just talking shops. They are there to say that people have the right to come forward.

It is a requirement of rail employers to ensure that their front-line staff have the right sort of training.

I thank the Minister for giving way; he has been generous with his time. I am interested in his point about writing letters. If I forward a letter to him from Disability Action in Islington concerning the cancellation of the step-free access programme to the London underground, I am sure that he will be straight on the phone to Boris Johnson who will make sure that these programmes are reinstated. Have I got a deal there? Is that okay?

I will do a deal with the hon. Gentleman. If he writes to me, I will pass on his letter to the Minister responsible who will then be in contact with Boris. I am trying to think of the station that has had the lift installed.

That is right. The lift cost £25 million. One issue that has been raised is the age of our network. I do not know whether that applies to our buses. Actually, the situation in London has dramatically improved because all buses have disabled access now. Although we have more modern trains, our stations and platforms are a massive issue for all constituency MPs.

I thank the Minister for his constructive response to the proposal of my hon. Friend the Member for Wigan for a wider discussion to take place and the establishment of a working group. That is welcome indeed. May I just ask him about the specific issue of the changes being proposed by London Midland? Given that the proposals are now on the Secretary of State’s desk, will he facilitate a meeting with the RNIB, Mencap and the Muscular Dystrophy Campaign because it is important that their voices are heard before a final decision is made?

The point that I was going to get to is the urgency of some issues, including the one that the hon. Gentleman has just mentioned. It is the Minister of State who is responsible for that issue. I will put a note on her desk tomorrow asking if that meeting can take place. I am not responsible any further than that, but I will do what I say and anyone who knows me will say that that is the case.

I thank the hon. Member for Wigan, who is relatively new in the House, for giving the Minister a list of the questions that she wants answered; it is ever so helpful. Notes are flying back and forth and I must have 20 notes sitting on my desk here. Clearly, I will not be able to answer all of them in the four minutes that I have left and I am not going to try. I do not wish to have a pop at the hon. Member for Nottingham South. I remember sitting in the same seat as a shadow Health Minister for almost exactly the same amount of time that she has been in the House. It is an honour and a privilege to be in this place whether in government or in opposition. Sometimes it may seem difficult, especially when one thinks of the huge number of civil servants backing the Minister and writing his speeches for him. However, I must say that I have not read the speech that they wrote for me. Well, I read it last night and did not like it. They will get used to me; I am just that way.

Let me stress again that all the points that have been raised are about tone and about people’s rights. I know that we are not allowed to indicate who is in the Public Gallery in Westminster Hall, but we are privileged that people have come here, sometimes in very difficult circumstances, to express their rights and to say, “Why am I getting a bum deal compared with other people?”—I do not know how Hansard will work that one out, but there we are. The situation is fundamentally wrong, but it is not easy to resolve. I hate the word “targets” but we have targets for 2020, which the companies will have to meet. In the hon. Member for Wigan’s constituency, there will be a franchise change in 2013. I am conscious of her question, and the Minister responsible will respond to it. I also need to know what rail operator she refers to. Perhaps she can write to me and let me know. We got rid of guards vans in 2004. If that was a comment, it might have been sarcastic, but it was also manifestly incorrect. There are no guards vans to travel in.

The rail companies operate a taxi service—I do not like it because it is a cop-out for them—and the people to whom the hon. Lady referred should have been offered a taxi for the short distance that we are talking about. Instead of one person waiting to be shuttled to their destination, which is an appalling situation to be in, common sense should have prevailed and a taxi should have been ordered to take all four people to their destination. If the hon. Lady can write to me and tell me the name of the company, it would help. People are out there checking up on these companies. It is a huge rail and bus network, but there are people out there checking out what is going on and whether promises, commitments and franchise agreements are being met.

Instead of being typically British and just putting up with things because that is the way we are, we should perhaps be more like the German transport people whom I met earlier today. They would not put up with this because they have a completely different attitude. They expect a service and they tell people in no uncertain terms where they should be. Let us speak up on behalf of our constituents. Constituents need to complain to their MPs and their MPs should tell us. If that happens, perhaps we can have a service for the 21st century that everyone deserves.

Violence against Women and Girls

Thank you very much, Mr Robertson, for calling me to speak. It is a pleasure to serve under your chairmanship.

Although I am delighted to have secured this debate on the prevention of violence against women and girls, I wish that it was unnecessary. However, the facts and figures on gendered violence remain so alarming that it is clear that, as a society, we are still failing to approach the problem with anything like the urgency or seriousness that it deserves. Currently, two women a week are killed by a partner or ex-partner and every year 60,000 women are raped. Sexual harassment in schools, communities and workplaces is routine, and an estimated 6,500 girls in the UK are at risk of female genital mutilation.

According to the British crime survey, in Brighton and Hove—where my Brighton, Pavilion constituency is located—around 25,000 women are likely to experience repeat domestic violence as adults. Last year, 277 women sought housing advice and 102 homeless applications were made—[Interruption.]

As I was saying, 102 homeless applications were made due to domestic violence. Nearly 11,000 women experience physical and emotional violence; more than 2,700 women experience sexual assault; and more than 6,600 women were the focus of stalking. Those are big figures, but behind each number is a real life that has been hugely damaged by this experience. Moreover, 44% of the 264 young people assessed by the youth offending service in Brighton and Hove in 2009 had been abused—that is nearly half—and 42% had experienced domestic violence at home.

I therefore welcome the fact that, in its call to end violence against women and girls, the Home Office has recognised the need for a targeted approach to tackle the ongoing scandal of violence against and abuse of women and girls. The Government’s strategy purports to put prevention at its heart, yet I fear that that objective risks being undermined by a lack of joined-up thinking and the policies of other Government Departments.

Furthermore, as the domestic violence team at Brighton and Hove city council has told me, in the Government’s strategy, there is no allocated funding for prevention of and early intervention for violence against women. All the money is still being allocated to crisis work, with only limited attention being given to addressing the cause of the problem—in other words, perpetrators’ behaviour. In Brighton and Hove, since 2004, the city has been working specifically with perpetrators to address their abuse and I am proud that it was the first programme to be accredited nationally by Respect. The local authority has committed to maintaining the programme, but due to demand it is not able to accommodate all the referrals. It finds it very difficult to turn away people who want to join the programme, because it is so concerned about the risks that people face if help is not available.

That work needs to be properly funded. It should not be made dependent on sympathetic council administrations, or put at risk because of central Government spending cuts. Brighton and Hove, whose intelligent commissioning on domestic violence is recognised as good practice, has a local commitment to developing a strategy on violence against women and girls, with work already under way to deliver that strategy. However, not many local areas have the same kind of co-ordinated approach and I want the Government to consider making it an obligation that all local authorities must fulfil.

As well as the historical focus on tackling the aftermath of violence, such as bringing perpetrators to court, we must ensure that preventing violence in the first place is much more of a priority across Government. Let us take, for example, work with young people in schools. The importance of that work is underlined by the findings of an NSPCC study, which revealed that almost half—43%—of teenage girls believe that it is acceptable for a boyfriend to be aggressive towards a female partner. One in two boys and one in three girls believe that there are some circumstances in which it is okay to hit a woman or force her to have sex.

Young people in Britain not only have an alarmingly tolerant attitude to violence against women but many of them are exposed daily to the results of our failure to confront such attitudes head-on. For example, a YouGov poll for the End Violence Against Women Coalition found that a third of girls are subjected to unwanted sexual contact at school, with sexual harassment being routine. In addition, the NSPCC found that 33% of girls between 13 and 17 who are in an intimate partner relationship have experienced some sort of sexual partner violence. Although there has been an increased focus on other forms of bullying, many schools fail to recognise that unwanted sexual contact, sexual harassment and sexual name-calling are also specific forms of abuse that girls suffer routinely.

Girls from ethnic minority backgrounds may face additional risks. The Home Affairs Committee recently reported that schools are failing to respond to girls who are at risk of forced marriage and may even be putting female students in greater danger. We will wait and see whether forcing someone into a marriage becomes an offence in its own right, as the Prime Minister has indicated that it should be. I hope very much that he will introduce legislation on that issue.

The hon. Lady made an important point about early intervention and prevention, particularly in relation to girls. Does she agree that we must do a lot more in schools and that we must talk to our girls about self-empowerment, self-esteem, gender equality and empowerment? Does she agree that we need to do much more in those areas?

I thank the hon. Member for her intervention, not least because I know that she has a great deal of expertise in this area, and of course I absolutely agree with what she says. It is also interesting that young women themselves tell us that they want things to change. Around 52% of young women who were polled said that ending domestic violence against women and children is the issue that they care most about. That is according to research carried out by Girlguiding UK in conjunction with the Fawcett Society, the British Youth Council and Populus.

All over the UK, women’s organisations are doing innovative work with these young people, often with only minimal resources. For example, Rise, a charity based in Brighton and Hove, delivers a personal, social, health and economic preventive education programme on healthy relationships to schools across the city. It is also currently working to integrate the Women’s Aid “Expect Respect” programme into work that is currently taking place in primary schools. Rise also delivers “Break for Change”, a groundbreaking group for young people who are aggressive in their relationships. That group is for the young people’s carers, too. The Home Office itself is currently running a campaign called, “This is abuse”, which is aimed at tackling teenage relationship abuse.

However, work to prevent violence against women and girls cannot be left to occasional campaigns or women’s organisations working in partnership with good schools where they can. It must be an absolutely integral part of education and policy that is delivered in every single school.

Unfortunately, it appears that the Department for Education is dragging its feet on this issue. The commitment to teaching sexual consent in personal, social and health education is welcome, but it needs to go much further and include all forms of violence against women, including teenage relationship abuse, forced marriage, FGM and sexual exploitation. It should also be linked to work on gender equality and work that challenges gender stereotypes.

I just wanted to draw on some of the experience that I have gained from the Education Committee. As I understand it, only three hours of teacher training time is dedicated to behaviour and discipline in schools throughout a two or three-year degree course. There is very little hope that we can even start to explore the issues affecting young women who face violence and give them any sort of strategy if the teachers have absolutely no awareness of behaviour and behaviour training. There needs to be a concerted effort from the Minister’s Department to work with the DFE to deal with that problem.

I thank the hon. Member for her intervention. I did not know that particular piece of information and it makes me even more alarmed than I was when I first stood up to speak. It shows that this is part of a much bigger issue, which is about ensuring that our teachers are properly equipped to pass on that vital training.

It is interesting that Education Ministers have signalled that they want these issues to remain outside the statutory curriculum, running the risk that many young women and men will never be exposed to education designed to reduce gendered violence. Cuts to specialist local-level posts, such as domestic violence co-ordinators and teenage pregnancy co-ordinators, risk exacerbating the problem even further.

In its report, “A Different World is Possible”, the End Violence Against Women Coalition recommends a “whole school approach”, with heads taking a lead, teachers been trained on the issues and all students receiving comprehensive sex and relationships education on consent, equality and respect. That is already a top priority in Brighton and Hove—it builds on work by a number of the agencies that I mentioned earlier. The local authority’s strategy states:

“Evidence shows that to be effective in domestic violence prevention work, addressing the issue in PSHE and SRE lessons or in assemblies has limited impact and value, if the messages promoted are not supported by other initiatives and the broader ethos of the school.”

I therefore ask the Minister to call on her colleagues at the Department for Education to clearly identify one single Education Minister to lead on preventing violence against women and girls. I also ask her to tell us what contribution she has made to the Department for Education’s internal review on PSHE, and whether she has argued the case for sexual consent and all forms of violence against women to be a compulsory part of the curriculum.

Yesterday, the Prime Minister hosted a summit on tackling the commercialisation and sexualisation of children and announced a range of policies, many of which I warmly welcome. However, amid the messages about consumer and parent power, there was an element missing: empowering young people themselves to be media literate and to cope with the bombardment of often inappropriate images. Although I recognise that the measures announced will go some way towards cutting down on the images that young people are exposed to—outside schools, for example—we can safely say that this is only the tip of the iceberg.

Like any parent, I absolutely understand the desire to protect our children, and one of the best ways of doing so is through specific education that allows young people to be more in control of their sexualisation, rather than being dictated to by the media or by advertising. There is no plan as yet, however, specifically to address that in schools.

Earlier, I noted that central Government cuts might undermine efforts being made to tackle violence against women and girls, and I am particularly concerned about cuts to legal aid. Informing women of their legal rights and giving them access to legal representation is one way of empowering them and of trying to protect them against violence. It can give them the information they need to stand up to their abuser. There are serious risk implications, therefore, for women who cannot access legal aid. By reducing women’s ability to access legal aid, the Ministry of Justice risks damaging work at the Home Office on preventing violence against women and girls, and I would love to know whether the Minister shares my concerns about that.

I also wonder whether the Minister is dismayed by the Home Secretary’s proposal to change the eligibility requirements under paragraph 289A—the domestic violence rule—of the immigration rules. That would mean that all applicants under the domestic rule must be free of unspent criminal convictions. That actively undermines the Government’s commitment to eliminate violence against women. Will the Minister contribute to the UK Border Agency consultation, and remind the Home Secretary about the coalition Government’s obligations and commitment to protect all women from domestic violence?

The Equality Trust points out that 24% of women in Britain are worried about rape and that all kinds of violence are more common in more unequal societies. It stands to reason that preventing violence against women and girls is closely linked to tackling inequality and other social injustices. As just one example of what happens if we fail to do that, Frances Crook, chief executive of the Howard League for Penal Reform, tells me that more than a third of girls in the youth justice system have experienced abuse and a quarter have witnessed violence at home. Of the more than 4,000 women currently serving a prison sentence, more than half report having suffered domestic violence and one in three have experienced sexual abuse. For the vast majority of those very vulnerable women, prison is not the answer, and that is why both I and the Howard League for Penal Reform support community solutions for non-violent women offenders. I am keen, therefore, to see the Government’s target interventions to ensure the prevention of violence against women and girls address intersections of gender with other social inequalities.

I stress that the Government’s work on preventing violence against women and girls needs to encompass an international perspective. Here, too, we see evidence of a lack of leadership and concerns about co-ordination. There are now a number of very welcome Government strategies that reference international violence against women and girls, so oversight of all the different processes is vital and, for maximum impact, the different strategies and policies across Government should be coherent and mutually reinforcing.

Is it not important to bring the international communities into this—the women and girls of different nationalities with different cultural backgrounds? The Prime Minister will be attending a conference in a couple of weeks’ time at which he should raise that point, so that we can get the international communities behind us.

I completely agree with the hon. Gentleman’s important intervention.

At the highest level, a member of the National Security Council should have explicit responsibility for women, peace and security, to ensure that gender perspectives are taken into account in all discussions. Despite some references in the “Building Stability Overseas Strategy” document and in the UK national action plan for the implementation of UN Security Council resolution 1325 on women, peace and security, violence against women and girls is still not fully recognised as either a foreign policy priority or a security matter. It is not recognised as both a cause and a consequence of conflict. When violent conflict occurs, violence against women and girls is not seen as a priority matter.

The UK Government must take a leadership role internationally, to ensure that preventing violence against women and girls stays on the international agenda. Globally, about one in three women or girls have been beaten or sexually abused in their lifetime, and 75% of the civilians killed in war are women and children, so I am keen to hear from the Minister what has been achieved, or what has changed in our approach to violence against women as a foreign policy issue, since she was appointed to the role of overseas champion about a year ago.

I congratulate the hon. Lady on securing this important debate and on her excellent and comprehensive speech. I agree that the international effort that we must be part of, and lead, is important, but it is vital that we lead by example. Yesterday in the Chamber, concern was expressed about the woefully low level of prosecutions for human trafficking, which affects many women and young girls, and about our country’s reluctance to take the lead on issuing a guardianship programme that would help us to secure those prosecutions. Does she have any thoughts about that?

The hon. Member is absolutely right to point to the guardianship programme as a concrete measure that we could take to show exactly that kind of international leadership. That would make a huge difference to some of the most vulnerable people coming into our communities. I very much support the proposal, and the work that she has been doing on it.

I was talking about the Minister’s role as the overseas champion, and I wonder if she can tell us what her priorities for that role will be over the coming year. Can she confirm whether she has a budget with which to carry out her responsibilities?

I am mindful that I have asked the Minister a number of questions, so I will wind up now. Making our schools safer for girls, enabling young men to challenge their peers, changing attitudes that blame women for violence and ensuring that the equalities team’s work is underscored by the policies of other Departments are all things that would make a genuine difference to the lives of women and girls here in Britain and around the world. The old adage that prevention is better than cure may well be familiar, but in this case it rings particularly true.

I genuinely congratulate the hon. Member for Brighton, Pavilion (Caroline Lucas) on securing this debate. The matter is a most important and serious one, both in this country and internationally, and I want to assure the hon. Lady that despite the very difficult times we are in, the Government are absolutely committed to nothing less than ending all forms of violence against women and girls. I, too, wish that it was not necessary to have such debates, but the statistics in this country are truly terrible, and across the world they are far worse. The issue is sometimes hidden, so there is a fear and a danger that it will be marginalised when priorities compete. However, as the first page of the action plan says,

“VAWG services should not be the easy cut”

for local councils.

I do not know how much more loud or clear we in central Government could have made our message. Even in this climate, we are ring-fencing £28 million for VAWG services and £10 million from the Ministry of Justice for rape crisis support centres. We are funding independent domestic violence adviser posts, including one in the hon. Lady’s home patch in Brighton and Hove. We are also funding Rise. Where we can provide funding, we are, although circumstances are difficult. We have done so expressly to send the message that violence against women is a priority and should not be vulnerable to cuts from local authorities, although we know that that is happening. Local areas are best placed to make local decisions, but we have tried and are trying to say to councils—I hope that they read today’s Hansard—“Do not cut these vital services.”

I will give way to the hon. Member for Lincoln (Karl MᶜCartney) and the hon. Member for Wells (Tessa Munt), but briefly, because I want to answer the questions asked by the hon. Member for Brighton, Pavilion.

I congratulate the hon. Member for Brighton, Pavilion on securing this debate and on how she delivered her speech. Is the Minister aware that of every three victims of partner abuse, two are female and one male? Is she concerned that successive Governments have placed all domestic abuse policy under an overarching violence against women and girls strategy? It means that men suffering domestic or sexual abuse are second-class victims. Effectively, it is an example of institutional sexism. Does she believe that domestic abuse must be—

I assure the hon. Gentleman that men are part of our strategy and funding. I will take a quick intervention from the hon. Member for Wells, but I want to answer the questions asked by the hon. Member for Brighton, Pavilion.

The problem is particularly acute in rural areas where there are serious stresses. I am in contact with the Farm Crisis Network, which is aware that people in isolated situations also face domestic violence, and there is practically no possibility that they can get to a rape crisis centre, which might be 25 miles away. Does the Minister have any thoughts on that?

I thank the hon. Lady for making that point.

I agree with the hon. Member for Brighton, Pavilion that prevention, which is one of the four key planks of our strategy, is extremely important. I assure her that my Department and I will bring as much pressure to bear as possible in discussions for the Department for Education to get a shift on with its consultation on personal, social and health education, which just finished and will be published in November. We regard it as vital, although we do not necessarily regard it as vital that it be statutory. We await the results of the consultation. I agree that young people’s attitudes and behaviour are vital, and that teachers need training in order to intervene successfully.

I am not taking any more interventions.

The hon. Member for Brighton, Pavilion mentioned the teenage relationship abuse campaign. It is one area on which we are spending money. The NSPCC research that she discussed is shocking. The abuse that teenagers seem to accept as normal—they think that it is okay to be treated like that—is the most frightening aspect. I do not know whether she has seen the films from the abuse campaign, but they are incredibly powerful and successful. The site has received more than 75,000 visits. It is not just about the film and the campaign; the purpose is to signpost young people towards help.

I will not. I am keen to answer the hon. Lady’s points, as it is her debate.

The hon. Lady asked me about my role of international champion in tackling violence against women and girls. The other half of that is policy coherence across Whitehall; it is in the job title. I assure her that when I came into the post in December, the first thing that I did was engage across Whitehall. Clearly, I will not be effective on my own in tackling worldwide violence against women and girls, unless I find a multiplier for the work that I am doing. I have done so, and have developed numerous messages on women and on lesbian, gay, bisexual and transgender issues. Travelling Ministers have agreed to take those messages to international meetings and raise them wherever they go. The issue at the moment is finding out who is going where and when, but it is an important step. I reassure the hon. Lady that I have nothing but support from the Foreign Secretary and the Secretary of State for International Development. They are absolutely committed to the human rights agenda, and I argue that equal rights are human rights.

While we are on the role of the overseas champion, will the Minister clarify whether she has a budget for any part of that work?

I do, and a little bit of help, although not as much as I would like. I have been to India and Nepal. I am working at three levels on such trips. I cannot go gallivanting across the world; I have a limited budget, and it is a matter of where I can get maximum traction on the issue. For example, in India, I met with the India Women’s Press Corps, which carried messages about gender-based violence across India and into every publication. I am trying to maximise bang for buck. I am meeting at the ministerial and permanent secretary level as well as in civil society. I am also visiting projects involving women in rural villages. I am going to Brussels on Tuesday to carry some of those issues forward, including LGBT issues. My eyes are on Afghanistan at the moment, as well as on the Arab spring, which I want to be a feminist summer, as I am sure the hon. Lady does.

The hon. Lady asked about immigration changes. No one with a minor conviction has been or will ever be denied their stay in this country, but neither do the Government think that it is right for different rules to apply if there is a conviction. On legal aid, we are keeping legal aid for victims in private family law cases where domestic violence is a feature, and we have not sought to change the accepted definition of domestic violence. We are including all forms of domestic violence, physical and mental, in legal aid criteria.

The hon. Lady mentioned forced marriage, which has been in the news recently. The Prime Minister has made it a priority, and we will consult on whether it should become a criminal offence in its own right. I am keen that we take evidence, for example from the women involved in the 257 forced marriage protection orders taken out under civil orders. We should ask those women whether they would have come forward had forced marriage been a criminal offence. In my view, the only reason not to make it an offence is that doing so might prohibit people from coming forward, which would undermine the benefits of sending a message that it is serious enough to be criminal.

I cite the issue of female genital mutilation, which is a criminal offence. The Opposition ask me every time we have oral questions whether there have been any prosecutions. There have not, either under the Labour Government or during the year and a half that we have been in government, because it is difficult to get evidence and make people come forward. I am keen that whatever we do should promote the best result in dealing with forced marriage. We know that there is great pressure, and the law may well change. The Prime Minister has announced that we will criminalise breaches of civil orders in the interim while we consult on the matter. However, I am not keen on messages; I am keen on getting it right. That is more important.

We as a Government have moved forward proactively. We have introduced domestic homicide reviews and pilots on domestic violence protection orders. If they prove successful, we will roll them out. We have extended the Sojourner project and will find a long-term solution. We are fast-tracking asylum applications for those in refuges who, due to their asylum status, have no recourse to public funds. I hope that hon. Members agree that we are on the right path to making society a better and safer place where women and girls do not have to live in fear of violence or lack support when they need it. These are tough times, but we are doing our very best.

Commonwealth Partners (Resources and Co-operation)

It is a pleasure to serve under your chairmanship, Mr Robertson. The subject of this debate is sharing resources and co-operation with Commonwealth partners, which I feel passionate about. I do not think that, in recent years, this country has necessarily put the sort of emphasis that we should have on our relationship with our Commonwealth partners, so I would like a response from the Minister.

It is important to recognise what the Commonwealth is and the important role that it plays around the world, especially in our own country. It is made up of 54 sovereign nations and contains 31% of the global population—about 2 billion people—more than half of whom are 25 or under, so the Commonwealth and its population really are the future. It contains the world’s largest, smallest, richest and poorest countries, and its members span six continents and oceans, from Africa, Asia, the Americas and, of course, Europe. There are 44 Commonwealth countries in the G77, which will be an increasingly important body, and five in the G20—Australia, Canada, India, South Africa and the United Kingdom. Nineteen of the 39 African Union members are from the Commonwealth. Similarly, 10 nations in the Pacific Islands Forum are Commonwealth nations. Indeed, even two countries in the European Union—Malta and ourselves—are members of the Commonwealth.

The Commonwealth is also a massive trade body, with $3 trillion of trade taking place within it each year. We hear a lot about our trading relationship within Europe, but considering the fact that the Commonwealth includes economies such as India’s, it is clear that the possibilities for trade growth within the Commonwealth are massive.

Commonwealth countries comprise a third of the destinations for our exports. When both trading partners are Commonwealth members, the value of trade is likely to be a third to half more than when one or both are non-Commonwealth. Indeed, five of the top 10 countries in which to do business are Commonwealth countries. As a body, the Commonwealth might be rooted in history, but its best potential lies in the future.

Don McKinnon, a former Secretary-General of the Commonwealth, has said:

“One of the standard misconceptions about the Commonwealth is that it is merely a ‘relic of the Empire’... The truth is that the Commonwealth is a unique organization, which provides an international forum where each member country can have its voice heard and increase its weight in world affairs. It is a family of nations, whose members share not only a common identity, but common values and a common sense of purpose.”

I would argue that it also shares a common future.

The Commonwealth has shifting focuses—from foreign affairs, particularly the promotion of democracy and human rights, to science and technology, and the role of women, which has been its focus this year—and it plays a vital role in education. I know from my former profession as a teacher that Commonwealth teachers and students are involved in strong education programmes and links. It is to be regretted, however, that Commonwealth citizens who come to this country are forced to pay fees to study in UK universities that European Union citizens do not.

We get all that from the Commonwealth for just 20p per citizen a year, as opposed to the £54 a year it costs us to be a member of the European Union. I promise to move on from the EU, but there has been a perception in recent years—this was certainly the perception in many of our Commonwealth partner nations—that when we joined the EU, we in some ways turned our back on the Commonwealth. I pay tribute to the Government, particularly the Foreign Secretary, who in recent months has made it clear that the Commonwealth is very much a part, and an increasingly important one, of our foreign policy as we progress. That should not be viewed as an EU-versus-Commonwealth argument, but it is clear that, when we entered the EU, there was a perception that in some way we left behind the Commonwealth. I have my own view on the EU, but we need not get into that today.

The Commonwealth has a huge role to play in aid and development overseas. Although that is not strictly part of the Minister’s portfolio, it is important that we refresh ourselves with some of the relevant statistics. India provides about £7 million a year to 19 African members. Indeed, Australia has recently increased its commitment to Commonwealth countries in Africa, which is something to which the UK Government are also committed.

I mentioned trade briefly in my introductory remarks. The Commonwealth is an incredibly important player in trade internationally. It is important that we as a Government demonstrate that, while our trading relationship with the EU is important, there are huge opportunities available to us in the Commonwealth, which is, in itself, collectively responsible for more than 20% of world trade, about 20% of investment, and approximately 20% of the world’s gross domestic product. Between them, Commonwealth nations imported some $2.3 trillion-worth of goods and exported $2.1 trillion-worth in 2008 alone. We should promote intra-Commonwealth trade and ensure that the Commonwealth plays a key role in new international markets, particularly considering the emergence of economies in Asia, Africa and Latin America. India will be an economic and democratic powerhouse. It is in the Commonwealth, so we have links and relationships, and could be making so much more of them.

Turning to the Minister’s responsibilities, the greatest potential for growth might lie in foreign policy and the Commonwealth’s soft power. I hope to hear from him what the UK’s vision is for the Commonwealth and any common foreign policy aims. I suppose that the advantage of a common foreign policy agenda in the Commonwealth is that that does not come through diktat, as might be true of other organisations. It is about coming together and sharing broad aims and principles, and working towards them. Moreover, there is no infringement on any nation’s sovereignty.

I and many others have said that the Commonwealth embodies the diversity of race, ethnicity, religion, political institutions and liberalism that characterises the reality of globalisation. Opportunities are available. By working together, we could have a major impact on international affairs and developmental issues in particular, which is something to which the Commonwealth Heads of Government meeting reaffirmed its commitment.

I want to press the Minister on the Government’s vision for the future of the Commonwealth. I have mentioned sharing resources. Discussions have taken place between other Commonwealth countries—perhaps we have been involved in some of them—about this country’s massive network of overseas missions and foreign embassies. The UK alone has, I think, more than 300 foreign missions. Canada, which is a country with which I am acquainted, has more than 260. That massive international Commonwealth network offers us huge potential, particularly at a time of fiscal restraint, when we are making tough decisions about our overseas missions. In this country, we do not necessarily always get the sense of the importance of the Commonwealth that we get when we visit other Commonwealth countries. A Canadian passport states, as clear as day, that if the passport holder needs help overseas they should head to a Canadian embassy or, if none exists, to a British embassy. There is the potential for us to share some of our resources for foreign missions with like-minded nations that are also making tough fiscal decisions.

I congratulate my hon. Friend and near geographical neighbour on the subject of his debate. He has touched on a few Commonwealth issues that have chimed with me. For example, he just mentioned passports. Through my role with the Sir Keith Park memorial campaign, I am aware that many people from New Zealand, South Africa and other countries that are part of the Commonwealth and that helped us during the second world war—such countries feel an affinity to our nation—think that the changes made to visa rules in recent years under the previous Labour Government have not treated them very well. Obviously, I hope he agrees that it is time to put back what they have given us over the years and to treat them in the way that fellow Commonwealth members should be treated.

I thank my hon. Friend and next-door-but-one or two neighbour—anyway, he is a fellow Lincolnshire Member—for that intervention.

When I return to the United Kingdom, I am offended that people are pushed along through the European Union channel. Latvians, Lithuanians, Poles, Germans and French people are able to walk through those channels, but our own brethren from Canada, Australia and other Commonwealth countries are made to feel very much like foreigners. Of course, Commonwealth citizens are not foreigners when they come to this country, nor are we foreigners when we visit Commonwealth countries. That is not something I was going to raise with the Minister, but it is a good point that I hope will be heard by the Foreign and Commonwealth Office, and as my hon. Friend says, it is about time that we treated those fellow Commonwealth citizens with dignity and respect. We should at least put them on an equal footing with other citizens.

I thank my hon. Friend for securing this important debate. We have mentioned the point about passport control. Is it not also right that, with the Queen’s forthcoming diamond jubilee, this is the perfect opportunity for us to reassert our relationship with Commonwealth countries, particularly in terms of economic resources and co-operation?

I thank my hon. Friend for that intervention. The diamond jubilee next year is an absolutely fantastic opportunity for us to show that.

The Commonwealth is rooted in history, but it is also about the future. Let us consider the statistics on the percentage of the world’s population, particularly young people, and on international trade, investment and where those emerging markets are. Let us park what is happening in the eurozone and the collapse of European economies and look to where the future is. The future is in those markets and in those regions of the world where the Commonwealth has links, both historical and actual, that no other organisation or international body has, with the possible exception of the United Nations, although that is variable. There is a chance for the Government to restate their absolute commitment to the Commonwealth.

In the two or three minutes remaining, I shall put my questions to the Minister. I apologise for not being able to send him my questions in advance, but I ended up putting this information together at a late stage because of various clashes. What is the Government’s vision for the Commonwealth? What progress has been made on the Foreign Secretary’s 2010 statement that the FCO would

“lead a co-ordinated cross Whitehall approach to help the Commonwealth achieve its potential and which underlines the United Kingdom’s commitment to this unique global organisation”?

I would like to get a sense from the Government of what areas of policy co-operation they feel could best help to promote the values of the Commonwealth and those elements of economic development and trade that are so important. Given the fiscal pressures on the United Kingdom and other countries, has the FCO yet considered sharing foreign missions and other resources internationally with our Commonwealth partners? The research paper “UK Defence and Security Policy: A New Approach?”, published in January, contains the following Government quote:

“We want to strengthen the Commonwealth as a focus for promoting democratic values and development”.

We would all agree with that and I hope to hear the Minister’s view on achieving it.

As my hon. Friends said in their interventions, there is the potential for the Commonwealth to move forward and be one of the most important bodies internationally during the next few decades, particularly given the development taking place there. While bearing in mind the United Kingdom’s relationship with Europe, its transatlantic relationships and so on, we need to ensure that at the heart of policy making is a commitment to working to improve and further develop Commonwealth relationships. The previous Government did not seem to pay much attention to the Commonwealth—the fact that no Opposition Members are here perhaps suggests that that is still the case—but this Government think differently. I hope that the Minister will take on board some of my points. I look forward to his response.

I congratulate my hon. Friend the Member for Brigg and Goole (Andrew Percy) on securing the opportunity to discuss this issue and pay tribute to him for his excellent speech. I will do my best to answer the questions that he posed. I am also grateful to my hon. Friends the Members for Erewash (Jessica Lee) and for Lincoln (Karl MᶜCartney) for their interventions. The debate has shown that there is a great deal of support and interest in the Commonwealth in Parliament.

It is important to note that enduring historical links form the basis of the strong bonds that join Commonwealth countries together and that, even though those historical links have roots in the 19th century, they form one of the platforms that is most suited to the world of the 21st century. As my hon. Friend the Member for Brigg and Goole pointed out, the UK has upgraded its relationship with the Commonwealth substantially. Under this Government, we now have a Minister for the Commonwealth, who has firmly put the “C” back into the FCO. I thank my hon. Friend for the praise that he gave to my right hon. Friend the Foreign Secretary; he feels equally strongly about the matter.

We are working with member states to help the organisation to realise its full potential to become a stronger force for promoting democratic values, development and prosperity, and trade. Before I comment on the specific issues raised, let me put the Government’s relations with the Commonwealth into context. We look to the Commonwealth as a key multilateral organisation, a ready-made network and an ideal platform for future co-operation in a rapidly changing global landscape. As the Prime Minister has said, Britain’s active membership of the Commonwealth is at the heart of our foreign policy. It is in the UK’s interests to be part of a strengthened Commonwealth, as it has a membership that includes many of the fastest growing and most technologically advanced economies in the world.

The Commonwealth already contributes significantly to international affairs, brokering agreements between African neighbours and calming tensions in fragile states during contested elections. It also provides a forum for smaller nations who may feel that their voices are lost in larger multilateral structures. I particularly point out the Commonwealth’s role in providing election monitors. So far this year, it has done so in Nigeria, Zambia and, indeed, will do so in the forthcoming elections in Cameroon. Commonwealth observers have been very much part of different observer and monitoring teams in those countries. They are respected and are acceptable to host countries. The Commonwealth is made up not just of the Governments of its member states, but of a multitude of non-governmental and civil society organisations and networks, which contribute, as the secretary-general of the organisation said,

“to the great global good”.

Turning to the issues discussed today, we enjoy a long history of mutual support among Commonwealth countries. On the consular side, which my hon. Friend mentioned, during the Libya crisis, in the space of a few days, the UK evacuated more than 800 UK nationals and more than 1,000 other nationals from more than 50 countries, many of which were Commonwealth countries.

During normal times, Commonwealth nationals in difficulty in non-Commonwealth countries where they do not have any diplomatic or consular representation of their own may turn to any other Commonwealth embassy for consular assistance. So where a Commonwealth national does not have representation in a non-Commonwealth country, our embassies may provide first response assistance. Once British consular staff have provided initial assistance by contacting someone who is detained or hospitalised, they will look to hand over responsibility to the individual’s nearest embassy to provide support. With some countries, notably Australia, those informal arrangements bring significant benefits to British nationals, particularly in the Pacific region where Australia’s diplomatic network is extensive.

When a country has been suspended from the Councils of the Commonwealth, we may still be able to provide consular assistance to its citizens. That is particularly so if the suspension was not aimed at ordinary citizens of the country. I refer particularly to Zimbabwe, which left the Commonwealth before it was suspended, where our dispute was not with the country’s citizens, but with the people running the country.

Let me make it clear that the UK can take no responsibility for other Commonwealth citizens in Commonwealth countries. In those circumstances, unrepresented Commonwealth citizens can turn to the host Commonwealth Government for assistance. We would expect the Commonwealth country concerned to make other arrangements if the host Government do not accept their responsibility towards unrepresented Commonwealth nationals.

On visas, under an unwritten convention agreed at a previous Commonwealth Heads of Government meeting, UK visa issuing posts in non-Commonwealth countries issue visas on behalf of Commonwealth countries. That is obviously good news. The convention does not apply where a Commonwealth country either has a visa issuing mission established in that country, or has special arrangements. Commonwealth partners for whom the UK issues visas vary from post to post and that reflects demand. For example, India is one of the biggest beneficiaries of that service, with more than 100 UK posts issuing visas on its behalf.

I take on board what my hon. Friend said about immigration controls and ports of entry. In some ways, it irks all of us that we do not even have a UK channel coming into our own country; it is an EU channel. People have asked me whether it would be better to have a channel for citizens of countries where the Queen is head of state, which would include the overseas territories, the realms and a number of Commonwealth countries. That is not just in the hands of the Foreign Office, but my hon. Friend has made his point, and we will take it on board and look at it.

Our embassies and our representation abroad are very important. I will just correct my hon. Friend on one point. We have 192 missions around the world. I wish we did have the number that he gave. The Government have extended the network—in fact, we have opened new embassies; the previous Government closed embassies—in Africa in particular. We are reopening our embassy in Madagascar. We are reopening our embassy in Abidjan. We will reopen our embassy in Somalia as soon as the security situation allows, and we have opened a new embassy in Juba, in South Sudan, a country that has applied for membership of the Commonwealth. We are reinforcing a number of our missions in African countries that are Commonwealth countries. I am sure that my hon. Friend approves of that.

In seeking to manage the Foreign and Commonwealth Office overseas estate and to deliver the best possible value for money, the Government always consider whether there is a sound business case for co-location. That might be as part of a drive towards closer working relations between the FCO and other Government Departments that are represented overseas—for example, operating from the same platform and sharing common services. We already look at co-locating with other countries’ representations, including those from various Commonwealth countries. In every case, our approach is the same: to ensure that we achieve the best possible combination of operational capability, value for money, and the safety and security of those working for the British Government overseas.

I assure my hon. Friend that very often we look to Commonwealth countries to form such a partnership. We are building partnerships with our Commonwealth partners on this issue where it makes sense for us to do so. For example, our high commission in Bamako is co-located with the Canadian representation, and we also sub-let space to the Canadians in Baghdad. We allow New Zealand to share our embassy facilities in Kabul. We are actively exploring other opportunities that may make a sound business case and offer value for money for Her Majesty’s Government.

The UK also shares embassy facilities with non-Commonwealth partners where it meets our requirements. Some of these partnerships include co-locating embassies with other countries. For example, when I was in Tanzania, I went to Dar es Salaam, where our high commission sub-lets space to the Dutch and the Germans. That makes sense, and there is absolutely no reason at all, where we build a new high commission or new embassy, not to sub-let space to our Commonwealth friends. In fact, I can think of one African country where we are looking at a new build and are actively discussing that option with a number of our key Commonwealth partners. I assure my hon. Friend that we are very much on the case.

I would like to say something about the Commonwealth Heads of Government meeting, and hope that this part of the speech will also answer some of the questions posed by my hon. Friend. I would like to conclude by informing the House of the UK’s aims for the CHOGM in Perth later this month. At this meeting, Heads will have a chance to consider the recommendations of the Eminent Persons Group, to examine the findings of the Commonwealth Ministerial Action Group review, and to discuss some of the complex global challenges that we all face. I pay tribute to the work done by the EPG. My right hon. and learned Friend the Member for Kensington (Sir Malcolm Rifkind) serves on that group in a very distinguished capacity. The group’s report is excellent and I commend it to my hon. Friend.

The EPG’s recommendations, and those set out in the CMAG review, answer some of the points that my hon. Friend mentioned with regard to his vision of a common Commonwealth foreign policy. I do not think that we will go quite as far as he would like to go, but there are a number of suggestions in those two reports that would certainly please him and which we can regard as very positive. The EPG report also contains important recommendations on modernisation and we strongly support that part of its work. Its emphasis on democracy, development and good governance in the Commonwealth will help to strengthen the organisation and focus its work on those core values, particularly where it can really make a difference. It offers an important opportunity to shape the future role of the Commonwealth, a role that will have more impact on our networked world.

We want a strengthened Commonwealth Ministerial Action Group that protects our values, but also offers encouragement to those facing challenges to democratic development. The Commonwealth is ideally placed to tackle the global issues facing us today, not least in the current economic downturn. As my hon. Friend pointed out, the membership includes many of the great markets of today and tomorrow. The middle class in the Commonwealth has expanded by nearly 1 billion in the past 20 years, and over $3 trillion worth of trade happens every year in the Commonwealth. Its importance in the world trading community is huge; it is vital to the recovery that western economies are going to make, largely through an export-led drive. We want the Commonwealth to lift the prosperity of all its members through increased free and fair trade. More democracy means greater confidence in investment conditions and in creating the environment for business to flourish, leading to more jobs and greater prosperity.

As I said in my speech to the Royal Commonwealth Society last month, the Commonwealth can also play a helpful role in tackling climate change. The diversity of our economies means that we hold a wide pool of solutions, from governance structures to policies. A united position on climate change at CHOGM would send a strong signal to the international community ahead of the UN climate conference in Durban in November.

On the drive to secure a binding world deal on climate change, most of the countries at the ambitious end of the spectrum are Commonwealth countries. COP 17 in Durban is the African Conference of the Parties. I have been impressed by the extent to which a number of key Commonwealth partners have really engaged with this agenda, not just looking to support the UK’s ambitions for a binding global treaty, but looking at some other areas of crucial importance such as mitigation and adaptation, the forestry agenda and the crucial boost we need to give to renewable technology and renewable transmission. As we push hard the agenda of low carbon and high growth, that has a resonance in a lot of Commonwealth countries. They see that they can bypass the stage from early development, miss out on some of the polluting, high-emitting technologies that we have in the west and go straight to the more environmentally friendly green technologies, not just for their power solutions but for many of their other requirements. That is an exciting agenda and we have the support of those countries.

In conclusion, the UK Government are committed to reinvigorating the Commonwealth. We want to strengthen it as a focus for development, democracy and prosperity. My hon. Friend said that he was going to put the “C” back into the FCO. This is work in progress, but we are absolutely determined to keep up the pressure. I am grateful to him, because it is knowledge and expertise from parliamentarians such as him that will help us with that agenda.

Question put and agreed to.

Sitting adjourned.