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Westminster Hall

Volume 536: debated on Tuesday 29 November 2011

Westminster Hall

Tuesday 29 November 2011

[Mr Lee Scott in the Chair]


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

Good morning, Mr Scott. It is a pleasure to serve under your chairmanship.

I am very pleased to have secured this debate. To be honest, it is so long since I began trying to secure it that I cannot entirely remember all the motivations for doing so. Recently I have had two different groups claiming ownership of the idea for it, and I am quite happy to accept that they are both right. I do not regard myself as an expert on epilepsy and I am not particularly motivated by self-interest or by the experience of relatives or close friends. Like many other MPs, I am motivated by constituents who have come to me to talk about their own experiences of epilepsy and by the interest of the various groups and charities that set out to help people with epilepsy. Consequently, any mistakes and omissions in my contribution this morning are entirely my fault, but I am extremely grateful to various groups for the facts in my speech and the good advice that I have received. They include Epilepsy Action, the Joint Epilepsy Council, Epilepsy Bereaved, the National Centre for Young People With Epilepsy, which is now called Young Epilepsy, and of course the all-party group on epilepsy—whose secretary in 2007 was, I note, the MP for Witney, who is now the Prime Minister.

Like my hon. Friend, I have a number of constituents who are affected by epilepsy. The Dattani family lost their son, Ravin, in February because of epilepsy, and with the help of others, in particular the local newspaper, the Coventry Telegraph, they have raised about £19,000. They point out that epilepsy causes more than 500 deaths each year in the UK, and one of the issues they have raised in correspondence with me is that often parents do not know the right questions to ask a doctor. That view is reflected in other correspondence that I have received on this subject, and it is a point that we should look into. In addition, the majority of people do not realise that epilepsy can end in death. Will my hon. Friend congratulate the Dattani family on their efforts to do something about epilepsy after the loss of their son, and particularly on raising about £19,000 with the help of our local newspaper?

I certainly congratulate the family on that fundraising, and the point about lack of information on epilepsy is crucial. The full title of the debate is “Prevention of avoidable deaths from epilepsy”, but given the nature of the subject I may occasionally stray into more general territory; I hope that you will forgive me for doing so, Mr Scott.

Epilepsy is defined as a tendency to have recurrent seizures, when a sudden burst of excess electrical activity in the brain causes a temporary disruption in the normal message-passing between brain cells. Epilepsy is not one condition but a composite of about 40 different types of seizures and up to 50 different syndromes. It affects about 600,000 people in the UK, which is one in every 103 people or about 930 people in each parliamentary constituency. It is estimated that about 69,000 people with epilepsy could have their seizures controlled with good treatment; about 74,000 people are taking aggressive drugs unnecessarily, because of misdiagnosis; a quarter of people who are known to learning disability services have epilepsy; half of the 60,000 young people with epilepsy are estimated to be underachieving academically relative to their intellectual capacity; and people with epilepsy have been shown to be twice as likely as those without epilepsy to be at risk of being unemployed.

Some studies suggest that the likelihood of early death in people with epilepsy is two or three times higher than in people without epilepsy. As my hon. Friend the Member for Coventry South (Mr Cunningham) indicated, the biggest risk appears to be poor seizure control, with the risk of early death increasing as the number of seizures that an individual suffers increases. A phenomenon that people are now starting to come to terms with is sudden unexpected death in epilepsy, or SUDEP. I understand that in 2009 about 1,150 people in the UK died of epilepsy-related causes. That means that, each day in the UK, approximately three people with epilepsy die, and at least a third of those deaths—one death each day—are potentially avoidable.

I am very grateful to Lucy Kinton, a consultant neurologist at Basingstoke and North Hampshire NHS Foundation Trust, who says that there is not enough research into SUDEP, which frequently affects young people who otherwise could be expected to have a fairly normal life. Indeed, she points out that our investment in research into epilepsy is much lower than our investment in research into other frequently occurring conditions, such as diabetes.

As a child, I lived on what was called an epilepsy centre—my mother was the resident doctor there—in the middle of the countryside. Does my hon. Friend agree that although we have made huge progress since those days in terms of changing social attitudes and raising awareness, research into epilepsy is still very much underfunded? Is there not a huge need to make research into epilepsy an urgent priority, so that we can gain some of the knowledge that could prevent some of the future deaths from epilepsy?

I certainly agree that there have been considerable strides and we should not dismiss them, but there is an overwhelming need for further research and for improvements in specialist care and treatment. That is one of the points that I hope the Minister will comment on later this morning.

SUDEP accounts for nearly half of all epilepsy-related deaths. Research suggests that the seizure activity in the brain may sometimes cause changes in the person’s heartbeat or breathing, very occasionally causing the person to stop breathing completely. The single most important risk factor appears to be uncontrolled generalised tonic-clonic seizures, which, I understand, are the type of seizure that causes a person to lose consciousness, while their body becomes stiff and then starts to jerk. Such seizures can lead to sudden unexpected death.

It is estimated that there are about 500 cases of SUDEP every year, and a further 500 deaths every year due to other epilepsy-related causes. About 39% of adult deaths from epilepsy were considered to be potentially or probably avoidable. The main problems or deficiencies that cause these deaths include inadequate drug management; lack of appropriate investigations; inadequate recording of patients’ histories; adults with learning disabilities being lost in the transfer from child services to adult services; and one or more major clinical management errors being made. The absence of evidence of a package of care for those suffering from epilepsy is also a cause of rising concern. In primary care management, the main problems identified include sparse evidence of structured management plans, missed triggers for referral and professional communication failures.

For women with epilepsy, the risk of sudden death in pregnancy remains higher for those with other long-term conditions. The risk of maternal death is an estimated 10 times higher for women with epilepsy than for women in the general population. It is probably fair to say, however, that the risk is still low overall.

I am very grateful to Young Epilepsy, formerly known as the National Centre for Young People with Epilepsy, which works on behalf of about 112,000 children with epilepsy.

I congratulate the hon. Gentleman on bringing this matter to Westminster Hall for debate. I went to school with a young fellow who had epilepsy. I well recall how scary my first encounter with the condition was, because I did not know what was happening. Does the hon. Gentleman agree that there is a need for better awareness in schools? If there are pupils with epilepsy in a school, the school needs to know that, so that it can react in a positive way rather than with the fear that comes from not knowing how to deal with it.

Absolutely. Young Epilepsy is very effectively carrying out a pilot project, with more than 20 schools, to develop and test a model of best practice that can be replicated in any school. Although there might well be the usual problems of time and finance, I understand that the pilot is now at a stage where it could be rolled out across the country. That would go some way to addressing fellow pupils’ concerns and to preparing staff much better in what to do in particular situations. I am extremely grateful to Young Epilepsy for its work in that area.

The figures suggest that there has been a general increase in epilepsy, but that could be due to better diagnosis. There certainly seems to be a suggestion that greater attention to the recording and monitoring of people with the condition has been a factor, due to the GP outcomes framework and the introduction of the National Institute for Health and Clinical Excellence guidelines, and similar ones for Scotland. Misdiagnosis remains a significant problem: a rate of between 20% and 30% of people being misdiagnosed could equate to something like 138,000 people without the condition receiving anti-epilepsy drugs, at a cost of about £220 million a year.

There is evidence that epilepsy is more prevalent in the most socially deprived parts of the country than in the better-off ones. There is a particular problem, with which the Minister will be familiar, in the allocation of residential care for some people who suffer from epilepsy, with the local authority describing epilepsy as a health condition, but most other people saying that a combination of health and social factors are involved. A particular group to mention in that respect is prisoners. A number of studies have been done, not least by the all-party group, that show that the NICE guidelines are not followed in the vast majority of prisoner cases, and that there are problems with prisoners having access to the proper drugs and, significantly, with diagnosis. There also seems to be a problem with how some PCTs determine access to services, with some using referral and funding panels rather than relying solely on clinical judgment. I would have thought that that is not necessarily in people’s interests.

All of that leads to a picture of a treatment gap. About 70% of the population with epilepsy in this country could be seizure-free if they received optimal treatment, but only about 52% are seizure-free. Too few children are offered or referred early enough for surgery that could cure their epilepsy or at least significantly reduce seizures. I understand that there is a backlog of more than 2,000 children who could benefit from such surgery.

The Prime Minister himself has acknowledged that there is a need for improved services. More than 10 years have passed since the then chief medical officer, Sir Liam Donaldson, said in his annual report that epilepsy services suffered from a lack of interest compared with the management of other chronic conditions such as asthma. Although national initiatives such as the NICE guidelines and inclusion in the GP contract have raised awareness of epilepsy, and although there are patches of excellence across the country, overall service provision in most communities has not translated into sufficient effective interventions. One purpose of today’s debate is to ask the Minister to meet with some of the epilepsy organisations, particularly Epilepsy Bereaved, to discuss what else we can do to prevent avoidable deaths.

I do not want to take too long because I want to let other people speak, but I should mention that there are recurring stories about the deaths of young people. A young boy of nine who experienced frequent seizures had benefited from excellent care from his paediatricians, but he died following a transfer of care during an overnight stay in hospital when his history was not adequately updated. In another case, a young woman died suddenly in her sleep, leaving behind two sons. She had had infrequent seizures but had never been given adequate advice. Some five years ago, two famous cases, those of Erin Casey and Christina Ilia, led to a fatal accident inquiry in Scotland, with which the Minister might be familiar. In summarising, the sheriff was absolutely clear that the risk of sudden death might have been reduced by access to a night monitor or much better information about the particular risk at that point in the evening.

I will not dwell on the number of things we need to do. I take the view that there has been progress in our understanding of epilepsy and that there is probably less stigma attached to the condition these days. I think that the previous Government and the present one have made efforts to improve the quality of care, but we know that significant problems remain. We need to think about whether we can set up a dedicated research fund to look much more closely at epilepsy. General practice needs to be much clearer about risk management, about the potential benefits of technology—for example night monitors—and the need to flag up injuries, A and E visits and missed prescriptions. Good medicines management is needed because, as I said earlier, about 70% of people could be seizure-free if prescribed the right medicine. Much more active monitoring of epilepsy deaths is also needed, so that we know what is happening and can draw up plans to help people to manage the condition.

The depth of the subject tempts me speak for much longer, but as I said at the outset, my purpose is to flag up some of the central issues involved in avoidable deaths and the actions that could be taken to help people who suffer from epilepsy. I will allow sufficient time for other colleagues to contribute and for the Minister to reply to the debate.

Before I call the next speaker, let me say that I intend to start the winding-up speeches at approximately 10.40.

It is a pleasure to serve under your chairmanship, Mr Scott. I congratulate the hon. Member for Birmingham, Selly Oak (Steve McCabe) on securing this important debate.

I am epileptic. I have nocturnal epilepsy. I have tonic-clonic seizures, which, as the hon. Gentleman explained, are the severest form of epilepsy and the form that we all associate with the condition. I am, at least for another fortnight, between the ages of 20 and 35. I am single and, for the avoidance of doubt, I should make it clear that I sleep alone. I am also male, for the avoidance of any further doubt, and it might surprise people outside this Chamber to learn that I work long hours in a stressful occupation—at least I think it is stressful. I therefore tick every box for being at risk of sudden unexpected death due to epilepsy. I go to bed every night knowing that there is an infinitesimally small chance that I might not wake up again. That is, of course, a great concern.

I realise that anyone with epilepsy has a 24 times greater chance of sudden death than the normal population. Those particularly at risk of SUDEP are 23 times more likely again to experience sudden death. That understandably preys on the mind, but what concerns me more than anything else is the fact that I did not learn of all the risks at the time of my diagnosis; I discovered them because I happened to Google my condition. I sat at my computer with a chill going over me, thinking, “My goodness, I never knew any of this could possibly occur.”

I know that that is a wider concern from meeting many people, including a constituent of mine, Avril Walker, who lost her son Christopher to SUDEP when he was aged 19. I have also met many families through Epilepsy Bereaved and Jane Hanna. They all say the same: they have a sense of anguish at the loss of a loved one, which is natural and entirely understandable, but many of them have a much greater sense of frustration that at the time of diagnosis no one explained the risks of SUDEP to them. If they had known, they could at least have sought to undertake mitigating activities to reduce their risk.

I know what those activities can involve. Before my diagnosis, when my epilepsy was not controlled, I managed to throw myself down the stairs. I woke up with my head in a fridge, a washing machine and an oven, which thankfully was not turned on. I threw myself out of bed and hit my head on my bedside cabinet, making a large gash only just above my eye. When I went to accident and emergency, I was told, “Oh, you’ve just been drinking too much.” The irony, of course, is that the treatment for my epilepsy involves the avoidance of any alcohol. That is what makes it so difficult to control: if any alcohol is used in any food that I inadvertently eat, I will have a seizure in the night.

Thankfully, I adhere to my medicine. The diagnosis is so important because there is no greater impetus to adhere to medication than the knowledge of what might happen if one does not. The most sacrosanct thing in my life is ensuring that I have my medicine. I live what is essentially a double life—I am down here half the week and up in Blackpool the other half—so it can be quite difficult to ensure that I have the little packet of pills that I usually carry around with me. If I am without them, panic ensues and I have to rush down to the Victoria walk-in centre to get an extra prescription. May I complain to the Government about its being shut in a month’s time?

I am listening with great interest to the hon. Gentleman’s personal experience; our debates are always enhanced by such contributions. Does he think that there is any particular reason why doctors are unwilling to tell people diagnosed with epilepsy about the risk of sudden death?

I thank the hon. Lady for that pertinent intervention. I was intending to come to that. I think that all doctors dislike dispensing bad news. It is perhaps the least fulfilling part of the job. I am sure that some of the doctors to whom I have spoken think that the moment of diagnosis is not necessarily the appropriate moment for a detailed discussion starting, “Oh, and by the way, you’re 23 times more likely to die now, so you need to do this, this and this.” However, it underlines the importance of epilepsy specialist nurses, who can have a more structured conversation one or two weeks later, after people have got over the shock of the diagnosis.

The diagnosis is a shock. When I was diagnosed in my early 20s, I had no idea when I went to the doctor’s that morning that he would tell me that I had epilepsy. I was stunned by the news. That might not have been the most appropriate time to say, “And by the way, you’ve got all this to deal with as well.” None the less, it is vital that that structured conversation occurs at some point soon after diagnosis, because it is possible to do things to mitigate the condition, even if it is just blunting the sharp corners of one’s bedside cabinet, lowering the height of the bed or fitting a child gate above the stairs. If one knows what is likely to occur, one can at least try to mitigate it.

It also underlines the dramatic importance of adhering to medication. Many of the young people who are most susceptible live what one might call chaotic lives. They do not always pick up their medication. If they are away at university, they are not under parental control and one cannot monitor their medicinal intake precisely. If they are aware of the risks, a degree of self-discipline might be brought into play to ensure that they stick to their medication regime. I have heard time and again that sudden deaths seem to occur particularly in a university setting. That concerns me. Self-discipline is necessary as early as possible, and the diagnosis and explanation process are fundamental.

When the worst occurs—tragically, it will occur, because one can never iron out the risks entirely—a much better post-death process is needed. It is natural for the family to be shocked, particularly if they were not expecting it and had not been made aware of the risk factors. There is a lack of awareness in the coroner service and among the police. There can be nothing worse than finding one’s child’s bedroom turned into a crime scene because police are not aware of the potential for sudden death from epilepsy. All that could be much better handled with instructions from on high. The coroner service in particular needs to make a list of national charities dealing with sudden death to which families can turn for help. That would be of great assistance, because many people simply do not know where to turn.

I beg the Minister to encourage the medical profession to ensure that some medical professional has a conversation either at diagnosis, if they feel it appropriate, or within a fortnight or so, to explain the risks. That alone would make a difference, rather than a conspiracy of silence that leaves those with epilepsy to find out about it for themselves. If that conversation occurs, at least people can try to take the actions necessary to protect themselves. That would make the most difference.

It is a pleasure to serve under your chairmanship for the first time, Mr Scott. I warmly congratulate my hon. Friend the Member for Birmingham, Selly Oak (Steve McCabe) on obtaining this debate and on his splendid contribution, which covered the ground of all the campaigning groups working on behalf of those with epilepsy.

It is a great pleasure to follow the most important and worthwhile speech that will have been made in the House today, whatever happens in the Chamber. It is enriching for us to have the hon. Member for Blackpool North and Cleveleys (Paul Maynard) in Parliament. We are not members of the same party, but I will happily embrace him as a friend and call him such. Hearing at first hand from those who suffer from illnesses or disabilities is of enormous value to us. There is nothing better than to hear from the hon. Gentleman about the simple changes that might be necessary, such as blunting sharp corners and taking simple precautions, to avoid the tragedies that occur all the time. I welcome his presence in the House. If this House is to restore our greatly damaged reputation—it is of profound importance to us all that we win back the trust and confidence of this country—we need more Members such as the hon. Gentleman with experience that can give us diversity. The House must become more representative of the nation in every way.

My reason for speaking in this debate relates to a matter involving two constituents and lifelong friends of mine, Gwyn and Gill Thomas. I knew one of their daughters, Rhian, throughout her brief, radiant life. Her parents were devoted to her. On a visit to Florida, the place where Rhian was happiest, she died suddenly during the night. There was no warning or expectation, and Gwyn and Gill were left shocked, as would we all at the untimely death of one of our children, and bewildered by what had happened. As in many cases when a family experiences terrible grief, they have become enthusiastic campaigners to ensure that no one else suffers in the same way as they have suffered. They wish to avoid this being repeated in other families—a strong and understandable reaction. My hon. Friend the Member for Birmingham, Selly Oak has mentioned the concerns, and I have heard about them first-hand in the House from other parents who have lost young people in similar circumstances.

Channel 4 covered the case of the Casey and Ilia fatalities, which involved two families who suffered in a similar way. Erin Casey was aged 19 and Christina Ilia was aged 15—one a university student and the other a schoolgirl. The sheriff concluded that, had Erin been told of the risk of sudden unexpected death in epilepsy, she might have picked up her prescriptions and complied more with her medication—she might not have died. Had there been supervision in the form of nocturnal devices, which have been discussed, Erin might have wanted them and might not have died. On the death of Christina, the sheriff found that, had she and her parents been told of the risk, they would have discussed and considered the possibility of providing night supervision, possibly by use of alarm. If Christina had had such supervision, she might not have died during the night. The judge recommended that there should be a discussion of SUDEP in order to reduce the risk at diagnosis, unless there was serious harm to the patient. The timing of the discussion should be deferred, but needs to be planned. The role of a specialist epilepsy nurse is vital, and the failure of the authority to provide a specialist nurse service was viewed as contributing to the death. Those points were well made in the television programme and must be of concern to us all.

My hon. Friend has given a list of the possible remedies—drugs and how they should be used, and the existing advice—that appear to be available. Part of my constituents’ additional agony as a result of their bereavement is that they were not informed of many of the things that they have heard about since Rhian’s death. They want to go out and make sure that everyone else is aware of the possible remedies that could avoid such tragedies in the future. As with many other subjects discussed in the House, my views on this issue are the result of constituents’ problems. I thank the persistence of the campaigning of my constituents and all others who are determined that everything possible is done to avoid these unnecessary deaths.

It is a pleasure to serve under your chairmanship for the first time, Mr Scott. I congratulate my hon. Friend the Member for Birmingham, Selly Oak (Steve McCabe) on securing this debate and on the work that he and the all-party group on epilepsy are doing to spread awareness in Parliament of the nature of epilepsy and to raise the profile of epilepsy and its related problems.

As we have heard, epilepsy currently affects almost 500,000 people in the UK. It is one of those conditions that, I think, excite a certain fear among people who are not familiar with it. One of the important aspects of the all-party group’s work is to get past that fear barrier, so that people understand and the climate is created in which services can be commissioned properly.

We have heard about the danger of sudden unexpected death in epilepsy and that it affects the younger age demographic in particular. I understand that an information resource has been issued in Wales and Scotland on the risks and prevention of SUDEP. Is such a resource currently available in England?

Certain factors can increase the risk of SUDEP, and hon. Members have referred to them, drawing on their personal experience. The total number of people dying needlessly of epilepsy each and every year is more than the total of AIDS-related deaths and cot deaths combined, yet for some reason SUDEP deaths have never had the same prominence in the public imagination and public debate as issues such as cot death and AIDS. It is also most unfortunate that the death rate in Britain for SUDEP is 25% higher than the average for the European Union. This is a difficult topic and I understand that doctors may have a certain reticence about discussing the risk with young people at the point of diagnosis, but if our death rate is 25% higher than that of the EU, it shows that more can be done.

A straightforward and important suggestion has been made that medical practitioners should be required to have that discussion with people soon after diagnosis. As we have heard, it is young people between the ages of 16 and 35 who are at greatest risk. That is the age, certainly if my life between 16 and 35 is any example, at which people are least inclined to listen, behave sensibly or take advice. That makes it doubly important that there is a formal requirement for a medical practitioner to sit with young people and explain exactly what the risks are.

In preparing for this debate, I looked at the National Institute for Health and Clinical Excellence guidelines on epilepsy. They recommend that all people with suspected epilepsy should be seen by a specialist, but I understand that half of acute trusts—49%—do not employ one. NICE guidelines also state that people with suspected epilepsy should be seen urgently within two weeks, but I understand that the waiting lists of most trusts—more than 90%—are longer than that. Will the Minister comment on what action his Department is taking to ensure that people diagnosed with epilepsy are seen more promptly in the future?

A further recommendation from NICE relates to epilepsy specialist nurses. NICE guidelines state that they should be an integral part of the medical team providing care to people with epilepsy, but more than half of acute trusts and PCTs in England do not have one. How will the Minister ensure that trusts in England and, of course, clinical commissioning groups use NICE guidelines to plan and commission epilepsy services? Will the Department of Health agree to treat the matter as a priority and put an end to the current situation, where people with epilepsy continue not only to have a poorer quality of life, but to face a greater risk of dying? As I have said, there is a 25% higher death rate here than in the rest of the European Union.

We know and respect the fact that the Prime Minister has personally pledged to raise the profile of epilepsy and to tackle the stigma that surrounds the condition, to which I referred earlier. I understand that the Prime Minister has met my hon. Friend the Member for Walsall South (Valerie Vaz) to discuss her ten-minute rule Bill on epilepsy. We know from the Epilepsy Society that, during the meeting, the Prime Minister agreed to consider the Bill and look at improving health and education services for people with the condition. In a letter to Lord Howe dated 16 May 2011, the Prime Minister acknowledged that

“there are historic weaknesses in the commissioning of services”

and that there is an urgency for change

“because these failures carry huge costs as well as having a massive impact on the lives of people with epilepsy”.

The Prime Minister concluded that there are

“potentially very significant savings from unplanned emergency admissions to be made by getting this right, which goes hand-in-hand with improvements in outcomes, including life expectancy and a reduction in the number of tragic sudden deaths in epilepsy”.

Labour Members respect the Prime Minister’s genuine concern about this condition, but I think the Minister would agree that we need to move on to action. The Epilepsy Society was very encouraged by what the Prime Minister had to say. He said that he would get back to Epilepsy Action but, to this day, he has not made any specific commitments. Does the Minister know whether the Prime Minister has had a chance to consider the points put to him by my hon. Friend the Member for Walsall South, representatives of the Joint Epilepsy Council and the hon. Member for South Thanet (Laura Sandys), who chairs the all-party group on epilepsy?

The Minister will also be aware that, during the last year of the Labour Government, the Joint Epilepsy Council won the support of the then Health Minister, Ann Keen, who so recently suffered a sad bereavement. She initiated a conference of epilepsy commissioners, which took place in January 2010. That was branded as jointly organised by the Department of Health and the Joint Epilepsy Council—a true partnership. Will the Minister tell hon. Members what discussions he and his colleagues have had with stakeholders and whether he is working with the Joint Epilepsy Council to address the shortfalls in service provision for people with epilepsy in England?

As I am sure that the Minister is aware, Epilepsy Action has carried out a study that revealed the variations in service provision, data collection, evaluation and quality of care. In the course of its study, it became apparent how many of NICE’s recommendations are still not being met, particularly in terms of access to specialist consultants and nurses, as I said earlier. Taken together, the facts from the survey do not paint a picture that is wholly encouraging. Some epilepsy sufferers and their families feel that it is a forgotten condition, which is why this debate is so important.

As the Minister will be aware, Epilepsy Action has called on the Government to take a lead in driving improvements to epilepsy service provision. Among other things, Epilepsy Action is calling for a national clinical director for epilepsy to ensure that local commissioners carry out a review of the implementation of the NICE guidelines, NHS work force planning to focus on the recruitment and training of sufficient epilepsy specialist consultants and nurses, commissioners to build a clearer picture of the epilepsy population in their area, a commitment to ensuring that all patients with suspected epilepsy see a specialist within two weeks, all acute trusts to have adequate diagnosis equipment in line with the patient population they serve and all patients to receive an annual review of their epilepsy. That would particularly help younger patients, who would be reminded, if they have forgotten, of the seriousness of their condition and of the things that they should be doing to help themselves.

Epilepsy Action is also calling for the introduction of effective transition services for children moving into adult epilepsy. Again, that is particularly important to the younger cohort. Finally, Epilepsy Action wants the Minister to consider ensuring that all patients with epilepsy who want a comprehensive care plan can get one. The Minister will be aware of those recommendations, and hon. Members want to hear how he plans to respond.

As I said at the beginning of my remarks, this condition excites a certain fear and, even today in 2011, a touch of stigma. Particularly for younger people—I consider people under the age of 35 to be young—the condition poses a risk of sudden death. That risk is higher than in other European countries, which suggests that there is something we can do. We know—the whole House knows—that the health service is going through a period of transition and change. I will not use this debate to challenge the changes that are going to happen, but because we are going through a period of change, it is very important that the measures are in place to ensure that the care people receive for such a condition is as good as it has ever been, particularly in relation to commissioning services locally. It is also important that we move forward with the improvements and pay attention to the quality of life of epilepsy sufferers that people campaigning on epilepsy have sought for many years. I await with interest the Minister’s response to the points that I have raised.

I, too, am pleased to serve under your chairmanship, Mr Scott. I congratulate the hon. Member for Birmingham, Selly Oak (Steve McCabe) on securing the debate and on being so persistent in applying for it week after week until, finally, being successfully in the ballot for Adjournment debates. The hon. Gentleman is right to bring the matter back to the House for a debate and I am grateful to all hon. Members who have contributed. The personal testimony and the testimonies we have heard on behalf of constituents speak to the devastation that the condition can bring to families and the people who suffer from it.

A lot of statistics have rightly been rehearsed to illustrate those points as part of today’s debate. They are undoubtedly very compelling and, as has rightly been said, quite depressing. They show that although we have known for a long time what needs to be done, it does not appear to be implemented as consistently as it should be across the country. There are places that follow the NICE guidelines and consequently make a difference, but over many years other areas have failed to invest or see the matter as an area of priority. That is not a comment on previous Governments’ records, but an acknowledgement of the difficulty in an organisation as large as the NHS of ensuring sufficient focus on something as important as this.

The hon. Member for Hackney North and Stoke Newington (Ms Abbott) paid tribute to the work of the all-party group on epilepsy. I come across many APPGs in pursuing my ministerial responsibilities; they are, truly, an important part of how this Parliament makes sure that the voices of many seldom-heard groups—or groups certainly not heard often enough—are heard by Ministers and the Government.

I will try to ensure that I respond to all the points that have been made. I have been encouraged to speak for as long as is necessary to do just that.

Members have, very generously, given the Minister 40 minutes to reply to the debate, which is rather longer than Ministers usually have. Will he find time in that 40 minutes to commit to the practical, affordable remedies that have been urged on him by the many charities involved in SUDEP?

I hope to do just that, and I hope to do justice to the points that the hon. Gentleman and other hon. Members made in the debate.

At least one hon. Member—my hon. Friend the Member for Blackpool North and Cleveleys (Paul Maynard), who initiated the debate we had about a year ago—has contributed to the debate on this issue again. The message I took from last year’s debate was clear, and I take it again today. There is a real sense that we need change in the system. We need change that delivers a real focus on issues such as epilepsy to ensure that clinicians and the service respond properly to the evidence, act on the evidence, and translate it into services that are fit for purpose. At the moment, the service continues to fail hundreds of thousands of people living with epilepsy, at a huge cost to them personally and to their families. When we debated these issues a year ago, there was some uncertainty about how the Government’s plans for reform would deliver improvements. I would like to spend a little time today setting some of them out.

In a moment, if I may. We have plenty of time. I just want to say something about the voluntary sector, and then I will happily give way to the hon. Lady.

The outlook for most patients with epilepsy is good—it is important to acknowledge that—but we know that more than 1,000 people die of epilepsy-related causes each year. Many of those deaths are due to accidents or status epilepticus, but a significant number of them are attributable to SUDEP—sudden unexpected death in epilepsy. The devastating effect of any epilepsy death cannot be overestimated and cannot be understated. I pay tribute to the many voluntary sector organisations that have been referred to in this debate. They work hard to highlight the challenge, and to ensure that the failings that have been described are identified and tackled.

In preparing for the debate, I was struck by how much higher our rate of sudden unexpected death in epilepsy is, compared with that in the rest of Europe. Do Ministers have any analysis of why that might be?

I will come on to outcomes and information in a moment. Understanding the performance of our health economies, compared with that of other systems around the world, is an important part of how to ensure that we focus on what matters most to deliver change and improvement. I will talk about outcomes, data and variation in a moment, if I may.

I particularly want to acknowledge the work of Epilepsy Bereaved, which since its foundation in 1995 has led cutting-edge work to establish major risk factors and ways to reduce risks and prevent deaths. The charity provides very well-regarded bereavement support, which helps to break the isolation that people experience following SUDEP, or other seizure-related deaths. I acknowledge the organisation’s concerns that failings in care and the commissioning of services have led to many avoidable deaths from SUDEP.

In the 12 months since we last debated epilepsy services in Westminster Hall, we have made significant strides in putting in place the necessary arrangements to level the playing field in commissioning epilepsy services relative to other services.

That leads me on to the NHS outcomes framework. The hon. Member for Hackney North and Stoke Newington referred to the NICE guidelines and the role of specialists. One role that the NHS outcomes framework can play is to ensure that commissioners, providers and others are better able to identify those things that can drive up performance in the NHS. The publication of the first NHS outcomes framework marks the start of a journey for greater transparency and accountability for the outcomes that the NHS achieves for patients. It demonstrates a move from traditional input and output targets towards a focus on delivering better health outcomes for all. The framework includes a focused set of national outcome goals and supporting indicators that patients, the public and Parliament will be able to use to judge the overall progress of the NHS. A number of those goals and indicators are relevant to epilepsy. They will, of course, inform the Secretary of State’s mandate to the NHS commissioning board and, in turn, to the NHS commissioning framework.

Let me give a few examples of the relevant indicators. In domain 1 of the NHS outcomes framework—preventing people from dying prematurely—the overarching indicator is about mortality from causes considered amenable to health care. This debate demonstrates graphically that epilepsy is one of the conditions where there is plenty of room for significant progress. The hon. Member for Hackney North and Stoke Newington rehearsed the statistics, which are compelling. They point, very powerfully, to commissioners having to look at this if they are to deliver measurable improvement against that indicator.

Domain 2, enhancing quality of life for people with long-term conditions, speaks directly to the issues addressed in this debate. The overarching indicator is health-related quality of life for people with long-term conditions. It addresses such specific issues as the proportion of people feeling supported to manage their conditions. That speaks directly to issues such as care planning and case management. That indicator is not just in the NHS outcomes framework; it also sits within the adult social care outcomes framework, to try to align more joined-up thinking and commissioning on these issues. Improving functional ability in people with long-term conditions relates to ensuring that more people are able to stay in employment.

There are many other indicators. The aim of domain 3 —helping people to recover from episodes of ill health or following injury—is to capture information on patients’ journeys through the system. Domain 4—positive experiences of health care—will look at such things as patients’ experiences of primary care. My hon. Friend the Member for Blackpool North and Cleveleys described the conversations that should happen, and they should be captured.

The emerging commissioning landscape will contribute to improving not just epilepsy outcomes but outcomes across the board. In the past, commissioning has been too remote from the patients it is intended to serve. Commissioning decisions made by clinical commissioning groups will ensure that they are underpinned by clinical insight and knowledge of local health care needs, and, importantly, the perspective of the patient and family carers. Clinical commissioning at its best is a collaboration of professionals. The NHS commissioning board and clinical commissioning groups will be required to obtain clinical advice from a broad range of professionals with expertise in the

“prevention, diagnosis or treatment of illness”—

and in the—

“protection or improvement of public health”.

There is a real pull in the framework that we are putting in place to make sure that that happens. As well as promoting effective clinical leadership and multi-professional collaboration around specific conditions and pathways, we expect doctors, nurses and other professionals to come together in clinical senates to give expert advice from a variety of health and social care perspectives.

NICE has rightly been alluded to a lot. The Government intend to build on its strong track record by re-establishing it as a statutory body. It will continue to play a key role in the NHS through the production of robust, evidence-based advice and quality standards. I will address the issue of quality standards specifically. The hon. Member for Birmingham, Selly Oak asked about surgical interventions in the context of the work being done to produce quality standards covering epilepsy services. They have already been commissioned by NICE and will cover children and adults separately. I will pass on the point that was made about the need to address issues of transition, so that that is not overlooked in producing two separate quality standards. In the children’s quality standard, there is a specific need to address access to surgical interventions, and it will be addressed.

HealthWatch has its part to play, and will better enable people to help shape health and social care services, at both a local and national level, by providing a strong forum where the views and experiences of patients, carers and the public can influence the commissioning process and improve the quality of health and social care services. There must be a clearer split of responsibility—a sense of joined-up access across the care pathway to deliver a less fragmented and more person-centred approach to planning. We accept that care and support for those with long-term conditions is a particular area where we do not get it right often enough. Not only are patients confused but their care and quality of life are compromised, and it leads to inefficiencies and duplications in the system.

The hon. Member for Birmingham, Selly Oak asked me specifically about prisoner health. One of the opportunities that arises from the establishment of the NHS Commissioning Board is that it will be the commissioner of prisoner health. With it leading on such work, we are in a much better place to assure ourselves that the NICE guidance on prisoner health and epilepsy is properly and consistently applied throughout the prison estate. I shall certainly pass on any further information that I can to the hon. Gentleman.

I have listened with great attention to the Minister and, naturally enough, he has started with generalities, but the nature of Westminster Hall debates lies in the opportunity for Members to get replies to specifics, so I have three questions arising from the speeches today. First, do the Government intend to appoint a national clinical director for epilepsy? The hon. Member for Blackpool North and Cleveleys (Paul Maynard) asked specifically about people being able to talk about sudden unexpected death within a couple of weeks of diagnosis, but am I to take it that the Minister has no means to direct that and will leave it to commissioning groups to decide what is appropriate? Finally, are the Government prepared to commit to the explicit inclusion of epilepsy mortality in the outcomes frameworks?

The hon. Lady needs to be patient, because I still have quite a lot of sheets of paper and quite a lot of answers to give. Before I took her intervention, I had answered a specific question on prisoner health from the hon. Member for Birmingham, Selly Oak. I am trying my best to cover the ground.

I will deal with the national clinical director proposition. As part of the transition—the hon. Lady alluded to this—from a command-and-control system in which the NHS is directed from the Department of Health to a model in which the service is at arm’s length and directed through goals and objectives set to a mandate, the NHS commissioning board will be where national clinical directors sit. The national commissioning board will make the decisions on the precise configuration of those appointments. Clearly, that will be modelled on the approach taken on an outcomes framework, so that there is proper coverage of all its domains. That is as much as I can say today, and perhaps we need to have a further debate, but if she wants more information, I will happily write to her with more detail. I cannot say today, however, that there will be a DH-appointed epilepsy national clinical director, because that is the old world and we are moving to a new world, whether we agree about that or not, and in that new world the responsibility for making choices about the appointment of national clinical directors will sit with the NHS commissioning board. That is as clear an answer as I can give to her question. I will answer the others as we move on.

Assessment of need was mentioned in the debate and goes to the heart of a challenge for the charities. My experience over the past 12 months of talking to many non-governmental organisations that advocate on behalf of patient groups is that some see huge opportunities in reorganising themselves to get much closer to the new commissioners and to those who will shape priorities for local services at a local level, and they are looking to organise themselves accordingly. Others are finding it more difficult to think through how to organise themselves to do that, and are therefore looking to how they can use the old levers, encouraging the Department of Health to proceed through central fiat and direction. My job is to say that that is not how it will work and, if they expect that that is how things will happen, they will be sadly disappointed. The Department and I as a Minister are only too pleased to work with organisations to ensure that they can realise and exploit the full potential of the new arrangements such as the health and wellbeing boards, the clinical commissioning groups and their duty to engage with their public, their patients and carers. Organisations, including some of the epilepsy charities, need to think that through carefully.

Health and wellbeing boards will be the local system leaders and will drive joined-up health and social care services. They have a key role, with joint strategic needs assessment and joint health and well-being strategies, in which they understand the population need and future population need, and that in turn drives commissioning for populations and outcomes. Simply said, to ensure that those joint strategic needs assessments are rich and informed, charities in the sector have a part to play in the conversation, to ensure that their input is not lost. NICE clinical guidance and quality standards play their part as well.

The hon. Member for Birmingham, Selly Oak asked about research. Who could disagree—I certainly do not—that the case for more research is strong? Again, however, directing more research through ministerial instruction is not how we should proceed. That might get more research but it does not guarantee quality, which is why we have for a long time had the Medical Research Council leading, with independent peer review as the process for allocating research resources. As in many other spheres, the key is to ensure the crucial infrastructure to support quality bids in the first place—the better the quality, the better the chances of an increase in the resources. We saw that with dementia; the Government had a priority to invest more but did not achieve that simply by putting up a quantum and stating that “This is what we must now spend.” Simply, it is about putting in place the steps to ensure quality research bids in the first place.

The information revolution is another important part of delivering the agenda. Today’s challenge in providing high-quality care services cannot be met without effective use of information. At present, many people who use our health and care services do not get the information that they need and expect as part of the care process, which we have heard described graphically. We sometimes fail to meet the information needs of our clinicians and care professionals, so information is critical to our ambition to put people in the driving seat of their services and their care. Through the work of the NHS Future Forum so far, we are examining how to ensure that the information strategy that will be published fully reflects the various concerns expressed.

The hon. Member for Hackney North and Stoke Newington asked a specific question about whether the information provided in Scotland and Wales is available. The answer is yes. There are comprehensive information sources available on NHS Choices, including a guide to epilepsy that contains information about SUDEP and minimising risk. The use of things such as NHS information prescriptions and, as we develop more of them, tools to help patients and clinicians make decisions are ways of further strengthening that important notion of “no decision about me without me”.

The hon. Member for Newport West (Paul Flynn) talked about his constituents Gwyn and Gill Thomas, the tragic death of their daughter from SUDEP and how they felt bewildered and, I suspect, outraged that they did not get information on which they could have acted at the time. That has spurred them on, and we can probably find echoes of that in every constituency surgery throughout the country—people motivated by personal experience to ensure that it happens to no one else. The hon. Gentleman’s example of the case of Christina and the lack of knowledge of risk underscored the as-ever exceptional contribution of my hon. Friend the Member for Blackpool North and Cleveleys to today’s debate. By talking about his own experience, he illuminates a much wider and more important picture about the frailty of human beings and their reluctance sometimes, even when professionally trained, to engage in the conversation that they are paid to have, which ultimately is a conversation about life or death. We know that NICE has set out clear guidance on care planning and case management, which provides good evidence of how they can make a difference.

The guidance also talks about the role of epilepsy nurses, and the hon. Member for Hackney North and Stoke Newington asked how the Department helps with their availability. One of the ways we help is by ensuring that good tools are available for local business cases to be put to commissioners locally. We do not mandate from the centre a certain number of such members of staff, but we make it clear through the regulatory framework and other ways that the skill and staff mix of organisations has to be appropriate to the services that they are providing. There is as well a strong economic case for epilepsy nurses to be commissioned, because of how they can have that honest conversation with the individual concerned.

Another way we can play our part at national level in raising the profile of these issues and making commissioners think through how they commission services effectively is through the development of outcome strategies. We have outcome strategies for respiratory and mental health conditions, and I recently announced the Government’s intention to develop a cross-Government outcome strategy for long-term conditions. The purpose of the strategy is to take a life-course approach. It will draw on the Government’s approach in developing our mental health strategy. Shaping it will involve a wide range of stakeholders beyond the Government.

The hon. Lady rightly rehearsed the Prime Minister’s enduring interest in these issues, which spans the whole health sphere. That is why he continues to pursue and to follow closely the key work of Health Ministers in taking forward the legislation to reform the NHS. I will inquire about the correspondence and find out what has happened about that.

Reference was made to the Joint Epilepsy Council and its activities. I applaud its work, but I must make it clear that the future of our public services is in a local rather than a national context. For the NHS, it is not about running commissioning services for specific conditions from the Department of Health; it is about local clinical commissioning groups working locally with patient groups and others better to understand local needs and to ensure that they structure services with those in mind.

I accept the case that the Minister is trying to make for the new commissioning arrangements, but, like many of us, charities and help groups that work with epilepsy are not entirely clear about how the new arrangements will work. Does he have any plans to meet the epilepsy groups so that he can better explain his ambitions and how those groups will be able to play a central role in the new world that he envisages?

It was kind of the hon. Gentleman to intervene, because it allows me to answer his final question. The Department continues to work with the charities and to discuss their concerns, and I am happy to arrange a meeting to have such discussions.

I will give way to the hon. Gentleman while the hon. Lady frames her questions—she clearly has one or two—and I will then give way to her.

I have listened with great attention to the Minister. I am aware of his record in opposition as a doughty campaigner for many causes. The Government are obsessed with change and upheaval in health service structures. Can he provide some practical assurance that by the end of their term of office, if they go to 2015, there will be fewer sudden unexpected epilepsy deaths?

I have referred to the focus on outcomes and the establishment of an outcomes approach not just to commissioning services, but to how we measure the performance of services. That provides hope of an improvement. The issue is not just a high-level one. I have not talked about specific statistics today, but sitting behind each and every indicator in the outcomes framework for the NHS are hard metrics that are being used to identify variations between parts of the country. We have seen in other services—for example, cancer services—how powerful the publication of atlas data, which shows performance in different localities, is at challenging clinical teams and challenging commissioners to commission differently and better. I genuinely believe that that approach and the focus on outcomes and data are key drivers to improving future performance.

I have listened with great care to the Minister, who has been at pains to outline that we are moving from a world of command and control health provision to a world in which individual clinical commissioning groups will make decisions for their locality. Should the groups that are lobbying on epilepsy take from this debate a message that the days of lobbying at national level are effectively over, and that they must mobilise themselves to lobby commissioning group by commissioning group?

They must certainly be prepared to engage a lot more at local level. That is an important part of commissioning to fit the needs of postcodes rather than by prescribing from the centre and having postcode lotteries. It is not possible from so far away to be clear about the specific needs of a population. That is why the change is so important. However, the Department of Health expects and Ministers want to have a relationship with those organisations, because they can inform the shape of the mandate that the Secretary of State will set for the NHS. They can inform the way in which NHS outcomes framework, the adult social care outcomes framework and the public health outcomes framework operate, and their priorities. There will still be a rich conversation at national level about action, but there will be an even richer conversation about outcomes, performance and commissioning, which need to be local.

In conclusion, I am grateful to the hon. Member for Birmingham, Selly Oak for calling this debate and his perseverance in applying for it. He has rightly rehearsed a matter that has been neglected for too long. I believe that the Government’s changes, particularly our focus on outcomes and greater respect for clinical judgment at local level, will deliver improvements in services and quality of life, and indeed will save lives through improved commissioning at local level.

Sitting suspended.

HGV Wheels (Safety)

It is good to see you in the Chair, Mr Scott. I am not sure whether I have served under your chairmanship before, but I look forward to it.

I regret having had to apply for this debate, and believe that the exchange that will take place over the next half hour could just as easily have taken place in the Minister’s office. Indeed, such an exchange might have benefited from a more informal setting, and we could have heard from industry experts who would have had much to offer.

I applied for this debate because I received a letter from the Minister on 11 November. The letter, which was dated 9 November, stated:

“Unfortunately, I am sorry to say that due to pressures on my diary I will not be available in the near future to meet with you.”

I was surprised to receive such a letter from the Minister, because I have always found him approachable and responsive, particularly on the important issue of HGV wheel safety. I know that he takes his responsibilities seriously, so I was extremely disappointed.

I was also shocked to receive such a letter because it was written on 9 November, less than a week after the tragic crash on the M5 in which seven people lost their lives and in which I know the Minister took a close personal interest. That the Minister should send such a letter at a time when the issue of road safety was so high in his mind and in that of the public and Parliament, and refuse to meet me and those expressing concern about the issue, was disappointing and shocking. We are, however, having our meeting in the Chamber this morning, and Hansard will write the report rather than someone from the Minister’s private office.

I first raised the issue of HGV wheel safety in June 2010 in a letter to the then Secretary of State. It followed my visit to Motor Wheel Service, a company based in my constituency that is the largest distributor of HGV wheels in the United Kingdom and across Europe. I remain grateful to the managing director of MWS, John Ellis, and to Matthew Wells who kept me briefed on issues that have concerned them for a considerable time. He also ensured that I was briefed for today’s debate, and both he and John Ellis remain vigilant and active across the industry on issues of wheel safety.

On 9 November last year—just over a year ago—we had a constructive meeting with the Minister in his office at which he willingly agreed to review the data available in his Department concerning accidents, failures and defects involving HGV wheels. We parted company after that meeting on agreeable and friendly terms, and we returned to the issue on 29 March this year in the first Westminster Hall debate on HGV wheel safety at which I made two suggestions to the Minister. My first suggestion was that he should consider holding a year-long trial in one region of the country, so that enhanced testing of HGVs could take place with particular emphasis on wheel safety. The Minister listened carefully, attentively and thoughtfully to my comments, but the answer was no at the end of the debate.

The Minister was slightly more encouraging about my second suggestion, which was that he should identify a senior official in his Department to be a point of contact between the Department and the wheel supply industry. If people in the industry had specific concerns or evidence about faulty wheels, they could report it to that named individual, who could then investigate and produce any necessary report. That would be an inexpensive way of dealing with any concerns raised, and it would help the Minister to separate speculation from facts—I accept that there may be speculation in this area, and it is important to establish the facts precisely. If only a few faults were discovered through such a reporting mechanism, confidence would be maintained and that would be good. If, however, faults were discovered, the Minister and representatives from the industry could sit down together and work out an appropriate way to ensure proper checks and reports on wheel safety.

Following that debate, there was a bit of a delay before the Minister got back to me, although he did reply in a letter dated 3 June. He thanked me for my e-mails of 15 April, 10 May and 27 May, in which I asked for further information, and crucially he confirmed that the Vehicle and Operator Services Agency has a specific team, the vehicle safety branch, that is responsible for HGV wheel safety. He also gave me the name and contact details of the head of the vehicle safety branch, who was clearly the senior official I hoped would be nominated. So far, so good. However, the Minister went on:

“The vehicle safety branch looks at issues of design or construction…and will request the manufacturer, producer or supplier to start an inquiry if there is evidence that a design and construction defect exists.”

That rather limited approach adopted by the Minister caused me some concern, so I sought clarification. The Minister wrote back to confirm that the vehicle safety branch

“will not investigate faults that have arisen due to the use of the product, for example poor maintenance or accident damage.”

The quality of wheel design and construction was never a problem for me or those in the industry who raised the issue. The United Kingdom has a high standard of HGV wheel manufacturing, and it is no surprise that few faults have been reported. My concern, which I raised in the earlier debate and raise again today, is the 10,000 second-hand HGV wheels that enter the UK market every year. The Minister has never disputed that figure, and the industry certainly believes it to be true. Some of those second-hand wheels may be damaged as a result of various incidents, and I will come on to that point in a moment. My principal concern, however, is the 10,000 second-hand wheels that enter circulation every year in the UK.

An HGV wheel can be damaged in several ways. Dents and cracks can be caused by over-tightening the wheel nuts or by any collisions in which the vehicle has been involved—road traffic accidents are an obvious example, but vehicles can also hit kerbs or potholes, which is sadly becoming more frequent given the condition of some of our roads. Damage can also be caused by rust, general wear and tear due to the weather, road surface conditions or age, or if the wrong tyre is fitted to a wheel. There are, therefore, various ways in which wheels can be damaged, and 10,000 second-hand wheels are in circulation and not being properly checked. That is my central concern.

Clearly, there is a lack of confidence across the wheel-supply industry concerning the checks carried out by VOSA. The VOSA inspection manual, which covers inspections carried out as part of an MOT and more random roadside checks, indicates that an inspector should look for missing wheel nuts and ensure that the wheel is appropriate for the load being carried. It is, however, of concern to me and the industry that insufficient emphasis and detail has been placed on the search for cracks and other damage.

You and I, Mr Scott, can only imagine the damage that would be caused by a 45-tonne truck travelling at 55 mph should there be a major tyre blow-out. It could cause a catastrophe, which is why we have a stringent system for checking and monitoring the tyres on all vehicles—cars as well as HGVs. Catastrophic wheel failure would produce exactly the same impact as a tyre blow-out, yet the Government seem unmoved by the concerns being raised by me and the industry.

Where is the evidence? As I have made clear, part of the problem is that the evidence is not being gathered as systematically as it should be. That is why I suggested in the first Westminster Hall debate both a year-long pilot project in one region of the country where more stringent tests could be carried out and a named official to be the point of contact between the Department for Transport and the industry.

Today, I shall give the Minister three recent examples that should concern him. The first is the evidence that I saw with my own eyes on a recent visit to MWS in my constituency. I do not pretend to be an expert on wheel safety, but it seemed to me, as I examined with my own eyes the wheel that was shown to me, that there was clearly a crack in the wheel. As an amateur—a non-professional—I would certainly want and expect a wheel damaged in that way to be thoroughly checked and examined. I sent a photograph of that wheel to the Minister. In the rather short reply in which he refused to meet me, he did not refer to that evidence, although he might want to comment on it today. I hope that he will recognise that if a wheel is damaged and is in the hands of people who are less reputable than the company in my constituency, it could be attached to a lorry in a hazardous way that could cause a catastrophe.

The second piece of evidence is an October 2011 press report in Truckstop News. It raises concerns that the Minister must respond to this morning. The headline was “Killer Wheels”. The article stated that

“wheel manufacturer Alcoa has warned there are fake wheels on the market that are failing early. Cracked wheels were sent to Alcoa’s distribution network by end users trying to have them replaced under the Alcoa wheel five-year warranty agreement. Alcoa says the imitation wheels are a good copy, making it difficult to see the difference between these and the genuine article. The manufacturer wants to ensure customers are not fooled and end up with worthless and potentially dangerous forgeries.”

Counterfeit items across the whole of society can cause great damage. That is the case whether it is counterfeit cigarettes damaging people’s health or counterfeit wheels. If counterfeit wheels were fitted to a lorry, they could have catastrophic results if they failed, and they almost certainly would fail if they were not built to stringent design and manufacture standards. I would like to know what the Minister makes of the report to which I have referred. If he has not had a chance to see it yet, he should check it and come back to me and others with his observations.

My third piece of evidence is an ITV news report from last Friday, which the Minister may have seen. The report was on the impact of potholes and said that there is an average of 15 potholes in every neighbourhood. I do not know about your constituency, Mr Scott, but that figure seems on the low side to me. Anyway, that is what the report said. The camera crew went to a tyre fitter in Gateshead, who showed them the impact on a wheel of a major tyre blow-out that had resulted from a collision. As viewers saw the picture of the wheel and compared it with how a wheel should be, coming from the manufacturer, they could certainly see the difference. They could see very clearly the damage that had been done. Again, I refer the Minister to that evidence, if he has not yet had the chance to see it.

The Minister has a choice this morning. He can tell me once again that the failure rate is 0.0006% and that if anyone supplies defective or faulty items to be fitted to a vehicle, they can be prosecuted; or he can take a rather more engaging approach—as I hope he will, even at this stage—and meet me and representatives of the industry to consider the need for more rigorous checks. The Minister may have gathered from the fact that he is here this morning—I am grateful to him for being here—that I am certainly not going away on this issue. There have recently been a number of presentations on the issue to important industry bodies. ATS Euromaster has had a presentation, as have the National Tyre Distributors Association, the Northwest Automotive Alliance and the Society of Motor Manufacturers and Traders. I can tell the Minister that further discussions are planned with those bodies about these concerns, which I can attest are growing concerns in the industry.

Indeed, such is the level of anxiety in the industry that when the Minister wrote to me to say that he was not prepared to go beyond the very limited offer that he had made, the industry was prepared to put in place its own reporting mechanism, so that it could say to companies throughout the wheel supply industry that if they had evidence of any wheel failure, they could report it through a specially designed industry reporting system and it could be passed on to the Department for Transport. That was the request that I made of the Minister: given that the industry was prepared to put in place its own self-reporting system, could we have a meeting to discuss how best to make the arrangements for that industry reporting structure to link to his Department? He has made it clear up to now that he is not engaging with the industry in relation to that question, but I urge him to reconsider that position and to be prepared to have a meeting or at the very least to be prepared to talk to the industry about its own ideas for self-reporting and how that could be linked to and engage properly with officials in his Department. As I have said, I hope that the Minister will reconsider. I am pleased to see him in his place today and I look forward very much to listening to what he has to say.

It is a pleasure to speak under your chairmanship on this important day, Mr Scott. I congratulate the right hon. Member for Wythenshawe and Sale East (Paul Goggins) on securing the debate, although I am slightly disappointed by his saying that I have not engaged. We had the previous debate in this Chamber, but before the debate we had meetings in my office; I think that that is engagement. I have said throughout that as the Minister—the right hon. Gentleman used to be a Minister himself—I have to have an evidence base to go forward. In the letter to him, I was trying to be as honest as possible: I did not have a slot in my diary between now and Christmas, and that is why I said that at this stage I cannot see him; I could have given him a date after Christmas, but I thought that such a long delay would have been an insult to him. However, like any other colleague, he can stop me at any time and I will engage at any time. My officials are also engaging.

It is important to talk about who is representing whom in the very important UK logistics industry. The Freight Transport Association and the Road Haulage Association, whose representatives I meet very regularly and with whom I have a very good rapport, have not raised this issue with me once. I was at a major haulier’s yesterday—in fact, I was going along the A13 in Essex in a 38-tonne articulated truck. I make those visits so that I can engage with the industry. I was feeling slightly jealous yesterday because I have only a class 2 licence, not a class 1. I have been very close to this issue for most of my career, especially when I had a licence in operation myself.

The right hon. Gentleman is absolutely right. I am going to quote the 0.0006% figure. I will answer the specific points he raised, but if anything has changed the position since the previous Adjournment debate—if more evidence has emerged—of course we will look at it and at the specific details to which we have alluded.

The right hon. Gentleman sent me a photograph of a damaged wheel. One of the facts I wanted to ascertain was when that vehicle was last tested, because the crack should and would have been brought up in the test. It is illegal to have that sort of damage on a vehicle, as he knows, and it is illegal to run the vehicle with it. The operator’s licence would be affected should they run a damaged vehicle; it is an offence under the Road Traffic Act 1988 as well as under the operator’s licence. However, the crack would have been picked up at the annual check. Unlike cars—we are to review the situation of cars in relation to MOTs—lorries are checked annually from when they are new.

I would like to know, and I would have hoped that the right hon. Gentleman might have told me because he was using this as evidence today, what vehicle the wheel came off and when the vehicle last had a check. It could have been the case that the damaged wheel on that vehicle was picked up and then removed, as we would all expect—so that it was not on the road at all.

Killer wheels are an interesting topic. The question of copies or snides has been around for a long time, particularly regarding aluminium wheels on cars. The failure rate for aluminium wheels, if they are not constructed right, has worried me for many years. The focus is often on design rather than function—people want them to look flash. That is something that we are looking at robustly, but legislation already exists to make sure that that sort of thing does not happen again. If the manufacturers are picking up copies being brought into the country, I assure the right hon. Gentleman that we will work with the Department for Business, Innovation and Skills on that.

The ITV report on potholes was interesting, because there are myriad reasons why a wheel could fail. Those who follow Formula 1 will know that during the race before last, a wheel failed on the first corner; there was an instantaneous puncture. Central Government have invested a huge amount of money in repairing potholes, which is why the number of potholes is as low as the report suggested. The right hon. Gentleman will have to wait until later today for further announcements on road infrastructure. It is absolutely right to say that failures take place when vehicles hit potholes or hit the kerb. I had a failure in an aluminium wheel when I attempted a U-turn, misjudged it and caught the wheel wrongly on the kerb. Not only did the tyre give way but the aluminium wheel broke.

During the first five minutes of the Minister’s speech he has not even glanced at his folder, which demonstrates both his enthusiasm for road safety and the fact that he is completely on top of his brief. He has responded to the three pieces of evidence that I gave him without looking at a note, so he clearly has the information at his fingertips.

If the hon. Gentleman had written to me on 9 November to say that he was dealing with a lot of pressing matters and would not be able to meet me until the new year, I would have understood and accepted that. I would have done so reluctantly, because before Christmas would have been better, but if he makes that offer again this morning I will be happy to accept.

I apologise for the fact that I am not reading the speech that was written for me—I rarely do—but I hope that I am on top of my brief. Road safety is paramount for me, especially as I come from a fire service background. While I was in the fire service, I attended road traffic collisions regularly as the driver of a rescue vehicle. I never once encountered an incident in which the wheel had failed, although there were lots of other problems, particularly on some older cars where the hub structure had failed. In the evidence that we have looked at, which I will not read out, there were 23 failures over a 15-year period, but such problems were often due partly to accidents where wheels had been struck and damaged.

I will write to the right hon. Gentleman in the very near future and offer him a slot after Christmas. I think that something positive has come out not only of today’s debate but of my saying no the last time we met in this Chamber, because the trade associations have stepped up to the plate. Rather than Ministers telling people what to do, the right approach is often for the industry to realise that it has a responsibility as well and that reform is needed.

There might be a certain amount of semantics on the part of both myself and the right hon. Gentleman about the wording of the letter and who the official responsible for these issues is, but the simple answer is that the buck stops with me. If the trade associations want to present evidence to me, rather than an official within VOSA, they can do so and I will be more than happy to provide that point of contact. This is not only about the manufacturer; if the failure rates are increasing, and that is what this is all about—I am not disputing that one way or the other because, frankly, we do not know, and there is no point disputing something that is not disputable—do I still want there to be a second-hand market? I do, because that is important for people who cannot afford to buy brand-new wheels every time, but those wheels must be safe. The operators have a responsibility to make sure that that happens, and I do not want to take that responsibility away from them.

When I was in that truck yesterday, I felt comfortable not because it was brand spanking new—it was not; it was about 18 months old—but because of the robustness of the legislation governing VOSA and its testing regimes. I have been at the side of many a road with the new VOSA testing and enforcement officers, and I know how remarkable the current equipment is. We can estimate the weight on an axle while the vehicle is travelling at 56 mph down the motorway; we can pull it over and put it on a weighbridge, and we know accurately what the result will be. When inspections take place, on overseas vehicles as well as our own, checks on wheels and brakes are carried out, there and then, to the best of the officers’ ability. Obviously, most of the weigh stations do not have a pit facility.

If the right hon. Gentleman—let me call him my right hon. Friend—has called this debate as a direct reaction to my letter, he should have pulled me over in the Tea Room, where I would have addressed the matter straight away and we would have had a meeting after Christmas. He will understand, because he was a Minister himself, why I do not like making appointments way into the future. Events take over and I might not even be at the Department any more; someone else may be doing this job if we go too far past Christmas, or even before Christmas.

I sincerely hope that the Minister is still in his position in the new year, not only because he has now promised me a meeting, but because he is clearly on top of his brief and doing a good job. I commend him for that. He has mentioned twice that I was a Minister, which I was for seven years, and I never, ever refused a meeting with a Member of Parliament. The message that I am sending to the Minister and the Government is that when Members of Parliament are pursuing issues that concern them and their constituents and they want to meet Ministers, it should be an absolute given that those meetings take place. Of course Ministers are always busy, but their busy diaries must not get in the way of their fundamental accountability to MPs and to Parliament.

I have a reputation in the House for being approachable, and this is the first time that I have ever been reprimanded by a senior Member. My letter was written in the best possible faith; a series of events to do with lots of things, which I will not go into now, meant that I could not guarantee a slot that I would be able to hold on to. The worst thing in the world is to make an appointment and cancel it, but that is what tends to happen. When I was in opposition, promises were made to me and they were not kept. If I make a promise, wherever possible and subject to business, I keep it, so the right hon. Gentleman and I will meet. I hope that the trade associations will do what they said they will do—that they will get the submissions together and come as a united body to present their evidence. That will allow me to go away and ask why we have certain failure rates coming from all the different expert bodies mentioned in the speech that I have not used, and to compare that with what is happening on the front line.

Whatever happens, I will not increase the burden on businesses. I think that the haulage industry, with the margins that it works on, is already heavily burdened, and I am trying to take some of that burden away. Road safety is paramount for me, but operators have responsibilities, which they must never forget.

Sitting suspended.

Girls (Educational Development)

[Mrs Anne Main in the Chair]

It is a pleasure to serve under your chairmanship today, Mrs Main, in this important debate on the development of confidence for girls in school and the importance of role models to the future career paths of young girls. The debate is important to every schoolgirl in the country. The outcome and agreed actions need to take effect to ensure that girls achieve their full potential. As Mrs Robinson, the headmistress of West Kirby grammar school, has said, we have to encourage girls to have a can-do attitude from as young as possible, perhaps from year 7. Many schoolgirls lack confidence in themselves and their ability, and while boys think that they can, girls think that they cannot.

I have worked in the area for the past decade with schoolgirls, women-in-business organisations and through academic study and research. Today, I hope to bring to the debate not only my experiences, but those of my colleagues, renowned academics, Girlguiding UK, which, with more than 500,000 members aged four to 25, is the biggest voluntary girls’ organisation in the country, teaching professionals and business women who mentor other business women and schoolgirls. I will also talk about the findings from a recent Ofsted report titled, “Girls’ careers aspirations”.

My personal journey resulted in my writing a careers guide for girls called, “If Chloe Can”. The book was written to help provide an array of role models for girls, showing them examples of inspiring women from different backgrounds who all excelled in their careers. The book has now become a play to inspire girls and to show them what they are capable of achieving with hard work and determination. The play is now being done with the National Youth Theatre, which found a young writer, Karla Crome. She is only 23 and was delighted to write the play, which helped her along her playwriting path. There is also a group of young female actresses, who are also gaining experience to help launch their careers. All that is consistent with the theme of building confidence through doing and achieving in a supportive environment, while being helped by role models.

The female role models who took part in the play and the career book totalled some 100 women, who are some of the most successful women in the UK and the world.

Does my hon. Friend agree that we, as Members of Parliament, also have a great deal to offer as role models? I am mentoring six young girls in Redditch, and I learn a great deal more from them than they learn from me.

My hon. Friend has an excellent point. As female MPs, we are role models. To become an MP, someone has to be one in 100,000 people, and there are so few of us here, which relates to the cycle of learning that she has discussed. Knowledge from one generation can be passed to the next.

I was impressed by how openly and honestly the 100 successful women that I have mentioned talked about confidence, the need to develop it and how important it was for them in achieving in life. They compared confidence to a muscle that needed to be worked out through repetition of small, ever-increasing achievements. From those accomplishments, they developed a mental power—a power based on ability, achievement and a track record, further enabling them to strive for success.

Confidence can be difficult to describe. Helen Fraser, chief executive of the Girls’ Day School Trust groups of schools, past managing director of Penguin Books and two-time winner of “Publisher of the Year”, explained it as follows:

“There are many interrelated aspects to confidence, but there are two I would highlight as particularly important for girls, and which schools can help girls develop. The first is having the confidence to take risks, to ‘feel the fear and do it anyway’. Schools can nurture this by encouraging girls to take small risks—to stand up in front of a crowd and make a speech”—

like I am doing today—

to direct and produce plays, to take part in debates, to take on challenges like the Duke of Edinburgh’s award. These kinds of experiences make girls much more confident about risk, and risk is absolutely essential in working life.”

I will give way first to my hon. Friend the Member for Mid Derbyshire (Pauline Latham) and then to my hon. Friend the Member for Maidstone and The Weald (Mrs Grant).

My hon. Friend says that confidence can be difficult to describe, but we know exactly what it is when we see it. Does she agree that girls often do much better in a single-sex environment in schools, even if it is only in a single-sex class in a co-educational comprehensive? They are not having to live up to a stereotype in front of their colleagues and friends, the boys—

Thank you, Mrs Main. Does my hon. Friend agree that girls do much better if they are not threatened by apparently more confident boys?

My hon. Friend raises a point about girls being taught in a single-sex environment. Obviously, parents know best whether they want their children to be taught in single-sex environments. Whether there is stereotyping, whether girls are living up to stereotypes and whether they have the ability to speak freely within their peer groups can affect their confidence.

Although academic subjects are important, does my hon. Friend agree that confidence-building subjects such as music, drama, the arts, sports and reading out loud in class are also important? Some children may not flower academically at a particular moment, and those subjects can boost their self-confidence and self-esteem.

I totally concur. That is what Helen Fraser was talking about—little bits that people can do to build up confidence. As we know, some of us flourish and blossom at different times in life. Therefore, someone has to feel confident in what they have done when they do it.

The second aspect that Helen Fraser raised is

“the confidence to be yourself, not to feel you have to conform to everyone’s expectations. This includes the confidence to stand up for yourself, to disagree with the group consensus if you believe they’re wrong and you’re right. Even if it is just speaking up at a meeting, or daring to have an opinion that isn’t the same as everyone else’s, it’s important to have the confidence that your…opinions and beliefs matter just as much as any other woman’s or man’s.”

An interesting thing that I found in business clubs, particularly in girls-only schools, is that when girls set up and run companies—the companies are sort of junior social enterprises—it builds their confidence and helps them break out from ordinary school. Will my hon. Friend comment on that?

I will indeed. I will talk about work experience and employing other styles of developing confidence later on. My hon. Friend has certainly touched on an important subject.

The aspects that I have talked about make up confidence. They are important throughout life, and girls lack them. Quantitative studies over many years have shown that levels of self-confidence in girls and young women are much lower than those in boys—Hisrich and Bowen in 1986, Hollenstead and Wilt in 2000 and Kickul, Wilson, Marlino and Barbosa in 2008. Such issues need to be addressed, because they have lifelong implications.

Today’s debate centres on the key ingredients that assist in life fulfilment and in achieving personal potential, which need to be nurtured especially in girls far more than boys. Broadbridge noted that a lack of confidence resulted in girls being far more critical of themselves and their abilities. That can become self-doubt later in life, preventing them from applying for promotion and bringing attention to their own achievements, as Singh, Vinnicombe, James said in 2006.

That stands the test from a recruitment point of view. Having conducted informal quantitative studies, recruiters will say that they can probably check a woman’s CV in 20 minutes, because a woman usually underestimates her ability, whereas they might need up to two hours to check a bloke’s CV, because he is convinced that he can do something, even if he has not necessarily done it yet.

In Carol Gilligan’s book, “In A Different Voice”, she explained how male and female traits develop differently from birth through parental guidance. Boys strive to be independent by, for example, playing competitive games, whereas girls stay close to their mother and their games are dominated by “sharing” and “playing together”. That means that men can put “winning” ahead of relationships and that women value co-operation and do not like the quest for victory, if it threatens the harmony of a group. The academic Albert Bandura noted that

“confidence in our ability to perform”

is developed in four key ways—social persuasions, mastery of experience, modelling and judgment of our own psychological state. Social persuasions and stereotyping, as identified by Bandura, are a huge concern when considering girls in school.

Girlguiding UK’s 2009 girls’ attitudes survey showed that girls aspire, stereotypically, to female careers. Hairdressing was the No.1 choice for under-16s; teaching was the No.1 choice for 16 to 21-year-olds; and only 1% of those surveyed said that they wanted to work in science or engineering. In the same survey in 2011, when the girls were asked why so many of them aspired to be hairdressers and so few to be engineers, more than half those surveyed—57%—said that hairdressing is what girls are interested in, while they veer away from engineering because of a lack of interest, as expressed by 51%, and a significant lack of female role models, as expressed by 60%. It was also perceived that girls “don’t do that sort of job”, as expressed by 47%, and that they did not know enough about it anyway, as expressed by 43%.

As demonstrated by those figures, there is a confidence issue when we explore areas of work that are outside the stereotypical areas of female work, which often limits the job prospects, wages and promotion of women. In turn, that often leaves women in much more vulnerable jobs later in life, such as “the five Cs”—cleaning, catering, caring, cashiering and clerical work. The widening of girls’ horizons from a young age is vital, especially as there is a constant battle with the daily barrage of media sexualisation and stereotyping of girls. Studies over the past 30 years—from McArthur and Resko, to Manstead and McCulloch, to Hyde—have constantly found that, overall, men and women in the media and advertisements differed in terms of credibility, with men being portrayed as authorities and women as users, and women in terms of relationships and men as independent. Given the daily amount of television alone that we consume—on average, four hours a day—and how highly we regard TV as our major source of entertainment and our most important news medium, we can realise how important that constant barrage of TV images is when it comes to fixing our views and adding to existing stereotypes.

Many girls tend to be seen, and see themselves, as the nurturers, which is reflected in their choice of occupation. The recent Ofsted report, “Girls’ Aspirations”, showed that the sort of fixed views exhibited by girls in the Girlguiding UK report are being maintained, because girls are sticking to strict, old-fashioned stereotyping. The Ofsted report also found a lack of knowledge among girls about what careers are available and about progression and promotion in careers in general, which highlights concerns about the careers system and careers advice.

What are the Government doing? They have taken some important steps. I welcome the introduction of the E-bac, or English baccalaureate, which is one of the Government’s most recent initiatives. It is a new performance measure for schools and is designed to give children a more rounded education, encouraging more students to take traditional academic subjects, including English, maths, history, geography, the sciences and a language. It was reported in August that the E-bac is steering twice as many pupils in England’s secondary schools towards core academic subjects. A Government-commissioned survey showed that 33% of pupils will take E-bac subjects in 2012 and 47% in 2013 compared with only 22% in 2010.

Further to the point made in an earlier intervention, will the hon. Lady tell us what the impact of the introduction of the E-bac has been on the study of music?

I must admit that I do not know what the impact of the E-bac has been on the study of music, but hopefully the Minister can answer the hon. Gentleman’s question.

I am working with the 30% Club, which is a group of women aiming to increase the percentage of women on top company boards to 30%. One member of the 30% Club, Katushka Giltsoff, a partner at the Miles Partnership, said that knowledge is key and that the most important thing that girls can do is study serious, mainstream subjects and obtain an all-round education, so that they can do what is best for them later in life. It is also important that we do not limit girls’ choice of subject early on, because limiting subject choice early on ultimately limits career choice later.

Where could we be doing more? We need to ensure that girls have a better understanding about career choice and its impact on their long-term earnings. We also need to develop better and more carefully planned opportunities for girls to meet female professionals who are working in non-stereotypical roles, so that they gain a better understanding of what a job entails and how they can follow a career path. That process could even be extended so that female professionals could act as mentors to guide girls into careers that they are interested in. Everywoman has begun the Modern Muse project, which tries to link business women with schoolgirls. Claire Young of Girls Out Loud is piloting Big Sister. That project is very much like the American model of Big Brothers and Big Sisters, which bring mentors and business professionals into schools so that children can have a selection of role models. Similarly, Etta Cohen, who is the founder of the biggest women’s network in the north-west and an ex-teacher herself, has said that schools and teachers in particular have a big role to play in getting real role models into schools and in getting schools to engage more closely with the business world. The Government could address that issue by preparing more girls to become women entrepreneurs, which we know is important. At the moment, 150,000 fewer women than men are setting up in business. If we had 150,000 more women in business, they would be fulfilling their potential and paying into the economy. Moderate estimates are that they would pay in £9 billion, but it could be as much as £30 billion.

There are various routes to follow. The other thing that the Government are doing, and need to do, is link up what is already out there. We should not reinvent the wheel but encourage organisations to do more together, whether that involves MerseySTEM promoting the study of science to girls, the Chemical Industries Association and the Royal Society of Chemistry encouraging girls to study chemistry or—if I can mention it again—the National Youth Theatre producing the play based on my book, which will be seen by 1,000 schoolgirls at a time. All those organisations can give girls an array of role models.

All this activity is vital for future generations of girls, and we are looking at this issue at a very important time. Lots of changes are going on, but the progress of girls has not improved in the past 30 years. The progress of girls has been glacial, and whatever has happened in the past 30 years has not helped girls. That is why today I have specifically cited academic studies from the past 30 years, as well as very practical studies and reports by business groups. I have done so to say, “We must do more.” The help and support is out there, and I know, from working within our Government, that we have a will to improve things.

I have a question for the Minister, who I know has done so much to change the landscape of apprenticeships and expand their availability and take-up by both companies and individuals. I hope that he can shine his spotlight on this area and achieve similarly successful results. To do so, he must encourage confidence-building measures for girls, through the types of activities that I have discussed, beginning with girls in year 7 or younger, and he must actively encourage girls in the pursuit of the Duke of Edinburgh award in performance, arts and music.

I welcome the Government’s national citizenship service, which was piloted in the summer. On Wirral, it brought children together from all kinds of backgrounds and at the end of the two-week project the children said it had pushed them, allowed them to engage in activities that they had never done before, including team play, and built their confidence. They said that it had been life-changing and transformational. If we could build on that success in one way or another and encourage more children, particularly girls, to participate in those projects in their summer holidays, it would be a giant step forward.

The Government should develop work experience links during summer holidays. I wonder whether the Government’s plans, for 5,000 women mentors over the next three years to inspire female entrepreneurs, could be extended into schools to help with initiatives such as Modern Muse and Big Sister. As John Asgian, a teacher at St George’s school in Maida Vale, puts it:

“Self-confidence is a function of self-identity. It is not always about ‘feeling good about yourself’, it is about doing well for yourself and doing good for others.”

If we want a generation who are doing well for themselves and good for others, it is time we helped them build the ability to do it, and we can do just that by building self-confidence for girls.

The Government are right to put so much emphasis on qualifications and on raising school standards. Every time our excellent Secretary of State for Education gets up and raises the flag for higher standards in schools, I want to cheer him, and as a parent I harass my children regularly, with mixed results, but I must confess that there is perhaps one thing more important than qualifications and that is, of course, confidence. If you have confidence and qualifications you are king and are likely to become a Member of Parliament—

Order. Could you not say “you”? I have masses of confidence and qualifications, but I am sure that the hon. Lady is not referring to me. I have noticed other hon. Members doing the same. I do not wish to stop the flow of the debate, but if speakers could not refer to me, I would be grateful.

Of course, Mrs Main. I will adhere to that, confidently. With qualifications and confidence—king. Without qualifications—trouble, absolutely. But anyone who is brimming with confidence can get on and make the right choices.

It is very important that, along with studying for their qualifications, young people learn confidence at school, but why is it particularly necessary for girls? We so often see girls outperforming boys in qualifications, so why is it that when I go, as I often do, to the mixed schools, particularly the secondaries, in my constituency and get up and talk to the pupils, I get many questions, but very rarely from the young women? They seem to think that they have to sit quietly, and that worries me. It worries me that the next generation of young women are not confident enough in the classroom, and that will have an impact on their future lives. We know what low confidence is about; it is about low self-esteem, and in areas of high deprivation, such as the ones I have in Hastings, we are more likely to get the low self-esteem that goes with lower family expectations and unwise choices.

The topic I want to address today is teenage pregnancy. The UK has the highest rate of teen pregnancy in Europe and the developed world, and one of the highest in the whole world. The previous Government made strong efforts to tackle the problem. In 1999 they put together a 10-year strategy to reduce the number of teen pregnancies, and a lot of money was spent on it. The different impacts and influences on the young women making the choices were analysed, and we found out a lot about the effects of welfare, of access to employment and housing, and of confidence, but unfortunately the strategy did not have a tremendous impact. Over those 10 years, the number of teen pregnancies fell by only 13%; the goal had been 50%. Any decrease is of course good, because having such high levels is an unacceptable way for communities to operate, but we could do more, by boosting confidence in schools. We must have a platform that addresses how we can influence young women so that they make smart choices.

Does my hon. Friend agree that one of the best ways of influencing young women to make smart choices is to show them role models? All too often the role models in the media are about make-up and singing as career success. Does she agree that a great advantage of the initiative taken by my hon. Friend the Member for Wirral West (Esther McVey) is that it shows young women that there is a huge multiplicity of female role models out there who can inspire them?

I agree. It is incredibly important that young women realise that there are other women out there who can help them to make smart choices. We need to reduce the impact of all the advertising and television that seems to suggest to them that celebrity and early parenthood are a way forward. It is well known that these young women sometimes make what we call a choice to go ahead and have a baby at a young age. They think it is a smart choice—they see the welfare benefits—but in the vast majority of cases it is not a smart choice, and it has unhealthy outcomes for the young woman and the baby.

In schools, we can do two things. We can raise educational standards, of course. In some cases, it is hardly fair to say that young women with no qualifications make choices. They do not make choices, because they are left with no qualifications. Having qualifications is incredibly important, and I hope that this Government raise standards. We also need to help young women with their self-esteem, so that they have, quite simply, the confidence to make choices—to say “No” when they want to, and to ask for birth control so that they do not end up having babies quite so young.

Last week I saw Hilary Pannack of Straight Talking, a leading UK charity, which was set up in 1998 to combat the high levels of teenage pregnancy. The charity does an extraordinary thing, delivering peer-to-peer education in schools. It employs young mothers who have had babies as teenagers to go into schools and make clear the sort of life that lies ahead. They do not say, “This is a disastrous thing to do,” because no life is a disastrous thing, but they do explain the hardships of young motherhood and the lack of choice about their own lives. The organisation is very successful. It told me that it tries to explain why not to get pregnant:

“The approach is centred on the belief that young people might know how not to get pregnant”—

this is not pure sex education; they understand the facts—

“but they also need to know why not to get pregnant.”

My experience of talking to young women in Hastings is that that would be a very useful guide.

Coming back to the impact of deprivation, in 2007-09 the teenage conception rate in Hastings was, unfortunately —

Order. I am trying to give some latitude to the Member, but somewhat tangentially some of her comments range rather wide of the debate on confidence. If she could keep bringing her comments back to confidence, I should be grateful.

Okay. I am interested in talking about this topic because confidence is probably the single most important element in a young woman’s life choices. One of the most destructive factors is a young woman not having the confidence to be able to make the choice to get her qualifications and develop her career, and instead making what is effectively a choice to have a baby very young. That is why this is absolutely about confidence. It is about having the ability to make that choice.

I encourage the Department for Education to engage with the charity Straight Talking so that we have more representations from women who have been in that situation and can deliver peer-to-peer advice in schools, so that young women can focus on that choice. I welcome the fact that the Department is consulting on the subject--if any Members would like to input into it, the consultation closes on 30 November. If we are going to reduce the rate of teenage pregnancy, which is a casualty of lack of confidence, addressing confidence is absolutely paramount.

For 14 years before becoming an MP, I was a primary schoolteacher. I ended up as deputy head of the primary school that I went to when I was three—Billy Backwater, perhaps, and some might say that I have swapped one set of bells and playground humour for another. While I was a teacher, I taught eight, nine and 10-year-olds. The young girls had confidence, dynamism and enthusiasm—I could see it in their body language, their movement, their facial expressions and how they interacted with boys, teachers and each other. Something happens around the age of 13 or 14 that turns girls from dynamic people to not-so-dynamic ones who adopt the role of second-class people in school.

I congratulate the hon. Member for Wirral West (Esther McVey) on securing this debate on a subject that is rarely debated. The briefing pack from the House of Commons Library concentrates on jobs and not on the essence of the debate, which, as you have said, Mrs Main, is girls’ confidence.

The hon. Member for Wirral West mentioned many research documents and books. I draw hon. Members’ attention to Mary Pipher’s book “Reviving Ophelia”. Ophelia, as hon. Members will know, determined her own value by how she was perceived by her father and Hamlet, and ended up dying, drowned in a beautiful dress that made her look ever so pretty but dragged her down and kept her underwater, surrounded by flowers.

At the crucial age of 13 and 14, in early adolescence and puberty, the battle for self is won or lost. Much is made of qualifications such as GCSEs and A-levels, but only 18% of a person’s success, measured over a lifetime, is down to qualifications. We focus attention and funnel billions of pounds of funding into education, but is that the wisest use of our public funds? Are there other ways we could try? Could we divert some of it into confidence-building measures such as mentors and role models?

If what the hon. Gentleman says about early puberty and age 13 and 14 is correct, should we not concentrate all our efforts on that age group? If we have to take resources away, we should take them and concentrate them on that age group, in order to give them the confidence to shoot through and go on to do GCSEs, A-levels and so on.

I agree that it is a crucial age, but as another hon. Member mentioned in an intervention, the most crucial age is probably nought to three, when children are dressed up in pink or blue and told to be active or passive. For me, though the thrust of this debate is that 13 and 14 are a critical age.

Other factors that determine success are emotional intelligence and confidence. Luck, as everyone within this room will know, provides a great deal, as do social connections and networks. Some people are well connected—I would say that most of us here are—but in places such as the constituency of the hon. Member for Hastings and Rye (Amber Rudd), a seaside constituency like my own, social networks and networking opportunities for jobs, placements and internships are minimal.

During the period when girls are aged 13 to 14, smartness is seen as a liability. There is pressure to be popular rather than honest with themselves, and young girls are taught to be feminine rather than a whole person, as that might be slightly unfeminine—“She’s a bit tomboyish. She’s a bit too big for her boots. Get down.” Many young girls spend more time on make-up than on developing value systems. We could do a lot to teach young girls to develop their own value systems.

I mentioned the education budget, but there are also consequences for the health budget. Mental illness among children is running at 25%, and obesity in young children at 29%. We are following the American model, although we are 10 years behind, so we have a lot worse to look forward to. Binge drinking is on the rise, and smoking has decreased in virtually every sector of society save for one group: 15-year-old white working-class girls. What is going on? Why is that group the worst affected? Incidences of bulimia, anorexia nervosa, loneliness and self-harm are on the increase and need to be tackled. Not only do they have an economic consequence, they have a human consequence. Girls’ complicated lives are often reduced to one thing by the media: weight. “If you’re thin, you’re okay. If you’re not, you’re not okay.”

Mary Pipher’s book outlines some practical tools, one of which involves centring oneself on a regular basis. We are all on the hedonic treadmill. As MPs, we get up at 6 or 7 o’clock in the morning and get home at 11 o’clock at night; often, we find little time for our spouses, parents and children. We are not alone; other people out there are in the same position. We pass on those values to our children, and they do not have time to reflect. Reflection and centring are key, especially for young girls, but perhaps for all of us here.

Mary Pipher says that a distinction should be made between thinking and feeling. Girls should not just follow their emotions; they should slow down and think. Is that feeling intelligent? They should check with reality. Girls need to develop personal value systems, which she describes as a north star, by asking, “Who am I? What is important to me?” and holding it up so that when advertisers try to throw them this way or that, they say, “No, I’m going that way. I’m following my star.”

Mary Pipher says that we should take time for the important decisions in life. Teenage pregnancy has been mentioned. Deciding who their first boyfriend will be is a big step for girls, as is how that relationship unfolds. Who are their friends? Are they the right friends and not just the popular ones? Do they have the right values that fit with a girl’s own personal values? Mary Pipher also says that young girls, like all of us, should try to manage pain. Pain can be a good thing if we handle it right: if we feel under threat and get on top of that threat, we become stronger people; if we fold under it, we become weaker. It is a dangerous game. Pain is all around, and to overcome that pain, proper support is needed, as is time to talk with family, friends, trusted mentors and role models. Organisation of a young person’s life is also important. We should help them manage their busy schedules and be there when they need help.

Other hon. Members mentioned providing the right activities, although it sounds a bit old-fashioned, a bit big society and a bit like the right hon. Member for Witney (Mr Cameron)—perish the thought. The right activities, such as exercise, reading, hobbies and meditation are all old-fashioned but good stuff, as opposed to the wrong activities, which are thrown at kids in every advert. We witness something like 1,400 adverts a day. They are full of promotions of drinking, eating and overeating, sex, drugs and smoking. The advertising industry is a multi-billion-pound industry that tells us to consume, consume, consume and not to bear in mind its effect on individuals and families.

Developing the right activities is important. As was mentioned, we need to recognise, record and celebrate successes, whether in sports or other activities. That becomes a virtuous circle, as a girl gains confidence in one activity such as singing or dancing and becomes a bigger person for it. Again, it is big society-ish, but we need to develop altruism and volunteering to get away from the self-absorption forced on us by the media, and to use skills such as humour and to develop a thick skin against our peers when they say, “Your values are wrong and ours are right.”

In his book “Affluenza”, Oliver James calculates the amount spent on advertising in America to be 2% of GDP. In the UK, it is 1.5%, and it is 1% in mainland Europe. The purpose of advertisers is to sow discontent and make people think that their life is not quite right, but that it would be right if they had this or that. Some of us can say, “No, I don’t want that,” but young girls are especially vulnerable to advertising and that state of permanent dissatisfaction. Advertising comes through the TV, the radio and, increasingly, through the internet. It comes especially through girls’ magazines, which have been described as the work of the devil. Considering the values that they communicate to young girls, should such magazines be regulated? I know that we are not in favour of press censorship, but let us at least have an assessment of the harm that they are doing to young women.

Order. I am sure that the hon. Gentleman will bring the word “confidence” into his discussion of all these activities.

With respect, Mrs Main, every single point I have made is about confidence. This is about someone creating their own value system rather than having the media’s values rammed down their throat, and it is about developing as a person with individual confidence. Another way people can combat such pressure and develop confidence is to check the messages that enter their ears and eyes daily. Hon. Members may laugh at the concept of media studies, but when we became a literate society 600 years ago, literacy flourished and people studied it. Now we are in the age of the moving image, but we do not study the moving image. It is pooh-poohed, because the owners of the media do not want us to understand it or to appreciate the control that they have over our lives.

I am overawed by them. The hon. Gentleman mentioned literacy. I also have two sons, and I have found that the daughters spend so much time reading compared with the boys. That is absolutely fabulous, and we should use it somehow to develop confidence among our children.

In conclusion—I realise that others want to speak—there is a number of positive actions I hope the Minister will take. Much of the research that was done for Mary Pipher is American, and although there is a direct correlation with this country, we need British research to find out what is going on in our society. We must not leave such research on dusty shelves, but use it to create practical activities in the classroom and in the home for young women. We need a curriculum that includes properly structured confidence building, which is measured over time to ensure continual improvement. Dare I say it, we may even need regulation. I know that the Government are loth to regulate, but we need an assessment of the damage advertising causes to specific groups, especially young, vulnerable women and children, and if regulation is needed, we should implement it.

Thank you, Mrs Main, for allowing me to take part in this incredibly valuable debate.

I commend my hon. Friend the Member for Wirral West (Esther McVey) for the huge contribution she has made to tackling the lack of confidence among girls by securing this debate and by working over many years to bring this issue to the public consciousness. It must have taken some confidence to stand up today and speak about this issue, because confidence among young women seems for some to be a marginal issue that is worthy of comment but always plays second fiddle to the goals of academic success, sporting achievement and extra-curricular excellence in schools. I believe, however, that the most important thing we can take from today’s debate is the understanding that confidence is absolutely pivotal to a girl’s success. That confidence and self-belief, which eludes so many girls in our schools, is the foundation of their achievement throughout life.

At senior levels across the sectors women remain a rare breed. FTSE 100 boards are plagued by a chronic under-representation of women, and only one of the 12 Supreme Court judges is female. However, the commendable aim of getting more women on the boards of top companies or to the heights of the professions is entirely alien to many girls in my constituency. The worlds of business, law or science are a million miles away from where some of the young women in Gosport believe they can take their lives, because of their persistent lack of confidence and aspiration. One teacher told me quite bluntly that many girls will get pregnant because they see having a baby as the one thing they are capable of achieving. As a primary school teacher, she sees first hand that from a tragically young age girls allow themselves to be shouted down by boys in class, as they mimic the lack of confidence, attainment and ambition they see in their own mothers and other female role models.

As children grow, so does the gender gap. National statistics show that girls are more than capable of outperforming boys throughout school. I could mention as anecdotal evidence the fact that, on the school run on Monday morning, my nine-year-old son bemoaned the fact that the two most brilliant children in his class were both girls and asked at what age girls stop being better than boys at everything. Despite the statistics, however, many girls are falling behind in the most deprived areas of Gosport. A teacher told me about one girl whose ability in maths far outstretched what she was actually achieving. At a certain point the girl started to believe that doing well in maths or in science was in some way not cool or attractive.

My hon. Friend the Member for Wirral West mentioned a survey by Girlguiding UK, which found that being a hairdresser or beautician is the top career goal for many secondary school girls. Although, God knows, I appreciate the work of beauticians and hairdressers as much as the next woman, more work is needed to ensure that careers advice and work experience opportunities highlight the hugely diverse avenues that are open to women.

I apologise for not being here earlier for the debate; I was detained in the main Chamber. Does my hon. Friend agree that we have an opportunity to advance the possibility of careers in science and engineering, and to show how attractive they can be for girls and how much opportunity there is?

That is absolutely correct. Raising aspiration for girls is about not only showing them opportunities but convincing them that those opportunities are within their reach. More than half the girls questioned eschewed science and engineering, because they believed that careers in them would be too difficult. From a very early age, our schools must convince girls of the simple truth that they are capable of achieving a great deal. One pioneering primary school in my constituency has launched a children’s university, which runs every Friday. The children’s university empowers kids as young as five to chose their own courses in subjects as diverse as microbiology, woodwork and Spanish. For a girl who has never seen a woman in her family go to university, or indeed even hold down a job, the impact is immense. The role that our schools play—through careers advice, the introduction of positive role models or innovative projects such as the children’s university—is central to raising the confidence and aspiration of girls.

Finally, we must accept that promoting confidence in young women requires a holistic approach. Other Members have said that eating disorders, mental health issues and self-harming all greatly undermine what girls can, and believe they can, achieve. We need to encourage more joined-up thinking between schools, training providers, and other youth and health services, rather than just seeing academic failings in isolation. Nurturing confidence in young women will ultimately rest on seeing the whole person; it will involve seeing the lack of ambition they experience at home, the insecurities that are re-confirmed by their peers and the emotional challenges that young girls will always endure. Only then can we ensure that young women will reach the great heights that we know they are capable of in their chosen career.

It is a pleasure to follow my hon. Friend the Member for Gosport (Caroline Dinenage) and other hon. Friends who have spoken thus far. I congratulate my hon. Friend the Member for Wirral West (Esther McVey) on securing the debate. I went to an all-girls school, and I look forward to going back shortly to do its prize-giving. I have a suspicion that confidence will be a key part of any speech I make, so this debate will be not only important but incredibly timely. For that, I thank my hon. Friend.

Everyone has approached the debate so far from completely different directions, which is interesting. The hon. Member for Vale of Clwyd (Chris Ruane) mentioned the importance of literacy and education, which is telling when we look at other countries across the world that ban women from reading books because the regimes are frightened of the information and education that women can gain from them.

One quote, which I did not use before, is: “The less a woman has in her head, the easier she is to carry.” What does the hon. Lady think of that?

It is interesting how in the past certain comedians have mocked women’s education, to try to belittle women. Some dictatorships have banned women from being educated, which makes the point.

In my short remarks I want to mention the importance of sport and physical activity in building girls’ confidence. I am interested and active in sport, and am pleased to say I have just been appointed parliamentary ambassador to Us Girls, a lottery-funded project within 50 areas of high disadvantage, spread throughout England. It is tied in with the hugely successful StreetGames. I am also the manager of a girls football team in Chatham. I have been with the girls since they were nine and 10 years old, and now they are 13 and 14—the key age group we have been talking about this afternoon. They have gone from timid little girls to strong, confident and often cheeky teenagers. It has been very interesting to see them grow up, and I am proud to have played a small part in their lives thus far.

I am pleased to be involved in youth sport, not least because a quick search on the internet shows that there has been much scientific research into how sport can help to build confidence in girls. In addition, it has been proved that girls who do sports do better in school, because exercise improves learning, memory and concentration. It can also help to reduce stress and make people feel a lot happier, not just about their physical self but about their mental ability. What is fantastic about some of the recent initiatives to get youngsters—boys and girls—active in sport is the fact that there has been much more innovative thinking about the type of sport or physical activity that is offered. In my day—without meaning to sound as if I am 100 years old—the only opportunities for sport we had were netball and hockey in the winter and athletics and tennis in the summer. We were very lucky to have the playing fields so we could do those activities, but not everyone wanted to do competitive team or field sports. Now there is much more to do, ranging from dance and trampolining to Zumba, which is apparently the latest craze.

I am not an expert on Zumba, I am afraid, so it was not on that matter.

The hon. Lady is making an interesting point about choice and diversity for girls in PE and games in school, and physical activities. In her role as an ambassador will she emphasise that to Ministers, too? An emphasis on competitive sports between schools is right, but for some girls the physical activities that will get them to participate, and increase their confidence, are not necessarily the traditional games she mentioned.

I agree. Competitive sport is important as it builds team spirit and confidence in many different ways, but other sports build personal confidence. I am thinking of dance and the advent of “Strictly Come Dancing”, which has inspired many more young people to get involved and interested in dance. We should try to maintain as much variety as possible in the range of sports available to young girls.

That reminds me of Debbie Moore, the first lady to set up a public limited company. She did not like sport, but wanted physical exercise, team play, confidence building and to go before an audience, and dance was how she found those things. That is not sport, but the encouragement of other active pursuits.

I completely agree with my hon. Friend, and have been careful not to talk just about sport, because physical activity is incredibly important.

Getting people involved in sport or physical activity is one thing; keeping them involved as they get older is a very different problem, and all clubs or organisations involved in providing sports opportunities are finding it difficult. In my field, football, girls drop out more as they get older. The Football Association and other organisations that are looking at sport for women are trying to deal with that. Interestingly, when girls start to drop out of sport their confidence often drops, partly because when they are participating they become more confident about their weight and body shape, so it follows that they get less confident if they drop out.

Access is one way of keeping girls involved, and that is a debate for another day, but confidence can be instilled by others, which is why media portrayal and positive role models are important factors. So far, every Member has mentioned those two elements. I hope that I am a positive role model for my girls football team and indeed for local schoolgirls, who may or may not be interested in politics, but see a female politician in the local area. There are only three female MPs in Kent, and I think it is important for me to go out to schools in my area. We have a few single-sex schools in Medway, and I visit them to show them that women locally can achieve.

I am merely one woman in their lives, and television and local newspapers are often shaping influences. The shape, size and style of women on our TV screens or in magazines is often commented on. I applauded loudly when in the current series of “The X Factor” talented but not stereotypically size 8 beauty-queen participants were put through to the later stages. From an early age girls see what happens, and they go from wanting to be the Disney Princess to wanting to be a slimline pop star. The irony is that often the bigger girls are better singers. What we do to encourage diversity of representation in the sector is important.

Will the hon. Lady congratulate Sami, from Rhyl, my home town, who, when pressured by the judges to lose weight, said, “No, I am happy the way I am”?

The hon. Gentleman will be delighted to know it was Sami I was thinking of when I wrote those words earlier. I thought she was a fantastic singer and that it was an inspiration to everyone watching to see someone of a bigger size be talented, and have the confidence to go up on stage and sing well.

It is a shame we do not see as much coverage of female as of male sporting heroes on our televisions. I hope that that will be addressed during the Olympics next year, and that serious consideration will be given to how to achieve balance in broadcasts and writing. The lack of women on the shortlist for BBC sports personality of the year is in the news today. Some superb sportsmen are on the list, and I would not want any woman to be included on it for anything other than merit and excellence, but it might be easier for females to be considered if they had a higher profile in the coverage in the first place.

I am proud to have co-signed with the right hon. Member for Leigh (Andy Burnham), earlier in the year, a letter to Mark Thompson, director-general of the BBC, which helped to secure coverage of the women’s football World cup quarter final on terrestrial TV. It was an important step forward in achieving wider interest in women’s football, but it is now time we looked at how broadcasters cover women’s sport in general. At the moment coverage is dominated by men’s sport. I do not suggest it should be 50:50, but I would like a bit more coverage, especially at peak times.

We have some brilliant sportswomen at the moment, and I will quickly plug Kat Driscoll, from Chatham, who has just secured her place in team GB, for trampolining. I cannot think of anything more inspiring for girls from Chatham than to see someone who grew up in the same street or went to the same schools as they did representing their country. Girls who play sports learn to set goals and develop discipline. Often they learn about teamwork. Those skills are good not just for sports but for life. We heard earlier, from my hon. Friend the Member for Wirral West, that confidence is hard to define. However, participation in sport and physical activity develops friendships and relationships and a passion for something that can stay with people for life, building the strength of mind and body that perhaps encapsulates what confidence should be about. I hope that the legacy of the Olympics and future sporting events will be to identify female role models, inspire greater participation in various sports and, ultimately, build confidence in girls, which in turn will stand the next generation of women in good stead.

I congratulate the hon. Member for Wirral West (Esther McVey) on securing the debate. It has been excellent, ranging far and wide on the issue of confidence and in particular on the confidence of girls in education.

As someone with two older sisters and a teenage daughter, I am aware of the importance of the subject and, particularly as the father of a teenage daughter, of many of the issues that hon. Members have discussed in relation to the way in which girls grow up and develop, what happens to their confidence over that time and the impact of culture, the media, school, education and friends on confidence, self-image and self-awareness. In fact, I had a conversation with my daughter about this debate when I found out about it.

She would be quite capable of doing so, having recently got through to the next stage of a debating competition with her school. Members may be interested to know, however, that she is not particularly interested in following me into politics—I think that she has higher ambitions than that.

The contribution of the hon. Member for Wirral West highlighted the work that she has done on the subject. I commend her for her work with girls to try to build their confidence and make sure that they have opportunities. She spoke about the National Youth Theatre project in which she is involved with her book and her work with Girlguiding UK, an excellent organisation with which I had many dealings as a Minister in the old Department for Children, Schools and Families. Girlguiding UK is a superb organisation that does great work with young women and girls, and it is also extremely progressive and forward looking. I commend some of its publications to hon. Members, if they have not had the chance to look at them and see the work that it is doing with young women. It is a modern organisation doing a great deal of good work, and the hon. Lady gave an extremely thoughtful and thoroughly researched speech on the subject.

The hon. Lady then talked about the English baccalaureate and the role that it might play in building confidence, but that is one point on which my opinion might differ from hers. The reason why I intervened on her on the matter of music—another hon. Member said that it is a subject that can give confidence to young people and to girls in particular—is that, when I asked the Minister of State, Department for Education, the hon. Member for Bognor Regis and Littlehampton (Mr Gibb), who has responsibility for schools, a question recently, I was unable to ascertain an answer from him about the survey to which the hon. Lady has referred as to what has happened to those subjects not included in the E-bac.

The hon. Gentleman is making a good point—we have all said that music, drama and sport are vital in developing confidence—but my point was about the ability of a person to have confidence and choice in their career later in life, so that they have the skeleton of a very good, sound education that does not limit them later. That is what we found to be the case for so many girls who limited their choices and future avenues early on.

That is a valid point. I completely accept that it is important that, when it comes to those crucial points in school when choices are made, young people and young girls in particular are aware of the choices that they are making and given good advice and mentoring about their consequences. My personal view is that the English baccalaureate does not serve that purpose particularly well and that it demonstrates that more young people are choosing the subjects that the Government want them to choose at a particular level. It is a self-fulfilling prophecy that that will happen when schools are told that that is how they will be measured. Inevitably, they will then change their timetables and resources in order for that to happen. My point is that that does not necessarily deal with the issue of having the confidence to take those subjects in the first place. I am concerned that we still do not know, because the Government did not ask the question thoroughly in the survey, what impact that has had on the other subjects that are outwith the English baccalaureate, such as religious education and music and drama, both of which have been referred to as confidence-building subjects.

The hon. Lady was followed by the hon. Member for Hastings and Rye (Amber Rudd), who made some important points about confidence in relation to teenage pregnancy and the rates of teenage pregnancy in this country. She is absolutely right. Teenage pregnancy fell by about 13% during the period in which the previous Government were in office, but the figure is still far too high in this country. All hon. Members want to figure out the best way to tackle that, because it is far too high. There are sometimes differences of opinion on the best way to approach the matter in relation to sex and relationship education and other such issues, but I have no doubt that the hon. Lady is absolutely right that building girls’ confidence and self-esteem is key to lowering that all-too-high statistic.

The hon. Lady also mentioned the issue of self-image, weight and obesity. I commend to hon. Members, if they have an opportunity to read it, the Foresight report, which was produced during the previous Government’s time in office, although it is not a political report. It centres on obesity and was published about four years ago. It is a key document to understanding the subject and its importance, particularly in relation to some of the issues under discussion.

The contribution of my hon. Friend the Member for Vale of Clwyd (Chris Ruane) was also very thoughtful and well researched. He made the point, which I think all of us strongly recognise, about the confidence that young girls have at about the age of 10. I have always thought that if someone wants to find common sense on legs, they should talk to a 10-year-old girl and they will get the common-sense answer to any question on any subject. Something happens, however, during the course of secondary education, puberty and the teenage years, and, often, girls who were tremendously confident, articulate and able to speak up for themselves, and who had ambitious ideas about what they wanted to do for their future, become withdrawn all of a sudden.

I was a secondary school teacher for 10 years from the mid-’80s to the mid-’90s, teaching children between the ages of 11 and 18, and I saw that for myself when I observed their progress during that period. I was lucky enough to be a form tutor for one form group for seven years, so I saw the boys and girls who stayed for each of those years grow up during that time. It can be depressing to see what can happen to young girls in particular at the crucial age mentioned by my hon. Friend, although I did everything that I could as their teacher and form tutor to try to instil in them the kind of confidence that they should have had. My hon. Friend also mentioned the importance of networks and the frightening statistic that the only group in which smoking is increasing in the country is 15-year-old, white, working-class girls.

My hon. Friend was followed by the hon. Member for Gosport (Caroline Dinenage), who spoke with a great deal of passion and commitment about the importance of science and engineering, and about encouraging girls to take up those subjects and to have the confidence to do so. I listened recently, while driving, to Jocelyn Bell on Radio 4. She was, of course, denied the Nobel prize for science. Many people think that that would not have happened to a man if he had discovered the pulsar, but because she was a relatively junior scientist at the time she never got the recognition, through the Nobel prize, for her achievement. She still went on to be an extremely distinguished scientist, but her description of the sexism that she faced as a young scientist working in the scientific community was disturbing. That was back in the 1960s, which is quite a long time ago, but there remains a certain attitude towards girls and science that we need to make sure is overcome.

The hon. Lady was followed by the hon. Member for Chatham and Aylesford (Tracey Crouch), who spoke about the importance of sport and physical activities in instilling confidence in girls. When I was a Minister with responsibility for school sport, I was fortunate enough to work with Dame Kelly Holmes and Baroness Sue Campbell on this subject. The hon. Lady is absolutely right. I had the wonderful experience of witnessing my daughter’s one and only brief experience on the hockey field at the age of 11, but then, somehow or other, she disengaged from sport and physical activity, so I think that the hon. Lady is absolutely right that we need to do more to encourage a wider range of activities for girls.

I want to mention one sporting heroine of mine, Nicole Cooke from south Wales, who won the gold medal for Great Britain in the cycling road race at Beijing. She won the world championship in the same year, which is something no other cyclist has ever achieved. If she were a man, I am sure that the recognition would have been absolutely enormous. It is a shame that there is not a female sports person on the sports personality of the year shortlist this year, as the hon. Lady has rightly said.

As I have said, I was a school teacher for 10 years until 1995 and became an MP in 2001. There is rightly a focus on standards and on the need for high achievement in the curriculum. However, I am absolutely convinced that we should not lose sight of some of the things that I fear might be regarded in some quarters of Government as the softer, wishy-washy liberal aspects of our discussion today. For example, one of the things that I was responsible for when I was a Minister was the social and emotional aspects of the learning programme in school. That dealt head-on with the problem that some children, particularly girls, were sometimes coming to school with a lot of baggage—emotional baggage rather than the bag in which they carried their school books—because of the nature of modern society, which some hon. Members have described today.

As my hon. Friend the Member for Vale of Clwyd has said, girls can come under pressure in the home, from the media or from the pace of modern life. As was mentioned earlier, the social and emotional aspects of learning programmes and subjects such as dance, drama and sport, or extra-curricular subjects such as debating, group work or the Duke of Edinburgh award can build self-esteem, confidence, resilience and the ability to take risks.

As the hon. Member for Wirral West has rightly said, those things are extremely important. I sometimes fear—it is entirely possible that when we were in government, we gave this message as well—that, in our desire rightly to say, “We want to raise standards. We want academic standards to improve. We want this to be the country that is the best place to go to school in the world and that has the highest academic achievements,” we lose sight of the importance of some of the social and emotional aspects of learning. Such subjects actually promote better academic achievement. Anyone who has worked in education will know that children who are well-balanced, well-rounded and emotionally stable will do better in the classroom.

I do not give credit to the Prime Minister for many things, but he is introducing the index of well-being, which is being dealt with by the Office for National Statistics. Will my hon. Friend pay tribute to the work that is being done by the Government to measure well-being as well as academic standards?

It is important to measure well-being, because welfare in the economic sense is not entirely related to the level of gross domestic product. There is nothing particularly new in that concept, but it is important to have a measure of well-being. It is also important for there to be such a measure in schools. That is the point I am making. If we are going to have such a measure for society as a whole, let us make sure we have it for schools, too.

Many books have been mentioned today. Hon. Members may have read the interesting book, “Grit: the skills for success and how they are grown”, by Yvonne Roberts, which talks about how to build social intelligence, emotional resilience, enterprise and discipline skills in girls and the importance of social and emotional intelligence. It also mentions how crucial reinforcement, mentoring and building resilience are. Some of the work done on that in schools by organisations such as the Young Foundation is extremely valuable and important.

Today’s debate has been extremely informative and of a very high standard. The subject is probably not highly politically controversial, but it has provided a useful opportunity to explore what the Government are doing to try to instil greater confidence among young women and girls in our schools and colleges.

As the shadow Minister, the hon. Member for Cardiff West (Kevin Brennan), has said, this has been an interesting and important debate, and I congratulate my hon. Friend the Member for Wirral West (Esther McVey) on securing it.

I do not have daughters; I have two young sons. However, women have been very important to me throughout my life. My mother was a woman and, curiously, my wife is, too. Therefore, what I learned literally from the cradle is that women—mothers—shape our character and form our ambitions. We gain the confidence that has been described by so many of the speakers in this debate—it was highlighted by my hon. Friends the Members for Hastings and Rye (Amber Rudd), for Chatham and Aylesford (Tracey Crouch), for Gosport (Caroline Dinenage) and, indeed, by the hon. Member for Vale of Clwyd (Chris Ruane)—very early in our lives. Governments, schools and others can do much—I will talk a bit about what we are trying to do—but, in the end, the familiar influences, particularly maternal influences, are critical to subsequent progress.

I learned from my mother and my father, who were both wonderfully archetypically male and female. I think of my mother and I think of her softness and the smell of talcum powder; I think of my father and I think of how bristly he was and how he smelled of tobacco and work. They were certainly both archetypically male and female and were both wonderfully demonstrative and loving. They gave me the feeling that I was the most special little boy in the world—a feeling that has never left me, by the way. I feel that now, at this very moment, so my ambitions were reinforced by not only their direct support but the sentiments that they instilled in me.

I entirely appreciate the points that have been repeatedly made in this debate. As the shadow Minister has said, they have been made on the basis of good information and a shared determination across the Chamber. I entirely recognise that the challenges people face as they turn their own ambitions into reality are affected by many influences. In the short time left, I will try to deal with some of those influences, some of which are benevolent and some of which are malevolent, as the hon. Member for Vale of Clwyd said.

The hon. Gentleman made a wonderful contribution that underpinned the fact that this debate is as much about values and attitudes as it is about education. I reassure the shadow Minister that we understand—at least, I understand—that education is more than utilitarian. It is about values and attitudes, and ethos and sentiments. Although the work done by parents in instilling both ambition and the capacity to realise ambition in children is critical, the work done by our schools matters so much, too. Indeed, it matters more for those children who are not as fortunate as I was in having a stable, loving and supportive family.

In respect of girls and women, we need to go the extra mile. We need to take further steps to ensure that they are able to fulfil their potential. In the brief time available, I will talk about some of the steps that the Government are taking, but before I do so I will just say a word about Plato because I know that hon. Members would be disappointed if I did not. Some 2,500 years ago, Plato said:

“Nothing could be more absurd than the practice that prevails in our country of men and women not following the same pursuits with all their strengths and with one mind, for thus, the state instead of being whole is reduced to half.”

How interesting that the classical world understood what so often in the modern world we forget.

My hon. Friend the Member for Wirral West, who initiated the debate, has not forgotten because she has dedicated a great deal of her considerable skill and energy to the promotion of the interests of young women. I pay tribute to the work she has done. I was pleased to be able to support it in a room close to here, when she was able to launch her magazine, Chloe Can, which is aimed at young women. She was able to articulate some of the points that she has made today at greater length then. The work we do to establish role models in these terms is important, and my hon. Friend is indeed a role model for young women whose interests she has championed with such vehemence and to such effect.

We have learned much—I defer to the two former teachers who have spoken—about what characterises good schools in this respect. Schools with little or no gender gap in achievement tend to be characterised by a positive learning ethos—we have heard about that today, have we not?—high expectations of all pupils, high quality teaching and learning, good management and close tracking of individual pupil’s achievement. Teachers know all their pupils well and plan their resources and teaching accordingly, rather than conforming to preconceived views about what those pupils might achieve, whether that relates to gender or any other particular characteristic.

We can do three things in particular to support teachers in their efforts to fuel social mobility and achievement. The first concerns advice and guidance. It is very important that young people get the right quality advice and guidance. In truth, one of the principal inhibitors to social mobility is this: I suspect that our children will become socially mobile because of us. Our children will benefit from the fact that we, in the Chamber, are reasonably well informed about the opportunities that might exist, be they boys or girls, and will impart an understanding of how to turn those ambitions into opportunity. That is not true for all young people, however. The advice and guidance that we can provide through the new national careers service will, to some extent, ameliorate the disadvantages of many young people who do not have either advice from a family or social networks.

Is the Minister concerned, in the light of the debate, that the lack of face-to-face guidance in the careers service will be a hindrance to girls gaining confidence and being able to make the right choices?

It is important to appreciate the value of face-to-face guidance. The hon. Gentleman will know that the Education Bill establishes the new statutory duty on schools to secure independent, impartial advice and guidance. When it was debated in the House, we agreed, in the statutory guidance accompanying the Bill, to ensure that face-to-face guidance was available in particular to people with the greatest disadvantage, those special needs and learning difficulties. We also said that schools should make the most appropriate provision for their pupils. I emphasise that it is vital that that should include a range of provision, and that that provision should be linked to the quality standards that are being developed by the profession itself.

As well as changing the law, we have worked with the careers profession to establish a new set of qualifications, with appropriate training and accreditation. That means that we will re-professionalise the careers service after the disappointing years—I put that as mildly as I can—of Connexions. We are on the cusp of a new dawn for careers advice and guidance, with a professionalised service, a new set of standards, a new statutory duty and the launch of the national service co-located in Jobcentre Plus, colleges, community organisations, charities and voluntary organisations. I do not say that the task will be straightforward, but it is a worthwhile journey. The destination to which we are heading will be altogether better than the place we have been for the past several years. That advice and guidance will assist young women, in particular, to fulfil their potential in the way I have described and, as a result of this debate, will re-emphasise the significance of opportunities for girls and young women in the establishment of the national careers service this spring.

The second issue I wanted to speak about was apprenticeships. I made a point—the hon. Member for Cardiff West knows this subject well too—when I became the Minister of challenging the National Apprenticeship Service on the under-representation of particular groups. The obvious example in relation to this debate is women in some of what might be called the traditional apprenticeship frameworks: engineering, construction and so on.

I conducted some surveys and analysis on that, which was very interesting. For young girls who took science apprenticeships, it fitted in far better with their family life because they could achieve a job and status far more quickly than the slow process of going through university. It fitted in much better with the cycle of a woman’s life and child-bearing age.

How interesting. I defer to the greater expertise of my hon. Friend, but what I have done is ask the National Apprenticeship Service to run a series of pilots, building competencies and understanding on how we can make the apprenticeship system more accessible to those who are currently poorly represented. That is not to say that women are poorly represented in apprenticeships per se. More than half of all apprenticeships are taken up by women, but they tend to be in areas such as care and retail. The effect of that, because of the wage rates in those sectors, is to exaggerate the difference in wage-earning potential among successful apprenticeships between men and women. I have asked the NAS to work on a series of pilots. Bradford college is prioritising action to increase female representation in the energy sector. Essex county council is focused on women in engineering and on acting as the prime contractor for a regional provider network. West Notts college, whose representatives I met recently, is also looking at increasing female representation in engineering. There are a number of others, but I want to give the Chamber merely a flavour of what we are trying to do.

The third issue I wanted to speak about is women and science, technology, engineering and maths. Basically, not enough girls study STEM after the age of 16, as has been mentioned a number of times, including by my hon. Friend the Member for Gosport. There are several things that we can do. The Department for Education has worked closely with the Institute of Physics. Its stimulating physics network incorporates many of the recommendations of the Girls into Physics report, which the hon. Lady will know about. The STEM ambassador scheme, co-ordinated by STEMNET, is arranging for working scientists and engineers to visit schools to support teachers, and engage and enthuse pupils to continue studying science. The hon. Lady will know that a large proportion of the STEM ambassadors are women. We want to focus that energy on what we can do to encourage more girls to study STEM subjects. By making different choices early, they cut off some of the routes that might be available to them later. So much of this is about early intervention and changing perceptions about what choices can be taken to facilitate subsequent progress. I will happily give way before I come on to my exciting conclusion.

Will the Minister congratulate the new president of the Royal Society of Chemistry? For the first time in 300 years, it has a female president. In the next year, she will try to increase the number of female teachers becoming ambassadors and the number of girls taking chemistry.

I not only add my voice to that congratulation, I suggest that we invite her here to a tea party with the hon. Lady and myself, which, needless to say, she will be funding.

This debate has brought to the attention of the House the important subject of opportunities for girls and women. I do not take the orthodox view, by the way, that men and women are more alike than is often supposed. I think that they are rather less alike—my life has taught me that. However, that does not mean that the opportunities available to them should not be just as demanding, just as exciting and just as exhilarating. We should work tirelessly to create those opportunities in the way that my hon. Friend the Member for Wirral West has done for so long, beyond old frontiers to new horizons.

I learned at my mother’s knee first, and I learn from my wife every day, as Yeats said:

“That Solomon grew wise

While talking with his queens”.

In that spirit, I assure the Chamber, and all those who have contributed to this important debate, that the Government will go the further mile that I described at the outset to achieve the ambitions of my hon. Friend, which reflect the ambitions of so many girls and young women.

Park Homes

It is always a pleasure to serve under your chairmanship, Mrs Main.

As a new Member of Parliament in 2010, I did not expect park homes to feature large on my radar. I freely admit that I did not know a great deal about them and that, although I knew that a significant number of park homes were dotted around my constituency, there are more than 200 spread over seven sites. To some colleagues, especially those from the south-west, that will seem a tiny number, but in Romsey and Southampton North it represents a significant and at times vulnerable minority.

I pay particular tribute to my constituent, Tim Deacon, a member of the park homes residents association, who has made it his mission over the past 18 months to inform me of the issues facing park home residents. He has endeavoured to educate me and, along with many of his fellow residents—in particular, with another whom I will mention later—he has highlighted their issues and encouraged me to apply for the debate.

I am conscious of the fact that the subject affects a lot of hon. Members, many of whom will have far greater expertise than I do. I congratulate the mobile homes all-party parliamentary group on its hard work in drawing attention to the issue and on seeking resolutions to the problems of park home owners. I am also aware that this is only a 30-minute debate, which is a disappointment to some and will not allow all of those Members who have an interest to take part.

Many owners of park home sites are fair and upright, especially the deputy leader of my local authority in Test valley, who owns a site in Ampfield. Unfortunately, however, others are not.

I congratulate my hon. Friend on securing the debate. There are many good park home owners throughout the country, including in my constituency. Does she agree that they have nothing to fear from a fit and proper person test?

I entirely concur with my hon. Friend: good park home site owners have absolutely nothing to fear from a fit and proper person test. I certainly did not wish to criticise those who treat their residents fairly and with respect; it is the others on whom I wish to focus and about whom something needs to be done.

Last November’s mass lobby of Parliament brought several of my constituents to Westminster and they outlined in detail their prime concern—that they could not sell their homes freely, without the consent of the park owner.

I congratulate my hon. Friend on securing the debate. Before she continues with specific details, will she agree that the unscrupulous practice of park owners vetoing sales so that they can, in effect, buy the properties at a knock-down rate and sell them on, while getting a commission of up to 10% on top, ought to be stamped out in any way possible?

That is exactly what I was about to come to—namely, park home owners not being able to sell their homes without the consent of the park owner. In the intervening 12 months there has been progress, not least by the all-party parliamentary group and, earlier this month, when the hon. Member for Mid Dorset and North Poole (Annette Brooke) asked the Prime Minister an important question about the actions of unscrupulous park owners. However, I and many of the hon. Members present at the debate today believe that action must be not only robust but swift. Many park home owners are elderly, and they fear that they are running out of time.

I am extremely impressed by the phenomenal work of Sonia McColl, the leader of the Park Home Owners Justice Campaign, who has campaigned tirelessly for the rights of park home owners and worked unceasingly to collect and collate the national statistics on park homes, which the campaign presented to the Prime Minister in October. The statistics are sobering: 63% of residents reported living under unacceptable conditions, with 48% living under the regime of an unscrupulous park owner.

Does my hon. Friend agree, as my hon. Friend the Member for Winchester (Steve Brine) has already said, that there are a number of good park owners, such as in Great Yarmouth? An important feature of the problem is that the bad park owners give the entire industry a bad reputation, while negatively affecting the good park owners who deserve the credibility that they should have for providing a good environment in which people live.

My hon. Friend makes an important point. The good park home site owners are unfairly gaining a poor reputation because of their less scrupulous counterparts, many of whom are reported to be not only dishonest in their dealings with park home owners but aggressive and abusive. It is sad that only a third of residents felt that their park owner was good. That clearly needs to change.

I represent an area containing a significant number of park home owners, with some 300 in one location. They are a very active group, with an active residents association, and have worked with elected representatives to help effect legislative change in Northern Ireland. Is the hon. Lady aware of that and, if not, perhaps the Minister will examine and investigate it to help in today’s study of the subject?

I thank the hon. Gentleman for his comments. One of our problems is the lack of a level playing field or of consistency in the different parts of the UK, which can lead to a measure of resentment when some residents see other parts of the UK treated differently from them.

Was my hon. Friend struck at the meeting of the all-party group by the relatively small number of names cropping up all over the country? The thickest file in my constituency filing cabinet is that for Beechdown Park, with its unresolved problems of water leaks and water meters. An owner has not only failed to deal with the leaks but collected money by holding people to ransom—holding up the sale of their properties unless they hand over money. We discovered that he has not passed any of the money to South West Water and has run up colossal bills. My constituents’ appliances have not been working, thanks to Mr Small, which I am sure is a familiar name.

As I said, I attended the mass rally last November and listened to many of the stories from around the country, and my hon. Friend is absolutely right that the same small number of names occur time and again at various locations—always, sadly, involving the same story and modus operandi.

Time is pressing and the issue is not new, although I am new to it. Media reports can be found going back 20 or 30 years, commenting on the difficulties of park home residents when selling their properties or gaining reasonable access to services without being charged over the odds for them. The single biggest issue, however, is the blocking of sales by site owners. If park owners refuse to approve a sale, the home owner is left in an almost impossible position. There are reports of owners of properties worth £100,000 having to sell to the park owner for as little as £5,000 as all other sales have been blocked. The home owner currently has recourse to a residential property tribunal but that not only costs the owner about £150 but has limited powers of enforcement and places no binding conditions on the park owner. The situation is being addressed by the Government, and I am eager to hear what assurance the Minister can give that it is subject to a rigorous timetable.

I congratulate my hon. Friend on securing the debate. I am interested to hear what the timetable is from the Minister. The problem has been going on for a number of years, as my hon. Friend said, and has been raised a great deal since the 2010 election. We have waited some time now to hear what the Government are proposing for a licensing regime. We understand the Government’s reluctance to legislate on everything, but it is unacceptable that vulnerable residents, often in park homes, are left less protected than people in registered social landlord accommodation or in other social housing. Does she agree?

I certainly agree with my hon. Friend’s comments. It is not right that park home residents are left more vulnerable and exposed than those in many other types of property tenure. It is important not to forget that park homes can provide an important element of reasonably priced accommodation—I will not refer to affordable housing, using the technical term that we all understand from various connections with our local authorities, but to less expensive housing. Such housing is almost inevitably a choice for some of the most vulnerable people in our society, including the elderly, those who want to downsize, and those who find housing in other parts of our constituencies too expensive.

A further injustice facing park home owners is that of landlords imposing administrative charges for the supply of services such as water and sewerage. Those charges should be reasonable and not out of the ordinary for residents, but many find they are charged fees that are well over the odds, in addition to site owners taking advantage of a monopoly in supplying canisters of liquefied petroleum gas for heating and cooking. Some residents were subjected to dreadful intimidation and harassment when they challenged the prices, and had no choice but to pay up to heat their homes.

I have heard many horror stories of unscrupulous park owners overcharging for basic services. Some major LPG providers do very good deals with park owners and provide the canisters at a significantly cheaper cost than for those living in bricks and mortar houses. However, dishonest landlords often use that loophole to charge park home residents exorbitant sums to heat their homes. Residents are at liberty to buy gas canisters elsewhere without the risk of being overcharged, but the recurring theme is that many of them are elderly and more vulnerable, so they are less able to travel and to haul the heavy canisters into their car, if they have one, let alone to offload them at the other end and to install them safely.

One of my constituents, who sadly has specifically asked not to be named, contacted me to explain that he is fully reliant on purchasing gas canisters from his landlord at a significant mark-up. He thinks his lack of mobility and his vulnerability are being exploited so that the site owner can make a profit. Needless to say, he feels cheated, but helpless to do anything about it.

Consumer law provides protection for park home residents, and I encourage them to refer such incidents to Consumer Direct, which will invariably take them up with trading standards officers on their behalf, and ensure that they are reported. However, yet again, vulnerable and elderly residents need to know that they can go to Consumer Direct and have the case taken up on their behalf.

I congratulate my hon. Friend, who is making the case exceedingly well. The mainly elderly, vulnerable residents are often terrified of reporting some of the incidents that happen. More and more evidence, beyond anecdotal, is emerging, but I suggest that it is still the tip of the iceberg. Consumer Focus is doing a survey, and I believe that it will provide the Government with the ammunition to introduce strong legislation as soon as possible. Will my hon. Friend join me in urging the Minister to take back that message today? We must have not only proposals but time for legislation.

My hon. Friend makes an excellent point, and she is right. We must have legislation, and we must have it soon. During a conversation with Consumer Direct earlier today, it told me that it is making progress in taking on cases. As my hon. Friend said, the problem is not just anecdotal because there is now evidence. It is crucial that we have time to legislate so that these poor, vulnerable residents receive the action and outcome that they have sought for so many years.

I congratulate my hon. Friend on securing this debate. Park home residents are also dealt a harsh hand by park owners in their electricity supply. An electricity supply in my constituency breaches the Electricity Safety, Quality and Continuity Regulations 2002, but the problem is that compliance rests with the Department for Energy and Climate Change, whereas the safety issues rest with the health and safety boards. A further complication in the Welsh context is that other aspects of park homes legislation are devolved to the Welsh Assembly, making it difficult for residents to know who to go to with their complaints.

My hon. Friend makes a good point. There is complexity in knowing who residents should go to with their complaints. There is no consistency throughout the United Kingdom, and that is what people are calling for.

My constituent, Tim Deacon, like many other park home residents, has been party to establishing a park home residents association. Such groups must meet several requirements to qualify as a residents association, the last of which is to obtain the park owner’s acknowledgement. Even when park home residents have completed all the required steps, park owners may refuse to acknowledge a residents association and thereby deprive the residents of the rights that becoming an association provides. A last resort is recourse to the county court, but many residents are scared or do not have the will, the energy or the know-how to do that.

In an era of localism, when the Government are seeking to disseminate power downwards, I hope that they will look favourably on the growth of residents associations on park home sites. Such associations can seek to resolve issues locally without having to turn to the courts. However, the situation at the moment leaves too much power in park owners’ hands, limiting accountability and the community’s ability to exert sufficient pressure on their landlord.

Statistics published by the Park Home Owners Justice Campaign show that the majority of park home owners are in their 70s or older. It is clear that unscrupulous park owners are taking advantage of elderly and vulnerable people, many of whom in my constituency live on their own. I thought it would be interesting to see exactly how many of the 200-plus park homes in my constituency are occupied by single people, and it transpires that it is the vast majority of them. The electoral roll shows that 250 residents in 212 park homes are registered to vote. That clearly shows that those people are mainly not living as couples or families. Sadly, in many cases, they are living alone, and my argument is that that increases their vulnerability, and susceptibility to feeling intimidated by unscrupulous park owners. It is vital that the Government establish robust measures to protect residents because current legislation is clearly failing them.

I would be grateful to hear the Minister’s comments on how his Department is addressing the problem of sale blocking—a prime concern of park home residents in my constituency—and preventing unscrupulous park owners from wielding disproportionate power over this part of the property market. That would be unacceptable in an ordinary residential community. I would welcome steps being taken urgently to prevent overcharging for basic services such as electricity and water.

My hon. Friend the Member for Aberconwy (Guto Bebb) made a valid point about different parts of the electricity market having responsibility for safety, and it is truly terrifying that some park home residents may be receiving an electricity supply that is less safe than we would want. It is important for the establishment of residents associations to be made as simple as possible, and to ensure that they receive proper recognition. I welcome the Department’s consultation on this important issue, and hope that the timetable for action is suitably short. As I have said, many park home residents are elderly and feel that they have been waiting far too long.

I fully acknowledge that there are many honest and excellent park owners, and I emphasise that, as my hon. Friend said, those who are not acting responsibly are giving the others a bad name. It is wrong that all should be tarred with the same brush. But some people live in parks where that is not the situation and where an unscrupulous landlord seeks to exploit the vulnerability of park home residents, to take a percentage of the proceeds of any sale, or to block a sale. Those people deserve greater rights, and a future free from exploitation and abuse from dishonest landlords. I hope that the Minister will outline at least a partial timetable to assure us that any proposed legislation will be forthcoming as soon as possible, and that he will tell us what action the Government are taking. I know that they are taking action, but it is important to understand it clearly so that we can give our constituents some reassurance.

It is a pleasure to serve under your chairmanship, Mrs Main. I congratulate my hon. Friend the Member for Romsey and Southampton North (Caroline Nokes) on bringing this important subject to the attention of the House this afternoon, and I commend the many Members who have contributed to the debate. I hope that it is not out of place if I mention that my hon. Friend the Member for Mid Dorset and North Poole (Annette Brooke) has played an active part in the all-party group and has met my right hon. Friend the Minister for Housing and Local Government to talk about these matters.

I absolutely agree with my hon. Friend the Member for Romsey and Southampton North that a park home is an affordable choice for many people. She described it as less expensive housing, which is how estate agents describe it. It is an economical and very successful choice for many people, and there are 85,000 such households in England. Fortunately, only a minority of households and site owners give rise to the anxieties that we have heard about today. Many sites are properly managed and maintained, and decent, honest and professional site owners deliver a good service for people on their sites. Unfortunately, the good work is masked by the unacceptable conduct of others. If one reads the debates held in this House, one would get the impression that this form of tenure and these sites are collectively completely unacceptable. I do not think that it is right for us to leave that impression unchallenged.

Rogue site owners certainly cause misery to communities by not maintaining their sites properly. We have heard reports about the bullying of residents and unreasonable and sometimes unlawful interference when residents try to exercise their statutory rights, and we have heard about problems when residents want to sell their homes. The park homes sector needs to be cleaned up. There is no place for such behaviour. It is not right for the sector or the residents, and it is certainly not right for a minority of site owners to exploit the situation that they find themselves in. The Government share the concerns that have been reflected in previous debates and in the work of the all-party group.

Sale blocking, to which several Members have referred, leads to the unjust enrichment of site owners. That is not an acceptable practice, and the Government are committed to eradicating it. We propose to introduce sanctions for those who continue, without good reason, to try to prevent residents from selling their homes in the open market to people who meet the appropriate rules. That is why my right hon. Friend the Minister for Housing and Local Government proposes to consult on a range of measures that will prevent such practice. We are also committed to improving residents’ rights more generally and to closing loopholes in the legislation that allow unscrupulous site owners to exploit residents or deny them their rights.

We are also determined that local authorities should be adequately resourced and have appropriate powers to allow them to protect the health and safety of residents through robust and enforceable site licensing.

While the Minister is on his list of things that he is determined to make happen, may I make a plea that he works with his colleagues in the Department of Energy and Climate Change? Now that we have established that the green deal is applicable to park home owners, will he work with his colleagues in DECC to make sure that park home owners—and indeed many other home owners—many of whom are trapped in fuel poverty, are aware of the green deal and are in a position to take advantage of it? It could revolutionise their fuel poverty.

I will certainly undertake to write to my hon. Friend and other Members when I have had the opportunity to discuss the matter with my colleagues in DECC. Members will be aware that the Energy Act 2011 has now passed into law and the green deal is due to start next autumn. Some of the necessary statutory instruments to support that are currently under consideration. My right hon. Friend the Minister for Housing and Local Government will be publishing the consultation early in the new year. I hope that it will provide a timetable and framework for the debate. Following that, we will bring forward the necessary legislative measures at the earliest opportunity.

On the calls for a fit and proper test for site owners, the Government are not convinced that the protection of park home residents requires a complex and costly national licensing system. We have to strike a careful balance that protects the vulnerable and targets the worst in the most effective way. That is what our consultation seeks to achieve, and I look forward to Members’ responses when that consultation is published.

We have already begun the process of enabling residents to enforce their rights and to challenge unreasonable behaviour through the residential property tribunal. Since it started dealing with park home issues in May, it has received 31 applications up to the end of October and it has determined 13 of them. Not everyone will be satisfied with the outcomes of those cases, because in judicial proceedings there will always be a winner and a loser. However, the number of applications shows that residents have been empowered to challenge unreasonableness on the part of site owners, something that few were prepared to do previously through the regular courts. I am certainly not suggesting that the residential property tribunal is the solution to all the disputes, but it is a first positive step, and, I hope, an earnest of our good intentions.

Several Members have raised the issue of service charges for gas, electricity, water and sewerage. It is important to put on the record that existing rules already strongly limit the powers of site owners to impose unreasonable charges. They are not allowed to charge an illegal rate of VAT or to control the service supply. I want to make it clear that if site owners provide services, they will be entitled to recover the cost from residents under the agreement. Sometimes that cost will be recoverable only through the pitch fee. In that case, any charges will be limited to the retail prices index at the next rent review, regardless of the actual charges that the site owner has incurred. For that reason, pitch agreements will often contain a provision permitting the site owner to levy a separate charge for the provision of services. It is important for Members to be aware that the charges are governed by orders made by Ofwat and Ofgem respectively. Under the rules, a site owner cannot charge residents more than the cost he incurs in purchasing water, electricity or gas from the supplier.

In some cases, the site owner can charge a reasonable administration charge. How that recharge is calculated and apportioned between the homes has to be fair and transparent, and residents are entitled to see the bills on which the recharge is based. It is also important to be aware that the site owner can recharge only for the supply to the home and the pitch and cannot include any amount relating to his own supply—for instance, for street lighting or heating of offices or communal buildings. VAT is payable by the home owner at the 5% domestic rate for electricity and gas, not the 20% business rate, even if the supply to the site owner is commercially rated. Water, of course, is zero-rated.

If a resident believes that they have been overcharged for the resale of the services, they can recover the charges in the small claims court. Administration charges on top of the actual cost of energy are also strictly limited. In the case of water, administration charges cannot exceed 1.5p per day for non-metered supplies and 2.5p per day for a metered supply. That effectively means that £5 or £10 per year is the maximum administration charge. I hope that all those measures give some comfort to Members that home owners have some protection. Our next step following the consultation will be to bring forward, when parliamentary time allows, the legislative measures needed to tackle the abuses that have been so eloquently set out today.


I am grateful to have secured this debate during the week in which world AIDS day is marked. The HIV virus was discovered 30 years ago, since when it has claimed the lives of more than 30 million people throughout the world, including 20,000 in the UK. Over the past 20 years, we have seen remarkable progress in the medication available to people living with HIV, including today’s welcome approval of a drug that will provide triple antiretroviral therapy in a single tablet taken once a day. That does not, however, diminish the fact that there is still no vaccine or cure for HIV, and more efforts must be made to prevent the transmission of the virus.

Let me take this opportunity to pay tribute to my predecessor as chair of the all-party group on HIV and AIDS, the late David Cairns. One year ago in this Chamber, he spoke on this topic with eloquence and passion, and he consistently spoke out against the stigma and discrimination faced by people living with HIV both in the UK and overseas. I am glad that his work continues in the all-party group and through the David Cairns Foundation set up in his name, which was launched last week.

The House of Lords Committee on HIV and AIDS, led by the vice-chair of the all-party group and former Health Minister, Lord Fowler, recently published a report on HIV in the UK. Lord Fowler has done much to champion the cause over his long and distinguished career, and I believe that many owe their lives to the work he carried out as HIV began to take hold in the United Kingdom. The needle exchange programme that he introduced is a good example of that work, and it changed the course of the epidemic, particularly in Edinburgh and the rest of Scotland. In September this year, the Committee concluded that the Government’s current policies on tackling HIV in the UK are “woefully inadequate.” I will focus on some of the report’s recommendations, and I look forward to the Minister setting out the Government’s response to that report.

I will start with some startling headline figures. Some 30 years after the virus was discovered, almost 100,000 people in the UK live with HIV. Newly diagnosed cases of HIV among young people have risen by 48% over the past decade, and it is estimated that about a quarter of those living with HIV in the UK do not know that they have the virus. Half of all cases of HIV in the UK are diagnosed late, meaning a greater cost to public health and the public purse. HIV is spreading for many reasons, but principally because of high levels of undiagnosed HIV, too few people with HIV receiving stable treatment, persistent risk-taking behaviour, and a lack of HIV awareness. That is set against a dangerous backdrop of inconsistent sex and relationships education in our schools and beyond.

Early diagnosis of HIV for one person can obviously translate into prevention of the disease for their future sexual partners. People diagnosed with HIV are far less likely to pass the virus to others, as they can take steps to prevent transmission such as using a condom. Once diagnosed, people can receive HIV treatment that dramatically reduces levels of the virus in the body, so that the risk of transmission can be reduced to almost zero. This year I was surprised by the results of a remarkable clinical trial in South Africa that proved that putting people on medication for HIV can reduce the risk of transmission by an enormous 96%. That has extraordinary ramifications for efforts to tackle the HIV epidemic around the world and makes the need for the early diagnosis of HIV all the more pressing.

It is estimated that 51% of all people with HIV in the UK have undetectable levels of the virus. That is great news, although the UK should aim to increase that percentage to at least 65% over the next four years.

I congratulate the hon. Lady on securing this important debate. Does she agree with the recent remarks made by the US Secretary of State, Hillary Clinton, who said that an “AIDS-free generation” should be a policy priority for all Governments, including that of the UK?

I completely agree with the Secretary of State’s remarks. I raised the issue during Deputy Prime Minister’s questions last week. I hope that the coalition will take that aim on board and that it will be raised by the Prime Minister. The all-party group on HIV and AIDS is a member of the “Halve It” coalition that campaigns for levels of late-diagnosed and undiagnosed HIV to be halved in five years through more testing. That will help to stop the spread of HIV, improve health outcomes for those living with the virus, and in the long term save the Government money.

Patients and doctors have a large role to play. A study of people of sub-Saharan African origin in the UK who were diagnosed late with HIV found that three quarters had visited a doctor in the year preceding their diagnosis. Doctors and patients must be more aware of the primary infection symptoms of HIV. Incentivising HIV testing, particularly in areas with a high prevalence of HIV, is vital to ensure that people are diagnosed in time. One powerful incentive would be to ensure the inclusion of the late HIV diagnosis indicator in the Government’s revised public health outcomes framework. We have heard several times that a decision on that will be made later in the year. Will the Minister assure hon. Members that that indicator will be included, or at least say when the Department will reach a final decision?

As I understand it, the Department is investigating the possibility of legalising home-testing kits. I look forward to the outcome of that investigation. It is clear from the House of Lords report that home-testing kits ordered from overseas, usually over the internet, are already in use in the UK. If legalised, that practice could be regulated and allow people to test themselves securely and safely in their own home, again producing savings for public health and the public purse.

How else can we prevent the transmission of the HIV virus? The House of Lords report stated:

“More resources must be provided at national and local levels… The current levels of investment in national HIV prevention programmes are insufficient to provide the level of intervention required.”

Hon. Members may be surprised to learn that the Department of Health currently spends just £2.9 million a year on two national HIV prevention programmes for gay men and black Africans. That compares with an enormous £762 million spent on treatment. Preventing one infection avoids lifetime treatment costs for HIV of between £280,000 and £360,000, but as local service cuts kick in throughout the country, HIV prevention programmes are being reduced.

Under the new NHS structure, local HIV prevention work, campaigns and testing will be commissioned by local authorities, leading—we hope—to additional national campaigns, but I am concerned about the possible fragmentation and subsequent prioritisation of prevention work between HIV treatment that is commissioned nationally by the commissioning board, prevention and testing work commissioned by local authorities, and national campaigns overseen by Public Health England. Within local authorities, HIV prevention work is likely to face strong competition for funding within constrained budgets. A fragmented health care system will not deliver the results that we desperately need, or enable us to make headway against the rising tide of new HIV infections. We do not want a postcode lottery, or for sexual health services to be sidelined because of local sensitivities.

I congratulate the hon. Lady on securing the debate. In my north Wales constituency there is an HIV respite centre, which is extremely well supported by the local community. The problem that the centre has is that many of the people who take advantage of the respite care are coming in from north-west England and are therefore not funded by the local health authority in Wales—health is devolved. A centre that is able to serve people from north-west England therefore finds it very difficult to secure funding, because it is based in Wales, but its patients are from England. Is that the type of postcode lottery problem that the all-party group could deal with?

We can certainly campaign on the matter. I will be happy to discuss that with the hon. Gentleman outside the Chamber. He makes a very important point: this issue is not just about the NHS and the Health and Social Care Bill in England, but about achieving agreements with the other Assemblies and Parliaments in the United Kingdom to ensure nationwide consistency in the treatment and support for people living with HIV.

I shall now discuss public awareness in the UK. Twenty-five years ago, Lord Fowler led huge public health campaigns about the virus. Leaflets were sent to every household in the country and there were very visible television campaigns. However, public awareness of HIV has undoubtedly fallen during the past 10 years. For my generation, it is just not a priority any more. Despite the very high increase in the number of young women contracting HIV, when I speak to my friends about this issue I find they rarely regard themselves as at risk.

Unbelievably, earlier this year, an Ipsos MORI poll found that one in five people do not realise that HIV is transmitted through sex without a condom between a man and a woman, and the same proportion do not know that HIV is passed on through sex without a condom between two men.

I congratulate the hon. Lady on securing the debate. It is a shame that it is only a half-hour debate, because the last time that we debated the issue, we had an hour and a half, I think, and even that was too brief. The figures that she is giving now are shocking, certainly for my generation, who are getting older now. I remember the HIV debate and campaign that she refers to and how phenomenally successful it was and how aware we all were of the dangers. Something needs to be done so that the younger generation realise the very severe dangers of having sex without protection.

The all-party group has consistently campaigned for the Government to put more funding into another national 1980s-style campaign. I hope that today’s debate and the events taking place throughout the week will get the message across to the Government that it is necessary to have that style of campaign again.

An increasing proportion of adults—about 10% at the moment—incorrectly believe that HIV can be transmitted through impossible routes, such as kissing and spitting. That is not helped by scaremongering media reporting. There was recently a report in Edinburgh about a couple who, when being arrested by the police, had bitten a police officer. Both members of the couple were HIV-positive, and that was the primary headline in the Scottish media, much to my disappointment. Misinformation fuels stigma and discrimination, which are still a daily reality for many people living with HIV.

The hon. Lady has rightly referred to the importance of people being tested, but she has also referred to stigma. Does she agree that unless we overcome the stigma surrounding simply having been tested for HIV and for AIDS and not having the disease—the stigma that still exists in society about going for those tests—that will decrease the number of people who come forward to submit themselves for testing and take care of their health as they should?

Yes, that is a crucial point. I hope that any future public campaign would incorporate looking at the stigma about the virus. Unfortunately, in the meantime, it persists. That is why I would also push for the home testing kits to become available, but that is not the ultimate solution.

In a recent study in east London, one in three people living with HIV said that they had been victims of discrimination, but most alarmingly the study showed that half of all that discrimination was in the health care system. The Department of Health must take a lead on tackling stigma and develop training resources for its staff that are aimed at stopping such discrimination. Those resources must be used by all current and new NHS and professional bodies.

Sitting suspended for a Division in the House.

On resuming

I remind hon. Members that there are 16 minutes of this interesting debate left. Members who make interventions should do so briefly.

Since I took on the role of chair of the all-party group, I have been extremely surprised by the high levels of inaccurate and sensationalist reporting in the UK’s press on HIV. That reflects a wider lack of public awareness.

The lack of basic information fuels prejudice and leads to the exploitation of people, as was tragically illustrated in recent weeks by the frightening cases of HIV-positive patients being told by evangelical pastors that they could be cured of HIV through the power of prayer alone and that they should stop taking their antiretroviral drugs. The BBC has reported at least three deaths resulting in London, which I am sure the Minister will agree is a grave tragedy on her own doorstep. I am aware that the Department already funds work through its partners to raise awareness among religious communities, but in light of the shocking revelations and the relatively small budget that is allocated to HIV prevention in the UK, does the Minister think that that is enough? Is the Department planning to do more to tackle that issue?

The Government must take a lead in acting to improve the understanding of HIV. It is vital that all young people learn about HIV in school, and HIV must be included in local and national sexual health promotion campaigns and information. Such measures will help not only to tackle HIV stigma, but to enable people to protect themselves and others to improve public health.

HIV treatment services in the UK are generally of a high calibre, but access to other elements of care, such as primary care services, social care and psychological support, can vary widely. Unfortunately, time and time again, individuals living with HIV have contacted the all-party group to tell us that the social impacts of HIV on their lives are much greater than the health impacts. Generic services are often ill-prepared to meet the specific needs of people living with HIV. Individuals can be apprehensive about accessing services because of concerns about confidentiality or lack of expertise. Numerous clinical guidelines relate to care and support for people with HIV, but there is no coherent and authoritative guidance that integrates clinical, social and psychological care and covers the different stages and eventualities of the condition. Integrated guidelines from the National Institute for Health and Clinical Excellence or a national care pathway would help to make the responsibilities of different bodies and professionals clearer and make service provision more consistent and cost-effective.

The House of Lords’ report recommended that NICE develop treatment and care standards for HIV patients, and the Government’s response acknowledged that they should consider the value that NICE could add in developing standards for HIV. The Government also cited the British HIV Association’s clinical guidelines, but the guidelines do not address the need to co-ordinate specialist HIV services with other services. We in the all-party group urge the Government to act on the Lords’ Committee’s recommendations.

People with HIV live with a fluctuating, long-term condition. However, like many other people with long-term conditions, with the right support, people with HIV can play a full and productive part in society. Social care services are being cut across many local authorities and are often limited to the most severely disabled people. It is not acceptable to limit social care only to the most acute cases. Social care has a vital preventive function, particularly in treating fluctuating conditions such as HIV. Social care can also play a crucial role in dealing with the new phenomenon of the increasing number of older people who are living with HIV.

It is clear that the Government understand the value of HIV social care. That is shown by the inclusion of a specific funding line for HIV/AIDS support in the formula grant. However, local authorities are no longer required to report on the spending of that grant to the Department of Health and we have heard of several cases—for example, in Hertfordshire and Leicestershire—where money for HIV/AIDS support has been siphoned off into other areas of spending. Once that expertise in HIV/AIDS support has been lost, it will be difficult to recover. The Government must ensure that the performance of HIV social care is effectively and consistently measured, and that the needs of people living with HIV are reflected in the social care outcomes framework. It is also clear that NICE must prioritise a social care quality standard for HIV.

To conclude, I am proud that the UK has nobly led the international community during the last 30 years in the response to AIDS, advocating universal access to HIV treatment throughout the world for all those who need it. It is my great hope that that leadership role will continue to be performed by the current Government, particularly at a time when we have such an incredible opportunity to improve the quality of life for those living with HIV, to make a dramatic impact on the number of new infections and to stamp out this epidemic for good.

Thank you very much, Mrs Main, for calling me to respond to the debate. It is a pleasure to serve under your chairmanship for the first time.

I want to begin by congratulating the hon. Member for Airdrie and Shotts (Pamela Nash) on securing today’s debate. She rightly started her remarks by referring to the issue of stigma, and it has been raised by other speakers. I also want to pay tribute to the significant contribution that has been made to fighting HIV/AIDS by my noble Friend Lord Fowler. Political leadership is not often spoken of these days, but it was precisely that leadership from Lord Fowler that made the progress in the UK against HIV/AIDS so remarkable. However, the issue of HIV has been dogged over the years by stigma, and it is disappointing for people as old as me to realise that stigma is still alive and well in our communities and even in some aspects of the delivery of services.

HIV remains a serious global issue that must always be at the top of our priorities, particularly now, of course, as we approach world AIDS day in a couple of days’ time. I also congratulate the hon. Lady on her appointment this year as chair of the all-party group on HIV and AIDS. I know the work of the group well. It deservedly has an excellent reputation within Parliament and it tirelessly works to raise awareness of HIV, both globally and within the UK. As is the case with many of the things that she mentioned, that work needs to continue.

World AIDS day provides an excellent opportunity to reflect on the progress that has been made and on the continuing challenges that we face. There is much to celebrate. Globally, new HIV infections have fallen by 21% since 1997 and new infections have stabilised in many regions, including sub-Saharan Africa, the Caribbean and south and south-east Asia. Nearly 7 million people are on anti-retroviral treatments, which is an increase of more than tenfold in the past five years. However, nearly 8 million people still need treatment and are not receiving it. I have responsibility in the UK for global health matters, and I have taken the opportunity to speak to the South African Health Minister.

Thanks to effective treatment, in developed countries such as the UK people who are diagnosed early with HIV can expect to live to a near normal life expectancy. As the Health Protection Agency says in its annual report, which was published today, in 2010 87% of people who were diagnosed with HIV were accessing treatment services within a month of being diagnosed and 85% were reporting an undetectable viral load within 12 months of starting treatment. That is excellent; it is not the end of the story, but it is a good start. However, the challenges remain at home and overseas. There are 34 million people living with HIV globally. The title of the recent report by the House of Lords Select Committee on HIV and AIDS in the UK says it all, really—there is still “no vaccine, no cure”. That report comes many years after Lord Fowler led the national response to HIV and AIDS in the UK, and I remember that time well.

In October, we published the Government’s response to the report from the House of Lords Select Committee, and we made it clear that we agree with many of the Committee’s recommendations. The Committee’s report will be critical in helping to inform the Department of Health’s sexual health policy framework, which we will publish next year. It will be a vital source of information and current evidence.

Hon. Members and hon. Friends have rightly mentioned the challenges presented by late and undiagnosed HIV. In the UK, there are an estimated 91,500 people living with HIV, of whom around 25% are undiagnosed, which means that those people cannot benefit from treatment and, of course, they risk transmitting the virus to others. Late diagnosis is the most significant cause of HIV-related death in the UK and we cannot say that often enough. The 25% of people with HIV who are undiagnosed are more likely to die than the other 75% of people with HIV who have been diagnosed, and we all need to do absolutely everything we can to promote the benefits and the uptake of HIV testing. I will come on to some of the specific issues that the hon. Lady raised in that regard.

The Department of Health is considering the findings of the final report by the HPA, “Time to test for HIV”, in developing the new sexual health policy framework. That HPA report presented the findings of eight pilot projects that were funded by the Department, which assessed the feasibility and acceptability of routinely offering HIV testing in general practices and some hospital settings. It showed that testing was acceptable to most patients, and I am really pleased to see that some of the pilots have led to changes in local practice in high-prevalence areas, which is quite a significant step.

We are also funding the Medical Foundation for AIDS and Sexual Health to help it to develop ways of getting GPs and primary care staff to offer HIV tests more routinely. Both the Terrence Higgins Trust and the African Health Policy Network actively promote HIV testing as part of the national HIV prevention programmes. Also, we have asked the UK National Screening Committee to provide evidence-based views on increasing routine HIV testing. As the hon. Lady rightly commented, we are reviewing our policy on the ban on HIV home-testing kits and we will ensure that we consult on any proposals to remove the current ban.

We are considering the consultation responses to the public health outcomes framework, which include a proposal for an indicator on late HIV diagnosis, and we will publish that framework very soon. We want to get it right, as it will be an important driver of what happens locally.

I am aware that some primary care trusts are already funding new HIV testing initiatives in both primary and secondary care, in line with guidelines from NICE and the British HIV Association. However, more work is needed to capture data through the HPA’s current HIV monitoring and surveillance programme.

Twenty-five years have passed since the first Government AIDS awareness campaigns in the UK, and who can forget those iconic TV adverts? At that time, we did not really know much about the virus and how it would evolve, and we certainly did not know very much about people’s sexual habits. As I say, I remember that period well and I want to pay particular tribute to the gay community and the terribly responsible attitude that it took to this issue at that time.

As our understanding of the virus has increased, our approach to it has changed. Our national prevention programmes focus on men who have had sex with men and people from sub-Saharan Africa, because they are the groups in the UK who are most at risk of developing HIV; the risks they face are significantly greater than those faced by other groups in the UK. We have invested £2.9 million in programmes of HIV prevention for those communities, delivered by the Terrence Higgins Trust and the African Health Policy Network, but of course that is only a fraction of the sum that is spent. A great deal more money goes in locally.

The programmes by the Terrence Higgins Trust and the African Health Policy Network both use evidence and a range of approaches to support responsible sexual behaviour and to reduce risk-taking behaviour. For example, to promote HIV testing they use social media and the internet, and for African communities they work with faith leaders. It is quite an uphill struggle in some areas to promote awareness, to reduce stigma and to encourage people to come forward.

Finally, it is vital that the public health system is versatile and sufficiently proactive to deal with HIV. Our modernisation of the NHS and the priority that we attach to public health provide an opportunity to reinvigorate HIV prevention and improve outcomes for those with HIV.

The hon. Lady is absolutely right to say that we need to bring everything together. What we do not want, although we sometimes have it, is fragmentation of services, not only for services dealing with prevention and diagnosis of HIV but, as she mentioned, for services dealing with the social and psychological impacts of HIV. Health and well-being boards and the joint strategic needs assessment will be critical. For the first time, ring-fenced public health funding is central to the NHS and to public health, and it will allow us to plan spending on prevention. In today’s restrictive financial climate, the fact that we will have a ring-fenced public health budget will be critical.

There is still a great deal of work to do, and everyone, in this House and outside, must work together to keep HIV at the very top of our list of priorities, because only by doing that can we improve the lives of people living with HIV. The hon. Lady is right to mention that young people’s awareness has slipped. Their awareness of the dangers they face and of the part they can play in ensuring that they maintain their sexual health is not as great as it should be. They need the skills to make some very difficult choices.

I finish by congratulating the hon. Lady on securing the debate. I am very keen to work with the all-party group to ensure that we get this right, and that the sexual health strategy reflects all the work that needs to be done to ensure that we decrease the level of late diagnosis of HIV, raise awareness and reduce stigma.

Sitting adjourned without Question put (Standing Order No. 10(11)).