Tuesday 8 January 2013
[Mr Philip Hollobone in the Chair]
Motion made, and Question proposed, That the sitting be now adjourned.—(Mr Swayne.)
May I wish you, Mr Hollobone, and—through you—everybody in this Chamber, a very happy new year? I hope that this debate will mark a small step in the attempts of the Tamil people of Sri Lanka to gain justice.
I called this debate in response to last November’s publication of the United Nations investigation of its handling of war crimes in Sri Lanka, which concluded that the response from the international community to the tragedy of the Tamils was inadequate. According to the internal review, UN staff in Colombo and New York simply did not perceive prevention of the killing of civilians as their responsibility. Despite the International Committee of the Red Cross reporting an “unimaginable humanitarian catastrophe”, the UN suppressed information on casualty figures and hid the Sri Lankan Government’s responsibility for the lives lost. Following intimidation and threats from the Government, the UN unquestionably relocated its staff away from the fighting.
Rather than trying to stop the atrocities, the international community turned a blind eye. Tens of thousands of people were being massacred, yet at the time the international community pretended that it was not happening. Oppression on a barely imaginable scale took place. Thanks to the fearless reporting of a small number of journalists, the truth is out. Channel 4’s documentary, “Sri Lanka’s Killing Fields”, deserves special praise. Anyone who doubts why we need justice should watch that astonishing documentary. The images broadcast by Channel 4 are among the most harrowing ever to appear on television. They showed what the UN special rapporteur on extrajudicial killings concluded was evidence of “definitive war crimes” and what the UN Secretary-General’s panel of experts admitted was
“a grave assault on the entire regime of international law”.
Last year, I nominated “Channel 4 News” for the Nobel peace prize. In my nomination letter, I said:
“By bringing to light the breaches of international conventions by the Government of Sri Lanka in a bold manner and by piecing together numerous forms of evidence in a coherent way, the value of independent journalism to the building of a peaceful global order in the century ahead has been amply demonstrated.”
I want to pay my respects to the amazing Marie Colvin, one of the most astonishing people whom I have ever had the privilege to meet. Marie was a veteran war correspondent for The Sunday Times, and won numerous awards, including best foreign correspondent. She was fearless in her reporting of Sri Lanka’s troubles. In fact, she was so unafraid of getting close enough to find out the truth that, in 2001, she sustained shrapnel wounds to her eyes, chest and arms while reporting from Sri Lanka. In March 2009, I invited her to speak at a meeting of the all-party group on Tamils, which I then chaired, and she was hypnotic. She explained how the Sri Lankan Government tried to prevent reporting of what was going on. They would not allow in independent journalists, but, thanks to her persistence and courage, Marie was able to present evidence that the Government were firing cluster bombs, white phosphorus and rockets on civilian areas, including hospitals and so-called safe zones. She was a trailblazer and a wonderful woman. I was fortunate to meet her on several later occasions, and she made a lasting impression not just on me but on everyone who met her. Unfortunately, she was killed last year while reporting from Syria, where there are many parallels with Sri Lanka. Her death was not only a terrible loss for journalism, but a real blow to those of us who want to know the truth about conflicts that the rest of the international community is happy to keep under wraps. In relation to Sri Lanka, her bravery contrasts with the cowardice of the international community.
As the internal review has proved, the international community knew about the abuses that Marie Colvin put herself in danger to uncover, but it still failed to protect tens of thousands of innocent people. The international community’s weakness shames us all. We now need to deal with that shame. Human Rights Watch has said that although Ban Ki-moon
“deserves credit for starting a process he knew could tarnish his office, he will now be judged on his willingness to implement the report’s recommendations and push for justice for Sri Lanka’s victims.”
The international community was weak in its handling of this tragedy as it unfolded; we should not be weak when it comes to imposing justice after it has happened. No regime in the world should be able to think that if it commits the most heinous crimes, it will be left untouched. The UN has an overriding responsibility to protect that supersedes sovereignty. We should have used the responsibility to protect during the conflict. If we had, thousands of Sri Lankan Tamils would still be alive. We now surely have a responsibility to hold to account a Government who have treated their citizens in such an appalling way. As Amnesty International has said:
“This report is…a wake-up call for UN member states that have not pushed hard enough for an independent international investigation into alleged war crimes… The report clearly illustrates the Sri Lankan government’s lack of will to protect civilians or account for very serious violations. There is no evidence that has changed”.
Responsibility to protect is a concept at the heart of modern international relations. It has three core elements: first, states are responsible for protecting populations from genocide, war crimes, crimes against humanity and ethnic cleansing and from their incitement, but, secondly, the international community has a responsibility to ensure that states fulfil that requirement and, thirdly, the international community—that is us—has a responsibility to use diplomatic, humanitarian and other means to protect populations from those crimes. If a state manifestly fails to protect its population, the international community must be prepared to take collective action to do so. All three pillars of the responsibility to protect were broken in Sri Lanka.
I congratulate the hon. Lady on securing this debate, and many others in this House on their work campaigning on the terrible and tragic war in Sri Lanka and the abuse and terrible suffering of many Tamils. She raises the issue of international pressure. Sri Lanka will host the Commonwealth Heads of Government meeting in 2013. Does she agree that unless the Sri Lankan Government live up to their promises and start a genuine process of peace and reconciliation, and unless there is an international inquiry, the British Government should not be represented at that summit?
I strongly support the right hon. Gentleman’s intervention, which I hope to address later.
The UN internal review proved that war crimes and human rights violations took place, but it admitted that UN staff did not think that preventing those killings was their responsibility and that they deliberately suppressed casualty figures. According to the review, when the UN began collating information on casualties the
“reports pointed to the large majority of civilian killings as being the result of Government shelling and aerial bombardment, with a smaller proportion of killings resulting from the LTTE actions.”
However, the UN played down evidence about the scale of what was happening, and the truth was portrayed as propaganda from Tamil Tiger terrorists.
In fact, as outlined by the Secretary-General’s panel of experts on Sri Lanka in 2011, and as we were told by Marie Colvin in 2009, there was systematic shelling of hospitals and civilians by Government forces, as well as restrictions on humanitarian aid and assistance. The panel of experts speaks of “tens of thousands” of casualties—perhaps up to 40,000—and even worse figures are now emerging. The Bishop of Mannar, Rayappu Joseph, has stated that over 146,000 remain unaccounted for, and the former BBC journalist Frances Harrison cites a World Bank estimate of 100,000 people still missing. All that only emphasises the importance of having an independent, international inquiry into the conduct of both sides during the conflict. Credible investigations into war crimes allegations and human rights abuses are a duty under domestic and international law. However, Sri Lanka’s own inquiry, the so-called Lessons Learnt and Reconciliation Commission, has failed completely to provide the accountability required. It has been described as “deeply flawed” by the panel of experts, which has called for an independent, international investigation into war crimes. The LLRC was not independent or international, and our fears about it have been shown to be well founded. Government forces were largely exonerated of culpability. Only military rather than independent courts of inquiry have been established to look into the few abuse cases that were deemed worthy of further consideration by the LLRC.
I am grateful to my hon. Friend for giving way and pay tribute to the work that she has done over many years in exposing what has been going on. Does she recall that, in a previous debate on the LLRC, the Minister said that the Government would see what action the LLRC took, and if it were not substantial they would take much stronger action and do precisely what the right hon. Member for Sutton and Cheam (Paul Burstow) said and review again the decision to hold the Commonwealth Heads of Government meeting in Colombo later this year? I hope that we will see such a view reflected in the Minister’s response today.
I absolutely agree with my hon. Friend. We all have faith in the Minister, and we ask him to take action.
As there is no justice or accountability with the LLRC, what we see instead is a culture of impunity—enforced disappearances, extrajudicial killings, gender-based violence as well as the recent trumped-up impeachment proceedings against the Chief Justice—which is testament to the breakdown of the rule of law in Sri Lanka. Just as we had a responsibility to protect civilians at the time of the killings, so too do we now for ensuring that there is accountability.
Does my hon. Friend accept that there are credible reports that torture is routinely being used against the Tamil community remaining in Sri Lanka? Constituents have come to my surgery with clear evidence of torture, which backs up the more widespread reports from Amnesty International and Human Rights Watch that torture is still going on routinely in the country.
I completely accept what my hon. Friend says about the ongoing torture against Tamils in Sri Lanka. It must be said though that other ethnic groups are also being tortured now.
Without accountability, we are seeing torture, disappearances and killings, yet the Commonwealth Heads of Government meeting is still scheduled to take place in Colombo in November. What sort of message does that send out? The Commonwealth was right a couple of years ago to take away from Sri Lanka the honour of hosting a summit. If it was right to do that then, how can it be right now to let Sri Lanka have that honour when our fears about its Government have been confirmed? Canada has bravely stated that it will not attend the 2013 summit unless significant progress is made on human rights and accountability. Why cannot Britain show the same leadership? Why are we so determined to brush accountability under the carpet, just as the UN did with the evidence of atrocities four years ago?
In November, I wrote to the Prime Minister imploring him to do the responsible thing. I pointed out that the number of people who had been killed in the space of just five months was roughly the same as the entire population of the major towns of his constituency: Witney, Carterton and Chipping Norton. Those poor people were herded into an area smaller than the Prime Minister’s constituency, tricked into believing that it was a safe zone and then relentlessly targeted while the institutions of the international community made a deliberate choice not to help, even though they knew what was happening. I pointed out that Britain’s Tamil community, which numbers more than 250,000 people, is still grieving. I asked what the British Government were doing to ensure that there is justice for Tamils now. In particular, I said that it would send out a terrible message if Sri Lanka were permitted the honour of hosting the CHOGM. I said:
“If a nation had systematically killed every single person you knew in Witney, Carterton and Chipping Norton, raping and murdering in cold blood, I do not think that you would find it acceptable for that Government to host an event as prestigious as a Commonwealth summit, or for our Government to attend… The international community has admitted it failed to help Tamils before, and cancelling the summit will ensure that mistake is not compounded.”
I understand the hon. Lady’s concerns, but does she accept that there were human rights violations on both sides of the community in Sri Lanka—certainly during the war and in the immediate post-war period—and that the relationship between the communities has improved in recent years? Secondly, does she accept that hosting the Commonwealth Heads of Government meeting would mean that Sri Lanka had a global audience looking at it, and that that in itself may produce the result that she is looking for?
I totally disagree with the hon. Gentleman. I am sure that his motivations are entirely good, but he misreads how the Sri Lankan Government interpret representations from foreign Governments. If the Queen were to put her foot on the soil in Colombo it would be regarded as a vindication of the Sri Lankan Government’s actions—and this is at a time when at least 40,000 people are still dying or missing.
I am startled by the view that if Her Majesty were to put her foot on the soil of Sri Lanka it would be an insult to democracy. Recently, Her Majesty had to shake the hand of the leader of the Provisional IRA in Northern Ireland in an effort to demonstrate that peace happens through process and progress. Sri Lanka should be hearing the message that we are here to help. We should stretch out our hand to Sri Lanka; we should not step on Sri Lanka. I must say that I am amazed by the hon. Lady’s position.
I am amazed by the hon. Gentleman’s intervention. As he knows, the process towards reconciliation has taken 600 years in Ireland. It is a struggle with which I am well acquainted because of my own family background. Unlike the Sri Lankan Government, the British Government under different parties accepted that there were things that they could and could not do. I accept that there were atrocities and human rights violations on the part of the Liberation Tigers of Tamil Eelam. Democratically elected Governments are always judged to a higher standard.
Let me continue with what I said to the Prime Minister:
“The international community has admitted it failed to help Tamils before, and cancelling the summit will ensure that mistake is not compounded. I believe it is in the international community’s best interests—and the best interests of the United Kingdom, as well as of Sri Lanka—for there to be an independent international investigation into war crimes in order to bring a lasting peace in Sri Lanka after such a long period of ethnic conflict. However, while this continues not to take place, Sri Lanka should not be hosting the Commonwealth summit.”
The response was weak. The Prime Minister himself did not answer my letter, passing it instead to the Foreign Secretary. The reply was very disappointing. First, instead of supporting an international inquiry into Sri Lanka’s behaviour, he said that the Government
“believe that the process of reconciliation has a greater chance of success if investigations are Sri Lankan-led rather than externally imposed.”
He said that the British Government were concerned about the human rights abuses in Sri Lanka, such as
“disappearances, political violence and reports of torture in custody.”
However, what will the British Government do about them? We have not stopped deporting Tamils who are claiming asylum, even though most reasonable people would think that any Tamil who made a big deal about hating the Sri Lankan Government when they were in the UK might be most at risk of disappearance, violence and torture.
I am aware of that report, and I have also read appeal judgments and documents from the Medical Institute for Victims of Torture. I am well aware of some of the cases involved; indeed, some of them involve my constituents or my hon. Friend’s constituents.
The Foreign Secretary said:
“We seek to promote progress through direct lobbying, working with international partners, and funding human rights projects.”
I have to say that it is not very reassuring to learn that the Government’s approach to getting Sri Lanka to behave is to give it more money.
Finally, the Foreign Secretary fails to offer any support for the idea of a boycott of the Commonwealth summit, although he says the UK Government
“believe that the host of the Commonwealth Heads of Government meeting should uphold the Commonwealth values of good governance and respect for human rights. We will look to Sri Lanka to demonstrate its commitment to these values, both now and in the run up to the meeting in 2013.”
I would be grateful if the Minister could expand a little upon that in his response to the debate. In what possible way does he think that Sri Lanka is currently demonstrating “commitment to these values”?
I note that the Minister is going to Sri Lanka later this year. No doubt his presence will be portrayed by the Government there as yet another vindication of their murderous approach. If he wants to ensure that his visit is not another public relations victory for a regime that feels it is immune from accountability for war crimes, will he use his visit as an opportunity to warn his hosts that Britain and the Queen will not be attending a summit that is built on blood? When my right hon. Friend the Member for South Shields (David Miliband) visited Sri Lanka in 2009, he was not afraid to confront the Rajapaksa regime. When the Minister visits Sri Lanka later this month, will he do the same as my right hon. Friend did, or will he have meetings about trade?
The hon. Lady mentions the fact that lots of people visit Sri Lanka. May I ask her when she last visited Sri Lanka? She has mentioned lots of second-hand evidence in her speech so far, but when did she last visit Sri Lanka and see for herself—at first hand—some of the things that she is alleging are happening there?
I have never been to Sri Lanka, but I respect the views of the UN special envoy to Sri Lanka, the UN, the Canadian Government, the Australian Government, the US Government, Human Rights Watch and Amnesty International. Are all of those organisations bogus? Do we not believe anything that any of them say?
My hon. Friend the Member for Cannock Chase (Mr Burley) made exactly the same point that I will now make. I do not think that anyone is suggesting that those organisations are bogus, or that the claims of constituents are bogus. We are asking the hon. Lady about her opinion.
Just as I have not been to Syria, Iran, Iraq, Afghanistan and—it has to be said—most countries in the world, I have not been to Sri Lanka and I determine my views of the country on the basis of the evidence provided by those organisations and by people whom I respect, including the many organisations that I have just named and my own constituents.
In fact, I would like to take this opportunity to give an apology to my constituents because in 2008 and 2009, when they told me that cluster bombs were being dropped on their relatives by a democratically elected Government and that tens of thousands of people were being herded into a tiny area, I did not believe them immediately; it was only when they became more desperate and told me more that I began to believe them. The problem is that too many of the institutions that we respect did not believe them either and did not accept what they were saying, which is precisely why we are in the position that we are in now.
I can thoroughly understand the hon. Lady’s approach to this whole debate. It is on a very emotive subject, and more to the point there have been atrocities committed on both sides—that is evident. However, I say to her that we are now years ahead from where we were. My hon. Friend the Member for North Antrim (Ian Paisley) is living proof of reconciliation—after 600 years—here in this House.
We should move on. As I say, I understand where you are coming from and I also understand what you have said has happened. I think that everybody in this Chamber accepts that there have been some irregularities in Sri Lanka, to say the least. But we are at a point now where we must move on, we must help Sri Lanka to improve and we must have reconciliation. I have been to Rwanda and I have seen what has happened there. The perpetrators of war crimes there are back in their own communities and being productive.
If you go to Sri Lanka, and I am sure that the Government there will invite you, and probably have invited you already, you will see what progress has been made—
Order. Thank you, Mr Morris. Interventions on another Member’s speech should be brief. Also, I remind new Members, who have now been in the House for more than two years, that they should not use the word “you” to refer to another Member in the Chamber.
Thank you, Mr Hollobone. May I say to the hon. Gentleman that I have never been invited to Sri Lanka? Generally, I do not do international travel in my role as an MP, because I am constituency-focused. I secured this debate, and I have become involved in the Tamil cause, because of the Tamil community in my constituency and because of the information that I have received from them. I have become aware of the despair and distress that they experience. My own experience as someone who is London-Irish—I have Irish parents— is that people cannot just ignore what happened in the past. People cannot just move on and forget, because people do not forget. If we do nothing now, we will say to the next young generation that violent struggle will continue. We must address the issues now, in order to make progress.
I compliment my hon. Friend on her work and I urge her to resist the temptations from the Sri Lankan Government lobby that is in Westminster Hall today and trying to claim that all is well in Sri Lanka when the reality is that it certainly is not. Furthermore, holding the Commonwealth conference in the country would be an endorsement of the Sri Lankan Government’s policies on the Tamil people, and would be extremely damaging to the cause of human rights, to the image of Sri Lanka and indeed to the prospect of a peaceful future for the country.
I am very grateful to my hon. Friend for giving way again. As she knows, I had the privilege of being a Minister in the Department for International Development during the last Government. As a result, I saw the private assessments of the situation in Sri Lanka, the type of which the Minister now has the opportunity to see. What was clear then was the scale of the human rights abuses that were being perpetrated. I do not think that we knew then the level of detail that has come out since, but we certainly knew that the Sri Lankan Government—through their military and paramilitary police, for example—were perpetrating considerable human rights abuses.
That was part of the reason why Britain led in Europe on the withdrawal of the GSP plus trading arrangements—the generalised scheme of preferences—which signalled our concern about human rights. My hon. Friend is rightly demanding that this Government show the same commitment as the last Government in demanding action by the Sri Lankan Government. It is a pity that we have not yet heard cross-party support for the aspiration for our Government to get a bit tougher with the Sri Lankan Government.
I totally agree with my hon. Friend’s comments. Although I completely understand the duty of any Government—most importantly during a recession—to travel to gain more trade and support, I ask the Minister to consider whether that is appropriate in the case of Sri Lanka.
I say that because the last thing that the international community needs right now, after the failings of the past few years, is for Governments such as our own to put the pursuit of profit ahead of the responsibility to protect. The ongoing humanitarian crisis in Syria and the developing situation in the Democratic Republic of the Congo—two countries that I have never been to—both show why we need to be strong. A credible and robust approach to international relations by the UK, and more widely by the international community through the UN, is vital. When the UN internal review was published in November, Ban Ki-moon said:
“Our obligation to all humanity is to overcome our setbacks, learn from our mistakes, strengthen our responses, and act meaningfully and effectively for the future.”
However, I am very much afraid that the international community would rather move on and pretend that these events in Sri Lanka never happened, just as it turned a blind eye while the atrocities in the country were taking place. If we are not strong now, we will abdicate our moral authority over Sri Lanka. Regimes such as those in Syria and DRC will see that there is nothing to lose and that justice will not be served.
We have a responsibility to ensure that the international community’s failures in Sri Lanka are addressed. Accountability and reconciliation must take place. When the 22nd session of the UN’s Human Rights Council commences next month, our Government should take a lead. The issue of whether Sri Lanka has complied with previous resolutions on accountability and reconciliation should be a priority. The UN’s HRC, with Britain to the fore, must be prepared to take urgent action to initiate credible, independent investigations in Sri Lanka. For the sake of other civilians around the world who are under threat from their own Government, we have a responsibility to be strong. We should tell Sri Lanka in no uncertain terms that we cannot support its hosting the Commonwealth summit while its reputation is under a cloud. We have a duty to protect, and we cannot fulfil that responsibility by continuing to be weak, weak, weak.
Order. Seven Members contacted me before the debate seeking to speak, and another Member has contacted me from the Floor. In a moment, I will call the first speaker, Lee Scott, followed by Barry Gardiner. With Members’ consent, I propose that the running order will then be Robert Halfon, Ian Paisley, James Wharton, Jeremy Corbyn, Aidan Burley and Simon Hughes. Personally, I am keen for all those Members to contribute, but if they are to do that, Members will need to keep their remarks to within five minutes; if they run over, the last speakers will not be called. I propose to call the Opposition Front-Bench spokesman at 10.40 am and the Minister at 10.50 am.
I congratulate the hon. Member for Mitcham and Morden (Siobhain McDonagh) on securing this vital debate.
Perhaps I can prevent any interventions and save some time by saying that I, too, have not visited Sri Lanka: someone who is criticised for everything they say because none of it suits the Sri Lankan Government is hardly likely to be taken to Sri Lanka and shown what they want to see in an uninhibited way. Like the hon. Lady, I would be delighted to make an unfettered, unhindered visit to Sri Lanka so that I could go wherever I wished to go, ask whatever questions I wished to ask and see whatever I needed to see. In that spirit, I look forward, in my role as the chairman of the all-party group on Tamils, to me and my deputy chairman receiving such an invite, but I will not hold my breath.
You will be pleased to hear, Mr Hollobone, that I am not going to repeat what has been said and that I want to look at different aspects of this issue. It is easy to say that one should forget the past, but if we do, we predict what will happen in the future. Should we forget Auschwitz, Rwanda or the atrocities committed in Northern Ireland? No, we should not. That would be an insult to the memories of the people who lost their lives on all sides, and that is not acceptable.
If we are to move on, there must be reconciliation and true justice for all. It is not my role as a non-Sri Lankan and a non-Tamil to say who was or was not responsible. Anyone who has watched “Sri Lanka’s Killing Fields” or listened to independent evidence knows that atrocities were committed, and people need to be brought to justice. Simply saying, “It wasn’t us who did it” is not acceptable. Someone took out women and children, someone raped people and someone interned people. Someone has not said where missing children are, when relatives in the Tamil diaspora around the world want to know what has happened to their families.
I congratulate the hon. Member for Mitcham and Morden (Siobhain McDonagh) on securing the debate. Is my hon. Friend aware that there are nearly 94,000 internally displaced Tamils without proper facilities, following the terrible tragedy that took place a few years ago?
Thank you, Mr Hollobone. Can I have 30 seconds back for that?
All I really want to say is that I want justice for the Tamil people and for all Sri Lankans. For that to happen, however, the UN must play its role. Over a number of years, it let down the Tamil people and allowed things to happen that should never have been allowed.
I note the Chair’s comments about the time, and I am grateful to the hon. Gentleman for giving way. Does he share the view of my hon. Friend the Member for Mitcham and Morden (Siobhain McDonagh) that it would be wrong for Britain to attend the Commonwealth summit in Sri Lanka unless there is a dramatic change in the situation on the ground?
Where do I stand? I am sorry, Mr Hollobone. The hon. Gentleman and I should not be having a conversation across the room. I apologise for that, as I am sure he does. Where do I stand? I want to see reconciliation and justice before any such thing happens. I think that is clear.
In my final 20 seconds, I should say that the Tamil people have suffered, and their diaspora suffers. There must be justice for all, but most importantly, at the UN’s meetings in March, I would like to hear what the Sri Lankan Government will do to ensure that an international inquiry shows what has happened and who is responsible so that those involved are brought to justice. I have gone five seconds over, Mr Hollobone, so I apologise.
I thank you for calling me to speak in this important debate, Mr Hollobone. I pay tribute to my hon. Friend the Member for Mitcham and Morden (Siobhain McDonagh). She knows more and has researched more than anybody in the House, and she has done more to keep this issue at the forefront of its debates and of the Government’s mind, as they consider their obligations to the international community.
I arrived here this morning with a speech that detailed many of the things in the UN internal report and the way in which the UN had looked at its own failure. It is important to understand that it was extraordinarily courageous of Ban Ki-moon to establish a report looking at the UN’s failure properly to protect people and to intervene at the right time in the war in Sri Lanka. Although it was a courageous report, however, it now needs to be followed up. It highlighted many of the actions that took place at the time, but the international community must now see whether the reconciliation that we all wish for has actually taken place.
My hon. Friend spoke of the LLRC. At the time, many of us said it was a smokescreen intended to avoid having the independent international review that was being called for. However, the Minister said, “Let’s give it space. Let’s see what it comes up with. Let’s see whether it actually delivers. If it does, we should judge it on that basis.” Well, it has now produced its report, but it has not delivered. The international community, from the UN right through to Amnesty International, has acknowledged and documented the LLRC’s failings. Initially, the commission made absolutely no mention of war crimes; subsequently, under pressure, the Sri Lankan Government made further moves to switch the international community’s focus. When the Minister sums up, I would ask him to be true to his words in our previous debate: we should judge the Sri Lankan Government by their actions. On any international standard, they have failed.
I said I had come with a speech that I had prepared. What I was not prepared for, however, was the schoolboy nonsense from the Government side—“Oh well, have you ever been to Sri Lanka?”—and the sniggering when my hon. Friend said that, no, of course she had not been there. Does that in any way reduce the value and the quality of her research? Absolutely not.
I wish I had not been to Sri Lanka, because I could have stood with my hon. Friend, but I have been there. A decade or so ago, the then Foreign Office Minister, my right hon. Friend the Member for Neath (Mr Hain), asked me to become involved in the second tier of the negotiations that were going on at the time. I was partly responsible for Anton Balasingham coming here with his wife, Adele. I also went to Sri Lanka and met all the parties there.
When I was a Minister in Northern Ireland, I invited Mahinda Rajapaksa to dinner there to discuss speaking to the communities in Northern Ireland to see exactly how reconciliation could be achieved and how a country could move on. At that stage, I hoped he would go back to his country to try to implement some of those ideals, but he did not: he went back and turned Sri Lanka into a kleptocracy, in which the Rajapaksa family controls absolutely everything. How is it that the President’s brother, Gotabaya, is Secretary of Defence? Another of his brothers, Basil, is Minister of Economic Development. Chamal, the third brother, is Speaker of the Parliament. They have carved up the country between them and there is absolutely no economic freedom.
If we take the Commonwealth Heads of Government or the Commonwealth Business Council there, what will we be doing? We will be putting money into the pockets not of Sri Lankan people, but of one family: the Rajapaksas. Anybody who pretends to be part of this debate without acknowledging what is going on in that country currently is fooling themselves. Those Members on the Government Benches may or may not have gone to Sri Lanka, but if they have, they have not looked into the detail of what is happening in that land, because it is corruption and it must end. The Government of this country should not allow Her Majesty the Queen to set foot on Sri Lankan soil.
It is a pleasure to serve under your chairmanship, Mr Hollobone, this morning.
The hon. Member for Mitcham and Morden (Siobhain McDonagh) has set out three compelling arguments, but before I go on to those, I want to say that I have never been to Sri Lanka. I would not want to go to Sri Lanka as it is currently constituted, just as I would not want to visit President Assad or the President of Iran—because I would be going to a bloodstained nation.
First, with every day that passes, it is clear that there is terrible persecution of the Tamils, especially of students, women, journalists and families. Secondly, because of our historic relationship and our economic ties, we can make a difference. I welcome what the Minister is doing to exert pressure on Sri Lanka’s rulers. Thirdly, the international community must show the Sri Lankan regime that there will be consequences if it does not respect and implement the recommendations of the Lessons Learnt and Reconciliation Commission.
Does my hon. Friend share my disappointment at the tone of the debate so far? Should not we all agree that both sides must be held accountable for the crimes that are committed and that there has to be a genuine process of reconciliation? Until that starts, the Government need to think carefully about the level of representation at the Commonwealth Heads of Government meeting.
I agree that it is important that we have a debate on both sides, but my firm view is that the emphasis must be to expose what has really been going on in Sri Lanka and how the Tamils have been maltreated.
Like the hon. Lady, I believe strongly in the responsibility to protect. As the Foreign and Commonwealth Office acknowledges on its website, after the civil war ended in 2009, approximately 300,000 Tamil civilians were displaced or caged in internment camps. The FCO website states:
“The Sri Lankan Prevention of Terrorism Act permits prolonged detention without charge or trial.”
We know that that power is routinely abused, most recently with the detention of four Jaffna university students just before Christmas. They were locked away without trial or any meaningful right of appeal. The regime also forbids the free movement of people, especially journalists, in many Tamil areas.
At the end of November 2012, an estimated 94,000 people were still internally displaced. In November 2011, the UN Committee against Torture even reported that the Sri Lankan military behave as if they are above the law. In 2011, Sri Lanka was ranked fourth highest in the entire planet for cases of unsolved journalist murders. Tens of thousands of Tamil men and women continue to live without security, shelter or independence.
I believe that Britain can put peaceful and diplomatic pressure on Sri Lanka. We are already Sri Lanka’s largest trading partner, their second largest investor behind China and their main source of western tourism. If the UN were to move towards economic sanctions under the responsibility to protect, British involvement would have a huge impact on the Sri Lankan economy. It is very rare for me to disagree with the hon. Member for North Antrim (Ian Paisley), but the Government need seriously to consider, as the Canadians have done, boycotting the Commonwealth event. I do not believe that appeasement works. If the Government said that there would be a boycott unless things dramatically improved, that would have a significant impact on the Sri Lankan regime.
On the responsibility to protect, the lesson, as we have seen in recent years, is that in almost every case where the UN has shouldered its responsibility and stepped in, such as in Iraqi Kurdistan in the 1990s or more recently in Libya in 2011, catastrophe has been averted and it has led to economic growth and the beginnings of democratic reform. Where the United Nations has done nothing, such as in Syria, things have worsened.
We have to use everything at our disposal to make it clear to Sri Lanka that it can no longer behave like a rogue nation. Concrete steps have to be taken to demilitarise the north and east, civil administration should be restored and Tamils should be given their basic human rights: the rights to life and a fair trial, freedom of expression, movement and assembly, property rights and the rule of law. Sri Lanka should publish a list of all prisoners and where they are being held. The International Committee of the Red Cross must have access to all detention centres and a neutral commission should be appointed by the UN to safeguard property rights in Tamil areas and all resettlement programmes. Sri Lanka’s Lessons Learnt and Reconciliation Commission should implement the recommendations made in its interim report. Above all, Sri Lanka must comply with the recommendations of the report by the UN panel of experts and arrive at a durable justice for the Tamils.
Clearly the Tamil Tigers are no longer a threat to the Sri Lankan Government and can no longer be used as an excuse, but persecution continues. The excuse of security was used as a cover for genocide, and it is now being used for an attempt to wipe out the inheritance of the Tamil-speaking minority. The UN, as the hon. Lady said, has a responsibility to protect if a regime is abusing its own people. If we can put peaceful, legitimate but tough pressure on Sri Lanka, whether through sanctions or a boycott of the Commonwealth summit, that is what we must do.
On my journey to the House this morning, I drove through the memorial gates near the Mall. The words “Sri Lanka” are carved in granite on those gates to remind us that the Indian subcontinent, during the two great world wars, gave 5 million volunteers to this nation to defend freedom. When we hear the aggression from Argentina over the Falklands this week, we are reminded that the only country that stood with us in the international community in the original attempt to take back the Falklands was Sri Lanka. When a country that has supported us in the past comes under pressure, we should not kick it in the teeth. We stretch out the hand of forbearance and say, “We will help you through the difficult, post-conflict situation that you are clearly in. We will give you our experience and our help. We will not give you our hatred and our anger.” That is an important lesson that we, in a nation part of which is in a post-conflict situation, should recognise.
I have visited Sri Lanka on a number of occasions, both as a private individual and with constituents who had business there, as well as on a cross-party parliamentary trip. My experience was very different from what I have heard from propagandists not in Sri Lanka. The people on the ground gave a very different message from the out-of-touch one that I have heard from the self-appointed diaspora, both in Canada and here in the United Kingdom.
I have visited Jaffna, the most disputed part of Sri Lanka in the north. There I saw new housing settlements, with Tamils living in them. I had tea with some of those families, whose interests are fishing and farming. They did not talk to me about the past, even though they had opportunity to do so. Indeed, when I raised the past—I was with them on my own—they wanted to talk about their future, their children and their new housing settlements, which were supported by money given by our country through the EU to help rebuild their country. They wanted to talk about moving forward. I have met both Tamil and Sinhalese families, and their united wish was to present a picture of hope for their country, not a picture of division. It was a community that wanted to move forward. They did not want to hear the international community talking about what happened in the past; they wanted the international community to help them to move to a better future.
On one occasion, two of my guides were a Tamil gentleman and a Sinhalese gentleman who had been at war with each other. At the end of my visit, in tears they embraced each other, and they spoke about how they were now new brothers in a new land. Whenever I raised with them issues that I had heard in the propaganda in the United Kingdom, they could not understand them. They said that they bore no resemblance to their reality on the ground. In many aspects, Sri Lanka has made more measurable gains post-conflict than Northern Ireland. That is what I have seen on the ground, and we should recognise it and stop the suffocation of a country by its past and help Sri Lanka to move forward to a better future.
I took a day out and spent it with the leader of Tamil National Alliance, Mr Sampanthan. I spoke to him and his party colleagues at length, and I waited for him because I wanted to hear from him at first hand, without his being pushed or prodded into some of the difficult issues about the past. He did not raise with me the issue of the disappeared; he did not take time to raise with me the issue of war crimes; he did not take time to talk about routine torture, in his country, of his people. He had a politician with him from this nation and he did not want to talk about those things. In fact, he actively applauded the Government, whom he opposes. He applauded them on their investment in the country—in parts of the north—and he said that the most effective thing that many of his people required was practical help to get bicycles and other tools to help them to work and run their country. That was the message of the man who is leading the opposition.
If people took the time to speak to the active politicians on the ground who are representatives of their community, they might have a slightly different perspective than that in some of the propaganda that we have seen and heard. I urge the Minister to appeal publicly today to Sampanthan to stop his boycott of the political process, to lead his people and his party, and to join with other parties in the parliamentary select committee of Sri Lanka to find a political solution to the problems. We learnt the lesson the hard way.
People find a political solution by engaging in politics, not by asking for a boycott or for the international community to do their work for them—they do it themselves. I appeal to our Government to say to Sampanthan, “Lead your people and do not boycott the process any longer.” Politics, not a boycott, will work. The international community will not solve Sri Lanka’s problems. It will be the people of Sri Lanka, living in Sri Lanka, who will fix the problems of Sri Lanka, and we should actively encourage them in that. The biggest mistake that this Government could make would be to send the message to Sri Lanka that they were going to pull out of the Commonwealth talks later this year and punish a country that needs help, not more persecution.
It is a pleasure to follow the hon. Member for North Antrim (Ian Paisley), who speaks passionately, with experience of post-conflict life and of rebuilding communities after a very difficult period. He gives us all cause to pause and to reflect on what the debate is really about. There was a great deal that I wanted to say, but as I have a very short time, I will significantly cut down my comments.
I have been to Sri Lanka a number of times, and the visits are all declared in the Register of Members’ Financial Interests. I have gone there with colleagues, some of whom are here today. What worries me is how much misinformation is out there about what is happening on the ground. My hon. Friend the Member for Ilford North (Mr Scott), who follows matters in Sri Lanka keenly, has a different position from mine, but it is a genuinely felt one. He was absolutely right to say that we must not forget the past, but we must not misinterpret or misrepresent it either.
A problem that Sri Lanka has faced in the debate in the western world, in this Parliament, in the media and in other places across the globe is that, for a variety of reasons, too many people try to change what happened in the past, to change the accepted facts of what went on. The reality is that a lot of what we see is not based on facts or in reality. I have raised the point before in the House that even the Darusman report, which preceded the UN report that has led to the debate today, specifically states, in paragraph 53:
“This account should not be taken as proven facts, and any effort to determine specific liabilities would require a higher threshold.”
It is made clear that the report establishes a narrative that can be used to work forwards but that none of the data—for example, on the numbers of casualties—should be quoted as specific figures. The facts on the ground regarding the provision of food and medical supplies are starkly different from some of the evidence given by unnamed sources to the expert committee that put together the report.
I am conscious of the time, so I just want to draw the House’s attention to a few areas in which progress is being made in Sri Lanka. Most of the 300,000 internally displaced persons have now been resettled. I visited Menik farm, one of the welfare camps set up to house the huge numbers of people displaced by conflict in January of last year. There were about 6,000 people left, and the camp has now closed and the people have gone home. They have been able to do so because demining operations have proceeded at an amazing pace, with more than 900,000 mines and unexploded ordnance having been cleared, primarily by the Sri Lankan army but also by the HALO Trust with support from UK aid, and I congratulate the UK on its contribution.
More than 120,000 houses have been constructed in the north and the east, nearly 600 child soldiers have been rehabilitated and more than 10,000 adult combatants have been rehabilitated or reintegrated into Sri Lankan society. Some 900 Tamil speakers have been recruited into the police force in the north and east, and that is important in building trust in a community that does not have historic trust in its Government and the organisations that represent it. Investment is key, as is infrastructure, so that the economy can grow and people can improve their lives.
When I went to Sri Lanka with the charity International Alert, we visited a group of young Tamil people in the Vanni, and they talked about jobs and employment prospects, about what they were going to do and what they wanted to do. They talked about the challenges that they faced at home and about how they wanted to get education and the cost of education. They talked about the same things that young people in colleges in my constituency talk to me about; they share some of the same problems. They wanted to look forward and go forward.
The tone of debate in the House too often worries me, because we focus on what we can do to punish the Government of Sri Lanka, whether by the removal of the generalised system of preferences or the UK’s pulling out of the Commonwealth Heads of Government meeting. Such things will not damage the Government of Sri Lanka; they will damage progress towards peace and the prosperity of the people who live in Sri Lanka. The tone of the debate here needs to change. We need to work constructively with the Government of Sri Lanka to put pressure where it is due and, where we can, to deliver improvement.
I will be brief, Mr Hollobone, so that the other Members can get in. I compliment you on your chairing of the debate and on your announcing in advance the line of speakers. That is helpful, and it is a good precedent for Westminster Hall debates.
I compliment my hon. Friend the Member for Mitcham and Morden (Siobhain McDonagh) and the hon. Member for Ilford North (Mr Scott) on their contributions and on their work within the all-party group for Tamils and in support of the Tamil diaspora. The right hon. Member for Bermondsey and Old Southwark (Simon Hughes) and I have been involved in issues regarding the Tamil people and Sri Lanka ever since 1983, when we were both first elected to the House, and I have never forgotten the huge demonstration that took place in July of that year in London because of the problems that there then were in Sri Lanka. There has been a litany of human rights abuses in Sri Lanka for the past 30 years and beyond.
It is not an accident that there is a large Tamil diaspora in London. Many Tamil people came to this country to seek a place of safety because of the civil war in Sri Lanka in the 1980s and the years before. I pay tribute to the diaspora community for pulling together. It supported the hunger strikes that took place out here in Parliament square and mobilised 200,000 people to march through London in support of the rights and survival of the Tamil community in Sri Lanka. Mobilising 200,000—almost the entire diaspora community—was a remarkable achievement; but, disgracefully, the British media routinely and almost totally ignored it. They were more concerned about traffic disruption in Parliament square than about human rights in Sri Lanka.
I recognise that things have changed and that things have to move on. There has to be a peace process, reconciliation and a reckoning with the past, which we are looking at to move forward.
My two essential points are that the UN report of last November specifically refers to the shelling of hospitals and civilian areas by the Sri Lankan armed forces and the way in which UN staff were driven away from the areas of conflict in 2008. I hope those issues will be seriously examined at the UN Human Rights Council meeting next month, which I hope to attend, as I have attended many Human Rights Council events
If we do not consider those issues, if we do not ensure the closure of what I do not refer to as welfare camps—at the end of the conflict, they were more like concentration camps—and if we do not address rights and opportunities for Tamil people in Sri Lanka, the war will return in a different form at a later stage. It is not a question of the Sri Lankan Government claiming victory over the Tamil people and the Tigers, as they have done; it has to be a question of their perception of the future of that country, otherwise in 10, 20 or 30 years’ time, if any of us are still here, we will be debating the same thing again: yet another massacre of Tamil people and yet another wave of asylum seekers from Sri Lanka trying to flee to a place of safety.
I hope that the Minister is able to tell us that the Government will be robust on the Commonwealth Heads of Government meeting and will play a robust role at the UN Human Rights Council next month to show that the UN, the Human Rights Council and the human rights of the Tamil people matter in bringing about long-term peace in Sri Lanka.
Many speakers this morning have started by declaring whether they have visited Sir Lanka, and I intervened on the hon. Member for Mitcham and Morden (Siobhain McDonagh) to ask whether she has done so, because I visited Sri Lanka in July 2012 and spent eight days travelling all over the country. I did not just fly into Colombo; I went to the north, the east and the south. I went to Jaffna and Kilinochchi, Trincomalee, Kandy and Hambantota. I went to all the rural areas, not just to the towns and cities.
I went to the Jaffna teaching hospital and discussed the lack of medical equipment with some of the doctors. I went to the chamber of commerce and discussed inward investment with business leaders. I visited resettlement projects in Ariyalai and mine clearing in Kilinochchi with the HALO Trust, which, as my hon. Friend the Member for Stockton South (James Wharton) mentioned, is partly funded through the Department for International Development.
I met the President in Kandy. I also met, Mr Sampanthan, a leader of the opposition, for several hours in Trincomalee—I recognise the comments of the hon. Member for North Antrim (Ian Paisley)—and I remember him telling us that he wanted a bicycle for every one of his people, which is his main priority.
I have detailed my trip because I strongly believe that people can only speak authoritatively and honestly about a subject if they have first-hand experience, seeing things with their own eyes and forming their own impressions, rather than just watching a Channel 4 documentary. After all, would a person buy a house just because someone told them it was nice, or would they want to see the property first hand? Would a person move to an area just because someone said it was a nice place to live, or would they want to visit the area first?
Everywhere I went on my eight-day trip to Sri Lanka last year, I saw the same thing first hand: Sinhalese, Tamils and Muslims living harmoniously with each other, getting on with their lives and rebuilding their country. I saw the different communities and faiths living beside one another after their horrendous civil war. I saw Sinhalese boys and Tamil girls playing together in the playgrounds of the schools that we visited. That is why I wanted to speak in this debate. The UK should be helping Sri Lanka, our former colony, to rebuild itself. British politicians should understand Sri Lanka’s reconciliation and help it to demine, so that communities can move back to their own lands. I saw that happening with my own eyes; I saw the minefields being cleared through the HALO Trust, and I saw houses being rebuilt and crops being grown on the old minefields. That is constructive. We saw HSBC and Marks and Spencer in Sri Lanka. I learnt that the software that runs the UK stock market is based in Sri Lanka.
All that is positive—it is about jobs and livelihoods—and we should be having a debate on encouraging trade to Sri Lanka. British politicians should be leading business trips and delegations of British companies to Sri Lanka to encourage Sri Lankan and British businesses to work together. Britain has the second-highest number of tourists to Sri Lanka—a country that desperately needs tourists’ pounds. I do not believe this debate will help that rebuilding process; it is a negative debate that perpetuates old myths and stereotypes and is based on narrow interest groups in the UK that have their own agendas.
The hon. Member for Islington North (Jeremy Corbyn) said that he was astonished to see the Sri Lankan Government lobbying here. I know lobbyists for the Sri Lankan Government. My constituency is 99% white, and there is no diaspora. I have no candle to hold for the Sri Lankan Government; I am just recounting the first-hand impressions that I witnessed for myself by bothering to go to the country. The hon. Lady should go to Sri Lanka and speak to the people of Sri Lanka, not to the people of Mitcham and Morden, and listen to what they have to say. I found a country at peace with itself. That is what we should be debating and supporting: helping Sri Lanka to build a better future for itself, rather than letting extremists in the UK divide it.
I thank you for your chairmanship, Mr Hollobone.
I appreciate the initiation of this debate by the hon. Member for Mitcham and Morden (Siobhain McDonagh). I remind some colleagues, who I think have forgotten, that the subject of the debate is Sri Lanka and the UN responsibility to protect. As the hon. Member for Islington North (Jeremy Corbyn) said, I have taken an interest in the subject during all my time in the House—not because I have a significant number of Sri Lankan, Tamil or Sinhalese constituents, but because I am a human rights lawyer and I think minority rights need to be protected.
I have been to Sri Lanka, and I paid for myself—I had political meetings some years ago. I was not allowed to go everywhere I wanted to go, particularly in the north. I regularly engage with Sri Lankan Ministers and high commissioners, sometimes very frustratingly, when they have been in this country. I am a co-founder of the all-party group on conflict issues. I have worked with the Royal Commonwealth Society and the Elders to ensure that young people from both communities have gone to Sri Lanka.
I found the civil war one of the most depressing, frightening and unhappy periods of my time in the House. I was with the Tamil community out on Parliament square pretty much every day, and I arranged to go with them to the White House to try to get the US to press the UN and the Sri Lankan Government. They met the Commonwealth secretary-general and the leader of the European Foreign Affairs Council. I had a conversation with the UN and the Tamils, and the UN was unable to do anything; it failed abysmally. The UN agreed in 2005 that there should be a responsibility to protect, but it did not do any protecting. The UN pulled out, which was absolutely scandalous and shameful. The UN proved itself to be a totally ineffective organisation at that time.
My interest now is to ensure that the UN learns those lessons, with the UK’s help, and that the Sri Lankan Government learns those lessons, too, because Sri Lanka is not yet a wonderful democracy. Sri Lanka is nepotistic, as has been described. Disappearances have not been explained. Sri Lanka has one of the worst records for journalistic freedom in the world on all objective indices. Assassinations have happened, and no one has been brought to trial for them. Not all people are allowed to go back to their own community, and I say that not because I am pro-Tamil and anti-Sinhala—I am a member of both all-party groups—but because, so far, minorities have not had an equal opportunity to play a part in Sri Lanka.
I know the commitment of my hon. Friend the Minister to peacekeeping and bridge-building from our work together over the years.
Given that the UN set up its panel of experts, which reported to Ban Ki-moon in November 2012, and given that the UN Human Rights Council agreed a resolution in Geneva—we supported that resolution, which will come back for assessment this spring—what are we doing to ensure that the UN responsibility to protect means something in future? That responsibility does not yet mean something, and an amendment to the way that the Security Council and the UN work is needed.
What will we do in Geneva in the next few weeks to ensure that the accountability that was sought is implemented? What do we do to ensure that the Sri Lankan Government are held to account for war crimes? There were war crimes on both sides, but Governments have a particular responsibility not to commit war crimes, and they need to be held to account.
What will we do about the Commonwealth Heads of Government meeting? It should not have been agreed to hold it in Colombo. Unless Colombo shows that it is moving in a fundamentally different direction, the UK should not support the Commonwealth, which has been weak on the issue, or endorse the Commonwealth’s support for the regime by its presence in Colombo. That would not be the right approach for the British Government. I hope that the Minister will be robust. We need Britain to be robust, in the interests of everybody in Sri Lanka and of a successful future for Sri Lanka as a whole.
Mr Hollobone, I join in congratulating you on how you have chaired this debate and managed to call all the speakers. I also congratulate my hon. Friend the Member for Mitcham and Morden (Siobhain McDonagh) on securing this debate. I have participated with her in previous debates on Sri Lanka, and she is not just passionate but knowledgeable about the situation there, despite not having visited the country.
It is interesting that the hon. Member for Cannock Chase (Mr Burley) discussed the eight-day trip to Sri Lanka in July, which was arranged by the Sri Lankan high commission. Nine Conservative MPs went on that trip, plus the hon. Member for North Antrim (Ian Paisley). I certainly was not invited. As I am the Opposition spokesperson on Sri Lanka, one might think that I would have been the first port of call if the high commission genuinely wanted it to be a cross-party trip. It is obviously useful and important to visit countries and see the situation on the ground, but the experience on such trips and the lessons learned tend to depend on what one is shown and who is the host. This debate has amply demonstrated how going to see things on the ground does not necessarily give the whole picture.
I will not, because it is important that we give the Minister time to respond. I want to use less than my time if possible.
Like the Government, we welcome the report of the internal review panel on UN action in Sri Lanka, and we note the panel’s conclusion that the Secretary-General took a courageous step in commissioning the review, but that in itself is not enough; we must learn lessons from it. We must not just focus on the extent to which the Sri Lankan people were let down by the international community; we must see how we can move forward.
The temptation with any review is to focus on the past. We should not forget the atrocities committed on Sri Lanka’s killing fields, the tens of thousands who needlessly lost their lives during the civil war or the many other civilians who have been affected. I do not support calls to draw a line under those atrocities; I do not think that the time has come to say that we can now move on and forget what happened. Many people have not been held to account for the crimes that they committed, and we must still focus on that. I thought it quite shocking that one Government Member referred to irregularities in the past. They were much more than irregularities. It is also shocking that people cast doubt on the evidence, such as was shown in the Channel 4 programme, about what happened in Sri Lanka. It is well documented by international organisations.
As the head of Amnesty International’s UN New York office stated, the review is
“a wake-up call for UN member states that have not pushed hard enough for an independent international investigation into alleged war crimes”.
Amnesty warned that there is “no evidence” that
“the Sri Lankan Government’s lack of will to protect civilians or account for very serious violations…has changed”.
The most pertinent conclusions on which we must now focus are that the report’s recommendations provide
“an urgent and compelling platform for action”
and that the
“UN’s failure to adequately respond to events like those that occurred in Sri Lanka should not happen again.”
Many have been shocked by the review’s finding that UN staff
“did not perceive the prevention of killing civilians as their responsibility”.
On the concept of a responsibility to protect, the review warned:
“Differing perceptions among member states and the Secretariat of the concept’s meaning and use had become so contentious as to nullify its potential value. Indeed, making references to the responsibility to protect was seen as more likely to weaken rather than strengthen UN action.”
The panel concluded that there is an
“urgent need for the UN to update its strategy for engagement with member states in situations where civilian populations…are not protected”.
Will the Minister outline the Foreign and Commonwealth Office’s current interpretation of the responsibility to protect doctrine? What discussions have the Government had with international colleagues about the internal review and how the situation can move forward?
During the past year, the final report of the Lessons Learnt and Reconciliation Commission has been published, but as has been widely acknowledged, it failed to address the credible allegations of war crimes and crimes against humanity committed by both sides in the conflict, as highlighted by the UN panel of experts. The LLRC’s composition and narrow terms of reference were deeply flawed, as is borne out in its report, which fails even to mention torture, despite the fact that the UN Committee against Torture noted “continued and consistent allegations” of its widespread use.
The LLRC was in no way adequate, but some of its recommendations offered a foundation on which we could build, providing that they are properly implemented. In accordance with the UN Human Rights Council resolution passed in March, the Sri Lankan Government developed their national action plan, about which I have asked the Minister before, but there remain few signs of meaningful progress, as noted by many countries and non-governmental organisations during Sri Lanka’s universal periodic review towards the end of last year. What contact has the UK had with the Sri Lankan authorities since the periodic review? Will the UK set out identifiable goals that can be assessed at the UN human rights plenary session in March, which must take the opportunity to reassure the people of Sri Lanka that the UN can help them?
The year 2013 could prove to be a crossroads for Sri Lanka, but the UN is not the only institution with a pivotal role to play. Many Members have mentioned the Commonwealth Heads of Government summit later this year. The UK’s stance to date has been ambiguous compared with, for example, that of the Canadian Prime Minister, who stated unequivocally that, unless there were clear signs of improvement in Sri Lanka’s human rights record, he would boycott the summit. Is the UK Prime Minister’s attendance at CHOGM provisional? If so, what conditions must the Sri Lankan Government meet if the UK is to be present?
We must also consider the UK’s duty to protect. Will the Minister update us on the Foreign Office’s discussions with the Home Office regarding deportations to Sri Lanka, which other hon. Members have mentioned? Finally, given the UN’s clear failures to protect civilians and recognise the Government’s human rights abuses and the shortcomings of the LLRC, does the Minister agree that the people of Sri Lanka deserve an independent international investigation to provide not only answers and accountability but a clear way forward for their country?
I add my thanks to those of my colleagues, Mr Hollobone, for your chairing of this debate. I also thank the hon. Member for Bristol East (Kerry McCarthy) for her brevity and her remarks. I start, as always, by congratulating the hon. Member for Mitcham and Morden (Siobhain McDonagh) on securing this debate. Her deep and committed interest in Sri Lankan issues is well known. I welcome the opportunity to state the Government’s position and the opportunity that she has once again provided the House to discuss the issue.
I welcome the interventions of a number of colleagues in this debate. They have been passionate, thoughtful and honest. The difference of views expressed across the Chamber emphasises the complexity of the issue. In an effort to defuse a little of the heat, may I say that, bearing in mind the history of the issue and who was in Government in 2009, a degree of humility in all parties is helpful? Hindsight is a wonderful thing. The contributions of colleagues with personal experience of reconciliation in parts of the UK were particularly important in bringing to the surface some of the difficulties involved.
The UK’s relationship with Sri Lanka is long-standing, strong and based on close historical, cultural, educational, commercial and family ties that will not weaken. The United Kingdom is fortunate to have a large Sri Lankan diaspora community, which contributes much to our rich and diverse culture. Over the past couple of years, I have met regularly with Sri Lankan Ministers, parliamentarians from different parties and members of the diaspora in the United Kingdom. As has been noted, in two weeks’ time, I will make my second visit to the country.
The hon. Lady suggested that my visit might be taken as a vindication of the Government. I assure her and the House that judging from experience over the past couple of years, my remarks are not always taken in that way by the Government, who are entitled to see them as they wish. I do not think that that is a particular risk.
There are different ways of visiting a country. People do not always have to go on a Government-sponsored visit; non-governmental organisations are operating, for example. People should declare everything and of course they must be on guard, no matter who takes them on a visit. It is helpful to visit and get a picture, if it is possible to do so, although that does not preclude views from those who have not visited but know a great deal about the issue.
The decades-long war in Sri Lanka, which ended in 2009 with the defeat of the Liberation Tigers of Tamil Eelam, devastated the country and deeply scarred its population. Sri Lankans deserve lasting peace and reconciliation and where the United Kingdom and international organisations, such as the UN, are able to encourage and support the process it is right to do so.
I want to deal with three elements that came out of this debate: the situation of the UN; progress being made in Sri Lanka; and issues to do with the Commonwealth Heads of Government meeting. In essence, I agree with and support the remarks made by the hon. Lady. It is right that the UN has been through an intense process, examining its role in relation to the conclusion of events in Sri Lanka. We welcome the report by the panel of experts appointed by the UN Secretary-General in 2011, which found credible allegations that both sides were involved in violations of international humanitarian law, and its setting up its own independent internal report to consider what happened with regard to the UN’s role. We agree that shortcomings were identified. In following that up, we note that the UN has moved swiftly to put in place a lessons-learned programme overseen by a panel chaired by the Deputy Secretary-General’s office. It is there that we will make our contribution to how the UN is going to repair what it failed to do in relation to the responsibility to protect, and we will follow that panel’s progress closely. I expect that questions will be raised about that over time.
We are committed to and support the concept of responsibility to protect, which was supported by all UN member states in 2005. The difficulty that was found in 2009 was that a pillar III responsibility-to-protect response required the agreement of the UN Security Council. It was clear at the time—former Ministers in this Chamber know this better than I—that there was not widespread support in the wider international community for a more assertive position towards the parties to the conflict. This turns out to have been a tragedy. The United Kingdom’s primary concerns during the final offensive were to ensure unimpeded access by humanitarian agencies and compliance with international humanitarian law, including investigations of allegations of violations. The UK focused, therefore, on the parties’ obligations to protect the civilian population.
In the light of what he has just said, will the Minister comment on paragraph 15 of the internal report? It says that there was
“concern that the moment that humanitarian organizations leave, the Government will begin bombing Killinochchi town and that the physical security of the civilian population will be at increased risk”.
It is implicit that there is safety by the UN organisation’s very presence and that there is supervision.
Yes. As we have all said during the debate, the UN is examining its processes carefully as it finds fault in what it did in the past and emphasises the importance of UN engagement in the most difficult circumstances. Of course, we see in Syria today how difficult that has become. No doubt, the UN panel will look carefully at how it failed to meet that obligation and what might be done in difficult circumstances in future.
The LTTE is a brutal, ruthless organisation that rightly remains proscribed in the UK, but a military victory alone cannot deliver the stable, lasting peace all Sri Lankans deserve. Addressing events during the final days of the conflict is important and the UK has consistently called for an independent investigation into allegations of violation of international humanitarian law on both sides. There needs to be a more fundamental approach that goes beyond accountability. Colleagues have mentioned this in terms of the context of the future of Sri Lanka being for Sri Lankans themselves and how they take this forward. Therefore, we support the view, widely held in Sri Lanka and outside, that long-term peace can best be achieved through an inclusive political settlement that addresses the underlying causes of the conflict. Such a settlement must also take into account the legitimate grievances and aspirations of all Sri Lanka’s communities.
On the progress that has been made, the Sri Lankan Government recognised that in appointing the LLRC, which submitted its report in December 2011 and made more than 200 recommendations, including calls for credible investigations of alleged judicial killings and disappearances, demilitarisation of the north, implementation of impartial land-dispute resolution mechanisms and protection of freedom of expression.
Although we welcome the recommendations that were made, as I said at the time, the Government’s view is that the report left gaps and unanswered questions on alleged violations of international humanitarian law and human rights law. We were disappointed by the report’s conclusions and recommendations on accountability. None the less, as colleagues have said, the recommendations, if implemented in full, would go a long way to achieving the reconciliation that we believe will achieve lasting peace.
What progress has there been and, in answer to colleagues who have asked what we are looking for, what have we measured? The UK recognises and welcomes progress made in various areas. UK officials have visited all nine provinces of Sri Lanka in the past 12 months and have seen much to welcome. The absence of conflict has brought greater security and opened up economic development—the demining was mentioned by colleagues—with UK financial support, freeing up yet more land for resettlement and agriculture. Rehabilitation of thousands of ex-combatants, including child soldiers, has allowed many individuals to integrate back into society. The majority of internally displaced persons have now moved out of camps, although there is still work to be done in ensuring that “permanent homes” means just that, and does not mean people being deposited in places that they came from. Troop numbers are well below those in 2009. Although that is positive, there still remains more to be done to ensure that there is lasting peace and prosperity.
The March 2012 Human Rights Council resolution, supported by the UK and a number of member states, called on the Government of Sri Lanka to implement the LLRC recommendations and address alleged violations of international law. I assure hon. Members that we will be robust in pursuing that in the March 2013 council meeting. We wish that action plan, with deadlines from early this year for the implementation of LLRC recommendations, to be carried forward. It only covers about half of the LLRC recommendations. When I go to Sri Lanka in a couple of weeks, I will see if Sri Lanka will consider implementing all the recommendations and, if so, how to take it forward.
It is too soon to talk about our attendance plans for the Commonwealth Heads of Government meeting. We will not move from that position for a period of time. Sri Lanka was scheduled to host the Commonwealth Heads of Government meeting in 2011, but given ongoing concerns about the humanitarian and human rights situation, the UK and other Commonwealth members did not support its bid. However, Commonwealth members decided that Sri Lanka would host in 2013. To reopen that decision would require a consensus of all member states and I do not think that is likely.
I have listened carefully to exchanges between hon. Members. The intensity of views and the sharp divide between colleagues emphasises how difficult and complex the situation is. A decision on the location of CHOGM is not for the UK; it is for the Commonwealth. The meeting will discuss many issues, not just Sri Lanka, but as Sri Lanka well knows it will inevitably shine a spotlight on the host country, demonstrating either its progress or lack of it. It is up to Sri Lanka to choose what will be seen. As the Foreign Secretary has said, we expect the Sri Lankan Government to demonstrate that they uphold the values of the Commonwealth.
Colleagues have said that the UK should not let Her Majesty the Queen go to the Commonwealth Heads of Government meeting. It is important to clarify that she attends that meeting as head of the Commonwealth, not the UK Head of State. Her attendance is not a decision for the UK Government. If she were to ask for advice, it would be from all Commonwealth members.
Following the resolution of the conflict, it is clear that long-term reconciliation is an issue. The hon. Member for Islington North (Jeremy Corbyn), perceptive as he often is, said that unless that is done the problem will come back at some stage to haunt everyone in Sri Lanka. The process of reconciliation is not easy. Some progress has been made in implementing some of the recommendations in the LLRC report. More needs to be done. The LLRC needs to be given time and good will must be there on all sides to see the process through. Nothing has been swept under the carpet and we are mindful of what has happened in the past and of the wishes of all Sri Lankans for the future.
Female Genital Mutilation
It is always a pleasure to serve under your chairmanship, Mr Hollobone, which I have done on many occasions.
I am delighted to have secured this important debate on what I believe to be a national scandal, with thousands of victims violated and failed every year. Although the scandalous practice of female genital mutilation is shrouded in secrecy, the Government estimate that 20,000 girls under 15 in England and Wales could be at high risk of FGM. That is more than 50 young victims every day. It is happening now, as we speak in the debate. The issue is not party political, and has been raised by Government and Opposition Members. I pay tribute to the hon. Member for Battersea (Jane Ellison), who is recognised in this place and outside the House for her tremendous work in raising the matter.
Eradicating the practice will take not only cross-party support but cross-departmental work involving the Home Office, the Department for Education, the Department of Health and the Foreign Office. The subject is complex, but I want to use today’s debate to understand the Ministry of Justice’s role in dealing with FGM and to press the Minister responsible for victims of crime on what the Government are doing to ensure that those voiceless victims are protected. I want to know what her Department is doing to champion that cause and what she is doing not only to prevent people from becoming victims in future, but to seek justice for existing victims. I understand that several failings fall under the remit of the Home Office, but my concern is that no Minister is specifically responsible for FGM. Given that there are 20,000 victims every year, the victims Minister should perhaps shoulder a fair proportion of that responsibility.
Female genital mutilation has been a criminal offence in this country since 1985, but some may argue that it has been a criminal offence for much longer, under the Offences Against the Person Act 1861. In my respectful submission, FGM is without a shadow of a doubt grievous bodily harm. It is an appalling practice. The Female Genital Mutilation Act 2003 made it illegal to take children abroad for the purposes of FGM. Despite that, however, it is astonishing that there has not been a single prosecution. I welcome the recent efforts of the Director of Public Prosecutions and the publication of the Crown Prosecution Service action plan. Keir Starmer QC stated:
“It is critical that everything possible is done to ensure we bring the people who commit these offences against young girls and women to justice”.
Right hon. and hon. Members will welcome that commitment, but those words need to translate into justice for thousands of victims.
Despite those recent developments, I am confused as to why it has taken such a long time for basic questions to be asked about why there has been a failure to prosecute this most despicable child abuse. It is a criminal offence, and it is not good enough for the prosecuting authorities to try to mitigate inaction by suggesting that prosecutions are made difficult, or even impossible, merely because young girls do not present themselves at a police station to report their parents for this vile abuse. It is a criminal offence and it needs to be tackled.
I am pleased that my hon. Friend has secured today’s debate. When I raised the issue of female genital mutilation and questioned the lack of prosecutions, the problem did not seem to be at the Crown Prosecution Service end; the police were simply not referring cases to it. I think that there were three cases in which the CPS had to make a decision on whether to prosecute, but it felt that there was not enough evidence. Does he agree that the police also need to make female genital mutilation a much greater priority?
I am pleased and grateful to the hon. Gentleman for securing today’s debate. To pick up on that last point, there is one thing that the police need to think about. There was a recent and well-known exposé in a major national paper. Some hon. Members were present at the annual general meeting of the all-party group on female genital mutilation when the Director of Public Prosecutions explained that prosecutions were not possible on the back of that exposé. However, the idea of going after the aiders and abettors, for which the 2003 Act more than makes provision, is one thing that we need more heft behind, because it is obviously a more promising route than trying to get children to report their parents.
The hon. Lady makes a good point. I had the opportunity through Hilary Burrage, who has campaigned tirelessly on female genital mutilation, to meet the leading French prosecutor. What the hon. Lady suggests is exactly the action being taken in France. Working in that way clearly helps to prevent perpetrators from committing the offence.
I am pleased that we now have a victims commissioner. It is not a party-political point, but it has taken at least 12 months for that to happen. I am sure that Baroness Newlove will do an excellent job and continue the good work of Louise Casey. I want to know the Minister’s thoughts on how much the victims commissioner should prioritise female genital mutilation.
Over recent months, we have heard many positive words, but I am concerned that positive words are not reducing the shocking number of victims on the ground or delivering the justice that victims deserve. The NSPCC rightly states that preventing future victims should remain a priority, but we need to see justice for the 50 victims who will suffer the abuse this very day.
Does the hon. Gentleman feel that other measures ought to be brought into play? In other countries, nurses in schools automatically have to ensure that the authorities are informed about such matters. That does not seem to happen in this country.
I agree with the hon. Lady that the authorities need to work more closely together, and to share information with teachers, nurses and GPs. I have spoken to many professionals who avoid the issue either because of the sensitivities or, as was suggested to me recently, because they are struggling with their departmental budgets. They avoid dealing with the matter. The hon. Lady does not seem terribly impressed at that comment, but that point was put to me very recently. The reduction in social services budgets is definitely an issue, because female genital mutilation is not the priority that it should be.
The lack of evidence and witnesses is also an issue. The lack of prosecutions is compounded by many factors. The police are not investigating FGM with enough vigour, as was suggested earlier. It is estimated that of the 20,000 suspected cases some 6,000 will be based in London. The Metropolitan police’s Project Azure was set up to tackle the problem, but a freedom of information request showed that the team consisted of only two police officers—one full-time and one part-time. It is ridiculous to suggest that such policing is sufficient to tackle this shocking issue.
I congratulate my hon. Friend on securing this important debate. Has he considered whether the authorities can work with individuals in the communities involved who are concerned about what is happening? Does he have any views on that?
I do have views, and my hon. Friend makes an excellent point. She has raised the matter in the House on numerous occasions. An issue that follows from that is the obvious lack of data collection. It is accepted that robust data collection and assessment of the problem are urgently needed. A Government equality impact assessment was published last year and stated:
“Lack of data is an ongoing issue in the government’s work to prevent and tackle FGM.”
It will be impossible to tackle the problem without robust systems in place to identify its true level and at-risk children. I am pleased that this is now a priority in the Crown Prosecution Service’s action plan, but the Home Office assessment said that a large-scale community-based study would have a very high cost, and that the Department will continue to examine alternative options and to consider how existing data may capture information about FGM.
I apologise for intervening again. On that specific point, the House may like to know that nearly a year ago Quality Now! led a Home Office-funded two-day expert methodological workshop. It made specific recommendations on how robust data could be gathered in ways that would be less expensive than those that the hon. Gentleman described. That report and the recommendations have been sitting in the Home Office for almost a year. It is good that it funded the original workshop, but a plan exists and could be funded cross-departmentally to get us away from relying on data that are extrapolated from the 2001 census. Hon. Members will be aware of how much Britain’s demography has changed since the 2001 census.
I entirely agree with the hon. Lady. She is more expert in the matter than I am, and has raised the issue consistently since being elected to the House. I welcome her thoughts on the issue.
I have said previously that the Crown Prosecution Service action plan is a step in the right direction, and I welcome it, but I would be interested to know whether the Director of Public Prosecutions believes that current legislation should be reviewed, and whether evidence to prosecute under other legislation is easier to support. The CPS action plan is not the silver bullet. We need a national action plan—an integrated cross-departmental plan—that is adequately funded to stop this despicable crime.
I am concerned that for many years there has been interdepartmental buck passing. When I say that the issue is not party political, I mean that sincerely. The reality is that the previous Government failed dreadfully in tackling the issue. They had 13 years in which to take the matter on, and since then the current Government have not done a lot. We must have a national action plan because the issue needs strong political will, not just warm words.
Given that this crime produces 20,000 victims every year, I suggest that the Minister’s Department has a single Minister with specific responsibility for providing justice to victims. As the NSPCC rightly states, female genital mutilation is a form of physical child abuse that should be dealt with through the child protection system. Reticence or failure to intervene effectively is not acceptable in other instances of child abuse, nor should it be in the case of FGM. We need a standardised FGM data collection policy. I wholeheartedly welcome last month’s landmark passing of the UN resolution calling for a global ban on FGM, and I hope that the UK will now act on the issue with focused priority.
Finally, I suggest that statutory teaching of sex education in primary school may assist in helping to eradicate this vile practice.
It is a pleasure, Mr Hollobone, to serve under your chairmanship. I earnestly congratulate the hon. Member for Kingston upon Hull East (Karl Turner) on securing this debate on victims of the abhorrent crime of female genital mutilation. I also congratulate the hon. Member for Bristol East (Kerry McCarthy), my hon. Friend the Member for South Derbyshire (Heather Wheeler), the hon. Member for Liverpool, Riverside (Mrs Ellman) and my hon. Friend the Member for Battersea (Jane Ellison) on their important interventions. I congratulate particularly my hon. Friend the Member for Battersea on her tireless work over many years, and as chair of the all-party group on female genital mutilation.
Female genital mutilation is an extremely painful and harmful practice that blights the lives of many young girls and women. The Government roundly condemn the practice and are determined to see it eradicated in this country and elsewhere. In my joint role as Minister with responsibility for victims and the courts and Minister for Women and Equalities, I am particularly pleased to have the opportunity of responding to this debate.
The practice of female genital mutilation is an age-old one that is deeply steeped in the culture and tradition of practising communities. Those who practise it no doubt genuinely believe that it is in their children’s best interests to conform to the prevailing custom of their community, but that does not excuse the gross violation of human rights. It is wholly unacceptable to allow a practice that can have such devastating consequences for the health of a young girl. The physical and psychological effects can last throughout her life. The mutilation and impairment of young girls and women have no place in a modern society where equality is prized.
My Department is responsible for the criminal law in this area. The Female Genital Mutilation Act 2003 extended significantly the protection that the law affords these vulnerable young victims. It created extraterritorial offences to deter people from taking girls abroad for mutilation. To reflect the serious harm caused, it increased the maximum penalty for female genital mutilation from five to 14 years. Sadly, like the Prohibition of Female Circumcision Act 1985 that it replaced, the 2003 Act has yet to result in a successful prosecution, which is a source of considerable frustration. That is not, as some have suggested, a reflection of the effectiveness of the law itself. The law is perfectly capable of dealing with perpetrators if offences are reported to the police, and evidential and public interest tests for prosecution are met. At the time of mutilation, however, victims may be too young, too vulnerable, or too afraid to report offences, and they may be reluctant to implicate family members. The simple fact is that no law can be effective in this area unless the barriers to prosecution are overcome.
Before being elected to this place, I practised as a criminal lawyer, and I worked on behalf of defendants who were charged with serious sexual abuse of children. It is not often suggested that it is difficult to bring such cases to prosecution, and the same issues are involved. Will the Minister explain her point?
I am aware of the hon. Gentleman’s criminal law experience. The law is robust, extensive and adequate but, unfortunately, dealing with the issue often involves very young children who are frightened and reluctant to take action against family members. There is often pressure within their community not to give evidence and not to say anything.
I would disagree, but obviously, the adequacy of the law is something that we will always keep under review. I know that the Director of Public Prosecutions has had conversations with the Home Office and Ministry of Justice officials—I think the hon. Gentleman is aware of those—on the effectiveness of the law, and whether new laws or other legislation, such as the Domestic Violence, Crime and Victims (Amendment) Act 2012, might help in those areas. I can assure the hon. Gentleman that the matter will be kept under review, but I will discuss a number of other things in my speech that can be done in the interim.
The Minister may well be moving on to this point, but I just want to agree with what the hon. Member for Kingston upon Hull East (Karl Turner) said. If the police wanted to go after the people who were organising this, they could. I hope that the Minister will address in her remaining comments the fact that, ultimately, there is a lack of will. We all know that children are not going to report it. They are too young. They are not going to report their parents, but people are setting up the travel and the medical care when the children get back, and they are meeting them at the other end. Where there is a will, there is a way. This has been held back by some misguided notion that it would be racist to pursue the issue. It is racist not to. If these girls were white middle-class children, we would be protecting them a lot better than we are now.
I hear everything that my hon. Friend has to say, and I am aware that she knows a considerable amount about the matter. I do not accept that there is a lack of will, but I hear what she has to say, and I will make sure that as much action as possible is taken to deal with the issues that she highlighted.
I very much welcome the action plan that the Director of Public Prosecutions published recently, with a view to bringing a successful prosecution for female genital mutilation. The willingness of victims and others to come forward and give evidence in court is crucial. We need to create a climate in which victims, and those close to them, feel able to report offences to the police and to receive the help and support that they need to give evidence, so that perpetrators of this unacceptable, dreadful practice can be brought to justice.
Of course, the law is only one part of tackling the problem of female genital mutilation in this country, and prosecution after the fact does not relieve the victim from a lifetime of pain and discomfort. Ideally, we want to prevent the mutilation from happening in the first place. We need to educate people and change their attitudes— sometimes long-established attitudes. A holistic approach and a multi-agency response are vital.
I note what my hon. Friend says. I shall come on to health and cross-Government, inter-agency multi-practice in a moment, but if I do not cover her specific point, I will be happy to write to her.
A joined-up approach within Government is also important. The Government’s approach to tackling female genital mutilation is set out in our “Call to End Violence Against Women and Girls” action plan. Our key focus is prevention, and cross-Government work, co-ordinated by the Home Office, has seen significant progress in raising awareness of female genital mutilation and supporting professionals to intervene. Central to that work are the multi-agency practice guidelines on female genital mutilation, which were published in February 2011. They highlight the risk factors that teachers, nurses, GPs, police officers and social workers should be looking out for in their work, and they set out what action they should take. Above all, they stress the need for a collaborative effort to protect girls at risk. A review of the use and effectiveness of the guidelines was launched by the Home Office in August 2012, and a report on the findings of that review will be published later this year. Additionally, over 40,000 information leaflets and posters about female genital mutilation have been distributed to schools, health services, charities and community groups around the country.
We also continue to support front-line organisations that work with communities to challenge their long-held beliefs about the practice. The Home Office launched a £50,000 fund in November 2012, from which organisations may bid for grants of £2,000 to £5,000. That follows from the success of the 2011 fund, which supported 10 organisations working to tackle FGM across England and Wales. Another recent initiative is the declaration against FGM launched by the Home Office in November. Based on the Dutch document known as the “health passport”, it sets out the law and penalties for female genital mutilation. It is supported by and carries the signatures of relevant Ministers, including my own and those of the Minister of State, Home Department, my hon. Friend the Member for Taunton Deane (Mr Browne) and the Under-Secretary of State for Health, my hon. Friend the hon. Member for Broxtowe (Anna Soubry), as well as that of the Director of Public Prosecutions.
The Department of Health continues to ensure that health professionals are able to respond appropriately to girls and women who may be at risk of genital mutilation and to those who have already been subjected to it. In May 2012, the then Health Minister, my hon. Friend the Member for Guildford (Anne Milton), wrote to the royal colleges and NHS agencies encouraging them to raise awareness of the problem among professionals, and the Department’s chief medical officer and the director of nursing, with the support of the royal colleges, wrote to health professionals drawing their attention to the multi-agency practice guidelines. It is clear from the responses received that all are committed to playing their part in eradicating this dreadful practice.
Work is continuing across Government to look at all possible ways of tackling this complex issue. To that end, in two days’ time, the Minister with responsibility for crime prevention, my honourable Friend the Member for Taunton Deane, will be co-hosting, with the National Society for the Prevention of Cruelty to Children, a round-table meeting with key professionals. The meeting’s purpose is to explore how those working with children can work together to detect potential victims of FGM and deter those from considering carrying out the act. The public health Minister, my hon. Friend the Member for Broxtowe, and the Minister with responsibility for children, my hon. Friend the Member for Crewe and Nantwich (Mr Timpson), will also be attending.
Ultimately, the eradication of female genital mutilation in this country will require the practising communities themselves to abandon this awful practice. It is a sad fact that older women, who are themselves victims of genital mutilation, are often the strongest advocates for the continuance of the practice. Such attitudes are deeply ingrained.
The hon. Member for Kingston upon Hull East asked what the victims commissioner’s role might be in relation to the issue. The victims commissioner has a statutory duty to promote the interests of victims of crime, including victims of female genital mutilation. I hope that she will be taking up her position later this month, and I look forward to working closely with her on those matters. He also asked about my role as victims Minister, with particular reference to female genital mutilation, and I can tell him that I will be working closely with the Home Office in a cross-Government capacity on an issue that, as I think he knows, is also very close to my heart.
In a wider context, I am responsible for looking after victims and doing everything that I can to care for, support and help them, including, of course, victims of female genital mutilation. I will be working with the police and crime commissioners to make sure that they do everything that they possibly can to eradicate the practice, and working with the police in their new capacities. We will be reforming the victims code, which will hopefully make it easier for victims—including victims of female genital mutilation—to navigate their way through the criminal justice system, which can often be very confusing and intimidating, as I am sure the hon. Gentleman is aware, having worked in it for many years.
In conclusion, the Government remain committed to protecting young girls and women from the abuse, and to ensuring that those living with its consequences get the care and support that they need and deserve. I thank all hon. Members who have contributed to the debate, and I hope that it will serve to keep this important issue firmly on the agenda.
Liverpool Care Pathway
[Mr Mike Weir in the Chair]
Mr Weir, I would like to say how much of a pleasure it is to serve under the chairmanship of a fellow Celt. I declare an interest as a board member of Living and Dying Well, which specialises in research into and opposition to the legalisation of assisted suicide.
I shall begin with a summary of the current position. The “Liverpool Care Pathway for the Dying Patient” was developed by the Marie Curie Palliative Care Institute Liverpool as a framework for health professionals to use to ensure that people who are dying have as comfortable and dignified a death as possible. The pathway was developed and has been in use since the 1990s. Today, about 130,000 of the 450,000 patients who die in hospital care every year die while being cared for on the pathway. It has also been exported and is now in use in more than 20 other countries.
However, during the past few months, the Liverpool care pathway has been the subject of some very serious criticisms and allegations in the media, which has led to questions about whether it is indeed a worthy process. I shall explain why I sought this debate and the outcomes that I would like to achieve before considering in greater detail the criticisms that have been made of the pathway.
By any measure, the Liverpool care pathway plays a very significant role in how the end of life is managed in our country. Its role is much greater than most of us realise: 30% of patients who die in hospital care die while on the pathway. The sheer scale of this is why I believe that debate about it is too important to be led by national newspapers, although I certainly do not criticise those newspapers for reporting stories in the way they have done. Indeed, they have served a valuable purpose by raising public awareness of such an important issue. However, there is, almost inevitably, a tendency for newspapers to couch the debate in sensationalist terms. It is up to us as parliamentarians to ensure that this complex and potentially controversial issue is subject to balanced and thorough debate in the House of Commons.
The outcome that I seek today is calm reflection by parliamentarians, including those on the Front Benches, on this most sensitive of issues—calm reflection on the issues without encouraging the spread of alarm and despondency among those entering care, which can result from sensationalist allegations. I also seek a response from Government—from the Minister—that they will ensure that the review on which they have already embarked includes careful and thorough investigation of the allegations that have been made of bad practice. It is important to know whether the allegations are accurate and, if they are, where the weaknesses lie and what needs to be done to put those matters right.
I am a supporter of the Liverpool care pathway, but my aim today is not to defend or to attack the pathway, those who have made allegations of shocking bad practice, or the media, which have given the allegations such great publicity. It is to promote open and genuine debate in Parliament. In any case, I am not in a position to judge how much substance there is to the various criticisms that have been made, but I do know that we cannot avoid death and I also believe that most people do not fear death so much as they fear the process of death. The aim of the Liverpool care pathway is to ensure that the process is as compassionate, dignified and free from pain and discomfort as possible and, importantly, consistent with public safety. Our aim should be that the pathway is used in a way that retains public confidence—that it is being used in accordance with the principles on which the Marie Curie Palliative Care Institute developed it.
I hope that the Minister will agree that we must ensure that the pathway is subject to the very highest levels of scrutiny and that the framework can be allowed to be implemented only against a background of total transparency. There must be discussion with patients or with patients’ families or carers and there must be clearly available avenues through which complaints and concerns can be channelled. I hope that the Minister will assure us that the very serious allegations reported in the media will be thoroughly investigated and that, if any examples of bad practice are found, action will be taken to expose those responsible, to hold them to account and to do everything possible to prevent it from happening again. The experiences at Winterbourne View and hospitals in Worcestershire and the appalling and chilling events that took place in Stafford are too raw in the memory to allow anything else. It is only through audit and disciplinary measures, if and when appropriate, that the Liverpool care pathway will retain the integrity needed for it to be acceptable and the confidence of those who might use it.
Two years ago, I had never heard of the Liverpool care pathway. I first took an interest in it as a consequence of my concerns about and opposition to the legalisation of assisted dying. I was hugely surprised by how widely the pathway was in use. I had no idea that 130,000 patients in hospital care died while on the pathway every year and I do not think that many people realise that today.
I am grateful to my hon. Friend for giving way to a fellow Celt. I congratulate him not just on securing the debate, but on the tone in which he has introduced it. He referred to the number of people who are on the Liverpool care pathway, but to help the debate has he done any work on the expansion in numbers since the 1990s? Did we swiftly move to 130,000? Is that a consistent number, or has there been a gradual increase over time? I ask that because of course it is the rolling out of the pathway that may lead to some people having less expertise—less skill—and then, as a result of that, some of the instances that my hon. Friend refers to some poor reporting of?
My hon. Friend makes a very important point about the need for training and expertise for all those who are responsible for putting people on the pathway and for looking after them when they are on it. I want to come to that later in my comments.
The negative coverage in our national media has probably increased awareness of the Liverpool care pathway. To that extent, I think that it has been a very good thing, but because I do not believe that the scale of the pathway is widely known, I think that it is right to say something about what the Liverpool care pathway is and what it is not in order to set out the context of the debate,. It is certainly not and must never be any form of “euthanasia by the back door”—a phrase that I have heard—nor is it a form of clinical treatment or even any specific type of care. It does not instruct doctors or nurses to provide this or that treatment. What it does is prompt them to consider whether certain treatments are appropriate in individual circumstances. It supports—it does not replace—clinical care. It is no more than a framework of good practice, backed up by training and education, to guide doctors, nurses and other health professionals towards delivering the high levels of palliative care that have been available in hospices for many years. It enables them to be transferred to hospitals, care homes and patients’ homes. It is about the appropriate way to look after a patient who is clearly dying through the last few days and hours of life.
Some other points should be made in this debate. The Liverpool care pathway does not recommend, as some have suggested, that dying patients should be deprived of food and water, although food and water may be withdrawn in individual cases if clinicians believe that that is the right step to take. The Liverpool care pathway does recommend to doctors and nurses that they explain to dying patients, or more often their next of kin, exactly what is happening and why. Secrecy forms no part of the Liverpool care pathway whatever.
It is also important to emphasise that there is nothing irreversible about being placed on the Liverpool care pathway.
I thank my hon. Friend for calling this very important debate. I, too, share some of his concerns about the consistency with which the Liverpool care pathway is implemented across the country. I made some inquiries in the hospitals that serve my constituents, but information seemed to be lacking on the implementation of the care pathway. I am particularly concerned that patients placed on the pathway may have no opportunity to be taken off it if they improve. There are no figures on the number of patients for whom care has been reintroduced after being placed on the pathway. One of the hospitals told me, anecdotally, that no one there could remember anyone being taken off the pathway. I find that worrying.
My hon. Friend makes a very good point. Patients on the pathway should be monitored regularly, and if the patient shows signs of rallying, as does happen in a minority of cases, the treatment should be modified to support recovery. If that is not happening, the pathway is not being implemented properly. The Liverpool care pathway is not a pathway to death —a phrase I have seen used often, but which I think is unbelievably awful. It is a travesty of the truth to describe it as a form of euthanasia.
Why have we reached the point of huge public controversy, which has caused so much angst and fear? It has arisen from allegations—serious allegations, some of them from doctors and nurses—that the pattern of end-of-life care I have described has not been followed in some cases. There have been stories of dying patients being deprived of the food and water they needed and others being kept continuously sedated until they died; and of patients being placed on the pathway without consultation with them or their families, or to meet targets. The fear of that is especially shocking, and I hope the Minister will comment specifically on the issue of targets.
Let me look at some of the allegations in more detail. According to the Daily Mail in June last year,
“NHS doctors are prematurely ending the lives of thousands of elderly hospital patients because they are difficult to manage or to free up beds”.
The report is based on a presentation to the Royal Society of Medicine by Professor Patrick Pullicino, a consultant neurologist. He stated:
“The lack of evidence for initiating the Liverpool Care Pathway makes it an assisted death pathway rather than a care pathway.”
That is the debate being led by the Daily Mail. Professor Pullicino continued:
“Very likely many elderly patients who could live substantially longer are being killed by the LCP.”
Imagine how a frail elderly person entering hospital a few weeks after reading that would feel. Professor Pullicino added:
“Patients are frequently put on the pathway without a proper analysis of their condition.”
According to the Daily Telegraph, in September, a group of experts stated in a letter that
“dying patients…can…have fluid and drugs withdrawn and many are put on continuous sedation until they pass away.”
The letter—again according to the Daily Telegraph—spoke of a “national crisis” in patient care, and
“a national wave of discontent…building up, as family and friends witness the denial of fluids and food to patients.”
According to the newspaper, some patients were wrongly being put on the pathway, which created a “self-fulfilling prophecy” that they would die. The report continued:
“Patients who are allowed to become dehydrated and then become confused can be wrongly put on this pathway”,
“many doctors were not checking the progress of patients enough to notice improvement in their condition.”
Those are shockingly serious allegations. If they are true, urgent corrective action is needed.
There is another side to the equation, however. More than 20 respected organisations, including the Department of Health, Age UK, the Alzheimer’s Society, Macmillan Cancer Support, and the Royal Colleges of Physicians, General Practitioners and Nursing, have signed a declaration that
“Since the late 1990s, the Liverpool Care Pathway has been helping to spread elements of the hospice model of care into other healthcare settings”.
“Published misconceptions and often inaccurate information”—
referring, I think, to the stories in national newspapers I have quoted. Our task and the Minister’s is to reconcile the support of all those organisations for the Liverpool care pathway with the allegations made—in good faith, I am sure—by people who believe that the pathway is what they call a pathway to death.
Any tool is only as good as the workman who uses it. The declaration states clearly that the Liverpool care pathway
“Relies on staff being trained to have a thorough understanding of how to care for people who are in their last days or hours of life.”
We have to face the fact that, in most professions, there are instances of excellence and malpractice, and health care is no exception. It would be surprising if, when 130,000 people a year are dying on the Liverpool care pathway, there were no cases in which the pathway had been misapplied. That applies to every branch of medicine and, indeed, every occupation. There are good and less good doctors and nurses; there are well run and less well run hospitals; but to lay the blame at the door of the Liverpool care pathway is like tearing up “The Highway Code” because there are some bad drivers. Where there is bad practice and poor care, it should be rooted out and replaced with good care.
It seems to me that the review the Government recently launched provides an excellent opportunity to consider thoroughly all those issues. It is urgently needed. The review should call for any evidence of poor end-of-life care. We need the Minister to assure us this afternoon that the stories I have quoted will not simply be taken at face value, but will be investigated in detail, so that we can establish the scale of poor end-of-life care, and understand the causes and correct them.
I am listening carefully to the important points the hon. Gentleman is making. My constituents John and Mary Roche lost their mother five years ago. They came to see me because, having seen the media reports, they were concerned about her care toward the end of her life—she had been admitted to hospital and subsequently had her food and nutrition withdrawn. Does he think my constituents and others like them should be encouraged to share their stories, so that they can be taken into account in the Government’s review of the Liverpool care pathway and its appropriate use?
I thank the hon. Lady for making that point, because I most certainly do agree. I hope that, as a result of today’s debate, more people will come forward to put their experiences, especially of bad practice, in front of the Minister and the review.
We must not forget that it is necessary not to allow the shortcomings of some end-of-life care providers to undermine the outstanding work that the majority of doctors and nurses perform. It is easy to forget that, for those caring for people in the last days and hours of their life, alarmist stories cause real problems, misleading vulnerable people and their relatives into thinking that the unhappy experiences reported so prominently are typical of end-of-life care as a whole, making them reluctant to accept care that is genuinely beneficial, and generating fear of going into any sort of care setting. My sense is that the high profile given to these serious allegations, unaccompanied by supporting evidence, is analogous to shouting “Fire!” in a crowded theatre. We need to know that the Minister will consider all the allegations that are made, including those that have been reported, look at the evidence, and institute whatever changes are needed to ensure safety and thereby confidence in the integrity of the Liverpool care pathway.
I end with a general observation. I was appalled, as I am sure everyone in the Chamber was, by the recent revelations of poor care in a Worcestershire hospital, in Winterbourne View and in Stafford hospital. I was moved, as many of us will have been, by the observations made in the main Chamber before the Christmas recess by the right hon. Member for Cynon Valley (Ann Clwyd) regarding the inadequate and cruel care given to her late husband. We are reading about too many such cases. Considerable advances have been made in medical science, but we must ensure that, at the same time, we do not lose commitment in the NHS to basic care. I cannot help wondering whether the examples of poor end-of-life care that some relatives believe was given to their loved ones stem from the wider malaise of forgetting how to care for the sick, rather than from any specific clinical protocols such as the Liverpool care pathway.
Order. Several Members wish to speak. I want to call the first of the Front Benchers no later than 3.40 pm. A quick calculation suggests that, if Members keep their speeches to about seven minutes—and interventions are brief—I will be able to call everyone.
It is a pleasure to serve under your chairmanship, Mr Weir. I congratulate the hon. Member for Montgomeryshire (Glyn Davies) on securing this essential and timely debate.
As hon. Members and the Minister will know, opinions on this end-of-life care framework tend to be polarised, but I believe that fundamental questions need to be answered about how the Liverpool care pathway has fallen into such disrepute, when it was developed to help doctors and nurses provide quality end-of-life care for the dying. That involves palliative care options for patients in the final hours or days of life, not a procedure that some members of the public now regard as a way prematurely to kill off the terminally ill or senior citizens.
The hon. Member for Montgomeryshire has outlined the process in which the Liverpool care pathway should work, involving significant communication if possible with the patient, but certainly with their next of kin and family. I share his support for the framework when it operates properly and allows the dying to die with dignity and free of pain. Why are there so many stories in the press of distressed families complaining that they did not know that a relative had been put on the pathway? The huge problem lies in the human application of the rules, not necessarily in the rules themselves. One in three families of those dying say that they never received the leaflet explaining the LCP process that they should have been given. Why is it not mandatory to evidence in the notes discussions with the patient or the family about the Liverpool care pathway?
Some would say that the difference between a multidisciplinary team decision, taken with the family’s knowledge and consent, and a decision taken in isolation could be seen as murder or at least manslaughter. The stark reality of the Liverpool care pathway is that 57,000 patients a year are dying without being told that efforts to keep them alive have been stopped. In some respects, there are parallels with the cases of Mid Staffordshire NHS Foundation Trust and University Hospitals of Morecambe Bay NHS Foundation Trust, which were supposed to be operating the same system as that in every other NHS trust in the country and yet somehow ended up abjectly failing their patients, so that people died unnecessarily. The sheer scale of the failure to inform people, or their relatives, that they are on the pathway opens up the practice to attack.
People talk about back-door euthanasia and some say that it is tantamount to assisted death, except that in 57,000 cases people were not aware that they were being assisted. That has to be added to the cocktail of the timing and the context of where we are now. The NHS is saving £20 billion over four years. There are service pressures—the lack of available beds and severe cuts in social services budgets that result in bed blocking, together with the demands of an aging society—but, frighteningly, as we have become aware via the press, at the same time hospital trusts receive financial incentives for achieving certain performance targets in putting people on the Liverpool care pathway.
Let me be clear—not for one second am I suggesting that those factors are part of the decision-making process; I use them merely to highlight the fundamental problem of the pathway and the perception that exists in the wider public, especially among the elderly.
Why do hospital trusts require any financial incentive to follow the Liverpool care pathway? For me, that question goes to the very heart of our national health service and our absolute understanding of what the medical profession stands for in people’s eyes. We believe that it is the role of the NHS and medical professionals to take every conceivable step to preserve life until the options are exhausted. The Department of Health has proposed to enshrine in the NHS constitution, as a patient right, an entitlement to be informed of any consideration about placing a patient on the Liverpool care pathway. Why can that not be made a legal requirement, so that everybody knows—and we are sure that everybody knows—and can be assured that taking such a decision is right?
I add my congratulations to the hon. Member for Montgomeryshire (Glyn Davies) on securing this important debate. To go back to the hon. Lady’s point about the financial incentives for hospitals, it appals me, too. Surely, if patients or their families are not consulted, the Liverpool care pathway is not being followed, so any payment by the Department of Health to a hospital for having supposedly had someone supported by the pathway is money paid wrongfully, deceitfully and possibly unlawfully. Does she therefore agree that the Department should tell hospitals that have failed to consult family and friends or the patients themselves that the Department wants back some of that money?
That takes me back to my earlier point that we should document the conversations with families, so that that would be the tick box for payments. I am running out of time, so I shall move on quickly.
Will the Minister elucidate how the NHS constitution requirement will make a difference? Procedures are already in place, yet 50% of patients on the pathway were not informed, or their families were not consulted. It is time that the soundbite, “No decision about me without me” became a principle and a value, rather than the vacuous phrase that it currently is. There is no politics in that—it is really important; it is the core of everything.
Through Lord Alton of Liverpool, I am aware that Liverpool medical school requires all its students to undertake one month’s training in the care pathway, working in a hospice during their fourth year. Such good practice should surely be a core component nationwide, and in the light of a recent study, there is perhaps an argument for making it mandatory across the country. That kind of training needs to be given to those already qualified and working on our wards—not just doctors, but nurses and all members of the multidisciplinary team who are called on to make decisions. If there have to be financial incentives, they should follow the training to ensure that all those who care for the terminally ill and dying are properly equipped with the skills that they need, in what for all concerned are traumatic and often complex situations. Good training costs money and must be externally validated, and I invite the Minister to respond specifically about that need.
I see merits in a system that manages end-of-life care effectively—it is a measure of our humanity that we seek ways to ease suffering—but my concerns about the application of the Liverpool care pathway remain. There is far too little reassurance in the system, which has allowed the pathway to move from an end-of-life care system to one that is held up as hastening death. We can talk about the theory of how the LCP should be followed, but the fact remains that, in practice, it is not always implemented as intended. It should never be seen as a conveyor belt to the cemetery. Some 80,000 patients are supported by—not put on—the Liverpool care pathway, and many receive the finest care, but many is not good enough. It is said that about 1% of cases go badly wrong, but just one case—never mind 1% of cases—is one too many. Those who founded the pathway did so because of their respect for the dignity of patients; those who implement it need to understand and share that view or face the legal consequences and their own consciences.
When I first entered the House of Commons some 30 years ago, I became the founder secretary of the all-party hospice support group, and Jack Ashley was the founder chairman. I am glad to say that that group has now become the all-party parliamentary group on hospice and palliative care. During those 30 years, an enormous amount of work has been done on enhancing palliative care in hospitals. We are fortunate in this country in having an outstanding hospice movement. Part of the purpose of the Liverpool care pathway was to ensure that the good practice of palliative care, which had been developed in hospices, could be spread to other health care settings, such as hospitals and care homes. Extending it to people’s own homes was also important because if people are asked where they would like to die, most say at home. The reality for each one of us is that we will die.
The Liverpool care pathway requires staff to ensure that all decisions to continue or to stop treatment are taken in the best interests of each patient, and emphasises that patients should be involved in decisions about their care and that carers and families should always be included in the decision-making process. An evaluation in 2011 showed that in 94% of cases, there had been such involvement. The idea of documenting conversations, which the hon. Member for West Lancashire (Rosie Cooper) mentioned, is sensible. In our own professional lives, and, indeed, as Members of Parliament, we all know that people, especially family members, do not always take on board news that may be distressing. Often it is quite a shock to be told that a loved one is near to death. Very often, the instinctive reaction is to want to ensure that life can be preserved for as long as possible, but we also have a duty of care to ensure that in people’s last days and hours they die well and painlessly and with as much dignity as possible.
I was very struck by two contributions in the Library briefing. One was a brave article by a specialist registrar who herself is a terminally ill cancer patient. Of the Liverpool care pathway, she said:
“It prompts us to have open discussions with relatives, and, if possible, patients, to stop unnecessary medication, to discontinue futile medical interventions, and to shift our focus of care to symptom-control, comfort and dignity… Most patients on the LCP, in my experience, are too poorly to eat or drink, but where a patient is alert enough to swallow we certainly continue to offer them food and fluids in my hospital. They are not ‘starved to death’. The problem with intravenous fluids is that cannulae need to be inserted to administer them. This is painful, often very difficult and sometimes near impossible in patients who have been in hospital for a number of weeks.”
Although the hon. Gentleman makes a pertinent point, surely the issue must also be about those people who are not convinced about the system and who are suspicious and worried about what they have been told. There are people who have been denied fluids, and also drink and food. Does the hon. Gentleman think that there should be some protection in the system for such families so that they can feel assured that there is care? The point I am trying to make is that this should be about care and not killing, but many of us suspect that there is more emphasis on the killing than on the care.
Very few of us can have the confidence of Cardinal Basil Hume who, in his book “The Mystery of the Cross”, observed:
“Death is a formidable foe until we learn to make it a friend. Death is to be feared if we do not learn to welcome it. Death is the ultimate absurdity if we do not see it as fulfilment. Death haunts us when viewed as a journey into nothingness rather than a pilgrimage to a place where true happiness is found . . . Death is not the end of the road, but a gateway to a better place.”
Few of us, irrespective of our faith, have that clear courage and confidence, but we all recognise that we will die. There is nothing about 21st century medicine that is going to keep the hon. Gentleman or myself, or any of us, alive for ever. Death, and the process of death, can be extremely painful, and it is our collective duty and responsibility to try to ensure that people die as painlessly as possible and with as much dignity as possible.
I can assure the hon. Gentleman that people do not go into the medical profession to kill. My father became a doctor and my mother a nurse to ensure that they could give people the best quality of care. Although the press have published a number of stories about relatives who have expressed concern about how the local care pathway has been used, there is no systemic evidence to suggest that the policy is being abused. A consensus statement was published last year by several non-governmental organisations and charities, all of which are much respected in this House, supporting the Liverpool care pathway. They include Age UK, the Alzheimer’s Society, the British Heart Foundation, Help the Hospices, Macmillan Cancer Support, Marie Curie Cancer Care, the Royal College of General Practitioners, the Royal College of Nursing, the Multiple Sclerosis Society and the Royal College of Physicians.
No, I will not give way because others want to speak. This is an important issue, but we must ensure that we put it in perspective. If we are not careful, all the work that has been done over the past 30 years by a whole number of organisations, including those that I have just mentioned, to enhance and improve palliative care could be undone. Sadly, people die every day; that is the reality. It is not a failure of the NHS that people die. It is only a failure of the NHS if people do not die well. We need to ensure that all improvements, whether they be to records or to communication with patients and their families, are undertaken, but nothing should deter us from trying to ensure that everyone in this country gets the best possible end of life and the best possible palliative care.
I am pleased to serve under your chairmanship, Mr Weir. I congratulate the hon. Member for Montgomeryshire (Glyn Davies) on securing this debate on such an important issue.
I represent St Joseph’s hospice on Mare street in Hackney, which is a beacon of good practice in end-of-life care. Under the expert leadership of its chief executive, Michael Kerin, its medical director, Dr Anjali Mullick, and the Sisters of Charity, who founded it more than 100 years ago, the hospice ensures that people in their last stages of life receive care and die with the respect and dignity that they deserve, and that is what we are talking about today.
It is worth reiterating here what end-of-life care should offer. It is about treating someone who is dying as a person, and not as a number or a patient, and about looking at that individual’s needs in the round. It is not about giving a mechanistic response. As my hon. Friend the Member for West Lancashire (Rosie Cooper) said, surely once a clinical decision has been made about someone’s life chances, we, as a compassionate society, should try to ease suffering and support them to die well. The Liverpool care pathway, which is used only when someone is in the last hours or, in some circumstances, the last days of their life, aims to provide the tools to enable rest and care rather than making active interventions that would cause a person to die less well.
Those fine principles are great, although they may not always be adhered to fully. Good leadership and training of staff are vital, and that is one of the issues I want to address in the short time I have to speak.
We face an important challenge as a society as we consider the end-of-life care we aspire to. Most of us want a choice of where we die. If we had a free choice, most of us would choose to die at home, supported by organisations such as Marie Curie or hospices such as St Joseph’s, whose nurses go out and care for people in the community. Where individual practitioners are out and about and are not being overseen, that will create greater challenges in the future for regimes such as the Liverpool care pathway, but that is no reason to dismiss it or not to see it as an important way of helping and supporting people as they die.
That raises an important issue for us as a society. If we agree that dying well is important, we need to recognise that practical and policy issues need to be addressed. Patient and family choice about where to die works only if proper 24/7 care is provided, whether in the home, the hospice, the hospital or another setting, and we need to make sure that proper resources and support are available. Often, that is about training practitioners in general so that they know what best practice is. If we look to our inner humanity, we all know what we would want, leaving aside all the medical trappings, if we were dying: we would not want to be poked and prodded in the last hours of our lives; we would want to have a good, well-supported death.
Training and development are vital, and I welcome the work done by trainee doctors in Liverpool, which my hon. Friend mentioned. When the hospice movement started, it was rare for doctors to get proper training; indeed, I think they spent about a day on the bedside manner for dealing with a dying patient and speaking to their family. Things have moved on a lot since then, and it is vital that, in the debate about the Liverpool care pathway, we do not throw out the baby with the bathwater. The LCP has done good things, although improvements could probably be made at any point to any such approach. None the less, it is vital that we maintain the approach that dying well is important and should be available to all in every setting.
I congratulate my hon. Friend the Member for Montgomeryshire (Glyn Davies) not only on securing the debate but on the calm and measured way in which he introduced it—his was exactly the constructive tone in which we should discuss this concerning issue.
Last year, an 83-year-old widower was taken into hospital feeling very unwell. His eldest daughter visited him every day. No particular illness was diagnosed, but he was certainly weak and frail. After a few days, the daughter asked a nurse in the corridor, “How is he today?” Almost casually, the nurse said, “Oh, he’s not very well at all. He has not long to live. We are putting him on the Liverpool care pathway.” There was no discussion, no explanation, no consultation—just an announcement, a statement of fact, almost in passing. The daughter was shocked. As his eldest child, she thought, “Surely there should be more formality, more dignity, more of a clear process.” What gave her particular cause for concern was that her mother had become frail just two or so years earlier—admittedly after a brain tumour operation—and had been put on a regime of limited food and fluids. It had taken her weeks to pass away, which was agonising for her and heart-rending for the members of her family, as they waited and waited for their wife and mother to die. Again, there was no discussion or consultation with the daughter, although perhaps there was with the father. He was an elderly man in his 80s, and he was now lying in bed himself, about to be put on a similar regime.
After her mother died, the daughter felt a terrible guilt. Perhaps it had taken too long for her mother to die. Perhaps the daughter should have asked more questions. Perhaps she should not have let her mother suffer so much. With no medical background, however, she was left rather sad and confused. When the nurse announced that the hospital was putting her father on the Liverpool care pathway, the daughter, knowing a little more about it by this time, immediately contacted her sister, and the next day their father was moved to a nursing home. There, his needs were attended to in a positive and caring way. There, he did not die; in fact, he got better.
Now, well over six months later, that elderly man is very much alive. He is still being cared for. He is eating well, getting up when he wants to and resting when he does not want to get up. He enjoys visits from his family, although he does not enjoy it when his favourite football team loses in the last minute or so of a match, as happened last Saturday. He is listening to tapes of Sadler’s Wells opera company singing Gilbert and Sullivan, and he is joining in with “Songs of Praise”. He is having intelligent and considered discussions about his finances and looking forward to his 85th birthday. It is not a fantastic quality of life, but it is a life, and as he told his doctor in the nursing home, “I want to live.”
Minister, Mr Weir, concerned Members, I know all that is true, because the lady who passed away so distressingly was my mother, and the elderly man I have described is my father. I, their daughter, witnessed all those events first hand. In one sense, I am not sure I need to say much else to support the points that have been made, but the application of the LCP needs to be looked into.
My hon. Friend is making a powerful case, and it is obviously painful for her. Does she agree that there is a distinction between accepting the notion that a life must end and accepting that there is an inevitable time frame in which that life must end? We must not make premature assumptions about that period, so it is critical that there is a clear understanding of what the Liverpool pathway means and how it can affect the timings of an event we do not know the actual trajectory of.
I thank my hon. Friend for that intelligent comment, and I will talk further about that.
I want to speak now as a vice-chair of the all-party group on dying well and the all-party pro-life group. Despite my personal experiences, I believe the main intent of the Liverpool care pathway is compassionate and good. It is fundamentally aimed at what is increasingly called a good death. When correctly administered, the principles behind it are those of good palliative care, and they are fully in accordance with the view, which I hold, that all life is God-given and should be allowed to run its course, without death being hastened through unnatural intervention.
I congratulate the hon. Lady on the passionate way in which she has dealt with this issue. Does she agree that it is important that those who work in the Liverpool pathway are highly skilled? If such care is left in the hands of those who are less skilled, there is a possibility that what could be termed voluntary euthanasia will take place. Does she agree that only highly skilled people should be involved in the Liverpool care pathway?
I do, and this is where training is so important. Without the proper application of the Liverpool care pathway, death can be hastened, and that is not the intent of the pathway. Occasionally, even with correct application, it can be the unintended consequence—for example, through the use of narcotics to alleviate severe discomfort and facilitate a more peaceful passing.
I wholeheartedly welcome the Minister’s decision to hold an independent public inquiry into the LCP. I have met him, and I thank him for his open-minded, calm and reasoned approach and for the fact that he has had ears to hear concerns about the LCP. Without wishing to prejudge the terms of the inquiry, may I make the following suggestions for it to consider?
First, a number of pressures might subvert the proper implementation of the LCP, and I am grateful to Professor David Albert Jones of Oxford, who is an authority on this topic, for highlighting them. He says they are:
“the subjective character of judgments about how soon someone is going to die…the fact that the LCP may be initiated by people who are not senior clinicians familiar with the individual patient’s case and have not consulted with palliative care physicians… the influence of managerial pressures to reduce bed occupancy …reluctance to face the difficulties of continuing care of certain difficult patients…the euthanasiast outlook of some clinicians…the possibility of doctors or nurses regarding the LCP as a set of ‘tick boxes’…rather than assessing the needs of the patient…Other NHS organizational/staffing procedures or constraints”.
“Research shows that care of the dying is poorest in the hospital setting”
in contrast to care in hospices, which I believe we all admire.
I also urge that the inquiry consider the following measures: that no patient should be placed on the LCP unless they are imminently, irreversibly and inevitably dying, which I understand to mean perhaps within 36 hours; no one should be placed on the LCP without its being discussed with a designated relative or carer; every patient placed on the LCP must be continuously monitored and reviewed by a multi-disciplinary team; documentation must be simplified and standardised, so that those implementing the LCP can easily follow the guidelines; training and supervision should be mandatory, as well as standardised and improved; non-clinical priorities in the use of the pathway must be eradicated and every patient must be treated solely according to their needs; payment for such care must be reconsidered; and the communication to relatives should be substantially improved.
I believe that, if it is well used, the LCP can improve standards of end-of-life care, especially in hospitals. It should promote better palliative care and support the kind of good death that we would all wish for ourselves and our loved ones. I sincerely hope that the independent inquiry will be a major step in facilitating that.
I also congratulate the hon. Member for Montgomeryshire (Glyn Davies) on introducing this important debate in such a measured and sympathetic way. It was effective indeed.
I do not like the term “Liverpool care pathway”; I prefer talking about guidelines for palliative care. That is probably a less contentious way of discussing it. The Liverpool care pathway was developed in Broadgreen, and I was born in Broadgreen. More importantly, my grandmother died there, having been readmitted several times. The last time she was admitted she had declined somewhat at home and I can remember the expression of horror on her face indicating that that was not the right way to treat her. She knew that she was going to die and she wanted to die at home, and she was being admitted unnecessarily to hospital. I regret that we arranged for that to happen. It is very important to get the last years, months and weeks of people’s lives correct and we certainly did not; hence there is a need for things such as the Liverpool care pathway and a more understanding, measured and sensible approach to affairs.
There is a need for the hospice movement, but the reality is that most people do not die in hospices; they die in the NHS and there is a need for the NHS to have some clinical guidelines to follow. That is particularly the case for those in their last hours, day, weeks and months, whose death is imminent and who cannot have that death prevented or, realistically, postponed. That is quite a high threshold to be met, and finance should in no way come into meeting that threshold. When finance does come into it, it can only corrupt the process. The Liverpool care pathway guidelines imply constant review and no one wants that coloured by financial incentives. After all, there is always the remote possibility of people getting the diagnosis wrong.
That is not a case against having guidelines at all or against thinking that we sometimes need to opt for a palliative choice rather than a remedial one, if there is no realistic remedial choice available. If that choice has to be made, there is no in-principle case for involving relatives and the patient in it, with the important caveat that what is done should be in the patient’s interest. I am not always sure there is an obligation to clarify the situation for the patient or their relatives, if they prefer to die in hope or expectation of recovery and find the thought of their inevitable demise insupportable, particularly if it will not change clinical behaviour and the only option is palliative care for that person. That is a difficult issue, which every clinician needs to face and be guided on in facing it.
There is certainly a need to inform the patient and/or relatives if expectations about care are starting to differ, or if the nature of the palliative care offered is unclear. That might be the case if a patient is wrongly categorised, or if there is a debate about the palliative care itself, and it is seen as substandard. Some of the episodes of dehydration that have been described in the national newspapers have seemed to me to be substandard palliative care. The bottom line is that palliative care should not worsen the condition or augment the suffering of somebody who inevitably will die, unless the patient chooses it. In certain circumstances, I can imagine somebody trading pain for more life.
Care can be worsened in two quite different ways: it can be worsened by disruptive, painful, pointless, futile interventions, and it can equally be worsened by neglect, and indifference to people’s symptoms and the manner of their decline. My aunt recently died in the Royal Liverpool, which has taken over Broadgreen. I remember going to her bedside and seeing the signs that said, “Nil by mouth”, and wondering whether we should offer her a drink while we sat there and talked. We never managed to get round to having a sensible conversation about that with the medical staff. I was never sure what I was confronted with. It might have been wise care; there may have been a genuine risk of choking, which I believe is one of the reasons why people are not given liquids at that stage. It might just have been neglect or absence of thought. What did not happen—and should have—was a discussion about treatment: a sort of negotiation.
If palliative care is the path chosen—it should only be chosen when it is, in a sense, the only path—there needs to be a negotiation. It is the trick of getting that negotiation right that is the difficult thing. We need to respect the rights of all people concerned, and the patient’s rights sometimes differ slightly from the family’s rights. The family fearing bereavement can only wish the patient to live at all costs. That may not always be the patient’s aspiration in that circumstance. The hon. Member for Montgomeryshire has started us along the path of having a measured discussion and review of these matters and I hope it continues.
I respect what my hon. Friend says on communication with the patient, but I would like to clarify something. A survey by the Marie Curie Palliative Care Institute Liverpool and the Royal College of Physicians said that half of those on the LCP are never told that they are on such a pathway. Also, the LCP is not just a framework of good practice but a pathway, taking the patient towards the presumed outcome of death. Surely, therefore, it is important to make it clear that there should be communication with the patient; it should not be only the best half who know.
That in part is the dilemma. I know that the saying is “No treatment about me, without me”, but there are certain circumstances that we will all be aware of where the patient is dying and the clinician is in an acute moral dilemma over whether to inform them that that is the case—that there is no hope and that they will be given purely palliative treatment. I am fairly confident that a good number of people will die in our hospitals for years to come, despite the Liverpool care pathway or any other guidelines that we put in place, who will, until the moment of their decease, expect recovery.
I am glad to have this opportunity and I thank my hon. Friend the Member for Montgomeryshire (Glyn Davies) for raising this important subject. We all know that the Liverpool care pathway was devised with the best of intentions. I assure my hon. Friend the Member for Banbury (Sir Tony Baldry) that none of us wants to end or take away palliative care. We all want to relieve pain and we all want people to die with dignity, but there are serious concerns about the Liverpool care pathway and that is why this debate is so important. Those concerns have been expressed by physicians. It was physicians—ethicists—who started this debate, not the newspapers. The newspapers did not start the ball rolling and we should be aware of that. Professor Peter Millard, emeritus professor of geriatrics at the university of London, and Dr Peter Hargreaves, palliative care consultant at St Luke’s cancer centre in Guildford, have warned of the risk of “backdoor euthanasia”—their words—and that economic factors are being included when treatment is considered. We must be aware of these concerns, which were originally expressed by clinicians. However, I believe that it is one of the chief duties of those of us in this House who are not clinicians to speak up in defence of the vulnerable, the voiceless and those who are sometimes forgotten.
It is simply unacceptable that vulnerable people, including the poor, the elderly and those who do not have close friends and family to look after them, come to a premature death—an unnecessarily early death. As my hon. Friend the Member for Congleton (Fiona Bruce) and others have said, in numerous cases, even friends and family caring for a loved one have not been informed that they have been put on the LCP. May I say that my hon. Friend’s speech was a wonderful speech? It drew on her personal experience and was one of the most moving speeches that I have heard in this place over many years.
I sat with my best friend, Piers Merchant, as he was dying; he was a former MP and my hon. Friend the Member for Banbury (Sir Tony Baldry) will remember him well. I saw the morphine being pumped through his body. I am sure that he died early—perhaps a few hours or even a few days early, I do not know—from the morphine. Those of us who loved him wanted him to be cared for properly, but we also did not want him, or any of our loved ones, to be put on an irreversible path to death where that was avoidable.
I welcome the statement by the Department of Health that it
“has consistently made clear that care provision, including for people at the end of life, should be based on need.”
But the question that we need to ask in this debate is this: how are the Department’s intentions implemented on the front line of medicine and hospital care? No doubt there is wonderful care being given in many hospices, but is that gold standard being replicated in all our hospitals?
It is undoubtedly true that the LCP has led to the premature death—it may not be premature by much, but it is still a premature death—of as many as 130,000 hospital patients each year. This is a vital issue that we must address in this House; with 450,000 hospital deaths in Britain each year, that figure of 130,000 is about 29% of the total number of hospital deaths. In fact, this is a frightfully serious issue.
Does the hon. Gentleman mind if I do not give way? I just want to make my speech and give my hon. Friend the Member for Plymouth, Sutton and Devonport (Oliver Colvile) a chance to speak too.
Professor Pullicino, who was quoted earlier, has himself personally intervened to have a patient taken off the LCP who went on to be successfully treated. So, despite the fact that we must listen to clinicians, it is simply impossible to determine satisfactorily that a patient has hours or days left to live, which is one of the worrying flaws of the LCP.
In November, an independent inquiry into the LCP was announced, and I welcome that announcement. My hon. Friend the Minister is doing his job extremely well in this regard, and we respect him as somebody who will genuinely try to get to the truth. He himself has said that there have been too many cases of patients dying on the pathway while their families were not informed, so he is quite right to zero in on that issue. He has said, “This is simply unacceptable.” I echo those words and I hope that he will repeat them when he winds up the debate.
Of course there are people who speak on both sides of this issue, but I believe that any inquiry must be conducted by a suitable variety of individuals and not just by supporters of the LCP. It is not good enough to state, as the Department of Health sometimes does, that the LCP is not euthanasia. It might not be euthanasia and, of course, if it is implemented properly it is not euthanasia. However, it has become obvious to many people that the LCP can be employed, and indeed has been employed, in cases that are highly questionable.
I say to those who have spoken today that what worries me is this: why is it that the average time to death on the LCP is 33 hours? An identical figure for average time to death was found in two consecutive national audits that were conducted two years apart. In the view of many people, that shows that the LCP has a machine-like efficiency in producing death within 33 hours, and that is why some people say that the LCP is in effect a “lethal care pathway”. Statistics suggest that fewer than 5% of patients put on the LCP are taken off it. Why only 5%? There is something wrong here, and the inquiry needs to get to the bottom of it.
I believe that we should appoint a member of the judiciary rather than a medical expert, to carry out the inquiry. Of course, they will have medical advisers, but we should appoint a member of the judiciary rather than just a medical expert to lead the inquiry, so that they can look at this complicated issue with a fresh perspective and a judicial mind.
Thank you for calling me to speak, Mr Weir. In conclusion, I believe that we have a duty to instil confidence in each of the citizens and residents of this country that they live in a society that believes in their inviolable dignity as human beings, and that takes the necessary steps to ensure that they are cared for and looked after when they are ill, especially in the closing moments of their life.
Thank you very much indeed, Mr Weir, for calling me to speak. It is a pleasure to serve under you.
I congratulate my hon. Friend the Member for Montgomeryshire (Glyn Davies) on securing this important debate. I suspect that I am not particularly well qualified to speak about the Liverpool care pathway, but neither are an awful lot of my constituents. Therefore, it is very important that what we talk about today is how we can look after their interests, and the interests of others, in this regard.
I am very aware of what kind of death I want to end up having. Some six years ago, my father died while driving his car. He came out of his office, at the age of 89, to go and have lunch with the Archdeacon of Canterbury. My father had a massive heart attack, pulled over to the side of the road—thank goodness he did not take anyone with him—and duly died. It was just yards away from the church and I know very well that God decided, probably in his infinite wisdom, that the one thing that he was not going to do was allow my father, a former naval commander, to give the archdeacon a difficult time. However, I am very aware that—frankly—an awful lot of us do not have that kind of option about how we end up dying, if we have an option at all. Many people find themselves having to go into hospital, and dying there.
Many of us have a great deal of notice about dying. So, in the next few minutes, I want to talk about an individual constituency case that I had—an appalling story about the death of the father of one of my constituents in the Derriford hospital in Plymouth. In doing so, I want to ensure that the public are aware of the controversial approach to ending life and that we have a discussion about it.
My constituent’s father went to Derriford hospital from Mount Gould hospital, which is also in Plymouth, in April 2011 because he had become bedridden. He was put on the Liverpool care pathway without any food and water. That was supposed to last for up to two days, but he lived for 12 more days, finally dying on 8 May 2011. My constituent claims that during the time that her father was on the LCP, he perked up and was even watching television. Despite that, he remained on the LCP.
My constituent’s family feel, and I rather agree with them, that giving someone 12 days to die is not what this system should be about. Although Derriford hospital claims that staff spoke to the family on the ward, my constituent and her siblings dispute that. They claim that they did not know that their father was on the LCP until the car park attendant told them.
To give Derriford hospital its due, the chief executive—who is new to the job and was not at the hospital when this case happened—has dealt with the case subsequently, recognising that the clinical teams may not have explained fully to my constituent’s family what was going to happen and what was actually involved in the LCP. The family feel that they were forced to watch their father die under very distressing circumstances. Despite having his food, water and medication withdrawn, the family were horrified to see him biting the sponge that was being used to wipe his lips, because he was so hungry and thirsty.
Unfortunately, my constituent has also had a subsequent —and completely different—experience of the LCP when her brother-in-law died at a hospice. It must be remembered that hospice staff are specialists in helping patients at the end of their lives, and the more that we can encourage people who are suffering in that situation to be dealt with by hospices, the better. Certainly a lot of hospitals are very busy indeed and their staff do not necessarily have the time to carry out the kind of checking that we feel they should do.
I am very aware that the death of a close relative is a traumatic time. One should remember that patients’ relatives do not always take in the full story that they are being told and that they can become confused about what they are being told. However, we must ensure that a system is in place that avoids those kind of complications.
I am very aware that the Government are taking this whole matter very seriously and I am grateful to them for that. I thank my hon. Friend the Minister and his colleagues for the review, about which he wrote to me just today, and their proposal to produce a new pledge on care planning. To help my constituent, and many other people like her, we need to ensure that we have a timetable for that.
I pay tribute to bereavement charities, such as Cruse Bereavement Care. They do an enormously good job in helping families through the whole grieving process. I ask for more training, and for more information for families so that they can be assured that their relatives will get the best care possible. By giving detail to the Government’s proposals, the Minister would be giving certainty to Benjamin Franklin. Members might remember that he wrote, in a letter to Jean-Baptiste Le Roy in 1789, that the only things we can be certain of are birth, death and taxes.
It is a pleasure to serve under your chairmanship, Mr Weir. I congratulate the hon. Member for Montgomeryshire (Glyn Davies) on securing this extremely important debate and on his heartfelt but calm and thoughtful opening speech, which set exactly the right tone. How we care for the dying is a measure of how we care for all sick and vulnerable people. It is a litmus test not only for the NHS and the wider care system but for society as whole.
This debate comes at an important time because, as the hon. Gentleman said, in recent months growing media attention has been paid to the Liverpool care pathway. Several Members have talked about the misconceptions and the inaccurate information that has been published about it. I have read the recent consensus statement from 22 patient and professional organisations and also the full care pathway documentation, and it is clear to me that the Liverpool care pathway is not in any way about ending someone’s life but about supporting the delivery of excellent end-of-life care.
The pathway does not seek to replace clinical judgment; it is not a treatment but a framework for good practice. It does not seek to hasten or indeed delay death, but to ensure that the right type of care is available for people in the last days or hours of life, when all the reversible possibilities for their condition have been considered. I do not believe that it is a deadly or lethal one-way street. Precisely because it is not always easy to tell whether someone is very close to death, the pathway emphasises the need for constant and regular review, and if a patient’s prognosis changes, their care needs should be reassessed and, if appropriate, the use of the pathway stopped.
The pathway does not preclude the use of clinically assisted nutrition or hydration; in fact, it explicitly states that patients will be supported to eat and drink for as long as possible. It absolutely emphasises that wherever possible patients must be involved in decisions about their care, and that carers and families should always be included in decision making. Such involvement of patients and families is enshrined at the very heart of the Liverpool care pathway.
I absolutely agree. The issue we face is less about the pathway itself and absolutely about how it is implemented in practice. The pathway document states on its very first page that the pathway is only as good as the teams who use it.
There has clearly been an issue about taking a pathway that was developed by experts in one part of the country over several years, with regular training and audit, and trying to implement it across the wider NHS. Individual patients and families—as we have heard—and also the national audit of the Liverpool care pathway, suggest that there are genuine problems with communication. Too many patients and families are not properly informed about what the pathway is and how it works, and they are not effectively involved and their consent not sought at every stage and on all the necessary decisions. One incident in which patients and families are not fully and sensitively involved is one too many. It is not acceptable, and it directly contradicts the very essence of the Liverpool care pathway and its key principles and values.
If my hon. Friend does not mind, I will not give way as I do not have much time.
I welcome the fact that the issues are now being looked into. I understand that three separate reviews are being undertaken. The national end-of-life care programme is doing a short, snapshot review of complaints about the use of the Liverpool care pathway, the Dying Matters coalition is working with families whose loved ones have been on the pathway, to see what worked well and what did not, and the Association for Palliative Medicine and a range of other national organisations are talking to clinicians, to get their opinions regarding integrated care pathways in the last days of life, of which the Liverpool care pathway is one.
In November, the Minister said he would appoint an independent chair to co-ordinate the work of the different reviews, so I ask him: has a chair now been appointed? Will the chair, the Department of Health or any other organisations consider any additional issues, alongside the work that is under way? For example, will the way in which the Liverpool care pathway is paid for be reviewed? It is important that hospitals receive proper payment for the care they give and for any associated training, but any evidence that patients are being put on a pathway for financial reasons is a serious matter and is totally unacceptable.
Will there also be a review of the education and training in end-of-life care for new and existing staff, in particular training in how to discuss difficult, complex and emotional issues with patients and their families? One of the real challenges is that the process of death and dying is so uncertain. A patient’s prognosis is not always clear; the situation changes. Doctors are used to treating and curing, giving clear evidence, treatment and advice—or they are trained to do so—but it is not always possible.
I want to finish on a broader point, which is important for us in this House. The difficulty that NHS and care staff, the media, families and the public have in discussing end-of-life care reflects wider society’s lack of familiarity with death and dying, which was not the case 100 years ago. Age, cause and place of death are generally very different now from what they were at the beginning of the last century, when a far greater proportion of deaths occurred in childhood or early adult life, often from acute infections, with most people dying at home. Now, more than two thirds of the 500,000 deaths a year are among people aged over 75, most of them following a long-term illness such as heart disease, cancer, stroke, chronic respiratory disease or dementia, and most are in hospitals and care homes.
Many people do not, therefore, experience the death of a loved one until they are well into mid-life. We do not see dying people and dead bodies—not for real. We see them on television and in computer games but not in real life, and we do not talk openly in society about death. I know that in all our families it is difficult to discuss death, but in the century of the ageing society, with chronic conditions as the major cause of death and disease, that must change.
As the hon. Member for Banbury (Sir Tony Baldry) said, death comes to us all, and we should strive for as good a death as possible. That will, of course, mean different things to different people—I would like to go quickly, and I hope that the people I love go quickly, too, and do not have a long, slow death.
Indeed, or have a premature death. For many of us, a good death means being treated as an individual with dignity and respect, without pain and suffering wherever possible, and in a familiar environment surrounded by the people we love. We need a full and frank debate about these difficult issues, handled calmly and sensitively and based on evidence and fact rather than on myths and misconceptions. Dying matters, not just to the NHS and the wider care system but to us all, and for that reason I am grateful to the hon. Member for Montgomeryshire for securing the debate.
I do not have a Parliamentary Private Secretary sitting behind me, and I am most grateful therefore to you, Mr Weir, for your assistance with some Members’ constituencies.
I congratulate the hon. Member for Montgomeryshire (Glyn Davies) on securing the debate, and on the sober, serious and rational tone he deployed in his contribution. The whole debate, in fact, has been exemplary in that regard. I suspect that all of us in this room are after the same thing; it is how we secure it that matters so much. I have just over 11 minutes, which is not really enough to do justice to every contribution, so as soon as I possibly can, I will write to all the Members who have taken part, to update them.
I take the Liverpool care pathway extremely seriously. It has been much discussed recently: many hon. Members and members of the public have written to the Department of Health expressing their concerns, and there have been numerous parliamentary questions, too, all of which stems from a lot of media interest over the past few months. Several stories have appeared discussing the ways in which the LCP is used and what it is for. In particular, there have been a number of reports in the media alleging that patients are being placed on the LCP secretly, with no consultation with them or their relatives. It has been suggested that the LCP routinely involves medical staff withdrawing treatment, including food and fluids, from patients. Perhaps most seriously, the LCP has been accused of being a way to kill patients to save the NHS money. There have been suggestions that the Department of Health bribes hospitals with extra money for every patient placed on the pathway.
Those accusations paint a misleading picture of the purpose of the Liverpool care pathway, yet I take seriously the concerns raised by the families of patients who have experienced extremely poor end-of-life care. I am horrified by some of the stories that people have told me about the withdrawal of food and fluids from sick relatives in hospital and about the failure to inform loved ones that the patient has been placed on the pathway.
The hon. Member for Congleton (Fiona Bruce) spoke movingly of her experience, and I am pleased that she came to the round table that I held to discuss those concerns. As the hon. Member for Gainsborough (Mr Leigh) made clear, the concerns are legitimate and should be taken seriously, not dismissed because of exaggerated reporting. What happens on the front line and how we translate theory into practice are so important.
I agree with my hon. Friend the Member for Southport (John Pugh). I dislike the jargon: what on earth does “Liverpool care pathway” mean to patients and their families? We must use language that ordinary people understand, particularly at a most traumatic time for all involved. That is one thing we need to address.
One aspect of care that receives almost universal praise, as the hon. Members for Banbury (Sir Tony Baldry) and for Hackney South and Shoreditch (Meg Hillier) have made clear, is the hospice movement, which grew from Dame Cicely Saunders’s belief that, however ill, people matter at the end of their life and should never be abandoned. That is why the Marie Curie Palliative Care Institute Liverpool, led by Professor John Ellershaw, developed the Liverpool care pathway in the late 1990s. The pathway was designed to transfer the principles of hospice care—the shadow Minister, the hon. Member for Leicester West (Liz Kendall), made this point—so that terminally ill patients always get the best treatment, even if they do not receive specialist palliative care.
The Liverpool care pathway is not a treatment but a framework for managing treatments, which is important to understand. As the hon. Member for Montgomeryshire made clear, the LCP, when used correctly, is one way to ensure that the last hours or days of a patient’s life are as comfortable as possible. The guidance for using the LCP makes it clear that the aim is to support, not replace, clinical judgment. Sometimes there are questions about clinical judgment, but not about the pathway itself.
The Liverpool care pathway guidance sets out the following objectives and considerations for taking care of patients: determining whether any further medications and tests would be helpful; ensuring that the patient is as comfortable as possible—surely we all agree with that; helping the patient to take on food and drink for as long as possible, which means not denying them food and drink, as we sometimes hear; and taking care of the patient’s spiritual and religious needs, which is of acute importance to many people. The guidance reminds clinicians that unnecessary treatment or tests may cause harm rather than good.
The guidance states that regular review is acutely important. If their condition improves, the patient should be taken off the pathway. The 5% figure to which the hon. Member for Gainsborough referred is of concern and should be considered; it is essential that the medical team discusses the pathway with the patient, their family or their carers. Those people need to be fully involved in decisions about end-of-life care, even though those discussions may be very difficult. Obviously, those conversations need to happen as quickly as possible.
The Liverpool care pathway can work as intended only if each patient is fully consulted, unless that is not possible. Even then, the family must be fully involved. Through his interventions, the hon. Member for Stoke-on-Trent South (Robert Flello) made that point strongly. The opening section of the information sheet that comes with the pathway cites the absolute importance of discussion with the family. Staff must talk to the patient and their family as much as they need and want, to explain what is happening and why. That is non-negotiable. Any failure to do so is completely unacceptable.
The hon. Member for West Lancashire (Rosie Cooper) mentioned documentation, which is best practice and should always happen so that everyone can see what has been discussed. She also mentioned the constitution, and we are considering how we can give it greater traction. There is a sense that everyone agrees with the constitution, but what value is it? How can we make the constitution provide real power to patients in the NHS?
I agree with the shadow Minister’s concerns about translating across the whole system something that has been designed by experts. Such translation can be problematic and needs further attention.
I am conscious that time is tight. I will write to the hon. Lady. If she wants to raise issues with me later, I will be happy to address them, but I need to respond to the debate.
From what people have said, it is clear that there are too many cases where patients have been put on the pathway without proper explanation, without the involvement of their family and sometimes without any notification, which is totally unacceptable. Yet again, we see how right Dame Cicely Saunders was when she said:
“How people die remains in the memory of those who live on”.
The impact is profound. My wife works for Cruse Bereavement Care, which does magnificent work helping people who have suffered bereavement. We have a duty to give such people the best possible experience as they lose a loved one.
On 26 November, I hosted a round-table meeting with patients, families and professionals—both supporters and critics of the pathway were represented—and at that meeting I announced that we will appoint an independent chair to consider how the LCP is used and experienced and to examine the accusations made in the press. We expect to announce the chair of that review very soon, and we expect that the chair will want to identify a small panel of independent experts from a range of backgrounds, including representatives from faith groups, which is important. I reassure hon. Members that the review will be independent.
The Liverpool care pathway is internationally recognised as good practice, and it is widely supported by organisations involved in end-of-life care. If people do not feel that they have received the best care or, worse, if patients cease to trust the pathway, that is a problem that needs to be addressed.
Training is fundamental, as the hon. Members for Hackney South and Shoreditch and for Congleton and the shadow Minister said, and it will be considered as part of the review. The review will systematically examine the experience of the Liverpool care pathway by patients, families and health professionals, and it will seek evidence to support or refute the accusations and to see where improvements might be needed. The review will hear directly from families. There will be a session dedicated to families so that they can tell the panel about their experiences.
The review will also consider the role of financial incentives in the use of the LCP. Like my hon. Friend the Member for Southport, the hon. Member for West Lancashire and others, I have concerns about the use of financial incentives. The review will report both to the Department of Health and to the NHS Commissioning Board by the summer.
Everyone wants their loved ones’ final hours to be as pain-free and dignified as possible. Used as intended, the Liverpool care pathway can help achieve that. The pathway prioritises comfort, dignity and appropriate care, but all that is undermined if the public distrust the pathway and if clinicians do not apply it properly. We do not dismiss people’s concerns, which I take extremely seriously. Instead, we have to ensure that care in the last few days and hours of life is always of the highest standard. Reinforcing the absolute importance of involving patients and their families in discussions on their care and treatment is essential.
Education Funding (Cambridgeshire)
It is a pleasure to serve under your chairmanship, Mr Weir. I am delighted to have secured this debate on an issue affecting every pupil in Cambridgeshire.
Educating our young people to the highest possible standard is vital for a fair and stable society. Every child should be given an equal and fair opportunity and educated to the best of their ability, no matter what their skills. Education should be the priority. Whatever financial situation that we find ourselves in, we must never bankrupt our children’s future. They get only one shot.
The pupil premium was on the front page of the Liberal Democrat manifesto, and we are now delivering it in government. In Cambridgeshire, our schools are getting £1.8 million to help 2,100 children from poorer backgrounds get a good start in school, with critical flexibility for heads to work out how best to spend it for their pupils. Every child deserves a fair start in life. However, Cambridgeshire has a systematic problem with basic funding for pupils.
Ever since the Tory county council under Baroness Blatch cut funding for schools in the 1980s, Cambridgeshire schools have been consistently under-resourced. Her cuts have been perpetuated, as central funding for schools has been based on previous years’ funding, with no opportunity to close the gaps that have grown. The Tory cuts have been perpetuated by the Labour Government and this Government so far. Children now are paying for poor decisions made in the ’80s.
Pupils in Cambridgeshire get far less funding than pupils almost anywhere else in the country. In 2009-10, Cambridgeshire got £34 million less funding than the English average, and that trend has continued. For the financial year 2012-13, the dedicated schools grant placed Cambridgeshire 143rd in funding out of 151 local authorities. That funding covers nursery provision, mainstream schools, special schools and all high-needs pupils.
The Government’s new approach makes the problem even more obvious. Basic school funding is, reasonably and sensibly, being separated out from early years and high-needs funding, so that people can see what is happening. The schools element of the funding for 2013-14 gives Cambridgeshire the least of any of the 151 local authorities, at £3,950 per pupil per year. The English average is £4,550.
What possible reason can the Government give for why pupils in Cambridgeshire deserve 13% less funding than the rest of the country? Other than historical accident—I hope that the Minister agrees that it is wholly wrong to punish kids now for political decisions made in the ’80s—why do pupils in Surrey, Buckinghamshire, Essex, Bedfordshire, Hertfordshire and Peterborough deserve more cash?
Of course schools serving more challenging communities should receive more funding, but that is supposed to be addressed, at least in part, by the pupil premium, and Cambridgeshire has challenging communities. Educational attainment in the north of Cambridge and the north of the county, in the fenland area, is significantly lower than it ought to be. I can see why people in expensive areas could argue for more funding—teachers must be paid enough to be able to afford to live near their schools—but Cambridge is a very expensive area. The Cambridgeshire Schools Forum has been campaigning for a number of years to narrow the funding gap between the higher and lower-funded local authorities. I have been delighted to support it over many years, both when I served on Cambridgeshire county council and now as MP for Cambridge.
Two years ago, on 7 February 2011, I raised the issue in education questions:
“Cambridgeshire gets less school funding per pupil than almost anywhere in the country. If we received the per pupil average across England, we would have some £34 million more for education. Can the Secretary of State explain why pupils in Cambridgeshire deserve so much less money, and will he review that?”
The Secretary of State for Education replied:
“They deserve to be treated like every other student. We are reviewing funding and will be publishing a paper in the spring to try to ensure greater equity in the allocation of schools funding.”—[Official Report, 7 February 2011; Vol. 523, c. 19.]
I agree with everything that he said. Pupils in Cambridgeshire deserve to be treated like every other student. That is all we ask.
The Cambridgeshire Schools Forum and I, and many others, were delighted by the promise of greater equity in the allocation of schools funding. We know that it takes time, and we know that we may not end up exactly at the English average, but a commitment to greater equity was what we wanted.
Instead, the gap has widened. We receive £600 less per pupil than the English average for schools block funding, and with 73,800 pupils, according to the Department for Education’s figures, so we are now short by £44.3 million across the county, compared with the English average. For an average two-form entry primary school, that is a difference of £250,000 a year in funding—enough for seven teachers on average pay. Alternatively, the money could be spent on more teaching assistants, better teaching materials, more activities or better school buildings; there are so many options. Yes, the national budget is limited, but Cambridgeshire kids deserve what everyone else gets.
We had hoped that the national funding reforms might start to address those inequalities. However, it now appears that the earliest any such change might be possible is 2015-16. That is having a real effect on children’s lives. Philip Hodgson is chair of the Cambridgeshire Schools Forum, and I served with him as a governor. He says that
“standards in Cambridgeshire are slipping in some areas or not improving at the same rate as better-funded local authorities. Cambridgeshire schoolchildren will suffer from the underfunding for even longer unless action is taken now to begin the introduction of fair funding”.
The gap in Cambridgeshire is widening because there is not enough resource to close it.
I have been in contact with my local head teachers to ask them about their individual situations. They are positive about the pupil premium. Many heads have said that it allows them to do things they had never been able to do before. At Chesterton community college, for example, the principal, Mark Patterson, has been able to fund specialist reading teachers to deal with the handful of pupils who reach secondary school every year unable to read at an appropriate level. Rather than having them continue to fall behind, he can give them the right support to keep up, which is fantastic. However, all the heads are concerned about the tightness of the funding that they in Cambridgeshire face.
Chris Beddow of Abbey Meadows says:
“As a school serving a challenging demographic area, we receive a considerable amount of extra funding. However, when compared to a school of similar size in Peterborough, we receive £80,000 less, due to funding differentials between authorities. How is this justifiable as our costs are the same? Cambridge is growing and as a school we are building extra capacity and growing. This year will see our numbers grow by 10%; however, our funding will only grow by 6%. Again, I fail to see how this gap is justifiable.”
To give another example, I recently heard from Steve Jordan, the head teacher of St Paul’s primary school in my constituency. The school, which is small, has been working on an extremely tight budget. Although it has been just about able to stay in the black, it has had to keep eroding its reserves to do so. It has a capital budget of about £7,000 a year. The school’s management cannot maintain the standard of the school site as they wish. The school field needs replacing. It is becoming a health and safety hazard, with rubble beneath the soil gradually working through, and drainage is being affected by tree roots in the pipe work, which the school cannot afford to repair. It is shocking that schools such as St Paul’s are so stretched that they cannot carry out small but necessary repairs. It is not a new problem; it has happened because decades of under-investment have compounded it in those schools.
I welcome the Government support for new school buildings. Cambridgeshire has a demographic bulge at the moment, and the county is frantically opening new primary school places to cope. The bulge will then move on to secondary school, and we will then need financial support to deal with that. I specifically welcome the inclusion of the Manor school in the Government’s priority school building programme. It will make a huge difference to the school, which was visited by the Minister’s predecessor, and the services that it can provide. It is especially welcome because it will be a grant, not tied to any PFI constraints. While I am mentioning the Manor, I pay tribute to Ben Slade, the school’s former principal, who was energetic and inspirational to many pupils and others.
Our problem with schools is that the deal is simply unfair. In Cambridge, there is a range of 16-to-19 education providers, including the excellent Cambridge regional college, which will sponsor the new university technical college in Cambridge, and two sixth-form colleges, Hills Road and Long Road, which educate thousands of 16 to 19-year-olds to a consistently high standard. I have spoken to both principals, Linda Sinclair and Chris Sherwin. They describe a funding situation in which they are struggling to keep their heads above water.
The problem is not unique to Cambridgeshire. Sixth form colleges across the country are suffering from the same problems. Although there are only 94 sixth- form colleges in England, they educate more than 150,000 16 to 19-year-olds and send more people to higher education than independent schools, with almost a third of those young people coming from the least advantaged areas of the country. Almost three quarters of those colleges are rated as either good or outstanding by Ofsted.
Hills Road sixth form college does phenomenally well at getting pupils into Oxbridge, beating every school in the country, other than Westminster and Eton, which is a great achievement for a state-funded school. The state sector can work wonders at much lower cost than any private education, but it needs appropriate funding and does not get that.
Sixth-form colleges face particular inequity. They have to pay VAT on goods and services, with a couple of exemptions, whereas schools and academies are reimbursed for those costs. That costs the sixth-form college sector some £30 million per year—about £320,000 per college—which could be spent on education. Can the Minister try to persuade the Treasury to fix that bizarre discrepancy, which also applies to regional colleges? Anne Constantine of Cambridge regional college highlights that
“The VAT bill on revenue spend at this college in the last financial year was £1.2 million of non-recoverable VAT, most of which was incurred in relation to 16-18 learners, a sum”
that could be reinvested in learning if they were treated the same as schools.
Pupils at sixth-form colleges are ineligible for free school meals. Will the Minister support the Association of Colleges “No free lunch” campaign to ensure that students in sixth-form colleges get the same as they would at a maintained school sixth form, an academy, a free school, a university or a technical college?
Sixth-form colleges are funded less than the alternative providers, and that funding is also being reduced. Hills Road sixth-form college, for example, devised a plan to cope with average funding of £4,500 per student—a fairly small amount, compared with what is available at key stage 4 in a number of other providers—but the more recent announcement of a simplified pro-rata funding scheme from 2016-17, at a rate of £3,900 per student, means a further 13% budget cut. That pro-rata funding system is a redistribution of funding between 16-to-19 institutions and not a national cut—it does not save money for the national purse—but it means that sixth-form colleges, such as Hills Road, that deliver large programmes with high success rates will lose heavily. They will no longer be able to act as an exemplar in the state system.
The new figure of £3,900 per pupil per year is less than is available at key stage 4, but must be used for the much wider aspirations of those aged 16 to 19. It does not allow for enrichment activities and does not cover extra costs of subjects, such as experimental sciences, and does not allow pupils to have funding to study a fourth A-level, which is particularly important for those who want to do double maths and go on to study sciences at a number of universities. A particular problem is that sixth-form colleges cannot cross-subsidise between different age groups, because they have only a narrow intake.
A particular issue affects Long Road sixth-form college. There is large growth in sixth-form places, as schools and academies expand into sixth-form provision, benefited by their financial advantages over sixth-form colleges, but without the matching increase in the numbers seeking to go on to sixth form. That makes the financial pressures far worse at Long Road, for example, and both Hills Road and Long Road colleges are facing serious cuts to their budgets. That will affect their ability to provide the quality of education that their students deserve.
It is not even clear how these changes will affect those colleges. Institutions that currently deliver larger than average-sized programmes, such as Hills Road, will have to reduce them by 2016-17 to match the new funded level. That will have to be managed gradually over the next three years, because the prospect of doing it all at once in 2016, as they face the cliff edge, would be too painful to contemplate. Can the Minister confirm whether institutions that reduce their programme sizes gradually over three years will be fully protected until 2015-16, in terms of funding per learner, by the formula protection mechanism, or will they be penalised for trying to avoid a cliff edge? Can he confirm—this is an issue for Long Road in particular—whether guided learning hours that are focused on enrichment, rather than specifically on qualifications, will also be included in that protection? If the Minister needs further details, I am sure that the principals will be delighted to talk to him.
Sixth-form colleges are not clear how their funding will operate. They need certainty. They are also concerned about the combined impact of all the changes happening at once. The decrease in income due to the decrease in student numbers as a result of expanded post-16 provision without demographic growth, the continued removal of entitlement funding and the decrease in income as a result of the new funding methodology will all hit at the same time, and they are already being hit. The 2011-12 funding impact survey of sixth-form colleges showed that almost half of sixth-form colleges have already had to drop courses. Several reported that science, technology, engineering and mathematics courses were removed from the curriculum, and a quarter indicated that at least one modern foreign language had been dropped. They are also having to reduce or remove enrichment activities, such as sport, music and drama and careers guidance.
Schools and sixth-form colleges in Cambridgeshire do a good job on limited resources. I am not asking for favours or special treatment. I simply ask for fairness: fair funding for Cambridgeshire pupils, so that they no longer get the least per pupil in the country, and fair treatment for sixth-form colleges, so they no longer face lower funding and higher costs than other providers. If we are to build a strong economy and a fair society, we must ensure that everyone can get on in life.
It is a pleasure to serve under your chairmanship again, Mr Weir. I congratulate my hon. Friend the Member for Cambridge (Dr Huppert) on securing this important debate, which will be of great interest in his constituency and in the county that he represents. I am grateful for the opportunity to address a number of issues that he has raised.
The Department accepts that Cambridgeshire is, on our latest figures, the 143rd lowest-funded authority in England. My hon. Friend knows that the Government are determined to address the injustices in our funding system and to seek, over time, to introduce a fairer national funding formula. We are still committed to doing that. I will explain later precisely how we will deliver that in the years ahead.
I am happy to meet my hon. Friend, head teachers and college principals from his constituency in the weeks ahead if he feels that there are further points to be made about funding fairness for Cambridgeshire and the other issues that he has mentioned, and should he want the opportunity for head teachers and principals to put those points directly to me.
I am grateful for the opportunity to address the important concerns that were raised today, which will be of interest to many families in Cambridge and Cambridgeshire and many of the people who work in the educational establishments that my hon. Friend mentioned.
We intend to move to a fairer funding formula across the country, and I will explain how we will do so. Our aim is for every child to be able to succeed at school, regardless of their background and where they live. That is why the Government, despite having to make difficult decisions on public spending since we took power in May 2010, have protected pre-16 school funding in real terms over the spending review period. As part of that, we introduced the pupil premium, which we advocated in our general election manifesto and which, by the end of this Parliament, will have targeted an additional £2.5 billion per year to disadvantaged pupils.
My hon. Friend mentioned how much additional money his county—his constituency—is receiving. He will be pleased to know that the per-pupil amount of the pupil premium will be rising from some £623 per pupil in the current recent educational year to £900 per pupil in the year that we are heading into, which will be a big help to many educational institutions with a large number of disadvantaged youngsters. However, we need an underlying system to support that investment and to ensure that pupils are not disadvantaged as a result of a national school funding system that, frankly, does not distribute funding fairly.
My hon. Friend has highlighted some reasons why the current system for funding schools is in desperate need of reform. It is based on an assessment of need that dates back to at least 2005-06 and it has not kept pace with the changing demographics and needs of pupils. It is also complicated, so head teachers, governors and parents are unable, usually, to understand how their school budgets have been calculated and what the justification is. In addition, the current system is not designed to support the successful expansion of academies. Therefore, it is difficult to demonstrate that schools maintained by local authorities and academies are being funded equitably, which is the Government’s intention.
For the lowest-funded authorities, such as Cambridge, that outdated system may well mean an allocation that does not reflect the current needs of schools in the county. It is not right that schools with similar circumstances in different areas of the country can receive vastly different funding for no clearly identifiable reason. That is why, on 26 March 2012, my right hon. Friend the Secretary of State for Education announced our intention to introduce a new national funding formula during the next spending review period. That formula would distribute money fairly across the country, targeting need and getting rid of some of the anomalies that make the current system so unfair and irrational. However, reforming such a complex system—particularly in an environment where, for understandable reasons, all Departments’ budgets are so constrained—is far from easy, and it is important that we do it at a pace that schools can manage, including schools in parts of the country that have been better funded in the past. The last thing that we want is to cause destabilising changes to school budgets, which cause anxiety and distract schools from delivering high educational standards for their pupils.
We are moving gradually towards introducing a new funding system at a pace that gives us sufficient time to agree to the construction of a new formula and that allows schools enough time to adjust to changes in their funding arrangements. At present, we are planning to introduce the national funding formula in the next spending review period. In the meantime, from April, the local system will be simpler and more transparent, meaning far less complexity for us to untangle when we come to address the national system.
Our first step is to ensure greater transparency and consistency in the allocation of funding locally. For 2013-14, the dedicated schools grant has been allocated in three clearly identifiable spending blocks: schools, early years education and high-needs pupils. We set each block for each local authority using details of its spending in 2012-13 and then agreed the blocks with each authority. The spending blocks provide greater transparency over how much has been spent in each of those areas.
We are also making changes to how funding is allocated to schools, so that, within local areas, pupils to the age of 16 begin to attract similar funding regardless of where they go to school. Moving to a more consistent way of funding schools may mean that local authorities and their schools forums have to think radically about how they distribute money to their schools, and a new local formula will inevitably generate shifts in school budgets. That may be uncomfortable, but if we can start to iron out some of the inconsistencies and unfairness that pupils and schools currently experience, that will ultimately help to pave the way towards a fairer, more pupil-led system.
Local authorities have worked hard under the new arrangements to build new formulae that adequately reflect the needs of their schools. However, for some areas, particularly Cambridge, that has proved problematic, and some schools are facing considerable budget changes. I also understand why in Cambridge, as a lower-funded authority, my hon. Friend is worried about how the changes will be managed. Although the budget changes are necessary to reflect a new system, we are clear that they should not be unmanageable, not least in areas such as his. That is why the Secretary of State announced in June that schools will continue to have planning certainty through the minimum funding guarantee. Therefore, in most cases, schools will not lose more than 1.5% of their budget per pupil in 2013-14 and 2014-15, and many schools will gain. In addition, the Secretary of State and I confirmed in October last year that we will continue to operate a minimum funding guarantee beyond 2014-15. We cannot confirm its exact value until the new spending review period, but we are absolutely committed to protecting school budgets from unmanageable changes.
I reassure my hon. Friend that we will carry out a thorough review this year of the impact of the new simpler formula on pre-16 funding, making any necessary changes based on that evidence in 2014-15. Over the coming weeks, we will start to work with local authorities to explore the effects of different factors, such as the lump sum and deprivation factors, so that we can ensure that a robust system is in place for 2014.
The Secretary of State announced on 2 July 2012 that, from April 2013, we are introducing a new national funding formula for 16 to 19-year-olds in education and training. That new formula will be based on the principle of funding per student, rather than the existing system of funding per qualification, which my hon. Friend mentioned. That will allow sufficient income for each student to undertake a full programme of study, whether vocational or academic.
Our objective is to introduce a system of fair funding that will provide a place in education or training for every young person who wants one and will support full participation by 16 and 17-year-olds by 2015. The new formula will give many benefits, including taking into account the needs of the disadvantaged, implementing the recommendations of the Wolf report and supporting the envisaged A-level reforms. The new formula will fund full-time students for an average of 600 teaching hours, which will be sufficient to offer a significant programme of study. The formula will mean that all students aged 16 to 19 will be funded using the same formula, removing the historical differences between schools and academies and sixth-form colleges.
I understand that some school sixth forms and sixth-form colleges that offer a predominately academic programme to their students, such as Hills Road in my hon. Friend’s constituency, are concerned about their funding under the new 16-to-19 funding formula. I am aware of that institution’s reputation, not only in Cambridge, but across the country. In response to my hon. Friend’s question, I confirm that we will provide at least three years of full funding protection from the formula changes, while we continue our reform of qualifications, including the forthcoming A-level reforms. I also confirm that the 30 hours currently focused on enrichment activities are included in that protection. Detailed allocations of funding for 2013-14 will be announced in March. Arrangements beyond 2014-15 will not be announced until the next spending review has been completed. As part of the process, we have established a ministerial working group with key sector representatives to consider the best way to implement the reforms to programmes of study and associated funding changes, as well as to help us to ensure that the reforms work in the best interests of all young people.
My hon. Friend mentioned VAT, and I am sympathetic to the concerns expressed about the different VAT treatment that sixth-form colleges receive from the Government. I have asked officials to raise the matter with the Treasury and Her Majesty’s Revenue and Customs and to report back to me.
On free school meals, it is only the entitlement to a free meal that is different for schools and academies compared with colleges. There is no actual funding given by the Department for free school meals for sixth- form pupils, even in the school and academy sector, which complicates dealing with the injustice in entitlement. We are currently looking at options for extending eligibility further across the 16-to-19 sector.
We also seek to address concerns around capital funding, which my hon. Friend mentioned. We have more than doubled the capital funding that will be made available in this spending review period to support specifically the provision of additional places to those made available in the same period by the previous Administration. We have made £2.8 billion available for basic needs in this spending review. Most recently, in last year’s autumn statement, the Chancellor announced £980 million of additional capital funding for basic needs over the next two years. That will help us to expand good and outstanding schools where there are shortages of places and to establish new academies and free schools where there is that basic need.
I am grateful to my hon. Friend for drawing attention in this relatively short debate to the funding issues faced by schools and sixth-form colleges in Cambridgeshire. I hope that I have provided some reassurance that our aim in making these reforms is ultimately to ensure that England has a fair and transparent funding system precisely to deal with some of the injustices that areas such as Cambridgeshire may have suffered in the past. A new national funding formula will reassess need across the country and will allocate funding accordingly. A refreshed distribution of funding will renew confidence in the system, but only if we put the right formula in place. The Department is working actively on the issues now in the run up to the spending review that will happen before the summer, and it is a preoccupation of mine. I am happy to meet my hon. Friend and any representatives from the education sector in his constituency to discuss this further.
It is a pleasure, Mr Weir, to serve under your chairmanship in this important debate. Towards the end of last year, charity donations had dropped by 20%, and one in six charities said that they face closure in 2013. We rely on charities to support some of the most vulnerable people in our society, and when 73% believe that they are unable to fulfil their philanthropic goals because of lack of funding, there is real cause for concern.
In May 2010, the Government launched their big society idea. The Prime Minister said that it was about allowing charities, social enterprises and companies to provide public services, devolving power to neighbourhoods, and making government more accountable. We are now relying on charities to provide much needed support, but only yesterday Sir Stephen Bubb, head of the Association of Chief Executives of Voluntary Organisations, said:
“The reality many charities now face is crippling spending cuts”.
The Government would like us to rely on charities, but they have neglected to support them in their time of need. What we need now is a Government initiative to support, not one led by charities. In recent years, the public have become increasingly wary of giving to charities following reports of aggressive campaigning. That may be going too far, so we need innovative solutions to access gift aid money, instead of pestering people to give more than they can afford.
Some charities are the only providers for many people, and sometimes they provide niche services to the most vulnerable people in communities. The Marie Collins Foundation provides support for children who have suffered sexual abuse via the internet or mobile technology and has unique expertise in this area. The One in Four charity supports people who were sexually abused as children and is facing an unprecedented amount of work following recent media attention. It relies on donations and volunteers, yet 80% of its clients are referred by the NHS. It is clear that those charities play a role that is genuinely needed in our society.
The problem lies in the reduction of grants and funding available to charities. The SHARE Community says:
“There’s less money available from charitable trusts, and more competition for what there is.”
This debate is not about the fundamental structural changes needed in Government financing to give better support to our charities, although I am sure that an assessment of how that works would be appreciated by many. It is about how to harness the British public’s generosity into a more successful donation record for charities, big and small.
I am sorry, but the hon. Gentleman did not come to me before the debate, so I will not give way.
People want to give, but they simply cannot afford to give as much as they used to. The problem is reaching breaking point. With the recent child benefit reductions and welfare reform at the forefront of hundreds of thousands of people’s minds, charities are being stretched in two directions. For many families, the reduction in income will mean they simply cannot afford to give as much as they used to, leading to reduced budgets for charities. We recently had a debate in the Chamber on food banks, which are classic examples of the strain facing charities during the financial crisis. For example, in the last year, the Trussell Trust almost doubled the number of food banks it oversees from 149 to 293. The BBC recently ran a report about a mother who is a full-time carer to one of her children and is relying on that charity for emergency food parcels. Her words echoed those of many people throughout the country:
“I choose between whether to pay my electricity company...or feed my kids”.
I am sure that the Minister is aware that I often criticise energy companies for their selfishness when raising their prices, and that should be addressed, but we can help to ease the burden in the face of corporate greed by making it easier for charities, such as the Trussell Trust, to secure donations. Similarly, the homelessness charity, Shelter, has seen an 80% increase in demand for homelessness services in the last three years. Additional funding is needed immediately to support its work, and as we enter the coldest part of the year more will be needed.
Elderly people—I have many in my constituency—are also struggling with cuts and rising living costs. In Glasgow, there are now more senior citizens than 16-year-olds. That is a growing trend, and the growing proportion of elderly people will put more strain on our resources. Charities such as the excellent Glasgow Old People’s Welfare Association face rising demands on their resources and rely heavily on increased donations. We must support their work so that they can support elderly people. Demand on such charities will only increase as people start to feel the pinch of years of austerity policies.
Last week, there were reports that a triple dip recession is feared, so 2013 will be a difficult year for many. More and more people will turn to charities for support in their time of need. The Margaret Carey Foundation says:
“Were the charity sector to go into steep decline, the state would have to step in or…just stand by and watch people suffer as a consequence of not having a support system.”
Due to the enormity of Government cuts, I fear it would be the latter. Supporting our charities is an absolute priority, but 20% say they fear they may close this year. We must do something urgently to secure their financing structures.
Unlike many businesses, charities do not have the luxury of reserves to cover income shortfalls, and this year will be a breaking point. The Charities Aid Foundation reports a £300 million deficit in the funds of more than 90% of small and medium-sized charities, and those not facing closure will reduce services.
A key aspect of harnessing donations is to make them more secure and effective, especially with the 20% drop in the last year. It is increasingly difficult to get the other 80%. Cystic Fibrosis Dream Holidays says:
“It is becoming more and more difficult to raise the funds we need. We seem to be doing twice the work to raise half the income!”
The Refugee Youth Project, a charity that provides support to young people who have fled to the UK, relies heavily on donations. Some significant costs on charities are not covered by project budgets, so they desperately need unrestricted funding, primarily from donations, to stay alive. Funding from donations is also used to develop research and to pilot new initiatives with young people, allowing the charity to grow and to increase its effectiveness. Project budgets may be financed by Government grants, but that is no good if the backbone of the charity is not supported by donations.
Many charities also rely on the selling of unwanted goods in shops around the country, but Age UK has noted a 20% drop in doorstep donations of unwanted goods, and I am worried that that will only increase as the world moves to online shopping. Online marketplaces, such as Amazon, make it easier and quicker to sell unwanted items, and that is increasing. The British people are finding that they cannot get such books, CDs and other items in charity shops, and the number of those shops will decline. Comic Relief and Sport Relief are doing an excellent job, but we cannot rely all the time on the money that they are raising. It is easier for them to do so, but the lifeline and money that are needed are not there. The fact that charities now have to consider UK problems as a more pressing priority means that international charities will get less, so there will be a reduction in money to developing countries. Donations from UK residents are dropping, and I suggest that, if that trend continues, donations to charities that distribute in the UK will be given priority by donors. That is shown by the food banks that we discussed earlier.
Some things must be done. I was privileged to chair the Committee that considered the Small Charitable Donations Bill, which aimed to make gift aid simpler. However, in the face of such a crisis, that is simply not enough. Charities employ the most successful fundraisers and they are very good at what they do, but a few steps from Government could make a huge difference to the amount they receive. Over £750 million of gift aid goes unclaimed each year. It is clear that more needs to be done to get that to those who need it most.
That is a significant amount of money—£750 million unclaimed. Do my hon. Friend or the Minister have any idea where that money is and how it can be accessed by charities, including a number of charities on my own patch? Erskine, which looks after disabled service personnel, would very much welcome access to that kind of money.
My hon. Friend is absolutely right. The Erskine hospital fund is greatly supported by many companies, as well as many people in the Glasgow area, but it may find that it does not get the funding that it has had in the past. Perhaps the Minister could answer what happens to that £750 million. Please do not tell me, Minister, that it goes back to the Treasury, when people really need it and we can direct it to some of those charities, rather than giving it to the Chancellor of the Exchequer.
We desperately need to modernise an outdated system. The fact that people fill in a gift aid form each and every time they donate is ridiculous. We could have a central database of gift aid donors, which would allow charities to claim it much more easily. They could check their donor quickly and easily against the system, so that they would not need to rely on people making extra effort each and every time they donate.
We also need an awareness campaign on the gift aid scheme. Many people do not use gift aid, because they simply do not know it exists. An awareness campaign could encourage thousands of people to take that extra step and allow gift aid, which is a great benefit to charities, at no additional cost to the donor. If charities were able to claim gift aid on doorstep donations, we could also mitigate the crisis with our charity shops. Charities may see donations decreasing, but that step from Government could see smaller amounts of donations go further. Following the reduction in donations, Age UK has seen a real-terms reduction in potential income of £750,000. Payroll giving—whereby money is taken out of employees’ pay packets—is also massively underused. Only 2% of employees use it, and yet giving £10 could cost them as little as £5. We need to push that further, and education is needed.
We also need to help charity donations to move into the new millennium. Many small charities cannot benefit from text donations due to high—actual or perceived— set-up costs. However, a key issue is that Apple, for example, does not allow direct donations from applications on smart phones. That is ridiculous. It would be simple to donate. The Government have been looking publicly into the issue since around 2011, so why has nothing been done?
We also need the Government to act on data about donating habits. We know that older people donate more. Why, and how can we harness that? We know that younger people donate less. How can we target them specifically? Are the Government scrutinising that data? We welcome the Innovation in Giving Fund, which will give rise to the use of new technologies targeting that group, but we need to ensure that any innovations are available to smaller charities as well.
As our move towards new technologies may reduce the role of our charity shop culture, we need to look at how we can move it online. It seems that the rise of e-books, for example, is a huge blow to the second-hand book trade. With Amazon taking a huge profit from that technology—while paying no corporation tax, it must be stressed—here is a chance for it to play a role in facilitating a charity book culture online. Could Kindle users donate their old books to a charity marketplace, and could they be resold with donations shared between Amazon and chosen charities? Could the same work be done with music? We owe it to Britain’s charities to look into how such a scheme might work, and how else online shopping could be used to benefit our voluntary organisations. We also need a way for people to identify how their donations are distributed and what percentage actually gets to the people who are being targeted.
There is some concern that a small minority of charities are not reputable. We believe that it is necessary to encourage people to trust the majority of charities that truly help people. Therefore, I would like to see a central portal where we can see how reputable they are and how donations are spent.
Finally, we need to protect our smaller charities. They are often disadvantaged through a lack of expertise in fundraising techniques. We need a system of sharing that knowledge. The Government should work together with charities of all sizes to provide training on fundraising techniques and on the ways in which they can reach the full potential of each donation given. There is also a role for business to play in training, and employees should be encouraged to donate their time to smaller charities to help them to modernise fundraising systems.
We are facing a crisis in the economy and a knock-on crisis in the charity sector. People want to donate, but I do not believe that they know the full potential of what they can do. Charities provide a vital service that we cannot do without, and we need to tackle the problems now before it is too late. I call on the Government to set to work on a comprehensive strategy to save our charities.
I thank the hon. Member for Glasgow North West (John Robertson) for a thoughtful, wide-ranging speech, and I welcome the additional comments provided by the hon. Member for Paisley and Renfrewshire North (Jim Sheridan). I venture to guess that my hon. Friend the Member for Warwick and Leamington (Chris White) was going to mention his valuable work on introducing the Public Services (Social Value) Act 2012, which I congratulate him on as well.
I turn to the comments made and the issues raised by the hon. Member for Glasgow North West in the debate today. I agree that charities play an important role in our society, and I take this opportunity to extend my thanks to the charitable organisations in this country that work so hard, and to those who work in them. They will be glad to see us taking these issues seriously in the House, and I know that there is much more that we must do.
I start with a general point that the hon. Gentleman will be well aware of. Matters pertaining to donations to charities in Scotland are, of course, devolved matters. He is nodding, and he will know as well as I do that it is for the Scottish Government to comment on those matters. Perhaps they have a clear idea of what they wish to do in the long term in Scotland about such things, but he and I can take that into a different debate any time that he wishes.
I turn to the broad issue of current donations and the health of the sector, which was raised in the hon. Gentleman’s speech and in reports a short while ago. Much has been said about the health of the sector generally, and I add that the picture is very mixed. Clear trends are not easy to discern at this stage. The evidence of recent reports from the Charities Aid Foundation suggests that charitable donations are down, while other evidence, such as the Taking Part survey commissioned by the Department for Culture, Media and Sport, finds that there is a slight increase in the proportion of people giving to charity. Similarly, the overall effect on the health of the charitable sector is unclear.
There are, however, grounds for optimism. Some reports suggest that the total income of registered charities has grown from £52 billion in 2009 to almost £59 billion now and that there are 2,000 more registered charities now than in 2009. Those figures are to be welcomed and cast an interesting light on the debate that we are having here today. What appears clear is that no one can say for certain whether donations are decreasing and certainly not at what rate. There is some debate in the sector about whether a decrease is what charities are experiencing on the ground.
We will need to wait and see if there is a clear trend in donations, but regardless of what trends emerge, it is also true that life goes on. We need to acknowledge that it is a challenging environment for charities and, clearly, for the people they serve. We should all make every effort to help the sector to raise money efficiently and effectively to meet the challenges, and that is exactly what we are doing. If the hon. Gentleman will allow me, I will go on to deal with a couple of ways in which the Government are seeking to play their part.
The hon. Gentleman referred to face-to-face fundraising, often referred to as chugging. That is certainly seen regularly in Norwich. Indeed, only recently I was corresponding with a constituent on exactly that matter. It is an important and successful method of fundraising, which can bring millions of pounds into the charitable sector every year, but I welcome the announcement in November by the Public Fundraising Regulatory Association and the Local Government Association of an agreed template for voluntary site management agreements as a way for local authorities to control chugging in their areas. I think that more than 50 site agreements are in place, with more being negotiated.
Much more is being done by this Government to support the sector, including by supporting a culture of giving both money and time—an important area of debate—by opening up new sources of income and finance through social investment or delivering public services where organisations decide that that is right for them and by providing wider support for the sector, thereby making it easier to set up and run a charity or social enterprise. All those actions support the health of the sector, either through increasing access to income of various kinds or through reducing costs and burdens, so that that income goes further.
The debate has focused on charitable donations, and perhaps the biggest help that the Government give to the sector is gift aid, which the hon. Gentleman went through in some detail. He will know that it is a matter for the Treasury. Although I used to be that Minister, I would not dream of going on to such territory here today, but he did mention his pride in chairing the debates in Committee on the gift aid small donations scheme, and I was the Minister responsible for much of the work on that and was deeply proud to be so, because it is a very good avenue of further help—up to £100 million a year, we hope—for the sector. I shall say more on that in a second.
I want first to deal with the administration of gift aid and ways in which traditional gift aid can be made better for the sector. My right hon. Friend the Chancellor of the Exchequer announced in the autumn statement that an examination would be carried out to identify ways to improve the administration of gift aid to reflect new ways of giving money to charity and, in particular, digital giving, to which the hon. Gentleman referred.
I accept what the Minister is saying. I have no doubt that she is right and I think that gift aid is a good idea. The problem is that the small and medium-sized charities seem to be suffering the most, and they do not seem to have the access to gift aid that the larger charities have.
On a similar note to what has been said by the hon. Member for Glasgow North West (John Robertson), rather than looking to reform gift aid, would my hon. Friend the Minister consider scrapping gift aid entirely and putting in place a system whereby people can make direct deductions from their taxation? If we want to create a culture of giving, nothing is better than letting people write a cheque to a charity. That is one way in which smaller charities would benefit, rather than having to go through the more cumbersome process of gift aid.
My hon. Friend makes a fascinating point, and I am always very interested to hear his ideas, some of which I have time to debate at length with him in this Chamber. I shall ensure that that idea goes where it can be well considered.
In answer to the point made by the hon. Member for Glasgow North West, the instigator of the debate, I think that the most important way to help smaller charities is to reduce the costs and burdens associated with what the state can provide to charities. That includes what we did in Budget 2011, which made it clear that we intend to make it easier for charities to claim gift aid by introducing a new IT system that will allow charities to claim gift aid online and through, as I mentioned, the gift aid small donations scheme, which will allow charities of all shapes and sizes—we hope that it will be of particular benefit to small local charities—to claim top-up payments equivalent to gift aid on small cash donations of up to £5,000 a year, without the need to have gift aid declarations from donors. That scheme should commence in April of this year, and as I mentioned, it is expected that it will increase the amounts received by charities by about £100 million a year. It is my sincere hope that it will be put to very good use by smaller charities as well as others.
If the hon. Gentleman will forgive me, I shall have to write to him on the figures because I did not catch the one that he was referring to. I will ensure that he gets the correct Minister’s response to the figure given. He does give me the opportunity to answer a question that was posed earlier: what happens to unclaimed gift aid? I think that both he and the hon. Member for Glasgow North West mentioned a £750 million figure in that regard. If they will forgive me for making a particularly political point at this stage, it is important to note that there is no such thing as a Treasury coffer that just sits there. There is no such thing as the Chancellor wishing to stockpile. There is every such thing as public spending, and if money that is within the public finances is not spent on one thing, it is spent on another. That is a very important point to note. I could also note plenty of other things that past Governments failed to do with public spending, such as control it properly, but I think that what is most helpful in this debate is to come back to the reasons why gift aid may be unclaimed. I want to return to that because I think that it is the constructive area for us to debate. We need to ensure that everyone who has a reasonable business claiming gift aid can do so easily, without costs and burdens.
I want to go on to payroll giving. The Cabinet Office, the Treasury and Her Majesty’s Revenue and Customs will come together to produce a joint consultation document on payroll giving in due course. I hope that that reassures the hon. Member for Glasgow North West on some of his points. We are further supporting giving at the top end by ensuring that people who donate at least 10% of their estate to charity will be eligible for a reduction in their inheritance tax bill from 40% to 36%. That is an incentive to help giving as well.
The hon. Gentleman suggested a number of other ideas to increase giving, and I am grateful for them. We will look at many of them; we will constantly look at this issue. We are making £10 million available to the Innovation in Giving fund. Many of the schemes use technology to further their aims. That fund will be delivered by NESTA—the National Endowment for Science, Technology and the Arts. In England only, I should note, the fund will find and support the growth of the most promising ideas with potential to create a step change in giving. That is something that we can all welcome.
In addition, the Institute of Fundraising, which is one of Government’s strategic partners, provides training and guidance to small organisations on fundraising issues. We are also doing much to support the giving of time and wider community action, such as through the National Citizen Service, which gives young people the chance to do voluntary activities, meet new people and put something back into their communities. We are supporting Join In, to encourage people to volunteer and get involved in local sports clubs.
We are also supporting the sector to find other forms of income. We launched Big Society Capital with up to £600 million. That is the world’s first social investment institution. We have provided support with a wider package of social investment measures. In addition, the Cabinet Office recently published guidance entitled “Making it easier for civil society to work with the state”, which brings together the range of reforms across the Government and the wider public sector. That is aimed at making it easier to set up and run a charity. Part of that is that charities and social enterprises should be able to shape and deliver public services.
We are doing much to support charities to work better, including finding sources of income, through the £30 million Transforming Local Infrastructure fund, to help 74 local support organisations to improve their performance in supporting front-line organisations locally. We have looked at the bureaucracy that frustrates charities and adds to their costs and expenses. We are making good progress in implementing the recommendations on red tape that Lord Hodgson made in 2011 and are undertaking a red tape challenge for the civil society sector.
I should like to make one brief point on the international aspect, which the hon. Gentleman’s comments very interestingly turned to. I am sure that he would welcome, in both the coalition agreement early on and yesterday’s mid-term review, the reinforcement of this country’s aim to give 0.7% of our GDP to development aid. That is an important way to fulfil the aspiration that his speech articulated, and we should not forget it.
The Government recognise that charities face a challenging time in the current economic conditions. We will continue to work with the sector to help them.
Question put and agreed to.