Wednesday, 23 July 2014.
Arrangement of Business
Good afternoon, my Lords. I remind the Committee that in the event of a vote in the Chamber, the Committee will adjourn for 10 minutes from the sound of the Division Bell.
Question for Short Debate
My Lords, most of us, even if we have had first-hand experience of a family member or friend who has had a stroke, think of it as associated with older people. Indeed, when my partner, who was then 62 years old, had a major stroke nearly seven years ago, I was a bit surprised to see two patients on the stroke ward and in the physio room in their 20s and mid-30s who had had major strokes, suffering from effects just as debilitating as for an older person but, of course, with even longer-term impact.
However, later, as a member of the All-Party Parliamentary Group on Stroke, I met the amazing Eliza Cooke, a 16 year-old ambassador for the Stroke Association, who has played a very important role in developing its key campaign to build awareness of child stroke, which has inspired the debate today. Eliza, who is here today, had a mild stroke aged 10 when she was on holiday in France, where an MRI brain scan, had it been available, could possibly have prevented the major stroke she suffered 10 days later on arriving back home. She had the classic symptoms of right-hand brain stroke but, here in Britain, she did not have the MRI scan straight away, because the health professionals she came into contact with were just not sufficiently aware that children have strokes.
By the time Eliza was referred to Great Ormond Street Hospital, 24 hours later, it was too late for surgery. She was completely paralysed down her left side and her brain was seriously injured. Eliza was an in-patient at the London Hospital for four months and had good physiotherapy, there relearning to walk, but she never regained the functioning of her left hand and has a weak left arm and leg, causing her to limp. School and study have been challenging because her memory was also affected, as was her ability to process things visually. However, she is an inspirational and determined girl and, and out of all that, is now doing her AS-levels—and, moreover, wants to study politics at university.
Eliza still has physio and occupational therapy, which she needs to ensure that she retains the movement that she has, but, like other young adults with disabilities, the key question and uncertainty for her is always: will the therapy continue when I am 18?
That children have strokes is the key message from the Stroke Association’s campaign. Awareness and recognition of the possible symptoms among health professionals and the public are vital so that, as with adult stroke, care and treatment can be fast and commence as soon as diagnosis is made. Children with suspected stroke should be seen by a consultant paediatric neurologist, paediatrician or neurosurgeon and have fast access to an MRI brain scan to determine whether it is a stroke and, if so, what type of stroke it is. Late diagnosis is a major problem with childhood stroke, and failure to get the right treatment can have a devastating impact on children and their families for the rest of their lives.
Childhood stroke is, thankfully, relatively rare. It has been estimated that about 400 children and young people in the UK have a stroke each year, and stroke is one of the top 10 causes of death in childhood. Indeed, reliable top estimates suggest that as many as 1,500 children a year could be affected by stroke.
The long-term outcomes of paediatric stroke are difficult to predict. More than half of children will be left with significant long-term disabilities after stroke—some well known, such as one-sided paralysis or weakness, or problems with speech and communication, but others less known, such as difficulties of perception and awareness and psychological and emotional changes.
The causes of childhood stroke are different from those in adults, more varied and often unknown, which is why early diagnosis can be so difficult. Those strokes occur as a result of a very diverse range of conditions—most commonly, congenital heart disease and sickle cell disease. Other underlying causes are infectious diseases, moyamoya syndrome, vasculitis and blood disorders. Childhood infections such as chicken pox, encephalitis and sepsis can also be linked to stroke in children and young people. Fear of the stroke recurring is a major concern for children and families. Ischaemic stroke, caused by a clot, recurs in between 6% and 20% of all children and in more than 60% of children with sickle cell disease.
Since tabling this debate, I have met a number of parents with their children who have suffered a stroke—Eliza and her mum, Liz, and Renee and her son Ollie, who had two strokes aged 13 and 14, are here today—all involved in the raising awareness campaign. I also want to mention eight year-old Caitlin McLaughlin, who had a stroke before she was born and now has a number of different conditions, including cerebral palsy, epilepsy and severe visual impairment. Caitlin’s 13 year- old big sister Cheyenne won the carer’s award at the Stroke Association’s recent Life after Stroke awards, for her commitment and dedication to helping to care for her sister and providing her with personal, physical and emotional support.
Sarah Scott was the deserving winner of the volunteering award. Now 23, she had a stroke while in the sixth-form class at school, at the age of 18. It resulted in right-side paralysis, from which she gradually recovered, but she was left with severe aphasia, affecting her speech, reading and writing skills. As we know, aphasia causes social isolation, particularly for someone of Sarah’s age, but she has benefited greatly from NHS speech therapy, which helped prepare her for working part-time in a local school. She has also set up a support group for young adults in her home city, and organises all their activities and outings as well as visiting other stroke survivors to provide support.
These are the inspirational stories on which I wanted to focus today, to reinforce the need for concerted action on child stroke to match the huge improvements we have seen in adult stroke care and support over the past decade. Three things need to happen. The lack of awareness of childhood stroke, its symptoms and impact—which contributes to the problem of late diagnosis—needs to be addressed; there needs to be more research into its causes, treatment and longer-term effects; and there needs to be a particular focus on improving specialist rehabilitation and longer-term services, as well as the provision of information and support for survivors and their families.
The Stroke Association and other excellent charities in this field, such as Different Strokes, Sickle Cell and Young Stroke Survivors and HemiHelp, have done tremendous work campaigning for action to raise awareness and to support parents and families. Different Strokes, for example, worked closely with the producers of the TV programme “Waterloo Road” on its recent storyline about a 14 year-old boy who had a stroke at school. When Sarah Scott had her stroke in the classroom at school, her classmates recognised the signs from the national Act FAST television adverts about strokes in adults, so an ambulance was called urgently.
Action to raise awareness needs to be taken nationally by the Government as part of an integrated strategy for childhood stroke. Does the Minister agree that plans should be put in place to build on the successful Act FAST campaign on adult stroke to raise public and professional awareness? The action of Sarah’s classmates showed how the campaign could have a very positive impact on young people. Does the Minister agree that a national strategy for childhood stroke needs to be urgently developed and fully integrated into the national cardiovascular disease outcomes strategy, which currently does not address this area? What action will the Government take to rectify this?
On awareness among health professionals, the parents I have talked to say they are often taken aback by the fact that so many doctors have not heard of childhood stroke, let alone nurses and paramedics. A recent study by Bristol University of children in the UK with ischaemic stroke found significant delays in the time from symptom onset to diagnosis, finding that diagnosis took longer than 24 hours in 51% of cases. Better implementation of national and international guidelines around the diagnosis, treatment and long-term management of childhood stroke is crucial here. What action are the Government taking to address this? What support will they give to the Royal College of Physicians, the Royal College of Paediatrics and Child Health and stroke organisations to develop new guidelines to replace the RCP’s 2004 document, which is now 10 years old? Does the Minister agree that bringing together the latest research and the views of children, families and health professionals in this way to develop new guidelines would be a major step forward in helping to address the cases of late diagnosis and misdiagnosis?
It is all-important for teachers and other schools staff to be aware of stroke symptoms and the need for rapid response, especially for children with sickle cell anaemia. They need to be part of a multiagency team which is involved in the return to school reintegration plan, and in the development of special needs education statements to allow the child to participate in school as fully as possible. Regarding research, there is widespread recognition that the best medical and rehabilitative treatment options in childhood stroke are significantly under-researched. I know other noble Lords will be addressing this, particularly the noble Lord, Lord Patel, whose experience and insights on the key issues and what needs to be done will be invaluable.
Finally, I turn to rehabilitation. Many parents of children who have had a stroke say they have to fight for their child to receive the care and treatment they should be getting. This is particularly the case for the frequency and intensity of contact with therapists, and delays in access to physio and occupational therapy. Of course, there are hospitals which do brilliant work in this area, such as the multidisciplinary child stroke services at the Evelina London Children’s Hospital at Guy’s and St Thomas’ NHS Foundation Trust, and Great Ormond Street Hospital.
I recently sat in on a session at the Evelina with a three year-old girl who had suffered a stroke when she was nine months old, and her parents. The session was led by Dr Anne Gordon, the consultant paediatric occupational therapist, who is also here today. As a carer of a stroke survivor I do not need convincing about the importance and necessity of physio and occupational therapy, but watching specialist child stroke therapy in action underlines this.
The little girl had left-side paralysis and, although she could walk, she just was not aware of her left arm. Why should she be when she had never used it? So Dr Gordon was working and playing with her and the parents, encouraging her to move her shoulder and learn to see the arm as a tool that she might use to tuck things under or generally to assist her. It was a process of joint working with the child, the therapist and the parents, and fully involving the parents so that they could continue the physio exercises with her at home. Childhood stroke impacts the whole family including parents, siblings and grandparents. Health, social and education services need to work together to provide the multidisciplinary assessments and support that the child and their family need.
Finally, the Evelina has a dedicated childhood stroke co-ordinator, who provides direct support and information to children and their families while in hospital, during the transition from hospital to home and over the longer term, by helping the child receiving rehabilitation or with starting or returning to school. The co-ordinator works closely with health professionals and uses the parent carer networks to help them reach out and support each other. Sadly that is a one-off, made possible by three-year funding from a Stroke Association corporate sponsor. How does the Minister consider that such services can be sustained and made more widely available to childhood stroke survivors and their families?
There is so much to say, and I have run out of time, but I am confident that the noble Lords who are due to speak will flesh out and expand on the many issues I have raised. I thank them all for coming to speak in this important debate today.
I thank greatly the noble Baroness, Lady Wheeler, for securing this valuable debate. I declare an interest in that I am the chairman of the charity Action for Rehabilitation from Neurological Injury. Last week, I was privileged to invite to your Lordships’ House a dozen distinguished professors and specialists in stroke rehabilitation from all areas of the United Kingdom. Their aim is to create a new UK stroke rehabilitation service which is specialised and effective enough to cope with the requirements of stroke survivors of all ages over the long term.
My guest at this panel was Andrew Marr, who, as your Lordships will know, suffered a debilitating stroke last year. I pay the greatest tribute to him for two things: first, his extraordinary and determined efforts, which are bearing fruit, to return himself to health and, secondly, his generous willingness to discuss his experiences in public. He shared with us some of the concerns that have reached him, since his own stroke, from other survivors and their carers. Many seemed to describe their treatment or that of their children by the multidisciplinary teams at the acute stroke phase as really excellent. However, their following therapy was time-limited and subsequent support for them or their children back in the community was very limited indeed. This was the third point made by the noble Baroness, Lady Wheeler: that they had to fight for it.
My connection to stroke and young people is personal. My son suffered a severe brain haemorrhage, causing a stroke, in 1997 when he was 21 years old. A few years after that, we started together the charity for stroke rehabilitation, which I have mentioned and which matches rehabilitation specialists and exercise professionals to stroke survivors after they have been discharged back to their communities. I have seen a number of the young people, from six year-olds upwards, who are brought by their parents to our centres or to visit our personal therapists. I have been hugely encouraged by the way that these young people can, with the proper treatment, do very well in conquering the effects of stroke. The ultimate aim for their rehabilitation is for children to start attending school or return to it, or other education, as normally as possible.
One of the limiting problems I see with the children who visit our centres—apart from speech and language difficulties, which often seem to be overcome more quickly—is weakness, particularly upper-limb spasticity. This seems to be the most devastating impediment, which needs consistent long-term affordable therapy because it has to be tackled head-on, often with the coerced use of the limb concerned. The evidence shows that whereas children have the advantage over adults of having a more flexible template for neuroplasticity to occur, with the younger brain adapting more easily to replace lost abilities, children can often simply decide not to use, for instance, an affected hand while playing. They do not understand why they must actively work hard on their limitations as adults, such as Andrew Marr, have done. I met a young boy recently, for instance, who had been allowed to put his stroke-disabled hand in his pocket and keep it there all day long.
That is why community charities are so crucial to continuing the work of the already stretched National Health Service, whose multidisciplinary teams have often completed their work as quickly as a few months from the initial stroke incident. Rehabilitation for children must be continuous, without let-up, to keep propped open the window of time that the brain is most plastic. A number of small charities across the country do this and there is an urgent priority for national support for their work. Many have proven records of successful rehabilitation which, of course, eventually saves the public purse huge sums in carer and ambulance call-out costs. Many are run by volunteers and operate on small private sponsorship. Yet it is to those very bodies that parents turn to request the provision of community therapy and training assistance for young stroke survivors.
We need the means effectively to help the young gain the post-stroke rehabilitation that they need to lead successful lives. A national rehabilitation service of the kind that my group hopes to see, co-ordinating the often disparate services that are currently available, would be an excellent way forward.
My Lords, I, too, thank my noble friend for raising this serious issue. For many of us, hearing the numbers has come as a surprise. I acknowledge the support I have had from the Stroke Association in getting together some of the research. I had certainly not heard of young children having strokes before my noble friend Lady Wheeler brought this subject to our attention. Looking at the statistics, it is alarming that around 400 young children have a stroke every year. A significant proportion can easily die as a result, and those who survive the impact of a stroke can perhaps be immensely more disabled, physically and emotionally, than they would have been had they been seen sooner.
As with strokes affecting adults, a quick diagnosis and rapid treatment are essential to help save lives and reduce the longer-term impacts in children and younger people. However, research recently carried out into childhood strokes in the UK shows that significant delays exist in diagnosis, with more than half of cases taking longer than 24 hours to be confirmed. This is because, as I said earlier, it is not something that one automatically expects.
I am now chairman of Milton Keynes Hospital NHS Foundation Trust. I was chairman of Barnet and Chase Farm until a month ago. In preparation for speaking today and considering the seriousness of the subject, I was delighted that I had the opportunity to speak to Kate Swailes, who is matron of paediatrics. Although Milton Keynes does not have a children’s stroke unit, it has an incredible adult stroke unit. During our discussion I tried to understand exactly what she would see if a child came into A&E. She confirmed that it was very difficult to identify whether a young person had had a stroke. Her view was that if they knew the child had sickle cell disease, or had had a fall or an RTA, they certainly would scan them. However, she was concerned that because clinicians did not get a lot of exposure to this, they might not be up to speed with it.
Kate Swailes did a lot of homework over the weekend before speaking to me on Monday and rang me this morning to wish me luck with this debate. She told me that she and her fellow clinicians, working with the OTs, physios and speech and language therapists, have now designed a poster, like the Act FAST campaign, and have put “This could be a child” across the top. Nobody has done that before as far as they are aware, so I was thrilled to bits, as I am sure that everybody listening will be. They have done that at Milton Keynes and want to make sure that the Minister is aware of it. Perhaps it is one of the answers to the Stroke Association’s question about what other tools we can make available for the recognition of children’s stroke.
The noble Lord, Lord Lingfield, mentioned Andy Marr. The main shock of reading about this hit home when I listened to Jackie Ashley, his partner and a Guardian journalist, when she came to my trust just a fortnight ago to recognise one of the initiatives that one of our academic nurses has undertaken, to get all the occupational therapists, speech therapists and physios together. She has put an accredited module together. All the nurses working on stroke wards at Milton Keynes now have this additional training module which makes them even more conscious of what they are looking for when they see a stroke patient and what they can do to assist before and after the therapist has already attended.
We have already made gains in having this discussion, but I say to the Minister—and I am sure that he is receptive to this—that the recognition that this debate is giving to the issue must be raised much higher in the health service. Is it possible to do something inside the department?
My Lords, this week, in advance of today’s debate, I looked at my copy of the second edition of the manual, first published in 2000, that is simply called Stroke. It was written by a team headed by Anthony Rudd, now the distinguished Professor Rudd of St Thomas’ Hospital. I could find no reference to children and young people in the index. I also looked at the NHS Stroke Handbook put together by the NHS North Central London Cardiovascular and Stroke Network and published a couple of years ago. Again, I could find no reference to children and young people.
There have been rapid advances, as the noble Baroness, Lady Wheeler, mentioned, in dealing with stroke over the last dozen years, and books and documents may have been revised to take account of stroke problems for children and young people. I see, for example, that there has been a Royal College of Physicians paper dated 2004. Either way, I am delighted that the noble Baroness, Lady Wheeler, introduced this debate and pleased that the Stroke Association is making a stand.
Every six weeks or thereabouts I walk across Hampstead Heath to the Royal Free Hospital in north London for a blood test to regulate my warfarin. Most of the patients are elderly, although a few are middle-aged. Others are physically disabled. However, I have not seen any children and young people. The problem is not visible to those many adults who have suffered a stroke and learnt to live with its consequences.
The Stroke Association says that the causes of stroke and the recommended treatment for children are different. In that case, how often is stroke diagnosed in children and how quickly can the necessary action be taken? Over the years, in debates in the House, I have asked whether GPs are trained and equipped to recognise the symptoms of stroke. I remain concerned that many GPs know little about stroke in the absence of direct experience of handling their own patients. On the assumption that the Minister will share our concern, can he tell us how the message can be passed on to GPs and reach those who have day-to-day contact with the public through their surgeries?
The noble Baroness, Lady Wheeler, expressly addressed the outcome of children and young people but the Stroke Association says that there needs to be research into the causes of childhood stroke. There is growing awareness of the characteristics and consequences of sickle cell disease and teachers should try to identify the potential signs of stroke. One of my daughters, a head teacher, tells me that among her 500 primary schoolchildren there is a girl who had a stroke at the age of two, resulting from moyamoya syndrome. She can understand but she cannot speak. Her teacher is almost one-to-one: she needs to communicate to the child in a very different way.
Seven years ago, my noble friend Lord Darzi set out a report called Health for London: A Framework For Action. It led to a major consultation and an agreement that certain hospitals should offer a top-quality service to stroke problems, recognising that all general hospitals could not offer the same level. I am not aware of how far this trend has successfully spread over and out of London and through the country. Given the need for services for children and young people, where are the services located—in general hospitals, existing stroke units or a high-quality specialist hospital?
There are many and rising demands on the National Health Service and costs have to be limited. The Stroke Association—a charity—has put £140,000 into research on childhood stroke at Bristol University. Does the NHS contribute to that Bristol fund? Can the Minister give an overall nationwide figure of money coming from public funds covering research on childhood stroke and where that research falls?
My Lords, it is a pleasure to take part in this debate. I declare an interest: at one time I was a council member of the Stroke Association and I chaired Stroke Scotland for a while. After the noble Baroness, Lady Wheeler, sat down I decided that my speech was not much good, so I will take a different approach to today’s debate.
I want to look at what an ideal service for children with stroke might look like. The ideal service would be when both parents and GPs are aware that children might have a stroke, but especially when paramedics and medical staff in accident and emergency departments have the knowledge that stroke is one of the differential diagnoses to consider for children with particular symptoms. These children should have rapid access to MRI scanning; currently that is not happening. They should have access to specialist staff to inform early acute intervention, either on-site or known at tertiary level centres for district-level medical professionals to contact for advice; a multidisciplinary team experienced in early sub-acute neurorehabilitation to commence the child on a pathway of care, including parent support and guidance from day one after diagnosis; supported transition into a rehabilitation setting, with in-patient beds for children and young people available equitably nationally; tertiary level out-patient services to support and guide local teams in their management and support of children and families; and flexibility in service delivery to work around the family, for example being able to respond when a new issue arises in the longer term around school, socialising, mobility and so on. A family support worker with experience of stroke should be available to the families from diagnosis through to long-term recovery, to signpost families to services across the NHS, social, education and charitable sectors. I know that that is a long list; but that is what an ideal service would deliver for the best outcome for children.
We can begin by in the first instance—as the noble Baroness, Lady Wheeler, mentioned—getting the guidelines updated, this time from the Royal College of Paediatrics and Child Health, with the help of NICE, which would possibly set the standards, which would then improve the commissioning process. We will have to go further than that. One other way would be to carry out in the first instance a national audit of stroke in children, as that would inform us how the services perform.
I will briefly address research areas that might be useful to improve the services in future. Currently we do not know much about interventions at the early stage—even, for instance, when anti-coagulation or blood-clotting drugs should be used. Research might be in areas such as what therapeutic interventions work and the type of intervention and dosage of drugs that will be required, in particular in motor/movement interventions for preschoolers and infants, and social, emotional and behavioural input for adolescents.
Intervention effects could be evaluated at the level of neural pathways through innovations and MRI imaging. For instance, I know that two centres in the United States are currently carrying out research into MRI imaging through neural pathways—as well as clinical evaluation of functional change. Questions that could be answered, but realistically only through multicentre studies to support a large sample size, include, when is the optimal time after diagnosis to intervene? How old should a child be to gain maximum effect? How intensive a dose of intervention should there be? What models of remote access to intervention are effective, such as telehealth, for parents and for children and young people, to support parents in managing stress, build resilience in young people to manage daily life challenges, and enable people to meet each other and provide mutual support? Those are some of the key areas of research that are required and should be supported.
In conclusion, the current service is not ideal, but we can begin to make it ideal. We have, even in this city, the Evelina Children’s Hospital and Great Ormond Street, which will match up pretty closely to this ideal service. They could be used as good practice places which other units can learn from. I hope that we might hear some positive answers from the noble Earl; I have no questions for him.
My Lords, I am grateful to the noble Baroness, Lady Wheeler, for initiating this debate on childhood stroke, a misfortune many will be surprised to learn children can suffer from. In fact, infants have the same risk of having a stroke as the old; an unborn child can have a stroke. One infant in every 4,000 live births has a stroke. It would be difficult to name an illness or disability more emotionally disturbing to a parent than a stroke occurring in a child. When it happens, a parent at first finds it hard to believe.
When I was young, both my parents died after having strokes, my father after several strokes. Between their deaths, someone I knew had a child of eight who suffered a stroke. Virtually nothing was done for my parents except to leave them to die in relative comfort. The little girl spent some time in hospital but was left partially paralysed, perhaps because it was a long time before what had happened to her was recognised and there was then no effective treatment. That was 40 years ago, and things have changed. Good care is now taken in hospitals and attention given to a parent’s psychological and emotional needs. There is recognition of the shock parents suffer when they learn of what has happened to their child.
The Evelina London Children’s Hospital, to which the noble Baroness, Lady Wheeler, and the noble Lord, Lord Patel, referred, is part of the Guy’s and St Thomas’ NHS Foundation Trust. It was founded in 1869 by Ferdinand de Rothschild, in memory of his English wife Evelina, who had died in childbirth. The hospital was restored and reopened in 2005 with 140 beds. At Evelina, the need of children to have their parents with them and the perhaps greater need of parents to be with their children is recognised, and there is no restriction on children and their parents being together. Parents can stay with their child at any time, and there is a pull-out bed next to the child’s bed.
Evelina collaborates with the Stroke Association in its Child Stroke Project. This provides tailored information for children, young people and families who are affected by stroke and offers emotional support in adjusting to the impact of stroke, while Scope runs a parenting befriending scheme called Face 2 Face. The Stroke Association has a helpline and provides support services across the country to help those affected by stroke to recover their lives.
Even more than the distress and anxiety caused to adults with stroke, childhood stroke brings fear and bewilderment to the parents of such children and it is they who need help and comfort. Apart from Scope’s Face 2 Face, the Stroke Association is now building a community of people who care about stroke and want to see people make the best recoveries. Emotional support is as crucial for recovery as physical rehabilitation, and stroke survivors’ emotional well-being should be a key part of their health and social care plans. Carers should be recognised as “partners in care” and included in the stroke survivor’s ongoing journey towards recovery. This must be especially true of stroke sufferers in childhood.
Investment needs to be increased in the provision of clinical psychologists, who should ideally be part of the multidisciplinary stroke team, both in hospital and in the community. Children and younger stroke survivors need ongoing support from diagnosis, through peer support groups and the transition to adult services, and this must include treatment of the emotional and psychological impact of stroke on children and their families. Specialist counselling is needed as children and their carers require individual attention specific to their needs.
The Stroke Association is asking health and social care providers to share their experience and successes. If such people are particularly proud of their service or the work they are doing to help people affected by stroke, they should get in touch with the Stroke Association’s campaigns website to share what they have discovered and achieved with others. Does the Minister agree that the passing on of such experience would be immensely beneficial to carers and parents of stroke-affected children, who can often feel isolated and forgotten?
My Lords, I thank the noble Baroness, Lady Wheeler, for introducing this short debate on stroke and young people. I shall concentrate on the young victims of sickle cell disease. It is, as other noble Lords have said, one of the major causes of stroke in young people.
Until I stood down last week, I was for some years vice-chair of the APPG on Sickle Cell and Thalassaemia. When my noble friend Lady Benjamin introduced me to His Excellency the Trinidadian High Commissioner and mentioned my involvement with the APPG, he looked somewhat quizzical. I explained that as I was susceptible to many modern diseases and had succumbed to many, both actually and hypochondriacally, the one I was unlikely to suffer from was sickle cell disease and therefore it was the disease I could speak about most objectively.
When the previous Labour Government announced the creation of a lead agent for adult stroke, I asked why they had not appointed one for children. Since sickle cell is the main cause of stroke in young people, was it because the Department of Health was unconsciously institutionally racist? Consequently, the Royal College of Physicians was swiftly announced as the lead agent for stroke in young people. Is this still the position? If so, what initiatives has the royal college taken since 2010 in relation to research into or treatment of the disease? Does the RCP make regular recommendations to the department and, if so, how many times has it done this since 2010? More generally, what initiatives has the Department of Health been involved with or know about?
This is a time of rapid advancement in both cell and gene therapy. It would seem opportune, therefore, to examine what likely improvements in the treatment of and research into sickle cell disease might be attempted, especially with regard to stroke in young people. I believe that there is a crying need, as other noble Lords have said, to develop a single centre of academic excellence to further both research and treatment. Accordingly, nearly two years ago, I enquired of all the London deans of medical colleges whether they would bid to host a dedicated chair in sickle cell disease in their institutions. They replied that they would all do so. Having got their assent, I next saw the Chief Medical Officer at the Department of Health and put the proposal for a dedicated professor and supporting staff to Dame Sally Davies, who, in her previous role as a consultant, had much experience of treating sickle cell patients. Her response was not encouraging. First, she could see no need for any special funding for research in the area. Secondly, no extra money would be made available. Thirdly, in her opinion there was too weak a gene pool of worthy professorial candidates in the UK who could fill such a chair.
That third reason is a damning indictment of successive Governments and agencies such as the MRC and other research foundations. Why has there been such a lack of concern and finance? In any case, why should the search for suitable candidates be confined to the UK? British universities attract many professors across disciplines from abroad, and I am sure that a visa would be awarded to a foreign expert to come and lead research into sickle cell if he or she could be found. At a meeting in November 2012, with Anna Soubry MP as the Minister responsible to Parliament for sickle cell disease, APPG officers put the idea of a chair to her and she responded enthusiastically. Unfortunately, her follow-up letter was written by the civil servants and did not reflect this but struck a depressing note as the official departmental line.
As an index of the trends at work, it is interesting to look at the role of the MRC and its increase in spending. What MRC funds were made available in 2012-13 for sickle cell disease? There has been a modest incremental increase, which is welcome, but the trend is still increasing. To what extent is the MRC adopting a strategic approach to sickle cell? Is it encouraging a centre of excellence or does it just respond to disparate bids? One way in which more money could be found perhaps is by greater co-operation within the Commonwealth. The MRC already gives money to the University of the West Indies centre for the treatment of sickle cell, which is commendable, but funds for pioneering research into the causes of the disease are lacking. Since the incidence of this disease is high in Africa and the Caribbean, as well as in the UK—and, for that matter, the USA—I urge Her Majesty’s Government to seek collaborative funding within the Commonwealth to secure adequate financing or research. Does the Minister agree?
My Lords, I was so glad when I saw that the noble Baroness, Lady Wheeler, had secured this debate. Since becoming the victim of a rather nasty disabling stroke some years ago, just a few months after being introduced in your Lordships’ House, I have, for very apparent reasons, taken a close interest in this country’s progress on prevention, diagnosis and treatment of stroke. The Government, the National Health Service and charitable groups such as the Stroke Association deserve congratulations on the improvements that we have seen in recent times in adult stroke diagnosis. I also acknowledge the improvement in later treatment, especially the use of the clot-busting thrombolysis drugs and rehabilitative support for adult victims but, wretchedly, this has not been matched in the area of childhood stroke. Too many parents of stroke-damaged children report that they have a constant fight so that their child can receive the essential care and treatment that they need.
Many people believe that strokes happen only to old people; tragically this is not so. Dr Anne Gordon of the Evelina London Children’s Hospital recently told a meeting of the All-Party Parliamentary Group on Stroke that as many as 1,500 children a year could be affected by stroke in the UK. Inevitably and tragically, a number of those die very soon after or during their stroke—and this brain attack, as it is sometimes called, is one of the top 10 causes of death in children. Of those who survive, can one imagine the enormous difficulties they have to overcome if they are to have a reasonable and fulfilling life to which all children should be entitled? But life is not fair and far too many of these young victims are not receiving the help and attention that they need.
I recall the feeling of dejection when I was first told, and understood, what had happened to me after my brain attack. Would I ever walk again? Would I get rid of that great wodge of cotton wool and glue which seemed to block my mouth and prevent me talking? Yet I was, and am, one of the more fortunate ones. I was in my mid-60s when I experienced this life-changing incident so, unlike young people in their early or formative years, I had already enjoyed a full, active and rewarding life.
Some days after that incident-filled and painful day, I stopped my selfish and self-centred thoughts about my own plight and the challenge which I now faced because I witnessed and was told of the difficulties and challenging times ahead for children. There were even some toddlers and babies who had suffered a stroke. How did they learn to speak and think in their native language when they had never known or experienced the joy of speech? If they are just toddlers, how do they learn to walk with one leg failing to play its part and simply getting in the way? Much more needs to be done to assist young people and children to cope with their dysfunctional limbs, brain and tongue, so what can be done to help these young people?
First, the improvements that we have seen in recent times in adult stroke care and support must be matched in the area of childhood stroke. There needs to be more work done to raise public and professional awareness of the risk factors, signs, progress and outcome of childhood stroke. The noble Lord, Lord Rodgers of Quarry Bank, mentioned the lack of understanding and knowledge among GPs. That applies in hospitals, certainly in accident and emergency departments. When I was taken in there, the colleague who was with me told the doctor what he thought had happened to me. I was conscious enough to understand that two doctors were standing by my bed saying, “What shall we do with him? Let’s put him in Elizabeth ward, as there is a spare bed there”. But did they attend the stroke or do something about it? No, of course not, so professionals must know more about the diagnosis and understanding of stroke—and I mean doctors and nurses.
There must be a particular and strong focus on improving specialist rehabilitation and long-term services and support for childhood stroke survivors and their families. Childhood stroke, as with that of adults, has an impact on the whole family but that impact and shock, it must be acknowledged, is greater when it is children who have suffered a fatal or permanently disabling stroke. Re-integrating a severely disabled child into the family not only affects the parents but has an adverse effect on the emotional and physical health of siblings, and even grandparents.
There is an urgent need to provide research into a more detailed understanding of childhood stroke and I hope that the Minister will assure us that financial provision will be made to tackle this problem. This should be government or public money and not left to charitable organisations such as the Stroke Association, which provided funding of more than £140,000 to a team at the University of Bristol for the biggest ever UK study into childhood stroke. It is simply disgraceful that the Government were able to find £100 million two years ago to introduce the farcical police and crime commissioner scheme, which the public said that they did not want. It will cost another £100 million to keep this highly discredited and increasingly laughable system going for the next 18 months. I plead with the Government to find an equivalent sum to save children’s lives and survive the devastation of a stroke. I look forward to the noble Earl’s answer.
My Lords, I express gratitude to the noble Baroness, Lady Wheeler, for raising this very important issue, and to all noble Lords who spoke for their valuable and excellent contributions. It will be difficult if not impossible to do justice to the points and questions in the time available, but I undertake to write on those that I am unable to cover today.
Strokes in children are thankfully uncommon, but the effects of a stroke can be devastating both for those who have one and for their families and loved ones. This is particularly the case with children, where a stroke may have a lasting impact on their development and educational attainment, with grave implications for their future.
It is important therefore that there is awareness of childhood stroke. Public Health England is responsible for awareness campaigns and has run the Act FAST campaign to raise awareness of stroke for the last six years. It is its most successful campaign. The Act FAST campaign depicts older adults, and, while there is no specific focus on children, the message remains the same. However, as many noble Lords will know, the signs of a stroke in infants and young children may be less obvious, and Public Health England will want to consider whether a specific campaign aimed at raising awareness of strokes in children is needed.
The provision of stroke care by the NHS necessarily embraces a wide range of different services. There are different causes of stroke in children—including disorders of the heart, blood and vascular system, as well as infections—and the effect of strokes will also be different. As noble Lords will know, there is a heightened risk of childhood strokes from certain variants of sickle cell anaemia, for which all newborn babies in England are screened with a heel-prick test. I will write to my noble friend Lord Smith in answer to his questions on this subject.
The risks of stroke for children with these variants of sickle cell disease can be assessed using a test known as a transcranial Doppler scan, and those deemed at high risk can be treated with blood transfusions. An annual scan is recommended for children with these variants of sickle cell disease, and NICE guidelines and a national screening programme for sickle cell are already in place.
Not all strokes can be prevented, though, and where a child does suffer a stroke it is important that they get the right treatment. Where a stroke leaves a child with complex or specialist needs, their treatment will normally be delivered through specialised paediatric neurology services commissioned by NHS England. Noble Lords will be pleased to hear that NHS England is running a number of pathfinder projects looking at the care processes for paediatric neurosciences through its Paediatric Neuroscience Clinical Reference Group. This work seeks to define the best arrangements for paediatric neurology patients and encompasses children’s strokes. In addition, the Royal College of Physicians is currently updating its 2004 guidelines on childhood stroke and I would expect these standards to be considered by the Paediatric Neuroscience Clinical Reference Group in due course.
I understand the call to integrate childhood stroke into the cardiovascular diseases outcomes strategies. NHS England is currently leading a group to implement the 10 key actions to improve outcomes for cardiovascular disease. It would be for NHS England, working with key stakeholders, to consider whether childhood stroke should be included in this work, and I will ensure that it is made aware of noble Lords’ views on this issue. I am sure that NHS England will look to encourage an integrated and life-course approach to stroke care, ensuring that paediatric care is appropriately aligned with adult strategies.
Mainstream services, including ongoing care, for supporting children who have had a stroke—and their families—are commissioned by clinical commissioning groups. It is worth recognising that clinical commissioning provides an effective basis for ensuring that children who have suffered a stroke are effectively supported: CCGs are under a duty to obtain appropriate advice from persons who, taken together, have a broad range of professional expertise in the prevention, diagnosis or treatment of illness. This is essential for such a complex area of clinical practice which must be informed by emerging evidence.
The noble Baroness, Lady Wheeler, and the noble Lords, Lord Patel and Lord Imbert, referred to the need for research. As far as evidence is concerned, the National Institute for Health Research currently funds two studies on childhood stroke through its biomedical research centres at Imperial College and Great Ormond Street Hospital, including one looking at the outcomes of childhood stroke. The NIHR welcomes funding applications for research into any aspect of human health, including the needs of children and young people who have had a stroke.
A number of noble Lords, including the noble Baroness, Lady Wheeler, mentioned the need for good rehabilitation services for children. We are aware that there is a significant issue around capacity in paediatric neurological rehabilitation in England. I understand that NHS England is currently undertaking work to assess future capacity needed. Any expansion of capacity would, of course, have cost implications. In addition, in April 2014, NHS England established the specialised commissioning task force to make immediate improvements to the way in which NHS England commissioned specialised services, and put commissioning arrangements on a stronger footing for the longer term.
I mentioned the pathfinder projects looking at end-to-end care processes for paediatric neurosciences. In addition, I am advised that NHS England has indicated that it will ensure that due consideration is given to the Royal College of Physicians guidelines for treating children who have suffered strokes.
My noble friend Lord Rodgers made the telling point that GPs should be required to do training in child health. As part of the mandate to Health Education England, it committed to ensuring that GP training produces practitioners with the required competences to practise in the new NHS. To support this, Health Education England has been asked to work with the devolved Administrations and the Department of Health on responding to the recommendations of the Shape of Training report on postgraduate specialty training, and the provisional findings of NHS England’s review of primary care services. The case for a fourth year and enhancements to GP training will be explored further as part of this response, including specific training in that extra year in child health and paediatrics.
The noble Baroness, Lady Wall, and my noble friend Lord Rodgers raised concerns about the time until diagnosis. We are committed to working to improve the health outcomes delivered by the NHS for children. That is why we set up the Children and Young People’s Health Outcomes Forum in 2010. Its report set out a number of recommendations. One which we are working on is to develop a new indicator which would report the time from the first presentation to the NHS to definitive diagnosis and start of treatment.
As part of our response, we made a pledge alongside key partners, including NHS England, NICE, Health Education England and the Society of Local Authority Chief Executives, to work together to improve health outcomes for children. Our shared ambitions are for children, young people and their families to be at the heart of decision-making. Together, the organisations who signed the pledge are making progress towards meeting those ambitions. However, there is much work to be done and the Children and Young People’s Health Outcomes Forum will continue to actively monitor progress on the action taken as a result of the recommendations made in its initial report published in July 2012. This work will help to improve the outcomes and experience of children who suffer strokes and their families.
In reply to the noble Lord, Lord Patel, I say that the new integrated arrangements for children and young people with special educational needs, which the Children and Families Act introduces from September, are the ideal basis for ensuring that special educational services and social care can be planned in a joined-up way with the healthcare that a child needs arising from a complex condition. Children with SEN will have an education, health and care plan, which different sectors will come together to assess and plan for, focusing on the outcomes which make the biggest difference to the child. We are committed to ensuring that staff who work with children have the right skills and experience. That is reflected in our mandate to Health Education England.
There are therefore a number of opportunities on the horizon which could contribute significantly to improved outcomes for childhood stroke, and I again thank all noble Lords who have spoken in this excellent debate.
North Korea: Human Rights
Question for Short Debate
My Lords, on 21 March 2013, the United Nations Human Rights Council established the Commission of Inquiry on Human Rights in the Democratic People’s Republic of Korea, with a mandate to,
“investigate the systematic, widespread and grave violations of human rights in the Democratic People's Republic of Korea, with a view to ensuring full accountability … for violations which may amount to crimes against humanity”.
North Korea’s scant respect either for its own people or for the people and security of the region as a whole is underlined by the launching of artillery shells and short-range ballistic missiles into the Sea of Japan, concomitant with the squandering of desperately needed resources that could be used to feed the millions of North Koreans who suffer acute malnutrition and chronic food shortages. Four times in the past two weeks alone, North Korea has test fired short-range missiles and rockets, and threatened a fourth nuclear test in violation of United Nations sanctions.
While 84% of North Korean households have borderline or poor food consumption, it is reported that in 2012 Kim Jong-un spent $1.3 billion on North Korea’s ballistic missile programme, in addition to $300 million on leisure facilities and nearly $700 million on luxury goods including watches, handbags and alcohol. Set against that, the findings of the commission of inquiry, which completed its investigation and released its findings last February, should be looked at from an accurate perspective. Its report detailed a truly shocking disregard for humanity, which included,
“extermination, murder, enslavement, torture, imprisonment, rape”,
“and other grave sexual violence and persecution on political, religious and gender grounds”.
The chairman of the commission, Mr Justice Michael Kirby, found many of these violations committed by the Government of North Korea to be,
“without parallel in the contemporary world”,
and to constitute crimes against humanity.
It will come as no surprise to noble Lords that at every stage the Government of North Korea refused to co-operate with the commission’s investigation and have since dismissed the report as,
“a product of political confrontation and conspiracy”,
and rejected its findings. During the four visits that I have made to North Korea, three of which were with my noble friend Lady Cox, I have been deeply impressed by the dignity and forbearance of the North Korean people, but equally dismayed and saddened by the hateful ideology that criminalises and brutalises its people.
Some North Koreans who have fled their country were able to testify at the commission’s public hearings in Tokyo, Seoul, Washington DC and here in London. Some originally gave their testimonies to the All-Party Parliamentary Group on North Korea, which I have chaired for the past decade. While mentioning the APPG, perhaps I may thank James Burt, its honorary secretary, for his work in preparing for today’s debate. It hardly needs saying that the bravery of the testifying witnesses has been remarkable; one of them is with us today. Many have families in North Korea, who remain in constant fear of reprisals. In breaking the wall of silence that surrounds the DPRK, those who have escaped—including 25,000 who now live in the Republic of Korea, and 700 or 800 who live in the United Kingdom—have been game changers.
As we meet today, 11 North Korean escapees are languishing in prisons in China’s Jilin province—a region I visited 18 months ago. I wonder whether the Minister can tell us whether Her Majesty’s Government would be willing to appeal to China to accept its obligations under international law and not return those escapees to North Korea, where they face persecution, torture and possible death. I hope that China will give serious thought to relaxing its policy of repatriation, not least because the commission of inquiry’s report describes how pregnant women are forcibly aborted and their newborn babies killed if it is thought that mothers have “diluted” the Korean bloodline by bearing a child with a Chinese parent. Not only is this ugly racism, it is utterly lacking in humanity and deeply offensive to China.
For terrorised North Koreans and the international community alike, the commission has marked a turning point. For too long, states have claimed that too little was known of the extent of North Korea’s crimes to justify action. In the words of Mr Justice Kirby:
“Now the international community does know. There will be no excusing a failure of action because we didn’t know…The suffering and the tears of the people of North Korea demand action”.
The findings detailed in the commission’s report stretch to well over 300 pages, and time does not permit a detailed overview. I know that other noble Lords will enlarge on some of these points but, in summary, the commission found that the freedoms of thought, expression and religion were routinely and brutally curtailed in the North Korean state. North Koreans are discriminated against on the basis of class, gender and disability. The vast majority of North Korean citizens are unable to leave their own country, choose where they live or decide where they work. The withholding of food by the North Korean state constitutes an explicit policy of enforced and prolonged starvation, which contributed to the deaths in the 1990s of at least 1 million people, with some estimating that as many as 2 million people died. Detention, torture and execution are established tools of social control. The abduction of foreign nationals has been routine. Up to 120,000 North Koreans face starvation, torture, forced labour, sexual violence and execution in the country’s political prison camps.
The inquiry found evidence of crimes against humanity. One firm of celebrated lawyers also suggested that the evidence points to genocide against the country’s Christians—a point to which my noble friend Lady Cox will return. My noble and right reverend friend Lord Eames will refer to some of the other issues that have been raised in the report. One of its underreported aspects is gender-based crime against women; another is the indoctrination of children. I wonder whether violence against women was raised during the recent conference on preventing sexual violence in conflict.
One witness who fled North Korea told the commission:
“You are brainwashed”,
“don't know life outside. You are brainwashed from the time you know how to talk, about four years of age … North Korea is not open to the outside world”,
“is a fenced world ... They want the people to be blind, deaf to the outside world, so that the people won’t know what is happening”.
The CoI report challenges us to think about how we counter hateful propaganda and that wall of silence, and how we break the information blockade. This is why Mr Justice Kirby supports the extension of BBC World Service transmissions to the Korean peninsula. The All-Party Parliamentary Group has heard from groups that have successfully broadcast into the country, and also from North Koreans who escaped and who told of the importance of foreign broadcasts.
Only yesterday, along with other members of the group, I met with Diane Coyle, the acting chair of the BBC. I have reiterated on many occasions, as have other noble Lords, that it would cost only about £1 million to commit to broadcasting to North Korea, compared to DfID’s budget of £12 billion. Surely this is money that we can find, to at least try to form some of those who have escaped into tomorrow’s journalists. Maybe that is an issue that the Minister could pursue with the BBC Media Action programme.
How do we intend to honour our obligations under Article 19 of the 1948 declaration if we are unwilling to break the information blockade? I have no problem with cultural programmes; but if that is all we do we will be failing North Korea. Instead of telling us about photographic exhibitions or cultural exchanges, I hope that the Minister will tell us whether any human rights projects, for instance, are going to be implemented in North Korea and how we will break the information blockade.
I was saddened that in a recent article a former FCO chargé d'affaires in Pyongyang, Jim Hoare, questioned the place of human rights in our engagement with North Korea, claiming that,
“human rights issues have proved a complication”,
to the UK's cultural projects in North Korea, and that a,
“modestly-successful parliamentary linkage seems to have more or less ceased because of the preoccupation with human rights of many British parliamentarians”.
It is the job of parliamentarians to be preoccupied with gross human rights violations, and I would hope that it is a preoccupation that the Government and their officials might share. Engagement with North Korea is not always the same as engagement with the North Korean state. The biggest improvements to the rights of North Koreans have come in spite of the North Korean Government, not because of it. We must engage with the victims of human rights abuses as well as the perpetrators.
When the United Nations Human Rights Council met in March to discuss the report, both it and the United Kingdom voted to recommend that the General Assembly should submit the report to the Security Council for appropriate action, which could include a referral to the International Criminal Court. Can the Minister tell us whether we will be seeking a Security Council resolution, a referral to the ICC or another judicial tribunal and an expansion of the existing sanctions regime to cover human rights violations?
The resolution also called upon member states to consider implementing the recommendations as laid out in the CoI’s report. Can the Minister tell us how many of the CoI’s recommendations that pertain specifically to states Her Majesty’s Government have implemented thus far?
As this report describes, North Korea is a country that is beyond parallel. The United Nations special rapporteur, Mr Darusman, recently said, following the publication of the report:
“There is no turning back; it cannot be ‘business as usual’.
Dietrich Bonhoeffer, who was executed by the Nazis, once said:
“We have been silent witnesses to evil deeds”.
Let that never be said of us.
My Lords, the UN Commission of Inquiry on Human Rights in the Democratic People’s Republic of Korea is a devastating indictment of life today in North Korea. It makes explicit reference to violations of the right to food; violations associated with prison camps, torture and inhuman treatment, arbitrary arrest and detention; and violations of the right to life and freedom of expression. It paints a detailed picture of a society that exists on fear and intimidation. It talks about a captive people cut off from the outside world.
As one who visited North Korea in 2007, I have seen something of the atmosphere that prevails in the lives of ordinary people. I was asked by the then Archbishop of Canterbury to lead an international delegation of Anglican communion members to present the proceeds of a world appeal in the aftermath of the floods and storms that devastated North Korea. Despite the outward appearance that I was presented with—the official face of North Korea—nothing could hide the stark realities of everyday life: the subjection of its people; the isolation of villages completely cut off from each other; the enforcement of strict measures by the military; and the fear of foreigners.
However, the difficulty of a report such as we are discussing today is even more than the tragic picture it paints. It is surely the question, “What now?”. Nobody denies the details of life in North Korea it contains; but what are the opportunities for the UK Government to bring about change in that hidden country? What can the outside world actually achieve in the face of the almost total isolation of North Korea? Article 2 of the Universal Declaration of Human Rights states:
“Everyone is entitled to all the rights and freedoms set forth in this Declaration, without distinction of any kind”.
In light of this, it may surprise noble Lords to learn that North Korea has acceded to the Convention on the Elimination of All Forms of Discrimination against Women. Yet the commission reported that domestic violence is still rife in North Korea and that it is quite common to see women beaten and sexually assaulted in public. North Korean officials are said to exact penalties in the form of sexual abuse and violence with no fear of punishment, while single women who seek membership of the Workers’ Party of Korea are subjected to sexual abuse. It was even testified that the rape of adults is not really considered a crime in North Korean society.
Despite all the attention given to the CoI’s report by the international media and Governments around the world, gender-based violence has been the most overlooked aspect of the report. The former Foreign Secretary has been vocal on the role of the UK in ending sexual violence, most notably in his establishment of the Preventing Sexual Violence Initiative. Can the Minister assure us that the FCO has been vocal on this issue in its dealings with the Government of North Korea? He may wish to consider matching FCO spending on cultural programmes in North Korea, mentioned by the noble Lord, Lord Alton, with spending on projects designed to improve the rights of women in that country.
In its report, the commission documented countless violations of the freedom of thought, expression and religion in North Korea. Using the International Covenant on Civil and Political Rights as its benchmark, the commission concluded that the indoctrination of the North Korean population has been implemented to such a degree that the emergence and development of free thought and conscience is entirely suppressed. Such extreme indoctrination is not reserved for adults; the indoctrination of children is routine.
Children are taught violence and hatred of the outside world. Their aspirations are not set for personal betterment, but to aspire to and emulate their former leader, who remains the country’s “eternal president” despite his death in 1994. One witness even claimed that as a child he was only interested in becoming a great warrior in order to become a killer of his enemies. Children who do not live up to such hateful standards are instructed to publicly berate themselves in weekly confession and criticism sessions. The children we are talking about are aged four. In their project for North Korea, this Government concerned themselves with children’s care institutions and teaching programmes. The Minister may wish to consider how teaching programmes may challenge the indoctrination of children, which seeks to imbue North Korean children with hatred.
I am particularly concerned about the position of religion and religious groups in North Korea. The Christian community is totally outlawed. Public worship is banned. Freedom to express the Christian faith is forbidden and those who refuse to renounce Christianity are subjected to imprisonment, torture and even execution.
I have two final points for the Minister. Some weeks ago she responded to remarks we made about the work of the BBC overseas and the hope that one day a way would be found to encourage its use in North Korea. What encouragement can the UK Government give to the BBC to consider this possibility afresh? Secondly, our embassy in Pyongyang presents an opportunity to do things that are denied to some of our partners. Is the Minister satisfied that we are making the most use possible of this facility?
My Lords, I am grateful to the noble Lord, Lord Alton, for securing this important and timely debate. The report of the United Nations commission makes horrifying reading, and it is surely incumbent on the democratic and free world to read, reflect, take counsel and take action. There is great evil in the North Korean regime, which the civilised world cannot simply ignore: not just because it threatens regional and world peace, although it does; not just because millions of innocent people are suffering, although they are; not just because every human right is being trampled, although it is; but, ultimately, because not to do anything about evil on this scale is to collude with it.
The Diocese of Peterborough is twinned through the Anglican Communion’s companion link scheme with the Diocese of Seoul in South Korea. That has given me the privilege of visiting South Korea, studying its history and culture, getting to know its people and seeing some of the wonderful work that the church does there. British people, even Members of your Lordships’ House, may be surprised to know that the Christian church is alive, strong and remarkably influential in South Korea—as it was in the north before the communist takeover. In the 2007 census, 46% of South Koreans identified themselves as having no religion; 29% as Christian; 23% as Buddhist; all other faith groups put together made up the other 2%.
Christianity has become the largest religion, and thrives. South Korea is second only to the United States in the number of its people travelling abroad as Christian missionaries. Internally, the Christian faith has had and continues to have great influence for the good on civil society, human rights—especially of women and children—and democracy.
During my most recent trip in May, I visited schools, residential homes and work projects for people with disabilities, migrant workers and others often seen as excluded in advanced industrial societies. Previously, I have visited major projects to feed and care for the homeless and a large residential home for the elderly, with high-dependency medical facilities and staff. All those projects are run by the Anglican Diocese of Seoul, sometimes under licence or with funding from the city council, sometimes simply as Christian charitable ventures. The big society—are we still allowed to use that phrase?—is alive and flourishing in South Korea, making civil society and people’s lives better.
The growth and influence of Christianity, not least through Minjung theology, which focuses on the image of God in people, their intrinsic worth and the need to lift them out of oppression and suffering, has been huge. The older Confucian hierarchical structure gave little or no value to individuals, and none to women or children. That culture has been totally transformed, largely through Christian influence.
My visit earlier this year followed shortly after the terrible ferry tragedy in which hundreds of children died. Seoul was covered with yellow ribbons in tribute to those children. The Government were in severe difficulty because of the avoidable accident. Those responsible were being prosecuted. Questions were being asked about how institutions and individuals could fail to protect children. Human life is now valued in South Korea as much as in the West, and that process has reached the point of looking for special protection for the weakest and most honourable. Christian influence and values have achieved that.
The process of advancing human rights and democratisation began across the whole of Korea before the Korean War, but has been effectively crushed in the north since then. I have also visited the demilitarised zone. I have not yet visited the north, but I have seen in Seoul’s Anglican Cathedral photos and lists of Christian leaders martyred by the communists during the Korean War, including the dean of the cathedral and the mother superior of the Anglican convent next door, where I stayed in May.
I have met some of the people involved in the Anglican Church’s remarkable initiative, TOPIK—Towards Peace in Korea. That organisation, which last year put on a major peace conference in Okinawa, Japan, works for the peaceful reunification of Korea. It provides famine and flood relief for North Koreans, and from time to time gets permission from the Pyongyang Government to take aid in. It promotes dialogue with North Koreans, and helps some of the few North Koreans who escape the brutality of their regime to resettle in the south.
I do not need to catalogue the horrors perpetrated by the regime in the north—the report does that. So do the testimonies of those who have escaped from the concentration camps, some of whom have been to speak to the All-Party Parliamentary Group on North Korea, as we have heard. I do not need to remind noble Lords of the brutal attempt to wipe out religion, particularly Christianity—the report does that. So do the accounts of various atrocities brought to us by agencies such as Christian Solidarity Worldwide.
I am neither diplomat nor politician, but certain things are clear to me. First, keeping North Korea isolated, treating it like a pariah state, will not help. It may well be that individual leaders need to be brought to the bar of international justice, but the state itself and its people must be cared for as part of the human family rather than demonised and held at arm’s length. Western and Asian Governments should press for aid agencies to be allowed in, and should offer to feed a starving people. Diplomatic channels should be kept open. Ideally, China would help Pyongyang to be more open to the rest of the world.
Secondly, the Government of South Korea should be encouraged and helped by the rest of the world to continue to work and prepare for reunification. Such work is going on under President Park, but more is needed. The economic cost of reunification will be enormous, even for a relatively wealthy country such as South Korea. The infrastructure of the north is virtually non-existent, millions have starved in recent years, hundreds of thousands are in concentration camps, and there is no freedom or civil society. The civilised world needs to be ready to stand alongside South Korea for this enormous humanitarian nation-building task.
Thirdly, the people of North Korea must be helped to prepare for a better future. Some Christian and other agencies are already doing that on a small scale, at great risk to themselves. However, the world can and should do more. As has been noted already, the failure of the BBC to provide a Korean service to reach the north, and the failure of our Government to encourage and even fund the BBC to do that, is quite inexplicable. That sort of outreach helped prepare the people of eastern Europe, and most recently the people of Burma, to aspire to and then live in a freer society. The BBC has changed and is changing, but surely its responsibility to promote our democratic and free values—not least in places where they are under threat or do not exist—must remain.
The world community cannot simply ignore the plight of the people of North Korea. They are our brothers and sisters in the human family, and we have a responsibility towards them.
My Lords, I, too, congratulate my noble friend Lord Alton on securing this debate, on his tireless dedication to human rights and freedom around the world, and on his leadership on the situation in North Korea. As has been mentioned, I have had the privilege of travelling with my noble friend to the DPRK on three occasions and serving as vice-chairman of the All-Party Parliamentary Group on the DPRK. I echo all the points my noble friend made.
North Korea is the world’s most closed nation, in which every article in the Universal Declaration of Human Rights is violated, and it has been aptly described as “one large prison”. As has already been emphasised, the report by the UN commission of inquiry has helped to put North Korea’s appalling human rights record higher up the international agenda and has shone a light on one of the darkest corners of the world. Among the catalogue of crimes against humanity which the commission has documented are the denial of freedom of religion and the brutal persecution of religious believers, which I wish to highlight today, echoing concerns eloquently expressed by the right reverend Prelate and other noble Lords.
According to the UN inquiry:
“There is an almost complete denial of the right to freedom of thought, conscience and religion, as well as of the rights to freedom of opinion, expression, information and association”.
It concludes that the regime,
“considers the spread of Christianity a particularly severe threat”,
and as a result:
“Christians are prohibited from practising their religion and are persecuted”.
Severe punishments are inflicted on “people caught practising Christianity”. We know from many testimonies of North Korean refugees that possessing a Bible in North Korea can lead to execution and/or incarceration in prison camps, being subjected to severe torture, inhuman conditions and, in some cases, slave labour.
I remember one story of a labour camp based in an iron foundry. One day, all the inmates were forced to stand in a large circle and the three Christian prisoners there were put in the middle. They were given an ultimatum: either they recanted their faith or they would die with molten iron poured over them. They refused to recant and they died singing praises to God as the molten iron was poured over them.
Although the DPRK’s constitution allows for freedom of religion in Article 68, in practice any belief that dissents from total loyalty to and worship of the Kim dynasty is a crime. An edict from Kim Il-sung declared that,
“religious people should die to cure their habit”.
The current ruler, his grandson Kim Jong-un, continues this policy. In 1950, 24% of the North Korean population practised religion. Today, that figure is just 0.16%. With the exception of the four state-controlled Potemkin-style churches in Pyongyang, which I and my noble friend have visited, Christians and other religious believers in North Korea worship in secret and in fear.
An indication of how the regime views religion—specifically Christianity—is seen in the response of the DPRK’s ambassador to the UN after the UN Human Rights Council’s universal periodic review. He highlighted the activities of Christians working among North Koreans in China, saying:
“There are in the northeastern area of China so-called churches and priests exclusively engaged in hostile acts against the DPRK. They indoctrinate the illegal border crossers with anti-DPRK ideology and send them back to the DPRK with assignments of subversion … human trafficking and even terrorist acts”.
China’s policy of forcibly repatriating North Korean refugees and sometimes arresting Christian missionaries who help them is cause for serious concern. North Korean escapees who are sent back into the DPRK face dire consequences, particularly if they are suspected of having converted to Christianity, of having been in contact with Christian missionaries or of possessing a Bible. I ask the Minister whether Her Majesty’s Government have raised these human rights violations with the Chinese authorities and, echoing the query raised by my noble friend Lord Alton, whether HMG have urged China to stop arresting missionaries and refugees and to end its policy of forcible repatriation.
A month ago, an international law firm, Hogan Lovells, commissioned by an international network of NGOs known as Human Liberty, published an independent legal analysis of North Korea’s human rights record, concluding that the DPRK’s targeting and extermination of religious groups might indeed constitute genocide. Christian Solidarity Worldwide’s 2007 report, North Korea: A Case to Answer—A Call to Act, also concluded that there may be “indicators of genocide” in relation to religious persecution. I ask the Minister to clarify Her Majesty’s Government’s response to the Hogan Lovells report. What steps are they taking to address the severe violations of freedom of religion and other human rights in North Korea, including lack of accountability and widespread impunity?
I also want to raise, briefly, two other issues: the information blockade, highlighted again and again by my noble friend Lord Alton and other noble Lords because it is so important; and humanitarian crises. Only by breaking the regime’s information blockade can the people of North Korea be given alternative ways of thinking to the propaganda that they are fed daily. I did a lot of work behind the iron curtain in the dark days of Soviet communism, and particularly martial law in Poland, and I remember how eagerly the people trapped behind the iron curtain yearned to hear news from the BBC and from the West. It was transformational in keeping them in touch with the wider world and giving them alternative ideas in preparation for the time of transition.
I therefore reiterate the view expressed on many occasions by many noble Lords that the BBC World Service should reconsider a Korean-language broadcast, especially as the UN inquiry notes the importance of foreign short-wave radio broadcasts. It calls on the international community to provide more support for the work of civil society organisations and to make efforts to broadcast accessible information to the country.
The inquiry also highlights North Korea’s dire humanitarian crises, concluding that the deprivation of food, calculated to bring about the destruction of part of a population, amounts to virtual extermination. In addition to the regime’s policies, which have caused food shortages and distributed food on the basis of political class, the international community also bears some responsibility. While there are legitimate questions to be asked about transparency and accountability of aid, what assistance will Her Majesty’s Government provide, and might that increase to meet the very real humanitarian crisis?
North Korea’s healthcare system is another issue needing urgent attention. The Guardian in April reported North Korean refugees describing a health system with,
“broken equipment, declining treatment standards and widespread self-medication”.
When my noble friend and I were in Pyongyang on one of our visits, we were told by local people that the contents of the first aid kit in our vehicle represented more equipment than would be found than in many a rural primary healthcare clinic in North Korea.
A US doctor, Ryan Choi, in a new paper on healthcare in North Korea, describes a healthcare system in shambles. The downstream effects are food shortages, a shortage of domestically produced pharmaceuticals, breakdown of the sanitation system, a shortage of medical supplies and, very seriously, a resurgence of infectious disease and a rise in mortality and morbidity. A 2010 report by Amnesty International paints a similarly disturbing picture. Are Her Majesty’s Government providing any assistance to address this crisis in the DPRK’s healthcare system?
I conclude with the words of the UN special rapporteur on human rights in the DPRK, from his most recent report. He said:
“The work performed by the commission of inquiry should be seen as the beginning of a process, not the end … The post-commission era presents a new phase for the human rights of the people of the Democratic People’s Republic of Korea … and requires a decisive change in the approach going forward ... The international community must set in train immediate, impartial and just action to secure accountability, fulfil the responsibility to protect, put human rights first and stop grave human rights violations, in accordance with international law ... The revelation of the truth, international scrutiny and sustained pressure have had some initial effects and will continue to do so”.
I hope the Minister can provide assurances today that Her Majesty’s Government will treat the desperate human rights and humanitarian situation in North Korea with the urgency and priority that are so desperately needed.
My Lords, I am grateful to the Deputy Chairman, to my noble friend Lord Alton and to other Members of Committee for allowing me to speak in the gap. I congratulate my noble friend—and he is my noble friend—Lord Alton on calling this debate and I pay tribute to him for his tenacious and courageous commitment to the endeavour of securing respect for human rights and democracy in North Korea.
We have heard this afternoon that the 2014 report of the commission on human rights in the Democratic People’s Republic of North Korea sets out clearly the horrific and cruel nature of the regime. In the first paragraph of its conclusions and recommendations, it says that,
“systematic, widespread and gross human rights violations have been and are being committed by the Democratic People’s Republic of Korea, its institutions and officials. In many instances, the violations of human rights found by the commission constitute crimes against humanity”.
Those are serious charges. It goes on to say:
“The gravity, scale and nature of these violations reveal a State that does not have any parallel in the contemporary world … a State that does not content itself with ensuring the authoritarian rule of a small group of people, but seeks to dominate every aspect of its citizens’ lives and terrorizes them from within”.
Amnesty estimates that more than 100,000 North Koreans are in prison camps, often at the whim of some apparatchik; slave labour, child abuse and torture are commonplace in these camps. Prisoners have little food and hundreds of thousands—possibly millions—of people have died in these camps since the 1950s.
In 1945, when the full nature of the heinous Nazi crimes became apparent, the free world wondered why it had failed to act, in the face of far less compelling evidence. We know what is happening in North Korea. We in Britain have a dilemma. We do not have the military or financial power to topple the regime. It is also in the best interests of those who sincerely wish to effect change and bring about democracy and respect for human rights in North Korea for us to preserve our embassy and representation in that brutally afflicted country.
Recently I took part in a debate on defence. I and other noble and noble and gallant Lords highlighted the fact that the world is becoming an increasingly dangerous place. It is not just the intractable Israel, Palestine and Middle East conflicts, and the conflicts that beset almost the entirety of Africa from north to south; it is the conflicts in Ukraine, India and Pakistan and the continued tension between China and Japan, as well as other conflicts in other parts of the world. Those of us who are deeply concerned about North Korea fear that the conflicts raging elsewhere are bound to take the attention and priority of the nations that can effect change in North Korea. I refer principally to China.
Our relations with China seem to be on a constructive course and there is some evidence that China takes an increasingly critical view of the horrors that the North Korean regime inflicts on its people. The United Nations special rapporteur’s report on human rights of June 2014 makes certain recommendations in paragraphs 51 and 52 in respect of neighbouring and other states concerned.
Paragraph 51 starts:
“On the issue of refoulement”—
that is, forced repatriation—
“the commission of inquiry recommended that China and other States should respect the principle of non-refoulement and, accordingly, abstain from forcibly repatriating any persons”—
I will finish by saying that we know how sensitive the matter is. We in Britain have a great deal of influence in the world. We in Parliament must continually impress on our Government the necessity to bring about the changes that should have been made decades ago to this cruel, unforgiving regime, which has for years imposed itself on the people of North Korea.
My Lords, the House again owes a debt to the noble Lord, Lord Alton, not just for obtaining this debate, but for the extraordinary work he has done in relation to North Korea for many years—often in association with the noble Baroness, Lady Cox. Without him, the public, Parliament and—dare I say—Government would be much less well informed than they are. He has raised this issue up the agenda, where it should and must be.
Reading the commission’s report was unlike reading any other report I can remember. In clear, reasoned and judicious terms, it sets out what the horror of being a citizen of North Korea today involves. Life in North Korea would be a classic case of dystopia, except that it is not imaginary. It is real. George Orwell’s magnificent imagination, which created Oceania in the wonderful novel Nineteen Eighty-Four, perhaps gets closest to it, but by comparison Oceania seems positively liberal.
In short, the report is a shocking read and noble Lords in this debate with much more expertise than me have spoken of their response, and it is difficult to say anything original or new. As has been pointed out, the challenge is how to respond to such a regime. Of course, engagement is the right course, difficult as it is in practice, provided—and this is a big proviso—that we never leave behind human rights issues. That is why our diplomatic presence in North Korea is to be welcomed. It is also why the work of the British Council—here I again declare my interest as chair of the British Council All-Party Parliamentary Group—is to be admired and encouraged. It was good to read the speech made by the Minister’s colleague, the right honourable Hugo Swire, in a debate in another place on North Korea on 13 May when he said that,
“through the British Council and educational immersion programmes, we have provided thousands of North Koreans with their first access to a foreigner and an understanding of British culture and values”.—[Official Report, Commons, 13/5/14; col. 236WH.]
It is also why it is right for noble Lords today to have been pressing, in a proper and appropriate way, for the BBC to set up broadcasts to the Korean peninsula. If ever there were a people who needed to hear the World Service and for whom the World Service was appropriate, it is surely the North Koreans. However, we must never not talk about human rights.
In a major debate in your Lordships’ House on 21 November last the noble Lord, Lord Hannay, made an important point when discussing how to respond generally to human rights abuses:
“In considering how Britain should respond to human rights abuses, I suggest that one mistake we need to avoid is looking at the issue principally, or even solely, in the context of our bilateral relationship with the country in question. However, Britain’s influence and leverage are unlikely to be decisive nowadays. All too often we have seen how easy it is for the country in question to punish us for our temerity and play us off against other countries which have been less assertive”.—[Official Report, 21/11/13; col. 1107.]
Human rights abuses are legion in North Korea and many undoubtedly constitute crimes against humanity. Of course the British Government must have a bilateral relationship with North Korea, as they must with all countries, but surely the UN Human Rights Council, the General Assembly of the UN and the Security Council of the UN are the key bodies to work through in combating these abuses. Do the Government agree with that sentiment?
Given the totally negative attitude of the North Korean Government, the remarkable Michael Kirby and the other members of the commission of inquiry have produced a full and devastating report. Whichever section of it one reads, I am afraid that the same deeply depressing verdict is overwhelming. Whether it is about abductions, freedom of thought, expression and religion; or about discrimination or violations of freedom of movement and residence; or the deeply shocking violations of the right to food and the equally shocking section on arbitrary detentions, torture, executions and prison camps, there is little or no comfort to be found. It is a very bleak picture indeed. However, at its end the report makes what I believe to be sensible recommendations. It points out the need for those responsible to be held to judicial account and, in its last recommendation, it calls for the UN and the states involved in the Korean War to convene a high-level political conference to consider and ratify a final, peaceful settlement of that war. That is a brave—some might even say a courageous—recommendation but it is also one which demonstrates that, even after hearing the appalling evidence about the regime, the authors of the report are determined to keep a light shining in the massive gloom that prevails. If they can keep that light shining, surely it is our duty to do so, too.
My Lords, I echo the words of the noble Lord, Lord Bach, in relation to the noble Lord, Lord Alton, on introducing this debate and shining a spotlight on atrocious human rights abuses in the DPRK. I pay tribute to his work, and indeed to the work of the noble Baroness, Lady Cox, and that of the North Korea All-Party Parliamentary Group for what, I believe, is the most important aspect of that work, which is giving ordinary North Koreans a voice.
Noble Lords will know that the United Nations commission of inquiry has provided an authoritative account of the systemic, widespread and gross human rights violations committed by a state described as,
“without parallel in the contemporary world”.
As others have said, it is now vital that we ensure that its report is a beginning, not an end. The commission of inquiry report called for:
“Urgent accountability measures … combined with a reinforced human rights dialogue, the promotion of incremental change through more people-to-people contact and an inter-Korean agenda for reconciliation”.
I cannot comment on inter-Korean reconciliation—that is a matter for the two Koreas—but I will set out how, as asked by the noble Lord, Lord Bach, the UK is responding, bilaterally and with others, to the commission’s recommendations on accountability, human rights dialogue and people-to-people contact.
First, on accountability, the UK agrees that, with no willingness from the DPRK to hold perpetrators to account, the international community has a responsibility to take action. We have already taken several steps. We worked with others to ensure that the UN Human Rights Council’s DPRK resolution in March contained strong language on accountability, including a recommendation that the commission’s report be forwarded to the UN Security Council. In April, we joined other Security Council members for an informal public briefing by commissioners. In May, we raised DPRK human rights issues during closed consultations with the High Commissioner for Human Rights. In June, my right honourable friend the Minister of State at the Foreign and Commonwealth Office, the Member for East Devon, visited Geneva. He took part in an interactive dialogue with the special rapporteur on human rights in the DPRK, raised DPRK human rights with UN Secretary-General Ban Ki-moon and discussed accountability with representatives from the United States, France, Japan, the Republic of Korea and the EU. We will continue to work with like-minded partners to maximise the prospects of achieving genuine accountability, despite the challenges.
There is broad agreement on what we need to do: focus on DPRK human rights at this autumn’s UN General Assembly; achieve a strong, well supported DPRK resolution in the UNGA Third Committee; and take forward the recommendation that the UN Security Council should formally consider the commission’s findings and recommendations. This includes referral to the International Criminal Court, which the Government have made clear we would support. However, the DPRK has not signed the Rome Statute. As noble Lords will be aware, this means referral can be achieved only through a UN Security Council resolution. As we saw with Syria, China and Russia are likely to use their vetoes to block any such resolution. This does not mean that we should not pursue an ICC referral, but it does mean that we need to think carefully about when and how to take one forward, not least to ensure the maximum support from other members of the Security Council and the wider UN membership.
However, not all the commission’s recommendations on accountability need Security Council action. A number of measures are already moving forward, including renewal of the special rapporteur’s mandate and the creation of a new regional field office, to be based in the Republic of Korea. This new office will continue the commission’s work of collecting and documenting human rights violations until the North Korean regime can be brought to account. The UK stands ready to offer our support.
The noble Lord, Lord Alton, asked specifically about sanctions. The commission made a recommendation to the Security Council on targeted sanctions. Existing UN and EU sanctions against the DPRK are based on UN Security Council resolutions targeting the DPRK’s nuclear and ballistic missile programmes. Like an ICC referral, a new UN sanctions regime would require a UN Security Council resolution. The UK would want any new sanction proposals to have a clear impact on the human rights situation in North Korea without any unintended negative impact on the general population. After recent successful legal challenges, we need to be sure that any proposals are both legally and politically deliverable in the European Union.
Alongside accountability, the UN commission of inquiry stressed the importance of continued human rights dialogue. The universal periodic review remains one of the few forums in which the DPRK is willing to engage on human rights, so we are exploring with partners how we can build on that.
The noble and right reverend Lord, Lord Eames, asked what avenues are open to the UK to influence the present regime. Bilateral human rights have always been an integral part of the dialogue with the DPRK. As the right reverend Prelate the Bishop of Peterborough said, we believe in the importance of keeping those diplomatic channels open. Through our embassy in Pyongyang and its embassy in London, we deliver clear messages about the unacceptability of ongoing human rights violations, including the persecution of Christians, which both the right reverend Prelate and the noble Baroness, Lady Cox, have rightly highlighted.
In this regard, we are aware of the report to which the noble Baroness referred—the Hogan Lovells report—and its conclusions with respect to genocide on religious grounds. This of course differs from the position taken by the commission of inquiry, which concluded that the available evidence in this respect was ambiguous. We raised the need for the DPRK to engage with the international community on these issues and made clear our readiness to work together to improve the situation on the ground.
In a small way, our engagement on disability rights has shown that this is not completely impossible, and that progress can sometimes be made. More meaningful improvements would need a radical shift in DPRK thinking. We must convince it that, if it takes that chance, the international community will respond in good faith.
The noble Baroness, Lady Cox, again asked about our human rights dialogue and how we raise particular issues. There are occasions when we raise individual cases as a way of making the broader points. One such case was that of the South Korean national Kim Jung-wook, who was sentenced in May to life with hard labour following convictions for trying to establish underground churches and espionage; another was that of the 33 North Koreans who allegedly have been sentenced to death for contact with Kim Jung-wook.
The noble Lord, Lord Alton, asked about whether the DPRK has committed crimes against humanity. The commission’s report presents horrifying accounts of the scale of human rights violations in the DPRK. Ultimately, as the noble Lord knows, only a court of law can rule on whether crimes against humanity have been committed in legal terms, but it is clearly a very strong case to answer. The noble Lord, Lord Alton, and the noble Baroness, Lady Cox, also asked about the position of China. We raised DPRK human rights concerns with China, including the specific issue of forced repatriation, which I think was mentioned by other noble Lords as well. The then Foreign Secretary raised this during his meeting with State Councillor Yang Jiechi in February this year, and officials raised it during the UK-China Human Rights Dialogue on 19 and 20 May.
Another area which the commission of inquiry highlighted was the role of people-to-people contact in supporting long-term change by giving North Koreans the opportunity—
I do not have the specific read-out of that meeting with me, and I need to be accurate about the information that I give at the Dispatch Box. I will therefore write to the noble Lord with further information.
I return to people-to-people contact, an issue highlighted by the commission of inquiry as a way of effecting long-term change. This is an area where the UK can help, given our presence on the ground in Pyongyang. Many of our engagement activities are designed precisely to increase such people-to-people contacts. Through the English language teacher training programme, we have provided thousands of North Koreans with their first access to a foreigner and an understanding of British culture and British values. The British Council is considering the scope of further cultural activity in line with its own commitment to engagement, not isolation. This year our embassy has funded a number of economic workshops, another area of engagement referred to in the commission’s recommendations.
The noble and right reverend Lord, Lord Eames, the noble Lord, Lord Alton, and the right reverend Prelate the Bishop of Peterborough all argued about whether the Government would support Korean-language broadcasts by the BBC World Service in line with the commission’s recommendation on addressing the information blockade. This is a question that has been asked on a number of occasions, as noble Lords will know, and I think I will disappoint them by repeating what I have said—that the BBC World Service is operationally, managerially and editorially independent. Decisions on new language services are for it to consider, and then, if appropriate, to put to the Foreign Secretary. It has undertaken to keep this issue under review. I remind noble Lords of the last Oral Question that I answered on this, when I went into some detail on some of the challenges that that proposes.
The noble Baroness, Lady Cox, and the right reverend Prelate again raised the issue of the humanitarian situation. While that has improved somewhat in recent years, there remain many causes for concern, such as those highlighted with regard to food security and healthcare. The UK helps to address these needs through its core funding to the multilateral aid organisations operating in the DPRK. The amount that goes to the DPRK varies, but in 2011-12 it was around £2 million.
The noble Lord, Lord Alton, specifically asked about the former chargé d'affaires and referred to comments he had made recently. I cannot comment on his personal views or what he may have said or written since leaving the FCO—he left in 2003—but I am aware that during the time he was in post his views were those of Her Majesty’s Government.
This Government are fully committed to tackling North Korea’s poor human rights record. We do not underestimate the challenges, but we do believe that change is possible. We, along with the rest of the international community, have a responsibility to do everything we can to support it.
Question for Short Debate
My Lords, throughout my life I have loved my local market, not only for providing the necessities of life—I increasingly need and cherish a diet of fresh fruit and vegetables—but for providing surprises and, above all, the serendipitous. When I was a poor student in Newcastle-under-Lyme, I would plunder the Saturday market, as cauliflowers and other vegetables were sold off at half-price in the late afternoon. Forty years later, my wife and I returned to that same Midlands market and found a stall dispensing prized historic Oxford English Dictionaries at knock-down prices to add to my home library of English dictionaries. My thrill at those bargains led me to go further and bid for a splendid acoustic guitar to add to another jackdaw collection of mine—guitars. My cheeky bid was roundly rebutted and rightly so; but the thrill of the market had scored again.
These days, my wife and I cherish our local Cheshire markets: Frodsham for fruit, veg and eggs, when you know the local farms from where they are sourced, and slippers, cheap and comfortable; or Neston, the home of Lady Hamilton, which is on the silted-up Dee Estuary and is a fabulous market for fresh fruit and vegetables, exotic bread and plants. Nor do we ever neglect to banter over a cup of coffee with the regular coffee trader who returns on Fridays after servicing summer music festivals around the country. These days, my wife and I schedule visits to local markets on our holiday travels. Last year, we filled up the car with purchases from contrasting markets in Yorkshire: the Saturday market in Beverley, near the historic Minster; and later the extensive and renowned Kirkgate market in Leeds. Perhaps the Minister can confirm whether the Government are still funding the local enterprise initiative “How Bizaar”, which permits new start-up traders 12 weeks’ free rental for testing new products, services or business ideas.
Britain is rich in local markets. We should prize them for what they are and strive to maintain and enhance their essence, but also ready them for the challenges of modern life. Today we hold the Government to account on their clarion call, published in May this year: “Love Your Local Market”. In 2009 there were some 1,100 traditional markets, representing a worrying decline. Some 38,000 market traders showed a decline of some 14% in five years. Retail markets employed some 95,000 people in 2008, with a further 10,000 employed in wholesale markets. The average spend of a declining number of shoppers has fallen, despite the total spend calculated at £3.5 billion for retail markets as a whole.
However, there is evidence that traditional markets create more employment than many other forms of retail—perhaps the Minister could confirm that—and that they support new business creation by providing low-cost entry to retail trading. In 2013, the NMTF’s “First Pitch” scheme launched 100 new entrepreneurs on traditional markets. Importantly, markets simply do not discriminate by age, class, gender, sex, ethnicity, religion or nationality. Young people fired up with the desire to try their hand at a business can freely open up a stall in a traditional market. The flexibility that is the hallmark of markets reflects the characteristic flexibility of start-up SME entrepreneurs to provide and respond to what the public want in terms of both regular and changing needs. The ethnic diversity that is a feature of so many of our contemporary markets offers visible proof of a society that is integrating: the diversity of people is reflected in the diversity of the goods, and the diversity of the goods bespeaks the diversity of the people.
However, we have problems. Many indoor, outdoor and covered markets are underfunded, undervalued and lacking support from their local communities. This often reflects unfavourably on the local authorities, which are charged with overseeing the local markets in their jurisdiction. Not only are the local authorities being rigorously held to account for every penny spent—with cuts that in my view undermine the very raison d’être of local authorities—but in seeking help from the town hall, the local market, nestled outside in the town hall square, is usually at the back of the queue of competing demands. Market infrastructure is often poorly maintained, despite onerous service charges inflicted on the traders. Public sector cuts lead to downsizing of the nominal market services provided by the council, leading to poor market management. Reduced publicity budgets denude local authorities of the wherewithal to publicise the local market and guide potential visitors and shoppers with simple advice, such as where to park.
Understandably, some councils supplement depleted council coffers by reallocating income from market traders to other worthy council services, many of which are a statutory obligation; it is equally understandable that the traders in the square outside feel cheated. However, unlike other groups with claims on the council, the market trader is too busy minding the stall to indulge in special pleading. The admirable National Market Traders Federation does its best to organise its members, but the Government must redouble their efforts to understand the heartfelt cry of market traders wanting nothing more than to pitch outside to do their job.
I turn to the Minister, to test how far HMG can help a group worthy of nurturing. What are the Government’s mature reflections on the Portas review of high streets? Has her characterisation of markets as an untapped resource as part of a town’s integrated retail offer been followed through? Perhaps the Minister might offer some successful examples.
Given that the major supermarkets are now responding to the challenge of Aldi and Lidl, are the Government sanguine that discounters have grown while local markets have declined? While the £25,000 granted to the “Love Your Local Market” campaign run by the National Association of British Market Authorities was welcome, it hardly does justice to the problem. Can the Minister do something better than this annual flash in the pan? Can the Government point to national information campaigns for consumers, especially those encouraging the population to eat healthily, which specifically point to support for traditional markets? What financial help are the Government giving to help traders adapt to and adopt important consumer legislation? Examples, please.
Many markets are housed in old Victorian market halls. Garstang in Lancashire has one such small hall, supplementing its wonderful Thursday street market, but such halls need to be updated, not only to give a fillip to the local market but to improve the attraction of our town centres. Do the Government recognise responsibility for these? Many local traders are in fear of UK and EU legislation and need advice as to what they can and cannot do. The local council can often play an active role here in advising and inspecting with a benign eye. Perhaps the Minister can give more illustration of that.
The Government must invest in local markets, because they are thereby investing in our local communities. This would include good parking facilities—why not free to customers?; good toilet facilities and wi-fi; bright lighting; energy-efficient heating systems; regular cleaning and maintenance of the market space; engaging websites and social media; and home delivery or click-and-collect services. These are all commonplace in most UK retail spaces; why not for local markets? Will the Government also address the practical training needs of market traders, especially in the field of adopting new technologies, including e-commerce, social media and mobile card payments? Rather than wilting under the reach of Amazon, market traders can warm to new ways of advertising their wares, but government help is desirable. I have hinted at the attraction of tourism and day visitors to local markets and I hope that we can have a response on that.
I conclude by noting with pleasure that the NMTF has signed a memorandum of understanding with its European equivalents; can we have a response to that? I would also welcome responses to the CLG Committee’s Market Failure?: Can the Traditional Market Survive? report and to the NMTF’s excellent 2012 report Retail Markets in the UK. I would be most grateful to the Minister if he could cover that ground, which is so important to an important group in our lives, in the square outside the town hall.
My Lords, I warmly commend the noble Lord for securing this debate. I come with a sense of enormous self-reproach, since in my first role in government, 25 years ago, as a Minister responsible for local government, planning and communities, I never mentioned or did anything whatever about street markets. I say this as somebody who has spent my entire life in street markets. As a younger woman I shopped in Brixton market, founded in the 19th century. It sold lovely Afro-Caribbean produce in Electric Avenue, the first street to have electric lighting. Everything I wore, ate or gave anybody came from the market. In fact, it is rare for me not to be wearing a number of items of clothing that came from a market—even today, a number of the items I am wearing came from street markets.
Then I used to spend a great deal of time in—this is somewhere that the noble Lord may know well—Lower Marsh at the Cut, again founded in the mid-19th century. I met my friends and took my children for walks there. My whole life was in the street market. Most particularly, going back to the 16th century, there was East Street Market down the Walworth Road. That was a very special market on Saturdays.
I then became a Member of Parliament for Surrey. There, we had one of the historic charter markets—going right back to 1300—in Godalming and another in Haslemere. In that constituency, we saw the development of the farmers’ markets, which have been an extraordinary innovation. Milford had one of the first farmers’ markets. It was warmly and helpfully supported by the local authority and it provided an extraordinarily valuable outlet for local farmers. However, it also fulfilled a double purpose in ensuring that an increasingly urbanised community understood agriculture. Farmers’ markets—there is a wonderful one that meets under Humber Bridge each month—have a role in communication.
Then I moved on and, apart from a number of other markets, I now frequently have the privilege of visiting the markets in Worthing, where there are farmers’ markets and a very exotic French market, which is a frequent and popular event.
When we think about markets and retail space, for which competition is so intense, we understand how the juggernauts that are supermarkets have transformed shopping—in many ways, for the good. For those of us who find weekly shops particularly trying, going to a huge supermarket can be of great value. At the same time, there has been a further revolution with developments online and extraordinary changes in retail behaviour patterns.
However, the street markets in the hearts of our cities have in many ways an ever-greater value. I have the strong view that people’s lives are fragmented. The digital world means that too many experiences are virtual. The joy and pleasure of a street market is that it involves direct communication, discussion and dialogue, as well as the huge variety of which the noble Lord spoke. Frequently, it can be an outlet for someone who is starting up a business—maybe a craft industry. It provides an opportunity to test goods. We do not discuss it in these papers, although I suspect that there is a connection here with the explosion of car boot sales. They provide a similar experience for people, as they are about congregation and meeting. They have the hurly-burly of the market.
Whatever the convenience of shopping online, it is a fairly lonely experience. Similarly, the great supermarkets are like factories of purchasing; they are quite different from the communal experience. That was the evidence from the excellent report sponsored by the Joseph Rowntree Foundation. It suggested that the social benefits of markets can do a great deal to promote social cohesion, encourage different communities to intermingle, and provide community support and information. That evidence came from Professor Sophie Watson, who, I am delighted to say, is a professor of sociology at the excellent Open University. I am someone who always feels that I need evidence before I can hold forth on a subject. It is not a handicap that many politicians face but I like to look at the evidence before giving a strong view. Her evidence is that the markets are extraordinarily important sites of social interaction for all groups in the community but—fortunately for many of us in this House—most significantly for older people, especially women. Markets are important social spaces for mothers with young children, young people and families with children, particularly at weekends. That identifies with the younger me and the older me.
The report also argued that markets have a significant social inclusion role as places to linger. Often when people are in a hurry, there are few places to linger, and I always feel that charity shops, for all the condemnation they receive, provide a place of congregation, meeting and, very often, study. Whatever the subject of the charity shop, it is a place where people learn more about the charity. If you were president of Abbeyfield, for example, as the noble Baroness is, you would learn all about Abbeyfield. Then, of course, the social life of traders plays a significant role in creating that vibrant atmosphere in markets.
Tomorrow, there will be a debate on organic food and the health implications. Most unfortunately, I am unable to participate in it. I am at what I would describe as the extreme sceptic end of the organic food market arguments. It seems to me that what street markets provide is fresh, good value food which provides all the benefits that we are looking for.
I congratulate the Government and a succession of Ministers for taking steps on this—there will always be people who say that they should take further steps. We have had contributions on this from Grant Shapps, Eric Pickles, the Secretary of State, and Mark Prisk. A number of them talked about planning restrictions, small business rate relief and other provisions for towns. My preoccupation, about which noble Lords may hear a great deal in subsequent years, is the 2017 City of Culture, Kingston-upon-Hull. The contribution of street markets to that will be magnificent. I have spoken with the local authority about the work that it is undertaking to ensure that both the covered and the open markets are really fit for purpose. The noble Lord made many valuable comments about the facilities needed to make a market a flourishing success, not least cleanliness and toilet facilities, but cash machines are particularly important.
In the city of Kingston-upon-Hull, there is great expectation about the number of visitors who will come during the year of culture. Preparations are well under way. In Londonderry/Derry, they had twice the visitor numbers during the City of Culture year; Hull expects to have three times the number. With 1 million ferry passengers a year, noble Lords will understand the huge potential of street markets as that great city, with a history far greater than many of those in the more prosperous south-west, undergoes a city renaissance—
I am sorry to interrupt, but, once a Whip, always a Whip. In the absence of one, these are time-limited debates. I am sorry to interrupt my noble friend in mid-flow.
My Lords, I, too, congratulate my noble friend Lord Harrison on securing this debate, and also on the absolutely spot-on tenor with which he used it. There is no doubt that markets are fun. If you want a proof of that, until last year, I was chairman of Covent Garden Market Authority. New Covent Garden Market is the largest wholesale fruit and vegetable and flower market in the country and is down at Nine Elms. During the period when we were getting our redevelopment proposal together, 10% of the Members of the House of Lords joined us at 7.30 am to go on conducted tours around our market. I see one or two noble Lords around the Chamber this evening who are pointing to themselves saying, “I was there”.
Markets are fun, but they are also important. In declaring that interest, I should say that the discussion so far has, rightly, been about street markets. I should like to talk about wholesale markets. New Covent Garden Market is crucial to London’s economy. I am delighted that the Minister who will answer the debate is a Treasury Minister. With all due respect to the Minister in Defra, which is an important part of this whole field, we need Treasury support for the changes we need initiated to help markets.
New Covent Garden Market supplies 40% of all the fresh food in London that is eaten outside the home. It supplies 20 of the top 20 restaurants in London with their fresh food supplies. It gives a quality and choice that is important within London because it is important for our tourism trade. It is part of the attraction. It is part of what makes London a place to come.
I was delighted to learn that the redevelopment in Battersea, on which I worked with a team to get government permission to proceed, will have a completely new market with the same trading space. It will be an icon for markets in this country, particularly for wholesale markets. There are 26 wholesale markets in the UK, employing about 10,000 people. They turn over something like £4 billion a year. If you link that to the retail markets, you are talking about £8 billion of turnover. In some respects it is not huge; in other respects it is without doubt crucial to our economy. About 2,000 jobs depend upon New Covent Garden Market, and about 200 small businesses. Many of those are third and fourth generation family businesses; that is true in street markets as well.
Although the individual areas are small, the totality is not. It is not just that markets bring trade. They bring fresh goods to a community. They also bring some life and an involvement with the community that brick shops do not. People take their time wandering down a street market. In a supermarket they want to be in and out as quickly as they can. Today, you can associate quality with the food that is sold in street markets. Gone are the days when my mother used to send me to Cross Lane Market and say, “Don’t let him give you the apples from the back, Brenda. You point out the ones that you want”.
Thanks to work done by the trade association for markets, NABMA, we know that the food can be as much as 30% less expensive than in the so-called value-for-money supermarkets. In this age of, for a number of reasons, smaller households, markets will supply small portions. If you want only one apple, you can have one apple; you cannot do that in a supermarket.
Markets are also important for breeding entrepreneurs. Where did Marks & Spencer start? Where did Morrisons start? Dare I say it, where did my noble friend Lord Sugar start? They are good for breeding good business.
My noble friend Lord Harrison’s debate asks the Government how they intend to help. I will give the Minister some help by making one or two suggestions. The DCLG picked up the Portas high street review and supported the “Love Your Local Market” scheme, to which my noble friend referred, with some money. In 2012 something like 2,000 new businesses benefited from a free pitch in a market, and the DCLG helped to fund this. As usual, a government department pinched pennies and gave too little. I ask the Minister to give us some help extending that budget, and not because it is a gamble. This year, 4,700 businesses will be start-ups, and 50% of the businesses in this scheme are still in business three months later. That is a pretty high rate of survival. Five European countries are copying it, and it is spreading. Let us support that “Love Your Local Market” scheme with some more money, help and support.
There has been lots of research but whereas the supermarkets can afford to pay for big research, these businesses cannot, and nor can NABMA. We need decent, in-depth economic research which will demonstrate the value of markets to our community and economy. I gather that the Valuation Office Agency has recently started to assess markets for business rates; if you are a street market you do not pay business rates. Many small markets are saying, “Well, I am a business” and are ending up having to pay business rates they cannot afford. Perhaps that could be looked at. I know that discussions are taking place with NABMA, but it would be good if we could make progress on that.
My final request to the Minister is whether the Government could look favourably at a change in the London Local Authorities Act, to enhance the ability of markets in London to operate more flexibly than they can at the moment.
My Lords, first I pay tribute to the noble Lord, Lord Harrison, for initiating this debate and indeed for initiating the debate a few weeks ago on tourism, in which I also participated. There is of course a relationship between tourism and markets, as has been touched upon. We very much enjoyed the noble Lord’s markets tour of the north-west and Yorkshire, and wish him well with his cheap slippers.
I must declare an interest as the chairman of the Wellington Market Company plc, which is our only quoted markets company. We operate 12 markets nationally, from Hull in the north-east and Morley near Leeds, right the way down to Cornish Market World near St Austell. In London we operate Old Spitalfields market and Shepherd’s Bush market. We received our charter in 1244; I have to say that I have not been chairman for all that time, although there are times when it feels like it.
We all love a successful, vibrant, prosperous market. As was said by the noble Baroness, Lady Dean, markets can be fun, but we have to be careful not to be starry-eyed about them. I can tell your Lordships that operating markets is a very tough business at the present time. There are two principal reasons for that. First, there is the question of competition. In the old days, markets were the ideal source of cheap clothing, and many people went to them for that reason. Of course, there is now a whole range of clothing outlets, such as Primark shops and similar. There are also charity shops, and there is competition from the internet, from supermarkets and also from out-of-town shopping. Competition has increased massively in recent years.
Secondly, there has been a very significant and noticeable decrease in the number of traders who want to operate in markets and operate market stalls. If you look at any of the trade magazines, you will see page after page of local authorities and market operators advertising for a whole range of traders. The shortage is of traders. People do not see it as an attractive career or a particularly profitable one at the present time, and to many the lifestyle does not appeal. At this juncture I pay tribute to the trade bodies, the National Market Traders Federation and the National Association of British Market Authorities, which work enormously hard for the industry, with new ideas and initiatives. In fact, they are closely following today’s debate.
What does a market need to be successful? First of all, investment in the premises is needed, particularly in the market hall. I am sorry to say that for many years many local authorities underinvested in their markets. They were at the bottom of the list of priorities and in many cases they were run by leisure services, with no one taking any real interest, and they withered. I must acknowledge that in recent years there has been very substantial investment in many markets, and I pay tribute to many local authorities—but of course the shortage is of traders, as I said.
Then of course there must be car parking; that is absolutely essential. There also needs to be a partnership in so many ways between the market operator and local authorities. You also need a good manager, and the manager of a market is called a Toby. You need an individual there on site who will banter with the traders, who is available to talk to punters, to talk to customers. The manager must be there on site. To repeat it again, there is no point in trying to run the market from where leisure services are based, four or five miles away. You then need footfall—a market that is well-positioned in this day and age—and a range of regular traders with attractive quality and value stock.
What are the pluses of markets? We have talked about tourism and the way that a successful market can add vibrancy and colour to town centres. As has been referred to, it can also provide an opportunity for young people and ethnic minorities to start businesses. We have seen this through the years. It has also been said that markets provide good value for shoppers—somewhere between 25% and 30% better value in the shopping basket than even some supermarkets.
In many ways, markets can create a bridge between the community and the operator. On Saturday, at our market in Cornwall, Cornish Market World, I opened something we called Creative Cornwall. This touches on what the noble Baroness said earlier. We designated an area of the market to be available to local artists or those who work in local crafts. We had 20 there on Saturday at the opening of Creative Cornwall. This was much welcomed and I hope it prospers and succeeds.
Overall, my message is that competition is increasing even further. An additional worry is that shoppers in our markets are predominantly elderly. Our young people, although there are exceptions, do not go to markets as we would like, so the future will be no easier than it has been so far. I look forward to hearing in the Minister’s wind-up speech how the Government, through a variety of measures, can help this industry, because it is tough at the present time—we should have no illusions about that.
My Lords, it is a joy and a pleasure to take part in this debate. We are all indebted to my noble friend Lord Harrison for his initiative in providing a platform for the various aspects of what one would call the markets industry. Some might say that everything that can be said, has been said, but I say: “Not by everybody”. My twopennyworth goes back many years, and the message is in retailing above all things nothing stands still.
My memory of my home town, Newcastle-upon-Tyne, is that there was fish, greengrocery, flower and meat markets which were all separate entities, managed and understood by people who wanted those goods. They were all connected with what was called the Grainger market, which was where many fine activities went on. Whenever I ring my sister, my only living direct relative, I ask her: “Where have you been?”. When she tells me, I say: “That is next to so and so”, and she says: “Oh, that’s been gone years ago”. Whether we like it or not, we have to recognise that change takes place.
I was interested in the opportunities markets can give people. I pray in aid a marvellous document called Market Times. It is a fund of knowledge about what goes on in the market industry. There is a piece where Alison provides the icing on the cake for “Love your Local Market”. The part I want to quote is this:
“I couldn’t have afforded a shop, but the market business has turned our fortunes around”.
The article continues that she has moved to a larger unit. She got the opportunity through the variety of sizes and the variety of goods. When one reads these articles, from which I shall quote further, one realises that nothing stands still. We must recognise that progress in retailing and shopping has been going on. We have all enjoyed it, because markets are patronised. At the same time, however, one has to look at history.
There is an advert here for Romford market, which gives 10 good reasons why we should support it. It says that it is,
“a vibrant market successfully trading”,
since 1247. That is not 13 minutes to 1 pm; that is 700 years ago. It is has been going on all that time, up and down. I know Romford reasonably well, though I do not know its entire history. I have another quote here about Waltham Cross. The great thing about this magazine, which does so much to tell us what is going on in the world, is that it is not only very readable, but it is very exciting to read these things. The statistics we have had from the noble Lord, Lord Harrison, are absolutely well-founded and well-based. Sometimes, of course, one gets upset. One of the other articles has the headline, “Struggling Crawley market loses lifeline”. I am told sometimes of decisions that have been made by the local authority in order to better plan, as the council sees it, but the council needs to see the impact on the market.
The National Federation of Market Traders is where I made my entry. In 1983 I was a new boy here. The late Lady Phillips—the wife of Morgan Phillips, the great man in Labour history and chairman of the Consumer Council—said to me, “Ted, I’ve been asked to have lunch with people who know a little bit about retailing. Would you come?” I said yes, and the outcome of that is that I became the parliamentary representative for market traders. I have kept in touch with them ever since.
We have got to appreciate that what we are looking for from the Government is for them to understand that if you do not use it, you lose it. It is all very well saying that the big boys are entitled to get bigger, but they only get bigger by pinching from the smaller boys, and we have got to be careful there.
The Minister, Mark Prisk, is not unfamiliar with the market business. An article states:
“He said markets had a unique charm and character. ‘They offer the opportunity to come down to taste the cheese—an experience you cannot replicate online”’.
That is great. It shows where his heart is: he wants to see the industry protected and thriving.
One of the pictures here shows the opportunity given to a Lithuanian man who is a cheesemaker and a cheese-importer. Therefore you have opportunities in the market industry to provide people with an opportunity to do what they want—to work—at a cost that they can afford, which many of them can, and so you have a perpetuation.
I simply want to say to the Committee that nothing stands still, and we are well served. I say to those who are listening to the debate here and elsewhere that voices from a number of places have been aired in this debate. Nobody is an expert with a capital “E”. We all have our own experience, I have mine; and I am grateful to the Committee.
My Lords, I echo the thanks of other noble Lords to my noble friend Lord Harrison, whom I will now think of as a magpie in slippers. This has been a very good debate. I pay special tribute to my noble friend Lord Graham of Edmonton, who has had a lifetime of supporting markets and market traders.
There are many examples across the country of local markets thriving and contributing enormously to communities. Like many noble Lords, I enjoy shopping in local markets, whether in food markets such as Borough Market here in London, covered markets such as the one in Oxford, or farmers’ markets, such as the one in Tavistock in Devon. Some are situated in market towns with a long-standing history of trading, while others are new additions to local communities. However, for the shopper or browsing tourist the experience is always quite unique. The sights, sounds and smells in markets are certainly a treat for all the senses. In Lydney, in the Forest of Dean, we have the Taurus Crafts market, which is a standing market, but every month a food market there sells delicious food and drink from the Forest of Dean, which is a matter for great celebration.
Markets are a testament to the vitality and determination of market traders, who promote local produce, encourage enterprise and support the local economy. However, the nationwide picture tells a rather different story. Markets up and down the country are struggling, which means that the impact that this industry has on the nation’s economy is much smaller than it could be. Hundreds of markets are just waiting for support and investment opportunities which, if provided, could transform not just the lives of market traders themselves but the communities in which their businesses trade.
The National Market Traders Federation—NMTF—is a terrific organisation that was established over a century ago to champion the case for markets. It reported recently that its membership had fallen from 34,537 to 25,576 in the last five years. That means that the industry has shrunk by a quite dramatic 25%. In the last 18 months alone, membership of the NMTF has fallen by 3,500 members, which suggests that over 5,000 market traders have stopped trading since December 2012.
The noble Lord, Lord Lee of Trafford, said that most market shoppers are older; clearly we have to encourage younger people to go to markets. However, I must say that my own children are very frequent shoppers at markets. Market traders, like thousands in the retail industry, are struggling with the pressures of the growth of online shopping and the expansion of large supermarkets. They are also feeling the strain because of the decline in the number of shoppers, and because the costs of running a business—affected by gas and electricity hikes—affect market traders as well as people who have shops. As the National Association of British Market Authorities has reported, public sector cuts have also contributed significantly to the underperformance of market service in the last few years.
Many noble Lords mentioned Mary Portas, who talks of markets as an untapped resource. It is increasingly clear that we have to view successful markets not merely as an end in themselves but as part of a vibrant local economy—an important part of the jigsaw of a local community. Does the Minister agree that we need to wake up to the real potential of local markets and start to view them as part of a vital component of the local economy? Their contribution, if truly unlocked, could help in numerous ways.
As food prices rise, and real wages fall, finding good deals on fresh produce is important. Farmers’ markets come into their own here, because they not only supply brilliant local produce but sell it at a cheaper rate than many local supermarkets, as my noble friend Lady Dean said. We also know that price is an extremely important factor in people’s decision to eat in a healthier way, so it is a win-win situation. Beyond promoting healthier diets, the Joseph Rowntree Foundation found that local markets are also an important site of social interaction for local communities, as has been said.
As well as the social and health benefits, the economic impact of local markets is potentially huge. This year, the Federation of Small Businesses reported that for every £1 spent locally, around 50p to 70p recirculates into the economy. If the same £1 is spent out of town or online, only 5p trickles back to the local economy. Chesterfield is a fine example of success. The market hall has almost full occupancy and is helping the town to buck the trend and drive trade back into its centre. Chesterfield has one of the highest levels of shop occupancy of any town in the east Midlands, and tourist numbers are up year on year, thanks to the thriving atmosphere in the town centre, which is in part due to the thriving local market.
As the NMTF says, as a tool for increasing footfall, stimulating consumption and adding vibrancy and diversity to a street or square, nothing beats a buzzing market. Does the Minister agree that with low costs and a direct relationship with customers, market trading is one of the best entry points to the world of business? As noble Lords have said, it is a great place to start trading.
There are clear economic, social and health benefits to establishing successful markets, but we need to promote their development and persuade local people of their benefits. Many noble Lords have mentioned the “Love Your Local Market” campaign, which is good and welcome, but is too small and does not have enough money. We know that some actions taken by local councils can encourage the development of markets, as noble Lords have said: free parking, wi-fi access and regular cleaning and maintenance. However, while retail spaces are able to offer these services with relative ease, market traders and producers find it more difficult.
Local authorities consistently report that they have little capacity for the strategic development of markets. However, one way of promoting greater autonomy in local areas is to ensure that local people with local knowledge and local investments have the power they need to bring about change. It is crucial that we give local councils the freedom and power to control the decisions which will enable investment in local projects. Developing a network of regional banks and working with business improvement districts would do just that.
Last weekend my right honourable friend Ed Miliband reaffirmed my party’s commitment to devolving power to local communities. That would help local economies and ensure that they serve the needs of the whole of society by creating an economy where power is taken away from Whitehall and Westminster and given to people in the communities in which they live. We want to equip councils with the power that they need. As noble Lords have said, the number one concern for many traders and businesses are small business rates—which, like food, gas and electricity prices, have risen under this Government. Labour will cut them and freeze rates for small businesses to help traders—the lifeblood of communities—achieve their ambitions.
Gwen Sangster, the operations manager of Darwen market, which has 130 stalls and is a crucial part of the area’s small business offer, believes that this policy could be the difference between survival and closure for businesses. For those doing well, it could persuade them to take the plunge to expand and create one or two jobs. If replicated throughout the country, this could make a big difference to the economy.
As our European partners recognise, to invest in a market is to invest in a community. It is to invest in the talents of local entrepreneurs and in the long histories and traditions of towns and villages, for the benefit not just of the market traders and communities but of the national economy.
My Lords, I will immediately start with a brief apology. Today’s response will be truncated in view of our being limited by time. I assure noble Lords that I have made detailed notes on all their questions and I will write to them on those I do not cover. I thank all noble Lords for their contributions, particularly the noble Lord, Lord Harrison, for initiating this debate and for his informed, impassioned and highly entertaining introductory speech.
Almost all our towns and cities owe their very existence to markets. Those markets grew up—as I did—where people came together to trade. I remember being sent out by my mother to the market stall for some groceries. Being bilingual, I knew the Urdu word for aubergine, but not what it was in English. So I persisted in asking for a range of vegetables, then said: “May I also have some bengans?”. The expression on the face of the trader was something you can all imagine.
My noble friend Lady Bottomley will be pleased to learn that, since her time as a local government Minister, we now have a dedicated retail markets Minister who also looks after town centres and high streets. Indeed, I met the recently appointed Minister, Penny Mordaunt, this morning in light of this debate and I can assure noble Lords that she is all guns blazing in ensuring that we protect this central part of our economy.
I was pleased to hear, during the debate, the great enthusiasm for markets from all noble Lords here today. People feel deeply, as they should, that these markets ought to remain and, indeed, thrive. The noble Lord, Lord Harrison, spoke eloquently about his local markets in Chester; people need to support such markets if they are to survive. I have great affection for my local markets. In Wimbledon we have a number of diverse and interesting markets, including farmers’ markets, and in Cobham a farmers’ market meets every fourth Saturday. However, markets, as they have always done, need to evolve to the changing high streets of today—as was said by several noble Lords. My department, DCLG, is working with the market industry to help traders adapt to the current retail environment.
Turning to specific questions, the noble Lord, Lord Harrison, asked about the “How Bizaar” programme in Leeds. That programme was funded: I believe its new quarter was funded in October 2010 as part of that but that the specific funding stream has now ceased. If there is any further detail on that, I will write to him. The noble Baroness, Lady Royall, talked about the onset of online trading. I totally share her sentiments on that but many market traders have an online presence as well as being behind a stall: forward-thinking is required for market operators in the public and private sectors. Indeed, the rollout of wi-fi across places such as Bolton has already had an impact.
Many noble Lords referred to the “Love Your Local Market” campaign and introducing new entrepreneurs. We have worked closely with, and funded, the National Association of British Market Authorities to set up and run the “Love Your Local Market” campaign. Since the initiative was launched in 2012 it has proven a tremendous success, with 920 towns delivering 7,000 markets in this year’s “Love Your Local Market” fortnight alone. This has not gone unnoticed and the brand has now been adopted in Barcelona and Venice, and interest has also been shown as far afield as the United States and Australia.
The noble Lord, Lord Graham, and the noble Baroness, Lady Dean, talked about the importance of entrepreneurs. I pay tribute to the noble Lord, Lord Graham, for his work in the market trading area. As the noble Baroness said, many names we know started life on market stalls. The noble Lord, Lord Sugar, and Richard Branson are among the names we could mention. The “Love Your Local Market” campaign is fundamental to encouraging the next generation of businessmen and women to contribute to the nation’s prosperity. I join my noble friend, Lord Lee, and others who talked about diversity in not just what is offered but also the people involved in markets up and down the country. The noble Lord, Lord Graham, also talked about encouraging people to use markets more. I agree with this very important sentiment and that is why the Government continue to back the “Love Your Local Market” campaign. The noble Baroness, Lady Dean, talked about the importance of wholesale markets. Her Majesty’s Government, through my colleagues at Defra, take the lead for wholesale markets. However, we recognise the close links between the retail and wholesale markets and I am pleased to say that Covent Garden Market Authority has a seat on the DCLG retail markets forum.
Several questions were asked about training. I have some substantive government responses but, bearing in mind the most detailed, eloquent and sometimes lengthy contributions we have had in today’s debate, and if noble Lords agree, I shall write to them on this important issue because it warrants the detailed response necessary.
Again, I thank all noble Lords who participated in this debate. It is important that it is recognised that markets are the heartbeat of what represents Britain today. They are a key part of the retail offering of Britain and the Government are alive to this. I thank all noble Lords, not only for their contributions but, as with the noble Baroness, Lady Dean, for their suggestions, which I shall consider most carefully. I end with a simple message and a simple request. We are all keen supporters of our local markets in towns up and down the country and it is incumbent on us all to ensure that this important part of British life is sustained not just for today but for generations to come.
Schools: Careers Guidance
Question for Short Debate
My Lords, in April the Government published the statutory guidance and non-statutory departmental advice on careers guidance. The House has not had the opportunity to debate the new statutory advice. Some was published the year before, but it has been superseded by this advice and I thought it was important that the House should have an opportunity to debate it.
The importance of good information, advice and guidance for young people in careers is obvious. Businesses are saying that they have 735,000 vacancies. In engineering alone, we have a shortfall of 87,000 engineers. Yet we know from survey evidence—and often also from personal experience—that many young people feel that they have had little, if any, useful advice on the complex choices that they have to make about, for example, their GCSE choices, whether to stay on at school and do A-levels, whether to pursue other opportunities, their choice of degree, or what to do when leaving university. It is too easy for our young people to follow the well trodden route through school whereby the teachers expect them to take GCSEs and go on to A-levels and, if they achieve well, to go on to university.
However, the choices before them get, if anything, more difficult and much more complex as time goes by, as the National Union of Students points out. They are now facing a situation in which A-level choices are decoupled from AS-levels. That makes it much tougher to decide precisely what they are going to do. They cannot put their toe in the water to see how they do and, if it does not work out, perhaps switch to another area. Modular exams and coursework assessment are also being phased out. The world is changing fast: jobs for life are gone.
Sir Steve Stewart, chairman of Careers England, gives two reasons why good-quality information, advice and guidance are necessary. One is,
“a moral-principle issue that, as a civilised nation, we should give our very best support to young people to help them make the very best decisions in life”.
The second is,
“simply the purely economic issue. As a nation we cannot afford to have too many of our young people in the wrong places doing the wrong things and not contributing”.
In order to put this Question into context, it is necessary to give a little background history. In 1974, local authorities were required to set up careers services for young people, to provide careers information, advice and guidance in schools, while the schools themselves provided background careers education. Background guidance was issued by Her Majesty’s Government and careers services were to be inspected by a dedicated careers service inspectorate.
That was changed in 1994, when local authority services were outsourced to a series of specialist service providers. In 2002, those providers were again reconstructed, together with youth services, to form the Connexions service, with which I think we are all very familiar, with a joint remit to provide youth support work, especially for the group not in employment, education or training—the NEET group—alongside careers guidance in schools. By the end of Labour’s term in office, in 2008-09, it had become clear that that joint remit was just not working and that careers guidance in schools had been marginalised. Ofsted, the CBI, the UK Commission for Employment and Skills, the Milburn report on social mobility, teachers, parents, social workers and the careers professionals themselves all admitted that the careers service in schools had more or less collapsed.
The Education Act 2011 brought a radical shift. In line with the coalition Government’s wish for schools to have more independence and autonomy, the responsibility for providing careers education, information, advice and guidance services was placed firmly with the schools themselves. The age range was extended in line with the raising of the participation age downwards to year eight and upwards to year 13. The duty of schools was to provide independent and impartial careers advice, which was to include information on a range of options available, including apprenticeships, and to provide face-to-face guidance for those for whom it was considered appropriate—especially for those from disadvantaged backgrounds. The Act came into effect in September 2012, and was supplemented by both statutory guidance and, a little later, by a practical guide detailing best practice.
At the same time, the Government set up the new National Careers Service, working in conjunction with the DWP, which was to provide adult careers guidance. The original aim was to provide an all-age service covering both young people and adults and, importantly, to provide continuing support for those in transition from education to jobs. In the event, school access to the National Careers Service has been limited to the use of its very good web-based information service and its telephone advice service. The irony is that we now have a rather good adult careers service, including face-to-face advice with qualified professionals, when in the past we had none; whereas provision has been largely lost for schools.
The arrangements came in for considerable criticism. For example, the House of Commons Education Select Committee, although acknowledging that Connexions itself had generally failed to provide the careers guidance needed, noted,
“a worrying deterioration in the overall … provision”,
and that the,
“quality, independence and impartiality of careers guidance offered to young people was a central concern”.
In particular, it found that far too few schools were taking their duties seriously. Vocational options were not being covered and, all too frequently, further education colleges were refused permission to explain or even distribute literature about their post-16 provision. Face-to-face guidance was available only to the few, while considerable reliance was placed on web-based services. Ofsted undertook a thematic review of the careers service, published in October 2013 under the title, Going in the Right Direction?, which noted:
“Very few of the schools visited knew how to provide a service effectively or had the skills and expertise needed to provide a comprehensive service. Few schools had purchased an adequate service from external sources”.
The CBI’s director-general, Sir John Cridland, described the careers service system in schools as being on “life support” in many areas as schools struggled with the statutory duty. He and Ofsted were particularly critical of the cutting back in years 10 and 11 of work experience provision.
In a response to those criticisms, Matthew Hancock issued a vision statement that in many senses underlies these new provisions, which provide for much more input from industry and have moved enthusiastically into what might be called a very radical change to develop real-world connections, with firm visits and work experience very much on the agenda, urging schools to link up with local businesses and inviting them into school to talk about what they do, using alumni who are enthusiastic and passionate about their career, to act as ambassadors to inspire and raise expectations. As required by the Act, the schools still have to ensure that their pupils get impartial and independent advice from external services, which should include face-to-face support. But it suggests that this comes from mentoring activities and employer linkage as much as careers guidance.
The question is whether this is enough. Will the new guidelines result in careers education in schools? I start by saying how much I welcome the emphasis on schools linking up with local employers and the recognition of the need to work with and for the local labour markets, seeking to enthuse pupils and raising their ambitions. Work of organisations such as Future First is admirable, and I am very proud that Guildford boasts one of the schools—St Peter’s Catholic School—that was regarded as an exemplar of what schools should do. But I still have some questions to raise.
I do not understand why the coalition Government have ignored the recommendations from Ofsted and the House of Commons Select Committee. These suggest that to provide effective careers advice and guidance, as St Peter’s does, they should implement a clear strategy for careers guidance; ensure that they make use of the National Careers Service resources, which are not well used at the moment; have well trained staff in charge of the area; use careers guidance professionals as well as employer networks; and foster links with local colleges and other trade professions.
On a point noted by the Select Committee, I am concerned that the £200 million provided for the Connexions services in the period 2009-10 has disappeared from view, and we no longer see that. Why have the Government been so resistant to including face-to-face guidance by qualified careers advisers? What has happened to the £200 million which, given the transfer of responsibilities, should have been available to help schools take on new careers responsibilities?
My Lords, I am sure that we are all very grateful to the noble Baroness, Lady Sharp of Guildford, for introducing this debate and doing so in such a splendid manner. The whole point and purpose of education is to discover and exploit the talents of each and every child who goes to school and that can be successful if that child, on developing into an adult when he or she leaves school, finds a career that is sufficiently challenging and rewarding in every sense. One problem that has bedevilled education—and I speak as a former schoolmaster, a parent and a grandparent with four grandchildren at school at the moment—has been the lack of comprehensive careers guidance. Many schools implant the idea that, unless the pupil goes to university, somehow or other it is a failure. That is so wrong. What we need to have is a careers guidance system that says to every child that there is a place for you—you can give of your best and achieve of your best and make a real contribution. I quote George Herbert, who said:
“Who sweeps a room, as for thy laws,
Makes that and th’ action fine”.
Whatever is done, if it is done to a high and proper standard, can be intrinsically rewarding. So we have to get rid of the notion that those who do not go to university have somehow failed—and we have to emulate those in Germany, for whom being an engineer is as high a calling as anything else. As the noble Baroness referred to, why are there 87,000 vacancies in this country for engineers? It is because our young people have not been sufficiently motivated.
I am particularly involved with craft apprenticeships, and I chair the William Morris Craft Fellowship Trust. I believe that we ought to get into our schools and tell our young people about this, and demonstrate to them that a career in the crafts can be as richly rewarding as anything else. I live in the shadow of Lincoln Cathedral, one of the most glorious buildings in Europe. How could that cathedral survive from generation to generation without dedicated craftsmen and craftswomen? We need to get into our schools and explain to the children that there are exciting opportunities for them.
How do we do that? One thing which we can and should do is ensure that every school has a panel of careers advisers, drawn from the local community. This should consist of successful business men and women, professionals and those accomplished in the crafts and what would in a previous age be referred to as the manual skills. Our young people would then have the opportunity not only to hear from those who have succeeded, but also metaphorically to sit at their feet.
Properly constructed work placements should be part of the education of every child, with work experience during the last two or three years of education. I have a granddaughter who just had some work experience in Lincoln itself, in the archives and so on. Her horizons expanded, and she went back to her school in Edinburgh —she lives up in Scotland—feeling much more aware of opportunities than she was previously.
I want a proper panel in every school. Guidance is fine, and the guidance to which the noble Baroness referred is admirable, but we have to give the policy some teeth. I know that the Minister is reluctant to prescribe this and prescribe that, but we are talking about the future of our children and therefore we have to ensure that they all have breadth of opportunity and experience. I beg of my noble friend to toughen up on this guidance. He also knows that I am a great believer in the importance of citizenship studies, and the two go side by side. As he knows, I would like to see every child coming out of school having undergone some form of citizenship ceremony, aware of his or her responsibilities and rights in the context of the wider world. That can come about only if these young people have an opportunity—and, indeed, an obligation —to do not only community service, but also properly constructed work placements.
We have to bring to this a sense of urgency, so that those at school at the moment do not feel that they are failures if they do not get three A* grades. They must not feel that they are failures if they do not go to university, and should feel that they are successful if they are attracted to vocational training, which tends to be denigrated. My six minutes are up so I will finish on that point, but I urge this upon the Minister.
My Lords, I, too, thank the noble Baroness, Lady Sharp, for allowing us to have this debate. I did not realise that we had not had the opportunity to discuss the guidance, which is very important. I thank her for giving us that opportunity. There are problems with careers education guidance at the moment, and I want to say something about that, but let me be clear that there were problems with Connexions as well. We have not got it right for 20 years, so it is not a party-political point. Successive Governments just have not got this right, and I want to address why that might be the case.
One point that has not been said is that we all understand and know about the importance of careers education and guidance for everyone, but for no one more than the youngster trying to break away from the pattern of employment that their family has had for generation after generation. How it plays into that social mobility agenda and opportunity agenda is huge.
When I look at the guidance, I cannot argue with any single aspect of it. Having employer engagement is great; having employers in school is fantastic; work experience is wonderful; raising aspirations and showing people new visions is just what we want. It is right that schools should have a choice in who provides the services for the children in their care. I also like the encouragement that schools are getting to use destination information. When I look at the component parts that address the careers problem, I cannot argue against them. So why is it not working? That is what I really wanted to look at. In truth, the problem is that it does not hang together. Although all the elements are good and sound, every single one of them risks failing and is likely to fail in a considerable number of schools throughout this country.
If we take businesses, it is great that there is business involvement but, during my very early years of teaching, I used to be a careers teacher, and I can tell your Lordships that some of the most difficult classes I had were when I had an employer in who was not very good at talking to recalcitrant 14 year-old boys. So the notion that the minute you get employers in it is all wonderful is just not true. Our children get good-quality work experience, but if you are in an inner-city comprehensive school, trying to get that quality work experience with no external help for a cohort of 200 students a year is very difficult.
If we look at the structure of schools themselves, none of them do not care about what happens to their children but all the levers are against them doing the careers education and guidance right. It is not just that there is a history of saying that the best thing is to stay until the sixth form and go on to university, as has been said today. Schools carry that weight and history with them, but they are also rewarded for saying that. They are seen to be better schools because sixth forms mean more money and more pupil funding for that age range. All the incentives are for them not to send children into apprenticeships or down to the local college.
Children have to make a decision, but the areas of the curriculum where that used to be encouraged—PSHE and citizenship—are no longer there. The problem is that Ministers will always be able to give us examples of where there is really good practice. However, to be really honest, the chances of all those elements hanging together to provide universal careers provision across the country—of them being brought together by a school that puts it top of its priority list—are next to none. This cannot be a subject where some kids miss out. We have to be able to guarantee that it is available for everyone.
I want to look at something which I think is not often mentioned. I remember that when I was a young careers teacher, I always used to think that there were really three elements to it. You had to give the child information and aspiration—the tools to get some stuff into his or her head. You also had to give them the skill to assess their own strengths and where they were—what was and was not reasonable. But the most difficult thing was getting them to make the decision and, having made it, to stick with it for the rest of their school life. We sometimes underestimate how difficult it is, especially with some children, to equip them with the skills to make the decision and stick with it. I often think of this analogy: anyone who has been house hunting knows of the huge gap between really liking a house and saying, “Yes, I’ll buy it”. It is exactly the same thing as saying, “I really like that job. I wonder if I could do it”. But jumping in and staying with it for years, throughout the rest of your career, is very difficult.
I hope that I do not often say this, but I do not think that we have ever had anything as good as the careers service that we had in the 1980s, when I was teaching. Certainly in my area, which was Coventry, we were an exemplar. As a careers teacher, I taught careers guidance lessons, but we had, devolved from the Coventry careers service, a careers officer who was full time and two assistants. I pay tribute to Bill Grantham, who was our careers officer. So what the children had in our office was not just my skills as a teacher but his skills as a careers officer and those of his team.
It was he who gave the impartial advice; it was he who said, “Is that what you want to do? Well, this is how you need to go about it”. Most crucially, it was he who gave the school leadership and the teachers the confidence to put careers at the centre of what they did. We were not equipped to do it, but with him there, by our side, on our senior management team, we had the cohesion that is so often lacking. I hope that, on this occasion, learning some lessons from the past may stand us in good stead for the future.
My Lords, I thank my noble friend Lady Sharp for initiating this debate. Having spoken a number of times in your Lordships’ House on the issue of apprenticeships and preparation of young people in schools to enter the world of work, I am very glad that we have the statutory and non-statutory guidance which has clarified a number of issues that needed resolution, following Ofsted’s report which concluded that three-quarters of schools were not executing their statutory careers duties satisfactorily. I agree with the noble Baroness, Lady Morris of Yardley, who is right that the new structure needs to hang together. However, following the publication of the guidance, I am now reassured that Ofsted is giving a higher priority in school inspections to careers advice and guidance. I also welcome the clarification in the guidance of the role of governing bodies.
It is important for the Government to be more interventionist. There is a lot of evidence that we have to get more employers into schools, albeit employers who contribute positively to the young person’s experience and motivation, and to get more school students to experience the world of work. Neither is an island. A few months ago, IPPR North produced a report entitled Driving a Generation: Improving the Interaction Between Schools and Businesses. Interestingly, a number of its recommendations have been addressed in the statutory guidance but I will quote one of its conclusions:
“In order to deliver a well-informed careers service with a broad range of job destinations, advisers located in schools need to be aware of the local employment opportunities around them. This means that they need to have some form of contact with local employers. At present, too few have any.”
I emphasise the word “any”, for I find that a very worrying conclusion. It is not simply a question of money; it is as much about culture, knowledge and a clear definition of roles. Students are in schools and the careers guidance they receive needs to be related to the curriculum they are taught. I am unsure whether Ofsted was right to say it was an error to transfer responsibility for careers guidance to schools from local authorities. Schools are best placed to give guidance to students. They need help in doing that, but the core delivery should be in schools.
I draw attention to what IPPR North said because it specifically recommended the following strategy, based on research it undertook. In year 7, students should know about the different careers available in the subject area and the qualifications and education choices needed to enter those careers. That is information and knowledge-building. In year 8, there should be visits from employers, relevant to subject classes. In year 9, there should be visits by school students to major employers in the local area. As the Browne review of higher education recommended, there should be more individualised career support for students in years 10 and 11.
All this means that secondary schools need to develop much stronger relationships with major employers in their catchment areas. It also means that more employers have to be engaged in the education system. I was somewhat surprised by research published by the Federation of Small Businesses, which showed that 40% of its members have no engagement with local schools. One way of improving things is to use former students to raise aspiration and I am aware of the work of Future First, which builds alumni communities with former students as role models. The guidance says that schools should engage with their former students and get them to raise aspiration. That is wise, because students who lack confidence or knowledge need far more than occasional advice; they need real, sustained motivation.
One of the consequences of the way in which our careers system has worked over so many years reveals itself in the lack of women in engineering. Of the UK workforce, 8.5% are women. When you look at Scandinavia, which has a quarter, or Italy and France, which have a fifth, you realise the extent of the cultural problem we have. As my noble friend Lady Sharp said, the UK needs almost 100,000 new engineering graduates each year to meet current demand; that is twice current levels. Half of our state schools send no girls to university to study maths and sciences, which is a massive loss of talent. Early career support and mentoring to choose the right courses to enter careers in engineering and sciences would help, as would promotion of vocational provision. Again, as has been said, too many schools still focus only on A-level provision.
Overall, I welcome the guidance that has been issued and hope that the implementation will be such that no school will be found to have few contacts with local employers, and few local employers will be found to have no contact with schools.
My Lords, the new statutory duty requires governing bodies to ensure that all registered pupils at school are provided with independent careers guidance. There must be,
“a range of activities … including employer talks, career fairs, motivational speakers, college and university visits, coaches and mentors … In-house support for students must be combined with advice and guidance from independent external sources to meet the school’s legal requirements”.
Searching for the word “entrepreneurship”, I found:
“Schools should offer pupils the opportunity to develop entrepreneurial skills for self-employment”.
This is what the Government are asking for. Matthew Hancock, who was the Minister for Skills and Enterprise at the time, said:
“There is now no excuse for schools and colleges not to engage local employers to support students in the transition from education to employment”.
However, as we have heard, Ofsted, in its report Going in the Right Direction? said that the link with employers was the weakest aspect of careers guidance in the 60 schools that it visited. About two-thirds of schools reported that they had cut down on their work experience provision for students in years 10 to 11. Can the Minister explain this? Most of the schools visited, especially those with sixth forms, are generally poor at promoting vocational training and, in particular, apprenticeships. Is the Minister aware of this?
I congratulate the noble Baroness, Lady Sharp, on leading the debate. As she said, the move from state-sponsored careers guidance through the Connexions service to school-mandated careers guidance started in 2011. Only three other countries leave the responsibility of careers guidance to their school systems: New Zealand, the Netherlands and Ireland. In the case of the latter two, this has led to a reduction in the extent and quality of careers guidance provision. Have the Government taken this into account? In England it is estimated that the careers guidance element of the Connexions services received funding of £196 million in 2010-11. However, none of this was passed on to the schools after the transfer. It is therefore estimated that schools have to make an investment of £25,000 each for something that they had previously had for free. Can the Minister confirm this? Is this about means before ends?
The statutory guidance is very weak in that it is spread across two different documents. Ofsted has said:
“We were … told of a head teacher, who, when faced with the option of either buying careers guidance or extra tutorial support for maths and English, commented ‘If I do not hit the floor targets, I get fired. If I do not do careers, I am not sure that I do get fired’”.
The National Careers Service is all very well but there is a lack of face-to-face support for young people. Young people are going to be making the wrong choices about their careers. The recommendation is that the National Careers Service be expanded so that it has capacity-building and can play brokerage role for schools.
There have been so many comments in the press when employers have spoken about youth unemployment hitting 20%-plus, yet the manufacturing industry cannot attract young people to work in the sector. Works Management said that a survey revealed that 42% of people polled thought that careers advice in secondary schools was poor. Furthermore, 42% of people think that the secondary school teachers have a poor understanding of business and industry in general, while 57% of people believe that teachers should undertake two-week work placements. Would the Government encourage teachers to undertake work placements? Are they doing anything about this?
According to HC online, more than half of employers believe that young people receive inadequate careers advice, and almost two-thirds said that the young people they recruited lacked insight into the working world. That is really serious. Another CIPD survey found that more than two-thirds of UK employers have expressed willingness to be involved in the education system; but they need the opportunities to do that.
I am a fellow of the Institute of Chartered Accountants in England and Wales and today I sit on the advisory board of Economia magazine. ICAEW’s manifesto policy on skills and social mobility says that work experience should be mandatory in schools. How are the Government encouraging work experience to be mandatory in schools? They have a programme called BASE—business, accounting and skills education—which is a competition for students aged 16 to 19. It is fantastic; it is working really well. Yet this is being done on a voluntary basis; the responsibility is on schools. If we take the extreme example of a school such as Eton, its entrepreneurship society gets the entrepreneurial stars in this country, week by week, coming in and inspiring its students. How can the other thousands of schools in this country have access to that?
If we look at the destination measures system, what confidence is there that it will actually work? This is a serious situation. According to Ofsted, not all the schools visited had accurate and complete data on the students’ actual destinations. How are the Government going to deal with that challenge? Only one in five schools had well developed provisions for careers guidance.
I conclude with the private sector, which has such a huge advantage in this. For example, ISCO has training courses for the staff. What provision are the Government making for staff to be trained in careers guidance? This country has changed in the last three decades. It was a country with a glass ceiling; it was the sick man of Europe. Today it is an aspirational country. Our careers guidance needs to harness that aspiration, encourage our children and give them a really bright future.
My Lords, I add my thanks to the noble Baroness, Lady Sharp, for initiating this debate. I hope your Lordships will indulge me at the beginning of my contribution to the debate and allow me to explain a little about my professional background.
In the 1990s I was the vocational co-ordinator in a comprehensive school in north Wales. Among my duties was responsibility for the school’s careers policy and its implementation. I believe that we delivered high-quality careers education and guidance for our pupils. Careers lessons in the school were delivered through modules in the PHSE curriculum. We had an effective relationship with our careers service, which provided impartial advice that the pupils needed. Careers teachers were helped in their professional development by the education departments of the local authorities—and yes, we did take up work placements in local industries.
In common with many schools at that time, we used the system many noble Lords will remember—the Jiig-Cal programme. Jiig-Cal—or Job Ideas and Information Generator-Computer Aided Learning—did exactly what it said it would do. It generated ideas and information about jobs after pupils had completed questionnaires and the forms were read by a computer. Jim Closs, the designer of the system, has admitted:
“Sometimes pupils would react quite negatively to jobs of that kind being suggested to them, but one of the principles of careers guidance is to broaden the pupil’s horizons by putting before them ideas that they would never otherwise have considered”.
I agree with that. Although the system has received some criticism, studies have shown that 70% of the pupils who went through the system actually ended up in the jobs suggested for them.
From a teacher’s point of view, the most important factor was the process pupils went through before they completed the forms—being guided, and taking time to reflect on their own interests, skills and abilities, whether they felt they were academic or not, or preferred working indoors or outdoors. All those factors need to be considered when choosing a career. Above all, that led to pupils learning about themselves, valuing aspects of themselves and their choices and valuing and respecting the choices of others—whatever those choices might be.
I argue that almost everything that appears in the new guidance for schools in Section 29 were things we were doing then—except for bringing speakers from the world of work into our schools, and the emphasis on mentoring and coaching. Those aspects of modern careers guidance, inspiring pupils to consider other careers, would have greatly enhanced our provision at that time. However, there is increasing concern among professionals about the diminishing role of the classroom teacher in careers education and guidance. For me, there is a fear that inspiring young people on the one hand, without the reality checks of the processes we went through on the other hand, could lead to what I call the “Britain’s Got Talent” phenomenon—when someone appears on stage and nobody has ever told them that they cannot sing.
Perhaps we should learn from Australia, where, last year, the National Centre for Vocational Education Research reported on its study of more than 2,000 pupils. It found that while many pupils had planned to be lawyers, psychologists, designers and vets at age 15, when interviewed again at 25 the majority had ended up as sales assistants, primary school teachers and retail managers. The centre blames a “patchy” careers advice system which inflated pupils’ expectations, only for them to be dashed 10 years later. Psychologist Professor Helen McGrath said that parents—and, I would argue, teachers—need,
“to focus more on giving their children some realistic feedback about what their strengths are rather than giving that message of ‘you can do anything you want if you set your mind to it’ … You simply can’t do everything, and the end result is that you fall flat on your face when you realise that even if you work hard you’re not getting anywhere”.
Career Development Association of Australia vice-president Dr Peter McIlveen said that parents and educators must encourage kids to aim high but not aim for the impossible. He said:
“It’s vital that our kids dream big but also make those dreams realistic through good guidance”.
Good careers guidance has many aspects, and I welcome the detail we have been given in the documents. Those aspects include: mentoring, inspirational speakers, work experience and work visits, careers fairs, and interviews with careers officers, yes—but the input of dedicated careers teachers who help the child to understand his or her ambitions, abilities and skills, is also needed. Take away any one of those aspects and one is left with a system that is unbalanced and perhaps ultimately unfair to the child.
I congratulate and thank the noble Baroness, Lady Sharp, on securing this debate.
We have all heard those stories from politicians and everyone else in the public eye; they go along to their school careers adviser at the age of about 14 or 15 to discuss their burning ambition, only to be told that they should shelve the dream and instead stack shelves. My careers adviser gave me slightly better advice. “What do you want to do?” she asked. “Become Prime Minister,” I answered. “Do you like reading?” she asked. “Yes,” I said. “In that case, I suggest you become a librarian”. I do not have anything against librarians, and I am extremely glad that they exist. However, given both my personality and my interests, I honestly had less chance of becoming a successful librarian than Prime Minister. Okay, I blew both my options, but my career advice highlights that unless advice is bespoke, professionalised, and inspirational to young people it is simply a complete waste of time.
In contrast, when I told my mum that I wanted to be Prime Minister, she replied, “And would you like to do that before or after you’re 30?”. I should add that I had to work in the Prime Minister’s office for only 10 minutes to realise that being Prime Minister is a terrible career choice, and not something I would wish on my worst enemy. However, the point is that my mum’s response instilled in me a matter-of-fact belief that I could have whatever career I wanted. That is why I am answering this debate today in the Lords instead of misfiling books in a library. Many people who are deemed to do well in life do so simply because people believe in them from a young age and give them both the tools and the expectation of success. That is precisely the job of an inspirational careers adviser: practical advice combined with great expectations.
What is the situation on the ground? As we have heard, the £200 million a year for the Connexions service has been axed and, as the noble Baroness, Lady Sharp, noted, we do not know where it has gone. Schools now have an unfunded mandate to provide careers advice. An Ofsted report last year found that a staggering 75% of schools offer poor careers advice. This surely is not a moment to withdraw resources from that area. Written evidence from Unison, the main union for careers service staff, is equally damning. Unison states that it is,
“extremely concerned about the future quality and availability of a viable careers service in England and we are particularly concerned that schools are not well prepared to fulfil their new duties as providers of careers guidance”.
Research by the University of Derby, with Unison, found a declining level of local authority involvement in youth and career support—as noble Lords would expect—and a consequent decline in the quality and quantity of overall support available. In general, therefore, local authorities have followed the direction of government policy and transferred responsibility to schools while focusing their resources on targeted services. In theory, that might not be such a bad thing, but those who were interviewed for the report were clear that the Government’s policy changes are unfortunately impacting negatively on young people. Many who work in the sector said that young people were now making educational and employment decisions without support and in many cases this led to unwise choices.
The Government make high-level inspirational statements. As we have heard, no one could disagree with a word of them—they are fantastic, we all agree with them and sign up to motherhood and apple pie. I do not really mean that sarcastically, but it comes back to the points made in the debate, particularly by my noble friend Lady Morris, that it just does not hang together and, unfortunately, cash-strapped schools are forced to go with the lowest bidder in terms of careers advice.
The CBI conducted a survey of 2,000 14 to 25 year-olds and 93% said that they were not provided with enough information to make an informed career choice. Only 26% received advice on apprenticeships and only 17% on vocational qualifications, another issue raised by my noble friend Lady Morris. This means that young people without parents to help or who are not connected have very little chance of fulfilling their potential. That brings us back to the heart of the matter. Good, targeted careers advice, critically offered early enough to make a difference, is one of the most effective policy tools that we have to increase social mobility and reduce inequality. That is why it is so vital and why it breaks my heart to see standards in this area eroded. As for the guidance itself, whether it is statutory or non-statutory, it cannot on its own rectify problems identified by employers, unions and Ofsted. There comes a point when the Government have to put their money where their mouth is.
The Government’s inspirational vision statement says that:
“The responsibility now lies with schools and colleges, who we have given a powerful new accountability to secure independent and impartial careers guidance”.
Yes, they have been given a powerful new accountability, but not a penny. I might be wrong. I hope that the Minister, magician-like with rabbits to pull out of his hat, can clarify which extra funds schools will have access to, to provide this inspirational careers guidance.
I do not have much time left, so I will mention the importance of enterprise education, which is absolutely critical. It is also timely, because in an interview today in the Daily Telegraph, the Employment Minister said that middle-class children should believe that setting up their own business is every bit as good as going to university or working for a big company. All children should believe that, and A4e is one of the organisations working in that area.
I end by asking the Government if they will provide the well trained staff and structure that are needed, and end their resistance to face-to-face sessions, which are so important. Let us ensure that we provide inspiration for our young people, regardless of whether they want to start their own companies or become librarians or, God forbid, Prime Ministers.
My Lords, I thank my noble friend Lady Sharp for securing this important debate and for her excellent summary of the history and status quo of the Government’s position on careers advice. I also thank other noble Lords for their valuable contributions.
There seems to be an assumption underlying the debate that there was once a golden age of careers advice and that we have to go back to it. I do not recognise that. Even if it was the case, I agree with the noble Baroness, Lady Morris, that the careers system that the Government inherited was clearly a long way short of that. I think that we all recognise that the Connexions model did not work. As Alan Milburn said, hardly one person had anything good to say about it.
I do not believe that we have ever had it right in this country since the days of choice emerged, probably about 60 years ago—before which people basically went into jobs that their parents did or that their parents organised for them. The system of careers advice that I recognise is one that I saw on a bookstall once, when I was in an airport in New York late one night—I cannot remember which; all airports look the same. It was a book written by Jack Welch and his wife. He was the inspirational head of GE. He had written a book about his experience as a manager. Then he and his new wife had gone around the world promoting the book for 18 months. When they came back, they wrote a small pocketbook on the best questions that they had heard. The best chapter was entitled,
“What am I going to do with the rest of my life?”.
He said that basically what you do is: you get a job; you do not like it very much; you get another job; and after about five jobs, if you are lucky, you find something that you enjoy. That was certainly the pattern of careers advice that I recognise in this country for the past 50 years, and certainly that experienced by many of my friends.
Of course we can do a lot better. We in this Government believe that people in jobs they love are best placed to enthuse and inspire a young person. For too long, careers guidance in our schools has been weak, characterised by an expensive, top-down approach and one-off careers interviews that did not prepare young people to take their place in the world of work.
The noble Lord, Lord Bilimoria, referred to Ofsted stating that the links with employers are weak. Frankly, for many schools, the links with business and the professions have been extremely weak for years. In our view, it is clearly getting better. Evidence from the McKinsey report on youth unemployment conducted across Europe was absolutely clear that the best careers advice is active engagement with business, but that face-to-face careers advice experience was extremely patchy. As for the head teacher to whom he referred who could not see the value of careers advice and was focused only on core standards, in my experience, for many successful head teachers in the country, the one way to get their pupils working for those exams is to engage them with work so that they have a clear line of sight and understand why they are working.
I certainly agree with my noble friend Lord Shipley that schools should have responsibility for that advice, because they know their pupils, their aptitudes, interests, passions, strengths and weaknesses. Through our reforms, this Government are driving closer working between schools and employers. We welcome business input into our schools—probably more so than anywhere else in the world.
We need to equip our pupils with an understanding of how their learning will help them to progress in a rewarding career, and schools and employers can do this by investing in the workforce of tomorrow through careers talks, mentoring, coaching, work tasters and work experience. From September, our guidance will encourage all schools to do what the best schools are doing: securing innovative advice and guidance on a range of ambitious careers. That is why this Government have given responsibility to schools and colleges.
Evidence from the Education and Employers Taskforce highlighted the positive relationship between the number of employer contacts that 14 to 19 year-olds experience in school and their outcomes—including the likelihood of their being NEET and their earnings if salaried. I am delighted to see a growing number of excellent organisations already working with schools to facilitate greater business involvement—organisations such as Business in the Community’s Business Class, which has 300 clusters around the country, as well as the Cutler’s Made in Sheffield programme, the Glass Academy in Sheffield, Make the Grade in Leeds, career academies, U-Explore, Barclays LifeSkills, the Education and Employment Taskforce’s Inspiring the Future, and the Speakers for Schools programme. All those organisations are building those vital links—the plumbing between schools and business.
At Pimlico Academy, my own academy, we have a substantial raising aspirations programme, bringing businesses and professional people to speak at the school. At Westminster Academy they have transformed the schools performance with the help of 200 business partners. At the Bridge Academy in Hackney the sponsor UBS runs a huge mentoring programme for the students and at Stoke Newington School and Sixth Form in Hackney, they have an excellent programme of engagement with businesses including a speed-dating careers fair.
The guidance gives schools a responsibility to act impartially and make sure pupils can find out about the range of options available. The accompanying non-statutory guidance paints a clear picture of what good careers guidance looks like, highlighting case studies and examples of good practice. To further support schools, from October the reshaped National Careers Service will expand its offer to schools and colleges, making it easier for employers and educators to engage. Importantly, schools will now be held to account for the destination of their pupils, be that an apprenticeship, university, job or further study in school or college. The Chief Inspector of Schools has made clear his commitment to give careers guidance a higher priority in school inspections. We are strengthening our focus on that, to answer the point made by my noble friend Lord Cormack.
We have set out a clear vision for careers guidance, clarified responsibilities for schools through new statutory guidance and enhanced the role of the National Careers Service, alongside Ofsted’s tougher scrutiny.
On the point made by my noble friend Lady Sharp about the recommendations from Ofsted and the Select Committee, we have considered these and implemented a number of them. We published our action plan on the same day as Ofsted published its response to all the recommendations. We have strengthened the guidance in relation to a clear framework for schools. We have made it clear to schools that they must build relationships with other education and training providers.
As for the money—on a point raised by the noble Lord, Lord Bilimoria, and the noble Baroness, Lady King—we are in a difficult economic climate, as we all know. We have protected the school budget, which is a fairly remarkable performance given the state of the public finances that we inherited, and we believe that there is money there for this, compared to other sectors.
My noble friend Lord Cormack referred to the culture—that unless one goes to university one is seen as a failure. We are determined to change this ethos, which is why this Government’s reforms have ensured that vocational qualifications are rigorous and can be as highly valued as the alternatives. That is why our new guidance focuses so clearly on apprenticeships. My noble friend referred to his concept of a careers panel, which is an excellent idea. As was noted, we have updated the guidance for school governors this year, which makes it clear that governors can play a key role in helping to connect schools with the local business community, since we know that governors from an employer background can help schools in this way. As for the citizenship ceremony, perhaps the idea could be promoted by forming a new charity or a co-operation with other charities, or through a pilot with a certain number of schools. I know that my noble friend has some interested schools.
The noble Lord, Lord Bilimoria, referred to the fact that not all schools have a complete set of destination data. The DfE is publishing key stage 4 and 5 destination data annually, and Ofsted is using this in school inspections to inform judgments on schools’ career guidance.
The noble Baroness, Lady Morris, referred to work experience. Hundreds of employers are offering work experience, including major national companies, and the offer of work experience has risen over the last couple of years from 63% of employers to 81%.
I think that the real picture is somewhat different from the one that has been painted. We have never had this right and we think that the model of engaging with business is the way forward. We need to get it developed—I have referred to a number of excellent organisations that are doing this. I am sure that noble Lords will agree that giving young people a clear line of sight to the workplace, particularly those from intergenerational unemployment backgrounds, is important in enabling them to fulfil their potential. It is not just economically important but also, as my noble friend Lady Sharp said in opening, a moral imperative. Once again, I am grateful to all noble Lords for their contributions.
Health: Dental Implants
Question for Short Debate
My Lords, peri-implantitis may seem to be a somewhat obscure matter to debate today, but that is the very reason why I am raising the subject. As a long-retired dentist, I was quite unaware of the condition. I found it most interesting when I heard Professor Nick Donos, head and chair of periodontology and director of research at the UCL Eastman Dental Institute, address an international dental conference on this subject in London last month. I thank him and others who have provided me with valuable material for the discussion tonight.
This is an important and growing health problem and there needs to be an awareness and a degree of understanding of the present position and the growing risks associated with this increasingly popular form of dental treatment. The condition is peri-implantitis. When I attended my first international dental conference in 1955 in Copenhagen, dental implants were a new idea and early cases reported by those dentists present had often failed spectacularly. In some cases, large portions of a jaw were lost in the process, mainly due to the rejection of the foreign body—the dental implant —by the patient’s immune system.
Time moved on and it was found that the metal titanium was accepted by the body. Since then, titanium-rooted dental implants have become widely used in the replacement of missing teeth. Half a million adults have at least one dental implant, according to the latest Adult Dental Health Survey. Studies suggest that one third of these patients will have a milder disease—peri-implant mucositis—which is common and treatable. If undetected or untreated, these red swollen gums can develop into peri-implantitis, which is associated with both inflamed gums and jawbone loss around the implants. As with so many health conditions, smokers have a significantly higher risk of peri-implantitis.
The European Association for Osseointegration emphasises the importance of appropriate patient selection. Most of us would accept that view and, as patients, we would expect to receive sound advice from the appropriately trained dentists performing implant procedures. It is important to indicate for the patient, particularly in complex cases, that implant dentistry should be seen as a multidisciplinary treatment. Within the objectives of the General Dental Council curriculae for dental specialists, it is indicated that periodontology, the treatment of gum conditions, is the specialty in charge for the planning and execution of the surgical component, and prosthodontics is the branch of dentistry that deals with replacement of missing parts with artificial structures and executes the relevant implant superstructures.
Complications of implant therapy, particularly peri-implantitis, are within the objectives of periodontology. Some experts studying the condition of peri-implantitis, a growing problem, believe that there should be formal national registration of implants, national health and private, in the UK. This would probably be the first in Europe, and would enable regulation of the type and quality of the implant-related procedures.
An implant is a titanium screw that is inserted into the jaw under a controlled protocol and, when fused with the bone, forms an artificial tooth root. Their use is growing rapidly in the UK, and although they are costly they are often considered the treatment of choice for replacing missing teeth. They can also be used as a support for a more extensive prosthesis.
When I googled “dental implant”, as a patient often would if they had heard about this treatment, I was disturbed to read the advertisement:
“Get smiling again with our same-day dental implants”.
That is surely what can cause adverse conditions post-treatment and is contrary to all the recommendations from the official dental bodies, which believe the patient must be fully assessed prior to treatment and informed and treated if there is an existing periodontal condition before the implant procedure. It must also be made clear to them that an implant is not a treatment you just have and forget. Regular follow-up visits are required to ensure that a periodontal condition does not develop, first into mucositis, and then progress on to the more serious disease, peri-implantitis, which causes loss of bone supporting the implant and often loss of the implant itself.
Remembering the time when so many women were at serious risk from cheap silicone breast implants and the heavy cost of dealing with unsatisfactory, even dangerous, treatments, including removal or replacement of these, it is particularly important that we are aware that many people seeking dental implants are tempted by cheap offers from abroad. These usually have the great disadvantage that the patient does not have continuing care and may be totally unaware that periodontal follow-up is essential to ensure continuing oral health. These patients certainly need to be clear that care and control of the gums before and following implants are most important.
My noble friend Lord Colwyn sends his regrets that he is unable to be here tonight. He also sends the message, as someone who has done implants himself, that implants should be put only into healthy mouths.
When I tabled this Question for Short Debate, I had seen nothing in the press on the subject. I was pleasantly surprised to see that on 14 July the Daily Telegraph had a very informative article on peri-implantitis titled “The ‘Time Bomb’ in Dental Implants” about a patient, age 52, who had four teeth implanted at a cost of £13,000 in 2002. Three months ago this patient felt a lump on her lower jaw, near one implant. She went to have this checked, and it responded to antibiotics, but the X-ray showed that the bone supporting the implant was receding, and the diagnosis was peri-implantitis.
Ten years ago this disease was almost unknown, but it is now a serious possible consequence of implantation, particularly when the implant patient has not continued to have regular periodontal checks, with treatment if necessary, following an implant. Some studies suggest that one-third of implant patients will be infected, and because jawbone loss is silent and invisible, people do not realise that they are at risk. Early warning signs are red, swollen gums and bleeding, which is often apparent when tooth-brushing; smoking seems to aggravate the situation, and significantly more smokers develop peri-implantitis.
The Faculty of Dental Surgery at the Royal College of Surgeons points out that long-term assessment and maintenance need to be assured if this threat to stability of the implant is to be prevented. It believes that the General Dental Council should introduce minimum standards of education and training for complex dental treatment, such as implants, to ensure patients are treated by a qualified professional. It supports the view that the General Dental Council should include peri-implant assessment and maintenance in the undergraduate curriculum. Too often the practitioner who inserts the implant does not provide long-term support for the patient, discharging them back to their general dental practitioner.
Periodontal disease has been associated with diabetes, cardiovascular disease and pneumonia. Some people speculate that an increase of bacteria in the body may aggravate these conditions but it is not considered to cause them. Professor Donos says:
“The main challenge is for the patients suffering from periodontal disease who represent a significant proportion of the population. As you know, due to the silent nature of the disease, it does not always provide ‘pain’ as a symptom for the patient”.
“I think it is important for the public to be informed that even though implants are successful and offer great functional and aesthetic solutions in terms of replacing missing teeth, appropriate patient selection is required”—
as my noble friend Lord Colwyn said—
“control of periodontal disease before and after implant placement is essential and all risk factors need to be controlled through regular follow up according to the susceptibility profile of the patient”.
In my experience, pain is the thing that brings many patients into the dental surgery. I cannot end this dental discussion without mentioning the report this week that 26,000 children in England aged between five and nine have been hospitalised to have multiple tooth extractions in 2013-14, which is nearly 500 children a week, at a huge cost to the NHS and a great disturbance and upset for the children and their families. However, that is a debate for another time: I flag it up here for the Minister.
Tonight, I hope that patients who want and should have dental implants will benefit from understanding the importance of dealing with periodontal conditions before and after treatment. I look forward to a positive response from the Minister and to his assurance that his department will create public awareness of this condition.
My Lords, the noble Baroness, Lady Gardner of Parkes, is one of our most active Members and I am sure we all owe her a great debt in bringing this matter to our attention tonight. I declare an interest as a member of the Faculty of Dental Surgery at the Royal College of Surgeons. Last Friday, I attended a celebration of the 50th anniversary of the fluoridation of the water supply in Birmingham. Will the noble Earl join me in congratulating the great city of Birmingham on this achievement? It is interesting that, when one looks at health outcomes, Birmingham is often towards the lower end of the table, but it is way up in the top 10 in oral health. Whatever one’s views on fluoridation—and I also declare my presidency of the British Fluoridation Society—there is no question that it has had a very positive impact in Birmingham and the West Midlands in terms of the number of children who have to go into hospital because of oral issues, which was a point raised by the noble Baroness.
As the noble Baroness said, the use of dental implants has grown rapidly across the UK in the last few years. That has been very welcome to many patients but we know that, on the other hand, alongside this rise, the General Dental Council has seen an increasing number of complaints, particularly regarding the lack of informed consent for treatment, damage to the tissue and bone surrounding the implant, and failures. The noble Baroness was very explicit about some of the health issues that can arise. I have looked very carefully at the briefing provided by the Faculty of Dental Surgery at the Royal College of Surgeons. It makes four points that I will put to the noble Earl, alongside the questions raised by the noble Baroness.
Essentially, the briefing says that it is very important for patients to be given adequate information about the risks and alternative options for treatment. Secondly, patients should be aware that periodontal and peri-implant checks are essential to ensure that problems are detected early. The stability of the implant is threatened by diseases such as the one mentioned by the noble Baroness. I do not dare attempt to repeat its name, although I believe that the noble Earl, Lord Howe, is perhaps braver than me on that. However, this is why checks are essential.
Thirdly, the GDC should consider ensuring that peri-implant assessment and maintenance is part of the normal undergraduate course. Fourthly, I would like to mention the Law Commission draft Bill. We are not to see the Bill, but it contains proposals to give regulators the power to annotate their registrar and indicate specialisms or other qualifications. Given that we are not going to have the Bill—I know that there will be some Section 60 orders—perhaps I could make a plea that this might be considered if a dental order is to be brought forward.
Finally, I refer to a very interesting note I received from the Faculty of General Dental Practice about the standards of training in implant dentistry. This is available from a wide variety of providers in the UK, including universities, royal colleges and hospitals. These standards have been developed to ensure patient safety and protection, and I understand that they also serve as a reference point for the GDC in consideration of patient complaints. The only question I wanted to put to the noble Earl about this is that, although this seems to be absolutely fine, how can we ensure that more dental teams take up these training opportunities?
Clearly, we have a good system where standards are very much developed. The providers have to provide training in line with those standards, and the General Dental Council is there to follow up complaints when there are indications that dentists are not practising according to those standards. I wonder whether the noble Earl thinks that there is an issue of some dental practitioners not doing that, which then has an impact on their provision of clinical services.
My Lords, before I respond to the particular points raised by my noble friend on the issues to which she drew our attention, I begin by paying tribute to the way she has consistently championed the commitment of members of her profession to improving the oral health of the population and the quality of dental care provided in this country.
The oral health of the nation has been transformed since the creation of the NHS in 1948, and the rate of improvement has picked up pace since the introduction and widespread use of fluoride toothpaste in the late 1960s and early 1970s, and the growing awareness of the need for good oral hygiene.
The coalition made two key commitments in relation to dentistry in 2010: to increase access to NHS dentistry and to improve oral health by reforming the NHS dental contractual system. We are making solid progress on that reform. As noble Lords know, there is currently an engagement exercise aimed at dentists and the wider dental community. As part of this I took part last month in a web chat, and I was encouraged by the positive—though, of course, rightly robust—questioning and debate from those dentists who took part.
However, we are not waiting for this more fundamental reform before starting to tackle access and oral health. We are already making progress on delivering on those commitments. The people of this country appreciate the ability to access dental care when it is needed, and the number of people seeing a dentist under the NHS since May 2010 has increased by 1.5 million. We are also committed to working with our partners, including those in the profession, to improve the oral health of the population—with a particular focus on children. The latest epidemiological data published by Public Health England demonstrates that progress is being made. Like the noble Lord, Lord Hunt, I follow with interest the decisions being taken locally about fluoridation of water.
These decisions are best taken locally and the arrangements we made under the Health and Social Care Act 2012 are intended to increase democratic legitimacy of decisions on fluoridation; I am pleased that the noble Lord attended the 50th anniversary of the city of Birmingham’s fluoridation scheme. Dental caries continues to affect a sizeable proportion of the population and is a common cause of children being admitted to hospital, as my noble friend mentioned, for the removal of decayed teeth. Public Health England recently published a health monitoring report which showed lower rates of tooth decay and hospital admission in fluoridated areas compared to non-fluoridated areas. In March, Public Health England published guidance for local authorities on improving oral health for children and young people. That guidance advises on the range of measures, including water fluoridation, that local authorities might consider as part of their oral health improvement strategies.
One of the real drivers of this improvement in oral health has been the greater appreciation by the public of the value and importance of both good oral health and acceptable appearance. With this value now placed on oral health has come significant technological development, and again the dental profession must be congratulated on the way it has researched and developed new techniques and procedures to improve oral health and functionality; the use of implants, which my noble friend focused on, is a case in point. We recognise that inequalities still exist and my officials are working with colleagues in Public Health England, NHS England and local authorities to tackle those inequalities; nevertheless, the overall trend is positive.
My noble friend pointed out that smokers are more at risk of peri-implantitis. Public Health England’s Smoke-free and Smiling guidance supports dentists to make brief interventions to help patients who want to stop or cut down to access dedicated stop-smoking services. Dental surgery is a key opportunity to get across brief messages of issues that have implications for oral health—and in this case, of course, the patient’s wider health.
Dental implants can be used in a range of situations. They can play a key role in reconstruction, post-trauma or major surgery. They can sometimes be used, as my noble friend mentioned, as a support for a more extensive prosthesis following surgery for head and neck cancer, and can also be used to retain restorations in the mouth where teeth are missing. I know that the vast majority of cases where implants have been used to replace missing teeth have historically been provided in the independent sector, outside the auspices of the NHS. There are, of course, many other treatment options to be considered, including bridges or dentures, depending on the individual clinical circumstances.
The NHS has a duty to commission services which are both clinically appropriate and cost effective and it is important when discussing the replacement of missing teeth that all those options are discussed. We also need to be aware, as my noble friend mentioned, that some patients choose to travel abroad to have implants fitted because the initial treatment might be available abroad at a lower cost. The General Dental Council has good guidance available on its website for members of the public considering travelling abroad for dental treatment. It is important that people travelling abroad for this sort of treatment understand that, without the ongoing clinical care and support that this type of treatment requires, what looks like a low-cost option initially might ultimately turn out to be high-cost—both financially and from a health outcome perspective.
I am aware that NHS England is providing a series of commissioning guides to give clarity to commissioners and clinicians when discussing treatment options with patients. For dentistry, four such guides are in development, focused on specific areas of dental care. One of these is a restorative commissioning guide and the appropriate use of implants is, I understand, included as part of that work. As my noble friend quite rightly mentioned, appropriate post-placement care is vital if these restorations are to be successful in the long term.
There has been a significant increase in the placement of intra-oral implants in the last 20 years and, although the immediate result can be instantly impressive, it is vital that patients receive good aftercare, including the periodontal checks my noble friend referred to and instruction on how to maintain a healthy interface between the implants and natural tissue. Indeed, in the third edition of Delivering Better Oral Health: An Evidence-Based Toolkit for Prevention, published recently by Public Health England, there is a section on peri-implant health which focuses on these very issues. This provides detailed guidance for clinicians on what they should do at each visit for patients who have had implant treatment. We would expect clinicians to carry out procedures only where oral health is good enough to support the treatment being provided—the point made by our noble friend Lord Colwyn, who cannot unfortunately be with us—and to provide aftercare advice to patients, including advice on self-care and the need for regular check-ups.
However, we know that there is more to do. My noble friend will also, I hope, be pleased to hear that my officials and the Chief Dental Officer have already recognised the issue she raises as a potential area for growing concern. A UK-wide working group, which includes representation from the dental faculties, has been established. Chaired by the Chief Dental Officer, it will look at developing clear and consistent cross-system guidance relating to treatment planning prior to the placement of implants, the education and training required by the clinicians—a point raised by the noble Lord, Lord Hunt—and best practice for aftercare, as referred to by my noble friend. It will also look at how appropriate, easily understood information can be made available to members of the public considering this form of treatment. I am pleased that this group has been set up and understand that it met for the first time earlier this month.
I hope that my noble friend is reassured by the fact that we have already recognised this as an area where public awareness needs raising and that we are taking action to address this. At the end of her excellent speech, my noble friend mentioned the recent data regarding the admission of young children for the administration of a general anaesthetic for removal of teeth. This is unacceptable as dental caries is a preventable disease which can be almost eliminated by the combination of good diet and correct tooth-brushing, backed up by regular examination by a dentist. NHS England is working with colleagues within and outside the profession to educate and inform the parents of these young children so that they are not subject to this extremely unpleasant experience at such an early age.
Committee adjourned at 8.12 pm.