Thursday 30 June 2016
[Mr Nigel Evans in the Chair]
Homicide Law Reform
I beg to move,
That this House has considered the matter of reforming the law on homicide.
It is a great pleasure to serve under your chairmanship, Mr Evans, on this auspicious day. I wish to make crystal clear that the debate is about the law of homicide, not fratricide.
Putting that to one side, the real point is that the law of homicide is a mess. That was put more elegantly by the Law Commission in its 2006 report “Murder, Manslaughter and Infanticide”, in which it said that the law of homicide is
“a rickety structure set upon shaky foundations.”
In essence, the problem is that the law lacks a rational or defensible structure. It does not chime with common sense—and in this area of the law perhaps above all others, it should.
As long ago as 1874, a Select Committee stated:
“If there is any case in which the law should speak plainly, without sophism or evasion, it is where life is at stake; and it is on this very occasion that the law is most evasive and most sophistical.”
That remains the case more than 100 years later, and that will not do. In the words of the Law Commission, the time has come to
“promote certainty…in a way that non-lawyers can understand and accept.”
But the problem is far more serious than mere opaqueness. The problem is that the law of homicide creates injustice—injustice to defendants and injustice to society—and that is something that we in this House must always stand ready to confront and resolve.
What is the solution? It is very simple: to split the current offence of murder into two categories, one of first degree murder and another of second degree murder. Manslaughter should remain as before, albeit more tightly circumscribed.
What, as a matter of law, is murder? It is committed when someone unlawfully kills another person with an intention to kill that person or to do them serious harm. That second element is really important. It means that someone who reasonably believed that no one would be killed by their conduct is placed in the same offence category as the contract or serial killer. That, in a nutshell, is the problem.
Let me give an example. Imagine a retired colonel living in my constituency of Cheltenham. He is aged 65, has lived an utterly unblemished life and served his country with great distinction, and is known for his charitable work. He is upstanding in every way. He lives with his wife, who has Parkinson’s disease and for whom he is the sole carer. A neighbour moves in next door who has a string of convictions for antisocial behaviour. Every night, he holds noisy parties that go on into the small hours. Endless polite requests from the colonel are ignored. Endless local authority noise abatement notices are ignored. So, after the umpteenth such party, with his and his wife’s already poor health suffering, the colonel goes round at 3 o’clock in the morning to remonstrate with his neighbour. He takes with him—this is important—a cricket bat in case there is a violent confrontation. The neighbour, who is very drunk, becomes abusive and the colonel, overcome with anger and frustration and at the end of his tether, says, “Right, that’s it. Let’s see how you party when your big toe is broken,” and strikes the neighbour’s foot with the cricket bat. The neighbour falls back, hits his head on a crate of beer standing in the hallway and is knocked unconscious. The colonel immediately calls 999 and tries to resuscitate him, the police and ambulance arrive and the colonel tells them exactly what happened, but the neighbour is rushed to the local hospital, diagnosed with a bleed on the brain, and dies.
The post-mortem report reveals that the deceased’s toe was broken. When interviewed, the distraught colonel admits that he lost his temper. What happens in this case? The only charge that the law allows for is murder. That means that the only sentence that the judge can impose, despite the colonel pleading guilty at the first opportunity, is life imprisonment, because he intended to do grievous bodily harm by breaking the toe. It is because he took a weapon to the scene—the cricket bat—that the starting point for the minimum term that he must serve is 25 years’ imprisonment, and because the offence is murder, he must serve every last day of that term. In effect, the colonel goes to prison for the rest of his life—25 years. He has a mandatory life sentence.
That is unjust. Although it is clear that a person who kills in such circumstances should be guilty of a serious homicide offence, it is equally clear that because he did not intend to kill, the offence should not be in the top tier or highest category. The current law does not chime with common sense. Academic research into public opinion tells us that, but frankly, we do not need academic research; we need simply to consult our common sense. The particularly daft thing—I hope that that is parliamentary language—is that when Parliament passed the Homicide Act 1957, it never intended a killing to amount to murder, which at that time was a capital offence, unless the defendant realised that his or her conduct may cause death. The law of murder was widened because of an unexpected judicial development immediately following the enactment of the 1957 legislation—the case of Vickers, which is about interpretation of the expression “malice aforethought”. In my view, that colonel should be guilty of second degree murder.
The injustice is further underscored when we add the potential for what are known as secondary parties or accessories to be convicted of a murder. Imagine that before the colonel had set off, his frail wife had told him where the cricket bat was stored and in frustration said to him, “Now, go and use it. Teach him a lesson.” She, too, could find herself facing the punishment and disgrace of a murder conviction and the same 25-year minimum term. She should of course be guilty of an offence, but again, she should be guilty of second degree murder, with the judge having the discretion not to impose a mandatory life sentence.
This issue is particularly topical because the Supreme Court has looked at the case of Jogee and more tightly circumscribing accessory liability—the so-called prosecutor’s friend—but still we are left with a situation in which the unsatisfactory law of homicide leads to manifest injustice.
Certainly, on any view, life imprisonment must remain the maximum sentence—that is the maximum in the United States for federal offences where second degree murder is charged—but the key point is that the judge should have discretion. The Sentencing Council has done a terrific job of laying down guidelines—not tramlines—and the courts have shown themselves to be well able to dispense justice.
The case for reform becomes even clearer when we consider manslaughter, another homicide offence. Whereas, as I have indicated, the law of murder creates injustice for defendants, the law of manslaughter creates injustice for society. What is manslaughter? It can be committed in one of four ways, but just two of those are relevant for these purposes: unlawful act manslaughter and gross negligence manslaughter. The latter largely speaks for itself for these purposes, but let me explain what happens when a killing is the result of a defendant’s unlawful act—that is, one that all reasonable people would realise would subject the victim to the risk of some physical harm, albeit not serious harm.
Take this example. The defendant barges into a nightclub queue in Cheltenham. He has a string of criminal convictions for assault and criminal damage. In the queue, he is being drunk and obnoxious. He is insulting women for what they are wearing and telling them to get out of his way. The victim is the mother of two children. She works at nearby GCHQ and she is on a hen do. She politely asks the defendant to move to the back of the queue. His response is to say, “You silly cow; you need a slap.” He then strikes her repeatedly and hard to the side of the face with his open hand. She falls back, hits her head on the kerb and is knocked unconscious. The defendant runs off. The victim later dies, and the post-mortem shows that she suffered bruising—albeit no fracture—to her cheekbone and the fatal injury was caused by the impact on the kerb. The police arrest the defendant, who denies everything, but CCTV proves his guilt.
Under the law at present, that defendant can be charged only with unlawful act manslaughter, because the harm that he caused falls short of grievous bodily harm. The net effect is that he will be convicted of an offence that carries a far lesser stigma than murder and for which there is no mandatory requirement for a life sentence, and if he gets a determinate sentence, he will serve only half of it. Is that thug, I ask rhetorically, less culpable than the retired colonel or his wife? The only distinction is that the colonel intended to break a toe and the thug intended to commit a marginally less serious assault. In my view, that is a distinction without a difference—it is a distinction that is completely lost on the general public and, frankly, on me.
So, what needs to happen? This is not some academic exercise. Those two examples are not entirely artificial and they expose fundamental injustices. The first, as I have indicated, is to the victim, in the case of the colonel, and the second is to society in the case of the pub queue thug. The solution is clear: we need an offence of first degree murder that would encompass intentional killing only. I recognise the Law Commission, in 2006, wanted to add
“killing through an intention to do serious injury with an awareness of a serious risk of causing death.”
That is fine, and I understand it, but in my view it is a complexity that unnecessarily detracts from the simplicity of the proposal I put before the House.
An offence of first degree murder would simply and coherently communicate to the public the particularly heinous nature of the crime of taking life and would attract the special condemnation and opprobrium that that deserves. To paraphrase Colonel Tim Collins’ famous eve-of-battle speech in 2003, anyone convicted of such an offence would truly live with the mark of Cain upon them. That offence should also, as at present, attract a mandatory life sentence.
Under my proposal, second degree murder would encompass killing through an intention to do injury that is more than merely transient or trifling. In plain English: it would encompass killing through unacceptable violence and thuggery. That would include the colonel and the pub queue thug—people who committed a significant assault on others but who did not intend to kill. That category of offence would not require a mandatory life sentence. Instead, judges would be free to do justice, weighing in the balance all of the aggravating and mitigating factors. For clarity, that would not include the case of the most minor assault. Think of someone creeping up behind a person, playing a trick on them and flicking their ear as a piece of horseplay. That is technically an assault, of course, but is obviously very minor. If that person fell over and died that should remain as manslaughter.
So, where does that leave manslaughter? Manslaughter would remain predominantly focused on cases of gross negligence. That is, offences in which there has been no unlawful assault or intention to kill, but in which the negligence has been so dreadful as to become criminal. The advantage of that is that people get it; people would understand that—it chimes with common sense.
Those are not outlandish suggestions. Other jurisdictions—most obviously the United States—have two categories of murder. For murders in the US over which the federal Government have jurisdiction, life imprisonment is only mandatory for first degree murder. For second degree murder the mandatory sentence is described as
“a term of years to life.”
So why now? Because it is long overdue. The current distinction between murder and manslaughter is almost certainly more than 500 years old. No further general category of homicide has been developed in the intervening period, despite the fact that society, values and knowledge have changed out of all recognition.
The need for modernisation was obvious to our Victorian forebears. In this place, William Gladstone himself indicated his willingness to rationalise the law but nothing came of it—it keeps getting put off. That approach led one cynical criminal lawyer to remark at the beginning of the 20th century that the hope of a criminal code being enacted by Parliament that would address the problems of the law on homicide was as remote as
“expecting to find milk in a male tiger”.
We cannot keep putting this off. Modernising this key area of law is, to borrow the words of the Law Commission
“an essential task for criminal law reform.”
It is time for this generation to take up the challenge and to create a law that is truly fit for the modern age.
I congratulate my hon. Friend the Member for Cheltenham (Alex Chalk), who is a fellow member of the Select Committee on Justice, on his prescience in calling for this debate. It is a very important subject and has been for many years now, and it seems to me that the time is right for change in this area.
As a constitutional lawyer, I do not always keep up with the intricacies of criminal statutes and sentencing. In preparing for today I was slightly surprised that the definitions of “murder” and “manslaughter” had not moved on substantially since I was a student many years ago. We were taught that the law was outdated and not really fit for purpose; very little has changed. The Law Commission in 2005 declared that:
“The law governing homicide in England and Wales is a rickety structure set upon shaky foundations. Some of its rules have remained unaltered since the seventeenth century, even though it has long been acknowledged that they are in dire need of reform.”
Sadly, that is even more the case today than it was then.
I next came across the effects of the law on murder in my work for the Government Legal Service, when the Prison Service was a major client throughout my career. At the start of my time there, the concept of whole-life tariffs was being tested in the Myra Hindley case. I became fascinated by psychopathy—though clearly not a practitioner. I learned that, though truly psychopathic murderers crossed my desk often, those cases, while newsworthy, were happily extremely rare and made up only a tiny proportion of those in our criminal justice system.
Just over 80 whole-life tariffs have been given since 1983 when they were introduced. Those guidelines are clear, judges seem to apply them sensibly, and there is also the right of political appeal where necessary. That system seems, to me and to the European Court of Human Rights, to work reasonably well, and is a good example of judicial discretion in action.
Later on in my career I was often called on to act for the Parole Board in cases of judicial review. There were frequent challenges to the legality of decisions of the Parole Board to refuse to release life-sentenced prisoners, who had often been accused of murder, either because they had not fully admitted their guilt or because they had not been able to do courses that would demonstrate that they had overcome their offending behaviour. Many of the young men imprisoned for murder were boys who had got tanked up in the pub and used a broken glass to inflict serious damage on somebody they did not like the look of.
Glassings in those days usually attracted sentences of around 10 to 12 years, but the variations in the availability of offender behaviour work meant that it was difficult to predict the length of time that anybody would serve. That has not got any easier with the pressures on the Prison Service currently, but we now know that the average length of a sentence for murder has risen from 13 years, which I think was measured in 2004, to about 17 years, which was measured recently. In those circumstances, it is more important than ever that we sort the law out.
I am in no way belittling the crushing effect of murder on the families of the victims. However, those sort of crimes, which my hon. Friend the Member for Cheltenham so clearly explained, are very different from the pre-meditated, sadistic murders carried out by psychopaths which passed my desk. It is important that the law recognises that. Many years ago, the Law Commission published a report in which it proposed changes to homicide sentencing. Its most radical suggestion was explained very clearly by my hon. Friend—in brief, it was to split the offence of murder into first and second degree murder, which itself can be categorised as voluntary or involuntary. After that, partial defences to murder of “diminished responsibility” and “loss of self-control” could be taken into account.
What is important is that those proposed changes would allow sufficient discretion for judges to choose from a far wider range of sentences. Yes, it would be more difficult for the public to understand at first, but with a concerted effort—possibly in a fictional context—our fascination for murder and serious crime would soon mean that the situation was clearer than it is now. After all, many of us have learned a great deal about coercive control recently, though happily not in a fatal context, through the goings on in Ambridge. Am I the only fan of “The Archers” in the room?
Sorry. I, too, have real concerns about the law of parasitic accessory liability, or joint enterprise. We have heard much about the joint enterprise law in recent months following the Supreme Court’s ruling in the Jogee case that
“foresight is simply evidence (albeit sometimes strong evidence) of intent to assist or encourage”.
The ramifications are far-reaching. In the Supreme Court’s words, the law has taken a “wrong turn” for more than 30 years. No longer must young adults out to rob or perhaps to drive a getaway car, but with no thought of killing, end up with life sentences through the actions of their colleagues. We must confront the problem of the breadth of behaviour and culpability encompassed by the offence of murder.
Progress has been virtually non-existent since 2006, despite further consultation undertaken by both the last Labour Government and the coalition Government. So much is changing in the areas of prison reform and rehabilitation of offenders at the moment; both the Ministry of Justice and the Home Office are filled with reforming zeal. I can see that the Minister is smiling at me—surely this is the moment to make long-overdue changes to the law of homicide as well.
It is a pleasure to serve under your chairmanship, Mr Evans, and it is a pleasure to follow two fellow members of the Justice Committee, my hon. Friends the Members for Cheltenham (Alex Chalk) and for Banbury (Victoria Prentis). I did not intend to speak in this debate, and I am sure many people would rather I did not, but I have been prompted to speak briefly.
If I am well known for anything—I am probably not well known for anything at all—it is for being a hard-liner when it comes to dealing with crime and sentencing. I despair at the shocking sentences that are given out by judges and at some of the sentencing guidelines, which do not do justice to the crimes that have been committed. It may well be that my hon. Friend the Member for Cheltenham thinks that I am instinctively opposed to his plans. I thought it worth saying that, as it happens, I am not instinctively opposed to his plans. He made a very compelling case, as anybody who knows him would expect. I would not say that I am wholly persuaded, but I still have an open mind on this particular issue. I hope that the Government will have an open mind on this issue, because it is worthy of further debate.
One of the attractions, it seems to me, of what my hon. Friend is proposing is that it may lead to some more honesty in sentencing. One of the things that really irritates people about the criminal justice system is that we have sentences that sound tough, and make politicians sound tough when they say they are going to extend life sentences for this and that, but in reality are not tough at all. Dishonesty in sentencing is one of the worst parts of our criminal justice system and brings it into disrepute. If my hon. Friend’s plans were to lead to more honesty in sentencing, that in itself would be a good thing.
I appreciate what my hon. Friend is saying about sentencing. Of course, we now have the Sentencing Council and, without wishing to create a bit of a love-in for members of the Justice Committee here, we do have the power to review sentences and comment on them. Is he suggesting that we should take a harder line on those in order to get the sentencing right? I get the feeling that the judiciary are simply following our guidelines.
My hon. Friend is another member of the Justice Committee who is more talented than me. Yes, we should concentrate more on sentencing guidelines as a Committee and as a Parliament, because these matters are of great importance to our constituents. They are the ones, at the end of the day, who feel that the law comes into disrepute with some of the sentences that are handed down. I do not think we should leave it to unelected people to determine sentencing guidelines. We should be taking a greater role in those guidelines, absolutely.
I have an open mind about what my hon. Friend the Member for Cheltenham proposes, and I hope that the Government will look at it, because I think there are some merits in what he said. I would certainly not rule out supporting some of the changes that he articulated. We should not rush into this either. There are other things that we should think about. My hon. Friend the Member for Banbury mentioned the fact that the average minimum tariff for murder had increased from 13 years to 17 years. I was not entirely sure, if she was making a point about that, whether that was a good a thing or a bad thing. Most of my constituents would say that the increase in that tariff is a good thing.
Just to clarify, I was making the point that that was the reality of the situation; that sentences for murder were getting longer and that it was important for judges to have the full range of sentences open to them so that they could match the sentence to the offence.
I am grateful to my hon. Friend for that intervention. I think most of my constituents will be pleased to know that the average length of the minimum tariff given for murder has gone up. I suspect that if I were to do a straw poll of my constituents, most of them would be shocked that the average minimum tariff for the crime of murder was so low. I suspect most people in the country would be shocked that the average minimum tariff for murder was as little as 13 years in the first place. This is one of the great disconnects that we have with the general public at large; they expect murder sentences to be much tougher than that.
One of my notes of caution, therefore, for my hon. Friend the Member for Cheltenham is that his proposal might be used as a mechanism to try to weaken sentences for murder. That would fly in the face, I suspect, of what the public want to see. If somebody’s agenda is that penalties for murder at the moment are too harsh and this is a way of weakening them, that would be a terrible development. One of my notes of caution is that this does not get hijacked for all the wrong reasons by some of the penal reform groups that seem to have a view that nobody should be sent to prison at all. That is my first note of caution.
My second note of caution, and the reason why we need to tread carefully, is that in the cases that my hon. Friend alluded to, most people would accept that somebody’s life had been taken with some form of malice aforethought. At no point should we belittle the fact that somebody has had their life taken away with malice aforethought.
My hon. Friend is making some very helpful and important contributions. What he says is absolutely right, but whether it is the retired colonel who goes round to his noisy neighbour or the pub thug, under my proposals they would both be convicted of second-degree murder. That would mark society’s condemnation and give the judge power to sentence.
I agree with that point; as I said at the start, I do not necessarily disagree with my hon. Friend. It is just worth making the point that in all the cases he referred to—hypothetical or not—somebody’s life had been taken, with some degree of malice aforethought associated with that. It would be dangerous if we did not give at least some recognition to that fact when considering these things. I certainly would not ever want to get into a situation where we seem to belittle one form of murder in order to form a distinction. We need to make it clear that both are terrible offences in their own particular ways.
If what my hon. Friend envisages is, perhaps, tougher sentences for first-degree murders in order to draw a distinction, I would welcome that. I think that there are many people in the country who, as it happens, think that life should mean life when it comes to murder, as it so often does in the United States of America, but very seldom does in the United Kingdom. If that was what he had in mind, I think he will get a great deal of support. If he was trying to use this as a Trojan horse to reduce sentences for murder, I suspect he would get very little support from the public. Knowing him as I do, I do not think he has that kind of agenda; he genuinely wants to make sure that the law is fit for purpose and is not brought into disrepute. He does a fantastic job in Parliament in pursuing that agenda, both in the House and on the Justice Committee.
This is something we need to debate further; there is not a clear-cut case one way or the other. I will retain an open mind—people who know me well know that that does not happen very often. All I ask of the Government and of the official Opposition is that they also keep an open mind and discuss all the implications of any such change in the law. My hon. Friend’s case is a very good one and is certainly something that I can envisage happening at some point in the future.
It is a great pleasure to serve under your chairmanship, Mr Evans. This is my first time doing so, and I am very pleased to see you in the Chair. I want to take this opportunity to welcome the proposal made by my hon. Friend the Member for Cheltenham (Alex Chalk) and highlight why I support it.
I want to raise the case of Stephen Martin. He is a 55-year-old man from West Sussex. I have sought the permission of my hon. Friend the Member for Worthing West (Sir Peter Bottomley) to mention the case, and he has said that he is happy for me to do so. He worked hard to rectify what I considered to be a miscarriage of justice.
I am keen on scuba diving, and I dive in Malta with my good friends Viv and Alan Whitehead. I often dive at a location called the Blue Hole in Gozo, which was where Mr Martin went diving with four other people. As he was considered more qualified than the other divers, it was decided that he would be the dive leader. However, during the dive, two of the participants—Mr Martin’s partner, Larissa Hooley, and another diver called Nigel Haines—lost consciousness. Larissa Hooley was taken to the surface, where she later died. Nigel Haines was missing for just a few moments before he was found and dragged to the shore.
The coroner’s court in Brighton and Hove decided the deaths were accidental, but the magistrate in Gozo sought an extradition warrant against Mr Martin, who spent six months on curfew. He had to report to the police station three times a day and was forced to wear a tag. The Maltese magistrate sought a charge of involuntary manslaughter. I bring up that case to demonstrate that we should consider an extension of murder offences and having an offence of involuntary manslaughter. No such charge exists in the UK.
As a British national, Stephen Martin was subject to the whim of an overseas judiciary for an offence that is not a criminal offence in this country. I would like not only the charge of murder but that of manslaughter to take in a different range of incidents. My hon. Friend the Member for Shipley (Philip Davies) is right that there should be no change to the law to reduce the sentence tariff, but there is an arguable case for extending the variety of charges available to the Crown Prosecution Service when bringing a case against an individual. I wanted to raise that case in the House and extend to Members my views on changes to murder legislation.
It is a pleasure to serve under your chairmanship, Mr Evans. I am pleased to respond to the debate, which I thank the hon. Member for Cheltenham (Alex Chalk) for securing. I very much enjoyed serving with him and other hon. Members who are here today in my brief time on the Justice Committee. So much has changed for all of us in the Conservative party and the Labour party since those straightforward and timid days.
The hon. Gentleman brings the expertise of someone who sits on the Justice Committee, whose work I will refer to later, and the experience of a distinguished legal career. His former legal practice described him as “a first-class practitioner” and a “persuasive and forceful advocate”. As he has persuaded the hon. Member for Shipley (Philip Davies) to keep an open mind on this matter, I can certainly say that I agree with his former legal practice.
The hon. Member for Shipley, a fellow Yorkshireman, said that people would not want hear from him in the debate. On that, as on many other things, I fundamentally disagree with him. I was pleased to hear from him, as we all are, because one thing we do respect him for is that he always says what he thinks, which is very important. It was a pleasure to hear from the hon. Members for Banbury (Victoria Prentis) and for Hendon (Dr Offord), both of whom made interesting points about this most serious of matters. I thank the Backbench Business Committee for allocating this slot for the debate and ensuring that such important topics are debated in the House.
As hon. Members know, this is my first debate as shadow Secretary of State for Justice and shadow Lord Chancellor. I am pleased to follow in the footsteps of Lord Falconer and my other predecessor, Sadiq Khan, who is now the Mayor of London. Not only have I had the pleasure of briefly serving on the Justice Committee, but for 10 years I was a lawyer in my home city of Leeds, and for eight of those years I practised employment tribunal work. I am yet to meet my opposite number, the Lord Chancellor and Secretary of State for Justice, but I understand that he is rather busy at the moment. I am sure that he will be agreeable to meeting me at some point and I look forward to that.
There have not been many speeches in this debate, but they have all been excellent, and I feel with confidence that we can move the debate forward. I want to give the Minister the maximum time to respond—he may get a full hour to respond, who knows?
Some people would like me to hold my breath, maybe for a long, long time but, on this occasion, I will not. I will limit my remarks to briefly addressing joint enterprise, an issue that has been raised in this debate and that the hon. Member for Cheltenham mentioned in his submission to the Backbench Business Committee.
Any change to the law of homicide, no matter how small, is of the utmost importance to the public and the House. That is because homicide offences are some of the most serious criminal offences that any individual can commit against any other individual or individuals. The state, as a signatory to the European convention on human rights, must undertake a positive obligation under article 2—the protection of the right to life—to take all appropriate steps to safeguard life, and to put in place a legislative and administrative framework to provide effective deterrents against threats to the right to life. That is what we are debating and why, in my new role, I am keen to listen carefully and engage with as many key stakeholders as possible. I am keen to hear more from the Minister about the Government’s next steps.
On joint enterprise, it is important to refer to Lord Neuberger’s judgment, in which he said that the Supreme Court ruling did not automatically mean that all previous joint enterprise convictions were unsafe, and that
“a person who joins in a crime which any reasonable person would realise involves a risk of harm, and death results, is guilty at least of manslaughter”,
the maximum sentence for which is life imprisonment. He also said that the rule that
“a person who intentionally encourages or assists the commission of a crime is as guilty as the person who physically commits it”
was not affected, and that it remained open to a jury to decide whether a person had intentionally encouraged or assisted a crime—for example, through knowledge that weapons were being carried. As the Prime Minister has said, we are dealing with a narrow change to the law, but one that could have massive implications for many people.
I am probably the only non-learned Member present in the room, apart from my hon. Friend the Member for Shipley (Philip Davies), but I understood that the ruling was quite specific. I thought that the Supreme Court had said that the interpretation of the law had been wrong but that there was no need to change the law. The judgment was quite specific about that.
I thank the Minister for making that important point, and I look forward to hearing about that in more detail in his response.
The lawyer Simon Natas, who has worked with the impressive campaign group Joint Enterprise Not Guilty by Association, said that the “historic” ruling would make the law “fairer for everybody”. He is right, but it is important to make it clear that if someone goes out as part of a gang carrying guns or knives, and their actions encourage or assist in a murder, they should face the consequences. I am sure that is broadly the view of reasonable people, and that the public would support that. After listening to the views of my friends, neighbours and constituents, I know that, by and large, that is people’s view.
The judgment was right to acknowledge the growing call for change following the concern that quite peripheral members of a gang involved in a killing, who had no real clue what they had been caught up in, were being prosecuted. That is why I welcome the judgment. I press the Government to commit to conduct a review of the effects of the change after two to three years.
I am concerned by evidence that the Cambridge Institute of Criminology provided to the Justice Committee revealing that the proportion of black and mixed-heritage young men serving very long sentences for joint enterprise offences is much higher than their representation in both the general population and the overall prison population. Will the Government commit to reviewing that, alongside the wider review by my right hon. Friend the Member for Tottenham (Mr Lammy)?
We have heard today about so-called one-punch killers. The hon. Member for Cheltenham provided examples, hypothetical and otherwise, showing the difficulty of the issue and the serious consideration it requires. I am concerned about the public perception that attackers who kill with a single punch seem to receive jail sentences that could be seen as lenient, despite the December 2009 Court of Appeal ruling on single-punch killings led by the former Lord Chief Justice, Lord Judge. The ruling’s conclusion stated that acts of violence resulting in death should be given “greater weight” in sentencing, even if the conviction is for manslaughter rather than murder. Will the Minister confirm whether he is reviewing that ruling?
I will close my remarks to give the Minister as much time as possible, although I suspect he will not take the maximum time available. The Labour party is clear that the criminal justice system relies on the fundamental principle that the public must have confidence in it, and it is our duty to ensure that victims and witnesses who come forward have confidence that their case will be dealt with thoroughly and fairly, and that people who break the law of the land and who are found guilty of some of the worst offences—homicide devastates families across the country—are punished accordingly.
I thank all hon. Members who took part in this debate, and I thank you, Mr Evans. I look forward to the Minister’s response.
As usual, it is a pleasure to serve under your chairmanship, Mr Evans—I really mean that. I congratulate my hon. Friend the Member for Cheltenham (Alex Chalk) on securing this debate. It is honestly a real shame that more colleagues are not here for such an important debate—a debate that should continue beyond this afternoon. Far be it from me, in my lowly position, to suggest that this debate should be on the Floor of the House or that a Select Committee should hold an inquiry, but if I were a member of the Justice Committee, I would probably look to hold an inquiry. Like my predecessors, I will keep an open mind on this subject for as long as I am in the job, and probably long after.
The Supreme Court judgment has been mentioned a couple of times, and the five judges who made that ruling specifically said that they were referring to a very narrow part of law, which they said had been interpreted incorrectly in the judgments handed down by different judges. The Supreme Court specifically said that its ruling required not a change of law but a change in how judges interpret the law. I say for the first time that the Government accept that ruling, and we accept that the law in this particular area does not need to be changed.
The Sentencing Council is currently looking at one-punch manslaughter cases, about which the public are understandably concerned. In the case mentioned earlier, such concern is only right and proper, but Parliament has rightly given the Sentencing Council responsibility for setting guidance—Parliament traditionally had that responsibility. I also fully accept that some parts of guidance are still set in statute, and there is an ongoing sentencing review.
I apologise for not welcoming the hon. Member for Leeds East (Richard Burgon) to his new post. I wish him every success in his very important position and, as with his colleagues who preceded him, I will give him as much support as possible. I wish him longevity in his position as a shadow spokesman—[Laughter.] That can probably be taken in many different ways, but I mean to be nice.
We have heard about sentencing and for how long people are imprisoned. Of course, the changes made in 2003 are still coming through the system. As politicians, we all bandy around numbers for how long people serve, but people are, correctly, starting to serve longer sentences. As previous Justice Secretaries and Justice Ministers have said, we have no plan to abolish the mandatory life sentence. I cannot be a hypocrite: as a Back Bencher, I appealed against several unduly lenient sentences, and most people know that I have concerns about the restriction on appeals against undue leniency. People can appeal against basically any sentence they are given, but we are restricted in appealing against unduly lenient sentences. The Attorney General and the Justice Secretary are working on a review of that restriction.
At this interesting time in politics, in Westminster and in the country, it would not be right for me to indicate whether we agree or disagree with the proposals. I was asked whether the Department and I will keep an open mind, and we certainly will. Further debate on this issue is important. I am also conscious that the subject might drift if we are not careful. My notes say that in December 2010 the then Secretary of State, my right hon. and learned Friend the Member for Rushcliffe (Mr Clarke), indicated that he was not minded to implement the Law Commission’s recommendations, but he qualified that by saying that he would keep an open mind about proceeding at a later date. We are now at a later date. Although I am probably shooting myself in the foot, especially if I stay in this position under the new Prime Minister—we will have one in the not-too-distant future—I think it has been too long. We now need to consider whether we accept the Law Commission’s 2005 report. Time has moved on. Although the report was important, and parts of it were accepted at the time, we must ensure that the report is still relevant, particularly in relation to subsequent changes to sentencing guidance. I cannot think of anything that can be done to another human being that is as bad as taking their life. There are myriad appalling things that people do to each other, but surely, in any society, taking a human life is the worst.
I will keep an open mind. I will ensure that whoever is Justice Secretary in the Government formed by the new Prime Minister sees my comments—the current Justice Secretary knows my views. We cannot let this matter drift for another five or 10 years. If something can be done, we must do it now. It sounds simple, but the lawyers in the room will know that it is not so simple in practice.
I congratulate everyone who has taken part in this debate, particularly the more learned Members. I look at the proposal from a simple point of view as a constituency MP—I think about what my constituents would think—so I agree with many of the comments made by my hon. Friend the Member for Shipley (Philip Davies). I probably have not answered all the direct questions asked by the shadow Minister, so I will write to him, and I will make those answers available to members of the Justice Committee, too.
This has been a helpful debate. I introduced the topic to see whether there was an appetite for discussing it, and it seems that there is. My hon. Friend the Member for Shipley (Philip Davies) made some important points. He is absolutely right to say that in respect of this offence, perhaps beyond any other, there must be clarity, consistency and logicality. Members of the public must be satisfied that the law reflects common sense.
My hon. Friend’s point about the need for sentencing power to be transparent is also a good one. It is particularly relevant in the issue of homicide. If someone gets a life sentence and is told that they have a minimum term of 15 or 17 years to serve, that is the period that they must serve, yet if they are convicted of an offence of grievous bodily harm and the judge sets a determinate sentence of 15 years, they will in fact serve only half of that.
Yes; a maximum of half. My hon. Friend the Member for Shipley made an important point, and there is a further agenda to put forward.
To return to my central point, if we could divide the law of murder into first and second degree, those charged and convicted of first degree murder, which would be the most serious crime in the criminal calendar, would be convicted of something that would earn—if that is the right word—the opprobrium of society. People would understand that someone guilty of that offence intended to take life. I respectfully endorse the point made by my right hon. Friend the Minister that we need particular clarity on issues involving the taking of life.
What attracts me to the idea of second degree murder is that we could then lump in—if that is not too inelegant—all the other offences that deserve society’s condemnation, as my hon. Friend the Member for Shipley indicated, because life has been taken through an unlawful act. If we grouped those offences under second degree murder, we would not need a mandatory life sentence, but if the judge thought—on the facts of the case—that that was required, that is precisely what could be imposed. Taking into account how the law has moved on in respect of Jogee and of our modern mores and understanding, it seems to me that this is a reform whose time has come.
Question put and agreed to.
That this House has considered the matter of reforming the law on homicide.
Hearing Loss: Action Plan and Commissioning Framework
[Valerie Vaz in the Chair]
I beg to move,
That this House has considered NHS England’s Action Plan on Hearing Loss and the adult hearing service commissioning framework.
I am grateful for the opportunity to open this debate, and I am pleased to see you presiding over our business, Ms Vaz. I am also pleased to see the Minister and the new shadow Secretary of State for Health, my hon. Friend the Member for Hackney North and Stoke Newington (Ms Abbott), in their places. I look forward to their comments.
I am disappointed that there are not more colleagues here, but given events taking place outside, it is perhaps no surprise that their focus is elsewhere. I am, however, particularly pleased that my hon. Friend the Member for Nottingham South (Lilian Greenwood), who chaired the all-party group on deafness before me, is here. She brought great enthusiasm and direction to that role and formed the work programme that the group is still following. I am also grateful to the Backbench Business Committee for granting me the opportunity to have a debate on this important issue, and to Alex Adcock and Tom Powell of the House of Commons Library, the UK Council on Deafness, the Royal College of Physicians and others for their briefings, which have helped me to formulate my comments.
I would like to put on the record how much work is being done. I do not intend to attack or criticise the Government; this debate is an opportunity to seek clarification on some of the important issues concerning deafness and hearing loss. The British Society of Audiology, the British Academy of Audiology and others have commented positively on the joint working on the action plan on deafness and the collective efforts to develop an overarching commissioning framework for hearing. That framework document is due to be published on 19 July and will be launched here in the Commons. Today was the closest date for securing a debate to give the Minister a platform to confirm the progress that has been made and to elaborate on arrangements for the day. But I am getting ahead of myself.
I am grateful for the opportunity to raise some issues for the Front Benchers to comment on. As I said, I am chairman of the all-party group on deafness, following my hon. Friend the Member for Nottingham South. We have an active all-party group, which is well supported by colleagues from both Houses of Parliament. I want to put on the record my appreciation for Dan Sumners of Signature UK, who was seconded to act as the admin secretary to the all-party group. I commend him for his support; he has done sterling work in service of the group. We are very grateful for that and wish him well in the future.
On a personal note, I wear two hearing aids. My hearing loss was originally diagnosed as industrially induced from my time in the London Fire Brigade, but I am sure that age could be contributing to my present difficulties. I thank the audiology department of the Royal London Hospital for the support and treatment that it gives me when I need assistance. I also thank the engineers and technicians who maintain the loop system here in the Palace of Westminster, which is very good in this Chamber, as it is in most of the venues in the House. In the main Chamber, it can be a little bit unpredictable, but there are speakers in the Benches to help with any difficulties we might have, so we are well served in these buildings.
Hearing loss affects more than 10 million adults and 45,000 children in the UK, which equates to one in six of the population, and it is estimated that by 2031, 14.5 million people in the UK—approximately one in five of the population—will have hearing loss. The most common form of hearing loss is age-related, and the prevalence of deafness approximately doubles with every decade of life.
The Royal College of Physicians says that NHS England’s action plan on hearing loss
“recognises significant regional variances of early diagnosis and care for children and adults with hearing loss. The document sets out a commitment to design and deliver excellent, high quality care audiology services to meet patient need. The National Improving Quality In Physiological Services accreditation programme (IQIPS)—run by the Royal College of Physicians…assesses audiology services across England to ensure they operate safely and to a high standard. IQIPS is a recognised marker of excellence in patient care and in reducing variances in audiology services.”
I recently visited Auditory Verbal in south London and attended its event held here in the Palace of Westminster. It demonstrated that the earliest diagnosis and treatment can help children who are born deaf or suffer severe hearing loss to learn to communicate normally, by using the brief window of the very early years to stimulate the auditory part of the brain before it loses the opportunity to develop. I commend Auditory Verbal for the work that it does. If the Minister is not familiar with that organisation and has not had the chance to visit it, I strongly recommend that he does so, because it is an inspiring experience. There are a lot of great people around the country working with and for that organisation.
Officers of the all-party group were grateful to the Minister for the opportunity to meet him recently to discuss the action plan and to ask about the commissioning framework. This debate is a continuation of that dialogue. We raised a number of issues, such as the provision of hearing aids; a national screening programme; promoting the prevention of hearing loss; providing innovative models of care; active support for people with hearing loss; and the recognition of British sign language.
The action plan addresses those issues and sets out five key objectives: good prevention to reduce the numbers of young people and adults with noise-induced hearing loss; earlier diagnosis to improve outcomes for babies with hearing loss and increase identification of children and adults in at-risk groups; integrated services; increased independence and ageing well; and good learning outcomes, including improving employment opportunities for young people and adults and reducing development and attainment gaps between deaf and hearing children.
The briefing from the UK Council on Deafness was very helpful in outlining the background to today’s debate. It says:
“This debate has been called prior to the publication of the NHS England adult hearing service commissioning framework. The framework will be launched in Parliament at 2pm on 19 July in the Boothroyd Room”.
I hope that a lot of colleagues will be able to turn up to support that event. It continues:
“The framework is an outcome of the NHS England Action Plan On Hearing Loss, published on 23 March 2015.”
All-party group officers told the Minister at our meeting that we commend the officials within the Department of Health and NHS England for their sterling work in drafting the report and bringing together the commissioning framework. There are a lot of great people doing great work. I have met and listened to a number of them in different meetings, and we are very grateful for all their efforts in this area of policy.
The UK Council on Deafness says:
“The aim of the action plan is to do more on prevention, early diagnosis and support for those who have permanent hearing loss.”
It makes the important point that the action plan acknowledges that
“without hearing aids people are ‘at greater risk of social isolation, and reduced mental well-being…there is a strong correlation between hearing loss and cognitive decline, mental illness and dementia’. The Ear Foundation has estimated the cost of untreated hearing loss to be £30 billion per year. It has found that hearing loss is associated with reduced income of £2,000 per year on average. Wearing hearing aids halves that loss. At least £25bn in potential economic output is lost each year because of a lack of support for people with hearing loss and deafness.”
The council also quotes Action on Hearing Loss, which
“has found that people wait on average 10 years to seek help after they first notice symptoms of hearing loss. Only a third of people who need hearing aids have them, leaving 4 million people with unmet needs. Yet hearing aids are shown to improve quality of life, and 90 per cent of people continue to use and benefit from hearing aids.”
The UK Council on Deafness also raises the issue of cuts in the provision of hearing aids, pointing out that some clinical commissioning groups proposed limiting access to hearing aids in 2015-16. Following a campaign, most decided to halt those proposals as the commissioning framework was being developed. However, North Staffordshire is reported to have implemented the cuts, and the risk of further rationing remains. Perhaps the Minister will comment on that.
The council also comments that in January, the national screening committee decided not to recommend an adult hearing screening programme. The all-party group has also made that point to the Minister. We fell that without an assessment of the scope and size of the problem, and of the quality of the response from NHS trusts across England, a question mark was left over whether hearing loss was being adequately assessed and the quality of provision adequately outlined.
On the recognition of British sign language, the UK Council on Deafness says that deafness has been put firmly on the agenda by the British Sign Language (Scotland) Act 2015 and the announcement by the Northern Ireland Executive that it plans to bring forward legislation relating to British and Irish sign languages. Perhaps the Minister will comment on BSL. There is a campaign for recognition in England, as there has been in Scotland and Northern Ireland.
As chair of the all-party group, I should put on the record my thanks—I am sure I echo the thoughts of my hon. Friend the Member for Nottingham South from when she was chair—to colleagues from both Houses who support the group so positively. The Minister knows from the parliamentary questions that come across his desk and from occasional debates and early-day motions that deafness is a matter of interest in the Commons. However, the number of parliamentary actions that my colleagues and I initiate do not reflect the importance of the matter or the number of people affected in this country. I hope that our efforts today and the positive progress that the Government and NHS England are making will reassure the people affected, and those campaigning with them and on their behalf, that the Government and NHS England recognise the condition of hearing loss and that it is being addressed.
As I started by saying, the all-party group requested this debate to demonstrate how much NHS England has done, to raise matters of ongoing interest or concern and to see what more we could solicit from the Minister on the issues that he knows are live within NHS England and the Department. I know he is very much on top of his brief, and I look forward to his comments. We look forward to 19 July and the publication and launch of the framework document, so that the provision for people suffering hearing loss can be not only understood but maintained and improved.
It is a great pleasure to see you in the chair today, Ms Vaz, and to have the opportunity to speak in Westminster Hall for the first time in a while.
I want to begin by congratulating my hon. Friend the Member for Poplar and Limehouse (Jim Fitzpatrick) on securing today’s date and on the excellent work that he is doing to lead the all-party group on deafness. I am very proud to represent a constituency that is home to the national charity, the Ear Foundation, of which I am a patron. We are also home to the Medical Research Council’s Institute for Hearing Research, the Biomedical Research Unit on Hearing and the excellent audiology department of Nottingham University Hospitals NHS Trust. Their work is outstanding and makes a huge contribution to our understanding of hearing loss and deafness in the UK and of the ways in which we can best support those with hearing difficulties to fulfil their potential and live the lives they choose.
Back in November 2013, I secured an Adjournment debate on hearing loss in adulthood and I pressed the then Minister, the right hon. Member for North Norfolk (Norman Lamb), to get on with publishing the long-awaited action plan on hearing loss and to monitor its implementation. When it was published in March 2015, it was welcomed on both sides of the House and by everyone with an interest in hearing issues. It sets out clearly the high personal, societal and economic costs of hearing loss—the case for action—and the action that needs to be taken: better prevention, early diagnosis and the right provision of support and services.
As my hon. Friend the Member for Poplar and Limehouse has set out, the case for action is huge: 11 million people in the UK are currently affected by hearing loss; that is 1 in 6 of us, which translates to about 10,000 of our constituents. With an ageing population, both that number and the proportion of us affected is rising fast. But it is not simply the numbers affected that makes this a major public health issue; it is the significant impact that untreated hearing loss has on people’s health and wellbeing.
To communicate is to be part of society. Losing one’s hearing is not simply about the absence of sound. If not addressed, hearing loss becomes the loss of our capacity to take part in social life. It is a 24/7 condition and in most cases there is no cure, so it is no exaggeration to say that it can destroy lives. Because communication is at the core of human experience, people with hearing loss can find it very difficult to negotiate everyday interactions, whether in the workplace, on the bus, at the supermarket or in the local doctor’s surgery. It can lead to isolation and exclusion. It can also damage personal relationships. Many deaf people report finding it difficult to join in with family conversations and jokes. Couples say they feel more distant from each other and from their friends; and partners of people with a hearing problem describe feelings of loneliness and frustration.
Travelling on public transport becomes a challenge. A minor problem such as a platform alteration or a delayed connection can become a major problem if you miss the announcement. That can leave deaf people feeling anxious and vulnerable and worried about being left stranded or lost. Failure to address hearing problems does not just affect individuals and their families; it has implications for society as a whole.
It is estimated that hearing loss costs the UK economy £25 billion a year in lost productivity and unemployment. Too many people are forced to resign, retire early or take redundancy as a result of their disability. Of the 300,000 people of working age with severe hearing impairment, 20% report being unemployed and seeking work, and another 10% report that they cannot seek work owing to their ill health. As the state pension age rises and more jobs depend on people’s communication skills than was the case 20 or 30 years ago, such vulnerability to unemployment is a growing problem.
Research shows that hearing loss is also linked to other health problems, doubling the risk of developing depression and increasing the risk of anxiety and other mental health difficulties. There is also increasing evidence of links between hearing loss and dementia and evidence linking hearing loss to learning disabilities, diabetes, stroke and obesity. That is the bad news. The good news is the incontrovertible evidence that hearing aids and other technologies, including cochlear implants, improve people’s ability to communicate and their quality of life. They reduce the risk of depression and other health problems. But early intervention is key to maximising the benefits, so we must address issues relating to early diagnosis, prompt referral to high-quality audiology services and appropriate provision of hearing aids and other interventions.
Hearing aids are most effective when they are fitted early, but on average, as the my hon. Friend the Member for Poplar and Limehouse said, people wait 10 years before seeking help, and when they do eventually seek help, GPs fail to refer 45% of those reporting problems with their hearing to NHS audiology services. That is why I was so disappointed that the national screening committee decided not to recommend an adult hearing screening programme that could have helped us to address the issue.
I am sure the Minister has read the research report by Action on Hearing Loss and the Ear Foundation—I have it here—which posed the question, “Adult Hearing Screening: can we afford to wait any longer?” If he has not, he is welcome to have my copy. Their evidence tells us that the answer to the question is a resounding no. I hope the Minister will agree to look again at that evidence.
The idea that people do not wear their hearing aids and keep them in a drawer is outdated. Today’s technologies are accepted and are worn, although the more we can do to improve follow-up care and reduce stigma, the better. Tackling hearing loss is cost-effective. We cannot afford to wait years for a randomised controlled trial. We should be acting now.
We are also very concerned, of course, about the risk of rationing access to hearing aids, as local health commissioners’ budgets are under intense pressure. In fact, the report on NHS audiology across the UK published by Action on Hearing Loss and entitled “Under Pressure” showed that 30% of NHS audiology providers had had their budgets reduced. Along with increased demand, that had led to two fifths of providers making service reductions, resulting in longer waiting times, fewer follow-up appointments and reduced availability of home visits. In a small number of cases, providers were not providing two hearing aids to patients with hearing loss in both ears.
Worse still, as everyone is aware, North Staffordshire clinical commissioning group decided in March last year to stop funding free NHS hearing aids altogether for those with mild hearing loss. There was a fear that others would follow it in doing that, but so far, as a result of significant campaigning by Action on Hearing Loss and many others, that has not happened. South Staffordshire, South Norfolk, Kernow and Mid Essex CCGs, which had all signalled their intention to restrict hearing aid provision, have now decided otherwise, or have at least delayed a decision until the national commissioning framework is published. However, three CCGs in Worcestershire are currently consulting on potential changes to local health services—including a proposal to cut NHS hearing aid provision; so there is still a threat to services.
When I asked the then Minister, the hon. Member for Central Suffolk and North Ipswich (Dr Poulter), about the North Staffs decision, he told me:
“If the hon. Lady has concerns about local commissioning decisions, she should take them up with local commissioners…It is important that clinical services are now designed and delivered by front-line health care professionals, and if she is concerned about them, I am sure she will take that up with her local CCG.”—[Official Report, 15 October 2014; Vol. 586, c. 407.]
I know that the Minister who is present today shares the concerns of the all-party group about rationing, and I hope that he can give me greater assurance that the commitments in the Government’s action plan will be more than warm words and will translate into effective action. The action plan and the commissioning guidance present an opportunity to improve millions of people’s lives, and I hope that we will grasp it.
It is a pleasure to serve under your chairmanship, Ms Vaz. I congratulate my fellow east end MP, my hon. Friend the Member for Poplar and Limehouse (Jim Fitzpatrick), on securing this important debate; I also congratulate my hon. Friend the Member for Nottingham South (Lilian Greenwood) on her thoughtful speech.
As we have heard in the debate, hearing is at the heart of the human experience. I think we will all have seen online the short films of babies who, through hearing aid devices, suddenly hear their mothers’ voices for the first time. Those babies’ faces are transformed, and that reminds us how important hearing is.
There is much to welcome in the Department of Health’s action plan on hearing. The aim of reducing the stigma related to hearing loss is important. I think that sense of stigma is the reason for people waiting so long before they get the help they need. Designing public services and public spaces to support good communication is also important. Here, and certainly in the Chamber of the House of Commons, the design is good and hearing loss need not stop any Member following what is going on; but there is more to be done in other public spaces, such as cinemas, theatres and so on.
The action plan also seeks to provide better communication support and understanding in the workplace. That is important, because for people of working age I think the worst thing is the feeling that hearing loss is cutting them off from the workplace. The workplace is not just source of income; it gives people a sense of identity, self-worth and importance. For that to be cut off through hearing loss is tragic. The things that are wanted in the workplace are timely access to assistive devices, language support—such as learning British Sign Language or sign-supported English—and speech to text. Another aim of the action plan is that there should be more research into the causes and management of hearing loss and tinnitus. Tinnitus is a particularly alarming issue. It is sometimes written and talked about as if nothing can be done. It can be as bad for people’s ability to function in society as absolute hearing loss. It is important that we have more research on its management, rather than just accepting that nothing can be done about it.
An important aspect of the action plan is the promotion of strategies for the prevention of hearing loss, and an understanding of hearing awareness. Some hearing loss is workplace-related, and my hon. Friend the Member for Poplar and Limehouse said that his may be related to his working life as a fireman. Some hearing loss happens as people get older. However, we need strategies to prevent it, if that is possible. Early awareness, diagnosis and management is vital. That is why we think the issue of stigma is so important. We want person-centred planning that is responsive to information and social needs and that reaches out into all communities.
We should not assume that communities whose first language is not English will be able to get access to all the things that are made available. Many communities, particularly in the east end of London, are wary of approaching the authorities—even their GP. A lot of thought needs to be given to the sort of information outreach programmes that will reach people of every age in every community. In big urban centres in particular, if thought is not given to outreach and an understanding of early awareness, diagnosis and management, thousands of people in a given area will not be able to get the help they need. So we need person-centred planning, and timely access or signposts to communication support, lip-reading classes, hearing therapy, counselling, support groups, befriending services and assistive technologies. I reiterate that we must consider that we are not in a mono-cultural society. It should be as easy for a Bengali widow in Poplar and Limehouse to get access to lip-reading classes, befriending services or support groups as it is for a retired man in Nottingham. Finally, one of the aims of the Department’s action plan is to promote inclusion and participation, through ensuring that all public services are accessible, and to support language and communication needs. Those are excellent aims.
The purpose of today’s debate is to consider how far the aims are being achieved, and my colleagues have touched on two major issues that are worth considering again. The question of hearing aid rationing arises in the context of pressure on NHS resources. One way in which the NHS and CCGs are seeking to manage the pressures is by raising the bar before someone can get access to a service or to help. One of the most alarming aspects of that approach is its effect in mental health, where people must manifest more extreme symptoms before they can get help. It might seem to CCGs that rationing hearing aids is a less obvious form of rationing, because only the patients know or understand what has happened. Thus, as we have heard, since October 2015 one CCG—North Staffordshire—has stopped providing hearing aids to patients who have mild hearing loss, and it subjects those with moderate hearing loss to a questionnaire before it decides whether to provide them with a hearing aid.
As the Minister heard from my colleagues, it is not acceptable to ration hearing aids in that way. There is a danger that people’s hearing loss will get more severe before they can get the help they need. There are some exemptions, such as for people with dementia; hearing loss can make people more susceptible to dementia, physical disability or tinnitus. However the approach in question is not good enough. If the Government feel that we must have rationing in the NHS, we need clarity about that—it must be transparent and there must be debate. It cannot happen just because the Government feel that somehow they can get away with it.
Ten further CCGs have consulted on proposals to stop the provision of NHS hearing aids to patients with mild to moderate hearing loss, although none, as we have heard, has gone ahead with the proposals. Some are seeking alternative cost savings and others await the publication of the commissioning framework. As the Minister has heard, hearing aids are good value for money. The cost to the NHS of a pair of hearing aids and three years’ support is under £400, but the average price for an individual purchasing them privately is £3,000. In the part of the world that I come from— the east end of London—£3,000 for a hearing aid is prohibitively expensive. Furthermore, the sad fact is that 30% of audiology providers have had their budgets reduced in real terms over the past two years, and 33% said that increased demand is directly impacting on the scope or quality of the service that they can provide.
The other point, apart from the notion of hearing aid rationing, is to do with routine health checks. The charity Action on Hearing Loss commissioned a cost-benefit analysis of hearing screening, which found that screening everyone and providing support to those who need it at the age of 65 would save £2 billion over 10 years, for a cost of only £255 million. Low levels of diagnosis mean that two thirds of people are not getting the treatment and support they need. The research suggests that there is an average 10-year delay in people seeking help for their hearing loss and that, when they do, GPs fail to refer fully 45% of those reporting hearing loss to hearing services.
Hearing loss can be a gradual process. The stigma around hearing loss might make people reluctant to get the help they need, in particular as they get older and feel it is a sign of ageing to which they do not want to admit. Imagine, though, the reality for people who gradually and incrementally find their hearing going, and find themselves increasingly shut off from the world, the workplace, family and friends. Some excellent work has been done on the issue, and I await with interest the Minister’s response to the points that have been made.
It is a pleasure to speak under your chairmanship, Ms Vaz. Thank you for chairing this important debate.
Whatever else may be going on in this place at the moment, it is important that every now and again we return to what most people would regard as real life. As both Government and Opposition Members, we should give a strong sense of how we remain very engaged with matters that affect people every day. We will continue to do so.
I am grateful to my friend, the hon. Member for Poplar and Limehouse (Jim Fitzpatrick), for bringing the subject before the House. It is some time since we played football together—too long—and we will have to find another way to do that. I have great fondness for the hon. Gentleman, who represents his constituents well, and who has always raised this cause in the best possible way, being informative as well as challenging when in opposition. I appreciate his work, and the work of the hon. Member for Nottingham South (Lilian Greenwood), in particular with the all-party group, which is so essential to keep Members informed about what is going on and what we need to be engaged with. I endorse the thanks to those who promote and support the all-party group and its work.
I welcome the hon. Member for Hackney North and Stoke Newington (Ms Abbott) to her role as the shadow Health Secretary. I thank her for her contribution today, and I look forward to hearing more from her. I appreciate the many burdens on her and her colleagues, so I appreciate her taking part in the debate.
The hon. Member for Poplar and Limehouse set out, broadly, the situation affecting the action plan and looked forward to the next stage, including the commissioning framework, which I will touch on. He spoke about the practicalities of life, paying tribute to those who put in the loop systems, and about how well technology has improved over the years—a sentiment I share. He made reference to a couple of specific topics that I will cover.
The hon. Member for Nottingham South did the same and spoke about the effects of deafness. Some years ago, as colleagues might be aware, I was Minister with responsibility for people with disabilities, and when she spoke about the importance of communication, I remember in particular a visit I made to Sense, the deaf-blind charity, at its premises in Peterborough, where I was introduced to a number of people. The importance and value of communication were brought home to me when I engaged with one particular gentleman, who understood what people were saying because he put his finger on their lips to follow the conversation. He could not see or hear, but his finger on their lips meant that he could follow the shape of the mouth. He then tapped out his reply on the back of his carer’s hand. Think how easily we communicate, at the drop of a hat, and see what someone was prepared to do because he was desperate to communicate. That reminds us of the absolute value of communication to human life and existence. I remember that example to this day, even 20 years on.
When the hon. Lady and other colleagues were talking about what being deaf means, how it affects life, how hearing and communication are a vital part of people’s existence, and about the absence of those and the difficulty that it brings, they brought home to me just how important the subject is. That is why I value the debate, and I am grateful to the Backbench Business Committee for allowing it and to the hon. Member for Poplar and Limehouse for securing it.
The shadow Secretary of State for Health also raised matters of rationing, financing and screening, so I will now cover those with my prepared remarks.
I congratulate the hon. Gentleman on securing the debate on NHS England’s action plan on hearing loss and the adult hearing service commissioning framework. The advent of the commissioning framework on 19 July will mark an important milestone. I share his sense that it is an important event. We hope that many people will come to the launch. It is only right, therefore, that we come together to discuss the opportunities and challenges that the publication presents.
As colleagues have mentioned, hearing loss is widespread. More than 10 million people in the UK are affected, and our rapidly ageing population means that that number is set to grow. As mentioned, projections show that by 2031 there will be more than 14.5 million people with hearing loss in the UK. Those demographics alone provide compelling evidence for why the UK needs to step up its response to hearing loss to enable further research, to take action on prevention and to enable people with hearing loss to access the services and support they need.
The Department of Health and NHS England’s action plan on hearing loss, published in March 2015, recognises the impact of deafness and hearing loss on individuals and society as a whole. Crucially, in my view, the plan accepts that hearing loss is not only a health issue, as we have been saying, but a cultural one. Tackling that societal challenge requires an integrated approach across the public, private and third sectors.
NHS England is therefore committed to delivering 20 outcome measures across five key areas, which have been touched on: prevention; early diagnosis; patient-centred, integrated management; ensuring that those diagnosed do not need unscheduled care or become isolated; and enabling inclusion and participation. That work will be spearheaded by a range of multidisciplinary groups with cross-sector representation.
The publication of the plan heralded an important new chapter in driving essential improvements, but we know that there are significant challenges for hearing services. Adults with hearing loss wait, on average, 10 years before they seek help—again, as colleagues have said—and, when they do visit their GP, 30% to 45% are not referred on for a hearing assessment. We know about significant unmet need and variation in services. For example, only about two fifths of people who need hearing aids have them. I have also heard some disquieting anecdotal accounts that some clinical commissioning groups have been taking difficult decisions and considering the rationing of hearing loss services.
Some of the news is helpful, such as the statistics on when referrals are made and things move forward. In 2013-14, 84% of people seen were seen within 16 days of referral; 92% were fitted with hearing aids within 20 days; 97% had their first follow-up within 70 days; and 800 different types of hearing aid were available from the NHS supply chain. So once someone is in the system, things are available, but we want to improve the provision of services.
My hon. Friend the Member for Nottingham South (Lilian Greenwood) mentioned—I think this was in my notes, and the Minister just repeated it—the numbers who are not referred on by GPs. I have not got to the bottom of why that is. GPs are not auditory specialists, so we would think that if someone comes to them and presents with audiological problems, the logical thing would be to send them to their local trust, who are the experts and have sound-proof booths, technicians and specialists, to identify and assess the nature of the problem. I have read that figure a couple of times. but I have not got to the bottom of why they are not being referred. I am not sure whether the Minister will have an answer, but I thought I would raise that point.
I must confess that I do not have an answer. He makes a perfectly fair point. Whether or not that is what people raise at the time they are in the surgery or whether they recognise it themselves or minimise it by saying, “I’m just getting old” or whatever, I do not know. I will make an inquiry and see what research we have at present. Family practitioner care and GP services are under constant review, and we have a number of different pilots and vanguards looking at the provision of primary care services.
I will see what emphasis is being given to this particular aspect. Certainly we recognise that the demographics indicate that all issues associated with getting older, which can include hearing loss, are rising up the scale and the agenda. I will make specific inquiry about whatever reasons we have at present in relation to this matter and write to each of the hon. Members present to give that information. I am very happy to do that.
I wonder whether the Minister thinks there is a role for raising public awareness to empower patients not just so that we improve GPs’ understanding—that might be the issue—but so that people are a bit more demanding and recognise that hearing loss is not an inevitable consequence of growing old that has to be put up with but something that can be addressed.
Absolutely. Again, there may be more to be done through charities, the third sector, the Royal College of General Practitioners and perhaps the British Medical Association, certainly about the thing that people have in the back of their mind and do not always raise. Clearly, if there has been a sudden change, people may mention it. I suspect that part of it may be that people’s hearing loss is gradual. Perhaps there is an earlier stage.
All colleagues mentioned early intervention and perhaps there is a point at which it should be stated that hearing loss is not necessarily a natural thing that people should accept; it is something that they could and should do something about. My father is a GP and he always said that the most important part of any consultation was when the patient had taken their coat from the chair and put it on and was just leaving the room and said, “Oh, there’s one more thing, Doctor.” At that point, he always brought them back. I wonder whether, for a number of patients, that one more thing that they think they might not bother the doctor with is actually that: “I’ve just been getting a little bit hard of hearing. Maybe it is something and nothing” and so on. Perhaps that is something we could promote and say, “If that is your circumstance, do let someone know, because there is support available.”
Let me develop the discussion. We spoke about rationing services. I am aware that NHS England supported a recent decision from North Staffordshire CCG because it was able to demonstrate that its commissioning policy was evidence-based and had followed extensive public engagement. The hon. Member for Nottingham South was right to say that I am extremely wary of rationing early intervention and hearing aids at the very early stage. I fully accept all the evidence that says that it is doing something at that early stage that prevents something else later on. As colleagues have said, no one else has yet followed that. There has been a lot of challenge. It remains possible for NHS England to intervene if it thinks that commissioning has gone badly askew, but for now that has not been followed.
I will make a general—if slightly light-hearted—remark about resources in the national health service. Due to the decision taken by the nation last week, those who promoted a decision to leave the EU have promised, I think, £350 million a week—or maybe it is £100 million a week—to come to the NHS. My understanding is that that will not happen immediately, but perhaps in two or three years’ time we might see that money written into the health service’s baseline. It would be nice if that were to be. That remains to be seen. Certainly if that comes to pass, it would be one silver lining in the clouds of last week, but I suspect that that will not be a decision for me to take.
I want to press the Minister on the issue of rationing—I was involved in the discussions on the current reorganisation in my earlier incarnation on the Front Bench. Is he saying that nothing can be done until a CCG announces that it plans to ration, or is there any way—even under the reorganised NHS—of giving central direction to CCGs about that?
There is not a way of giving a central direction, because the whole direction of travel in the health service in recent years, as we know, has been to allow decisions to be made as close to people as possible. CCGs and the areas covered by them vary in the nature of their provision—there is variation in services, as we know—and if we were to go back to giving national direction on virtually everything and taking decisions that amount to micromanagement, as this one would, we would be moving away from that.
I will come on the commissioning framework and the action plan in a moment, but the commissioning framework should set out what the expectations are. However, it is right to leave local decision making to those working locally. Indeed, the recent decision and the pressure in other places have reminded CCGs of the importance of early provision, which has probably been far better than any directive from the centre.
No, in all fairness I am not, because it has happened in only one CCG. It has not spread everywhere, and I think that is because the concerns that have been raised in the NHS and elsewhere have persuaded CCGs that they would not like to make that restriction.
To come back to the issue of resources, and to be a little more serious, the NHS remains under significant financial pressure. We have committed to making an extra £10 billion available to the NHS by 2020, as the chief executive has requested, but money will remain tight. Unless we want to go back to a situation in which everything is directed from the centre, we must leave local decision making to those closest to an area—that idea will remain in place. To characterise that as crossing our fingers is not entirely fair, and it has not proved to be the case.
The forthcoming commissioning framework will support CCGs to make informed decisions about what is good value for the populations they serve, using an evidence-based methodology to determine policy. NHS Improvement has received expressions of concern about commissioners reducing prices for audiology services, causing firms to exit those services, and reduced access and choice for patients. So far, except in one case, those allegations have not been substantiated and no formal complaint has been made to enable NHS Improvement to consider taking regulatory action.
NHS England could consider any immediate concerns about a CCG’s behaviour at local level under the assurance framework, and there may be scope for NHS Improvement to consider them under the National Health Service (Procurement, Patient Choice and Competition) (No.2) Regulations 2013, under the pricing rules contained in the national tariff.
Hon. Members raised the issue of screening. I am aware that the “Hearing Screening for Life” campaign has called for hearing screening to be introduced for everybody at the age of 65. However, advice from the UK national screening committee—the expert group that advises Ministers on all aspects of screening—suggested that the evidence did not demonstrate that screening would provide any hearing-related improvement in quality of life in comparison with the identification of hearing loss in other ways.
That is different from screening for newborn children—I have seen some of that work in action. I went out to Hounslow, where I will always recall the three-week-old baby who was cradled in her mother’s arms and being tested by the lady responsible, who was watching for the brainwave patterns. The hearing test could only be done when the baby was asleep and the brainwave patterns were absolutely level. The care and consideration taken with that baby was really quite remarkable. We should be proud that that programme exists. Seeing such things in action—even in one individual example—really cuts through all the statistics. In that instance, screening is the right response.
There are, however, a number of other policy solutions under active consideration by NHS England and CCGs, such as better training as part of the ongoing work to support the uptake and dissemination of the action plan and framework, including better training for GPs to identify and improve the response to hearing loss in adults. That will feed into what we discussed earlier about better recognition at an earlier stage.
The hon. Member for Poplar and Limehouse raised the subject of BSL and sign language in general. My hope is that access to personalised information in appropriate formats and support for communication will improve because of the new accessible information standard, which is mandatory. All organisations that provide NHS or publicly funded adult social care must implement and conform to the standard by 31 July this year. More generally, responses to the Department for Work and Pensions review of the market for BSL and communication support for people who are deaf, deaf-blind or have hearing loss are currently being analysed, and the results will be reported this autumn. From my previous work on disability, I know how important British sign language is. It is a culture and a language that is capable of expression, of drama, of comedy and of all sorts of things. We discussed earlier the life and culture of people who are hard of hearing or deaf, which is very important, and we look forward to the conclusions of that DWP review.
NHS England, along with patient groups, charities, CCGs, providers and professional groups, set out to respond to some of the challenges I have mentioned with the forthcoming commissioning framework. The framework ensures that first and foremost, CCGs have a clear guide to what good commissioning looks like. It is designed to ensure that CCGs are properly supported not only to provide more consistent, high-quality integrated care to meet the needs of local people, but to make informed decisions about what represents good value for the populations they serve. A golden thread throughout the publication is action to be taken to help reduce inequalities in access and outcomes. The framework is a real attempt to deal with the issues of variation that we come across.
The framework underscores the value of co-ordination and integration. In a climate of financial constraint, improved understanding of prevention means that effective measures can be taken to improve services and save money. The framework encourages CCGs to utilise outcome-based commissioning to incentivise change and advocates improving patient access to and choice of services. Implementing contracting, pay and monitoring outcomes and referrals from all providers should ensure fair choice and drive up quality. That shows that we are moving in the right direction, but a lot more work is needed to encourage action and promote the change we all want to see across the public sector and across the age range.
System partners have shown demonstrable commitment to working together to ensure that progress is made to achieve the goals set out in the action plan. Although there is no one perfect model, NHS England and the sector need to continue to collaborate to support CCGs to improve value, innovate and build sustainable services. I also think that lessons can be learned and applied across the system from the valuable work of NHS England and system partners.
It is clear, as this debate has demonstrated, that there are passionate advocates out there who are eager to achieve the improvements in outcomes, experience and services that we all want to see. The publication of the framework provides us with the opportunity and the incentive for action. We all need to be on the front foot on prevention. We will only achieve gains through concerted action across all the partners in the hearing landscape.
I will continue to play my part in holding system partners to account for commitments made. Collaboration and partnership working at national, regional and local level are key, and the work of colleagues here in the House and the all-party group in ensuring that interests are constantly represented here will also be of great importance. On behalf of the Department, I am very grateful to the Backbench Business Committee and to colleagues for raising such an important subject and contributing to the debate.
Thank you for the opportunity to make a couple of closing comments, Ms Vaz. I am grateful to the shadow Health Secretary, my hon. Friend the Member for Hackney North and Stoke Newington (Ms Abbott), for being here today and for her contribution. I especially thank my hon. Friend the Member for Nottingham South (Lilian Greenwood) for her contribution. She demonstrated her complete awareness of these matters and her long-standing commitment to campaigning on them in her constituency and here in Parliament, as a former leader of the all-party group on deafness.
I thank the Minister not only for his response and the reassurances he gave but for the obvious personal commitment he brings to the role he now commands. He is held in high regard by many of us. We look forward to working with him, supporting him and encouraging him in his continued endeavours in this area. I am grateful for the opportunity to have this debate.
Question put and agreed to.
That this House has considered NHS England’s Action Plan on Hearing Loss and the adult hearing service commissioning framework.