Tuesday 12 July 2016
[Mr Nigel Evans in the Chair]
Early Years Development and School-Readiness
Before James Berry moves the motion, I just want to indicate that quite a number of Members wish to contribute to the debate, which will last for only an hour and a half. Of course, the Front-Bench spokesmen and the Minister will need to make their contributions, so we are looking for brevity if we are to get everybody in.
I beg to move,
That this House has considered children’s early years development and school readiness.
As always, it is a pleasure to serve under your chairmanship, Mr Evans. I thank the Backbench Business Committee for selecting this motion, which had cross-party support, for debate. I also thank Save the Children, for which I am a parliamentary champion, and the Sutton Trust and London Councils for their help in preparation for the debate.
I would like to record my profound sadness at the death of Jo Cox, who was one of the signatories to the application for this debate. The subject meant a lot to her and she would have made a very valuable contribution were she here with us.
It is a real privilege to speak on this subject given my family background. Both my parents were teachers who dedicated their lives to improving children’s life chances, and they were firmly of the view that, of all the interventions available to the state, investment in education was the best tool for promoting social mobility. It is fair to say that since my parents finished their teaching careers, a significant body of evidence has developed that suggests that the best and ripest time for interventions that have an impact on a child’s life chances is in not secondary school or even primary school, but in the early years.
I was delighted to stand last May on a platform that included a commitment to invest in the early years, including by doubling the availability of free childcare for three and four-year-olds from 15 to 30 hours. Indeed, the Prime Minister and my hon. Friend the Member for Uxbridge and South Ruislip (Boris Johnson) launched that policy at Advantage Day Nursery in Tolworth in my constituency. As they were completing a puzzle with some four-year-old children, one child looked at the Prime Minister and said, “David, why are all those people taking photographs of us?” The Prime Minister’s response was, “If we finish this puzzle, they might just go away.” Well, the puzzle was duly completed, the election was won and this House has now delivered on the Government’s commitment to 30 hours of free childcare, which will be rolled out next year.
The hon. Gentleman talks about the need for a specific focus, and I entirely agree with that. The Welsh Labour Government focus on the years from pregnancy to the age of seven by looking at every single agency that is involved in a child’s life during that time. Does the hon. Gentleman agree that that sort of holistic approach is necessary?
That sounds like an interesting approach. In January, the Prime Minister launched the life chances strategy, which looks at the whole process from birth onwards, and there are the childcare offers for two-year-olds and for three and four-year-olds, but the holistic approach sounds like a sensible way forward.
The purpose of today’s debate is to ensure that the opportunity provided by the Government’s significant investment is grasped with both hands so that children’s life chances really are improved. I will make three key points, which are about the importance of children’s early years to their development; the lasting impact of poor early years input; and how the Government can make the best of this opportunity to promote social mobility.
My hon. Friend talks about the importance of the early years. Does he agree that one of the best starts in life is to grow up in a strong, stable family, whatever the make-up of that family? In such a family, a child can enjoy secure relationships, which they can then develop in school with teachers and with other pupils. That gives them a firm ground on which to proceed in their educational life.
I understand that research shows that growing up in a strong and stable family is important for life chances. Not everyone is able to grow up in a strong, stable family, but the presence of one or two good parents—and, where that is not possible, the presence of good early years education—can make a real difference to a child’s life chances.
Recent data have shown just how important a child’s early years are to their development. The National Academy of Sciences in the United States found that:
“Virtually every aspect of…human development, from the brain’s evolving circuitry to the child’s capacity for empathy, is affected by the environments and experiences that are encountered in a cumulative fashion, beginning…in the prenatal period and extending throughout the early childhood years.”
Evidence has demonstrated that the rapid development of the brain in the first few years of a child’s life provides the foundation for future health, wellbeing and attainment. Without stimulating environments and experiences in those early years, children will fail to develop the skills that they need, particularly language skills, in the same way as their peers. The extent to which a child’s life chances are fixed in the first two to four years is truly astonishing, particularly in the field of communication skills, which provide the foundation for vocabulary development and the understanding of language. They are a springboard to the literary skills needed to get through school.
A responsive adult caregiver can minimise the effects of significant stresses on a child’s development, such as growing up in poverty. That echoes the point made by my hon. Friend the Member for Congleton (Fiona Bruce). Supportive parenting is recognised as an important protective factor against long-term disadvantage, as is professional early years input. Much could be said about parenting and the need for the state to consider supporting good parenting strategies, which the Prime Minister focused on in his January speech on life chances. However, for the purposes of this debate, I will focus mainly on the pre-school setting and the lasting impact of a poor early years experience.
Statistics show that one in three children in England start primary school without meeting the Government’s recommended level for early development. That figure is even higher among children from poorer backgrounds and among boys. In my borough of Kingston upon Thames, 87% of children reach the expected level of speech and language skills at the age of five, partly due to the demographic and partly due to the excellent early years opportunities in Kingston. The national average is 67%, but just 50% of children from the most disadvantaged backgrounds reach the expected standards at the age of five. That is worrying in itself, but it is even more worrying for three reasons.
First, children from poorer backgrounds are less likely to get the necessary help at home to get them school-ready. A study in Kansas in the United States has shown that by the time children of professional parents enter kindergarten, they have heard 19 million more words than children of working-class parents, and a staggering 32 million more words than children of parents on welfare. Secondly, the school-readiness gap between the richest and poorest five-year-olds is as big as 19 months, which is nearly two academic years. Thirdly, research shows clearly that children who start behind at primary school stay behind at primary school, and go on to stay behind at secondary school and in post-school academic and work opportunities.
Save the Children’s fantastic “Read on. Get on.” campaign, which a number of hon. Members here support, found that one in four children who did not meet the expected levels of speech and communication skills at the age of five failed to reach the expected reading levels at key stages 1 and 2. It also found that one in four of those children failed to meet the expected level in English at the age of 11. The findings go further than that, as they do not just apply to English but correlate with the development of ability in maths at the age of 11.
The Sutton Trust has demonstrated that the gap in early years development is directly correlated with later educational outcomes and, as a consequence, later life outcomes. Its paper “Subject to Background” shows that disadvantaged students are significantly more likely to do A-levels if they have attended any pre-school, and particularly if they have attended a pre-school offering high-quality early years education.
I agree entirely with the hon. Gentleman that the early years point to later development. My local nursery in Torfaen—Abersychan Brynteg, which my daughter attends, incidentally—recently had an excellent Estyn inspection, achieved through innovative teaching and strong leadership by the headteacher. Does he agree that it is vital to have that in the early years?
I agree entirely. Having visited a number of daycare nurseries in my constituency, as I am sure other hon. Members will have done in theirs, I have seen that well led operations are always the most successful, particularly when they are led by professional early years practitioners.
Children who start behind stay behind, and vice versa. Given that children who start and stay behind are more likely to come from families in socioeconomically deprived areas, a cycle of disadvantage is created. That cycle can be broken by improved guidance and support for parents and improved early years offers to ensure that when children arrive for their first day of primary school, they are ready to learn, whatever the circumstances into which they were born.
Finally, on how the Government can make the best of this opportunity, it is important to start by recognising what they have done. They have committed to investing nearly £3 billion a year in the early years, the greatest sum ever, to boost the availability and quality of the early years offer. There are a number of ways in which they can ensure that that massive investment has maximal impact on boosting social mobility. Those who speak later in the debate will no doubt add their own suggestions, but I have four.
The first involves the workforce. In Kingston, as in the rest of the UK, there are some excellent early years educators. Some are qualified early years teachers and others are not, but the workforce is bound to increase significantly when the additional offer of 15 hours a week comes into force next year. It is encouraging that the Government plan to deliver an early years workforce strategy; that offers welcome recognition of the important role of that workforce in a child’s early development. Unsurprisingly, international studies have found that good-quality, graduate-led childcare secures the best early years outcomes, but the evidence also shows that good-quality early education disproportionally benefits boys and children from disadvantaged backgrounds—the very groups currently being left behind—not only in the short term but right through primary and secondary school. Equally, the evidence shows that low-quality childcare has no benefit, or even a negative impact on a child’s development.
Early years educators and staff with equivalent qualifications can play a critical role in creating high-quality learning environments in a nursery, providing leadership and increasing the skills of other staff. What assurances can the Minister give the House that the early years workforce strategy will include plans to attract and retain enough bright staff for us to achieve the ambition of an early years teacher in every nursery setting?
My second suggestion is to increase the availability of speech and language therapy services. I was recently fortunate enough to meet the Royal College of Speech and Language Therapists and to see the speech and language therapy services provided by Your Healthcare in Surbiton, in my constituency. From those briefings, it is clear to me that access to high-quality SLT is vital to ensure that parents and early years staff are trained in the right strategies to optimise a child’s verbal communication development, and to enable early identification and specialist intervention when a child shows signs of a speech and language deficit.
Nevertheless, as the 2008 report by Mr Speaker—the Bercow report—showed, the availability of quality SLT services for nought to 19-year-olds is patchy across the country, and greater consistency is required. It is not possible, or indeed desirable, to have a full-time speech and language therapist in every single nursery, but high-quality SLT input into the curriculum and SLT-facilitated training for all staff in early years settings would be a big step forward. I hope that Kingston Council will consider funding such a programme locally, and that other local authorities will do the same nationwide.
My third suggestion is that we do not ignore the additional requirements of children with special educational needs or disability—a subject close to my heart, as my mother was a special needs co-ordinator. In London, 0.8% of children benefiting from early education have an education, health and care plan, the highest percentage in the country. The cost of providing childcare for children with special educational needs or a disability, whether or not they have a formal plan, is higher than for children without special needs. Under the current Government proposals, it is not entirely clear whether providers delivering the additional 15 hours for EHCP or SEND children will receive additional funding to meet those children’s needs. I would be grateful for the Minister’s clarification.
Finally, on take-up, the Government have introduced a number of early years schemes since 2010. Research by the Sutton Trust and the National Audit Office shows that although take-up for early years offers has generally been good, it has been poorer among the most disadvantaged families. From 2010 to 2015, uptake of the 15 hours of free childcare was 98% in the least deprived areas, but only 90% in the most deprived areas. The figures for the offer for two-year-olds are more stark. Against a departmental aspiration of 73% to 77% take-up, only 58% of parents of disadvantaged two-year-olds have taken up the offer. I appreciate that there may be more up-to-date figures, but those were the figures available to me. The very children who need such interventions, for which the Government are making funding available, are the least likely to receive them.
I know that the Department for Education advertises its early years offers, but the advertising campaign appears to be missing some of its core target audience. Given the disparity in uptake, it seems to me that a better solution would be to mandate the provision of a user-friendly information sheet to all new parents. One fixed point of parental interaction with the state might be when parents register their child’s birth; they could then be provided with the crucial information about what is on offer to help their children.
In his January speech on life chances, our Prime Minister recognised that the early years present a window of opportunity, saying:
“Destinies can be altered for good or ill in this window of opportunity.”
In the early years, parents can make a huge difference to their children’s life chances, as can the state through early years education. We have seen how high-quality early education can transform children’s future, particularly those from disadvantaged backgrounds. If we want to achieve social justice and promote social aspiration, we must ensure that the Government’s welcome investment in the early years makes the best possible impact in that short window of opportunity. I look forward to hearing hon. Members’ contributions about how best to achieve that, and the Minister’s remarks on how he will ensure that it is achieved.
Several hon. Members rose—
Order. To give further guidance on the interpretation of “brevity”, it will mean three and a half to four minutes; then I think we will get everybody in.
It is, as ever, a great pleasure to serve under your chairmanship, Mr Evans. I thank the hon. Member for Kingston and Surbiton (James Berry) for securing this important debate, and for his thoughtful opening remarks. I would particularly like to associate myself with his remarks about our dear friend, the late Jo Cox. We remember her fondly today.
I will be brief. I want to talk about poverty and its impact on children’s early years development and readiness for school. I recently produced a report on child poverty in my constituency, which showed that one in five children live in poverty. By any metric, that is a deeply concerning statistic. A childhood that is safe, supportive, warm and healthy, with the prospect of a bright future ahead, should be the right of every child, not just a luxury for some. It is important because how people start their life heavily determines what the rest of their life will be like. For those born into poverty, it is hard to climb out of it.
We know that poverty has a negative impact on children’s development in their earliest years. Figures from Save the Children, which does incredibly important work on early years development, show that in my constituency last year more than 200 children fell behind before they had even started school. Nationally, one in three children in England start school without meeting the Government-recommended level for early development. That should shame us all and ensure that we redouble our efforts to stop children falling behind.
A lot of good work is being done to stop children falling behind. In particular, I draw attention to the work of my hon. Friend the Member for Nottingham North (Mr Allen), who has been a champion of early intervention for many years and was heavily involved in the cross-party manifesto “The 1001 Critical Days”, which contains a number of sensible policy suggestions. The Early Intervention Foundation is also leading the way on this issue by championing early intervention and, crucially, evaluating the evidence to find out what works.
Stopping children falling behind in their earliest years will require the Government to be bolder in their approach to tackling the root causes of child poverty and of children falling behind. I had hoped that a step towards that bolder approach would be delivered in the life chances strategy, which we were told would be forthcoming after the EU referendum. I was disappointed to learn that the announcement of the strategy has now been pushed back. I urge the Government to bring it forward at the earliest opportunity.
I make the case to the Minister that the possibility of new leadership at the top of the Government offers fresh opportunities to look again at these issues. There is no doubt that some of the Government’s measures over the past six years have contributed to children in my constituency remaining in or falling into poverty. There is now an opportunity to change that, so I urge the Government’s new leadership to be ambitious.
I am bringing forward a private Member’s Bill that will seek to legislate for a target to reduce child poverty and to introduce steps to measure how well the Government are performing in achieving that target. I would be happy to work with the Minister and the Government on the Bill, and urge them to consider the idea seriously. We can end the scandal that is child poverty only by everyone in this place working together, with national and local government working across society. I hope this important debate can be a step towards that goal.
I thank my hon. Friend the Member for Kingston and Surbiton (James Berry) for securing this debate.
I would like to take the debate in a slightly different direction. I was a school governor for a long while before I came into this place, covering early years and senior years, and I have four children. I am concerned about, and want us to bear down on, the fact that the problem is not diminishing; school resilience, early years development and school-readiness are increasing problems throughout all parts of society. While I am talking, the Minister should keep in mind the fact that mine is a large, rural constituency. There are enormous problems with delivering in rural environments as opposed to metropolitan ones, such as the relevant organisations not having enough staff.
I shall concentrate first on the fact that school-readiness is not a “one hit”; it has to be started from the beginning. Early years teachers in the readiness setting cannot do it in that final year, with four-year-olds. It has to start earlier. We know what the problems are: they were largely indicated in the NSPCC report; the important research on speech and language therapy that was carried out for the Scottish Parliament in 2014; Speaker Bercow’s report in 2008; and the work done by Save the Children and Newcastle University in 2013. But what about the solutions?
Speech and language enable our children to communicate. If they cannot communicate, they are disadvantaged—end of. In Suffolk, we have a paucity of speech and language therapists. That is probably because the demand on the system is rising. As my hon. Friend the Member for Kingston and Surbiton said, we need to address that problem.
We teach our children through nursery rhymes and repetition. We now have less talk in our daily lives and more use of mobile devices and so on. Our children face away from us when we are pushing them in prams. From their earliest start, children need to look at an adult’s face to see our facial expressions. Not one Member present will not have laughed at a baby taking a little bit of lemon in its mouth and looking as if it has been given something dreadful to taste. These things help our children to learn and are incredibly important.
The way we ask our children to do things is important. If someone says, “Cake?” to a child, they can say yes or no. If someone says, “Does Emily want a piece of cake?”, that gives the child the ability to interact and develop language. A child who has had the benefit of good language skills before they go to school is not only not 18 months behind—those months are impossible to make up—but will accelerate through school.
Children learn to listen when we talk. As we know in this place, the ability to listen can be very useful throughout life. Children must learn resilience. It is hugely important that they are allowed to fail. The rise in mental health issues later in children’s lives shows that teaching them resilience—letting them understand that they can fail in a situation and that that is not wrong—helps them.
We do not do enough to develop personal skills. Children must be allowed to put on their own coats. One in four children arrive at school in nappies. It is absolutely criminal that teachers have to try to teach while spending their time getting children dry, and that is particularly difficult if there are few classroom assistants. I had four kids under five. Mine all got dry by 18 months, because it is ruddy expensive to leave them in nappies. There is no excuse. It was felt discriminatory to insist children were dry, but it is not. We should be providing environments that help parents to understand. Parenting support is one thing that I ask for.
Outdoor play is also important. Children climb and improve their muscle tension. A lot of children arrive at school unable to hold a chubby crayon because they have held iPads and other such things. Children need to play and to explore. We need to build that into their routine.
I urge the Minister to think of rural areas and not treat them the same as towns, particularly in relation to workforce planning. We parents buy our childcare for the hours that suit us. That might not work with the business model of nurseries and the early years provision that enables school readiness. As the Bercow report and my hon. Friend the Member for Kingston and Surbiton said, we need to improve speech and learning support. We need to consider parenting classes to encourage supportive families around our children, to ensure that children do not fail in the system.
Several hon. Members rose—
Order. Speeches should now be kept to around three minutes.
I am grateful to the hon. Member for Kingston and Surbiton (James Berry) for securing this debate on such an important subject.
In these times of national turmoil, as the UK looks to redefine its status in the world and concerns about our economy loom large, it has never been more important for us to fulfil the potential of all our citizens. It has never been more important to ensure that we give our children every educational advantage available. We need each and every one to be equipped to play their part.
The previous Labour Government understood that education is the foundation for all: “Education, education, education”. In that context, there is a lot of talk of GCSEs and A* to C grades, and, as a former secondary school teacher, parent, school governor and nursery school governor, I know that they are extremely important.
In my constituency, which is fast becoming a hub for advanced manufacturing and is developing as a centre of prosperity, there is much talk of improving educational standards. It is vital that we all recognise the starting point. The launch pad for our children is not in secondary school, when they are aged 11, and nor is it in primary school. It is in those very important pre-school early years that the foundations for success are laid.
Consider the fact that the total size of the human brain is 95% of its maximum size by the age of six. That is really important. It is true that cortical and subcortical components of the brain change dramatically during childhood and adolescence, but the fact remains that 95% of human brain function is developed by the age of six, so what happens in the early years is incredibly important for the individual’s future wellbeing and economic success.
Of course, the earliest education for the child begins in the home. When that is compromised in deprived communities, when that is limited because parents and carers have themselves been deprived of education, opportunities and extended experience, when that is curtailed because every ounce of the parents’ energy is expended on grinding out an impoverished existence, the child is deprived of crucial learning opportunities and so often disadvantaged from the outset.
It is especially for those reasons that the state must concentrate on providing quality early years education. The experiences of a child in their early years are critical for their future, encouraging the drivers of learning, curiosity and imagination, as well as critical learning behaviours. Self-regulation, resilience and empathy are key to a child having positive early learning experiences.
Indeed, there is a growing body of understanding that demonstrates that these early behaviours have a significant impact on life chances and employment prospects. Recent research has clearly shown that children who have access to quality nursery school education go on to high levels of school achievement, have positive attitudes and achieve higher test scores. They are less likely to need remedial or special education; they are more likely to go on to further and higher education; and they are more likely to have stable employment. They have a significantly lower incidence of involvement in criminal activity, are less likely to need access to social services and are less likely to engage in substance abuse.
Therefore, it is clear that if we genuinely want to effect change in our country, we should begin in these early years. Only yesterday, I was speaking to a nursery school teacher in Tower Hamlets—I will have to leave her comments for another time, as my time this morning is limited. I will just say that I am extremely concerned that we are confusing childcare with quality nursery school education and I am worried to hear from nursery school headteachers that recent cuts in budgets for nursery schools mean that it is difficult for them to keep quality and qualified nursery staff in their schools. It is admirable that the Government want to increase free childcare to 30 hours, but that must not be confused with quality education. The Government know the difference and should invest accordingly, because while childcare can educate children, it is not the same as planned nursery education. For the sake of our children and the prosperity of the country, I ask the Minister to give an assurance that the Government will prioritise investment in early years education.
Several hon. Members rose—
Order. To assist with time discipline, the speech time is now going to be displayed on the screens around Westminster Hall.
It is a pleasure to serve under your chairmanship, Mr Evans.
I congratulate my hon. Friend the Member for Kingston and Surbiton (James Berry) on securing this debate. I also declare an interest as a former infant schoolteacher. Indeed, almost exactly six years ago I was just ending my previous career. My first day as an infant school teacher remains the scariest new day in any job I have ever undertaken. Sadly, infant school was not the last time that I have dealt with five-year-olds’ behaviour.
I will talk briefly about the Imagination Library, which is a project we have developed in north Lincolnshire and in the east riding of Yorkshire—people may know of it. It is a free book-gifting scheme, which was originally established by Dolly Parton in Tennessee in the United States, and then brought here some years ago. As an infant schoolteacher, I obviously understood the importance of kids reading at home and how much better prepared they were when they turned up at school having actually opened and read a book, and read with their parents or carers. Sadly, for too many of the children I used to teach in Scunthorpe, that was not the case.
When I became an MP, I was fortunate enough to be able to work with North Lincolnshire Council, under the innovative leadership of Baroness Redfern and Councillor Rob Waltham, to establish the Imagination Library scheme in north Lincolnshire. The scheme now delivers books to 87% of all five-year-olds in our borough. Since we started the scheme in 2013, it has already had a significant impact on the results of kids who arrive at school. In 2015, 70% of our five-year-olds in north Lincolnshire were judged to have achieved a good level of development by the time they arrived at school, compared with just 53% in 2013.
This free book-gifting scheme is wholly integrated with the NHS locally and with our children’s centres—of course, we have protected and actually expanded some of our children’s centres in north Lincolnshire. The scheme is also integrated with our library service—of course, in north Lincolnshire we have actually built new libraries and extended all of our library opening hours to support this scheme, which has had a really transformative effect.
As I said, 87% of all five-year-olds in north Lincolnshire are now registered with the scheme; indeed, in parts of my patch, on the Isle of Axholme, 92% of children are registered. The scheme is open to every child and it is having a really transformative effect. In the other part of my constituency, which is in the east riding of Yorkshire, the council has not funded the scheme, but I myself run and fund a scheme in Goole that has 56 children signed up to it. Getting books out to kids from a very early age to get them reading and learning with their parents gives them the very best start in school.
I do not have time today to go on too much further, and have just two questions to put to the Minister. First, what assessment has been made of schemes such as the Imagination Library? The Scottish Government provide the Imagination Library to all looked-after children in Scotland and perhaps we could consider doing something similar. Secondly and finally, will he look at the Imagination Library’s bid to the Department for Education’s children’s social care innovation programme, which will mean more of these books being distributed to more children nationally?
I will focus on early intervention and school-readiness. In 2013, Home Start UK, working with the Department for Education, undertook a pilot programme over a two-year period called “Big Hopes, Big Futures”. The report that emerged from the pilot showed that, in 2014, there was a 19% gap in achieving a “good level of development” between children on free school meals and their classmates. Action for Children’s most recent report shows that, in the past two years, there has been improvement but by only 1%. Ofsted’s assessment in 2015 was that the gap between disadvantaged children and their more advantaged peers, in terms of early years development and school-readiness, was not closing.
Why are we not getting results? I had a quick look at some of the Library briefing papers on poverty in the UK and on early intervention from the Library. We have Healthy Child programmes, Healthy Start and Public Health England’s seven national priorities, and we are getting support from health visitors and family-nurse partnerships, so why are we not getting the improvements that all of us wish to see?
We can make a difference, but solely increasing free childcare hours should not be seen as a panacea. Families supported by the “Big Hopes, Big Futures” programme saw an improvement of between 25% and 33% in their children’s school-readiness for language, cognition, behavioural adjustment, daily living skills and family support. Not only did that programme directly affect the children, but it helped the parents in many ways, from improving their physical and mental health to improving their skills and knowledge of early years and child development, as well as their work-readiness.
If we know the impact of those schemes, why are two out of every five children in deprived areas lagging behind their classmates on measures of child development? That is true around the country and true in my constituency of Great Grimsby, where 34% of children—more than 400 children—are not reaching a good level of development by the age of five. The answer is not all about academic achievement, because everything from the ability to make friends and form good relationships to understanding feelings form part of what it means to be school-ready.
A study undertaken in 2000 found that socio-emotional and behavioural development help to improve a child’s “teachability”, and do far more than a traditional simplistic focus on reading, writing and arithmetic would. The “Big Hopes, Big Futures” report cited international studies that demonstrate the “pivotal” importance of family support in the transition from home to school. It recognised that many families in the “deprived” category have multiple needs, and that helping them requires complex intervention-based solutions. That is why I am surprised and disappointed that a scheme in my constituency that has existed since 1995 to provide exactly those sorts of solutions was first of all wound down to a narrow perinatal pilot scheme and then closed in March this year, owing to a lack of funding.
I know that I only have a little time left—well, not any time at all—but I will extend my speech anyway before I get told off. I will just mention the funding, because there are issues around where pupil premiums are spent and whether they are really making a difference, and around the reductions in and changes to the early intervention grant—that funding was reduced to a figure 20% below the original 2010-11 allocation. It also included a specified amount for education places for disadvantaged two-year-olds, but because it was not ring-fenced by local authorities, that money did not have to be spent in that way. Subsequently, the funding was subsumed into a dedicated schools grant; the payment of the remaining early intervention grants was transferred into the business rates retention scheme; and the remaining £150 million was centralised into the DFE for adoption and reform grants. We need to ensure that that funding gets to the appropriate areas and schemes that can actually help disadvantaged children.
I wanted to take part in this debate because I strongly endorse the four points with which my hon. Friend the Member for Kingston and Surbiton (James Berry) began: the workforce, speech and language therapy, special educational needs and disability—SEND—and what the most disadvantaged need most. He was absolutely right about that last point and, with regard to my own constituency, I am sad to report that Norwich recently turned out to be a cold spot of social mobility according to the social mobility index—the Minister is familiar with that. I am leading local work to investigate the finding, which returns us directly to the fact that we need to focus on the point in the early years when intervention can make the most difference for later years. Evidence on life chances shows a very clear progression when intervention starts as early as possible.
On getting the help to those who need it most, I would like to present a local example of impressive joint working in Norwich between a children’s centre, health visitors and a school. It is a tight-knit geographical cluster, but they are taking on the challenge of reaching out to those who most need the help—my hon. Friend the Member for Kingston and Surbiton pointed out that there is a risk that those who need the provision less are the ones who use it. It is no secret to anyone that children’s centres need to be able to use their resources in the most effective way, and I thoroughly support that team in Norwich in their efforts to reach out to those parents and families who need the support most.
There is also a clear piece of work that children’s centres and infant schools in particular can do together—approaching school-readiness—which takes me on to another theme that has been well-argued already this morning. I concur that school-readiness is crucial. Will the Minister take the opportunities presented by the expansion of the 15 hours’ childcare offer to 30 hours and the associated funding formula changes to review what he expects of school-readiness? I note that in the 2014 “Statutory framework for the early years foundation stage”, school-readiness is rightly laid out but, currently, settings report to local authorities on request. The Minister might like to look at that. He has a puzzled look on his face—it is on page 15 of the statutory early years framework document. I urge him to see what can be done to help childcare and early years settings work with schools, as in the local example I presented.
I was pleased to serve on the Childcare Bill Committee last December to try to improve what was, on the face of it, tremendously powerful legislation designed to make a huge difference for our youngest children before school. Sadly, Ministers did not recognise the flaws in their plans, so I tabled a new clause that would have meant they were mandated to ensure that all three and four-year-olds had access to high-quality, flexible and accessible early education and childcare provision, delivered by well-qualified, confident and experienced practitioners and led by an early years graduate. It would also have required Ministers to publish proposals for the development of the early years workforce. At the time, early language attainment was increasing, but the pace of improvement was so slow that it would have taken more than a decade of similar progress to get all children school-ready by the age of five. Figures from Action for Children suggest that one in three children across England still arrives at school not ready to learn. Yes, I recognise that policy changes take time to have an impact, but I have reservations about whether the world of childcare out there is able to deliver what the Government say is needed.
Half of children living in low-income families will arrive at school ill-equipped, as will almost 40% of children who live in our most deprived communities. In the north-east, where my constituency sits, fewer than two thirds of children will have reached a good level of development before starting school at the age of five, which is significantly lower than the 70% in the south-east. However, the gap between the most and the least deprived communities is growing, while the gaps between the north and the south and between boys and girls have not changed in three years. The Government will, I am sure, have the support of every Opposition Member if they can narrow that gap during the current Parliament. We must not settle for the small changes of recent years. Will the Minister therefore deliver a new measure of child development at age five to allow a national picture of child development that incorporates a definition of school-readiness, to remove the uncertainty regarding the outcomes the Government believe early years education should deliver? Will they set ambitious goals to focus on those children whose life chances are being blighted from their earliest years, to close the attainment gap?
High-quality early education—specifically nurseries led by graduate early years teachers—has been shown to have the most significant impact on the early language skills of young children, especially those from disadvantaged backgrounds. But therein lies the cruelty of the current system. Childcare settings in disadvantaged areas are the least likely to be of high quality, which is why I argued during the Childcare Bill Committee for the Government to have both the power and the responsibility to ensure that all our children are cared for and taught by highly qualified professionals. Instead, we have a situation in which nurseries are unable to pay the wages needed to attract early years teachers because of the chronic underfunding of the free education entitlement from the Government. At the same time, universities are withdrawing their early years teacher courses because they cannot attract the applicants.
I ask the Minister: when will his long-awaited early years workforce strategy appear and will it include an assessment of the level of provision available and likely to be available in the next few months? Finally, what is he doing to ensure that all children have access to the high-quality care we all desire, delivered by high-quality professionals?
It is a pleasure to serve under your chairmanship, Mr Evans. I congratulate the hon. Member for Kingston and Surbiton (James Berry) on securing this important debate on the investment of resources, time and effort in very young children so that they get the best start in life and at school. It does start with the family, whatever format that family may have, but it is also important that they get access to pre-school hours and nursery education.
Starting school can be a stressful time for any child, but for a child with special educational needs it can be even harder, and it is on that aspect that I wish to concentrate from a Northern Ireland perspective. Imagine the challenges that every child faces on their first day in the playground—socialising with new children, being in a new environment and coping with separation from parents. Imagine dealing with all that while also dealing with the challenges of an educational disability, such as Down’s syndrome or autism. Such children may make up only a minority of those starting school each year, but we in this House never lose sight of the duty we have to give children with special educational needs the best educational start possible. I am afraid I am not confident that that is happening in the Northern Ireland context.
Earlier this year, the parents of young children with special educational needs were sent letters telling them that the pre-school hours they were entitled to would be cut from four and a half to two and a half. Those plans could only have hurt children’s school-readiness, which is why the leadership forum for special schools came out so strongly against them, particularly on the grounds that they would give nurseries less time to help children overcome severe to extremely challenging behaviour. We have been told that the plans have been put on review and will not be implemented until September 2017. I suggest to the Minister that it might be useful to have some good exchanges with Ministers in the devolved Administrations to pool knowledge and expertise and implement best practice from the devolved regions alongside that which exists in England to ensure that children with educational and behavioural challenges get the best start in life.
Despite that review of the plans, we are still hearing of uncertainty at an individual school level. The Northern Ireland Education Authority has stated that the root cause of the problem is an unprecedented number of families needing to find places at special needs nurseries. If that is so, it fits with the broader picture that we have heard about today of children being brought up in poverty: children who face poverty are also facing that more difficult challenge. Children’s early education and long-term life chances are being held back by a scarcity of accessible nursery places and a lack of action from decision makers.
I am conscious, Mr Evans, that I have gone over my time. The important thing is to find solutions, and that is about investment in resources and pooling knowledge from across the regions.
It is a pleasure to serve under your chairmanship, Mr Evans. The way in which a child develops in their early years has a huge influence on every aspect of their lives, including their future economic wellbeing, educational attainment and health. More poignantly perhaps, a child’s early years development is key to their emotional development and their ability to sustain positive and meaningful relationships. Yet according to the Department for Education’s most recent early years foundation stage profile results, one in three children starts school without having achieved the expected level of early development.
To our shame, but perhaps not to our surprise, the likelihood of falling behind is much higher among the poorest children. In my constituency of Rotherham, 38% of children—almost four in 10—are not reaching a good level of development at the age of five. In fact, Rotherham ranks in the bottom 25%. How can four children in every 10 in my constituency be arriving for their first day of school unprepared to learn, socialise and thrive? It is appalling that we have a system where the postcode a child is born into can determine their readiness and preparedness on their first day of school. How can we have failed children to such an extent that their future chances of success have already been determined even before they begin formal education? I find the situation deeply frustrating, because it is something that this House could prevent with the right interventions.
Parents are the first mentors and role models for their children. They have a strong influence on their learning and play a fundamental role in helping their child develop. For a number of reasons, however, some parents simply need a bit of extra guidance on how to positively interact with their child. Through my Dare2Care campaign to prevent child abuse, I know that parents from all backgrounds are calling for support. There seems to be an assumption that people innately know how to be parents and have all the necessary parenting skills and that a parent is inherently skilled and ready to deal with even the most serious issues their child could face, such as sexual or online abuse.
During my roundtables, I heard from parents, charities and academics, and they all asked for support, including well-funded Sure Start centres at the core of every community, providing flexible, trusted parenting support; targeted support for parents who may be struggling to cope or may not be confident in their own abilities; and reviews of every existing point of intervention in a child’s development, including using the personal child health record or red book.
I completely agree that parents need much more support to break cycles and give young children much better opportunities and life chances. Does the hon. Lady also agree that in certain areas support is available, but is not promoted or accessible? In my county, there is a lot of support, but the courses are too expensive, the hours are not appropriate and nobody knows about them.
I completely agree with that, and it goes back to my original point about the postcode lottery, which cannot be fair. Every child in this country needs the best start.
The Government also need to run awareness campaigns highlighting the tell-tale signs of abuse. Tomorrow evening we may have a new Prime Minister, but can the Minister please tell us whether he still plans to take forward the Government’s life chances strategy? Will the strategy include action to provide parents with the support they are asking for to protect children from physical, sexual and online abuse? Will the strategy look at giving parents the tools to enable them to face the challenges their children have to endure? Will he look at every available existing opportunity, from Sure Start centres to health checks to free childcare, and outline how each intervention can be used to support parents? Finally, will he please tell us today whether the Government will use the opportunities created through the strategy to take action in the early years and improve the life chances of all children? The strategy should especially focus on the most disadvantaged children, because every child should have the opportunity to be the fully empowered citizen they deserve to be.
We all recognise that the achievement of development goals in the early years is the foundation for a healthy life, whether that is socially, psychologically or economically. Given that, it is all the more important that state agencies and voluntary, community and faith sector schools, in partnership with and in support of families, do their utmost to play their part in ensuring that our children get the best start in life.
In my professional career as a social worker—I started in a day nursery—I never ceased to be amazed by the capacity of children to gain so much from play, social interaction, direction, encouragement and simple kindness. Children’s first smile, first wave, first frown, first crawl and first “no” are all part of the development process that brings joy to families. Of course, there are the downsides to child development, such as the sleepless nights, the tantrums, the crying, the sickness, the worries—and that is just the parents.
Notwithstanding the significant amount of research over the years in the whole field of child development, it is clear and self-evident that a loving and caring environment in which to grow is the most important gift that can be given to a child. I am sure that many parents in the room would do things differently in how we brought up our children, and I am no exception to that, but one key aspect for a child is the consistency of the care given to them by their parents or carers. At the other end of the spectrum, it is also important to ensure that parents or carers feel that they have a consistent economic environment in which they can nurture and help their children grow. It is therefore the responsibility of Government to ensure that the wider economic conditions in which families bring up children are as stable as possible. There also has to be the effective use of policy drivers, which many Members have alluded to.
It is the responsibility of us all to ensure that we have a nation of healthy children who have been given the best start in life, who live in a safe environment and who have good support and social systems there to help them. In particular, for those children who are not fortunate enough to have a stable, loving, caring family, it is all the more important that we do everything we can to ensure that they have as good a chance as possible to develop into mature, socially and personally confident children whose self-esteem is not damaged by their circumstances.
I hope this debate helps to play a part in keeping this very important issue on the agenda. I thank the hon. Member for Kingston and Surbiton (James Berry) for giving us the opportunity to say these few words of support. I also thank such organisations as Action for Children and Save the Children, which remind us of our responsibilities in this crucial area of social policy.
I congratulate the hon. Member for Kingston and Surbiton (James Berry) on securing this debate. I cannot compete with the expertise. A lot of people have done a lot of work in this field already. I am, however, the grandfather of six grandchildren, all of whom are close to me. Two live next door. I spend at least as much time every week playing narrative games with Playmobil as I do making speeches in this place, and to somewhat better effect.
The goal of education—and life, I suppose—is the fulfilment of potential, and fulfilment is far more variable than potential. Crucial to that, as we have all recognised, is a good start. What does that good start look like? I think it can be defined only in broad terms, recognising that not every child does or can develop in precisely the same way. There is a danger in this debate of being far too precise, because a good start is not the same as an accelerated start, and the phenomenon of tiger mums and people fretting about their child’s development is a new cultural phenomenon. In our society, we tend to value educational learning, possibly above other factors that other cultures might value, such as emotional resilience or social skills.
Broadly, however, we have a concept of what a happy, developing, normal child is like and what their capabilities should be, and we simply find that some children do not match up to that, and it is fair to call them deprived. They are deprived in a range of senses: sometimes deprived of environmental stimulus and emotional support, and often deprived of parental attention and opportunities for creative play. Those are all forms of deprivation, and such children therefore arrive at school less capable of taking advantage of school and without parents who can teach or encourage them in how to take advantage. School therefore becomes a struggle and life becomes a struggle. We all recognise that; it has been well laid out by other Members in the debate.
Sure Start and many other policy initiatives sought to correct that. There has been a whole pile of initiatives, local and national, and they have varied in reach, impact, resource and effectiveness. I pay tribute to all the researchers and policy makers. I pay particular tribute to a Member who is not here and who has done an enormous amount of work on this matter in this House: the hon. Member for Nottingham North (Mr Allen). He has done a tremendous amount to put it on the agenda. Some of the policies, it has to be said, are slightly conflicted. Is childcare primarily about developing the child or about freeing the employment market a little bit?
My central and only point is that key to so much of this is the acquiring and teaching of parental skills. Children spend a lot of time at home—more than they ever will at school—and we cannot just assume that the skills are transmitted and passed on. As a Government, we recognised that fact, but we tinkered rather than addressed it full on. When Sarah Teather was in the chair that the Minister now occupies, some pilots were conducted and the Prime Minister spoke warmly about developing parental skills.
Most of the learning that we engage in during our hard-pressed time in school—learning the pluperfect, trigonometry or how to make a coat hanger, none of which I have had to use—has not done me any good in life. But I have had to be a parent, as will most people. Early learning development is simply not on the school curriculum in the significant way that it ought to be. There is a serious danger that in trying to develop all the policies outlined today we leave parents out of the equation, and we also leave the training of parents as very much a backstop issue rather than something that we ought to put up front as a major policy issue for any Government.
I rise to speak in this debate as somebody who has experience of being an English teacher for more than 23 years before I entered this place. As the hon. Member for Brigg and Goole (Andrew Percy) said, there are certainly similarities in the kind of behaviour that we might encounter. I have a particular interest in this debate from that perspective. I do not think I have ever been involved in a debate where there has been such consensus about the need for all children from all backgrounds to receive the best start that we can possibly give them in life, which they deserve regardless of the circumstances into which they are born. For that reason, I thank the hon. Member for Kingston and Surbiton (James Berry) for securing this debate today and for encouraging this consensus that is so unusual in this place.
The hon. Member for Barnsley Central (Dan Jarvis) pointed out something that I think we would all agree on: if a child starts school when they are not school-ready, the entire school experience from primary 1 right through to the end of secondary is tainted by that. At worst, school is a very negative experience and at best it is tolerated. We have all talked about the importance of increasing the hours for early learning and childcare to 30 hours a week. That is to be applauded, but I want to pick up on some of the points that have been made. Fundamental to that increase is not simply providing childcare, but providing qualified professional experienced staff.
In Scotland, the 30 hours will be rolled out with the addition of 600 new early learning and childcare centres with 20,000 more fully qualified and professional staff. That is very important when rolling out extra childcare for the purposes of making sure that children are school-ready. But we can make all the policy decisions we like; we can sit here and pontificate and perhaps even throw investment, money and resources at the problem, but the experience at home is fundamental. We need to support parents at home as they bring up their children, particularly those who live in poverty and face much more challenging circumstances than we or they would like.
I want to bring a new dimension to the debate this morning because I believe that fundamental to child development, to being school-ready and to being a good citizen—indeed, fundamental to a happy life—is instilling a thirst for learning and an inquiring mind, and we do that through cultivating a love of reading. That must be nurtured in our children, but in order for us to nurture that in our children we need to nurture that in our citizens as widely as possible. That is why I will always argue and kick against any attempts to close libraries, particularly those in my own constituency.
I do not believe it is possible to talk about closing the attainment gap or raising attainment if we deprive citizens, particularly those in socio-economically disadvantaged areas, of access to books, because that is what closing down libraries too often means for too many of our citizens. Access to books for parents and for children is fundamentally and inextricably linked to reading attainment. If we want our children to come to school with inquiring minds, we must introduce them to books as early as possible: not just those living in poverty, but especially those living in poverty. We must support and encourage parents in their endeavours to read with their children so that reading becomes a part of what is done at home.
The hon. Member for Norwich North (Chloe Smith) talked about the fact that the most needy families do not necessarily engage. The same applies to books and libraries and getting people to go to libraries. What is the Scottish experience in getting people from deprived communities into libraries, and accessing early childcare as well?
I am glad the hon. Gentleman has raised that point because in Scotland we have initiatives. We have the Bookbug, PlayTalkRead and Read, Write, Count campaigns, and every parent with a new child is given a bag of free books for their children. That experience is repeated intermittently as the child goes from birth to the age of five and is supported in nurseries where books—the hon. Member for Brigg and Goole talked about the Imagination Library—become integral to raising attainment.
I do not think it is possible to talk about raising attainment unless books are a big part of that equation, so I am delighted that the Scottish Government have taken that on board. I despair when I hear of libraries closing down in any part of the UK, because I know that that means depriving people of books. I grew up in a family where, if I had not had access to a local library, I would not have had access to books, because the school library, such as it was, did not really exist. Books are fundamental to a happy and fulfilled life, to feeding the imagination and creativity, and to feeding the mind. Access to books is fundamental and must be part of this conversation.
Very often when we hear about libraries being closed down, it is about cost cutting and how we cannot afford them and need to make cuts, but some things we cannot count in pounds and pennies, such as what we get back in terms of informed citizens who are encouraged and supported, particularly those who have children. We obviously want to reach out to people who do not have children and who do not access the library, but we are talking about the next generation. We need to think about what we lose rather than what it might cost in pounds, shillings and pence. The Scottish Government’s Bookbug, PlayTalkRead and Read, Write, Count campaigns offer universal support for parents regardless of their socio-economic circumstances. Everybody has a stake in this.
Closing the attainment gap is very important, and early intervention is the canvas on which we must paint everything that we do. Early intervention must be about instilling the love of reading into our citizens as they become parents. We cannot afford to leave our children behind: if they are not school-ready for a full school life, it creates all sorts of social problems for the future. How we support parents with young children is an investment in the future. We must in all conscience and from an ethical point of view try to create a more inclusive educational and social environment for our citizens as they grow up and have their own children. We owe it to our children and we owe it to our country.
It is a pleasure to serve under your chairmanship, Mr Evans. I hope to be brief so that I can give the Minister time to respond to the fantastic contributions that have been made. I congratulate the hon. Member for Kingston and Surbiton (James Berry) on securing the debate and thank him for his kind words about our friend Jo in his opening comments. I concur with many of his comments, and particularly his recommendations.
My hon. Friend the Member for Barnsley Central (Dan Jarvis) made stark comments regarding the one in five children who still live in poverty. I pay tribute to him for his work in tackling that issue. The hon. Member for Bury St Edmunds (Jo Churchill) was passionate in her commitment to ensure that the problems of school-readiness and the early years are tackled. As she said, those are growing problems, especially in rural areas. The hon. Member for South Down (Ms Ritchie) reminded us that we must continue to consider all children, including those who live under devolved Administrations.
Getting a good start in life should not be a privilege; it is every child’s right. I have documented how my mum could not read or write. I was one of those children who did not see a book before going into education, so I can personally say how important early intervention prior to school is. I am also proud that I was a recipient of wraparound services such as Sure Start when I was a young mum, and I concur with the comments of my hon. Friends the Members for Rotherham (Sarah Champion) and for Bootle (Peter Dowd) about that. Those services gave me and many of my friends much-needed support and a hand up in difficult times. The Labour Government were a trailblazer for early years intervention, and Sure Start is one of Labour’s greatest legacies.
Unfortunately, however, under the current Government, childcare and early years services have been left chronically underfunded. Early intervention services are failing to reach those most in need. Families with young children have borne the brunt of unfair Government cuts, and that looks set to continue in the near future.
My hon. Friends the Members for Burnley (Julie Cooper) and for Stockton North (Alex Cunningham) made important contributions about the importance of the early years—that critical time before the age of six. The early years are not only about childcare but about ensuring quality education, which is crucial. We need a bigger vision for early education and childcare. Our kids deserve the best early intervention services that are the envy of the world. The hon. Member for Brigg and Goole (Andrew Percy) talked about some of his fantastic work before coming to this place and about the importance of library services—he helped set up a library scheme.
When will the Government commit the funds and resources required to match the universal acknowledgement, which we have heard today, of the benefits of the early years system? The Government response to Munro was fine words but no action. Will the Minister explain why the Government did not commit to a statutory duty on local authorities? One in three of the families who were promised free extended childcare by the Government before the last election are now set to miss out, as a result of the Government failing to make their sums add up. That was starkly illustrated in the pilot area of York, where not one childcare provider out of 30 was willing to take up the additional 15 hours due to the pitiful payment of £3.95 per hour.
My hon. Friend the Member for Great Grimsby (Melanie Onn) spoke passionately about the closure of services in her constituency. Why were Labour programmes scrapped, such as the graduate leader fund, which supported graduates to work in private and voluntary nursery and childcare settings, and the requirement for Sure Start children’s centres in the most disadvantaged areas?
In addition, real-terms spending per child on early education has fallen. There are 763 fewer Sure Start centres, child trust funds are ending, and maternity grants are being cut. Every child deserves an education that enables them to flourish in childhood and sets them up for life in Britain and the world. Early intervention is key to closing the life chances gap that exists for too many young people in constituencies such as mine.
The hon. Member for Southport (John Pugh) reminded us of the importance of play in the family setting for learning and development. The first 1,000 days of a child’s life are crucial. What are the Government doing to recognise the importance of putting access to high-quality early education at the heart of Britain’s mission to tackle inequality? Today, 3.7 million children are growing up in poverty in the UK, costing the Government about £29 billion a year.
Parental income can have a profound effect on the educational attainment and long-term life chances of millions of children. Family income remains the most significant factor in a child’s success in education. Will the Minister at least acknowledge that changing child poverty targets could mean that thousands of children are forgotten, missed or left behind?
If we want to tackle poverty and build a truly productive economy, we need to look at how to make life easier for ordinary working families and help parents get back to work. The Government should be looking at how to ease the burden on working people and create a system of world-class early years provision. I am afraid their policies are doing just the opposite. Investing now in the essential formative years of a child’s life will be an investment in our country’s future.
I am pleased to serve under your chairmanship, Mr Evans, and I congratulate my hon. Friend the Member for Kingston and Surbiton (James Berry) on securing this important debate.
I agree that improving the life chances of our children is important to all of us, so I will first strike a note of consensus. In this country, we have strong cross-party consensus on the importance of the early years and the need to invest in them. The free entitlement offer was started by the most recent Labour Government, with 12.5 hours of free childcare for all three and four-year-olds. The coalition Government extended that to 15 hours, and the Conservative Government are doubling the entitlement to 30 hours.
In addition, the coalition Government introduced a free early education offer for the most disadvantaged two-year-olds, recognising that we have to start even earlier with disadvantaged children. We also introduced the early years pupil premium, extending the pupil premium in schools to the early years so that disadvantaged three and four-year-olds can get extra funding for reading and intellectual stimulation. I will come on to the detail of that later.
There is therefore cross-party consensus, and the direction of travel in policy is broadly similar. Sometimes, however, in such debates as today’s, some Members seem to have an interest in making out that what is happening is really bad. I am not saying that we can afford to be complacent, but some good work is still going on in early years, in which we lead many parts of the world. For example, the entitlement to free early education for three and four-year-olds, which has an average take-up of about 96%, is unique in the OECD. We have achieved what many other countries in the OECD have not: a universal early education offer. We should be proud of that.
I praise the Minister for his work on childcare, but although putting in all those resources is tremendous, universities are still withdrawing their early years teaching courses, because, as I said in my speech, they cannot attract applicants. The Public Accounts Committee has stated that the Department for Education has no “robust plans” to ensure that there are
“enough qualified early years staff so that providers can continue to offer high quality”
education. What will he do about that? We can throw as many resources as we like at the problem, but if we do not have enough people being trained to do the job, we will not be able to deliver his ambition and mine.
I will come on to the workforce strategy in more detail, but the simple point is that from 2019-20 we will be investing £6 billion a year in the free entitlement in this country, which is more than we have ever invested before. If we fund providers, they will be able to pay the quality staff that they need so that they can attract and retain them.
For the early years, we do not have a system such as we have in schools, in which the Government try to control the number of staff going in. Most of our early years sector consists of private or voluntary providers, so we need to ensure that they are adequately funded to be able to attract and retain high-quality staff. That is why the Government made a strategic choice to invest in early years provision even at a time when many other Departments were having to have their budgets retrenched.
As I said, we have all those resources being poured in, but if people are not applying to go to university for the necessary training, how on earth do we get people in? How do we incentivise them further to get them into the profession, so that we can—I repeat—deliver his ambition and mine?
As I said, later this year we will be publishing a workforce strategy to go along with the introduction of the 30 hours of free childcare for three and four-year-olds. The strategy will focus on removing barriers to attracting, retaining and promoting staff. However, I point out to the hon. Gentleman that 87% of the workforce are qualified to level 3 at the moment, compared with 81% in 2010. The proportion of graduates is steadily increasing, with 13% holding at least level 6 qualifications, compared with 8% in 2010. There is still a lot to do, but the direction of travel is positive.
My hon. Friend the Member for Kingston and Surbiton rightly mentioned the take-up of the free entitlements, in particular by the most disadvantaged. The three-year-old offer is a huge success, with 93% of families taking it up, and 97% of families are choosing to take up the offer for four-year-olds. In the case of the two-year-old entitlement, which is for the most disadvantaged 40% of families, 70% are taking up the offer. It is worth remembering, however, that the take-up of those entitlements is voluntary. Parents do not have to enrol their children, so it is remarkable that we have that many parents doing so.
My hon. Friend made a good point about how we market offers to parents, especially the two-year-old offer. We knew that a lot of disadvantaged families were suspicious of having to send their children to school that early, which was how some perceived it. Or if the mother was at home looking after the child—it was often the mother—they wondered why they should send their child to a nursery. The fact that the Government were involved made some of them nervous, so we did a lot of work in the Department to find new and innovative ways of marketing to those parents, even recognising that changing the colour of an envelope would make it more likely that it would be opened. To some families, brown envelopes looked like they came from the Government, so they would not open them at all, but if we made the envelopes more interesting they were more likely to open them. We are conscious that we need to drive take-up, and we need to look constantly at innovative ways to do so.
The Minister is making some important points about encouraging parents to take up the offer. Does he recognise the real concerns of nursery school headteachers that are driving them to come down to Parliament in numbers with their governors—they are coming again tomorrow—to express concerns that they are no longer able to fund qualified teaching staff? That is particularly important in deprived areas.
Nursery schools do a fantastic job. We will publish a reform of early years funding to go with the 30 hours’ free childcare. I have had meetings with those people and understand their concerns. I can give an assurance that we recognise the important work that they do, particularly in disadvantaged areas, and I certainly want it to continue and will do what I can to ensure that it does.
An extremely brief factual question: will the Minister give us the results of his consultation and the funding formula he referred to before the summer recess, or should we await that a little later on?
All I can say is that we want to provide that as soon as possible, because we understand the need for providers to prepare so that they can deliver the full 30 hours in 2017—it is in the “urgent” in-tray at the moment.
I will develop my points further and answer some of the questions that have been asked. On take-up, we will publish a workforce strategy shortly. Speech and language is absolutely important. If a child arrives at school and cannot communicate or recognise that those squiggly things on a page are words, and that words are used to form sentences, they have got a problem. One of the things the early years pupil premium is there for is for those disadvantaged kids to get extra funding—about £300 a head—and the nurseries can make a discretionary decision on how to spend that to ensure that those kids do not arrive at school already behind.
Will the Minister give way?
I will not take any more interventions, because of the time.
We have introduced reforms to improve the standard of literacy in the early years, which has included awarding grants, for instance through the National Day Nurseries Association’s literary champions programme, which supports practitioners to provide a high-quality, literacy-rich experience for all children. In 2015, 80% achieved the expected goal in communication and language, compared with 72% in 2013.
All of that sits in the broader context of life chances. School-readiness cannot be divorced from the broader discussion of life chances. Earlier this year, the Prime Minister set out his vision for improving life chances, and the Government want to transform the life chances of the poorest in our country and offer every child who has had a difficult start the promise of a brighter future.
We are already transforming lives. Since 2010, there are 449,000 fewer children living in workless households. The early years foundation stage framework is improving the quality of early education and care for young children, and our most recent results show that 66% are achieving a good level of development at that stage. A number of hon. Members touched on that point. It is worth noting that 66% is an increase of 14.6 percentage points in the past two years. The quality of settings continues to improve, with the highest proportion ever—86% of settings—judged good or outstanding in their most recent Ofsted inspections.
We know that some of the poorest children are already behind their peers by age three, before they start school. Such children miss out in the number of words they speak, as my hon. Friend the Member for Kingston and Surbiton pointed out, although the proportion of school children eligible for free school meals who achieve a good level of development is increasing—it was 51% last year, compared with 45% the year before. However, I will be the first to admit that we still have a long way to go.
Obviously, in considering school-readiness and life chances we also need to take into account what happens in the health sector. A number of hon. Members touched on that. All children aged from two to two and a half are offered a universal health and development review by a health visitor, which includes checking a child’s communication development and referring families to more specialist support if necessary. One thing that I introduced when I became the Childcare Minister was an integrated review for children who are not in early years settings, so that health visitors could recommend and introduce parents to other support services that they might need.
To touch on a point raised by the hon. Member for Southport (John Pugh), we also published “What to expect, when?” so that parents know what they can do to support their children’s development in the early years. It is easy for Government to think that we have all the answers, but children, especially in their early years, spend a disproportionate amount of time at home with their parents, so parents need to understand what good development is and what they can do to influence it. That is what our guide is meant to achieve.
I am particularly interested in the role of health professionals and others who go into homes in the most deprived communities. What are the Minister’s policy ideas and instructions to encourage them to play a greater role in directing families to the childcare and literacy support we want them to have?
A lot of home visits are done by health visitors, which is incredibly important. Health visitors are trusted by parents and do a great job. The previous Government and this Government have continued to invest in increasing the number of health visitors. I would like to see more joined-up activity between health and education in the early years. There are a number of great programmes out there, such as the Lambeth Early Action Partnership, which are successful because they join up health and education in early years interventions.
My hon. Friend the Member for Norwich North (Chloe Smith) rightly touched on assessment. Obviously Ofsted is one way of holding nurseries accountable and assessing what they do—as I said, 86% of settings are rated good or outstanding—but the early years foundation stage profile is another way of ensuring that individual children reach a good level of development. That will become non-statutory in September, but we are looking at ways of ensuring that we continue to have such evaluation. She therefore raised a relevant and important point.
The point was made that we should differentiate between childcare and early education, especially when we talk about the 30 hours of childcare. I completely agree that childcare arranged for the purposes of parents’ employment is completely different from early education. That is why the first 15 hours of the offer is universal—so that every three and four-year old in the country is entitled to 15 hours of free early education. Why 15 hours? Evidence from the effective pre-school, primary and secondary education longitudinal study, carried out over 13 years, suggests that children at that age need a little bit of education every now and again. They need little and often, not the equivalent of a school week at the age of three and four. The eligibility for the second 15 hours—the employment offer—is based around parents’ work.
Perhaps the Minister can give us a few seconds on workforce development.
I have made it clear that we will publish the workforce strategy, which will look at workforce development.
Finally, my hon. Friend the Member for Brigg and Goole (Andrew Percy) asked whether I would consider the bid by the Imagination Library. That bid is interesting, so I will take that on board and look at it.
Question put and agreed to.
That this House has considered children’s early years development and school readiness.
Compensation for Rail Passengers
I beg to move,
That this House has considered compensation for rail passengers.
It is a great pleasure to serve under your chairmanship, Mr Evans. May I thank the Under-Secretary of State for Transport, my hon. Friend the Member for Devizes (Claire Perry), for being here to respond on behalf of the Government? May I also apologise to her for once again raising an issue involving trains?
My constituency, as the Minister knows, is home to many commuters. We are just under an hour away from London Liverpool Street station, and tens of thousands of my constituents travel on the Great Eastern main line every day. I admit that they have many complaints—short formations; staff members being unavailable; broken toilets; and services disrupted by too much rain, wind, sun and every other type of weather. My Twitter feed is often inundated with criticisms of our train operator; most are valid, and some less so.
All of us in this House know that few things are more annoying than a delayed train. All too often, we have swept this issue under the carpet by saying that at least the trains are clean, and with laptops we can still work, even if we are delayed. We prioritise new rolling stock and free wi-fi as part of new franchises, but let us be clear. We cannot just think of these people as passengers stuck in a carriage going nowhere and being a bit annoyed. They are commuters who cannot make it into work due to factors beyond their control, and job insecurity can follow. They are parents unable to get home in time to have dinner with their children or put them to bed, missing out on something so important to their lives.
I would like to take this opportunity to applaud the Government for recognising this issue and not only investing in our railways but committing to reducing the threshold for compensation to 15 minutes from half an hour. The Government are also extending the Consumer Rights Act 2015 to our railways, which will allow for compensation when the service our constituents receive does not meet expectations. I have some thoughts on this matter—particularly on the urgency of implementation, but I will spare the Minister those on this occasion. Much more needs to be done on making it as easy as possible for passengers to receive any compensation they are owed. I hope the Minister will agree that the end point must be commuters automatically receiving compensation when their train is delayed.
Another issue, which is potentially even more frustrating, is that many franchise holders may be profiting from these delays. As I have mentioned, passengers are currently able to claim for compensation from train operators when they suffer delays greater than 30 minutes. What many probably do not realise is that Network Rail pays out compensation to train operators whenever there is disruption on the track. That compensation is known as schedule 8 payments. The guidance on those payments states that their purpose is to
“compensate train operators for the financial impact of poor performance attributable to Network Rail and other train operators”.
That is not unreasonable; I do not think any of us would believe it is. Given that we do not have vertically integrated lines, Network Rail is responsible for track and signalling. Who would want to take on a franchise if they were financially liable for things beyond their control?
The problem is that there can be a big gap between the amount of compensation train operators receive from Network Rail through schedule 8 payments and the amount of compensation then paid out to passengers for delays. For example, Abellio Greater Anglia—the train operator that runs the line in my constituency—last year received £8.56 million in compensation from Network Rail for disruption. How much did it pay out to passengers for delays that year? Just £2.3 million. That is a subsidy of more than £6 million, and it is not a one-off. East Midlands Trains received £11 million from Network Rail but only paid out £516,000 to passengers. Southeastern received £7.09 million but paid out £1.35 million. Southern, which we know has issues at the moment, received £28.54 million from Network Rail and paid only £1.6 million to passengers. That is nearly a £27 million difference.
I know that train operators would say we cannot compare those figures and that they measure different things, but my response is simple. On seeing the massive subsidies for delays that operators are receiving, the average person will ask, “What incentive do our franchise holders have to push Network Rail to tackle these issues? Why would they demand better infrastructure when they are profiting from my disruption as a commuter?” As I mentioned, I welcome the Government cutting the threshold for when passengers can receive compensation. However, I truly believe we need further reform. We need to deal with the subsidy for delays.
May I praise my hon. Friend for securing this debate on an extremely important issue and for the research he has done into the figures? It is essential that we highlight what is effectively a double subsidy. After all, it is a subsidy to Network Rail from the taxpaying population who are using the trains to get to work that is going back to the train companies they are already buying tickets from. It seems rather extraordinary that people are now paying twice for delayed trains, not just once.
My hon. Friend raises a good point. I strongly believe that rail operators should not receive more in schedule 8 payments than their passengers receive in compensation for delays and the cost of handling the disruption, and I have a solution.
One option is to claw back the difference to Network Rail and ring-fence the money for infrastructure improvements in the line, which I am sure the Minister would like. That would tackle the issue by ensuring that the necessary infrastructure was funded and delivered on. However, given that we believe very much in devolution, localism and empowering our constituents, we should ensure that passengers have a say on how the money is used, even if it is not in the form of direct compensation. I suggest that the Government seek to change the terms of our franchise agreements to require that, at the end of every financial year, train operators put any net difference between these amounts into a fund to be controlled by a local railway panel. That panel could be modelled on local highways panels and involve local authorities, businesses and rail passenger groups. It would listen to passengers on how they would like the extra funds to be used to improve their railway, whether it is through extra benches at stations, cleaner trains, stronger wi-fi or more staff.
I accept that that may not be possible without being subject to judicial review while train operators have existing franchise contracts. Instead, we should make those conditions part of all new franchise agreements, coming into effect on each line whenever the franchise comes up for renewal. No one disagrees with Network Rail compensating franchise holders when there are delays due to infrastructure problems, but it is not right that train operating companies are able to receive more money in compensation for delays than they pay out to their passengers. It is a subsidy for failure. We need to stop rail operators profiting from the disruption of passengers’ lives and end the subsidy they are receiving from delays.
Several hon. Members rose—
It is the norm for Members to have the permission of the proposer of the motion and the Minister if they wish to speak, but if both are happy, there is time.
My apologies, Mr Evans. It is a pleasure to serve under your chairmanship. I am grateful to the hon. Member for Colchester (Will Quince) for securing this debate and permitting me to speak in it.
As the Minister knows, my constituents are currently subject to the most appalling rail services, made catastrophically worse this week by the introduction of the emergency timetable on the Southern railway part of the network, which has seen as many as four out of five trains per hour completely withdrawn from stations in my constituency.
In that context, I would like to raise two issues about compensation. The first relates to the compensation scheme as it currently works for commuter rail services in the metropolitan area in a normal scenario. Even with a reduction to a 15-minute delay for eligibility for compensation, the compensation scheme is still designed for longer journeys. My constituents commuting into central London have a maximum journey time of 25 minutes from the furthest away station in the constituency, so a 30-minute delay is a delay of more than 100% of their scheduled journey time and a 15-minute delay is still a delay of more than 50% of their journey time. In some cases, there has to be a delay double the scheduled journey time before they are eligible for compensation. The compensation scheme needs to be revised in order to be fit for purpose in normal circumstances for commuter rail services in London.
The second issue is the utter inadequacy of compensation arrangements in the context of the current Southern railway emergency timetable. To claim compensation at all, passengers need to demonstrate proof that they have taken the journey that they set out to take. This week in my constituency, all trains stopping on the Southern railway network in my constituency are full. There is no possibility of my constituents taking the trains that they set out to take, because they simply cannot board them. I will add that I was horrified, after reading that Southern rail is advertising a replacement bus service, to learn that no replacement bus service is provided by Southern rail at all. It is asking passengers to get on existing and already overcrowded Transport for London bus services. Essentially, it is just asking passengers to make their journey by any other means possible. My question to the Minister is this: how are my constituents to be compensated in the current context for what is in effect the large-scale withdrawal of commuter rail services from south-east London?
It is always a pleasure to serve under your chairmanship, Mr Evans. If my hon. Friend the Member for Colchester (Will Quince) will forgive me, I will try to address directly the points made by the hon. Member for Dulwich and West Norwood (Helen Hayes), because of course the Southern rail situation is very much at the front of my mind and the minds of others.
The hon. Lady knows that the emergency timetable was put in place to try to restore some reliability to the services. It was almost impossible for someone to know whether they could actually get on a train and get home, and a decision was taken—I am sorry it has affected the hon. Lady’s constituents in that way—that where there were alternative services, whereby people could make an alternative journey on an additional service, the services would be withdrawn temporarily in order that 85% of the services could run. I was not aware that the replacement bus services to which she referred were actually just an invitation to take a bus journey, so I will certainly take that up, because I had reviewed carefully the planning of alternative provision and was told that it was satisfactory.
The hon. Lady’s point about compensation is well made. From my right hon. Friend the Prime Minister downwards, there have been conversations about how to target compensation for a sustained period of disruption. As the hon. Lady knows, back in April, when we met, performance on the whole network was running at about 84%. That was not good enough, but it was certainly on an upward trend. Since then, a whole series of issues, particularly in relation to industrial action, have caused the service in effect to become completely unreliable. I welcome the company’s commitment to reliability. The determination to get the majority of people to work and home in a more predictable pattern is good, but I take her point about compensation seriously, and although I cannot answer it today, I will certainly come back to her in the weeks ahead.
Let me turn to the substance of my hon. Friend’s debate. I congratulate him, as my hon. Friend the Member for Tonbridge and Malling (Tom Tugendhat) did, on once again being an extremely eloquent and well informed presenter of his arguments. He is always a joy to work with and to listen to, and although I may not have all the answers, he certainly always prompts me to go away and think even harder about the problems. I am also grateful for the other views that were expressed.
The logic of my hon. Friend the Member for Colchester is of course impeccable. When we look at the numbers, it does seem very bizarre that companies are paid compensation by Network Rail that they then do not pay out fully to customers. He and I know that behind the very clear logic is a whole series of complicated financial relationships relating to a future earnings hit to franchising, and relating to the fact that many franchises are not in a premium-paying position. They are subsidised by the taxpayer because of the social benefit of rail, so simply to say that the money should automatically be paid out to passengers risks unpicking the financial relationships and contracts that sit behind the railway system today.
However, I completely agree with my hon. Friend that, for too long, people taking train services have been almost treated as an afterthought in the system. One of the things that I have been so pleased to see in my last two years as Minister with responsibility for rail is that customers are being put front and centre of the franchising process. My hon. Friend will know from the current franchise competition on his line of the absolute commitment to delivering a much better service on brand-new trains and contracting for that. It is not contracting for the inputs—“Do you clean your stations; do you buy trains?”—but considering what the service actually looks like for customers. That is the start of a long focus on customer satisfaction that we all need to get to.
I will touch on the technical points about schedule 8 just in case there is one fact that my hon. Friend does not know, although I suspect that is unlikely, given that he is right across this brief. Schedule 8 payments compensate train operators for delays of which Network Rail is the cause. That is a contractual and commercially confidential element set up between Network Rail and each operator, overseen in this case by the regulator, not the Department. It does not include provision for additional costs, so train operators may argue that they pay out almost from a separate pot to compensate for provision of alternative bus services or, indeed, other compensation payments.
The compensation regime across the country is based on the passengers charter. As hon. Members will know, there is a discrepancy between some operators, which pay out on delay repay—I will address later the point about delay repay 30—and those that are still on the national conditions of carriage, which is a slightly less generous regime. Hon. Members will know that the Government are determined to get all franchises on to the same basis through the process of negotiating about franchising. Actually, we want to accelerate that through negotiations and perhaps not just wait for the franchises to come up for renewal. Interestingly, the headline compensation numbers for delay repay show that they are among the most generous in Europe, certainly when compared with other transport systems. People do not get a compensation payment if, for example, their long-distance coach is delayed; they just have to sit there and suck it up.
There was a proposal earlier this year. I was advised that we should have a permanent exemption for the railway industry from the Consumer Rights Act 2015, which I completely rejected, because in my view train companies are simply providing customers with a service. In this case, it happens to be taking a train from A to B. There was no logic in providing a permanent exemption, so I have granted basically a one-year grace period for the industry to get itself aligned before that Act comes completely into force. Of course, the work that Nicola Shaw has done for the Department, whereby she proposes aligning Network Rail’s route provision much more closely with the operating companies and joining that up, is another way of ensuring that those companies deliver a much more flexible and responsive service.
Currently, as was pointed out by the hon. Member for Dulwich and West Norwood—I consider the hon. Lady a friend—we have a T-plus-30 trigger point for delay repay, which is not appropriate for many metro-style journeys. The other problem is that not everyone claims. Indeed, estimates suggest that only 12% of those who are eligible actually put in a claim.
The Department has been doing two things: first, it has been looking at how best to introduce a T plus 15 for delay repay, which I hope to be announcing shortly. I am not sure what the average journey time is for the hon. Lady’s constituents, but there is the possibility that it will capture at least some of them. Secondly, the Department has been looking at improving how compensation is paid. For example, compensation used to be paid in vouchers, which seems ridiculous in a world where people use cash or cards. That has been changed so that all passengers can receive compensation in cash instead of in rail vouchers.
We are also very much committed to the idea of automatic compensation, and I want to highlight the work that c2c has done on the Southend lines. It will be of interest to the hon. Lady, because c2c customers who are using its automatic payment card—about 25% of season-ticket holders—start to receive compensation if their train is delayed by even a minute. It is a pence-per-minute deal, so it means that their time is valuable. I think it starts after two minutes of delay—the clock is ticking and they receive compensation—and we want to see that right across the industry. Hon. Members will also be aware that Virgin Trains West Coast has introduced automatic compensation. If someone books a ticket through their website, they do not have to do anything to claim should the train be delayed; the money will automatically come through to their account.
There has been a lot of progress in the industry on compensation, but I absolutely recognise the point that my hon. Friend the Member for Colchester has made. I am very keen to think about—either through franchising or through some of the alternative structures that Nicola Shaw suggested—how we can hold money that is paid out for poor performance in a way that targets it more specifically towards improvements on the line. My hon. Friend knows that I am sympathetic to the spirit of his proposal. It is a question of how we make it work in the often byzantine world of current railway structures.
Ultimately, what customers want is not to have to faff around with compensation claims; they want a reliable service that they can depend on to get to work and to get home. A major change that we are starting to see is about capturing the value of that reliability. I hope hon. Friends and hon. Members in the Chamber will have noticed the move among those in the industry to stop talking about punctuality as a train that arrives between five and 10 minutes late, focusing instead on the “right time”. If we arrive 10 minutes late to a debate, we are late, even though, in train terms, we are perfectly on time and everything is normal. I want to flag up the recent industry-led proposals to move to a “right time” railway and to measure performance and compensation claims from the “right time”, which the industry is moving rapidly to introduce. Ultimately, we want a “right time” railway, where people are confident in its reliability. That is what is driving this Government’s record investment in rail, but I am very sympathetic to all the points that have been made today, because if customers do not see and feel that benefit, we are not all collectively doing our job.
Question put and agreed to.
North Middlesex University Hospital NHS Trust
[Valerie Vaz in the Chair]
I beg to move,
That this House has considered the performance of North Middlesex University Hospital NHS Trust.
It is a pleasure to serve under your chairmanship, Ms Vaz. North Middlesex University Hospital NHS Trust serves two thirds of my constituency and more than 350,000 people living in Enfield, Haringey and the surrounding areas. I am grateful for the opportunity to bring this important matter before the House.
The situation at the hospital is, frankly, a scandal. It operates the busiest emergency department in London, which is attended by more than 500 people a day, yet the Care Quality Commission has rated safety at the emergency department as inadequate. Medical care, including older people’s care, at the hospital also requires extensive and immediate improvement. The senior leadership team at the trust and the Government have serious questions to answer about how patient safety at North Mid has been allowed to have been put at grave risk.
What has been happening at the hospital has major implications for my constituents, for residents in north London and for health services across the capital and beyond. My speech will consider all those issues and the steps that need to be taken to ensure the safety of patients and the quality of care. I will call on the Government to give assurances that services at the hospital, including those provided by the accident and emergency department, will be protected and improved in the short and long term.
Before I get to the heart of the matter, I should make two important points. First, the many concerns and criticisms that I will raise about what has happened at the hospital are not directed at the front-line staff—the doctors, nurses and trainees who work there. They are overworked and under-resourced, and have been doing a challenging job in incredibly difficult circumstances. The CQC has made it clear that:
“Most staff were competent and endeavoured to provide good care and outcomes for patients.”
However, just like the patients, the front-line staff have been badly let down by poor management and a lack of leadership at the hospital, and by the Government’s health policies over the past six years, which have left the national health service on its knees.
My second point is one that I believe is shared by all London MPs whose constituents have been affected by the performance of the hospital. Although all of us have raised concerns about how North Mid has been operating, we were not made aware of the true extent of the crisis at the hospital until the CQC issued a warning notice at the beginning of June, requiring the trust significantly to improve the treatment of patients attending the A&E. That was almost two full months after its unannounced inspection of the hospital in April.
Many recent revelations about the chaos at North Mid have been exposed only because of the press via leaked documents, yet it appears that the terrible situation has been an open secret in health circles for a significant period of time.
I hesitate to interrupt my right hon. Friend, who is laying out the story so comprehensively. Is she as concerned as I am that many health professionals knew what was going on, but that MPs in the three boroughs covered by the trust were kept in the dark?
That was exactly the case and I am very concerned. It is not an exaggeration to say we were kept in the dark. All of us across Enfield and Haringey have, over the past year, raised the issue of North Mid in the Chamber at a local level and with Ministers at various times. We received no information until a recent meeting with the Minister, who, I am pleased to say, is here today. Prior to that, there was almost no answer to the points that we raised, other than to brush them aside with answers such as how much better the NHS is doing now than ever before. The phrase “kept in the dark” absolutely covers the situation, with those in the know including the likes of NHS Improvement, NHS England, the General Medical Council, Health Education England and, no doubt, the Department of Health. However, but for the actions of the General Medical Council and Health Education England, the situation for patient safety could be even worse.
I have had a number of meetings with the senior leadership teams at North Mid and at the Enfield clinical commissioning group, and many of the problems I will discuss today were not thought noteworthy enough to bring to my attention. If they were brought to my attention, the exposure of those problems was minimal, such that they did not raise the alarm bells that they should have.
In May, the severity of the situation at the hospital was discussed at a high-risk summit, involving several north London hospital trusts, clinicians and other stakeholders. MPs were not even informed that the summit was happening, never mind informed of the outcomes. I would be interested to know whether the Minister thinks that that state of affairs is acceptable given that our constituents have to suffer the consequences of the failures at the hospital. Even as of today, despite numerous requests, we have received no minutes of the high-risk summit and no account of what was discussed in any detail whatever.
Would the Government be willing to bring in early warning measures to ensure that MPs and constituents are kept properly informed about impending healthcare crises in their communities, rather than being notified after the crisis has hit? To do our job on behalf of our constituents—to safeguard their safety and interests in the use of and access to one of the most important public services any of us can imagine—we need some kind of early warning system. It is clear that very many people knew about the situation, but nobody who is accountable to the public at a local level was properly informed. I look forward to the Minister’s response to that point.
I am pleased to see my hon. Friend the Member for Edmonton (Kate Osamor) in her place, as the hospital is just inside her constituency, although it serves a large number of my constituents and constituents from Hornsey and Wood Green. I think it also serves practically the whole of Tottenham—my right hon. Friend the Member for Tottenham (Mr Lammy) is in his place, as is the hon. Member for Enfield, Southgate (Mr Burrowes). I am pleased to say that we have been working cross-party on the issue. Frankly, I will work with anyone—other hon. Members involved would do the same—who is willing to put the hospital first.
The CQC’s damning report into North Mid was published on Wednesday 6 July, and its inspection of the emergency department and two medical wards at the hospital was in response to a
“number of serious incidents…which had raised concerns about the standards of care”.
Between March 2015 and March 2016, there were 22 cases at North Mid’s A&E department where patients experienced serious or permanent harm or alleged abuse, or where a service provision was threatened. The CQC found that people were waiting far too long to be assessed on first arriving at the hospital, to see a doctor and to be moved to specialist wards in the hospital. The main experience of anybody turning up at the hospital’s emergency department was to wait, wait and then wait again.
The report tells of a lack of respect and dignity in how patients were treated, including a time when there was only
“one commode available in the whole of the ED”—
“to serve over 100 patients.”
Most people reading this will find that shocking.
Resources had been so stretched that, by the time the CQC issued its warning notice to the hospital in June, only seven of 15 emergency department consultants were in post, and seven of 13 middle-grade emergency doctors. As a consequence, junior doctors and medical trainees have been left unsupported by senior staff in A&E at night, including in emergency paediatric care. Junior doctors have been asked to perform tasks for which they are not yet qualified, and there have even been reports of receptionists with no medical training being used to triage patients, at least to the extent of deciding whether they should go to urgent care or the emergency department.
In February, A&E staff were so overwhelmed that patients, many of whom had already been waiting for hours, were told that they should go home unless they thought their illness was life-threatening. How can anyone be expected to know how ill they are without seeing a doctor? We have self-service checkouts in our supermarkets, but self-service A&E? I think not.
I thank my right hon. Friend for securing the debate. Even though the hospital is not in my constituency, much of what she describes happens in hospitals in my constituency and just outside it. At Central Middlesex hospital, which is just outside my constituency but serves many of my constituents, healthcare provision has also been affected by cuts. A recent inspection by the CQC similar to the one that she is describing highlighted a lack of experienced medics for seriously ill patients. Does she agree that such staff shortages threaten patient safety?
I do indeed, and I am grateful to my hon. Friend for that intervention. One point that I argue most strongly is that, although the MPs concerned are banding together to defend our hospital and fight for adequate and safe service, it is obvious that this is not just about North Mid—North Mid is just the first point where the crisis has hit. This is an issue around outer London, across London and probably nationally, particularly for district general hospitals.
I am delighted that my right hon. Friend has secured this debate, which resonates across London and probably outside it. We recognise the point about waiting, especially in ambulances outside hospitals. People are waiting for up to four hours and then being admitted just before the four-hour mark, so that it is not registered against the time limit, and then waiting again. That is happening even before the planned closures of accident and emergency departments. As one clinician said to me just today, there is no credible clinical evidence that out-of-hospital services can deliver on the scale necessary, but that is all we are being offered as an alternative.
I agree with my hon. Friend. Again, that demonstrates that this is not just about North Mid; it is just that North Mid has reached the crisis point before anywhere else.
The CQC has also raised concerns about the lack of equipment within the department, from missing monitors and missing leads for cardiac machines to trolleys in resuscitation rooms that are not fully equipped. I cannot imagine the distress of a patient with chest pains who is connected to a cardiac machine to monitor their progress, only to find that the staff member cannot connect it up to get an instant read-out because the leads are not there. Even a chute meant to carry specimens from the emergency department to the pathology unit was out of operation for six whole weeks. According to the CQC,
“this caused major delays to the speed in which results were returned to the department, thus slowing down the time in which some patients could be treated.”
That is unacceptable.
All those problems have been exacerbated by a lack of effective clinical leadership and a culture of bullying at the hospital, meaning that staff do not feel confident in raising concerns and have even
“stopped reporting incidents of staff shortage as management had not responded to them in the past”.
A quality visit report by Health Education England from March 2016 found that none of the medical trainees interviewed would recommend the emergency department to their family and friends for treatment, principally because they felt that the department was unsafe. The postgraduate trainee junior doctors at the hospital would not themselves recommend the hospital or the emergency department to their family and friends—what an indictment.
The General Medical Council, which oversees the standard of training for doctors, has threatened to ban North Mid from providing postgraduate training because standards have been so poor. The loss of junior doctors would leave the A&E so badly understaffed that it would effectively close. The future of North Mid’s emergency department is at risk.
I note that the chief inspector of hospitals—Professor Sir Mike Richards, whom a number of us are due to meet tomorrow—has said that since the CQC’s inspection in April, “some progress” has been made to improve the situation, although there is
“still much more that needs to be done.”
A new clinical leadership team has been put in place, and there have been moves to appoint more senior doctors. However, in almost every instance, the new appointments are short-term, with the doctors taken on loan from other hard-pressed local hospitals for up to six months. The situation is safe at the moment, given the number of doctors in the A&E, but the measures are only a sticking plaster, as many of the doctors are on a three to six-month loan. What measures are the Government willing to put in place to support North Mid and ensure that it has the consultants and doctors it requires on a permanent, long-term basis?
The CQC also states that North Middlesex University Hospital NHS Trust
“has supplied an action plan setting out the steps it will take to address the concerns identified in the Warning Notice and report.”
Does the Minister agree that the action plan should be published in full and updated regularly with the measures taken to improve patient safety at the hospital?
Tellingly, the CQC says that previous serious incident investigations and subsequent action plans at the hospital have not always been shared with staff in a timely manner, which has
“meant that in certain circumstances, reports were received when actions should already have been taken in order to mitigate against a future occurrence.”
Given the analysis of how things have been kept in the dark, which we have explored, and that statement from the CQC, the Minister will understand why I ask for a fully published action plan and regular reports on progress. This is about implementation and outcomes.
Surely the Minister will understand that without full transparency, many of my constituents and those of my colleagues who are here today will have little confidence that the required improvements have been made and are being sustained. As I said earlier, the trust’s shocking mismanagement and poor leadership have played a big part in creating the mess at North Mid, but the chief executive, who I understand is stepping down, is not solely responsible for what has happened. The Government cannot be let off the hook when they have done so much to undermine healthcare provision in Enfield.
The tipping point for the crisis at North Mid was the closure of the A& E department at Chase Farm hospital in my constituency. In 2007, the then Leader of the Opposition—the current Prime Minister, for now—posed outside Chase Farm hospital and promised to protect the emergency department on site. By 2013, his Conservative-led Government had ripped the heart out of the hospital, closing both the A&E unit and the maternity services. It went from a 480-bed hospital to one with 48 surgical beds. Those of us who campaigned against the closure at the time said that the decision would put huge pressure on North Middlesex hospital, Barnet hospital, our ambulance services and GP surgeries right across Enfield. We were right.
My right hon. Friend describes exactly our experience in west London, where two A&E departments have closed and two more are intended to close, despite assurances having been given that they would not. We have heard nothing at all since February 2013 about what those plans will be. I was told just this week that the next report is not going to be in September, so until another report is done we will not know exactly what services there will be. People are waiting in limbo for years, and meanwhile there is a drain of staff and expertise from hospitals, so their closure becomes a self-fulfilling prophecy.
And that is exactly what happened at Chase Farm hospital. It was under threat for so long that it had no stability and it was no longer an attractive place for staff because they had no security. I hope I am wrong, but my fear is that in cases such as my hon. Friend outlines, no news is definitely not good news.
One year after the closure of Chase Farm’s A&E department, the CQC reported that services at North Mid were struggling with the additional workload. We know now that the hospital has had to manage an increase in A&E patients of between 20% and 25% as a result. That is unmanageable and unsustainable for an A&E department; many would bend, if not break, if put under such strain. The situation was so bad that by February 2016 only 67% of patients were seen and treated within the national four-hour target at North Mid, compared with an average of 88% across England.
Our local health services and the emergency department at North Mid would have been better placed to cope with the closure of Chase Farm’s A&E department if other promises to improve primary care had been fulfilled. In November 2013, the Prime Minister stood at the Dispatch Box and said:
“Enfield is…getting an increase in primary care funding. That is part of our plan of not cutting but expanding our NHS.”—[Official Report, 20 November 2013; Vol. 570, c. 1226.]
But many people in Enfield find it really hard to get a doctor’s appointment when they need one. Over the last six years, 12 doctors’ surgeries in Enfield have closed and only one new practice has opened. That is why, even though Enfield is now the fourth-biggest borough in London, we have fewer GPs per head than almost anywhere in the capital. That situation is not sustainable.
Will the Minister join me in calling for a proper plan for at least 84 more GPs in Enfield over the next four years, as recommended by the Royal College of General Practitioners? Will he support my calls to improve health funding across the board in Enfield? As he will know, Barnet, Enfield and Haringey Mental Health Trust anticipates a £13 million deficit by 2016-17; Enfield Council needs to deliver a saving of £24 million in adult social care by 2020 because of reductions in funding from central Government; and per capita spending on public health in Enfield is only £43 this year, far lower than the average across London and in England. Given that cutting preventive services piles pressure on hospitals, does he seriously believe that allowing the current situation to continue will take the strain off North Mid—or will it in fact do the exact opposite?
It should come as no surprise that I and many of my constituents have very little faith that the NHS is safe in the Government’s hands. The financial crisis in the NHS is a major reason why North Mid did not have enough equipment, consultants, doctors and nurses to cope with demand. The inability to recruit permanent staff has meant that many hospitals, including North Mid, have been forced to drain their resources on expensive agency workers and locums. One might have thought that, in the light of such circumstances, the Government would be bending over backwards to encourage people to join the medical profession—but no. Instead we are witnessing the sorry situation of a Government fighting with junior doctors over contracts and removing bursaries for nurses. What a slap in the face for the future front-line staff we so desperately need.
The Government also plan to make £22 billion of efficiency savings by 2020. I know that savings must be found, particularly in back-office services, but efficiencies on such a scale simply cannot be achieved without putting patient care at risk. I am also concerned that the Government’s methods to implement those cuts—described using woolly phrases like “the rationalisation of clinical facilities”, “the consolidation of trusts” or “the introduction of transformation and sustainability plans”—will result in takeovers, mergers and the downgrading of services. Even before the crisis at North Mid was revealed, plans were already afoot to launch an NHS pilot programme, involving the Royal Free London NHS Trust, to look at options to link hospitals including North Mid together and to merge clinical and support services. At the same time that it was announced that the chief executive of North Mid was going on leave, we learned that an acting chief executive was being appointed from the trust and that David Sloman, the trust’s chief executive—a very good chief executive, I might add—would be taking on the role of accountable officer on an interim basis. I fear for the future of service provision at North Mid as a consequence.
Local residents remember to their cost that the A&E and maternity units at Chase Farm were shut only a few months before the Royal Free London NHS Trust took over Barnet and Chase Farm hospitals in 2014. Chase Farm has been left as little more than a cottage hospital. North Mid cannot suffer the same fate; that would have terrible consequences for health services across North London. Think how much further people in Enfield would have to travel to get emergency hospital treatment, and how much pressure it would put on A&E departments at hospitals such as University College hospital in Euston, Barnet hospital and the Royal Free hospital in Hampstead.
What assurances will the Minister give my constituents, first that North Middlesex hospital will not be taken over by the Royal Free London NHS Trust by stealth, using this crisis as the back door to a merger; secondly, that constituents will be consulted fully on all future proposals for North Mid; and thirdly and most importantly, that its key services will be protected and improved in the short and long term? The performance of North Middlesex University Hospital NHS Trust must be a wake-up call for the Government. I urge the Minister to use every tool at his disposal to help North Mid make the immediate improvements required in the quality of care provided to patients. The Government must ensure that the hospital and our health services have the funding and support they need so that this situation never happens again. I look forward to the Minister’s response.
It is a pleasure to take part in this debate, which is vital for my constituents and for all those around Enfield and Haringey. I pay tribute to the right hon. Member for Enfield North (Joan Ryan) for securing it and for presenting a comprehensive case for the need for urgent action and reassurance for our constituents about the sustainable future of North Middlesex hospital. She has tempted me on to a political path: plainly this is a cross-party concern and call for action, but mention was made of the outgoing Prime Minister. I remember reminding a previous outgoing Prime Minister, Mr Blair, at his last Prime Minister’s questions—those are now coming up for the current Prime Minister—that he had said that there were
“24 hours to save the NHS”,
but that his Government had decided to downgrade Chase Farm hospital. There is a lot of history to this, but I will avoid, if I can, being tempted down that route.
I believe that, because of the Government’s investment, Chase Farm and the Royal Free hospitals have a secure future that is not shackled by the private finance initiative deals that have severely affected Barnet and North Middlesex hospitals. In terms of resources, they are paying a big mortgage, and in relation to finances they have been chasing their tail. Sadly, A&E has been part of that tail. In April, the hospital was whacked with a £320,000 financial penalty, which made a significant dent in its finances and contributed significantly to the £8.3 million deficit with which it is struggling to deal.
The issue is with the A&E. I want reassurances from the Government that someone will take responsibility and action will be taken. Many of us have been expressing concern about local A&E provision for far too long. The concern is that responsibility has not been taken and there has been no proper action. In short, how bad does it have to get before someone takes responsibility and action is taken?
Like the right hon. Member for Enfield North, I pay tribute to staff. We all do. There are obviously great, dedicated staff. Many of us will know them—they are friends and people we know locally. They are as concerned about what is happening as anyone else. Later in my speech, I will say a little more about my experience as a patient in the A&E department two years ago. I saw things for myself, and there are regular reports. The Care Quality Commission made particular reference to the “caring and compassionate” work and service of staff. The current situation is letting them down.
Health Education England and the General Medical Council said that, as much as there was a duty of care to patients, there was a duty of care to doctors training at the hospital, which was why there was such profound, extraordinary, exceptional concern that they reached the point of threatening to pull doctors out. We know that that threat will not be realised, that a corner has been turned and action taken, but why did it take this long for such urgent, expensive crisis management to take place? There were earlier warning signals, so why was there no proper plan?
It is all very well having a new programme calling for “safer, faster, better” services, but for goodness’ sake our constituents expect a safer, faster, better service without a new programme having to be put together, no doubt in glossy print and at considerable expense. They expect a basic service, not a new programme. They have been expecting that for far too long and have been let down.
The 10-year context is important. Despite some interruptions, we can all testify to that 10-year journey. It is so very frustrating because the context is positive: the journey of the Barnet, Enfield and Haringey clinical strategy since 2005-06. We can have our criticisms and our campaigns, but the context is London’s biggest reorganisation of acute services in more than a decade, which was inevitably going to be a challenge. It inevitably needed a careful plan and serious clinical leadership—not just proper clinical leadership in secondary care and the appropriate number of consultants and middle-grade doctors, but the appropriate primary care. Those of us who were involved in the discussions heard the promises from Sir George Alberti, and the talk about bridging loans and the pump priming of primary care, which was also necessary. Sadly, we are seeing the lack of all those things at the same time.
Nevertheless, North Middlesex hospital has been physically transformed since 2009, when it was mostly old Victorian buildings that were not fit for purpose. Those buildings were demolished and a new £123 million modern hospital took shape. That was incredibly welcome, as was the added investment. Some £80 million of public funds was invested to provide the new facilities in line with the reorganisation in the BEH strategy. The plan was, quite properly, to modernise the older facilities, and the hospital has been visibly transformed. Sadly, though, the service that has been provided to constituents has not matched the modern facilities from which they are now able to benefit.
North Middlesex has become one of the busiest A&E departments in the capital, so it is plain that no one can afford it to close. I know the Minister can counter the suggestion that there is any risk of closure, and I am sure he will reassure us that it will not close in any way, that there will be no partial closure and that it will continue, with a long-term, sustainable future. Nevertheless, the concern is why, with all that investment having gone in—initially private finance initiative investment, then direct taxpayer-funded investment—it has taken until this point, so far down the line, for regulators to be able to tell everyone what we all knew far earlier.
I have read the trust’s minutes from 26 May, which state:
“Since the problems first surfaced last year, we have been open with our health partners about the challenges and have worked closely with them to tackle the many interlinked contributory factors, both internally and in the local health care system.”
Well, the problems did not first surface in 2015. I was a patient two years ago and saw for myself that there were problems when I was sitting on a trolley for 11 or 12 hours and was missed by very busy, overstretched staff who were dealing with so many patients. It was an ordinary summer’s day in June—not a winter’s day—and there were more than 400 patients. The staff were absolutely overstretched and missed my CT scan. Lo and behold, my appendix burst. It could have been fatal. That happened because no one was available to take any responsibility for what was happening.
There was real concern about the leadership of staff who were overstretched. I raised the alarm then, as did others. Indeed, the CQC happened to be inspecting the A&E on the very weekend I was sitting on that trolley and seeing for myself the huge challenges it faced. The CQC said that the A&E required improvements. Its report recognised that the hospital was fully embracing the reconfiguration of services, but also said:
“While the hospital had achieved much in absorbing increased numbers of patients, its infrastructure of staffing levels, training provision, complaints handling and governance had been stretched, and there had been an underestimate of the resources needed to maintain services at the current level.”
The warning signals had gone out. Why was prompt action not taken to provide sufficient numbers of consultants and middle-grade doctors?
On Chase Farm hospital, one of the bottom lines for the reconfiguration was the fact that, true to the Prime Minister’s words, we had a moratorium and delayed the previous Government’s plans. All options were looked at, but it came back to the unanimous clinical advice from the local doctors and others, who said that it was in the best interest of the patients for the reconfiguration to take place. Why? They referred particularly to the lack of consultants and middle-grade doctors. That meant that Chase Farm had to be downgraded and A&E patients referred to Barnet and to North Middlesex.
How can it have come to pass that, three years later, we are still hearing the same excuse—that there are not enough consultants or middle-grade doctors? It is completely unacceptable. Why is the system not reacting quicker? Whoever the system is—whether it is the chief executives of the trust or the ever-changing roll-call of interim managers and directors of NHS Improvement, NHS London or NHS England, or, indeed, Ministers themselves—why has it taken so long, with the regulators threatening to pull out doctors, for everyone to pull out their fingers and turn the corner that has now been turned? It is not good enough.
Without my permission—there was a leak—the Daily Mail did a big splash on my experience, and there has been tension ever since about other very serious incidents, some of which have already been mentioned. There was the awful example of someone who had died being left unattended for four hours. There were other shocking and deplorable incidents. Staff themselves see it as something that shames them as well. Managers say to me, “Why hasn’t more action been taken?”
Until July 2015, the A&E department, which is in a very challenging London hospital, was performing relatively well against the standard of seeing and admitting or discharging 95% of patients within four hours. In the first four months of 2015-16, the hospital continued at 94% to 95%. We have to recognise that it has undergone extraordinary growth. Compared with 2013, before the BEH changes were implemented, the hospital now has 25% more staff, cares for 19% more A&E patients, admits 44% more patients, undertakes 44% more surgical operations and procedures, sees 27% more patients in outpatients, and delivers 37% more babies. Yes, all of that is happening.
Of course, performance dipped in other trusts in the country and the downturn continued in January 2016, but when it reached a low of 66%—yes, it recovered slightly to 70%—why were those signals not heeded? How could it get to that level and no urgent action is taken? It was mentioned by hon. Members and others at the time, so why was urgent action not taken? Why was somebody not ready to seize it and say, “We are not going to wait for these regulators, the CQC, to come and tell us down the line that it is inadequate, or for the HEE and GMC to say it is not even safe for doctors, let alone for patients?” Why did it take so long? How bad does it have to get? Why does our health service have to get to this stage for prompt action to be taken?
Many of us could have said that it was not just about secondary care, but about primary care as well. The right hon. Member for Enfield North has made that point already. I referred to the issue of a tale of two health cities within London. Compared with the Camdens and Islingtons of this world, we are very much the poor relations. We are 25% poor. We have had meetings with Ministers about mental health provision, and we have pressed the Minister about the need to ensure fair funding for London. We must get that. We have got this sustainability and transformation plan. It is another siren call. There will be other problems down the line on mental health and other issues affecting our constituents unless the Government and NHS England London ensure that we get fair funding.
The Government have put in a new fair funding formula, but it is taking far too long. We do not need to listen to the Public Accounts Committee to tell us it is taking too long—we can listen to patients, to this debate now and to the regulators. Although in the round our health economy is not all about resources, they have a big impact, particularly in primary care. Why does the health trust have to go through a financial penalty system? Another £130,000 was taken away in April, so more money is taken away from the system when there is a cry for help.
The chief executive, who has gone on leave or has left, made a plea for help over many years. We were all making a plea for help. Why has the NHS not done more about it? It is totally unacceptable for us to be in this position here with this debate. I know from our meetings that the Minister is holding the NHS to the fire now, but why were feet not held to the fire years ago to ensure that people took responsibility? Yes, they could have lost their jobs, but there could have been proper clinical leadership that did not let down our patients in Enfield.
I look forward to the Minister giving us every assurance that there is, as I believe there is, a long-term sustainable future for the A&E at North Middlesex. We cannot afford to lose it and I am sure we will not. The CQC tells us that a corner has been turned, but it was far too long in coming. I want the Minister’s assurance on consultants, although I understand there is a national crisis in getting consultants on the ground, particularly in emergency departments. I want to ensure that the Government will fix it to ensure there is every financial incentive for the right number of consultants and middle-grade doctors to come to Enfield to ensure we have the A&E service that our constituents need and deserve.
I am grateful to have the opportunity to speak in this debate. The hospital serves almost the entirety of the constituency of Tottenham and has done ever since the closure of the Prince of Wales hospital in my constituency in the 1980s. It is important to emphasise that North Middlesex hospital is located in a strategically essential area. It serves not only the boroughs of Enfield and Haringey, but some of Barnet and Waltham Forest. Many years ago, when I was a Minister for Health, a neighbouring hospital, Whipps Cross, was a general hospital that on occasion struggled considerably with its emergency department, so I cannot emphasise enough that it is critical for the broader health economy of north-east London that the North Middlesex survives, flourishes and does well.
The concern that has been raised in this Chamber is really about how the situation has got to this stage over such a length of time, with so many Members of Parliament ringing alarm bells in a context where all of us have privately said, “We must tread carefully. We don’t want to talk down the hospital.” We say, “The chief exec seems to be…” as we whisper among ourselves. We do not want to talk down the hospital, but it has now got to the point at which we have to be absolutely frank about what has been happening at that trust, as we have heard, and we must ask some very hard questions about what has been going on.
I hope that the Minister will assist me on this point. There have been successive risk summits, meetings have been held, and the chief exec has asked for support, but I am not clear why support was not provided. In the old days, Members of Parliament would have been able to contact the strategic health authority and there would have been a clear line of leadership. We literally had two bodies to deal with: the strategic health authority and the chief executive of the trust. Frankly, chief executives went if they were not up to the job, and emergency teams were brought in to run the hospital. I did that as a Minister responsible for emergency care. I saw it happen in a range of trusts across the country as, under the Tony Blair Government, we pushed for the first targets of four-hour waits. I am struggling to understand how things have got to this level.
Life expectancy in a constituency such as mine is among the lowest in the country: men reach 74, six years behind the average life expectancy. We have homelessness and we have had two riots in a generation. The issues are clear, but what is not clear is who was in strategic charge? Why were meetings held in successive years? What is the role of NHS Improvement? Is it ever the case that anyone there would contact a Member of Parliament to say what they are doing to improve a trust? What is the role of NHS England’s London office? The individuals there are paid a hell of a lot of money—hundreds of thousands of pounds. Have they got a responsibility to contact a Member of Parliament to ask for a meeting or a conference call to speak to us about what is happening in the trust?
What is the role of Health Education England, which has been concerned about training and qualifications? We know the role of the General Medical Council, but has it been nobbled not to withdraw doctors by NHS England or any other body? What we have are numerous quangos. I have not even mentioned the clinical commissioning group. We have CCGs, HEE, NHS Improvement, NHS England London and the chief executive. The Government came into office determined to reduce the number of bureaucrats, but—my God!—each of us has at least 10 or 12. Then there are all the staff that work under them. Meetings have been held, but what has been done?
I have done the Minister’s job, so I feel for him. When I did his job, we did a lot of the running of the NHS from Whitehall. The Minister’s party came in and I understand why they said they could not run it from Whitehall, but we now have all these bodies and I am not clear what they have done. As a former Minister, I want to hear more of what they have been up to. I hope that the Minister will answer the question asked by my right hon. Friend the Member for Enfield North (Joan Ryan). Given that there have been CQC reports—the one that we had on the 6th is not the first—and risk summits, what is the obligation to inform Members of Parliament and therefore our constituents? At what point does that kick in? Or is it expected that that should be done solely by the trust? If it is, that is problematic if it is a failing trust in which the chief executive has been put on emergency leave. I have the CQC report before me and it says that safety at the hospital is inadequate, and so is responsiveness. As to whether it is well led—leadership is also inadequate, which is presumably why the chief executive has been put on emergency leave. Overall the hospital is inadequate. Under the headings of caring and effectiveness, it requires improvement. That is pretty damning. It does not get much worse than that.
Many hon. Members are concerned—and my right hon. Friend the Member for Enfield North, the hon. Member for Enfield, Southgate (Mr Burrowes) and I certainly are, having been around for a few years. We campaigned to get the PFI that put millions—I think it was £150 million—into building a brand new hospital. It is therefore deeply frustrating that we now have such an uphill struggle. Chase Farm has been mentioned and I will not discuss it again, but the Minister will recognise that we all rang alarm bells about the implications of closing emergency there. Money was put into the trust; yet it has got to its present situation.
I heard yesterday about the case of Mrs Alice Morfett, a 92-year-old lady who still went shopping in Morrisons. She had a heart operation in Barts and she was recuperating on the T3 ward. In the morning she told her daughter about her concern about a male nurse’s behaviour; she could not understand why he kept wanting to touch her chest. Her daughter said she did not believe Mrs Morfett and thought the anaesthetic had not worn off, but her mother complained about the nurse rubbing against her chest. After that Mrs Morfett was scared to ask for help. No one was summoned to help her. The next day, after an hour of asking for someone to take her to the toilet, Mrs Morfett tried to get out of bed herself and she fell. She ended up with huge open wounds; my constituent sent me a photo of the terrible wounds her mother suffered. Mrs Morfett died a couple of weeks later, and her daughter believes that she died as a result of her injuries. Mrs Morfett said to her daughter, “Please don’t let them get away with it; they have to pay for what they’ve done to me.” I do not lightly raise constituency case work in this way. I have used this letter because it is the latest one I have in a stream of letters from constituents about what is happening in the trust.
Such incidents are what the CQC calls “never” events because they should never happen: a patient dies, and it is not necessarily from medical issues or natural causes. I am sure that my right hon. Friend knows that the CQC report notes that one patient lay dead in a cubicle for four and a half hours last December because there were not enough doctors even to do the hourly rounds. It does not get much worse than that.
No, it does not, and that cuts to the critical issue of safety at the hospital. In fact, the problems at the hospital have been going on for well over two years. What happened to the hon. Member for Enfield, Southgate, who lay in the hospital with a burst appendix and who frankly would not be here but for a stroke of luck, says it all. How have we got to the situation where the local Member of Parliament is about to die of a medical emergency after waiting without being seen for 11 hours? He has been friendly—[Interruption.] Well, that is what happens with a burst appendix. The hon. Gentleman is looking well, but he is not that young. People die of a burst appendix if they are not treated.
Perhaps it is an issue of profile, but they did not know I was the Member of Parliament. I kept it quiet and was there as an ordinary patient—which is the point. It was only when they found out 11 hours on, following some communication that I was the Member of Parliament, that, lo and behold, the seniors all came down and had a look, and saw what was going on. It was actually my mother who was banging on the desk saying, “Why aren’t you getting a scan for my son?” That is what it takes—it is the ordinary experience of any patient, who, sadly, may not have their mother there to badger the staff for them. That is the patient safety concern.
The hon. Gentleman took the business of mystery shopping a little far, but his encounter was well reported locally, and at that time alarm bells were being rung. By my recollection it was a good couple of years ago.
The CQC report confirms what we all long feared—that the closure of the emergency department at Chase Farm hospital in December 2013 had a significant impact on demand at North Middlesex hospital. Concerns were also raised about doctors training in anaesthetics, and they were removed from training in the hospital in April 2015, and have never returned to it because the GMC was so concerned. I wrote to the Secretary of State for Health on 22 March—four months ago. I did not get a reply. I am grateful to have seen the Minister eventually, a couple of weeks ago; but he can see why I am concerned when, after failures of the kind we have heard about in the debate, the Secretary of State did not reply to me in March. I will gently say that a hospital where alarm bells are ringing about such issues would have commanded the attention of the Secretary of State in the past, under successive Governments. Certainly MPs and local authority leaders would have been called together and the issue would have been addressed. I raise the matter in the gentlest of ways, because I am concerned about it.
Many issues have been raised and other hon. Members want to contribute; and we want to hear from the shadow Minister, too. The bottom line is that we are very concerned that the hospital has reached the state it has, given the investment that has gone into it. Week after week there are complaints from constituents. Yes, the leadership has now changed. It is important that local governance and the hospital’s relationship with Enfield and the London Borough of Haringey should be retained; but we want to hear from the Minister that such things cannot happen again. It is a question of who is accountable, and when, and of how Members of Parliament could have been heard much more constructively. Given all that happened at Mid Staffordshire, it is a matter of deep concern that although things are clearly not quite at that stage, they could have reached it had leaks not been published in The Guardian and had MPs such as my hon. Friend the Member for Edmonton (Kate Osamor) and my right hon. Friend the Member for Enfield North not rung alarm bells as they have in the past few weeks.
It is an honour to serve under your chairmanship, Ms Vaz. I congratulate my right hon. Friend the Member for Enfield North (Joan Ryan) on securing the debate. It feels a bit like mark 2 for her, I think, given the earlier experiences with Chase Farm. I am pleased about the cross-party nature of the debate; it was interesting to hear the personal experience of the hon. Member for Enfield, Southgate (Mr Burrowes) of care at the hospital.
Like my right hon. Friend the Member for Tottenham (Mr Lammy), I am at a loss; I attended the annual general meeting a couple of weeks ago and have written letters to Ministers—indeed, the Minister present today has been kind enough to have a meeting with us. We have had press reports and urgent questions. We have asked questions at Prime Minister’s questions. We have had Adjournment debates, and the Mayor of London has raised the matter with NHS London. I am at a loss to know what we should do next, and which levers can be pulled.
I am pleased that management action has been taken, and that Mr Sloman has now taken an interest and is the accountable officer. I am equally pleased that Ms McManus has been brought in to take over on an emergency basis while the leadership of the hospital is being looked at. However, I have concerns for the long term about a situation in which decision makers in Hampstead would make decisions about a north London hospital whose area is Edmonton, Tottenham, Wood Green, Enfield and Haringey. I am concerned about how remote and out of touch they might be. I look forward to hearing in the spring what the management arrangements will be for the medium to long term. We must ensure that there is proper representation of local people at board level and a proper voice for our area in the hospital management and governance structure.
I will briefly raise two constituency cases. One is about medicines training, which was referred to in the Care Quality Commission’s report. I understand from a constituent that when her father was discharged from the hospital, somehow his name had got mixed up with another patient’s name, and when she got home she had the incorrect medicine for him. That is a basic error, and the wrong medicine could have been fatal for an elderly and frail man.
The second case arose after an anonymous phone call to my office reporting on the condition of an elderly patient. The caller was very distressed, as the patient was his elderly wife. He said, “I’m so worried to tell you, because I am afraid that they actually might kill her if I tell you her name.” There is a level of desperation, and that call was made not so long ago; it was within the last month.
There are some general lessons to be learned from this specific situation about the lack of leadership and lack of quality control in our public services. The first is about the recruitment and retention of properly qualified staff. We desperately need to tackle the low morale of staff, which has been exacerbated by the poor handling of the junior doctors dispute. Morale is low not only at senior level or consultant level but at the middle level, and even at the level of junior doctors. Once the hospital lost the contract for the training of junior doctors, everything went downhill from there. We need to get that training back, and we need to work very hard and very quickly to get back the doctors and experts who want to serve, learn and train in a university hospital.
The second lesson to learn is about the crucial issues in our health economy, one of which is the problems with primary care. I understand that there are immense problems with the current Enfield primary care arrangements. The clinical commissioning group is not in a good place. I would like to hear about any associated issues, and I would like to know what levers the Minister can pull to ensure that proper primary care arrangements are put in place for Enfield and that primary care in Haringey is strengthened.
I understand that Haringey has done some very good things, including putting some extra general practitioners into the accident and emergency department to educate people about where to go when they first come into hospital, and about how they can go and see their GP in the local community. I would be happy to hear about an evaluation of that programme and whether it has been helpful. Rather than rushing in with a band-aid solution, can we hear back about that programme? What has the evaluation been, and what do the experts think? Has that programme stopped the flow of people coming—perhaps incorrectly—to A&E, and has it helped the primary care health economy?
It is well known that Members including my right hon. Friend the Member for Tottenham secured a debate in the main Chamber on mental health in Haringey. At St Ann’s hospital in Haringey, the acute care places are really overloaded, which has led to greater demand for beds at North Middlesex hospital. Once the health economy becomes unbalanced, that can put more strain on A&E departments from general patients who do not have mental health problems.
Furthermore, there is an ambulance crisis. Police officers have told me that there are not enough ambulances and that they have to take patients to the North Middlesex hospital themselves because the ambulances cannot cope. Of course, we know that once the ambulances get to hospital, people are being treated inside the ambulances, which is completely unacceptable.
My hon. Friend will also appreciate that a major criticism in the CQC report was that after patients have left the ambulance, they are treated solely by nurses at grade 5, with no doctors in sight and no consultants available after 11 o’clock at night. How can there be an emergency department when there are no consultants available on a Friday or Saturday night?
My right hon. Friend makes an excellent point about an issue that must be monitored. I look forward to the Minister reporting back on the lack of the leadership and clinical excellence that we expect on behalf of our constituents.
The cuts to public health provision will have an extra impact. I will give just one example, which many Members here have pursued—basic HIV/AIDS care. We are not doing the preventive work, and we are unnecessarily cutting back the public health budget, which will eventually lead to more people turning up at A&E or acute care departments in crisis. These issues in the health economy are all linked, and we need to do much more about all of them.
We are all aware that litigation accounts for a quarter of NHS expenditure. Why do we not get better at doing the proper work first, so that the money we spend on lawyers and expensive court cases when we get things wrong does not add up to so much? The situation is absolutely desperate. We need more investment, and we need to stop making mistakes so that we do not have to pay for litigation and so that instead of litigation there can be front-loading of resources into prevention, mental health and good-quality primary care and basic services. People accessing the NHS could then have confidence that their local service is as good as we should expect it to be.
Finally, we know that in London, there are a number of issues with the cost of living, the cost of transport and the cost of childcare for medical practitioners and nursing staff. Those issues are linked to the others that I have mentioned, and I would like to see a more robust approach from the NHS around London to the needs of those working in our hospitals and our public services. London is not like other areas, where it is cheaper to rent homes and so on. We are unable to recruit the medical practitioners and nurses we need because they cannot afford to live in the area, and we should examine that issue more energetically and not just in a theoretical way.
Thank you very much, Ms Vaz, for calling me to speak. I look forward to hearing the Minister’s conclusions.
I point out to the Front-Bench spokespersons that the wind-ups are starting now, and we are expecting a Division in the House at around ten to 4.
I congratulate my right hon. Friend the Member for Enfield North (Joan Ryan) on securing the debate and giving a masterful summation of the situation.
There have been some important speeches today, including from the hon. Member for Enfield, Southgate (Mr Burrowes), my right hon. Friend the Member for Tottenham (Mr Lammy) and my hon. Friend the Member for Hornsey and Wood Green (Catherine West). I also note the presence of my hon. Friends the Members for Hampstead and Kilburn (Tulip Siddiq), for Hammersmith (Andy Slaughter) and for Edmonton (Kate Osamor).
This debate is about more than an individual hospital such as Central Middlesex or North Middlesex. There are certain underlying issues, which I will touch on. One source of pressure on an accident and emergency department—whether it is in the North Middlesex hospital, the Central Middlesex hospital or any other hospital around London—is what is happening in social care. For years, local authorities, both Labour and Conservative, have said that they are struggling to meet social care need, and studies show that many of the people who turn up at A&E would not have to go there in the middle of the night to get the care they need if the social care system was functioning properly.
There is also the difficulty of getting GP appointments. The level of difficulty may vary from constituency to constituency, but in the City and Hackney area, for quite a long time now—for years, in fact—it has taken two weeks to get a GP appointment. I am afraid that means that many of my constituents take it upon themselves to go to A&E, because they know that, however long they wait there, they will ultimately be seen. Another problem is the lack of investment in public health, which could deal with some of the health conditions that people turn up to A&E with.
There is also the issue of alcohol abuse. On a Saturday night, too many people are in A&E as a consequence of alcohol abuse, and we must consider how we can deal with those cases and stop A&E departments being filled up.
On the issue of staff recruitment, I am not seeking to be particularly party political, but I cannot believe that the junior doctors dispute will make it easier to recruit staff. One thing that was manifest in the junior doctors’ refusal of a contract that the British Medical Association had recommended to them was the complete collapse in morale among doctors, and that will be reflected in the difficulty of recruiting staff.
Part of the problem with outer-London hospitals may be the changing demographics of the areas they serve. I said I would not be party political, but I campaigned for many of my right hon. and hon. Friends at the last general election, and I was struck by the situation in areas such as Enfield, Edmonton and parts of Hornsey. When I was a child, those areas were very much leafy suburbia, but now they have a much greater density of population, a much more complex demographic profile and much more complex health and social care needs.
As shadow Secretary of State for Health, I hope to look at that issue further. We should remember that outer London does not have many socially connected teaching hospitals such as those that exist in inner London. I am not sure whether the level of funding that outer-London areas get reflects the demographic and social changes in those areas that I have seen in my lifetime.
It is easy to talk about the issue abstractly, and to talk about reports and hieroglyphics, but it is about people. The tragedy at North Middlesex is a tragedy for patients. Who would want their mother to be dead on a trolley for four and a half hours and have no one come to look for her?
We also have to think about staff morale. People have congratulated the staff but, strikingly, the unpublished Health Education England report, for which 24 members of staff were anonymously interviewed, said that some doctors found working in the A&E unit so stressful that they cried when they finished their shifts. It stated:
“Foundation doctors had been reduced to tears by the sheer volume of patients they had to deal with, for example 200 patients and a six-hour wait, and they felt that they regularly had to send children home without having discussed their case with anyone senior…They often finished their shift and returned home full of anxiety that they had not been able to provide care at an appropriate level.”
This is about the patients and their families, but it is also about the staff who know that they are not providing the right level of care and are demoralised and upset.
As my right hon. and hon. Friends and the hon. Member for Enfield, Southgate have reminded us, we are told that North Middlesex is implementing a safer, faster, better programme to bring down waiting times and address the issues in the Care Quality Commission’s report. As the hon. Gentleman said, why should there have to be a shiny new programme to ensure that our constituents get safe, fast, high-quality treatment? It is good to hear that a new A&E clinical director—Turan Huseyin from Barnet A&E—has been appointed, and that there is a new A&E nursing lead and five additional middle-grade doctors and consultants on loan from other London trusts. It is also good to hear that in July the Care Quality Commission said that although North Middlesex was still inadequate, it had “turned a corner”.
I want to raise a few points with the Minister. One, which has already been made today, is that what happened could have been foreseen. The drop in both standards and performance at North Middlesex is intimately tied up with the closure of the A&E at Chase Farm in 2014. Members who are here today raised that point at the time. I would also like to hear from the Minister about how much support is being given to the emergency care intensive support team. In response to a parliamentary question asked by my right hon. Friend the Member for Tottenham we heard that the trust had requested such support, so what is happening?
My final point is about doctors being kept in the dark. I want to avoid crudely party political points, but I spent three years in the Opposition health team dealing with the health Bill, and we were concerned about transparency and accountability. When there is a crisis in a hospital, despite all the different organisations that my right hon. Friend told us about, there seems to be no simple method of ensuring accountability to local representatives, and therefore to local people. Something is lacking in accountability, and we need to consider that. The fact that the collapsing performance at North Middlesex hospital was an open secret among the health service professionals but none of my hon. Friends knew about it—except anecdotally from constituents—is alarming.
This is about more than North Middlesex. There are systemic issues. There might be a systemic issue with NHS funding failing to keep up with changes in local demographics, and there is a systemic issue in social care. I am sure we will return to that in this Chamber, because local authorities have been flagging it up for some years now.
In closing, I can only repeat what the hon. Member for Enfield, Southgate asked: how bad does it have to get? It is troubling if our constituents, who pay their taxes and rates, cannot get a basic level of care when they go to A&E. For most of them, that is their engagement with hospital care. They are getting almost a third-world service. I do not say that lightly—someone being on a trolley for four and a half hours after they have died, and there being only one commode between 100 people, is more like a third-world than a first-world standard of healthcare. How bad does it have to get? Will the Minister assure us that we will not have a situation again in which a collapsing service at a major hospital is an open secret within the professional health services but not made apparent to Members of Parliament and the wider community?
I thank the right hon. and hon. Members who have given such thoughtful, considered, well-researched and knowledgeable speeches, and also the hon. Member for Hackney North and Stoke Newington (Ms Abbott) who provided such a thoughtful reflection from the shadow Front Bench. Members will be pleased to know that I agree with much of what they have said. I will come on to how I think the NHS has let Members and their constituents down and what we will do to try to fix the situation.
If Members do not mind, I will first set the issue in a bit of context. North Middlesex hospital was classed by the Care Quality Commission as requiring improvement for reasons that have been mentioned. The quality of care was not consistent enough and there were concerns about patient safety. It was not one of the worst hospitals in London, or in the country, but it was certainly not one of the best. Until July 2015, it was largely meeting its institutional standards. The 95% waiting time target for A&E was being met most months, even though the department is one of the larger ones in the capital, and in spite of the reorganisations that were discussed at length by the right hon. Member for Enfield North (Joan Ryan).
We need to be careful, therefore, with causality, and I will not give a definitive reason why the problems came about. A direct connection between the reorganisation of Chase Farm, which began under the Government before the coalition, and the problems experienced at North Middlesex over the past year, cannot be made with great surety because the hospital was dealing with the A&E caseload within the required timelines, albeit with a standard of care that was not at the level it should have been.
Nor is this about money. It is important to point out that organisations across the NHS, as the shadow Minister knows well, have reported deficits in the past year and this is one of the smaller ones. The posts that are established in the hospital are fully funded; the problem is trying to get the right people into them. I do not deny that the hospital has a staffing problem—I will come on to that in a second—but it is not connected with funding.
Let us get to the core cause of the problems that Members have noticed and brought to the attention of the House. I am afraid that I am not able to give a complete answer at this stage, but Members are entirely right to ask why this happened. We need a better explanation. This morning, I agreed with officials and NHS England that we will look in detail at the reasons within the hospital why the performance standards slipped so significantly in the middle of last year, and why the training routines and practices slipped as well. That is the first part of the review.
The second part is on why the system did not react with the speed it needed to when concerns were first expressed about a year ago. Here, I offer an apology to Members on behalf of NHS organisations. Members were not informed at the pace and the time they should have been, and for that I offer regret. Members are right to say that they should have been the first to know there were problems so that they could properly represent their constituents and hold local leaders to account.
I offer that apology within the context of a much better story across the NHS of what happens when hospitals fail. A warning notice was issued—that was the first reason that the right hon. Member for Enfield North knew something was going wrong—because of a change to the law under the coalition Government in 2014 on when the CQC was able to issue warning notices.
Will the Minister give way?
I will in a second. The whole system of CQC Ofsted-style inspection ratings, which are designed to be user-friendly so that non-clinicians can understand how well hospitals are performing, was instituted by the Secretary of State because we wanted to shine a light on the performance and quality of care in hospitals. Through two and a half years of having special measures routines and regimes for hospitals, we have a much better understanding of why things go wrong and can put them right far more quickly. Most importantly, we have a process for engaging Members of Parliament right at the beginning. That did not happen in this instance, and I will explain why after I have taken the right hon. Lady’s intervention.
The Minister may be coming to this, but I wanted to ask who Members should look to inform them of a catastrophic drop in standards. They should not have to wait for the CQC to issue a warning.
Ideally, if things are going wrong and that has been noted within the hospital, the hospital chief executive or commissioners should inform local people, but in the past—and over the two and a half to three years since we instituted the special measures regime—it has taken a Care Quality Commission investigation to highlight poor standards of care so inadequate that the hospital needs to be placed under special measures. At that point, before the public are informed, Members of Parliament are informed by the CQC and what was Monitor and the Trust Development Authority, but is now NHS Improvement.
Before I take the right hon. Lady’s intervention, I will explain why Members were not informed, and it is by no means an excuse. The core problem around emergency medicine and paediatrics was to do with the training places and the relationship between the General Medical Council, which looks at and regulates the quality of training, Health Education England and NHS Improvement. Because this case did not go through the traditional special measures route, which is governed by the CQC and NHS Improvement, things did not happen at the pace I would have expected and nor were Members talked to when they should have been.
The first thing I want to ensure, once we have receipt of the review I asked for this morning, is that we have a similar standard approach, were this to happen again. We have to assume that it might, because things in a large system do go wrong. We need to learn from this scenario over the past year, where Members have been let down, and ensure that it does not happen again. We can move with greater celerity and ensure that Members are informed at the earliest possible opportunity.
I appreciate the Minister’s expression of regret and his acknowledgement that something went badly wrong, but I take issue. A CQC report in 2014 noted added pressures in A&E that we are all aware of. I only came back into Parliament in May 2015, and over the past year a number of Members, including me, have raised the issue several times in the Chamber. We were given no information. The CQC report is very welcome, but for it to take more than three months to be published means it is of no use as a warning note with any detail. [Interruption.]
Before the Minister responds, there is a Division.
May I respond to the right hon. Lady before we suspend?
I do not know how long the Minister wants.
I will be 20 seconds, and then we can come back for part 2.
I will answer the right hon. Lady directly. Of course there is more to do, but we are much further ahead than 10 years ago. There is no blame on any particular Government—we are further ahead than 20 or 30 years ago. The Care Quality Commission is a respected regulator that comes down with tough judgments and makes Members aware. When we come back after the Division, I will explain what we will do.
Sitting suspended for a Division in the House.
[Mr Charles Walker in the Chair]
I promised to explain to the House what we will do to correct the situation. There are two parts to this. First, the short-term rescue plan has been put in place by Health Education England, NHS England and NHS Improvement, with the approval of the General Medical Council, to ensure resilience in the A&E department and for paediatric services. Two consultants have gone on secondment to the department, and a further five are coming this month. The GMC is happy that that will provide the rota resilience we need in the short term.
If we think that will fix things, however, we will quickly end up in the same situation. That is why we need to look at a far more robust plan for the next few years, so that the North Middlesex can become the centre of excellence that hon. Members and I certainly want it to be. A new improvement director will be in place to deliver an improvement plan, which I will ensure is shared with hon. Members. So the plan that the right hon. Member for Tottenham (Mr Lammy) requested will be available for other hon. Members to see. It will have the transparency that has been lacking so far.
I must answer a particular point made by the right hon. Gentleman about the General Medical Council. I do not think that it was silenced in any way. Genuinely, this is more muck-up than conspiracy, and I hope that it will not be repeated, as I have already assured hon. Members.
On the long-term plan, the hon. Member for Hackney North and Stoke Newington was entirely right: the North Middlesex is like many hospitals on the periphery of London, which not only are seeing rapid demographic change, but suffer from the fact that they are not the attractive training places that the central London hospitals are—we have to be blunt about that. I think that is wrong, because many of the challenges that aspiring doctors want are in those hospitals, which are diverse with an extraordinary range of clinical conditions. However, because of the history of the NHS, which I cannot change, a glamour is attached to the central metropolitan hospitals, and that causes challenges for district general hospitals throughout the country, as well as those on the periphery of London.
I want to change that, but we cannot do it by fiddling around. That is why I am excited by the link-up with the Royal Free. That kind of branding, which the right hon. Member for Enfield North pointed to, the strong leadership, which will provide stability, and, I hope, the ability to move consultants and senior nursing points around—some people recruited already into the Royal London and Barts will also work at the North Middlesex—will result in the diversity of career opportunities necessary to attract the kind of clinicians that the right hon. Lady and her colleagues have requested for their hospital.
To press the Minister on a bit of detail, the CQC’s press release stated:
“We have strongly encouraged the trust to engage with other organisations across the local health and social care system to resolve this challenging issue...there are moves to appoint more senior doctors—and I note that the trust is calling on consultants from other departments within the hospital to provide the routine daily support to A and E which is so badly needed.”
That was on 6 July and, clearly, the CQC did not feel that the hospital had got there. Will the Minister therefore confirm what the required number is? If he cannot tell us that, it would be helpful for him to come back to us. What is the golden number that should comfort us? Will he also confirm, because this is important, that nurses are not still reviewing patients who arrive by ambulance, because that is seriously inadequate, and we want to ensure that patients are seen by doctors?
I reassure the right hon. Gentleman that NHS England has a live rota stream from the hospital to give it the reassurance that every single junior doctor has a consultant supervisor in place at all times—precisely to ensure that the reported lapses of supervision do not recur. When the right hon. Gentleman meets the chief inspector at the CQC tomorrow, I hope that he hears something similar to what I have heard: things are not good, but they are better than they were, and the trajectory is in the right direction.
Nevertheless, we will not fix this without looking at fundamental reform of local health services, which requires changes to primary care, of the kind that we discussed when I met local Members of Parliament last week. I hope to meet them again, in a few weeks or months, and to be able to talk about progress and the plans for the future, so that right hon. and hon. Members will be satisfied that things are getting better at the North Middlesex.
I thank the Minister—my constituents in Broxbourne will be following the outcome of this debate closely.
Question put and agreed to.
That this House has considered the performance of North Middlesex University Hospital NHS Trust.
Free Childcare for 3 and 4-year-olds
I beg to move,
That this House has considered free childcare for three and four year-olds.
It is a pleasure to serve under your chairmanship, Mr Walker. I am grateful for the opportunity to hold this important debate, the background to which is the Government’s plan to double the number of hours of free childcare that working families with three and four-year-olds are entitled to from 15 to 30 hours per week from September 2017. Pilots are due to begin this September. That builds on the introduction six years ago of an entitlement to 15 hours’ free childcare per week, which, in 2013, was extended to include two-year-olds from disadvantaged families.
There are matters on which I profoundly disagree with the Government, but I firmly believe that when their record meets the needs of people in my constituency, credit is due. I very much welcome the Department’s good progress towards ensuring that all three and four-year-olds benefit from 15 hours of free early education and childcare. In 2015, 94% of three-year-olds and 99% of four-year-olds had taken up a funded place.
My work on the Public Accounts Committee has helped further develop my understanding of a range of issues, and childcare is no exception. The Committee’s recent inquiry and subsequent report—a copy of which I have with me, in case the Minister has not managed to peruse it in detail—helped me in this area. The report’s conclusions and recommendations are numerous, but probably chief among them is the danger that the Government may not deliver on their pledge to extend the childcare offer.
I will highlight some specific concerns. They fall into four main areas: the availability of quality information for parents; workforce planning and the supply of enough qualified early years staff; the high cost of childcare in some areas, and what I call “reverse means-testing”; and monitoring the impact to ensure value for taxpayers’ money, which is very much what the Public Accounts Committee’s work is about.
The first of those four areas is the availability of quality information for parents about the childcare available close to where they live. I have welcomed the Government’s progress on free childcare, but there are concerns throughout the House about unacceptable local variations in the amount of information that is available to parents about access to free childcare.
My hon. Friend is making an important speech. I recently met members of the Rochdale branch of the National Day Nurseries Association, who had real concerns about provision and the low funding available for places, to the point where they thought that they would not be able to make the provision. They also have concerns about things like quality and who will pay for meals. Does she share the concern of those businesses?
I do. In the Public Accounts Committee, we have found that the situation varies across the country, and many hon. Members will be able to tell the Minister about their local experience. I will discuss quality later.
Local authorities have to provide the family information service, which gives parents details not only about childcare providers that offer free entitlement but about how to claim it. I know from my own constituents that navigating the processes can be as big a barrier to claiming entitlements as knowledge of the offer itself. That extends, incidentally, to other entitlements such as pension credit and income support.
The hon. Lady is making an important contribution. The challenges are multifaceted. A couple of weeks ago I met the YMCA, which runs a local nursery, and it told me that it felt that some local authorities take very high administration charges when it comes to allocating per-pupil funding to children in their care. Does she agree that local authorities need to do all they can to ensure that free childcare is spread as widely as possible?
I do, and I will come on to the need for local authorities to abide by the statutory direction given by the Government. That was one point that the Public Accounts Committee picked up on.
Information for people in my constituency is generally good. We have 1 Big Database, a searchable database of 1,000 childcare providers that is a collective effort of Bristol, Bath and North East Somerset and South Gloucestershire Councils and enables parents to locate the providers nearest to their home or workplace, although it lists only provision, not vacancies. However, it is clear that the quality of information varies between authorities nationwide. Shockingly, the Public Accounts Committee heard that only 30% of parents are even aware of family information services. If there is an offer but most of those who are eligible for it do not know about it or how to access it, its value is diluted to say the least. I hope that the Minister will outline how his Department will improve the quality and consistency of information for parents.
My second area of concern is workforce planning. As a former governor of a nursery and children’s centre, I recognise the importance and difficulties for providers of such planning. The Public Accounts Committee found that the Department lacked robust plans to ensure that there are enough qualified early years staff for providers to continue offering high-quality childcare. The sector has become increasingly professional, and there has been an increase in graduate recruits. That raises quality but brings challenges for providers, which now report that they are struggling to recruit. As the Department has set funding rates until 2019-20 based on 2014-15 costs, many providers are also concerned about the impact of the national living wage on their costs. The Department does not have a workforce plan for the early years sector.
There are also concerns that there is a real risk to the delivery of the pledge to provide 15 additional free hours from September 2017, due to too few providers being able to deliver that pledge because many will be minded not to become involved in the offer. I find that alarming, and it raises serious questions about the process of making pledges when deliverability appears not to have been properly assessed.
The hon. Lady is making some powerful arguments. I point out to her that one of the pilot schemes is in York. I have worked closely with the nursery providers in my constituency. Because of the funding stream and the hourly rates, there was a lot of concern among those providers to start off with about whether they would opt in to provide the second 15 hours, but the local authority and the Department for Education worked together closely and have now persuaded 60% to 70% of those providers to opt into the scheme. Does she not agree that we can persuade providers to opt in as long as there is good will from the Department and local authorities to deliver the scheme?
I certainly agree. That shows the importance of good pilots and good working nationally and locally, and we want to see that with the other pilots, which will start this year.
Private and voluntary providers reported to the Public Accounts Committee that the amount they are currently paid for providing free childcare is not enough to cover their costs, so in some cases they feel the need to charge parents for additional hours or obtain other sources of income to meet those costs. Providers can of course choose whether to offer parents free childcare, so there is a genuine risk that many businesses will simply choose not to offer the new entitlement because doing so could reduce their opportunity to charge parents for hours outside the entitlement. As hon. Members have said, it is important for that issue to be looked at, because different situations exist across the country.
Maintained settings—nursery classes and nurseries run by schools—tend to operate fixed morning or afternoon sessions and are less likely to offer additional chargeable hours, so their ability to offer the new entitlement is limited. That disproportionately affects children in disadvantaged areas, simply because those settings are more likely to operate in such areas. I hope the Minister will be able to outline how the Department will address the challenges of ensuring that there are enough people with the right skills to work in the sector in the years ahead. I also hope that he can reassure me that the Department will be able to use the pilots that will begin this year to test providers’ capacity to meet the expected demand for the increased entitlement. He may also want to explain how that will be done and how evaluation will be carried out, given that there is just 12 months between the start of the pilots and the scheduled full roll-out of the new entitlement, and I would welcome his thoughts on how the Department will ensure prior to the 2017 roll-out that the pilots have had genuine influence.
My third area of concern is the high cost of childcare. I know from my constituency that childcare fees present a real challenge for many working parents, as I am sure many hon. Members will agree. I have been contacted by parents who have been informed of some quite significant fee increases—up to 30%—being imposed by their private nurseries. Bristol already has some of the most expensive childcare outside London, as the Bristol Women’s Forum has highlighted, and I agree with the forum that childcare is an infrastructure issue and needs to be considered as part of our economic thinking. Indeed, the Women’s Budget Group in Bristol has indicated that 84% of the cost of universal free childcare will be recouped through taxes and reduction in welfare benefits.
High childcare fees are a key reason why the offer of 30 free hours is so important to so many working families and why I support that offer, but many parents have reported that some providers are offering the free entitlement only if parents also pay for the additional hours, and the charity Gingerbread receives calls from parents whose childcare providers have put conditions on the free offer. That contravenes the Department’s statutory guidance for local authorities, which states that they should ensure that
“if providers charge for any goods or services, this is not a condition of children accessing their place.”
The Department has acknowledged that issue, and I hope that the Minister will be able to explain what progress is being made on identifying the scale of the problem and how the Department plans to address it to ensure that those who are least able to pay do not miss out through such reverse means-testing.
My fourth and final area of concern is about measuring the impact of the offer to ensure that the taxpayer is getting value for money, which is why the Public Accounts Committee held an inquiry on this subject. As someone who is passionate about the value of investing in early years—I am a firm believer in the Labour Government’s Sure Start programme, for example—I am concerned that the Department’s most recent evaluations of the effectiveness of early years education and childcare are based on the academic outcomes of children who started early years education in 1997. I was surprised and alarmed to find that the Department had no routine data to assess the impact of its investment in the early years. That must be remedied, since such data must play a key role in helping to shape future policy. If the Department does not know what works well and how to get the best bang for its buck, taxpayers could be left short-changed. Since the Department appears to lack sufficient current data to measure the impact of free childcare, I hope the Minister will be able to explain, along with his responses to the other issues that I have raised, the steps that he is taking to bring its assessments up to date.
I thank the hon. Member for Bristol South (Karin Smyth) for securing this important debate. Successful implementation of the extended free childcare offer is a key priority for the Government. Childcare was included in the Queen’s Speech for the first time after the last election, and the Childcare Act 2016 shows how much of a priority our manifesto pledge on childcare is for the Government.
At a time when there is austerity and a lot of other Departments face budget cuts, the Government have made a strategic decision to continue to invest in childcare, as a result of which an extra £1 billion investment will be made in the three and four-year-old offer from 2019-20, taking the amount going into the early years free entitlement to £6 billion a year. That is more than we have ever spent on childcare in this country. I reassure the hon. Lady that delivering on our pledge continues to be a high priority for the Government, and the passage of the 2016 Act shows that we are well on our way to turning that pledge into a full commitment for parents.
The hon. Lady mentioned the availability of information for parents about the offer. The high take-up rates for current three and four-year-olds indicates that parents are already highly aware of the free entitlement, but it is worth mentioning that we are not necessarily increasing demand but extending an offer. A lot of parents already use 30 or more hours of free childcare. The Government offer encourages those who do not get it to do so, but those who are already using the 30 hours of free childcare will get a subsidy from the Government rather than having to pay for it all themselves.
That principle is particularly important to understand because a lot of the criticism of the 30-hour entitlement, whether it is about workforce, places or whatever, seems to assume that somehow no parent in the market is already taking 30 hours of childcare and that, suddenly, from 2017 every parent will do that. The truth is a lot of parents already take more than the free 15 hours of childcare. By giving them an extra 15 hours, the Government are subsidising the additional hours they buy. We are therefore not necessarily increasing the demand, but extending the entitlement.
That principle is particularly important because it has a bearing on information and how we need to make parents aware of it. A section in the Childcare Act, which the hon. Lady will be aware of, asks local authorities to publicise information about the childcare available in the local area. The new statutory duty in the Act requires local authorities to publish information about childcare services in their local area, which will increase the information available to parents.
We have not stopped there. The Department has provided funding to the largest website in the country on childcare places—childcare.co.uk—to develop an innovative digital solution that will make it easier for parents to find information. Further, in my experience, generally when something that is otherwise quite expensive for people when they pay for it themselves is free, they tend to find out about it. I am very confident that, given the statutory duty, the innovative solutions we are taking and the fact that 98% of four-year-olds and something like 94% of three-year-olds already take 15 hours, parents talking to early years settings will realise that they can get that extended entitlement.
There will be a communications campaign before launch. I chair a cross-Government taskforce with the Minister for Employment, and at the right time we will launch a campaign alongside a new Government website to alert parents. I hope I can assure the hon. Lady that parents will be able to find out about this fantastic offer, delivered by a Conservative Government.
The second issue the hon. Lady raised was about workforce planning. As I said, the Department will launch a workforce strategy later on this year alongside the introduction of the 30-hour commitment. The quality of the workforce is already good and has been improving. Between 2008 and 2013, the proportion of full-day care staff with at least a level 3 qualification—equivalent to A-level study—grew from 75% to 87% and the proportion with a degree or higher increased from 5% to 13%. However, we are not complacent. We want to continue to attract quality staff into the early years and support those already working in the sector to progress. That is why we will publish the workforce strategy to which I alluded—it will be on how the sector can attract and retain people. That is something we are focused on.
When the hon. Lady made the point about workforce, she also talked about places, and places in maintained settings in particular. One thing to be aware of when we discuss childcare is that no one size fits all. It is easy for us in Government to think that every parent should do this, but some parents want only the 15 hours of early education for their children. That is free, and they can continue to get it. Some might want 20 hours and some might want 30-plus hours.
The strength of the childcare sector is that there are different providers to deliver different types of childcare. We have full day-care nurseries that deliver all-day childcare; nurseries in schools that, as the hon. Lady mentioned, will do three hours in the morning and three hours in the afternoon, which are focused on early education; childminders who deliver excellent childcare; and sessional providers operating from, say, church or village halls that offer 15 hours a week.
The strength of the sector is that there is diverse supply to suit different parents’ needs, which is important. We should not try to impose one model of childcare on parents. However, for parents who have been using a nursery in a school, for example, that currently offers only the first 15 hours, there is capital available to enable those schools that want to expand their provision to do so. One of the interesting things we have seen in innovative local authorities such as York, as my hon. Friend the Member for York Outer (Julian Sturdy) mentioned, is the bringing together of childminders and school nurseries to offer a one-stop shop for parents, so that the child can be in the school nursery for a time and then be picked up by a childminder if that is what works for the parent. We will look for a number of different solutions to be available not just to increase the supply of places but to ensure that parents get the childcare solution that fits their working lives.
I am grateful for that assurance. I agree that diversity of provision is important and valuable—I took great advantage of that when my three children were younger. Will the Minister comment on the security of income for providers? Although I do not have data to verify his assertion that the people who take 15 hours are the same as the people who might take 30 hours—I would be interested in such data—income that gives struggling providers security is important. Choice for parents is welcome, but equally providers need security of income.
That is an important and relevant question. We want the childcare sector to be sustainable and we want providers to be able to deliver this offer. That is why in November we published the most comprehensive review of the cost of childcare ever. In order for the Government—we will become the biggest buyer of childcare in the UK—to set a price for the sector, it made sense for us to work out what the unit cost of providing childcare was and set a price that allows providers to deal with increased cost pressures such as the national living wage, which the hon. Lady mentioned, and, given that 80% of the sector is in private and voluntary settings, to enable the sector to make a profit. That was the purpose of the review, which was described by the National Audit Office as “thorough and wide-ranging.” Those are not the Department’s words, so I hope she is reassured that the detailed work that underpins how we will decide the funding rate for providers is there.
That is what underpinned the spending review settlement. The Government’s commitment of an additional £300 million a year to increase the national average funding rates paid for the free entitlement was based on that research. We are also committing £50 million of capital funding to create an additional 4,000 early years places. More money is going into the system than ever before, but we need to ensure that it is distributed fairly. That is what we saw in York. The issue is not just the quantum of money. Because the funding formula is based on local authorities and history, we have a situation where some local authorities are getting £9 an hour per child and others are getting something like £3.50 a child. There is therefore no point in increasing the funding pot without reforming how the money is distributed to local authorities and, in turn, how it goes from local authorities to providers.
I am grateful to my hon. Friend the Member for Bristol South (Karin Smyth) for securing this important debate. The Minister has made several references to the need to be sure about such and such, and my hon. Friend mentioned that the full roll-out will take place soon after the pilot, so will the Minister comment on how lessons will be learnt in time for the full roll-out?
What I can say firmly is that the Government will bring about funding reform imminently to create a system that is transparent to local authorities and fair to all early years providers. Part of the package introducing the 30 hours will be wholesale reform of early years funding. That was mentioned in the spending review and the autumn statement, and that reform is imminent. We will consult on that to seek views on our proposals from across the early years sector. We already listen to the sector in a number of other ways to ensure the funding works. Our red tape challenge is looking at bureaucracy and barriers. We have consulted on ensuring that providers are paid on time, which has been raised specifically by childminders in many areas, and on making local authority contracts with providers more consistent across different parts of the country.
We are looking at the local authority role in building on the success of the existing 15-hour entitlement. Rolling out that manifesto commitment is an opportunity to improve the way the system works on the ground. We received over 1,300 responses to our recent consultation on key elements of the operation and delivery of the extended 30-hour free entitlement from a wide range of childcare providers, local authorities and parents. Crucially, those views will help to inform how the 30-hour entitlement will be delivered at local level. We will publish our response to the consultation in the autumn ahead of affirmative debates in the House and the other place on the regulations of the Childcare Act 2016.
I hope I can assure the House first that a record amount of funding is going into the sector. Secondly, in terms of how that funding is distributed, we are looking at wholesale reform and will be publishing our intentions, on which we will be consulting the sector, imminently. Thirdly, we are looking to reform how local authorities work with providers and will consult on that as well. Much of the disquiet around the 30-hour commitment and its implementation is from a number of people who are assuming that we will be following through with the system as it is, but we are going to reform the entire system to underpin the fact that, if the Government are going to be the biggest buyer of childcare, the old system will not work. That is because it was based on just 15 hours a week, which was a limited offer. If we are to move to 30 hours a week, we need to ensure the system we are operating in is fit for purpose.
The hon. Member for Bristol South also mentioned the high cost of childcare. The Family and Childcare Trust is the guru when it comes to childcare costs. I look forward to its childcare costs report with a degree of trepidation every year because I know I will have to tour the TV studios if the report says the cost of childcare is getting out of control. The most recent report showed that childcare costs, which had risen for the best part of a decade, are stabilising and only rose in line with inflation in 2015.
The principle here, and the reason why the Government are introducing the 30-hour commitment, is precisely to help parents with the cost of childcare, but the available support to parents does not only come in the form of the 30 hours. We will be introducing other childcare measures such as tax-free childcare, which will give parents 20% off the cost of childcare up to £10,000. If they spend £10,000 they will get £2,000 off the cost of childcare, so a parent buying in excess of 30 hours of childcare will get 30 hours free and 20% off for anything over those 30 hours—obviously, that is for three and four-year-olds. Other parents on the lower end of the income scale will get additional support through universal credit.
I hope the hon. Lady will appreciate that a substantial amount of support goes to parents for childcare, but she is right that we need to make it simple for parents. The issue is that there are multiple areas of support for childcare that are parented by different Government Departments and there is a need to stitch those together. That is what the cross-governmental childcare taskforce is looking at, so that parents do not have to go to three or four different places to try to figure out which childcare offer works best for them. There will be one portal and one port of call from which they will be able to access childcare.
The issue of cross-subsidisation was also mentioned and it is particularly important from the provider perspective. A lot of providers have been content with the free 15 hours almost as a lead generation aspect of their business, so parents get 15 hours free and then have to buy additional hours for which the providers can charge a lot more. One of the things the funding reform will specifically look at is to price this in such a way that there is every incentive for providers to actually offer parents free hours, rather than thinking that they will opt out of it. The truth of the matter is that providers do not have to offer that, but parents will be looking around for providers that can. The Government have to set a price that brings the buyers and sellers in that market together and the cost of childcare review gives us a strong basis from which we can and, I am sure, will, get that right when the funding review is published. It is an issue that we are alive to.
Another point is that, with so much subsidy going into the sector—
Motion lapsed (Standing Order No.10(6)).
The Oxford-MK-Cambridge Arc
I beg to move,
That this House has considered the report by the MK Futures 2050 Commission and developing the Oxford to Milton Keynes to Cambridge arc.
It is a pleasure to serve under your chairmanship, Mr Walker. Before I go into the substance of the debate, I pay warm tribute to the chair of the MK Futures 2050 Commission, Sir Peter Gregson, who is the vice-chancellor of Cranfield University, and his team of commissioners. They have drawn on their wide set of skills and experiences to produce an excellent report. That great care was taken to select commissioners from diverse backgrounds gives considerable weight to their findings, from Lee Shostak, a former director of planning at the old Milton Keynes development corporation, to the ever-inspirational Pete Winkelman, chairman of MK Dons, and to the young entrepreneur and broadcaster Oliver Dean, who spoke for the next generations.
The people behind the report care deeply about the future of Milton Keynes and I pay tribute to them all for their hard work. It is a body of work I have long argued for. I think the title of the report—“Making a Great City Greater”—is apt. I believe the report will be extremely significant in shaping not only the future development of Milton Keynes but of the whole Oxford to Cambridge arc, of which Milton Keynes is the fulcrum.
Before I go on to talk about some of the report’s findings and their implications, let me first put it in some context. The motto of Milton Keynes is highly pertinent—“By knowledge, design and understanding”. Milton Keynes will celebrate its 50th birthday in January, and as we approach that milestone it is worth reflecting on that troika of guiding principles. We certainly have design. Over the past half century we have filled out the urban space that was designed by the original developers and our population now exceeds the original target of 250,000. Throughout that period we have also applied great knowledge and understanding to inspire the design and grow the development of the city. Sometimes mocked by those who have never visited, Milton Keynes is characterised by quality urban design, open green spaces, inclusivity and cultural richness.
“Infrastructure before expansion”—I before E—has been key to our success. We are now expanding beyond the originally designed size of Milton Keynes, both in the physical footprint and in the number of people. In the absence of the report, which was published recently, we had to ask ourselves if we properly understood the factors that had made Milton Keynes a success as we went forward. Going beyond our designed limits has put pressure on infrastructure, which has been crucial in placing Milton Keynes as the most successful and fastest growing new city in the country.
In the previous decade, I contend that John Prescott’s English Partnerships proposals to double the size of Milton Keynes started to break that essential partnership of knowledge, design and understanding. Thankfully, those proposals were scaled back in the 2013 core strategy, which mapped out a more sustainable development of Milton Keynes into the mid and late-2020s. That strategy is now under threat. Housing developments that have outline permission are not being brought forward sufficiently quickly and place Milton Keynes in danger of not meeting the five-year supply targets.
I congratulate the hon. Gentleman on securing this important debate, and I join him in congratulating Milton Keynes on its 50th anniversary, which I look forward to celebrating. Does he agree that right across the Cambridge-Milton Keynes-Oxford arc, which he rightly says has such enormous potential, we need not only to provide additional affordable housing but to take the opportunity to show how economic expansion and growth, notably in public and other transport links, can be an agent of improving the environment and the sustainability of the ecology and biodiversity? Often, damage to the environment is put forward as a price worth paying. Should we not be able to show that there are gains in environmental quality that economic expansion can pay for?
I am grateful to the right hon. Gentleman for his intervention. I will touch on the potential for growth later in my speech. One project that he and I share a passion for is the east-west rail link, which will not only be of huge economic significance for Oxford and Milton Keynes but hopefully will see a modal shift of transport away from roads and on to rail, thus enhancing the environment. I look forward to working with him on ensuring that the project happens.
Not meeting our five-year housing supply target will lead to speculative planning applications outside the core strategy being submitted, and sometimes granted, in the face of strong local opposition. That in turn creates unplanned demands on infrastructure, which may already be strained, and on services, and it means that Milton Keynes will continue to grow without an overall strategy or an understanding of the wider implications. There is a clear need for the thousands of already agreed planning applications to be brought forward.
My first ask of the Minister today is to explore every possible opportunity and to work with the developers, Milton Keynes Council, South East Midlands local enterprise partnership and all the other stakeholders on upping our annual rate of completions to levels that will satisfy the short to medium-term demand. We may also need to consider having some flexibility in the five-year target if we are able to demonstrate house building in the longer term. There are precedents for Government getting involved: one of the Minister’s predecessors helped to unlock the western flank and Newton Leys developments in Milton Keynes when they stalled in the previous Parliament.
Innovations such as council-initiated housing companies have been successfully deployed by other councils around the country to help bring forward developments. I know that the leader of the opposition in Milton Keynes, Councillor Edith Bald, has proposed that, and I urge Milton Keynes Council seriously to consider it. I also gently remind the Minister of the debate I secured a year ago on shared ownership. Shared ownership could tap into the extra capital sums made available by the Chancellor’s pension reforms, which could help to pump-prime the development of new housing estates.
I urge the Minister to consider all measures that could help to accelerate schemes that already have outline planning permission. Such measures would give Milton Keynes and the surrounding areas the space and time to develop their longer term strategy and their place in the wider Oxford-Cambridge corridor. Let me be clear: I do not see the core strategy from 2013 as the limit of Milton Keynes’s ambitions, but it has to be progressed and completed before we rush into further growth that would compound pressures on our infrastructure and services, which we might come to regret further down the line.
I regularly hear very real concerns from constituents about pressure on infrastructure and services. Those people are not anti-growth. The people of Milton Keynes have a positive, forward-looking, can-do attitude, but they are genuinely worried about ill-planned growth compromising the qualities that have made Milton Keynes the success it is. Those concerns cannot be ignored. By getting the short term right, we can plan our future and make our contribution to the national economic and housing growth that we need.
During and since the last general election, I have been calling for such a strategic vision to be developed. I was therefore delighted when Milton Keynes Council set up the Futures 2050 Commission last year. The commission has speedily but thoroughly produced its conclusions. I am particularly pleased that it sees Milton Keynes very much as an enabler in the development of the wider Oxford-Cambridge corridor. I strongly believe that our future economic development will be centred on us being a hub in the middle of that arc.
Looking at our housing growth in the context of that arc is a must. While some intensification of housing in the centre of Milton Keynes and some of the original estates is feasible and arguably would add to the vibrancy of the city centre, my personal view is that continuously adding housing developments to the periphery of Milton Keynes is not necessarily the answer. Nor is there an appetite for enormous housing developments in the greenfield areas surrounding Milton Keynes as that would start to compromise the open spaces and environmental benefits of our existing design. We should have a network of smaller developments that are proportionate and sympathetic to existing settlements, but not massive urban sprawl. That will be a subject of debate when the report is taken forward to Milton Keynes Council next week. If agreed, it will lead to further workstreams. I hope that my views will find favour with many of those who are taking part in that debate.
Whatever the future style of expansion, there are a number of prerequisites. Co-operation with neighbouring authorities will certainly be necessary, and I shall return in the last part of my speech to the administrative aspect of that. As I alluded to when answering the intervention from the right hon. Member for Oxford East (Mr Smith), there is a need to develop infrastructure along the arc. I am delighted that in the Budget this year, it was announced that the National Infrastructure Commission has been commissioned to look at those projects.
Infrastructure development will certainly involve proceeding as quickly as possible with existing schemes such as east-west rail and the Oxford-Cambridge expressway, but it will also involve ensuring that the arc is at the forefront of installing the very latest communications technologies, such as 5G. Most significantly, it will need to include the potential transformative effect of smart mobility technology and wider smart cities technology. Milton Keynes is already pioneering such work, with numerous projects up and running—for example, at the transport systems Catapult, at the Open University and in Cranfield. Such technology will facilitate a better network of smaller developments across the arc that will command far more popular support than ever greater urban sprawl.
By developing that infrastructure and placing us at the fulcrum of the arc, Milton Keynes and surrounding towns and villages will be ideally placed to develop a globally competitive knowledge-based economy of scale. Addressing skills is critical to that. The commission’s report contains many imaginative proposals, and one of the most exciting of those is the Milton Keynes institute of technology—MK:IT. Milton Keynes has long aspired to have a campus-based university of its own, but I am not sure that the traditional model necessarily fits with what we are and what we can aspire to be. We should innovate, and something like MK:IT would complement the existing higher and further education institutes and provide a pool of skills from which local companies can draw as the economy develops. It would be particularly well placed to be the centre for the intelligent mobility education needed to create a qualified workforce and to allow the UK to gain the lion’s share of the intelligent mobility market, which is forecast to reach £900 billion by 2025.
I urge hon. Members to read the report recently published by the transport systems Catapult, which identifies a real gap in our knowledge market and makes some interesting proposals about how we can address that. I believe MK:IT would sit squarely with that. It would also fit neatly with the Government’s intention to expand higher education and research, as set out in the recently published Higher Education and Research Bill, which I hope will be in front of the House soon. I urge the Minister to work closely with the Department for Business, Innovation and Skills and our local higher and further education institutions to explore that opportunity. I believe MK:IT can be the driver of our future growth.
My final point concerns the governance structure for the developments to which I have referred. Milton Keynes’s future cannot be seen in isolation from the wider area. Historically, the boroughs, cities and counties along the arc have faced in different directions; that is a product of history and geography. There have been some positive developments to get the different authorities to work more closely together. An example is SEMLEP, but I urge the Minister to consider other innovative solutions. The growth of Milton Keynes and the arc will have to be different from the other models of devolution being introduced in traditional metropolitan conurbations. I do not want the expansion of Milton Keynes to be seen in any way as a land-grabbing exercise from neighbouring authorities, which would rightly and inevitably be resisted, but I urge the Minister to engage with all the authorities along the arc to develop something new that is innovative and collaborative and will facilitate the sorts of development that I have discussed.
My key ask today is for the Government to give us the space and time to develop our long-term strategy and implementation timetable. There must be solutions to meeting the short-term housing needs while we develop Milton Keynes at the heart of the corridor. The Milton Keynes Futures 2050 Commission report and the work of the National Infrastructure Commission represent a golden opportunity to develop a bright and successful future built on knowledge, design and understanding. Let us not squander it.
It is a pleasure to serve under your chairmanship, Mr Walker. I congratulate the hon. Member for Milton Keynes South (Iain Stewart) on securing this important debate. I am obviously proud to respond on behalf of the Labour party to the issues raised, and I pay tribute to my predecessor, my right hon. Friend the Member for Wentworth and Dearne (John Healey).
You will understand, Mr Walker, that I have been in post for only a short period and it has been rather a busy time for me, but I had the pleasure of serving as a local Labour councillor for 16 years in a previous life, and I understand the importance of strategising and of linking housing to economic development. I am pleased to see in the MK Futures 2050 Commission report a really good example of how a well run, Labour-led local authority—I accept that this is cross-party work—can provide leadership, direction and ambition for the future, even during a very difficult financial period for local government.
As the hon. Member for Milton Keynes South mentioned, Milton Keynes is approaching 50 years since being designated a new town by the Wilson Labour Government in 1967. I am familiar with new towns. Peterlee, in my constituency, is from a similar generation, or in fact a little earlier—the post-war generation—and just slightly to the south of that is Newton Aycliffe.
New towns have particular strengths and problems. As the hon. Gentleman pointed out, this new town—actually, it is a new city—has developed to the extent that it is home to 270,000 people. As Milton Keynes has grown, so too has its regional, national and, indeed, international importance. I understand that it is now the biggest economy in the South East Midlands LEP area. It has a strong and internationally recognised smart city project and is fast developing into what could be described as the Milton Keynes city economic region.
The city is acknowledged as offering a particularly high quality of life, with many parks and open green spaces. The concept of the original planners was that open green spaces and parks would run throughout the built environment—that was a feature of many new towns of the period.
The importance of Milton Keynes to the UK economy was recognised by no less a person than the Chancellor himself in his Budget speech, when he asked that the National Infrastructure Commission should investigate how infrastructure investment in the Oxford-Milton Keynes-Cambridge arc—the so-called innovation corridor referred to by the hon. Member for Milton Keynes South—could improve the overall output of the UK economy.
I therefore commend Milton Keynes Council for establishing the MK Futures 2050 Commission, a panel of independent, nationally respected figures from across the academic, business, public and private sectors who have come together to produce a report on how the city can continue to be prosperous into the future. Indeed, the commission has gone further, identifying the challenges and barriers to success and what the city can do in the short, medium and long term to ensure sustainable growth. It is a fine example of not taking the status quo for granted but instead ensuring that local authorities lead the way in innovating and adapting so that, as my right hon. Friend the Member for Oxford East (Mr Smith) mentioned, the citizens they represent can access affordable housing, well paid jobs and a clean, healthy lifestyle.
The commission undertook detailed research and gathered evidence, including more than 6,000 submissions from local residents and stakeholders. It highlights the fact that the factors that have made Milton Keynes a success in its first 50 years are the very issues that may have an impact on future growth: affordability, access to well paid employment, good infrastructure and the advantageous geographical position that the hon. Member for Milton Keynes South described—it is near the M1 and the west coast main line and between London, Birmingham, Oxford and Cambridge.
The commission identifies some of the risks to employment that could threaten many jobs, including well paid ones. Housing affordability is a key issue, as it is in much of the south-east, as unaffordable housing limits the supply of a skilled workforce. The city of Milton Keynes, like so many others, including Washington in County Durham, was designed on a grid system. That worked well originally, but is approaching capacity, which could have an impact on future growth. Finally, competition, not just from the UK but from our European and global competitors, will continue and intensify.
The commission concluded that to be successful, Milton Keynes needed to focus on the growth of high-quality, knowledge-intensive jobs and its continued development as a green and affordable place to live. To deliver that economic growth and prosperity, the commission has recommended six “big projects” that are vital to the future success of Milton Keynes. I will not talk about them all, because of the shortage of time, but I want to pick out a couple. The commission recommends that Milton Keynes’s population should grow in the future to at least 400,000 people. As the hon. Gentleman said, much of that growth would not take place in Milton Keynes itself; it would not be within the current local authority boundaries, but would take place along the Oxford-Milton Keynes-Cambridge corridor.
I am told that at a recent meeting with the National Infrastructure Commission, the leaders of Milton Keynes, Cambridge and Oxford expressed strong support for that idea, with support from their respective local enterprise partnerships. I am pleased to say that those councils, along with Norwich and Swindon, have come together to form the Fast Growth Cities network, which has also promoted the idea, with the support of the much respected Centre for Cities think tank. Again, the hon. Gentleman referred to that. The importance of those cities to our national economy, with their high-wage, high-productivity, high-skill and low-welfare economies, is significant. To highlight that, I will make a comparison with my own region, the north-east of England. The gross value added output of those cities is almost equal to that of the northern powerhouse. Given recent events and the UK’s intent to leave the EU following the recent Brexit vote, the continued success of those economies is even more vital to the success of the public finances.
If I may, I would like to put a few questions to the Minister. I would like to ask, in particular, when the infrastructure investment in the east-west rail link linking Oxford, Milton Keynes and Cambridge is to be delivered. The scheme has been subject to continued delays and time slippages. I understand that the local authorities, businesses and potential investors are concerned about the great uncertainty over the speedy delivery of that project. Will the Minister give top priority to making representations to the National Infrastructure Commission?
As the hon. Member for Milton Keynes South identified, there is a gap in university provision. I point out that Milton Keynes is home to another excellent creation of the Wilson Labour Government—the Open University, a pioneer in distance learning. The MK Futures 2050 Commission recommends the establishment of a Milton Keynes institute of technology—a kind of Massachusetts Institute of Technology concept, like they have in the United States, which seems a brilliant idea. It would take advantage of, and apply, advanced research and training and transform it into world-leading innovative enterprises. The UK currently lacks that type of establishment, and the idea has enormous potential. Again, I echo the hon. Gentleman by asking the Minister to engage with his colleagues in making representations to BIS, asking it to make contact with Milton Keynes Council to investigate how the idea can be taken forward.
This is a good point at which to highlight that the commission is clear that if growth is to be delivered, the population of Milton Keynes must be able to share in the benefits of growth. It calls it “inclusive growth”, and the point requires highlighting that growth must benefit not the few but the many. As my hon. Friend the Member for Hayes and Harlington (John McDonnell), the shadow Chancellor, has pointed out for some time, that will be easier to achieve with sustained investment in infrastructure. I am pleased that the report favours that approach to growth. Will the Minister agree to meet representatives from the Fast Growth Cities group to discuss their needs, and does he agree that the opportunity of having five local authorities that want to embrace growth, and housing growth in particular, should not go to waste?
I am sure the Minister agrees that the report is an exceptional and groundbreaking exercise by a local authority. It provides a context in which Milton Keynes and the surrounding authorities can discuss growth for the future and address issues they face. I am sure that many local authorities in other parts of the country would be very interested in learning from their experience and example. I therefore urge the Minister to meet representatives from Milton Keynes Council to discuss the benefits and potential of this approach, and to offer any assistance he can in co-ordinating responses from other agencies.
Finally, I would like to place on record my thanks and appreciation to Milton Keynes Council for commissioning this forward-thinking report, and to the hon. Member for Milton Keynes South for raising it today. In particular, council leader Councillor Peter Marland and the chief executive Carole Mills have shown excellent leadership throughout. The director of strategy, Geoff Snelson, the head of policy, Sarah Gonsalves, and the project manager, Fiona Robinson, have worked tirelessly to produce an excellent report. The Milton Keynes Futures 2050 report is a fine example of local innovation and the power of good local leadership. I look forward to hearing the Minster’s reply, and I hope that he will welcome the report; it is well worth considering taking it forward with Milton Keynes Council and the other local authorities.
Minister, you have until 5.45 pm, but if you would like to leave two minutes at the end for the Member who moved the motion, that would be very well received I am sure.
It is a pleasure to serve under your chairmanship, Mr Walker. I will ensure that I leave at least two minutes for my hon. Friend the Member for Milton Keynes South (Iain Stewart). I really want to congratulate him on having secured this debate, along with everybody involved in the work of the Milton Keynes Futures 2050 Commission—all the commissioners and Sir Peter Gregson, obviously—who have put this forward and worked with ambition and vision to feed into this long-term plan for Milton Keynes. I think it mirrors the clear ambition and determination that my hon. Friend has to see Milton Keynes continue being a very special place, which I know it is from my experience many years ago—I was not too far from there as a student—and from visiting him over the last few years. It is a really good example of the real success that there has been from the original new town’s ambitions; it has continued to grow ever since.
There is the ambition for seeing things like more lifelong learning opportunities at a new university, as the hon. Member for Easington (Grahame M. Morris) on the Opposition Front Bench outlined, along with a good example of that kind of ambition. As was said, it is linked with the Open University. It is also important for areas to realise that the planned reforms in the Higher Education and Research Bill announced in the Queen’s Speech earlier this year make it easier to establish new universities, helping more providers to offer higher-quality degrees. As a Government we are making sure that we work to deliver in those areas.
No one is in any doubt about the clear ambitions for Milton Keynes for the future, not just through this plan but as part of that Oxford, Milton Keynes and Cambridge growth corridor. In March 2016, the Chancellor announced that he had asked the National Infrastructure Commission to lead an inquiry into the potential of Oxford, Milton Keynes and Cambridge. He asked the commission to explore the corridor as a key growth locale for high-tech, knowledge-intensive industries coupled with an ambitious, high-quality housing offer to meet the growing needs of the area. That commission’s inquiry is currently under way and I look forward to seeing its recommendations in due course. It is worth noting, in response to the point made by the hon. Member for Easington, that the consultation is open until 5 August and I encourage people to feed into that.
Increasing the supply of housing is critical to our economic success, in Milton Keynes and more generally. As a Government, we have got the country building again with a 25% increase last year alone. We have set out an ambitious vision for housing—probably the most ambitious vision for a generation—by doubling the housing budget to more than £20 billion to deliver on our ambitions to build 1 million new homes. My hon. Friend the Member for Milton Keynes South outlined and commented on the type of homes, affordable homes and shared ownership. I would encourage the area to look at the available funds. There is £4.7 billion-worth of funding for shared ownership specifically, as well as the £1.2 billion fund for starter homes that is available as well. I hope that organisations in the area will look at those.
We also welcome the recent announcement by the Home Builders Federation, on behalf of its largest members, to further increase that growth in supply. My hon. Friend touched on this issue around build-out rates. This is also creating more transparency as we go forward about what those rates are, and building more homes to support the ambitions we all have to see the homes we need actually being built. Increasing housing supply cannot be done in isolation, and I recognise the important roles that having the right spatial plans, infrastructure and services play in creating the right communities for the future.
I will turn to a couple of points around this issue specifically. First, on planning, Milton Keynes adopted a core strategy in 2013 and I know that it is now working on a new local plan to be published, hopefully, later this year. It is right that local authorities keep their plans up to date and that they work with neighbourhood plans. I was delighted when visiting Milton Keynes not too long ago to see some of the ambitious neighbourhood planning work that is going on; indeed, I think the largest in the country is in Milton Keynes. Local councils need to make sure that they are making decisions on planning applications locally and neighbourhood plans are the ultimate way to do that with the local community having real involvement and control over planning by having a neighbourhood plan that has weight in law. In determining planning applications, local councils have to have regard to their local plan as well as to national planning policy and neighbourhood plans. We are committed to making sure that we keep the country building, to deliver the homes, and the type of homes, that our communities want to see.
Our consultation document in December 2015 proposed specific changes to the national planning policy to drive up the delivery of new housing and bring forward more land for development. However, I recognise that excessive pre-commencement planning conditions can slow down or even stop the construction of homes after they have been given planning permission, and my hon. Friend made the point about the frustration people feel about the gap between planning permission being granted and housing actually being built. The new neighbourhood planning and infrastructure Bill that was announced in the Queen’s Speech will seek to deal with that issue. We need to make sure that the homes that are getting planning permission are being built and that the process is not being slowed down by unnecessary bureaucracy.
Does the Minister accept that the constraints often do not just relate to delays in planning? In my experience, certainly in my authority, that was never an issue. The problems often relate to the lack of infrastructure. The MK Futures 2050 Commission has highlighted how important it is to invest in transport infrastructure. Will he at least acknowledge that that is one area—from the six big issues—that should be addressed?
The hon. Gentleman is getting the cart and the horse the wrong way round. He is absolutely right that, in terms of getting homes built and planning for homes in future, infrastructure is part of the equation and is part of what a local authority should be looking at when it develops its local plan. However, once planning permission is granted—infrastructure is part of the consideration in granting planning permission—one of the main delays that causes the gap between planning permission being granted by the local authority and work starting on site is planning conditions. Examples from around the country show that there can be more than 1,000 planning conditions on one site. That explains why, in many cases, a council will give permission but it can be up to a year or two years later if not longer before a builder can get on site and physically start doing anything, including putting in infrastructure. That frustrates communities, local authorities and builders. We need to make sure that we are doing something about it, so we are taking that kind of bureaucracy out of the system. That is what I mean by saying that we want to continue to reform and speed up the planning process, so we minimise the delays caused by unnecessary or burdensome conditions.
Looking towards the longer term, I recognise the key role that dedicated delivery bodies have played in the creation and continued growth of somewhere such as Milton Keynes. At the outset, there was the new town development corporation, and more recently there has been the Milton Keynes development partnership. I welcome the MK Futures 2050 Commission’s focus on ensuring that the right delivery vehicle is in place to drive Milton Keynes’ further transformation in future.
Through the Housing and Planning Act 2016, which we have just passed, we have made some important changes to the new towns legislation to make it easier to set up new statutory development corporations when local areas decide that that is the best way forward, but having the right infrastructure in place to support growth is critical for the wider planning process. The neighbourhood planning and infrastructure Bill will transform how we make long-term plans for our nation’s infrastructure, empowering local communities to get the homes and local infrastructure that they want and need delivered, and making infrastructure policy at the national level much more strategic and consistent. The Bill will underpin that statutory function.
Significant funding is already being invested to support housing growth. More than £200 million of the local growth fund has been prioritised to date to support growth across the south-east midlands and the Northamptonshire areas. We are expecting a further bid for local growth funding from the south-east midlands shortly as part of the current bidding round.
In addition, the Government have announced plans to radically reform the business rates system to enable local government to be more self-sufficient and to benefit from growth. The changes build on the existing reforms that have given areas 50% of the business rate growth, and full retention pilots are going on in four areas. The 100% retention reforms are accompanied by additional flexibilities for local authorities to reduce rates to boost growth, and mayoral combined authorities will have the opportunity to increase rates through an infrastructure levy with the agreement of the local enterprise partnership.
Those are big changes with significant opportunities for local government. How local government chooses to use that retained income and the growth in business rates in areas such as Milton Keynes will be a matter for the people there. However, I am encouraged by Milton Keynes’s wish to earmark spending for education and infrastructure investment and by the ambition shown in the report through the six projects. We are sensitive to the challenges that will come with the changes we are making and are therefore seeking feedback on them in an open manner, through a consultation that was launched last week. I encourage people to take part in and respond to that.
Securing the right level of developer contributions is also vital to ensuring that infrastructure is delivered in the right places and is supporting growth. That is part of the planning process. A review of the operation of the community infrastructure levy is being undertaken by an independent panel, which will report back to Ministers later this year. That review is to look at assessing the extent to which the levy provides an effective mechanism for funding infrastructure and to recommend changes that would improve its operation in support of our wider housing and growth objectives, with a clear focus on the needs and plans for local areas.
I recognise the significant ambitions that Milton Keynes has, both as a city and as part of the wider Oxford-MK-Cambridge arc. We look forward to working with the area on just that, as the hon. Member for Easington said.
In view of that commitment, will the Minister agree to meet representatives of the Fast Growth Cities group to discuss how it is possible to embrace growth—housing growth, in particular—and how that initiative should not go to waste?
I meet the cities group fairly regularly and have done as a local government Minister over the last few years, and I am always happy to meet any organisation that wants to talk about developing more housing in its area. There is very much an open-door policy on areas that want to develop housing.
This is all part of our drive for local areas to have the power to work out what is right for them. That is why it is absolutely right that we continue to devolve powers, and the devolution landscape has been driven by those local areas. Government have responded to places that are clear about their ambitions and how they want to get there. I encourage areas to work out what they think is right for them and then to make that pitch to us. With the right governance and structures in place, anywhere could look to drive forward its own priorities and find its own local solutions, and to have the power and ability to do that. I look forward to seeing that develop further in Milton Keynes and to seeing it work to deliver on the ambition it clearly has. I know that it will be supported and matched by the ambitions of my hon. Friend the Member for Milton Keynes South.
May I place on record my gratitude to the Minister, the hon. Member for Easington (Grahame M. Morris) and the right hon. Member for Oxford East (Mr Smith) for their contributions to the debate?
I conclude with this observation: Milton Keynes is unique and it has been an enormous success, and I believe it can continue to innovate and provide the exemplar for other towns and cities round the country. I think the report from the MK Futures 2050 Commission is inspirational and, although I will probably not be here looking back in 50 years’ time, I think history will judge this report as the start of a new chapter in urban planning and development.
I am heartened by what the Minister says on a number of fronts, and by the welcome that the Government will give to an innovative model of governance structure. What will work in Milton Keynes and surrounding areas will not be the same as for the west midlands, Greater Manchester, Bristol or any other urban area. It will have to be new and I look forward to seeing proposals coming out from Milton Keynes Council and the neighbouring authorities. I also look forward to seeing the detail in the neighbourhood planning and infrastructure Bill, which will help to unlock developments that have been stalled. What will be interesting is if we can develop a new delivery vehicle for implementing the types of projects that the report contains.
In conclusion, I am very grateful to have had the opportunity to bring to the attention of national Government what we are doing locally. There are still many debates and conversations to be had locally about how we take this forward, but I hope they will be favourably received.
Question put and agreed to.
That this House has considered the report by the MK Futures 2050 Commission and developing the Oxford to Milton Keynes to Cambridge arc.