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Westminster Hall

Volume 623: debated on Tuesday 14 March 2017

Westminster Hall

Tuesday 14 March 2017

[Mr Adrian Bailey in the Chair]

Health and Social Care Budgets

I beg to move,

That this House has considered budgets for health and social care.

It is a pleasure, as ever, to serve under your chairmanship, Mr Bailey. I thank the Backbench Business Committee for granting this important debate about the funding of health and social care. I pay tribute to my fellow Committee Chairs—the hon. Member for Totnes (Dr Wollaston), Chair of the Select Committee on Health, and my hon. Friend the Member for Sheffield South East (Mr Betts), Chair of the Select Committee on Communities and Local Government—for their work, including with my Committee, to shine a light on the challenges of funding our health and social care system for the next generations. I also pay tribute to the Select Committee on Public Administration and Constitutional Affairs for its work in this area. The fact that four Select Committees, and three in particular, are focusing their attention on the issue demonstrates its importance to the nation and to the long-term health of our citizens.

The Public Accounts Committee’s view and concern, which is well documented in a dozen reports produced by us in this Parliament alone, is that there is a challenge with the funding settlement for the national health service. I will not repeat all the arguments that I made in the Chamber during the debate on the estimates the other week, but we are also in the grip of a crisis in social care. The NHS accounts are showing the strain again as we approach the year end.

Last year, as I am well documented as saying, the Comptroller and Auditor General put an extraordinary commentary on the Department of Health accounts, which were laid on the last day of Parliament’s sitting. Extraordinary measures were taken to get them into balance—again, I will not mention them all, but it was a difficult adjustment. The permanent secretary at the Department of Health has acknowledged that that was not good enough, and that such one-off measures should not be repeated. We are now hearing concerns that NHS trusts are delaying paying their suppliers in order to ensure that their budgets balance. We know that, once again, capital funds will be raided and converted into resource funding to keep the NHS on track.

My Committee has discovered that funding in every area of the NHS is facing increasing demand, including specialist services, diabetes and discharge from hospital, which we have considered. The increasing age of the population and advances in medicine mean greater demand on our national health service. When the Government tell us that they are putting more money into the NHS, we must treat that with caution: more money without consideration for the number of people using the service and those who will need it in future is not always enough. Not only is the money not meeting current need, but it will not meet the growing demand.

I will speak briefly, as I am aware that 15 or so Members are scheduled to speak in this debate. The Budget came up with some solutions, as the Chancellor sees them, for funding the NHS. Our concern is that, once again, piecemeal funding is being offered rather than long-term solutions. The Chancellor talked about putting £2 billion into social care, £1 billion of it in the next financial year, starting in April. However, the Local Government Association estimates that more than £1 billion every year is needed to fund the gap in social care. The 2% council tax, often vaunted as a great solution, is a challenge in some areas, particularly where the council tax base is low. My own local authority has increased council tax to cover it, which of course means that local taxpayers are helping fund the system.

I congratulate my hon. Friend on securing this important debate. Dementia Care, a charity based in my constituency, has deep concerns about the current and future funding plans for social care. Dementia Care believes, and I agree, that funding should be based on need, not on a local area’s ability to raise council tax, which clearly disadvantages people in areas such as Newcastle. I know that my hon. Friend shares this view, but I wanted to reiterate on the record that charities providing vital services up and down the country share her concerns.

I know that my hon. Friend the Member for Sheffield South East will discuss the funding of social care in more detail.

I, too, congratulate the hon. Lady. Does she agree that Ministers are engaged in wishful thinking? The ability to reduce the number of hospital beds relies on the availability of better and more social care, yet in Brighton our sustainability and transformation plan footprint means that we are being forced to find another £112 million in efficiencies specifically in social care. It just does not add up, and it is not sustainable.

One concern that our Committee has uncovered is the pressure to make 4% efficiency savings. That figure was used in the last Parliament, but has now been acknowledged to be too stiff a target. However, we are also seeing a move to 4% efficiency savings in STPs. That is challenging to achieve while going through transformation. One would expect the Public Accounts Committee to be no slouch in considering where efficiencies can be found, but even with efficiencies there is just not enough money in the system. It is being squeezed.

One welcome aspect of the Budget—I hope that the Minister can give us more detail—is that there will be a Green Paper later in the year on the future funding of social care; again, I know that my hon. Friend the Member for Sheffield South East will want to talk more about that. There are also other bits of money: £100 million to support 100 new on-site GP triage projects at accident and emergency departments in hospitals in time for next winter; £325 million in capital funding to support the implementation of sustainability and transformation plans that are ready to proceed; and a multi-year capital programme for health. That all sounds like a lot of money, but relative to the total NHS budget, it is a very small amount, and the concern is that it is not long-term and sustainable. That is what our Committee said. A long-term plan is necessary for funding the NHS.

After looking at this year’s accounts, we are concerned about the number of trusts in deficit; perhaps the Minister can update us on that. As of month 9 of this financial year, 74 of 238 trusts were in deficit, to the tune of £886 million total. Granted, that is less than the £2.5 billion last year, but it is still not a healthy situation. Raiding capital funds to pay for resource and other such measures is just not acceptable in the long term.

I commend the hon. Lady on working cross-party to find long-term solutions for the huge issues facing social care and the NHS. She highlighted the fact that capital money has been transferred to revenue. Does she agree that in places such as Huddersfield, in my area, that makes the prospect of looking for another disastrous private finance initiative deal to fund capital improvements more likely? The disastrous PFI at Halifax is now dictating disastrous changes at Huddersfield; services are being moved to fund that PFI deal.

The hon. Gentleman rightly highlights that the NHS is not new to challenges in dealing with capital projects. One of our concerns about taking out capital is that NHS buildings and equipment will deteriorate, costing more in the end. That is not good value for money, which is what my Committee considers. We should all be watching the situation. The consequences might not be apparent today, but they will become so as time goes on, and we as parliamentarians need to keep a close eye on what is happening in our local area. I am glad that the hon. Gentleman is doing so.

I will finish, as I am aware that an awful lot of Members want to speak. We must not forget that the situation has an impact on patients. For instance, the target for accident and emergency waiting times is 95%, but actual performance is just under 87%. Diagnostic waiting times have risen from 1% to 1.68%, and referral to treatment within 18 weeks has not reached its 92% target; it is just under 90%, at 89.41%. The number of people waiting more than 52 weeks for referral to treatment is 1,220. Those are just some of the figures demonstrating the impact of how NHS and social care finances are being managed and what is happening to patient outcomes.

I congratulate the hon. Lady on securing this much needed debate. Does she agree with me and other stakeholders that a comprehensive review is needed in which everybody—stakeholders, the Government and the Opposition—works together to find a way forward for a comprehensive funding solution?

The hon. Lady neatly brings me to my conclusion. That is what we need: a long-term, sustainable future for our national health service. The present situation will not last from Parliament to Parliament and from one governing party to another. We need to agree a way forward and have a national conversation. We did that with pensions. It was difficult, but we got there—I know that there are still issues, but we reached cross-party agreement. We cannot chop and change, and we cannot have Governments pretending that throwing a little bit of money at the problem in a Budget is a solution. We need a long-term, sustainable solution and a national conversation about what the NHS will deliver and what outcomes we want to achieve.

Order. Before I call the next speaker, I will just make it clear that I am trying to shoehorn a three-hour debate into one and a half hours. I need to call the Chairs of the relevant Select Committees, and I am looking for five minutes each from them. There will be a hard and fast three-minute time limit for subsequent Back-Bench contributions. If anyone wishes to intervene, they are perfectly free to do so, but I might take it into consideration when I consider the order of speakers.

It is a pleasure to follow the hon. Member for Hackney South and Shoreditch (Meg Hillier). I pay tribute to all the Select Committees and their members for the work that they done and to all those outside this House who made the compelling case that led to the announcements in the Budget. I say to the Minister that I unequivocally welcome those announcements, and I thank the Government for listening to the case that was made, not only about social care but about capital.

However, I would nuance some of that, because the point about social care is that we must not consider it “job done”. The £2 billion over the next three years is very welcome—it is also welcome that it has been profiled to address the back-loading of the previous settlement. However, I would like the Minister to say how we will ensure that it gets to the frontline and is distributed fairly according to need, and also that that reflects the different abilities of councils to raise their own money through the social care precept, because that is important for public confidence about how the money is spent.

I also welcome the announcements on capital—the £325 million for the sustainability and transformation plans that are ahead of time is very welcome. I look forward to the announcements in the autumn Budget about further money, although the Minister will know that £1.2 billion has been transferred to revenue from capital. That is an ongoing issue that is hampering the ability of areas to put effective plans in place. Will he touch on that and say how quickly he thinks we will get to a position where we do not see these capital-to-revenue transfers as being necessary?

Another welcome announcement was about the capital improvements available to accident and emergency departments, although I would caution that this is being linked to putting general practitioners alongside casualty departments through co-location. This is not only about funding; it is about having a general practice workforce that can fund these co-located departments alongside out-of-hours departments and providing routine surgeries on Sundays. I am afraid that we simply do not have the workforce to sustain that activity. I know that there is a commitment to increase the workforce in primary care, but that is alongside a significant retirement bulge in primary care. Something will have to give. As things stand, I simply do not feel that we have the workforce to do that work.

Finally on the Budget, there was a very welcome announcement of a review and a Green Paper in the autumn, which we all look forward to. However, I call on the Government to stop and take stock, because next year will be the 70th birthday of the NHS, and it will come at a time when it is under unprecedented financial pressure. Over the last Parliament we saw a 1.1% annual uplift, against the background of uplifts of around 3.8% traditionally since the late ’70s. This is a sustained financial squeeze, at the same time as an extraordinary demographic change and an increase in demand across the whole service. As welcome as the announcements were last week, I am afraid that they do not go far enough to address the scale of the generational challenge that we face. It is of course very welcome that more people are living longer, but that is happening alongside a shrinking base of our working population who are able to fund that demand.

We simply cannot carry on as we are. If the review focuses simply on social care, we will miss an extraordinary opportunity to address the issue in time for the 70th anniversary of the NHS. I would therefore ask the Minister to go back to colleagues and say, “Can we widen this Green Paper to take in health and social care, and can we try to do that on a consensual, cross-party basis?”, as has been said by many across the House. Notwithstanding the issues about that in the past, the scale of the challenge is so great that we owe it to all our constituents to put that aside and to take nothing off the table in considering the scale of the challenge and the solutions ahead.

We have an opportunity to explain that to the public, because whenever I address public meetings and I ask people whether they would be prepared to pay more to fund our health and social care adequately, I find that the response is almost unanimous. People are ready for this. They understand the pressures, and they value health and social care immensely. That would be my big ask of the Minister: think again, widen the review, make it consensual and explain it to the public. Let us get the consent and move forward.

It is a pleasure to follow the two Select Committee Chairs, my hon. Friend the Member for Hackney South and Shoreditch (Meg Hillier) and the hon. Member for Totnes (Dr Wollaston); we have worked very closely on these issues. It is also a great pleasure to see so many other colleagues in the Chamber today. It is obvious that social care and health issues are now coming very high up the agenda, which is absolutely right.

I will refer to the report that the Communities and Local Government Committee has just produced, “Adult social care: a pre-Budget report”. In the next few weeks, we will produce a longer report about longer-term issues in social care. To begin in the here and now, the Committee welcomed the fact that the Government have allowed local authorities to increase the precept in the next two years and have encouraged local authorities to take up that offer, while still recognising that there are challenges around the fact that the precept raises very different amounts of money in different local authority areas. We asked for an immediate further injection of £1.5 billion, so it is welcome that the Chancellor announced an increase of £1 billion, even though £1.5 billion would have been more welcome—I think that is how the Committee will look at that.

Recognising that that would not be a permanent solution for this Parliament, however, we asked for the National Audit Office to be given the responsibility to look at what is required for the rest of this Parliament—the further two years of the spending rounds—to address the issues in social care. Those issues are very real, with an increase by a third in the number of people in their 80s or 90s over a 10-year period, with local authority spending on social care down by 7% since 2010 in real terms, with the increase in the minimum wage, with the Care Act 2014 and with all these other pressures.

Does my hon. Friend recognise that there are two groups of victims of the crisis in social care? They are not only those who depend on the services, but those who work in the sector and who face, for example, widespread non-compliance with national minimum wage legislation, which the Government are aware of but not acting on. Does he agree that needs to be recognised in a future settlement? We need a paradigm shift in how we view care work.

We will return to the proper training, long-term commitment and pay of staff in the care sector in our Committee’s further report, but we certainly had evidence to that effect.

We need another way of dealing with the funding gap for the rest of this Parliament. For the longer term, I very much welcome the announcement of the Green Paper, but I echo the comments of the two previous speakers. We need to get cross-party agreement on a sustainable, long-term settlement that will last not merely for the next Parliament, but for several Parliaments after that. There are major challenges. I agree that we should look at health and social care together, but there are fundamental differences in governance and accountability between the two systems, so how do we resolve that?

We should certainly look closely at what is happening in Manchester, to learn about the devolution deal there and how the two can work together within the same governance structure. Personally, I feel that losing the local accountability that the social care system currently has and simply centralising the whole system would be a mistake. That would take us in the wrong direction, so it is important to look at what is happening in Manchester. We have two very different funding systems. We have the health system, which is free at the point of use, but I do not think that anyone suggested in evidence that we could fund social care on exactly the same basis. We will have to consider something slightly different to fund social care, but how the two systems fit together will be a challenge.

If we are considering the future for social care funding, we should bear in mind that currently we have a mixture of funding. We have some central Government funding, local authority funding and the personal contributions that come through people paying for their care, particularly in residential homes, and what happens to their estate when they die. Will that mean a bit extra from those different elements—a bit more from central Government, local Government and personal contributions—so that the total whole grows? However, the Government have said that they will introduce the Dilnot proposals in the next Parliament—that is what the Minister said to us—which will cap and reduce the contributions that may come in from people’s private estates when they die, so does that mean more money from somewhere else?

I am sorry that the Chancellor did this, because everything should be on the table, but he ruled out a different way of taxing or receiving contributions from people’s personal estates when they die: taking a percentage of everyone’s estate. Currently, people contribute their estate if they end up with dementia and go into a care home, but if they have a heart attack, they tend to contribute nothing. Is that system fair? Is that a challenge we must look at? Even with Dilnot, the £72,000 limit would take most of the estate from a small house sold when someone in my constituency dies, but it would be only a fraction of the value of a property sold in the more expensive parts of London. Is that fair either? Do we simply scrap the whole thing and go on to a German system of social insurance?

The Communities and Local Government Committee went to Germany to have a look at its model. There are pros and cons to it, but we really need to put everything on the table and not rule out any possibilities. We need something that we can, in the end, reach cross-party agreement on, recognising that the social care system will probably be different in its funding from the health system. How they can fit together and be governed together will be absolutely crucial to the success of a long-term settlement, when we eventually reach one.

I shall be brief, Mr Bailey.

Our NHS is the envy of the world; our social care system, frankly, is not. Much has changed since the war years, and that has not yet been reflected or accepted. The health budget of £120 billion sounds a lot, but it is inadequate. It assumes that demand is falling; it is not, it is rising. Even NHS England has admitted that it is not enough. It is not sustainable—that is what the Public Accounts Committee report has set out. Trusts are still in deficit. Clinical commissioning groups have a very varied outcome, financially. The GP triaging offer is welcome, but it is a drop in a proverbial ocean.

The move to sustainability and transformation plans is absolutely right; the problem is that it is not properly funded and we are considering implementing models of care that are untried, untested and uncosted. That cannot be right. There is no transition funding and, although I welcome the capital funding for the project, £325 million is, I am afraid, not enough, Minister. Social care represents a third of local authority spending. We currently spend £14.4 billion. Unlike with the NHS, it is means-tested. Again, demand is going up but the funding is going down.

The funding to local government is inadequate. The 3% precept is helpful, but those of us in rural areas clearly have to pay more because we pay more council tax overall, compared with input from the state. The £2 billion is very welcome, but as my neighbour, my hon. Friend the Member for Totnes (Dr Wollaston), explained, it is a little bit but not enough and we need a proper review. We must also ensure that that money does not get stuck with our local authorities. That has happened before and I would not be happy with its happening again.

On the big picture, we do not really measure the system. We do not look at, or measure, need. We do not look at the people who do not even ask for help. Until we start measuring input, output and outcomes across the whole of health and social care, we will not solve the problem. The Green Paper is extremely welcome, and I agree with my hon. Friend the Member for Totnes that it must cover both health and social care. It would be better than a commission, but it must look at the whole system. It must look at the free/means-tested issue. It must look at integration, joint commissioning and a joint budget and accept some structural changes. We have had Sutherland, Wanless, Dilnot and Barker; the issue really is not that simple.

The Government must face up to the problem, but the public also must play their part. We have to accept change, and that is not easy. We must, as others have said, look at general tax, hypothecated tax, insurance, compulsory saving and much more, but the issue is not about just money, but models of care. While we are at it, Minister, please could we have some fair funding for rural areas? We have a disproportionate number of over-85s and rural sparsity that is not properly dealt with. Please Minister, can we have honest acceptance of the problem and the will to face up to it?

It is a pleasure to serve under your chairmanship, Mr Bailey, and also to serve on the Public Accounts Committee.

Whatever the right level of funding is, there must be agreement on what that is and, crucially, on what it can provide. In our Select Committee sittings over the past year, we have come to the conclusion that the promised programme cannot be delivered with the money available. Via the NHS mandate, which sets out each year what is expected, we know what the NHS is set to provide and what money is available. However, today is 14 March and we have not really had sight of what is mandated for next year.

The mandate is a requirement of the Health and Social Care Act 2012; it sets the direction for the NHS, helps to ensure accountability to Parliament and, crucially, sets objectives. We know from this year’s mandate that the indicative budget from April is £109,853,000 and the capital is £310 million, but it would be useful to hear from the Minister today when we can expect to see next year’s mandate.

The second crucial document in this debate is the NHS constitution, which we do not talk about enough. The constitution sets out the rights to which patients, the public and staff are entitled, including consultant-led care within 18 weeks of a referral from a GP and a specialist referral from a GP for urgent cases when it comes to suspected cancer. It sets out pledges and people’s responsibilities.

I agree that we need to involve the public much more in this debate. Waiting times will, I think, quickly start to increase. We have already seen today information from the King’s Fund on what is happening with hip operations. We will, invariably, go back to the days of the 1990s, with longer lists. Access to GPs and other professionals will continue to decrease and, largely, we will start to depend more on families and local care—not just for social care, but because of the consequences of not having well-accessed healthcare. Staff will become more demoralised and we know that morale is crucial for patient safety.

What I want to hear from the Government today, therefore, is how we are going to include the public in the trade-offs that are now necessary with the sustainability and transformation plans in local communities. How will that be done? Will Parliament start to debate the erosion of the NHS constitution and the rights that people have come to expect? Crucially, will the Minister say when—within the next two and a half weeks—we will see the mandate, so that we will know what funds are available and what they are set out to do?

Like many colleagues from across the House, I recognise that the issue of adult social care is not easy to fix. It will affect many of our constituents at some point in their lifetimes, and some of the barriers to care can be heart-breaking for families.

In May this year, I will stand down as a county councillor in Northamptonshire after eight years’ service; I was also leader of Northampton Borough Council for four years, so I have witnessed at first hand how the system works. Also, as a member of the Communities and Local Government Committee, I have been part of a four-month inquiry into adult social care. We published an interim report ahead of the Budget. I have also had discussions with professionals in the system, from the chief executive of Northampton general hospital down to care workers.

It is clear that the recently announced additional £2 billion of new money in social care is welcome. I recognise that it shows that the Government have listened to representations made by many Members of the House and the social care sector, and to the Select Committee recommendations. But no one on either side of the House is under any illusion that that will fix everything or, indeed, that money is the only issue. It is vital that we find a more sustainable way of paying for the increasing cost of social care over the long term, but we must also fix the systemic problems.

I welcome the Government’s statement that they will shortly set out proposals in a Green Paper. Although short-term action is vital, the social care sector faces medium and long-term funding, structural and other problems that need to be addressed, and it is important that we have a full review of the service for the long term. We must move the debate away from the idea that the entire sector can be saved with increased funding, because the issues go much deeper.

The idea of joined-up care must be exactly that. I have lost track of the number of cases I have worked on with families who are trying to resolve issues between the care provider and the local authority—in some cases, local authorities—and deal with the multiple pressures of finding solutions while dealing with the emotions and trauma of an ill relative, sometimes with many complex or difficult medical conditions.

The systemic problems in some cases can lead to financial pressures, which will only get greater as we have an ageing population, demographic growth and enhanced medical treatment. Often, too many organisations are involved: the poor family can get overwhelmed and unsure about which organisation is dealing with which part of the care package and who they should be chasing to make something happen.

The carers and staff involved are usually equally frustrated, and concerned for the patient and their family. The Green Paper needs to focus both on the structural barriers that prevent care packages from being put in place or patients from being discharged from hospital, and on a serious examination of how the different organisations involved work together. In my opinion, the review must take a wide-ranging look at whether the organisations currently involved are fit for purpose, whether the current splits between health and adult social care can be justified, and the possibilities for reform.

I congratulate my hon. Friend the Member for Hackney South and Shoreditch (Meg Hillier) on securing this important debate. I want to draw attention to the crisis in social care in Liverpool. The background is the severe cuts put on a city with a very low council tax base. Some 80% of Liverpool’s properties are in council bands A and B. Cuts to Government funding will reach 68% by 2020, resulting in a £90 million cut in funding for adult social care. The consequences up to now have been a reduction in social care packages from 14,000 to 9,000.

There are two aspects to social care: domiciliary care that enables people to live independently in their own homes, and social care that enables people to be discharged from hospital. Both are equally important. I certainly welcome the announcement of an additional £27 million for Liverpool over the next three years from the £2 billion additional allocation. That money is very important and has staved off an immediate crisis, but it will be eaten up by demographic changes.

For example, the increase in the number of people aged 65 and over will lead to an £8 million increase in cost next year. The increase in funding required to implement the living wage means that an additional £25 million is required by 2019-20. Welcome as that £27 million is, it will be eaten up by those increases. The situation is compounded by an error by the Department for Communities and Local Government in assessing how much funding could be raised from Liverpool’s council tax. I gather that that error has now been rectified, but it confused the situation.

What do we need? Additional funding now is welcome, but we need long-term consistent funding related to need and more integration between the national health service and social care. I recognise the problems that the Chair of the Select Committee, the hon. Member for Totnes (Dr Wollaston), identified, but a move towards integration is essential. Liverpool is innovative and is already trying to do that, but it needs funding and general support from the Government to enable it to work constructively with the NHS.

I congratulate the hon. Member for Hackney South and Shoreditch (Meg Hillier) on securing this important debate. I would like to touch on three different elements of adult social care: the short, medium and long-term aspects of funding. In the short term, the Government have allowed revenue raising of nearly £14 billion since 2010; most recently, there was the £2 billion in the Budget. That was very welcome and has had an immediate impact on my constituency. North Yorkshire will see an extra £18 million over three years. While I very much appreciate that response to the various different submissions that have been made, I think that most people, including the Chancellor, accept that it does not provide a long-term solution.

The medium-term solution would be to look at business rates retention, which is coming down the line for 2020. A lot more money will be coming into the system, with £12.5 billion to local authorities. What bang for their buck the Government want for that, we do not quite know. The reality is that more money will be coming in, but the point has been made that the current distribution of local authority funding is not fit for purpose. There is no correlation between the need in local authorities and the amount of funding that goes in. It is based on an old formula—regression—and we need it to be based on cost drivers, which are around such things as age and deprivation.

We often fight the battle here between rural authorities and metropolitan authorities, but the battle we should be fighting is about the fact that the lion’s share of funding goes to London authorities. If we add up all the different elements, including the revenue support grant, business rates and council tax, total spending power in London is on average 40% higher than any other authority. Often those London authorities have lower need, younger populations and wealthier populations. There is no correlation, and I think we all want to see a fair system. I have nothing against London—it is a fantastic place—but I want a fair deal for North Yorkshire.

The other issue with business rates retention is the quantum. Will it grow to meet the need as need grows? The need is growing exponentially, and we need a longer-term solution. We have hugely increasing demand, and there needs to be correlation between need and the money coming in. In business, we always used to say when we came to such problems, “Ideas are ten a penny. We need a proven solution that is sustainable and scalable.” On our Select Committee visit to Germany, we saw that sustainable, scalable solution, which was delivered with cross-party agreement. I absolutely agree with the calls for us to tackle the issue on a cross-party basis.

I think there is a consensus in Westminster Hall, informed by multiple Select Committee reports that have highlighted the crisis in our health and social care system. My clinical commissioning group is facing a £40 million deficit. My local hospital, which is one of the best run in the country, is facing a £20 million deficit. It is obvious that that simply is not sustainable.

As other colleagues have pointed out, accident and emergency figures are deteriorating, waiting times are lengthening and there are increasing difficulties in seeing a GP. In Devon, we face controversial plans to close community hospital beds and to close a number of community hospitals completely. That is not an accident; it is the result of seven years of the most stringent restraint on NHS investment in its history, combined with 40% cuts to social care when we have a growing elderly population and increasing demand. The issue was exacerbated by the disastrous Lansley reforms in the Health and Social Care Act 2012—the biggest structural upheaval in the NHS’s history— implemented at the same time as maximum spending restraint.

As well as that organisational upheaval, we face a workforce crisis in health and social care, as the Chair of the Select Committee, the hon. Member for Totnes (Dr Wollaston), pointed out. That has been exacerbated by the uncertainty over Brexit. Until recently, the Government have appeared pretty oblivious to all that. The £2 billion extra in the Budget was welcome, but it is a drop in the ocean compared with the amount of money that is needed.

I welcome the commitment in the Green Paper to look root and branch at a sustainable funding solution for health and social care. I worry, however, that a Green Paper is often a euphemism for kicking an issue into the green grass. I would like to see a policy announcement or a White Paper. As colleagues have pointed out, we have had much cross-party support. One proposal was scuppered in the run-up to the last general election. I worry that to grapple with the issue in the second half of a Parliament is not sensible timing. Governments need to get a grip on the issue at the beginning of a Parliament so that there is maximum time for cross-party working to get something in place. I am not optimistic that the Green Paper will come to a conclusion.

We also need to have an honest conversation with the British public about how we fund health and social care. I share Members’ regret that the Chancellor seems to have ruled out any sort of posthumous levy on people’s estates. We need to look at all options, including the excellent sugar tax that was recommended by our Select Committee. It is already having a dramatic effect in getting drinks manufacturers to reduce the sugar in their products and therefore improve public health.

Finally, we would like the Government to end the uncertainty over EU nationals working here in our health and social care system. They could do that today when the Prime Minister stands up in the House and gives her statement on article 50. That would give a huge boost to morale and end the uncertainty. People are already leaving, and the system is not able to recruit. That workforce crisis will do more damage in the short term than anything else.

It is a pleasure to serve under your chairmanship, Mr Bailey. I congratulate the hon. Member for Hackney South and Shoreditch (Meg Hillier) on securing this important debate. It will not surprise colleagues to hear that I am unashamedly here to speak up for Devon, and North Devon in particular. We are part of the south-west, and it is significant, looking around the Chamber, to see so many Members from the south-west from all sides. It is because we are concerned that rural areas in the south-west are not getting our fair share in the distribution of available funds.

I join my hon. Friend the Member for Totnes (Dr Wollaston) in unequivocally welcoming the extra money that the Government have put into health and social care. The £10 billion extra for the NHS over this Parliament and the £2 billion for social care announced in the Budget are extremely welcome, as are the extra revenue-raising powers that have been given to local authorities for social care, and I thank the Minister and his team for those.

However, we need our fair share in areas such as Devon and the south-west. As has been mentioned by the right hon. Member for Exeter (Mr Bradshaw), we face a sustainability and transformation plan that is causing huge concern among my residents in North Devon and among those of other colleagues here from Devon constituencies. There are particular concerns about the future of some acute services at North Devon district hospital. I have said before and I will say again that any cuts to services at that hospital would be absolutely unacceptable. That is because of what I describe as the three Ds: distances, demographics and deprivation. I will not rehearse the arguments here; the Minister knows them well. He has been kind enough to hear me out on many occasions, as have the Secretary of State and many others. Those three factors in Devon and in North Devon in particular mean that we have to look at a fairer way of funding our health service so that we get the services we need. I repeat that any cuts to services at North Devon District Hospital would be absolutely unacceptable.

The holy grail of social care is the integration of the health and social care systems, which many colleagues have mentioned. I want to pay tribute to the Northern Devon Healthcare NHS Trust, which does better than most in working with its social care partners to ensure that packages of care are in place when people are able to move out of hospital. I welcome the hard work of all the people who work in the North Devon services to achieve that.

I will not. The Chair was clear about the time limits; I apologise to my hon. Friend.

I will end by saying we must remember the three Ds. Let us work together across parties to find a long-term solution for the fairer funding of health and social care.

The consensus in this room on the scale of the challenge that we face strikes me as remarkable. The £1 billion for social care this coming year is welcome, but against the £2 billion gap identified by the Health Foundation, the real risk is that this will result in more older people ending up unnecessarily in hospital because care fails at home, which puts more pressure on the NHS. In the following financial year, 2018-19, real-terms spending per head on the NHS will start to fall. That is a remarkable statistic. At a time when demand is rising rapidly, that makes no sense to anyone, wherever they are on the political spectrum. I want to touch on the human consequences of that.

Across the country families with children who have significant mental health problems routinely wait months for treatment. They suffer enormous anxiety. A man in my constituency was told he had a two-year wait for the adult ADHD clinic. Routinely across the country we are breaching the referral to treatment standard on cancer care. There is now an awful insidious trend whereby anyone who has money—we cannot blame people for this—is minded to opt out and fast-track treatment privately. Families faced with long delays do what they can for their loved ones, but do any of us really want to live in a country where timely access to treatment and potentially survival depend on whether we can pay? That is where we are heading.

No party has come up with a full solution to the crisis facing our NHS and care system. We have to be honest about that. Collectively, we are letting down the people of this country. It is remarkable how many speakers today have called for the Government to embrace a cross-party process. A load of MPs—senior MPs, Select Committee Chairs and former Ministers—have come together to call on the Prime Minister to establish an NHS and care convention to engage with the public in the mature discussion that we know we need to have but keep putting off. So I call on the Minister to support us within government, be audacious and recognise that this is a once-in-a-lifetime challenge. The Government will get credit for working with others to achieve the solution that this country badly needs.

It is a pleasure to serve under your chairmanship, Mr Bailey. I congratulate my friend from the Public Accounts Committee, the hon. Member for Hackney South and Shoreditch (Meg Hillier), on securing this debate, which is welcome. To start on a positive note, we are having this debate because the NHS has been a great success. Life expectancy in England is now approaching 81, which would have been unimaginable when the service first started. Treatments in today’s hospitals would have been seen only in “Star Trek” in the late 1980s. So, to be positive, the story is about how we deal with a challenge created by the greatest success.

I remember my time in local government. Other former councillors in the room may have seen the same graph showing that emptying bins and disposing of rubbish and social care would be the only thing left that councils would be able to afford to provide owing to the predicted rise in the cost of social care as demand increased. We have heard a lot today about the possibility of integrating services. I can certainly reflect on the challenges that my hon. Friend the Member for Northampton South (David Mackintosh) faced in terms of different budgets and different organisations.

In Torbay we have an integrated care organisation that is fairly successful in removing barriers. It has certainly helped contribute to one of the lowest levels, if not the lowest level, of delayed discharges over winter, yet now we are having to discuss how the risk-share agreement is structured, because the NHS organisations still need to comply with budgetary rules for them as individual organisations. It is not about the amount of money in the system overall; it is not about the spending of taxpayer pounds; it is about how that is divvied up in terms of a risk-share agreement. That is the exact opposite of what we want to see when we look at integrated care.

The issue is also the pace of some of the changes. Paignton Hospital will stop taking inpatients on 3 April after a consultation that many of us felt was a bit of a done deal and a waste of time. I was shut out of the first meeting because a small venue had been booked for a large meeting. There was a feeling that the measure was going to happen anyway. On top of that, we have 32 beds being closed at Torbay hospital in the same period. For me the issue is how the pace of change is being forced.

There is a long-term debate. We have touched on pensions and—let us be blunt—there was an element of cross-party agreement when the pension age for my generation was increased to 68. It can be tempting to talk about the amnesia of opposition. We need to discuss long-term solutions. The Budget was welcome, but it has to be seen as a short-term measure. We need a long-term schedule that will last for more than one Parliament and more than one Government.

I congratulate my hon. Friend the Member for Hackney South and Shoreditch (Meg Hillier) on securing today’s debate. There must be honesty in the room. The trajectory of the funding crisis started with the Health and Social Care Act 2012, which introduced a funding formula that has failed. It also put the wrong financial drivers into the system, which has pushed us into this crisis.

I need only look to my own clinical commissioning group, which is seeking £1,150 per patient in an area of ageing demographics and increasing social deprivation. From the primary care group to the primary care trust right through to the CCG, my area has been seriously underfunded, and it is now having to pay heavily when a CCG down the road is getting over 50% more per head. That does not suggest equality across our NHS. Our CCG is now being pushed into special measures and is having to make a £50 million saving because of a governmental failure instead of trying to meet the real needs of our community. Of course, we see that reflected across the country. In addition, the STP includes a £420 million cut, and that will really affect patient outcomes.

Of course we need to agree a way forward on funding for health and social care, but public health also has to be included, because we are seeing public health funding severely cut. Public health measures and prevention are the drivers of better healthcare in future. We have seen the end of the smoking cessation programme, NHS health checks, and the ability to drive better health for future generations. The local authority will see a further £250,000 cut in that budget over the next three years and a £400,000 cut to sexual health services.

Rationing is coming into the service. Just two weeks ago, the Minister and I debated the rationing of surgery. Putting the wrong, perverse financial drivers in yet again is going to escalate costs in the medium term. We need to examine the way CCGs and trusts are handling the current financial crisis to make sure that we are not just kicking the can down the road and therefore escalating costs as we move forward.

Ensuring that we have early diagnosis in the system is also important. We have heard about waiting times for diagnoses of mental health conditions and emotional and psychological difficulties. In York, I heard from a parent who had spent four to seven years waiting for a diagnosis; support did not come forward until the diagnosis had been made. We should really be looking at functional care and supporting the family as a whole—we know that not supporting the family brings an additional cost. In any review, we need to make sure that we focus on prevention and early intervention, and its financial impact, and put the right financial drivers in the system now.

I congratulate the hon. Member for Hackney South and Shoreditch (Meg Hillier), the Chair of the Public Accounts Committee, on securing this debate. First, I would point out that a strong NHS requires a strong economy, and on that front the Budget brought good news.

In the short term, we need to think about how to deal with some of the problems we now face. To that extent, I very much welcome the £2 billion for social care, the £300 million to underpin sustainability and transformation plans and the £100 million for A&E. I also welcome the rumours of more medical school places, which, as my hon. Friend the Member for Totnes (Dr Wollaston), the Chairman of the Health Committee, said, are very important indeed.

We need to look at intergenerational fairness. Sadly, most healthcare cost is generated in our declining years. It is reasonable, after 2020, to look at instruments such as the triple lock to see whether those substantial sums of money should be handed to our national health service. Most elderly people I know would welcome such a thing.

We need to look fundamentally at what to do with healthcare funding going forward. It is very good to hear of the injection of money in the Budget, but it will not do in the long term, for reasons that have been explained. A Green Paper will not do either. Although that is welcome for social care, health care is much more complex.

A conversation with the public means looking fundamentally at what underpins our health service and trying to work out why outcomes in this country fall significantly short of those in countries such as Germany, which has been mentioned, France and Holland. That means examining Beveridge versus Bismarck, something in between or something completely different, which requires a commission or a convention—perhaps an Adair Turner-type commission. It needs to have that conversation with the public. On the NHS’s 70th birthday, that is appropriate, because we need to carry the public with us if what we are ultimately suggesting is quite substantial sums of money injected into healthcare to bring our healthcare outcomes to where they should be.

As an optimistic sort of person, I rather suspect that the reason why a Green Paper has not been suggested for healthcare—notwithstanding the “Five Year Forward View”, which is only halfway through its evolution—is that the Government are considering such a conversation as a proposition. I very much hope that the support I think the Prime Minister gave to the concept when a number of our colleagues met a short while ago is translated into concrete proposals in the near future, so that—on a cross-party basis—we can have the convention, commission or conversation that we need with the public to establish, in the NHS’s 70th year, a long-term funding arrangement for this national institution that we all hold so dear.

I congratulate the hon. Member for Hackney South and Shoreditch (Meg Hillier) on securing this debate and thank you, Mr Bailey, for making sure that we all get a chance to participate. As my party’s health spokesperson, this is an issue that I long considered in the run-up to the Budget, hoping and praying that there would be funding for drugs such as Orkambi for cystic fibrosis sufferers, money available for the training of additional GPs and more cancer drug funding. The list is exhaustive—we all have a long list of things—but I want to mention three issues in the short time that I have.

Together for Short Lives provided me with a briefing full of information for this debate. It is clear that local authority funding for children’s palliative care charities does not reflect the level of social care provided by such organisations. In the spring Budget, the Government announced a further £2 billion for adult social care funding over the next three years.

Given the vital role that these charities play in delivering children’s social care, including short breaks, what guidance will the Government give local authorities to make sure that they provide financial support to those organisations? Will the Government use the forthcoming Green Paper on social care funding to consider evidence and proposals for increasing funding for children’s social care? The care costs for children’s palliative care rose by 10% in the last year, due to an increase in the number of children with life-limiting and life-threatening conditions and the increasing complexity of their needs and the care that they require.

As a member of the all-party parliamentary group on blood cancer, I am aware of the inquiry into blood cancer care that is being launched on Wednesday. Blood cancer, as the Minister knows, is the fifth most common cancer in the UK and the third biggest cancer killer, yet awareness among the general public and policy audiences is very low. I trust that the Minister will look at that report. It is important that we consider reports, because we want the willingness to act on them. I respectfully ask the Minister to consider that.

My third point is about multiple sclerosis. Some 100,000 people in the UK have MS—4,500 of those in Northern Ireland. Great research has been done by Queen’s University Belfast to revolutionise life for people with MS. They are trying to find a way forward, looking at how the damaged brain repairs itself. The research is good stuff. I remind Members of the importance of ensuring that funding is available for research into diseases. I believe the Department must step up and make sure that that happens.

I know that there is not an unending supply of funding, but I believe that it is necessary that the money is used in the most productive way. I am subsequently asking that consideration be given to the issues that I and others have raised this morning. My mother often said, “Your health is your wealth,” and that is very much the truth. We must do all we can to protect the real wealth of this nation, and make sure that help is available to those who need it most at the time they need it.

I congratulate my hon. Friend the Member for Hackney South and Shoreditch (Meg Hillier) on securing this important debate.

On 4 March, just over a week ago, a quarter of a million people marched through central London to call on the Government to stop the cuts and the privatisation of the national health service. I pay tribute to each and every one of those people who came to London to make that protest to the Government. When a quarter of a million people assemble directly outside this Parliament, the Government should think about what they are asking for. People value the NHS highly and are prepared to fight for it.

Many of the problems that we are facing in the health service have their roots in the Health and Social Care Act 2012. I hope that in any cross-party discussion, where we say that everything will be on the table, repeal of the 2012 Act will be on the table for consideration. One of the very many changes it introduced was the removal of the requirement to provide a comprehensive health service in England. As a result, we are seeing increasing rationing, and patients are suffering.

My hon. Friend the Member for York Central (Rachael Maskell) made an excellent speech in the Adjournment debate she recently secured on the rationing of surgery. As a former physiotherapist, she is very well-placed to make those points. Earlier this year, three clinical commissioning groups in the west midlands produced proposals to reduce the number of people qualifying for hip replacements by 12% and for knee replacements by 19%. Clearly, that has nothing to do with addressing patient need; it is all about balancing the books on the part of a Government with an austerity agenda that they are wedded to. Thousands of elderly people in our country are losing their sight, due to the rationing of cataract operations. That kind of rationing has a real and painful cost to many people in our society.

We are seeing the emergence of a postcode lottery. People are being told that we cannot afford a comprehensive service any more, but that needs to be challenged. Ministers will cite the ageing population and the costs of technology. Well, technology can reduce the costs of care; treating somebody sooner for a cataract operation— a relatively cheap operation—is a much more efficient way of using money than letting somebody become blind and hence terribly dependent on social care.

The coalition cut £4.6 billion from social care. The £2 billion over three years that the Government are providing is nowhere near enough. We want an injection of £2 billion now to stabilise the social care system. The public will not stand for it, and they will not forgive or forget a Tory Government who take the national health service off them. Ministers might think that they can erode it by trimming a little bit here and a little bit there—[Interruption.] But the public know what is going on. Those who have hospitals that are going to close understand what I am talking about. People will not stand for it: they will march again, and it will not be—[Interruption.]

Order. I ask Back Benchers in sedentary positions to allow the speaker to speak. She did not interrupt their contributions, and I wish they would offer the same courtesy to her.

When 250,000 people are so unhappy about what the Government are doing and we are seeing the closure of A&Es, hospitals and all sorts of services, and the rationing of services that people really need, the Government should listen, as should Conservative Members.

We now come to the Opposition spokespersons’ contributions. I wish the Minister to have a minimum of 10 minutes to respond to the debate, because many points have been made. I can allow the Opposition spokespersons 10 minutes each, but it would be helpful if they kept their speeches a little shorter so that Meg Hillier may respond to the Minister’s comments.

It is a pleasure to take part in this debate, Mr Bailey, once again with you in the Chair. I will keep my remarks brief to allow the required summing up to take place.

I pay tribute to the hon. Member for Hackney South and Shoreditch (Meg Hillier) for securing the debate, and I congratulate her on her speech. She highlighted the issues very well and was right to focus on the shift from capital to resource: £940 million this year, the third year in a row of such a shift in NHS England.

This has been another good debate on the subject. Only three weeks ago, I summed up for the Scottish National party in a social care debate. The right hon. Member for Kingston upon Hull West and Hessle (Alan Johnson) said in that debate—I agreed with him—that social care was the greatest domestic policy challenge facing the UK Government. Some revisions to what was said in that debate are required, however, as a result of the Chancellor’s Budget statement. It was welcome that he chose to spend £2 billion on health and social care in England, but it was a mistake for him to stagger it over three years. That is simply not enough.

We welcome the Barnett consequentials that go to the Scottish Government as a result of the social care enhancement—£99 million in 2017-18, £66 million in 2018-19 and £33 million in 2019-20. I am sure that those funds will be used by the Scottish Government to continue investing in the new health and social care joint boards which have been legislated for and recently established. The joint boards are local authorities and health boards working together to overcome the challenges of bed blocking, delayed discharge, domestic adaptations and care packages.

One of the most frustrating cases that we all deal with as MPs is delay to domestic adaptations, which is frustrating for the family, the recovery time and the flow through the healthcare system. I used to deal with dozens of those as an MP and previously as a parliamentary assistant. Thankfully, they are now becoming fewer and further apart. I am not saying that there are no challenges in Scotland—of course there are—but north of the border we are in a very different place from what we see in England.

Over the past two years, as we have started to integrate health and social care and invested record levels in our NHS in Scotland, Scotland’s core A&Es have been the best performing in the UK. On 5 February this year, in a report comparing UK health services, the BBC stated:

“Out of all the four nations, hospitals in Scotland seem to have fared the best...Much of the credit has been given to the way councils and the health service are working together.”

According to the most recent figures, the four-hour A&E waiting time target is being hit in 92% of cases in Scotland, 79% in England, 76% in Northern Ireland and 65% in Wales. Taken with other initiatives and investments, standard delayed discharge of more than two weeks has dropped by 43% in Scotland.

In the Scottish Government’s 2016-17 draft budget, we have allocated a further £250 million to health and social care partnerships to protect and grow social care services and to deliver our shared priorities, including paying the real living wage to adult care workers. In spite of the cuts to Scotland’s budget, the SNP has increased funding for adult social care. As a result, the average time received for home care is 11.3 hours a week, compared with 5.6 hours a week in 2000. Again, I am by no means saying that things are perfect in Scotland, but we faced up to the social care challenge long before it became the crisis we see south of the border. I hope that the UK Government can look to the Government up the road for inspiration as they face up to their own serious domestic policy challenges in England.

It is a pleasure to serve with you in the Chair, Mr Bailey. I congratulate my hon. Friend the Member for Hackney South and Shoreditch (Meg Hillier) on securing the debate and the excellent way in which she opened it.

Last week, in the spring Budget statement, the Chancellor announced that the Government would provide £2 billion in funding for social care over the next three years. We have heard a variety of comments about that in the debate. It is welcome that Ministers have finally heard the warnings from the Opposition, a wide range of health and care leaders and the three Select Committees represented in the Chamber today about the fragile and underfunded state of social care, but the extra funding has to be seen against the cuts to local council budgets, leading to the loss of about £5 billion from adult social care budgets since 2010. Clearly, the announced funding is not enough.

The cuts have already had an impact on the lives of many people. Older, vulnerable and disabled people have had support that they relied on taken away. Others have been turned away by local authorities and left to rely on friends and family for help. Last week, in this Chamber, we debated social care in Liverpool, when we heard that the cuts there meant that care could be funded for only 9,000 people, not the 14,000 people who had previously received care packages, as my hon. Friend the Member for Liverpool, Riverside (Mrs Ellman) reminded us today. In one city alone, that is 5,000 care packages lost and, nationally, 400,000 fewer older people than in 2010 receive publicly funded care.

We should remember that, as Age UK tells us, 1.2 million older people have to live with unmet needs for care—older people who do not have help they need to feed themselves, wash or get dressed. Apart from coping with future demographic change, we have to look at that unacceptable level of unmet need, because that is part of the serious state of social care and it is having a knock-on effect on the NHS. As Mark Porter from the British Medical Association said:

“When social care is on its knees, patients suffer delayed transfers, and the personal and financial cost is vast.”

In January we saw a record high in the number of delayed discharges from the NHS. The King’s Fund recently described social care as

“little more than a threadbare safety net for the poorest and most needy older and disabled people”—

it is a threadbare safety net that many people are now falling through, with the NHS left to pick up the pieces.

Given the damage done over the past seven years and the crisis that the Government have caused in social care, the £1 billion announced in the Budget for this year is simply not enough. As we have heard in the debate, the King’s Fund, the Nuffield Trust and the Health Foundation warned the Government about a £1.9 billion funding gap in social care, which means that the Government are funding only half of what is needed now. As for comments outside this place, the Care and Support Alliance has said that the extra funding

“keeps the wolf from the door”,

but no more, while the Academy of Medical Royal Colleges said that

“we’ve now got to get real and recognise that short term measures of the kind we’ve seen today won’t help in the longer term.”

Is it not time to examine the true gap in social funding? Will the Minister acknowledge that £2 billion in funding is needed now, rather than spread over the next three years?

We also heard about the intention to produce a Green Paper on the long-term funding options for social care. The Chancellor said that those options do not include what he described as “Labour’s hated death tax”. As my hon. Friend the Member for Sheffield South East (Mr Betts), the Chair of the Communities and Local Government Committee, said, the Government should not reject options proposed in the past by other parties, and the Chancellor should not label one such option as a “death tax”, because to describe it in that pejorative way is not helpful in securing cross-party support for a sustainable solution to funding social care. That was done back in 2010 for political reasons, and it is being done now for political reasons. Inheritance tax is not called a “death tax”, although it is a tax levied after death. It has been known in the past as probate duty, estate duty and capital transfer tax. The Labour party has not played such political games with the Government’s highly unpopular increase in probate fees, which will affect people in the coming months.

I also challenge what Ministers have said about previous work on a sustainable and long-term funding option for social care. We need to deal with the issue now. In the Budget debate, the Financial Secretary to the Treasury denied that the Government might kick it into the long grass, instead talking about previous reviews. Let us be clear about that, however. In 2010, the Labour Government produced a White Paper called “Building the National Care Service”, a copy of which I have with me. Before that, in 2009, we had a Green Paper and the “Big Care Debate”, involving 68,000 people. Members are right that we need that big conversation with the public, but we have already had it once—we held it in 2009. We had firm plans to build a national care service. In seven years, this Government abandoned those proposals, established the Dilnot commission on the future funding of adult social care, adapted Dilnot’s proposals for their 2015 manifesto and then abandoned them. I call those seven wasted years. We appear to be back where we were in 2009.

As we have heard, it is clear that the demographic pressures in social care have a real impact on the NHS. In a typical hospital at any one time, two thirds of in-patients are over 65 and more than a quarter have a diagnosis of dementia. On top of rising demand, the Government have simultaneously sought to pass on what I see as unachievable savings. As we have heard, hospitals already have record deficits. NHS providers ended last year with a £2.5 billion deficit, although the Nuffield Trust suggests that the real underlying deficit was closer to £3.7 billion. The Public Accounts Committee identified that the NHS is resorting to

“repeated raids on investment funds in order to meet day-to-day spending”.

We have heard those issues covered in this debate.

The decision to provide just £100 million in the Budget for capital investment looks odd, given that the NHS had to resort to raiding £1.2 billion from capital funding this year just for day-to-day running costs and faces a £5 billion repairs backlog. It has become increasingly clear that a £22 billion savings target for the NHS is simply not realistic. The Public Accounts Committee said:

“we remain concerned about whether plans are really achievable”.

Not one independent expert I have seen believes that such savings can be achieved with services maintained at current levels, and I am worried that efficiency savings on that scale will increasingly affect the quality of care that patients receive. We know that the number of trolley waits rose by 58% last year and the four-hour target has not been met since July 2015, and we have now heard about the rationing of hip replacements.

Importantly, the King’s Fund told us this week that the financial pressures on mental health services have been

“a major factor driving large-scale changes to services, which may have had a detrimental impact on patient care”.

Its report states that patients who are able to access treatment get fewer contacts with adult secondary mental health services. That suggests that there is rationing of support in England. It is also clear that the shortage of specialist mental health beds is resulting in a significant increase in the number of patients being sent for treatment away from their home area. In the four months to January this year alone, more than 2,000 vulnerable people in England with serious conditions such as schizophrenia, psychosis and anorexia were sent for out-of-area treatment. Almost half those placements were more than 60 miles from the patient’s home, and one in five of those patients were admitted to a psychiatric intensive care unit.

The Public Accounts Committee said that

“the financial performance of NHS bodies has worsened considerably and this trend is not sustainable.”

In social care, mental health and the NHS, it is evident that the most vulnerable people in our society are bearing the brunt of financial pressures. We have heard a strong consensus in this debate that that has to change.

I congratulate you on chairing this substantial debate so efficiently, Mr Bailey. Some 31 colleagues were present—that is a very high turnout for Westminster Hall—of whom 18 spoke, including three distinguished Select Committee Chairs and two Opposition spokesmen. Certainly I have not attended such a significant debate in Westminster Hall, and it reflects our common interest in ensuring that the NHS and social care services in this country provide as high-quality a service to the public as possible.

Virtually all speakers welcomed the developments in last week’s Budget, and I welcome that broad consensus across the Chamber. Only one discordant note was struck—reference was made to a march in the streets of London led by the shadow Chancellor, the right hon. Member for Hayes and Harlington (John McDonnell). That march obviously demonstrated a degree of concern, but it happened before the Budget, which, as I shall touch on, responded to many of the concerns that have been raised.

We all recognise that the NHS faces a significant challenge, given the increasing demand for health services as a consequence of our ageing and growing population, new drugs and treatments, and safer staffing requirements, and that in turn is increasing the pressure on social care services. We know that finances are challenging for both areas, which is why we have ensured that spending on the NHS has increased as a proportion of total Government spending each year since 2010.

We backed the “Five Year Forward View” as part of the spending review in late 2015. That ensured that real-terms NHS funding will increase by £10 billion by 2020-21 compared with the year before the spending review. Some hon. Members said that they wanted to see a plan. We have supported the NHS’s own plan—the “Five Year Forward View”—and announced that we will publish a Green Paper this summer looking at how social care is funded in the long term, which hon. Members have welcomed, so it is churlish to deny that this Government are providing long-term strategic thinking about the way we fund both those services. I remind colleagues that the NHS budget was £98 billion in 2014-15 and will be £119.9 billion in 2020-21. That is a £21.8 billion increase in cash terms, which seems to get lost from time to time in these discussions.

We are almost at the end of the financial year. The NHS received a cash increase of more than £5 billion in 2016-17. That was front-loaded, as NHS chief executive Simon Stevens requested. For the year that starts on 1 April, there will be another significant increase in funding once the mandate is settled. The hon. Member for Bristol South (Karin Smyth), who is a member of the Public Accounts Committee, asked when we will see that document. It has to be published by the end of this month, and I assure her that it will be.

The measures announced last week, which many hon. Members referred to, have three features. I will not go into them in detail, because they have all been covered. Much of the focus has been on the additional £2 billion that we will provide for social care over the next three years, half of which will start to come in next month, when the new financial year begins.

Some hon. Members are aware of the numbers for their areas and some are not, and one colleague came up with a slightly incorrect figure. I will not go through every area, but I applaud the presence of Devon MPs in particular, given the manner in which they have massed themselves with colleagues from across the House. Devon will get a £30.3 million increase in its social care budget over the next three years and will receive half of that in the year that is about to start. My hon. Friend the Member for Thirsk and Malton (Kevin Hollinrake) referred to an £18 million increase for North Yorkshire. I can give him a bit of good news: it will actually be £19.6 million over the next three years. I am grateful to the Chair of the Public Accounts Committee, the hon. Member for Hackney South and Shoreditch (Meg Hillier), for her support for the Budget measures. Hackney will receive £12.8 million, as she acknowledged. Like many colleagues, she sought a long-term funding settlement.

I am afraid I cannot take interventions, as we have very little time.

The spending review provided a settlement for the NHS. The Chancellor indicated that there will be a social care Green Paper this summer. Several colleagues called for a cross-party consensus. The Green Paper will provide an opportunity for debate and consultation, and such discussions should focus on that.

The second Budget measure was a £100 million increase in funding for A&E services, so that people who present at A&E who do not need intense or urgent care can be diverted to GPs or clinics run by nurse practitioners. That best practice has been proven to work in A&Es that have such a streaming service, so we are looking to provide facilities for basic capital spend to ensure that every A&E hospital across the country has streaming in place by next winter. I am pleased that that has been welcomed by hon. Members from across the House.

The third measure—this was touched on in the debate, albeit not in such detail—is the £325 million capital investment in the first set of sustainability and transformation plans. Those who make the strongest case for investment and can deliver better, more joined-up services, which can bring real improvements to patient care, will benefit from the funding. We look to that to be an exemplar for other areas whose plans are less well developed, to encourage them to develop a better, more integrated approach to patient care for the future, including closer working with local authorities for the provision of social care. That should encourage areas to bring forward more comprehensive plans for the next wave of STPs, which will be supported. As hon. Members have said, we look forward to explaining more about that at the time of the next Budget.

Something that has been missing from the debate is the 6.5 million carers in the UK— 17,000 of them are in Portsmouth—who save costs of £132 billion a year. Will the Minister recognise that in the Green Paper and, in particular, respite care for them?

In the sustainability and transformation plans there is the opportunity for commissioners of care and health services to look holistically at the demands of the residents in their area, which to a degree includes palliative care and respite care. As we move towards an STP, there is a greater opportunity for those things to be considered as well.

I agree with the hon. Member for Portsmouth South (Mrs Drummond). There is a real dearth now and respite care for carers has got lost. With £120 million, 40,000 carers could be helped with a respite care break. The Minister should look at that.

As I just said, the STPs provide an opportunity for areas to place greater focus on respite care if they consider that to be required.

I would like to touch on the adequacy of the social care funding package. The announcement means that in the next three years councils will have access to some £9.25 billion of more dedicated funding. That includes extra money going to local authorities through the combination of the improved better care fund and the social care precept, which, for those councils introducing it with effect from next month, will raise some £1 billion extra. The £1 billion provided in the Budget and the £1 billion from the precept amount to the £2 billion called for by external sources for the coming year. That funding will allow councils to expand the numbers of people they are able to support and, in turn, address issues at the interface with the NHS such as delayed discharges from hospital, which as we know cause problems with patient flow through the system.

Questions were raised about how the social care funding is to be allocated. I inform colleagues that 90% will be allocated using the improved better care fund formula to local authorities that have responsibility for adult social care. That distribution takes account of the ability to raise money through the council tax precept for social care and means that it is well targeted at areas of greater need and market fragility. However, in recognition of the social care pressures faced by all councils, 10% of the funding will be allocated using the relative needs formula.

The response to the measures from external audiences reflects comments made by hon. Members today: they have been broadly welcomed. Of course, several hon. Members said that it is not enough, but that is a traditional response to any increase in money—it is always easier to say that it is not enough. Hon. Members have generally recognised that the Government have listened to concerns about social funding. Those of us with responsibility for the health service recognise that there has been a particular problem in dealing with delayed discharges from hospital. Through closer working in the sustainability and transformation plans as they are rolled out across the country, with local authorities working more closely with health service providers, we think that the money will provide a lifeline to help to remove some of those pressures and to improve patient flow through our hospitals.

I would like to touch on the medium-term challenge and how in the coming months we can try to use the development of a social care Green Paper to address the longer-term concerns. The Government are committed to establishing a fair and more sustainable basis for funding adult social care in the light of the future demographic challenges that the country faces. We will therefore bring forward proposals to put the state-funded system on a more secure and sustainable long-term footing, setting out plans in a Green Paper. Some hon. Members asked when the Green Paper will be published. If I was in charge of Government timetabling, I would be in a better position to answer. They will not be surprised to hear that I cannot give a definitive answer, but, to use traditional parliamentary language, it would be fair to say that it is expected to be published in the summer.

Will the Minister clarify the Government’s position on the idea of a posthumous levy on estates? The Chancellor ruled that out, yet we read in the newspapers that the Prime Minister slapped him down over that. Are the Government ruling it out or not?

I will not pre-empt anything in the Green Paper, and it is not for me to give the right hon. Gentleman any comfort on discussions that might or might not have happened around the Budget.

We recognise that the NHS and social care face huge pressures and that there is more for us as a Government to do. However, we can be confident that we have plans in place both to cope with the pressures that we currently face—winter, A&E pressures and delayed discharges—and to sustain the system for the future. We have a long-term plan in place through the “Five Year Forward View” and the efficiency work being undertaken and rolled out progressively this year. We have given extra funding to both the NHS and social care to support those plans, and we have plans to bring forward a Green Paper on social care. I am pleased that that was broadly welcomed and recognised by hon. Members and distinguished parliamentarians in the debate, and I am grateful for that support.

I thank all hon. Members for their contributions to this thoughtful and reasoned debate. I do however need to challenge the Minister on his suggestion that there was strong support for the Budget measures. Let us not overplay it: there were “buts” in the speeches of nearly all hon. Members. Therefore, while those measures are a help, I think everyone agreed that they are not sufficient, because that is not long-term funding.

Let us be clear. We have had short-term funding though the better care fund, a recent announcement on money for GPs at A&E, the cash injection of £2 billion for social care front-loaded for the next financial year, and a precept increase of 2%. None of that is long-term sustainable funding. Let us also nail the issue of the £10 billion with which the NHS plan has been resourced. That has now been stretched by the Government over a six-year period, not five years—both my Committee and the Health Committee have highlighted that—while they continue to seek a 4% efficiency saving. It is not just the Select Committees saying that; the Comptroller and Auditor General said of the NHS accounts that there is not yet

“a coherent plan to close the gap between resources and patients’ needs.”

Ministers really need to get a grip on that.

Will the Minister write to the Select Committee Chairs, outlining in more detail not just the timescale for the Green Paper’s publication but the proposed plans for discussions around that and when it will be taken further forward? Will he also write to us about the Care Act, phase 2, which has come up in the debate, albeit not mentioned directly? The permanent secretary at the Department of Health could not give an answer to our Committee. He talked about it being postponed, possibly to 2020. It would be helpful if the Minister would write to say what is happening with that element of the Care Act.

There is a strong view that there is a need for a long-term solution, and the Budget measures are not yet that. Health and social care are interconnected, and hospitals are not a great place for older people to be in. We need to ensure that we have a long-term sustainable solution to keep people out of hospital, keep them well as long as possible and keep them independent. That requires long-term thinking, not the sticking-plaster measures that we keep seeing unveiled by all Governments at the time of elections, especially in the light of cuts.

Motion lapsed (Standing Order No.10(6)).

Food Labelling

I beg to move,

That this House has considered the future of food labelling.

I draw hon. Members’ attention to my declaration in the Register of Members’ Financial Interests.

Accurate food labelling is vital to UK food producers and consumers. It is important in ensuring that there is a fair, functioning market in the sector. It enables products to compete on a fair basis—especially given that imports are often made to lower quality, with poorer animal welfare standards. It allows consumers to make informed choices about how they want to buy, without being misled. As the 2013 horsemeat scandal demonstrated, our labelling regime has an impact on consumers and businesses in every community in the country. Of course it also has a particular impact on farming and food manufacturing businesses and the wider rural economy.

The Minister’s Department calculates that the value of food and farming to the economy is about £108 billion, and the sector employs one in eight members of the total workforce. The strength of British agriculture is essential to maintaining food security and to the conservation, through its vital role in land management, of the countryside and landscapes. A strong farming sector also sustains rural communities, especially in more remote areas where there may be fewer alternative sources of employment. I know that the Government are committed to supporting the agriculture sector, and that support is all the more important as we face the challenges and opportunities of leaving the European Union.

I thank my hon. Friend for obtaining this excellent debate. It is great that we have high standards of animal welfare, but they cost the industry money; does he agree that, as we get new trade deals and leave the European Union, we must be certain to label products securely so that we can stop imports coming in if they do not meet our standards? We should properly label our products; otherwise our farming community and food industry will be seriously disadvantaged.

I entirely agree, and that is exactly why I wanted to have the debate now. I do not know whether my hon. Friend has seen a copy of my speech; but he is right. There will be opportunities and challenges for the food and farming sector in leaving the European Union. Developing a comprehensive and accurate food labelling regime is an indispensable element of that.

I applaud my hon. Friend for obtaining the debate, at just the right moment. Often when we shop online we do not know whether the food is British. Could consideration be given to a button to press when doing an online shop to enable people to choose from just British produce? Surely that would really help us as we leave the EU.

As always, my hon. Friend brings a new dimension to the debate. If I am honest, that is something I had not thought about, but I applaud the idea, which is excellent. I hope that the Minister will take the point on board.

As hon. Members will be aware, the relevant law has mainly been decided by the European Union, so our withdrawal gives us the opportunity to tailor the rules to the needs of the United Kingdom. I firmly believe that withdrawal must not mean going back on the progress made during our EU membership.

I too refer hon. Members to my entry in the Register of Members’ Financial Interests. I do not disagree with anything that the hon. Gentleman has put forward, but how are we to motivate consumers, who are driven by price and not always by concerns about the country of origin?

I have some sympathy with what the hon. Gentleman says, but I will remind him about a supermarket founded in Yorkshire that has put a levy on its milk and gives that money back to the farmer. The consumers pay slightly more for their milk but know that the extra goes directly back to farmers. I will not name the supermarket, but that item has been its fastest growing product. That shows that when consumers have knowledge, because of proper labelling, they are prepared to buy British.

I commend my hon. Friend on bringing the debate today. I am sure that he will be aware, as I am from the experiences of Suffolk farmers, that far too often some current EU regulations—I say this having voted remain—prohibit the proper marketing of local produce. They make it much more difficult for consumers to know that they are buying genuinely British beef from farms in Great Britain. At the moment, some of the beef they buy could be from overseas.

I entirely agree. My hon. Friend is right that it is crucial to have accurate labelling. That should not only mean country of origin labelling; it should go right down to local and regional labelling.

My hon. Friend is making a typically powerful and timely speech on an important subject. On the same point, does he share my frustration when some supermarkets try to take advantage of consumers’ good will and support for local manufacturers by making up fictitious brands such as “Nightingale Farms”? We consumers make purchases, thinking we are supporting the UK industry, only to discover that it is a fictitious brand.

That is another excellent point in what is indeed an important debate. I entirely agree: this is about making sure that labelling is accurate and fair to the producer and the consumer—so that the latter can make a properly informed choice. As my hon. Friend pointed out, that is not always the case.

I firmly believe that withdrawal from the EU must not mean going back on the progress that we have made.

On the point about mislabelling, there is a big chain in this city and others that sells Angus beef, which I suspect is not Aberdeen Angus, from either Scotland or the rest of the United Kingdom, but mostly south American. I suspect that because it is labelled Angus beef, a lot of people eating it think that it is home-grown Angus beef.

My hon. Friend makes a good point. I know exactly the places that he is talking about; I cannot say I have frequented them, but I know where they are and they stand out very well in the capital. What he says is right, and it goes back to the point made earlier. It is a question of consumer choice, but consumers want accurate information—whether online or in restaurants—so that they can make an informed choice about the products they buy.

The three main types of origin label are country of origin, method of production and method of slaughter. In this short debate—I am already running out of time—I intend to concentrate mainly on country of origin labelling, because I feel it is both the category for which accurate labelling is most important and because a British product is already guaranteed to be made to some of the highest standards of quality and animal welfare in the world. While accurate labelling is obviously important for producers, we also know that it matters deeply to consumers. It is therefore only right that labelling is clear and accurate.

Department for Environment, Food and Rural Affairs figures from 2016 show that just under 40% of shoppers check food labels for national origin, while separate research suggests that figure rises to 47% for meat products—double the percentage who look at nutritional information. Under EU rules, country of origin labelling is currently mandatory for unprocessed pork, sheep, beef, goat’s meat, shellfish, poultry, most fruit and vegetables, wine, honey and olive oil. That is a fairly recent development for sheep, pigs, goats and poultry, applying only since April 2015.

The bottom line is that the substance of these regulations must be preserved as the bare minimum when we cease to be an EU member state; promoting “brand Britain” through our exports will become all the more important as we move towards the exit door. I also believe that the Government must act to remedy existing problems with these regulations once they have the power to do so independently. As the Environment, Food and Rural Affairs Committee was told last year during its “Farmgate prices” inquiry, EU rules allow for the national origin of meat to be given as the country where the last significant change in production took place and not where the animal spent all of its life. For me, that does not amount to a fair, common-sense definition of national origin.

Published in May last year, the Government’s response to the Committee’s report said that they were

“continuing to press at EU level for mandatory country of origin labelling for staple food products.”

The wide scope of action that that suggests is very welcome.

I thank the hon. Gentleman for initiating this useful and informative debate, and I welcome the case he is making. Should infant formulas be added to the products that he suggests should have country of origin labelling? The ten-minute rule Bill that I presented on marketing of formula said that country of origin labelling might be useful in helping consumers to make an informed choice if it were put on the tins and made clear exactly where the formula came from.

I entirely support that; it is another sensible suggestion of where we should consider country of origin labelling. Parents would look at that in great detail and want to make an informed choice for their children. It goes back to the point that consumers need information so that they can make a detailed, informed choice. On the point I was making, I hope that the efforts Ministers were planning to expend on the EU in that regard will now be channelled into examining the opportunities for the UK on this issue on a similar broad basis. I am sure that the Minister will look at this in detail.

I will focus the rest of my remarks on the difference between fresh meat, which, as I have said, is subject to mandatory country of origin labelling, and the wider range of processed meat products, which are not. That is the most striking example of the regulation needing urgent improvement. It should not always fall to a Yorkshireman to plead for plain-speaking and straightforwardness in this place; I know that the Minister will probably argue that the south-west does an equally good job of speaking straightforwardly—calling a spade a spade. However, the current divergence between country of origin rules for meat and processed meat products is a significant source of unfairness and confusion within the UK meat market.

The lack of mandatory labelling for processed meat products and our own Food Standards Agency guidelines mean that those products can legally be labelled as British or “made in Britain” if they are only processed in this country, even if they are made from non-British meat. It is important to bear it in mind that products not currently covered by mandatory country of origin labelling make up a huge share of total meat consumption, including pies, ready meals, ham, bacon and sausages. Crucially, those products are displayed side by side on supermarket shelves with fresh meat that is subject to mandatory country of origin labelling requirements. A national origin label on two very similar products sitting next to each other can in fact mean very different things, potentially misleading the consumer and disadvantaging both them and British agriculture.

There is a significant number of welcome voluntary schemes that encourage country of origin labelling of processed meat products, such as the Red Tractor label and the voluntary standards agreement agreed by the industry and DEFRA in November 2010, but the fact that they are voluntary obviously limits their effectiveness. The number of different labelling schemes, each with their own standards and applying to some producers but not others, risks confusing consumers and prevents a level playing field on which products can be judged according to one ultimate standard.

Current food standards guidelines suggest that the country of origin of principal meat ingredients should be declared, and that any information provided cannot be misleading. Sadly, that is not sufficient to prevent unclear or inaccurate labelling of processed meat products. For instance, a packet of two gammon steaks from one of our leading supermarkets can be labelled

“produced using pork from the UK”

on the front, while the back of the packet reveals the more complete information in small print—that it was

“produced in the UK using pork from the EU”.

Similarly, a spaghetti bolognese ready meal from another leading supermarket can bear the Scottish flag on the front to indicate that it contains Scottish beef, clearly implying that the meat in the product is 100% of UK origin. However, in small print on the back is the information,

“produced in the UK using Scottish beef and Italian, German and French pork”.

That is all hugely unfair to our producers, who have gone to great efforts to ensure that their produce is of the highest standard, which is rightly demanded in this country, and should not have to see their products labelled as being no different from imports from countries where standards are much lower. For instance, research has suggested that an estimated 70% of pork imports fall below UK standards. The classic example of that is sow stalls, which have been banned in the UK for 10 years but remain common practice in many other countries.

My hon. Friend is making a good point. We are not self-sufficient in food in this country. If we get the labelling aligned correctly, does he think that it would give farmers, like those in my constituency of Taunton Deane in the south-west, more opportunities to produce and sell more?

I think it will allow farmers to compete against imports on a fair pitch, as it were. That is very important, because at the moment I feel it is very skewed by the labelling. Whether in my hon. Friend’s patch, up in Yorkshire or anywhere within the UK, including Scotland, Northern Ireland or Wales, British agriculture produces products to some of the highest standards and the highest welfare standards in the world. That is not reflected fairly within food labelling at the moment, and we have to ensure that it is.

It seriously inhibits consumers’ choice if we do not get this right. We know that many consumers wish to buy British meat, in many cases because of the high quality and high animal welfare standards to which it is produced. Research suggests that 74% of people believe it is important that the meat they buy is of UK origin. That strengthens the point made by my hon. Friend the Member for Taunton Deane about what such labelling can do for UK agriculture. However, under the current regime, consumers are restricted in their ability to do so.

For meat and processed meat products more broadly, I urge the Minister seriously to consider establishing a clear single UK country of origin standard, with a single country of origin label on the packet meaning that the animal was born, raised and slaughtered in the country and making it clear that the location of the last substantial change to the product is not an adequate description of its origin.

I also believe that the Government should use their new freedom of action outside the EU to proceed with introducing mandatory country of origin labelling for dairy products wherever possible. The Minister has made clear his disagreement with the unwillingness of the European Commission to act on that issue, and I therefore hope that in making this call I am pushing at an open door.

The future prosperity of the food and farming sector and its ability to maintain and enhance its export performance will also depend on the promotion of traditional regional and speciality foods, which is another issue within food labelling. Given the time, I will not go into that, but it is worth putting it on record that that is an important sector within food labelling that we need to focus on.

Finally, I urge the Minister to ensure that the labelling standards I have described are preserved in future trade agreements with the EU and other countries, so that British agriculture is able to thrive in conditions of fair competition, with accurate disclosure of origin information to the consumer. Accurate, honest country of origin labelling in food is of great importance to the success of UK agriculture, the prosperity of rural communities, the rights of consumers and the competitiveness of our products in the world market. I look forward to seeing what measures the Minister can bring forward in this area as the Government develop the first independent UK farming policy for more than 40 years.

I begin by congratulating my hon. Friend the Member for York Outer (Julian Sturdy) on securing this very important debate. He is known for campaigning on these issues and, as he said, as a straight-talking Yorkshireman. In fact, I shall be visiting Yorkshire this Thursday and look forward to lots of straight talking about the future of agriculture policy.

This is a very important issue. UK consumers spend £200 billion on food, drink and catering services each year. Consumer confidence is key to the integrity of the supply chain, and that is more important in food than in anything else. As my hon. Friend pointed out, existing regulations are largely set out in the food information for consumers regulation, which dates from December 2014. It sets out in quite a bit of detail mandatory labelling requirements for the name of the food, the list of ingredients, ingredients causing potential allergy or intolerance, the quantity of specific ingredients or groups of ingredients, net quantity of the product, the use-by date, any special storage conditions, the name and address of the food business operator, the country of origin, instructions for use where required, alcoholic strength and nutrition declarations. That is a fairly comprehensive set of regulations. The UK helped to shape those regulations at UK level, but when we leave the EU we will take our position again on Codex, which is the UN body that tries to set standards internationally and is increasingly influential in this area.

On leaving the EU, there will be an opportunity to do things differently, to improve things and to introduce clearer labelling in some areas. However, it is also important that we have continuity; we do not want to throw the baby out with the bathwater. That is why in the first instance the great repeal Bill will put all our existing regulations pertaining to food labelling and all other aspects on a legal footing in UK domestic law. There will then be opportunities over time to revisit things.

While I appreciate that this was not a major focus for my hon. Friend, we are looking at whether we can have some kind of mutual recognition of existing protected food names. That will be important for European countries seeking recognition in the UK as well. We are looking at whether we could use trademark regulations to develop brands in other areas.

My hon. Friend the Member for Tiverton and Honiton (Neil Parish) mentioned Angus beef. There is another issue with Angus beef, which is that it is not always—or indeed, rarely—from a pedigree Angus animal; it is usually from one crossed with a dairy animal. We will have the opportunity, through trademark regulations and other intellectual property law, to develop brands for pedigree native beef breeds, for instance, which we are looking at.

I want to talk predominantly about country of origin labelling, which was the focus of my hon. Friend the Member for York Outer. As he pointed out, since April 2015 country of origin labelling has been required for fresh and frozen meat from pigs, sheep, goats and poultry. It has been required for fresh beef since 2003 and for certain fish products since 2000. As my hon. Friend knows, we have campaigned for the extension of mandatory country of origin labelling to cover some dairy products. The European Commission has always resisted that, arguing that it is too complex for processed products. Our view is that it might not be possible for all dairy products but would certainly be possible for some, such as butter and cheese, where it is relatively easy to identify country of origin. Once we leave the EU, there will be an opportunity to look at strengthening mandatory labelling in that area, if that were the view of the Government of the day.

My hon. Friend mentioned the fact that beef sometimes is not born, raised and slaughtered in the country of origin. My recollection of the regulations—I can double-check this—is that in the case of beef, for the label to state country of origin as UK the animal must be born, reared and slaughtered in the UK. For other meats, the animal must be reared and slaughtered in the UK. It is possible to say “slaughtered in the UK” if the animal is not born and reared here. The regulations cover this issue to some extent for fresh meat.

My hon. Friend also raised important issues about processed meats, which are more complex. A composite product such as a pizza might have vegetables on it from different parts of the country and might use flour from one country, meat from another or, indeed, meat from two countries. It is harder to put country of origin labelling on all processed meats.

There has been a growing tendency for other foods to be labelled voluntarily with their country of origin. For example, the vast majority of lightly processed meat products, such as bacon and sausages, already have country of origin labelling as part of a voluntary scheme, but it gets harder with some of the more complex products. I am always open to strengthening transparency for consumers. If there is a way of going further, beyond the issues we have highlighted previously in the case of dairy, we can look at that.

My hon. Friend mentioned method of production labelling. There are some very good voluntary schemes, such as the RSPCA Assured scheme, which recognises high standards of animal welfare, as well as the British Lion eggs and Red Tractor schemes. We are keen to encourage those further.

I want to touch on a couple of other points. My hon. Friend the Member for North Swindon (Justin Tomlinson) raised the issue of slightly dubious farm name brands used by supermarkets. That is a difficult area. While those cannot mislead, there are cases where, for instance, a brand celebrates a product of a particular standard. I have heard some people complain about the Duchy Organic label because the products are not always produced on Duchy farms; in fact, they rarely are. It nevertheless is an important organic standard that has recognition. This is a difficult area. Labels are not allowed to mislead people, but I accept that some labelling is in a slightly grey area.

My hon. Friend the Member for Taunton Deane (Rebecca Pow) talked about online shopping. We are discussing that with the National Farmers Union; it may be one way we can avoid voluntary principles. We have had a very good debate, and I will take on board these points.

Question put and agreed to.

Sitting suspended.

Detention of Vulnerable Persons

[Geraint Davies in the Chair]

I beg to move,

That this House has considered the detention of vulnerable persons.

I have brought this debate to the Chamber because the arguments about detaining people simply because of their immigration status are not over. I will argue that that is not necessary, is extremely damaging and is not cost-effective. I will also argue that unless the Government get on with examining the alternatives and implementing the bulk of the Shaw review recommendations with alacrity, I can only conclude that the use of immigration detention for vulnerable people is purely ideological. To make my arguments, I will explore the impact of detention, particularly on vulnerable people; say something about the alternatives to detention; and highlight some of the Shaw review recommendations that have not been implemented more than one year down the line.

I will say at this point that my experience of the Minister for Immigration, limited as it is, is that he has listened when I have had something to say and he has acted, so I come to this debate fairly sceptical but not completely cynical. I very much hope that today will signal a turning point.

I thank all the organisations that wrote to me and provided me with information. It did not make pleasant reading, but it is important to know what is going on. I pay tribute to all of them for the work that they do. They include Scottish Detainee Visitors, Detention Action, Medical Justice, the Scottish Refugee Council, the English Refugee Council, the Immigration Law Practitioners Association, Liberty, the United Nations High Commissioner for Refugees, Asylum Aid, the Helen Bamber Foundation, the Association of Visitors to Immigration Detainees, and the Detention Forum.

I am fortunate: I have never had to flee my home or my country and I have never been detained for anything, far less detained without having committed a crime. However, I know the damage that it does to a person’s physical and mental health to experience that. I know because of what I read and because of friends who have been through it. I will refer to two sets of friends of mine who have been in immigration detention.

I congratulate the hon. Lady on securing a debate on a subject whose time has come again—many of us have been involved in debates on it in times gone by—but may I caution her on something? I welcome her scepticism: she is right to be sceptical, given the evidence that she will present to us. However, I would hope and expect my hon. Friend the Minister not to say that the reason for continued detention of vulnerable people is in any way ideological. Sadly, it could well be administrative. That is unacceptable too, particularly when the Government have said to Parliament that the presumption should be that those who are at risk are not detained.

I genuinely hope that the hon. Gentleman is right and the reason is not ideological, but we can only wait so long before we come to the conclusion that it is. Hopefully, though, it is not.

In case the Minister thinks that I am coming to him with worst-case scenarios, I will start with the best-case scenario and tell him about Romeo—that is not his name, but he is a bit of a Romeo, so I have decided to call him Romeo rather than using his real name.

Nobody is better equipped to deal with immigration detention than Romeo. He has a creative, flexible and problem-solving approach to life. He is confident, vibrant and philosophical, and deals with whatever life brings to him. However, this is what he told me about the time when he was detained. He had woken up early to pick up ingredients from a friend who was leaving this country to go back to her European country. She had baking ingredients and knew that he loved to bake. He came out of his door, and the next thing he knew he was handcuffed and shoved in a van and then in a detention centre.

Romeo said that trying to get in touch with the friend to tell her why he could not make the appointment was difficult. Trying to explain to somebody who does not come from the UK that he was in detention but had not committed any crime was quite distressing for him. He told me that he asked whether, if he was to be deported, he could go to his room and get his stuff, and he was told, “You’ll never see your room again.” There were two UK Border Agency officers there at the time. One said to him, “You sound Scottish; you sound British,” and the other said, “You’re not British and you never will be.” He said to me, “Even though I am that person who can cope with anything life throws at me, it was so hard to hear that from somebody.”

I will now go to my worst-case scenario—the worst experience that any of my friends have ever had. A friend of mine from Eritrea and her 10-year-old son were detained in Dungavel immigration removal centre. I want at this point to mention the work of Scottish Detainee Visitors. Its visitors visit people in Dungavel and have done so for many years. As it has pointed out to me, and as others will say today, Dungavel is a particularly difficult place to be detained, because of its isolation; it is 6 miles from the nearest public transport. I was in daily contact with the mother by phone, and the son said to her after a few days, “We can’t live like this, Mum. Please can we die?” And every day after that until they were released, he asked her, “Please, Mum. Please just let us die.” Can anybody imagine their own children thinking that, far less pleading with them to let them end their lives?

I know that we have reduced the number of children in detention, but we have not stopped it; we had 71 in detention last year. However, the point that I want to make is not about children in detention. Yes, we all agree that that is wrong, but the mother told me that it was so hard for her to respond to her son and tell him that there was something to live for and he had to keep on going, because she was not feeling it herself—she, too, wanted to end her life. The reason she did not was that she had gone through so much to save this child’s life, she was not going to allow them to end it there and then.

The hon. Lady is telling some really important stories that are bringing the points home to us, but I wonder to what extent she feels the situation would be significantly worse if the people involved had serious mental health problems, and whether the system is capable of dealing with that.

I will come on to say a little about that issue, and I thank the hon. Gentleman for raising it. One of the most significant issues is that the system is not capable of dealing with people who have mental health problems, and the agreement was that people with mental health problems would not be detained, but unfortunately that is still happening. As I said, I will come to that.

The hon. Lady is making a passionate speech about a very important issue that is close to my heart. She will be aware of my constituent, Nazanin Ratcliffe, a mother who has been imprisoned in Iran for a year and is suicidal. In April, it will be one year since she has spoken to her husband, and she barely ever sees her two-year-old daughter, Gabriella. Will the hon. Lady ask the Minister to make a point on that, because we need to bring Nazanin home, back to West Hampstead?

I echo that call and hope that the Minister will respond to it. The hon. Member for Hampstead and Kilburn (Tulip Siddiq) has fought long and hard for this woman who is fortunate to have her, but so unfortunate to be in the situation she is in—it is so wrong.

The hon. Lady is being very generous. I congratulate her on the debate and agree with what my hon. Friend the Member for Hampstead and Kilburn (Tulip Siddiq) has just said. On medical conditions, does the hon. Lady agree that the issue is not simply mental health conditions? I would cite the example that I was told about of someone with an urgent arthritic condition, who, rather than being given medical treatment in Campsfield House IRC, was put on a bus to central Oxford, where a taxi driver who spoke his language got him to Asylum Welcome, and an ambulance had to be called. Do we not need urgent re-evaluation and attention to the medical guidance?

Absolutely. As I said, my personal experience of the Minister for Immigration is that he listens. He cannot be expected to know absolutely everything less than a year into the job. I hope that he will respond to that intervention and do as the right hon. Gentleman asks.

Immigration detention attacks and destroys the soul—it is soul-destroying. As many of the groups have told me—some of their members are here today—“If you are not particularly vulnerable when you enter detention, it makes you vulnerable.” And there are alternatives that work. That is the ridiculous thing. The Government agreed to look into the alternatives, but they have not done so yet, and I think they still need convincing. However, before I attempt to do that, let me look at what we all agree on: the recommendations—or some of the recommendations—of the Shaw review that the Government agreed to.

Most hon. Members will be aware that the review was published in January 2016. Its remit was to “review the appropriateness” of

“policies and practices concerning the welfare of those who have been placed in detention”.

Shaw begins his conclusion with a comment that hints at the frustration felt by many of the organisations that have worked on this issue over the years. He says:

“Most of those who have looked dispassionately at immigration detention have come to similar conclusions: there is too much detention; detention is not a particularly effective means of ensuring that those with no right to remain do in fact leave the UK; and many practices and processes associated with detention are in urgent need of reform.”

Mr Shaw’s 64 recommendations include a number that focus on vulnerable people. To their credit, the Government have made a bit of progress with some of the recommendations, but when dealing with a system as fundamentally flawed as the detention system, and working with people who are so vulnerable, there has to be both an urgency to the improvements and a recognition by Government that a handful of adjustments are just not enough.

I obviously do not have time to detail everything today—there were 64 recommendations—but I hope that other Members will talk about the particular issues for stateless people, pregnant women and transgender people, among others. Shaw called for the definition of vulnerable persons to be extended. He said that the presumption against detention should also apply to victims of rape and sexual violence, to those with post-traumatic stress disorder, to transsexual people and to those with learning difficulties, and he rightly includes people who have suffered female genital mutilation in those groups.

Many of the recommendations are said to be addressed by the introduction of the adults at risk policy, which is apparently intended to better identify and lead to the release of vulnerable people. But so far there is no indication that, despite those intentions, the policy is actually having that effect. Aspects of the policy are subject to litigation. Medical Justice and a number of other non-governmental organisations have raised concerns that instead of increasing protections for vulnerable people, the policy does the opposite—including by narrowing the definition of torture so that less vulnerable people will not be identified as torture survivors and protected. The policy states that survivors of sexual and gender-based violence should not be detained, but there is no proper mechanism for identifying them and no mechanism for monitoring whether they are being identified. Will the Minister agree today to introduce such mechanisms and, if so, when can we expect that to happen?

Recommendations 62 and 63 encourage the Home Office to further consider ways of strengthening the legal safeguards against excessive length of detention, and to investigate the development of alternatives to detention. Shaw, in turn, was influenced by the UN High Commissioner for Refugees, who said:

“Pragmatically, no empirical evidence is available to give credence to the assumption that the threat of being detained deters irregular migration, or more specifically, discourages persons from seeking asylum.”

However, Shaw did note a broad consensus on the damaging effects of both lengthy detention and the threat of it, stating:

“The indefinite nature of detention was almost universally raised as making people more vulnerable and for its impact on mental health. There was strong support for a time limit for detention, starting at 28 days.”

The hon. Lady knows that I was the vice-chair of a cross-party investigation into immigration detention that included the hon. Members for Enfield, Southgate (Mr Burrowes) and for Bedford (Richard Fuller). There is a great deal of cross-party unity, which was reflected in a decision by the House of Commons on this specific issue of the impact of indefinite detention.

We heard evidence from people who said that such detention is worse than being in prison, because in prison people know when the sentence finishes. To take up the point made by the hon. Member for Henley (John Howell), that uncertainty and the indefinite nature are not only inappropriate for people with mental health challenges—but develop those challenges and create crises for people who have, in many cases, already suffered trauma.

Absolutely. It is very clear today that there is much cross-party consensus on this issue. On the length of time that people are held in detention, the Home Office’s own statistics show that migrants in detention are being held for longer since the publication of the review. That is astonishing. At the end of December 2015, the month before the Shaw review was published, 453 people had been detained for longer than four months. According to the Home Office, nine months later that number had gone up to 553.

I am sure the hon. Lady is aware that many of those who are detained for longer than usual are foreign national offenders and are assessed to pose a risk to the public. There are about 1,300 foreign national offenders in immigration detention. Is she suggesting that those people should be released, even if they pose a risk to the public?

What I am suggesting is that this Government will always raise that point. They will always say that. I am talking about people who have committed no crime. The Minister wants to talk about people who are in immigration detention because they have a criminal conviction; I am going to assume that they were sentenced, served a prison sentence and should be treated the same as any other prisoner. If they are a danger, they should not be out of prison. If they are not a danger, they should not be in detention.

As one of the few people in the Chamber who was actually in the House when immigration detention as we know it was introduced, I have never forgotten that when we queried the lack of due process and safeguards we were told that people would only ever be in detention for a few months. The use of immigration detention has mushroomed, and the length of time has expanded, and that has shone a light on the lack of due process. We should never forget that none of these people, as matters stand, has committed a crime.

Absolutely. I could not agree more. I was not here at that time; I was a Member of the Scottish Parliament, I think, and very aware of the arguments being used.

I want to say a little about how we treat people with mental illness. Often they have an illness that did not exist or that lay dormant before they were detained, and the detention exacerbates it. I mentioned some of the organisations that have sent me information for today. One of them, Detention Action, helped Mishka to tell his story. This is what he said about being detained:

“I was detained with my twin brother. It was very difficult for us. We went in ok and we came out broken. The last three days before my brother was removed he tried to commit suicide two times. The first time, there was blood everywhere. The officers and nurses were so annoyed. They are thinking he is just trying to escape from removal. The nurse put a plaster on his wrists and took him to segregation.”

For goodness’ sake! Those are my words, not his. He continues:

“There he ripped a piece of metal off the wall to cut himself again. He was very, very vulnerable by the end. He was not the only one. There were many other people in bad states—mental and physical. There is more than one suicide attempt a day in detention now. All I know is that when suicide becomes normal—anywhere, ever—something has gone very, very wrong.”

My hon. Friend is making a powerful and strong case in defence of her constituents and many others; I have constituents in this situation as well. Does she know that I tabled a written question last year to ask how many detainees were currently being monitored because they were a suicide risk? Is she surprised to learn that on 21 December 2016, 78 detainees were being monitored in line with care in detention assessment procedures?

Actually, the thing that surprises me about that—I am not sure whether this is my hon. Friend’s point—is that the number is so low. I am telling the Minister that 78 is not the number of people in these circumstances feeling suicidal and considering suicide.

Such people are human beings who the Government agree should not be put through this; yet they are being put through it and the British Government are doing it to them. Every time the Government are asked when a recommendation that they have agreed to will be implemented, the answer is “in due course.” Notwithstanding all I said about the Minister at the start, I do not want to hear “in due course” today. That is not good enough. The most soul-destroying thing about being in detention is the unlimited nature of it—not knowing when or whether you will be released; the most soul-destroying thing for campaigners, many of whom have been in detention or are still at risk of detention, is not knowing when the Government will do as they promised.

I want to look at some of the alternatives to detention. There is a strong moral case for community-based alternatives. However, I am often, if not always, on a different side of the argument from this Government when it comes to discussions based on morality and values, so I will make the arguments based purely on effectiveness of outcome and cost.

In this place, I have often accused the Tory Government of knowing the cost of everything and the value of nothing. Yet when it comes to immigration detention, it seems that money is no object. Why? Why do we use the most expensive system, particularly in these times of austerity? Why is there no money to support people in need—vulnerable young homeless people who now cannot claim housing benefit, for example—but an unlimited pot of cash to put already vulnerable people through a living hell in detention centres, given that the Government agree that that is what they are doing and that it can be catastrophically damaging to people? Evidence is increasing that working with people in the community, using a case management approach, works.

The hon. Lady perhaps understates the costs. What about people whose stay is extended, so their time in detention is longer than legally required? The compensation bill is going up by millions of pounds. That is taxpayers’ money, which is being wasted on illegal, extended detention. Frankly, that is a scandal—it should go on effective, alternative ways of controlling people.

In a recent two-year period, the bill for compensation for people detained illegally was about £10 million. I pay tribute to the hon. Gentleman for all that he does and says—it cannot be easy for someone when their Government are involved—and for all his campaigning on behalf of people in these circumstances.

There are a number of established alternatives to detention, such as the Toronto Bail programme, which is centred on community-based release. Importantly, that model has achieved a 94% cost saving compared with detention, and a compliance rate of 95%. I will not go into all the other models, but Sweden has a case management welfare and rights-based approach, which works with the person who is seeking asylum. Is the Minister aware that in 2014 in Sweden, the voluntary rate of return was 76%, whereas here it was 46%? Does he realise that the longer a migrant is detained, the more likely it is that they will be released from detention and not returned to their country of origin? Does that not just make the exercise completely pointless? Would it not be better to strengthen the decision-making process in the first place, and would that not be cheaper? Well yes, it would.

I am delighted that the hon. Lady has secured this timely debate. She talks about foreign examples, but we do not need to look offshore to reinforce her point. A signal achievement of the coalition Government was that they stopped locking up children in immigration detention and introduced the family returns panel. Since that was introduced in 2011, the voluntary return proportion has grown from 51% in 2011-12, to 76% in 2012-14, to a voluntary return percentage of 97% in 2014-16. Does that not fully reinforce her point without our needing to look abroad?

Absolutely. I pay tribute to my colleague, the hon. Gentleman, who is also on the Government Benches and has been a strong campaigner on this issue. I urge the Minister please to look at the different examples, domestically and internationally, because they save money and are more effective.

Before the hon. Gentleman’s intervention, I was about to invite the Minister to guess how much we spend each year on the long-term detention of migrants who are ultimately released and should therefore never have been detained in a removal centre. Well, he does not have to guess; independent research from Matrix Evidence uncovered the fact that we waste £76 million on that every year. I am calling on the Minister to look into strengthening the decision-making process—not just to save money, but so that we stop causing unnecessary trauma to individuals who have done nothing wrong.

The reason why we use the current system is definitely not effectiveness of outcome, given the much higher success rates in Sweden and Canada, and definitely not cost-effectiveness, so I am interested to hear the Minister’s explanation. Perhaps he can complete the following sentence in 15 words or fewer: “Well yes, Anne, it is the most expensive option, but it is worth it because…”. I tried, but he would not like my finished sentence and I do not like it either, so I ask him in all sincerity: why, when there are less expensive, more effective systems, do we not go for them as opposed to the system that we have?

I shall finish with this point. Yesterday, Nicola Sturgeon announced plans—this is relevant, Mr Davies—for Scotland to have an independence referendum. Last Thursday the Select Committee on Scottish Affairs had a debate in Parliament during which the Scottish National party called for immigration powers to be devolved. Either of those scenarios—further devolution or independence—are options for Scotland, but I have no crystal ball. There may be absolutely no change, but we will have to wait for the people of Scotland to decide. There is a real chance that we—not just SNP MPs, but MPs representing Scotland—will be out of here in the next few years, but we might not and people might still be being detained in Scotland against our Government’s will.

However, even if Scotland becomes independent, that does not mean we do not care what happens in the rest of the UK. Far from it—my fervent hope is that whoever is in power in the rest of the UK will see that Scotland is running a far more welcoming, humane immigration system and will follow suit when they see for themselves that it works and is cost-effective. I urge the Minister not to wait until then, but to make this something that he is personally in charge of and will expedite, because people have been waiting for long enough.

In this debate, I have focused primarily on those seeking refugee status—rightly so, because they are likely to be the most vulnerable, given that they have had to flee their own countries. But an IRC is an immigration removal centre, which means that anyone who is classed as an immigrant can be detained there—and they are. I was interested to read about the increasing number of Europeans being detained for long periods. The rest of the UK is leaving Europe, but that does not have to be hostile. Is it not time to extend the hand of friendship to our European neighbours and the rest of the world, and could that not start with treating their citizens who come to live here with respect, dignity and humanity?

Order. If hon. Members keep their remarks down to around eight minutes, we should get everyone in. I call Mr David Burrowes.

It is a pleasure to take part in this important debate, which gives the Minister a chance to get a taste of the cross-party concern that was amplified last year in the run-up to the Immigration Bill—now the Immigration Act 2016. Many hon. Members, from all parts of the House, made it clear that indefinite detention was unacceptable—that was the easy point to make—and that there needs to be progress, not least towards a statutory time limit. Through the passage of the Act, and through Stephen Shaw’s scrutiny and welcome report, it was accepted—some of us conceded—that the welcome recommendations, the broad thrust of which the Government accepted, could well lead to a reduction in the numbers being detained and for how long.

Stephen Shaw talked about the package of “adults at risk” policies, individual assessments for removal and reviews, and the welcome progress that was made on outlawing the detention not only of children, but of vulnerable people, such as pregnant women, unless there are exceptional, limited circumstances. We all recognise that that package might not be the only lever to deal with too many people being in detention for too long—there are also statutory time limits—but it might be successful. However, Stephen Shaw said he that he would revisit that tool if progress was not made. Time has now gone by and, sadly, we have not seen the steps that were promised to Parliament and Members, so it may need to be revisited. I say advisedly to the Minister that cross-party concern will grow, not least in terms of interest in the blunt instrument of a statutory time limit, unless we see further progress.

The hon. Gentleman and I have worked closely on these issues, and I pay tribute to his work. He is right to highlight that the progress we appeared to be making seems to have stalled. However, does he agree that there are worrying signs that things may be going into reverse? The most recent report on an immigration detention centre was done by the chief inspector of prisons on Brook House, where the average length of detention has increased, rather than decreased. Does he share my concern that that is a worrying sign? Clearly, we hope that the Minister will listen to the cross-party concerns that the issue needs to be addressed.

I agree. There are warning signs. We have seen the reports in the media and elsewhere on Yarl’s Wood and the scandals that have taken place. We do not want to be in that position. We want to ensure that the recommendations, which were broadly accepted, mean real results, but we are not seeing them.

In January last year, the then Minister committed in Parliament to safeguarding the most vulnerable, with a clear presumption that people who are at risk should not be detained. I want to talk about the victims of trafficking and the need for reviews and assessments relating to their removal, not least because Ministers have given assurances, as did the Prime Minister last July. She made it clear—rightly, given that she has championed the cause of tackling modern slavery—that the Home Office has taken the lead. The Home Secretary is leading the task force, bringing Whitehall together in regular meetings, in which I am sure the Minister is also involved, to ensure that we apply our full force in tackling the evils of modern slavery, so that we can, in the words of the Prime Minister on 30 July,

“get a real grip of this issue”,


“drive further progress in the battle against this cruel exploitation”.

The words of the Prime Minister are pertinent to today’s debate. She wrote:

“Vulnerable people who have travelled long distances believing they were heading for legitimate jobs are finding they have been duped, forced into hard labour, and then locked up and abused....These crimes must be stopped and the victims of modern slavery must go free.”

The victims of modern slavery must go free and not be in detention.

I will refer to an example given to me by Detention Action. It is about T, a trafficking survivor:

“Like many Vietnamese people in detention, he was trafficked to work in a cannabis farm.”

That was referenced by the Prime Minister.

“He has been left with long-lasting injuries and psychological trauma after being beaten by his traffickers. The Home Office accept that he is a torture survivor but have refused to release him. On the basis of limited information, the Home Office refuses to believe that he is a trafficking survivor. He has been detained for four months.”

Victims of modern slavery must go free.

I will refer to the Helen Bamber Foundation and a recent example this month about someone with a rule 35 report from a detention centre. The doctor noted extensive scarring that was in keeping with a history of torture. Sadly, though, there was a negative reasonable grounds decision that turned on the credibility of the applicant, as the trafficking claim was not raised when first questioned in the UK. We have made great strides in dealing with the issue of reporting referrals. Here is a clear example where no doubt the threats by the trafficker not to tell anyone of the exploitation at the time of initial questioning is something that is normal and not exceptional, but is not given any weight. There are also indicators that the individual had been re-trafficked after coming into contact with UK authorities initially.

I will draw on reports referred to by the Home Office. There are reasons why the claim of a torture survivor trafficking victim had not been properly maintained above issues around immigration. The vulnerability issue is the concern, but sadly it is weighed among immigration factors and the vulnerability concerns are downgraded. The Home Office report stated that entry into the UK took place

“in a clandestine manner”—

in other words, on the back of a lorry. That is not surprising for a trafficked victim:

“You have no close ties in the UK to ensure your compliance.”

Again, that is not surprising in terms of the indicators present. The individual had been trafficked. Here is an example from the Shaw report in relation to mental health:

“Whilst it is noted that you have encountered physical torture and are suffering poor mental health as a result of this, the doctor has not diagnosed any serious physical or mental health conditions that are likely to worsen within the detained environment during the duration necessary to effect your removal.”

Page 306 of the Shaw Review states:

“Together the literature, which spans a 25-year period and a number of legal systems, tells a consistent story of the harmful effects of detention on mental health.”

That is compounded in a victim of trafficking. What is going on here? We have the Shaw report referencing clear evidence of mental health aggravated by detention, not least among those who are victims of torture.

The report continues:

“When balancing your vulnerability against your negative immigration factors, the negative factors outweigh the risks.”

What is happening here to very vulnerable people? At the time of writing, despite the adults at risk policy, this individual has now been in detention for four months, with a further three and a half months being proposed to effect removal. It is not the will of Stephen Shaw, it is not the will of Parliament, and I do not believe it was the will of the Ministers and the Government during the passage of the Immigration Act 2016. We must do better.

I must press the Minister on his answer to my questions that followed up on the clear will of the Minister’s predecessor in response to the Shaw report. My question is about timescales for individual reviews and assessments for removal, which should take precedence over issues around detention. It is what immigration removal centres are all about: removal and ensuring that individuals are assessed for removal, which is there to supplement the adults at risk policy. There was a clear commitment that that would be in place by the end of the year.

The then Minister responded on 14 January by saying in response to the recommendation that

“the Home Office should examine its processes for carrying out detention reviews, the Government will implement a new approach to the case management of those detained, replacing the existing detention review process with a clear removal plan for all those in detention.”—[Official Report, 14 January 2016; Vol. 604, c. 28WS.]

The following month in the Select Committee on Home Affairs, the then Immigration Minister, now the Secretary of State for Northern Ireland, told me that the current system of detention review would be replaced by removal assessments by the end of the year. It has not happened. The current Minister responded to my question yesterday by saying that

“work continues on designing and implementing a more effective case management process to replace the existing method of reviewing detention. Case Progression Plans are intended to act as the single caseworking record for all individuals entering immigration detention. Wider planned for later this year, subject to the findings from the evaluation of the pilot phase.”

Again, we must do better.

In conclusion, whether it is on that issue or publishing a plan for the whole of the estate that will be predicated on the Government’s commitment to reduce the numbers in detention, we must do better. At the very least, let us commit ourselves to follow through with what the Prime Minster said:

“the victims of modern slavery must go free.”

I congratulate the hon. Member for Glasgow North East (Anne McLaughlin) on setting out the issues so well. May I say at the outset that I would be very pleased to see our Scottish hon. Members remaining as part of the United Kingdom? As I always say, we are better together in relation to the United Kingdom of Great Britain and Northern Ireland, so we do not want to see them go. They make a valuable contribution, and today’s debate is an example. I thank the hon. Lady for that, and I thank also the hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron), who will shortly make an equally valuable contribution.

I am concerned about this issue. As my party’s spokesperson on human rights, I believe it is right and proper that this issue is raised and that the Department responds by saying how far the recommendations have been implemented. It is clear that change is needed. I was shocked to find that in 2015, the number of suicide attempts in UK detention centres averaged more than one every day, with 393 people trying to take their lives—a record high. If that is a record high, there has to be a change of direction or a change of attitude in how we stop that. The hon. Member for Glasgow Central (Alison Thewliss) referred in her intervention to some of the suicide attempts. I am sure it has much to do with the fact that people are not allowed to stay in the UK—it cannot simply be how they are treated in detention centres—and their dread of going back home. It is also clear that the recommendations in the Shaw report need to be implemented, which is why we are here to ensure that treatment does not exacerbate the problems that people already face.

I completely agree with the statement by our Prime Minster—she is our Prime Minster, whether or not we are in government with her—from when, in her former hat, she was Home Secretary. The fact is that we have asylum criteria for a reason. We have to have criteria to work to, and the Minister knows that. How the criteria work and affect people’s lives is the reason we are having this debate. We cannot sustain an influx of people from other nations. No country can do that—or, indeed, does.

We always have examples from people who work for us or from people who call in and regale us with their stories. My parliamentary aide went to South Africa with her entire family—some 20 of them in total—and they decided to spend a few days in Mozambique. The trouble that the family had to go to just to get a visa for three days was extreme and very costly. It was some £1,000 for the family to get the visa and documentation. The process is there for a reason. Although the hoops that the family had to go through to get access to their resort were extreme, they felt that the benefits outweighed the hassle. It is the same for our immigration process. The process is difficult, but it is so for a reason. We must protect our citizens first, and the immigration process does this.

Not everyone who wants to come here has a right to be here. That is a fact that must be accepted. The system and the process are there to ensure that the right people have the opportunity to come here. I support the Government’s ability to make that decision. However, it should also be accepted that people who come here but have to go home must be treated well. The hon. Member for Glasgow North East outlined that well.

The Prime Minister said in a written statement when she was Home Secretary:

“The Government believe that those with no right to be in the UK should return to their home country and we will help those who wish to leave voluntarily. However, when people refuse to do so, we will seek to enforce their removal, which may involve detaining people for a period of time. But the wellbeing of those in our care is always a high priority and we are committed to treating all detainees with dignity and respect.”—[Official Report, 9 February 2015; Vol. 592, c. 29WS.]

However, the suicide figures perhaps do not reflect that. I ask the Minister to take that on board.

The question of treating people with dignity is particularly important when it comes to the detention of children. Does the hon. Gentleman share my concern about the closure of the Cedars centre, which was not easy to set up or cheap to run but was about exactly that—treating people with dignity? Is he concerned that, unlike Cedars, the new arrangement has not had the active participation of Barnardo’s?

I wholeheartedly agree with the right hon. Gentleman, as I think does everyone in the Chamber. What he has described shows the issue we face: changes happen, but are they for the better? In the present case I believe they are not.

I would like to know how, in the Government’s view, dignity and respect have been upheld since the Prime Minister’s statement was made just over two years ago. I understand that the recommendations in part 4 of the Shaw report, which addressed the concept of vulnerability, have largely been accepted by the Government. However, there are examples, including the one outlined by the right hon. Member for Orkney and Shetland (Mr Carmichael), that do not show that acceptance in action. There was a recommendation that the presumption against detention be extended to include victims of rape and other sexual or gender-based violence, including female genital mutilation, as well as people with a diagnosis of PTSD or with mental health issues and, as other hon. Members have mentioned, transsexual people and people with learning disabilities. Those are clear and specific categories where there are issues that need to be addressed. The presumptive exclusion of pregnant women should be replaced by an absolute exclusion, and the phrase

“which cannot be satisfactorily managed in detention”

should be removed from the section of the guidance covering those suffering from serious mental illness.

It is always good to read the newspapers, although whether we believe them or not is another thing. However, a reputable newspaper that I read contained an article stating:

“In June last year, the Home Office published new guidance that says women on suicide watch in detention should never be watched by male guards. In July, it introduced a 72-hour time limit on the detention of pregnant women—a measure which I particularly welcomed as it was clear that detention was often harmful for pregnant women. And in September, the Home Office also published guidance which states that survivors of sexual and other-gender based violence should not be detained.”

If the Government are pressing ahead with such measures and protection for pregnant women, that is good news; if they are not providing them with protection, they should be. I tabled some questions on this matter some time ago, and I am keen to hear how the Minister responds to the debate. It is good that the Government action described in the newspaper report is happening, but more needs to be done. What more is scheduled to happen? I should like to hear the Minister’s thoughts on the protection of pregnant women in detention and whether the change to a 72-hour time limit has been effective. Is it working, and is it enough?

I have read reports suggesting other ways of dealing with asylum seekers, which we could explore, in countries such as Sweden. Sweden sets examples to the world of how to do many things. We can learn from each other. While we have the current system, we must ensure that procedures are followed and the Government send those who have no right to be here back home; but while they are here, their needs should be catered to in the most humane way. I know that that is the intention of the Minister and the Government but perhaps we need to see it more in action than in words. I offer support, but I ask that our procedures be carried out in a humane, compassionate and effective way.

It is an absolute pleasure to serve under your chairmanship, Mr Davies, and I thank you for that welcome. I congratulate my hon. Friend the Member for Glasgow North East (Anne McLaughlin) on bringing the debate to the House and on an excellent speech, as well as other hon. Members, who spoke in a most informed manner.

Dungavel immigrant removal centre is in my constituency, so I have a particular interest in the debate and the issues. I have been several times to Dungavel. The current UK Government policy of detention is not the policy of the Scottish Government, but the dedication of the staff, who apply themselves to difficult work with extremely vulnerable individuals who are in some of the highest-risk times of their lives, is commendable. We may not believe that the people in question should be detained, but the staff work to the best of their ability in difficult circumstances.

I received an email this morning saying that at the weekend, when people went to make their presence felt outside Dungavel, they saw staff patrolling with what looked like police dogs. I wonder if my hon. Friend would ask the Minister to find out what that is about. I am sure it is not the idea of the staff. There must be a Home Office directive saying that that is a good way to look after people in detention.

That is certainly not something I witnessed when I visited Dungavel, but perhaps the Minister would like to comment.

It is recommended that the presumption against detention be extended to include victims of rape and sexual or gender-based violence, including FGM, people with a diagnosis of post-traumatic stress disorder, people with learning disabilities and other vulnerable groups. As to the exclusion of pregnant women, surely we must agree that their care cannot possibly be managed adequately within detention. The Shaw report also found that rule 35 of the detention centre rules, designed as a key safeguard for victims of torture or those whose health would be at risk from continued detention, failed to protect vulnerable people in detention. The report highlighted a fundamental lack of trust in medical staff and advised consideration of independent GPs or professionals.

I should like to address several issues in the time I have: assessment of those with PTSD, assessment of those with a learning disability, and the important issue of the detention of vulnerable and traumatised individuals alongside foreign national offenders—something that I believe poses a risk in itself. As a psychologist, I can say that assessment of post-traumatic stress disorder is complex and cannot be done as a snapshot. I went on occasion, in a previous life, to Dungavel to assess mental health, but there is a brief timespan.

I want to reassure the hon. Lady that the worst foreign offenders are detained in the prison estate and not mixed with other detainees.

I thank the Minister for that response. I shall come on to the concerns that I have. The situation involves some detail on which we need further information.

The time afforded for clinical assessment is extremely brief—perhaps only an hour. Meeting clients in Dungavel, alongside an interpreter, makes it even more difficult, because more time is needed to get accuracy. In my experience, the time afforded has not been enough. Building rapport in clinical practice takes time. To expect professionals to do a full, thorough assessment within a snapshot of time is not realistic. It takes repeated appointments. Trust must be built. After all, it is expected that people will open up about some of the most traumatic incidents or experiences of their lives. That does not happen in a few appointments. Clinically, that approach is not good practice, and from the point of view of humaneness it could be re-traumatising. Post-traumatic stress disorder and its symptoms mean avoidance and suppression of emotion, so people are being asked to do something very difficult in the context of their disorder.

Another issue that I found was that the background information needed for a full diagnosis was often not available. Perhaps it has not travelled with the person, or not much is known about their background, meaning that even more careful consideration and lengthier assessment are merited. How many trained psychologists are working in detention centres, and what time and space are they afforded to complete mental health assessments? My concern is that people are slipping through the net; that PTSD is not being diagnosed, that mental illness is not being recognised and that vulnerable and unwell people are being detained when they should not be.

Individuals with learning disabilities are likely to be extremely vulnerable, and in my opinion they should not be detained at all. Assessment to detect individuals’ IQ and history of developmental delay and significant impairment in everyday functioning is even more complex than mental health assessment, and IQ tests are often not culturally transferable. Once again, information for such individuals is often lacking, although background information on development is necessary. It can take multiple sessions speaking to numerous people involved in someone’s care to avoid missing critical information.

The hon. Lady is describing powerfully the clinical issues that affect the diagnosis of vulnerable people who are detained. Does she agree that there is an additional layer involving trust? People who are detained may see clinicians as representing the authorities, which creates an additional barrier that must be penetrated in order to make an effective diagnosis.

I thank the right hon. Lady for that excellent point. I agree; that has certainly been my clinical experience. It is obvious that someone undergoing a clinical assessment will wonder about the motive for and outcome of the assessment, which will affect their level of trust and ability to open up. Once again, it shows just how lengthy and detailed an assessment must be, and that it must be built up over time.

How many people in detention are currently being assessed for learning disability, how is that being undertaken and are appropriate resources available for professionals? Such individuals are very vulnerable. If someone is presumed to have a learning disability, they should not be detained, because of that vulnerability. If there is any question of that, are alternatives sought straight away?

Thirdly, I have a concern about detaining foreign national offenders who may be sexual or violent offenders alongside those who are already traumatised. Often, information is lacking. When I visited Dungavel, I was told that sometimes when people come from prison, their records do not follow. That poses a clear risk to staff, because they do not know how high risk the individual is, and to the people alongside them in detention. We must ensure that information follows the person in order for a proper risk assessment to be made.

There is a clear risk to people with post-traumatic stress disorder following torture, rape or other trauma if they are detained alongside sexual offenders. That should not happen, but I know from my visits that, although some risk management procedures are in place, it sometimes happens; people speak about having been assaulted or sexually assaulted in detention. The risk management measures must be firmed up. What risk assessment and management measures are standardised to ensure that people are not at risk of further abuse? People with mental illnesses, learning disabilities or post-traumatic stress disorders should not be detained, and certainly not alongside offenders, which can re-traumatise and re-victimise them while they are in our care.

I call Richard Fuller to speak. I will call the Front-Bench speakers at half-past 3, so you have about six minutes.

Thank you very much, Mr Davies. It is a pleasure to serve under your chairmanship. I am delighted to have the opportunity, presented by the hon. Member for Glasgow North East (Anne McLaughlin) at this important time, to review progress on the detention of vulnerable persons and to welcome the Minister. He is in the middle of a process, which is probably the most difficult period in which to be questioned, but I know that he is made of stern stuff. As others have done, I would like to thank some groups in particular—Medical Justice, Women for Refugee Women and Liberty—which have been constant companions on the journey for reform.

We have heard a number of reasoned and thoughtful voices in this debate. I shall be neither of those things. I had to be dragged kicking and screaming away from voting against the Immigration Bill and every part of it that dealt with the detention of women, or indeed detention, in due regard for the efforts of the Government to recognise that a well-entrenched policy in the Home Office was in need of root and branch reform. The then Immigration Minister presented it skilfully, I am sure with the support of the then Home Secretary, who is now our Prime Minister. As my hon. Friend the Member for Enfield, Southgate (Mr Burrowes) mentioned, the Prime Minister has shown a sensitive interest in trafficking issues, many of which overlap with the issues that we are debating.

Here we are again. We have heard from members of the Scottish National party, the Liberal Democrats, the Democratic Unionist party, Labour and the Conservatives, in a cross-party consensus, arguing for the replacement of the default of detention with a case management system for those in this country with no right to remain, for the important reason, as the hon. Member for Glasgow North East said, that it is the most cost-effective and most just method of doing things.

The Shaw report, produced in January 2016, contains 64 recommendations. How many of those have been accepted, and how many have been implemented? I would like to ask the Minister how many victims of torture, rape and war crimes are currently in detention, but as we know, it is difficult for him to answer, because how do we differentiate a claim from a proven fact? He can get around that, but the man or woman in detention cannot, because the system in immigration detention is that if they cannot prove that they were a victim of rape, torture or war crimes, the claim has to be denied. That has led systematically to the detention of men and women who are vulnerable because of their physical history and their treatment, in a country that likes to call itself civilised.

With Stephen Shaw, we got a light that we could shine on Governments, of whatever colour, to say that this is not acceptable in a modern society. There are better alternatives, and we—this Government—have the courage to implement change, so that we will never again have to ask such questions about the detention of victims of torture, rape or war crimes. I do not want to ask those questions any more.

The Government have made some progress. They have drafted a detention services order on segregation—the most significant part of detention—but the draft order was deficient in many respects. It said that someone could be segregated for being a refractory detainee, defining “refractory” as “stubborn, unmanageable or disobedient”. I know many MPs who are stubborn, unmanageable or disobedient, but I would not say that they should be segregated.

I could well be. So why is that in the draft DSO? Why is it not phrased more tightly? There is not enough protection in the draft DSO against detention of more than 14 days, which was itself deemed unacceptable, but which the draft DSO said might be possible and could be applied for. No—we will not have that. We shall not have that, if the Government really mean business. The Government have really got to get to grips with the fact that they have to provide mental health support—the personnel there making the judgments—before they segregate anyone because of their mental health status.

I do not have enough time to go into more controversial topics about which I am slightly more passionate than the ones that I have mentioned. I will just say that the care progression plans that my hon. Friend the Minister outlined in his response to my hon. Friend the Member for Enfield, Southgate are the way in which this Government can demonstrate progress. So, can my hon. Friend the Minister please give us an assurance that he remains committed to those plans and that they will be implemented by the end of the year?

It is a pleasure to serve under your chairmanship once again, Mr Davies. I congratulate my hon. Friend the Member for Glasgow North East (Anne McLaughlin) on securing this debate, particularly as she has campaigned for many years for the rights of the very people who the UK Government choose to detain. She made a powerful and at times emotional speech.

I also pay tribute to my hon. Friend the Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron), the hon. Member for Enfield, Southgate (Mr Burrowes), the hon. Member for Bedford (Richard Fuller), who asked some very pointed questions, and the hon. Member for Strangford (Jim Shannon), who used his Westminster Hall season ticket to give a very thoughtful speech this afternoon.

The Scottish National party has long opposed the UK Government’s approach to immigration detention, which is not only inhumane but ineffective and hugely expensive. It is inhumane because it allows the indefinite detention of vulnerable people without a time limit and children and pregnant women to be detained; it is ineffective because evidence confirms that the longer a person is detained, the less likely it is that their detention will result in removal; and it is expensive, as we are detaining far too many people at great cost to the taxpayer, many of whom are not removed in any event.

The SNP’s position on immigration detention is very straightforward: we oppose indefinite detention. We oppose an abhorrent policy that allows pregnant women and children to be detained in these environments; instead, we favour an alternative approach that treats people with respect and dignity, helping those in need but still enabling us to abide by our responsibilities. We also support the calls for immigration detention to be limited to 28 days and for it to be replaced with community-based solutions. We believe that detention should always be the last resort.

The UK is the only country in Europe that allows vulnerable people to be detained in prison-like detention centres for an indefinite period. The former director of Liberty, now Baroness Chakrabarti, has spoken about

“The scandal of limitless detention”.

She has explained how this inhumane practice was designed “unashamedly for administrative convenience” and said that it is

“one of the greatest stains on the UK’s human rights record…a colossal and pointless waste of both public funds and human life.”

The Home Office defends its inhumane approach to immigration detention by saying that detention can be used

“where there is a realistic prospect of removal within a reasonable period.”

However, that defence does not stand up to scrutiny. According to Government statistics, 7% of detainees have been detained for more than six months and in 2016 only 47% of those leaving detention in the UK were being removed from the UK. The figure for Dungavel detention centre is even more stark: a mere 23% of people leaving detention were being deported. However, those statistics do not reflect the true scale of detention in the UK; migrants detained in prisons by the Home Office rather than in immigration removal centres are arbitrarily excluded from them.

As we have already heard, in 2015, following a number of shocking stories that laid bare the toxic legacy of the UK Government’s present and past approach towards immigration detention, Stephen Shaw carried out a review of the welfare of vulnerable people who had been forcefully detained by the UK Government. My colleagues and others have spoken about this issue in great detail, but it is worth noting some of the Shaw report’s findings, which confirmed that the UK detained too many people and that detention was not an effective approach to removing people who do not have the appropriate right to live here.

The Government have appeared to accept many of Shaw’s recommendations; it is an indictment of them that, more than a year on from the report, the number of people spending more than two months in detention has actually increased. More than half the detainees across the UK and more than three quarters of those in Dungavel were released back into the community. If any other Government service or Department had that rate of failure, there would be demands for an urgent inquiry, to establish why so many people were being incorrectly detained and why so much public money was being wasted.

Those who defend the detention of innocent people in these prison-like environments suggest that the public generally support this policy. I can state firmly and with some authority that that is not the case in my constituency of Paisley and Renfrewshire North. Members might remember that, in an attempt to close Dungavel, the UK Government submitted a planning application to Renfrewshire Council for a short-term immigration detention centre to be built near Glasgow airport. That application was soundly and firmly rejected in a rare cross-party and cross-sector political and civic show of unity. Renfrewshire wanted no part in the UK Government’s inhumane, ineffective and expensive approach to immigration detention.

The Minister’s desire to build a short-stay detention centre in my constituency was put forward only to make it easier to deport vulnerable individuals from their homes. That shameful approach would have resulted in individuals being moved hundreds of miles away from their homes, their families and their legal advisers. Again, the application for the centre was put forward with little concern for the rights of asylum seekers.

On that point, I have recently contacted the Minister about one of my constituents, Jorge Kidane, who has been moved hundreds of miles away from his family to Brook House immigration removal centre in London, where he has been for seven months. My constituent is a Spanish national but has lived in Paisley for 16 years and wants to move back to Dungavel to be closer to his friends and family. I would be grateful if the Minister could treat this case as a matter of urgency, because Mr Kidane’s mental health is deteriorating severely.

I return to the issue of the detention centres themselves. In the response to me confirming that the UK Government had decided not to appeal the refusal of planning permission for a new centre in Renfrewshire, the Minister helpfully stated that the UK Government were reviewing the detention policy being used in Scotland. At first glance, that seemed a positive move and something that the SNP have long called for. We do not believe that the UK Government’s approach to immigration works for Scotland. We have continually called for immigration to be devolved, to allow Scotland to deliver a more flexible and humane immigration system that meets our own needs.

However, that review will be carried out away from the public eye, it will not consult widely with the public or experts, and its findings will not be published. The fact that the UK Government plan to review immigration detention away from the public gaze is telling, because the effectiveness of their approach is not and cannot be supported by evidence in any way whatever. The Government approach is flawed and ineffective. They should consult widely, listen to the views that have already been expressed in this place and beyond, and adopt a fairer and more humane approach to immigration detention—particularly the detention of some of the most vulnerable people in society.

As my hon. Friend the Member for Glasgow North East has said, Scottish Detainee Visitors carries out invaluable work. SDV staff have met people in detention who have serious physical health issues, including some people with scars that strongly support their claim to have been tortured. SDV staff have also met people in detention who are suffering from mental ill-health, including people with pre-existing serious mental health conditions, such as schizophrenia, and people whose mental health has deteriorated as a result of their indefinite detention.

The latest inspection report on Dungavel by Her Majesty’s inspectorate of prisons highlighted concerns about the detention of vulnerable people, including a torture survivor and a women with a serious health condition. There are 14 bed spaces for women in Dungavel, compared with 235 bed spaces for men. In a film made by SDV, one woman who had been detained in Dungavel described her experience there as being like that of

“a chicken surrounded by dogs”.

Over the years that SDV has been visiting detainees, it has not been unusual for there to be just one or two women detained at the Dungavel centre. That is an isolating and potentially frightening experience, particularly in light of research by Women for Refugee Women showing that many detained women have historically suffered from gender-based violence.

The most recent inspection report on Dungavel noted that

“there were inevitable risks associated with holding women in a predominantly male population”

and that there were no specific policies focusing on this issue. That report recommended that

“a specific safer custody and safeguarding policy should be developed for women.”

I definitely support that call.

Regarding legal issues, wherever detained people are held, they are subject to frequent and arbitrary moves around the detention estate. Those moves are disruptive and disorientating for anyone who has been detained, but when the move is between Dungavel and centres in England the consequences can be particularly serious because of the differences between the legal systems in England and Scotland. A move to England often takes place just before an attempt is made to remove someone. It may not then be possible for a Scottish solicitor to make representations on a person’s behalf in England, and there may not be time to find an English solicitor to challenge a possibly unlawful removal.

As a country, we are better—much better—than the immigration policies that we have in place. Those policies do not stand up to scrutiny and are a blight on our human rights record. The UK Government should and have to use their power to reject this failed approach and replace it with one that treats people with respect and dignity.

It is a pleasure to serve under your chairmanship, Mr Davies. I congratulate the hon. Member for Glasgow North East (Anne McLaughlin) on securing this really important debate on a subject that does not get enough public scrutiny.

In 1998, the Labour Government—my Labour Government—published a White Paper with the title “Fairer, Faster and Firmer—A Modern Approach to Immigration and Asylum”. That Labour Government had many great achievements to their credit but this White Paper, and the legislation and the actions pursuant to it, was not one of our finer moments. It was that White Paper, and the legislation that followed, that led to a flurry of new detention centres being opened, mostly under the private finance initiative—Oakington, Yarl’s Wood, Dungavel and Harmondsworth. That is how we went from fewer than 50 immigration detainees in 1988, mostly detained within the airports where they had come in, to the current figure of 3,000, with the number of people detained at one time or another during the year now exceeding 30,000.

It is important to remind the House that we were told initially that we should not worry about due process, human rights and fairness because the people would be held for only a few months, but there is now very little due process around immigration. That is why we are faced with exploding numbers and a situation that is hard to defend.

Stephen Shaw was asked to report on the detention of vulnerable persons, and he recommended a series of exemptions for vulnerable immigration detainees, including, as we have heard, for victims of rape and other sexual or gender-based violence such as female genital mutilation; for those with a diagnosis of post-traumatic stress disorder; for transsexual people; and for those with learning difficulties. He also called for a presumptive exclusion of pregnant women to be replaced by an absolute exclusion, and for the words, “which cannot be satisfactorily managed in detention” to be removed from the section of the guidance covering those suffering from serious mental illness.

I am interested in hearing from the Minister how far advanced we are in putting in place those exemptions recommended by Stephen Shaw, who the Government themselves asked to report on the detention of vulnerable persons.

We have seen the explosion in numbers. The hon. Member for Glasgow North East asked the question more than once: given that it is so expensive and there are so many human rights issues involved, why do we not examine cheaper and more effective methods of managing immigration detention, possibly in the community? I have followed this issue for my entire career as a Member of Parliament and I am afraid that, for me, the reason the Home Office seeks to cling to the notion of immigration detention is that it is seen as a deterrent. There is always a debate in immigration policy between push factors and pull factors, and the notion, certainly at the time, was that if individuals were detained in this way—quietly, contrary to any due process and with no consideration of their human rights—that would somehow deter people from seeking to come here as immigrants and asylum seekers. Of course, that has not proved to be the case.

The hon. Member for Glasgow North East also talked about cost. The annual cost for one person is £34,000 and the total annual cost of detention is approximately £120 million. It is hard to believe that we could not spend that money on dealing with whatever immigration detention challenges we face more humanely, and in a way that reflected better on us as a country.

I have done a certain amount of work with Bail for Immigration Detainees and it has briefed me on some cases it has dealt with recently. Last week it won bail for a client who had spent 15 months in detention after serving a six-week prison sentence. How can that be proportionate? It also had a client held in detention in prison for almost a year, despite mental health problems and an outstanding appeal; and a male client, the sole carer of a child, who had a serious health condition and who was released on bail after nine months in detention. Another client spent 27 months in detention despite the fact that it would not be possible to remove them anyway and, finally, a client was released in January after spending two and a half years in detention, despite suffering from schizophrenia and, again, despite not being removable. Those cases are unacceptable, and I think that Members on both sides of the House want to hear what progress the Government are making towards living up to what the Shaw inquiry said.

Stephen Shaw also stated that there is little or no correlation between the number being held and those later deported, and that other methods, such as electronic tags, should be considered. He talked about mental health, which right hon. and hon. Members have spoken movingly about, and he also mentioned the number of cases in which the Home Office has breached article 3 of the European convention on human rights in respect of detainees.

I have always taken an interest in detention because of having been in Parliament when there was the explosion of detention that we now see. I am perturbed that, although I have been asking since November to visit Yarl’s Wood detention centre, we have yet to have a reply from Ministers. I remind the Minister, in case it has slipped his mind, that the chief inspector of prisons described Yarl’s Wood as a place of national concern. It was burned down three months after it was opened and there are current accusations of abuse, poor healthcare and inappropriate sexual contact. I put it to the Minister, therefore, that if four months after I first asked to visit he is not able to respond, people might ask what he has to hide.

In common with Members of all parties who have spoken in the Chamber today, I think it is time to address the long-running concerns about immigration detention—concerns that go back to the measures introduced in the ’90s by a Labour Government. I have talked about the role of the Labour Government because I do not approach the matter from a party political perspective. I have visited Campsfield, Oakington and Yarl’s Wood and, with the help of the Minister, I will visit Yarl’s Wood again. The conditions in which these people are held is a shame for this country. If people have a criminal record and should be deported at the end of their sentence, it is for the Home Office to organise itself so that they can be deported directly from prison. People should not be deprived of their liberty, with no due process, because the Home Office is chaotic in how it deals with people who have a recommendation of deportation when sentenced.

In common with other speakers this afternoon, I think we need to see an end to indefinite detention. I am glad that the numbers of detained children have fallen, but there are still 71 children entering detention, and that is 71 too many. Despite the fact that this subject does not excite the attention of the tabloid press and that Ministers might think there are not many votes in making immigration detention fairer and more humane, this is a long-running cause for concern. I hope that, decades after we introduced immigration detention at this level and on this scale, the Government will move to bring about some of the changes recommended by Stephen Shaw.

I shall be delighted to allow the hon. Member for Glasgow North East (Anne McLaughlin) a minute or so at the end. It is a pleasure to serve under your chairmanship, Mr Davies, and I congratulate the hon. Member for Glasgow North East on securing the debate.

I welcome the opportunity to set out the Government’s position on these matters and to address the points raised by right hon. and hon. Members. Where a specific case has been mentioned or there has been a request for statistics, it may be better if I write to the Members concerned, not because I cannot give them that information but because time is restricted.

Detention and removal are an essential part of an effective immigration control system, but it is vital that they are carried out with dignity and respect. Indeed, I have visited a number of detention centres myself, including Yarl’s Wood and, recently, one in Belgium. The Government there face similar challenges and have similar facilities to the ones in the UK. We expect those who have no right to remain in the UK to leave the UK voluntarily, and we have programmes in place to support voluntary return. In many of the cases that have been discussed, people will have had the opportunity of an assisted return. There are financial packages and the airfare is picked up by the British taxpayer.

When people with no right to be here refuse to leave of their own volition, it is absolutely right that we take steps to enforce their removal. In those cases, detention may be necessary as part of that process. However, there is always a presumption of liberty for an individual, and the decision to detain any person under immigration powers is never taken lightly. Our policy already makes it clear that detention must be used sparingly and for the shortest period necessary. We are certainly not driven by any ideological motives, as was alleged at the beginning of the debate.

We take the welfare of detainees very seriously. That is why in February 2015, the then Home Secretary commissioned Stephen Shaw to carry out an independent review of the welfare of vulnerable people in the detention system. Mr Shaw’s report was published in January 2016, alongside the Government’s response. In our response, we accepted the broad thrust of Mr Shaw’s recommendations and set out three key reforms. First, a new ‘adults at risk’ concept was introduced into decision making around detention, with a clear presumption that vulnerable people at risk of particular harm should not be detained, building on the existing framework. The second reform was the detailed mental health needs assessment in immigration removal centres, along with a joint mental health action plan developed with the Department of Health and the NHS. Although the action plan applies to England, we will work with colleagues in Scotland and Northern Ireland to share information and best practice on the provision of mental health services in the immigration detention estate. The final reform was a new approach to the case management of those detained.

Taking those reforms in reverse order, work has been ongoing to design a more effective case management process to replace the existing procedure for reviewing detention. Case progression plans take a more proactive approach to the monitoring and review of ongoing detention, with a focus on removal or, if appropriate, release. They are being piloted across the Home Office, and the pilot will then be subject to evaluation. As well as introducing case progression plans for individual detainees in February 2017, we also introduced case progression panels, which provide an increased level of oversight of cases within the detention estate. Although internal, the panels operate independently of the officials working on detention operations and aim to reduce the number of long-term detainees.

Turning to mental health, the Government published a joint Department of Health, NHS and Home Office mental health action plan on 1 December. The plan will improve our understanding of detainees’ mental healthcare needs so that the right interventions are available and we can manage effectively the removal of such individuals from the UK, or their transfer within the detention estate or back into the community. In addition, a more detailed mental health needs assessment will be carried out in immigration removal centres, using the expertise of the Centre for Mental Health. That was published on 9 January 2017. NHS commissioners will use that assessment to consider and revisit current provision to ensure that healthcare needs are being met appropriately.

I will expand a little on mental health, which was raised during the debate. Detainees are seen by healthcare staff within two hours of arrival and often have an appointment with a medical practitioner within 24 hours. Clinical pathways into other healthcare services, such as mental healthcare services, are initiated at that point, depending on the outcomes of the reception scheme. We take health needs seriously, particularly mental health.

The final element of the Government’s response to Stephen Shaw’s review was the new “Adults at risk in immigration detention” policy, which was implemented on 12 September 2016. The policy recognises the dynamic nature of vulnerability and strengthens the existing presumption against the detention of those who are particularly vulnerable to harm. The intention is that fewer vulnerable people will be detained and that, where detention is necessary, it will be for a shorter time. The adults at risk policy is based on a case-by-case assessment of the appropriateness of detention, based on the nature and evidence of vulnerability available in each individual’s case. That evidence of vulnerability is assessed against any immigration control factors that apply in the individual’s case, such as the likely speed of removal and any public protection concerns. That is particularly important where we have foreign national offenders.

Individuals are detained only if the immigration considerations in their case outweigh the vulnerability considerations. The policy recognises a broader range of individuals as vulnerable than the previous policy, and we expect the policy to have the greatest impact in the cases of individuals who are most at risk, including—we heard some of these examples during the debate—victims of sexual or gender-based violence such as FGM, transsexual individuals, individuals suffering from learning difficulties and individuals suffering from post-traumatic stress disorder. All those groups are explicitly regarded as vulnerable in the context of the policy, in line with Mr Shaw’s recommendations.

The adults at risk policy has a statutory basis by virtue of the Immigration Act 2016. It is worth noting that through that Act we have placed a 72-hour time limit on the detention of pregnant women for removal or deportation. With ministerial authorisation, that can be extended up to an absolute maximum of one week in total. We also made it clear in the Act that pregnant women would be detained only if they could be removed from the UK shortly or if there were exceptional circumstances that justified the detention. In addition, we have placed a duty on those making detention decisions in respect of pregnant women to have regard to the woman’s welfare. We have asked Stephen Shaw to carry out a follow-up review later this year to assess the implementation of all the recommendations from his previous report.

Equally important to our strategy for detention is the need to keep our detention estate under constant review to ensure that we have the right resources in the right places and that we are providing value for money. The announcement of our intention to close Dungavel immigration removal centre was part of our wider estate planning. The closure was, however, dependent on the opening of a new short-term holding facility in Scotland. It was disappointing therefore that the planning application for that facility near Glasgow airport was rejected by Renfrewshire Council. Dungavel will therefore remain open for the foreseeable future, and we will continue to work with the centre service provider to ensure that Dungavel continues to receive positive reports from Her Majesty’s chief inspector of prisons.

One of the points raised in the debate was the protection of vulnerable families. The Government ended the routine detention of children for immigration purposes in 2010 by fundamentally changing the system to ensure that the welfare of the child was at the heart of every decision we made. That will remain the case at the new pre-departure accommodation. Pre-departure accommodation remains an essential component of the family returns process. The decision to accommodate families at a PDA is taken only after they have exhausted all legal challenges to their departure and have refused to comply with other options for return, and only after advice has been obtained from the independent family returns panel. Children with families can be accommodated for 72 hours prior to departure and no longer, without my personal authorisation.

A number of Members made the allegation that we are not doing better and are slipping backwards. I reassure Members that the Home Secretary and I are personally committed to ensuring that every individual in detention is treated with dignity and detained for the minimum time possible. The welfare of vulnerable people is particularly important to me, and Members can be assured that I am determined to see through the reforms started by my predecessors. I have invited Mr Shaw to return and review his policy and the work later in the year.

One particular point was made about the victims of trafficking. Home Office staff working in all immigration removal centres, including Yarl’s Wood, have been trained as first responders to identify signs that individuals may be victims of trafficking or slavery. Where an individual is identified as a potential victim, they are referred to the national referral mechanism for assessment. If the NRM takes a positive decision that there are reasonable grounds, the individual will normally be granted temporary release for a 45-day recovery and reflection period, unless detention has been maintained on the grounds of public order.

In conclusion, I hope that I have expressed the seriousness with which the Government take the welfare of those detained. The measures we have put in place, including the adults at risk policy, the statutory protections for pregnant women, the improvements to the approach to caseworking and the mental health action plan, represent a comprehensive package of safeguards for all vulnerable people in the immigration system who are detained or who are liable to detention, especially the most vulnerable.

I feel quite depressed now, because a number of questions have not been answered, although I accept that the Minister said he would write to us. I think I will write to him and remind him of some of those questions. One of the fundamental things he has not addressed is the gap between stated policy and practice. Policies are not being carried out in practice, and we have given numerous examples of that.

Will the Minister have a meeting with me and some of these groups, which have a lot of experience of detention and a lot of valuable information about the alternatives? He has not answered why we are not using all the alternatives that are far cheaper and far more effective. Why are we not looking at following those? Will he agree to that meeting? He is very good at agreeing to meet me, and he has responded before. Will he please give me half an hour of his time to sit down with some people who know exactly what they are talking about so that they can try to convince him a little bit more? It will save us money in the end and lead to a far better outcome.

Question put and agreed to.


That this House has considered the detention of vulnerable persons.

Primary Care: North Essex

[Mr Philip Hollobone in the Chair]

Order. Would those who are not staying for the debate please leave quickly and quietly? Television sets are being switched on all over Essex to hear the hon. Member for Clacton (Mr Carswell) move the motion and start his debate. I call Mr Douglas Carswell.

I beg to move,

That this House has considered primary care in North Essex.

I am grateful for the opportunity to have this debate. We face a serious problem of primary care provision in our corner of Essex. To put it bluntly, there are not enough GPs. In my part of Essex, there are three local GP surgeries, which are not taking on any new patients at all. Those fortunate enough to be registered with a surgery often struggle to get an appointment.

Here are some of my constituents’ experiences, pulled out from my postbag in the past three weeks, to give a flavour of what they are having to put up with. An elderly lady from Little Clacton wrote to me a couple of weeks ago:

“On attending the practice, I realised that there was an average of three weeks waiting time to see a GP. … When I did finally get seen, the practice nurse said, and I quote, ‘You have to be at death’s door to get an urgent appointment on the NHS now.’”

This is a woman who has spent decades paying into the system, unable to see a doctor for three weeks.

Then there is a lovely lady from Kirby near Frinton who emailed me, saying:

“I’m writing to say how abysmal the doctor’s surgery is now. I waited two weeks for an appointment, only to be told to go to a different surgery if I wasn’t any better in two weeks.”

There is not much sign of customer service there, is there?

Finally, a man from Clacton wrote:

“I am my mother’s carer. I’m not a doctor. I just do my best and feel abandoned by my medical practice. I am having great trouble making appointments for my mother to see a doctor so that we can control her pain.”

Those are not isolated cases. My postbag is full of examples—it is fair to say that something is badly wrong with primary care in our part of Essex. What concerns me is that it was possible to see the problem coming. Back in September 2013, I led a delegation of GPs to see the Health Secretary to flag it up, precisely because GPs said the problems were going to happen.

To be fair to Ministers, we in this room all know—I hope people outside know it too—how disastrous the 2004 GP contracts were. They were certainly disastrous for those who are meant to be provided with primary care—but that is now more than a decade ago. We also recognise that a Minister cannot, as I think Nye Bevan put it, be held responsible for the “sound of every dropped bedpan” in every NHS surgery and waiting room. In fairness, I do not think we can blame Ministers for the failure of individual surgeries to get their appointment systems sorted out. But the question is, who does take responsibility? Who will answer to my constituents for these failings?

It is clear there has been a failure to provide the level of primary care that is needed in our part of Essex. What is less clear is who we hold to account. We have an alphabet soup of different agencies and quangos in charge, but none of them seem to be properly responsible. There is something called the CCG—the clinical commissioning group. It allocates the money and the patient is then expected to follow. The technocrats commission and the patient is expected to follow. Then there is the CQC—the Care Quality Commission. It inspects the GP surgeries. Would it not be better if surgeries had to satisfy customers and not simply comply with CQC assessments? Then, of course, there is NHS England, and in our part of Essex, something called ACE—Anglian Community Enterprise—which provides certain primary care services.

I have raised concerns with all those different branches of NHS officialdom on behalf of constituents and I have done so repeatedly. Promises are invariably made. I am told that we will get more GPs, that new contracts and a new kind of contract will be sorted out—always tomorrow. Not much ever actually seems to change on the ground.

Sometimes I am told, or it is implied—they do not dare tell me this any more because I react very strongly to it—that all of this is to be expected. There is, they say, an elderly population in our part of Essex. The profile of the patient group, I was once told, means that there is all this extra pressure.

Those sentiments are excuses for failure; they are not credible reasons. We should not be in the business of blaming people for being elderly. After all, if someone is elderly, it means they have paid more into the system. In what other walk of life or area of activity is a surfeit of customers regarded as a problem? In Clacton, it is possible—I speak as a father—to go shopping for the family 24 hours a day, seven days a week, so why is it not possible to see a GP on a Saturday if a child is ill?

At the root of the problem is a system of state rationing—it is probably one of the last vestiges of the mid-20th century system of state rationing—in which the patient is expected to stand in line and wait. The patient is made to follow the money. We need a system of primary care in which the money—for a taxpayer-funded service, free at the point of access—follows the patient.

Ministers are absolutely right to want to see surgeries open on a Saturday, at weekends and in the evenings. Heaven forbid, if we really had a system of primary care that responded to my constituents’ needs, there might even be GP surgeries in railway stations, where quite a large number of my constituents tend to congregate in the early morning and late evening. If we are to have a more accessible, customer-focused service, it means making the patient king. It is not something that can be done by top-down design or by ministerial decree. Good customer service comes from the need to please customers, not from on high.

GPs tell me that the burden they face could be alleviated in part if more people were willing to use and made better use of pharmacists. There is a lot of truth in that. Pharmacists are highly qualified and often very experienced, and we are right to look into that. I say this in the week when we have finally passed the legislation to get us out of the EU, but perhaps we could learn from some of our European neighbours who seem much better at making good use of pharmacists, particularly Italy and France. I gather that in Germany people do not have to depend on the equivalent of a GP acting as a gatekeeper in the way that we do in this country. I would be very grateful if the Minister could elaborate and talk about not just what we can do to alleviate the problems in our part of Essex but the far-reaching reform that is needed if we are to make sure that people who have spent all those years paying into the system can be seen by a doctor when they need to.

I recognise the issues that my hon. Friend rightly raises. Does he agree that a direct result is the considerable pressure placed on the general hospital in Colchester, which serves his constituents and mine, and that the foolhardy decision to consult on the closure of minor injuries units and the walk-in centre in Colchester should be dropped immediately, because it is such a ridiculous idea? It will just put additional pressure on Colchester general hospital.

My hon. Friend, as so often, is absolutely spot on. His judgment is impeccable. The failure to provide people with the primary care they need when they need it means that more people then tend to go to A&E departments. The people who run the ambulance service tell me that that then causes a bottleneck in A&E, which has a knock-on effect on ambulance response times. Many of the problems we are grappling with are a consequence of the failure to provide accessible, customer-focused primary care where it is needed.

The consultation on the minor injuries unit and walk-in centre is irresponsible. I share the view that it would clearly be absurd to shut that facility. A lot of angst and worry could be addressed if the option was ruled out now, and I hope it is.

I am most grateful to the hon. Gentleman for inviting us to take part in his debate, and I commend him for securing it. We are now in the throes of the so-called sustainability and transformation plans, which are being constructed on the acknowledgment, confirmed by the Boston Consulting Group, that there has been underinvestment in primary care in Essex for 20 or 30 years. If the STPs are to address the demand on the primary care units and deal with the shortage of GP facilities, there has got to be a programme, supported by Ministers, of investment in primary care in Essex so that the GPs can do far more for their patients without sending them off to hospital.

The hon. Gentleman is absolutely spot on. This is a cumulative problem that has been allowed to get worse over decades—perhaps a generation or more. I am often struck by how some of the GP surgeries in my constituency are located in what started out as residential houses built in the 1930s. There has simply not been the investment that was needed over a long period of time. That is also part of the problem. To be fair to GPs, if we do not provide attractive surroundings and surgeries, people are not going to want to work in those 1930s houses. If anyone in the district council is listening, I urge them to take that into account when talking about new planning for the area. Some top-quality, first-rate surgeries in which GPs are happy to work would go some way to addressing the problem.

I am incredibly grateful to the Minister for coming along to respond, and to the hon. Members for Harwich and North Essex (Mr Jenkin) and for Colchester (Will Quince), who are committed to this issue and have done a lot of work for their constituents. I hope to hear from the Minister not only about how we can get more GPs in our area but about the reforms we need to change the way people obtain primary care, so that they are no longer supplicants standing in a queue to receive care on the system’s terms but valued patients who get the care they need when they need it.

It is a pleasure to serve under your chairmanship, Mr Hollobone. I congratulate the hon. Member for Clacton (Mr Carswell) both on obtaining the debate and on the lucid way he put forward his case. I thank my hon. Friends the Members for Colchester (Will Quince) and for Harwich and North Essex (Mr Jenkin) for their points, which I will try to answer.

There is an issue with the number of GPs in the CCG in that part of north Essex. I will talk a little about why that is the case and what we can do about it. It is very hard to make progress on a number of the issues that were raised without fixing that problem. We are short of GPs across the country, but we are particularly short in the North East Essex CCG. Let me give some numbers for context. There are 40 GP practices and a little over 210 GPs within the CCG, which covers 330,000 people. The CCG estimates that it is 28 GPs short. I spoke to it this afternoon, and I was told that if any GP wants to get a job in Clacton, it will not be a difficult process. Indeed, the figures for Clacton and the coast are marginally worse than those I have just given.

That is somewhat mitigated by the fact that the CCG has more nurses than the UK average. That might well be to do with the walk-in centres and minor injury units, which are nurse-orientated. I will come on to talk about how we can work in a slightly different way—this was implied by the remarks of the hon. Member for Clacton—by making use of other disciplines, such as pharmacists, physios, allied health professionals of different sorts and mental health professionals. The CCG now has 10 full-time pharmacists, and there is a plan to increase that number considerably between now and 2020. Frankly, it is easier to recruit pharmacists than GPs, but we need GPs too.

I will spend a little time talking about the reasons for that. I spoke to the CCG about them in some detail today. As the hon. Gentleman mentioned, Clacton has an older population, which causes problems, and there may be contractual issues relating to that, although the GP contract allows extra money for areas of deprivation and those with ageing populations. There are no training GP practices in Clacton, which puts it at a disadvantage, as GPs are likely less to go there as part of their training and then stay. It is also true that Clacton has a higher than average age demographic of GPs, so there is a higher tendency for them to retire, which exacerbates the situation. I concede that there is a problem, and I will talk about some of the things being doing about it. The hon. Gentleman used the phrase “jam tomorrow”, and I am afraid that some of it might sound a bit like that.

I want to draw attention to some of the things that the CCG in north Essex does well. We often talk about issues to do with locations—bricks and mortar—whether minor injury units or hospitals, but all MPs, including me, should properly evaluate our CCGs on the full set of published metrics. We have done an awful lot on transparency. I will just mention some of the things that the CCG does well. The hon. Gentleman’s CCG is well above the national average for cancer diagnosis in stage 1, for dementia care planning, for organising health checks for patients with learning disabilities, and for organising care packages for people with mental health episodes. I say that to put its issues in context. It is clearly true that there are difficulties with access and, to a lesser extent, with getting on lists in the first place.

The hon. Gentleman rightly made the point that we should be following the patient. We do a lot of work across the NHS and with every CCG to poll patients to ascertain how satisfied they are with the level of service they have received. North East Essex CCG received something like 82% patient satisfaction—lower than the national average. It is thought that the figures for Clacton are likely to be lower than the CCG average as a whole, so I will not hide behind that number.

In terms of what we are going to do about it, I will start by talking about some national initiatives—the comment about STPs related to that—and the need to invest more in primary care. There are two national initiatives that I want to mention. First, there is the GP five-year forward view. I know it sounds like jargon, but it redresses the persistent underinvestment in primary care over the past decade or so. Between now and 2020, there will be a 14% real increase in primary care across the country, which will manifest itself in the workforce and in different ways of working. That is real money; it is accepted by the British Medical Association’s general practitioners committee. It is very welcome, and frankly it has been a long time coming.

If we were designing an NHS today, with the sort of patient environment we have now, we would not design it around acute hospitals, as was done in 1948. We would design it much more around long-term conditions—diabetes, dementia, heart disease and so forth—which account for 70% of the NHS’s total cost and mean that much more can be done in the community. That is our very clear direction of travel.

Although I very much welcome those plans and the steps the Minister is hoping to take in relation to primary care, there is still very serious pressure on Colchester general hospital. I welcome last week’s Budget announcement of £100 million for triage services in accident and emergency units. Will the Minister give serious consideration to making Colchester general hospital a pilot for that, which would help to alleviate some of that pressure?

My hon. Friend may be relieved to hear that Colchester general hospital is not in my portfolio, but I will speak to my ministerial colleagues about it being a pilot and write to him.

A moment ago the Minister mentioned some extra money for primary care. Who is responsible for investing that money? Does it come from NHS England and not from the CCG? How do we influence how that money is spent, so that there is some accountability in the process?

All money goes into the health service through NHS England, which used to be called the NHS Commissioning Board. The money is then given to the CCGs around the country to spend. In terms of a funding formula and so on, there are some specific primary care initiatives, including infrastructure-based ones for new premises and things of that type, and specific ones, which I am about to talk about, such as recruiting more GPs. We absolutely need more GPs, not only in Essex but across the country, although we do need them in particular in parts of Essex. The responsibility for that lies with NHS England, through the CCG. It is the CCG that has the accountability—to answer the earlier question, “Who do we blame for this situation?”—and I want to make that quite clear.

As for what all that means, we have workforce issues in primary care, and the Government and NHS England are committed to having 5,000 more doctors working in primary care by 2020, which should mean more availability and vacant jobs in Clacton being filled. We are determined to meet that commitment with progress made this year, with more medical students going into GP training than has ever been the case before in the history of the NHS—just over 3,000 of them. The hon. Member for Clacton was right to talk about pharmacists, and we also need to make progress with them. We aim to have 2,000 pharmacists working in primary care by 2020, as well as 3,000 mental health therapists.

All of that matters, but in addition we have to allow people to work in a different way from how they have up to now, and some of that is happening across the CCG in Essex. Broadly speaking, however, we find that a GP hub of 30,000 to 40,000 patients enables more scale. That would let us employ physios, pharmacists, mental health therapists and, indeed, social workers—in terms of the relationship with hospitals and the transfer of patients—and to have longer opening hours. I therefore completely accept the hon. Gentleman’s points about working and being open on a Saturday. We are determined to achieve that by 2020, although we are starting from a difficult position in Essex, given the lack of GPs generally. Only by collaboration and working across practices will we make progress. The model of a single GP practice—and such practices still exist—is self-evidently not viable and does not allow us to do some of the things that we need to in primary care, such as employing pharmacists and other such disciplines.

Those are my general comments, but I completely agree that unless all that lands in Essex, it is just words. Judge and jury on it will be the extent to which we are successful in landing some of that stuff in Essex. To address the specific issues, I will now talk about a number of things that have gone on in the hon. Gentleman’s local CCG. Of the nine practices in Clacton, a number have been closed to new patients, as he said. I am informed that the East Lynne practice, the Ranworth practice and the St James practice all closed to new patients in 2015, but two of those are now completely opened. The other has temporarily closed again but is expected to reopen soon. On the statistic he cited at the start, my understanding is that only one practice in Clacton now has no immediate opening in its list. The CCG has worked hard on that.

There are clearly specific issues with getting people with a GP background to move into the area. The CCG has put in place a workforce plan to address matters of recruitment and retention of GPs principally, but also of pharmacists, nurses and allied health professionals. Again, the judging of that will be in something actually happening and the vacancies in Clacton being filled. The plan exists and is being managed, and I understand that the CCG expects to make progress with it.

The practices in the CCG have come together in three collaborative groups, covering about 80% of the total number of patients seen, although the patient who sees the same GPs from the same practice and goes to the same clinic might not realise that. GPs are working collaboratively in a way that should enable better leverage of their time—I return to that point made in connection with pharmacists. We have to get away from every patient’s principal contact in the primary care system having to be a GP, rather than other professionals who could help a great deal. For example, I was recently in a practice where a pharmacist was conducting a diabetes clinic. Diabetes clinics are routine, happening perhaps every month or so, with a set of standard questions to be asked, and there is absolutely no reason why they need to be conducted by a GP, as opposed to a pharmacist. That applies in Essex, too.

I draw the attention of hon. Members from Essex to a couple of grants lately given to practices in their area. A £46,000 resilience funding grant has gone to the Clacton GP Alliance and, in a specific effort, almost £400,000 of capital funding to three GP practices that are coming together I think in Clacton hospital. The CCG understands that the standard of premises and infrastructure in Clacton is generally weaker than in other parts of the country—certainly weaker than is needed to attract the sort of talent necessary.

I have a “jam tomorrow” point to make, but it is worth putting it on the record. There is a plan to have a medical school in Essex, in Chelmsford, I think in 2018. That will obviously help, because people who train as doctors in that part of Essex will be more likely to live there, enjoy living there and, in time, make their careers and lives there. We have found that to be so in other parts of the country; I hope it works for Essex.

In connection with the minor injuries and walk-in centres, I want to speak briefly about the consultation. Members have pointed out that it would be absolutely ridiculous if, by closing those centres or doing anything to affect patient flows, more patients were to go to Colchester hospital. That is self-evidently true, and the CCG believes so too. Interested Members will know that the consultation, which set out four options, has received more than 3,500 replies. In all fairness, I do not believe that the CCG was consulting in order to close; it was consulting because contracts were up, and it wanted to look at the options and how to do better. One view given to me was it was more confusing than it ought to be for patients to know where they ought to be.

I cannot say anything today about the outcome of the consultation, other than that the CCG board will consider the recommendations received in the 3,500 responses and the various other pressures that have been discussed today. Frankly, people in the CCG will also be listening to our debate today. I would be surprised if closure of the centres was top of the list, given the other pressures on GP practices, the hospital and so on. The decision will be made by the CCG at the board meeting on 30 May.

I will finish as I started, by saying that there is a problem with the number of GPs in Clacton and North Essex. The problem is understood and action is being taken that I hope does not all amount to “jam tomorrow”, to use the phrase of the hon. Member for Clacton. Although progress has been made in getting lists open and so on, clearly a lot more needs to be done. I am happy to continue to meet the hon. Gentleman in the months ahead if we are not making progress and getting things better.

Question put and agreed to.

Dog Fouling

I beg to move,

That this House has considered dog fouling.

The aim of this debate is to raise awareness of the ongoing problem of dog fouling, specifically in woodland and rural areas. I am a dog owner and a dog lover, and I must declare an interest: I sponsor a dog through Dogs Trust, the UK’s largest dog welfare charity, which runs initiatives throughout the country to encourage more responsibility among dog owners. Such efforts to encourage responsible dog ownership are welcome, but we need to do so much more. This debate is not about dogs or demonising dog owners; it is about the actions of irresponsible or ignorant dog owners and the environmental blight caused by dog poo that is dealt with inappropriately.

The Department for Environment, Food and Rural Affairs discontinued the collection of figures on the number of fixed penalty notices issued for dog fouling in 2010, as it was viewed as an unnecessary burden on local authorities. I agree—it would be enormously burdensome to keep collecting those data. The most recent figures show that 2,082 fixed penalty notices were issued in 2009. I gave the Minister some pictures before the debate to illustrate the extent of the bagged dog fouling problem. I suggest that those figures do not show the true extent of the problem.

Experience and anecdotal accounts from across the country show that this really is a big problem. It affects tourism, local authorities, private landowners, forestry commissions and farmers, as well as the public at large. I will refer later to the challenges that farmers face as a result of fouling on their farmland, as they have particular concerns about livestock safety, but the two key strands to my argument are the burgeoning nationwide problem of the inappropriate disposal of dog poo bags and how we can encourage the correct disposal of dog poo.

There is no one-size-fits-all solution to this problem. Solutions need to be appropriate to the surroundings, well publicised and simple to execute. There is no doubt that dog fouling is an antisocial and environmentally damaging problem. It blights parks, forests and farmland as well as fields and verges. To compound the problem, we have seen the rise of the phenomenon of the ghastly dog poo bauble. Walkers, cyclists and families out with small children are greeted by lumps of dog faeces wrapped in pink, blue, black and even apricot-coloured plastic dangling from trees or bushes, or decoratively tied to people’s fences. Deer ingest the bags, children may handle the packages and cyclists have even ridden headlong into bags dangling from low-hanging branches. It is disgusting. Some dog walkers use sandwich bags, freezer bags or even supermarket carrier bags to scoop up the poo before lobbing it off into the environment, where it festers, causing blight for years.

I accept that many bags are biodegradable, but even if they are marketed as such, they still hang around for a very long time. According to the BBC’s Focus magazine, it can take six months or longer for even degradable dog poo bags to decompose. Although that is a marked improvement on the 500 years that scientists think it takes for a normal supermarket plastic bag to decompose, they are still a prolonged blight on the countryside landscape.

Initially, I thought that this foul practice of lobbing poo in bags into hedges and trees might be limited to a few irresponsible owners, but a quick trawl of social media and news archives shows that the problem is rampant and growing across Britain. It is estimated that local authorities receive upwards of 70,000 complaints a year about dog fouling, which is no small number. Local newspapers are filled with reports of the problems that it can cause, and Twitter is alive with concerns raised by people about the impact that dog fouling, particularly bagged dog fouling, has on their area.

Is it just me, Mr Hollobone? I do not understand the mentality of the person who enjoys walking on a beautiful woodland trail and goes to the trouble of purchasing and carrying a dog poo bag, picking up the often smelly deposit and even carrying it for a short distance, but then takes the opportunity to lob the carefully wrapped package up into the trees. I just do not understand it, but believe me, a quick look on the internet shows that that happens thousands of times every day.

Dog walking is one of life’s pleasures. Long rambles in the fresh air are good for dogs and their owners. Dogs Trust and many other groups strongly oppose blanket bans on dog walking in parks, beaches or countryside areas. I agree with them that that would be a great loss to communities of people who meet in those areas with their dogs and would directly punish the vast majority of dogs and their law-abiding owners just because of a select few offenders.

There are approximately 9 million pet dogs in the UK. One in four households in the UK has a pet dog, and they produce 1,000 tonnes of poo a day, or 365,000 tonnes a year. That is the weight of the Empire State building in New York or, to bring the problem closer to home, 5.6 times the weight of St Paul’s cathedral in dog excrement every year. We have a huge, smelly problem, and dog poo baubles are a relatively new and disgusting phenomenon. Online posts from Slough, Dartmoor, Rhondda, Glasgow and Kent, to name but a few places, show that this is a countrywide issue that we really need to tackle.

Keep Britain Tidy’s 2014-15 local environmental quality survey of England addressed both dog fouling and bagged dog fouling. Statistics that it gathered prove that dog walkers are far more likely to collect and dispose of dog poo when it is light and they feel they are being watched. In the light of that, Keep Britain Tidy started a “We’re watching you” campaign, which featured a pair of eyes that glowed in the dark and was designed to reinforce the message: “If you let your dog foul in an urban or rural area, someone may be watching you.” Often, of course, they are not. That campaign, which was trialled in 17 local authorities in 2014, led to a 46% reduction in recorded fouling and bagged fouling, but too often, the dog poo bauble is lobbed into the trees, away from sight.

It is argued that people should simply “bag it and bin it”. Would that it were that simple. Human nature often leads people to take an easy way out. Carrying a bag of poo for several hours on a family walk is often seen as an unattractive prospect, so, having been picked up, the poo gets lobbed into the bushes. We need to ensure that there are dog poo bins in appropriate locations, but that is only part of the solution.

The strategic placement of bins in rural parks and countryside dog walking hotspots is a key aid to prevent people from incorrectly disposing of dog poo bags. The National Trust is trying to address this issue on its sites by placing dog poo bins in the immediate area of car parks. Its studies show that, on leaving a vehicle, the vast majority of dogs relieve themselves within 50 metres of the vehicle. Having maps in car parks for country walk areas showing the placement of bins would also encourage more people to bag and bin poo, as they may know that the next bin is only a short distance away.

But that scheme cannot tackle the problem of bagged dog fouling in less populated woodland and countryside environments—open wild spaces where locating a bin would be impractical or even detrimental to the natural landscape. Lawrence Trowbridger, lead ranger at the National Trust’s Ashridge estate, said in an interview in 2015 that the solution was not just about introducing more bins but about

“challenging the mindset of the dog walker”.

I completely agree, so how do we change that mindset? How do we educate the public and steer them into good countryside practice?

I have a few suggestions, which I hope the Minister will look at. I believe that we need much better signage in areas such as country parks and forests to show where bins are located, so that people know how far they are from bins and whether bins are available past a certain point. Dog poo counts as waste refuse—not everyone is aware of that—so all waste bins, wherever they are located, should carry a logo showing that it is appropriate to put bagged dog poo in them.

For dog walkers further on in their walk and in a “no bin” area—an area of natural habitat—the sign at the entrance to the walk should show them that they ought to use the “stick and flick” approach, which the Forestry Commission advocates on its website, or cover the poo with leaves or vegetation. Having tried to stick and flick a pseudo-poo—it happened to be chocolate éclair, which did not flick at all well—on the Jeremy Vine show, I can say that that is actually quite an effective way of doing things. We need clear, easy-to-recognise graphics in parks, woodland areas and laybys close to footpaths to suggest those methods of disposal.

I recognise that there is a problem here. Organisations from the National Farmers Union to Keep Britain Tidy, which the hon. Lady referenced, strongly support “bag it and bin it”. Anything that detracts from that could cause confusion and undermine the essence of the issue, which is that we want dog owners to act responsibly, in the way that she describes. Does she think that we can have both messages?

I have done quite a lot of radio interviews on this today, and that is the tension. That is why signage is important. We should have easily recognisable graphics, because then people could see that there is somewhere to put the poo bags and that the poo will be collected. There is no point in bagging poo and then hunting in vain for a bin. That is when it gets lobbed.

We have to work with human nature. “Bag it and bin it” is one thing, but although that is the ideal solution, it is not the only one. I would like to expand on that. We need to look at Natural England’s “Countryside Code”, which is authorised by the Government to enhance comments on dog poo in the various situations that walkers find themselves in. The hon. Gentleman is quite right: that code says

“always clean up after your dog and get rid of the mess responsibly—‘bag it and bin it’.”

That is a simple message. Unfortunately, as I showed the Minister before the debate—I am happy to show other people—that simple message is clearly not working. It works a lot of the time, but if someone picks up their dog poo bag, feels that they do not know what to do with it and then lobs it, that is a far worse scenario. Deer and cattle are ingesting the plastic bags. We must tackle that.

Part of the issue is about education. Dogs Trust is working with a pet provider, running education classes for brownies, guides, scouts and so on to try to educate the dog owners of the future. This is a relatively new phenomenon: we did not use to have dog poo bags.

The hon. Lady is making a compelling case. I have attended walk-arounds with dog wardens in my constituency and they say that part of the process required is to educate not only dog owners and walkers but the general public, because the dog wardens cannot take action unless they see walkers depositing where they should not. Does she agree that part of the education process needs to be on the public, who could give information, to help the public help themselves?

I do. That is why I said that the approach of saying, “There are eyes watching you” does work. However, if someone is out walking their dog, do they want the grief of watching a person’s dog foul, going to find a ranger—assuming they know where he is—and having the argument about whether it was that dog, given that the owner has walked off by that point? The situation is difficult, which is why we need a multi-strand approach.

I am not coming up with answers, but some suggestions: better signage, better placed bins, and a country code that says, “If you are here, this may be the appropriate thing to do. But if there are no bins, it would be inappropriate to bag.” We should get a set of graphics, which should be printed on dog poo bags to reinforce the message. There should be a dog poo bag code of disposal, a bit like for packets of cigarettes.

Dog poo bags are what plastic bags were yesterday. Given the number of pets in this country, I suggest that dog poo bags are as big an environmental problem as we had with people using disposable plastic bags from supermarkets. People use sandwich bags and all sorts, which flutter into waterways and float down into drains. We need to tackle that now and get a grip on it.

I would look at “The Countryside Code”. On farmland, I completely accept, as the hon. Member for Poplar and Limehouse (Jim Fitzpatrick) said, that the NFU is opposed to dog poo being left in rural areas because of the risk posed to the health of cattle and sheep, which may eat the poo. We are back to the educative approach: the NFU has called for posters to be displayed in farmland areas to raise awareness of the problem and for a change to the “Scottish Outdoor Access Code”—I know this is a devolved matter, but it is worth looking at that—to explain the risks posed to cattle more clearly.

The NFU said that there has been an increase in cases of the disease Neospora, which can be spread by dogs that have eaten infected material from cattle, such as placentas from newly calved cows, and then through dog faeces. The parasite survives for several months and can contaminate the pasture and water supplies. I suggest that while that may have increased, that is one part of the entire problem that needs to be taken into account in the broad brush approach.

Of course, not all farmland has livestock on it, so we need to work with landowners to come up with signage to reflect the local disposal need. Improved signage should appear in lay-bys close to footpaths that cross farmland. People park up in lay-bys and ramble across farmland, where there will not be any bins, guidance or signage. Perhaps where the sign for the parking lay-by is could be an appropriate point to have a small graphic showing dog walkers how to deal with dog poo.

Finally, I know there have been suggestions about DNA testing. That theory has gained a lot of coverage in the media, being viewed by some as a silver bullet to the problems of dog fouling. However, to operate a successful DNA scheme, we would need all dog owners to volunteer to register their dog on a database. Then, using DNA technology, we would be able to trace exactly which dog had committed an offence.

There are fundamental flaws to that initiative at the present time. The major groups involved are not supportive and the scheme would come at considerable cost to local authorities in creating and filling a DNA register as well as carrying out the tests on the offending poo. As I said, we have abandoned the registering of dog fouling incidents; that process would be hugely costly and would not tackle the problem. We would need armies of people to police it. Improved signage should appear in lay-bys and close to footpaths—that would be more helpful. We have to get the public educated so that they feel that not dealing properly with dog fouling is as antisocial as smoking in public places.

I also see an issue in that the type of person who would allow their dog to foul would not register their dog on a DNA register anyway. We therefore need to tackle this problem with awareness and education. The Government have recently announced that they will come up with a new litter strategy. Since dog poo counts as refuse, it would be excellent if the work could incorporate that.

I have been told that I need to tell the Minister that he needs a PPS—a pragmatic poo strategy. I suggest that a pragmatic poo strategy would recognise both the failings of human nature and the need to enjoy the family walk and do the right thing. I look forward to hearing his comments. Hopefully, when he comes up with his new litter strategy, there will be input from landowners, councils, dog walkers, dogs trusts, forestry commissions and all those bodies who experience this problem and seek to encourage the public not to keep creating a mountain of refuse in our wildlife areas.

It is a pleasure to serve under your chairmanship, Mr Hollobone. I thank the hon. Member for St Albans (Mrs Main) for bringing the debate. It might not seem the most glamourous or exciting of topics, but keeping our communities clean and pleasant is a key part of local government’s remit. Ensuring that our streets, parks, playgrounds and open spaces are free from ugly, unhygienic dog mess is really important.

Dog mess is a source of nuisance to residents and an eyesore on many streets, from high streets in towns and city centres to country paths and village lanes. Roads littered with dog mess damage civic pride and tarnish the image of an area. It is unpleasant in both sight and smell, it is unhygienic, it spreads disease and it becomes a costly problem for local authorities to tackle. In fact, councils spend about £1 billion a year dealing with littering, including dog waste. Furthermore, dog owners who break the law on dog fouling and refuse to clean up after their dogs put the health of others at risk, particularly children.

It is children who are most at risk of contact with dog excrement, which can cause toxo—I cannot say the word.

That’s it—I thank the hon. Lady for her intervention. It is a nasty infection that can lead to dizziness, nausea, asthma and even blindness and seizures.

It is not surprising that 47% of people in the UK think that dog fouling is one of the most annoying things they experience in public places. I recently met a group of cyclists who told me that one of the worst things they encounter, when cycling through country lanes, are these “baubles”, which the hon. Lady referred to, hanging from trees, which hit them in the face as they are riding and trying to enjoy the countryside. The public rank dog fouling as even more annoying than general littering, pollution, traffic and smoking. According to Keep Britain Tidy, dog fouling is

“a major concern to members of the public”.

A survey that it undertook of more than 10,000 sites found dog mess left in 7% of places. As such, it is a major issue for local authorities.

We seem to have got the “bag it and bin it” message out in towns, but there needs to be a different message in the countryside. In particular, it is important to keep local parks free from dog mess. Parks and green spaces play a crucial role in the health of our communities, including the mental health and general wellbeing of our residents. Parks provide spaces for exercise, cultural events, picnics, walks and everyday contact with the natural environment, which is proven to have a positive impact on mental health—particularly in towns and cities, where people’s lives are increasingly confined to home, work and commuting between the two.

Parks and open spaces are crucial to improving health and happiness in a society with increasing levels of obesity and disorders such as depression and anxiety. In that context, it is disappointing that parks and green spaces are facing unprecedented budgetary cuts that threaten their future existence. More than 90% of park managers expect decreased funding this year, while 97% of street cleaning services expect decreased funding over the next five years. That reduction will amount to more than 20% of their funding, which will have an impact on the presence of dog mess on our streets and in our parks.

The hon. Member for St Albans mentioned earlier that DEFRA no longer collects figures regarding dog mess. I agree with her that doing so might be an unnecessary burden; however, BBC figures show that 103 of 302 local authorities surveyed did not issue any fines for dog fouling at all in 2014-15. Enforcement is quite difficult. As was explained, it has to be witnessed and somebody has to report it. It is almost impossible: somebody would need to be very lucky to be in the right place at the right time.

I thank the hon. Lady for reinforcing that point. People are also reluctant to be confrontational. Putting the onus on somebody having to report somebody else is very difficult. I understand why. We have to face into this.

I completely agree. There are particularly bad dog owners in some parks quite near where I live. To be quite honest, one would not want to confront them—or the dog—on any issue, because they are quite aggressive people. I did a very unscientific survey among my friends earlier today. I asked if they understood what bin to put dog mess in, and a huge proportion thought it could only be put in the dog mess bin, which is not correct. These are regular dog walkers, yet they did not know that, so education is really important.

Many local authorities are using behaviour-change approaches to reduce dog fouling, but we need to make sure they are using the right message. As I said, “bag it and bin it” may be the right message in towns, but in the countryside it may be completely the wrong message and could actually cause further problems. I was particularly interested in the hon. Lady’s experiment with the chocolate éclair—I might see if I can find it on YouTube.

I can tell the hon. Lady that she can do that. They also put down a can of chilli sauce and a bread roll soaked in water. They gave me a flimsy stick to try to demonstrate stick and flick, but it was not really the best representation of the way to do it, according to the Forestry Commission. The video is online.

I thank the hon. Lady for the clarification. Local authorities have been campaigning with public sector bodies such as Keep Britain Tidy and third sector organisations such as Dogs Trust on the issue of dog fouling. Keep Britain Tidy’s 2010 campaign, “There’s no such thing as the dog poo fairy”, led to some communities seeing a 90% decrease in dog mess. The Dogs Trust’s “The Big Scoop” campaign involves posters, installations in parks and dispensers of free dog poo bags—although as we have heard, that might not be the answer in some areas.

In 2012, West Dunbartonshire Council armed its local clean-up workers with cans of bright spray paint to tag abandoned dog waste in a highly visible colour scheme to shame guilty dog owners and notify pedestrians that the dog waste was there. Leeds City Council’s litter and dog fouling campaign includes a reward scheme for people seen by enforcement officers using litter bins, and Manchester City Council ran a campaign with posters reinforcing responsibility for littering. However, dealing with these issues is expensive, and local authority budgets are restricted at this time, so we need to change behaviours. I was a dog owner for many years; unfortunately we lost our little Jack Russell, Mrs Biggles, last year. I would never have dreamt of bagging and not binning. If I could not bin, I would take it home. However, I was not on a long country walk, which is a different circumstance altogether; I was always relatively near where I live.

Unless there is continued investment in campaigns to deter dog owners from shirking their responsibilities, we will see regression in a culture that has actually been steadily improving for years. Lack of bins, particularly on public footpaths through the countryside, can also prevent dog owners from collecting dog mess. However, it is not only the lack of bins; it is about disposing of the dog mess properly. It is incomprehensible that anybody could think it was okay to bag and then just throw or flick. It is the equivalent of someone throwing a fast food bag out of the car as they drive along. It is basically pushing the responsibility for clearing it up on to somebody else. I was particularly struck by the reference to plastic shopping bags and how this is becoming a similar issue. One of my local councils recently suggested that it could increase its income by putting advertising on dog poo bags, because so many are sold. I am not quite sure whether that is a good idea or not—it is innovative, if nothing else.

Dog mess is the most unacceptable and offensive type of litter on our streets, and dog fouling is one of the most annoying and avoidable issues that concerns the public. However, the problem will not disappear on its own. An estimated 8 million dogs produce more than 1,000 tonnes of mess every day in the UK alone. Nearly a quarter of British people find dog mess in their local city, town or village at least once a day, and almost three quarters of people experience that on a weekly basis. We need to educate dog owners. The “bag it and bin it” message seems to have been successful, but this new phenomenon needs tackling. The hon. Lady said that she is not coming up with the answer today, but she is identifying and publicising the problem, which is the first step in finding an answer. I look forward to the Minister’s response.

It is a pleasure to serve under your chairmanship, Mr Hollobone. I thank my hon. Friend the Member for St Albans (Mrs Main) for securing this important debate. It is easy to make light of this subject; many puns, jokes and all of those sorts of things come to mind. I reassure my hon. Friend that I will not venture down that path, because this is an extremely important and serious issue—not only for my hon. Friend’s constituents, but for our constituents right across the country.

Our manifesto included a clear commitment to be the first Government to leave the environment in a better state than we found it. While Government policy on local environmental quality issues, including litter and dog fouling, is led by the Department for Environment, Food and Rural Affairs, I assure my hon. Friend that DEFRA works very closely with my Department on these issues, and I certainly take a keen personal interest in them as well.

This country is often described as a nation of animal lovers: with a population of more than 8.5 million dogs—one dog for every seven people—we can certainly say that we love our dogs. We know that owning a dog brings companionship. According to some studies it can also bring certain health benefits, such as the lowering of blood pressure and overall stress levels. Of course, when someone exercises their dog, they are exercising themselves.

Having a clean environment in which to live, work and exercise, including exercising our pets, is of great importance. There is certainly evidence that a poor-quality local environment affected by problems such as litter, dog fouling and graffiti can restrict that area’s economic growth, reduce property prices and increase people’s fear of crime. That, in turn, discourages people from going outside, exercising and being an active part of their local community.

As we all know, with dog ownership comes significant responsibility. All dog owners are required by law to provide for the welfare needs of their animals, and they must ensure that their dogs are under proper control at all times. That includes dealing with the inevitable consequences of owning a dog, including cleaning up after them. One estimate puts the amount of dog faeces produced daily in England at more than 1,000 tonnes. Littering and dog fouling are, without question, deeply antisocial actions that pose a significant risk to human health and animal welfare.

For local authorities, maintaining a clean local environment is a significant financial issue. It costs councils hundreds of millions of pounds every year to clean up litter, including removing dog waste from our streets and public streets. Local authorities should not have to do that. Dog fouling is an avoidable problem. We have to acknowledge, as my hon. Friend the Member for St Albans did, that most dog owners are very careful; they clean up after their pets and are responsible people. That said, we must do more to take on the small minority who think it is right and appropriate to leave the mess that my hon. Friend described and has provided me with pictures of, from situations across the country. We must hold those people to account.

This is a significant issue, but we must look at the overall context. The latest local environmental quality survey of England found that fewer than 10% of sites surveyed were affected by dog fouling or bagged dog faeces in 2014-15. The few irresponsible dog owners who do not clean up and leave an unsightly, unhygienic mess rather spoil the environment for all other users.

Research has found that dog fouling is perceived by more than two thirds of people to be the most offensive type of litter. I certainly agree with them. Recently, on the day of the Great British Spring Clean, I went out on several occasions in my constituency with teams to pick up litter, and I can identify with what my hon. Friend said. I found myself on a riverbank collecting litter, a significant amount of which was caused by this very problem—people doing the right thing and bagging up their dog faeces but then, for some inexplicable reason, thinking it is right to either put it down on the grass or throw it into the hedge. That seems remarkable, and particularly so in the location involved, because there was a dedicated dog fouling bin within a matter of 100 metres. My hon. Friend is raising an issue that is extremely pertinent right across the country.

I thank the Minister for sharing that personal experience with us. Councils have said that their operatives are having to climb into trees to cut these bags down and are coming across decomposing poo. That is bad for the health of the council operatives and a more costly way to collect. It is a litter and refuse problem tied together, which is really the worst combination.

I completely agree. This is a completely unacceptable practice that causes a huge problem to local authorities, which are left with the prospect of having to sort out the issue left behind by the very people who pay the council tax. We might think that those people look at their council tax bill and ask, “Do I want to spend part of my council tax on a problem that I am creating?” There is a real issue in terms of education, which I will come on to in a moment.

Having said that, it is still in local authorities’ interests to invest in maintaining a clean and welcoming environment, to improve wellbeing and attract inward investment. A number of councils and other organisations are looking at innovative solutions, examples of which have been given today. We know that signage can have an impact. Examples such as Keep Britain Tidy’s successful poster campaign on dog fouling—my hon. Friend mentioned the demon eyes on the poster, watching us—have had a positive outcome in the areas where they have been used.

As my hon. Friend mentioned, the Forestry Commission is encouraging people to use the stick and flick method in the forest, moving the waste away from the path into the undergrowth, where it can be naturally broken down. There were also recent articles about provision of poo bag dispensers in an Aberdeen community and areas in Stoke where they are trialling a fine of £100, using a public spaces protection order, if dog walkers fail to carry poo bags. I acknowledge what has been said in relation to enforcement. That comes with its challenges, and therefore alongside any enforcement activity there must be significant education, so that people finally realise this is not an acceptable practice.

Different methods work in different places. The stick and flick method certainly may work where the Forestry Commission advocates it, but as my hon. Friend said, the Forestry Commission does not advise that practice near car parks or other sensitive areas. It may also not be acceptable in urban parks and areas where there are housing developments.

My hon. Friend talked about signage and a number of other initiatives that could be used, such as more information on waste bins and the manufacturing of the bags. The hon. Member for Erith and Thamesmead (Teresa Pearce) made an important point about advertising. The packaging that bags come in could be used as a way of informing dog owners of the right thing to do. Those are things we will look at.

We have a litter strategy, which will be published. We do not just want that strategy to be a document that sits on the shelf, gathering dust and not doing the job we intend it to. We will have a number of working groups, including organisations involved in providing bins, manufacturers of packaging and so on. We fully intend, through those working groups, to look at some of the individual challenges and see if we can come up with solutions. I am certainly keen to hear more from my hon. Friend—or indeed, any other hon. Member in this House—if she comes across any ideas that we may be able to take on to deal with this important issue.

There is no excuse for dog fouling. Some dog walkers seem to think it is acceptable to leave their mess behind. They think someone will pick the bag up or, in the worst case scenario, they are just completely ignorant and do not think they need to deal with it, because someone else will pick up the tab. We should be clear that this is disgusting, antisocial, dangerous to human health and dangerous to animals and other wildlife. We should, at every turn, encourage people to act responsibly and follow the vast majority of dog owners who do the right thing by picking up after their dogs and, if there is no bin, taking the bag home.

I thank the Minister for those very helpful comments. I suggest broadening the approach to include, for example, pet food manufacturers and vets. Clear guidance should be printed on everything—a bit like tobacco warnings—and there should be more use of advertising. As the hon. Member for Erith and Thamesmead (Teresa Pearce), who speaks for the Opposition, said, people are not aware that they can use ordinary bins. There needs to be signage on ordinary bins to show that they can be used for dog poo waste. There should be a graphic on all these things.

I have explained what we need to be doing. It is really important that we get feed-in from countryside landowners, farmers and, as I said, vets and pet food manufacturers. Let us exploit the good will that is out there for those of us who love our pets. I would not mind reading on the side of my dog food tin about how to dispose of dog poop. We should all have that information. It should become a matter of course for this practice not to be tolerated. As the hon. Lady said, it is exactly like jettisoning stuff out of a car window. That used to happen such a lot, and it still does happen, but not as much.

Let me close with the poem that the Forestry Commission likes everyone to read:

“If your dog should do a plop, take a while and make a stop, just find a stick and flick it wide into the undergrowth at the side.

If your dog should do a do, you don’t want it on your shoe, find a stick, pick a spot, flick into the bushes so it can rot.

If your dog should do a poo, this is what you should do, just find a stick and flick it wide into the undergrowth at the side.

If your dog should make a mess there really is no need to stress. Find a stick, pick a spot, flick into the bushes so it can rot.”

With that, I rest my case, Mr Hollobone.

Question put and agreed to.


That this House has considered dog fouling.

Sitting adjourned.