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Westminster Hall

Volume 666: debated on Wednesday 23 October 2019

Westminster Hall

Wednesday 23 October 2019

[Phil Wilson in the Chair]

TB in Cattle and Badgers

I beg to move,

That this House has considered government policy on TB in cattle and badgers.

It is a pleasure to serve under your chairship, Mr Wilson. I realise that many of us in the House will feel that we have had enough of difficult subjects this week; this debate, I am afraid, will probably offer little relief.

This is a difficult subject for me: there are many farmers in my constituency, as well as plenty of wildlife lovers. Derbyshire is the site of the largest badger vaccination pilot, which is led by Derbyshire Wildlife Trust, with its skeleton staff and dozens of volunteers who regularly get up at 4.30 am to vaccinate badgers; it has been a privilege for me occasionally to go with them. High Peak is also an edge area for bovine tuberculosis, and we have seen cases recently on local farms. That is very difficult for the farmers affected and for their families, and it is worrying for all the farmers in the area.

As well as having farmers in my constituency who are concerned about TB in their cattle, I have constituents who are concerned about the badgers. More than 500 constituents wrote to me—some of around 6,000 people across the county who wrote in—about the Government’s proposal to extend the cull area to Derbyshire. High Peak is a place where issues for farmers and for wildlife collide, so I am probably the last person who should have applied for a debate about this subject, but it is important to air and scrutinise the issues.

We last debated this topic in November last year, just before the publication of the Godfray report. That report made important recommendations, which I will come to. It is disappointing that, almost a year after the report’s publication, the Government still have not published a response to it, yet they have proceeded to license new cull areas and the killing of around 63,000 badgers. Whether they are considering badgers or Brexit, it is important that the Government make policy based on evidence, and I hope we can focus on that.

I am grateful to my hon. Friend for bringing forward this debate. I find it deeply distressing that 67,000 badgers have been culled over the past five years. Does she agree that the evidence about improving biosecurity, along with vaccination, is the most compelling of all?

I agree that biosecurity needs to be considered, along with measures on trading and high-risk areas. A whole range of measures need to be looked at together with vaccination, as the Godfray report—the Government’s own review—recommended

I thank the hon. Lady for bringing forward this debate. I represent a constituency where the control of badgers is very important for the farming sector, particularly the dairy sector. In Northern Ireland we have an agreed approach based on the common ground between what conservationists and the farming community want. That involves trapping and testing badgers, vaccinating those that are healthy, and culling those that are infected—it is important that we do that.

Given that some studies show that TB incidence can rise in an area where a badger cull has taken place, as infected badgers move in from other areas, does the hon. Lady agree that the approach in Northern Ireland is much more sensible than simply culling every available badger in an area?

Absolutely. That is a very sensible approach. It is costly, but so is culling badgers, which does not have a proven effect.

We have heard the number of badgers that have been culled. What estimate has the hon. Lady made of the number of healthy badgers that are protected by the vaccination programme in her edge area?

The Derbyshire Wildlife Trust has vaccinated 192 badgers this year as part of its five-year programme, which covers an area of around 120 sq km, so healthy badgers are being protected by that vaccination programme. Just as the debate last November preceded the publication of the Godfray report, I hope this debate may be a prelude to the Government’s long-overdue response to that report.

We must focus on farmers. I pay tribute to the farmers in my constituency, many of whom I know personally, and across the country. For them, farming is not just a job but a way of life. They work very long hours in all weathers, caring for their animals—their livestock—and producing food for us. Farmers, possibly more than any other business, are at the mercy of events: of weather, prices, policy and disease. It can seem that they have very little control over the factors that influence their business.

The hon. Lady is being very generous in giving way. She is right that this issue is massively important to farmers and farm businesses. Farmers care massively about the welfare of their livestock and, indeed, wildlife. Does she agree that the Government’s 25-year strategy, long though it is, is showing signs of having some impact and that we should not throw all the toys out of the pram and stop things as they stand? Does she also agree, though, that 25 years is a long time, and that if the Government do not continue basic payments through to the point when the new environmental land management scheme comes into effect, there may be no farmers left to protect by the end of the process?

Absolutely. Although farmers are at the vagaries of many things, we should at least try to set consistent policy so they know where they stand. That very much applies to farm payments to replace the common agricultural policy.

Bovine tuberculosis is one of the major unknowns and fears affecting farmers. Four fifths of farmers under 40 think mental health is the biggest problem facing their sector, and the fear of bovine tuberculosis is one of the major influences of that among cattle and dairy farmers. In High Peak we have sheep farmers, dairy farmers and cattle farmers, and sometimes all three are farmed together on the same farm. I pay tribute to our local National Farmers Union representatives, who provide an excellent service to support those farmers. They are practical and they are prepared to speak out, as I know only too well. I am sure Members across the House know NFU reps who are prepared to speak out on behalf of their members and their businesses.

Although the majority of farming in my constituency is sheep farming, we also have dairy and cattle farms. The number of dairy producers in particular is falling year on year: it dropped by 675 in the last 12 months across the country, although the sharpest reductions have been in the areas in the east of the country not affected by TB. The number of cattle slaughtered due to bovine tuberculosis in 2018 was the highest ever, at 44,656—an increase of 30% since 2010.

Does the hon. Lady agree that any strategy on bovine TB needs to use all the tools in the toolbox? In Wales last year, 12,000 cattle were slaughtered because of bovine TB. That casts a long, dark shadow over farming in Wales, and it is a particular issue in my constituency, where we have dairy and cattle farming. Does she agree with the assessment of NFU Cymru that we must use all the tools in the toolbox, including continuing vaccination at the same rate while also looking at targeted culls that are clearly engineered and clearly focused on high-risk areas?

I do agree that Governments in all parts of the United Kingdom—particularly in England, Wales and Northern Ireland, where there are high incidences of TB—need to be able to look at all the tools in the box. However, they should also use the evidence. I hope that the Godfray report will be of use to the Welsh Government and the NFU there, as it is such a systematic examination of all the evidence and gives many pointers to the way forward, which I will come to.

It is important to consider the welfare of cattle as well as that of wildlife. Many cows are pregnant when slaughtered, and if they are unfit to travel they must be slaughtered on the farm. I welcome the use now of lethal injection instead of shooting, but farmers still have to see the slaughter of animals they have often bred and known from birth.

Farmers and their businesses are affected not just by the slaughter of infected animals but by the testing regime every 60 days, movement restrictions, extra costs, lower income and extra work. While compensation for each animal is now more generous, it still will not compensate for the most valuable animals. Farmers are left with a huge amount of financial and emotional stress. The Farming Community Network reported that although farmers are characteristically not ones to speak out when they feel under pressure, they can be led to feel stressed or depressed—in some cases to the point of physical illness or not wanting to carry on. We must recognise that, because farming is one of the most isolated professions. Some of those who are slowest to speak out may also be in most need of support.

I congratulate the hon. Lady on making a well-balanced and sensible speech, taking neither one side nor the other. I very much endorse her on mental health. This problem particularly affects places such as North Wiltshire, where 200 farms have been entirely closed down—many on several occasions—and entire herds slaughtered. The psychological effect on a farmer seeing his or her herd entirely slaughtered two or three times is horrendous.

Absolutely. Any of us who has had a pet put down knows how painful that can be, so a farmer having to put down a whole herd that they have built up does not bear thinking about. Bovine TB does not just have an emotional cost; it is also one of the greatest animal health threats to the UK. It costs the public more than £100 million a year in compensation, and it costs the farming industry about £50 million a year.

In Derbyshire, we are on the edge of bovine TB. Last year, 1,230 cattle were slaughtered in the county, compared to just 672 the previous year. The annual incidence rate in herds increased from 7.7% to 8.4%, mainly, I would argue, because in January 2018 the high-risk area of Derbyshire was reclassified as an edge area. The increase in cases was driven solely by the reclassified area, as the area that remained classified as edge area was reduced. In the new edge area, on the edge of the outbreaks, annual surveillance testing was replaced by six-monthly testing and the higher use of interferon gamma testing where TB-free status had been withdrawn. That replaced the skin tests, which we know are only 50% or 60% accurate, meaning that under those annual tests many more cattle go by undetected with TB. In 2018 in Derbyshire, 45% of infected cattle were identified by gamma reactor testing, compared to just 7% in 2017.

The Animal and Plant Health Agency report on TB in Derbyshire states that the interferon gamma test has a higher sensitivity than the skin test, so it discloses more infected cattle, often at an earlier stage, or those that may have been missed by the skin tests. In 2018, 2,400 tests were done, compared with 1,800 in 2017. This also applies to other areas, as gamma testing was introduced for edge areas from 1 April 2017. The number of new herd incidents fell slightly, from 4,700 in 2010 to 4,400 last year. More cattle are therefore being slaughtered but from a lower number of herds, with the average per herd increasing from 10 to 12. It is interesting that bovine tuberculosis has spread from areas with higher herd numbers to areas such as Derbyshire, where herd numbers have traditionally been much lower.

We come to the role that badgers play in the increase in bovine TB in Derbyshire. The APHA study states that, based on probability, 77% of infections come from badgers. However, only one case in 148 was confirmed to be definitely due to badgers. Alternative academic analysis suggests that between 75% and 94% of infections are caught from other cattle, not from badgers. It can appear as though badgers are being scapegoated while the evidence for residual infection within herds is being discounted.

Badgers are present throughout Derbyshire and on most farms. I pay tribute to farmers, who have been most helpful in the badger vaccination programme. However, testing last year of badgers killed on roads across Derbyshire by Professor Malcolm Bennett of the University of Nottingham found that only four out of 104 were infected with bovine TB—just 4%. It therefore seems surprising that they are deemed to account for 77% of cattle infections. Considering that the higher number and greater accuracy of tests has driven the increase in cases, it is surprising that only 5% of cases of bovine TB are deemed to be due to residual infection in a herd, especially when in 40% of all cases there had been a history of infection in the herd in the last three years.

I will have to make some progress, as there are several more speakers to come in. I am sure the hon. Gentleman will have a chance to make his point later.

It is acknowledged that the pattern of livestock markets facilitates the flow of cattle in Derbyshire from the high-risk area to the edge area and that the major risk to other edge areas adjacent to Derbyshire—Cheshire, Nottinghamshire and Leicester—is mostly via cattle movements. When we say we must look at all the reasons why cattle are contracting bovine tuberculosis, we must look at cattle movement and infection in a herd.

The size of the herd was also a major factor. Herds of under 50, which account for about half of all cattle herds in Derbyshire, had only a 3% risk of contracting bovine tuberculosis. That rose to 27% in herds of 200 to 350 and 38% in the largest herds of 500-plus. It seems very odd that badgers would discriminate between small herds of cattle and large herds.

The smaller herds are beef suckler herds and the larger herds are dairy herds. The cows also live longer in a dairy herd.

I thank the hon. Gentleman for that point. I have beef suckler herds and dairy herds, and they both have plentiful badgers in the area.

Professor Sir Charles Godfray looked at all the evidence when he chaired a review of the Government’s 25-year TB eradication policy—a sensible measure to ensure that the strategy was on course. Sir Charles reported in November last year. His report emphasises the importance of improving testing and recommends the more sensitive test for high-risk and edge areas; biosecurity measures on farms to prevent contagion among animals with endemic disease; and reducing risk-based trading, because cattle movements, which increase risk, are comparatively high in the UK.

Professor Godfray states that the presence of infected badgers poses a threat to cattle herds, but he also acknowledges evidence of the perturbation effect from culling, and the impact on adjacent areas when badgers move further as territory becomes available and they become disturbed from their setts. The report states clearly that TB control efforts have focused too heavily on managing badgers, when most transmission occurs cattle to cattle. He therefore states that moving from lethal to non-lethal control of the disease in badgers would be highly desirable—something we would all agree with.

Culling is expensive—it costs more than £5,000 per badger, compared with less than £700 per badger vaccinated. It also involves trapping badgers at night and shooting them with a high-powered rifle. In 2013, the Government’s independent expert panel stated that at least 7% of badgers were killed inhumanely and took more than five minutes to die. That panel was disbanded in 2014, but its former chair, Professor Munro, and 19 other vets, scientists and animal welfare campaigners wrote to Natural England last month to say that of the 40,000 badgers culled before this year, a minimum of 3,000, and as many as 9,000, would have suffered immense pain from that process. The same proportion of the 63,000 badgers licensed for slaughter this year would equate to between 5,000 and 15,000 badgers suffering. I have been out with Derbyshire Wildlife Trust and seen the badgers in the traps, full after a night of gorging on peanuts and usually fast asleep and ready to be vaccinated. It is very hard to think of someone shooting them instead.

Order. Quite a few Members want to speak. The hon. Lady has been good at giving way, but I hope she will come to the end of her speech at some point.

I have been out with Avon Wildlife Trust, which has an excellent badger vaccination programme. The cull is now being rolled out to Avon, and we have a ridiculous situation where badgers that have been vaccinated are now liable to be culled. Does my hon. Friend agree that that seems a complete and utter waste of money and effort?

Absolutely. We would not want that to happen in Derbyshire either.

In 2014, 20% of culls were supervised by Natural England staff, but by 2018 the organisation was able to monitor only 0.4% of them. That gives rise to safety concerns, particularly if protests are involved. Without even responding to their own report, last month the Government extended the badger cull to a total of 40 areas, including around Bristol, Cheshire, Devon, Cornwall, Staffordshire, Dorset, Herefordshire and Wiltshire. It was not extended to Derbyshire, however. That delighted the thousands of supporters of Derbyshire Wildlife Trust and its vaccination programme, but not the Derbyshire farmers, 700 of whom had signed up to the cull in their area.

With infections increasing so much recently, and no other Government policy forthcoming, farmers feel that the badger cull is their only option to escape the real fear of TB. As has been said, however, there is conflicting evidence about the effectiveness of the cull, and it is disappointing that Professor Godfray’s team was specifically asked not to evaluate whether ongoing culls are reducing TB in cattle. A recent report from the Animal and Plant Health Agency stated explicitly that the data cannot demonstrate whether or not the badger control policy is effective.

The Downs report shows some reduction in infections during and immediately after the cull, but infection rates are now rising again and TB is spreading among cattle. Professor Godfray stated that the only feasible alternative to control badgers is vaccination, and that leads me to the work of Derbyshire Wildlife Trust—the largest volunteer-led vaccination programme in the UK, supported by the National Trust, the National Farmers’ Union, Derbyshire County Council, the Badger Trust, RSPB, Derbyshire police and local badger groups. Derbyshire’s police and crime commissioner is also a strong supporter, especially after assessing the resources that policing protests against the cull would involve. DWT is supported by more than 100 volunteers, and that number is continually increasing. I thank the small band of professionals and all the volunteers who dedicate a substantial amount of time in the evenings and early mornings to trap and vaccinate badgers. They have vaccinated 742 badgers so far, including 218 this year.

Order. Is the hon. Lady coming to the end of her speech? She has been speaking for 25 minutes, and I want to be fair to other Members who wish to take part in the debate.

You are eating into the time of other Members—that is what I am saying. If you could come to a conclusion, it would be good.

Right. This is a much more popular debate than I had envisaged for 9.30 on a Wednesday morning, so I will make progress, Mr Wilson.

Derbyshire Wildlife Trust has vaccinated badgers over an area of 120 sq km, and that area is expanding since the wildlife trust reached an agreement with Natural England to start work on national nature reserves in the Derbyshire Dales. Government funding has been just £280,000 through the scheme over four years, given the much lower cost of vaccinating badgers instead of culling them. Derbyshire presents the ideal opportunity for a large-scale vaccination programme of the kind recommend by Professor Godfray. It has no cull, an expanding vaccination programme and a highly experienced professional vaccination team. Such research is vital to help to inform the Government about their bovine TB policy and the opportunity significantly to increase badger vaccination across the country.

There is currently no clear strategy or clarity about where vaccinations should take place or at what scale. Vaccination has not been pushed as a viable option to culling in any meaningful way, whereas the Government have been vocal in support of culling. There needs to be a level playing field. The current funding model provided by DEFRA provides only 50% of the funds needed to run a badger vaccination programme, and that is preventing other organisations from establishing programmes. If such a model is to be extended, it must be offered proper financial support.

The people of Derbyshire and Derbyshire Wildlife Trust seek assurance from the Government that the cull will not come to an area with such a high success rate in vaccination—that it did not this year is a positive step. When will the Government publish their response to the Godfray report? Will consideration be given to monitoring the disease status of badgers, as well as badger populations, within cull areas? As the hon. Member for Strangford (Jim Shannon) said, that already happens in Northern Ireland. Why is there no systematic testing of culled badgers for TB? A key factor for farmers in my area is for them to get access to the tests they need to ensure that their herds stay as risk-free as possible. I look forward to hearing speeches from other hon. Members, and to the Minister’s response.

Order. We need to introduce a four-minute time limit on speeches, and we may have to reduce that if people do not stick to it.

It is a pleasure to serve under your chairmanship, Mr Wilson, and I congratulate the hon. Member for High Peak (Ruth George) on securing this important debate. Like other colleagues, I thought her speech was incredibly well balanced and truly reflected the nature of her constituency.

The hon. Lady’s constituency is very different to mine. As hon. Members will recognise, I represent an urban constituency and I therefore would not pretend for a nanosecond to understand fully and appreciate the concerns felt by other colleagues who might represent more rural constituencies. That said, I was one of the few Conservative MPs who spoke and voted against the badger cull when it first came before the House, and I have been a longstanding opponent of the cull ever since.

As I have served as a Minister for three and a half years, this is my first opportunity to speak on this issue since 2015. Although I recognise—especially looking around the Conservative Benches this morning—that I am probably in a minority on this side of the Chamber, I believe it is important that I speak. In my first speech on the issue I spoke of my appreciation of the devastating effect on farmers, which has been reflected in the debate today. It is important that the issue does not become one of farmers versus badgers. We have enough division as it is, and it is important to reflect on that.

Because of my deeply held views on animal welfare I have had the pleasure of working on the issue alongside various charities and organisations. It is important to recognise that they, too, have worked tirelessly to raise awareness of badgers and bovine TB and to provide the Government with scientific evidence that could protect both badger and cattle numbers. The evidence is clearly important, and I have worked with those, such as the Save Me Trust, who have worked for years to try to show that the scientific evidence used by the Government is flawed. Working with a farmer in Devon, the trust has helped to implement a different strategy to tackle TB in cattle, called the Gatcombe method, developed by veterinarian Dick Sibley. The method focuses on maintaining standards in cattle herds such as cleaning up the birthing of calves, cleaning up excrement as soon as it is dropped, and not pumping cow slurry on to the feeding fields. That has given the farmer an officially TB-free herd for three years, without the need to slaughter badgers.

Success in tackling bTB is not limited to that farm. We have already heard that Welsh herds are 94% free of bTB, and that it is dropping significantly without the culling of badgers, so surely there is an alternative for tackling the disease in English farms. As the Save Me Trust makes clear, the reason badgers have not been culled at the farm is that the likelihood of badgers passing TB on to cattle is low. According to the randomised badger culling trial, 5.7% of bTB outbreaks have been caused by badgers, but other scientific studies have put the figure at less than 1%. As has been mentioned, the RBCT estimates that 80% of badgers culled in England do not have bTB; so they were culled unnecessarily.

We need to look at other methods and take a more holistic approach to tackling bovine TB. I appreciate that that would require investment of time and money. I think that it is something the Government can support. A suggestion that was put to me was a Government-led grant programme, for farmers to invest in aerobic digesters to remove bTB from slurry, protecting cows and the wider environment from contamination, and, better still, providing biogas to be turned into electricity.

If we are to eradicate bTB it is clear that the current system for testing cattle needs to be improved. At present the skin test is ineffective and many infected cows remain in herds. Experiments with blood tests have shown TB organisms in cattle—

Farmers in my constituency are experiencing the worst difficulties with bTB in their cattle anywhere in Cheshire—and Cheshire has been hard hit, with 2,331 cattle having to be slaughtered last year. The Animal and Plant Health Agency report for the year ending 2018 states:

“The burden of TB in Cheshire is considerable…it can prove difficult to source cattle to replace reactors which have been slaughtered”

and that

“TB can have a significant economic impact resulting in cash flow problems…full market prices are rarely available for TB restricted cattle.”

It also states:

“The economic losses to dairy farms in the case of lost milk yield can be further impacted by financial penalties imposed by the dairies through breaches of contract and not meeting forecasted milk yields.”

However, those statistics can never fully describe the financial and emotional toll on farmers and their families from the impact and threat of bovine TB, which cannot be overstated.

Many farmers have told me about that and I will never forget when I sat in the kitchen, at a farm where infection had taken hold, and the farmer’s wife sat sobbing at the kitchen table. Another told me last week, “We literally live daily in trepidation of bovine TB infecting our animals” and another wrote to me this week:

“We have failed our TB tests and have our next test on 17th December…Cow movements are on hold which will damage us financially as there will be no income from sales, nor will we be able to buy cows in, which we have been trying to do”.

They are in suspense. That is why, on their behalf and as requested by many who have written to me and met me in the past few days, I am asking the Government to continue with their bovine TB eradication strategy, including wildlife control in endemic areas, to free our country from this awful disease.

I am a strong supporter of animal welfare, and for healthy cattle we need healthy wildlife. To those who dispute that the disease is spread by wildlife movement, I would point out that the Animal and Plant Health Agency report that I mentioned states, with reference to Cheshire:

“In the south…of the county there has been a large number of new incidents…which are not thought to be due to movements of undetected infected cattle...The farms are not related nor connected by cattle movements, there has been no contiguous cattle contact. Infected badgers are suspected to be the source of infection. In total there have been ten herds known to have been affected.”

The NFU says of the results of a 2018 TB epidemiology report for high-risk areas,

“the results concluded that badgers constituted 64.19% of the source attribution whilst cattle movements accounted for 12%”

and

“these results provide further evidence that by controlling the badger population the number of new TB breakdowns can be minimised.”

I agree that we need evidence-based decisions. A range of interventions is, indeed, appropriate, but, as the NFU says,

“no other major cattle producing country in the world has ever successfully dealt with BTB in cattle without addressing disease where it is present in wildlife to break the cycle of infection.”

Culling has been effective in the Republic of Ireland and the NFU has also said that after 1997, when all badger culling ceased, in subsequent years infection spread in wildlife.

The scientific evidence exists. The Downs report, which was peer reviewed in the journal Scientific Reports, published last week, and endorsed by DEFRA, deals with analyses conducted to compare the rate of new TB breakdowns in cull areas, compared with rates matched in areas with no culling. There was a 66% reduction in new TB rates in cattle in Gloucestershire after culling, and a 37% reduction in Somerset. A DEFRA spokesman said of the report that

“this independent and detailed analysis builds on previously published data showing strong reductions in the disease in cattle following culling in Gloucester and Somerset areas over four years compared to unculled areas.”

As the NFU vice-president Stuart Roberts has said,

“Controlling the disease in wildlife is a crucial element to tackling this devastating disease”.

I am grateful to have caught your eye, Mr Wilson, and also to the hon. Member for High Peak (Ruth George) for the reasoned way she introduced the debate. I did not agree with all her conclusions, but her demeanour and the tenor of her remarks were very reasonable.

I have experience of the matter because I grew up as a farmer on my mother’s dairy farm in the foot and mouth regime, where farmers around us had their herds slaughtered. It was a pretty devastating time, growing up. I know only too well the effect that TB can have on the agricultural community and indeed on farmers themselves. As the hon. Lady said, rural farmers live in isolated areas, in close-knit communities and families; the loss of even one cow, let alone an entire herd of cattle, can have a devastating effect.

In the past few days, numerous farmers have said to me that they would like the Government’s eradication scheme to continue. Mr Harry Acland, of Notgrove Farm, said

“the badger cull has been immensely successful here, from being shut down with TB on average for 10 months in the year we now only rarely have a break down (once this year) and matters are considerably improved”.

I have supported the cause of the eradication scheme for more than two decades, and worked with my right hon. Friend the Member for North Shropshire (Mr Paterson), when he was the Secretary of State for Environment, Food and Rural Affairs, on the roll-out of the first, second and third cull areas in Gloucestershire, which have been transformational. In the first two years of the first cull, the TB incident rate was down 16%. After four years of the industry-led eradication scheme, between 2013 and 2017, the culling by farmers had reduced TB in cattle by 66% in Gloucestershire. Interestingly, while no change was found after two years in a 2 km buffer area around Gloucestershire, after four years there was a 36% decrease in the area. The so-called perturbation effect was not seen. Badger control licences now cover 57% of high-risk areas in the country. The efficiency of the licences has seen a 19% decline in TB incidence since the culling began in 2013, from 3,283 to 2,655. A comprehensive range of measures alongside the badger culling seems to be the most effective strategy for controlling the disease, with greater biosecurity, cattle testing and movement restrictions for TB-positive herds, and continued research into badger vaccinations, particularly oral ones.

Backing our farmers and ensuring a healthy, prosperous agricultural industry in Britain is a vital way to manage our sustainability. We cannot encourage people to buy local or in season if we do not protect our farms from devastation when TB infects entire herds. Grass-fed beef raised in this country has a far lower carbon footprint than importing foreign meats or plant-based products. Quite simply, we have the grass and climate to produce the best naturally-raised beef in the world. Eradicating this disease would be a quantum leap in increasing the productivity of British agriculture and provide a substitute for imports in a post-Brexit world. Jobs and livelihoods depend on it.

This is not a debate about wildlife lover against farmer; it is about healthy badgers being protected from a vicious and unpleasant infectious disease. It is all about stopping our healthy badger population dying from what used to be called consumption.

The genie is out of the bottle. The figures that my hon. Friend the Member for The Cotswolds (Sir Geoffrey Clifton-Brown) just gave show a 66% decline in TB in areas that were culled in Gloucestershire. We can never again expect a cattle farmer in this country to accept that culling does not work. It is proven to work, based on the science brought about in the Department for Environment, Food and Rural Affairs by the meddlesome right hon. Member for Leeds Central (Hilary Benn) when he was Secretary of State.

The story of TB in cattle is one of delay. The chief vet stopped the culling in the 1950s, and then TB took a grip. We must not stop the scientifically-based cull that we have going on today in areas of high infection. To do so will be to create illegal culling. We all know that the problem with badgers is the perturbation effect; the minute we have a perturbation effect, we will have a terrible spread of the disease, so the culls we have at the moment must continue. They are working, and the science that they are generating is critical to the progress we need to make in stopping this disease, which of course can infect people as well.

I have heard that there is now a new mustelid vaccine—it is being tested on ferrets, because testing is not allowed on badgers—that is more effective than Bacillus Calmette-Guérin, or BCG. There are new tests that show a variety of reactions in cattle, so that we do not need just one indicator. They may show eight different types of reaction to Mycobacterium bovis, so we will not have the number of false positives or false negatives that have plagued the skin test. There is tremendous science coming along. The OIE—the World Organisation for Animal Health—is approving some of the tests. We have had a new test for camelids.

My question to DEFRA is this: “What are you doing to ensure that this new science can be brought in? We are still in the European Union. We need these tests approved so that we are internationally compliant in our fight against TB. We must ensure that sufficient funds go into that research. We need you to keep going on the science that you are currently applying, because not only is it working, but it is bringing results home to farmers in my constituency who love their cattle.” More than that, they love badgers too. Once we have beaten this disease, we will know that the whole UK badger population is secure, safe and likely to continue to provide the entertainment that people get when they see them.

However, people such as me who love their cattle want to know that they are safe from this horrible disease—not least because of the risk to farmers when they are testing and testing and testing. No cow likes to be jabbed twice in the neck, and they react dangerously when they are continually tested. For me, the worst thing that can happen is an outbreak—not just because I lose my animals, but because of the risk to my family when we have to perform those compulsory tests to go clear. I say to the Government, “Please do all you can.”

It is a pleasure to serve under your chairmanship, Mr Wilson. I congratulate the hon. Member for High Peak (Ruth George) on securing this important debate and the measured manner in which she spoke.

I take issue with the idea that there is a battle between badger welfare and culling. I have told numerous people this, and many of them laugh, but I am probably the only person in this Chamber who has had one pet badger, and I am definitely the only person in the Chamber who has had two pet badgers. I am very pro-badger. I am pro-healthy badgers. Ever since I began working on this, when I was the junior shadow agriculture spokesman, I have set in train, I hope, a series of policies to ensure that we have healthy wildlife living alongside healthy cattle.

There is not a single country in the world that I have visited—whether the problem is white-tailed deer in Michigan, wild feral cattle in Australia, the brushtail possum in New Zealand, or, in particular, the badger in the Republic of Ireland—where there is a reservoir of disease in wildlife that has not been tackled at the same time as it has been tackled in cattle. It is so obvious, and it has worked; when we had a bipartisan approach in the 1960s and 1970s, we got the disease down to 0.01%.

It is absolutely tragic that we threw that away, and it has caused great misery. The hon. Lady was right to highlight the hideous cruelty of shooting a pregnant cow, so that the calf suffocates, which is rarely mentioned. The Badger Trust always shows beautiful black-and-white photographs of badgers, like my dear old badgers—never a revolting picture of a diseased badger in the last stages of TB, covered in lesions, driven out of the sett, covered in bites and dying a horrible, long, lingering death.

There is also a human element. My hon. Friend the Member for North Wiltshire (James Gray) mentioned the mental trauma of being tested—the sheer trauma for farmers, the tension, the nightmare of waiting to see whether they will fail the test—and the physical danger. I am afraid that one of my constituents was killed while doing a TB test, when a young bull threw his head up and smashed my constituent against the crush.

All that is completely unnecessary if we can get rid of the disease in cattle and in wildlife, but we have to address both together. It is not either/or. We cannot go on with the expense: we are spending £1 billion on a disease that has been eradicated in other countries. The Germans take out 70,000 badgers a year. We can look at what New Zealand has done on the brushtail possum. My question is this: can we please acknowledge that this is working?

I was in charge of introducing the first two trial culls. We had intense saboteur activity, with hunt saboteurs coming from all over the United Kingdom, some of them with convictions for violent offences. I pay tribute to the farmers who, with incredible bravery, got those first culls going in Somerset and Gloucestershire. The Downs report shows a reduction of 66% in the cull area in Gloucestershire, where we had intense activity—we had saboteurs camping out on badger setts—and 36% in Somerset, where I went to a public meeting about 18 months ago to discuss what could be done on floods, and I had people coming up to me almost in tears, saying, “Mr Paterson, I just want to say thank you. We’d been closed up since my grandfather—for 40 years we’d been closed up. We’ve gone clear.”

My last point is to ask whether we can look at the basic reproduction number of this disease. Can we look at the level where the disease peters out, when we get the badger population low enough to have a healthy population? I would like the Minister to look at the basic reproductive ratio, R0, which represents the number of cases that one case generates on average over the course of its infectious period, in an otherwise uninfected population. Could we make it the target of our policy to get the disease down to a level where it is not sustainable in the wildlife population and end this hideous trauma for wildlife, cattle and our farmers?

I congratulate the hon. Member for High Peak (Ruth George) on the very balanced way that she made her points. I was pleasantly surprised by the interventions from our colleagues from Wales, the hon. Member for Brecon and Radnorshire (Jane Dodds), and from Northern Ireland, the hon. Member for Strangford (Jim Shannon), who made similarly balanced points, as did our colleague from Cumbria, the hon. Member for Westmorland and Lonsdale (Tim Farron).

We have heard that TB is a devastating disease. It is devastating for animals, for wildlife and for farming communities. What makes me angry is that we had beaten this disease. We had almost got on top of it, but then we had the perfect storm. We had the foot and mouth epidemic when, for obvious reasons, vets’ visits to farms were deemed to be a risk of spreading the disease, and at the same time we protected the badger—without, I must say, having done any real work on the effect that that has on other wildlife such as bumblebees, hedgehogs and other species. As we heard, last year almost 33,000 cattle were slaughtered in England, and we have had suicides, even this year, in the farming community because of the stress we heard about. We also heard that the only successful incidents of control or eradication involved controlling wildlife—in New Zealand, the brushtail possum, and in Ireland, the badger.

What should come out of the debate, as I hope the Minister will reaffirm, is that policy should be based on sound science and the latest research, which has shown that breakdowns have been reduced by 66% in Gloucestershire and 37% in Somerset. Vaccination, I am sure, has a role, but it should not replace wildlife culling. Infected badgers cannot be cured by vaccination, and those badgers cannot all be caught. Indeed, the vaccine itself is not a vaccine; it has a high failure rate. Caught badgers cannot be rapidly tested and then released if they are clear, or vaccinated or killed if they are infected.

Sadly, we had to curtail research on the oral vaccine, because we could not get a bait abrasive enough to allow the vaccine to get sufficiently into the bloodstream of the animal. Badgers can be caught and the backs of their mouths scratched, getting the vaccine to work to some extent, but, sadly, it is not possible to have an oral vaccine. Of course, the real holy grail would be a cattle vaccine that only protected cattle, with a blood test to differentiate between vaccinated cows and cows with the disease. We would then have to get agreement across our major trading partners, including the EU, to be able to sell meat and products from those animals.

What more can we do? We need more sensitive tests and, in some areas, more regular tests. The skin test is specific. An animal with a positive reactor has only a one in 5,000 chance of not being infected; three reactors give a one in 250,000 chance. That is a very specific test, but it is not sensitive enough. The gamma interferon test would give us the ability to detect more animals, but there would be more false positives, and farmers would have to accept that situation in certain parts of the country. We need enhanced basic biosecurity measures, and we need to look at what we can do on dealers, who are sometimes reckless in the way that they transport animals around the country. I would like the National Trust to look at the evidence that we now have and perhaps change its policy on allowing its tenant farmers to undertake culling in their areas.

We can control this disease only by using all the tools at our disposal. We must not respond to ill-informed representations in the pursuit of short-term, populist political gain. To do so would risk long-term misery for our cattle, our farmers and, indeed, our badgers.

It is a pleasure to serve under your chairship, Mr Wilson. There have been so many passionate contributions that, in winding up for the Scottish National party, I do not think I can mention them all; I presume that I have a limited amount of time as well. However, I will highlight three in particular.

I commend the hon. Member for High Peak (Ruth George), who secured the debate, for her nuanced and evidence-led approach to this clearly very sensitive and emotional issue. The hon. Member for Chatham and Aylesford (Tracey Crouch)—this point was made by other Members from across the Chamber, and I commend them for that—mentioned the importance of making it clear that this is not a farmer versus badger issue. She gave alternatives to badger culling, which I am sure the Minister will be interested in pursuing the details of, if he was not aware of them already, because they sound like they are achieving some impressive results. The hon. Member for Congleton (Fiona Bruce) spoke of a human aspect that we must never forget: the devastating impact that this disease has on farmers, their families and the communities around them. There were numerous other contributions from other Members who spoke with passion and often from personal experience.

I suppose I should make it clear that, despite the fact that I am a Brock, I have no conflict of interest. In spite of the name, I have no relatives who are badgers and I know no badgers personally. I will admit, however, to a general liking for the creatures, who seem amiable enough. I certainly have the occasional visit from badgers in my garden in Edinburgh.

I was reading the British Veterinary Association’s website recently, as one does, and spotted a report about the badger culling areas of Gloucestershire, Somerset and Dorset, using data from 2013 to 2017. The BVA clearly considered that this report showed that culling was effective in controlling bovine tuberculosis, indicating a 55% drop in bovine TB incidents. On the face of it, that is clear evidence that the policy is working.

However, it struck me that this is the removal of a species from an area, which in itself raises obvious questions about whether an effective solution is necessarily the best solution and, perhaps more importantly, about the effect of taking an entire wild species out of an ecosystem. What does removing badgers from these localities do to biodiversity? Their diet is mainly earthworms and insects, I think, but they also clean up carrion and windfall fruit and perform other similar housekeeping duties. I am not an expert—we will have to ask someone else—but I assume that their burrowing and hunting habits help to till the soil and move nutrients. An ecologist could no doubt educate us on the benefits to a local ecosystem of having a brock or two in the area; I imagine that there are multiple benefits.

The hon. Lady has, until now, been making a sensible speech. My memory from my upbringing in Scotland is that there was a scarce population of badgers —almost none at all. If she came down to Wiltshire, she would find a large number of badgers indeed. It is not one or two here and there; we are talking about dozens and dozens of setts absolutely crammed to the doors with ill badgers. These notions—the idea that there are one or two, and questions like: “aren’t they nice?”, “what about the biodiversity?” and “don’t they help till the soil?”—just show that she has absolutely no idea about what life is like in a badger area.

I appreciate that the hon. Gentleman has greater experience of these things, given where he resides, but I assure him that there are significant brock populations now in Scotland. I will go on to speak about what is happening in Scotland around this issue.

Lastly on the point that I was making, I point to our experience of the effects of wiping out other species in large geographical areas, and to the fact that we often find conservation organisations trying to reintroduce the animals that we have hunted to extinction. England may continue down this road, and that is, to some extent, a matter for England to decide. However, it is worth remembering how much we criticise other nations for failing to protect their wildlife.

The cull is not about eradicating the badger. Typically, the population will be reduced to about 30% of what it was before. In areas such as Scotland and North Yorkshire, where we have low levels of TB, the badger population is not a problem. However, in areas where we have large numbers of badgers and high infection levels, controlling—not eradicating—the population at sensible levels might also have good knock-on effects for other species, such as bumblebees and so on, which have been crowded out by the badger.

That is an interesting point. As I understand it, culling badgers actually encourages them, in some instances, to roam further, because they are not threated by other setts in other areas, and that potentially encourages the spread of TB. I do not believe that Members have yet raised that aspect of it.

Scotland has, of course, gone down another route. The control of bovine TB in our country is a partnership working success, with the Scottish Government assisting the livestock industry in maintaining Scotland’s position as officially tuberculosis free since 2009. That might be unpopular around these parts at the moment, since it is an EU Commission recognition of how good Scotland is on this. There is a monitoring regime, with movement controls and quarantine where needed. The hon. Member for High Peak spoke about the big drop-off in monitoring by Natural England. Will the Minister help us to understand why that might have happened, and what impact the huge recent cut to Natural England’s funding—since 2014, I think—has had on its ability to monitor?

We have a monitoring regime, with movement controls and quarantine where needed, and that now includes other animals as well as cattle. It is about better animal husbandry, good biosecurity and high-spec testing. I say to my good English friends that that may be a better solution than killing thousands of animals. It has also been very important for trade for Scottish farmers. People cannot trade beasts across the EU, as many hon. Members will know, without their herds being certified as TB free. There are concerns about what will happen post Brexit, and perhaps the Minister can also address that. English farmers may also be concerned that the EU funding, stretching to millions of pounds, for TB control will not be there after Brexit. The question will be how and, indeed, whether it is replaced.

It is disappointing that neither the House of Commons Library briefing for this debate nor any speaker today, I think, has referred to the example of Scotland—officially TB free since 2009. Might I suggest to Ministers and to hon. Members concerned about this issue that they take the time to look to Scotland for some inspiration?

I am delighted to serve under your chairmanship, Mr Wilson. I congratulate my hon. Friend the Member for High Peak (Ruth George). What she said was very measured. [Interruption.] I do not know whether a debate is still going on—that is always better than comments sotto voce. My hon. Friend presented the case very well, so I will not go over what she said. Hon. Members will disagree on the way in which this terrible disease is currently being fought.

Of course, we are all in favour of eradicating bovine TB. My area has suffered from it more than most. I have seen what it does to both cattle and badgers, and anyone who does not believe that it is an awful disease does not know much about it. However, we will disagree on how we go about eradication—including the notion of when we will eradicate it, if we ever can. We have to hope we can, but that is at least questionable.

I shall start with what we know—and I will congratulate the Government. They were brave, given all the pressure that they came under, not to extend the cull to Derbyshire, because it is worthwhile looking at different models. I shall also start by saying that I think we could learn from what has happened in Wales. I heard what the hon. Member for Brecon and Radnorshire (Jane Dodds) said, but the Welsh Government have taken a fundamentally different approach. I do not know enough about what the Scottish Government have done, but I hope that the UK Government are open to the suggestion that we can bear down on this disease in different ways. Wales, with its concentration on herd breakdown, has shown us at least some very different notions of what we can do.

Let me go back to what Labour did when we were in government. It is a bit of a myth that we did not spend an awful lot of time on this disease: we did, including through the work of John Krebs. I recall that one of Krebs’s conclusions was that killing badgers would make no significant difference to the spread of bovine TB in cattle. That was borne out by the independent expert panel, under John Bourne. We put serious resources into that, and it is where we got to understand the perturbation effect. All the scientists who were associated with it have come down very strongly against the current, privatised cull, given the potential damage that it does, with the spread outwards of this disease because of the perturbation effect.

I am grateful to my constituency neighbour for giving way. He is aware of the latest figures, which show very clearly that in Gloucestershire, far from there being a perturbation effect, the opposite has actually been the case: there has been a reduction in the level of the disease on the edge of the cull areas.

Let me come to that later, because I will point out something slightly different.

We have had the two articles, and they are articles; they are not necessarily anything other than a position taken by both Brunton and Downs. Brunton used the findings given to her by APHA and she made the point that

“to use the findings of this analysis to develop generalisable inferences about the effectiveness of the policy at present”

was at least questionable. Downs was more definitive and did say that there was some strong evidence, in her opinion, that the cull was working. But this is where I disagree with the hon. Member for The Cotswolds (Sir Geoffrey Clifton-Brown). The current figures from Gloucestershire have shown an upward spike, in both incidence and prevalence, in the cull area. This is the problem with this disease: it is not a disease that can easily be measured in terms of one policy. My fear about the Government is that they have gone along the badger cull route as the main policy.

With regard to where we are, the one real criticism that I have of this Government is that I think it is outrageous that MPs are not allowed to know where culling is taking place. I recently had an incident locally that was about culling on the edge of the Woodchester Park area. Anyone who knows anything, and certainly those who have studied the matter, will know that Woodchester Park has spent more time than most of us have had hot dinners in trying to understand how the badger population is affected by bovine TB and in looking at the relationship—the transmission mechanism—between badgers and cattle. Certainly we had some evidence that a badger was shot within that trial area. I know the police will not prosecute, but I hope that the Minister will give me every assurance that there is no possibility of culling, because that would throw away 40-plus years of how we have been studying those badgers, and we need to keep doing that.

I have been talking about where we are. This, of course, is a stress-based disease. That is why I am quizzical, and want to hear from the Government, about why they have not yet responded to Godfray, because it is right and proper that we do respond to Godfray. We need to understand this issue. My area had a recent incidence of TB caused by the way in which people were putting in a new pipeline. Because they did not move the badger setts properly, five farms have gone down, no doubt because of the stress on the badgers that were moved wrongly and on the cattle, which suffered accordingly. It is important that we understand that a number of different things are involved.

I welcome what the hon. Member for Chatham and Aylesford (Tracey Crouch) said about slurry. I hope that the Government are looking seriously at the work of Gatcombe, down in Dorset—on the Dorset-Devon border—where Dick Sibley has tried to do things.

May I just continue? I will never finish my speech otherwise, and the Minister will need quite a lot of time to respond because of the excellent debate that we have had, even if hon. Members do not agree on this issue.

I hope that we are looking at what Sibley has discovered in trying to eradicate this disease from a cattle herd. He has narrowed things down, again, to, dare I say, the impact of slurry being put out on farms. We need to know more about that.

With regard to where else we need to be much better, I think that the hon. Member for North Herefordshire (Bill Wiggin) brought up the notion of the Enferplex test. We need to push forward on the different measures. I will be blunt: the SICCT—single intradermal comparative cervical tuberculin—test, the skin test, is notoriously unreliable. Far too often, cattle that have the disease are missed. Sometimes they are picked up with the interferon-gamma test. Again, Gatcombe is doing work with PCR and phage.

It is important that we know that these tests are much more accurate. We need to bear down on this disease. I do not want to kill cattle any more than I want to kill badgers. Far too often, cattle are killed that are clean of the disease. But sadly, there are cattle that are not clean of the disease and get through. We still have 14 million cattle movements. It is important that we understand that those movements could be a major cause of the spread of the disease, because if we do not know which cattle have it, as we may not know which badgers have it, and we allow those cattle to travel around the country, that is clearly a real threat.

We need to look at every tool in the box. We will not agree on how this disease is currently being fought, but fought it must be. The Leader of the Opposition offered with equanimity to work with the Government at the end of yesterday’s debate and I would like to work with the Government on this. I would love for the Minister to come to Woodchester Park and look at the implications of what researchers have found there over many years.

I agree with the Prime Minister about the need to end cattle movement—all live exports—in terms of what we send abroad. That could give us an opening. Much of the way in which we have fought this disease has been to do with the need to keep our trade policy “TB-free”. If we maintain that, it is important to understand that this might be a way forward. Thus far we have been within EU rules. That is something we could address.

In conclusion, I would like to work with the Minister. Sadly, previous attempts at cross-party work have not always succeeded, but I make that offer now—and I hope the Minister will take me up on it.

I congratulate the hon. Member for High Peak (Ruth George) on securing this debate and, as several hon. Members have said, on the sensitive way she approached a difficult and contentious issue, particularly in her recognition of the trauma this issue causes farmers.

Bovine TB is one of our most difficult animal health challenges. It is a slow-moving, insidious disease. It is difficult to detect. None of the diagnostic tests are perfect. I will come on to that later. It can exist in the environment for several months. There is a reservoir of the disease in the wildlife population, hosted in badgers. No vaccination is perfect. The best vaccine we have is the BCG vaccine, which typically provides protection of around 70%.

As the hon. Lady said, bovine TB also imposes a huge pressure on the wellbeing of our cattle farmers and their families. As many hon. Members have said, including my hon. Friend the Member for Congleton (Fiona Bruce), it is a tragedy when farmers have a TB breakdown. Some farmers lose show-winning cattle. For many, their herd of cattle is their pride and joy, and it is utterly soul-destroying to see those cattle lost.

No single measure that will achieve eradication by our target of 2038. That is why our 25-year strategy, launched by my right hon. Friend the Member for North Shropshire (Mr Paterson) in 2013, sets out a wide range of interventions. Cattle testing is the cornerstone of our current programme. Several hon. Members, including the hon. Member for Edinburgh North and Leith (Deidre Brock), suggested that we are focusing on badgers at the expense of other interventions. That is simply not true. We have a wide range of testing regimes.

There are regular surveillance tests, every four years in the low-risk area, every year in the high-risk area and every six months in hotspots. There are pre-movement tests. Recently, we introduced compulsory post-movement tests for cattle moving between holdings. There are trace tests on cattle that have recently been added to a herd. We have tests on a herd following a sale of cattle to another herd, where that leads to a TB breakdown. We have radial testing in some areas and contiguous testing in others, where there are implications from a neighbour’s farm with a breakdown. Where there are inconclusive reactors, we have re-tests. Recently, we dramatically increased the use of the far more sensitive interferon gamma test, to ensure that we detect the presence of the disease and root it out faster from our herds.

It is not correct to say that our policy is built solely on the contentious badger cull policy. The cornerstone of our fight against TB is and always has been a very thorough testing regime, to remove the disease from cattle. All the demands we place on farmers through testing, despite the trauma concerned and the dangers they pose, are crucial to our fight against the disease. We must continue to be vigilant on this front. That was one of the recommendations from the review conducted by Sir Charles Godfray.

Seven years into our 25-year strategy to eradicate TB, we feel that it is a good time to reflect on the strategy and think about other elements we might want to evolve. That is why the former Secretary of State asked Sir Charles Godfray to conduct a review around the five-year point of the strategy. That was published a little under a year ago. Several hon. Members have asked why the response has been delayed and when to expect it. All good things are worth waiting for. I envisage the response being published soon. I hope it will not be interrupted by an election purdah.

The response to the Godfray review is an opportunity for us to take stock and review the current strategy, seven years in. The shadow Minister offered to work with me on this. When we publish our response to the Godfray review, I will invite him and his team to meet me in the Department for Environment, Food and Rural Affairs to go through what we are proposing. The tone of this debate has been slightly different to previous debates on the matter. While we will never entirely agree, I detect a sense that both sides can make a step towards one another and achieve a consensus on certain issues. I am keen to try to achieve that. This is a long- term fight—it is a 25-year strategy—so it would be helpful to have cross-party understanding and consensus on elements of it.

This debate relates to Derbyshire. As the hon. Member for High Peak knows, we took a difficult decision to pause a proposed cull in the south of Derbyshire. I understand that has caused great frustration to farmers. We did that to ensure that we can assess how we can have co-existence of badger vaccination and culling in parts of the edge area. That is why we chose to pause it for this year.

Badger culling is a controversial policy. We have powerful scientific evidence to show that the cull is working, despite passionate attempts by some to suggest otherwise. TB was first identified in the badger population as long ago as 1971. A series of trials in the 1970s demonstrated that a badger cull could lead to significant reductions in the incidence of the disease. That was borne out further by the randomised badger culling trial in the early 2000s.

Crucially, a recent independent peer-reviewed epidemiological study, published by Downs and others in the internationally-renowned scientific journal Scientific Reports, showed that licensed badger culling is leading to a significant reduction in the incidence of the disease in cattle in each of the first two cull areas. The study showed that there was a 66% reduction in TB incidence rates in Gloucestershire and a 37% reduction in the Somerset cull area, over the four years of intensive badger culling, relative to similar comparison areas. No significant changes have yet been observed in the third area in Dorset, but that is after just two years of culling. Furthermore, there was no evidence of an increase in the TB herd incidence rates in cattle located around the buffer area. One of the key findings of the report was that the so-called perturbation effect, which was a concern for some when the cull was launched, has not materialised in the culls so far.

The Government do not dismiss badger vaccination, but it is important to remember that the only vaccine we have is the BCG vaccine, which does not provide full protection. We do not have any hard, scientific evidence of how it works on a field deployment scale.

I may have missed something, but I noted from the Library report that was given to us that the Animal and Plant Health Agency was conducting an efficacy study and that the results were expected later this year. That is a research programme to identify an oral vaccine and a palatable bait. I wonder whether there is any update on that.

I think that was dealt with by my right hon. Friend the Member for Scarborough and Whitby (Mr Goodwill). In all my time in this role previously, I kept going and persevered with the research to try to identify an oral vaccine, because—in reality—if we want to deploy a vaccine on scale in the wildlife population, an oral bait vaccine would be the answer. I have had numerous submissions over the years inviting me to pull up stumps on that research, but I persevered.

However, I am afraid that in the end we could not get there, for the reason that my right hon. Friend pointed out, namely that a badger’s digestive system is too powerful and it breaks down the vaccine. All attempts to find other ways around that were unsuccessful. It is also the case that when such vaccines were deployed in the field, certain badgers would get a lot of the vaccine and others would get none at all, because there would be a propensity for some badgers to take up the bait but not others. So it is not something that we are continuing with at this stage.

I will pick up on a few points that hon. Members have made. The hon. Member for High Peak raised the issue of cows that were heavily pregnant with calves. She is right that it is an absolute tragedy to cull such cows and in fact a couple of years ago I changed the rules in this area, so that a cow that is in the final month of its pregnancy can now stay on the farm and be placed in isolation. We have even provided that a cow in the final two months of its pregnancy can be isolated, provided that the isolation facilities are sufficiently robust. So I have already changed the rules in that regard, because, as my right hon. Friend the Member for North Shropshire pointed out, it is horrendous when a cow that is about to give birth has to be shot on a farm.

The hon. Lady also raised the issue of the badger population in Derbyshire. The reality is that in in her area in the north of Derbyshire, where badger vaccination is taking place, incidence of the disease in badgers is quite low. However, that is not the case in south-west Derbyshire, particularly along the border with Staffordshire, where there is a high prevalence of the disease in the badger population.

What evidence is there for the incidence of the disease in badgers? Will the Minister look to test badgers in the cull areas post-culling, because it is so important that we are clear about whether there is or is not incidence of the disease?

We have a number of approaches. We do some roadkill surveillance in areas to identify where there is disease. Also, whenever we have a breakdown on a farm, an assessment is carried out by APHA vets to try to establish the most likely cause of that breakdown. So there are breakdown epidemiological reports.

The hon. Lady also raised an issue about herd size. In addition to the point made by my hon. Friend the Member for North Herefordshire (Bill Wiggin), the fact of the matter is that it is an epidemiological reality that the more cattle there are in a herd, the more interfaces there are with the environment and the more likely they are to pick up infection. I remember that some years ago our chief scientist in the Department for Environment, Food and Rural Affairs got very excited and thought that those with small herds must be doing something right. However, we concluded that it is simply a mathematical fact that a small herd has fewer interfaces with the badger population and therefore has a lower propensity to have a breakdown.

My hon. Friend the Member for Chatham and Aylesford (Tracey Crouch) raised an important issue about slurry. I can tell her that I have had meetings with Dick Sibley and that he has attended roundtable discussions we have had on this issue. However, as long ago as 2015 we launched a biosecurity plan that included slurry management best practice guidance, so this is an issue that we recognise and that we try to improve. The evidence is a little mixed, because the reality is that if we are testing and removing cattle, we would tend to remove them before the disease shows up in slurry, unless the test is ineffective and is missing those cattle. So this is an area that we are keen to look at further and, as I have said, we are in dialogue with Dick Sibley on some of these matters.

My hon. Friend the Member for North Herefordshire made a point about diagnostic tests. He is absolutely right—we are now allowing the use of unvalidated tests and, again, Dick Sibley is using one of those tests. We have also dramatically increased our deployment of the more sensitive interferon gamma test.

My right hon. Friend the Member for North Shropshire made an important point about epidemiology and, crucially, how we get daughter infection below one, so that we can put this disease into permanent retreat. The R0—the reproductive number that he mentioned—is notoriously difficult to calculate, but we have a track record in our own history of taking this disease from a very high prevalence in the 1930s down to zero in the 1980s. So there is a point whereby, if we keep going, we can put this disease into permanent retreat.

I will make a point briefly. Will the Government look at evidence from other countries, particularly Ireland, where the evidence is quite contrary to what the SNP spokesperson—the hon. Member for Edinburgh North and Leith (Deidre Brock)—said, in that there is no intention of eliminating a species? This process is about getting the population per kilometre down to a level whereby the disease simply cannot reproduce itself, and then we will end up with a completely stable, healthy badger population, and this whole nightmare will go away.

We will look at that evidence, but this is a difficult issue. My right hon. Friend is right that our aim, as my right hon. Friend the Member for Scarborough and Whitby pointed out, is to get the badger population down by 70% in the four years of the cull; it is not our intention at all to eradicate the badger population. This is an issue that we will continue to look at because, as we plot how to get from where we are now to being officially TB-free by 2038, it is clearly an important issue.

My right hon. Friend the Member for Scarborough and Whitby also pointed out some of the challenges of vaccinating badgers and the further challenge that we have had with an oral vaccination. However, if we can use such a vaccination, there are also some advantages. It provides herd immunity and there is some evidence that cubs born in badger populations that have been vaccinated have a higher degree of resistance to the disease than other badgers.

Finally, the hon. Member for Edinburgh North and Leith asked about Scotland. The approach taken in Scotland is very similar to the approach that we take in a low-risk area elsewhere. Scotland does not have a large badger population and nor does it have a presence of the disease in the badger population, which is in common with the north of England. Therefore, the nature of the challenge in Scotland is very different to that elsewhere.

The badger population has more than doubled in this country over the last 20 or so years. In the cull areas, which we are targeting because the disease is rife there, we simply look to reduce the badger population by 70% for the duration of the cull.

The one thing that has not been mentioned—I should have mentioned it myself, of course—is cattle vaccination. Such vaccination was always 10 years away, but I gather that it is now five years away. Are the Weybridge and Pirbright research institutions still working on this vaccination and, if so, can they clarify where they are with that work?

Yes, we are continuing to do cattle vaccinations; that particular research has not been stopped. As the hon. Gentleman says, cattle vaccination is an important line of work and it is one that we intend to continue.

I thank all the Members who have contributed to this very constructive debate and I look forward to the cross-party working with the Minister, and with the shadow Minister, my hon. Friend the Member for Stroud (Dr Drew), and the rest of the shadow team.

However, I was disappointed that the Minister did not talk about the other measures that he will use as other tools in the box. I hope that he will consider scaling up vaccination and I invite him to come and visit High Peak to see the excellent work being done there by Derbyshire Wildlife Trust, work that is really capable of being scaled up.

Question put and agreed to.

Resolved,

That this House has considered Government policy on TB in cattle and badgers.

Sitting suspended.

Health and Social Care (Kettering)

I beg to move,

That this House has considered health and social care in Kettering constituency.

I welcome you to the Chair, Mr Wilson, and I thank Mr Speaker for granting this debate. I also welcome Northamptonshire colleagues who are here: my hon. Friends the Members for Wellingborough (Mr Bone) and for Northampton South (Andrew Lewer). If he is released from his important role in the Government Whips Office, my hon. Friend the Member for Corby (Tom Pursglove) hopes to be able to attend. Others with a local interest are also here, including my right hon. Friend the Member for Rutland and Melton (Sir Alan Duncan), who I welcome to his place.

I also welcome our excellent Minister for Health, my hon. Friend the Member for Charnwood (Edward Argar). He is not only excellent in his own right, but he is super excellent because within just a few weeks of being appointed as hospitals Minister, he made a visit to Kettering General Hospital one of his very highest priorities. He did that on 7 October and met: the superb chairman of Kettering General Hospital, Alan Burns; our wonderful chief executive, Simon Weldon; the medical director, Andrew Chilton; the chief nurse, Leanne Hackshall; the chief operating officer, Joanna Fawcus; the director of strategy and transformation, Polly Grimmett; the director of finance, Nicola Briggs; the director of estates, Ian Allen; the clinical director of urgent care, Adrian Ierina; and the head of nursing in urgent care, Ali Gamby. All those magnificent people were there to meet the Minister because the hospital is absolutely determined to get the necessary funding for a new urgent care hub at the Kettering General Hospital site.

Kettering General Hospital is a much-loved local hospital. It has been on its present site for 122 years, and there cannot be many hospitals that have such a record. The problem at Kettering General Hospital is that the A&E department is full. It was constructed in 1994 to cope with 45,000 attendances each year. This year, we could well go through the 100,000 attendances mark, which is well over 150% of the department’s capacity. By 2045, 170,000 attendances are expected at the same site. The solution to that pressure is for an urgent care hub facility costing £46 million to be constructed on the site. It would be a two-storey, one-stop shop with GP services, out-of-hours care, an on-site pharmacy, a minor injuries unit, facilities for social services and mental health care, access to community care services for the frail elderly and a replacement for our A&E department. All the NHS organisations in Northamptonshire, as well as NHS Improvement regionally, agree that that is the No. 1 clinical priority for Northamptonshire. They are all saying the same thing to the Government, and I am delighted to support their campaign.

The A&E department at Kettering General Hospital was visited in 2016 by Dr Kevin Reynard of the national NHS emergency care improvement programme. He said:

“The current emergency department is the most cramped and limiting emergency department I have ever come across in the UK, USA, Australia or India. I cannot see how the team, irrespective of crowding, can deliver a safe, modern emergency medicine service within the current footprint.”

Despite some temporary modifications over recent years, including moving other patient services off the hospital site, detailed surveys show that no further opportunities remain to extend the department and that a brand new building is required on the site. The hospital has developed a superb business case for a fit-for-purpose emergency care facility that will meet local population growth for the next 30 years. It has been developed with all the health and social care partners across the county so that patients can get a local urgent care service that meets all the Government guidance on good practice, ensuring that they get the care they need to keep them safely outside of hospital if necessary, and ensuring that if they come into hospital, they are seen by the right clinician at the right time, first time. The bid has been submitted to the Government. We have been pressing the case for the facility since 2012. It is about time that the Government listened to the concerns and responded by promising the funding.

The pressure on Kettering General Hospital is primarily being driven by very fast population growth locally. The Office for National Statistics shows that we are one of the fastest growing areas in the whole country at almost double the national average. The borough of Corby is the fastest growing borough outside of London. The population served by the trust has grown by almost 45% since the A&E opened in 1994. The area is committed to at least 35,000 new houses over the next 10 years. That means a population rise of some 84,000, to almost 400,000 people locally. The A&E department now sees approximately 300 patients every single day in a department that is safely sized to see just 110. Every day, 87 patients are admitted into the in-patient wards from A&E, and over the next 10 years, the hospital expects the number of A&E attendances to increase by 30,000, equivalent to almost 80 extra patients every day. Bluntly, a solution is required immediately if the hospital is to have time to prepare and build for that.

I thank my hon. Friend for giving way. I recently visited A&E at Northampton General Hospital, which also has a space and crowding problem, particularly in paediatrics. Does he agree that investment there would assist Kettering with the problems it has and would lead to a whole Northamptonshire approach to solving some of these problems?

I am delighted to take that intervention from my hon. Friend, who is a superb representative for his constituents in Northampton and is very much in touch with the importance of local healthcare issues to our constituents. He is absolutely right.

I am delighted to welcome the Government’s commitment to include Kettering General Hospital on the list of hospitals that will be considered for health infrastructure plan 2—or HIP2—funding from 2025. That is important for Kettering, because the hospital has been there for 122 years, 70% of the buildings on the main hospital site are more than 30 years old and there is a maintenance backlog of £42 million. We need the reconstruction of many wards at the hospital. I welcome the Government’s commitment to investment in the hospital site from 2025 onwards, which could transform the whole of Kettering General Hospital. The point about the urgent care hub is that we need the money now to address the pressure on the A&E department.

The second part of the debate is about the need for us to use the opportunity of local government reorganisation in Northamptonshire to create in the county a combined health and social care pilot that will put responsibility for healthcare and social care under one organisation. Northamptonshire County Council has faced tremendous financial difficulties. The Government appointed an inspector, who concluded that it was not possible to turn around the organisation. The Government’s solution is to create two unitary councils in the county: a “north” council and a “west” council that will take over all the responsibilities of the eight different councils in the county from May 2021. We can use that once-in-a-generation opportunity to create a new organisation on a pilot basis to combine health and social care in Northamptonshire.

That is important for Kettering General Hospital because it has 531 beds; at any one time 110 of those beds—21%—are occupied by patients who should not be in hospital at all, but in a social care or other setting. In Government jargon, they are defined as super-stranded patients who have been in hospital for more than 21 days. If the hospital discharges 87 patients a day from the A&E department to the hospital, and 110 of the beds are occupied by patients who should be in a different setting, it creates huge problems for the A&E department, so finding a solution to the social care issue is also important for the A&E department.

I congratulate my hon. Friend on having led a seven-and-a-half-year campaign to get the expansion at Kettering General Hospital. It has been my great pleasure and that of my hon. Friend the Member for Corby (Tom Pursglove) to support him, but he has led this magnificent campaign and I hope that today he will succeed in his objective. Does he agree with me that the reorganisation he has talked about could possibly—hopefully—lead to an urgent care centre at the Isebrook Hospital in my constituency, which would reduce the number of people that go to Kettering A&E by 40%?

I would be delighted to support my hon. Friend’s campaign. He is a very effective champion for his constituents. He, along with my hon. Friend the Member for Corby, has been an integral part of a joint effort to campaign for the urgent care hub at Kettering. I would be delighted to reciprocate, because health investment in our local constituencies is very important for our local residents.

My hon. Friend the Member for Wellingborough will join me in welcoming any proposals that the Government introduce to create a health and social care pilot in the county. We simply have to make sure that elderly, frail residents in hospital, who need not be there and should be in a social care setting, are given the social care that they need in the right place at the right time. With social care now the responsibility of Northamptonshire County Council, I am afraid it simply is not working.

Evidence shows that the longer an elderly person stays in hospital, the more they lose critical muscle mass and strength, which affects their ability to return to their home or social care setting without appropriate support. Patients with long lengths of stay in hospital become revolving door patients. They get better and could go to a community setting of care, but they become unwell again because they wait so long for an appropriate out-of-hospital placement, so we need to get that sorted out. Financially, it does not make sense, either. If a patient stays in hospital, it costs £2,500 a week. If they are put into a social care setting, the cost to the taxpayer is £700 a week. Not only is the setting more appropriate, but it is financially beneficial for our health and social care providers.

I am pleased that the Secretary of State for Health and Social Care, together with the appropriate Minister in the Ministry of Housing, Communities and Local Government, wrote to all Northamptonshire MPs on 24 July, encouraging Northamptonshire County Council and the local NHS providers to knock their heads together to thrash out an appropriate plan. The Secretary of State wrote:

“I agree that the unitarisation process offers an excellent opportunity to re-imagine the delivery of health and social care services across Northamptonshire. I believe that local leaders should be bold in their ambitions for integration”.

He stated that he and the Housing, Communities and Local Government Minister

“are happy to back a bolder plan for integrated services in Northamptonshire, learning from other areas that are further ahead in the integration journey”,

such as Greater Manchester. Since that letter of 24 July, my colleagues and I, as parliamentary representatives from Northamptonshire, have seen little evidence of any concrete proposals from the county council and the local NHS. It is time for the Government to knock heads together locally, because the Government will want a pilot to pioneer their reform of health and social care. We have a wonderful opportunity in Northamptonshire to be the first in a shire setting to get it right.

Local organisations are doing their best in the present circumstances—I declare my interest as a member of Kettering Borough Council. To give one example, Karen Clarke, a housing options adviser at Kettering Borough Council, has been working extremely hard to make sure that patients can come out of hospital and find appropriate accommodation if they have difficulties in doing so. She recently wrote:

“I think the majority of the public assume everyone goes in to hospital, receives their treatment and is discharged home, but what if that patient doesn’t have a home? Or what if their home is no longer accessible? What if someone needs more than just independent living? Where does the patient go then?”

Karen has seen more than 250 patients in the past two years. She has managed to return home, or to secure permanent accommodation for, approximately 7% of those referrals, and 25% have gone into some level of temporary accommodation. That pioneering initiative is at Kettering’s health and housing partnership, where Kettering Borough Council, the local mental health trust and Kettering General Hospital work together. It has been pioneered by John Conway, the inspirational head of housing at Kettering Borough Council. It is a superb initiative.

However, such local initiatives are not enough. We need one organisation, preferably NHS-led, to sort out health and social care provision in Northamptonshire. The Government have a golden opportunity to pioneer a pilot in the county, so I hope they will press ahead. There are two issues: we need £46 million for an urgent care hub at Kettering General Hospital, and we need the Government to seize the initiative, knock heads together locally, and make sure we can have a pilot for health and social care in Northamptonshire.

I congratulate my hon. Friend the Member for Kettering (Mr Hollobone) on securing this debate on health and social care in Kettering. It is testament to his strong commitment to the issue on behalf of his constituents that we hold this debate today around six weeks after he secured a debate on his local hospital. I had the privilege, as he mentioned in his speech, of visiting his local hospital a couple of weeks ago. His constituents can be in no doubt of his tenacity and persistence in this place on their behalf—something all too familiar to numerous Ministers—and they are lucky to have him as a strong local voice fighting their corner here in Westminster.

The local context for health and social care in Northamptonshire, and in Kettering specifically, was well set out by my hon. Friend. The area has seen considerable population growth. On the basis of projections, the wider area is set to see further significant growth in population in the coming years, with circa 35,000 new homes over the next 10 years, as he set out. That will in turn see additional demand for health and social care services. The presence of my right hon. Friend the Member for Rutland and Melton (Sir Alan Duncan) emphasises the fact that not only Kettering and Northamptonshire residents are served by the hospital, but so are many of his constituents in Rutland as well.

If we overlay on this the broader national picture of an ageing population—a positive we should be proud of as we are all living for longer, but one that brings with it the need for additional support and care for people to live independent, fulfilling lives for longer—we see a clear need for new integrated models of care, addressing the increase in demand in numerical terms; the greater number of older people requiring support; and the young families that the new development and housing will bring with them. Working towards greater integration of health and social care services in Northamptonshire is a critical part of the journey towards local government reorganisation in the county.

On the establishment of the two unitary councils, I know my right hon. Friend the Secretary of State for Housing, Communities and Local Government is working hard to ensure that legislation can be considered by the House as soon as practicable. I know that my hon. Friend the Member for Kettering has, in that context, raised the proposition, as he did today, of trialling or piloting a new integrated health and social care system in Northamptonshire. That proposal was also highlighted to me compellingly by members of the hospital team and trust during my recent visit, and I understand it has been discussed with the Health Secretary and the Secretary of State for Housing, Communities and Local Government. Following that discussion, local council and NHS stakeholders have held further discussions on an outline proposal around system design principles and governance, as a precursor to any possible formal integration.

I look forward to seeing the outcome of those discussions as swiftly as possible. However, although effective, seamless integration is vital to patients and, as my hon. Friend set out, to the overall health ecosystem in his county, I must turn to the heart of his speech and to another key element of the health and social care landscape in Kettering—Kettering General Hospital and the challenges that it faces, particularly around urgent and emergency care provision.

Following the Secretary of State’s announcement of the health infrastructure plan—HIP—which set out a clear plan for strategic investment in our NHS, ensuring that it has the capital investment that it needs to progress and improve for many decades, atop the £33.9 billion annual funding increase for the NHS in the long-term plan, I had the privilege of visiting Kettering General Hospital with my hon. Friend. I received a very warm welcome and had the opportunity to speak with the amazing team of staff, led by the chief executive, Simon, as well as with patients. Equally importantly, I was able to see for myself conditions that I may read about in briefing papers, or be briefed about by my hon. Friend, and see for myself the real need.

As he has today, my hon. Friend and the hospital team set out to me compellingly the challenge facing an emergency department that opened in 1994 for around 40,000 patients a year and that, last year, had more than 90,000 and is forecast to have more than 100,000 this year. It is one thing to be briefed on something; it is another to see the problem for myself, despite the amazing work, which I also saw, by all staff—day in, day out—to ensure patient safety and care. I pay tribute to those staff for playing a central role in the trust’s removal from special measures for quality reasons in May this year.

Despite that amazing work every day to ensure that patients get the care they need, this is a real challenge that needs a long-term resolution. The trust has proposed an urgent care hub—an earlier bid to the sustainability and transformation programme having been unsuccessful —and my hon. Friend is a key part of the trust’s overall larger plans to address that need. I pay tribute to my hon. Friend, and my hon. Friends the Members for Wellingborough (Mr Bone) and for Corby (Tom Pursglove), for their commitment to campaigning for the hospital, and to all Northamptonshire MPs. I recognise my hon. Friend the Member for Northampton South (Andrew Lewer) in that context.

My hon. Friends have not given up. They have been clear that the proposal represents an effective long-term way to solve existing issues and to meet future need. They have pressed their case with eloquence and charm, but with determination. That is why I was delighted that the major scheme for Kettering General Hospital was selected, as part of the HIP 2 announcement, to receive seed funding to develop its plan and investment case to deliver its proposals for a rebuild of the hospital. The trust and my hon. Friend the Member for Kettering fully welcomed that, but made a strong case that aspects of those plans were already well advanced and ready to proceed, and that all the preparatory work had been done on those aspects. When I visited, not only was that argument made compellingly to me, but the need to proceed swiftly with respect to urgent and emergency care provision was clear.

That is why I can go further: I am delighted to inform the House that, in the next capital review, Kettering General NHS Foundation Trust’s £46 million project for a new urgent care hub has been approved by Her Majesty’s Government. My officials and NHS England will be in touch with the trust to discuss further details, in order to ensure that funds are released and that work starts on the project as swiftly as possible. I am conscious of the urgency that my hon. Friend the Member for Kettering highlighted. I know that that news will be welcomed by all my hon. Friends in the Chamber and their constituents. It is a reflection of not only our commitment to delivering on the announcement that we made at the start of the month, but of the work of the trust and that of my hon. Friend and other hon. Friends in their campaign for the investment.

That investment is only one part of the health and social care landscape in Kettering and Northamptonshire, but it is a vital part, and further demonstrates our commitment to the NHS—to our NHS. The investment will, I believe, make a huge difference to the people of Kettering and beyond; having visited and heard my hon. Friend’s arguments, and those of the clinical staff, it is a pleasure to announce it in the House today. I conclude by paying tribute to my hon. Friend not only for securing the debate but for his central role in securing this investment for his constituents and his community.

Question put and agreed to.

Sitting suspended.

Exploitation of Missing Looked-after Children

[Mr Nigel Evans in the Chair]

I beg to move,

That this House has considered the matter of sexual and criminal exploitation of missing looked after children.

It is a pleasure to serve under your chairmanship, Mr Evans. In 2012, an expert working group was set up by the then children’s Minister, the hon. Member for East Worthing and Shoreham (Tim Loughton), at the Department for Education, to look at—among other issues—out-of-area placements of children. That was because of the high number of looked-after children in children’s homes going missing, and concerns about their vulnerability to sexual exploitation. That group was set up partly in response to the 2012 inquiry by the all-party parliamentary group for runaway and missing children and adults, supported by The Children’s Society and Missing People. One of the objectives of that expert group was to make recommendations that would improve the care system, so that

“children are safer and better cared for in residential care—not disproportionately at risk of…exploitation”

because of their vulnerability. The group stated that placements should be

“close to home unless it is in the best interests of the child to be placed out of area”.

An analysis of the children’s home market was commissioned. At that time, more than 50% of homes were concentrated in three regions: the north-west, the west midlands, and the south-east. Some 25% of all children’s homes were in the north-west, and just 6% were in London. That meant there was an under-supply of places in some areas and an over-supply in others, resulting in an unnecessary level of out-of-area placements. One of the issues identified with children being placed out of area was the difficulty for social workers in being able to provide the necessary levels of support. In short, children with high needs were left isolated in children’s homes, miles away from family, friends and social workers, and they were targets for paedophiles.

In 2012, 26% of the children’s homes registered with Ofsted were run by local authorities, and 65% were run by private companies. The report expressed concern about the market being taken over by larger providers. It said that if the under-supply and over-supply in the market was not addressed, children would continue to be placed at a distance from their home communities. The report recommended a reduction in the number of out-of-area placements, and added that those that result in children being placed at very long distances should be exceptional and always explicitly justified in terms of the child’s best interests. The expert group recommended that national and regional information on the structure of the children’s residential care market be improved, and that such information should be used to determine a medium-term market strategy at regional and national levels.

That report is now seven years old. Over the intervening years, successive Ministers have committed to reducing the number of out-of-area placements, yet that figure continues to soar. Last month, the all-party parliamentary group for runaway and missing children and adults published our most recent report, “No Place At Home”. We found a 77% increase in the number of children placed in out-of-area placements since 2012; that figure is now at an all-time high. The majority of the 42 police forces that gave evidence to our inquiry were adamant that placing children out of area increased their risk of exploitation and very often resulted in their going missing.

Some 75% of all children’s homes are run by private companies, representing a 23% increase since 2012, and local authorities now run 19% of children’s homes, representing a decrease of 26% since the same year. According to Ofsted, 47 local authorities—one third—did not run any children’s homes at all in 2019. Given the increasing dominance of the private sector, the APPG recommended that Ofsted should have the same powers in relation to children’s homes as the Care Quality Commission has for nursing and care homes.

The north-west, west midlands and south-east remain the three regions with the highest concentration of children’s homes, accounting for 55% of all homes, and there continue to be issues with over-supply and under-supply. Some 80% of local authorities now place children outside their area. There has been an increase in the number of children coming into care, and an increase in the number of children’s homes. However, it is not clear whether, in practice, that means there are more places to meet the needs of children. Many of the children being placed in homes would previously have been placed in mental health provision or secure accommodation if it had been available. Homes may manage children with increasingly complex needs by reducing their bed occupancy.

The increase in the number of children coming into care also means that providers can pick and choose. In our “No Place At Home” inquiry, we heard evidence that one local authority had to try 150 providers to find suitable accommodation for a vulnerable 15-year-old boy. We have also heard that up to 25 children can be competing for a place at any one time. Those children go on a waiting list, and often end up in crisis and short-term placements because none of the registered children’s homes is willing or able to offer places. These can be the children with the greatest needs. In future, more children are likely to be placed in unregulated and unregistered short-term accommodation because of the pressure on children’s home places. Let us be clear: that means those children’s care needs will not be met.

I entirely accept that some children need to be placed outside of their area because it is in their best interests, but evidence to our inquiry suggested that the overwhelming reason why children are placed out of area is that it is the only place that can be found for them. When I announced that I had secured this debate, I received many comments on Twitter from practitioners who said that the system was broken. One, from the National Association of Independent Reviewing Officers, said:

“It’ll need money Ann, more importantly a wholesale rethink of the care ‘system’. Trying to find residential placements for young people is often ‘any port in a Storm’.”

The fact that distribution has not changed, together with pressure on places, explains the inevitable rise in out-of-area placements.

Our “No Place At Home” report focused on the risks faced by children who go missing from care. There has been a 97% rise in the number of reported incidents of children missing from children’s homes since 2015. The number of children missing from out-of-area placements has more than doubled since 2015, and about a third of children in unregulated provision went missing in 2018. We heard that record numbers of out-of-area children are repeatedly going missing. The inquiry heard evidence about the trauma and emotional impact that being sent away can have on children who have already suffered neglect and trauma.

My hon. Friend is making a powerful case about a very serious subject. Does she agree that since the Greater Manchester Police introduced the iOPS computer system, children in Greater Manchester are at even more risk than before? Children who go missing overnight are not being registered, and the information is not getting through to police officers when they come on duty the next morning. The reassurances of the chief constable that everything is all right are at odds with the evidence. The iOPS system is putting more children at risk, and when Her Majesty’s Chief Inspector of Constabulary goes into Greater Manchester, I hope he will look seriously at these problems.

I totally agree with my hon. Friend’s comments about the new computer system. A system that cannot manage information in a way that keeps children safe is not fit for purpose, so I am pleased he has raised that point.

Moving children to unknown and unfamiliar placements, particularly at short notice, causes anxiety, distress, fear and anger, as well as causing further trauma to children with both short-term and long-term impacts. The reaction of many is to go missing, enticed by those who have targeted them for exploitation. In June, research by Missing People that looked at nearly 600 episodes involving more than 200 missing children found that one in seven of the children had been sexually exploited, and one in 10 had been a victim of criminal or other forms of exploitation while missing.

There is an issue about the take-up of return-home interviews, which can be an invaluable source of information about further risks to that child and other children when they go missing. Research by the Children’s Society found that, on average, just 50% of missing episodes resulted in return-home interviews taking place, despite its being a statutory requirement on local authorities to offer them each time a child goes missing. That means that opportunities to safeguard children are being missed.

The Howard League told our inquiry that children are sometimes placed out of area to protect them from exploiters. Although that is often done with the best intentions, and sometimes successfully, there are considerable concerns about the practice. The Howard League said, for example, that criminals increasingly control children using social media, the reach of which extends wherever children go, and through threats to family members and siblings, which means that removing the child from a location does not resolve the problem and could make it worse.

The Howard League also said that children who are being exploited may be used to groom and exploit other children in their new location, and that children who are in out-of-area placements are separated from their families and support workers, and therefore more vulnerable to abuse and exploitation. We received evidence that county lines gangs had been sent to areas where young people were predominantly placed out of area to scout new opportunities where they could develop business and recruit new members.

The individual experiences recounted by children to the inquiry were a salutary reminder of the misery experienced by some children in care. One girl told the inquiry that she had run away 100 times since being moved out of her home area. Another boy tried to hang himself on Christmas day. Another girl walked 10 miles home to see her mum. That is the reality behind the statistics. The increasing number of children going missing is a protest by those children, who feel that the social care system does not care about them. It is the only protest they can make.

One area of increasing concern, which we raised in our report, is the rise in the number of older children, aged 16-plus, being sent to live in unregulated semi-independent accommodation—a shady twilight world. Some 80% of the police forces that gave evidence to our inquiry expressed concern about the increasing numbers in those unregulated establishments, which are off radar, because, unlike children’s homes, they are not registered or inspected. More than 5,000 looked-after children in England live in unregulated accommodation, which is up 70% on 10 years ago. Such accommodation is not registered by Ofsted because it does not provide care, although it is difficult to imagine under what circumstances a vulnerable 16 or 17-year-old would not require care as well as support.

The police gave us many examples of inappropriate and dangerous placements in unregulated homes, including a young person bailed for murder being placed in the same semi-independent accommodation as a child victim of trafficking, who was immediately recruited to sell drugs in a county lines gang. Another boy was sent to live more than 50 miles from his home area where he began drug-running and committing crimes. When he was returned to his home area, he took children from his new area back home to involve them in county lines because they were unknown to the police. Other examples included a girl who had been sexually exploited being housed alongside a perpetrator of sexual exploitation, and another young girl victim of sexual exploitation who was moved some distance from home and then targeted by a local organised crime group.

We should not forget the impact that unregulated accommodation, in which young people are not properly supervised and become involved in criminal activity, can have on the surrounding neighbourhood. After our report was published, I was contacted by a mother in Greater Manchester who described her “devastating experience” of the consequences of unregulated accommodation. Her two daughters were seriously attacked as they walked home by a group of older boys who were living in an unregulated home in their neighbourhood. Local residents had been reporting incidents of antisocial behaviour, sexual harassment, criminal activity and drug-taking in and around the accommodation for about six months. If the home had been regulated, there would have been a process by which it could have been closed down, but it continues to operate.

There are some good providers but, equally, there are some poor providers that should not be let anywhere near a vulnerable young person. One police force told us:

“Where there are areas of high deprivation, these will always present opportunities for potential unscrupulous organisations to set up ‘pop up’ children’s homes with little or no regulation, where the housing market is much cheaper, heightening the risk of the most vulnerable of children being exploited.”

I was recently made aware that there may be connections between organised crime gangs and providers of unregulated accommodation. It would be a logical extension of their business model to gain profit from providing accommodation at high cost to local authorities and, at the same time, have access to young people whom they can exploit to sell drugs.

Our report called for a regulatory framework that would ensure national standards, including checks on the suitability of providers and the qualifications of staff supporting young people. That is becoming urgent, as children under 16 are being placed in unregulated accommodation. As I have said, there are extremely good providers and very diligent social workers, but unregulated care is wide open to abuse. All the evidence shows that that abuse is happening.

Over the years, there have been many improvements in data-sharing, guidance, notifications, multi-agency partnership work and understanding child sexual and criminal exploitation and the grooming process. Attitudes to children have changed and the term “child prostitute” has been replaced in law with “sexually exploited child”. There is an increasing understanding that young people can be groomed into criminal activity and county lines gangs. That understanding is reflected in the increasing number of children accepted on to the national referral mechanism as victims of criminal exploitation.

There is some excellent provision in the private and voluntary sectors and in local authority children’s homes. I pay tribute to the people who work in residential care homes with the most challenging young people. Government cuts have had a devastating effect on children’s social care; we are often asking social workers to safeguard children in the most difficult circumstances without the resources they need. An important part of providing resources is ensuring that there is sufficient residential provision to meet the needs of the children we take into our care. That is not happening.

We talk a lot about the voice of the child and how that should be at the heart of what we do, but it cannot be at the heart of decisions when we have no options to offer that child. The children’s homes market is failing and broken. There is widespread agreement and evidence that it is not providing a sufficiency of placements to meet the needs of the children we take into care. Until that is sorted out, we will continue to have care provision that is unsafe for some children and we will continue to fail in our responsibilities to the children who need us most. Urgent action is now needed.

The main recommendation of our APPG report echoes the recommendation made by the expert working group in 2012. We recommend that the Department for Education develops an emergency action plan to significantly reduce the number of out-of-area placements. The Government must take responsibility for ensuring that there are sufficient local placements to meet the needs of looked- after children. The plan should address the supply and distribution of children’s homes nationally and the use of unregulated semi-independent provision, and it should be backed by funding.

Local authorities have a statutory duty to ensure a sufficiency of school places to meet the needs of children in their area. The Department for Education provides capital funding and investment so that they can meet that statutory responsibility. It could equally provide the investment and capital funding to ensure a sufficiency of local places to meet children’s needs, working with local authorities and private and voluntary providers.

Section 22G of the Children Act 1989 places a duty on local authorities to take strategic action by requiring them to secure sufficient accommodation in their area that meets the needs of their looked after children,

“so far as reasonably practicable”.

When private providers are unwilling, as they have been in the past, to run children’s homes in certain regions of the country, local authorities should be encouraged to develop their own direct provision. There is no way forward without the Department for Education taking leadership and responsibility for this. We do not need any more working parties or reports. There is widespread consensus among practitioners, professionals and children with experience of the care system that the children’s home market is failing children, and that urgent action is needed. Warm words are not enough, better data sharing is not enough, and more awareness is not enough. None of this enough, if we cannot provide sufficient good care placements to meet the needs of children who have been failed by close adults in their life, and who are now being failed by a care system that cannot keep them safe and that leaves them wide open to criminal and sexual exploitation.

I congratulate the hon. Member for Stockport (Ann Coffey) on securing the debate. I had probably expected that there would be more hon. Members present to discuss this issue, because it is certainly of some importance to me and my constituency, and to many other hon. Members. Perhaps other things have been prioritised, and they therefore cannot be here. It is very nice to see the Minister in her place, and I look forward to her response. She is having quite a busy introduction to all these matters in the House—in two Adjournment debates that I attended, and now in Westminster Hall. I am very grateful for the opportunity to take part in this debate.

I pay tribute to the hon. Lady for securing the debate. She can be rightly proud of her long record of campaigning for the protection of vulnerable children and young people, which we appreciate. Throughout her time in Parliament, she has been a true champion of the rights of young people at risk and in danger. Today’s debate, which she introduced, is further evidence of that.

I refer to the website of the National Society for the Prevention of Cruelty to Children—an excellent charity—which provides a useful summation of who exactly is defined as a looked-after child:

“A child who has been in the care of their local authority for more than 24 hours is known as a looked after child.”

I thank the Library for the information that it has brought forward. I looked at some of the headlines included in the briefing. Headlines sometimes catch the eye, because that is their purpose. One of the headlines from The Children’s Society was, “Parliamentary inquiry into the scandal of ‘sent away’ children”. The Children’s Commissioner’s headline was, “The same mistakes that led to child sexual exploitation are being repeated with gangs”. The hon. Lady referred to that. Ofsted’s headline was, “Criminal exploitation and ‘county lines’: learn from past mistakes, report finds”. The National Youth Advocacy Service had “Parliamentary report calls for end to ‘national scandal’ of children missing from care”. They are not just sent away; they are missing from care. “BBC News” did a report called, “Care crisis: Sent-away children are ‘easy victims’”. The Guardian referred to the “Surge in vulnerable children linked to the UK drug gangs”.

The BBC, again, referred to, “Teens in care ‘abandoned to crime gangs’”. The Howard League for Penal Reform has produced a report entitled “Criminalising children, the Department for Education and county lines exploitation.” The Times published an article with the headline, “Gangs circle as children ‘dumped’ on seaside”. All those headlines catch the eye and tell an unfortunate story about the issue we are debating.

Looked-after children are also referred to as “children in care,” a term that many children and young people prefer. Each part of the United Kingdom has a slightly different definition of looked-after children and follows its own legislation, policy and guidance. In general, however, looked-after children are living with foster parents, in a residential children’s home, or in residential settings such as schools and secure units. The Minister was at the earlier debate—I am trying to remember the constituency of the hon. Member who secured an Adjournment debate on this issue. He described what was happening in his constituency in the east of England; again, the hon. Lady has reinforced that with her personal input into this debate.

I was talking to the Scottish National party spokesperson before the debate. Scotland often leads the way on many things—I mean that very sincerely. Scotland’s definition of looked-after children also includes children under a supervision requirement order. This means that many looked-after children in Scotland are still living at home, but with regular contact from social services.

There are a variety of reasons why children and young people enter care. The child’s parents might have agreed to it—for example, if they are too unwell to look after their child, or if their child has a disability and needs respite care. Sometimes the pressures of life on families lead them to do something that they did not want to do but that they have to do because they were unable to cope. The child could be an unaccompanied asylum seeker, with no responsible adult to care for them. Children’s services might have intervened because they felt the child was at significant risk of harm. If this is the case, the child is usually the subject of a court-made legal order.

A child stops being looked after when they are adopted, return home or turn 18. However, the law is clear that local authorities in all the nations of the UK—all four of us together—are required to support children leaving care at 18 until they are at least 21; there is a responsibility beyond the age of 18. This may involve their continuing to live with their foster family.

Most children in care say that their experiences are good and that it was the right choice for them. It is good to hear those stories, because sometimes we focus on all the bad things. That is the nature of our job—people do not always come to tell us how good things are, but they certainly come to tell us when things are not right. That is the nature of what we do: we respond to complaints and concerns, and try to do our best to help.

I believe more needs to be done to ensure that all looked-after children are healthy and safe, have the same opportunities as their peers, and can move successfully into adulthood. What a responsibility we have for that child—to mould them and help them to be a better person as they move towards adulthood. It is so important that we do that as a society, and also through our duties as elected representatives of our constituents. We should also look to the Government for a positive response.

When the system works well, it allows young people to build stable lives and go on to become fully integrated and constructive members of society. When it fails, it can have a devastating impact from which people can never recover. That is the reality. The scale of the problems of criminal and sexual exploitation of looked-after children is frightening. A recent survey by Barnardo’s, which is a wonderful charity, showed that one third of the children who are sexually exploited in England are looked after. The finding, taken from a survey of 498 children helped in one day by the charity’s 20 specialist sexual exploitation services, also revealed marked geographical variations—I think the hon. Lady referred to that in her introduction.

More than three quarters, or 76%, of victims in the north-west were looked-after children. Given that figure, it is not hard to see why the hon. Lady was so determined to use Westminster Hall to highlight the sheer scale of the problem. Some 42% were in care in London, eastern and south-east England, whereas the figure was 39% in the south-west. Those figures are horrendous. Overall, Barnardo’s found that 29% were looked after. Shockingly, 16% had a disability and 5% had a statement of special educational needs.

Working towards the goals of protecting vulnerable young people from all kinds of exploitation is serious and important work. Sadly, our recent history is littered with examples of local authority and statutory agency failure, and it is our responsibility as legislators to ensure that our country has the most robust child protection frameworks. The Minister can confirm that there is a legal duty for children’s homes and foster carers to report a missing looked-after child to the police. I want to see how that can be done better, to ensure that we can deliver on it. Perhaps the Minister can confirm what financial support is available for that. I understand that some of the figures indicate that some councils and areas that have responsibility are feeling the pinch. I know the Government have committed some moneys to it, but I want to check that it is going forward.

The hon. Member for Rotherham (Sarah Champion) is not present, but I pay tribute to her in her absence. As we all know, she has been an absolute stalwart in standing up in spite of great personal provocation and threat to herself. She has been an absolute champion—Sarah Champion is aptly named—of her constituency. I pay tribute to her—I thought she might have been here, but obviously other things have taken place and she cannot be here—for all she has done to highlight exploitation and for taking a marvellous, courageous stand. Well done to her! The Rotherham child sexual exploitation scandal consisted of organised sexual abuse between the late 1980s and 2010 on an unimaginable scale. Some of those stories made me cringe and feel unwell emotionally and physically. The abject and total failure of the local authorities to act on reports of abuse throughout that period led to it being described as the biggest child protection scandal in UK history.

Many factors combined to produce the scandal: indifference towards the victims, a culture of ignoring complaints and a fear of being viewed as politically incorrect, as the papers highlighted on more than one occasion. Whatever the motivations, the results were devastating. It is incumbent on us all to ensure that there are no more Rotherhams or Rochdales—no more of any of it.

Criminal exploitation continues to be a massive issue for each and every one of us. The hon. Member for Stockport referred to it in her introduction, and I want to speak about it. Criminal exploitation in the UK involves children and vulnerable adults who have been coerced into crime, such as ATM theft, pickpocketing, bag snatching, counterfeit DVD selling, cannabis cultivation, metal theft, benefit fraud, sham marriages and forced begging. The most common types of criminal exploitation are cannabis cultivation and petty street crime.

The criminal exploitation is serious: 71% of the police forces that submitted evidence to the inquiry believed that placing children and young people out of area increases their vulnerability to becoming sexually and criminally exploited. Looked-after children and young people are at significant risk of being groomed for exploitation, due both to the experiences and situations that led to their becoming looked after in the first place, and to factors associated with being in care. It is clear from the evidence that when placement moves take place, new protective factors are often not built around the young people in their new areas. The hon. Lady referred to that in her introduction and gave three or four examples, including of a person who walked 10 miles to meet their mum, and of others who had been exploited in their own areas.

I was deeply moved by the information about sexual exploitation, because it shows how unscrupulous people are. There are many unscrupulous people in the world who see individuals not as people—they do not have compassion for them—but as commodities. The hon. Lady referred to a couple of examples of young girls who found themselves in that situation. Child sexual exploitation means to

“manipulate or deceive a child or young person under the age of 18 into sexual activity (a) in exchange for something the victim needs or wants, and/or (b) for the financial advantage or increased status”.

All those things are pure, unadulterated exploitation.

The involvement of children in the movement and sale of drugs in the context of county lines has been receiving more professional and media attention recently. Of the 90% of looked-after children who go missing from care, 60% are suspected victims of trafficking. As a Northern Ireland MP and the Member for Strangford, I am very pleased that it was Stormont—when we had a functioning Northern Ireland Assembly—that led the way in tackling human trafficking and exploitation with groundbreaking legislation in 2015 that specifically targets those who would exploit other human beings for sexual purposes, enforced servitude or criminal activities.

When it comes to the protection of children, especially those who are looked after, we need a redoubling of efforts and a multifaceted approach. The first step is education. We must educate our children to know what to look for in order to prevent them from falling victim. Sometimes a teacher looking at a young child in the front row will see things that no one else sees. Schools, youth groups and carers all have a valuable role to play, but they must have resources—I look to the Minister when I say this—that are child-appropriate, help to address the issue and are easy to understand. The statistics show that there is a major problem with looked-after children; the hon. Lady said that very clearly.

Secondly, the police, local authorities and statutory agencies need to be fearless in the pursuit of those who would engage in such criminal activity and behaviour. There can be no hiding place for those committing criminal activities and engaging in criminal behaviour. We all have a responsibility to play our part in ensuring that this wicked activity—this evil activity—is stamped out.

It is a pleasure to serve under your chairmanship, Mr Evans. I thank the hon. Member for Stockport (Ann Coffey) for securing this important debate and for the excellent inquiry that the all-party group for runaway and missing children and adults, under her chairmanship, conducted into this issue.

As the hon. Lady knows, my constituency of Bedford has been identified as a hotspot for out-of-area placements for looked-after 16 and 17-year-olds. It featured in the diligent reporting done by “Newsnight” into the crisis in care for the most vulnerable children in society. Many of us in this Chamber have repeatedly called for the regulation of semi-supported care settings. I first met the Minister in March to call for urgent action to protect those children and ensure the most basic of requirements—that all care settings for 16 and 17-year-olds are safe and of a reasonable standard. Seven months and a change of Government personnel later, I am afraid we are no further forward. I know that the hon. Member for Stockport has been asking for that for a lot longer.

It is the state’s responsibility to look after children in care, but it is clearly failing. Bedfordshire police have raised concerns about the number of teenagers reported missing from care homes. They have highlighted that vulnerable children are being placed in accommodation with known perpetrators of sexual and violent crimes, and they are at risk of becoming victims of sex trafficking, organised crime or serious violent crime, and of being lured into criminal activity.

In Bedfordshire, the number of incidents for the 12-month period ending in September involving looked-after children missing from unregulated homes was 1,333, involving 173 children. I am very worried about the fate of those missing children, who are at risk of criminal or sexual exploitation and other aspects of modem slavery.

Although Bedfordshire police are doing tremendous work in this area and have a sympathetic understanding of those who go missing, policing such settings is a significant strain on an already under-resourced force. The Centre for the Study of Missing Persons at the University of Portsmouth estimates that the average cost of investigating a missing person is £2,400. That is a financial cost to Bedfordshire police of about £1.9 million, caused by unregulated homes. It is the job of the Government, not the police, to ensure the safety of such settings. They must get a handle on the scale of the issue, and I urge them to improve the reporting systems on the number of children of going missing from homes and hostels that are not subject to children’s homes regulations, to prevent more children from becoming unnecessarily and excessively criminalised or becoming victims of crime.

If there is no alternative to local authorities receiving out-of-area looked-after children, it is only right that they should be adequately funded so they can provide suitable, safe and secure accommodation. The Minister has admitted that the current system is “completely untenable”, so I hope that today we get action from the Government on the APPG inquiry’s excellent recommendations, not more excuses and delay.

It is a pleasure to serve under your chairmanship, Mr Evans. I welcome the Minister to her place. Today we are discussing an extremely difficult topic and focusing on the difficulties that children face within the care system. Some of the endemic problems are probably beyond their control and can have dangerous and devastating consequences, not only for their lives right now, as young people, but in the longer term. We should take a moment to appreciate how serious the subject is, and how the serious ramifications of not taking action can have a long-term impact on their lives. I congratulate the hon. Member for Stockport (Ann Coffey) on securing this debate, and I thank her for the work that she has done as chair of the all-party group for runaway and missing children and adults.

The APPG’s report, “No Place at Home”, which was produced with The Children’s Society, indicates just some of the figures—as Members can imagine, they are difficult to obtain—to outline how much of a problem this is. The worrying factor is the untold statistics. After I graduated, I supported a young looked-after person in Brighton. That was a good 10 years or more ago—I am sure the system has changed since then—but my experience has informed me. The idea that a young person at 16 years old is mature enough, or sufficiently supported, to be able to live independently is perhaps something that the Minister could look at, with regard to how the process works in England. How can we allow such a young person to leave the foster care setting—their foster care placement might not have been the most successful—and go to live in private, independent accommodation? That accommodation might be provided through the charity sector, a business or an organisation that gives a sense of support, but ultimately it can never provide the same level of support as a family parental setting or a foster care setting. I am sure the Minister will agree that we can look further at how local authorities in England contract out responsibilities to organisations and how much their accountability for that contracting service is truly examined. Is that the most efficient, the most cost-effective or even the best way to trace the outcomes of young people?

The young person I supported was incredibly inspirational; she had sought to go to fashion college in London and had got a place. Sadly, though, she had come up against the education system and had not succeeded for a variety of reasons. Her foster care placements had not been very successful, and then she had found herself living independently, with everything that comes with that, and she was starting to enter a world of challenges and distractions—be it drugs or alcohol—at the age of 16. No matter how much I wanted to support that person, my role was simply to tutor her and support her to get through her college coursework. No amount of intervention that I singlehandedly, or the many other peripheral services, could put in place could prevent her from entering that path. I will never know where she ended up or what happened, but I know about the outcomes for 16-year-olds and the opportunities that were presented to her in that vulnerable and challenging setting of living independently at 16 years old. I still live with the regret that perhaps I could have done more, and I was one of many people involved in the service. I hope the Minister will have a serious think about whether that model of care is the best one.

The hon. Member for Strangford (Jim Shannon) should be a spokesman for the Scottish National party, but we have slightly different views on numerous subjects. None the less, he does a very good job. He highlighted the work of the Scottish Government, which is what I want to speak to today. From a professional perspective, I want to outline where we are tackling this matter differently. The report is hard-hitting, and it details the harsh realities faced by some children in the care system who have been let down by failures in the system. I appreciate that one Minister or one Government Department cannot prevent the systematic failures that can befall a young person, but the most important point that the report makes is that children are often ripped away from their support networks of family and friends because of placements far away from where they have grown up. The placements are based not on where is best for the child, but on where is cheapest for them to be sent. Tragically, the report makes it clear that these children can on occasions become magnets for paedophiles and drug traffickers.

Children in care are among some of the most vulnerable in society. Their circumstances are often due to problems of neglect and abuse within their family, which can mean additional mental health problems for children. Children in care run away for many reasons, such as stress, anger, and unhappiness at being in care. Myriad other issues can come with adverse childhood experiences. Running away can put those children in huge danger, including sexual and criminal exploitation, and, as we have heard, physical harm, being introduced to drugs, and untold other harms. For that reason, every missing person report is deeply worrying, and never more so than when it involves a child or a young person.

In 2018 in Scotland, 1,935 cases of children in care going missing were reported to the police. Earlier this year, the Scottish Government awarded £30,000 to two charities, Missing People and Barnardo’s, to develop materials to educate children and young people about the dangers of going missing, and to encourage them to access support. The project supports the goals of Scotland’s national missing persons framework, which aims to improve the way in which agencies and organisations work together to support vulnerable people and prevent individuals from running away.

According to the charity Missing People, only one in 20 young people in Scotland who ran away reached out for professional help. Most young people simply do not know that support is available to them. We can put as much money into the system as possible, but if we do not start to tackle the myriad other factors, we will not get to the heart of it. The Scottish Government are also leading a bold drive to reduce stressful and poor quality childhoods, and to support children and adults in overcoming early life adversity. We recognise that ACEs, as we now know them—adverse childhood experiences—can have a long-term impact, but the SNP also recognises that it is important to respond appropriately to the emotional distress that is linked both to the circumstances that led to a child becoming looked after, and to the experience of being looked after in any setting.

The 2018-19 programme for government builds on our commitment to prevent adverse childhood experiences and to mitigate the negative impact where they do occur. The Scottish Government also aim to have a care system where fewer children need to become looked after by engaging early to support and build on the assets within families and communities. I know my hon. Friend the Member for Livingston (Hannah Bardell) has a lot to say on that from her own personal experience.

I thank my hon. Friend for giving way. She is making a powerful speech on a hugely important subject. When I was growing up as a teenager, my mum ran the residential unit of a care home in West Lothian, and my brother and I often visited it for parties. We got to know some of the young people and became a part of that family, which is very much what that setting was. It created a family. Nobody can ever emulate or replicate the family that some children sadly lose, but does my hon. Friend agree that it is important that we get this right for children wherever they are in the UK? Does she agree that care homes, foster homes and other care settings must be properly funded and appropriate for any child who needs to go into care, to make sure that those children get the best possible start in life?

Absolutely. I thank my hon. Friend for that point. While the number of children in care in England and Wales has grown since 2015 by 9% and 14% respectively, the number of children in care in Scotland has steadily declined by 4%. Last year, the Scottish Government introduced the care-experienced children and young people fund, which commits £33 million over the life of Scotland’s current Parliament to improve the attainment and wider outcomes of care-experienced young people. We have also introduced a care-experienced students’ bursary, which provides £8,100 a year to support young people going to college or university.

Scotland’s looked-after children policy is part of “Getting it right for every child”, the national framework for improving outcomes and supporting children and young people. That approach puts the best interests of children at the heart of decision making—something that is missing right now within the care system in England and Wales. It disempowers children to remove them from the support networks and communities that they know. In fact, in the unfortunate cases that prompted the “No Place at Home” report, it is clear how a bad situation can turn vulnerable children into victims of crime and, in some instances, into criminals later in life. We want to prevent that from the off.

I ask the Minister to say honestly how much money is being spent externally on organisations that provide unregulated care, how much of it is then focused on outcomes and attainments, and how that is measured, with respect to supporting a looked-after child. We all have a responsibility to do more to support young people. As the hon. Member for Bedford (Mohammad Yasin) outlined, we—the state—are their parents. I have never been a parent, but I take my responsibility as an MP seriously. There is more that we can, should and must do to support young people like the young lady who I supported and often think about. I want to do more for young people in England and Wales, in particular, where the system is different.

It is a pleasure to serve under your chairmanship, Mr Evans. I congratulate the hon. Member for Stockport (Ann Coffey) on securing this extremely timely and important debate. I thank all the Members who have taken part and the all-party parliamentary group on runaway and missing children and adults for the work that it has led on this important issue. We spend far too little time focusing on the needs of looked-after children, given that they are one of the most vulnerable groups in society.

We have already heard some shocking examples this afternoon of how badly too many looked-after children have been let down. Far too many children are given placements far away from friends, family and the community that they are part of. Far too many are put in accommodation that is unsafe because it is not properly regulated or supervised. A key reason for that is a severe lack of funding, but we must also recognise the failure properly to involve children themselves in the decisions that affect their lives.

More than two out of every five looked-after children are placed outside their home local authority area; that rises to two in every three children in children’s homes. The fact that children lose contact with everything that they are familiar with is one of the contributing factors to so many of them going missing. They simply want to go back home to the family and friends they miss.

It is desperately worrying that children in placements far from home are at greater risk of exploitation, as the hon. Member for Lanark and Hamilton East (Angela Crawley) explained so clearly. The police recognise that as an important factor in the luring of young people into gangs, or into the hands of adults who want to exploit them sexually or criminally. It is a major factor in the growth of county lines drug dealing operations and the horrific escalation in levels of knife crime that go with that. The existence of unregulated semi-independent housing is a major concern, and a growing national scandal. Social workers I have spoken to tell me that children are placed in those hostels because current levels of funding do not allow for better alternatives. It is shocking to hear that there are now 5,000 young people who have been placed in institutions of that kind.

Lance Scott Walker was just 18 when he was placed in an unregulated teenage hostel miles away from his home, with another vulnerable young person with severe mental ill health. That second young person stabbed Lance in the hostel, chased him out of the building and stabbed him to death in the garden. Lance should never have been left in such dangerous circumstances by the authorities responsible for his care, but when the funding is so inadequate risks are taken, and sometimes they lead to tragic outcomes such as the death of Lance Scott Walker.

The cross-party Local Government Association estimates that an extra £3.1 billion is needed simply to keep the services at their current inadequate levels over coming years. The Children’s Commissioner says that to fund the wider set of children’s services properly, an extra £10 billion is needed. The Government need to ask themselves why they have not made funding care for the most vulnerable children in society the absolute priority that it should be. The lack of funding and support is literally destroying young people’s lives.

Adequate funding is fundamental, but it is not the whole story. I am very impressed by the focus of the report on giving looked-after children a voice. There should be a requirement on children’s services to demonstrate that children and young people have been consulted and involved in the decisions taken about them. Young people will tell you what support they need, what is going wrong in their lives and what they are afraid of. We need to listen, and act on what we hear.

I had the privilege earlier this week of visiting Camden Council’s children’s services department, under the inspirational leadership of Councillor Georgia Gould. Its services are among the best rated and most innovative in the country. Its family group conferencing model puts the child and their immediate family at the centre of decision making and allows them to involve friends, family and community members in decision making rather than leaving it to professionals alone. That ensures that the child’s voice is heard and that their wishes are acted on. Just as importantly, it respects the relationships that matter to those children and it has dramatically improved results, through how it is implemented.

Up north, Leeds City Council, under the equally inspirational leadership of Councillor Judith Blake, has made similarly impressive progress pursuing its child-friendly city agenda for almost a decade now, I believe. Every decision that the council takes is measured against its impact on children—vulnerable children, in particular. It does not just talk about children as a priority; it has acted to make children a priority. It is examples such as those, in Leeds, Camden and many other places across the country, that show us how we should be treating vulnerable children differently—not as problems to be managed, but as young people full of potential with valid views about their own life that deserve to be heard, and relationships that matter to them that need to be respected.

The Government must now take a lead. We need a fully funded national action plan to reduce the number of out-of-area placements and ensure that vulnerable children and safe and that they have a voice. Key to that plan must be the immediate regulation and inspection of semi-independent housing.

No country that loved its children would treat them in the way I have described. There is no group more vulnerable than children who cannot be with their parents, so I ask the Minister now: will she commit to regulating semi-independent housing without delay? Will she take action to reduce the number of out-of-area placements? Will she review funding to bring it up to the level needed to support vulnerable children properly? Will she look at models such as those in Camden and Leeds and bring in a new legal requirement to involve looked-after children properly in the decisions that affect them? Children need change, and they need it now.

I congratulate the hon. Member for Stockport (Ann Coffey) on securing this important debate. The Government, the Department and I share her fierce commitment to protect all looked-after children and to work to reduce the number of children who go missing. The hon. Lady raised a number of important issues facing the children’s social care system that can lead to children going missing, and today we have heard some harrowing stories, which I am sure will stay with us. I am absolutely determined to address those issues, because nothing is more important than protecting the most vulnerable children. I am sure we all agree on that.

As a new Minister in the area in question, I am committed to ensuring that the Department is dedicated to providing high quality services to all the children and families who need them. I know that we need to take a multi-agency approach—something that we have been doing. Social workers cannot do it alone; it cannot fall only on their shoulders. The joined-up response has been working and is not just a matter for local government; it is also for national Government, and I am committed to working closely with my colleagues at the Home Office to ensure that local partners are properly equipped to respond quickly and efficiently.

As part of that, the Home Office is working with the National Police Chiefs Council to deliver a national register of missing persons, which will enable us to have a snapshot of current missing incidents across police forces in England and Wales. The register will give officers real-time information when they encounter a missing person—particularly if that missing person is outside their area. The hon. Member for Blackley and Broughton (Graham Stringer), who has left the Chamber, mentioned difficulties in his area, and I hope that that will alleviate his concerns.

The Home Office is working towards that register being operational by 2020-21. Ofsted plays a vital role in considering how local areas safeguard children, and to support that we are strengthening statutory guidance from the Department for Education. Such guidance must be clear about the role that each safeguarding partner must play, and that is why we are working with the police to respond to the issue raised by the hon. Member for Strangford (Jim Shannon).

The hon. Member for Stockport raised concerns about the fear that children who go missing from the care system could fall prey to criminal and sexual exploitation—something that I and all hon. Members find completely abhorrent. I reassure Members that the Government are prioritising that issue. We are determined to tackle child sexual abuse and close down county lines, putting an end to the abhorrent exploitation of children and young people. We have already revised safeguarding guidance to reflect the emerging menace of threats to children and exploitation from outside the home, as well as the role that children’s social care needs to play in protecting them.

Earlier this year, we launched the £2 million Tackling Child Exploitation support programme to provide bespoke support to local areas. The programme will help local safeguarding partners to develop a tailormade effective multi-agency strategic response to the specific types of harm and exploitation that children are facing in their area.

I am glad that the national Child Safeguarding Practice Review Panel’s first independent review is looking into whether adolescents in need of protection from criminal exploitation get the help they need. That will better inform us about how to tweak and improve the current system, and I pledge to take a personal interest in that. Ensuring that children who have been taken into local authority care are in a safe and secure placement that meets their needs is one of the most crucial things we can do. That brings me to an issue that I know the hon. Lady and other hon. Members are working hard to highlight: the use of unregulated independent and semi-independent settings for children in care and care leavers. Some of those children and young people are indeed at risk, and I take on board the comments from the hon. Member for Croydon North (Mr Reed).

The report from the all-party group for runaway and missing children and adults continues to highlight that issue, and I thank the hon. Member for Stockport for her work. She will know that I share her concerns about the current state of affairs, and last week in the Chamber I was clear that it is unacceptable for any child to be placed in a setting that does not meet their needs and keep them safe. I note the comments from the hon. Member for Lanark and Hamilton East (Angela Crawley) on that issue, and I shall write to her with the specific figures she requested.

Unregulated semi-independent and independent settings are intended for older children as a stepping stone towards independence. There are good examples of such places, including in my constituency, and they are not all letting children down. However, vulnerable young children were never intended to be placed in them: I will not hesitate, where needed, to strengthen guidance to make that clear. Last week I called on local authorities to put their houses in order regarding unregulated and unregistered provision. Unregistered settings are illegal, and I invite all hon. Members to inform me about any providers that they know are operating in that manner.

Hon. Members also raised the placement of children in settings outside their local area. No child should be placed outside their area when that is not in their best interests, and I am grateful to hon. Members for their sustained interest in that issue. Moving a child away from their home is not a decision that any authority takes lightly, and we have strengthened legislative safeguards regarding children who are placed outside their local area.

Directors of children’s services are required to sign off each individual decision, and Ofsted can challenge them if it believes that an incorrect decision has been made. It can sometimes be right to place a child outside their local area if there is the risk of sexual exploitation, trafficking or gang violence, but those are the only circumstances in which local authorities should consider such a move. Similarly, such a decision could be made to access provision for children who have complex needs, if such provision is not available locally. The welfare of the child must lie at the heart of this issue, and I am sure hon. Members agree that the child’s needs and future must always come first. The needs of the child are paramount, and I will continue working to ensure that our decision-making is based on that.

Although local authorities have a duty to meet the needs of children in our care system, I recognise that more should be done to support them in responding to that challenge. Those children are a changing cohort, and we are taking steps to help local authorities manage the system, improve their work with families, and safely reduce the number of children who enter the care system in the first place.

I recognise some of the good initiatives from the Department for Education over the years, but as I said there are not enough places to allow local authorities to make a choice about what is in the best interests of the child. They are placing children in placements hundreds of miles away because they have no option. That is why we are urging the Department to take a lead responsibility, not only by putting more money into preventing children from entering the care system, which is important, but by dealing with the care needs of existing children in the care system, so that they have the choice of staying nearer home. That choice should not be dictated by the market. Does the Minister have any plans to convene a strategy group and consider how the market is functioning, just as was done in 2012, and to find a way forward to support local authorities and voluntary organisations to develop provisions that meet the needs of children?

I will certainly look at that. We need a combination of ways to prevent children from entering the care system—we will all agree that that is fundamental—and to tackle the supply of places. That is why we put an extra £40 million into creating more secure homes. The Government recognise that issue and are acting on it.

I recently announced an investment of £84 million over five years to support 18 local authorities as part of the Strengthening Families programme, and that is one example of how we are enabling children to stay safely with their families. We have also provided funding through our £200 million children’s social care innovation programme, £5 million of which is specifically targeted at residential care and expanding provision.

For the most vulnerable children who need secure provision, we have added a £40 million capital grants programme. We are funding local authorities—£110 million to date—to implement Staying Put arrangements, under which care leavers remain with their foster carers for longer. We are piloting the Staying Close programme with £5 million of funding to support ongoing links with a residential home.

I am listening with interest to what the Minister has to say. She is absolutely right about the need to prevent, to reduce the numbers of children needing to go into the care system. Is she aware—she must have conversations with the heads of such services, as I do—that the reason why local authorities are not spending more on prevention is that their funding has been reduced so much: by 50%, on average? They must use what is left to manage crises, so that they have even less to invest in prevention.

Will the Minister consider working with local authorities to set up an investment fund to focus on prevention, to allow them to stop the problems happening? It would cost a little money up front, but save multiples more in future by not allowing young lives to be destroyed.

The approach we have taken is to target money at those areas that need it most, ones which have not been performing well, so that we can be specific with that Strengthening Families money of £84 million. We have invested in the workforce as well— £200 million—and our strategy is to put children first. We are doing things in a co-ordinated way.

The hon. Member for Lanark and Hamilton East made reference to care leavers, a subject that the Secretary of State is passionate about and—I share his passion. This week, we announced a £19 million package of things to assist them and to give them the choices and chances that they deserve in life.

Fundamentally, I believe that young people can only ever be safe when they are cared for by local children’s services that have their best interests at heart—something that the hon. Member for Croydon North stressed. Funding is of course important, as he also stressed, and that is why the 2015 spending review gave local authorities access to more than £200 billion up to 2019-20 for services, including children’s social services. In addition, last month we announced another £1 billion for social care in 2020-21, so the issue is a focus of this Government and to say it is not would be unfair.

As I am sure hon. Members agree, however, that is only part of the solution. We are delivering an extensive programme of reform that has a strong focus on prevention, intervening early to provide families with the support that they need. The programme also works to ensure that, where children cannot stay with their family, there are enough places—a point laboured throughout the debate. We are also reforming social work and children’s social care so that we recruit and retain some of the most highly professional individuals. Providing the best possible support for local young people leaving the care system is also paramount.

Let me reassure hon. Members that my Department and I are committed to ensuring that children who go missing can be brought back safely, and that the service they receive in the care of the local authority means that they are in a home that is safe, secure and meets their needs. I commit to work relentlessly on the issue, and I invite any Member to follow up with and meet me after the debate. This is something that should be done and tackled not only across Government but across party. The issue is non-political and, at its heart, should always be about children—their safety, security and futures.

It has been an excellent debate. The area is complex, and each of the contributions has reflected that complexity. The hon. Member for Bedford (Mohammad Yasin) has clearly seen the impact of unregulated accommodation in his constituency, which I know is a hotspot for county lines activity.

It is also interesting to hear the contributions from the different parts of the United Kingdom. I do not think that I have ever participated in a debate in Westminster Hall at which the hon. Member for Strangford (Jim Shannon) has not been present. He has a long-standing commitment to the subject. The hon. Member for Lanark and Hamilton East (Angela Crawley) very much gave us the Scottish perspective. Perhaps all that shows us the strength of the Union.

I tell the Minister that I do not doubt for one instant the commitment of every single Minister with whom I have raised this issue over the past 10 years. The worrying thing for me is that, since 2015, things have got worse in terms of the number of children going missing and the harm that has come to them, in spite of very good initiatives by the Department and a complete focus on prevention, which is absolutely right.

In this debate, I was asking for a focus on the underlying cause of the problem, which is to do with the insufficiency of places to meet the care needs of the children whom we are taking into care. I believe that unless that is managed and sorted out, and we get a proper supply distributed across England, we will continue to have children go missing in huge numbers and be at risk of exploitation. No one else can lead on this except the Minister and her Department. Only the Minister has the information, the financial leverage, and the authority to bring together and lead a group to address the fundamental market failures.

Question put and agreed to.

Resolved,

That this House has considered the matter of sexual and criminal exploitation of missing looked after children.

Sitting suspended.

Waste Processing Facilities: Local Environment

[Mr Peter Bone in the Chair]

I beg to move,

That this House has considered the effect of waste processing facilities on the local environment.

It is a pleasure to serve under your chairmanship, Mr Bone. However conscientiously we all try to manage our own rubbish, most of us probably do not give a second thought to what happens to it after it is taken away—and to the extent that we do think about that at all, we often assume that the waste is transported, stored and processed in a pretty orderly way, out of sight and out of mind, away from homes and away from people. But for many of my constituents who live in and around Avonmouth, in the west of my Bristol North West constituency, the everyday reality of living close to a concentration of these facilities can be challenging. I know that other right hon. and hon. Members have constituencies where residents live close to these facilities and have had similar issues, so I am introducing this debate on behalf of many other constituents as well as my own.

In Avonmouth, we have seen a significant proliferation of waste processing facilities over the past decade. That has not come about by accident. The leadership of Bristol City Council in 2011 updated its planning guidelines to welcome such businesses to the area of Avonmouth, and as a consequence we saw an increase in the number of planning permissions being granted for them. According to the figures available from the Environment Agency, that has meant that there has been an increase in the quantity of waste being processed locally, from about 6,000 tonnes in 2013 to more than 200,000 tonnes in 2017—that figure is already a couple of years out of date.

The most immediate challenge in the surrounding areas, and my main concern in today’s debate, is the volume of flies that can be associated with the processing of the waste and the impact that that has on local residents and their community. This is a quality-of-life issue for hundreds of my constituents. It features prominently in local media and in correspondence to my office, and it has got markedly worse over the period of the increase in bundles of waste being processed each year. I was born and grew up in the area affected, and it never used to be an issue when I was growing up, but it has become one over the past five years.

There can be a particular problem in the summer months, when heat and humidity combine, alongside an increase in the amount of processing of waste, and we see a spike in the number of flies in the local community. In the absence of a permanent solution, local residents have had to get used to installing nets and flytraps, stocking up on fly spray and keeping windows and doors closed during hot weather. That evidently is not an enjoyable way of life. There have been striking photos of flypaper strips that have been put up overnight and are full of dead flies by morning. Eating and drinking outside and even making food in the home becomes increasingly difficult. The fire station, I was told on a visit, often ends up with no food for the firefighters, because if the bell rings, by the time they get back, there are flies all over the food that has been produced for them in the fire station.

The situation is extremely stressful not just for local residents and workers, but for the pubs and restaurants and some of the businesses in the area. They are concerned about return trade, but also about maintaining their health and safety compliance, which of course they take very seriously.

My concern is that this seems to have been an issue at points when we have had very hot weather, but with the effect of climate change—albeit we wish to mitigate that—it is becoming more frequent. We have started to see complaints from local residents more frequently throughout the year and not just in the hottest summer months. The science, from my perspective, is clear that flies will thrive in the presence of decaying organic matter and their populations will grow. That is why the Environment Agency provides permits for the type of activity that we are discussing. There is agreement on what the safe limits are for the amount of waste that can be processed. If businesses do not comply with the guidelines and permits, the Environment Agency is of course able to take action.

In a few cases, there has been significant negligence and action taken by the Environment Agency. One company in my constituency, New Earth Solutions, was found to have breached its permit on more than a dozen instances in the space of a year. Breaches included failing properly to cover the bales of rubbish that are packaged up and shipped out to other countries for burning. The Environment Agency said that the company had “exceeded the quantity” of waste

“that can be processed and removed without causing a build-up of onsite materials”.

To help people to visualise it, I will describe what happens. Our black bin rubbish gets dropped off, poured into large piles, treated, packaged up into bundles that look like hay, wrapped in either black or white thick bin-liner material and stored, ready to be shipped out from the docks in Avonmouth or on lorries to the continent for other countries to burn for energy. Although I endorse the circular economy principles behind that, the issue, when we are processing waste not just from Bristol and the region but from London, is that we often end up with a significantly high number of bundles on open land that can be torn or can have other issues. There are factories where, in the past, doors and roofs have not been fixed properly and where piles of rubbish are therefore subject to the open air.

I have been trying for some time to work locally with the Environment Agency, Bristol City Council, businesses and local residents to fix the problem. It has been an ongoing and difficult problem. Ultimately, I had to write, in June of this year, to the then Secretary of State for Environment, Food and Rural Affairs, who is now Chancellor of the Duchy of Lancaster. In that letter, I quoted regulation 22(3) of the Environmental Permitting (England and Wales) Regulations 2016, which sets out that, to revoke a permit, a 20-day notice period has to be served on the offending operator. Under regulation 31(1)(f), an operator on whom notice has been served has the right to appeal to the “appropriate authority”—normally the Planning Inspectorate—which then can exercise the power on behalf of the Environment Agency. Any revocation notice that comes will take effect only once the appeal has been concluded. That not only imposes costs and time issues on regulators, but provides such a slow response for local residents that often the issue may have come and gone.

I am sorry that I missed the first two minutes of my hon. Friend’s remarks. He will be aware that I initiated an Adjournment debate in the main Chamber on this very issue; the situation sounds exactly the same. It was with regard to the recycling plants at Teal Farm in my constituency. As I came into this Chamber, he was talking about flies, which is a massive issue that can fill my inbox every summer. My hon. Friend is talking about the Environment Agency. I have come to the conclusion that the Environment Agency needs more powers, specifically to issue spot fines, rather than having to go through the current rigmarole. The bar seems to be far too high in terms of the amount of time required and the legal process that has to be gone through, and spot fines could be the answer. Does my hon. Friend agree?

I do agree. I thank my hon. Friend for her intervention and for her Adjournment debate on the Floor of the House, which I referenced in my letter to the then Environment Secretary, not least because the Government had promised to bring forward some regulations. To be fair, they had done that, but those measures evidently have not been able to solve the types of issues that my hon. Friend and I have to try to tackle in our constituencies.

This is a very lived matter for us locally. My constituents will make complaints to the Environment Agency, to the council, to me and to others, and often there seems to be something that falls between the cracks. If it is not a major, significant issue that the Environment Agency can tackle, Bristol City Council might rightly not be able to tackle it, and constituents then feel that they have nowhere to go and nothing happens. This is the frustration that many of my constituents face.

Even when actual breaches can be demonstrated, an individual instance in itself needs to be sufficiently big for action to be taken. With regard to Bristol North West, Avonmouth historically was land associated with a stately home in the constituency. Its owner built the village very close to industry, essentially for workers, but that has meant that we have an unusual situation—it may not arise in other parts of the country—in which people are living very close to the processing that is taking place. My conclusion as the local MP is that there seems to be just too much processing of waste, by too many facilities, too close together and too close to local residents.

I wrote to the Department about assessing the cumulative impact—not just the individual impact of a particular site or planning permission—with proper sight of how permits are monitored, managed and enforced as well as the impact on the community. The Environment Agency should have greater flexibility to raise minimum standards for the approval and renewal of permits as part of the lifecycle, taking an evidence-led area-wide view in setting conditions on the types and quantities of waste that can be handled, the processes taking place on site and the acceptable means of storage. For us, that might mean in lived experience that less rubbish needs to be processed at any one time, and perhaps fewer bundles may be stored on local sites. Perhaps bundles should be stored in closed, maintained facilities, not in open-air environments.

At present, operators are required to demonstrate how they will seek to minimise and mitigate negative consequences that attach to their work by submitting a written management plan. In affected areas, applicants and existing operators should be subject to more exacting requirements to explain how their processes adhere to the Environment Agency’s guidance on fly management, and such processes should be frequently inspected to ensure that they are delivered on a day-to-day basis.

As things stand, the only avenue for dealing with the problem is through identifying significant rule-breakers. Therefore, even in the best-case scenario, there is slow, piecemeal progress and no resolution to the issue. My constituents are clear that that is not good enough. The Environment Agency needs to be able to draw on a framework for assessing cumulative impact and have the teeth and the flexibility to take action to deal with that impact.

I am listening carefully to the hon. Gentleman. In my area, the recycling centres are all enclosed in buildings. Does he not think that the planning system is a better means for controlling this problem?

I thank the hon. Gentleman for his intervention. That is part of the puzzle. National and local planning frameworks should better reflect some of these issues when decisions are being taken. For example, a number of early planning decisions were granted by Bristol City Council, but the previous two applications were rejected locally only to be overturned by the national planning authorities, not having taken into account the proper representations made by local councillors about the cumulative impact. We therefore need improvements to the planning process as well as to the rules and the Environment Agency’s ability to take action.

I do not want to spoil the flow of my hon. Friend’s speech. On planning, when a company, which could be rogue to say the least—some of these places can be said to be the scrapyards of our modern age—shuts up shop and goes, someone else can move in without having to apply for new planning permission; the permit still stands. Does he agree that that should be looked at?

I very much agree, because I have had exactly that issue: a company that went into administration was bought by an overseas company, and activity on the site continued with the existing permit. That is a problem. It shows a lack of enforcement, and that is why constituents get concerned about that.

To extend my answer to the planning question, one of the issues is about putting too many of these facilities too close together. I understand why it might seem good to put warehouses to process rubbish in parts of the industrial space in my constituency. We probably would not want to put them in other places. However, I go back to the main thrust of my argument, which is the cumulative impact. Surely there is a threshold at which there are too many of them and someone should think about putting them somewhere else.

I am told waste is a profitable business, and some of these businesses can invest significant amounts in their facilities. For example—not to make any of the companies blush—Viridor seems to be building a well-funded facility in my constituency, whereas New Earth Solutions did not have the investment or capital available to maintain the highest possible standards.

Surely that must be a consideration for planning and Environment Agency powers, because there is an impact on the character and economic prospects of an area. Many Avonmouth residents feel doubly trapped and frustrated. They cannot sell their homes because of the press coverage and local understanding that at points in the summer families are eating their dinners under mosquito nets and the pub has to close because it feels unable to serve its customers. It takes its toll on community life and puts a tone on a community that no one wants where they live. They want to be part of a vibrant community where outdoor spaces can be enjoyed in the summer.

This area, like so many others, deserves a diverse range of high-quality, well-paid jobs in a community in which people feel happy and able to live and enjoy the outdoor environment. We must be careful that in clustering such facilities and not having proper rules and enforcement powers to deal with them, we do not create waste capitals across the country, where for local residents it will have to do. It does not have to be that way. We can make changes.

It is clear that there is no consent from my constituents in Avonmouth, or indeed the surrounding areas of Bristol North West, for this to continue—nor for it to have been put in place. I have therefore been left with no choice but to bring it to the House in a Westminster Hall debate to raise it with the Minister. Like my constituents, I have run out of places to go. I have come to dead ends in trying to find a solution. I can only conclude that the Government and the Minister’s Department are the best and only place left to try to find some solutions to fix these issues for my constituents and those in other parts of the country.

It is an honour to serve under your chairmanship, Mr Bone. I congratulate the hon. Member for Bristol North West (Darren Jones)—almost a neighbour in the west country—on securing the debate and on his commitment to bringing this issue to our attention. I know he has been working hard locally with the Environment Agency and other partners to try to pinpoint the sources of some of the problems faced by his constituents. Having grown up on a dairy farm, I am well acquainted with living with flies in everyday life, and I sympathise with his constituents who are living with this. I know the Avonmouth area relatively well, having been a news reporter based in Bristol. I was often sent to Avonmouth to report from the industries there—and, indeed, some of the recycling centres.

A relatively significant cluster of waste facilities in close proximity to a residential area will, by its nature, have some impact on local amenity. The planning and permitting systems need to work together to ensure that those impacts are managed within acceptable limits. We need to ensure that we have clear and strong environmental regulation and planning controls that work for the environment, for the people living there and for business. The Environment Agency and local planning authorities therefore each have distinct roles with regard to pollution and planning control to enable that to happen. That is their purpose.

It is for local planning authorities to prepare local plans to meet the need of waste management in their areas and deal with relevant planning applications. All steps of the planning process are subject to public consultation, and local planning authorities do consider representations from stakeholders when making planning decisions. When determining planning applications, local authorities have to give due consideration to potential statutory nuisance and other cumulative impacts—flies could come under that—as well as similar developments being close to one another.

Bristol City Council’s core strategy, which, I remind the House, was adopted by a Liberal Democrat-led council back in 2011—the council is now Labour—identified Avonmouth as a priority area for industrial and warehousing development, including waste management activities. A decision, which was thought about, was taken to make the area a centre for such activity. Planning applications are determined in accordance with the local plan unless material considerations indicate otherwise, and they take account of the likely impact, including cumulative impacts on the local environment, communities and the economy.

When considering those impacts, the planning system has the power to limit the number and types of operation being developed in any particular area, if appropriate. Although I am unable to comment on individual cases, I believe that the hon. Gentleman’s reference to central Government’s overturning the council’s decision to withhold planning permission may relate to an occasion when an independent public inquiry allowed an appeal against the decision. The decision to allow the appeal was then upheld following a challenge in the High Court.

I hear what the Minister says about what the planning system and local councils can do, but does she recognise that many local councils have different standards for implementing these things, and that that leads not to standardised performance in this field, but to widely varying performance around the country?

I thank my hon. Friend for his intervention. Local authorities do have power and are required to act for the benefit of local people; I gather that my hon. Friend’s council has decided that its recycling facilities have to be enclosed, so that is the decision it has made for the benefit of its constituents.

Our published guidance makes it clear that when applying for an environmental permit for regulated activities, operators should make applications for both planning permission and environmental permits in parallel whenever possible. This helps the operator, the planning authority and the Environment Agency to join up, to the benefit of all concerned. I know that necessary distinctions in regulatory roles and remits can lead to particular issues on the ground. It is therefore important that all parties involved in the consideration of granting permission to and permitting regulated facilities work together openly and transparently at a local level, to achieve the best outcomes.

The Minister will have to forgive me if I am treading on the next paragraph of her speech, but the issue here is the retrospective view. Planning permissions and environmental permits have been granted, and we are now in a position where we have too many of these facilities, too close to residents and processing too much rubbish. The question is about powers to deal with them now that those decisions have already been taken, whether at local or national level. Are there powers that the Minister can refer to that will deal with the issues already in place, or are we just discussing powers for getting this right on new applications in other areas?

I thank the hon. Gentleman for his comments. Of course, powers were used in the case of the company he referred to, New Earth Solutions, in respect of the fly infestation. Action was taken, and I am told by the Environment Agency that the situation has improved and the company has subsequently complied. Clearly, the powers worked in that particular instance.

The Environment Agency is working closely with Bristol City Council and, I believe, with the hon. Gentleman, but it has not been able to identify a single source of the fly infestation. The agency would have to be very certain before it could take action, because there are 39 permitted waste facilities regulated by the Environment Agency in close proximity to Avonmouth. They manage a range of waste materials, including metals, healthcare waste, and household, industrial and commercial waste, and they will therefore all have different impacts. Not all of them will be the source of flies, noise, or dust, but all those facilities—both those that are and those that are not currently operational—are regulated by environmental permits that set out the measures with which operators are expected to comply in order to minimise any adverse impacts to local residents, businesses and the environment. So, there is a system.

The Environment Agency has a range of powers that it can use to address shortfalls in operators’ performance. In fairness, the agency has put a lot of effort, as I am sure the hon. Gentleman will agree, into investigating the potential causes of the fly infestations at Avonmouth, and it continues to work closely with local partners. I have spoken to the agency myself about how much it is doing to try to crack the situation.

It is clear that any operator who does not comply with the conditions of its permit will be subject to compliance and enforcement action by the Environment Agency, but revoking is the end of the line. What the agency really wants is to work with the businesses to make the system work, because we need places to send our rubbish. Bristol is a big city, so that is very important. Depending on the action being taken, there are different timescales, but revocation is an absolute last resort. Fly infestations can also be treated as a statutory nuisance and enforced against by the local authority—that comes under the local authority as well, so it has that power.

I understand the hon. Gentleman’s comments about the cumulative impact of the facilities. The Environment Agency investigates complaints received from local residents regarding odour, dust, noise and flies. I reiterate that although it has been possible to substantiate historic complaints in some cases, with the Environment Agency taking appropriate enforcement action, in many instances it still has not been able to identify any one source for the issue.

Although it is not in the Environment Agency’s remit to determine the locations of waste management facilities, it continues to meet the council to ensure that they work together to minimise the impact on residents. I believe it has also done a lot of work with the city council over the summer, because that is when the flies are worst, to investigate and monitor local fly populations. Officials from the Environment Agency have even toured the area with the Mayor; I believe the hon. Gentleman may have been there as well.

Going on to the ground seemed to me like an eminently sensible thing to do. I gather that, following that tour, the Mayor decided that they would try to see whether they could help somewhat by looking at how local waste is collected and tasking each collection team with more emphasis on the cleanliness in its particular streets. That is just one of a list of measures that have been used to help. The Environment Agency continues to visit the permitted facilities in and around Avonmouth constantly, although those visits still do not seem to have found the one source of flies.

Following the Adjournment debate that I secured in the House, the then Minister, the hon. Member for Camborne and Redruth (George Eustice), said that he would go away and look at the question of future further powers for the Environment Agency, as my hon. Friend the Member for Bristol North West (Darren Jones) mentioned. Now that this Minister is in post, can she commit to looking into that, specifically with regard to spot fines? For littering and dog poo, officers from the council can issue spot fines, but for something as big as this, the Environment Agency does not have that power. Does she think she could look into that?

I was not at that particular debate, but there are a great many measures coming through the resources and waste strategy, which I am sure the hon. Lady is familiar with, with plans to reduce waste and increase recycling and resource efficiency, as well as an ambitious set of reforms to the way waste will be regulated and managed to mitigate future impacts. We will write to her about any progress being made on the idea of spot fines, but there is already a process that the Environment Agency can operate, with revocation being the end, if possible. I will get back to her. She mentioned earlier the transfer of permits; the Environment Agency has to assess transfers of permits, and there are regulations for how that should work.

Going back to the resources and waste strategy, there is a great deal in there that will be coming forward. As indicated by the hon. Member for Bristol North West, waste management facilities are now all required to have a written management system, designed to minimise the risk of pollution and reduce the impact on local communities and the environment, which should cover things such as the management of flies, odour, noise and dust. However, I take his point regarding requirements and actions to combat flies. That is already picked up through the written site management plan for Avonmouth, but I would expect the Environment Agency to be paying particular attention to that—I know it is doing so, but I will highlight that it is essential that it looks at that.

In the resources and waste strategy we will also strengthen the requirement for those operating permitted waste sites to be technically competent, remove or change some of the higher risk exemptions from the permitting system to ensure those facilities can be regulated fully, and enact far-reaching reforms to the ways in which waste can be transported and tracked. Just yesterday, £1 million was announced for investment in technology to help to crack down on illegal waste.

To sum up, I thank the hon. Gentleman for bringing this subject to the House. He is clearly working hard on behalf of his constituents. I hope I have made it clear that there is a system in place, and that the Environment Agency is doing all it can and will continue to monitor the situation with Bristol City Council and, indeed the hon. Gentleman himself.

Question put and agreed to.

Health Visitors (England)

I beg to move,

That this House has considered the reduction in the number of health visitors in England.

I am grateful to the hon. Members who have come to speak on this important subject. I declare an interest as the chair of the all-party parliamentary group for conception to age two—the first 1,001 days. I also chair the board of trustees of the Parent-Infant Foundation, which runs attachment facilities and lobbies for better early intervention around the country.

I will start with some slightly alarming statistics. The cost of perinatal mental ill health in this country has been worked out at £8.1 billion per annum, according to the Maternal Mental Health Alliance, with up to 20% of women experiencing some form of mental health problem during pregnancy or the first 12 months after birth. The cost of child neglect in this country has been estimated at some £15 billion, with 50% of all maltreatment-related deaths and serious injuries occurring to infants and babies under the age of one. We currently spend in excess of £23 billion getting it wrong in those early years, particularly for mums and new babies. That is equivalent to something like half the Defence budget.

There are 122,000 babies under the age of one living with a parent who has some form of mental health problem. Amazingly—this statistic came out time and again during conversations on the Domestic Abuse Bill—a third of domestic violence begins during pregnancy, and suicide is one of the leading causes of death for women during pregnancy or in the year after giving birth. About 40% of children in the United Kingdom have an insecure attachment to a parent or carer at the age of 12 months, according to Professor Peter Fonagy and others. Alarmingly, there is a 99% correlation between a teenager experiencing some form of mental illness or depression at the age of 15 or 16 and his or her mother having had some form of perinatal mental ill health during pregnancy. It is that close a correlation, making it that much more important that we make sure that the mums bearing those children, and also fathers, are as happy, settled and healthy as possible in those early stages, from conception to age two.

The hon. Gentleman set out the costs incurred in trying to prevent such travesties. Does he agree that the figures he refers to are actually conservative estimates? I believe that he was at the launch, quite a number of years ago, of the Maternal Mental Health Alliance, which arrived at the figure of more than £8 billion. Is it not the case that, although the economic costs are significant, it is the social and moral reasons that have brought Members from all sides of the House here for this important debate?

If the hon. Lady is patient, I will come on to the social impacts. I think the MMHA report came out in 2014 or 2015, so obviously things will have moved on, although the birth rate has slightly fallen in that time as well. These are substantial financial figures, but as she says, most important are the social impacts and the impact on the child.

On the physical impacts, our childhood obesity rates are among the worst in Europe, while breastfeeding rates in the United Kingdom are one of the lowest in the world. We have rising emergency department attendances by children under the age of five, and infant mortality reductions have recently stalled. Just last week, we had the worrying figures about the dwindling vaccination rates in England in particular, with only 86.4% of children having received a full dose of the MMR vaccine. We have effectively lost our immune status, because the World Health Organisation vaccination target to protect a population from a disease is 95%.

The Children’s Commissioner estimates that, in total, 2.3 million children live with risk because of a vulnerable family background, but that, within that group, more than a third are effectively invisible and not known to services and therefore do not get any support. We are talking about an expensive and widespread problem.

I pay tribute to the remarkable work of health visitors in my constituency. Does the hon. Gentleman agree that cutting the health visitor service by 30% over the last few years has clearly made it even harder for the profession and for the families and mums that they take care of?

Again, I ask the hon. Gentleman to be patient, because I will come on to all that. I realise that he wants to put on the record his tribute to health visitors in Eastbourne, as do I—as someone who was born in Eastbourne and had wonderful health visitors, I am sure, albeit 57 years ago now.

The one thing that all these problems have in common, and a lot more problems I have not mentioned, is that they come under the remit of the health visitor, to some extent or other. The health visiting service provides an important safety net for infants and young children—as well as mums and dads—who are at particularly high risk of having their needs missed, as they are not visible in the same way as children who are accessing an early-years setting or a school, for example.

I am very pleased to briefly interrupt him. I pay tribute to the health visitors in my constituency. Is it not an important role of theirs to ensure that health inequalities are drummed out of the system?

That is a serious point; my hon. Friend is absolutely right. Health inequalities are still a big problem in this country, and those professionals on the ground, not least health visitors, are the first to come face to face with them and have the practical means, in many cases, to do something about them.

I am happy to take interventions, but it will mean that hon. Members will have to make shorter speeches, as I am sure Mr Bone will point out.

The Royal College of Nursing’s briefing for the debate says that the number of health visitors with caseloads of more than 500 children rose from 12% to 21% between 2015 and 2017, so it will have risen even more in the two years that have elapsed since. The caseload is really worrying, in terms of people being missed.

The hon. Lady pre-empts a point I was going to make on page 5 of my notes, so I will take that bit out.

Unlike some other public service professionals, health visitors are non-stigmatising and usually welcomed over the threshold into homes, enabling them to give early advice and support to prevent later problems, encourage healthier choices, detect problems early and, in some cases, act as an early-warning safeguarding alarm. Often when social workers are the ones to knock on the door, it may be too late, and that professional has a completely different sort of relationship with the family.

I am grateful to the hon. Gentleman for securing this timely debate. What he just said is so important. The mandatory health visitor contacts in my constituency are not taking place as they should. When constituents complain or I complain, we are essentially told that they are profiled based on risk, which is clearly not how a mandatory set of contacts should work. I worry that we sometimes make assumptions about socioeconomic status or other factors, whereas the kind of problems we are talking about can manifest themselves in any family. If we are serious about having a mandatory system, should it not be that, rather than discretionary? If it is about capacity, let us talk about that.

Again, the hon. Gentleman makes a good point, which was on page 5 of my notes. This issue affects everybody across society, often better-off, more affluent families who might be better at hiding it or less inclined to come forward to seek help. The charity that I chair has units in Liverpool, Newcastle, London and so on, and we see that middle-class parents who have serious attachment dysfunction problems with their children are less likely to come forward. Those, ironically, may be harder-to-reach people. Health visitors are the early warning system and are able to signpost some of those people to services. They can also point out, “I think you have a problem,” and it will be taken on trust.

I appreciate the good points that have been made, but I will make some progress. The cost of failing to intervene early is enormous—financially and, more importantly, socially. The impact of not intervening early can disadvantage a child through early years, school years, adolescence and often into adulthood. In some cases, it can be life-defining.

One of the great achievements of the coalition Government was to pledge a massive increase in health visitors. In opposition, the then shadow health Minister, Andrew Lansley, championed the recruitment of no fewer than 4,300 new health visitors, based on the successful model of the Dutch Kraamzorg system—I was involved in research into that—where post-natal care is provided to a new mother and her baby an initial eight to 10 days immediately after birth.

Four years ago, the Government’s health visitor implementation plan and the “Call to action” scheme were the pride of the nation. The policy was built on sound evidence that the health visiting profession had the power to drive health improvements and provide a universal service designed to give every child that best possible start in life, as we all want to see. Impressively, for a Government target, it was achieved—just about—in the lifetime of the 2010 to 2015 Parliament.

Depressingly, since then, the numbers have started to drop dramatically. In June 2015, there were 10,042 full time equivalent health visitors in England. A year later, that had fallen to 9,491 and the latest figures show a 31% drop from the peak. According to the Institute of Health Visiting,

“one in four health visitors do not have enough time to provide postnatal mental health assessment to families at six to eight weeks, as recommended by the government.”

In response to a survey that the institute put out,

“three quarters of respondents said they are unable to carry out government recommended maternal mental health checks three to four months after birth.”

That is a crucial stage at which to pick up mental health problems with the parents, which may already be impacting or will impact on the infant. It is not only about looking after the baby, but the family unit and particularly the prime carer.

To a large extent, the reason for that has been the transfer of responsibility for health visitors from the health service to local government, as part of its enhanced public health responsibilities. I am not challenging the wisdom of doing that, but it has come at the time of the greatest squeeze on local government spending recently. The architecture of the delivery of health and wellbeing services for babies and young children, I think, has been fragmented in a disorienting manner between local councils, CCGs and NHS England, with insufficiently qualified scrutiny of how it works. There is an issue around the quality of informed local authority oversight over many of these public health roles.

I congratulate my hon. Friend on securing this debate. He has been consistently right in this area. My research ahead of this debate presented a worrying picture from GPs in Winchester, who report a distant relationship with health visitors. That is not their fault; it is because health visitors are so thinly spread. Does he agree that as well as providing more health visitors, it would be smart to address where they sit in the system and, maybe, to co-locate teams around the emerging primary care networks?

First, I pay tribute to the real acknowledgment of the importance of this area by my hon. Friend when he was public health Minister. He was always prepared to take our sometimes-annoying approaches to prioritising the issue. He may be right. I am not too concerned with processes and structures; I am concerned with getting the professional face-to-face with the parent and baby. We need to be smarter about where we can make that engagement happen and ensure it is not through lack of workforce that we are unable to do it.

The issue is important because the primary care networks and the GPs who rightly run them are responsible for the outcomes of the patients they manage within those lists. If they had ownership of those health visitors, because they were commissioned within that structure, they would have every incentive to close the distant relationship that I mentioned.

My hon. Friend may well be right. One of my constituents is a health visitor. According to her, the current status of health is not serving families well, based, as it is, on universally delivered process outcomes, which risk, to use a phrase she quoted to me, “ticking the box but missing the point”. That plays to the point my hon. Friend is making.

To illustrate the most successful ways of dealing with vulnerable families, I will use children’s centres as an example, although I will not get into a whole argument about them. The most successful ones that I have seen are those where hot-desking occurs between a district nurse, a health visitor, a social worker, a school nurse and others, who are all signposting. The health visitor may get over the threshold and say, “I am a bit worried that there is a mental health problem there. When I go back and see the community mental health nurse at the children’s centre, I might suggest she has a word.” That is the way it must happen. These are interlinking problems and it is not just down to one professional to treat them.

On the local authority, public health budgets have seen a significant reduction from 2015. The recent 1% increase for 2021 is welcome, but there is a long distance to go to replace some of the past reductions. Some areas have suffered disproportionately. I want to flag Suffolk, where, I gather, the council has been considering plans to slash the health visiting workforce by 25% to save £1 million. I think that is a false economy and short-sighted.

The decline in the number of health visitors since 2015 has been due to qualified nurses retiring or moving to other roles within the health service and too few trainees entering the profession. Alongside workforce cuts by local authority commissioners, the health visiting profession is also facing recruitment and retention problems, falling staff morale and poor progression opportunities. Health visitors have also raised safeguarding concerns as their caseloads increase to meet increasing need and cover shortages.

In a 2017 survey by the Institute of Health Visiting, health visitors reported that children are put at risk due to cuts in the workforce and growing caseloads, finding that 21% of health visitors are working with caseloads of over 500 children, as the hon. Member for Lincoln (Karen Lee) pointed out.

When health visitors visited me in my constituency surgery in Penkridge, their frustration was that, although they love their job and want to do it properly, they cannot do it to the best of their professional satisfaction, because of the caseloads and because there were too few of them. Health visitors want to serve my constituents—the mothers, families and children—but they cannot, for those reasons. I had huge respect for their professional attitude, but it showed their real sorrow that they could not do the job as well as they want to.

My hon. Friend is absolutely right. I have met many health visitors. They are a fantastic resource and do huge amounts of good work well beyond their remit. They are frustrated by some of the processes and financial considerations that are stopping them from doing their job to the best of their ability with sufficient support.

One of the greatest frustrations is when families do not let the health visitors in, which is a growing trend. They come back time after time and they find there is nobody there or, if the people are there, they will not let them in. Does he agree that that is a very worrying development?

Earlier, I raised the contrast with social workers where there is a safeguarding issue. It is a completely different dynamic and relationship. There is a reluctance to let the social worker over the threshold. That is less the case with health visitors, because they are seen to be there to help. But there is a reluctance from some people, perhaps due to ignorance as to what the health visitor is there to do from people who think, “I know it all; I don’t need you,” or due to people who may fear that their vulnerability will result in their child being taken into care. That is why that friendly face is so important. The health visitor is on their side to help them in being a new parent, in a way that other professionals cannot be.

According to the state of health visiting survey by the Institute of Health Visiting, one in four health visitors did not have enough time to provide the postnatal mental health assessments to families at six to eight weeks, as recommended by the Government; the hon. Member for Stalybridge and Hyde (Jonathan Reynolds) mentioned that. These PMH checks are a key part of the Government’s maternal mental health pathway. Previous research involving clinical trials with 4,000 mothers found that those who received health visitor support were 40% less likely to develop postnatal depression after six months.

There are five mandated reviews under the Healthy Child Programme that health visitors undertake. While those are spread across the first 1,001 days, they are concentrated in the first 12 months. Health visitors are concerned that the number of reviews is insufficient and leaves too large a gap between contact with families. Not enough scheduled reviews are happening, and we probably need more reviews intensively at those early stages.

There was also a lot of concern about steps being taken to help recruitment. I tabled a question earlier this week, which the Minister kindly answered. I asked

“the Secretary of State for Health and Social Care, what steps he is taking to reverse the fall in the number of health visitors.”

She replied in a written answer, saying that

“Since 2015, local authorities have been responsible for the commissioning of services for zero to five-year-olds and as such, they determine the required numbers of health visitors based upon local needs.”

We understand that. She continued:

“A Specialist Community and Public Health Nurse apprenticeship (Level 7) is currently in development. This will offer an alternative route directly into the health visiting profession.”

I am afraid that that answer raised some alarm among people at the Institute of Health Visiting, and the response to it that I got back was to point out that

“The apprenticeship route is not an alternative route directly into health visiting. Applicants still need to be nurses or midwives and the course presents a number of risks: it is longer, the end point assessment delays qualification unnecessarily…it does not deliver a national strategy for the profession. HVs”—

that is, health visitors—

“who are not employed by the NHS do not have the same opportunities to those covered by the NHS People Plan - this includes NHS funding for CPD”—

that is, continuous professional development—

“leadership development, pay rises, safer staffing and national action to address recruitment/retention difficulties.”

It also pointed out that

“Local Authorities determine the level of HVs dependent on local need, however there is no measure of quality of service or guidance on how far the service can ‘flex’ to meet those needs.”

In addition, the apprenticeship is still not ready to be rolled out; it takes longer than current training; and it is more costly and therefore less attractive to employers and/or recruits.

An urgent workforce plan is needed to tackle dwindling health visitor numbers. I have spoken to representatives of the Local Government Association. They are very concerned about this situation; as representatives of local government, they want to get their public health role right. The LGA said that

“it had offered to work with the Department of Health and Social Care, the NHS and Health Education England to help deliver a plan that would see the ‘right number’ of training places commissioned. It would also develop new policies to ensure health visiting remained an ‘attractive and valued’ profession.”

I hope that the Minister is receptive to that offer; I am sure she is.

What needs to be done? Again, we need to value the role of the health visiting profession. I am sure that all of us in this Chamber and beyond would want to do that, but we have to will not only the inclination but the means as well.

A publication by the Institute of Health Visiting, “Health Visiting in England: A Vision for the Future”, makes 18 sensible and practical recommendations, and they all involve some investment. I will touch very quickly on a few. The institute wants to see

“urgent and ring-fenced public health investment…A review of 0-5 public health funding…to cover the cost of delivery of the Healthy Child Programme in full in all Local Authorities in England.”

All local authorities in England will need that funding. It goes on to say that

“As we await the refreshed Healthy Child Programme, as an interim measure, the proposed metric should be a floor of 12,000”—

that is, 12,000 full-time equivalents—

“to restore the workforce to the target figure calculated for the Health Visiting Implementation Plan, 2011-2015…New National Standards for health visiting are needed to support consistency within the profession. The title ‘health visitor’ and its role should be protected and restored to statute. A review of health visiting training with a risk assessment of the impact of the removal of Health Education England funding of training and replacement by the use of the Apprenticeship Levy.”

Frankly, those are sensible measures. I very much hope that the Minister will look at them positively; I am sure she will. It would be a false economy not to do these things. They need to be part of a bigger shift in Government policy—the policy of any Government; I may be pushing at an open door—towards an earlier, more intensive, preventive intervention approach, from conception to the age of two especially. Health visitors are absolutely at the centre of that.

Order. It might be helpful to right hon. and hon. Members to let them know that the wind-ups must start at 5.15 pm, and that there are four Members trying to catch my eye. I hope Members can bear that in mind.

It is a pleasure to serve under your chairmanship, Mr Bone, and I am grateful to the hon. Member for East Worthing and Shoreham (Tim Loughton) for securing this important and timely debate.

Before I was elected to this place, I was a lay representative who chaired Unite the union’s national health sector committee. As a result, I had a great deal of involvement in the work done by our health visitors and community practitioners under the umbrella of the Community Practitioners and Health Visitors Association, which operates under the auspices of Unite the union.

I gave up that role in 2014 when I was elected to serve the constituents of Heywood and Middleton. However, I recall that at that time there was great deal of disquiet and unrest about health visitor services, which, as a result of the Health and Social Care Act 2012, were being transferred from NHS commissioning to be commissioned by local authorities. It seems, from what the hon. Gentleman has said and from readily available figures, that the worries that existed at that time have come to pass, as the number of children’s health visitors fell by 31% between 2015 and 2019.

The Local Government Association says that the number of health visitors who are retiring or taking other NHS jobs, combined with too few trainees entering the profession, has led to the workforce being stretched to its limits, at a time when the number of vulnerable children and families is rising.

With cuts to public health budgets, councils are struggling to afford the number of health visitors needed to cope with the workload. Figures from the Office for National Statistics show that the number of under-fives in the borough of Rochdale, in which my constituency is situated, is just over 15,000. With just 52 health visitors in the borough, that gives an average case load of 290 children per health visitor, when the recommended maximum—as recommended by both the CPHVA and the Institute of Health Visiting— is 250.

With health visitors being so overworked, they may, through no fault of their own, fail to spot child abuse, domestic violence and post-natal depression, and they may also have too little time to help mothers to bond with their babies. A survey conducted by the Institute for Health Visiting showed that health visitors themselves are voicing fears about child tragedy, as a result of increasing case loads and high levels of stress.

With year-on-year cuts to our public health grant, it is difficult to see where the funding will come from to provide and improve this vital service. In the borough of Rochdale, the public health grant is now £3 million lower than it was in 2016-17, having decreased from £19.7 million then to £16.7 million in 2018-19. For this financial year—2019-20—the budget has been cut yet again, to £16.3 million, giving cumulative cuts over the past four years in the Borough of Rochdale of more than £8 million. Nationally, councils’ public health budgets have reduced by £531 million between 2015-16 and 2019-20.

I welcome the fact that in the NHS long-term plan the Government pledge to look again at commissioning arrangements, not only for health visitors but for school nursing and sexual health—areas of health provision that are also suffering with increasing case loads and staff shortages. It is my hope that the responsibility for commissioning will revert to the NHS, and that it will be adequately funded and resourced. I will be very interested to hear the Minister’s comments on that.

Before I conclude, I will just mention some good news about the CPHVA. It has just appointed two high-profile vice-presidents: Professor Gina Higginbottom, who was the first black, Asian or minority ethnic nurse to hold a professorial role at a Russell Group university; and Sara Rowbotham, who is a friend and colleague of mine. Sara worked for Rochdale’s crisis intervention team from 2004 to 2014, and she helped to expose the Rochdale grooming gang scandal. She is also currently the deputy leader of Rochdale Council.

These appointments are welcome at a time when health visiting and school nursing are facing this crisis of falling numbers. Professor Higginbottom has declared her commitment to reducing health inequalities in the role, while Sara has pledged to fight for members’ voices to be heard. I hope that the Minister might find the time to meet these two inspiring women. I am sure that she will find such a meeting productive and helpful in preparing a much-needed clear plan to improve health visiting numbers and the quality of care provided for children and families.

It is a pleasure to serve under your chairmanship this afternoon, Mr Bone. I congratulate the hon. Member for East Worthing and Shoreham (Tim Loughton) on securing this important debate and on his work with the all-party parliamentary group for conception to age two—the first 1,001 days.

I will start by paying tribute to the Institute of Health Visiting and, most importantly, to the army of health visitors themselves. I know what an important job they do from my own experience as a mum to a two-and-a-half-year-old and a seven-month-old. In particular, I put on record my thanks to Gill and Katie, who have helped me and my family. Health visitors do a brilliant job against a backdrop of falling numbers, growing case loads and, in some cases, unconscionable pressures. In the wake of the cuts to public health, it is now clear that we have seen a steady diminution in health visitors across England.

As we have heard, since October 2015, the number of health visitors in England has reduced by a quarter from just over 10,000 to just under 8,000, which piles extra pressure on existing health visitors. Nearly a third of health visitors have case loads of more than 500, which is twice the safe level set by the Institute of Health Visiting. Unfortunately, that can only have a detrimental impact on the quality of care. At best, it risks health visitors being less helpful. At worst, it is counterproductive to their aims and goals.

Looking at a number of indicators, there is mounting evidence that things are getting more challenging. The reductions in infant mortality have stalled. We have already heard about issues around breastfeeding, which is a subject that is particularly close to my heart. We now have some of the worst breastfeeding levels in Europe, and I say that as an MP in Liverpool, where so much work has gone on via our Babies and Mums Breastfeeding Information and Support—or BAMBIS—service to support and assist mums in their own homes. We have seen a great increase in the proportion of women breastfeeding in Liverpool, but levels countrywide are still far lower than they should be. We are facing an obesity crisis. Immunisation rates are falling. We have missed the target for measles and the UK has lost its measles-free status. We are living through a mental health crisis, and I reflect on the fact that the period of a woman’s life where she is 30 to 40 times more likely to experience a period of psychosis is the year after birth. That is the moment in her life where extra additional support is needed.

We see a particular challenge with adverse outcomes not being distributed evenly, which speaks to health inequalities. That issue falls far down the agenda and gets much less attention than it deserves, but we are seeing a widening of inequalities across the country. Poor health goes hand in hand with someone’s postcode, income, social status and what their parent or parents do for a living. The impact of inequality is keenly felt in too many areas, including in Liverpool and other disadvantaged neighbourhoods. Nearly 70% of health visitors have reported having to access emergency food aid and go to food banks on behalf of the families they are supporting. The Institute of Health Visiting stated in its report that those inequalities resulted in poorer physical and mental development, poorer academic achievement and poorer employment prospects at every stage of a child’s life.

We are talking about the most fundamental of issues: how can we ensure that every child born in this country has the best life outcomes and best life chances? Health visitors play such an important part in those outcomes and provide such a vital intervention in supporting new parents. The list of what they do goes on and on, and we have heard much about that already. They also play an important part in preventing ill health, rather than trying to cure it later. Health visitors play a critical role beyond health, whether that is supporting troubled families, improving early language development and learning at home, particularly where a child might have special educational needs, or improving parental confidence and knowledge to avoid unnecessary trips to our health service.

Health visitors should form part of a truly integrated system of health, care and wellbeing that is tailored to the parent and child, with the right interventions, advice and support at the right time. I reflect on that as a member of the Health and Social Care Committee. We did a report called “First 1000 days of life”, in which the first priority was for every child to receive the five mandatory visits. In fact, we said that that number should be increased to six, with a visit at three or three and a half years old to ensure that every child is ready for school. We perhaps do not like to talk about that issue, but we are seeing increasing concern about it from teachers across the country.

I am conscious that my time is coming to an end, so I want to reflect on that recommendation from the Health and Social Care Committee. Health visitors play such an important role. They support families where others do not have the opportunity to do so. They enter people’s homes and they are trusted. When I think about all the health professionals I connected with as a new parent, it was my health visitor who I relied on. We need to ensure that we are not creating the conditions for a public health crisis for future generations, and I hope that in the Minister’s response we will get some glimmers of hope that we will see an increase in the number of health visitors, not a further decrease.

It is a pleasure to serve under your chairmanship, Mr Bone. I congratulate the hon. Member for East Worthing and Shoreham (Tim Loughton) on securing this vital debate. The role of the health visitor is important to our local communities. The health visiting service provides the vital support that young children and their families need to ensure that every child has the best start in life. Health visitors address cross-departmental priorities for children and give a voice to young children living with adversity, who can in some cases be invisible to other services. The health visiting service provides an important safety net for infants and young children who are at particularly high risk of having their needs missed, as they are not visible in the same way as children who are accessing an early years setting or are at school.

Early intervention is vital for children and their families and an effective health visitor service is a proven way to improve health outcomes and reduce inequalities. However, in January 2019, the Royal College of Paediatrics and Child Health raised serious concerns about widening child health inequalities, highlighting that:

“Universal early years services continue to bear the brunt of cuts to public health services”.

In Lincoln, 28% of children live in poverty. Health visitors are desperately needed to ensure that those children receive the support they deserve. In 2015, the commissioning of health visitors was transferred from the NHS to local government—a bad move in my view—and that has resulted in a negative impact on the working conditions of local health visitors and the capacity of the service delivered to my constituents, as the funding is not ring-fenced. I am deeply worried by the steps that Lincolnshire County Council has taken to divide the health visitor role, and I was proud to support the health visitor strike against the proposed changes.

The changes will divide the health visitor role into two different job descriptions, which will create a flawed career progression scheme that restricts health visitor career progression. All health visitors undertake the same training, and upon qualification they are all expected to carry out every facet of their role on a daily basis. It is my understanding that there is no rationale to explain why one health visitor would be demoted to a junior job description while another continued at the same level. It is a fact that fully qualified top band 6s are leaving or have left—many with years of experience—due to a reduction in their status and an enforced three-year pay freeze. We are losing an important skilled workforce that is invaluable to our community. As a qualified nurse, I have to say that nurses and healthcare professionals do not go on strike without a really good reason.

Analysis undertaken by Unite shows that those held back from progression due to the changes will lose a substantial sum annually in comparison with the NHS pay structure. I am concerned that the reforms are not being undertaken in the best interests of the health visitor service, but rather as a mechanism to deskill the service in order to reduce pay. Financial efficiency must come second to the wellbeing of our local communities. It risks the long-term social benefits created by investing in our children’s future at a crucial early stage. Will the Minister make representations to Lincolnshire County Council—please do not push it one side and say it is a local government issue—to prevent the downgrading of the health visitor role? It is important in my constituency of Lincoln, and I hope I am being heard. It is important that Lincolnshire County Council recognises health visitors’ professionalism and importance to our community and rewards them accordingly.

It is a pleasure to serve under your chairmanship, Mr Bone. I thank the hon. Member for East Worthing and Shoreham (Tim Loughton) for introducing this important debate. The Labour Government recognised the decline in the number of health visitors and therefore put in train a health visitor implementation plan. As head of health at Unite—I refer Members to my declaration in the Register of Members’ Financial Interests—I was delighted to see that plan come to fruition during my time there. The ambition to raise the number of health visitors by 4,200 was a steep challenge, but a necessary one. We have heard the reasons why. Health visitors are the backbone of early intervention by health services. They are the pioneers of public health, and are instrumental in addressing health inequality. At a time when there are real challenges on children’s health, it is so important that a workforce is there to deliver that service.

Unfortunately, as we have heard, the numbers have fallen by 31% to date, from a peak of 12,292. That is having a serious impact not only on young people and their opportunities but on staff. We know from the work that the Community Practitioners and Health Visitors Association has carried out that 85.3% of health visitors are experiencing stress. They have case loads that are unsafe. It is therefore vital that the Minister put a statutory case load figure on the books. It is important that health visitors work to criteria under which they can cover their case loads. In York, we have only 29 health visitors to cover our city, which has a population of nearly 10,000 children. That clearly is not safe at all.

The health visitor implementation plan was good, though very rushed. Often mentoring was being stretched from a one-to-one relationship, which is the norm, to one-to-six. That is what I heard from some health visitors in training. No sustainability was put into the plan after its implementation. Therefore, with an ageing workforce, we saw rapid decline and people moving elsewhere in the health service—partly because they were placed in local authorities that, under the austerity measures, decided to cut back not only on opportunities for training and development but on pay.

Such cutbacks had a significant impact, and downgrading was part of it. For people who went to work in outsourced services, for which we obviously cannot get hold of information about true numbers through freedom of information requests, we know that conditions were even worse, and that people have left the service after their training period. That is a massive loss to our service as a whole.

I will rapidly move on to what needs to be introduced—a new, and properly resourced, health visitor information plan. There was a promise in the report on young people by the right hon. Member for South Northamptonshire (Andrea Leadsom) that the comprehensive spending review would resource the future programme, but of course we have not had the comprehensive spending review. It is therefore urgent that the Government put money on the table to deliver that.

We also need to ensure that we bring services back into health that have been outsourced, so that there is proper monitoring of the service and it is seen as a statutory service to be delivered. I am very interested in the ideas that have been proposed in today’s debate that it either be moved back into the NHS or into a proper partnership between health and local government. The reality is that the right relationships need to be built for health visitors to deliver the programme.

Finally, we need to ensure that the right stakeholders are brought around the table. It has been brought to my attention that some consultation has taken place on how we should move forward on such issues as the number of mandated contacts and so on, but not all the stakeholders are there. I urge the Minister to meet with the CPHVA, which is the lead organisation representing health visitors, and to ensure that included in that cohort are people working in the profession who can really reflect what it is like on the frontline today.

It is a pleasure to serve with you in the Chair, Mr Bone. I thank the hon. Member for East Worthing and Shoreham (Tim Loughton) for bringing this important subject before us, and for the sterling work that he does chairing the all-party parliamentary group for conception to age two—the first 1001 days.

We have had some really interesting speeches, and I thank all Members who have spoken for some very convincing contributions that have outlined very clearly the massive contribution that health visitors make to communities and to individual families, covering all sorts of services—from basics such as the transition to parenthood, particularly helping new parents, to support with breastfeeding and weaning, and encouraging the full take-up of immunisations. It has been pointed out that we have a very poor record on that. Health visitors also support the mental health of parents who might be feeling vulnerable in their new role; advise on a host of minor ailments from which children might suffer; ensure readiness for school; check that developmental changes are happening at the appropriate stage; and help to pick up early any special needs and problems.

The hon. Member for East Worthing and Shoreham talked about the importance of safeguarding and the cost—not just the cost to the family, but the financial cost of services when it does not happen. Health visitors, as registered nurses with additional midwifery, community and public expertise, play a tremendous role. I not think that there is any disagreement in the Chamber about the contribution that they make. Praise for them among health professionals is widespread. The president of the Royal College of Paediatrics and Child Health has said:

“Health visitors act as a frontline defence against multiple child health problems”.

The Children’s Commissioner for England said:

“Health visitors are an essential part of the country's support structure for young children and their parents”.

My daughter Anna became a new parent six months ago today. Ahead of the debate, I asked her what she thought of her health visitor. She said:

“We loved our HV. We didn’t have consistent midwifery care—a different midwife every week before and after Nora was born—but we had one HV who first visited me before Nora was born and told me she would be my health visitor throughout the early stages of me becoming a mum. We found her especially helpful when Nora started struggling”

with feeding. Anna also said of her health visitor that

“we’d been discharged by the midwife and didn’t want to bother the GP. She was just a phone call away or would pop to see us.”

I am grateful to the hon. Member for Liverpool, Wavertree (Luciana Berger) for what she said about the benefit she had from health visitors. There is no disagreement about their value, and I put on the record my thanks to health visitors across the country for the sterling work that they do in times of considerable difficulty and challenge. They are very much a British phenomenon. We are the envy of the world, having health visitors—and with good reason. We all know that there is nothing more important than giving children the best possible start in life.

Bearing all that in mind, it is distressing to hear that the number of health visitors is falling so drastically. We are going backwards and it is extremely worrying. The Minister may point to the fact that David Cameron increased the number of health visitors, but that is old news, and the picture now is very different. In 2015, there were 10,300 health visitors; by 2017, that number had fallen to 8,244. The reality is that every month the numbers fall. None of that is really surprising considering that, in late 2015, public health and the commissioning of health visitors became the responsibility of local authorities. That transfer of responsibility was accompanied by a budget reduction of 6.2% and the requirement to cut year on year until 2020. Funding for health visitors is not ring-fenced, so is it any wonder that cash strapped authorities are commissioning fewer and fewer?

I raised my concerns about this last year with the former Health Minister, the hon. Member for Thurrock (Jackie Doyle-Price). She said:

“health visitors are probably the most important army in the war against health inequalities. They provide an intervention that is very family-based and not intimidating…There has been a decline…which we really must address if we are to get the earliest possible intervention and the best health outcomes for children.”—[Official Report, 23 July 2019; Vol. 663, c. 1204.]

I totally agree. That was said last year, and the Government have failed to act and the numbers have continued to fall.

The numbers of children have not fallen, though, and it is therefore important to recognise the increased workload of the remaining health visitors. My hon. Friends the Members for Heywood and Middleton (Liz McInnes), for York Central (Rachael Maskell) and for Lincoln (Karen Lee) all raised the falling numbers, and pointed to the fact that the Institute of Health Visiting current case load identification exceeds safe levels. The recommended maximum case load for health visitors is 250. The Care Quality Commission reports that the average is 500 and, in the London Borough of Hounslow, the average number—not the highest—is 829 per health visitor. That is obviously affecting their ability to deliver a quality service, and it is now true that the proportion of six-to-eight-week reviews completed for newborn children ranges from 90% in some areas to only 10% in others. It seems that vital workforce planning is a thing of the past, and our children and communities are paying the price.

In the widest sense, that approach is so short-sighted. No health professional is better placed than a health visitor to support parents and children in those vital early years. The early intervention of a well-qualified, accessible health professional can be the difference between children thriving and not. For every child who does not thrive, there is a cost, not just to the family but to wider society. There is a wealth of evidence to demonstrate the high impact that health visitors have in key areas.

Order. I am sorry to interrupt the shadow Minister, but there is a guideline of five minutes for shadow Ministers in these debates, with 10 minutes for the Minister. We are cutting into her time, so I hope the shadow Minister has finished her speech.

Today, the Minister has heard an appreciation of the contribution of health visitors. We look to her to address the question of future provision, and outline how she is going to turn around the decline in numbers.

It is a pleasure to serve under your chairmanship, Mr Bone. I congratulate my hon. Friend the Member for East Worthing and Shoreham (Tim Loughton) on securing this important debate.

I also congratulate Members on the degree of consensus that there has been about how important health visitors are to each and every family they touch. I may not be able to answer Members’ contributions directly, but I will ensure that if there are further points to make after this debate, I will write to Members in due course. I pay tribute to my hon. Friend’s leadership and support on the issue of children and young people, and particularly his efforts to focus on those first 1,001 days, which can impact on social, economic and physical outcomes throughout life. I strongly agree about the importance of early years intervention, and that strengthening support at the very start can stop problems escalating and help the broader family. As both my hon. Friend and the hon. Member for Liverpool, Wavertree (Luciana Berger) pointed out, we can stop these problems before they start, or we can certainly intervene.

My hon. Friend made strong arguments for the value of health visitors and their ability to cross every threshold, which cannot be overestimated. Good health is one of our country’s greatest assets, and we cannot take it for granted; just as we save for retirement, we should be investing in our health throughout life, from the cradle to the grave. Starting in childhood—actually, even before a child is born—we can help to ensure that our children enter the world, and that they are raised, healthy and happy.

Most babies get a fantastic start in life, benefiting from the support of loving parents and dedicated health professionals. However, we know that some lives can be easier than others, often because of circumstances over which those babies have no control and the conditions in which they are brought up. Children who live in more deprived areas are more likely to be exposed to avoidable risks and have poorer outcomes by the time they start school. As the hon. Member for Liverpool, Wavertree pointed out, some of those things have impacts further down the line: at the weekend, a teacher said to me that if a child has poor linguistic skills, that will affect their ability to learn to read because of phonics and so on. It is right, therefore, for support to have a clear focus on reducing inequalities and targeting investment to meet higher needs.

The Government remain absolutely committed to working with partners to identify how to support growth in the community workforce, including through district nurses, general practice nursing, GPs, health visitors and school nursing—the team that my hon. Friend the Member for East Worthing and Shoreham described so well. We are taking significant actions to boost the workforce, including training more nurses, offering new routes into the professions, enhancing reward and pay packages to make nursing more attractive and improve retention, and encouraging those who have left nursing to return. I know that there is still post-qualification, but I do not pretend that there are no challenges; many Members have articulated the challenges that exist, particularly issues such as CPD, which we are aware of and are working on.

We know that the electronic staff records show a reduction in the number of health visitors employed by NHS organisations. However, we also know that this is not a complete picture of the health visitor workforce, who may be employed in social enterprises, private sector organisations or local government. I want to work with partners such as the Local Government Association and the Institute of Health Visiting to establish a much clearer picture, which is what the IHV asked for in its “Health Visiting in England: A Vision for the Future” report—I think it was recommendations 12 and 13. That will help to move the debate forward.

I am pleased that Health Education England is also leading on the development of a specialist community public health nursing standard. That standard will cover several roles, including those of health visitor, school nurse, occupational health nurse and family health nurse, and I am keen for that development to progress swiftly. Currently, as my hon. Friend mentioned, a specialist level 7 community and public health nurse apprenticeship is in development. That apprenticeship will offer an alternative route directly into the health visiting profession, on top of existing pathways that enable people to qualify as health visitors. We must make the best use of these highly skilled and valued members of the profession and of the broader healthcare family, and we must ensure that they can optimise the good they can do when they intervene in children’s lives.

Local authorities remain well placed to commission health visiting and early years support, but they should do so in partnership with all those around them.

Like many other Members, I have been contacted by some terrific health visitors, in my case from Woking. They do a wonderful job, but against a very difficult financial backdrop. As the Minister looks to resource this area in the future, can we make sure that there is fair funding across the country, including to our counties?

I thank my hon. Friend for his intervention, which links to the fact that fragmentation also remains a challenge throughout the system, running counter to the aim of whole family support that my hon. Friend the Member for East Worthing and Shoreham mentioned. I believe strongly that there is scope to improve collaboration between councils and NHS bodies in order to improve delivery, particularly on important issues such as breastfeeding, immunisation and the like. The digital child health programme is one area in which we are helping to overcome barriers, securing national backing so that information is shared properly between key professionals. That is particularly important for strengthening the links between primary care and health visitors. However, there are further areas in which we can work together better to support those with higher needs, and I intend to reflect on the points made during this afternoon’s debate and work further on the recommendations of the “Vision for the Future” report.

The commitment to grow the public health grant as part of the local government settlement underlines the Government’s commitment to protecting and improving the health of the population. Local leaders remain well placed to make decisions for their communities; there is a disparity across the piece, and we need to better understand the data. Local decisions should be based on robust assessments of local needs, supported by workforce plans.

Research also suggests that there are short and long-term educational and socio-emotional benefits from early childhood education and care. That is why we have prioritised investment in early education; the 15 hours of free early education for disadvantaged two-year-olds is welcome. However, those benefits start earlier—with a person’s interaction with their health visitor when they are 28 weeks pregnant, or even before that, in personal, social and health education lessons in schools. In those lessons, we talk about healthy relationships and equip our young people with advice on issues such as substance abuse and parenting.

In the prevention Green Paper, we announced our commitment to modernise the healthy child programme to reflect the latest evidence about how health visitors are part of a wider integrated workforce, providing support. Doing so provides an important opportunity to work with partners, and I will take my hon. Friend the Member for East Worthing and Shoreham up on his offer, made in his recent letter, to bring with him academics and other interested parties—I note that there are interested parties across this Chamber—to talk about how we can best move this forward. I want to ensure that support is both universal in reach and capable of a personalised response, focusing support where the additional needs suggest we should put it.

I understand the continued focus on five mandated contacts, which provide a vital opportunity for contact with families, and national data shows that coverage has improved. However, I take on board the points that have been made; I do not want to reduce contact to those five moments, and there have been some interesting conversations about other points of contact. I have heard some within the health visiting profession say that they are being pushed to tick the box but miss the point, and I have spoken to my local health visitor lead about that issue. Health visitors are highly qualified professionals who have an important leadership role, and I wish to reinvigorate that role. Through working closely with commissioners and other professionals, particularly midwives, health visitors are critical to a child’s journey.

If we are serious about supporting early intervention, that means starting with relationships. Becoming a parent is an important time in anyone’s life, but it does not come with a manual; we all need help, and professionals have an opportunity to give evidence-based advice and support. Our vision for prevention encompasses the whole of life. We are now reviewing the prevention Green Paper, including the response to it by my hon. Friend the Member for East Worthing and Shoreham. We will ask ourselves what more can be done, and we will work with local authorities and NHS bodies to address that question.

To give every child the best possible start in life and the opportunity to fulfil their potential, we need to fundamentally change the way we operate. I want to ensure that systems are in place to help infants as they develop, move to school and grow into adulthood; to overcome fragmented service provision; and to make the best of what exists, while using the evidence to maintain a resolute focus on additional needs. I look forward to working with my hon. Friend, and I am optimistic that we can make the change.

I apologise to right hon. and hon. Members, but time has beaten us, so I am afraid that the sitting stands adjourned.

Motion lapsed, and sitting adjourned without Question put (Standing Order No. 10(14)).