Westminster Hall

Tuesday 24th January 2012 Westminster Hall

Tuesday 24 January 2012

[Linda Riordan in the Chair]

Health Inequalities (North-East)

Tuesday 24th January 2012 Westminster Hall

Motion made, and Question proposed, That the sitting be now adjourned.—(Mr Vara.)

09:30

[Chi Onwurah (Newcastle upon Tyne Central) (Lab)]

As a Member of Parliament, my priority must be the health and well-being of my constituents, and many MPs feel the same. Regional health inequalities are of profound concern and strike at the heart of our sense of fairness and equality: people are suffering unnecessarily in this country just because of the region in which they are born, and that undermines not only the idea that we are all in this together, but our very sense of national unity. At a time when the Scottish Government are seeking independence, does it help the case of those who believe in the Union, as I do, that a Brit born in Glasgow is likely to die 14 years earlier than one born in Chelsea?

As we shall see, health inequality is a complex subject, but the key question for the Minister is, do the Government recognise regional health inequalities in their health funding? I look forward to the Minister’s reply.

I was born in Wallsend and grew up in Newcastle. In Newcastle, we are more likely to die early from cancer, heart disease and stroke. We tend to die younger, are more obese as children and are more likely to die from the cold as pensioners. We suffer more from the diseases of our industrial legacy, such as asbestosis. Last year in Newcastle, there were 89 early deaths from heart disease and stroke—19 more than the national average. Disability-free life expectancy for women in Newcastle is 3.3 years shorter than the English average. For men, it is 4.9 years shorter. Not only do we live shorter lives, but more of those shorter lives are spent with a disability.

Such inequalities are not unique to Newcastle. Thanks to the public health observatories set up by the previous Labour Government, we have a comprehensive view of the inequalities in health across the country. Every year, 37,000 people in the north die earlier than their counterparts in the south. That is enough people to fill a modern football stadium. A report published in the British Medical Journal last year said that the excess toll of ill health and disability in the north is

“decimating”

the region

“at the rate of one major city every decade”.

In Newcastle, one in 25 adults claim incapacity benefits for mental illness. That is four times the rate in the Secretary of State for Education’s constituency. Across the river in Gateshead, we have one of the highest levels of obesity in the country, and on the Wear, the 2010 chlamydia rate for 16 to 24-year-olds was almost three times the rate in Surrey.

Of course, there are inequalities within regions and within cities. The Institute for Ageing and Health at Newcastle university has produced an interesting map of the Tyne and Wear metro, which shows how life expectancy reduces by more than a decade as we ride from Ponteland north to Byker.

Although I see mainly north-east MPs here today, this is an issue for the whole country, for the Exchequer and for the Prime Minister, but given that the Prime Minister press-released yesterday’s visit to Leeds as a visit to the north-east, it is clear that his grasp of geography still leaves something to be desired.

Every year, health inequalities cost £31 billion to £33 billion in lost productivity, up to £32 billion in lost taxes and higher welfare payments and £5.5 billion in additional health care costs, so this is a problem for us all. It is important to emphasise that the poorer health in the north-east is not a function of the level of health care. The Newcastle Hospitals NHS Foundation Trust is in the top 10% of best-performing trusts in the UK. We have the Campus for Ageing and Vitality, the Centre for Life, the Great North Children’s Hospital, the Northern Institute for Cancer Research and the Northern Vascular Centre and Freeman Hospital’s Cardiothoracic Centre. They are world-class institutions.

Evidence going back six centuries tells us that the root causes of health inequalities are economic. The BMJ report that I mentioned earlier says:

“Social and economic factors are extremely reliable predictors of health”

If more resources are put into an area, its health improves, but if they are taken out, its health declines. The north-east has the lowest income per head in England, and in Newcastle, a quarter of the city’s neighbourhoods are in the 10% most deprived in the country. So the poorest are hit by a double whammy. Not only does poverty impact on their quality of life, but it reduces their life expectancy and makes them susceptible to a host of diseases.

It is also ironic that in the north-east we live with the health consequences of industries that were long ago allowed or even encouraged to die. Just last month, Cabinet papers showed how Margaret Thatcher’s Cabinet discussed the managed decline of the north. We are still dealing with that. Last year’s figures from the Health and Safety Executive show that rates of death from mesothelioma in the north-east are by far the highest in the country, and although we address the symptoms, we can do nothing for the causes. But in other areas we can and are tackling the causes.

The north-east has the highest number of mothers smoking during pregnancy—22%—so Fresh, a local charity, is working with local primary care trusts to make smoking history for children. Higher than average alcoholism in the north-east has resulted in excessive numbers of hospital stays for alcohol-related harm, so a campaign to reduce alcohol dependency is supported by local press, such as the Newcastle Journal and the Evening Chronicle. But I am worried that essential work to improve health in the north-east is threatened by measures that the Government are taking.

Under Labour, health funding doubled in real terms, waiting times reduced and death from heart disease and stroke went down by a massive 40%. The previous Government also worked hard to tackle poverty and its associated evils—poor housing, high fuel costs and low wages—but the inequalities remained. So although the health of people on low incomes improved significantly, the health of those on high incomes went up by the same amount or more. In some areas, health inequalities decreased. For example, the infant mortality health inequality for manual workers fell by almost a third to 12%. To understand why that is so, we must go back further than the previous Labour Government.

The Thatcher Government refused to acknowledge the relationship between poverty and ill health. The Department of Health was prohibited from using the phrase “health inequalities”. It had to talk about variations in health, and they were always couched in terms of its being people’s fault because they led such an unhealthy lifestyle.

Labour’s experience with infant mortality shows that targeted interventions can work. Infant mortality is really interesting, because it is a sensitive measure of immediate health, which is susceptible to direct interventions, such as the ones the Labour Government introduced, including improving the health of expectant mothers through the pregnancy health grant and of babies through Sure Start.

As the Labour-commissioned Marmot review demonstrated, to reduce health inequalities we cannot just focus on lifestyle factors; we need to address their social and economic root causes.

[Guy Opperman (Hexham) (Con)]

I have listened carefully to the hon. Lady’s arguments, and I congratulate her on this debate. It is good to see so many hon. Members from the north-east in the Chamber. She talks about inequalities, and referred to Surrey’s excellent mortality rates and alcohol abuse recovery rates compared with the north-east and Scotland—people in Glasgow have the lowest life expectancy rates in the country. Does she support the proposal for an alcohol Act that would statutorily restrict alcohol availability?

[Chi Onwurah]

I thank the hon. Gentleman for his intervention. As I said, the causes of health inequalities are complex. Alcohol dependency certainly varies significantly throughout the country. We need, and we are seeing, targeted campaigns to address that. I hope that the Government will introduce concrete measures to address alcohol dependency, such as legislation and a minimum price if that is appropriate.

Labour prioritised addressing health inequalities. We could not overcome the legacy of inequality in 13 years, but we made real progress, as the figures for infant mortality show. However, that is set to change. There are three main ways in which the Government are undermining work to reduce health inequalities.

First, the Government have changed the funding formula, and reduced the component designed to address health inequalities. I have been in Parliament for 19 months, and I have raised this matter directly with Ministers four times, not counting written questions. I am hoping it will be fourth time lucky for receiving a direct answer. Will the Minister confirm that in 2010 the Secretary of State decided, against the advice of the Advisory Committee on Resource Allocation, to reduce the health inequalities component of the primary care trust target funding allocation from 15% to 10%? Two weeks ago, during an exchange on the Floor of the House, the Secretary of State cited a 2.8% rise in funding when I asked him about changes to the funding formula. Will the Minister address the change to the formula, rather than the overall increases that the Government claim?

During a speech on the Floor of the House in December 2010, I asked the Secretary of State to confirm that more will be invested in health services for every man, woman and child in Newcastle for every year of the comprehensive spending review as the Government claim that they are increasing NHS spending. He declined to do so, so will the Minister step into the breach?

Clearly, if funding is changed to reduce the amount associated with health inequalities, the north-east will lose out. The Minister will say that the Government have ring-fenced public health spending and handed it over to local authorities. She may refer to the public health outcomes framework, which was published yesterday, just in time for today’s debate, and is very interesting reading. It includes 66 measures, which will be monitored, but they cannot distract from the assault on public health that the Government’s wide-ranging cuts represent for local authorities. For example, cuts to fuel poverty reduction programmes such as Warm Front will leave pensioners in Newcastle colder and more vulnerable to illness. Cuts to area-based grants such as the Supporting People programme mean there will be less investment in support services for those with mental health issues.

The second way in which the Government are undermining work to address health inequalities is the top-down, unnecessary and destructive health care reforms. It is estimated that they will cost £3 billion, and we now know that in the north-east the NHS has been asked to put aside £143 million for those organisational changes. The Government claim that efficiencies will make up for that, but the service is already being asked to meet the 1.5% efficiency cuts challenge at a time of wholesale reorganisation. As the Select Committee on Health said today, it is incredibly difficult, if not impossible, to make such efficiency savings when everything is changing.

In the north-east, our strategic health authority and primary care trusts are being abolished. Funding will be in the hands of GP consortia. Newcastle already has a pathfinder consortium in place. Newcastle Bridges GP commissioning consortia covers most of the city, and has shown that it is keen to work with other stakeholders across the city to promote public health, but it is having to make it up as it goes along in the face of huge uncertainty and change in the public sector and in the third sector, with unprecedented local authority cuts, watched over by an eager private sector that is keen to take advantage of the profit-making opportunities that the Prime Minister and the Health Secretary have promised.

A recent letter to the Health Service Journal, signed by more than 40 directors of public health and more than 100 public health academics, argued that the Bill will increase health inequalities, not reduce them. If the Government will not pay attention to what the Opposition say, perhaps they will pay attention to what the profession says. Michael Marmot told the Health Committee that there is little evidence that the health premium will reduce inequalities. Indeed, he said that it is most likely to increase them. Seven former presidents of the Faculty of Public Health have said that the Bill will “exacerbate inequalities”.

[Jim Shannon (Strangford) (DUP)]

I congratulate the hon. Lady on bringing this matter to the Chamber. I am a Member not for the north-east, but for Northern Ireland, where health is a devolved matter, but she is expressing concerns felt by many people throughout the United Kingdom, even where such matters are devolved. There are two reasons for that. The problems for her constituents, to which she referred, are as real in my area as they are in other areas of the United Kingdom. The Government’s reduction in the block grant for Northern Ireland means that our health will also be affected. The changes in health care here will be the marker for future changes for us. Does she believe that the service that the NHS is offering is not the standard that we in the United Kingdom expect and are accustomed to, and is not of the standard that is needed to address core health issues?

[Chi Onwurah]

I thank the hon. Gentleman for his intervention. I believe strongly that the national health service is one of the best, most efficient and most effective health services in the world. The evidence shows that, as I will explain. It is absolutely right to say that the concerns I am expressing on behalf of my constituents and the north-east are felt throughout the country, and with good reason. The proposed measures will have an impact on the health of all constituencies in the country. The profession believes that the changes will have a negative impact on health inequalities. The Health Committee’s recent report on public health warned that the Bill poses a “significant risk” of widening health inequalities, yet the Government are pressing ahead.

The third way in which the Health Secretary will widen regional health inequalities is through the wholesale marketisation of the national health service. Before the Minister pretends otherwise, let me quote her colleague, the Minister of State, Department of Health, the right hon. Member for Chelmsford (Mr Burns), who admitted last year that the Bill will turn the NHS into a “genuine market”.

We should recognise that despite having serious health inequalities, we suffer relatively little from inequalities of access. I am no expert on health services, but I am told by those who are that the stent insertion that Prince Philip recently underwent at Papworth hospital did not differ materially from the treatment that any of my constituents would have received at the Freeman hospital if they had suffered a similar condition. That is fantastic, but it is not the case in the United States of America where there are terrible health access issues due to its private health care system. In the short term, the Government’s reforms are diverting funds away from patient care, which will have an impact on waiting times. Those who can afford it will tend to seek private health care, but those on low incomes will be unable to do that. In the longer term, the Bill is about the privatisation of the NHS. Strong independent evidence indicates that the NHS is one of the most efficient and equitable health systems in the world. Why would we want to make it into a market? The Bill misses an important opportunity to focus on the real issues and the wider determinants of health in this country.

I shall therefore finish by asking the Minister these questions. The Government have signed the recent World Health Organisation declaration to deal with the social determinants of health inequalities, so what concrete actions will Ministers take? The previous Government accepted the Marmot review’s recommendations in full. When will the current Government do the same? What are the coalition’s proposals for introducing a national minimum unit price for alcohol? Will the Government confirm a commitment to undertake a consultation on plain and standardised packaging for tobacco products, and on what date that will take place?

Does the Minister share my concern about the Royal College of Midwives and Netmums survey showing that women from lower incomes were denied antenatal classes and the choice of a home birth? Will that not entrench health inequalities from before birth? The Minister looks somewhat surprised at that question, but differences in health access do exist in our country.

As Blane said, no law of nature decrees that the children of poor families should die at twice the rate of children born into rich families. In the north-east, there are more poor families. Will the Government commit to reversing their changes to the funding formula component designed to deal with health inequalities?

The national health service’s first Minister of Health, Nye Bevan, famously said that when a bedpan falls to the floor in Tredegar, it should echo in the Palace of Westminster. The Minister of State, Department of Health, the right hon. Member for Chelmsford, quoted that with some amusement and disdain and proclaimed that those days were long gone, so what does this Minister think should echo in Westminster? Does she accept responsibility for reducing health inequalities? Can she assure me that health inequalities between the north-east and the rest of the country will reduce over the term of the present Government?

[Several hon. Members]

rose—

[Mrs Linda Riordan (in the Chair)]

Order. At least six Back Benchers wish to speak. I mean to call the first Front-Bench speaker at 10.40 am. That leaves about 45 minutes, so I ask hon. Members to bear that in mind.

09:53

[Ian Swales (Redcar) (LD)]

It is a pleasure to speak under your chairmanship, Mrs Riordan. I congratulate the hon. Member for Newcastle upon Tyne Central (Chi Onwurah) on securing the debate. I agree with her that the issue of health inequalities is of great importance to all MPs and particularly those of us who represent constituencies in the north-east. Having been born in Leeds, I was delighted to emigrate to the north-east in my early 20s.

First, I would like to refer to the July 2010 National Audit Office report, which was specifically about “Tackling inequalities in life expectancy in areas with the worst health and deprivation”, and to the subsequent hearing of the Public Accounts Committee and the report that it produced in November 2010. That report was in effect a catalogue of action by the previous Government and bears detailed reading. It said that the Department of Health had been

“exceptionally slow to tackle health inequalities…we find it unacceptable that it took it until 2006—nine years after it announced the importance of tackling health”—

[Grahame M. Morris (Easington) (Lab)]

Will the hon. Gentleman accept that tackling health inequalities effectively requires a broad range of actions, including tackling things such as educational under-achievement, the need for warm homes, and child poverty, which go across a broad range of Departments, not just the Department of Health?

[Ian Swales]

I absolutely agree with that and will go on to say more about it. The Department of Health has an important role in being the umbrella Department for monitoring action in this area, however. The report went on to say that the Department recognised its failings, admitting that it had been

“slow to put in place the key mechanisms to deliver the target it had used for other national priorities”

and

“slow to mobilise the NHS to take effective action.”

However, I agree with the hon. Gentleman that there is much more to this than simply the NHS.

There certainly has not been a shortage of reports on this subject. The Department of Health issued 15 major publications on the issue, starting in 1998 and rising to a crescendo in 2010. In fact, 2007 was the only year in which the previous Government did not issue a publication.

[Debbie Abrahams (Oldham East and Saddleworth) (Lab)]

I wonder whether the hon. Gentleman could catalogue the action that was taken after the publication in 1980 of the Black report, which first demonstrated a causal link between ill health and poverty. In addition, “The Health Divide” was published towards the end of the ’80s. As I recall, because I was working in this field, there was absolutely nothing.

[Ian Swales]

I bow to the hon. Lady’s knowledge in this area. She certainly has a great deal more than I do. I do not know the answer to her question.

In 2003, the Government identified 12 cross-Government headline indicators and 82 cross-Government commitments, but sadly overall it was effective action that was the problem. In 2005, the Government identified 70 spearhead local authority areas for special attention, and credit to them for that. One third of those areas were in the north-east. However, only in London did those spearhead areas see a narrowing of health inequalities.

I know that this issue is complex, but some things are basic. The NAO report showed that more deprived areas had fewer GPs. Some had significantly fewer. They were also paid less. I was shown barely believable figures showing that Redcar and Cleveland had only half the average GP resource of the most deprived 20%. Clearly, that is not a good position to be in.

[Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)]

How does the hon. Gentleman think that forcing through NHS reforms that are vehemently opposed by both the British Medical Association and the Royal College of General Practitioners will encourage GPs to go and work in deprived areas that have a shortage of GPs?

[Ian Swales]

I believe that the wider issue of NHS reforms is outside the scope of this debate, but certainly I see a growth in the number of GPs already.

[Chi Onwurah]

rose—

[Ian Swales]

I am not giving way again on that subject.

As the hon. Member for Easington (Grahame M. Morris) said and as we all know, many factors are involved in health inequalities: smoking, alcohol, obesity, housing, income and others. Sadly, the area that I represent has the worst rate or one of the worst rates of obesity in the country, and one third of my constituency is in the poorest 10% of most deprived wards, so I am well aware of how these things operate in the local area.

In the public health area, we should, as the hon. Member for Newcastle upon Tyne Central said, celebrate a great success and learn from it. The Fresh organisation has had a great impact in terms of smoking reduction. The rate in the north-east went from 29% in 2005 to 22% in 2009. I also find this hard to believe, but apparently males in the north-east have the lowest rate of smoking in the country. It was probably the highest at one time, but apparently it is now the lowest. That shows that effective public health action and education can have a big impact. Models such as that, in which innovative third sector organisations focus on change, can assist with this important job, which is a lot about behavioural change.

As well as successes such as the one that I have described, I welcome the increased spending in the NHS by the previous Government. That has increased health outcomes for all, regardless of the fact that it failed to narrow health inequalities. My area has seen the setting up of excellent facilities such as the James Cook university hospital. As has been mentioned, there is also the data gathering, which is so important in learning how to deal with these problems.

There is still a lot to do. In my constituency, there is a 16-year gap between the life expectancies in the richest and poorest wards. I therefore welcome local health commissioning, which will lead to a more joined-up approach to local issues. An excellent pathfinder GP group is already up and running in Redcar; in fact, it was running as a social enterprise for five years before the recent reforms were introduced.

I welcome the public health agenda and the fact that the budget will go to local authorities. I also welcome the setting up of health and wellbeing boards, although we will have to watch how the money is spent to ensure that the maximum amount gets to the front line. Similarly, I welcome the proposed establishment of Public Health England, which will have the specific aim of reducing health inequalities.

Even more study is needed into, for example, the psychological aspects of why people choose lifestyle options they know to be harmful. Recent research clearly shows that many social problems, including the one we are discussing, stem from income inequality, not from absolute levels of income, and some interesting data are emerging. Sadly, income inequality also widened under the previous Government.

The new Government have made a start, but there is much more to do, and I look forward to the Minister’s comments.

10:00

[Mr Alan Campbell (Tynemouth) (Lab)]

It is a pleasure to serve under your chairmanship, Mrs Riordan. I promise not to mention Leeds, which is nearer to your constituency than it is to the north-east.

I congratulate my hon. Friend the Member for Newcastle upon Tyne Central (Chi Onwurah) on securing this important debate. She set out very well the challenges facing our constituents in addressing health inequalities, which still exist in the north-east, despite the progress made over the 13 years of the Labour Government. I have to say I found the hon. Member for Redcar (Ian Swales) somewhat confusing and confused about the nature of those inequalities—I suppose confusion is one result of trying to face both ways.

I want to make three broad points, and I will be interested in the Minister’s response to them. The first is about health spending in the north-east. The Government’s view is that NHS spending will continue to grow overall in the next few years, and figures from the House of Commons Library certainly confirm that planned spending is set to grow in cash terms. For 2010-11, the cash figure is £102 billion; by 2014-15—at the end of the spending round—it is set to be £114.4 billion. If we look at the issue in real terms, however, and we take 2010-11 as a base figure, the broad trend is essentially flat.

I do not, however, want to argue that point. Instead, I want to ask how that spending affects the north-east and institutions in my constituency. The Government will no doubt tell us that there is a 3% increase for PCTs this year. They will say that is evidence of their commitment to growing budgets; in fact, that is, effectively, what the Secretary of State said on this morning’s “Today” programme. However, the tariff that funds hospital treatment has been reduced. Next year, the budget of Northumbria Healthcare NHS Foundation Trust, which serves my constituency and those of a number of Members here, will be reduced by 1.9%. Hospitals have a key role to play in not only treating patients, but addressing health inequalities, and I want to place on record the excellent work done at my local hospital—North Tyneside general hospital—particularly in treating diabetes and stroke, where we have made huge advances in the past few years, although we are still running to catch up.

My first question to the Minister, therefore, is this: if PCT budgets are rising, why are hospital budgets, which are already under pressure, being cut? Where is the money going? Is it to pay for reorganisation? Will the Minister confirm the fear that PCTs are required to put the extra money into contingency funds to pay not only for reorganisation, but for other things that might arise? Will she confirm that if those things do not arise, that money will be clawed back by the Department of Health and ultimately, one fears, by the Treasury? That helps to explain the difference between the planned expenditure that the Government announced and the actual expenditure in the past 12 months.

The second issue I want to turn to is alcohol-related harm. The north-east has a reputation for heavy drinking, which in some ways reflects our heavy industrial past. The region does significantly worse than the English average on alcohol-related hospital admissions. In February 2009, Balance, the north-east alcohol office, was launched, based on the excellent work of Fresh, which works for a smoke-free north-east. For the first time, we had a strategy that covered the whole region on this issue. One of Balance’s concerns—I remain to be convinced on this issue—relates to the introduction of a minimum unit price for alcohol. There was no consensus in the previous Government on the issue. The Home Office, of which I was proud to be a member, was sceptical about minimum unit pricing, because it was most concerned about addressing alcohol-related crime and disorder. However, the Department of Health, which was more concerned about individuals’ health, was more positive.

Just before Christmas, the Prime Minister entered the debate in The Daily Telegraph, saying that he was in favour of minimum unit pricing and will overrule any Department or Minister who stands in his way. As my hon. Friend the Member for Newcastle upon Tyne Central asked, will the Minister confirm that the Government will introduce proposals for minimum unit pricing and, if so, when? Will she confirm that the Department of Health supports the policy? Is she personally committed to it? Is the Secretary of State a supporter of it?

Thirdly, I want to acknowledge the points that have been made about health inequalities being addressed only if we go beyond NHS professionals and make sure that individuals make the right choices about issues such as smoking, how much alcohol they consume and whether they eat healthily. The Government have a role to play—if they had not played a role, we would not have made the progress that has been made in recent years.

In my constituency, there is a clear link between health inequality and deprivation. Life expectancy in the borough of North Tyneside is 76.8 years for a man and 81 years for a woman, which is about 18 months lower than the English average. However, in parts of my constituency, such as Chirton ward, Valley ward, Collingwood ward, central Whitley Bay and central North Shields, life expectancy can be about 11.5 years less for a man and over nine years less for a woman than it is in the least deprived areas of our country.

As we have been told, the Marmot review recommended that the focus should be on the social causes of health inequality, and it highlighted the need for an effective integrated approach. In my constituency, however, health inequality is worst among those groups and those areas that are most likely to be hit by cuts elsewhere. My hon. Friend the Member for Strangford (Jim Shannon) mentioned Northern Ireland. I recall, as he will, that the Prime Minister—then the Leader of the Opposition—was interviewed by Jeremy Paxman days before the general election. They talked about the scale of public spending cuts, and the Prime Minister was asked to name the regions that would be hit worst. The first one off the tip of his tongue was the north-east and the second was Northern Ireland, so my hon. Friend and I, as well as my other hon. Friends, are here to raise these issues because our regions face the most cuts overall.

Let me give an example of what that means. North Tyneside council has to make £48 million of cuts over the next four years. Next year and in subsequent years, it proposes to charge bowling clubs more to use bowling greens. It also proposes to close more bowling greens in my constituency than in any other part of the borough. The outcome will be that fewer people will be involved in the sport. Many of them will be pensioners, and my constituency has one of the highest numbers of pensioners of any in the country. The proposal could have an adverse impact on their physical and mental health.

I am concerned about getting a joined-up, integrated approach—which just is not happening. The region has a better than average record of reducing child poverty and premature winter deaths, but what effect will the proposed benefit changes have, and what about increasing energy prices, which the Government appear powerless to do anything about? What about the impact of cutting Warm Front? That will affect not just the bills of people who are trying to keep warm, but their health.

Do the Minister and the Government believe that central Government still have a role to play in reducing health inequality? Will the Minister confirm that she is raising the issue of health inequality across Government, wherever Departments want to take action? I tell her this: in our region alarm bells are ringing about the effects on health and a range of other matters. Or has her Department, as the report of the Select Committee on Health suggests today, put its focus and energy on a costly NHS reform Bill, which no one asked for and for which there is decreasing support?

10:11

[Guy Opperman (Hexham) (Con)]

My grandmother was an NHS matron, and I worked with health care professionals for nearly 20 years in my former profession as a barrister. I also spent far too much time as a patient, attempting to become an expert on all health matters. I probably hold the House record at the moment for the most time spent in hospital in the past year. I certainly spent a lot of time in hospital in my other former profession of jockey. I think that I have broken 19 different bones at various times. I was actually quite a good jockey, but I did not always stay on board in a 20-year career. If people ride over fences at 35 mph, they occasionally hit the deck.

I congratulate the hon. Member for Newcastle upon Tyne Central (Chi Onwurah) on obtaining the debate and welcome the chance to speak on behalf of the citizens of Northumberland whom I represent. I should make a declaration that, before I first came to the House, I worked as a barrister in health care matters. I also worked for the Free Representation Unit, providing assistance as a lawyer in health care cases. I am proud that two successive Labour Governments gave me awards under the national pro bono scheme for lawyers. I do not expect that to happen again in a hurry, but it is still a great source of pride about the work that we did on behalf of patients.

As I was ill last spring and summer, I could not speak in the health debates about the children’s heart unit, but I am most pleased to support the Freeman hospital in its campaign to keep its amazing unit open. The hospital is outstanding. It is not in my constituency, but everyone in the north-east recognises that it is a flagship. We all very much support the work that it has done and continues to do. I was proud to see that my constituents Graham and Andrea Wylie, who have raised a phenomenal amount of money and supported the hospital very well, were able to bring their daughter Kiera home last week.

The debate is about inequality in health care, and all hon. Members present would acknowledge that disparities exist within the region. I accept that in Northumberland the quality of the health care and the results and optimum findings will be better than in some of the more urban parts of the region. There are also disparities by comparison with other parts of the UK. The point that I was trying to make in intervening on the hon. Lady was that clearly, when compared with Surrey or other places down south, there is a genuine difference. We all recognise that. The statistics are overwhelming. The point can also be made that in Scotland, in parts of Glasgow that I have been to, where life expectancy is barely 59 or 60 for some people, the situation is considerably worse.

I spoke in the debate on alcohol pricing before Christmas and expressed my support for an alcohol Act similar to the one that exists in Scotland. It seems to me that that is supported—to this extent I disagree somewhat with the hon. Lady—by a vast number of health care professionals and clinicians. I hope that the Minister will support that today. I welcome the fact that the Prime Minister seems to have swung behind the idea of an alcohol Act. We should all applaud the work done by Balance and Smoke Free North East. When I was a barrister, I used to see the effects of crime and the links to alcohol. Hon. Members who go out on the beat with the police in any of our constituencies will be aware that the rate of alcohol-related admissions is the highest in the country; 46% of all violent crime is alcohol-related; and about 50% of domestic abuse is alcohol-related. I strongly support the campaign of my hon. Friend the Member for Totnes (Dr Wollaston) to change the law.

To touch briefly on hospitals, I am lucky enough to have Hexham hospital in my constituency. I accept it was built by the former Prime Minister, Mr Tony Blair—[Hon. Members: “Personally!”] Not personally; he was not there with the bricks and mortar, but he certainly signed off on the upgrade to the original hospital. It is an outstanding hospital, with a tremendous cancer support group, which I went to listen and talk to in the summer. The quality of care and its integration into the health care trust’s programme is outstanding. However, I am pleased that finally, after successive Governments—I am going back in history 20, 30 or possibly even 40 years —the small hospital in the west of Northumberland called Haltwhistle is being rebuilt. It is impossible to go there without being asked when the hospital will be rebuilt, and I think that successive MPs have had to deal with that repeatedly.

I want to talk about inequality in relation to provision throughout the region. I represent the far west of Northumberland and the people of Bellingham, Kielder and the far west are very conscious of the fact that there is no hospital or ambulance provision all that close to them. There are outstanding paramedics and other people and a system that works very well, but there are rural inequalities, and I wholeheartedly support the campaigning by the Friends of Bellingham Surgery and by those who are trying to introduce a more integrated system to take care of the inequalities suffered by those who are far away from hospital. It is not easy to explain why the hospital at Hexham, which was built as a particular type of hospital, is unable to deal with certain things on an ongoing basis, including significant accident and emergency. It is necessary to drive past that hospital to Wansbeck, the Royal Victoria infirmary or other hospitals.

I am living proof that people should not necessarily go to the nearest hospital, but should go where the specialists are. I wholeheartedly support—I hope that the House does, too—specialist hospitals where people go for the best possible treatment. When I was taken ill on 26 April and collapsed in Central Lobby, I was taken initially to St Thomas’, which is a very good hospital; there is no dispute about that. I was subsequently taken to the National Hospital for Neurology and Neurosurgery, a specialist hospital for the treatment of meningiomas and brain tumours. I have broken umpteen bones, and I would want to go to the hospital that is best able to deal with the problem and that does so regularly.

I will finish on two matters on which I want to give support. First, I strongly urge local authorities to work together with the health care trusts during the coming changes, because across the region there are examples of local authorities’ failure to do that. I urge them to integrate the provision of services, particularly care, on a continuing basis. Finally, in the north-east, we are proud to be the champions of certain screening programmes. I raised the matter of bowel cancer screening in an Adjournment debate on 23 November. Two hospitals in the north-east, in South of Tyne and Wear and Tees, piloted bowel cancer screening by Flexi-Scope. It is likely that the pathfinders for the future will be there, too. I applaud and recommend to anyone the quality of continuing health care screening that successive Governments have introduced.

10:20

[Mr Iain Wright (Hartlepool) (Lab)]

It is a pleasure to serve under your chairmanship, Mrs Riordan. I apologise for turning up late to this debate. I was chairing another meeting, which I was obviously doing badly because we overran our time.

I congratulate my hon. Friend the Member for Newcastle upon Tyne Central (Chi Onwurah) on securing this debate, which is on one of the most important issues facing the north-east. The health inequalities in my own constituency are certainly unacceptable. For many years, the health of the people in Hartlepool has generally been worse than the national average. Although progress has been made, health levels remain too low and are not improving fast enough for many of my constituents.

Life expectancy in Hartlepool is lower than in the rest of the country. A boy born in Hartlepool today would expect to live until he was 75.9 years old, which is two years shorter than the national average. A girl born in Hartlepool would expect to live until she was 81 years old, which is longer than her counterparts in Middlesbrough, Gateshead, South Tyneside or Sunderland. None the less, her life expectancy is still more than a year shorter than the national average for girls and women.

Those figures have improved dramatically over the past 15 years, which reflects increased health funding, more investment in primary care, a greater emphasis on prevention and rising living standards. However, there are several worrying elements within the data. First, generally rising life expectancy rates mask huge inequalities within Hartlepool that simply should not be tolerated in a civilised society. A constituent of mine living in Stranton, Dyke House or Owton Manor would expect to die up to 11 years earlier than a similar constituent living in the area close to Ward Jackson park.

Secondly, the mortality rate for women of all ages has fallen across all parts of the country, with the exception of those in my constituency. Data show the contrasting fortunes of different local areas. In the decade after 1998, the mortality rate for women in Kensington and Chelsea fell by more than 40%, but it barely moved in Hartlepool. I suggest to the Minister, who has some experience of Hartlepool, that women in my constituency consider the health of their children and family over and above their own. What can she do to address that cultural issue, so that the caring nature of Hartlepool’s womenfolk is retained, but not at the expense of their health?

Thirdly, much behaviour in Hartlepool leads to poor health outcomes. For example, estimated healthy eating, smoking rates and obesity are significantly worse than the England average. Although deaths from heart disease and strokes in Hartlepool have fallen, they remain well above the national average, while death rates from cancer remain some of the worst in the country. Hip fractures for people in Hartlepool aged 65 and above are off the scale by comparison with other areas in England. Why? It is mostly because of our place in history and the manner in which we have been affected by de-industrialisation.

Given our legacy as a place of heavy manufacturing, we have a disproportionate amount of people suffering from industrial diseases and injuries. I particularly want to highlight the number of chest-related diseases. The number of people suffering from asbestos-related diseases such as pleural plaques and mesothelioma is heartbreaking. The present Government’s delay in setting up any response to deal with those cases is prolonging the suffering for many constituents and their families. I urge the Minister to speak to her counterparts at the Department for Work and Pensions and the Ministry of Justice to ensure that the employers’ liability insurance bureau is established as quickly as possible.

[Ian Swales]

rose—

[Mr Wright]

If the hon. Gentleman will forgive me, I will not take interventions because a lot of my hon. Friends want to contribute to this debate.

I mentioned the de-industrialisation of the past 30 years. The loss of the shipyards, the docks and many of the steelworks and our engineering firms has hit Hartlepool’s prosperity hard. As my hon. Friend said, there is a very clear correlation between income, employment and health. Given the bad and deteriorating economic situation in my constituency and the wider north-east, the Minister needs to be mindful of the implications on health of the Government’s economic policy.

As unemployment in the north-east and in Hartlepool is high and rising, and there is a direct link between being unemployed and being unwell, the significant health inequalities that my constituents experience will only get worse. Only this week, the Centre for Cities highlighted a growing divide between northern cities and their southern counterparts in prosperity, innovation and resilience to an economic downturn in 2012 and beyond. That is bound to have a worsening effect on health inequalities, whether physical health or mental well-being.

The Minister will recognise the direct link between economic policy and health inequalities. How will she combat the health fall-out from the failures of the Chancellor’s economic policy and the neglect of the north-east? The problem will be made worse by the Chancellor’s announcement in the autumn statement to regionalise public sector pay. That will have enormous repercussions on the NHS in the north-east. Although highly professional, the NHS in the region is already struggling to recruit and retain appropriate staff tasked with addressing health inequalities in our region. Health services are already under strain not merely because of budgetary pressures, but because of difficulties in recruitment.

My hon. Friend the Member for Tynemouth (Mr Campbell) mentioned difficulties in attracting and recruiting GPs. My area has one of the lowest GP per capita rates anywhere in the country, and that does not help to reduce health inequalities. Does the Minister not think that that problem and therefore health inequalities will get worse under the Chancellor’s proposals for regionalised pay, and how will she counteract it with regards to recruitment and retention in the NHS?

Let me refer to the ongoing saga of the University hospital of Hartlepool. The Minister will be aware of the closure of accident and emergency last year, which no one in Hartlepool wanted. It has been announced recently that some services will migrate back, which is very welcome, but the whole health economy in my area and, by implication, the health inequalities in the region remain uncertain because of the lack of a clear decision about the new hospital and its funding arrangements.

Will the Minister today provide some clarity about what will happen with regards to the future provision of a hospital in Hartlepool? I do not want to take away the welcome news of a new hospital for the constituents in Hexham, but what about my constituents in Hartlepool? Will she reconsider the proposals put forward by Lord Darzi five or six years ago? In short, can we have clarity with regard to the ongoing provision of a hospital in Hartlepool?

We in the north-east and in Hartlepool have suffered for far too long with disease, ill health and early death, much of which is linked to deprivation and poverty. Government policy threatens to make that worse, so I hope that the Minister can provide us with some reassurances this morning.

10:27

[Grahame M. Morris (Easington) (Lab)]

It is a pleasure to serve under your chairmanship for the first time, Mrs Riordan. I congratulate my hon. Friend the Member for Newcastle upon Tyne Central (Chi Onwurah) on securing this debate. The number of Opposition Members who are present today is a testament to the issue’s importance. I wish we had a little longer to speak, because I will have to truncate my remarks.

I served on the Committee that considered the Health and Social Care Bill, and I am a member of the Health Committee. As someone who has worked in the health service for more than a dozen years, I can say that the subject is very close to my heart. I am grateful to a number of organisations for their work, including the Association of North-East Councils, the National Education Association, the Campaign for Warm Homes, Durham county council, the North East Public Health Observatory and Health Works, which won a national award last week for its innovative and pioneering work in tackling health inequalities at the very heart of my constituency, and I thank that organisation for the information that it provided to Members for this debate.

The NHS reforms contained in the Health and Social Care Bill are only one aspect—a very important aspect—of how Government policies will increase health inequalities. We must make it clear that there is no consensus on this matter. There is clear blue water between the views of the Opposition, who think that resources should be applied to the areas of greatest need to address real and fundamental problems, and the attitude of Government Members. Across every Department, coalition policies will exacerbate socio-economic inequalities and, ultimately, health inequalities, as indicated by Professor Sir Michael Marmot in his report. I wanted to mention some figures in my region, but I do not have enough time.

Chronic obstructive pulmonary disease, or COPD, is particularly prevalent in the north-east. It is often associated with heavy industry, coal mining and the like. Last year, my own primary care trust received a national award for its innovative approach to tackling this public health issue within our community. COPD costs the NHS an estimated £491 million every year.

Mortality rates in the north-east are higher than in the rest of England, accounting for 6% of all deaths in England, and the inequality gap appears to be increasing, which is a real concern.

I want to focus on two significant issues in the limited time that I have: first, inequalities in access to health service, which is a key factor that influences health outcomes; and secondly, the broader problem of health inequalities produced by deep-seated differences of social class.

As we have heard, in 1979 the Government’s chief scientific adviser, Sir Douglas Black, produced a report on the extent of health inequalities in the UK, and he acknowledged that the NHS could do much more to address those inequalities, alongside other improvements across the Government. As I mentioned earlier, those improvements include ones to child benefit, maternity allowances and pre-school education, as well as an expansion in child care and better housing. All those changes would address health inequalities.

Those findings by Sir Douglas Black were subsequently reinforced by further research and reports by Professor Peter Townsend and Sir Derek Wanless and more recently by Professor Sir Michael Marmot, all of whom I have had the pleasure to meet in one forum or another before and after I was elected to serve in the House.

There is a stark danger—a clear and present danger—of a downturn in the progress that has been made in addressing health inequalities because of decisions being made by the Government, both in the Department of Health and elsewhere, and severe cuts to services for the most vulnerable. That makes it all the more important that the NHS focuses on tackling health inequalities. Let us make no mistake: under Labour, good progress was made to address health inequalities, but a great deal more needs to be done.

I have served on the Health and Social Care Bill Committee for a year now, as well as on the Select Committee on Health, and I would argue that that Bill changes the fundamental aspects of our NHS. The NHS has been fragmented, with privately led commissioning, the reintroduction of a postcode lottery, an unco-ordinated health system and greater competition. That fragmentation risks entrenching the inequality of access to health services and health outcomes. Fragmentation is the antithesis of a co-ordinated approach. We need more co-ordination, more integration and a more focused approach.

Stephen Thornton, chief executive of the Health Foundation, talked about health inequalities when he was one of the expert witnesses who gave evidence to the Health and Social Care Bill Committee. He said:

“a duty needs to be placed on the national commissioning board and the consortia”—

the commissioning groups—

“to embed shared decision making in all care and treatment”.––[Official Report, Health and Social Care Public Bill Committee, 8 February 2011; c. 19.]

Only by reinforcing the duty on the commissioners themselves to reduce health inequalities is there any chance of achieving that goal.

The cuts that are falling across every Department are clearly hitting the poorest hardest. The Association of North East Councils has shown that the north-east will be worst affected by those cuts between now and 2013. Child poverty is rising in my constituency. Currently, one child in three in my constituency is living in poverty, but in the Eden Hill ward in Peterlee 48% of children are in poverty, and in Deneside in Seaham, which is next to where I live, the figure is 40%. Those figures should concern not only the local MP but the national Government.

Recently, the TUC produced figures after the unemployment figures were released that show that, on average, 7.5 jobseekers are chasing every vacancy, but in the constituency of my hon. Friend the Member for Hartlepool (Mr Wright) the figure is as high as 24 jobseekers chasing every vacancy. Youth unemployment is rocketing, and the coalition Government seem to have no intention of reducing health inequalities.

[Ian Lavery (Wansbeck) (Lab)]

I will make a very brief intervention. My hon. Friend has just mentioned statistics about child poverty, unemployment and jobseeker’s allowance applications, and earlier in the debate other colleagues talked about the inequalities in the north-east regarding the situation within the NHS. Those statistics and that situation are wholly unacceptable. The Prime Minister said before the election that he would attack the north-east first and then Northern Ireland second. That is happening. With the Welfare Reform Bill, there will be a continued attack on the north-east. Does my hon. Friend agree that that does not bode well for the future of the people in the north-east and that things can only get worse?

[Grahame M. Morris]

I am grateful to my hon. Friend for that intervention, and I agree with him. I was shocked to attend a meeting in my constituency last Friday about the contingency plans that are being put in place for emergency feeding centres after 2013. Those centres are the soup kitchens that we have not seen since the 1930s or the miners’ strike in 1984.

My final point is that the Labour Government produced the first ever targets to reduce health inequalities in the population, and the poorest were healthier when we left Government than they had been when we took office in 1997. My plea to the Minister is this: raise the standards and be a champion for public health and not an apologist.

[Mrs Linda Riordan (in the Chair)]

Order. I remind Members that I will call the Front-Bench spokespersons from 10.40 am onwards.

10:35

[Pat Glass (North West Durham) (Lab)]

It is a genuine pleasure to serve under your chairmanship, Mrs Riordan.

I congratulate my hon. Friend the Member for Newcastle upon Tyne Central (Chi Onwurah) on securing this debate. Also, I want to welcome to Westminster Hall the two Tanzanian women MPs who are shadowing me today. Whether they like it or not, they are finding out a great deal about health inequalities in the north-east of England.

I will be very quick; I am becoming good at truncating my speeches now. We have heard some excellent speeches that have been based on well researched statistics. I do not intend to use any statistics today. I will be unashamedly emotional and, like the hon. Member for Hexham (Guy Opperman), I will start by talking about my own family, because I want to talk about the practicalities of health inequalities.

I attended a memorial service in the village of Esh Winning last summer, which was to remember the men—they were men—who had died in the three pits of the Deerness valley. There was a huge list of men who had died; there were 75 names on it. Those three pits had never had a major disaster, but over 100 years 75 men were killed in them, including my grandfather, Andrew Corrigan, who I think was 27 when he died, and his brother, Peter, who was 25 when he died. They were on my father’s side of the family. On my mother’s side of the family, however, Alix Wright, who was 25, and his brother, Jack, who was 22, died in the trenches of world war one within two months of each other.

I will not pretend that wartime deaths were unique to the north-east, but they came on top of all the health inequalities that existed in the north-east. If people survived the trenches and the pits, they were very likely to succumb to consumption, problems in childbirth or the diseases of poverty. That continued right through the two world wars, and through the ’50s, the ’60s, the ’70s and ’80s. We created tens of thousands of ships, we hewed coal and we made iron ore into steel. That industrialisation left us with a massive legacy in the north-east—a history of early deaths from cancers, emphysema, stroke and heart disease.

The Labour Government did something about that situation. For the very first time, they focused on the social causes of health inequalities and put together a planned and integrated system to level the playing field. What concerns me is that, although the current Government are saying that they are committed to tackling health inequalities, what we are seeing is a complete difference between the drivers that they have put in place to deliver their stated objectives and what actually happens. There is a real skew between what they say and what they do.

I sat through the debate yesterday in the main Chamber on food prices. I do not want to be rude but I must say that it was almost as though the Secretary of State for Environment, Food and Rural Affairs was handing out bouquets at a village fete. We are faced with people telling us that there have been massive increases in charitable food banks and in middle class poverty; a return of diseases such as rickets among children; and children being admitted to hospitals during school holidays with malnutrition, which shocked me. However, the Secretary of State said to us that she welcomed the increase in food banks as a sign of the success of the big society. I see that as being a massive skew between what the Government are saying and what they are actually delivering.

I will finish by saying that in the north-east we have things that we are rightly proud of. We have a proud history; we fired the industrial revolution. As I have already said, we built tens of thousands of ships and we provided the powerhouse for this country for many years. And we have things that we can still rely on: our community and kinship; our social cohesion; our stability; and our wonderful surroundings, of which we are rightly proud. But we are saying to the Government, “You have a duty to ensure that we live long enough to be able to enjoy these things.”

10:40

[Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)]

It is always a pleasure to serve under your distinguished chairmanship, Mrs Riordan.

I congratulate my hon. Friend the Member for Newcastle upon Tyne Central (Chi Onwurah) on securing this debate. Its importance to the north-east is exemplified by colleagues’ high level of attendance this morning, but it is also important because the lifestyle issues and the social and, if I might say so, class determinants behind health inequalities lie at the heart of bringing down levels of acute diseases such as cancer and heart attacks. Until we tackle the range of public health issues that underlie health inequalities in the north-east, we have no hope of building a healthier Britain overall, or of containing the cost of the national health service.

My colleagues have comprehensively dealt with the data on health equalities in the north-east, and I do not plan to repeat most of them. I want to talk specifically about smoking and alcohol, which are big issues in the region, and to pose some questions to the Minister. I was very pleased to visit Newcastle last year, at the invitation of the then, and current, leader of the city council, Councillor Nick Forbes. I chaired a round table on tobacco and alcohol, and heard about the work of Fresh under the leadership of Alisa Rutter, and saw a presentation by Balance North East. On the same day, I visited Newcastle Royal Victoria infirmary and discussed the devastating impact of the excessive alcohol consumption in the local community with a top north-east liver specialist and consultant gastroenterologist, Dr Chris Record. He kindly gave me a chart of alcohol units, and I have it up in my office because I need reminding that the average glass of wine nowadays contains 2.5 units. How many people know that?

There is no question but that we did not achieve all we wanted to on health inequalities under the previous Labour Government, but we did make progress, and I hope that the Minister will acknowledge that. Drilling down into the overall figures shows that we made progress in specific areas, and the Minister acknowledged during a speech to a fitness industry conference in London that the previous Government were indeed firmly committed to reducing health inequalities. As colleagues have said, and as the North East Public Health Observatory tells us, the health of people in the north-east generally is worse than that of people in England as a whole, and that is largely to do with the social determinants I referred to earlier, and also the region’s industrial legacy.

I now want to talk specifically about tobacco. Work in this area is an example of good practice and partnership, but it is the sort of public health work that is potentially threatened by some of the changes the Government are bringing forward. Smoking remains the major cause of premature death and disease in the north-east, killing more than 5,000 people a year. It costs the region £174 million, the NHS £104 million—£35 million through passive smoking—and businesses £34 million in absence days alone. The average age at which people start smoking in the north-east is 15. The region has historically had the highest smoking rate in England, but, as we have heard, the rate has come right down due to the activity of Fresh.

Fresh has won all sorts of awards, including the gold medal in the inaugural chief medical officer’s public health awards, and it delivers work across eight key strands, but it is concerned about the changes in public health that are coming forward. It is currently funded on an annual subscription basis by all 12 north-east PCTs, and the PCTs are worried about what will happen when they finally fold. I understand that discussions are under way to secure the continued commissioning of the Fresh programme by local authorities. Is the Minister aware of those discussions? Can she update the House on what progress has been made to secure funding for this important and successful initiative, which is leading the nation?

Fresh is also concerned about the loss of the regional tier of tobacco control programmes in England as a whole, and the advent of the localism agenda might make it more difficult for local authorities to co-ordinate, and to attack some of the public health issues. How will the Government ensure that all local authorities prioritise tobacco issues? How does the Minister plan to ensure that there is no fragmentation or duplication of resources and efforts when the PCTs go? How will she ensure that localities work together to achieve economies of scale and have a population-level impact, as we have seen happen so successfully with Fresh? Can the Minister tell the House today when the new tobacco marketing strategy will be published? Will the Government ensure that there is a clear focus on tobacco?

Alcohol is another major cause of health inequalities in the north-east. We know that generally the affluent tend to consume the most, but for a variety of reasons the health effects of disproportionate alcohol consumption are felt most keenly among the poorest, and in areas such as the north-east. We also know that although in a recession levels of drinking tend to level off, among young people they go up, and we are seeing evidence that levels of self-harm are going up among young people. Alcohol is therefore a worrying issue, not just because of the physical health issues, but in relation to mental health and public order. The north-east continues to have the highest rate of alcohol-related hospital admissions, and in the past nine years alcohol-related liver disease has increased, sadly, by 400% among 30 to 34-year-olds, which is the highest rate in the country. I want, therefore, to know from the Minister about the Government’s alcohol strategy. Is she content that the constituents of my hon. Friend can buy two litres of cider for £1.34? That is less than the cost of an equivalent quantity of a soft drink.

On my recent visit to the region, I found that availability was a genuine concern, with alcohol available 24/7 and many off-licences centred in the more deprived areas. I see that in Hackney; we have more off-licences and bookies than shops where we can buy fresh food.

[Guy Opperman]

Will the shadow Minister give way?

[Ms Abbott]

I would love to, normally, but I have to try to get through my speech so that we can hear from the Minister.

Last September, the leader of Newcastle city council, Nick Forbes, amended a motion calling for the introduction of a minimum price for alcohol. He made the motion more comprehensive, calling for a wider range of measures to address the availability of alcohol. They included more powers for the council to refuse or withdraw licensing applications, following a report last year that linked under-age drinking to areas with a high density of licensed premises. Nick Forbes said:

“Figures show that alcohol is being sold for pocket money prices in Newcastle. Cider is available for 16p a unit…Most pubs back the idea of a minimum price for alcohol, as it would only affect the loss-leading deals offered by some supermarkets and wouldn’t have any impact on the price of a pint. It’s a controversial step, but there’s evidence that more and more people are ‘pre-loading’—downing cheap spirits at home before going out on the town. Minimum pricing would reduce this, and thereby reduce the overall figures for anti-social behaviour and hospital admissions”.

What decisions are being made at a national level to support local leaders such as Nick Forbes, who are committed to reducing health inequalities overall, and are taking strong action on issues such as alcohol?

The figures show that NHS North East has been told to set aside £143,350,133 to pay for the Government’s plans over the next two years. The NHS operating framework published in November requires health trusts to set aside 2% of their budget to pay for the Health Secretary’s changes in the Health and Social Care Bill. County Durham PCT has to set aside the greatest amount, followed by Sunderland and Northumberland. It is wrong to force local health trusts to set aside money to pay for bureaucracy and redundancies, when patients in the north-east, and constituents up and down the country, are waiting longer for treatment.

The Minister will know that the Heath Committee, chaired by not just a Tory Member of Parliament but a distinguished former Health Minister, the right hon. Member for Charnwood (Mr Dorrell), has raised a number of concerns about public health. It is concerned about whether the so-called responsibility deals can help alcohol and obesity problems, and about whether the health premium will just involve money going to people in regions where they are managing to tackle the problems, perhaps because they do not have the underlying social and class issues of other regions, at the expense of regions with genuine problems. The Health Committee also raised concerns about the closure of public health observatories in regions including the north-east.

What we are debating is not just a matter for the north-east. The underlying social issues apply to the health service all over the country. Even the north-east, with all the challenges posed by its industrial past, has examples of excellence and of path-breaking partnership work. We want an assurance from the Minister that the proposed changes—the confusion, chaos and cuts—will not hold back that work, and that she will not confine herself to discussing Labour’s record in general terms but will address the issues that affect the day-to-day lives, life expectancy and life chances of millions of people throughout the country, including in the north-east.

10:50

[The Parliamentary Under-Secretary of State for Health (Anne Milton)]

It is a pleasure to serve under your chairmanship, Mrs Riordan. I congratulate the hon. Member for Newcastle upon Tyne Central (Chi Onwurah) on securing this debate on a matter of considerable importance, and not only for the UK. Non-communicable diseases are a problem around the world, and inequalities also exist in Tanzania. I welcome Tanzanian MPs’ interest, as I do my new daughter-in-law, Maureen Rachel Mwasha, who married my son in Dar es Salaam at Christmas.

However, I will return to inequalities, if you will forgive me, Mrs Riordan. It cannot be right that people in one part of the country are likely to live about 11 years longer than people elsewhere, or that the likelihood of developing heart disease or cancer is determined to a significant degree by postcode. I stress that some of the detail of inequality is missed, and that it is necessary to consider large, significant but often hidden populations of inequality in otherwise affluent areas.

As the hon. Lady mentioned, inequalities in the north-east are particularly poignant and generally worse than in England as a whole, but although I recognise that spending on health increased under the past Government, so did health inequalities. As the hon. Member for Hartlepool (Mr Wright) stated, links between education, employment and health are well recognised, but we inherited a dreadful budget deficit, a terrible economic climate and worsening health inequalities.

[Debbie Abrahams]

Will the Minister give way?

[Anne Milton]

I am afraid that time does not allow me to.

Health in the north-east has historically been poor due to a legacy of heavy industries such as coal mining and shipbuilding, lifestyle choices and a complex web of factors. Levels of deprivation are high and life expectancy for both men and women is lower than the national average. Members might be interested to know that the Hartlepool shadow health and wellbeing board is already having a detailed debate about tackling the issues mentioned by the hon. Gentleman, including child immunisation. The proposed health reforms are enabling the people of Hartlepool to address the issues through local solutions instead of a top-down approach.

Even within local health authorities, wide and unacceptable health inequalities remain. Life expectancy can vary by as much as 18 years within a relatively small geographical area. On the plus side, although previously falling rates of early death from cancer have started to level off, death rates from all causes among males have fallen faster than the national average in recent years.

I reassure the hon. Member for Newcastle upon Tyne Central that I do not pretend about anything. She must look to her own party for the answers to her concerns. They were in Government for 13 years.

[Debbie Abrahams]

Will the Minister give way?

[Anne Milton]

I have only six minutes, and I have numerous questions to answer. The north-east has made commendable efforts to tackle its problems, acknowledging some of the things that happened under the last Government. At the core of Better Health, Fairer Health is a drive to tackle inequalities through multi-agency partnerships.

The north-east has its own tobacco control office, the first of its kind in the UK; Fresh began life in 2005. I am sure that the local authorities will recognise the work that has been done. It will be down to them to decide how the money is spent in local areas to improve their stubborn smoking rates. In the north-east, Fresh has managed to reduce the number of smokers by 137,000, and local NHS stop smoking services continue to provide support to the highest number of people in England. We in Government have introduced a tobacco control plan, and I assure the hon. Member for Newcastle upon Tyne Central that we will be consulting on plain packaging and continuing progress, as detailed in the plan, which I am sure she has seen.

However, the major part of poor health in the area will be remedied only by widespread changes in behaviour. It is this Government’s policy to encourage people to change how they live—[Interruption.] Hon. Members might gain slightly more from this debate if they listened to the answers rather than shouting at me from across the Chamber. We cannot frog-march people out of the off-licence, compel them to stop smoking or force them to practise safe sex. Our challenge is to make the case that freedom without responsibility is not sustainable, so for the first time, allowing for the progress of the Health and Social Care Bill through the House, the Secretary of State will have a specific responsibility to tackle health inequalities, whatever their cause, and will be backed up by similar duties— [Interruption.]

[Mrs Linda Riordan (in the Chair)]

Order. Will Members let the Minister be heard in this debate?

[Anne Milton]

Maybe they would do better to reflect on their own record.

For the first time, the Secretary of State will have a specific responsibility, backed up by similar duties on the NHS commissioning board and clinical commissioning groups, which will create a focus on reducing those inequalities.

Balance, the north-east alcohol office, was set up in 2009. Its remit is to change the culture of drinking to reduce alcohol consumption. The hon. Member who raised the issue might do well to remember that one of the problems with alcohol involves the discrepancy in price between supermarket alcohol and alcohol sold in pubs, and that the Licensing Act 2003, introduced by the previous Government, played a significant part in the availability of cheap alcohol.

We are doubling the number of family-nurse partnerships and increasing the number of health visitors by 4,200, and we have said that we will increase NHS funding, but critically, we will improve people’s life chances by ring-fencing public health money for the first time, so public health budgets will not be raided to fund services. We are introducing the first public health outcomes framework.

The hon. Lady mentioned older people. This year, a £30 million budget is being distributed to local authorities so that they can take action locally in ways that will reduce the number of local resident deaths from cold weather. I remind hon. Members that the previous Government’s policy was to cut funding in the NHS. We are ring-fencing the public health budget and increasing duties on the Secretary of State.

The proposed mandate for the NHS commissioning board and the suite of outcomes frameworks for the NHS and public health will enable organisations to be held to account for the first time on health inequalities. The Health Secretary will also have new responsibilities to address health inequalities as part of the NHS reforms.

The hon. Member for Tynemouth (Mr Campbell) is confused about funding. I point out to him that the Department does not distribute funds to local hospital trusts. He mentioned alcohol in particular. It would be simplistic to suggest that the rise in alcohol harm and alcohol misuse is due to price alone. The issue is complex, and we will be introducing an alcohol strategy in the near future.

Tackling inequalities and supporting the principles of the Marmot review are a priority. Inequalities are deeply embedded in society and highly resistant to change. What echoes with this Government is the fact that public health funding will finally get the priority that this country deserves and that was missed by the previous Government.

Self-Employment

Tuesday 24th January 2012 Westminster Hall

11:00

[Richard Harrington (Watford) (Con)]

It is a pleasure to serve under your chairmanship, Mrs Riordan, and I am pleased to see so many hon. Members present, particularly the Minister for Further Education, Skills and Lifelong Learning and the shadow Minister, the hon. Member for Chesterfield (Toby Perkins).

This debate came about as a result of a conversation between me and my hon. Friend the Member for Wyre Forest (Mark Garnier), who is sitting next to me, about people in this country setting up their own businesses. We reached the conclusion that not enough people do so. Everybody knows the benefits of people setting up their own businesses, but there is a certain culture against self-employment and business in this country, notwithstanding everything that this and the previous Government have tried to do. Politicians brand the terms “entrepreneur,” “small and medium-sized enterprises” and similar without really understanding what they are about. My hon. Friend and I have, therefore, decided to focus the debate on how Governments can change attitudes.

Like so many people of my generation, I was the first member of my family ever to go to university. Few people at that time had the idea of setting up their own business, and I do not think that much has changed. I have two sons, one in his late teens and the other in his early 20s, and from what I have observed of my family life, as well as that of my sons’ friends and during my constituency duty of visiting schools—some very good, others not so good—and further education colleges, there is very little idea, culture or yearning among people, from the most academically gifted to the least so, to set up their own business. However, I commend people such as my hon. Friend the Member for Newton Abbot (Anne Marie Morris), whom I am pleased to see and who is co-chair of the all-party group on micro-businesses. Others have also tried very hard in the main Chamber, as well as elsewhere in the Palace of Westminster and throughout the country, to help the cause of small business. The Government themselves have also made a lot of effort, and I do not feel that it would be right for me to criticise them.

This debate will be divided into two halves. I will deal with social, cultural and educational barriers, and what I think the Government might do about them. My hon. Friend the Member for Wyre Forest will then deal with taxation, regulation and other more direct governmental aspects. It is also nice to see so many other hon. Members present who want to take part.

On the face of it, self-employment seems to be going well. Recent figures show that 300,000 people have become self-employed in the past year, which means that they are registered with Her Majesty’s Revenue and Customs as being self-employed, but I do not think that that necessarily means that they have set up their own business. Some of them will, legitimately, have taken on part-time functions that classify as self-employment. I do not want to get into a political debate about whether that is self-employment or not, or whether the recession is to blame, because I want to focus on a culture that will give ambitious young people the desire to set up their own business.

The education system is the most important opinion-former for young people, and many aspects of it are encouraging. Like many other hon. Members, I have Young Enterprise groups in my constituency. We have Hertfordshire Young Enterprise in Watford, and I have seen many teams of young people setting up little businesses at school. They are largely supported by voluntary contributions from local businesses and they get mentors. In fact, only last Saturday, there was a display of the best teams at the Harlequin centre in Watford, which is well known to some Members present and to those more illustrious alumnae of the better Watford girls school—without naming names—whom I am also pleased to see present. It is interesting to see that these teams set up real businesses, producing bracelets, handbooks and all sorts of things. Some of the products make them a bit of money, and it is good to see local businesspeople helping them. This, however, is only useful if it gives those young people a desire to say that, when they graduate—assuming that they want to go to university; I am not saying that that is necessarily the most important thing—they want to set up a business, but I do not find that to be the case.

I recently visited Watford grammar school for boys, which is one of the better schools in the country— 30 boys are going to Oxford or Cambridge this year. After I finish my talk to the sixth form, I always ask them what they want to do after university—most of them go to university, but I would ask a similar question at a school where not so many pupils do so. When I ask how many want to be lawyers, accountants or involved in advertising or the media, many hands go up, but when I ask who wants to set up their own business, very few want to do so, including those who have taken part in the education system’s successful schemes.

[Toby Perkins (Chesterfield) (Lab)]

The hon. Gentleman is making an important case for the role that education can play. Another part of getting young people excited about running their own business is the experience of those who do so at the moment. Today’s Financial Times includes an article on an Aviva report that involved interviewing 500 owners of SMEs for its research. A quarter of them said that they were considering returning to work as an employee, because of how difficult it is at the moment to run a small business. When people who actually run their own business find it that difficult, will it not be more difficult to persuade young people to do so?

[Richard Harrington]

The shadow Minister makes a valid point. I read that article in the Financial Times online—if I cannot sleep at 3 o’clock in the morning, I find that that is the best way to get back to sleep. It focused on the general problems of the economy and how much more difficult it is for people who are self-employed and have their own business. Some of those people look towards employment as an answer, and I do not disagree with anything that was said. I am sure that some people want to go back to the comparative security of employment, but I do not think that that changes my main argument. People becoming self-employed and setting up their own businesses is one of the most important things for this country to expand the economy.

[Priti Patel (Witham) (Con)]

I come from a small business family. My parents were immigrants to this country and it is interesting to see the number of immigrants who are self-employed. My hon. Friend’s premise is to get young people engaged in self-employment. Does he agree that part of the challenge is getting started, which is always very difficult, particularly for young people who feel insecure about doing so? Does he also agree with the concept of a youth investment fund to provide Government funding or incentives that give people a cushion and confidence to develop their own ideas to become self-employed?

[Richard Harrington]

I appreciate that comment, because I intend to address the youth investment fund, which is important. Indeed, Sir Richard Branson has expressed an interest in this debate. He is elsewhere in the House at the moment and will join us later. The fund is important, but it is just one aspect and I hope to come back to it shortly.

On the education system, it frightens me that 60,000 people a year do GCSE business studies—this was true of my own sons—and are forced to learn accounting ratios, liquidity ratios and the difference between US generally accepted accounting principles and British accounting standards, but there is nothing whatsoever that will give any of them any desire or incentive to relate to business as they see it, which is buying a product and selling it at a profit, or providing a service for which people will pay. That is a real gap in the system, which, at the moment, is filled by Young Enterprise and various other very good schemes. However, that does not change the deep cultural point that people in this country do not perceive business as something to do that is either socially or economically worth while.

[Mrs Helen Grant (Maidstone and The Weald) (Con)]

On igniting the flame of desire for a young person to start a business, does my hon. Friend agree that it would help if we had better, bolder, more ambitious career advice encompassing enterprise for our kids and young people at school and university?

[Richard Harrington]

That is a very valid point. It could help and it is part of the whole picture that I want to build up in this brief speech.

We have to tell young people that setting up a business and employing people is socially acceptable and good for the country, and that they will make a lot of money. If they want fast cars, big houses and all that stuff, providing they pay their taxes, well done to them. It is very easy in politics to take examples of capitalism not working, of people being paid large amounts of money without doing much work for it and of people avoiding tax. We all have our views on those things and I think that everyone would agree that many of those issues need correcting. However, my fear is that such matters help to fuel the view among young people that business is not a very cool thing to be in, which is not right.

A socially responsible young person should be told, “Yes, you can do the kind of occupation that is directly socially responsible. You can be a teacher; you can be a nurse; you can qualify as a doctor and help to cure cancer; you can be a social worker. Those are all very good. But if you decide that you want to go into business and employ people, providing you pay your taxes, that is as much use to the country, if not more, because you are helping many people in their way of life. You are helping to fund the teachers, the doctors and the social workers and it is a very, very creditable thing to do.” Society should say to such a young person, “Well done to you. You have done something that is very worth while. Do not believe the stuff about Gordon Gekko and greed is bad. Actually, greed is quite good. Providing you pay your taxes and employ people, you are really contributing a lot to society.”

One of the big problems in this country is leaping over that barrier to make people think. Let us consider the notion of wanting things. People will only go into business to make money. I did it to make money. I did it because I did not have any money, and I did not like not having it. There is nothing wrong with that. People have to understand that going into business is a good thing to do. When I got my business to the level of employing 600 people, it was a constant nightmare. I was often worried. I did not sleep at night for thinking, “Have I done the right thing?” My wife once told me at 4 o’clock in the morning—she did not help matters; she never says things at 4 o’clock in the morning that help matters—that I was directly responsible for the lives of nearly 2,000 people. That is quite a burden of responsibility. People might think, “He’s filthy rich,” or, “He makes loads of money.” However, whatever people think and say about those in business, they do not believe that they are performing a socially responsible function.

I want the Government and all of us who are in the opinion-forming business—that is what politics is, irrespective of what party hon. Members belong to—to realise that something has to be done to change that attitude, because it is in the national interest.

[Julian Smith (Skipton and Ripon) (Con)]

Does my hon. Friend agree that teachers have a major role to play? What does he think teachers need to be doing and saying to young people on the subject of enterprise?

[Richard Harrington]

I thank my hon. Friend for that comment. The problem is that teachers by definition have chosen teaching as a career, so it is very hard for them to communicate on that. I do not want to take much more of this Chamber’s time, but I will come on to a proposal that I think answers my hon. Friend’s question.

I am not being critical of what the Government are doing. Yesterday, the Prime Minister and other Ministers made an announcement about this year being the year of the business and said that a minibus will go around different institutions, helping to give people the idea to set up businesses. All that is very good, but the cream of young people who are thinking, “I’m going to go to Goldman Sachs,” or, “I’m going to become a top man or woman at the Bar,” or, “I’m going to be a partner at Deloitte,” need to think, “Actually, the status of my setting up my own business and employing people will launch me to a higher level in society. I will be applauded and not thought of as a person who tries to avoid taxes and should hide the fact they have bought a decent car.”

The last vestige of the class system in this country is contained in the attitude that business is a bit grubby, something to be looked down and not something that proper chaps do. Until we change that attitude, we will not have enough people setting up businesses, employing people and providing the growth that we need in the future.

[George Freeman (Mid Norfolk) (Con)]

rose—

[Richard Harrington]

I will give way, after which hon. Members will be relieved to know that I shall be brief with my comments.

[George Freeman]

I congratulate my hon. Friend and my hon. Friend the Member for Wyre Forest (Mark Garnier) on raising this important debate. I also congratulate Virgin on the support and work that it is doing in this field. Like many hon. Members here, I am sure that he agrees—he has touched on this—that part of what we must do is to help those youngsters who do not have the experience of entrepreneurship and self-employment through their family, so that they can experience it through schools. Many of us in our constituencies can help and, indeed, are helping with schemes. In my constituency, we have set up a programme called the Norfolk Way enterprise bursary and we are linking school leavers with local businesses, which can be very empowering. Lastly, does my hon. Friend agree that it is very striking that some of our best entrepreneurs, for example, Richard Branson and Bill Gates, are not graduates? They started their businesses pre-university, which sends a very powerful message to youngsters who are feeling disillusioned and disengaged by the mainstream curriculum. Some of our most deprived communities could benefit hugely from such initiatives.

[Richard Harrington]

My hon. Friend makes very valid points. I hope that I speak for all hon. Members involved in this debate when I point out that Richard Branson and Bill Gates are examples of people whom we would regard as being very successful and would look up to. Both Richard Branson and Bill Gates were rejects from the mainstream academic system. Obviously, when I say “rejects”, I do not mean that they were not up to it, but that they were, through whatever personality they had or whatever came about, not part of it. My hon. Friend’s helpful intervention supports my argument, rather than the other way round.

In my constituency of Watford, there are some excellent initiatives. For example, Wenta, which is run by Chris Pichon and Sharon Gaffney, has many schemes to help schools give young children the opportunity to become entrepreneurs and to create an incubator for people who are without a job to help them set up their own business. Lots of good efforts are happening, but the fundamental point is to ask people to think culturally, socially and educationally. There is still a feeling against the acceptability of business in this country that is not present in Germany or the United States. As I have said, such an attitude is a result of hundreds of years of looking down on business.

[David Morris (Morecambe and Lunesdale) (Con)]

I agree with everything my hon. Friend has said. Back in the 1980s, the manpower allowances service scheme was brought in by Margaret Thatcher’s Government. That scheme took people who were on the unemployment register and gave them twice the amount of unemployment benefit, so that they could go self-employed. Indeed, I was one of those people, and I built up a business that employed more than 100 people and experienced the same sleepless nights as my hon. Friend.

[Richard Harrington]

I absolutely agree. Indeed, I was also one of those people. My hon. Friend is talking about a business start-up scheme whereby if someone was unemployed, they got £100 a week. If they did well, they paid tax on it. That scheme helped a lot of people to start their business. I think that my hon. Friend the Member for Wyre Forest will discuss many of the schemes that the Government are doing.

I have a final proposal for the Minister. There should be an institution at university level—whether it is called a university technical college, a special university college or whether it is part of an existing university, such as the university of Hertfordshire, which does a lot of work in the field of business studies and management training—that exists entirely to train and help people to set up businesses. The course should be run predominantly by people who are successful in business and who are prepared to give up their time to do that, rather than by people who have taken business studies. At least half the course should involve practical work on how to set up a business. Sir Richard Branson’s scheme for the youth investment fund could help to fund it, as perhaps could the Government if local business people were to become involved. Students may include mature students as well as those from sixth forms going into the normal higher education system, and when they graduate they should have set up a business that either works and is doing well, or does not work. If it does not work, it should not mean that they do not graduate, because many people in business try things that do not work.

[George Hollingbery (Meon Valley) (Con)]

rose—

[Mrs Grant]

rose—

[Richard Harrington]

I give way first to my hon. Friend the Member for Meon Valley (George Hollingbery).

[George Hollingbery]

I have set up several businesses, some of which were not successful, but one of which was, and I am very aware of the shadow Minister’s reasonable point that 25% of people are seeking to go back into employment because of the difficulty in starting a business. Does my hon. Friend agree that we must be careful not to sugar-coat setting up a business? It is a difficult career, full of challenges, and if we teach it in schools and universities, we must be realistic. People must understand that failure is part of the education process, and that although it may lead to success, the road on the way will be bumpy.

[Richard Harrington]

That is an exceptionally good point, and I am sorry that my hon. Friend, like me, in later life has had to do the job that we are doing now instead of being in business. However, I know that he, like me, benefited greatly from his time in business. His serious point was well made. The alternative of salaried employment for a company is not secure either, and many people lose their jobs. My generation may be the last one that believed that the professions provided a job for life. There is a risk element now.

I return to my university college, which I hope the Minister will immediately decide should be located in Watford, because that is the obvious place for it. Watford is a good example for small businesses. It used to depend on two heavy industries—printing and lorries—but it now has more than 1,600 small businesses, and the employment background is small business, so Watford would be a suitable place for the college. It would be an ideal location because of being well known internationally as a centre for commerce, culture, intellect and so on.

My serious point is that the Government, with all the excellent measures that they are taking, should consider introducing a degree on setting up a business—obviously, that is not what it would be called—helped by local business people who would agree to take part for perhaps two or three days a week. Students could set up real businesses that would go on to provide real employment for people. That is where academia should meet the practicality of setting up a business.

[Toby Perkins]

rose—

[Richard Harrington]

I will happily give way to the hon. Gentleman, but my hon. Friend the Member for Maidstone and The Weald (Mrs Grant) rose first.

[Mrs Grant]

Does my hon. Friend agree that banks need to be more reasonable in their behaviour and attitude to businesses and potential business clients, and that if they were, that would encourage business and future enterprise? At the moment, banks are so overly cautious that they are impeding business.

[Richard Harrington]

I agree with my hon. Friend, and my hon. Friend the Member for Wyre Forest will speak about that.

[Toby Perkins]

I want to explore the hon. Gentleman’s idea. He has rightly identified that many successful entrepreneurs with great business careers were not academically inclined, and perhaps those who have that motivation and spark do not sit well with long periods of study. How does he square that argument with his idea that people should undertake three or four years of study to set up a small business, when many of the best small business people have been instinctively brilliant rather than studiously and academically brilliant?

[Richard Harrington]

I have to accept the logic of that point. Not everyone who wants to go into business would go to the sort of college that I am proposing. Many people would start businesses as happens now. Many people who have been in employment may decide when they become a bit older that that is for them. There are different routes to the same objective. However, I believe that an all-star college with teaching by people such as Sir Richard Branson and senior politicians and business people—people who have been in business—would show that the Government are serious, and that the status of such a course is as good as those at Oxford, Cambridge and so on. It is wrong for people of my age to use the expressions of younger people, but that would show that it is cool to set up a business, and just as good as anything else. In addition to the many other things that the Government do, they could help with that, and it would not cost too much money.

11:25

[Mark Garnier (Wyre Forest) (Con)]

I thank my hon. Friend the Member for Watford (Richard Harrington) for his helpful and useful comments. As he said, I will speak about the slightly more tangible and gritty problems facing businesses. Before getting into the meat of my speech, I am struck by how many MPs are in the Chamber and the fact that I cannot see one who has not been in business. It is remarkable that the Chamber is so full, although I am sorry not to see more support for the shadow Minister with responsibility for small businesses. It is incredible to see so many politicians here, all of whom have extensive business experience.

As my hon. Friend said, I want to speak specifically about taxation, regulation, access to finance and cash-flow management. For the purposes of clarity, we are interested today in self-employed people and those who employ fewer than five members of staff—small businesses and micro-businesses. It would be wrong to start my speech without highlighting some of the initiatives that the Government are already taking.

On finance for businesses, the Government are introducing measures to increase the availability of equity finance through venture capital trusts and improvements to the enterprise initiative scheme. They are making regional growth fund allocations for business opportunities and addressing tax initiatives, such as rolling over capital gains into new venture funding. The national loan guarantee scheme is seeking to push debt finance further down the line, and the emergence of community finance organisations, which my hon. Friend the Member for Mid Norfolk (George Freeman) highlighted, is providing locally based informal financing opportunities.

On helping businesses with advice, my hon. Friend the Minister has recently announced three new websites. The Business Link website has an information section offering help on a range of business-related issues, including how to start up a new business. The “mentors me” website offers an opportunity not just for new businesses to find business mentors, but for business people to provide mentoring services. My hon. Friend the Member for Meon Valley (George Hollingbery) made the very good point that setting up a business is tough and that having the benefit of the experience of business people who have learned from their mistakes and can impart their wisdom to new businesses is incredibly important. Websites such as “mentors me” are a way of disseminating that information.

Finally, the improved Business Link website has a wide range of information on how to finance and grow a new or expanding business. However, were I to stand here praising the Government’s glorious achievements, many though they are, as I am sure all hon. Members agree, the Minister would have nothing to say, so I shall turn to some of the problems facing businesses. I hope that he will address some of them and explain how the Government can help and thereby reinforce the process of developing part of the economy that has so much potential for growth and is so liberating for a huge number of people.

I shall start with taxation. No one wants to pay tax, but if we all want to enjoy the wealth of services that the Government provide and to sort out the problems that we inherited, we accept that we must make a contribution to tax. But as we know, it is widely reported that the UK tax system is the most complex in the world. Whether that is true is a moot point, but irrespective of where we are in the ranking of complexity, the fact that we have tax complexity at all is completely at odds with any sort of entrepreneurial spirit that we may want to foster. The last thing a bright, young and enthusiastic business creator wants is to have that entrepreneurial spirit crushed by the dead hand of taxation regulation.

There are various simple answers. On national insurance, for example, the Chancellor has not only put in place a policy to help small businesses by giving employers a national insurance holiday for the first 10 employees, he is investigating doing away with that pointless and superfluous tax. That is definitely a noble direction, but things such as the accounting period for national insurance and PAYE and the fact that two forms must be filled in doubles the bureaucracy facing small businesses. Something as simple as dealing with that would be a quick fix.

We are familiar with the Federation of Small Businesses, which is an incredibly rich source of information on issues facing many small businesses. However, for micro-businesses and the self-employed, there is little specific data. The FSB definition of a small and medium-sized business is one with up to £25 million turnover and 250 employees. I do not know about other hon. Members, but certainly in Wyre Forest anybody bigger than that is quite a large employer locally, and there are few of them.

[Glyn Davies (Montgomeryshire) (Con)]

I agree from a standpoint of running a micro-business myself: I have been a farmer and my wife has been a restaurateur. Regulation, and the fear of it, is particularly damaging to a micro-business, because the individual running it simply has to have the capacity to deal with all these things. In a larger business, often other people can deal with such matters, but it is typical of the small and micro-businesses that we meet for one person to do so. That is incredibly difficult. Fear of regulation and not being able to deal with health and safety issues are probably more of a deterrent than anything else.

[Mark Garnier]

I will come to the regulatory burden in a minute. My hon. Friend is right. I have seen a turkey farm that has had to comply with huge industrial reporting requirements for toxic chemicals, because turkeys produce ammonia, but it also has to prove that it is not producing a great range of other chemicals. These are the unintended consequences of over-bureaucratic regulation.

The FSB provides a great deal of helpful data on business attitudes. Sticking with the taxation issue, 60% of FSB members—two thirds of businesses—complained that the UK tax system is not only too complex, but has a negative impact on their ability to take on more staff and expand.

[Guto Bebb (Aberconwy) (Con)]

The VAT threshold creates problems for micro-businesses. The fact that that kicks in at £73,000 is a cliff edge for many small businesses, because if they hit that level, they end up being penalised to the tune of £10,000, so they make a decision not to grow. Having a tax cliff edge of that nature is a barrier to growth for many micro-businesses in my constituency.

[Mark Garnier]

I agree. Our complex tax code is full of all sorts of unintended consequences exactly like the one that my hon. Friend mentioned. It is ridiculous having a tax that means businesses going above £73,000 will have to start charging their customers. That is a disincentive to growth in terms of going out and gathering business. If people stay below that threshold, it is a disincentive to employ more people.

[Toby Perkins]

The hon. Gentleman is talking about the difficulty with taxation faced by small firms. Will he support Opposition Members calling for a national insurance holiday for any micro-business with less than 10 employees that takes on a new member of staff?

[Mark Garnier]

A national insurance holiday? I think that we are already doing it. That is a policy of ours.

[Toby Perkins]

For micro-business.

[Mark Garnier]

I am sorry; the hon. Gentleman is talking about extending it to micro-businesses. Yes, all this has to be put into the mix of things that we need to look at. It is important to consider any way that we can help more micro-businesses.

FSB members say that our tax system is detrimental to their ability to make capital investments in their business, which again is another reason why people are being held back.

On a wider social point—sticking with tax complexity—it is worth noting that a complex tax system allows a huge range of opportunities for tax avoidance and tax evasion, which makes it extraordinarily complex for Her Majesty’s Revenue and Customs to collect tax and ensure that we avoid the tax gap, which is estimated at anything between £40 billion and more than £100 billion a year. The rest of us have to pay for that tax gap and lack of revenue through increased taxes.

Half of small businesses spend at least two hours every week complying with their tax responsibilities alone and for 10% of businesses, particularly small micro-businesses, that can take up to six hours per week—six hours when those businesses should be capturing new customers, developing new products and investing in their future.

Two thirds of businesses feel that they need professional help to complete their tax returns, which costs them on average an extra £3,000 a year. One third of them find that national insurance in its various forms is difficult to understand. Half of businesses find allowances difficult to get to grips with. Frankly, it is all far too complicated and too expensive in man hours and financial resource to administer.

Regulation is the second area of extreme unrest for micro-businesses. According to the World Economic Forum’s global competitiveness report, the UK is ranked 89th out of 139 for the burden that regulation places on businesses. Aside from the obvious problem of possibly deterring inward investment, the overburden of regulation, especially in the realm of employment law, is cited by businesses as a reason not to expand.

In a business survey in 2008—that was some time ago, but it gives a good idea of trends—a third of businesses thinking about expanding cited fear of regulation as a significant headwind to be faced in expansion and therefore a key factor in their decision. The same survey revealed that half of businesses planning to downsize or close rated regulatory burden as important in their decision to do so. The 2008 survey was undertaken in difficult trading conditions, but regulatory burden should not be a significant factor when businesses are struggling to stay alive in a difficult environment.

Possibly more worrying is the fact that in the 2009 business survey 34% of businesses that were no longer employers cited complying with legislation as a reason for no longer employing staff. This is madness.

[Karen Lumley (Redditch) (Con)]

In my constituency, I have been working closely with small businesses. Does my hon. Friend agree that they feel isolated, with a perceived lack of business support around them?

[Mark Garnier]

Yes. Being a small business man is quite an isolating experience, as many hon. Members will know. People are out there on the front line, struggling to get more business in. They can join network groups and all the rest of it, but they feel like they are in a foxhole, with letters in brown envelopes coming at them from HMRC and all sorts of regulators. That is not necessarily a particularly enthralling experience. My hon. Friend is right.

In addition to accountants and tax specialists to handle tax compliance, a plethora of organisations offer advice on human resources, fire and emergency, health and safety and other things. All that is welcome and they provide an excellent service, but the fact that they are needed and that a sub-class of business advice has been created shows the amount of regulation that we have to face.

The Government have made some progress on access to finance and cash flow. I do not want to be an apologist for the banking crisis. I have to declare an interest here. I was an investment banker and one or two other hon. Members here were, too. It is important to understand that banks have an aversion to risk. Part of the problem faced by the banks is that the Basel III and the Vickers’ recommendations, and so on, are trying to deal with the problem of not wanting the banks to fail. On one hand the banks are being asked to tighten their balance sheet, and on the other they are, rightly, being asked to lend more money. For the banks, those are opposing requests. We need to take great consideration of that as we go through the process of implementing the recommendations of the Independent Commission on Banking, because we cannot ask the banks to take on more risk and expect them not to go bust. That is a contradiction.

[Sheryll Murray (South East Cornwall) (Con)]

Is my hon. Friend aware that in my constituency—with particular reference to the fishing industry—someone receiving training who then wants to start a business needs to purchase a fishing vessel? The banks will not just accept that fishing vessel, although it is a valuable asset, as collateral for a loan. They ask for additional collateral, such as a charge on a property, which a lot of young people do not have. That is stopping industries that support our coastal communities from expanding. Does my hon. Friend think that there is an answer to that?

[Mark Garnier]

My hon. Friend raises two important points. First, on the general point about raising finance for businesses, part of the problem is that, in the past, loans have not so much been business finance loans as mortgages, where a bank has taken a secure guarantee, such as a property, thereby effectively giving a mortgage used to finance a business and the cash flow out of the business is used to service that debt. The feeling that I get out there is that banks have slightly morphed away from being business financers to being mortgage companies dressed up as business financers.

Secondly, my hon. Friend mentions marine finance. We have one of the finest marine businesses in the world. We produce the most fabulously made yachts—we are world class. I hope you will forgive me for getting in a plug for one of my constituents, Mrs Riordan, but Sealine in the middle of landlocked Kidderminster builds very good ocean-going yachts, and if you ever get a chance to take one out, you should. However, this country does not have a significant marine financing industry, and that is a real problem for all the marine industry, whether we are talking about luxury yachts or working fishing boats. I am working with constituents and various marine industry representative bodies to see whether we can address that point, because we must look at it specifically.

In addition to problems with equity and debt, part of the problem businesses face lies with cash flow. All too often, small businesses suffer as a result of delayed payments. To return to the FSB, three quarters of its members have received late payments in the past 12 months, while nearly half claim that a third of invoices are paid late. That is costly in terms of the time spent chasing invoices. In addition, a fifth of the claims for money owing to those businesses are for more than £20,000. Many businesses go bust not because they do not have enough capital or customers, but because of their cash flow. The problem is that, although a business is perfectly viable, it can easily go bust because of a late payment.

[Christopher Pincher (Tamworth) (Con)]

Further to that point, is the problem not that businesses have difficulties with their cash flow, but that banks do not offer decent overdraft facilities to tide companies over in such difficult times? We need to ensure that, when banks lend money, they do not simply do so through loans tied to interest rates and specific rules. They should be much more flexible about offering overdrafts, so that businesses can get through difficult times.

[Mark Garnier]

My hon. Friend is right. Various factoring, invoice and financing arrangements can be put in place for businesses. They are designed, in theory, to help businesses through their cash-flow problems, such as paying for stock to put on their shelves and sell on. A number of the banks in my constituency are certainly much more cautious about asset filing and invoice filing than they were. That is a serious problem, but it can be dealt with, despite some of the bigger problems that the banks face in meeting the Basel III requirements. My hon. Friend makes an incredibly important point.

I want to look at what the Government can do to help. I ask my hon. Friend the Minister to take note, and I am sure he will have some helpful comments at the end of the debate. First, we already have the Office of Tax Simplification, and it is incredibly important that we get the Government to take on its recommendations. We must make absolutely certain that any tax changes are properly thought through in terms of simplicity and that they have a good economic and social justification. If we are going to write taxes, we should do so with an eye to international competitiveness. They should make it easier for our businesses to trade and for us to attract businesses to come and invest in our country.

I talked a bit earlier about merging income tax and national insurance contributions, but I should stress again that it would be incredibly helpful if the collection of national insurance and PAYE could be merged, so that people have a simple form to fill in, rather than two complex forms.

The one-in, one-out system of regulation is welcome, and it should start to force some helpful changes. However, the system needs to be rigorously enforced, and the Government’s commitment to it must remain strong.

[Lorely Burt (Solihull) (LD)]

The hon. Gentleman makes a really important point. Does he agree that, as well as introducing regulations in a rigorous way when they are absolutely necessary, we should measure whether they do their job, with a post-examination within a specific period, so that we can sunset those that we do not need and get rid of them?

[Mark Garnier]

Yes, absolutely. I agree with the hon. Lady. She is absolutely right on UK regulation, but we should also do that on European regulation. We simply cannot have endless regulation coming through, and we really need to see whether it is worth having.

[Julian Smith]

Does my hon. Friend agree that, with very small businesses and start-ups, the Government might need to be more radical than they are being at the moment? On issues such as flexible working and the right to request training, there may be an argument for exempting very small businesses and new businesses from legislation. We should seriously think about more radical measures, such as making it easier for small businesses to get rid of staff. That is politically difficult, but I would like to encourage the Government to think carefully about those proposals from Adrian Beecroft.

[Mark Garnier]

My hon. Friend could have been reading my speech, because my very next point was exactly that. It is vital that we help businesses. Ronald Reagan introduced a law under which businesses with fewer than five employees were exempt from a lot of business regulation, and he increased the number of jobs by 30 million as a direct result.

On a practical point that is deliverable, rather than necessarily doing something wholesale, it is vital that we have a system under which we exempt micro-businesses with fewer than, say, five employees from new legislation. We should also give such businesses a holiday when new measures are introduced. If we introduce new regulation—to follow on from the comments of the hon. Member for Solihull (Lorely Burt)—we need to see how it beds down with those organisations that can afford to implement it. If it works and it is sensible, we can translate it through to smaller businesses when we know how to implement it. We should not load it on to small business right at the beginning and expect them to tackle it and to be the crash-test dummies, when they do not really have the resources to deal with such regulations.

Another problem with regulation is that its introduction is like Chinese water torture, with one drip after another throughout the year. It is quite difficult for many businesses to tackle that drip-feeding of regulation. If we are to bring in regulation, we should bring it once a year. That would make it a lot easier for businesses to focus and comply.

Finally, there is no doubt that the Government have plenty of opportunities to help businesses on cash-flow issues. They have quite a lot of money, although, admittedly, not as much as they used to, and they have a useful cash flow. When they take on contractors, particularly SME contractors, they could achieve a number of things by having a process whereby invoices were paid within 10 days. First, that would set an incredibly good example to the business community and show that early payment is important. Secondly, the Government could push such early-term payments from the contractors to the sub-contractors. Such a process would also give them the ability to persuade their sub-contractors and contractors to sign up to an agreement to help businesses by adopting better payment terms. Those are just a few suggestions, and I am sure that hon. Members will have many others.

I am heartened to see the Minister in his place. He has been in the private sector and has worked hard in business in the past. It is incredibly heartening to see so many business people here, including the Minister. I have every confidence that he will have some helpful comments when he winds up. Much more importantly, when he goes back to his civil servants, he will have a zeal and an enthusiasm for helping small businesses that can come only from somebody who has first-hand experience of the business world.

[Several hon. Members]

rose—

[Mrs Linda Riordan (in the Chair)]

Order. I intend to call the Front Benchers at 12.10. A number of hon. Members are trying to catch my eye. I would like to call as many Members as possible. I therefore urge Members to make short speeches.

11:48

[Sarah Newton (Truro and Falmouth) (Con)]

I will speak for two minutes, and I will probably speak very quickly so that more colleagues can get in. I congratulate those who secured the debate on the excellent way in which they opened it.

I would like to talk about enabling self-employment from the point of view of groups of people who find it difficult to engage with the workplace. These are not necessarily people who would go on to set up a business of their own. One such group is people living with disabilities that make it difficult for them to leave home. Another is women who would like to balance employment with caring responsibilities for children, an elderly relative or perhaps somebody with disabilities. I am really talking about people being self-employed as home workers.

I would like to share with Members the story of a really successful organisation I have been working with over the past 12 months. It enables call centres to be in-sourced back to this country by creating a network of call centre operators based in their own homes. The Government are investing a great deal of money in superfast broadband, and we are definitely benefiting from that in Cornwall. The networks I am talking about would be a good way of utilising that investment to encourage people who are probably not in a workplace now to get training and to become self-employed as call centre operators from their homes.

In America, such an initiative was set up a couple of years ago. It was specifically targeted at getting people off welfare and into work. Globally, the company to which I am referring and which invested in the technology employs more than 22,000 people. It set up in the UK just 12 months ago. It employs 1,500 people and is taking on 2,000 this year. Companies such as Littlewoods and many well known holiday organisations are involved.

With a concerted effort, all of us as Members of Parliament can promote what I have described. I would also like my hon. Friend the Minister to consider something that President Obama is considering this week. I am talking about giving tax incentives to the very big employers, the very big national companies, such as BT, that are outsourcing their call centres throughout the world to repatriate those jobs to the UK—to in-source them back to the UK. Barack Obama is considering giving financial incentives to companies through the taxation system—a financial incentive for every job that they bring back to America. I would like the Minister to examine what is being done in America to see whether we can do the same to repatriate what would be tens of thousands of jobs to these shores and enable people who are finding it difficult to fit into the workplace—such as people with disabilities and people with caring responsibilities—to be self-employed.

11:51

[Nick de Bois (Enfield North) (Con)]

I shall be brief. I intended to make two points, but I will now make only one, in the interest of enabling other hon. Members to speak. I want to talk about the role of education and of finance and how help can be provided to people. I fully confess to being heavily influenced by a constituent of mine, who has been working under the scheme led by Virgin Media. In the past year, she has taken steps to establish a competitive business. In fact, while she was at college, she was so entrepreneurial that she decided to use some of her student loan to help to fund the website that is driving her business. The entrepreneurial spirit is to be admired. I have no idea whether she was allowed to do that, so I will not name her, but it shows that with some lateral thinking, perhaps some of the young talent that exists can be put to good use.

I myself did not go to university. I went to a technical college in Cambridge, which I am told is now a university. The business studies course that I did was a sandwich course. It struck me that the only choice that I had during that sandwich course was to go to a placement that was put to me by the college, very helpful though it was at the time. Why cannot we set up an arrangement whereby we allow a sandwich year, even in a course of reduced time length, to become an opportunity for someone, under mentoring and guidance and with the ability to use student finance at their disposal, to take their first steps towards running a business?

If we think creatively, we can not only foster the educational and mentoring skills that are so vital; we could even allow people access to finance, perhaps on the same terms as those of the student loans scheme. I suspect that it would not be able to extend its remit to do that and we may have to look elsewhere for other sources of financing. However, if we are genuinely saying, “Let’s educate and let’s motivate,” and we have students who are showing character and willingness by seeking out the courses, there could be a useful match with an existing system in order to help them. At the end of the day, the payback to them as individuals will be substantial—the payback to the economy will be vital.

I therefore ask my hon. Friend the Minister to give the initiative that I have described some consideration and not to lose sight of something that we all too glibly talk about—

[The Minister for Further Education, Skills and Lifelong Learning (Mr John Hayes)]

I have given that some consideration and I am grateful to my hon. Friend. I think we will do it. I think it is a very good idea and I will ask my civil servants to work something up.

[Nick de Bois]

I say, when you’re ahead, quit. I thank the Minister.

11:54

[Anne Marie Morris (Newton Abbot) (Con)]

I will be brief, given the number of hon. Members who want to speak. The UK Commission for Employment and Skills, which reported last August, said that we are at an all-time high; we have 4.1 million people in self-employment at the moment. That report was particularly interesting because it examined what drives the increase in self-employment, and it does not depend on the economy, as we might have thought. It is principally driven by looser regulation, access to finance and Government policy that specifically drives unemployed people into self-employment. The 1980s was a particularly fine example of that.

[Mr Gary Streeter in the Chair]

Let me deal with each of the three elements. With regard to Government policy, the new enterprise allowance has been a great step forwards; I endorse it entirely. The Government now need to consider whether, having extended it from young people to the whole working population, they should take away the requirement for a person to have been on jobseeker’s allowance for six months as a precursor to being eligible to receive it. Many people see unemployment as a bit of a stigma. They may want to come into employment after having brought up children or for many other reasons.

Equally, the Work programme is excellent. I am working with the Minister of State, Department for Work and Pensions, my right hon. Friend the Member for Epsom and Ewell (Chris Grayling), who is responsible for employment, to consider the extent to which the Work programme is enabling and encouraging individuals to become self-employed rather than going into employment.

I come now to the two other issues raised by the commission’s report. On regulation, the Government have clearly taken a very good first step by exempting micro-businesses from regulation for three years. However, I urge them to exert all their energies on getting the European Union to exempt micro-entities—that is a new definition for the very smallest businesses—from new regulation. I gather that that is being discussed, but I urge the Government to push it forward as a priority.

The Government’s red tape challenge has been extraordinarily useful and powerful. It has explored 12 different areas of red tape—12 sectors—and five more are to come. The Government have said that they will report on that three months after the closure of the consultation. I look forward to those results. I urge the Government to examine in particular those regulations that disproportionately disbenefit the self-employed and the very smallest businesses. The EU has recognised the need to simplify regulation for the very smallest businesses. I ask the Government to work hard at insisting that the EU has its own red tape challenge. It has examined simplification, but it has not considered root-and-branch removal, which is crucial.

Finance is the third issue. Points have been made clearly and well about the challenge faced by the self-employed and the small business in trying to access finance. Tributes have been paid to Business Link. A new portal, Business in You, sets out a number of schemes that are available. There are 851 of them. My advice to Government would be that it is a great idea, but some guidance is needed because it is quite difficult for a self-employed individual to work out which of those is particularly beneficial.

The real challenge is ensuring that a very small business can find information about the opportunities available. It is the case that 28% of micro-businesses are not online, so we need to make the information available in libraries and to encourage the chambers of commerce and the local enterprise partnerships to play a role in disseminating that information. Without that, we will not secure the change that we need.

There was mention of the Government schemes to support access to debt, equity and guarantees. Most of those schemes are aimed at the whole remit of the SME community, which takes us up to 250 employees. The banks, who are usually the people delivering the schemes, will go for the easy wins because they are in business to make money, and the easy wins are the bigger businesses with good business plans and a good track record. The Government need to ring-fence—perhaps they will do this with their credit-easing proposals—a pot specifically for the self-employed, recognising that they are looking for smaller pots of money and do not have well developed business plans.

Perhaps the best initiative has been the growth of the community development finance initiative. The Fredericks Foundation should be recognised for the work that it has done to provide loans to those businesses that cannot find money anywhere also. I also pay tribute to the Government for considering making credit unions able to lend to small businesses, rather than just making loans to individual people. In addition, the Virgin Media pioneers proposal to enable those wanting to set up a business to be given financing at the same rate as applies to a student loan is definitely to be welcomed.

I pay tribute to my hon. Friend the Member for Watford (Richard Harrington), who initiated the debate. He is absolutely right to say that culture change is the key. In the November report of the all-party parliamentary group for micro-businesses—I have to declare an interest here because I chair that group—the research that was supported by the London Business School, Lancaster university, Imperial and Manchester Metropolitan indicated that we needed an education change, not just at university level but at primary and secondary level. We need to consider how to inculcate the idea that setting up a business is a good, valuable and genuine alternative.

I am delighted with the Government’s support for the National Association of College and University Entrepreneurship, which has put in £500,000 to support the establishment of entrepreneur groups in universities across the country. It has succeeded in establishing groups in about three quarters of the universities across the country. It is now looking at colleges.

Finally, we need to enable the self-employed who are setting up small businesses to have bottom-up mentoring support. Although there is a Government scheme to create 40,000 mentors, a scheme that will require the banks to mentor those who get refused loans and the “mentors me” website, which is great, it is still not enough and we need to consider bottom-up volunteering, and, as has been suggested by the Virgin Group, we need local chambers of commerce and others to take some responsibility as well.

I look forward to hearing the Minister’s reply. I hope that I have not taken up too much time and I welcome the changed agenda that this debate heralds.

[Several hon. Members]

rose—

[Mr Gary Streeter (in the Chair)]

Let me remind colleagues that wind-ups begin at 12.10. Let us try to get in three more colleagues.

12:01

[Nigel Adams (Selby and Ainsty) (Con)]

Government should, of course, try to make it easier for entrepreneurs to start businesses. Like my hon. Friend the Member for Newton Abbot (Anne Marie Morris), I welcome the reintroduction of the enterprise allowance scheme, which enabled me to kick off my business in the early ’90s. I learned last night that in India, thanks to advances in technology, it is possible to incorporate a firm in 24 hours, which we cannot do here. We also need an increase in the availability of start-up loans. Banks should get better at providing some of the money that they were bailed out with.

In the spirit shown to my hon. Friend the Member for Enfield North (Nick de Bois), perhaps the Minister will consider this idea. Graduates who start businesses and then employ people should be eligible for university fee debt relief—well, that clearly went down well in the Chamber. I appreciate my colleagues’ support!

Starting a business should not be an ambition exclusively for young people. Many successful entrepreneurs become self-employed later in life after a successful career. They may be interested in helping others make money or they may become self-employed out of necessity or because of redundancy.

Advances in technology have led to an explosion of people working from home. As such an approach has advantages for family life, I urge the Government to continue their efforts in ensuring that every part of the UK gets access to superfast broadband.

If there is one thing that entrepreneurs know, it is that waiting for Parliament to act will get them nowhere. Entrepreneurs do not wait around for help; they take action. Although business people cannot do anything about clearing university fee debt or increasing the availability of start-up capital, which is down to the banks and venture capitalists, one obstacle they can help young people and anybody wanting to start a business overcome is lack of knowledge.

I am encouraged by the Government’s plans to set up a network of experienced mentors. For too long, business advice has been doled out by well meaning people who invariably have never run a business. Recently, I met some careers advisers who had hardly ever spoken to local employers.

I am pleased to say that via the excellent local business accelerators programme, which was set up by the Newspaper Society and backed by the Prime Minister and that excellent newspaper The Selby Times, I shall be providing mentoring to a local Selby business called LRB Trophies run by the Butler family. The company was born out of adversity, but it will hopefully go on to great things.

[Andrew Bingham (High Peak) (Con)]

Is my hon. Friend aware that the Prince’s Trust also runs a business mentoring scheme? I was a business mentor for the Trust, which helps young people to start businesses. Again, such organisations are really helpful for young people.

[Nigel Adams]

I am aware of that, and I am pleased that my hon. Friend is involved in such a scheme. It is crucial that people get to speak to those who have been at the coal face. There is nothing like real world experience to help people with small businesses.

The Government should say to existing business people with an interest in encouraging the next generation of entrepreneurs, “If you know anyone who is interested in entrepreneurship, be their mentor. Check out the excellent apprenticeship programmes at your local college and hire some apprentices. If you have kids of your own, involve them in your business at an early stage and show them that entrepreneurship is a viable option for them. Let anyone you come across know about the benefits and thrill of being their own boss.”

Finally, we should be celebrating entrepreneurs and the wealth creators and not demonising them. There is nothing wrong with success and there is nothing wrong with those who fail while trying to succeed. Those who put everything on the line to grow businesses, to create jobs and to pay the taxes that pay for the public sector and our services should be applauded and supported.

[Several hon. Members]

rose—

[Mr Gary Streeter (in the Chair)]

George Hollingbery followed by Marcus Jones. Mr Jones will be the last speaker.

12:05

[George Hollingbery (Meon Valley) (Con)]

I am very grateful to you, Mr Streeter, and I shall be very brief.

I shall mention two things that the Government have put in place. The first is universal credit, which is coming through as part of the Welfare Reform Bill. The 65% taper takes away the 16-hour-a-week cliff edge, which is incredibly important. Those who are unemployed and who are looking to start their own business from their own homes now have an incentive to look forward to the future. I am talking about them having not just a limited income but a proper business run for the long term. They can now go through that 16-hour barrier and not see some of their benefits disappear. That has a beneficial effect for those bosses who would employ such people in, say, restaurants, bars or whatever. They can invest in the training of such employees and expect them to remain full-term employees for the long term. That has to be a good thing both for the employer, who is generally self-employed, and the employees.

The second area is planning. Hon. Members who know me well will not be surprised to hear that I am going to bore them slightly on planning. They may ask, “How can that possibly relate to self-employed businesses?” Let me say very straightforwardly that I chaired a conference on that matter last Thursday. We talked about neighbourhood planning. It is now entirely within the remit of small businesses, especially rural ones, to petition for the go-ahead of neighbourhood development plans that take a real account of what local businesses need, particularly in regard to converting farm buildings and using redundant rural buildings for accommodation. I urge all hon. Members to make it plain to their constituents that there is a real opportunity for small businesses here. Small businesses can shape their communities around them and take full account of affordable housing all the way through to the conversion of redundant buildings for their business for the long term. It is a huge opportunity, and one that they should all take.

[Mr Gary Streeter (in the Chair)]

Marcus Jones, you have three minutes.

12:07

[Mr Marcus Jones (Nuneaton) (Con)]

I will try to use that time wisely, Mr Streeter.

Many people often have a rosy view of self-employment. They think of afternoons spent on the golf course, corporate boxes at cricket matches, sloping off early and the large financial rewards that come with all that. In reality that is not the case. The hon. Members in this Chamber who have run their own businesses know that running a small business involves hard graft and long hours. That is particularly the case to start with, when there are often few rewards and plenty of stress. My hon. Friend the Member for Watford (Richard Harrington) hit the nail on the head earlier when he mentioned taking on people and the fact that for small businesses it is about not only employing people and the difficulties that come with that but being in a situation in which people are dependent on them for their living and their livelihoods.

As I have so little time, I will focus on the issue of risk and reward, particularly in relation to taxation. I will then specifically focus on the relationship between people who operate very small and micro-businesses and those who then expand those businesses so that they can take on people to grow our economy. When I looked on Wikipedia, it said that taxation may well be higher for someone starting a small business than for someone who is actually employed. We must ensure that we allow people to expand those businesses. One example that I want to bring to the Minster’s attention is that of a hairdresser who may go from renting a chair in an existing business to taking on their own premises, if they were so incentivised. A VAT threshold of £73,000 could cause a problem with incentivising people. That is one micro-example, but we need to consider taxation in the round and think about how it affects micro-businesses and small businesses in comparison with medium-sized enterprises and larger businesses to ensure that the Government create an enterprise culture, which was sadly lacking under the previous Government.

12:10

[Toby Perkins (Chesterfield) (Lab)]

It is a great pleasure to speak under your chairmanship, Mr Streeter, even if only for 10 minutes. It has been an excellent debate and I congratulate the hon. Member for Watford (Richard Harrington) on obtaining it and on his speech.

Like some other hon. Members, I have run my own business—twice: the first time was at the back end of the last century, when I set up an IT recruitment firm; subsequently in 2005 I launched a rugby product business, Club Rugby, which I continued to run until I was elected. As someone who has been on that journey twice, I know very well the different motivations for heading towards self-employment. In my case, it was inspiration on one occasion and desperation on another. In fact, many great businesses have been created from fledgling inspirations caused by the desperation of those trying to feed a family and keep a roof over their heads in tough times. Certainly, some will still thrive in these most desperate of times. However, the fact that some will still come through, and that the strongest may still thrive and survive, is not a reason for the Government not to do everything in their power to support people in all walks of life and all parts of the country to take that first brave step and put their name above the door.

One of the lessons of the recent past is that we must create an environment that gives the greatest number of new business people an opportunity to be a successful business owner. Why would any Government not want to do that? Therefore I particularly welcome a debate in which the hon. Member for Watford expressed his frustration at what he sees as the unglamorous image of running a business in Britain today. Of course, he is right to say that we all—politicians, school teachers, careers advisers, business leaders, media figures and trade union leaders—have a responsibility to promote the vital importance of new start-ups and small businesses in creating the growth we need to get the economy moving again. For that reason I welcome television programmes such as “The Apprentice” and “Dragons’ Den”, which for all their flaws at least tend to get young people to see business in a sexier light.

[Justin Tomlinson (North Swindon) (Con)]

Will the hon. Gentleman give way?

[Toby Perkins]

I am afraid that there is not time, if I am going to leave time for the Minister.

“The Apprentice” in particular also has a welcome focus on the importance of sales techniques and ability, which is a vital and intrinsic part of business success, which the nation has neglected for too long, and which I want to promote through the Labour party’s policy review. I started my first job in sales at the age of 17. The old adage that until someone sells something in a business nothing happens has never been truer than it is today. As part of the Labour policy review programme Nigel Doughty, a tremendously successful business investor, is chairing our small business task force. Within that policy review process, he hosted a session on high-growth businesses. There were many contributors to that session from across the business spectrum, but one of the key defining facts revealed during it was that about 7% of all businesses will go on to become high-growth firms, irrespective of market sector or geographical location. The key to getting more high-growth firms coming out of the bottom of the funnel is to get more going into the top.

Of course, we have been here before. Starting in 1997, Labour’s new deal programme was the most successful back-to-work programme in British history. The self-employment programme was the most successful part of it. Some 70% of the people who started on it went into business, and 81% of those businesses were still trading three years later. Moreover, they were employing, on average, an extra 1.6 people each, meaning that for every 100 people who started on the programme, 112 were employed three years later as a result. That may be the first and only back-to-work programme ever to have a greater than 100% success rate.

The key features of the success of that programme that are not being duplicated by the current Government’s back-to-work programme are the special provision with a ring-fenced pot of new deal money specifically for the self-employment option and the financial cushion in the early stages of self-employment, which was so important in giving new business people an opportunity to test trading as a viable career option. In that context, the void in face-to-face business advice left in the absence of Business Link is deeply worrying.

It is a key aim of the Government to encourage the unemployed to look towards self-employment as a viable career option, and we entirely support them in that general aspiration. However, we must also be aware of the dangers of false self-employment. Bogus self-employment has rocketed in the past decade, particularly in the construction industry. Workers are often told that they will be taken on only if they agree to declare themselves self-employed, thus giving up hard-won employee entitlements such as national insurance contributions, and sick and holiday pay. Recognition of the unique challenges that the unemployed face in setting up new firms or becoming sole traders must lead to specific actions to support them into self-employment. The unemployed are less likely to have the cash to enable them to set up in business, and less likely to be able to borrow money towards start-up costs. They are likely to be less able to cope with the early cash flow shortages that are often inevitable for fledgling businesses.

As a Member of Parliament, I am a publicly employed representative of the people, who earns about £64,000 a year. Yet if I decide to write an article, provide advice or even take on a directorship to provide me with extra income, I am legally entitled to do so. However, if an unemployed person on £65 a week wants to see whether they can make a go of a business as a painter or hairdresser and does a few jobs before coming off benefits, they are committing a criminal offence. In the new deal, there was an opportunity to recognise the fact that the informal economy plays an important part in helping people to move from unemployment to self-employment.

On the new deal programme, the test trading aspect entitled people who were unemployed to enter the world of self-employment with a six-month financial cushion between leaving benefits and setting up. Subsequently the tax credit system replaced that financial cushion. Originally there was hope that the universal credit would also be an effective tool. However, as it is currently structured it works on the narrow basis of a set number of hours and set earnings, which does not fit easily with the self-employment model. Under Labour’s policy review, we are investigating an enterprise credit that would recognise the flexibility of income derived from self-employment and replace that all-important cushion to give new start-ups the security that they need.

I want to touch on a couple of speeches by other hon. Members. The hon. Member for Watford talked about the sleepless nights that often come with running one’s own business—and, indeed, we are led to believe, with being a Conservative Member of Parliament. He expanded on his wife’s role and the lack of help that she provides him with on those occasions, which she may wish to discuss with him at a future date. He also talked about children who want to go into fields such as advertising or marketing, but who do not see setting up their own business as a viable or exciting option. He rightly mentioned the huge social value in setting up a business and going on to provide employment to other members of the community.

The hon. Member for Wyre Forest (Mark Garnier) supported Labour’s policy on a national insurance holiday for micro-businesses that take on a new member of staff. He was also right behind us on pushing the Government to take forward the late payments directive. We thank him for that support. I hope that he will be successful in persuading other hon. Members to be equally enlightened.

The hon. Member for Newton Abbot (Anne Marie Morris) shared my concern that the “mentors me” website may not provide enough support for new businesses, and she expressed the importance of that. The hon. Member for Selby and Ainsty (Nigel Adams) said how important it is to celebrate entrepreneurship and highlight people’s success. The hon. Members for Nuneaton (Mr Jones) and for Meon Valley (George Hollingbery) warned us not to give a sugar-coated view of the ease of running a business. In doing that, however, I feel that the hon. Member for Nuneaton added to the myth that Britain has a particularly difficult regulatory system. The reality discovered by the World Bank is that Britain is the easiest place to set up a new business anywhere in the EU and the fourth easiest place in the world. It is important that hon. Members speak up for all the positive aspects of running one’s own business and do not exaggerate the difficulties.

There is a broader context to the discussion. When the Government have choked off the recovery with their anti-growth policies, they cannot seriously expect the private sector to provide the growth that we so desperately need. That is why we have put growth at the heart of our five-point plan and why we called for a temporary cut in VAT; it is why we supported the call by the Federation of Small Businesses for a cut to a rate of 5% for VAT on home improvements; and it is why we are calling for a national insurance holiday for micro-businesses to boost employment at small firms.

People want more than gimmicks from Government. They want a genuine programme for growth. Where the Government deliver that, they will have our support. We recognise the vital role that self-employment can play in delivering growth, creating jobs, reducing unemployment and, most of all, giving people back their pride and their sense of belief. They need have no doubt whatever about Labour’s commitment. After all, we got Britain working for itself before.

12:20

[The Minister for Further Education, Skills and Lifelong Learning (Mr John Hayes)]

It is a pleasure to serve under your chairmanship, Mr Streeter, and to speak in this important debate, to which there have been many valuable contributions. I do not want to be excessively partisan—as you know, I regard it as vulgar—but it is noticeable that this debate has been dominated by my party, the party of business. It must be slightly disappointing for the shadow Minister that he has been so poorly served by his own Back Benches. There is almost no one here to support his—I was going to say oratory, but I do not want to overstate the case.

Ezra Pound, the great poet, said that genius is the capacity to see 10 things where an ordinary man sees only one, so I shall try to make 10 points in response to what has been said in this debate. Education was mentioned in the introductory remarks of my hon. Friend the Member for Watford (Richard Harrington), whom I congratulate on securing this debate. He led it with style and acumen, making a strong point about the importance of education, of ensuring that young people are imbued with a sense of enterprise, which permeated several Members’ contributions, and of countering the prevailing prejudice against business.

[Justin Tomlinson]

Will the Minister give way?

[Mr Hayes]

No, will not, because of time. Forgive me. Chesterton said that those who were impatient enough to interrupt the words of others seldom have the patience to think of good words themselves. I put on record that that is not true of my hon. Friend, but just in case, I will not give way.

My hon. Friend the Member for Selby and Ainsty (Nigel Adams) spoke about the importance of finance. My hon. Friend the Member for Nuneaton (Mr Jones) discussed enterprise and small business, and what a champion he is for the small businesses of Britain. My hon. Friend the Member for Wyre Forest (Mark Garnier) spoke about tax and the importance of having the right tax regime. My hon. Friend the Member for Maidstone and The Weald (Mrs Grant), who is no longer in her place, made a useful contribution on information about careers. My hon. Friend the Member for Montgomeryshire (Glyn Davies) made a point about the disproportionate effect of regulation on very small businesses. My hon. Friend the Member for Selby and Ainsty also mentioned skills, my hon. Friend the Member for Newton Abbot (Anne Marie Morris) mentioned mentoring and my hon. Friend the Member for Meon Valley (George Hollingbery) discussed the communal value of business. I think that I have covered most of hon. Members’ contributions. If I have not, I apologise. They were all immensely valuable, and are valued by the Government.

It is important to recognise the critical role that small business in particular plays in our economy. As an expert on these matters, Mr Streeter, you will know that small and medium-size enterprises are a crucial engine for growth and are critical to our national economic success in every sector. Together, they are responsible for almost half the private sector’s £900 billion output and 60% of private sector jobs. Since 2000, the 31% increase in businesses has been driven entirely by SMEs. Small business is the backbone of our nation and the driver of innovation. It is the embodiment of enterprise, because it is in start-up businesses that ideas have their genesis and subsequently germinate. Every business starts as a small business.

Politely—almost flatteringly—several Members referred to my own business career. I was lucky in business. All success in business is a combination of good luck and good judgment. I entered the IT industry when it was growing; what a great place it was to be in the 1980s. I learned there that politicians must be sensitive to the needs of business. They particularly need to understand that by and large, businesses want politicians to get off their back and on their side. The Government play their part through regulation, the tax system, information, support and pump-priming, but they must step back to let business thrive.

Having said that, I will mention the 10 things that Government can do, in the six minutes available to me. First, we are focusing on education. We are establishing an enterprise village website, which we will develop further, enabling teachers to access free online resources to assist them in developing school businesses. Secondly, on the “inspiring the future” website, we have made more information available about business and business education to at least 2,500 local enterprise champions and role models.

Thirdly, the National Association of College and University Entrepreneurs, which was mentioned in the debate, is building sustainable national infrastructure to develop and drive forward student enterprise societies across higher education institutions and further education colleges. I expect about 90 universities and 160 FE colleges to be involved in that initiative. Fourthly, reducing the small profits rate from 21% to 20% from April 2011 and reversing the previous Administration’s plans to raise the rate to 22% will undoubtedly help business.

Fifthly, we have increased the national insurance contributions threshold for all employers by £21 a week above indexation from April 2011, reversing the previous Government’s plan, which I think the hon. Member for Chesterfield (Toby Perkins) failed to mention because he is embarrassed about it. He is a decent and honest man, so I can understand his embarrassment, and I will not dwell on it further.

[Toby Perkins]

Will the Minister give way?

[Mr Hayes]

No, I cannot, because of time.

Sixthly, the Government also know that ensuring the flow of credit to viable small businesses is essential and a core priority for the Government. We want to ensure that the financial sector can supply the affordable credit that businesses need, and we would like to see more sources of credit and finance. I accept that banks have a role, but other organisations need to play their part too.

Seventhly, in April, we will launch a new seed enterprise investment scheme to encourage investment in new start-up companies. Eighthly, at the same time, we are launching two new Business Link services with an additional investment of £1.2 million and a new initiative to recruit and train 15,000 volunteer business mentors, which numerous people have welcomed during the debate.

Ninthly, as I am sure you know, Mr Streeter, the Government have placed great emphasis on start-up Britain. This is the year of enterprise. We want everyone to know what is happening in the UK, to promote enterprise and to give young people who wish to set up a business access to diverse sources of finance. We want to support SMEs with improved information and streamline the process by which they and others can get the knowledge and information that they require to set up their business.

Tenthly, the introduction of a national loan guarantee scheme to help businesses raise funds from non-bank sources, the £1 billion finance partnership to invest in medium-sized businesses and SMEs, the continuation of the enterprise finance guarantee scheme, a new export enterprise finance guarantee scheme, the continuation of the Government’s enterprise capital funds programme and, of course, the encouragement of the business angels scheme that we established will give businesses the boost that they need.

What has been repeated in speeches throughout this debate is that we need to change the culture to one that recognises that business has not only a communal role in delivering the growth that we need to prosper but also a vital role in enabling many of our citizens to achieve their potential to be the best they can be and, through that role, to create jobs and growth, seeding recovery in every community in Britain. The problem in Britain is not that none of that exists; far from it. We know from our constituencies and our personal business experience that that spirit exists. The problem is creating circumstances that allow it to thrive.

In those terms, the contrast between this Government and the last is profound. There is no doubt that the last Government were starry-eyed about the glitz and glamour of money, but it is clear that they were blind to the needs of small business and enterprise in particular. I hope that there has been a change, as the hon. Member for Chesterfield said. My hope is that we can understand throughout the House that business is virtuous, because it builds jobs, sustains growth and fuels healthy communities. My business is the promotion of growth, and my mission is the pursuit of the common good. It is clear that in that mission, I have the support of many colleagues in my party and throughout the House who share my enthusiasm for British business and my determination that business will prosper under this Government.

084 Telephone Numbers (NHS)

Tuesday 24th January 2012 Westminster Hall

12:29

[Mr Bob Ainsworth (Coventry North East) (Lab)]

Thank you very much, Mr Streeter, for presiding over my debate.

In 2008, in response to a consultation, the Department of Health concluded that for some individuals on low incomes and unable to access a fixed line, the use of NHS 084 telephone numbers constituted a significant proportion of their weekly income. In April 2010, as a result of that conclusion, the Department amended the general medical service contract and the personal medical service agreements for GP practices to ensure that

“persons will not pay more to make relevant calls to the practice than they would to make equivalent calls to a geographical number.”

GP practices were given until April 2011 to comply with the amended terms, but unfortunately, now, nine months after the deadline, Which? and other organisations estimate that 13% of surgeries in England continue to use 084 or 085 numbers that cost more than the equivalent geographical call.

One might think that as the amendment was made at the end of the previous Labour Government and we now have a new Conservative-led coalition, there would have been a change of policy, but that is denied. The Under-Secretary of State for Health, the hon. Member for Guildford (Anne Milton) said, on 12 July:

“It is absolutely clear that there is no distinction between landlines, mobiles or payphones. The directions are very clear that patients should not expect to be charged any more.”—[Official Report, 12 July 2011; Vol. 531, c. 150.]

So we can only conclude that 13% or thereabouts of GPs, including at the Crossley practice, which serves a deprived part of my constituency, and at least one other service in Coventry, are in breach of their own contracts, which were agreed by the previous Government and are supported by the current one. We have to ask why they are being allowed to continue to do that.

[Mr Geoffrey Robinson (Coventry North West) (Lab)]

Will my right hon. Friend give way?

[Mr Ainsworth]

If my hon. Friend can wait, I will try to give way later. A number of Members want to intervene.

The GPs argue that they have entered into contracts that give them enhanced telephony solutions, and that they cannot get out of them. That is the kind of thing that they say to justify their non-compliance, but none of it is true. All the arguments are flawed, and there is the simple solution of migrating to an 034 number, which provides the same supposedly enhanced telephony services. As an aside, I will say that what we mean by such services is call queuing and call diversion options. When in the middle ages people fell foul of the inquisition, they were shown the instruments of torture but not made to pay for them, but people are now being made to pay for these supposedly enhanced telephony solutions.

[The Minister of State, Department of Health (Mr Simon Burns)]

Will the right hon. Gentleman give way?

[Mr Ainsworth]

If the Minister does not mind, a number of Members want to intervene, and he will have an opportunity to respond in a moment.

The people affected are disproportionately the more deprived members of our community. It is no longer the case that people who use mobile phones are among the better-off. That might have been the case once upon a time, a generation or so ago, but there is proven evidence that people who do not have access to a fixed line and therefore depend on a mobile phone are disproportionately from the poorer sectors of society. The other people who are disproportionately affected by the excessive charges are those who are concerned about the cost of their fixed lines and have therefore entered into contract agreements that charge for the use of the access numbers for GP surgeries because they do not fall under the contracts. How can we can allow GPs to continue to flout their contracts? Why are we not effectively enforcing them?

At the moment, the Minister is trying to convey to the House that the NHS will not be made unaccountable through his health Bill, and it would really help his argument if he made an effort to show that he is prepared to make the NHS accountable, as it currently is. I would therefore like to know what he intends to do about this. I want him to issue new Department of Health guidance that makes it clear to the GPs who are effectively trying to deny it that the use of such telephone numbers is in breach of their contract and that they must comply without further delay and migrate to an 03 number or provide a landline equivalent. He must not take no for an answer.

I wonder whether all the changes that the Minister is imposing upon the NHS are affecting PCTs’ ability to enforce what they are supposed to be enforcing. I want him to ensure that PCTs, to which he appears to have passed the buck of responsibility for this, enforce compliance by GPs. GPs must stop evading their responsibilities, under the very principles of the NHS, to enable people to access services without enhanced costs.

[Mr Jim Cunningham (Coventry South) (Lab)]

Has my right hon. Friend been able to measure the profit being made from the poorer members of society, who are most likely to need the services? That might be difficult; it might be a question for the Minister. Less well-off patients are clearly being exploited, so does he have any idea how much they are being exploited by?

[Mr Ainsworth]

The GPs will deny that there is any profit and will say that they provide an enhanced service for which the customers pay. But if there is profit in the partnership at the end of the year, it returns to the doctor, so potentially there is a profit, and that would clearly be in breach of the contract. People could be provided with access to their GP services without any enhanced charges, but GPs, because they have chosen to enter into the contracts, are passing the costs on to their patients.

[Mr Andrew Smith (Oxford East) (Lab)]

I congratulate my right hon. Friend on securing this important debate, on an issue that my constituents, in Risinghurst in particular, have raised with me. I commend his suggestion to the Minister that renewed guidance be issued. Could the Department not send out with it a legally watertight template letter that any GP practice that is genuinely worried about its legal status regarding its present contract could use, to change to the cheaper alternatives that he has mentioned?

[Mr Ainsworth]

That is a good idea. If the Minister communicates with GPs again, he should do so in the strongest of terms, because it is clear that well over 10%—the estimated figure is 13%—of GPs have totally ignored the Department of Health to date. They are determined to continue not to pick up the costs of the systems that they have put in place and to pass them on.

[Jim Shannon (Strangford) (DUP)]

I am grateful to the right hon. Gentleman for bringing this critical issue to the House’s attention. Many of my constituents do not have landlines, but they have mobiles, the costs of which are extreme. A call to a doctor can cost £4, and some of my constituents’ tariffs have run out while they were on the phone. Does the right hon. Gentleman agree that it is time to return to a landline number rather than an 084 number?

[Mr Ainsworth]

The 03 number would give people an opportunity to use the system for no enhanced charge, and the GP should, if they are not prepared to migrate to an 03 number, provide a landline alternative. Since I first raised this issue, most of the people who have contacted me have been pensioners. They have told me that they have contracts with their telephone provider and have found that, at the end of the quarter, the charges under discussion are additional to the contract and therefore to their bill. People who use mobile phones are probably not as ready to contact a Member of Parliament, or do not listen as closely as pensioners to such debates. People who use mobile phones—overwhelmingly poorer people—are being charged extortionately for access.

[Dr Eilidh Whiteford (Banff and Buchan) (SNP)]

This is a very important issue, because it affects all parts of the UK. A much smaller percentage of people in Scotland are affected by 084 numbers, but more than half of them are in the Grampian health board region. I am concerned, because although I share the right hon. Gentleman’s sentiments on the difficulties faced by people in lower income groups in relation to 084 numbers, if we secure a ban on them, how will we prevent the goalposts from shifting and another revenue-sharing number from taking their place?

[Mr Ainsworth]

We can do that only if the Department of Health is determined, right up to ministerial level, to enforce the contract. The terms of the contract are clear, as I hope the Minister will say when he responds. No one should pay enhanced charges to access their GP.

[Mr Simon Burns]

indicated assent.

[Mr Ainsworth]

The Minister is nodding. Let us hope that he says that and that, for heaven’s sake, we do not have non-Government and that, having made a decision, they make sure that it is complied with across the board. I look forward to hearing the Minister’s response.

12:44

[The Minister of State, Department of Health (Mr Simon Burns)]

I congratulate the right hon. Member for Coventry North East (Mr Ainsworth) on securing this debate on the use of 084 telephone numbers in the NHS. The Government’s position is extremely clear—when patients contact their GP or anyone else in the NHS, they should not be charged more than they would be to call their next-door neighbour’s landline. Those are the rules. That is why we have retained the previous Government’s directions, published in December 2009, and regulations, passed in April 2010, which make it a contractual requirement for GP surgeries to ensure that that is the case.

Under the directions and the amendments to the general medical services and primary medical services regulations, it became compulsory for GP practices and NHS bodies to review how much it cost patients to call them. If they found that patients were being charged more than a standard local landline call, they had one year to take all reasonable steps, which could include varying the terms of their telephony contract, cancelling the contract, or offering an alternative number to call, such as an 03 number, which charges callers at a local rate. GP practices should not, in any case, enter into, extend or renew their contracts with their telephone supplier if patients are being charged more than a local call.

This legislation was the result of a lengthy consultation by the Department in 2009, to which there were about 3,000 responses. The vast majority agreed that patients should not be charged additional costs to contact their GP. However, many also valued the enhanced services they receive when calling their GP, such as queuing and additional booking options, but we are clear that that should not cost patients any more than a local landline call.

[Mr Andrew Smith]

Will the Minister give way?

[Mr Burns]

I will not at the moment, because I do not have much time to answer all the points raised by the right hon. Member for Coventry North East. [Interruption.] I might give way in a moment, although hon. Members should remember that the right hon. Gentleman did not give way to me either.

We must also be clear that the additional services can also be offered on other number ranges—such as 01, 02 and 03—and GP practices should feel able to choose the number that is most suitable for their patients, provided that it does not cost them any more to call.

Many people ask why we do not simply ban 084 numbers outright. I fear that that would not solve the real problem, which is that some patients continue to be, or believe that they are being, charged too much to contact their GP.

[Mr Andrew Smith]

Given that the Minister has said that practices should not charge more than the cost of a landline call to a neighbour, if a patient can demonstrate from their bill that they have been so charged, will they be able to get the money back, and how would they go about that?

[Mr Burns]

The right hon. Gentleman has anticipated something that I will deal with shortly, namely the 1,300 GP practices mentioned by his right hon. Friend the Member for Coventry North East that have allegedly been abusing the system.

As I have said, I fear that banning 084 numbers would not be the panacea that Opposition Members might believe it to be. The Department, to its credit, banned the use of premium-rate telephone numbers beginning 087 and 09 in 2005, but new number ranges with additional costs began to appear. Although it seems to be a simple solution, I do not think that it will be over the medium and longer term, because people will seek to avoid it. That is why it is crucial that the previous Government rightly sought to tackle the problem at source and why we have continued the policy that they introduced in the dying days of their regime. The 2010 regulations make it clear that patients must not be charged more to contact their GP than they would be if they called a local number.

Since the rules came into force, I understand that there has been confusion in the NHS about what the regulations and the directions include. I am grateful for this opportunity to clarify some of those misconceptions in the NHS and elsewhere. There have been claims that mobile phones are not covered by the 2010 regulations, but that is not true. The regulations cover landlines, mobiles and payphones equally. The legislation is absolutely clear that if a person calls a GP surgery with an 084 number from a mobile, landline or payphone, they should not pay more than they would if they called a local landline number from the same phone.

That is very important, because more and more people now use mobile phones as their primary form of communication, as has been mentioned by the right hon. Member for Coventry North East. That is particularly true of the less well-off—the right hon. Gentleman also made this point—where 25% of households only have access to mobile phones, and for young people, where a third of people under 25 only use mobile phones for communications purposes. In 2011, for the first time, the majority of call minutes originated from mobile phones.

Questions have also been raised about how a patient can challenge their GP practice or PCT if they believe that they are being charged more than the cost of an equivalent local call. Any action taken should be on the basis of robust evidence. GP practices and their PCTs should look at evidence of call costs to determine whether their patients are being charged more than they should be. Such evidence could include cost-per-call information from providers, such as O2, Vodafone and BT. A suitable sample should be considered, bearing in mind the different contracts that patients can choose to sign up to.

A practice can also look at cost-per-call information that is provided by patients. Using that information, it would be possible to compare directly the cost of calling a GP practice’s 084 number with the cost of calling a local land-line number. If the evidence suggests that using a specific number is not costing patients more than it should, the GP practice should be free to continue using 084 numbers. If patients are being charged more than they should be, they should take the steps that I have already mentioned to rectify the situation.

[Mr Ainsworth]

Although I welcome a lot of what the Minister has said, I am not at all sure that we can afford to leave this problem to the individual. There is deference towards doctors and people are loth to offend or upset their doctor. The Department and the local PCT must be prepared to take action to ensure compliance, and they should not expect individual patients to do so.

[Mr Burns]

The right hon. Gentleman anticipates a point that I was about to make. As a preface to that point, however, I must say that patients can be extremely helpful in providing evidence that can help to prove if this practice of overcharging, which is in defiance of the regulations and directions, is going on.

I now come on to the point that the right hon. Gentleman made about the figure that is in the public domain and that is used a lot, namely that there are 1,300 GP practices that are—in effect—defying the regulations and charging patients more than they should. I have made inquiries and I can find no evidence to support that figure. People say that there are 1,300 GP practices that charge more than they should; what they do not say is which practices they are, and they do not provide the robust proof that overcharging is happening.

I say to the right hon. Gentleman, and to anyone else who has an interest in this important subject, “Please send us the evidence”, because we cannot find concrete evidence that overcharging is going on. If it is going on, we want to see the evidence and we want to see which GP practices are engaged in it, so that the PCTs, which enforce these regulations, can take action. I assure the right hon. Gentleman that if we get the evidence and if it is proven that overcharging is happening, the PCTs and—after the modernisation of the NHS—the NHS Commissioning Board, which will have responsibility in this area, will also vigorously pursue the matter because, like his Government, we believe that such overcharging is unacceptable.

However, I must reiterate that we need the evidence. We do not need anecdote or the “friend of a friend”, who has said this or that. We need precise, concrete evidence, to be able to pursue this matter.

As I have said, PCTs are currently responsible for ensuring that GP practices meet the terms of their contracts, including ensuring compliance with these regulations. The Department will soon clarify the existing guidance, which I hope will help GP practices and PCTs to understand this issue more fully and to dispel some of the myths and misunderstandings about the use of 084 numbers.

This Government are committed to creating a patient-focused NHS, as the right hon. Gentleman said we were planning to do; I can confirm that he was accurate when he said that. One of the key elements of that process is ensuring that patients find it easy to access the services they need, when they need them. Using an 084 number can help a GP practice to offer additional services that improve patients’ access to care. It is right that GPs remain responsible for their own access arrangements, including their telephone number, opening hours and booking arrangements. Those arrangements will be different for different practices, and the ability of GPs to be locally responsive is something that we know patients value. Primary care is the cornerstone of the NHS. Around 90% of patient contact with the NHS takes place in a primary care setting, with around 300 million consultations per year, so it is essential that patients can easily access care, and have a choice about how to do so.

One way that we are improving access to care is through the roll-out of the NHS 111 service, which will be available to everyone in England by April 2013. That service will give the public a phone number that is easy to remember and free to call when they need help urgently but do not know where to turn. Callers will be quickly assessed, and sent to the right service on the first point of contact. The primary aim of NHS 111 is to ensure that patients get to the right service, and quickly, at any time of the day or night. In most areas, patients can also expect to be able to see their out-of-hours GP through NHS 111, which will simplify how patients access NHS services and improve patient experiences.

NHS 111 will replace NHS Direct’s 0845 4647 service, which obviously uses an 084 number. NHS Direct was exempted by the last Government from the directions and regulations, and rightly so. That is because the Department had already begun considering plans to implement NHS 111, and it would have been confusing to the public to change NHS Direct’s number shortly before introducing a new number for patients to call that will be free to the user.

By April 2013, there will be a simple system in place, whereby patients can access care quickly and easily. If there is an emergency they should dial 999, but if people do not know where to go they should dial 111, and otherwise they should continue to use their GP as usual.

I give an assurance that we take these directions and regulations very seriously indeed. We expect them to be adhered to and obeyed. I can assure Opposition Members who raised this issue that PCTs carefully monitor the situation to ensure that, when there are complaints about 084 numbers, GP practices are adhering to the regulations and not costing patients more than they should. The PCTs vigorously enforce the regulations. I also reconfirm that we are issuing clarification guidance to GPs, which I hope addresses another point that the right hon. Gentleman made.

I cannot emphasise strongly enough, however, that despite the numbers that are bandied around—as I said earlier, 1,300 is the number that is most commonly used to describe the number of GP practices that are not adhering to the regulations—we cannot find any evidence to establish the accuracy of that figure. Nevertheless, we are anxious that the regulations are enforced. So, if there is any concrete information, proof or evidence that GPs are abusing the system and not abiding by the regulations, it is important that that it is provided to the PCT, which acts as the enforcement officer. If the right hon. Gentleman himself has concrete evidence— following the research that he has conducted to secure this debate and then take part in it—and wants to send it to me, I would be more than happy to accept it and I will direct it to the appropriate body, whichever PCT it is, so that the allegation can be investigated.

In conclusion, the use of 084 numbers is controversial but we are very clear that patients should not be charged more than they would be to make an equivalent call to a local number. That is the belief and principle that underlies the policy, one that we are continuing from the last Government’s term in office. However, we also believe that we should not restrict the freedom that GPs have to improve access arrangements for their patients, provided that they are complying with the regulations. I hope that this debate has not only clarified the situation but has set a challenge to the right hon. Gentleman and others to provide evidence if they have it or come across it, so that if there are any abuses we can put an end to them.

HMS Affray

Tuesday 24th January 2012 Westminster Hall

13:00

[Tim Farron (Westmorland and Lonsdale) (LD)]

It is a great pleasure to serve under your chairmanship, Mr Streeter. I am extremely grateful to have the opportunity to raise such an important matter in this Chamber.

HMS Affray was an A-class submarine, which entered service in 1946. She left Gosport harbour at 4.30 pm on 16 April 1951 on a training exercise. She was due to resurface at 10 am the following day, but no signal was received. Within three hours of her failure to report, a major search began, in which the entire home flotilla and many foreign vessels took part. The search was scaled back on the evening of 19 April. Some weeks later, the wreck of the Affray was discovered on the sea bed north of Alderney in the Channel Islands, beneath 260 feet of water.

The tragedy took the lives of 75 men. It is clear that it could easily have been avoided and that those men lost their lives needlessly. The inquiry that took place at the time was a closed inquiry. When its details were made public under the 30-year rule in 1981, it became clear that it had been staggeringly inadequate. In the words of a widow of one of the men lost on the Affray, this was an inquiry of the admirals, by the admirals and for the admirals—it was not for those who died or for those they left behind.

The widow I have just quoted is Mrs June Tower. June is a constituent and, in 1951, she was married to 23-year-old John Treleaven. John was one of 25 trainees among the 75 crew who lost their lives. On 16 April— 61 years after the event—June will attend a ceremony on the island of Alderney, where a plaque will be unveiled to commemorate the 75 who died in the Affray tragedy. The event presents the perfect opportunity for our Government to make amends for six decades of obfuscation.

The closed inquiry in 1951 reported to James Callaghan, who was Parliamentary Secretary to the Admiralty. It reported that the loss of the Affray was most likely caused by metal fatigue and faulty welding on the Affray’s snort—a long tube added to the vessel in 1950 to act like a large snorkel. When the wreck was discovered, it was reported that the snort had snapped and that the likely cause of the tragedy was the resulting influx of water into the ship.

What was not included in the report to the Minister was the Affray’s dubious history, the extraordinary lack of experience among the crew and the fact that the Affray was carrying a significantly larger crew than normal. The mechanical problems that beset the Affray included the fact that her battery flooded without warning during trials, defects she had experienced in a starboard supercharger on her way to Australia and the need for a partial refit when she was in Singapore.

By 1950, the Affray had done 51,000 miles and was not rated highly by seamen who knew her well. Chief Petty Officer David Bennington reported that

“she leaks like a sieve and when doing a deep dive the other day the water poured into the engine room faster than we could keep it out”.

He also described an occasion when an engine broke down. After the same exercise, he stated that

“we limped in on one”—

one engine—

“and just as we arrived in the other went...I think that this boat is just about finished.”

The snort was fitted in January 1950, but it developed defects very quickly. Mechanic William Day was responsible for raising and lowering the snort, and he detailed a number of defects with the device, adding that

“as soon as we surfaced from snorkelling there was always a lot of water in the engine room”.

Lieutenant Commander Blackburn, who captained the Affray and died with his men, told the crew that they would be going on a short, five-day voyage because the Affray was booked to go into dock at the end of those five days due to trouble with her battery.

There is plenty of evidence that the Affray was bordering on unseaworthy, if not actually unseaworthy, and that the Admiralty was well aware of that. The Affray was an unfit vessel. Each of the 75 men who died was talented, dedicated and proud to serve their country, but as a collective unit, they were the wrong crew for the wrong ship—again, something the Admiralty was fully aware of.

The Affray carried 75 crew on that voyage, but she was meant to carry only 61 in peacetime. Even in wartime, which this was not, she was meant to take a crew of only 66. Worse, only 26 of those on board were part of the Affray’s regular crew. A further 20 crew members had been moved out of barracks at the last minute to take part in the exercise, due to confusion over Easter leave. There were also four Royal Marines and 25 trainees. Among those trainees was John Treleaven, who, in the words of June, his widow,

“had spent 2 years on HMS vanguard but hadn’t a clue about submarines and had never been out in the Affray”.

This was, therefore, an unfit submarine, carrying a brave but unsuitable and oversized crew. Yet, the inquiry, which was hushed and rushed, reporting just three and a half months after the tragedy, concluded that the cause of the loss of 75 men was a snapped snort pipe. The snort was no doubt snapped, but was it the cause of the tragedy or the result of an explosion caused by the faulty battery? I have no idea, but the closed inquiry made no serious attempt to look at the issue.

When all is said and done, though, there are two failures for which the Admiralty must take responsibility. One was sending out a vessel with 75 men on board when it was clearly not fit for duty. The second was sending out an ill-prepared, inexperienced crew on such a ship. It is entirely possible that an accident happened that day and that it could have been mitigated had the crew been smaller or more experienced.

One of the other widows, Mary Henry, who was married to First Lieutenant Derek Foster, told June that she had found her husband in the garden on 15 April, the day before the Affray set sail. He was working unusually furiously at his garden, and his wife inquired what was upsetting him. He replied that

“we are taking a gash—or rubbish—crew and they’ll all be sick and get in the way, it’s dangerous”.

June Tower talked to one of the men who was taken off the crew at the last minute due to double booking and the complications over Easter leave. He told June that

“it was incredible that they took those trainees out in the Affray, if there had been an emergency they wouldn’t have known what to do”

He added that

“the affray leaked like a sieve, she was always turning turtle but nothing that an experienced crew couldn’t deal with”.

He explained that the 20 crew who were swapped over at the last minute to allow those in barracks to join the ship were later told by their superiors not to talk about the incident for fear of blackening the Navy’s name.

That gives us a clue as to what happened in the hushed and rushed inquiry. Britain was, and remains, rightly proud of her Navy. In 1951, we were in the early and fevered days of the cold war, and out in Korea, it was getting decidedly heated. The foolhardy decision to allow an unfit ship, crewed by the inexperienced and the untrained, to take part in a challenging exercise, which led to such a dreadful tragedy, must have been a matter of huge embarrassment to the Admiralty and the Navy as a whole. The need to present a picture of an invincible Navy must have overridden the need to ensure justice for the families of the dead. However, that was 61 years ago. Do we need to allow those considerations to haunt us today, while June and other relatives are still yearning for answers? I am sure the answer is that we do not, of course, need to allow those considerations to hold us back.

June Tower is an incredible woman. For 61 years she has sought justice for John. Now, she is a widow for a second time. Like the other relatives of those who died, she is delighted by the decision to unveil the plaque to them. She is hugely grateful to the Essex Submariners Association, which has led the work in raising the funds for, and organising, this important memorial. When John died, she was overwhelmed by the gifts of condolence sent to her and the rest of the bereaved families from right across the Commonwealth. Happily, she remarried in December 1954. She married a GP, Julian Tower, with whom she spent more than 50 wonderful years. When she and Dr Tower married, the Affray fund provided her with a generous dowry. She says that she has much to be grateful for and many to be grateful to.

The great shame is that the Navy and the country to whom June’s first husband was so dedicated, and for which he gave his life, have acted quite differently. We have had a hushed and rushed inquiry, a lack of truth and no contrition, no admission of fault and no apology. I hope my hon. Friend the Minister agrees that that is a dishonourable position for us to be in. I hope he will do all in his power to put that right.

June is clear that the wreck of the Affray is a grave and that it should remain undisturbed. She does not want it lifting to the surface, and she does not want divers to risk their lives to investigate it, because it lies on the bottom of the English channel. However, there is sufficient evidence above the water for there to be a reinvestigation of the evidence, and I formally ask the Government to do just that. Secondly, June and the other relatives of the crew deserve an apology from the Royal Navy and Her Majesty’s Government for the mistakes made in sending out an unfit submarine with an inexperienced crew. Thirdly, I would be grateful if moneys remaining in the Affray fund could be utilised to pay for the maintenance of the bronze plaque on Alderney, so that it will remain a fitting and proud tribute to the 75 who lost their lives.

June wrote a delightful and extremely moving book about her relationship with her husband John, culminating in the Affray tragedy. She wrote the book, “Maritime Mail”, because she wanted to provide a memorial for those brave men. The plaque and June’s book are tremendous memorials and outstanding tributes to a brave crew who died needlessly. The most important tribute that we can pay them today is to agree that a reinvestigation should take place and that an apology should be made.

13:11

[The Minister for the Armed Forces (Nick Harvey)]

I commend my hon. Friend the Member for Westmorland and Lonsdale (Tim Farron) on raising this important issue through the vehicle of an Adjournment debate. I acknowledge his concerns for his constituent, who lost her first husband in this tragedy. I would, of course, like to pass on my sympathy to her and to all the families and relatives of those who were affected by this loss. I also have a constituent affected by this, Mr Kevin Cook, whose father went down on the Affray in the months before he was born. He has approached me for help with this issue as a constituency MP.

As my hon. Friend explained at the outset of his speech, it is now 50 years after the Affray was lost with all hands. However, what passes as history for many can remain a fresh concern to some, particularly if they feel—as clearly my hon. Friend’s constituent does—that there remains unfinished business. We have a duty to ensure that concerns are addressed as fully as they can be and that they are dealt with sensitively, within the bounds of what can reasonably be achieved this far after the event.

Let me set out a little of the background. HMS Affray was an A-class submarine completed in 1946. The class had originally been designed to undertake operations in the far east during the latter part of the second world war. The submarine used diesel-electric power-plant. Diesel engines were used for surface propulsion and charging of the electric batteries, which were used to power electric motors for propulsion when dived. Subsequently, Affray was fitted with a snort mast, which was a breathing tube to permit the submarine to run its diesel engines while at periscope depth, much reducing the chances of it being detected.

As we have heard, on 16 April 1951, Affray left Gosport on a training exercise under the command of an experienced submarine captain, Lieutenant Blackburn. There were 75 men on board and she was scheduled to make a surfacing report by radio at 10 o’clock the next morning, 17 April. When that was not received, Operation Subsmash was ordered in accordance with standard submarine search and rescue procedures, beginning at 11 o’clock the same morning. Over the next few days, many ships and aircraft were involved in the search for the Affray, but, sadly, to no avail. On 19 April, the Admiralty accepted that the Affray was lost, with no reasonable hope of any survivors. It was not until 14 June that the wreck of Affray was detected and identified north of Alderney in the Channel Islands, lying in 260 feet of water. In the following months, divers from HMS Reclaim spent much time investigating the wreck, hoping to discover the reasons for her loss. That was considerably dangerous work.

The board of inquiry convened to investigate the loss of HMS Affray presented an interim report on 19 July. The board considered a number of possible causes. Material failure was considered the most likely cause. That was not, however, a definitive finding. The board also considered issues of human error or the possibility of collision. The board of inquiry continued to seek further evidence. Diving continued to be carried out on the wreck, using some of the most advanced techniques available at the time, but no firmer conclusions could be reached and diving was brought to an end in early November 1951.

The final report of the board of inquiry reached conclusions that were broadly similar to those of the interim report: that the submarine was lost because of the material failure of the snort mast, which broke off without warning, and that the resultant rapid influx of water resulted in the submarine dipping markedly by the stern, becoming increasingly heavy and sinking to the bottom. The board also concluded that the rapidity of events did not allow the release of position indication signals, that the crew died rapidly and that the search organisation was rapidly and energetically implemented.

The report was laid before the House on 14 November 1951 by the First Lord of the Admiralty, Mr J P L Thomas. It noted that there was no certainty about the reasons for her loss and that the broken snort mast might be either the cause or the consequence. The Government judged that any attempt to salvage the Affray would be dangerous, expensive and not at all certain to be successful. With the extra risk to life that salvage would have incurred, the Government decided that it was best not to proceed. As a result, the definitive cause of the loss of the Affray could not be proven and the wreck of HMS Affray would therefore be the final resting place for the 75 souls on board.

As I am sure the House will agree, it is fitting that that grave is now protected from being disturbed under the Protection of Military Remains Act 1986. I took note that my hon. Friend told us that his constituent’s clear preference was that it should not be disturbed. As Members may be aware, claims were made in print in 2007 alleging that the true cause of the loss of the Affray was known but suppressed to spare the embarrassment of senior naval officers. A study of those claims has been carried out by the Naval Historical Branch of the Royal Navy, but it has concluded that there is no reason to disagree with the findings of the original board of inquiry. Indeed, scrutiny of the paper trail around the inquiry found that it was far from a review carried out by the Admirals for the Admirals, which was, I think, the expression my hon. Friend used. In fact, far from the Royal Navy hierarchy encouraging the board of inquiry to the conclusion that what happened was caused by the mast snapping, they were, on the contrary, very sceptical about that account. They did not encourage the inquiry down that line, but continued to question whether that was the true explanation. Some people have called for a new inquiry to be launched on the basis of those various allegations.

I listened to the points that my hon. Friend has raised today. He stated very confidently that this was an accident that could easily have been avoided and that the lives were lost needlessly. I cannot see any evidence that enables so bold a statement to be made. It is perfectly true that there had been problems with the condition of the vessel, but it had spent three months in the dockyard earlier in 1951, during which time most of the serious problems were addressed.

Furthermore, it is true—this is, effectively, common practice—that the Affray was booked in for further repairs to be carried out. However, the decision on whether or not she was fit to go to sea was not taken by the hierarchy of the Admiralty in the fashion described by my hon. Friend; the decision rested with the commander of the vessel, who was, as we know, a popular, decorated and extremely experienced captain. He judged that the vessel was in a fit condition to go to sea, although it is also true that there were more people on board than usual because the exercise was going to combine two different training exercises: one for the submarine crew and one for a small number of Royal Marines who were on board for that purpose. Again, the captain made the decision that the size of the crew was reasonable in all the circumstances, and that it was appropriate to go out to sea with that number on board.

Some of the issues that have been raised, and some of the points that were made separately in the Bennington letters, were known to the Board of Inquiry when it was considering the events that led up to the tragedy. We cannot say with any certainty at this point what the board members made of each of those pieces of information, but we can say with reasonable confidence that those factors were known about at the time, and were considered by the Board of Inquiry. I am struggling to see that new evidence is available today that was not available to the Board of Inquiry when it looked into the matter. It is my duty to tell the House that in the absence of any new evidence, it would not be possible to authorise a new inquiry. The main purpose of a Board of Inquiry is to ascertain the cause of an incident so that a recurrence can be avoided.

The House will understand that submarines of the same class as Affray have been out of service for more than three decades. Indeed, we do not even have any diesel electric submarines in the 21st-century Royal Navy. The subsequent safety record of the Royal Navy submarine service since the sinking of Affray has been excellent—Affray was the last submarine lost at sea—so it is exceedingly unlikely that a new inquiry could make recommendations that would materially affect the running of our modern nuclear-powered Vanguard, Trafalgar or Astute class submarines. A new investigation, even with new technology, would involve significant expense and significant risk, and we would have to be realistic about what it would be capable of discovering, particularly if we respected the wishes of those who would not want graves to be tampered with.

My hon. Friend also raised a question about the Affray fund. It is an independent fund, and is not controlled by the Ministry of Defence. The trustees are the Lord Mayor of Portsmouth, the mayor of Gosport and the Public Trustee. If he wishes to pursue any matters pertaining to the fund, it would be best if he addressed them to the trustees.

Submarines are complex ships, operating in an environment that is extremely dangerous, even in peacetime. Submariners operate at the limits of human ingenuity, and that is to their credit. They are among the bravest men in the Royal Navy, and soon to be the bravest women too. The loss of Affray and the men who served on her was a national tragedy, as well, of course, as a personal tragedy for many. We all understand only too clearly why those who were personally affected want definitive answers, but nothing can bring the fallen back, and after more than 50 years, there seems to me to be no realistic likelihood that we can ever provide the answers that, for understandable reasons, they crave. I cannot see that any new evidence is available to us now that was not available to the original Board of Inquiry. The passage of so much time seems to me to make the prospect of discovering anything new infinitesimal.

[Tim Farron]

The Minister is right to say that there is not much in the way of new evidence, but there are two clear sides that were never really put together. He referred to Affray’s dubious service and maintenance history, and the technical and mechanical problems that it experienced. It is the marrying together of sending the craft out in that state with a crew that was oversized and, probably crucially, under-experienced—25 trainees and a crew that was two thirds inexperienced in that ship—that makes Mrs Tower and me believe that those in charge were culpable. I accept that the argument about the inquiry is one thing, but an apology should be made for that poisonous cocktail of an inexperienced crew and an unfit vessel.

[Nick Harvey]

I have already touched on the points about the condition of the vessel. The records of its condition were all available and properly documented at the time. They were available to the Board of Inquiry to consider. It is true that Affray had had some service and maintenance issues, but there is no particular evidence that their number was unusually high for submarines at that time. Therefore, the decision by the commanding officer and the chain of command was based on their judgment at that time about the safety of the vessel. There is no evidence that anyone can see that they were pressed to take the vessel out. According to the standards of the day, the risk was within the parameters of what they considered to be normal. It is also true that there was quite a large number of relatively inexperienced trainees on board at the time, but again that was not radically out of the ordinary. The captain judged at the time that the blend of experience and trainees on board was acceptable, and that the vessel was fit to set sail.

I would be hugely regretful and deeply sorry if either of those factors contributed to the loss of the Affray, but there is no evidence in truth that either factor did. We must be realistic about what we can hope to establish as definitive fact 50 years after the event when a Board of Inquiry conducted in the immediate aftermath with all the information at its disposal at the time was not able to say with certainty exactly what the cause was. It remains a huge tragedy for the Navy and a personal tragedy for those involved, but after more than 50 years, I just cannot see any new evidence or any realistic prospect that we would be better able to identify the cause of the disaster now than we were at the time.

I am delighted that in April some of the relatives will go out to commemorate the anniversary. I hope that my constituent, who is planning to go with them, finds the experience moving and meaningful, but I just do not think that there is anything we can do to put to bed the unanswered questions, because I do not believe that any more information is available to us today than was available then. I fear that the 75 souls who were lost will have to be left in peace on the sea floor, and that we will not find out anything new as a consequence of the allegations that have been made in the recent few years.

Legal Aid (Women and Families)

Tuesday 24th January 2012 Westminster Hall

13:30

[Mr Virendra Sharma (Ealing, Southall) (Lab)]

It is a great honour and a privilege to present this debate under your chairmanship, Mr Streeter. Legal aid was first established by the post-war Labour Government under the Legal Aid and Advice Act 1949. It was established to ensure that ordinary members of the public who cannot afford legal fees can obtain legal services when they need them in areas such as family law, mental health, education, immigration and asylum, consumer issues, welfare benefits, employment and criminal defence.

The aim of legal aid is to ensure that individuals are able to defend or to enforce their rights, or to obtain advice on how to tackle the problems they face. As a result, it plays a key role in tackling social exclusion, and in helping individuals to protect their rights against richer and more powerful opponents. Since its creation, it has formed a central plank of the post-war welfare state. It is the arm of the welfare state that keeps the other arms honest and ensures that they are all directed towards the public good.

Legal aid funds private practitioners to provide that service, rather than setting up a legal equivalent of the NHS. As a result, many legal aid practitioners provide support through a comprehensive network of outlets, often run by self-employed individuals in small partnerships, as opposed to the state directly contracting lawyers. But that makes them uniquely vulnerable to major systemic shocks, such as current plans brutally to cut social welfare legal aid.

[Rehman Chishti (Gillingham and Rainham) (Con)]

I am grateful to the hon. Gentleman for giving way and congratulate him on securing this important debate, which I know he cares passionately about. On funding and sustainability, does he accept that our legal system costs more than £2 billion a year and is one of the most expensive in the world and that that is, in current economic and financial circumstances, unsustainable?

[Mr Virendra Sharma]

The hon. Gentleman is a lawyer who has practised in the past. I will respond to his point later.

The Government know that many legal aid practitioners provide support in the way that I have described. That is why the Cabinet Office has taken over this Minister’s mess and is trying to ensure the long-term viability of the advice sector. Legal aid support, particularly early intervention, demonstrates effective value for money for the taxpayer. According to cost-benefit analysis by Citizens Advice, for every £1 of legal expenditure on housing, debt, benefit and employment advice savings are made, although I will not give all the figures, which I am sure are available to hon. Members. As a result, it is clear that the savings made by cutting the legal aid budget will be dwarfed by increased costs elsewhere to the public purse. That is why cuts to advisory services, particularly to welfare advice, are both short-sighted and short-termist.

There is also a human cost. In any given year, legal problems such as divorce, eviction or debt will be experienced by one in every four people, but by one in three people with long-term sickness or disabled people, half of unemployed people and half of lone parents. People with one unresolved problem often accumulate other problems rapidly. If you cannot resolve early-stage problems, more problems will often accumulate and end up in a vicious circle. These cycles can result in people losing their jobs and income, suffering stress-related illnesses and experiencing relationship and/or family breakdown.

[Kate Green (Stretford and Urmston) (Lab)]

I, too, congratulate my hon. Friend on securing this important debate. Does he agree that if we do not deal with the whole cluster of problems, we might allow problems to get worse? If people’s employment and debt problems are related, and we resolve the debt problem but not the employment one, we are merely postponing the problem and it will come back again.

[Mr Sharma]

I thank my hon. Friend for her important intervention. I agree with every word that she said. I will come back to this matter and develop it later in my speech.

Such problems are closely related to social exclusion, poor outcomes for children and levels of crime and antisocial behaviour, all of which represent significant costs to public services. Children whose families are experiencing civil and social problems are more likely to become involved in truancy, exclusion, and offending.

For the past 40 years, local law centres have been providing legal advice and support to the most vulnerable and needy in their communities. In the late 1970s and early ’80s I worked as an advice worker in a law centre and have experience in that field. I dealt with communities that suffered due to unemployment and other reasons. Law centres are an essential part of community life and are the first port of call for many people experiencing social and civil legal problems.

Law centres must be protected because of their experience. They have been working for 40 years with local communities, building a relationship with the public, landlords, organisations, local authorities and projects. They have local access; they are well established in communities; they are easily accessible; and they are trusted by communities. The brand power of law centres, like citizens advice bureaux, lies in their having gained public trust and confidence. They provide face-to-face advisory services and build trust and stronger relationships with clients. Services provided by the 52 law centres in England and Wales can be divided into three strands, namely individual casework, education and prevention, and developing policy. All three strands of services provided by law centres and CABs demonstrate the important strategic role played by these organisations in their local communities.

[Rehman Chishti]

On advice centres, does the hon. Gentleman welcome the fact that this Government will spend £4.7 million to fund 44 court-based independent domestic violence advice positions across the country, which clearly shows that they are committed to supporting the most vulnerable in our society?

[Mr Sharma]

I will answer that question later in my speech.

Issues raised in individual casework are often the root causes of problems faced by communities, which places law centres in the unique position of being able to disseminate information to other support bodies and to propose remedies. Research by the New Economics Foundation calculated the contribution of law centres by quantifying the social value such institutions provide and found that for every £1 invested in a law centre, a further £15 of social value is generated.

Family legal work remains the most costly area for the civil legal aid budget. It covers issues of child welfare and protection, as well as divorce, property and relationship breakdown issues. The proposals have retained legal aid for cases where domestic violence or forced marriage is involved and for cases where children’s safety is in danger.

[Jim Shannon (Strangford) (DUP)]

I, too, congratulate the hon. Gentleman on securing this debate. A lady in my area who reared her children and left her job, and depended on her husband for income, finds herself needing legal aid after a messy divorce, but cannot receive it. Does the hon. Gentleman share my concern that families—ladies in particular—will find themselves vulnerable at this time?

[Mr Sharma]

I agree. As I stated earlier, the impact will be on families in society.

Abundant research has been carried out into the adverse consequences of family breakdown. There is also ample evidence suggesting that job loss, financial difficulties and loss of income can bring about family break-up. Therefore, the provision of advice for other civil law problems, such as employment, housing and debt are important in preventing problems from escalating.

The Government’s proposals would seriously damage access to justice, especially for the most vulnerable in society. The Ministry of Justice impact assessment shows that there will be a disproportionate effect on women. Similarly, the cuts disproportionately impact on black and minority ethnic clients and those with disabilities. As legal aid is targeted to those with low incomes, it will have a disproportionate effect on this section of the community. However, it is likely that those on very low incomes will be particularly negatively affected.

And then there is domestic violence. I direct the Minister to a speech of great power delivered by the noble Baroness Scotland in another place to the Minister, Lord McNally:

“look at the average case, such as when a woman has run from her home. She manages to go to her GP, who sees the injuries and notes them and then sends her to hospital because there are fears that she may have cracked a rib or another bone. She is seen by the medical staff and they verify that the injuries that she complains of are genuine. Her neighbours may have come in to rescue her from an assault. They may not have seen the assault taking place but have noted what was happening and taken her away. Social services may have come along and examined the children, spoken to them and heard what they had to say. All of that might have been used by the police who then came along and arrested the man. He may then acknowledge that he has indeed committed the offences that are alleged against him. Even if all those things had happened, under”

the Government’s current

“provisions the woman would not be entitled to legal aid. That cannot be right.”—[Official Report, House of Lords, 18 January 2012; Vol. 734, c. 595.]

[Rehman Chishti]

Does the hon. Gentleman accept, in relation to the interdepartmental working between the Ministry of Justice and the Home Office, that the Home Office is providing more than £28 million of stable funding until 2015 for specialist local domestic and sexual violence support services and £900,000 to support national domestic violence helplines and the stalking helpline, and that that shows its commitment on this issue?

[Mr Sharma]

Again, the hon. Gentleman makes a very good intervention, but at the same time we need to consider the impact of the reductions and where the resources are going. That is what the debate is about.

[Alex Cunningham (Stockton North) (Lab)]

Does my hon. Friend agree with the noble Baroness Scotland that the definition that the Government plan to adopt on domestic violence could result in some 46% of the cases that currently attract legal aid no longer doing so?

[Mr Sharma]

I thank my hon. Friend. Every hon. Member who has spoken has made a very good intervention. I agree with what he has said and am sure that everyone will have recognised and noted it.

I was referring to the speech delivered by Baroness Scotland. She is a practitioner of great experience and ability and is, of course, right.

I am fortunate enough to have the brilliant Southall Black Sisters in my constituency of Ealing, Southall. It is one of the UK’s leading organisations for black and minority ethnic women, and it told me that those women will be particularly hard hit by the Government’s plans. It said that

“the Legal Aid Bill will make it difficult for all vulnerable sections of society, especially BME women, to access justice and in doing so, remove meaningful legal protection from them and instead push them into community forums such as religious arbitration tribunals where not only will they be denied justice and protection but they will be encouraged to reconcile with abusive partners in order to uphold so called religious and family values. Women who have experienced and are at risk of violence and abuse will be at further risk of domestic and sexual violence, sexual exploitation and forced labour.”

It has been widely reported as fact that women who have experienced domestic violence will still be eligible for legal aid in private family law proceedings, such as disputes concerning the care and upbringing of children, but that is simply not the case. Experts in the field have unanimously raised the concern that too many women who have experienced domestic violence and need help will fall through the gaps in the proposals.

[Mrs Helen Grant (Maidstone and The Weald) (Con)]

Does the hon. Gentleman agree that men are likely to be financially better off than women and therefore better able to pay for legal work privately and that women are more likely to be in non-unionised jobs?

[Mr Sharma]

I agree with every word that the hon. Lady has said. I am sure that the Minister will also take note of those points in his response.

Experts in the field cite two particular concerns. First, the definition of domestic violence currently used in the Legal Aid, Sentencing and Punishment of Offenders Bill is inconsistent with the cross-Government definition of domestic violence, which guides statutory agency practice and governs access to Government services. Importantly, the definition used in the Bill fails explicitly to refer to financial abuse and sexual violence, which are particularly insidious forms of domestic violence. It is not clear why the Bill uses a different definition of domestic violence, unless the purpose is to restrict the number of cases that will be deemed eligible for legal aid. Under the current proposals, many who are already known to be victims of domestic violence by other departments will not obtain the legal support that they need.

[Karl Turner (Kingston upon Hull East) (Lab)]

I am obliged to my hon. Friend for giving way; he has been very generous. I wonder whether he would like briefly to address the fact that 23 special domestic violence courts are closing on the current Government’s watch. How will that affect women?

[Mr Sharma]

I think that I will come back to that. I thank my hon. Friend for the intervention. When I reach the last lines of my speech, he will hear about the impact of the various proposals on women.

Under the proposals, victims of domestic violence will be expected to provide “objective evidence” of that violence to qualify for legal aid. Experts unanimously agree that too many victims will remain ineligible for legal aid because the evidence that they will be required to present is dangerously restrictive. The evidence of domestic violence that the Government propose to accept relies on victims taking civil and criminal proceedings against perpetrators, yet we know that a large proportion of victims do not take those routes. To ensure that all women affected by domestic violence are protected, it is essential that the evidential criteria used reflect the experiences of women and the reality of domestic violence. That must include evidence from specialist domestic violence organisations, health services and social services. The Government have failed to think through their proposals adequately.

The notion that “We are all in it together” is not alien to the Labour party. Indeed, this may be the first time that a Conservative Prime Minister has adopted a socialist slogan as his mantra. However, these cuts are deliberately, unashamedly and, I argue, viciously targeted at those who most need help. I am looking at the time; I am sorry, but I have indicated that I need to rush. As I have said, the cuts are targeted at those who most need help and, in the case of domestic violence sufferers, there can be no defence.

I ask the Minister to think again, particularly on domestic violence. In its current form, the Bill will leave thousands of women who have experienced the trauma of domestic violence, trafficking for the purposes of sexual and other forms of exploitation and exploitation as a migrant domestic worker in a private household with a stark choice between representing themselves in legal proceedings or taking no legal action at all to protect themselves. It will also have a life-threatening impact on black and minority ethnic women, who, as a result of cultural, religious and other social pressures and racism, already struggle to access the legal system. The Bill will violate the rights and fundamental freedoms of all vulnerable women, but it will have an immensely disproportionate impact on black and minority ethnic women.

It is not too late to think again, but if the Minister does not make up his mind to do what I have asked, I pray that my colleagues in the other place will make his mind up for him.

13:47

[The Parliamentary Under-Secretary of State for Justice (Mr Jonathan Djanogly)]

I congratulate the hon. Member for Ealing, Southall (Mr Sharma) on securing the debate. This is an important topic and one that we have discussed at length. I recognise a number of Bill Committee colleagues in the Chamber today. As the hon. Gentleman said, the issue is still being discussed in the other place, as the Legal Aid, Sentencing and Punishment of Offenders Bill continues its passage through Parliament. However, I welcome the opportunity to have a debate on this specific topic today.

It is notable that the subject of the debate on the Order Paper emphasises the effects of our reforms to legal aid, rather than leading us to debate only the justification for those reforms. It may be helpful, therefore, if I give the wider context for our proposals, without which a proper response about the effect on women and families cannot be given.

I start by confirming that the Government are committed to the principle that domestic violence victims need support both legally and otherwise. The Home Office is providing more than £28 million of stable funding until 2015 for specialist local domestic and sexual violence support services and £900,000 to support national domestic violence helplines and the stalking helpline.

The Ministry of Justice has contributed towards the funding of independent advisers attached to specialist domestic violence courts since 2007-08 and will have contributed just over £9.25 million by the end of 2012-13. In addition, the victim and witness general fund will provide a total of nearly £15.5 million in grant funding over the next three years to voluntary sector organisations that support the most seriously affected, vulnerable and persistently targeted victims of crime. Of that, nearly £4.7 million will be used to fund 44 court-based independent domestic violence adviser positions across England and Wales for the next three years. My hon. Friend the Member for Gillingham and Rainham (Rehman Chishti) was right to mention that. We will also allocate nearly £3 million a year for the next three years to 65 rape crisis centres, and we are working with the voluntary sector to develop the first phase of the new rape support centres where there are gaps in provision.

Domestic violence protection orders are being piloted in three police force areas. They are designed to give immediate protection to victims by banning a perpetrator from returning to the house, thus giving the victim the breathing space that they need to consider their next steps. Such orders show a real commitment by this Government to tackling domestic violence—and, if I may so, it is a commitment that is rarely recognised or taken into account when directing criticisms to our proposals for legal aid.

[Karl Turner]

I am obliged to the Minister for giving way. Will he address the point that I made in my earlier intervention? What effect does he think that the closure of 23 special domestic violence courts will have on women?

[Mr Djanogly]

The hon. Gentleman is avoiding the reality of the situation. In all except for fewer than five of those courts, the service is being transferred to other surrounding courts. I will write to him with the specific details because I do not have the numbers in front of me.

With that context in mind therefore, I will move on to the specific issue of the legal aid reforms. The £2 billion annual cost of legal aid, combined with the economic climate of the day, mean that hard choices must be made. It is essential that resources are focused on cases where legal aid is most needed—that is where people’s life or liberty are at stake, where they are at risk of serious physical harm or immediate loss of their home, or where their children may be taken into care.

As well as retaining legal aid for criminal cases, we are also keeping legal aid for mental health matters, asylum matters, debt and housing matters where someone’s home is at risk and legal aid for judicial reviews of public authorities. All of those are directly relevant to family welfare. That means that we are retaining legal aid to seek an injunction to prevent domestic violence and to oppose a child being taken into care. We are also retaining legal aid for private law family cases where domestic violence is a feature. We will also be keeping and extending legal aid for family mediation. The power to waive the financial eligibility limits in cases where someone is seeking an injunction against domestic violence also remains, so those who need help securing protection will be able to get it.

[Mrs Grant]

Does the Minister agree that excluding undertakings from the domestic violence gateway could have the perverse effect of encouraging litigation, thus potentially increasing costs?

[Mr Djanogly]

As I said in Committee, the Government are looking at the question of undertakings and that continues to be our position. We hope to come forward with that as the Bill progresses through the other place. If I am to say very much more, I will not be able to take any further interventions.

We are also retaining legal aid for all child parties in family cases, and of course exceptional funding will be available in any out-of-scope case where a failure to provide legal aid might breach the European convention on human rights or EU law. Taken together, we expect such provisions to mean that we will continue to spend around £120 million a year on private family law legal aid, based on 2009-10 figures. When we include legal aid for public family law matters, spending will well exceed £400 million, again based on 2009-10. We will continue to spend nearly £130 million a year on legal representation for child parties. That represents around 95% of current spend.

I accept that women and children will often be directly and indirectly affected by private family law proceedings, but, as I have said in the past, we have had to make tough choices here. We cannot afford to fund generally lengthy and often intractable disputes in the family courts. However, we know that mediation can lead to better results that are consensually and less acrimoniously agreed and that are potentially longer-lasting than those imposed by a court. We expect an extra 10,000 mediations a year, which is up from the current figure of around 15,000.

Mediation will not always be appropriate, however, particularly when domestic violence is involved. We know that it can have a devastating effect on women and children, as well as men, who are a significant and often overlooked group of domestic violence victims. Domestic violence is also a significant predictor of children being taken into care as well as a precursor to all sorts of other social problems. On top of that, we also know that perpetrators of domestic violence can assert a controlling, insidious power over their victims, which could potentially stop a victim from effectively presenting their case against the perpetrator in court. On those points, I agree with the hon. Member for Ealing, Southall and with Baroness Scotland. However, the hon. Gentleman’s example of a woman who would not get legal aid after running from an abusive husband is not accurate. That sort of case would get legal aid. When a person is convicted of domestic violence against a partner, the partner will be eligible, as conviction would count as evidence. That is why we have made a large, and extremely important, exception in our proposal to remove most private family legal aid from scope of our reforms—that is where domestic violence is a feature.

There has been much debate about the definition of domestic abuse in the Bill and the fact that we do not use the definition of the Association of Chief Police Officers. We are considering that as the matter proceeds through the other place.

There has also been much focus on the evidence criteria for domestic violence to qualify for legal aid in private family law cases. We need clear, objective evidence of domestic violence to target taxpayers’ money on cases where the victim needs assistance. The allegation, which has again been made today, is that the Government’s criteria will miss a great number of genuine victims, and various pieces of evidence have been adduced to support this, and we will continue to look at them. They include the evidence provided by Southall Black Sisters, who have made a significant contribution to the whole case.

Those pieces of evidence refer to domestic violence victims as a whole and point out their difficulties in dealing with the civil or criminal justice systems. We are dealing with a subset of that group—those who are seeking private family law legal aid. They will have, in certain respects, slightly different characteristics to domestic violence victims as a whole. By definition, they will be engaged in the civil justice system. A significant number, nearly 10,000 in 2009-10, will be seeking civil legal aid for a protective injunction at the same time as they seek legal aid for their private family law matter. They will all meet the evidential criteria. We know that in total there were 70,000 legal aid family cases in 2009-10. Let me compare that figure to the prevalence of the types of evidence that we are requesting. Around 24,100 domestic violence orders were made in 2010, the great majority with the benefit of civil legal aid. Around 74,000 domestic violence crimes were prosecuted in 2009-10, and there were 53,000 domestic violence convictions. Around 43,000 victims of domestic violence were referred to Multi-Agency Risk Assessment Conferences in the 12 months up to June 2010.

We also propose that an ongoing criminal proceeding for domestic violence and a finding of fact in the courts will be taken as evidence. Now these figures will clearly overlap to some degree, but what they point to is that a significant proportion of those 70,000 private family law cases that we currently fund will continue to be funded. We think that this proportion will be around 25%, which matches our rough estimate of the prevalence of domestic violence. I should also say, though, that this comes from a number of sources, and definitive evidence is not available.

I have also committed to look again at whether the issue of undertakings in a court can be used as evidence. We are clear about the need to ensure that those who are victims of domestic violence and need legal aid can access it and these requirements are designed to enable that.

Turning to legal aid for children, we have protected funding in areas that specifically involve children. We have retained legal aid for child protection cases, civil cases concerning abuse of a child, and for cases concerning special educational needs assistance. We have also made special provision so that legal aid is available for children who are made parties to private family proceedings.

I should highlight that in civil cases, such as clinical negligence, claims brought in the name of a child are usually conducted by their parents acting as the child’s “litigation friend”, rather than the child themselves. That is a normal part of the rules around civil litigation. As I mentioned earlier, there will also be an exceptional funding scheme for cases where legal aid will not generally be available, which will take into account a person’s ability to represent themselves in legal proceedings where the European Court of Human Rights applies. That will clearly be an important factor in the case of children who might otherwise be left to present their case without assistance.

It is worth noting that the Government published an equality impact assessment, which laid out our assessment of the effects on women of planned changes to legal aid. It recognised the potential for the reforms to have an impact on women and children, but in the context of the cuts that need to be made, and the deliberate focus of legal aid on those who are most vulnerable and in need, we do not believe that this impact is disproportionate.

I do not pretend that the choices we have had to make will have no impact, but they needed to be made.

14:00

Sitting adjourned without Question put (Standing Order No. 10(11)).