Preventing Avoidable Sight Loss

Melanie Onn Excerpts

Tuesday 28th March 2017 Westminster Hall

[Melanie Onn (Great Grimsby) (Lab)]

It is a pleasure to serve under your chairmanship, Mrs Gillan. I congratulate the hon. Member for Wealden (Nusrat Ghani) on securing the debate. To lose one’s sight partially or wholly, gradually or rapidly, is a life-changing experience. Ordinary, everyday activities that were once straightforward become increasingly complicated, with simple tasks taking longer, and people create their own adaptations in order to cope. The number of people who live with sight loss in the UK is predicted to double to about 4 million by 2050. Due to our ageing population, more people are living with conditions that can lead to visual impairment, such as diabetes.

Loss of sight is more prevalent in my constituency, which is having a dramatic impact on quality of life, particularly among older people, yet we are failing to provide sufficient access to preventive treatment. In October last year, Northern Lincolnshire and Goole NHS Foundation Trust was found to have nearly 22,500 appointments overdue at its three hospitals. More than 12,500 of those were at the Diana, Princess of Wales hospital in Great Grimsby, with hundreds of people at least eight months overdue for appointments. Across all three hospitals, the department most affected was ophthalmology, with 2,200 appointments overdue in Grimsby alone.

By 2030, there are expected to be 7,050 people in north-east Lincolnshire living with sight loss, an increase of 32.5%, and 980 living with severe sight loss, an increase of 38%. That increase is largely because we have an ageing population and, generally, the older someone is, the more likely they are to suffer from loss of sight. That is important, because visual impairment has a considerable impact on our psychological wellbeing, which means that older people are three times more likely to experience depression caused by sight loss, not to mention isolation and loneliness.

Yet as the RNIB and the hon. Member for Wealden have pointed out, nearly half of sight loss is avoidable. Timely access to treatment, including follow-up appointments and the effective monitoring and management of eye conditions, is vital to preventing unnecessary loss of or deterioration in sight. It is important because successful treatment of many conditions is time-dependent. That is why it was so shocking to learn in late October last year that up to 800 patients in the eye department of Northern Lincolnshire and Goole NHS Trust who are potentially at risk of harm were left waiting—many of them for months on end—to be told what treatment they needed. Additional clinics were arranged to deal with the backlog, but patients should never have been left for such an extensive period of time without any check-ups or assessment of their condition.

In that area of the world there is a shortage of clinicians across the board, but particularly in ophthalmology, which adds to the strain on the system. When asked about the backlog of patients, the leadership at Northern Lincolnshire and Goole Trust said that they knew about it and saw it grow, yet they failed to draw up a coherent plan to address it, despite it being a year on from the tragic 2015 case of Brian Critten, a patient at Scunthorpe general hospital, which is run by the trust. In an investigation that was launched after Mr Critten alleged a failure in duty of care, the hospital acknowledged that there might have been an opportunity to identify his cancer earlier if a cataract operation had not been cancelled and subsequent appointments not repeatedly postponed.

We cannot continue with a situation where preventive treatment is missed. The NHS must work with stakeholders, including the RNIB and other charities, to develop and implement a strategy that ensures adequate eye care services across England. I was contacted by Scartho Eyecare, an optician in my constituency, and informed that we are one of the few areas with no optical enhanced services—services that can ease the burden on GPs and on hospital ophthalmology services. There is apparently capacity to help at a lower cost to the NHS, but it has not been taken up. Perhaps the Minister will reflect on that in his speech.

It seems irresponsible that eye care strategies exist in Scotland, Wales and Northern Ireland, but that England does not have a strategy to meet the future needs that have been highlighted. Surely now is the time to get that right.

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Health (David Mowat)]

It is a pleasure to serve under your chairmanship, Mrs Gillan. I congratulate my hon. Friend the Member for Wealden (Nusrat Ghani) not only on leading the charge today but on her work on the APPG more generally. A number of Members have made the point this morning that we have not debated eyes and sight in this place very much over the past few years. It is good that we have the time to put that right today, so I congratulate her on doing so.

I start by acknowledging what a number of Members have said—that 50% of sight loss is preventable. I think my hon. Friend said that 85% of people regard sight as the most precious of all our senses. Frankly, I am surprised that the figure was not higher than that. This is clearly massively important. We can debate numbers—the hon. Member for Burnley (Julie Cooper) just talked about £28 billion—but the key figure is the statistic that my hon. Friend the Member for Twickenham (Dr Mathias) started with. Some 20 people a month are losing their sight, whether due to lack of prevention or lack of early treatment, in ways that are preventable. That is not acceptable, and we need to work collectively to address it—I will try to set out the Government response to it now.

I will talk first about prevention and the need for early detection and improved treatment. We heard about waiting lists in Great Grimsby, which I will come to. I will also talk about the social exclusion that can occur, and the mental health issues that can come from that. As I go through, I will try to address the points raised during the debate by Members on both sides of the House. If I do not, I am sure Members will remind me that I have not; in any event, we will write on any points that are not directly addressed.

The UK vision strategy was produced jointly with the RNIB, which does a lot of extremely good work in this space, for which the Government are grateful. Both the Department of Health and NHS England fully support that strategy, and need to continue to drive it forward. We also support global issues; Members have talked about the WHO global plan, which intends to eliminate preventable sight loss by 2020, and my hon. Friend the Member for Wealden talked about some of the work we do globally. She talked about patient choice and the referral process—whether it is via GPs or direct—which is an interesting point that I will come to. She talked about STPs, as did the hon. Member for Burnley, cancelled appointments and the need for a national strategy in England. I will come back on those points, if I do not get to them during my remarks.

To frame the issue, 2 million people in the UK have sight loss—because sight loss is so related to age, 4 million people will almost certainly be affected by 2050—and 80% of those are over 60 years old. Several Members cited statistics illustrating the demographic changes, including the hon. Member for Strangford (Jim Shannon), who spoke about Northern Ireland. As we debate these things across health and social care, we have to recognise the incredibly significant changes to our demography.

When the national health service was set up in 1948, one person in four lived to be over 65. We have totally fixed that, in the sense of increasing longevity. In the last 10 years, our population has increased by 10% and our population of over-85s has increased by nearly 28%. That trend will continue and accelerate, which gives us all challenges, including resourcing and all that that means. I heard a very apposite phrase recently: “We have done a good job of increasing quantity of life, but we haven’t yet increased quality of life to the same extent.” That is true of sight loss. As we heard, 148,000 people are certified blind in this country, with all that that means in terms of benefits and tax changes. That figure has been fairly stable—indeed, it has gone down slightly in the past three years—but nevertheless, it presents us with a big challenge.

In responding to those changes, we have to look at prevention and understand the risk factors. I have just covered the first risk factor, which is age. We cannot do a great deal about that, other than note that we are all getting older. Like the hon. Member for Strangford, I am over 50—considerably so—and the fact is that the sight loss numbers are driven by age. Smoking and obesity also play a big part in eye health, as they do in other aspects of health. Our tobacco control strategy will be produced imminently. We have done a good job in this country of reducing smoking, but we need to go further and faster, and I hope that the strategy will be a big part of that. There will be specific targets by age group for what we need to achieve. Obesity is equally and possibly more important; it is a risk factor for all sorts of things. I perhaps did not fully understand that obesity affects people’s chances of getting cancer, dementia and suffering from sight loss as much as it does. We need to drive home the potential benefits of the obesity strategy that we published, which aims for a 20% sugar reduction by 2020.

Hon. Members, including the hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron), mentioned cataracts. Obesity doubles the probability of getting a cataract. That is an extraordinary statistic given that it is not intuitive that those are linked, even though they clearly are. I do not want this debate to be about money—what we are talking about is more important than money—but the cost to the country of obesity and diabetes put together means that we now spend more in the NHS on treating them than we do on the police service, the judiciary and the Prison Service combined. That puts into perspective the magnitude of the cost and what we need to achieve.

On prevention, we have not talked about the screening programme that we have introduced for diabetic eye disease, which was the principal cause of blindness in working-age people until recently. As a result of the programme, which involved offering a digital photograph to all people with diabetes over the age of 12, something like 2 million people were screened last year. For a screening programme, there was a very high uptake—over 80%—and some evidence shows that it has resulted in significant progress in preventing that type of blindness. This is the first year for which we have those figures, and diabetic eye disease is no longer the principal cause of blindness in working-age adults. That has largely been achieved through that very effective screening programme.

Let me talk briefly about the four most common causes of blindness, which are cataracts, age-related macular degeneration, glaucoma—that is the most prevalent, as we have heard—and diabetic eye disease. All of those can be treated most effectively through early diagnosis—frankly, that applies in most areas of health, but it is particularly true of eye health—and the first part of that is timely sight tests. Sight tests are free for children at school, although parents have to arrange them. They are also free for the over-60s, for anybody who is in a high-risk group, including those with diabetes or glaucoma, and for people on various income-supported benefits. There were 13 million eye tests last year, which was an increase of 2%. There is always a case for doing more, and I say to anyone who is listening to this debate, even if they are not of such an advanced age as me or the hon. Member for Strangford, that these things are worthwhile.

Treatment is CCG-led in this country. The principal reason relates to some of the issues that we heard about from the hon. Member for Great Grimsby (Melanie Onn), who spoke well about the large numbers of people on the waiting list of the Northern Lincolnshire and Goole NHS Foundation Trust and the extra clinics that had to be put on. That is a CCG responsibility. With national strategies, there is a choice about whether something should be locally focused, with local commissioners having the resources and money—although resources are a different issue—or whether there should be an overarching national plan.

I was struck by what the hon. Lady said about the actions that were taken. Those were local actions, which were completely appropriate. In England, we produce a public health outcomes framework—I do not think that is the case in Scotland, notwithstanding the excellent speeches by the Scottish National party Members about what is done in Scotland. The framework sets out for every local authority area in the country the extent to which there is glaucoma, diabetic eye disease and age-related macular degeneration, and the total number of people who are certified blind. Those data are tracked over the years and ought to inform local commissioners, and indeed, local health and wellbeing boards in the priority areas. There are striking differences and clusters of different types of blindness and different issues in different areas.

To cite a few of those differences, Barnsley has three times the national average of age-related macular degeneration and twice the national average of people who are certified blind. To me, that suggests that the commissioners in Barnsley should, in particular, be putting effort and resources into treating AMD. London has something like 20% more diabetic eye disease than other parts of the country. That may be to do with the large south Asian population in parts of London and the diabetes that that implies. Those sensible decisions should be taken by local commissioning groups in the knowledge of the facts. I commend the public health outcomes framework to hon. Members, who may not have looked at it for their own constituencies and patches. That should be considered and understood, because for this and other issues, it tells us where the priorities ought to be.

[Melanie Onn]

If CCGs are to focus on providing more support for a particular service, it prompts the question, “What will support be taken away from?” The trust in my constituency has now gone into financial special measures. There is only so much give in the system. What does the Minister think is the solution?

[David Mowat]

I did say, when I was making the point, that I was not talking about priorities in terms of total resource there. We must make choices. I will come to the point about the £20 million budget.

The hon. Member for East Kilbride, Strathaven and Lesmahagow mentioned concerns that cataract operations were being rationed. In response, the Secretary of State requested that NICE issue guidelines this year rather than next year, and we will pursue that. However, I make the point that 17% more cataract operations are being done in England now than five years ago. That does not imply rationing to me, but we need to be careful. Operations should not be rationed, and we want NICE guidelines in place to ensure that they are not.

I will address some of the points made by hon. Members. My hon. Friend the hon. Member for Wealden mentioned referral pathways. She is right to say that different CCGs do things differently. Some CCGs will require an optician to refer a patient to a GP, who then refers onward to the hospital or ophthalmologist; around 11% of CCGs do not do so, which is quite odd. I will ask officials to investigate why. The principle is that CCGs are responsible for setting their own pathways. It is not for the Government to tell them what to do, but it is possible—indeed, likely—that some might not have wholly addressed the issue.

There is a general drive right across the health service to do more things in the community and fewer things in hospitals. Part of that involves using opticians in the best way possible, and not just on this issue. Although it has not been mentioned in this debate, I would like to see opticians used much more for glaucoma monitoring and other such things that, at the moment, tend to happen in hospitals, because as we have heard, there is a great deal of strain on a number of hospitals. We will try to make progress on that issue. I am happy to sit down with my hon. Friend and the Royal National Institute of Blind People, as she asked, to talk about it in more detail.

My hon. Friend mentioned shared delivery plans. She said that only 50% of STPs include a coherent eye strategy, and the hon. Member for Burnley said that some of those looked like tick-box exercises. I accept that, and I have two points to make. One is that an STP is not an organisation but a planning document, which must be put in place to begin to establish planning areas across the country where we can marry up prevention, primary care and secondary care. Not all STPs have yet addressed all the issues that they should; they are a process, not an event. I say to the people concerned about that that they should keep lobbying their local STP leadership, who are responsible for addressing it. Frankly, many STPs have a long way to go to become coherent plans, and eye health is just one area on which we need to make more progress.

We heard about the issue of cancelled appointments. They are a particular problem with eye appointments, which can be time-critical; the figure of 20 avoidable sight losses a month was quoted. The principles governing missed appointments across the NHS apply in exactly the same way to eyes as they do to all other things. The NHS constitution sets out an 18-week limit. I have heard speakers in this debate mention clinics where 50% of appointments are not attended. Such numbers are completely unacceptable. What is hard to understand in that context is that in the last five years we have increased the number of consultant ophthalmologists across the patch by around 27%. That does not imply that the problem is staffing, but I will take the issue away and consider it. I reiterate that the same provisions that apply to all aspects of our NHS apply to eyes and to national waiting lists. People who fail to get appointments for which they are clinically ready should be on a national waiting list. We should performance manage it in that way.

My hon. Friend the Member for Wealden mentioned choice, rightly saying that people are entitled to choice in their secondary care. The same principle applies to eye care as to all other types of care, but there is more that we can and must do to build awareness.

I will touch briefly on the issue of an eye strategy. I have asked why NHS England feels that it is better for it to be owned and controlled locally; I made the point previously about the degree of local variation. We heard some instances from Northern Ireland, where there is an eye strategy, that show that it is not a panacea. As a Minister, I have a general view. There are a lot of strategies, but many fewer clear action plans with deliverables and accountabilities. It is rather like what we heard about in Great Grimsby. My preference is to work with NHS England and with Health Education England, if it is a question of getting more people into roles and all that goes with that. Having said that, I am happy, as I said, to talk to my hon. Friend the Member for Wealden and the RNIB more generally, but overall, across the health system, I do not see a lack of strategies. I sometimes see a lack of action plans with accountabilities and clear deliverables. My bias is towards the latter, not the former.

On the point about rationing, the NICE process is an attempt to create, across the whole health system, coherent guidelines and structured ways to evaluate different medicines. Broadly speaking, a cost of £20,000 per quality-adjusted life year is used by NICE to decide whether a drug should be offered or not. However, the point about the £20 million cap is slightly different. The cap is being introduced, potentially, for new drugs; it would not apply to any existing treatment. We are accelerating new drugs coming into the system. The cap would act as a trigger point: after £20 million has been spent, a renegotiation with the manufacturer would take place. On that point, I will sit down and allow my hon. Friend to sum up.

Oral Answers to Questions

Melanie Onn Excerpts

Tuesday 21st March 2017 Commons Chamber

[Mr Hunt]

I am very happy to meet my hon. Friend. He will know that the surgery got an £80,000 grant this year through NHS England’s general practice resilience scheme, but I am aware that there are lots of pressures on surgeries such as St Luke’s and I am happy to talk about it further.

[Melanie Onn (Great Grimsby) (Lab)]

I am delighted to hear the Secretary of State issue some information about the additional GPs who will be coming on stream in the coming years. How many will be coming to north-east Lincolnshire and when will they be there? We have a critical shortage of GPs and people are struggling to get appointments.

[Mr Hunt]

The hon. Lady is absolutely right that areas such as Lincolnshire find it particularly difficult to attract GP recruits, which is why we have set up a fund that gives new GP trainees a financial incentive to move to some of the more remote parts of the country. This is beginning to have some effect, and I am happy to write to her with more details.

Social Care

Melanie Onn Excerpts

Wednesday 16th November 2016 Commons Chamber

[Melanie Onn (Great Grimsby) (Lab)]

It is a pleasure to follow the thoughtful and heartfelt comments of my hon. Friend the Member for Heywood and Middleton (Liz McInnes).

Today is Unison’s SOS—save our services—day of action, so I join it in calling on the Government to ensure that social care is properly funded, so that people in this country can be properly looked after.

In the past six years, the largest share of cuts has fallen on local government. Given that councils spend a third of their budget on social care, the Government will have known from the very start that social care would be one of the biggest casualties of their spending programme.

The budget of North East Lincolnshire Council has been cut by more than £70 million since 2010, with a further £7 million of cuts to be made by next year, causing spending on adult social care in my constituency to fall by 20% since 2010. People have been forced to live in completely unacceptable conditions, because there is not enough funding to provide adequate care.

I know of wheelchair-bound adults living in a care home in Great Grimsby who have been waiting for over two years for the button that automatically opens the door out of their flat to be fixed. At the moment, until a carer comes to visit, they are effectively trapped in their own home. That is an unacceptable position to leave people in, but it is just one example of the state of social care today.

The council has had to limit access to adaptations by increasing the thresholds for accessing them and capping spending. Disabled and elderly people are therefore often left in unsuitable housing. Understandably, that is also hugely frustrating for carers who are trying their best to look after people in inadequate conditions, while having continually to fight the council and care providers for the improvements they need.

A constituent who cares for his adult son was told by occupational health about six months ago that his home needed the back door widened and a ramp and lift installed. He feels as though he is being deliberately fobbed off, rather than getting the help he needs to look after his son properly. It is as uncomfortable for the son to live in those conditions as it is frustrating for the father to be unable to look after him properly.

Today, the Communities and Local Government Committee took evidence from family and friend carers who save the state so much money. One issue that was raised was the disconnect between the NHS and local authorities at the point of discharge from hospital. There were reports of families feeling abandoned when discharge occurs, with very limited support being accessible and no single point of contact or dedicated service to guide people through the options available to them and their families. That heightens the risk of readmission to hospital for many of those patients, costing the state even more money.

The carers spoke of the neglect of their own physical and mental health, with their overriding concern being for their loved ones. Respite that had previously been offered is ending. We heard the example today of two hours of respite being provided a week. That does not seem like an awful lot, but it was a lifeline to the women who came and gave evidence. That was provided by a local charity and funded by the local authority. It is now going to end because of cuts being made to and by the local authority.

We also heard about a looming crisis in intergenerational care, with a gap of hundreds of thousands of carers predicted over the next 10 years. The pressure on social care services provided by the state is only set to increase. As we heard at Prime Minister’s Question Time today from my hon. Friend the Member for Bradford South (Judith Cummins), there are also problems with dementia and Alzheimer’s services.

The social care precept is not the way to solve this problem. As we have heard, the areas with the highest demand for care are often those where the precept will raise the least. Furthermore, the Chair of the Health Committee, the hon. Member for Totnes (Dr Wollaston), claimed earlier this month that the additional funds raised through the precept have been “entirely swallowed up” in higher wages for carers. Although I am glad that carers are being paid more, albeit still not a proper living wage, councils are therefore unable to allocate any of the new funds to improving care.

When the right hon. Member for Tatton (Mr Osborne) announced the social care precept this time last year, he said:

“The truth we need to confront is that many local authorities will not be able to meet growing social care needs unless they have new sources of funding.”

Although the Government have accepted the need to better fund social care, they still need to find that new money if the growing demand for care is to be met. This is not only about supporting people who need that support in their old age or because of a disability; it affects us all. As the then Chancellor also said last year:

“The health service cannot function effectively without good social care.”—[Official Report, 25 November 2015; Vol. 602, c. 1363-64.]

Failing to fund social care properly means that patients are forced to remain in hospital for weeks longer than they need to, blocking beds for new patients who need them and pushing up hospital waiting times. Meanwhile, every day the patient is kept in hospital costs the NHS far more than caring for them in a suitable environment would.

Baby Loss

Melanie Onn Excerpts

Thursday 13th October 2016 Commons Chamber

[Will Quince]

Absolutely; the hon. Lady makes a very good point. I will mention that a bit later. Charities such as the Twins and Multiple Births Association do incredible work in this field; one of my hon. Friends raised that issue earlier.

[Melanie Onn (Great Grimsby) (Lab)]

Following on from the point about mothers who experience late-term baby loss and the treatment that they receive in hospital, very often they are kept on maternity wards, which can be incredibly traumatic. The point was made about tailoring care and support for parents who lose their children. Is remaining on a maternity ward the most suitable option for them?

[Will Quince]

I thank the hon. Lady for that point, which I will come to in a moment.

Begging the indulgence of the House, I would like to share my experience, in the spirit of showing people outside the Chamber how important it is to talk about this, if we are able to. We found out at our 20-week scan that our son had a very rare chromosomal disorder called Edwards syndrome, a condition that is rather unhelpfully described as being “not compatible with life”. We knew throughout my wife’s pregnancy that the most likely outcome would be stillbirth, but our son was an incredible little fighter, and he went full term—over 40 weeks. He lost his life in the last few moments of labour at Colchester general hospital.

To pick up on the hon. Lady’s point, Colchester has a fantastic hospital that has a specialist bereavement suite called the Rosemary suite, where we got to spend that really special time—including before the birth, because we knew what outcome was, sadly, likely. I got to stay with my wife; we got to stay there overnight; we had a cold cot, so that we could have lots of cuddles. We could continue, the next morning, to spend time with our son. I completely agree with the hon. Lady, which is why my hon. Friend the Member for Eddisbury (Antoinette Sandbach) and I had a debate in November last year on bereavement care in maternity units. Bereavement suites are so important. In this country, in the NHS, there should never be any excuse for a mother and father, or a mother, who have lost a baby to go back on a maternity ward with crying babies, happy families and balloons; that is just not appropriate or acceptable. Having gone through that experience, I know that what people need is the peace and quiet to come to terms with the personal absolute tragedy that has just happened.

NHS Spending

Melanie Onn Excerpts

Wednesday 6th July 2016 Commons Chamber

[Karin Smyth (Bristol South) (Lab)]

The Public Accounts Committee, of which I am a member, has published seven reports since January on the workings of the Department of Health, including on diabetes, the cancer drugs fund, services for people with neurological conditions, access to GP services, acute hospital trusts, NHS clinical staff and personal budgets in social care. We have had two further hearings, for reports yet to be published, on discharging older people from hospital and specialised services.

I recommend those reports to those on the Government Front Bench—I have a few copies with me, just in case they do not wish to watch the football tonight. Taken together, they paint a bleak picture of a system under immense pressure, with commitments undelivered, a massive increase in complexity as a result of the Health and Social Care Act 2012 and, above all for the Public Accounts Committee, continuing poor data upon which to make decisions and manage performance, as well as a complete lack of clarity about accountability for delivery on the areas we have investigated.

The concerns outlined in our reports include: on staffing, that trusts have been set unrealistic efficiency targets, and that the shortage of nurses is expected to continue for the next three years; on funding, that the financial performance of trusts has deteriorated sharply, and that this trend is not sustainable; and that the data used to estimate trusts’ potential cost savings targets are seriously flawed.

[Melanie Onn (Great Grimsby) (Lab)]

Northern Lincolnshire and Goole NHS Foundation Trust has only just been taken out of special measures, but last week’s Care Quality Commission report highlights a concerning dip in standards at Diana, Princess of Wales hospital. The bosses have said that that is because they struggled to recruit quality staff. Does my hon. Friend agree that removing the NHS nursing bursary is long-term pain for short-term gain?

[Karin Smyth]

I agree with my hon. Friend. In fact, one of the reports I have with me is the one we published in December about the work of the Care Quality Commission and some of the concerns that have already been issued about the work it does to uncover issues such as the ones she has highlighted in her constituency.

Points of Order

Melanie Onn Excerpts

Tuesday 7th June 2016 Commons Chamber

[Mr Speaker]

I say to the hon. Gentleman and the House that there is a firm convention that if a Member intends to visit the constituency of another Member on official business, as opposed to purely private or personal business, the Member whose constituency is being visited should be notified in advance. Nothing is written down anywhere, but it would be a courtesy to notify the Member sufficiently in advance that he or she could be present, or at least in the vicinity, in his or her constituency if it was so wished. That would rather depend on the circumstances of the event, but there should be proper notice.

In the case of Ministers, the requirement is stipulated in the ministerial code. If that has not been complied with in this case, it is regrettable. The hon. Gentleman has made his point and it will have been heard by those on the Treasury Bench. Doubtless it will be communicated, in the forceful terms in which he typically expresses himself, to the Secretary of State.

I hope that it will not be necessary for this point constantly to be raised and then underlined by me from the Chair. It is an elementary courtesy and I think that a lot of people who are listening to our proceedings will think, “Surely colleagues can treat each other in a civil and grown-up way, as would happen in other institutions.” Indeed, I note in the distance some agreement with the point I have just made.

[Melanie Onn (Great Grimsby) (Lab)]

On a point of order, Mr Speaker. I fear that I am going to disappoint you, because my point of order follows on from that exact point, although it does not relate to Ministers. I discovered that the hon. Members for Wellingborough (Mr Bone) and for Corby (Tom Pursglove) were in my constituency last week with the Grassroots Out campaign. They were not on official business, but were campaigning, and they failed to advise me in advance. Will you remind all Members that, by convention, we notify each other in advance? I might not have wished to be there alongside them, however.

Another issue is that factually incorrect information was shared with my constituents. I am sure that the hon. Member for Wellingborough would be horrified to learn that he misled my constituents, in the same way that I am horrified. How can he correct that?

[Mr Speaker]

I am very grateful to the hon. Lady for her point of order. With reference to her last point about allegedly factually incorrect information being disseminated to her constituents, I am bound to say to her that that is a matter of politics. Although I do not know the people of Great Grimsby, I dare say they can bear with stoicism and fortitude the proffering of views to them with which their locally elected Member of Parliament may disagree. That is not a matter for the Chair. [Interruption.] I do not think it is fishy. However, a visit was undertaken, admittedly not by Ministers, but by Members engaged in professional business, and the hon. Lady should therefore have been notified.

Given the context of the EU referendum campaign, I recognise that there will be Members—including doubtless the hon. Members for Wellingborough (Mr Bone) and for Corby (Tom Pursglove)—who may well visit a great many constituencies in a concentrated period. Nevertheless, the convention is an important courtesy and should continue to apply. It is not very difficult or time consuming to comply with it, so I hope that colleagues on both sides of the House will do so from now on.

World Autism Awareness Week

Melanie Onn Excerpts

Thursday 28th April 2016 Commons Chamber

[Jess Phillips (Birmingham, Yardley) (Lab)]

I speak as a mother currently on the long waiting list for diagnosis. I thank everybody for their comments today.

I am delighted to speak in this debate. Like everybody else, I commend the right hon. Member for Chesham and Amersham (Mrs Gillan), who is a tireless campaigner on this issue—a subject incredibly close to my heart. So many misconceptions about autistic people get thrown around, such as “Everyone is somewhere on the spectrum”, which I am sure we hear a lot in this place, or my favourite, which is that people with people with autism have some sort of superpower or special gift. I can tell everyone now that they do not.

Last Friday, I watched the newly released DVD of “Star Wars: the Force Awakens” with my sons and their lovely autistic friend. Between us we decided that what appeared as the teenage tantrums of the new Dark Lord, Kylo Ren, was perhaps just him needing a bit of a “time out”. We concluded that perhaps he was autistic and just could not fit into the world he found himself in. Perhaps the new Death Star was just too noisy and made him feel stressed out. We thought he might wear the mask because he did not like eye contact. I am not sure that this was the film-maker’s intention, but it softened us to him. The group of people I was with “get” autism and ASD—they live with it every day—so they can see how a person’s behaviour might alter if things start to kick off. To all of us, it is not the person with autism who has the problem—it is the rest of the world. We have to think differently about people who think differently.

On every street I visit in Yardley, I meet families struggling with autism in adulthood or in their children. My postbag is full of heart-breaking cases of how much autistic people are struggling. In my constituency there is an amazing autism support group called Spectrum, where every meeting is packed with parents who want a break. This is not a minority issue—it is a growing issue, and we are not keeping pace with our provision, our awareness or our attitudes.

Today I want to focus on how the world needs to think differently about employment for people with autism. Only 15% of working-age people with autism are currently in work, according to the National Autistic Society. For any parent with a child with autism, this presents a heart-breaking and bleak future—but it does not need to be. Ambitious about Autism has identified that in fact 99% of young people with autism want to work.

So what can we do? The Department for Work and Pensions has made some impressive commitments over the past few years in saying that Jobcentre Plus will implement autism awareness and autism networks. I welcome all this, but in reality it is not what people in my constituency are experiencing. One constituent told me: “I do not blame the staff, but it comes down to a lack of understanding of autism. The support the jobcentre claim to be providing is not there. I was treated as though I had no disability and left to my own devices. That is the problem of having an invisible disability.”

[Melanie Onn (Great Grimsby) (Lab)]

At a meeting last week, somebody raised the issue of jobcentres specifically regarding the personal independence payment and self-assessment of people with autism or Asperger’s as being incredibly difficult. Why does that continue to be part of the process?

[Jess Phillips]

I could not agree more. Another of my constituents told me just this week how the jobcentre had failed to recognise the need for his mother to be able to attend meetings about his PIP arrangements and to change his benefits. That has resulted in frequent incidents of faltering benefits, which has made him incredibly vulnerable and left him with totally insecure finances.

On another occasion I heard of a mother who wanted to access a bus pass from the local authority for a home-to-school scheme, in order to get her son travel-ready for when he leaves school in a few years’ time so that he will be able to go on the bus on his own. She was given a “computer says no” answer and told to come back in the few years when it would actually matter. However, because she is a mum with an autistic child, she knows it is going to take time and training.

We have got to be bold and flexible. We have got to think differently about how we make our services and the world’s jobs available to people on the autistic spectrum. Although things are not perfect, we have come a long way from the days when a person in a wheelchair could not have a job because they could not access the building. Autistic people may not face a physical barrier like a staircase, but the barrier effect is exactly the same.

Not providing fair and equal access to these people is not only wrong; it is also illegal, and we have got to make sure that employers know that. We need employers to understand how an interview might feel to somebody with autism. It is terrifying enough for somebody who is neuro-typical, so I ask Members to imagine for a second that they do not want to look someone in the eye, find talking in front of strangers impossible, or find it impossible if two people speak over each other.

Ambitious about Autism has just launched its “Employ Autism” campaign to transform the employability of young people with autism. I ask everyone in this place to do as I have done and offer to provide work experience to young people with autism. I imagine that I will learn as much as my placement, possibly more. I also encourage Members to ask our local business improvement districts, chambers, local enterprise partnerships and businesses to offer tailored work placements and apprenticeships. That will help us all to think differently.

I want to stand here and say with confidence to every young person with autism and every parent with a child on the autistic spectrum: you can do anything. I want to say: your future is bright. I want to say it to myself, for my son. I want to say it to my son’s “Star Wars” fan friend. But I can’t. I don’t know what the future will be like for them. So let’s try to change it. Let’s think differently.

--- Later in debate ---

[Melanie Onn (Great Grimsby) (Lab)]

I join in the congratulations to the right hon. Member for Chesham and Amersham (Mrs Gillan) on securing the debate and on all her work on this issue. Last week, I was invited to Grimsby autism forum, which was held at Open Door. It is a fantastic group that helps to give people with autism and their families a voice in the many different systems that they find themselves thrust into.

I would like to raise some of the issues that were shared with me at the forum. There seem to be two main areas of concern: problems with diagnosing autism and Asperger’s, and a lack of post-diagnosis support and subsequent pathways. From speaking to the parents, I got the impression that diagnosis was seen as something of a golden ticket to the support and help that they are desperate for, but they really have to work for it. It sounds as though there is a hurdle every step of the way.

There is the fundamental problem, at least in Grimsby, that no one knows who is responsible for diagnosis. There is no clear division of responsibility between the clinical commissioning group and the child and adolescent mental health services. The issue is particularly acute for 16 to 18-year-olds. As a support worker put it to me, “If you are 16 to 18, you can forget about being diagnosed”. I would be grateful to the Minister if he clarified which body has the legal responsibility for diagnosis for people between those ages, and if he explained why they are not currently being diagnosed.

Many parents feel that schools, the local authority and the clinical commissioning group are reluctant to statement children, which prevents them from accessing the additional services they need. Does the Minister believe that there may be an issue in that councils and schools are not as proactive as they could be in diagnosing children? Some people have complained about assessments being done out of area. If long journeys are likely to exacerbate the worst symptoms of the condition, some people simply will not take their children, who will therefore miss out on the help they so desperately need.

Autism and Asperger’s on their own can be difficult conditions for people and their carers to cope with, but as was said by the hon. Member for Congleton (Fiona Bruce), who is no longer in her place, comorbidity is very common and can make diagnosis even less likely. It is a real frustration for carers when people receive help for ADHD or anxiety depression, for example, before they even receive a diagnosis for what they feel is the core problem. Obviously, help for co-existing conditions is welcome and necessary, but when it supersedes autism or Asperger’s support, it is simply seen as messing around at the edges.

Whether or not children have been successfully diagnosed with autism or Asperger’s, they are still held back in their education and find it difficult to break into the jobs market. Too often autistic children are put in the naughty box at school. NASUWT research shows that most teachers do not feel they have had adequate training to teach children with autism, which is worrying given that 70% of autistic children are educated in mainstream schools. I believe that children with autism can absolutely succeed at school, but if teachers are not properly equipped to help them, they are too often simply written off. I find it shocking that, as the hon. Member for Dudley South (Mike Wood) mentioned, the majority of school exclusions are for children with special educational needs, yet they account for only 15% of all students. How can that be compatible with section 85 of the Equality Act 2010, which specifically prohibits discrimination against a pupil

“by excluding the pupil from the school”?

On leaving school, young people with Asperger’s and autism often struggle to maintain long-term employment, or even to get a job in the first place. Navigo, a charity in Grimsby, runs shops and garden centres that provide opportunities for work and training for people with mental health conditions. It is a really valuable scheme, and as my hon. Friend the Member for Birmingham, Yardley (Jess Phillips) mentioned, I would like more employers from outside the charity sector to do the same. I am sure there is plenty that the Government could do to promote employment for people with mental health conditions in the public sector, as well as to incentivise private sector firms to do so.

Of course, some employers already do a lot to encourage disabled people to apply for jobs with them—for instance, by including the “Positive about Disabled People” symbol in their job adverts. Although disabled people are advised to look for that symbol in adverts, I do not understand why jobcentres do not hold lists of employers in the local area that are so certified. Surely that would be a relatively simple and helpful step for jobseekers with autism and Asperger’s. I hope the Minister will join me in calling on my local jobcentre to collect such information and start sharing it with autistic jobseekers.

Overall, there needs to be a better understanding of autism and Asperger’s across society, diagnosis needs to be much more common and the process for parents who are seeking a diagnosis needs to be made much easier.

National Minimum Wage: Care Sector

Melanie Onn Excerpts

Wednesday 23rd March 2016 Westminster Hall

[Paul Blomfield]

My hon. Friend is absolutely right. Indeed, arising from our last debate, six investigations were commissioned. I asked a parliamentary question about those investigations. They were launched in February 2015 and have yet to report. That is clearly a disgrace.

I was talking about the human stories in my constituency. I know of two local women who work for a care company that uses GPS technology to monitor when they arrive for and leave appointments. They told me their stories. The company monitors the time that they spend travelling; to be accurate, it monitors the distances that they are travelling, but it does not pay them for that time. Incidentally, the company also rips them off on the cost of travelling; it pays them 12p a mile for using their own cars, when Her Majesty’s Revenue and Customs assumes for its calculations that 45p a mile is a reasonable benchmark.

One of the women, Sharon, told me that it was not unusual for her to be out of the house at 6.15 in the morning and not return until 11 o’clock at night. She gets a break, but she is only paid for seven hours’ work, which is the time she is actually at appointments. Never mind how long it has taken her to get to an appointment or to travel between appointments. Consequently, a so-called “hourly” rate of £7.52 means that, according to Melanie, who works alongside Sharon:

“A 15-minute visit is worth £1.88”.

These women have even been refused payment for the time they have spent waiting for ambulances to arrive for people in their care. Why do they put up with that abuse? As Sharon told me:

“You get in a bit of a trap, because I actually do love the work.”

We should be ashamed that tens of thousands of people like Melanie and Sharon across the country, who look after our most vulnerable, are treated in that way simply because they care.

It also makes a mockery of our national minimum wage legislation. Let us be clear that it is a criminal offence knowingly not to pay the national minimum wage. However, the situation has not improved since we last debated this issue. In fact, there are signs—

[Melanie Onn (Great Grimsby) (Lab)]

Does my hon. Friend agree that it is a disgrace that only 36 English councils out of 152 that are responsible for social care stipulate in their contracts that home care providers must pay for workers’ travel time?

[Paul Blomfield]

I do indeed and I pay tribute to those councils that are now changing their rules, so that when they commission they require workers’ travel time to be paid. Hopefully, more councils will follow their example.

I am disappointed that the Government seem to be taking this issue even less seriously than when we last debated it. Last summer, HMRC launched a new national minimum wage campaign that allows employers who have not been paying it to escape punishment. That is shocking. But it is simple: offending employers can declare details of arrears owed to their employees. They then “self-correct” and, with a cursory follow-up by HMRC, that is it—no more HMRC sniffing around and examining their practices. I do not know of many crimes where the offender escapes punishment entirely if they come forward. As I say, it makes a mockery of the increases in penalties for non-payment of the national minimum wage that were introduced under the coalition Government.

According to the Low Pay Commission, between 2011 and 2015, £1.75 million was recovered in arrears for 8,698 workers, which amounts to an average of £201 per worker. The shameful thing, however, is that that is just a drop in the ocean. The Resolution Foundation, which the Minister will know is chaired by one of his former colleagues, a former Conservative Minister, estimates that 160,000 care workers are collectively cheated of £130 million each year. The Resolution Foundation estimates that the average amount of arrears owed to care workers is more than £815, which is four times the rate at which HMRC is recovering the money.

The real scandal is that it does not have to be like this. The Government have the power to act, but they appear to lack the will to do so. Therefore, let me set out some proposals and I look forward to hearing the Minister’s comments on them.

For a start, the Government are far too reliant on self-reporting. The use of zero-hours contracts is rife in this sector; for example, both Sharon and Melanie, to whom I referred earlier, are on such a contract. So who is going to rock the boat when there is so little job security? Following up on every call made to the helpline is all well and good, but what are the Government doing to help those vulnerable care workers who do not dare to make such a call?

--- Later in debate ---

[Matthew Pennycook (Greenwich and Woolwich) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Rosindell. I congratulate my hon. Friend the Member for Sheffield Central (Paul Blomfield) on securing this important debate.

My hon. Friends and I are proud that it was a Labour Government who, in the teeth of opposition, legislated for a national minimum wage. That national minimum wage is a right, not an optional privilege. At the moment, anything between 160,000 and 220,000 home care workers are still likely to be paid less than the legal minimum, collectively losing out on nearly £130 million a year, as my hon. Friend said—an average of £815 per worker. That is nothing less than a national scandal, not only because a significant minority of home care workers are being exploited—let us remember that they are low-paid and mostly women, that a growing number of them are migrants, and that they find it very hard to organise collectively because of the irregular and fragmented nature of their work—but because underpayment of the minimum wage on such a scale has a direct impact on the quality and dignity of the care provided to the older and disabled people who rely on that care.

As we have heard, there is a variety of reasons for underpayment of the national minimum wage in the care sector, ranging from hourly rates that are simply below the appropriate minimum wage rate to deductions from pay for unpaid training or business expenses. However, the most ubiquitous reason, in my experience, is that care workers are increasingly paid only for contact time. To be clear, that does not include all the time that many care workers actually spend with each client.

I worked for the Resolution Foundation before I was elected and I did a lot of work on this subject. I spoke to hundreds of home care workers from throughout the country about their experiences. I found that “call clipping” —where home care workers leave earlier than they might want to, to ensure that they are not working for free—does happen, but most stay for far longer than their contracted time. For many of the people being cared for, the care workers are the only people they see for hours at a time, perhaps for the whole day. Home care workers enjoy and value the work they do and they often stay for far longer than they need to, but the added insult for them is that, as my hon. Friend the Member for Sheffield Central said, they are often not even paid for that contact time.

[Melanie Onn]

Is my hon. Friend aware that when home care workers overstay their allotted time they can be subject to disciplinary procedures for failing to follow their company’s rules, which stipulate the limited time they are to spend with each of their clients?

[Matthew Pennycook]

Absolutely—I think that happens quite frequently. The way they are disciplined relates to a point made earlier by my hon. Friend the Member for Sheffield Central. Increasingly, they have to clock in and out, and sophisticated technology is used to monitor the time they are with a client. Yet, on their timesheets and payslips—I have seen many of them and they are incredibly confusing—their employers cannot give them the clear detail of how much they are being paid and whether they are being paid the minimum wage. The law in this area is very clear, and yet we still have hundreds of thousands of workers denied the legal minimum to which they are entitled. So why is that happening? At its root, as my hon. Friend said, is the lack of a sustainable funding settlement for social care, which is the result of successive Governments not doing enough, and we know the 2% precept will do little to address that.

Going forward in the medium term, we need to address the funding gap, which is growing on a yearly basis. Local authorities need to do more to ensure they commission care in such a way as to protect those who deliver it, and the independent care providers who employ the home care workers need to do everything possible to ensure that they meet their statutory obligations. There are good examples in the field, but unfortunately far too many do not meet their obligations. None of that should stand in the way of doing what we and the Government can to end non-compliance in this sector.

A variety of things could be done. To give them credit, some of the steps that the Government have taken have been welcome. For example, fines have increased to 100% of underpayments owed to each worker, up to a maximum of £20,000, and they are set to rise again in April. But the scale of the problem and the small solutions that the Government have proposed are clearly not having the impact that they need to, so more could be done. We could have the six investigations report in a timely manner, and we could do more to name and shame employers. Only 13 small social care providers have been named and shamed so far using the powers introduced in 2014.

We could do more to end the over-reliance on self-reporting and ensure that low levels of arrears are recovered. When an abuse is found, we could investigate the whole workforce at that provider, which currently does not happen. However, even if we did all that, we would still be back here next year or the year after talking about what more needs to be done. The Government must seriously consider amending section 12 of the National Minimum Wage Act 1998 so that we deal with the problem by proactively forcing employers, putting the onus on them to prove that they are paying their workers the minimum wage to which they are entitled rather than the other way round.

The sector employs 1.5 million people and has the potential to grow by another million in the next decade alone. If our country is to have the care service that it needs and that disabled people need, the Government need to do more—and quickly—in terms of recruiting and retaining staff who care about their job and of ensuring that those workers are not exploited.

--- Later in debate ---

[Melanie Onn (Great Grimsby) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Rosindell. I will keep my comments brief. The notion of a kindly small care home no longer exists. The person who lives in your town or village, down your street or in your community, who cycles around and gives care to those who need it, no longer exists. The small companies that we used to know so well and recognise in our communities simply cannot compete with the large corporations.

I came across Mears when I worked with Unison. I speculate that companies such as Mears provide a multitude of public services alongside their own private interests. They can bid at incredibly low levels on a per hour basis. With the downward pressure on local authorities and the amount that they can afford to pay, such corporations are winning the contracts. There is a huge gap between the corporations at the highest level and the domiciliary care that is offered to people both in their homes and in residential care. We must not forget that what is offered is the most intimate and personal care.

The corporations continually try to minimise their costs to such an extent that it falls on staff to subsidise their employment, whether that is through travel time, as has already been mentioned, or the purchase of uniforms, which happens frequently as well. I also know that many care staff have taken to buying biscuits or small treats for the clients they serve because their company had previously provided that as an option, which was something nice for the residents in the afternoon. Such things are now being taken away as margins are squeezed and companies have to answer to their shareholders much more than they have to answer to the people who receive the care or deliver it.

Simple things that mean so much to residents are being taken away. Individuals who give so much of their time and their love to their clients are being put in an impossible position in trying to create a less clinical environment. It is absolutely right to say that the people who work in the sector are mainly women, increasingly migrant workers. Why are the women who do those jobs put at the bottom of the pile when it comes to reward? Is it because there is still that traditional view that it is women continuing their household work in the wider community? If that is the only reason why it is so poorly valued, the Government must address that immediately.

Also, the large companies often do not engage positively with trade unions that wish to raise important issues perfectly legitimately and through the appropriate channels. Those workers deserve proper, full and easy access to independent support through a union, and the employers should take proactive steps to encourage their staff to become members, and support that by recognising the trade unions. Too often, trade unions must fight those corporations to achieve recognition. They cannot even get across the threshold of care homes.

I have worked alongside care workers who dared to put their heads above the parapet and who were representatives for the other workers. It did not do their careers any favours. They have been subjected to spurious disciplinary proceedings, and had their shifts reduced—they have limited-hours and sometimes zero-hours contracts. They are punished by having their hours reduced so that they do not take home as much money as they should, merely because they have tried to represent their members properly. They have been threatened with having the police called should they dare to gather outside the company’s property, which is a shameful way to treat staff who are only trying to improve the working conditions of the people who deliver the care.

--- Later in debate ---

[George Freeman]

I will come on to the funding of social care, which is a major issue that we all face as a society and will require some pretty deep thinking over the years ahead. I will also describe the extra money that the Government have put in. Although there is never enough money, we have made this priority very clear.

It may help if I review how we got to be where we are today. In 1999, the national minimum wage came in. It was the first time that legislation had been introduced in the UK to ensure a minimum level of pay for virtually all workers. Its aim is to help as many low-paid workers as possible, end extreme low pay and ensure a level playing field for employers. We are absolutely clear that anyone who is entitled to be paid the national minimum wage or, from 1 April, the national living wage must receive it.

[Melanie Onn]

Will the Minister give way?

[George Freeman]

I will continue, if I may—I am under a tight time limit. The enforcement of the minimum wage is therefore essential to its success and we are committed to cracking down in every sector across the economy on employers who break the minimum wage law. Our approach is simple: through effective national minimum wage enforcement, we are able to support workers and businesses by deterring employers from underpaying their workers and removing the unfair competitive advantage that underpayment could bring.

Crohn’s and Colitis Treatment: England

Melanie Onn Excerpts

Wednesday 24th February 2016 Westminster Hall

[Melanie Onn (Great Grimsby) (Lab)]

It is a pleasure to serve under your chairmanship, Sir Roger. I congratulate the hon. Member for St Albans (Mrs Main) on securing this debate. It is most welcome, especially to those people who are suffering and feel that they have a forgotten illness. It is important to discuss this immune system-related condition and to remind those in the Government that IBD is not IBS. I previously submitted a written question to the Minister about some of the data on Crohn’s and colitis gastroenterology appointments and asked whether they were being cancelled or postponed by the provider. No data are collected on that and it seems that quite a lot of data are not collected on the illness. I welcome the hon. Lady’s comments on centralising data on sufferers. As a sufferer myself, I think it would be a particularly good idea.

The appointments issue was recognised by my local trust. First appointments after a referral by a GP were timely but subsequent appointments to consultants were frequently being rescheduled at short notice and people would not be able to see their consultant for a further six months. For IBD sufferers, the gaps between assessments and, for consultants, the gaps between monitoring, are increasingly problematic. Consultants cannot get the data they need to monitor sufferers properly.

Specialist IBD nurses are absolutely essential as a resource for between-appointment reassurance and advice for sufferers. The nurses cover not only IBD. Those at my local hospital, including Kay Foster, who has been particularly helpful to me, cover IBS and a whole range of bowel conditions. Her caseload is enormous but if someone rings her, she will always call back. If that service were available more widely, it would be greatly appreciated.

Funnily enough, I had an email from a constituent, who said that she has recently come out of hospital after being admitted with suspected inflammatory bowel disease after having a camera investigation. She was discharged from hospital after becoming very ill and having to be put on a drip because she was dehydrated and collapsed. She is now on a waiting list of about six weeks for a CT scan. At the moment, she is constantly having flare-ups as soon as she eats anything. She is losing a lot of weight and is not digesting anything. Her big concern is that she is malnourished, dehydrated, weak, exhausted, in pain and constantly having to use the toilet.

--- Later in debate ---

On resuming—

[Melanie Onn]

My constituent is suffering with daily anxiety attacks. She has three young children, and she feels as if she cannot be a proper parent because she is so poorly. She has already signed off sick and is unable to work. She asked me to intervene to try to move her appointment forward. Of course, I recognise that numerous people will, unfortunately, be in that situation.

In my previous role as an organiser for Unison, I met a carer for older people in a nursing home. She had two young children, too, and she was struck down by the illness particularly severely. Within a short period of time, she was taken down the route of capability by her employer. Fortunately, we were able to intervene because, as a long-term condition, it falls under the Equality Act 2010. We were able to assist, but all employers should be aware and make reasonable adjustments, as they are required, including to work patterns, which can assist in supporting people.

At the moment, treatment seems to be limited to preventive measures, but that is very much about people’s physical health. It is also about mental health, because stress can form part of the illness. Continued use of steroids is not a healthy way to live and can have negative long-term effects. Many people are desperate to get control of this disease, and investment in research to try to combat the illness cannot come soon enough.

Hospital Parking Charges (Exemption for Carers) Bill

Melanie Onn Excerpts

Friday 30th October 2015 Commons Chamber

[Philip Davies (Shipley) (Con)]

First, I congratulate the hon. Member for Burnley (Julie Cooper)on being elected to the House and, in such short order, introducing this Bill. It has clearly been brought forward with a great deal of worthy sentiment with which it is very difficult to disagree. I should perhaps also congratulate her on the expert doughnut she appears to have arranged for herself. She has not long been in the House, but even long-standing Members would be proud of that doughnut. It masks the fact that there is literally nobody else on the Opposition Benches. She deserves particular praise for that, and she will clearly make an expert Member. I wish her very well in her time here.

As you will know, Mr Speaker, when I was first elected to Parliament 10 years ago, my mentor was the late, great Eric Forth, and one of the things he taught me was the importance of private Members’ Bills. He taught me early on that many of them had a worthy sentiment behind them, but that we should not just pass legislation on the whim of a worthy sentiment, because it can have lots of unintended consequences that affect people’s lives and livelihoods. It strikes me that this is one of those Bills. It is based on a worthy sentiment with which people would find it difficult to disagree, but the consequences would be sometimes impractical, sometimes unnecessary and sometimes very negative.

I have mentioned before that when a politician is given a problem, their solution always incorporates two ingredients. The first is that they have to be seen to be doing something. It is the bane of my life. I detest the fact that politicians always have to look as if they are doing something. I long for the day when a Minister stands up at the Dispatch Box—I have high hopes that the Minister today will do so—and says, “Well, that’s got nothing to do with me. It is for people to sort out themselves. It is not for the Government to do something about this.” That is seldom said in the House though. Everyone always wants to be seen to be doing something.

The second ingredient is that the proposal does not offend anybody. If a politician can be given a solution that makes it look like they are doing something without offending anybody, they will go for it every single day of the week. It does not matter whether it makes any difference or whether it is a good thing. As long as it meets those criteria, most politicians will go for it, and the Bill is a perfect example. Clearly, the hon. Lady has quickly acquainted herself with this way of dealing with things in the House.

The hon. Lady believes that carers, who might have to visit hospital very often, are charged unfairly for car parking. I can certainly sympathise with that sentiment. I say from the outset that hospital car parking charges are often very costly, but her proposed solution, which does not offend anybody and makes it look like she is doing something, is simply to make car parking free for carers. I do not think the solution is that simple, which is why I oppose the Bill, despite sympathising with the sentiment.

Before anybody misconstrues my comments, let me say I do not oppose the Bill because I am not concerned about carers. I do not believe there is a single Member in the House who has anything but praise for carers. Carers do a very difficult and very demanding job, and it comes with a great amount of emotional problems for themselves and those they are caring for. Caring is essential. I should point out, too, that the work of caring on behalf of other people in many respects saves the taxpayer a considerable amount of money each year. We should not underestimate that contribution, or indeed the wider contribution they are making to society and their families, which is almost immeasurable.

I do not believe anybody present is arguing against the Bill because they have no sympathy or regard for carers. I oppose the Bill fundamentally because in many respects it is completely unnecessary; what the hon. Lady proposes can already be done. There is no legislation that forces carers to be charged for their car parking, so we do not need legislation to force them not to pay for their car parking. These things can already be done at a local level, if it is decided that that would be the best course of action in the local area.

[Melanie Onn (Great Grimsby) (Lab)]

In that case, would the hon. Gentleman be prepared to lobby his local hospital to exempt from these charges carers in the Shipley constituency?

[Philip Davies]

I do not want to get distracted so early in my speech, but I will come to my local hospital during the course of my remarks, so I hope the hon. Lady can be patient. Of course, if I fail to deal with that point, she can always come back and chastise me for not having done so.

Let us look at the origin of the Bill. On 4 July, the hon. Member for Burnley explained it on her website blog—I am a keen reader of it, as I am sure are many others both here and in Burnley; indeed, I am sure that the Minister has a great regard for the hon. Lady’s blog. This is what she wrote:

“Having read through over 100 suggestions, and after much deliberation, I have finally chosen the subject for my Private Member’s bill: I intend to try to help carers by making provision for them to be exempt from hospital parking charges. During recent years, I have met with carers from across the constituency from different backgrounds, all of whom had different stories to tell but all with one thing in common: their willingness to support a sick person, whether it be a child with cancer, an elderly person with complex needs or a person attending hospital for regular treatments such as chemotherapy. All of these carers often have reason to be parked at hospitals for long periods and can incur charges which they can often ill afford. It seems to me that it is time we put an end to this ‘tax on illness’.”

Ten days later, however, the hon. Lady said something else in her blog; there was a subtle difference on which I would like to focus. She said:

“Many of you may know that I am trying, through the bill, to obtain free hospital parking for carers. Support for this is growing but, if I am to be successful, I really do need your help. I know from my conversations with so many of you, that hospital car park charges are a problem for many carers, who often spend a lot of time hospital visiting. If you are a carer, and this is a problem for you, please get in touch and share your problem with me. Sometimes it is more than the charge (though these are quite hefty and can mount up) because I understand that visiting, particularly for extended hospital stays during winter months, can be quite stressful and distressing, and queueing for parking can sometimes feel like the last straw. If I am to get this bill through government, I need plenty of evidence.”

In my experience, people usually get the evidence of a problem first, and then bring forward a Bill to tackle it. On this occasion, we seem to have had a more novel approach to legislation, which is to bring forward a Bill and then ask people for the evidence to support it. Personally, I view that as a novel approach, but I commend the hon. Lady for starting a trend that we may see more of in the months to come.

It strikes me from the hon. Lady’s blog that the Bill has been brought forward only on the basis of a worthy sentiment, from which very few people would dissent, because she was still collecting evidence to show the need for the Bill after she had announced she was going to introduce it. She did not look at the reality of situation, find a problem and then try to find a solution.