Hospital Car Parking Charges

Mike Wood Excerpts

Thursday 1st February 2018 Commons Chamber

[Lucy Allan (Telford) (Con)]

It is a great pleasure to follow the hon. Member for Great Grimsby (Melanie Onn), who made a very thoughtful and engaging speech on this important issue. I am very glad that so many Members are in the Chamber to take part in the debate.

I particularly congratulate my right hon. Friend the Member for Harlow (Robert Halfon) on steadfastly championing this issue in Parliament for many years. He is much admired across the House for taking up issues that not everybody chooses to champion, but his work on such issues so often makes the lives of the people he and I represent much better, so I thank him for it. Indeed, I was inspired by his efforts in this area when, before I became an MP, I campaigned in my constituency of Telford on the whole issue of parking charges after they went up by 75% at our Princess Royal Hospital, creating a great deal of local upset.

My constituents, like my right hon. Friend’s, raise their concerns about this issue frequently. During the time I have campaigned on it, I have received over 5,000 letters —letters, not emails—on this specific issue. In Telford, we really care about this, and that is why I am here today. I was supposed to giving a speech at Thomas Telford School’s ethical debating society but, unfortunately, I have had to cancel at short notice so that I can be here, because this matters so much. I apologise to the students at Thomas Telford School.

I was told by my hospital trust in 2014 that it was not possible to change the existing arrangement because of the long-term nature of the trust’s legally binding contract with CP Plus, a parking contractor. Even poorly negotiated long-term contracts eventually expire, so we must look forward to what we will put in place when they do. It is not acceptable for those who can effect change simply to stand back and wait for onerous contracts with parking contractors to be renewed.

[Mike Wood (Dudley South) (Con)]

As my hon. Friend says, part of the problem is that so many hospital trusts are locked into long-term PFI contracts. Many of them were negotiated in the late 1990s or early 2000s and will shortly be coming up for renewal or expiry. Does she agree that now is the time to look at what provisions we can put in place to ensure that, as the contracts are renewed, they do not contain exploitative provisions that allow hospital trusts to take patients, as well as their families and visitors, for mugs by overcharging them for parking?

[Lucy Allan]

My hon. Friend eloquently makes a very important point, and I am very glad that he has raised it. The debate is timely, and it is important for us to be here to make this case.

Sadly, my local hospital trust has continued to increase hospital parking charges in a way that some feel thoughtless and has been described to me as cavalier. Following the rises in 2017, it is cheaper to park in Southwater shopping centre in Telford than to go to hospital to visit a sick relative. There is clearly something wrong with a model that operates in that way, because, as many hon. Members have said, no one chooses to go to hospital.

Telford is a new town, much like the constituency of my right hon. Friend the Member for Harlow. There are problems to do with the way in which many new towns were designed because, rightly or wrongly, they are all about road users. Major roads and roundabout systems are much loved in Telford. Everything is focused on the car, and it was never intended that the pedestrian should be able to walk from A to B. That is one of the problems that makes this such an important issue locally.

We do not have good public transport. We cannot just hop on a bus, jump on a tube or walk to the local hospital, as people might in other areas; instead, we have to take buses, changing a few times. Many people are therefore driven, or drive, to hospital, and they have to pay. My trust gave several reasons why its charges increased, one of which was that they were lower than those elsewhere in the country. That argument does not have a lot of teeth to it, because London is very different from Telford, in terms of income and accessibility of transport. Trusts need to consider local factors when setting charges.

It is good if concessions are offered, and there are concessions at the Princess Royal in Telford, but they are complicated to administer and operate. People have to prove that they are on benefits, that they have had an appointment and that they have paid their charges. Healthcare staff have to administer that system. They have to cancel charges and give out refunds and concessions, but that is not what they are there for. It is no good saying that if there was more money for hospitals, they would not need to charge for parking, because we all know what happens in many cases. In my local hospital, 50% of the revenue goes to CP Plus, the parking contractor, which has to be wrong.

Another argument that we have heard today is that if there were no parking charges, there would be nowhere for people to park, because anyone who wished to could use the hospital car park. It is argued that charges are a disincentive to parking. My local hospital trust says that without charges, people might stay all day in the hospital cafés, having refreshments, rather than leaving the site. Clearly that is complete nonsense, because even with incredibly high charges, there is nowhere to park. All the spaces—and the grass and concrete—are filled. The argument that everyone is sitting in a café is simply beyond my comprehension. This issue needs to be addressed with careful thought, rather than charges being seen as an instant panacea to a problem, when they clearly are not.

Bizarrely, my hospital trust tried to justify the increase by talking to residents about the number of nurses whom the parking revenue has paid for. I do not like that argument, because nurses are paid for by taxpayers through Government funding, not by parking charges. The increase that it implemented was in the contractual agreement, and nothing whatever to do with the number of nurses whom it employed.

I worry when hospital managers think that the charge is not that big a deal because parking is cheaper than somewhere else; that transport is not really their problem; and that if people are spending too long in cafés, managers need to move them on by putting up the charges. That shows that they probably do not understand the people whom they serve as well as they should.

If we dig a little deeper, we see the reason why it is not possible to park at the Princess Royal is that there has been a huge increase in the number of staff working on the site and therefore parking in the car park. We need to look at ways of helping staff to reduce car park use, as that would free up many spaces for patients to use throughout the day. We need to think imaginatively about how that might be done. Perhaps park and ride schemes specifically tailored to shift times might help. It is a surprise to find that hospitals are not looking at that.

We have heard today that this is a tax on the sick. Most taxes take account of people’s ability to pay, as is absolutely right, yet hospital managers and porters pay the same to park at work. It is always the least well-off who are hit the hardest. If the aim is to tax people and then give half the tax revenue to a car parking company—that is a bit senseless in any event—do it through pay-as-you-earn, and do not get nurses and other healthcare staff involved in the enforcement. It is completely inefficient to operate the system in this way.

Others have touched on the rigmarole that goes with paying for parking. Whether that means people paying with coins, typing in their number plate, or being videoed as they go in or come out, there is a punitive element. When a person is rushing to see someone who is extremely ill, or if they are waiting for an appointment and the consultant is running over time, it all adds to the anxiety, and in this context, it is completely inappropriate.

No one really wants to own this issue, so we all end up accepting it rather than solving it. Too many people say, “It is not our problem, it is too difficult to fix and actually, it is not really that important, because it is only £8 a day.” Too often, people in power look at the world through their own eyes and not through the eyes of those whom they serve.

There is little appetite among hospital management to deal with this. It is not a big-ticket issue. It is not exciting. It is not a shiny new hospital. It does not cost £300 million—in Telford, we spend a lot of time talking about our new emergency unit—so that is why I am here today. I want the Government and hospital managers to sit up and take notice. Do not brush this off as a non-issue—it is not. Try to see it through the eyes of others and tackle the issue that is facing everyday users of our hospitals. It can be fixed and it will make a difference to the lives of those who most need hospital services. For that reason, we should all care about it.

My right hon. Friend the Member for Harlow does a great service to his constituents. I thank him for securing this debate and I support him entirely.

Mental Health Units (Use of Force) Bill

Mike Wood Excerpts

2nd reading: House of Commons
Friday 3rd November 2017 Commons Chamber

[Mike Wood (Dudley South) (Con)]

Like other hon. Members, I wish to start by congratulating the hon. Member for Croydon North (Mr Reed) on introducing such an important Bill. I know from my own experience two years ago of being drawn high up in the private Members’ Bill ballot that it can feel a bit of a mixed blessing. There are a few days in the lead-up to publishing the Bill when they are probably among the most popular Members of Parliament; telephone lines and email inboxes are rarely idle. Of course once the simple step of presenting the Bill is done, the really hard work begins, not only in producing the Bill and the explanatory notes, but in starting to build the consensus that allows the Bill to have a reasonable chance of progressing into legislation. The hon. Gentleman has done that exceptionally well to this point, and I know he will be proceeding as he has begun.

I also wish to thank my constituents who have contacted me, some with their own experiences and others with their own views of the current use of force in mental health units. I also thank West Midlands police and the range of organisations with an interest in mental health policy which have briefed us all, shedding new light on both the scale and nature of the problems in the system.

In recent years, mental health has come to the fore in public policy, and much of that is due to the outstanding work done by a number of right hon. and hon. Members who have a real passion for improving the way mental health is treated and ensuring that parity of esteem is not just a catchphrase but rather that it reflects the way mental health is treated, not only in the NHS, but across public policy and society more widely. In particular, I am thinking of the excellent work done by my hon. Friend the Member for Halesowen and Rowley Regis (James Morris), when he chaired the all-party group on mental health; by the Secretary of State for Health; and by my right hon. Friend the Member for North East Bedfordshire (Alistair Burt) and, of course, the right hon. Member for North Norfolk (Norman Lamb), when they were Ministers responsible for mental health.

We have seen the changes in the guidelines and the way sections 135 and 136 of the Mental Health Act 1983 are handled, and the new provisions that will be brought in through the Policing and Crime Act 2017, which gained Royal Assent earlier this year. The political consensus that there is a need to do more is being matched with real progress in both policy and legislation. All of us have welcomed the prominent place mental health reform has had, not just in the Conservative manifesto ahead of the general election, but in its being reflected in the Queen’s Speech and in the Prime Minister’s announcement that the Government would begin a comprehensive review of the Mental Health Act. Public servants who work in the police, the NHS and the justice system are often on the frontline of dealing with people with mental ill health, particularly those affected by acute episodes of mental ill health. My hon. Friend the Member for Berwick-upon-Tweed (Mrs Trevelyan) was, though, right to question why we always talk about mental health in terms of mental illness, because it is also important to talk about mental wellness and consider how we support, develop and improve people’s positive mental health.

A lot of the changes in the public policy framework in recent years have been driven by innovation in public services. I think in particular of the excellent work done by Inspector Michael Brown, who blogs as Mental Health Cop. He previously worked for West Midlands police, and I think he now works for the chief constable of Dyfed-Powys police. It is largely because of his work that the need to address sections 135 and 136 came to the fore of the public policy agenda. In recent decades, section 136 has set the framework within which people suffering from mental ill health are treated in the police and criminal justice system. Although it is part of legislation that is nearly 35 years old, it is barely different from equivalent measures in the Mental Health Act 1959. That was 60 years ago, when there were still asylums in Britain and the whole approach to mental health was completely different. Thankfully, we no longer have asylums and we make huge efforts to treat people in the appropriate settings and in the community. We need to ensure that we adapt not only public policy but a legislative framework that was designed for a completely different society with a completely different outlook on and approach to mental healthcare. The Bill has an important part to play in changing the legislative framework.

In my area, West Midlands police have made substantial progress in how they deal with people suffering from mental illness. In July, the office of the West Midlands police and crime commissioner and the West Midlands combined authority provided an update on and summary of some of their innovations, particularly the model of mental health triage that has been operating for the past few years. A successful model for mental health triage is being rolled out across the force, throughout the Black country, Birmingham and Solihull. The model relies on an ambulance vehicle, a mental health nurse and a paramedic being available between 10 o’clock in the morning and 2 o’clock the following morning, so that when there is a call-out and it is thought there might be mental health issues to consider, there can be an appropriate health response and health assessment, alongside and as part of the police response. Shortly before I was elected to Parliament, I had the privilege of joining a triage team on a call-out in Birmingham. I saw how it worked and the difference it made compared with the old model of police officers being deployed and, more often than not, somebody suffering from a serious episode of mental ill health ending up in a police cell or another custodial setting.

Let me give an example of how the system has worked. When the police and ambulance services received a report of a 19-year-old female self-harming in the street and threatening to kill herself, a check on the mental health systems was able to establish quickly that she had an extensive history with mental health services. The paramedic had wanted to take the female to an acute hospital immediately, but the deployment of the street triage team meant not only that her wounds could be dressed by the paramedic in the car at the scene, but that the mental health nurse could carry out a face-to-face assessment and make an urgent referral to the home treatment team. As a result, she got crisis access to services overnight and then home treatment the next day, which was a much more appropriate response for somebody going through a crisis. Ultimately, she was safeguarded with a friend for the evening, who took her home and stayed with her through the night, and the whole incident lasted 45 minutes, compared with the many hours it would have taken had she gone to A&E and then other more conventional settings.

The triage teams in the west midlands have treated about 9,000 people in the last year, and as a result—despite the worrying figures we have heard from around the country—the use of section 136 powers in the west midlands has been reduced by about a third over the last five years, from typically 1,200 to 1,300 a year to 852 last year. Remarkably, in the first half of the year, nobody at all in the west midlands was detained in police custody under section 136 of the Mental Health Act—the first time this has ever happened in the west midlands. Instead, more than 8,000 people have received alternative outcomes, including referrals to a GP or other partners, to ensure they get mental health care rather than have their case treated as a purely criminal justice matter.

Although significant progress has been made, and continues to be made, the Bill will help to make further progress, especially through the way it addresses the use of force and restraint against people suffering from mental ill health. Currently, the code of practice clearly states that restrictive practices should only be used where there is a real possibility of harm, either to the patient or to someone else, and should not be used either to punish or inflict pain or suffering, and should be used with minimum interference to autonomy, privacy and dignity. In the case of children and young people, it should not be used at all. Staff should always ensure that restraint is used only after taking into account an individual’s age, size, physical vulnerability and emotional and psychological maturity.

Although the guidelines exist, further openness around the use of force and restraint is not only welcome and progressive but absolutely necessary for the individuals involved and if our public service workers are to have confidence that their actions are reasonable and defensible. That is why clause 5, which requires that registered managers have a training programme for frontline staff, is particularly important. “Frontline staff” would include all registered managers who might reasonably expect to use force or authorise its use on patients. The proposal to guarantee that staff use the latest and safest procedures should be an opportunity to build on previous learning, not only on mental health care and proportionate use, but on wider issues of equality and necessity.

Clause 6 deals with the requirement on all mental health providers systematically to record information on their use of force. As has been said, if we can measure it, we can track progress and drive changes in behaviour. Including records on the gender, age and ethnicity of patients will help to improve our understanding and, more importantly, the understanding of public services about the use of restraint, particularly on the basis of gender and race.

Let me turn now to body-worn video. Clause 13 provides that on-duty police officers who are called to a mental health unit for any reason must wear body cameras that start recording from as soon as is reasonably practicable. The west midlands, which is within my own force area, is now rolling out body cameras to all its response officers. The kind of body cameras it is using can be automatically triggered by a siren or a blue light, or if airbags are deployed and firearms are drawn. We should consider how these body cameras can be automatically deployed and, without having to think about human error, can automatically stay on until they are manually turned off.

[Kevin Foster]

Does it make sense that, if a police officer is on duty in a response role, the presumption should be that the camera is on? We see that in other walks of life—for example, it is the case with ticket inspectors, so it should not be that difficult to apply this practice to on-duty, on-call police officers.

[Mike Wood]

My hon. Friend makes an excellent point, and he is absolutely right. We have seen body cameras used in other scenarios. They help to protect the police as well as those to whom they are responding.

[Philip Davies]

I agree with everything that my hon. Friend has said, but my understanding is that, in some areas—certainly with some police forces—the issue is that the battery life on some of these cameras is not all that it could be, which means that the cameras might not last long enough in all these circumstances. Does he agree that we need better technology for the battery life before we start insisting on these things being used in all circumstances?

[Mike Wood]

It is extremely important that we have adequate and appropriate technology. Of course the battery life of these cameras on the frontline is a key part of that. Police using the system being rolled out in the west midlands, which is partly funded through the Home Office, are confident that they can use the cameras from when they are automatically triggered through to when the footage can be uploaded back at the station. As has already been pointed out, research strongly suggests that the use of force is reduced by about half if body cameras are worn. Attacks on police officers are also reduced. In the west midlands, harm to police officers has been reduced by about three quarters since body cameras started being routinely used, and complaints against police officers have fallen by more than 90% when evidence from a body camera is used.

There has been great progress in the area of mental health, but there is still much more that needs to be done. We need a greater focus on mental wellness, prevention, early intervention and ensuring that primary care is in a position to support and treat our patients at an early stage. There will always be occasions when restraint is appropriate and even a small number of circumstances in which the use of force is necessary. That use of force must be properly regulated, registered, controlled and used as a last resort—when no other adequate course of action is available.

[Kelly Tolhurst]

There has been increased police use of body-worn cameras in Kent and it has been going quite well. Will my hon. Friend give me slightly more information about what has been happening in Dudley South?

[Mike Wood]

In the first year of general use, there has been a sharp fall in the number of assaults against police officers. There are also fewer complaints against police officers, and the time it takes to handle responses has fallen. It used to take many of hours of investigating and phone calls; now, in some cases, it takes barely minutes of reviewing clear body camera evidence.

The measures in the Bill are necessary and welcome, so I wholeheartedly support it today and look forward to supporting it in its passage through this place.

Young People’s Mental Health

Mike Wood Excerpts

Thursday 27th October 2016 Commons Chamber

[Lyn Brown]

Absolutely. I totally agree with my hon. Friend, and as I go through my speech I am hoping to provide an example to show how intervention is particularly important for a very young child because of the impact on the rest of the family. Early intervention can do a lot to mitigate other events and difficulties occurring in the family that might include other family members, too.

Unfortunately, tragically and outrageously, young people’s mental health services often receive less attention than adult mental health services, so that young people’s mental health services have been called the “Cinderella of Cinderella services”. In November 2014, the Health Committee found that there were

“serious and deeply ingrained problems with the commissioning and provision of services for young people’s mental health.”

Many providers reported increased waiting times and increased referral thresholds for specialist services, where patients would have to show severer symptoms to receive treatment than they would have done in the past. GPs reported feeling ill-equipped and lacking in confidence when dealing with young people’s mental health issues. The Select Committee found that early intervention programmes were

“suffering from insecure or short term funding, or being cut altogether.”

There really is no excuse for this failing. Around half of people with lifetime mental health problems experience symptoms by the age of 14, and about 75% of them before the age of 18. Catching these problems early could well lessen the severity of adult problems, possibly saving the NHS money in the long term. More importantly, I would suggest, it would reduce unnecessary suffering and enable people to live better lives.

I want to be fair to the Government, who have recognised that there is a problem. In 2014 they set up a children and young people’s mental health and wellbeing taskforce, which made a number of recommendations in its 2015 “Future in mind” report. The taskforce identified a number of problems with young people’s mental health services. The right hon. Member for North Norfolk (Norman Lamb), who was then the responsible Minister, said that there needed to be a fundamental shift in culture, with a much greater focus on prevention and early intervention.

The taskforce rightly recognised that one of the challenges facing young people’s mental health services was—unsurprisingly—funding. I was pleased when the Government responded by announcing the provision of an additional £1.4 billion of transitional funding for youth mental health services, but that additional money needs to be considered in the context of the less encouraging overall picture of mental health services funding. NHS England’s planning guidance states that all clinical commissioning groups must increase their spending on mental health services by at least as much as their overall budget increases. However, there have been warnings from organisations including mental health trusts that mental health funding is not properly ring-fenced, and that NHS England’s target is being missed.

Let me again follow in the footsteps of my hon. Friend the Member for Dulwich and West Norwood. We know from the responses to a series of freedom of information requests from my hon. Friend the Member for Liverpool, Wavertree (Luciana Berger) that more than 50% of CCGs intend to spend a smaller proportion of their budgets on mental health in 2016-17. That clearly demonstrates that what the Government tried to do has failed, and that that target is being missed as well.

[Mike Wood (Dudley South) (Con)]

The hon. Lady is making some important points. She referred to the taskforce’s “Future in mind” report. According to one of its startling statistics, only between 25% and 35% of young people with diagnosable mental health conditions access support. Does that not underline the need for much better training and much more awareness among both teachers and GPs, in respect of early identification as well as early intervention?

[Lyn Brown]

We need early identification and we need early intervention, but we also need the funds to ensure that there are services to which people can be referred. That is the rub of this whole debate. There does not seem to be the necessary funding at any point in the journey of young people who need help, whether in the form of awareness, intervention or services.

I have been looking into the good work done in my borough, the London borough of Newham. Even in these difficult times, it is increasing its mental health spending in both absolute and relative terms, and its children’s mental health services received an “outstanding” rating from the Care Quality Commission. I wanted to find out how we could improve young people’s mental health provision, and to learn about the challenges that an “outstanding” local provider continued to face in its fight for better services. Professionals in Newham recognise that a good young people’s mental health service does not just help those who have already developed severe and serious conditions, but provides early intervention and preventive programmes so that problems can be dealt with at source.

Health Service Medical Supplies (Costs) Bill

Mike Wood Excerpts

2nd reading: House of Commons & Programme motion: House of Commons
Monday 24th October 2016 Commons Chamber

[Mike Wood (Dudley South) (Con)]

Has my right hon. Friend made any assessment of how the prices of the drugs quoted in the article in The Times compare with those paid in other health services and by healthcare providers in other western European countries?

[Mr Hunt]

We have made some assessments of those things, but, in essence, our concern is that, even without comparisons with what is happening in other countries, we are talking about totally unreasonable behaviour. I mentioned one example earlier, but I can give another of a medicine whose price increased by 3,600% between 2011 and 2016. I just do not think we can justify that. Given that we want to have strong, harmonious, positive relationships between the NHS and the pharmaceutical industry, we need to eliminate the possibility of that kind of behaviour happening in the future.

This Bill therefore amends the 2006 Act to allow the Government to control prices of these medicines, even when the manufacturer is a member of the voluntary PPRS scheme. We intend to use the power only where there is no competition in the market and companies are charging the NHS an unreasonably high price. We will engage with the industry representative body, which is also keen to address this practice, on how we will exercise this power.

The final element of the Bill will strengthen the Government’s powers to collect information on the costs of medicines, medical supplies and other related products from across the supply chain, from factory gate to those who supply medicines to patients. We currently collect information on the sale and purchases of medicines from various parts of the supply chain under a range of different arrangements and for a range of specific purposes. Some of these arrangements are voluntary, whereas others are statutory. The Bill will streamline the existing information requirements in the 2006 Act relating to controlling the cost of healthcare products. It will enable the Government to make regulations to require all those involved in the manufacture, distribution or supply of health service medicines, medical supplies or other related products to record, keep and provide on request information on sales and purchases. The use of this information would be for defined purposes: the reimbursement of community pharmacies and GPs, determining the value for money that the supply chain or products provide; and controlling the cost of medicines. This will enable the Government to put the current voluntary arrangements for data provision with manufacturers and wholesalers of unbranded generic medicines and manufactured specials on a statutory footing. As the arrangements are currently voluntary, they do not cover all products and companies, which limits the robustness of the reimbursement price setting mechanism.

A statutory footing for these data collections is important so that the Government can run a robust reimbursement system for community pharmacies. I know that some colleagues have raised concerns about the implications of our funding decisions for community pharmacies, and today I want to reassure the House that this Bill does not impact on those decisions, nor does it remove the requirement for consultation with the representative body of pharmacy contractors on their funding arrangements in the future. However, the information power will give us more data on which to base those discussions and decisions, rather than relying on data only available to us under voluntary schemes and arrangements. The information power would also enable the Government to obtain information from across the supply chain to assure themselves that the supply chain is, or parts of it are, delivering value for money for NHS patients and the taxpayer—we cannot do that with our existing fragmented data.

Junior Doctors: Industrial Action

Mike Wood Excerpts

Monday 5th September 2016 Commons Chamber

[Mr Hunt]

Yes, I can absolutely confirm that. We have put in place pay protection to make that happen. My hon. Friend is right that this is very damaging for his constituents in Cheltenham. Given that there is so much pressure in the NHS, the junior doctors who are thinking of striking must ask themselves whether it is really going to help their organisation respond to those pressures if it has this enormous distraction—this incredible demoralisation that we get with these kinds of strikes.

[Mike Wood (Dudley South) (Con)]

Does my right hon. Friend share my disappointment that the BMA leader who co-authored the new contract and said that it was beneficial for our patients and for our junior doctors is now trying to whip up support for a series of strikes that every credible medical leader has said would be disproportionate and harmful to patients?

[Mr Hunt]

I am extremely disappointed and I hope that she reconsiders.

Alcohol Consumption Guidelines

Mike Wood Excerpts

Tuesday 28th June 2016 Westminster Hall

[Mike Wood (Dudley South) (Con)]

We as Members should question the credibility of alcohol advice, but our primary role is surely to consider the wisdom and effectiveness of such guidance from a public policy viewpoint. The guidelines fail to acknowledge the decades of research demonstrating that moderate alcohol consumption is compatible with a healthy lifestyle. Multiple studies since the 1970s show that light to moderate alcohol drinkers have a lower mortality rate than non-drinkers or heavy drinkers. When plotted on a graph, the relationship between moderate consumption and total mortality appears as a J-shaped curve, demonstrating the benefits of light to moderate alcohol consumption compared with both abstinence and heavy drinking.

I would not presume to argue with the chief medical officer’s opinion that any alcohol is damaging, but I do not believe that as a matter of public policy, an abstinence approach is either wise or effective. We recognise that recommending abstinence is a counterproductive policy in tackling teenage pregnancies, yet we are asked to imagine that saying that there is no safe amount of alcohol is an effective way of tackling alcohol abuse. The previous unit limit might have been an arbitrary figure, but it was a realistic target for most people and helped reinforce the message that alcohol needs to be kept to light and moderate levels. The guidelines threaten that.

As well as significant evidence about physical health, there is growing evidence about the benefits of moderate alcohol consumption in a safe and social environment for mental health. In particular, a recent study commissioned by the Campaign for Real Ale from Oxford University found that people who regularly visit a community-type pub tend to have more close friends on whom they can call for support, and that they are happier, healthier and more trusting of others. A moderate amount of alcohol improves wellbeing and some social skills, just as it has been shown to improve other cognitive abilities and health.

Any future guidance must, of course, be cautious, but it should also recognise the protective effects of moderate alcohol consumption. I also advocate withdrawing the advice that there is no safe level of alcohol consumption so that we can concentrate on the social and medical benefits of limiting alcohol consumption to moderate levels.

Carers

Mike Wood Excerpts

Thursday 9th June 2016 Commons Chamber

[Jim Shannon (Strangford) (DUP)]

It is a pleasure to contribute to this debate, and to thank the hon. Member for Eastleigh (Mims Davies) for bringing it forward for us all to participate in. This is the second such debate that she has led on this subject, and we look forward to many more on similar subjects in times to come. I also thank all those who have spoken—I understand that I will be the last to speak from the Back Benches before the shadow Minister and the Minister. The hon. Member for Worsley and Eccles South (Barbara Keeley) has just nipped out, but I look forward to her speech, and I very much look forward to the Minister’s. I have honestly found the shadow Minister and the Minister to be compassionate—we have a compassionate shadow Minister and a compassionate Minister—and I am convinced that their responses will both focus on the issues we have raised and those that it is important for us to be involved with.

Carers UK estimates that there are some 6.5 million carers in the UK. Over 1 million people in the UK say that they are supporting or caring for family members who have an illness that is terminal, which is also an issue. To put those figures into perspective, there are two carers for every person who died last year in the United Kingdom. Statistically, that is a massive figure. It is estimated that the NHS saves some £11.6 billion each year because of these unsung heroes. We have used that expression often today, but just because we use it often does not mean that it is any less appropriate. Their contribution as volunteer carers is immeasurably valuable.

Carers may end up providing more than 100 hours of care per week. From my knowledge of those who come to see me and those with whom I have worked in my constituency, I know that 100 hours per week is a low estimate. For some of them, caring is a 24/7 exercise, such are the medical and health difficulties of those for whom they care. All too often the outside world is completely oblivious of their efforts. Even those who know carers may be oblivious, because they do not always know what is happening once the door is closed and the carer is left alone to look after the cared for. We do not know what happens behind those closed doors.

I believe that employers are forcing some workers to forgo promotions. That is clearly stated in the background information that has been provided, on which I congratulate those in the Library. Its staff are not often thanked for what they do, but the background information they have provided—the stats and the paperwork—is very detailed and informative, and they deserve to be congratulated on how well they have prepared us for this debate.

Carers have said that they have had to forgo promotions, reduce working hours or leave work altogether. More than a third of them do not feel comfortable at work talking about caring, just over a third say their employer does not understand their caring role and exactly a third say their employer does not have policies in place to support carers. Some 60% of carers have given up work or reduced their hours to provide care, 25% have been unable to pursue or have had to turn down a promotion, 37% say their work has suffered and 42% say they have struggled financially. These are not just figures; these are people’s lives.

The figures illustrate very clearly what the issues are. Some 55% of carers have struggled financially, as it says in the background information. My colleague, the hon. Member for South Antrim (Danny Kinahan), mentioned that. I suppose all MPs have personal knowledge of this, but we are certainly aware of how carers are struggling in Northern Ireland. Some 72% of carers have given up work or reduced their hours. Again, these figures tell us where the problems are.

As the hon. Member for Eastleigh said, Carers Week is being supported by all the health organisations, including Age UK, the Carers Trust, Independent Age, Macmillan Cancer Support, the Motor Neurone Disease Association, and the Multiple Sclerosis Society. I work with these organisations almost every day of the week. They are household names, unfortunately, because of the level of problems that we have across the whole of Northern Ireland and the United Kingdom.

A subject close to my heart, as is the case for many of those here, is dementia and Alzheimer’s disease. A few months ago, we had a debate on that in Westminster Hall. I have not experienced it personally in my family, but I have certainly experienced it through meeting some of my constituents and their families. It is hard to explain to anyone who has not experienced it. These are very delicate issues to address; they are not just physical but emotional and mental. I have seen people with dementia who can often, unknowingly, become agitated or even violent. Night-time wandering can have a serious impact on carers’ sleep patterns, let alone the sufferer’s. Many people out there require someone close to them to give up much of their lives to provide the care that they need. Sleep patterns are just the tip of the iceberg.

I commend the groups in my area, particularly some of the church groups. For example, a Church of Ireland church, St Mark’s in Newtownards, has a group for the whole of Ards and North Down where people with dementia and Alzheimer’s come together to do painting and crafts. Music is a wonderful thing for helping those with dementia and Alzheimer’s. It helps to relax them, and for some people it takes them back to where they were many years ago—to their youth and their childhood.

[Mike Wood (Dudley South) (Con)]

The hon. Gentleman is speaking movingly about the challenges that dementia sufferers and their carers face. This week the Carers Trust raised with me concerns about patchy levels of support in dementia care around the country. Does he agree that local authorities need to go out and learn from best practice around the country, such as the church groups in his constituency and the successful dementia gateways in Dudley, to make sure that more carers and more dementia sufferers can receive the support they so desperately need?

[Jim Shannon]

I thank the hon. Gentleman for his intervention. I wholeheartedly agree; I think we all do. Those of us who are aware of this issue will understand the importance of all these groups. The issue that he touches on was frequently mentioned in the debate in Westminster Hall. Some 38 Members were involved in that debate, and it got a massive response. I thank him for his very important words.

The hon. Member for Eastleigh referred to young carers, as have other hon. Members. Crossroads Young Carers in Newtownards has been around for many years. We have a massive number of young carers in my constituency alone. I was rather shocked to find that they were so numerically strong. That illustrated to me the importance of the role of these schoolchildren, sometimes even primary schoolchildren, who almost become old before their time in looking after parents and family. The Carers Trust says that 80% of young carers miss out childhood experiences. They grow up before their time. They miss out on the leisure, the fun and the nights out with friends because they are looking after their mum, dad, brother, sister, or whoever it may be. They are almost hidden carers in the job that they do. I recognise the good work that Crossroads Young Carers does in my constituency.

We need an awareness campaign about carers so that they are no longer the unsung heroes but become the recognised heroes that they should be, not just in this House but in all our constituencies across the whole of the United Kingdom of Great Britain and Northern Ireland. Too often, carers are left to suffer in silence. The services on offer are not publicised enough and, sadly, too often are not up to standard either. When we read the background material that explains some of the everyday events that carers have to deal with, we get a feeling for and an idea of what they endure each day. I am not sure whether this has been mentioned yet, but, if not, it needs to be put on the record: many carers suffer from bad health themselves as a result of looking after others. In an intense situation, looking after someone 24/7, they need some time to switch off—their brain and their body have to get a bit of rest. It is very important every now and again to get a weekend, or even an hour or two, away from it all.

The main social security benefit available to carers is carer’s allowance. This is for someone who provides more than 35 hours of care a week, and it entitles them to only £62.10. Furthermore, carers may incur sanctions on how much they can earn on top of the allowance. Dementia carers save the NHS more than £11 billion per year, to put a financial cost on it, yet they get only £62.10 per week for giving up their lives for someone less fortunate. I know that the Minister’s Department is not responsible for that, but, with respect, it is not a good reflection on Government, given the hours that carers spend on caring. I recognise that times are tough financially. You cannot produce a high-quality suit if you have low-quality cloth, and the same thing applies to finances. We therefore have to be realistic about what we can do, but it must be highly insulting to carers to see some of the things happening in the news when they are getting only £62.10 per week. Although the Minister is not responsible for benefits, could he give some pointer for carers with regard to benefits advice? I give them benefits advice when they come to my office. To be fair, the benefits system is very responsive. We just have to point people in the right direction and show them the right opportunity. Perhaps there is a role for Government in that. I understand that our colleagues in Scotland have considered upping the carer’s allowance. That was discussed in our debate on dementia and Alzheimer’s.

Carers UK calculates that the value of unpaid care is some £132 billion each year—the equivalent of NHS spending. Although it is hard to calculate how much of this relates to people who care for someone who has a terminal illness, research has found that carers who look after someone with one of the four most prevalent cancers—lung, breast, colorectal or prostate—provide care worth £219 million per year: a third of the total of end-of-life care costs. Providing end-of-life care—that difficult time for people emotionally and physically—saves the NHS a massive amount of money as well. Other people have referred to personal things in families. My mother looked after my dad before he passed away, and that was not always easy. My mum is a fresh 85-year-old, or she will be on 14 July. If it were not for the closeness and the commitment of family, we would face a lot of other serious issues.

According to research by Carers UK’s Northern Ireland subsidiary, Carers NI, 16% of carers cannot afford to pay their utility bills, while nearly 40% cannot afford their bills without struggling financially. I can vouch for that in my constituency, given the numbers of people who come to me who are finding it very difficult to make ends meet financially. The hon. Member for South Antrim (Danny Kinahan) raised the question of heating or eating during the cold spell. That is a reality today as well, perhaps even more so than in the past. A third of carers are using savings to pay everyday living costs, and a third have used up any savings they had and now have nothing to fall back on. Thirty-two per cent. of carers have ended up in debt as a result of caring, and over four in 10 carers—almost half—are cutting back on food or heating. Furthermore, carers experience higher levels of fuel poverty in Northern Ireland than anywhere else in the UK. We have the highest levels of fuel poverty in the whole of the United Kingdom of Great Britain and Northern Ireland.

Information given to us by the Library indicates that 51% of carers

“have let a health problem go untreated…Half of carers (50%) have seen their mental health get worse…Two thirds of carers (66%) have given up work or reduced their hours to care…Almost half of carers (47%) have struggled financially…Almost one third of carers (31%) only get help when it is an emergency.”

That is the reality for carers. Full-time carers are twice as likely as non-carers to be in bad health. Eighty per cent. of carers say that caring has had a negative impact on their health, and half of carers state that they experienced depression after taking on a caring role. Sixty-three per cent. of carers say that they are at breaking point, and one in six carers receive no practical support at all. Despite an ongoing rise in the number of carers in the UK and sharp rises in the number of people caring full time, the number of people who receive carers’ assessments and carers’ services is falling. When we hear all those stats, we need to remember that there are people behind them who have to deal with reality.

It is often said, and we need to say it again, that food banks have been extremely helpful. That is the case in my constituency and, I am sure, in others. Food banks operate out of compassion and heart. They bring together Government bodies, churches and individuals who want to do their bit for the community. The food bank in my area, run by the Trussell Trust, has done exceptional work with carers, those who are under financial pressure and those who are experiencing delays in benefit or not getting all the benefits that they should be getting. The food bank is very much a part of life in my constituency. By the way, I think it is good to have food banks in our constituencies. They bring a lot of good things to my area. I do not see them as a negative; I see them as a positive, because people reach out and want to help each other. That is good, because if we help each other, we do what we are supposed to be doing in this world, which is to make lives better as best we can.

Carers UK estimates that the number of carers will grow to 9 million by 2037. Will any of us in this Chamber be here in 2037? I am not sure. I probably will not be—if I am, I will be the oldest man in the world, but that is by the way. We have to look at the stats, because they take us to where we will be in a few years’ time. I hope that the Government take cognisance of the stats, because it is important to form a strategy.

It is clear already that the support provided to carers does not suffice. Independent analysis demonstrates that the gap in funding for social care is expected to reach between £2.8 billion and £3.5 billion by the end of this Parliament, and that does not even begin to cover what will happen if the Government do not take into account the fact that the number of carers is growing. This should serve as a wake-up call to everyone—the Government, the regional Assemblies in the devolved Administrations and all stakeholders—about the reality ahead. There will be significantly more carers than there are already, and appropriate planning is needed to ensure that support is there.

I conclude with these comments. I welcome the fact that the Government are developing a new carers strategy, and I look forward to the Minister’s response on that. It is important that we, as elected representatives, put forward this debate in a positive fashion to get a strategy and responses to our questions, which we can feed back to our constituents. On the issues that I and others have raised, I impress on the policy makers the need to remember that there are real people behind all the statistics. It is people such as carers whom we are elected to serve. I can only hope that the debate will raise awareness of the need for urgent and large-scale reform of the way in which the Government treat carers.

A number of carer support groups come together in the churches and the community centres of Strangford. They are wonderful people who do great work, and they deserve to be supported and helped by us, as MPs through our Government and through the regional Assemblies, in whatever way we can. Those groups bring together all the people of the Ards and North Down Council area who want to participate. They give carers much needed opportunities for rest and socialisation. The opportunity to socialise and interact with others, or to get a moment or two to themselves, can make a world of difference to carers.

Defending Public Services

Mike Wood Excerpts

Monday 23rd May 2016 Commons Chamber

[Mike Wood (Dudley South) (Con)]

On the Monday of last year’s Queen’s Speech debates, at almost exactly this time, I made my maiden speech. Twelve months on, I am delighted to see legislation being brought forward to implement so many parts of the manifesto on which my colleagues and I were elected. This Queen’s Speech is about improving life chances for all. It is about securing our economy so that we can provide the excellent public services on which our constituents, and we ourselves, depend. It is about delivering a truly seven-day NHS and about making our promise on parity of esteem for mental and physical health into a reality.

I depend on the national health service, as do my family. When we needed it most—when my children were born and when my wife was taken ill—the NHS was there for us. I am proud of, and will always be grateful for, the fantastic care provided in our health service, but I have also seen how the level of healthcare available varies depending on when you have to go into hospital. My daughter turned eight a few weeks ago. When she was born, there were complications during labour but, as this was in the early hours of the morning, consultants and some specialist staff who would normally have responded were not available. Fortunately, with the support of the excellent midwives on duty, everything turned out okay. Surely we have a responsibility, however, to do everything we can to reduce those risks, regardless of what time it is or which day of the week you go into hospital.

The Conservative manifesto promised to ensure that people could access good quality healthcare seven days a week in our NHS. This was a key commitment and I am pleased that legislation is being brought forward to allow for it to be delivered. People will be able to see a GP in the evenings and at weekends to suit modern life. Making it easier to see a GP should relieve pressures on other parts of our national health service, while those patients who need urgent or emergency hospital care should have access to a similar level of consultant-led assessment, diagnostic tests and treatment seven days a week. Under the new proposals, they will be seen by a consultant and have diagnostic tests available, and the most critically ill patients will be seen within the hour.

This can be done only because of the extra money that is being invested in the NHS, and that is achievable only because of our strong economy. The chief executive of NHS England said on “The Andrew Marr Show” yesterday that when the economy suffers, the NHS suffers. However, this Government have put rebuilding the economy and protecting our NHS first. In Dudley, my local hospital trust’s income last year was £64 million higher than it had been five years previously. That has allowed us to have 60 more doctors and 192 more nurses, midwives and health visitors in Dudley than there were in 2010. That is an example of a stronger economy leading to a better-resourced national health service.

That includes mental health care—a part of the NHS that has too often been viewed as the Cinderella service. The Health and Social Care Act 2012 introduced a commitment to parity of esteem between mental and physical health, and I am delighted to see the right hon. Member for North Norfolk (Norman Lamb), who did so much to bring about that legislation, in his place tonight. This Queen’s Speech includes further measures to turn that commitment into a reality for everyone in the country who needs mental health care.

In response to the mental health taskforce, the Government announced an additional £1 billion. This will fund all the taskforce’s priority recommendations. With the increased funding going into mental health services, the focus now rightly shifted from treatment to prevention. Members might not be aware that one in 10 children between the ages of five and 16 have a mental health problem. We need to intervene early, instead of simply throwing money at prescription drugs or treating the symptoms at a later stage. It is a false economy if we do not tackle problems early, before they end up becoming much more expensive and, more importantly, before they cause even more distress and human cost to the individual and their family.

While we are increasing NHS funding, we have a responsibility to ensure that the available resources are focused on services for all our citizens who depend on the NHS. It is right that people who come to Britain for elective healthcare should cover the costs of their treatment rather than expect British taxpayers to pick up the bill. This Government were the first to act to tackle health tourism and the abuse of our NHS, and I am pleased that the Government are to go further with the Bill announced last week, extending the rules on charging people who come here for non-emergency treatment.

I am proud of our NHS. Of course, it is not perfect, but the NHS provides a generally excellent service, free at the point of use. Our NHS has remained so great because of its ability to change and adapt. It has not attempted to preserve whatever was right for 1947 in aspic. Instead, it has responded to changing needs and demands. The measures in the Queen’s Speech will allow our national health service to continue to respond to the challenges of today and of tomorrow, offering the best chances for everybody at every stage of their life.

World Autism Awareness Week

Mike Wood Excerpts

Thursday 28th April 2016 Commons Chamber

[Mike Wood (Dudley South) (Con)]

I am proud to be a governor at Halesbury School, which has become a specialist autism school where more than a third of pupils have autism, many undiagnosed when they join the school. I am grateful to the deputy head, Amanda Appleby-Payne, for the insight she offered ahead of this debate.

Two special schools in my constituency are doing excellent work for children with autism. The Brier School has been rated “outstanding” in every category in its two most recent Ofsted inspections, and Pens Meadow provides an incredible level of education, care and support for children with very severe and complex special needs. I was pleased to open its new post-16 facility last autumn, which means that more young people with autism will be able to access further and vocational education.

Autism is a lifelong condition that affects people very differently. It affects how they communicate and how they make sense of the world around them. While many people live largely independent lives, others need more specialist support. Unfortunately, many people live a life full of anxiety, depression, mental health issues and sensory sensitivities that make it extremely difficult for them to function or to access the normal situations and public services we take for granted.

A 2012 study found that about 1.1% of adults were on the autistic spectrum, and a later study found a similar prevalence among children. If this House is representative of the population at large, therefore, we would expect at least seven Members to be on the autistic spectrum.

Unfortunately, the excellent support and education provided to children with autism at Halesbury, The Brier and Pens Meadow are not always reflected in the education system as a whole. There are 120,000 school-age children in England on the autistic spectrum, more than 70% of whom are in mainstream education. The implication is that many teachers in mainstream schools are likely to have children with autism in their classes—if they do not at the moment, they almost certainly will at some stage during their careers.

I pay tribute to the NASUWT for the valuable work it has done on this issue and particularly for the report my right hon. Friend the Member for Chesham and Amersham (Mrs Gillan) referred to, which showed that 60% of teachers do not believe they have enough training to meet the needs of pupils with ASD.

[Mrs Gillan]

My hon. Friend is making some powerful points about the education of young people with autism. Is he aware of the work being done by Ambitious about Autism, which shows that the number of special educational needs appeals at tribunals went up from over 1,000 in 1995 to over 4,000 in 2014? Among the most common types of appeal are those involving autism.

[Mike Wood]

Having met Ambitious about Autism and discussed that very point, I certainly recognise the challenge to which my right hon. Friend refers.

Difficulties in the classroom and for families of children with autism often arise because of a lack of knowledge and understanding about the condition. Children on the autistic spectrum often get chastised for not behaving in exactly the same way as other children. Their exclusion rates are extremely high, and figures from the Department for Education show that autistic pupils are four times more likely to be excluded than pupils with no special educational needs.

Teacher training must equip teachers with the knowledge and tools they need to provide all pupils with the best possible support throughout their time in education. That is why I support the call by Ambitious about Autism and the National Autistic Society for autism to be included in the new teacher training framework.

If I may, I will conclude with the words of Mr and Mrs Whitmore, the parents of a pupil at Halesbury:

“We want our son to be accepted—and for him to be accepted equally as a citizen of this country, as his peers are...Autism is only a small fraction of our son; it is not everything he is. Will is so much more than the label society has given him.”

It is for people such as Will and the families who are working to make sure their children and everybody affected by autism can have the best possible chance to fulfil their full potential, whether that is in the workplace or in society as a whole, that we are having this debate. This debate is a huge and positive step forward, and we have seen the quality of the contributions that have been made. I therefore look forward to hearing the Minister’s response.

National Minimum Wage: Care Sector

Mike Wood Excerpts

Wednesday 23rd March 2016 Westminster Hall

[Mike Wood (Dudley South) (Con)]

It is a pleasure to serve under your chairmanship, Mr Rosindell, I think for the first time. I thank the hon. Member for Sheffield Central (Paul Blomfield) for securing this debate on an extremely important issue. Before I begin, I declare an interest in that my brother works in the social care sector—he started a new role on Monday—although he is not directly affected by the issues we are discussing this afternoon.

Social care is such an important feature of our society and social workers are integral to the care of people in need and those at risk. Despite that, too many social workers have suffered at the hands of unscrupulous employers—employers who have continued to flout the law and who simply do not pay the full national minimum wage. While HMRC maintains the operational enforcement of the national minimum wage, in my 10 months as a Member of Parliament I have yet to see either a coherent or sensible approach.

I will draw Members’ attention to two cases that I have seen since my election last May and contrast them with each other. The first concerns a care company in the black country. None of its care workers is paid for their travel time or when calls run over. The hourly rate therefore fell well below the national minimum wage over a substantial timeframe, but the HMRC investigation has been ongoing for nearly four years. To date, it has resulted in a notice of underpayment for only one of the employees who filed a complaint, even though the same principle applies to all the care workers.

My constituent, Debra, complained about not being paid the minimum wage in November 2012. It took 30 months before she managed to force HMRC to issue the care company with a notice of underpayment. She was forced to complain to the then Secretary of State for Business, Innovation and Skills and my predecessor, Chris Kelly. HMRC wrote to her in February 2013 to say that it was looking at all the care workers’ records, and wrote again following Debra’s complaint to the Secretary of State in June 2014 that the other care workers were also owed arrears for non-payment of the minimum wage. Nevertheless, HMRC then issued the notice only for her, as if she was the only worker who had not been paid the national minimum wage.

HMRC’s continuous delays have been shocking, and they have been ongoing since Debra’s complaint at the end of 2012. HMRC has also been looking at the cases of two other constituents of mine, Alison and Michelle, since at least March 2015, yet we do not seem to be any further forward than we were at this time last year. HMRC continues with what seem to be unnecessary delays and excuses—according to my case notes they appear to be the very same excuses given to Debra.

None of the care workers at the firm were paid for their travel time between calls or if calls ran over the allotted times. The company’s own paperwork—the rotas and pay slips—clearly show that they did not pay their care workers for what we would understand to be necessary working time. All the care workers were on the same terms and conditions, so the same position applies equally to all the workers.

Despite HMRC writing to Debra that it had “all workers’ records” dating back to February 2014, in a recent telephone call HMRC asked whether my constituents would be prepared to go to an employment tribunal and be cross-examined. That does not seem appropriate given the objectively verified facts. HMRC has not even calculated the arrears that the women appear to be owed. The same tactic had been used previously with Debra. HMRC does not have to mention any employment tribunal; its job is to get the evidence, calculate the arrears and issue a notice of underpayment. Only after the notice is issued can the employer force a tribunal, and an employer has only 28 days to do so following the issuing of such a notice by HMRC. Indeed, until a notice is issued the care company has absolutely nothing to appeal against.

There is clearly something very wrong indeed with how HMRC enforces compliance with the national minimum wage in the care sector. As I said, it has been investigating this care company for nearly four years, yet despite finding that not only Debra but the other care workers are owed minimum wage arrears, it has still issued only the one notice.

That case should be contrasted with HMRC’s response to another case, although it goes slightly beyond the narrow confines of the debate. At a manufacturer in my constituency, a genuine clerical error led to the underpayment of four pieceworkers out of a workforce of 240. Over three years, the underpayment totalled just under £600, or 0.005% of the total wage bill. It was clearly a genuine oversight that had not been identified in five external audits.

Despite the fact that that manufacturing company co-operated fully with HMRC—indeed, as soon as it was made aware of the underpayments, it repaid them, along with the penalty, on the next available working day—its response seems to have been very different from what happened with the care company. The manufacturer has been named and shamed and now has to deal with the resulting implications while trying to negotiate a contract with high-street retailers.

HMRC’s response has been very inconsistent. In my experience, it is focusing its energy on what might be seen as the easy cases—companies that are genuinely trying to do the right thing but may have made a mistake —while it does very little effectively to enforce the national minimum wage for companies such as the care company I highlighted, which have consistently obstructed and obfuscated and shown total disregard for HMRC and for their legal requirement to pay the national minimum wage. That has to change.

I urge my hon. Friend the Minister to ask HMRC urgently to review its general approach to the enforcement of the national minimum wage. I will also write privately with the details of the two cases to which I referred to ask him to speak to HMRC about what is going on and how we can have a more consistent and equitable approach to ensure that all employers pay the national minimum wage.