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7 Mar 2007 : Column 494WHcontinued
The Minister of State, Department of Health (Andy Burnham): I am grateful to the hon. Member for Wyre Forest (Dr. Taylor), a fellow member of the Health Committee when I served on it, for the generous spirit in which he made his comments. As always, I respect his opinions on these matters and I agreed with much of his speech. However, there is a genuine point of difference and I will explain that before dealing with his specific questions. I am not sure that I will be able to answer everything in the 10 minutes that I have left, but I will do my best and will write to hon. Members with more specific answers, in particular to the hon. Member for Westmorland and Lonsdale (Tim Farron).
The hon. Member for Wyre Forest asked whether Aneurin Bevan would recognise todays NHS. I am pleased to say that he would and that he would be proud of it. Since Labour has been in government, the state of the NHS has improved immeasurablythat is not spin; it is fact. That is what has happened on the ground and in constituencies up and down the country. There are not just considerably more staff in the public employment of the NHShe knows the statistics and I do not think that he wants me to reel them off againbut the bricks and mortar on the ground in many of our communities are of a standard far superior to those in 1997. The very fabric of the NHS has been renewed. That is the progress that we have made.
The size of the public side of the NHS is considerably larger today, but I would be the first to say that it does not have a monopoly on good ideas or on how to deliver health care. I have described the changes that we have made, but our ambitions do not stop there. The hon. Gentleman knows that our ambition is to deliver a maximum 18-week wait by the end of 2008. In reality, for the vast majority of patients that will mean a wait of eight to 10 weeks. I would describe that situation as providing an end to waiting and waiting lists. People will begin their patient journey and will not simply be put on to lists to be managed. That represents the end to a process that the Government set in train.
Why is that important? I listened carefully to the hon. Member for Banbury (Tony Baldry), who made some valid points. However, to me his remarks portrayed reform as an intrinsic attack on the NHS. He read out a letter that I had sent and I stand by every word of it. Essentially, he put forward the idea that reform was a form of attack. If we, as a Government, had not taken steps to ensure that the NHS is responsive and delivers quick, high-quality care to patients, the arguments of those who call for alternatives to the NHSthose on the Oppositions side of the political argumentwould have been far louder.
There has not been a disagreement about whether the NHS is the right model for the future health care needs of the country. I am hugely proud that we have made the case for a universal health care service that provides care on the basis of peoples needs, not their
ability to pay. That is increasingly accepted as not just the right way, but the fair way and the way in which we can continue to provide health care efficiently to the whole population. I do not accept that anyone from the Opposition can say that they have always believed in that. It is this Government who have shown their commitment to the NHS, stuck their colours to the mast and been a true friend to the NHS. A true friend would ensure that the NHS moves with the times and that it can deliver care of the quality and convenience that people expect today and will expect in the future.
Dare I say that I am probably the youngest contributor to the debateor perhaps not. People of the hon. Gentlemans generation, my generation and younger will have extremely different expectations of the national health service as they get older and become more regular users of health care services. If the NHS is not ready to provide the level of service that they expect, we will not in the long term be in a position to support its value. That is why we are taking forward a programme of reformso we can shore up and maintain solid levels of public support for the NHS.
I remember the conversations that the Health Committee had during our inquiry into the role of the NHS. There was opposition to the concordat with the private sector that was signed shortly after the general election and to private finance initiatives. Such opposition is not heard from the patients and the communities that are benefiting from those initiatives, and that is why I fundamentally disagree with opposition to such schemes.
I will pick up on some more of points made by the hon. Member for Wyre Forest, as they were important. He asked whether the capacity is genuinely additional. Absolutely it is. In many ways, he contradicted himself in his next point because he went on to say that the additionality clause in some of the wave 1 contracts was a wired clause that worked against the interests of the NHS. Wave 1 ISTCs were commissioned to provide genuine additional capacity to that provided by the NHS. That was the reason for the clause that he went on to describe as detrimental to the interests of the NHS.
Andy Burnham: I do not have a great deal of time to deal with anything else. I will push on and perhaps we can pick up on that point in future.
The hon. Gentleman raised the issue of value and questioned how private sector involvement can be the right thing. As a long-standing clinician, he will know that NHS spot purchases from the private sector are not new and have taken place for many years. Across the full period of wave 1 ISTC contracts, the average percentage costs above the NHS equivalent costs for all wave 1 ISTCs is currently 11.2 per cent. That compares favourably with the historical costs to the NHS of spot purchasing from the independent sector. That is
because it has been done in a planned way and in a way in which economies can be generated. That is driving good value through the NHS. Let me quote Laing and Buissons 2005-06 health care sector report, which says:
The emergence of a new raft of ISTC providers able to quote at, or fairly close to, NHS reference costs made it clear that the days of NHS spot purchasing from the incumbents at 30-40 per cent. over reference costs were over, and that they would have to reduce costs and prices if they wished to be involved in any significant way in servicing the NHS market.
Hon. Members have failed to recognise that point, which is extremely important. There is a powerful value-for-money argument as well as benefits to patients who will be offered treatment more quickly than they could otherwise have secured it.
A question was asked about capacity planning when schemes are taken forward. I assure all hon. Members that there is a robust process in place to ensure that there is local support and capacity need for each ISTC scheme introduced. That is guaranteed.
The hon. Gentleman asked about training, which is another important issue. Training is a requirement for all phase 2 providers and is contractual. However, it is the choice of local training local organisationsthe deanerieswhether the training capacity is used. Such an approach has been agreed with the Postgraduate Medical Education and Training Board. I hope that he welcomes the progress that has been made on that.
My right hon. Friend the Member for Oxford, East (Mr. Smith) mentioned specialist orthopaedic trusts and quoted my local trust, Wrightington, Wiggin and Leigh. I understand the situation in which those providers find themselves and the argument that they make about the costs of providing specialist orthopaedic work not being adequately reimbursed through the tariff. I understand that point. The process of payment-by-results will refine and improve as we progress so that there can be a further differentiation of high-value work and work that can be provided at a lower cost. I recognise the need for a sustainable solution.
My right hon. Friend has raised issues in relation to the Royal National Orthopaedic Hospital NHS Trust before. The trust needs clarification on such questions to take forward plans in relation to its estate or to realise its ambitions to be a foundation trust hospital. There is a need for a sustainable solution, and I and the Secretary of State met the trusts concerned not long ago. I assure my right hon. Friend the Member for Oxford, East that we will work towards finding a solution.
Mr. Baron: Will the Minister give way briefly?
Andy Burnham: I do not believe that I have time to do so. I was about to wind up the debate.
Mr. Martyn Jones (in the Chair): Order. We probably do not have time for an interventionin fact, now there definitely is not time. We must move on.
Mr. Lee Scott (Ilford, North) (Con): I am delighted to have secured this debate on education provision for autistic children. Estimates of the number of people with autistic spectrum disorders total 587,900, and of those 133,500 are under 18 years of age. In the past few years, numbers have risen in my own constituency. According to UK researchers, autism may affect up to one in 100 children. Autism impairs social interaction, communication and imagination, and the spectrum also covers Aspersers syndrome.
The debate was inspired in part by my constituents Ivan and Charika Corea of Buckhurst Hill in Essex. They have a son, Charin, who is 11 and has ASD. To the Corea family and anyone who has met him, as I have on a number of occasions, Charin is a God-given blessing. He is a special child, with the most wonderful loving, caring nature. He has inspired the family to campaign long and hard, with no funding, because, in Ivans words,
There are thousands of Charins who are suffering without public services in education, health, specialist speech therapy and respite care.
Charin goes to Buckhurst Hill primary school, where an autism unit has been built, and Hatton school.
The Corea family launched their autism awareness campaign in the United Kingdom in 2000. A small acorn of an idea turned into a substantial movement with the launch of autism awareness year in 2002, supported by the British Institute for Brain Injured Children, the Disabilities Trust, the National Autistic Society and more than 800 other UK organisations.
Ivan has met and lobbied the Prime Minister and my right hon. Friend the Leader of the Opposition. Last Saturday, Ivan met the Secretary of State for Education and Skills. The Corea family have shared the serious concerns that they have, as parents and carers, with parliamentarians of all parties. They and many other families affected are calling on the Government to launch a 10-year programme of building and staffing specialist autism schools and the construction of autism units in mainstream schools. They are urging the Department for Education and Skills to address the failure of some secondary schools to come up with education strategies to deal with autistic students.
Stephen Pound (Ealing, North) (Lab): I am sure that I speak for everyone in the Chamber when I congratulate the hon. Gentleman on securing the debate and on the passion and commitment that he brings to the subject. He has referred to a 10-year plan. He will be aware that, 10 years ago, not remotely the same number of children were identified as being on the autistic spectrum as now, and 10 years before that there were hardly any. What does he assume that the figures will be in 10 years time? Does he envisage the situation worsening and numbers increasing, or does he feel that we have plateaued and that all the children on that spectrum have been identified?
Mr. Scott: I thank the hon. Gentleman for his intervention. I fear that the situation will become worse over the coming decade and that we have not yet plateaued.
Mr. Andrew Pelling (Croydon, Central) (Con): I add my congratulations to my hon. Friend on securing this important debate. Does he agree that there are real challengesparticularly for secondary schools, which perhaps, despite the guidance provided by the Government, feel that an obligation is being thrown back on them to deal with these concerns? I have found that in my own constituency. Looking to the future, there are also issues about the lack of support for adults who are encountering autism. That is a real concern.
Mr. Scott: I thank my hon. Friend for that intervention. Yes, he is perfectly right. I hope to cover a number of the points that he has raised.
Another concern relates to the bullying of autistic children as well as the lack of recreational activities and further and higher education opportunities for young people with autism. On the health front, children with autism desperately need osteopathy on the NHS and parents are calling for answers on what causes autism, although I do not intend to go into that today.
Carers need respite as dealing with autism is a 24-hour-a-day job. Many of my constituents have spoken to me about marriages breaking down, people having nervous breakdowns and the stress and pressure that is put on people who are carers 24 hours a day. I am sure that other hon. Members on both sides of the House have encountered similar cases.
In 1978, the Warnock report argued passionately in its conclusions for the inclusion of children with special needs in mainstream schools, and that view has influenced education policy ever since. Recently, however, Baroness Warnock called on the Government to set up another commission to review the policy of inclusion. She concluded that there is an urgent need to reconsider the concept of inclusion.
We need a level-headed and rational assessment of the situation as it is, not as we would like it to be. The dogmatic approach of placing all pupils with special needs in mainstream schools has frequently benefited neither them nor the children whom they are educated alongside. A far more pragmatic approach, offering parents and special needs pupils a real choice between mainstream and special education, must be adopted. All too often, with the postcode lottery of special educational needs provision, the choice is, Take it or leave it.
In my area, Redbridge, we are fortunate in having Hatton school and Little Heath school, both of which provide a first-rate service to children with special educational needs. I pay tribute to the teaching staff and everyone else involved with those schools. We are also lucky in having a very active group called STAARSupporting Together Autism and Aspergers in Redbridgewhich works tirelessly in support of autistic children and their families.
I would also like to draw attention to Kisharon day school in Finchley, which does excellent work with children from the Jewish community who have special educational needs. A religious element in education should be recognised as a legitimate choice for parents.
I commend the work of TreeHouse, which is a national charity for autism education. Its vision is to
transform through education the lives of children with autism and those of their families. Established in 1997 by a group of parents, TreeHouse runs a school for children and young people with autism, and campaigns for better autism education nationally.
More needs to be done to identify at an early stage children with autism. More detailed information about how to recognise the condition needs to be made available to parents, doctors and teachers. Getting that right will bring the educational support that the children need to progress in structured learning.
Since 1997, more than 90 special schools have closed and those remaining have fewer pupils, despite a steep rise in the number of children diagnosed as having special educational needs. Ministers state, Inclusion is not an agenda to close special schools, so we need to ensure that we prevent special schools from closing, recognise the poor provision in many areas of the country and record the fact that there is increasing demand for those places.
Mr. Iain Duncan Smith (Chingford and Woodford Green) (Con): My hon. Friend referred to the Government saying that their policy is not to close special needs schools. I remember initiating a debate on this issue three or four years ago. I pointed out at the time, and it is worth pointing out again, that the problem with stated Government policy and the way they approached it back in 1997, 1998 and 1999 was that they gave an opportunity and an excuse to local authorities to use the rationale of inclusion to get rid of special needs schools, selling the land for housing to make short-term money, very little of which was ploughed back into the system. A very casual statement such as the one that we have heard about does not deal with the truth of the matter.
Mr. Scott: I thank my right hon. Friend and constituency neighbour for his intervention.
Stephen Hammond (Wimbledon) (Con): May I follow on from the intervention made by my right hon. Friend the Member for Chingford and Woodford Green (Mr. Duncan Smith)? The situation has become worse. I raised it in the main Chamber earlier today and the Prime Ministers response was disappointing. The issue is not only local authorities closing special schools, but local authorities not taking cognisance of the need for out-of-borough placements. Of course, the Prime Minister was right to say that the decision is a local one, but 75 per cent. of local government funding comes from central Government, and unless central Government will the means, local government cannot take that on board. That is a particularly important point.
Mr. Scott: I thank my hon. Friend for that comment and I am sorry for what I am about to say. It would be easy to turn the debate into a political Punch and Judy show and blame the Government for all the ills in education provision for autistic children, but that would not be totally deserved and would not take the discussion in the right direction. I recognise exactly what my colleagues have said, but I want to look forward to how to resolve problems.
Baroness Warnock is right to say that inclusion
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