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That this House commends the dedication and energy of the doctors, nurses, therapists and other professionals working tirelessly to help the 110,000 people affected by stroke each year; notes the significant recent progress made in stroke care with falling premature mortality rates and more people treated in stroke units than ever before; further commends the work of the National Audit Office, the Committee of Public Accounts and the All-Party Parliamentary Group on Stroke in scrutinising progress on stroke care and recommending further improvements; welcomes the opportunities offered by new treatments and the growing evidence on effective rehabilitation; celebrates the investment of £20 million in the UK Stroke Research Network to help ensure stroke medicine fit for the 21st century; further welcomes the additional training places made available in stroke medicine; further welcomes the new guide and tools available to support improved commissioning of stroke services; thanks the Stroke Association, Different Strokes, Connect, the Royal College of Physicians and over 100 individuals for their work in developing proposals for a new stroke strategy; and commends the consultation document A new ambition for stroke.
That this House notes with concern the fact that the United Kingdom comes bottom of a league table of 21 rich countries in a recent UNICEF study of child well-being, has one of the worst drug problems in Europe, has low levels of social mobility, has higher rates of family breakdown than many other European countries and has more people living in severe poverty today than there were in 1997; regrets that sufficiently effective action has not been taken to deal with these problems; recognises that a shared sense of social responsibility is the basis for a more effective response to multiple deprivation and for more effective solutions to the problems of social breakdown; and urges politicians of all parties to join together in an attempt to support families, provide new routes into work, enable people to escape from addiction and indebtedness and to enable voluntary organisations and social enterprises of all sizes to increase their invaluable contribution.
No subject we could debate is of more importance. Moreover, it is a good sign for British politics that that proposition, at least, is shared by Members on the two Front Benches and on the Liberal Benches. The subject is of importance not only because of the extraordinary effects of poverty and multiple deprivation on individuals and families, but because of the scale of the problems that we face.
There is a marked difference in the impression one receives of the country we are living in when one reads the motion and then the amendment. Of course, there is some truth in both the light and the shade, and I do not mean to suggest that Britain is everywhere in the same condition as it is in some places. Much of our country is in splendid condition in many ways. The problem is that much is not, and I shall retail a few of the indicators brought to light in the vast report that we have all been debating and discussing for weeks and monthsas we shall continue to do for weeks and months ahead. I shall then try to tackle the question of what is underneath the dispute between the two Front Benches on how we go about curing the problems.
In 2006, child poverty rose by 100,000 before housing costs, which I think is the Governments preferred measure, or by 200,000 after housing costs. The UNICEF study showed that for child well-being the UK is the lowest rated of 21 Organisation for Economic Co-operation and Development countries.
Tom Levitt (High Peak) (Lab): I am grateful to the right hon. Gentleman for giving way so early in his speech. The first line of the motion uses the word comesthe present tensein reference to the UNICEF report. Will the right hon. Gentleman put on record that almost all the data in the UNICEF report predated 2001 and that none of it was newer than 2004? Does he therefore accept that the report does not, as its authors accept, detail the current situation?
It is inevitable that any report based on a large amount of statistical accumulation will reflect a period some time before it was published, but as we are
considering what is, by agreement, the most important issue before us as a nation, I hope we shall not have to debate the exact use of the present tense in relation to what is inevitably the case with a report.
In our country, more than 1.2 million young people aged between 16 and 24 are not in work, education or training. The UK has a higher proportion of children living in workless households than any other EU country. That is a really important indicatorI want to come back to thatbecause, as we should all be able to agree, work is the crucial way out of poverty. I do not think that there is any remaining difference of view between the parties about that. Work is fundamental, so worklessness is fundamental, and the worklessness record is not good.
It is true that the Government have managed to move some peoplea noticeable number of peopleout of poverty, as measured by the 60 per cent. of median income line. However, unfortunately, if one looks at the figures carefully, one can see that in general the movement has involved people going from rather slightly below the line to rather slightly above the line. The problem is that, over the past seven or eight years, the number of people living in severe povertydefined as less than 40 per cent. of the median incomeincreased by 600,000. In a way, that is the less important point, because it is a point about what has happened recently. The point about our country is that there are now 3.1 million people living on less than 40 per cent. of the median income. That figure is from the Institute for Fiscal Studies. Whatever view one takes of what has been done and is being done, that cannot be right. It cannot be where we are trying to be as a country. To be fair to Members on the Government Front Bench, the right hon. Member for Darlington (Mr. Milburn), the former Secretary of State for Health, was perfectly open about that and said that poverty had become more entrenched. That is a real problem for our country.
Mr. Jamie Reed (Copeland) (Lab): I hesitate to shatter the emerging embryonic consensus, but does the right hon. Gentleman share my fear that, given the manifesto on which he and his colleagues stood, people in the country might struggle to take him seriously on these matters?
I do not know who will take what seriouslyI am not a psephologistbut in the end what matters is whether the present Government, the next Government and the Governments after that are seriously going to tackle the issue. If the hon. Gentleman thinks that we are not seriously committed to tackling it, he is wrong. We are. We would not have bothered to do the work that we have done on the issue if we were not seriously committed to tackling it. Moreover, we would not be making the argument that I am making, which is that this is the single most important thing we can tackle, unless we intended to tackle it. Just as a matter of political prudence, it would be slightly odd for a party to set itself up to try to tackle something and make that a priority if it thought that it was not going to spend any time or effort trying to tackle it and did not care whether it succeeded or
failed. The truth is that we are committed to the issue. I know that it is uncomfortable for the hon. Gentleman and others who wish to be in a partisan position to acknowledge that we may have joint aimsalthough we may disagree about meansbut the truth is that that is the position that we are in, so we ought to recognise it.
The new deal is a very considerable programme. I see the distinguished right hon. Member for Birkenhead (Mr. Field) in his place. He and many others have pointed out that, despite what are no doubt the best of intentions, the new deal has, to a very considerable degree, failedin the sense that a large number of the people for whom it finds work unfortunately move back out of work extremely quickly. It has cost about £1.9 billion, but the number of unemployed young people has increased by about 70,000.
There cannot be anybody in the HouseI go back to the right hon. Gentleman: I remember learning about this from him 10 or more years agowho thinks that it is satisfactory that there are roughly 2.7 million people on incapacity benefit in Britain. That cannot be the position that we ought to be in as a country, especially when many of those people might be able to work, would like to work but are not working.
Chris Bryant (Rhondda) (Lab): I completely agree with the right hon. Gentleman. It is distressing that nearly one in five people of working age in my constituency are on incapacity benefit. What we have been doing over the past couple of years has had some success. The programme to get people off benefits and into jobs, through Jobcentre Plus, is expensive. There are all sorts of complex reasons involved, particularly in former mining constituencies. I would be interested to hear whether he has any ideas about how one would cut that number. There is no point in just bewailing the situation; one has to have concrete ideas that work in practice.
Mr. Letwin: Yes, we do, and I will come to those ideas in more detail in a moment. However, let me answer the hon. Gentleman so that he does not think that I am evading his question. The proposition put forward in the social justice policy groups report, which is the foundation of our thoughts about these matters, is that we should move to an arrangement under which welfare to work is handled by agencieswhether social or voluntary agencies, or those in the private sectorthat are paid by results. Those results should be long-term, not short-term, work. In other words, the agencies should receive remuneration related to the benefits saved when people move into work and stay in work for a considerable period, so that there is an incentive to help people to remain in work. It then becomes a sensible financial proposition for those enterprises to invest in helping people to become able to work either by trying to do something about their health, or by trying to find them things that are appropriate to their health conditionor both. As a matter of fact, I think that we might be able to achieve some consensus in the House on that. We are certainly considering the proposition seriously.
Mr. Frank Field (Birkenhead) (Lab):
Is there not a danger that both parties are thinking institutionally about how to combat the huge extent of worklessness
in many of our constituencies? Ministers on the Treasury Bench might be thinking about what to do centrally, while Conservative spokesmen might be thinking about what to do through voluntary organisations. Why do we not set the claimants free? We know perfectly well that most of our constituents on incapacity benefit will never be interviewed, or have anything happen to them, if we are the agents of change. Why do we not say to them, Those of you who can, try to get a job in the next year, but keep all your benefits, including housing benefit. Come and tell us when youve got a part-time job, and well try to help to build it up into a full-time job? Those people would then become the agents of change, and it would not be uswhether the state or the private sectordoing good for them.
Mr. Letwin: I am in the embarrassing position of not knowing whether the social justice policy groups report makes that very recommendation because the right hon. Gentleman gave evidence to it, which I know he did, or whether the group invented it. However, I am happy to tell him that we are looking at that possibility seriously. Clearly, part of the answer must lie in not penalising people on benefits who would like to move into work when they try to get work and fail, and come back out of work and try again. We need a much more flexible system.
Mr. Field: It is not just a matter of failing. Quite a few of our constituents who have been on benefit for a long time are hesitant to take the risk of moving into work because things might go pear-shaped. If we could say to them, Dont worry. Heres a years money, and whatever you do will be in order, many of them, although not all, would be able to make that journey without any of us having to interfere in their lives.
Mr. Letwin: I have the same experience of meeting constituents who are frightened about the effect on their benefits of moving into work. We must change that situation. We are looking extremely seriously at propositions that will allow us to achieve that, which must be an aim.
Angela Browning (Tiverton and Honiton) (Con): Does my right hon. Friend agree that one weakness of the system, especially when trying to get people with long-term disabilities into work, is that many of the schemes, irrespective of who delivers them, work on the premise that once people are made work-ready a sum is paid and a box is ticked? The hardest part of the process is helping people to apply for a job and to go through an interview so that they get sustainable employment. If his long-term plans involve bridging that gap, many such people will take the risk mentioned by the right hon. Member for Birkenhead (Mr. Field).
I have just spotted the author of the social justice policy group report, my right hon. Friend the Member for Chingford and Woodford Green (Mr. Duncan Smith); he is sitting behind me, but I will take the liberty of saying that that is precisely the point that the report raises about welfare-to-work programmes. They need to be carried out by people who have an incentive and a desire not just to find people something that looks like a job for a minute, but
to help them into it, to help keep them in it, and to help them to get back into it if they fall out of it. That is a crucial component of such programmes.
John Bercow (Buckingham) (Con): Is my right hon. Friend aware that, at the last count, there were no fewer than 2,063 young school leavers in Buckinghamshire, Oxfordshire and Milton Keynes not in education, employment or training, 1,000 of whom were in that position because they suffered from the hidden disability of speech, language and communication impairment, which had not been treated? Does that not underline the crucial significance of early intervention to tackle those problems, in the interests of both the economy and the fulfilment of individual potential?
Mr. Letwin: Happily, I am in a position to reply yes, absolutely. The issue is not just worklessness; the structure of things is somehow wrong, too. That is partly to do with the couple penalty, an issue to which we have drawn much attention in the past few days. Indeed, the Minister for the Cabinet Office and I discussed it in a broadcast yesterday evening. The Institute for Fiscal Studies sets out a case in which the husband, or one partner, earns £15,000, and the wife, or the other partner, earns £5,000. It calculates that as a couple, they would get benefits and tax credits worth £2,317those are not my figures, but those of the IFSwhereas the wife on her own would receive £7,785 from the state. That is a difference of £5,000. I neither know nor care whether those figures, calculated by the IFS in March 2006, are currently exactly correct. The point is clear, and it is repeated by a wide spectrum of people on low incomes: there are significant incentives in the system against admitting to being a couple. That is why we find cases of people living apart together, as it is mysteriously and rather horribly called.
The issue is not just poverty, worklessness or odd and misaligned incentives in the system. There are underlying critical problems about lifestyle that we have to face as a country, and here we are bound to be on common ground, because we are simply talking about facts. More than 300,000 people in Britain are drug addicts; I think that the figure was 327,000 in 2006. That is a little under 10 people per 1,000. Must we regard that as an inevitable feature of life that we must deal with and accept, or is it something that we could be more optimistic aboutsomething that we could actually cure? In the Netherlands, three people per 1,000 are problematic drug users, and in Sweden the figure is 4.5 people per 1,000. I do not know every respect in which the Netherlands and Sweden differ from the UK, but the report for which my right hon. Friend the Member for Chingford and Woodford Green is responsible makes it extremely clear that there are significant differences in the way in which we think about rehabilitation and treatment, and I am sure that that is part of the explanation. In any event, it is clear that something needs to be done about the levels of addiction.
Paul Flynn: There is an encouraging tendency for the parties to agree, and many of us look forward with admiration to the Opposition report that we will soon see. Will the right hon. Gentleman consider two other countries? Portugal has reduced the number of deaths from drug use by 50 per cent. since 2005, and Australia has reduced the number of deaths from overdoses by 70 per cent. in nine years.
Mr. Letwin: Yesthe report looks at a wide range of countries. Reducing harm and reducing death, about which the hon. Gentleman is extremely and rightly concerned, are important aims, but there is a difference. He and I may disagree, to judge by our previous conversations about the matter over the years. The report says, and I agree, that it is not good enough just to prevent harm. What we have to do is try to lead people, or enable people to lead themselvesit is a reconstruction of personality and ability that we are talking aboutout of the condition of addiction into a non-chaotic lifestyle where they can work and be part of the mainstream. So harm reduction is an important goal, but it is not enough.
Mr. Gary Streeter (South-West Devon) (Con): I am grateful to my right hon. Friend who, as usual, is making a lucid and intelligent speech. Is it not the case that when young people addicted to drugs, make the brave decision that they need help and want to come off theirtypicallyheroin addiction, it is no good saying to them, Thats fine. Come back in a month and we will find a place for you, or, You will have to join a queue for treatment in five or seven months? One may as well say that there is no treatment available. It must be now or not at all. That is expensive, but it is a priority. Is there something that my right hon. Friend would like to say about that?
Mr. Letwin: With distinction or otherwiseI spent a lot of time going around treatment centres here and in other countries. What I saw is exactly what my hon. Friend the Member for South-West Devon (Mr. Streeter) saysthat in order to be effective, treatment must be available at the moment when the addict is ready for it. It is part of the same conundrum that explains why it is often the case that only those who have been through addiction can lead others out of it effectively. So awful is the condition into which people are drawn that they need to relate to somebody who has been through it. For the same sort of reason, the condition is so awful that if there is the prospect of a wait, hopelessness sets in. We must be able to tackle the problem directly.
Mr. Letwin: Of course, to my right hon. Friend. In his report there is a recommendation that we deal with that by the expenditure of a considerable sum of money. We will have to consider that extremely carefully.
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