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10.48 am

The Minister of State, Home Department (Mr. Liam Byrne): This may be the first time that I have served under your chairmanship, Mr. Atkinson, and it is a privilege to do so. I echo the congratulations given by hon. Members from all parties to the hon. Member for Mid-Sussex (Mr. Soames) on securing this debate. Its content and tenor illustrate that this House can debate this in an intellectually sensible and important way. I back his call for more of this kind of debate in the House. My right hon. Friend the Member for Birkenhead (Mr. Field) put it well: this is an extremely important matter for our constituents and it needs to be debated more. I understand that immigration is not on Steve Hilton’s prescribed list of topics for general debate by Conservative Members and realise that that has led to a bit of a vacuum, so I am grateful that the hon. Gentleman has sought to step into the breach. I want to sketch out a few points of agreement and a few points where a little more debate may be needed. On a large amount of the policy, there is now a degree of consensus that we have not had before..

I shall start by reflecting on numbers, because that is precisely where the hon. Member for Mid-Sussex started and it is the right place for the debate to begin. It is true that the level of immigration to this country has changed over the past 10 years, and that European economic area nationals have increased—there were around 145,000 in 2005. The number of work permit holders has doubled, rather than tripled, up to 137,000. The point is that underneath that movement of people there is a degree of consensus that is worth sketching out. We agree that we should phase out low-skilled migration from outside Europe. We have introduced controls on Bulgarian and Romanian nationals coming to this country, and for the lifetime of that policy we shall phase out low-skilled migration from outside Europe. That is a matter on which we agree.

There is now a degree of consensus on refugees. In 2005, the Conservative party said:

That would have involved renegotiation of the Geneva convention, and was an unfortunate policy. The hon. Member for Ashford (Damian Green) was intelligent and wise to reverse it on 29 December when he said in The Guardian:

There is a degree of consensus on the level of EU migration. It does not include my right hon. Friend the Member for Birkenhead, but the position that both sides of the House have settled on is that we should accept free movement of people inside Europe. When the free movement of persons directive was laid on 4 April 2006 and then translated into immigration regulations, no party prayed against it, which signalled a degree of consensus.

The hon. Member for Mid-Sussex referred to work permits. There has been an increase in the number issued, but 25 per cent. were for those in the health and medical services and 17 per cent. for IT workers. There is a sense that the increase in the number of work permits has been driven by changing patterns of
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economic growth. When we tightened some of the rules on work permits, there was a debate because many people thought that that was wrong. The hon. Member for Ashford wrote to me on 12 June saying that he not only spoke against our changes to the highly skilled migrant programme, but voted against them.

Damian Green: Will the Minister give way?

Mr. Byrne: As a courtesy to other hon. Members, I will not give way because of the number of points to which I must respond.

There was one disappointment in what was otherwise an excellent peroration by the hon. Member for Mid-Sussex. He was absolutely right to put the debate in an historical context, but it was not set in the context of changes in the world today. That point was picked up by the hon. Member for Sheffield, Hallam (Mr. Clegg). When there are sharp bursts of increased independence, as during the past 200 years of economic change, there are big movements of people. That was true in the late 19th century and it has been true since the 1980s. The hon. Gentleman was right to point out that global migration has doubled since the 1960s. The annual rate of change began to increase sharply from the late 1980s but, crucially, it was at the beginning of the 1990s that, for the first time, the majority of global migrants moved to developed countries rather than to developing countries. That has affected not just the United Kingdom, but all industrial economies around the world.

Between 1990 and 2005, the United States gained 15 million migrants, and Spain and Germany both gained around 4 million migrants. That is in sharp contrast with the 1.6 migrants who have moved in and out of the UK. Italy’s net immigration rate today is around three times higher than that in the UK. The pattern of the debate has changed over the past decade, but that is because the world is changing.

I am grateful to the hon. Member for Mid-Sussex for making, for the first time, some practical proposals for how an immigration limit could be introduced. That has been talked about on the Opposition Benches for some time and finally we have heard one practical way of doing that. There was a degree of support, and difference of opinion, in the Chamber this morning, but finally we have had a practical solution. I do not think the hon. Gentleman proposes a cap on the number of refugees as part of that limit, which is a change on the Conservative Benches. If the cap does not include EU migration, it may not be the cap that he thinks because around 48 per cent. of the UK’s net migration is from within Europe. However, it was good to hear some practical proposals at last.

Our proposals are obviously different, and we are beginning the countdown to the points system, under which only people whom Britain needs will be able to come to work and study in this country. The system will be introduced in the new year, but with any new points system the important question is, “How many points should someone need to be able to work and study in the UK?” I have said repeatedly that we need a far more open and intelligent debate about what immigration is good for Britain and what is not. I
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absolutely agree with the hon. Member for Mid-Sussex and my right hon. Friend the Member for Birkenhead that the media must be part of that debate. I am sure that many hon. Members have had debates with colleagues in the media and—dare I say it?—the BBC where there is a sense that the matter is difficult to talk about and that it would be better not to. That attitude must go, and we must debate the matter more openly. It is not racist to talk about immigration, because this is the real world.

When we set the number of points that people need to come to Britain, we should have a debate that includes a much more open discussion of the evidence, which is why we propose to set up the migration advisory committee. It will be in place at the end of the year, and will advise transparently on where immigration is needed in the economy, and where it is not needed. Alongside that, it is not sufficient to set immigration policy simply with an eye on the economy. We must consider what is going on in Britain as a whole, and we are establishing the migration impact forum to take account of the wider evidence of social and other impacts of immigration on British life before setting the points threshold. I am grateful to members of the forum, which met for the first time a few weeks ago and will meet again to begin discussion in earnest after the recess.

When that policy is set, it will be critical that it is enforced effectively. I reject the calls of the hon. Member for Sheffield, Hallam for regularisation, which would be an amnesty in any other name and would put illegal immigrants at the front of the jobs queue when they should leave the country. It would send the wrong signal, and we should reject it.

We have set out measures with which to increase enforcement of the rules. That includes establishing stronger border controls not just in this country, but abroad to keep the problem of illegal immigration as far from our shores as possible. That is why we are introducing systems that will track people in and out. We shall count the majority of passengers in and out by 2009, but the same systems will allow us to increase screening of migrants before they get on a plane, train or boat and before they come anywhere near our shores.

The technology that we have put in place is already beginning to work. We have made progress with biometric visas, and have already found 4,000 people who had applied for a visa to come to Britain but who were misleading us about their identity. Passenger screening systems have found around 1,000 people who were subsequently arrested at airports. That sort of technology will be vital in strengthening future border security. It must be used alongside the new powers in the UK Borders Bill which will be important in strengthening future enforcement.

I want to reflect on Britishness. I completely agree with my right hon. Friend the Member for Birkenhead and the hon. Member for Mid-Sussex that we must have that debate in earnest in the months to come. There must be a stronger relationship between what new citizens get and what they give. Exploring whether English should be required before permanent entry is important, and I hope that when we publish that consultation it will receive wide support.


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Epilepsy Services

11 am

Chris McCafferty (Calder Valley) (Lab): I am pleased to have obtained this debate, which is about epilepsy services and the all-party group on epilepsy’s report entitled, “Wasted Money, Wasted Lives”. It is a hard-hitting report about the human and economic costs of epilepsy in England today, and in undertaking it the all-party group was supported by the Joint Epilepsy Council of the United Kingdom and Ireland.

The report found that people with epilepsy are being left behind by society and by a system that has consistently failed them, despite the development of effective treatments in recent years. Some 69,000 people live with unnecessary seizures, while 74,000 people take drugs that they do not need. The regularity of avoidable deaths, at almost 400 a year, is shocking. In addition, the number of people who experience seizures unnecessarily and the number taking anti-epileptic drugs for which they have no need, is an issue that demands recognition as a national scandal.

The money wasted in delivering inadequate services is almost as appalling as the unnecessary deaths and the damage to quality of life that people with epilepsy experience. The all-party group gathered evidence to provide a realistic picture of epilepsy services, and it highlighted problems caused by poor service provision. The written and oral evidence from patients and their families highlights the challenges of life with the condition—and in some cases, death.

During our inquiry, it became increasingly clear that even in today’s world of competing health interests, the case for improving epilepsy services is overwhelming. Government guidelines for major changes to the treatment of epilepsy exist, but without targets or powers they are little more than wish lists, and of little use to patients who face critical failure.

The all-party group calls on the Government to accept responsibility for the shortfall in services, and to ensure that health care providers implement guidelines. It also urges the Government to address work force shortages by increasing as a matter of urgency the number of doctors with a special interest in epilepsy. The group invites the Health Select Committee to drive progress by examining the provision of health services for people with epilepsy in England, and looks to the Government to account for the decades of under-investment in this neglected area.

Epilepsy, which is the most common serious neurological condition, affecting about 382,000 people in England, is defined as a tendency to have recurrent seizures. A seizure is caused by a sudden burst of excess electrical activity in the brain, which causes a temporary disruption in the messages passing between the brain cells. Epilepsy is not a single condition; there are about 30 different epileptic syndromes and more than 38 different types of seizure. A person may have more than one type, and epilepsy can affect anyone at any age from any walk of life. Every year 990 people in England die from epilepsy-related causes, of whom about 365 are young adults and children.

Many people are wrongly diagnosed with epilepsy, and many have been diagnosed with the wrong type of epilepsy. Misdiagnosis rates in England are shocking,
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standing at between 20 and 30 per cent. An unknown number of people also experience misdiagnosis whereby they have epilepsy, but it is diagnosed as something else. Assuming a misdiagnosis figure of 23 per cent., that means that in England alone, about 74,000 people who do not have the condition are diagnosed with it and receive treatment for it. The Joint Epilepsy Council, in its recently published manifesto for epilepsy, shows how improvements in epilepsy care in England could realise estimated savings of £134 million a year in the annual cost of epilepsy misdiagnosis, based on figures from the National Institute for Health and Clinical Excellence.

The medical cost alone of the unnecessary treatment of people who do not have epilepsy, and of the wrong treatment of people who have been diagnosed with the wrong kind of epilepsy in England, is estimated to be £22.5 million a year. That includes neither the economic cost nor the cost in lost opportunities to people who, because of misdiagnosis or mistreatment, could be in work but are not. When those costs are included, the estimated total cost of misdiagnosis in England rises to £134 million a year.

Some 70 per cent. of the population with epilepsy in the UK could be seizure-free with optimal treatment.

Mrs. Cheryl Gillan (Chesham and Amersham) (Con): I am most grateful to the hon. Lady, first, for securing the debate, and secondly, for letting me intervene briefly, because as she knows, the National Society for Epilepsy has its headquarters in my constituency. Does she agree that it is important that centres such as the NSE centre in the Chalfonts—and particularly its assessment centre, which is so successful in helping diagnose patients’ underlying problems—continue to operate? Does she also agree that an increase in resources, wherever the financial support comes from, is absolutely essential to reduce the wastage of lives, money and time, which is caused by not having the correct facilities to diagnose and support such patients?

Chris McCafferty: The hon. Lady makes some valid and crucial points, and I agree with her entirely. All her points are reflected strongly in the report. Many such young people find that they have no future—their lives are wasted simply because the initial diagnosis is incorrect, or they are not diagnosed correctly at all. The point about the economic cost—the cost to the health service, and the cost in benefit terms of wasted opportunities and wasted lives—is clear.

As I said, 70 per cent. of the UK population with epilepsy could be seizure-free with optimal treatment. However, only 52 per cent. are, which means that 69,000 people in the UK who experience seizures could in fact be seizure-free. The human cost of those failings, as the hon. Lady has pointed out, is huge—for the individuals concerned, for their families, and indeed for society. Not only do they receive treatment for a condition that they do not have, but their true condition is not treated.

The NICE guidelines on epilepsy recommend that individuals requiring an MRI scan should have the test performed soon. The guideline development group subsequently decided that “soon” meant being seen within four weeks. In a recent survey by Epilepsy Action, only 26 per cent. of the 185 respondents who
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had undergone an MRI scan within the past two years said that they had undergone it within four weeks.

Surgery should also be made available for all people with epilepsy for whom it is indicated. There is a clear saving when we take into account the alternative of expensive lifetime medication and occasional hospitalisation —and, of course, a health benefit to the individual. Patients who are successfully treated also have better employment prospects. They are less dependent, and the high initial expenditure on epilepsy surgery would result in long-term cost savings.

In recent years there has been an increase in reported epilepsy deaths, the majority of which have involved SUDEP—sudden unexpected death in epilepsy. SUDEP deaths are usually referred to coroners, as they require specialist investigation. I have a particular interest in the draft Coroners Bill, because Harold Shipman practised in my constituency. I have come to realise that the lack of standardisation and quality assurance in post-mortem investigations and certification of SUDEP deaths is a key barrier to the implementation of recognised prevention strategies.

Mr. Paul Truswell (Pudsey) (Lab): I congratulate my hon. Friend on securing this debate and apologise for not being able to stay for all of it. On identifying and investigating SUDEP deaths, is it not also a problem that coroners are at the mercy of local authorities in terms of the resources at their disposal? A few months ago, the all-party group heard from coroner Mary Hassall about the often grossly inadequate accommodation and staffing with which coroners must contend. It seriously compromises their ability to respond to SUDEP cases and to meet the needs of bereaved families seeking an explanation for a sudden and tragic death.

Chris McCafferty: My hon. Friend is absolutely right—there are important and serious issues concerning the coroner service. I know that he welcomes, as do I, the draft Coroners Bill, which allows for a proper full-time professional service. That will make a great difference to any family dealing with a sudden or suspicious death. My hon. Friend is also right to refer to families, because another issue that needs to be addressed is the non-implementation of NICE guidelines for health professionals on communicating essential information about SUDEP and referring families affected by it to SUDEP support services.

The NICE clinical guidelines note that all adults and children with a recent onset suspected seizure should be seen by a specialist within two weeks. Generally, such specialists are adult or paediatric neurologists, but they also include neuropsychiatrists, learning disability or other specialists, and occasionally even general practitioners. An epilepsy services survey this year by Epilepsy Action suggested that only 14 per cent. of people with a recent onset suspected seizure who were referred to a specialist saw one within two weeks. Access to specialist neurologists is too limited, and a postcode lottery applies to access to neurological services.

England still has one of the lowest numbers of neurologists of any European country. The Royal College of Physicians has called for a target of 909 whole-time equivalents in the UK by 2012. In addition, the Joint Epilepsy Council believes that GPs with a special interest in epilepsy are key in delivering services
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closer to patients’ homes and are a vital link between primary and secondary care. It is clear that such professionals, who are easier for patients to access and do not have long waiting lists, can play an important role, specifically in making accurate diagnoses and performing effective annual reviews, as recommended in the NICE guidelines.

Epilepsy specialist nurses are also a crucial source of care, support and advice for patients with epilepsy. They enable many to manage their epilepsy effectively and remain independent in the community. Their vital role has often been recognised by the Government, including in recent NICE clinical guidance on the diagnosis and management of epilepsy, which stated:


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