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30 Apr 2008 : Column 89WH—continued

According to research on the views of young people conducted recently by the children’s charity NCH, which was referred to, 63 per cent. of respondents said
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that a main reason why they thought that young people got involved in gun and knife crime was to protect themselves. The NCH report notes that

Should that be surprising when infants, toddlers and children are exposed to violence at an extremely young age? I am very disturbed by research coming out about the number of very young children—children under the age of 10—who are exposed to violence. A study by Cardiff university showed that the number of under-10s attending accident and emergency departments as a result of crimes involving a violent attack had almost doubled in the past year. What path are we setting young people on if, at the very start of their lives, rather than receiving support, nurturing and protection, they are becoming victims of violent offending?

The risk is that, for some young people, that desensitisation to violence can lead to the use of extreme violence becoming an accepted social behaviour. That risk is heightened by social and economic deprivation, family breakdown, lack of values and structures, under-achievement in schools and poor job prospects, leading to involvement in the drugs trade, with territorial rivalries between gangs seeking to exercise control over their areas through the use of violence.

In evidence to the Select Committee on Home Affairs, Superintendent Leroy Logan, deputy borough commander of Hackney police, warned of an increase in “postcode violence” driven by the “paranoid misguided loyalties” of young people who feel threatened by the presence of strangers in their area.

Prevention through education, which has been advocated, will work only if young people’s experience of being in their communities is not one of risk and danger. That is why policing and enforcement are an essential element in combating this serious problem, and that is where the Government have failed by not providing any deterrent, with just two people out of 6,000 convicted of carrying a blade in a public place receiving the maximum sentence. Detection is not leading to meaningful detention and sanction. Also important is the continued failure by the Government even to recognise that crimes against young people exist, with under-16s excluded from the British crime survey. Just thinking about change in that respect is not good enough—the Government need to make the change.

However, even when the Government do implement measures, they are not monitored properly. For example, new powers were introduced to screen pupils randomly using metal detectors in October 2006, with a right for schools to carry out searches of pupils suspected of carrying a weapon since May 2007. A parliamentary answer that I received on 17 March shows that there is no monitoring and no collection of information on screening, searches or the number of weapons recovered. That is despite the fact that having a bladed article on school premises is an offence under the Criminal Justice Act 1988 and despite the fact that the Government are supposed to be collecting information to inform policy making in this important area.

Knife crime among teenagers is a complex issue, and time does not allow me to deal with a number of the causes or solutions. The key, however, is its impact on
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our communities. The Government are often quick to legislate but slow to enforce. We do not have that luxury on this most serious of issues. Too many young lives are being blighted by knife crime. Too many young people continue to carry weapons—and too many people continue to get away with it.

Taking action is different from talking about action. Cutting crime means curbing the causes of crime, and delivering change involves more than delivering plans. The question is whether the Government recognise that, and whether they really will bear down on this appalling crime, which affects too many people every year.

10.50 am

The Parliamentary Under-Secretary of State for the Home Department (Mr. Vernon Coaker): It is a pleasure, Mr. O’Hara, to serve under your chairmanship. I congratulate my hon. Friend the Member for Edmonton (Mr. Love) on securing this debate, and on setting the tone of our discussions. He has obviously done a lot of work on the subject. I know that knife crime greatly affects his constituency. Indeed, it has affected him not only as a constituency Member but as an individual. Knife crime affects us all.

The important thing to have come out of this debate is the realisation that too often debates on crime are a caricature; one is either a hanger and flogger, or one is a wishy-washy liberal. I thought that most contributions to the debate showed the futility of that argument and its ridiculous nature. Clearly, if someone is running around stabbing people, we need others to stop it. We need the police to respond in an appropriate way, as they do, and to bring it to an end.

Tough enforcement of the law in our communities is essential; it is part of what is going on. I have not heard anyone suggest otherwise today, but the debate is often caricatured by whether or not one is a tough enforcer. Frankly, no one with a half-decent sense of the issue would say that enforcement does not play an important role. However, enforcement alone will not solve the problem. Alongside it, we need other things to happen—diverting young people, preventing crime, tackling poverty and inequality, and the other issues mentioned today.

Let us lay the matter to rest. We should try, once and for all, to lay aside that sterile debate. As far as I can see, we have a sense of unity today; it is about putting all those things together. One without the other will fail. The important thing is how to bring those factors together. That is the first important point of principle.

The second is this. We all meet large numbers of young people. Last week I met a lot of young people from NCH—the charity recently published a report on tackling violent crime—and I discussed the problem with them and dealt with a series of questions. They and all the other young people that I meet in my constituency and across the country do not believe us when we say this, so I say it again and hope that it will be picked up: the vast majority of our young people are decent and law-abiding, growing up in difficult times. They do not break the law, they do not go around stabbing people, they do not commit violence, and they do not threaten elderly people. In fact, huge numbers of them help others in caring roles and in many other voluntary ways.

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We should say so and be proud of the fact. There should be as much publicity and comment about them as there is about the small number who cause such immense problems in our communities—and not to those who are most scared, namely the elderly, but to young people. It is they who demand that we do more to tackle the problem because, by and large, it is they who are the victims of such crime. I say that with some passion because although it has been said here this morning and it is repeated in many other forums in Parliament, it is rarely commented upon. That almost creates a sense of despair among our young people.

I turn to some of the specific points raised by my hon. Friend the Member for Edmonton. He and the hon. Member for Hornchurch (James Brokenshire) spoke about including under-16s in the British crime survey. We are considering whether to take that forward. I understand that under-16s can be charged with possession offences, an issue raised by my hon. Friend, the hon. Member for Hornchurch and others.

I met Assistant Commissioner Alf Hitchcock, the spokesman on knife crime for the Association of Chief Police Officers, and discussed the need to ensure that the courts have the right guidelines. Guidelines on possession offences may not be necessary for first offences if there are no aggravating factors, but they need to be sufficiently clear for the courts to know that we regard possession as a serious offence and that they should deal with it appropriately. As my hon. Friend knows, we have increased the maximum sentence available to the courts, which they can use if they wish.

On the question of arches and wands, we made a statement a few weeks ago in which we outlined a starting point of 350 wands, 8 arches, but we hope to extend and expand the number. On CAT scanners, my hon. Friend will know from the drugs strategy that we are considering that question. We want to do some research on the matter because there are differing views about the way forward. We want to know whether there is a particular problem that needs to be addressed through CAT. If it appears that we need to take matters forward, we will, but a comment in the drugs strategy document says that we recently considered the subject.

My hon. Friend the Member for Islington, North (Jeremy Corbyn) spoke not only about neighbourhood policing but about broader social issues. I agree with him. As I said earlier, tackling the problem is not only about enforcement. There are housing issues, and we need to ensure that every young person has opportunity. We should not concentrate only on the bright academic young people in our communities; we need to ensure that all young people have opportunity. I am encouraged by some of the statements that the Government are now making on the importance of vocational education, and ensuring that those who can do with their hands are regarded as being equally important as those who do with their brains. That would be an important step forward.

I also agree with what my hon. Friend said about rehabilitation in prison. People sometimes have to be locked up, but the idea that we should throw away the key is not appropriate in a civilised society. We need to ensure that, as far as possible, people do not re-offend after leaving prison.

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I agree with my hon. Friend the Member for Hackney, North and Stoke Newington (Ms Abbott) about the importance of schools.

Mr. Love: I thank my hon. Friend for dealing with specific issues. One of the common themes that has come out in the debate is the need for a comprehensive youth service. I know that that is not my hon. Friend’s responsibility, but I ask him for two things. First, the subject goes across all Departments, so we need joined-up government for youth provision at a local level. Secondly, will my hon. Friend take what has been said here to those Ministers responsible for youth provision, and ensure that they understand what we mean?

Mr. Coaker: My notes say that I should next respond generally to the fact that the hon. Members for Hornchurch and for Hornsey and Wood Green (Lynne Featherstone) and my hon. Friends all spoke about the importance of schools and of youth services.

I shall do what my hon. Friend the Member for Edmonton asks. I know that the Department for Children, Schools and Families is investing significant sums in youth services. We need to work in a joined-up way. I will talk to ministerial colleagues and write to my hon. Friend about our discussions, and I shall copy that response to the other Members here today.

We are going to take tough enforcement action. We are taking action on prevention and diversion. We are also considering communication. In a few weeks’s time, there will be a new advertising campaign. The hon. Members for Hornsey and Wood Green and for Hornchurch and others spoke of listening to young people. We developed our advertising campaign with young people; it is about getting across the message that carrying a knife can increase the chance of being a victim of knife crime. It will be launched in a few weeks’ time.

The weekend before last, a group of young people came together to develop the work needed in that respect. We hope that it continues make a difference, alongside the other things that are being done.

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Local Tuberculosis Services

11 am

Julie Morgan (Cardiff, North) (Lab): I am pleased to have the opportunity to discuss tuberculosis today and delighted that my right hon. Friend the Minister will reply to the debate. I am sure that she is aware that it has come about as a result of the report, “Putting Tuberculosis on the Local Agenda”, which was published by the all-party group on global tuberculosis, which I co-chair with the hon. Members for Arundel and South Downs (Nick Herbert) and for St. Ives (Andrew George). The group is supported, and was inspired, by RESULTS UK. The report was produced in conjunction with the British Thoracic Society, with which the group works closely on the issues.

TB is a common and deadly infectious disease. It most commonly attacks the lungs as pulmonary TB, but it can affect any part of the body, including the brain, lymph glands, intestines, kidneys, spine, bones, joints and even the skin. During the Victorian era, it was so much part of life, so inevitable and so little understood that its existence was completely accepted as a fact of life. In the early 19th century, it may have accounted for one third of all deaths. Indeed, some argue that the UK gave TB to the rest of the world, emerging as it did from the cramped living conditions of the industrial revolution. They say that we exported it with our engines and armies and rolled it around the world.

Many people today can still remember friends and family who were struck by TB in this country up until the 1950s, and people live with the consequences of having TB. When antibiotics came, everybody thought that TB would be consigned to the history books and that it would be a disease of the past—that was a strong belief in this country.

One of my first jobs was as a social worker—I worked in a TB hospital in Sully in south Wales. At the time, my colleagues and I thought that the people we saw would be the last to have TB. The hospital is now closed, and we thought that there would be no need in future for the treatment that we gave to people but, sadly, today more than one third of the world’s population has been infected by TB and new infections occur at a rate of one per second. The emergence of drug-resistant strains has contributed to the new global epidemic and, in March, the first UK case of extensively drug resistant tuberculosis was reported in Glasgow; it was noted with a lot of publicity and is of great concern.

The all-party group began to work with the British Thoracic Society in early 2007. The society expressed concern that the chief medical officer’s action plan, “Stopping Tuberculosis in England”, and the National Institute for Health and Clinical Excellence guidelines, “Clinical diagnosis and management of tuberculosis, and measures for its prevention and control”, which were published in 2006, were not being implemented. At the same time, rates of TB were rising. Since the Health Protection Agency’s new surveillance system was put in place in 1998, the incidence of TB has increased by a remarkable 42 per cent., from 5,658 new cases in 1998 to 8,051 in 2006. The group is pleased that the trend appeared to stabilise in 2007, but we do
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not know whether that was a one-off or whether the trend continues. However, we now consistently see, year-on-year, more new reported cases of TB than hepatitis C and new diagnoses of HIV. Actually, in some parts of the country, particularly London, the rates of TB are equivalent to those found in Asia and sub-Saharan Africa. The situation is serious.

The report is made up of two surveys, both of which were carried out in 2007. The first was an online survey and the second a paper survey that was sent to all primary care trust chief executives. It followed the publication of the Department of Health TB toolkit in June 2007, “Tuberculosis prevention and treatment: a toolkit for planning, commissioning and delivering high-quality services in England”, which was a guide to help PCT commissioners to implement the NICE guidelines. The group was pleased with the response to its survey. More than 70 per cent. of PCTs responded, which was excellent, and we intended the survey to be sent out in both England and Wales.

Mrs. Ann Cryer (Keighley) (Lab) rose—

Julie Morgan: I am pleased to give way to a fellow member of the all-party group.

Mrs. Cryer: On the role of PCTs, do my hon. Friend and the Minister agree that it would be useful if they or other bodies encouraged ethnic communities to desist from stigmatising those with TB and their families? I have some experience of that: one or two of my constituents have put off seeking treatment for TB because they did not want the extended family or community to know about it. It would be useful if PCTs could persuade communities to desist from such behaviour.

Julie Morgan: Stigma is an important issue in relation to TB. It prevents people from seeking treatment and makes them hide their condition from their family and friends. PCTs need to take that important issue on board.

As I was saying, we intended the survey to cover England and Wales, but because of the different health structures in Wales, we need to have a specially worded survey. We hope to include it in our next survey, but I have had a number of discussions with key professionals in Wales. As a Welsh MP, I am pleased that we will be able to include Wales in our next survey.

The report gives us a pretty good picture of the state of TB services throughout England. I do not intend to go into the details of the results of the survey. I have written to request a meeting with my right hon. Friend the Minister, and I hope that she will agree to it. Also, the British Thoracic Society has asked for a meeting with the chief medical officer. It is important, however, to draw attention to some of the report’s key findings, and to the chief medical officer’s foreword to the TB toolkit, in which he says that

It is therefore important that the recommendations are followed even in areas where there are low TB rates.

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This Victorian disease is on the march again. Not a single PCT thought that there would be a fall in TB in its area, yet the overwhelming majority—68 per cent.—said that they had no plans to deal with the expected increase in cases. That analysis was supported by hospital-based TB clinicians, 88 per cent. of whom believed that TB cases were set to increase in the next five years. For TB to be controlled, the Government must take real leadership and co-ordinate a response at all levels of our health service. PCTs must implement national guidance to allocate TB resources appropriately, strategic health authorities must ensure that TB is given the priority that it requires, and the Government must put systems in place at national level.

Step 1 of the toolkit is to identify an appropriate person as the TB lead, regardless of the incidence of TB within the PCT area. That individual will be in a position to take strategic decisions and influence commissioning at board level. The all-party group’s survey found, however, that 50 per cent. of primary care trusts had not taken even that first step and had not identified a lead. In those that had, the position was often filled by people who did not have a strategic role and who could not influence decisions, such as nurses, health visitors and even a hospital-based clinical lead not employed by the PCT. Will my right hon. Friend therefore look at the local uptake of national guidelines on TB and ensure that the Department drives forward implementation? The key point about TB patients is that if they are not looked after well, their family and local community will have a higher chance of catching TB, given its infectious nature. That is why it is so important to treat the disease early.

The next important thing to do, after identifying a TB lead, is to ensure that there are properly funded TB services. Delays in diagnosis can lead to drug resistance and increased expense. Our report found that PCTs were not identifying appropriate funding, and three quarters of hospital-based TB clinicians have seen no increase in resources since the action plan was published four years ago. Similarly, the jobs of many TB nurses are under threat or review, and many nurses complained of being under-resourced.

Why are PCTs failing to allocate the appropriate resources to TB? We suspect that it is because of the clear lack of priority afforded to the disease. Areas with high incidence rates are usually poor, with many competing priorities, while those with low incidence rates are not putting plans in place, despite the chief medical officer’s warning. TB rates have recently stabilised to some extent, and we welcome that very much, but there is no room for complacency. I therefore ask my right hon. Friend to ensure that regional directors of public health make PCTs give TB the priority that it should have.

I want now to raise a number of issues relating to leadership. First, I congratulate my right hon. Friend on making TB prescriptions free on the national health service from September 2007, which will certainly remove some of the barriers to seeking treatment.

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