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I do not want this contribution simply to be about Members, so I shall return to my constituents' concerns about health and education and make two simple, local points. On health, last week, two mums-of course
there were more-gave birth in my constituency, and I am sure that the whole House will want to congratulate them. Unfortunately, they did not do so in the safety of a labour ward: they both gave birth in ambulances. They did not give birth in the security of a hospital, either: one gave birth in an ambulance in a lay-by on the A4010, which stretches between Wycombe and Aylesbury; and the other gave birth in an ambulance outside the Eden shopping centre, which has many virtues but is not, after all, a hospital.
My constituents will ask the simple question that our party asked during the 2001 general election: "Where has all the money gone?" Although I could revisit the territory that has been covered by some of my hon. Friends, who have seen health cuts and closures in their constituencies following the Government's change to the health service funding formula in 2004, I shall resist the temptation to go back and, instead, make two points about the present.
In Buckinghamshire, we are trapped in a vicious circle. After the restructuring of the past eight years and, in particular, the change to the funding formula in 2004, we have had a primary care trust deficit. That tends to leak into the hospital deficit, and, because the hospital trust has a deficit, it is very hard for it to make progress on its entirely noble aspiration to become a foundation trust. We receive about 17 per cent. less NHS funding per head than the average citizen in England, so we cannot address the deficit fully. I am not suggesting that the PCT does not have a role to play in getting its deficit down, but that is very hard if it is 17 per cent. behind the rest.
I have had several constructive conversations with my hon. Friend the shadow Health Secretary, who, unlike the Health Secretary proper, is in his place on the Front Bench, listening to the debate. My hon. Friend has been able to reassure me that there will be a simpler, fairer and independently administered funding formula if a Conservative Government are elected in May, as I believe they will be, and that will greatly help to improve my constituents' situation. In the long term, if some of that extra money can unlock foundation status, Wycombe hospital may be able to regain some of the facilities that it lost to Stoke Mandeville hospital after the 2004 changes to the Government funding formula.
I am sure that my hon. Friend will get any structural changes that he wants to make in early, because, like my hon. Friends in other areas, we have seen absolutely bewildering health-structure change in Buckinghamshire. When I arrived, there were three primary care groups, which became three primary care trusts. There is now one primary care trust. The mental health trust has been merged with Oxfordshire. The regional health authority has been abolished and recreated, and the ambulance authority has been merged. Not one single team of chair and chief executive is in place now that was in place in 2001. For us, the experience of the NHS in Buckinghamshire has been almost like watching permanent revolution in China. If my hon. Friend the Member for South Cambridgeshire (Mr. Lansley) becomes Health Secretary, as I am sure he will, my constituents will look to him to introduce some stability to the situation.
On education, I want to make a simple point about social mobility. I will not rehearse all the figures-my hon. Friends will be familiar with them-which show
that social mobility has stalled under this Government since 1997 and that the gap between rich and poor has not narrowed but, in several key respects, widened. Our education system in Buckinghamshire is unusual, although not unique, because we still have a selective system. For a long time, it has been my party's policy not to seek to reintroduce a selective system nationwide or to seek to disrupt the selective system where it is working well, as it does in Buckinghamshire. Given that the 11-plus, at least as it works in our county, is essentially not dissimilar from an IQ test and seeks to match pupils to schools, and given that a large proportion of pupils in our excellent grammar schools appear to come from better-off areas, I want to ask one simple question as I approach my departure from the House in March, May, or whenever the general election takes place. Are we absolutely certain that that test is working as well as it should for pupils in the poorer areas of my constituency, who would greatly appreciate the chance to be as socially mobile as their predecessors were a generation ago, and who arguably appear to be doing less well out of the system than others?
I want to conclude with a few remarks about Afghanistan in the light of my experiences, which my hon. Friends and Members in all parts of the House will have shared, on Remembrance Sunday. As each year passes, certainly in my constituency, I have observed the crowds growing as the involvement of our servicemen and women becomes greater, and sensed a greater appreciation of the sacrifice that they are making.
The current strategy in Afghanistan is that the American Government and our Government require a surge-there is no controversy about that. Clearly, our troops need to be better equipped. In some respects, the Government's record on that has been absolutely scandalous. The alternative to a surge and better-equipped troops-immediate withdrawal from Afghanistan-would plainly be disastrous; apart from anything else, it would place enormous strain on the western alliance. I am sure that no one in the House would want to contemplate an immediate unilateral withdrawal. However, we must look forward and ask ourselves seriously whether, if the surge does not work, the Helmand mission in which our troops are engaged is fundamentally indispensable to our national security. There are different views in the House about that. The right hon. Member for Pontypridd (Dr. Howells) recently said, in effect, that it is not indispensable, and called for much higher spending on security in this country and for a scaling down of our presence in Afghanistan.
I think that hon. Members and others would benefit from reading the recent interesting pamphlet by my hon. Friend the Member for Gravesham (Mr. Holloway), which was published by the Centre for Policy Studies. It follows very much the line of thought developed by a man who I believe will be a future colleague here-Rory Stewart, our excellent candidate in Penrith and the Border-and argues that a new emphasis should be placed on more local decision making in a country where, after all, there is no history of unitary Government. My hon. Friend and Mr. Stewart emphasise the need for a smaller military and development presence but, crucially, enough of a presence to be able to search out and destroy any bases that the al-Qaeda leadership might seek to re-establish. Those ideas are well worth examination.
It would be wrong of me to anticipate the general election result next May, but I must say that I am looking forward to the possibility-I will put it no more strongly than that-of a Conservative Government led by my right hon. Friend the Member for Witney (Mr. Cameron). The challenges, which are not substantially addressed in the Queen's Speech, if they are addressed at all, are enormous.
The deficit, Afghanistan, to which I just referred, and the emerging crisis in Iran-any one of these would be a big enough challenge for one Government, but it is quite possible that my right hon. Friend will find himself dealing with them all at once. This is not my last contribution, but a valedictory note is perhaps appropriate. Those will be very big challenges for him if he becomes Prime Minister, and all I want to say is that I will be cheering him on from whatever journalistic perch I happen to find myself occupying.
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Annette Brooke (Mid-Dorset and North Poole) (LD): I am very pleased to make a short contribution to the debate, which gives an opportunity to tie health and education issues together. Although a lot of legislation endeavours to do that, I think we are all aware of the huge gaps where children's services and health services are not working together as they should.
I should like to speak about access to health services and subsequent outcomes for children and young people. The hon. Member for Huddersfield (Mr. Sheerman) mentioned child protection and said that even after a year of debate and after we have identified so much that needs changing in our children's services, it did not come up in the Queen's Speech-perhaps I should say that it is yet another such issue that did not come up. The problem has impacted greatly on the public and they certainly want to hear more about how we can tackle it.
I have tabled amendments to a series of Bills to achieve provision of therapeutic services for all abused children, starting with the Bill that became the Sexual Offences Act 2003. Sadly, I have been unsuccessful so far, but most of my political life has been "Try, try again," so I have not given up yet. As an ambassador for the National Society for the Prevention of Cruelty to Children, I agree with its call for comprehensive post-abuse therapeutic provision for children in care, custody and refuges, and for children exhibiting sexually harmful behaviour.
Child abuse remains an unacceptably large problem in the UK. An NSPCC study from way back in 2000 showed that 16 per cent. of children had experienced some form of sexual abuse, which may well have been by a parent or another relative. Other forms of abuse-physical or emotional or neglect-can also have a traumatic impact on children. In 2006, the then Department for Education and Skills said that of 60,000 children in care, 63 per cent. were there because they had experienced some form of abuse or neglect. Of course, in reality, the problems are likely to be much more widespread, because instances of abuse go unreported or because they are reported many years after they occur. The long-term consequences of child sexual abuse include anxiety and depression, anger and guilt, phobic reactions, substance abuse, difficulties functioning at school, poor self-image and difficulties with personal relationships and parenting.
The Corston report in 2007 highlights criminality as a very real potential consequence of these problems, and it revealed that a high proportion of female inmates have a history of sexual abuse. Adults being treated for mental health problems often identify childhood abuse as an influence. Research shows that 25 to 40 per cent. of all alleged sexual abuse involves young perpetrators. The majority of those children and young people have been, or are being, sexually, physically or emotionally abused themselves.
Therapy at an early stage could therefore help to reduce the scale of the problems over time by breaking the cycle. In addition, of course, it could save much money and anguish, and many troubled adults. Therapy can transform children's lives, but provision is inadequate and patchy across the country.
A recent NSPCC report published just this year, "Sexual Abuse and Therapeutic Services for Children and Young People", concluded that the overall level of specialist provision is low, with significant gaps in provision both nationally and locally, and that there is a huge gap between the estimated need for services and service availability. The report identified potential shortfalls in provision ranging from around 51,000 to 88,000 therapeutic places. That is a massive problem.
I was talking to a member of the NSPCC just yesterday about ChildLine, a service so important that I hope that all parties will say in their election manifestos that they will continue funding it. Young people who do not want to speak up face-to-face with someone do manage to contact ChildLine and explain what has happened to them.
ChildLine also provides counselling services at the end of a telephone, and has allocated times when children and young people can ring in. Obviously, that is not as good as face-to-face counselling sessions but it is a start, as talking about these issues has to be a good thing. All the contacts made through ChildLine indicate how much a comprehensive service is needed.
Specialist services are not only too few but are often offered too late, when a child or a young person is already showing symptoms of mental health or behavioural problems. There are very few services available for young people who have been raped or seriously sexually assaulted. Recently, a Victim Support volunteer from my constituency came to talk to me about the total lack of rape counselling in our area for young people under 16 who have been raped. It took an enormous amount of work to convince people that merely referring a person in those circumstances to a website was really not satisfactory.
Not so long ago, I got a letter from a mother whose child, sadly, had been raped. The child had waited months for counselling, and I do not think that that is good enough. That may not be the most popular of items to talk about in relation to the Queen's Speech, but there are problems that we need to face up to and do something about.
Finding resources to provide a comprehensive service will obviously be a problem in today's economic climate, but I should like to see at least a commitment to a strategy to make such services fully available in time. Preventive action that should be taken automatically now will save money and heartbreak in the long run.
We need joined-up thinking. The new Department for Children, Schools and Families covers not only schools and children, but young people's health issues
and youth justice. All those matters must be brought together when considering the need for therapeutic treatment. My last attempt to get the provision of therapeutic treatment included in legislation was on Report on the Children and Young Persons Act 2008. As I recall, the Government had agreed to amend the Bill to make provision for medical assessment for children taken into care. I tabled amendments to link the provision of therapeutic treatment to that assessment where appropriate. I was advised by the Bill Clerks that it was a DCSF Bill and that it would therefore probably not be possible to have an amendment accepted for debate which would place a monetary commitment on the Department of Health. Sure enough, my amendments were not selected.
I should like to ask all the Ministers who have been present at some point during the debate what more can be done at national level to ensure that health and children's services are fully co-ordinated. We should not get the answer, "This is not my Department," if we are looking at the child as a whole. I made a similar plea for more therapeutic services two years ago in the Queen's Speech debate and was heartened by the response that I got from the then Secretary of State for Health, who said:
"My right hon. Friend the Secretary of State for Children, Schools and Families and I will work together on children's health on a Joint Committee to try and join services up in the way that the hon. Lady seeks."-[ Official Report, 13 November 2007; Vol. 467, c. 637.]
I do seek that, and I seek real movement on it before the general election.
I recognise that the Government have invested in child and adolescent mental health services. There will never be enough money, but there has been considerable investment. However, that pot of money will not necessarily help the children about whom I am talking, because they may not have a diagnosable mental health condition, for example, and not all children and young people will wish to receive CAMH services.
The National Society for the Prevention of Cruelty to Children delivers excellent programmes, and Action for Children is doing a lot of work with children in care, including running some pilots for the Government on the provision of therapeutic treatment. There is a lot of good work, but we need more. The Barnardo's report "Whose Child Now?", published just this week, identifies the need for better services in local authorities, to provide special support to children who are sexually exploited or at risk. We need more preventive work in all our local authorities to stop sexual exploitation and truly tackle trafficking rather than pretend it does not exist. When it sadly does happen, there needs to be appropriate treatment and counselling if young people are to be able to go on in life and fulfil their full potential.
I congratulate the Secretary of State in particular on his commitment to supporting disabled children and their families, but I recently came across a local case in which there was a battle between the primary care trust and social services about who would pay for the support in overnight care that was necessary for a very sick child to be returned home from hospital and restored to his parents. The battle was acted out over four to six weeks, with the parents tragically in the middle. I hope that everybody is happy now, because three nights' support are being provided by the PCT and two by children's services, but why should the family have been in the
middle of that tussle? That is one family, needing one set of services. Why cannot we do these things better?
I wish to touch on maternity services, which are a local issue that the hon. Member for Poole (Mr. Syms) will also be concerned about. When we are talking about good outcomes for children and young people, we have to go back and get pre-birth services right. Equally, it is really important that mothers have a good experience at the time of the birth, because attachment to the baby, love and caring are all-important. If there is not a strong bonding, perhaps because of an unfortunate situation at birth, it can lead to all sorts of further problems. We have to get that right at this level.
My granddaughter was born on Poole maternity unit just 16 months ago. Although it was a proud moment, I was shocked at the physical state of the buildings. A few months later, on a routine visit to the chief executive of Poole hospital, I mentioned that I had been deeply shocked. It had been many years since I had last been there, but clearly the buildings were outdated and it was difficult for staff to operate in such conditions. I was reassured at the time because I was told that everything was in hand for a new maternity unit to be built. That is long overdue and the existing buildings are past their sell-by date.
Poole hospital is an important, main hospital serving a large area, including my constituency, and has really tackled the Government's agenda. It was recently awarded a double "excellent" rating. What more can we ask of an NHS hospital? It has been ranked as the safest hospital in the country, because of how it has tackled infections. We are not talking, therefore, about a badly managed hospital-quite the contrary. Yet problems have arisen with the funding for the new maternity unit. I make a special plea to the Minister to look into the matter. The unit is much needed in a hospital that has been managed extremely well.
We are approaching the 20th anniversary of the signing of the United Nations convention on the rights of the child, and I am really disappointed that no one from the Department for Children, Schools and Families is here. The anniversary should be acknowledged in all debates today given that we are debating the Queen's Speech on health and education. That is really important. We have some wonderful programmes in our schools on the rights and responsibilities agenda put forward by UNICEF over the years. I am sure that many hon. Members will be visiting schools to celebrate the 20th anniversary.
I make a plea to the Government: so much has been done and the Government are getting much better reports when they go to the United Nations and talk about the progress that has been made, but this country has not fully implemented the convention, despite being an early signatory. We need to care about, for example, children in detention and asylum seekers' children, and fundamental issues need to be addressed. As we face the 20th anniversary, we have much to celebrate, but we need to ensure that we put our children first and foremost.
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